[10 years of screening for retinopathy of prematurity (2009-2019) : Results analysis of two German level-1 neonatal intensive care units (NICUs) with university on-site screening and a telemedical approach in the non-university NICU]

BACKGROUND

Retinopathy of prematurity (ROP) is one of the most common causes of childhood blindness in Germany and worldwide and adequate screening is essential. The telemedical approach with objective documentation of retinal findings opens up the possibility of reliably diagnosing all ROP stages independent of the examiner, if a team of ophthalmologists specialized in ROP evaluates the images.

OBJECTIVE

A 10-year comparison of ROP screening at two level‑1 neonatal intensive care units (NICU): university and on-site vs. non-university and telemedical.

MATERIAL AND METHODS

Retrospective analysis of screened premature infants by gestational age (GA), birth weight (BW), sex, multiple births, time of ROP occurrence, treatment needs and time as well as examination frequency.

RESULTS

From 2009 to 2019, we screened 1191 infants of whom 29 had been screened before by an external clinic. The internal 1162 infants were screened on-site with 3713 retinal examinations. We diagnosed 34% with ROP and treated 5.4% (3.7% in Giessen, 7.2% in Siegen). Mean GA was 28.9 weeks (± 2.5 weeks); mean BW 1155 g (± 417.5 g). The number of ROP diagnoses increased by 227.3% in Giessen and by 111.1% in Siegen due to the increasing number of premature births in neonatal care.

CONCLUSION

Comparative analysis confirmed nationally and internationally increasing ROP screening and children with acute ROP. Telemedical screening was equivalent to on-site screening and safe. Both screening methods identified infants requiring treatment on time. No child with GA > 29 weeks required treatment, analogous to Swedish ROP registry results; however, in the German ROP registry some premature babies with GA ≥ 30 weeks required treatment.

Deletion of Tbc1d4/As160 abrogates cardiac glucose uptake and increases myocardial damage after ischemia/reperfusion

BACKGROUND

Type 2 Diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease and associated with poor outcome after myocardial infarction (MI). In T2DM, cardiac metabolic flexibility, i.e. the switch between carbohydrates and lipids as energy source, is disturbed. The RabGTPase-activating protein TBC1D4 represents a crucial regulator of insulin-stimulated glucose uptake in skeletal muscle by controlling glucose transporter GLUT4 translocation. A human loss-of-function mutation in TBC1D4 is associated with impaired glycemic control and elevated T2DM risk. The study's aim was to investigate TBC1D4 function in cardiac substrate metabolism and adaptation to MI.

METHODS

Cardiac glucose metabolism of male Tbc1d4-deficient (D4KO) and wild type (WT) mice was characterized using in vivo [¹⁸F]-FDG PET imaging after glucose injection and ex vivo basal/insulin-stimulated [³H]-2-deoxyglucose uptake in left ventricular (LV) papillary muscle. Mice were subjected to cardiac ischemia/reperfusion (I/R). Heart structure and function were analyzed until 3 weeks post-MI using echocardiography, morphometric and ultrastructural analysis of heart sections, complemented by whole heart transcriptome and protein measurements.

RESULTS

Tbc1d4-knockout abolished insulin-stimulated glucose uptake in ex vivo LV papillary muscle and in vivo cardiac glucose uptake after glucose injection, accompanied by a marked reduction of GLUT4. Basal cardiac glucose uptake and GLUT1 abundance were not changed compared to WT controls. D4KO mice showed mild impairments in glycemia but normal cardiac function. However, after I/R D4KO mice showed progressively increased LV endsystolic volume and substantially increased infarction area compared to WT controls. Cardiac transcriptome analysis revealed upregulation of the unfolded protein response via ATF4/eIF2α in D4KO mice at baseline. Transmission electron microscopy revealed largely increased extracellular matrix (ECM) area, in line with decreased cardiac expression of matrix metalloproteinases of D4KO mice.

CONCLUSIONS

TBC1D4 is essential for insulin-stimulated cardiac glucose uptake and metabolic flexibility. Tbc1d4-deficiency results in elevated cardiac endoplasmic reticulum (ER)-stress response, increased deposition of ECM and aggravated cardiac damage following MI. Hence, impaired TBC1D4 signaling contributes to poor outcome after MI.

Multicentre randomised trial of invasive and less invasive surfactant delivery methods showed similar spirometry results at 5-9 years of age

AIM

We explored whether subnormal forced expiratory volume within one second (FEV₁ ) at 5-9 years of age was lower in children born preterm who received less invasive surfactant administration (LISA) rather than surfactant via an endotracheal tube.

