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Contains fulltext : 305151.pdf (Publisher’s version ) (Closed access), PURPOSE/OBJECTIVES: Huntington's disease (HD) requires high-quality care to reduce disruption of the patient system, prevent crisis situations, and prevent early admission in a nursing home. In the Netherlands, case management has been available for the last to 9 years for people with HD. However, there is a notable gap in understanding experiences and beliefs of HD patients regarding case managers' care, guidance, and support for quality of life. To improve the international quality of care for people with HD, insight in experiences of ambulatory HD patients with the care, guidance, and support received from a case manager HD (CMHD) is crucial. PRIMARY PRACTICE SETTING: Ambulatory care. FINDINGS/CONCLUSIONS: Ambulatory patients with HD highly appreciate and value the role and support of the CMHD. This was reflected in four themes: (1) the CMHD as a person, with commitment, sympathy, and reliability as central concepts; (2) the CMHD as a professional, with the key roles of coordinator, point of contact, expert, and supporter; (3) impact of the CMHD on quality of life, with support of coping with decline and monitoring the home situation as important subthemes; and (4) support of the CMHD for family members, with providing help and giving attention as subthemes. This insight into patients' experiences of the CMHD's role adds value to the improvement of the international quality of care for people with HD. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Commitment, expertise, support for both family members and patients, and bond of trust from the CMHD are experienced as very valuable. These qualitative findings from a patient's perspective add significantly to the body of knowledge on CMHD's role and practices as "spider at the center of the web."

Despite the increasing use of standards for documenting and testing agent-based models (ABMs) and sharing of open access code, most ABMs are still developed from scratch. This is not only inefficient, but also leads to ad hoc and often inconsistent implementations of the same theories in computational code and delays progress in the exploration of the functioning of complex social-ecological systems (SES). We argue that reusable building blocks (RBBs) known from professional software development can mitigate these issues. An RBB is a submodel that represents a particular mechanism or process that is relevant across many ABMs in an application domain, such as plant competition in vegetation models, or reinforcement learning in a behavioural model. RBBs need to be distinguished from modules, which represent entire subsystems and include more than one mechanism and process. While linking modules faces the same challenges as integrating different models in general, RBBs are “atomic” enough to be more easily re-used in different contexts. We describe and provide examples from different domains for how and why building blocks are used in software development, and the benefits of doing so for the ABM community and to individual modellers. We propose a template to guide the development and publication of RBBs and provide example RBBs that use this template. Most importantly, we propose and initiate a strategy for community-based development, sharing and use of RBBs. Individual modellers can have a much greater impact in their field with an RBB than with a single paper, while the community will benefit from increased coherence, facilitating the development of theory for both the behaviour of agents and the systems they form. We invite peers to upload and share their RBBs via our website - preferably referenced by a DOI (digital object identifier obtained e.g. via Zenodo). After a critical mass of candidate RBBs has accumulated, feedback and discussion can take place and both

Contains fulltext : 296177.pdf (Publisher’s version ) (Open Access), INTRODUCTION: Accumulating evidence suggests that increased neural responses during the anticipation of high-calorie food play an important role in the tendency to overeat. A promising method for counteracting enhanced food anticipation in overeating might be mindfulness-based interventions (MBIs). However, the neural mechanisms by which MBIs can affect food reward anticipation are unclear. In this randomized, actively controlled study, the primary objective was to investigate the effect of an 8-week mindful eating intervention on reward anticipation. We hypothesized that mindful eating would decrease striatal reward anticipation responses. Additionally, responses in the midbrain-from which the reward pathways originate-were explored. METHODS: Using functional magnetic resonance imaging (fMRI), we tested 58 healthy participants with a wide body mass index range (BMI: 19-35 kg/m(2)), motivated to change their eating behavior. During scanning they performed an incentive delay task, measuring neural reward anticipation responses to caloric and monetary cues before and after 8 weeks of mindful eating or educational cooking (active control). RESULTS: Compared with the educational cooking intervention, mindful eating affected neural reward anticipation responses, with reduced caloric relative to monetary reward responses. This effect was, however, not seen in the striatum, but only in the midbrain. The secondary objective was to assess temporary and long-lasting (1 year follow-up) intervention effects on self-reported eating behavior and anthropometric measures [BMI, waist circumference, waist-to-hip-ratio (WHR)]. We did not observe effects of the mindful eating intervention on eating behavior. Instead, the control intervention showed temporary beneficial effects on BMI, waist circumference, and diet quality, but not on WHR or self-reported eating behavior, as well as long-lasting increases in knowledge about healthy eating. DISCUSSION: These results suggest that an 8-wee

