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RIVM rapport:De Europese Unie wil de schadelijke effecten van plastic zwerfafval voor het milieu stap voor stap tegengaan. Zo zijn sinds 2021 verschillende soorten plastic producten verboden die één keer worden gebruikt en daarna weggegooid - de zogeheten Single Use Plastics (SUP). In plaats van deze producten zijn er nu veel herbruikbare producten op de Nederlandse markt, zoals rietjes, drinkflessen en koffiebekers van siliconen, roestvrijstaal (RVS) of herbruikbaar plastic. Het RIVM heeft geïnventariseerd welke herbruikbare voedselcontactmaterialen in Nederland op de markt zijn en van welke materialen ze zijn gemaakt. Daarna is op een rij gezet welke stoffen uit deze materialen zouden kunnen vrijkomen. Ook is gekeken hoe hygiënisch het is om bijvoorbeeld een koffiebeker verschillende keren te gebruiken. Verder is gekeken of het type materiaal het lichaam kan beschadigen. Uit het onderzoek blijkt dat plastic, RVS en siliconen de meest gebruikte materialen zijn. Literatuuronderzoek lat zien dat uit deze materialen onder bepaalde omstandigheden verschillende stoffen kunnen vrijkomen. Het RIVM adviseert om gerichter onderzoek te doen naar mogelijke schadelijke effecten van 20 stoffen, zoals melamine en dibutylftalaat. Deze stoffen zijn geselecteerd op basis van hun schadelijke eigenschappen en de kans dat ze ook echt uit het materiaal vrijkomen. Het RIVM heeft daarbij aangegeven welke materialen en stoffen het eerst moeten worden onderzocht. Als je een herbruikbaar product regelmatig schoonmaakt, is de kans klein om bijvoorbeeld ziek te worden van bacteriën. Als mensen een drinkfles delen met anderen, is dat wel mogelijk. Goede hygiëne is dan belangrijk. Lopen of rennen met een herbruikbaar product als metalen rietjes kan, vooral bij jonge kinderen, letsel veroorzaken. Het RIVM heeft dit onderzoek in opdracht van de Nederlandse Voedsel en Waren Autoriteit (NVWA) gedaan., The European Union aims to reduce the presence of plastic waste in the environment. Therefore, since 2021, various types of plastic products that are only used once - so-called single-use plastics (SUP) - have been banned. Instead of these products, there are now many reusable products on the market. These include straws, coffee cups, drinking bottles and festival cups made of reusable plastics, stainless steel or silicone. The RIVM has inventoried which materials are used in reusable products available on the Dutch market as alternatives to SUP. Following this, substances which can be released from these materials were listed and the associated potential toxicological issues were investigated. In addition, potential microbiological safety issues of reusing for example a coffee cup were investigated. Furthermore, it was examined whether reusable products can cause physical damage to the body. This reports shows that plastics, stainless steel and silicone are the most commonly used materials in reusable products. The literature search revealed that various substances can be released from these materials. The RIVM recommends more targeted research into the possible release of 20 substances into food. These 20 substances have been prioritised based on their toxicological potential and their potential to be released into food. The RIVM has indicated which materials and substances should be examined first in future research. If you regularly clean a reusable product, the chance of becoming ill from bacteria, for example, is small. If people share a drinking bottle with others, this chance may increase. Good hygiene is then important. In addition, walking or running with a reusable product like metal straws can cause injury, especially in young children. The RIVM conducted this research on behalf of the Dutch Food and Consumer Product Safety Authority (NVWA).

De ketenaanpak ‘Medicijnresten uit Water’, waarin een groot aantal partijen uit de zorg- en watersector samen optrekken, is gericht op het verminderen van medicijnresten in het water met het doel om de waterkwaliteit te verbeteren. Vanaf 2018 is de ketenaanpak ondergebracht bij de ‘versnellingstafel medicijnresten’ (onderdeel van de Delta-aanpak Waterkwaliteit) die tot 2021 heeft gefunctioneerd. De versnellingstafel heeft het uitvoeringsprogramma (2018-2022) vastgesteld dat de basis vormt voor de uitvoering van tal van activiteiten door de ketenpartijen. Het ministerie van IenW is de trekker van de ketenaanpak. In opdracht van het ministerie van IenW hebben Berenschot en Arcadis de ketenaanpak tegen het licht gehouden. In de evaluatie analyseren en beschouwen zij de ketenaanpak vanuit vier invalshoeken: vanuit de inhoud, procesmatig en procedureel, de gezamenlijke gerichtheid en de samenwerking. Berenschot en Arcadis bezien met andere woorden onder andere hoe de keten is opgebouwd, hoe deze is georganiseerd, welke resulaten zijn behaald en hoe de partijen zich tot elkaar en het beleidsdoel verhouden. In deze rapportage brengen ze positieve- en verbeterpunten in kaart en doen aanbevelingen voor een doorstart van de ketenaanpak vanaf 2023.