METHODS

The multicentre, randomised Nonintubated Surfactant Application trial enrolled 211 preterm infants born at 23-26 weeks of gestation from 13 level III neonatal intensive care units from April 2009 to March 2012. They received surfactant via LISA (n=107) or after conventional endotracheal intubation (n=104). The follow-up assessments were carried out by a single team blinded to the group assignments. The main outcome was FEV₁ <80% of predicted values.

RESULTS

Spirometry was successful in 102/121 children. The other children died or were lost to follow up. Median FEV₁ was 93% (interquartile range 80-113%) of predicted values in the LISA group and 86% (interquartile range 77-102%) in the control group (p=0.685). Rates of FEV₁ < 80% were 11/57 (19%) and 15/45 (33 %) respectively, which was an absolute risk reduction of 14% (95% confidence interval -3.1% to 31.2%, p=0.235). There were no differences in other outcome measures.

CONCLUSION

The proportion of children aged 5-9 years with subnormal FEV₁ was not significantly different between the groups.

[Soft tissue necrotizing infection]

Necrotizing fasciitis and gas gangrene represent a rapidly progressive and fatal tissue infection in the absence of early multidisciplinary treatment. There are multiple risk factors, but diabetes remains the main one. The presence of crackles or extensive lesions are an indication for exploration and surgical treatment. Conservative management is associated with zero survival. Iconography, biology or bacteriology can help in the diagnosis, but the latter is only made during surgery. The associated mortality is high, despite appropriate management. We report here the case of a diabetic patient requiring insulin, having presented this pathology, the starting point of which is a traumatic wound, with an extensive acute course, contra-indicating any surgical procedure.

Scallop Theorem and Swimming at the Mesoscale

By comparing theoretical modeling, simulations, and experiments, we show that there exists a swimming regime at low Reynolds numbers solely driven by the inertia of the swimmer itself. This is demonstrated by considering a dumbbell with an asymmetry in coasting time in its two spheres. Despite deforming in a reciprocal fashion, the dumbbell swims by generating a nonreciprocal Stokesian flow, which arises from the asymmetry in coasting times. This asymmetry acts as a second degree of freedom, which allows the scallop theorem to be fulfilled at the mesoscopic scale.

Active perinatal care of preterm infants in the German Neonatal Network

OBJECTIVE

To determine if survival rates of preterm infants receiving active perinatal care improve over time.

DESIGN

The German Neonatal Network is a cohort study of preterm infants with birth weight <1500 g. All eligible infants receiving active perinatal care are registered. We analysed data of patients discharged between 2011 and 2016.

SETTING

43 German level III neonatal intensive care units (NICUs).

PATIENTS

8222 preterm infants with a gestational age between 22/0 and 28/6 weeks who received active perinatal care.

INTERVENTIONS

Participating NICUs were grouped according to their specific survival rate from 2011 to 2013 to high (percentile >P75), intermediate (P25-P75) and low (<P25) survival. We compared these survival rates with data in 2014-2016.

MAIN OUTCOME MEASURES

Death by any cause before discharge.

RESULTS

Total survival increased from 85.8% in 2011-2013 to 87.4% in 2014-2016. This increase was due to reduced mortality of NICUs with low survival rates in 2011-2013. Survival increased in these centres from 53% to 64% in the 22-24 weeks strata and from 73% to 84% in the 25-26 weeks strata.

CONCLUSIONS

Our data support previous reports that active perinatal care of very immature infants improves outcomes at the border of viability and survival rates at higher gestational ages. The high total number of surviving infants below 24 weeks of gestation challenges national recommendations exclusively referring to gestational age as the single criterion for providing active care. However, more data are needed before recommendations for parental counselling should be reconsidered.

TRIAL REGISTRATION

Approval by the local institutional review board for research in human subjects of the University of Lübeck (file number 08-022) and by the local ethic committees of all participating centres has been given.