Item does not contain fulltext, Background: Delirium is a pathobiological brain process that is frequently observed in Intensive Care Unit (ICU) patients, and is associated with longer hospitalization as well as long-term cognitive impairment. In neurological ICU patients, delirium may be more treatment-resistant due to the initial brain injury. This study examined the effects of a multicomponent non-pharmacological nursing intervention program on delirium in neurological ICU patients. Methods: A single-center interrupted time series trial was conducted in adult neurological ICU patients at high risk for developing delirium who were non-delirious at admission. A multicomponent nursing intervention program focusing on modifiable risk factors for delirium, including the optimalization of vision, hearing, orientation and cognition, sleep and mobilization, was implemented as the standard of care, and its effects were studied. The primary outcome was the number of delirium-free and coma-free days alive at 28 days after ICU admission. The secondary outcomes included delirium incidence and duration, ICU and hospital length-of-stay and duration of mechanical ventilation. Results: Of 289 eligible patients admitted to the ICU, 130 patients were included, with a mean age of 68 ± 11 years, a mean APACHE-IV score of 79 ± 25 and a median predicted delirium risk (E-PRE-DELIRIC) score of 42 [IQR 38-50]). Of these, 73 were included in the intervention period and 57 in the control period. The median delirium- and coma-free days alive were 15 days [IQR 0-26] in the intervention group and 10 days [IQR 0-24] in the control group (level change -0.48 days, 95% confidence interval (95%CI) -7 to 6 days, p = 0.87; slope change -0.95 days, 95%CI -2.41 to 0.52 days, p = 0.18). Conclusions: In neurological ICU patients, our multicomponent non-pharmacological nursing intervention program did not change the number of delirium-free and coma-free days alive after 28 days.

Contains fulltext : 299345.pdf (Publisher’s version ) (Closed access)

‘Water en Bodem Sturend’ is een leidend principe voor de ruimtelijke ontwikkeling van Nederland geworden. In de kamerbrief Water en Bodem Sturend zijn de eerste kaders hiervoor gesteld. Daarmee is een zoektocht ontstaan naar hoe dit principe concreet vorm gegeven kan worden. Inspiratie voor deze zoektocht kan gehaald worden uit het ontwerptraject ‘Bouwen vanuit de Bodem’. In dit traject onderzoekt het Stimuleringsfonds Creatieve Industrie een nieuwe omgang met bodem en ondergrond.

Om de risico’s van droogte door klimaatverandering te mitigeren en zoetwatervoorraden op lange termijn veilig te stellen zijn technieken nodig die lokaal hergebruik van water faciliteren, zoals regelbare drainage met subirrigatie (RDS). RDS is een techniek waarbij water via drains onder de wortelzone van gewassen in de bodem wordt geïnfiltreerd. Uit ervaring bij de drinkwaterbedrijven is bekend dat kunstmatige infiltratiesystemen gevoelig zijn voor afname van de infiltratiecapaciteit door verstopping. Er is echter weinig bekend over verstopping van RDS-systemen, met name bij gebruik van ander water dan oppervlaktewater (zoals gezuiverd effluent, grondwater). In dit onderzoek is in beeld gebracht welke factoren van invloed zijn op verstopping van RDS en hoe deze verstopping mogelijk te beheersen is. Hiertoe is een evaluatie uitgevoerd van hydrologische-, chemische- en moleculair-biologische monitoring bij 4 veldproeven en een kolomproef met verschillende waterbronnen: grondwater (veldproef America), oppervlaktewater (veldproef Stegeren), effluent van een zuiveringsinstallatie voor industrieel afvalwater van een bierbrouwerij (veldproef Lieshout) en effluent van een zuiveringsinstallatie voor stedelijk afvalwater (veldproef Haaksbergen).