RIVM rapport:As part of efforts to combat the harmful environmental impact of plastic litter, the European Union has been rolling out a series of measures. Among them is a ban – introduced in 2021 – on a range of single-use plastics (SUP). These are plastics that are designed to be used once and then thrown away. Many of these products are used to pack, serve and consume food and beverages. They include drinking straws, stirrers and disposable plates. Following the ban on using plastic for the manufacture of these products, they are now being made from alternative materials such as paper, wheat straw and bamboo. RIVM investigated for which products these materials are being used and which chemical substances they might contain. It then assessed whether any of these substances might be harmful to health and whether they could migrate into food. The investigation shows that the materials currently in use potentially contain a wide range of substances. To enable targeted research into their potential risks, RIVM has identified which substances and materials would have to be further investigated first. RIVM conducted this survey on behalf of the Netherlands Food and Consumer Product Safety Authority (NVWA)., De Europese Unie wil de schadelijke effecten voor het milieu van plastic zwerfafval tegengaan. Sinds de zomer van 2021 worden daarvoor stap voor stap maatregelen ingevoerd. Zo zijn sinds 2021 verschillende soorten plastic producten verboden die gemaakt zijn om één keer te gebruiken en daarna weg te gooien - de zogeheten Single Use Plastics (SUP). Veel van deze producten worden gebruikt om eten en drinken te verpakken, te serveren of te consumeren. Dat zijn bijvoorbeeld rietjes, roerstaafjes of wegwerpbordjes. Vanwege het verbod op het gebruik van plastic voor deze producten worden ze nu van andere materialen gemaakt, zoals papier, tarwemeel of bamboe. Het RIVM heeft geïnventariseerd welke materialen worden gebruikt en welke stoffen in die materialen zouden kunnen zitten. Daarna is gekeken welke van deze stoffen mogelijk schadelijk zijn voor de gezondheid en of deze stoffen in voedsel kunnen terechtkomen. De inventarisatie laat zien dat er in de gebruikte materialen heel veel stoffen zouden kunnen zitten. Om gerichter onderzoek te kunnen doen naar mogelijke risico’s heeft het RIVM aangegeven naar welke stoffen en materialen het eerst onderzoek zou moeten worden gedaan. Het RIVM heeft dit onderzoek in opdracht van de Nederlandse Voedsel en Waren Autoriteit (NVWA(Nederlandse Voedsel- en Warenautoriteit)) gedaan.

Contains fulltext : 200227.pdf (publisher's version ) (Open Access), Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy (MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity (morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

Item does not contain fulltext, A nil-by-mouth regime with enteral nutrition via an artificial route is frequently applied following esophagectomy. However, early initiation of oral feeding could potentially improve recovery and has shown to be beneficial in many types of abdominal surgery. Although short-term nutritional safety of oral intake after an esophagectomy has been documented, long-term effects of this feeding regimen are unknown. In this cohort study, data from patients undergoing minimal invasive Ivor-Lewis esophagectomy between 04-2012 and 09-2015 in three centers in Netherlands were collected. Patients in the oral feeding group were retrieved from a previous prospective study and compared with a cohort of patients with early enteral jejunostomy feeding but delayed oral intake. Body mass index (BMI) measurements, complications, and nutritional re-interventions (re- or start of artificial feeding, start of total parenteral nutrition) were gathered over the course of one year after surgery. One year after surgery the median BMI was 22.8 kg/m2 and weight loss was 7.0 kg (9.5%) in 114 patients. Patients in the early oral feeding group lost more weight during the first postoperative month (P = 0.004). However, in the months thereafter this difference was not observed anymore. In the early oral feeding group, 28 patients (56%) required a nutritional re-intervention, compared to 46 patients (72%) in the delayed oral feeding group (P = 0.078). During admission, more re-interventions were performed in the delayed oral feeding group (17 vs. 46 patients P < 0.001). Esophagectomy reduces BMI in the first year after surgery regardless of the feeding regimen. Direct start of oral intake following esophagectomy has no impact on early nutritional re-interventions and long-term weight loss.