Surface swimmers, harnessing the interface to self-propel

In the study of microscopic flows, self-propulsion has been particularly topical in recent years, with the rise of miniature artificial swimmers as a new tool for flow control, low Reynolds number mixing, micromanipulation or even drug delivery. It is possible to take advantage of interfacial physics to propel these microrobots, as demonstrated by recent experiments using the proximity of an interface, or the interface itself, to generate propulsion at low Reynolds number. This paper discusses how a nearby interface can provide the symmetry breaking necessary for propulsion. An overview of recent experiments illustrates how forces at the interface can be used to generate locomotion. Surface swimmers ranging from the microscopic scale to typically the capillary length are covered. Two systems are then discussed in greater detail. The first is composed of floating ferromagnetic spheres that assemble through capillarity into swimming structures. Two previously studied configurations, triangular and collinear, are discussed and contrasted. A new interpretation for the triangular swimmer is presented. Then, the non-monotonic influence of surface tension and viscosity is evidenced in the collinear case. Finally, a new system is introduced. It is a magnetically powered, centimeter-sized piece that swims similarly to water striders.

Magnetocapillary self-assemblies: Locomotion and micromanipulation along a liquid interface

This paper presents an overview and discussion of magnetocapillary self-assemblies. New results are presented, in particular concerning the possible development of future applications. These self-organizing structures possess the notable ability to move along an interface when powered by an oscillatory, uniform magnetic field. The system is constructed as follows. Soft magnetic particles are placed on a liquid interface, and submitted to a magnetic induction field. An attractive force due to the curvature of the interface around the particles competes with an interaction between magnetic dipoles. Ordered structures can spontaneously emerge from these conditions. Furthermore, time-dependent magnetic fields can produce a wide range of dynamic behaviours, including non-time-reversible deformation sequences that produce translational motion at low Reynolds number. In other words, due to a spontaneous breaking of time-reversal symmetry, the assembly can turn into a surface microswimmer. Trajectories have been shown to be precisely controllable. As a consequence, this system offers a way to produce microrobots able to perform different tasks. This is illustrated in this paper by the capture, transport and release of a floating cargo, and the controlled mixing of fluids at low Reynolds number.

Self-propulsion and crossing statistics under random initial conditions

We investigate the crossing of an energy barrier by a self-propelled particle described by a Rayleigh friction term. We reveal the existence of a sharp transition in the external force field whereby the amplitude dramatically increases. This corresponds to a saddle point transition in the velocity flow phase space, as would be expected for any type of repulsive force field. We use this approach to rationalize the results obtained by Eddi et al. [Phys. Rev. Lett. 102, 240401 (2009)PRLTAO0031-900710.1103/PhysRevLett.102.240401] who studied the interaction between a drop propelled by its accompanying wave field and a submarine obstacle. This wave particle entity can overcome potential barrier, suggesting the existence of a "macroscopic tunneling effect." We show that the effect of self-propulsion is sufficiently strong to generate crossing of the high-energy barrier. By assuming a random distribution of initial angles, we define a probability distribution to cross the potential barrier that matches with the data of Eddi et al. This probability is similar to the one encountered in statistical physics for Hamiltonian systems, i.e., a Boltzmann exponential law.

Preliminary evaluation of cytosine-phosphate-guanine oligodeoxynucleotides bound to gelatine nanoparticles as immunotherapy for canine atopic dermatitis

Cytosine-phosphate-guanine oligodeoxynucleotides (CpG ODN) are a promising new immunotherapeutic treatment option for canine atopic dermatitis (AD). The aim of this uncontrolled pilot study was to evaluate clinical and immunological effects of gelatine nanoparticle (GNP)-bound CpG ODN (CpG GNP) on atopic dogs. Eighteen dogs with AD were treated for 8 weeks (group 1, n=8) or 18 weeks (group 2, n=10). Before inclusion and after 2 weeks, 4 weeks, 6 weeks (group 1+2), 8 weeks, 12 weeks and 16 weeks (group 2) 75 µg CpG ODN/dog (bound to 1.5 mg GNP) were injected subcutaneously. Pruritus was evaluated daily by the owner. Lesions were evaluated and serum concentrations and mRNA expressions of interferon-γ, tumour necrosis factor-α, transforming growth factor-β, interleukin (IL) 10 and IL-4 (only mRNA expression) were determined at inclusion and after 8 weeks (group 1+2) and 18 weeks (group 2). Lesions and pruritus improved significantly from baseline to week 8. Mean improvements from baseline to week 18 were 23 per cent and 44 per cent for lesions and pruritus, respectively, an improvement of ≥50 per cent was seen in six out of nine and three out of six dogs, respectively. IL-4 mRNA expression decreased significantly. The results of this study show a clinical improvement of canine AD with CpG GNP comparable to allergen immunotherapy. Controlled studies are needed to confirm these findings.