Previous studies targeting skills to deal with performance anxiety showed promising results for academic stress as well as for coping. Despite adaptive coping being associated with favorable outcomes, and adolescents reporting the highest amount of academic stress out of any age group, few studies have examined whether performance anxiety interventions predict the use of coping strategies in adolescents. The current study is a longitudinal quantitative study investigating both the effectiveness of a performance anxiety training on adaptive coping, as well as whether social support was a moderator. Firstly, it was hypothesized that the performance anxiety training would have a positive effect on adaptive coping. Secondly, it was hypothesized that social support would moderate the effect of the training on adaptive coping, in which higher social support would cause a stronger effect of the training on adaptive coping. A randomized controlled trial was performed with participants who were randomly allocated to intervention or wait-list control groups. The sample was made up of N = 231 adolescents from diverse educational levels and ethnic backgrounds. A simple regression and a multiple regression analysis have been carried out. Results showed that the intervention had (1) no significant effects on adaptive coping, and (2) social support did not moderate this effect. However, a trend significant negative effect was found for the intervention. It is important to further study this effect, since finding and removing harmful sections of the intervention can potentially prevent harm from being done. Suggestions for future research are discussed. The intervention “Schoolstress de baas” could be improved upon to help students navigate academic stress and performance anxiety more effectively.

De COVID-19 pandemie heeft ertoe geleid dat symptomen van sociale angst toegenomen zijn onder adolescenten. Adolescenten die een hoge mate van sociale angst ervaren lopen later mogelijk het risico op schooluitval, werkverzuim, werkloosheid en psychische stoornissen zoals SAS en depressie. Er zijn aanwijzingen dat sociale steun negatief geassocieerd is met sociale angst onder adolescenten en dat dit verschillend is tussen jongens en meisjes. Om deze risico’s in te perken door middel van het bieden van aanknopingspunten voor mogelijke interventies, was het doel van dit onderzoek om te onderzoeken of sociale steun voor de COVID-19 pandemie voorspellend is voor sociale angst tijdens de COVID-19 pandemie en of dit verschilt tussen adolescente meisjes en jongens. Een totaal van 188 Nederlandse adolescenten (54% vrouw; Mleeftijd = 13.49, SD = 0.81) namen deel aan dit longitudinale onderzoek. Dit onderzoek liet zien dat meer sociale steun voor de COVID-19 pandemie gepaard gaat met minder sociale angst tijdens de COVID-19 pandemie bij adolescenten. Dit effect verschilt niet tussen jongens en meisjes. De adolescenten die een hoge mate van sociale angst tijdens de COVID-19 pandemie rapporteerden, hebben in de toekomst of tijdens een eventuele volgende (pandemische) crises hulp en ondersteuning nodig door middel van interventies op het gebied van sociale steun om latere nadelige risico’s van sociale angst te voorkomen.

De kwaliteit van grondwater in Nederland staat onder druk. Nitraat, zouten, zware metalen en pesticiden bereiken het diepe grondwater. Licht verontreinigd grondwater verspreidt zich steeds verder door het grondwatersysteem (‘vergrijzing’). Drie natuurlijke barrières remmen dit af: slecht doorlaatbare kleilagen, reactieve sedimenten in de ondergrond en het bodemleven dat verontreinigingen kan afbreken. Binnen de Kennisimpuls Waterkwaliteit is de werking van deze barrières in beeld gebracht en de noodzaak van bescherming ervan onderzocht.

Na veertig jaar ondernemen in de varkenshouderij hebben de inmiddels gestopte varkenshouders Peter en Ria Druijff een nieuwe uitdaging gevonden: de BIG Challenge editie 2023. Ze hebben al bijna 15.000 euro opgehaald voor de strijd tegen kanker. Als extra uitdaging wil Peter Druijff de Alpe d'Huez beklimmen op zijn klompen. 'Maar eerst moet ik de nodige kilometers trainen.'

De vraag naar 1 ster Beter Leven-eieren, stijgende huisverkoop en veranderde inzichten zorgden voor grote veranderingen bij Stipkip. Familie Van Stiphout bouwde de stallen om voor de productie van deze eieren, die volautomatisch worden ingepakt naar wens van de klant.

