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Stuifmeel (of pollen) is de verzamelnaam voor de mannelijke zaadcellen van bedekt- en naaktzadige planten, zoals van een zonnebloem of grove den. De laatste gebruikt de wind als transporteur van het stuifmeel, evenals grassen. Dat zijn windbestuivers. Bloemplanten maken vaak gebruik van insecten om hun stuifmeel te vervoeren naar een andere plant, waar dan de bestuiving plaats vindt. De plant lokt insecten met nectar. Er zal stuifmeel blijven kleven in het haarkleed van het insect, de bestuiver, die dat meeneemt naar de volgende bloem, waar het stuifmeel aan de stempel van die bloem kan kleven en zo voor de bevruchting zorgt. Het belang van een goede bestuiving is dat de vrucht beter groeit en egaal uitgroeit, met minder misvormingen. Verder komt een betere zaadzetting tot stand, met minder vruchtrui en een hogere opbrengst.

This Bachelor thesis focusses on the breakdown of the Franco-American Alliance. This essay will explain why this breakdown of French-American relations occurred by looking at American politics and diplomacy during the French Revolution. It will especially involve individual actions of American politicians, on the background of the French Revolution, like Thomas Jefferson, Alexander Hamilton, George Washington, and John Jay. The main question of this essay is therefore how American politics responded to the developments of the French Revolution and how the French Revolution influenced the breakdown of the Franco-American Alliance. The hypothesis of this thesis is that the French Revolution did in fact create the end of the Franco-American Alliance as it created a situation which would see about the American entanglement into European affairs; something that had been feared by most American politicians and collided with the political demand at the 18th century of an nonalignment policy in world politics. To achieve a comprehensive conclusion to this question, this essay is divided into three time periods. The time periods consist of the American political and diplomatic response to the changing situation of the French Revolution and especially the relationship with France.

Het onderscheid tussen Autism Language Impaired (ALI) en Autism Language Normal (ALN) is moeilijk te maken. Toch is dit belangrijk, omdat de aan- of afwezigheid van een Taalstoornis bij kinderen met Autisme consequenties heeft voor de toelaatbaarheid tot het cluster 2 onderwijs. Zowel voor het vaststellen van Autisme als van een Taalstoornis is diagnostisch materiaal beschikbaar. Er zijn echter geen tests die zich specifiek richten op de differentiaaldiagnostiek van deze stoornissen. In deze studie worden de beschikbare diagnostische instrumenten (de Peabody Picture Vocabulary Test (PPVT-III-NL) (Dunn & Dunn, 2005), de Clinical Evaluation of Language Fundamentals, (CELF-4NL) (Kort, Schittekatte, & Compaan, 2008), de spontane taal analyse procedure (STAP) (Van den Dungen & Verbeek, 1999) en de Frogstory (Mayer, 1969)) aan de hand van een casusanalyse onderzocht op de mogelijkheid om te differentiëren tussen ALI en ALN. De composietscore van de PPVT en de CELF leidt tot relatief hoge waardes van de sensitiviteit en specificiteit. Ook de Frogstory verteltaak en het IQ geven een waardevolle toevoeging voor de classificaties tot ALI en ALN. Verder is gebleken dat er meer, grootschaliger onderzoek nodig is naar de differentiaaldiagnostiek van ALI en ALN.

