Kidney transplant recipients (KTRs) elicit an impaired immune response after COVID-19 vaccination; however, the exact clinical impact remains unclear. We therefore analyse the relationship between... Show moreKidney transplant recipients (KTRs) elicit an impaired immune response after COVID-19 vaccination; however, the exact clinical impact remains unclear. We therefore analyse the relationship between antibody levels after vaccination and the risk of COVID-19 in a large cohort of KTRs. All KTRs living in the Netherlands were invited to send a blood sample 28 days after their second COVID-19 vaccination for measurement of their IgG antibodies against the receptor-binding domain of the SARS-CoV-2 spike protein (anti-RBD IgG). Information on COVID-19 was collected from the moment the blood sample was obtained until 6 months thereafter. Multivariable Cox and logistic regression analyses were performed to analyse which factors affected the occurrence and severity (i.e., hospitalization and/or death) of COVID-19. In total, 12,159 KTRs were approached, of whom 2885 were included in the analyses. Among those, 1578 (54.7%) became seropositive (i.e., anti-RBD IgG level >50 BAU/mL). Seropositivity was associated with a lower risk for COVID-19, also after adjusting for multiple confounders, including socio-economic status and adherence to COVID-19 restrictions (HR 0.37 (0.19-0.47), p = 0.005). When studied on a continuous scale, we observed a log-linear relationship between antibody level and the risk for COVID-19 (HR 0.52 (0.31-0.89), p = 0.02). Similar results were found for COVID-19 severity. In conclusion, antibody level after COVID-19 vaccination is associated in a log-linear manner with the occurrence and severity of COVID-19 in KTRs. This implies that if future vaccinations are indicated, the aim should be to reach for as high an antibody level as possible and not only seropositivity to protect this vulnerable patient group from disease. Show less
Voermans, W.J.M.; Napel, H.M.T.D. ten; Passchier, R. 2016
In this contribution, we will illustrate the modern-day dynamics of the interplay between the need for expedience and efficiency on the one hand, and the demand for openness, inclusiveness and... Show moreIn this contribution, we will illustrate the modern-day dynamics of the interplay between the need for expedience and efficiency on the one hand, and the demand for openness, inclusiveness and transparency on the other by looking into one of government’s main decision-making processes: the legislative process. Particularly in the field of legislation, the balancing of both efficiency and transparency is of the essence for modern legislatures in parliamentary democracies: laws expressed by acts and legislative instruments can only be truly effective if they rest on broad societal support. As we will argue, a transparent and inclusive legislative process functions as a kind of democratic check on government action: it guarantees sufficient deliberative activity before a government may act. Throughout our contribution, a 2012 comparative study commissioned by the Dutch Ministry of Security and Justice, and carried out by an interdisciplinary team of researchers from Leiden University will be used as a guiding rail to illustrate some the ways in which different jurisdictions in Europe have managed to combine, or at least balance, the need for legislative efficiency and transparency. We will use this study to demonstrate how traditional legislative processes nowadays grapple to translate the will of the citizens into effective legislation, how modern administrations still need democratically underpinned legislative procedures as the basis for the legitimation of (their) decisions, how efficient delivery of decisions and careful (lengthy) scrutiny interact. On the basis of this material we will further discuss concepts of, respectively, efficiency and transparency and especially the way modern legislatures examined in the study use information and communication technology (ICT) to overcome the sometimes opposing demands on their legislative processes. Insofar as possible we will try to highlight a few ‘best practices’ that show how legislative processes can (and cannot) adapt to new present day demands. Show less