This paper explores the potential for voluntary sustainability standards (VSS) organizations to contribute to policy-making on biodiversity protection by examining their biodiversity policies, total standard compliant area, proximity to biodiversity hotspots, and the networks and pa

Contains fulltext : 200227.pdf (publisher's version ) (Open Access), Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy (MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity (morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

Item does not contain fulltext, A nil-by-mouth regime with enteral nutrition via an artificial route is frequently applied following esophagectomy. However, early initiation of oral feeding could potentially improve recovery and has shown to be beneficial in many types of abdominal surgery. Although short-term nutritional safety of oral intake after an esophagectomy has been documented, long-term effects of this feeding regimen are unknown. In this cohort study, data from patients undergoing minimal invasive Ivor-Lewis esophagectomy between 04-2012 and 09-2015 in three centers in Netherlands were collected. Patients in the oral feeding group were retrieved from a previous prospective study and compared with a cohort of patients with early enteral jejunostomy feeding but delayed oral intake. Body mass index (BMI) measurements, complications, and nutritional re-interventions (re- or start of artificial feeding, start of total parenteral nutrition) were gathered over the course of one year after surgery. One year after surgery the median BMI was 22.8 kg/m2 and weight loss was 7.0 kg (9.5%) in 114 patients. Patients in the early oral feeding group lost more weight during the first postoperative month (P = 0.004). However, in the months thereafter this difference was not observed anymore. In the early oral feeding group, 28 patients (56%) required a nutritional re-intervention, compared to 46 patients (72%) in the delayed oral feeding group (P = 0.078). During admission, more re-interventions were performed in the delayed oral feeding group (17 vs. 46 patients P < 0.001). Esophagectomy reduces BMI in the first year after surgery regardless of the feeding regimen. Direct start of oral intake following esophagectomy has no impact on early nutritional re-interventions and long-term weight loss.

Contains fulltext : 200227.pdf (publisher's version ) (Open Access), Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy (MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity (morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

Item does not contain fulltext, A nil-by-mouth regime with enteral nutrition via an artificial route is frequently applied following esophagectomy. However, early initiation of oral feeding could potentially improve recovery and has shown to be beneficial in many types of abdominal surgery. Although short-term nutritional safety of oral intake after an esophagectomy has been documented, long-term effects of this feeding regimen are unknown. In this cohort study, data from patients undergoing minimal invasive Ivor-Lewis esophagectomy between 04-2012 and 09-2015 in three centers in Netherlands were collected. Patients in the oral feeding group were retrieved from a previous prospective study and compared with a cohort of patients with early enteral jejunostomy feeding but delayed oral intake. Body mass index (BMI) measurements, complications, and nutritional re-interventions (re- or start of artificial feeding, start of total parenteral nutrition) were gathered over the course of one year after surgery. One year after surgery the median BMI was 22.8 kg/m2 and weight loss was 7.0 kg (9.5%) in 114 patients. Patients in the early oral feeding group lost more weight during the first postoperative month (P = 0.004). However, in the months thereafter this difference was not observed anymore. In the early oral feeding group, 28 patients (56%) required a nutritional re-intervention, compared to 46 patients (72%) in the delayed oral feeding group (P = 0.078). During admission, more re-interventions were performed in the delayed oral feeding group (17 vs. 46 patients P < 0.001). Esophagectomy reduces BMI in the first year after surgery regardless of the feeding regimen. Direct start of oral intake following esophagectomy has no impact on early nutritional re-interventions and long-term weight loss.

Aandacht voor een goede presentatie op het World Wide Web

Aandacht voor een goede presentatie op het World Wide Web

The 2400-b/s linear predictive coder (LPC) is currently being widely deployed to support tactical voice communication over narrowband channels. However, there is a need for lower-data-rate voice encoders for special applications: improved performance in high-bit-error conditions, low- probability-of-intercept (LPI) voice communications, and integrated voice/data systems. As a result of continued research, the intelligibility of very-low- data-rate (600 to 800 b/s) voice processors has steadily improved, from the upper 70s about a decade ago to the middle 80s in recent years. This report presents a new 800-b/s voice-encoding method that produces an intelligibility score of 92 (measured by the Diagnostic Rhyme Test (DRT)). This high score compares favorably with that attained by the 2400-b/s LPC.