Contains fulltext : 117924.pdf (publisher's version ) (Open Access), BACKGROUND: Due to prophylactic colectomy, mortality in patients with familial adenomatous polyposis (FAP) has changed, with duodenal cancer currently being the main cause of death. Although celecoxib reduces duodenal polyp density in patients with FAP, its long-term use may increase the risk of cardiovascular events and alternatives need to be explored. Preclinical studies suggest that the combination of celecoxib with ursodeoxycholic acid (UDCA) is a potentially effective strategy. We performed a randomized, double-blind, placebo-controlled trial to investigate the effect of celecoxib and UDCA co-treatment on duodenal adenomatosis in patients with FAP. METHODS: Patients with FAP received celecoxib (400 mg twice daily) and UDCA (1000-2000 mg daily, ~20-30 mg/kg/day, n=19) or celecoxib and placebo (n=18) orally for 6 months. Primary outcome was drug efficacy, assessed by comparing duodenal polyp density at pre- and post-intervention by blinded review of endoscopic recordings. As secondary outcomes, cell proliferation, apoptosis, and COX-2 levels in normal duodenal mucosa were assessed by immunohistochemistry or real-time quantitative polymerase chain reaction. RESULTS: In intention-to-treat analysis, deceased polyp density was observed after celecoxib/placebo treatment (p=0.029), whereas increased polyp density was observed after celecoxib/UDCA treatment (p=0.014). The difference in change in duodenal polyp density was statistically significant between the groups (p=0.011). No changes in secondary outcomes were observed. Thirty patients (81%) reported one or more adverse events, 16 patients (84%, Common Toxicity Criteria for Adverse Events version 3.0 (CTCAE) grade 1-3) treated with celecoxib/UDCA and 14 patients (78%, CTCAE grade 1-2) treated with celecoxib/placebo. Nine patients (24%) discontinued intervention prematurely, 5 patients (26%) treated with celecoxib/UDCA and 4 patients (22%) treated with celecoxib/placebo. CONCLUSIONS: Celecoxib reduces duodenal polyp

Background: Due to prophylactic colectomy, mortality in patients with familial adenomatous polyposis (FAP) has changed, with duodenal cancer currently being the main cause of death. Although celecoxib reduces duodenal polyp density in patients with FAP, its long-term use may increase the risk of cardiovasc

Background Due to prophylactic colectomy, mortality in patients with familial adenomatous polyposis (FAP) has changed, with duodenal cancer currently being the main cause of death. Although celecoxib reduces duodenal polyp density in patients with FAP, its long-term use may increase the risk of cardiovascular events and alternatives need to be explored. Preclinical studies suggest that the combination of celecoxib with ursodeoxycholic acid (UDCA) is a potentially effective strategy. We performed a randomized, double-blind, placebo-controlled trial to investigate the effect of celecoxib and UDCA co-treatment on duodenal adenomatosis in patients with FAP. Methods Patients with FAP received celecoxib (400 mg twice daily) and UDCA (1000-2000 mg daily, ~20-30 mg/kg/day, n=19) or celecoxib and placebo (n=18) orally for 6 months. Primary outcome was drug efficacy, assessed by comparing duodenal polyp density at pre- and post-intervention by blinded review of endoscopic recordings. As secondary outcomes, cell proliferation, apoptosis, and COX-2 levels in normal duodenal mucosa were assessed by immunohistochemistry or real-time quantitative polymerase chain reaction. Results In intention-to-treat analysis, deceased polyp density was observed after celecoxib/placebo treatment (p=0.029), whereas increased polyp density was observed after celecoxib/UDCA treatment (p=0.014). The difference in change in duodenal polyp density was statistically significant between the groups (p=0.011). No changes in secondary outcomes were observed. Thirty patients (81%) reported one or more adverse events, 16 patients (84%, Common Toxicity Criteria for Adverse Events version 3.0 (CTCAE) grade 1–3) treated with celecoxib/UDCA and 14 patients (78%, CTCAE grade 1–2) treated with celecoxib/placebo. Nine patients (24%) discontinued intervention prematurely, 5 patients (26%) treated with celecoxib/UDCA and 4 patients (22%) treated with celecoxib/placebo. Conclusions Celecoxib reduces duodenal polyp den

