God as First Known: The Common Ground of Philosophy and Theology in Bonaventure s Thought

Goris, W. [Promotor

Ultimate Performance of the ATLAS Superconducting Solenoid

A 2 tesla, 7730 ampere, 39 MJ, 45 mm thin superconducting solenoid with a 2.3 meters warm bore and 5.3 meters length, is installed in the center of the ATLAS detector and successfully commissioned. The solenoid shares its cryostat with one of the detector's calorimeters and provides the magnetic field required for the inner detectors to accurately track collision products from the LHC at CERN. After several years of a stepwise construction and test program, the solenoid integration 100 meters underground in the ATLAS cavern is completed. Following the on-surface acceptance test, the solenoid is now operated with its final cryogenic, powering and control system. A re-validation of all essential operating parameters is completed. The performance and test results of underground operation are reported and compared to those previously measured

Renal function at two years in liver transplant patients receiving everolimus: results of a randomized, multicenter study

Abstract In a 24-month prospective, randomized, multicenter, open-label study, de novo liver transplant patients were randomized at 30 days to everolimus (EVR) + Reduced tacrolimus (TAC; n = 245), TAC Control (n = 243) or TAC Elimination (n = 231). Randomization to TAC Elimination was stopped prematurely due to a significantly higher rate of treated biopsy-proven acute rejection (tBPAR). The incidence of the primary efficacy endpoint, composite efficacy failure rate of tBPAR, graft loss or death postrandomization was similar with EVR + Reduced TAC (10.3%) or TAC Control (12.5%) at month 24 (difference -2.2%, 97.5% confidence interval [CI] -8.8%, 4.4%). BPAR was less frequent in the EVR + Reduced TAC group (6.1% vs. 13.3% in TAC Control, p = 0.010). Adjusted change in estimated glomerular filtration rate (eGFR) from randomization to month 24 was superior with EVR + Reduced TAC versus TAC Control: difference 6.7 mL/min/1.73 m(2) (97.5% CI 1.9, 11.4 mL/min/1.73 m(2), p = 0.002). Among patients who remained on treatment, mean (SD) eGFR at month 24 was 77.6 (26.5) mL/min/1.73 m(2) in the EVR + Reduced TAC group and 66.1 (19.3) mL/min/1.73 m(2) in the TAC Control group (p < 0.001). Study medication was discontinued due to adverse events in 28.6% of EVR + Reduced TAC and 18.2% of TAC Control patients. Early introduction of everolimus with reduced-exposure tacrolimus at 1 month after liver transplantation provided a significant and clinically relevant benefit for renal function at 2 years posttransplant

Seasonal evaluation of the land surface scheme HTESSEL against remote sensing derived energy fluxes of the Transdanubian region in Hungary

The skill of the land surface model HTESSEL is assessed to reproduce evaporation in response to land surface characteristics and atmospheric forcing, both being spatially variable. Evaporation estimates for the 2005 growing season are inferred from satellite observations of the Western part of Hungary and compared to model outcomes. Atmospheric forcings are obtained from a hindcast run with the Regional Climate Model RACMO2. Although HTESSEL slightly underpredicts the seasonal evaporative fraction as compared to satellite estimates, the mean, 10th and 90th percentile of this variable are of the same magnitude as the satellite observations. The initial water as stored in the soil and snow layer does not have a significant effect on the statistical properties of the evaporative fraction. However, the spatial distribution of the initial soil and snow water significantly affects the spatial distribution of the calculated evaporative fraction and the models ability to reproduce evaporation correctly in low precipitation areas in the considered region. HTESSEL performs weaker in dryer areas. In Western Hungary these areas are situated in the Danube valley, which is partly covered by irrigated cropland and which also may be affected by shallow groundwater. Incorporating (lateral) groundwater flow and irrigation, processes that are not included now, may improve HTESSELs ability to predict evaporation correctly. Evaluation of the model skills using other test areas and larger evaluation periods is needed to confirm the results. &lt;br&gt;&lt;br&gt; Based on earlier sensitivity analysis, the effect of a number of modifications to HTESSEL has been assessed. A more physically based reduction function for dry soils has been introduced, the soil depth is made variable and the effect of swallow groundwater included. However, the combined modification does not lead to a significantly improved performance of HTESSEL

Safe use of proton pump inhibitors in patients with cirrhosis

Aims: Proton pump inhibitors (PPIs) belong to the most frequently used drugs, also in patients with cirrhosis. PPIs are extensively metabolized by the liver, but practice guidance on prescribing in cirrhosis is lacking. We aim to develop practical guidance on the safe use of PPIs in patients with cirrhosis. Methods: A systematic literature search identified studies on the safety (i.e. adverse events) and pharmacokinetics of PPIs in cirrhotic patients. This evidence and data from the product information was reviewed by an expert panel who classified drugs as safe; no additional risks known; additional risks known; unsafe; or unknown. Guidance was aimed at the oral use of PPIs and categorized by the severity of cirrhosis, using the Child–Turcotte–Pugh (CTP) classification. Results: A total of 69 studies were included. Esomeprazole, omeprazole and rabeprazole were classified as having ‘no additional risks known’. A reduction in maximum dose of omeprazole and rabeprazole is recommended for CTP A and B patients. For patients with CTP C cirrhosis, the only PPI advised is esomeprazole at a maximum dosage of 20 mg per day. Pantoprazole and lansoprazole were classified as unsafe because of 4- to 8-fold increased exposure. The use of PPIs in cirrhotic patients has been associated with the development of infections and hepatic encephalopathy and should be carefully considered. Conclusions: We suggest using esomeprazole, omeprazole or rabeprazole in patients with CTP A or B cirrhosis and only esomeprazole in patients with CTP C. Pharmacokinetic changes are also important to consider when prescribing PPIs to vulnerable, cirrhotic patients