[Euthanasia and organ donation]

We report the case of a 61 year's old patient with an amyotrophic lateral sclerosis who donates his organs after being euthanised. We recall here the strict legal framework of euthanasia and organ donation in Belgium. We also highlight the absolute need to respect the ethical principles essential for the correct implementation of both procedures.

A Comparison of Three Procedures for Robust PCA in High Dimensions

In this paper we compare three procedures for robust Principal Components Analysis (PCA). The first method is called ROBPCA (see Hubert et al., 2005). It combines projection pursuit ideas with robust covariance estimation. The original algorithm for its computation is designed to construct an optimal PCA subspace of a fixed dimension k. If instead the optimal PCA subspace is searched within a whole range of dimensions k, this algorithm is not computationally efficient. Hence we present an adjusted algorithm that yields several PCA models in one single run. A different approach is the LTS-subspace estimator (see Wolbers, 2002; Maronna, 2005). It seeks for the subspace that minimizes an objective function based on the squared orthogonal distances of the observations to this subspace. It can be computed in analogy with the computation of the LTS regression estimator (see Rousseeuw and Van Driessen, 2000). The three approaches are compared by means of a simulation study.

Remote control of self-assembled microswimmers

Physics governing the locomotion of microorganisms and other microsystems is dominated by viscous damping. An effective swimming strategy involves the non-reciprocal and periodic deformations of the considered body. Here, we show that a magnetocapillary-driven self-assembly, composed of three soft ferromagnetic beads, is able to swim along a liquid-air interface when powered by an external magnetic field. More importantly, we demonstrate that trajectories can be fully controlled, opening ways to explore low Reynolds number swimming. This magnetocapillary system spontaneously forms by self-assembly, allowing miniaturization and other possible applications such as cargo transport or solvent flows.

Strings of droplets propelled by coherent waves

Bouncing walking droplets possess fascinating properties due to their peculiar wave-particle interaction leading to unexpected quantumlike behaviors. We propose a study consisting in droplets walking along annular cavities. We show that, in this geometry, they spontaneously form a string of synchronized bouncing droplets that share a common coherent wave propelling the group at a speed faster than single walkers. The formation of this coherent wave and the collective droplet behaviors are captured by a model. Those are at the opposite of the ones found in two-dimensional geometries. Our results shed light on walking dynamics.

A quick rhizobacterial selection tests for the remediation of copper contaminated soils

AIMS

The main objective of the study is to develop and improve quick bacterial tests to select the best candidates for the bioaugmentation of metal-contaminated soil, coupled with phytoextraction.

METHODS AND RESULTS

Bacteria isolates (181) were selected from a collection originated from a Cu-contaminated sediment, on the basis of several miniaturized biochemical tests adapted to the copper contamination. Amongst them, we used a growth soil based-medium to select metal-tolerant bacteria, and their ability to grow and mobilize metals by mean of metabolites (siderophores, organic acids) was also assessed.

CONCLUSION

The result of the bacterial selection tests showed differences in presence or absence of copper, especially for phosphate-solubilizing strains which ability decreased by 53% in the presence of copper hydroxide phosphate as compared to the standard tricalcium phosphate test. A promising Pseudomonas putida was selected from the collection.

SIGNIFICANCE AND IMPACT OF THE STUDY

The study underlined the importance of choosing significant selection tests regarding the nature of the metal occurring in the soil to be cleaned-up to assess the real potential of each bacterial strain for subsequent soil bioaugmentation purposes.

Resonant and antiresonant bouncing droplets

When placed onto a vibrating liquid bath, a droplet may adopt a permanent bouncing behavior, depending on both the forcing frequency and the forcing amplitude. The relationship between the droplet deformations and the bouncing mechanism is studied experimentally and theoretically through an asymmetric and dissipative bouncing spring model. Antiresonance phenomena are evidenced. Experiments and theoretical predictions show that both resonance at specific frequencies and antiresonance at Rayleigh frequencies play crucial roles in the bouncing mechanism. In particular, we show that they could be exploited for bouncing droplet size selection.

Very low birth weight infants after discharge: What do parents describe?

BACKGROUND

Morbidity and mortality in Very Low Birth Weight (VLBW) infants during their hospital stay have been well described. However, there are insufficient data regarding health problems after discharge.

STUDY DESIGN

In a multicenter study performed between January 2009 and December 2010 including 2493 VLBW infants, questionnaires were sent out to all participating parents in the first year of life. We compared the parental reported health of VLBW infants with a national cohort (KIGGS).