1 mei 2012, Item does not contain fulltext, BACKGROUND: Duodenal cancer is a major cause of mortality in patients with familial adenomatous polyposis (FAP). The clinical challenge is to perform duodenectomy before cancer develops; however, procedures are associated with complications. Our aim was to gain insight into the pros and cons of prophylactic duodenectomy. METHODS: Patients with FAP from the nationwide Dutch polyposis registry who underwent prophylactic duodenectomy or were diagnosed with duodenal cancer were identified and classified as having benign disease or cancer at preoperative endoscopy. Surveillance, clinical presentation, surgical management, outcome, survival, and recurrence were compared. RESULTS: Of 1,066 patients with FAP in the registry, 52 (5%; 25 males) were included: 36 with benign adenomatosis (median: 48 years old; including two (6%) cancer cases diagnosed after operation), and 16 with cancer (median: 53 years old). Cancer cases had been diagnosed with colorectal cancer more often (6% vs 44%; P < .01). Forty-three patients underwent duodenectomy (35 benign/eight cancer): 30-day mortality was 4.7% (n = 2), and in-hospital morbidity occurred in 21 patients (49%), without differences between patients with benign adenomatosis and cancer. Adenomas recurred in reconstructed proximal small bowel in 14 of 28 patients (50%, median time to recurrence: 75 months), and one patient developed cancer. Median survival of all 18 cancer cases in the registry (1.7%; 12 ampullary/six duodenal) was 11 months. CONCLUSION: Prognosis of duodenal cancer in patients with FAP is poor, which justifies an aggressive approach to advanced benign adenomatosis. Strict adherence to recommended surveillance intervals is essential for a well-timed intervention. Given the substantial morbidity and mortality of duodenectomy, patients' individual characteristics are to be critically evaluated preoperatively. As adenomas recur, postoperative endoscopic surveillance is mandatory.

In het Nederlands staat een lidwoord voor de meeste nomina. Er zijn echter enkele posities mogelijk waar er geen lidwoord voor het nomen hoeft te staan. In deze scriptie worden drie constructies behandeld waar de nomina geen lidwoord nodig hebben. Het gaat om de constructies ‘kale titels’, ‘kale predicaten’ en ‘kale absolute predicaten’. Er wordt gezocht naar een antwoord op de vraag: Hoe kunnen de constructies ‘kale predicatie’, ‘kale titels’ en ‘kale absolute predicatie’ met elkaar worden geïntegreerd? Ik heb in de literatuur over dit thema gezocht naar de eigenschappen van deze constructies. De verzamelde informatie heb ik met elkaar vergeleken om er achter te komen of de constructies overeenkomsten vertonen. In aanvulling op dit literatuuronderzoek is er ook een corpusonderzoek uitgevoerd. De vergelijking wordt gemaakt aan de hand van een tabel die in de loop van de scriptie verder ingevuld kan worden. Door het naast elkaar plaatsen van eigenschappen en constructies, is er een duidelijk overzicht van de resultaten. Er worden enkele verschillen en overeenkomsten gevonden tussen de constructies. Kale titels en kale predicaten blijken bijvoorbeeld zeer dicht bij elkaar te liggen.

New modalities are available to visualize the small bowel in patients with Crohn's disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20-74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.

Background:The interval between the onset of Barrett's oesophagus (BO) and oesophageal adenocarcinoma (OAC) can be termed the incubation period. However, the unrecorded onset of BO precludes its direct observation.Methods:Determining the range of intervals between BO diagnosis and OAC within the longest observational BO follow-up study. Exclusion criteria were presence of high-grade dysplasia (HGD) or OAC at baseline, death within <2 years of BO diagnosis, oesophagectomy without HGD/OAC and loss to follow-up. A total of 133 patients (M/F 73/60) were taken into account.Results:In 1967 person years of follow-up there were 13 cases of HGD/OAC, (0.66% p.a.; 95% CI 0.58-0.74), 96 patients died without HGD/OAC and 24 survived without HGD/OAC. The mean intervals between BO diagnosis and either HGD/OAC, death or end of follow-up were 10.8, 12.6 and 25.5 years, respectively, and the mean ages at endpoint were 72.5, 80.0 and 68.3 years, respectively. The survivors without HGD/OAC had a lower age at BO diagnosis (mean 42.8 vs 61.2 and 67.4 years, P=0.001). Baseline presence of low-grade dysplasia was associated with progression to HGD/OAC (log rank P=0.001).Conclusion:The Rotterdam BO follow-up cohort revealed a long incubation period between onset of BO and development of HGD/OAC, in patients without HGD/OAC at baseline as illustrated by 24 patients diagnosed with BO at a young age and followed for a mean period of 25.5 years. Their tumour-free survival established a minimum incubation period, suggesting a true incubation period of three decades or more.