A voice processor operating satisfactorily in laboratory environments with carefully prerecorded speech samples often fails to operate satisfactorily with live speech. Potential reasons are: (1) the speech level may be too high or too low; (2) the speech signal may have too much interference (ambient noise, breath noise, 60 Hz hum, digital noise in analog circuits, a DC bias (caused by component aging, etc.) generated at the analog-to-digital converter output); (3) the microphone frequency may be severely distorted; (4) the speech signal from the existing audio system, in certain operating environments, may be improperly coupled to the front-end circuit; (5) the speaker may be talking too fast or may have an improper mouth-to-microphone distance, or the speech may lack high- frequency energies. In this report, we have generated a comprehensive design for a speech preprocessor that removes interferences, adaptively equalizes frequency anomalies, and conditions speech for speech encoding, speech recognition, speaker recognition, or extraction of verbal or nonverbal information from speech. Speech preprocessing, Speech conditioning, Perception of speech distortion, Microphone response equalization, Automatic gain control, Digital antialiasing filtering.

After nearly a dozen years of research and development, the narrowband linear predictive coder (LPC) operating at 2400 bits per second (b/s) has become a practical means to transmit speech at less than 5% of the bit rate of the original digitized speech. The 2400-b/s LPC is expected to be deployed extensively on various military platforms. Recently, however, there has been a growing interest in very-low-data-rate (VLDR) (800 b/s or less) voice communication for certain specialized military communications. Likewise, there is a demand for a voice processor operating at 4800 b/s that outperforms significantly the current 2400-b/s LPC is for operation in less than favorable environments. We present in this report a means for implementing 800- and 4800- b/s voice processors. Both processors use a similar speech synthesis filter in which control parameters are line-spectrum frequencies (LSFs). The LSFs are frequency-domain parameters transformed directly from the prediction coefficients used in the conventional-narrowband LPC. The use of frequency- domain parameters is highly significant because they allow filter coefficient quantization in accordance with properties of auditory perception (i.e., coarser representation of higher frequency components of the speech spectrum). The excitation signal at the 800-b/s rate is similar to that used in the conventional-narrowband LPC. On the other hand, the excitation signal at 4800 b/s is the baseband residual signal. At 800 b/s, speech intelligibility as measured by the diagnostic rhyme test (DRT) is 87 for three male speakers; this is about 1.4 points lower than that of the 2400-b/s LPC.

This report presents a means for achieving an 800-bits per second (b/s) speech communication capability by redigitizing the linear predictive coefficients present in the 2400-b/s data stream produced by the narrowband transmitter currently under development by the Department of Defense and private industry. The 2400- to 800-b/s rate converter uses a vector quantization scheme to achieve most of the data reduction. This approach makes it possible to interconnect, without user intervention, 2400- and 800-b/s users (although both users would be effectively at the lower rate) via rate converters located somewhere along the link. The intelligibility of the synthesized speech produced by this procedure compares well with other existing very-low-data-rate systems as determined by the Diagnostic Rhyme Test. (Author)

This report documents recent developments of the Navy-developed voice processor that provides compatible low-data-rate and high-data-rate voice communication: 2.4 kilobits per second (kb/s) for narrowband channels; 9.6 and 16 kb/s for wideband channels. The compatibility of the narrowband and wideband channels arises from the unique characteristic of the voice processor that the transmitted bit-stream of the 16-kb/s data contains the bit-stream of the 9.6-kb/s data as a subset. Likewise, the bit-stream of the 9.6-kb/s data also contains the bit-stream of the 2.4-kb/s data as a subset. This embedded data structure makes it possible to interconnect, without user intervention, narrowband and wideband systems via a digital rate-converter located somewhere along the link. An advantage of this method of rate conversion is that it permits end-to-end encryption of speech data. Also during overloaded or disrupted channel conditions, communication survivability may be increased by rate reduction and/or rerouting through other available narrowband communication links. This report includes results of intelligibility and conversation tests which indicate the embedded 9.6-kb/s rate compares well with continuously variable slope delta modulation (CVSD) at 16 kb/s, and the embedded 16 kb/s performs comparably to CVSD at 32 kb/s. (Author)