RESULTS

The reported health of VLBW infants born after 29 weeks of gestation was identical to term infants. Even in the group of infants born before 24 weeks of gestation health was regarded as very good or good in >70% of cases. However, parents described a delayed development in >50% increasing to >70% with lower gestational age. In the first year of life VLBW infants have an increased risk of visual and hearing problems. Bronchitis was more frequent in VLBW infants but there were no differences in other infections typical for that age group. VLBW infants had less sleeping problems. No gender differences were described.

CONCLUSION

VLBW infants in our study require slightly more medical care compared to their peers. However, medical problems are relatively small compared to the developmental needs as perceived by their parents. Therefore, close follow-up and advice by specialists in infant development are needed.

Information fusion for diagnosis coding support

All patient-related medical information during a hospital stay in France, has to be collected and coded in the compilation of medical units discharge documents, according to a standardized approach. The process of describing a patient disease in terms of appropriate diagnostic codes is nevertheless, a non-intuitive operation for the physician. As a consequence, coding errors, inaccuracies and missing data are frequent, leading to potentially severe economical upshots. A coding support system developed to improve medical coding results, integrates three information processing methodologies, using the outputs from various Hospital Information System applications. Each methodology generates partial heterogeneous information, with considerable semantic variety. In order to properly synthesize these outputs, information fusion is required to produce enriched contextualized information, presented to the physician as an ordered list of suggested codes. This paper explores two information fusion approaches: voting system and possibilistic. Both methods are tested on a database of 1,000 discharge summaries, to show the interest of information fusion in this context. Results show that fusion methods perform better in most of the cases than partial information extraction methods.

[Physical therapy for parkinson's disease]

Parkinson's disease is a complex neurologic and progressive incapacitating disease. Parkinson's disease severely threatens the quality of live and the number of patients worldwide is expected to rise considerably in the coming decade due to aging of the population. Even with optimal medical management using drugs or neurosurgery, patients are faced with progressively increasing impairments (e.g. in speech, mental and movement related functions), and restrictions in participation (e.g. domestic life and social activities). Physical therapy is often prescribed next to medical treatment but there is a lack of uniform treatment. A systematic literature search for guidelines, systematic reviews, trials, and expert opinions lead to a better understanding. The key question: Is physiotherapy able to optimally treat the Parkinson's disease symptoms? In which way, how and on which scientific bases can the physiotherapist participate to improve autonomy and to help them living independently and avoid, as long as possible, institutionalization? This article has integrated clinical research findings to provide clinicians with an overview to physical therapist management of disorders in people with Parkinson's disease. An Evidence-Based Physical Therapy Guideline providing practice recommendations was developed by the Royal Dutch Society for Physical Therapy (KNGF). Evidence from research was supplemented with clinical expertise and patients values. Randomized clinical trials reflect specific core areas of physical therapy, that is, transfer, posture, balance, reaching and grasping, gait and physical condition. Another aspect is that of educating patients (as well as their partners and family) about the disease process and the benefits of exercise therapy. Alternative therapies can be helpful like Tai Chi, virtual games, dancing, yoga, ball games for example.

ANTEROCOD: actuarial survival curves applied to medical coding support for chronic diseases

For the practitioner, choosing diagnosis codes is a non-intuitive operation. Mistakes are frequent, causing severe consequences on healthcare performance evaluation and funding. French physicians have to assign a code to all their activities and are frequently prone to these errors. Given that most of the time and particularly for chronic diseases indexed information is already available, we propose a tool named AnterOcod, in order to support the medical coding task. It suggests the list of most relevant plausible codes, predicted from the patient's earlier hospital stays, according to a set of previously utilized diagnosis codes. Our method applies the estimation of code reappearance rates, based on an equivalent approach to actuarial survival curves. Around 33% of the expected correct diagnosis codes were retrieved in this manner, after evaluating 998 discharge abstracts, significantly improving the coding task.

Oxygen tension directs the differentiation pathway of human cytotrophoblast cells

During placental development, human cytotrophoblast cells can differentiate to either villous syncytiotrophoblast cells or invasive extravillous trophoblast cells. We hypothesize that oxygen tension plays a critical role in determining the pathway of cytotrophoblast differentiation. A highly purified preparation of cytotrophoblast cells from human third trimester placenta was cultured for 5 days in either 20% or 1% oxygen tension. The cells incubated at 20% oxygen formed a syncytium as determined by immunohistochemistry using an anti-desmosomal protein antibody that identifies cell membranes. In addition, the mRNA was markedly induced for syncytin, a glycoprotein shown to be essential for syncytiotrophoblast formation, and for human placental lactogen (hPL), which is a specific marker for syncytiotrophoblast cells. In contrast, the cell incubated at 1% oxygen tension did not fuse by morphologic analysis and did not express syncytin or hPL mRNA. However, these cells expressed abundant amounts of HLA-G, a specific marker for extravillous trophoblast cells, which was not seen in cells incubated at 20% oxygen tension. These results suggest that low oxygen tension directs differentiation along the extravillous trophoblast cell pathway while greater oxygen tension directs differentiation along the villous trophoblast cell pathway.