The role of functional health literacy in long-term treatment outcomes in psychosocial care for adolescents

Although among adolescents with psychosocial problems low health literacy may increase the risk of poor treatment outcomes, the contributing mechanisms within treatment remain unclear. A better understanding of these mechanisms could contribute to improved treatment processes and outcomes. This study aims to examine the relationship between functional health literacy, treatment processes (treatment adherence, learning processes), and treatment outcome (level of psychosocial problems) in adolescents in psychosocial care. We used data from a prospective cohort study among adolescents aged 12-18 (N = 390), collected in four successive measurements: at entry into care, and 3, 12, and 24 months thereafter. We used a mixed effect model to investigate the association between level of functional health literacy (adequate vs. inadequate) and treatment processes (treatment adherence, learning processes) and treatment outcome (level of psychosocial problems). Between adolescents with adequate and inadequate functional health literacy, we found no differences or change over time in adherence or learning processes. The level of psychosocial problems significantly declined over time (β = - 1.70, 95% CI [- 2.72, - 0.69], p = .001) to a similar degree in both groups, though, in all measurements, the level was consistently higher for adolescents with inadequate health literacy. We conclude that health literacy levels did not affect change in treatment processes nor in outcomes of psychosocial treatment. However, the consistently higher level of psychosocial problems among adolescents with inadequate health literacy suggests an unaddressed need in psychosocial care

Adherence to a plant-based, high-fibre dietary pattern is related to regression of non-alcoholic fatty liver disease in an elderly population

Dietary lifestyle intervention is key in treating non-alcoholic fatty liver disease (NAFLD). We aimed to examine the longitudinal relation between well-established dietary patterns as well as population-specific dietary patterns and NAFLD. Participants from two subsequent visits of the Rotterdam Study were included. All underwent serial abdominal ultrasonography (median follow-up: 4.4 years) and filled in a food frequency questionnaire. Secondary causes of steatosis were excluded. Dietary data from 389 items were collapsed into 28 food groups and a posteriori dietary patterns were identified using factor analysis. Additionally, we scored three a priori dietary patterns (Mediterranean Diet Score, Dutch Dietary Guidelines and WHO-score). Logistic mixed regression models were used to examine the relation between dietary patterns and NAFLD. Analyses were adjusted for demographic, lifestyle and metabolic factors. We included 963 participants of whom 343 had NAFLD. Follow-up data was available in 737 participants. Incident NAFLD was 5% and regressed NAFLD was 30%. We identified five a posteriori dietary patterns (cumulative explained variation [R2] = 20%). The patterns were characterised as: vegetable and fish, red meat and alcohol, traditional, salty snacks and sauces, high fat dairy & refined grains pattern. Adherence to the traditional pattern (i.e. high intake of vegetable oils/stanols, margarines/butters, potatoes, whole grains and sweets/desserts) was associated with regression of NAFLD per SD increase in Z-score (0.40, 95% CI 0.15–1.00). Adherence to the three a priori patterns all showed regression of NAFLD, but only the WHO-score showed a distinct association (0.73, 95% CI 0.53–1.00). Hence, in this large elderly population, adherence to a plant-based, high-fibre and low-fat diet was related to regression of NAFLD

The Complexity of Malignant Glioma Treatment

Malignant glioma is a highly aggressive, therapeutically non-responsive, and deadly disease with a unique tumor microenvironment (TME). Of the 14 currently recognized and described cancer hallmarks, five are especially implicated in malignant glioma and targetable with repurposed drugs: cancer stem-like cells, in general, and glioma stem-like cells in particular (GSCs), vascularization and hypoxia, metabolic reprogramming, tumor-promoting inflammation and sustained proliferative signaling. Each hallmark drives malignant glioma development, both individually and through interactions with other hallmarks, in which the TME plays a critical role. To combat the aggressive malignant glioma spatio-temporal heterogeneity driven by TME interactions, and to overcome its therapeutic challenges, a combined treatment strategy including anticancer therapies, repurposed drugs and multimodal immunotherapy should be the aim for future treatment approaches.</p

A thermionic energy converter with a molybdenum-alumina cermet emitter

A study is made of the properties of cermets as electrode materials for thermionic energy converters. For thermodynamic reasons it is expected that all cermets composed of pure Mo and refractory oxides have the same bare work function. From data on the work function of Mo in an oxygen atmosphere this bare work function is estimated to be F=4.9 eV (at T=1400¿°C). Experimentally, the bare work function of Al2O3-Mo cermets was found to be F=4.5 eV, independent of the relative amounts of Al2O3 and Mo. The cesiated work function of the Al2O3-Mo cermets was found to be 0.15 eV lower than the cesiated work function of pure Mo. The bare work function of Mo3Al was found to be F=4.0 eV. The cesiated work function of Mo3Al at collector temperature conditions was 0.3 eV lower than the cesiated work function of pure Mo. The electrical power density of a diode with an Al2O3-Mo cermet emitter was 0.4 W/cm2 at 1300¿°C. The barrier index at this temperature was 2.36 V. The high barrier index is attributed to a high plasma voltage drop Vd=0.91 V