Background: Several studies have evaluated predictors for complications of endoscopic retrograde cholangiopancreatography (ERCP), but their relative importance is unknown. In addition, currently used blood tests to detect post-ERCP pancreatitis are inconsistent. The aim of this study was to determine predictors of post-ERCP complications that could discriminate between patients at highest and lowest risk of post-ERCP complications and to develop a model that is able to identify patients that can safely be discharged shortly after ERCP. Methods: In a single-center, retrospective analysis over the period 2002-2007, predictors of post-ERCP complications were evaluated in a multivariable analysis and compared with those identified from a literature review. A prognostic model was developed based on these risk factors, which was further evaluated in a prospective patient population. Results: From our retrospective analysis and literature review, we selected the eight most important risk factors for post-ERCP pancreatitis and cholangitis. In the prognostic model, the risk factors (precut) sphincterotomy, sphincter of Oddi dysfunction, younger age, female gender, history of pancreatitis, pa

Physics based simulation in conceptual design is widely seen as a way of increasing the information about designs, thus helping with the avoidance of unanticipated problems as the design is refined. This paper reports on an effort to assess the use of CFD level aerodynamics for the development of tables for flight dynamics analysis at the conceptual stage. A number of aerodynamic data sources are used with sampling and data fusion to allow the efficient generation of the tables. A refined design passenger jet wind tunnel model is used as a test case, and three simplified conceptual versions of this geometry are generated. The influence of geometry approximations and modelling influences are evaluated to assess the usefulness of CFD for this application. Finally, the aerodynamic differences are assessed in terms of basic longitudinal flight dynamics analysis., QC 20141001

Item does not contain fulltext, BACKGROUND & AIMS: Desmoid tumors are a severe extracolonic manifestation in familial adenomatous polyposis (FAP). Identification of risk factors might be helpful in the management of FAP patients with such tumors. The aim of this study was to assess potential risk factors for the development of desmoids in a cohort of Dutch FAP patients. METHODS: The medical records of 735 FAP patients were analyzed for the occurrence of desmoids. Relative risks and survival times were calculated to assess the influence of potential risk factors (female sex, family history, mutation site, abdominal surgery, and pregnancy) on desmoid development. RESULTS: Desmoid tumors were identified in 66 of the 735 patients (9%). The cumulative risk of developing desmoids was 14%. No correlation was found between specific adenomatous polyposis coli mutation sites and desmoid development. Patients with a positive family history for desmoids had a significant increased risk to develop this tumor (30% vs 6.7%, P < .001). No association was found between female sex or pregnancy and desmoid development. Most desmoid patients (95%) had undergone previous abdominal surgery. In a substantial proportion of patients with an ileorectal anastomosis, it was impossible to convert the ileorectal anastomosis to an ileal pouch-anal anastomosis as a result of desmoid development. CONCLUSIONS: A positive family history of desmoids is an evident risk factor for developing desmoids. Most desmoids develop after colectomy. No correlation was found between desmoids and the adenomatous polyposis coli gene mutation site, female sex, and pregnancy. Ileal pouch-anal anastomosis is the appropriate type of surgery in FAP patients with a positive family history for desmoids.