Membrane perturbation by an external electric field: a mechanism to permit molecular uptake

Electropermeabilisation is a well established physical method, based on the application of electric pulses, which induces the transient permeabilisation of the cell membrane. External molecules, otherwise nonpermeant, can enter the cell. Electropermeabilisation is now in use for the delivery of a large variety of molecules, as drugs and nucleic acids. Therefore, the method has great potential in the fields of cancer treatment and gene therapy. However many open questions about the underlying physical mechanisms involved remain to be answered or fully elucidated. In particular, the induced changes by the effects of the applied field on the membrane structure are still far from being fully understood. The present review focuses on questions related to the current theories, i.e. the basic physical processes responsible for the electropermeabilisation of lipid membranes. It also addresses recent findings using molecular dynamics simulations as well as experimental studies of the effect of the field on membrane components.

Monitoring Cl− Movement in Single Cells Exposed to Hypotonic Solution

Self-referencing ion--selective electrodes (ISEs), made with Chloride Ionophore I-Cocktail A (Fluka), were positioned 1-3 microm from human embryonic kidney cells (tsA201a) and used to record chloride flux during a sustained hyposmotic challenge. The ISE response was close to Nernstian when comparing potentials (VN) measured in 100 and 10 mM NaCl (deltaVN = 57 +/- 2 mV), but was slightly greater than ideal when comparing 1 and 10 mM NaCl (deltaVN = 70 +/- 3 mV). The response was also linear in the presence of 1 mM glutamate, gluconate, or acetate, 10 microM tamoxifen, or 0.1, 1, or 10 mM HEPES at pH 7.0. The ISE was approximately 3 orders of magnitude more selective for Cl- over glutamate or gluconate but less than 2 orders of magnitude move selective for Clover bicarbonate, acetate, citrate or thiosulfate. As a result this ISE is best described as an anion sensor. The ISE was 'poisoned' by 50 microM 5-nitro-2-(3phenylpropyl-amino)-benzoic acid (NPPB), but not by tamoxifen. An outward anion efflux was recorded from cells challenged with hypotonic (250 +/- 5 mOsm) solution. The increase in efflux peaked 7-8 min before decreasing, consistent with regulatory volume decreases observed in separate experiments using a similar osmotic protocol. This anion efflux was blocked by 10 microM tamoxifen. These results establish the feasibility of using the modulation of electrochemical, anion-selective, electrodes to monitor anions and, in this case, chloride movement during volume regulatory events. The approach provides a real-time measure of anion movement during regulated volume decrease at the single-cell level.

[The practice of needs assessment for the supply with technical aids in The Netherlands]

In Germany the assessment of needs for technical aids occurs widely unsystematic and without the possibility to verify the advice process. A systematic assessment of individual needs for technical aids that follows standardised indication criteria so far has not been paid much attention. Compared with this, the advice and supply measures in the Netherlands are increasingly based on a systematic and comprehensible analysis of the individual inquiry. This analysis is called "indication and selection advice" and is usually carried out by therapists. Under Dutch law, consultants can act rather independently of any commercial interest. The basics of the analysis derive from the ICIDH and theoretical models of occupational therapy. Besides an overview of the legislation on the supply with technical aids in the Netherlands, the procedure of needs assessment plus a specific instrument based on occupational therapy knowledge are presented. The realization of advice as a defined part of the supply process required a new definition of tasks for occupational therapists. The resulting changes in the comprehension of professional roles are briefly described, too. The results of this investigation regarding the practice of needs assessment in the Netherlands suggest that changes are also required in the German service delivery system and its legal basis. Because of their specific expert knowledge of indication and selection of suitable technical aids, a more extensive involvement of occupational therapists in this key process of measures of home adaptation and the supply with technical aids is recommended in Germany, too. The development of practicable, standardised instruments to assess individual needs is advisable because it will contribute to increased efficiency of the supply with technical aids.