Met de nieuw gepubliceerde EU Soil Health Law (SHL) verleent de Europese Unie de bodem hetzelfde beschermingsniveau als lucht en water. Deze bescherming is nodig aangezien 60-70% van de bodemecosystemen in de EU ongezond zijn en verder worden aangetast. Het doel van de SHL is om in 2050 te komen tot een gezonde bodem. De bodemkwaliteit is een belangrijke factor voor een goede grondwaterkwaliteit en voldoende grondwateraanvulling. Grondwater is een essentiële bron van drinkwater in Europa: 75% van het Europese drinkwater wordt geproduceerd uit deze waardevolle bron. In de SHL moet daarom een duidelijke koppeling tussen bodem en grondwater aanwezig zijn. Dit rapport laat enkele Europese voorbeelden zien van het belang van een gezonde bodem voor voldoende grondwaterkwaliteit en -kwantiteit. Enkele vitale processen die in de bodem plaatsvinden worden beschreven en hun invloed op de kwaliteit en kwantiteit van het grondwater wordt geïllustreerd. Alle wetgeving waarin grondwater een belangrijke rol speelt wordt beschreven en de acties vanuit de SHL worden geëvalueerd op bijdrage aan grondwaterbescherming. De link met het grondwater moet duidelijker gedefinieerd worden in 8 kernacties in de SHL., With the newly published EU Soil Health Law (SHL), the European Union grants soil the same level of protection as air and water. This protection is needed since 60-70% of soil ecosystems in the EU are unhealthy and suffering from continuing degradation. The goal of the SHL is to achieve healthy soils by 2050. Soil quality is a significant factor in achieving good groundwater quality and enough groundwater replenishment. Groundwater is an essential source of drinking water in Europe: 75% of European drinking water is produced from this valuable resource. Therefore, a clear link between soil and groundwater should be present in the SHL. This report shows several European examples of the importance of healthy soils for sufficient groundwater quality and quantity. Several vital processes taking place in the soil are described, and their influence on groundwater quality and quantity is illustrated. All legislation in which groundwater plays an important role is described and links the actions from the SHL to groundwater. The link with groundwater should be defined more clearly in 8 key actions in the SHL.

Bij het paard spelen hartproblemen maar een kleine rol in vergelijking met bijvoorbeeld kreupelheden of problemen van het maagdarmkanaal. Toch leiden hartproblemen vaak tot veel zorgen bij eigenaren en ook in de handel van paarden geven hartbijgeruisen of hartonregelmatigheden veel onrust. De belangrijkste hartproblemen worden in dit artikel voor het voetlicht gebracht.

Radboud University, 08 april 2022, Promotores : Hopman, M.T.E., Loon, L.J.C. van Co-promotor : Verdijk, L.B., Contains fulltext : 241553.pdf (Publisher’s version ) (Open Access)

European Union (EU) trade policy is in the spotlight. The Transatlantic Trade and Investment Partnership (TTIP) negotiations triggered substantial public mobilization which emerged in a surge of literature on trade politicization. Notwithstanding politicization's topicality and significance, it varies considerably over time, across trade agreements negotiations as well as across EU member states. By picking up on the latter, this article examines why, despite similar economic benefits potentially to be gained from trade liberalization, TTIP negotiations revealed striking differences in politicization in Germany and the UK. Understanding this variation is illustrated by highlighting the impact of some of TTIPs’ substantial issues mobilizing a range of materially and ideationally motivated stakeholders, who in turn shaped diverging governments' trade positions of the countries under scrutiny. In explaining this selective politicization across two European countries, focus is on three explanatory variables, domestic material interests (business associations and trade unions), societal ideas (voters and non-governmental organizations [NGOs]) dominant in these countries' domestic politics, as well as their interaction with national institutions. For this reason, the societal approach to governmental preference formation is employed which provides a detailed exploration of these three domestic factors, as well as the importance of their interdependence, in shaping the TTIP positions of the UK and German governments.

Item does not contain fulltext, BACKGROUND: Increasingly, social media is being recognized as a potential resource for patient-generated health data, for example, for pharmacovigilance. Although the representativeness of the web-based patient population is often noted as a concern, studies in this field are limited. OBJECTIVE: This study aimed to investigate the sample bias of patient-centered social media in Dutch patients with gastrointestinal stromal tumor (GIST). METHODS: A population-based survey was conducted in the Netherlands among 328 patients with GIST diagnosed 2-13 years ago to investigate their digital communication use with fellow patients. A logistic regression analysis was used to analyze clinical and demographic differences between forum users and nonusers. RESULTS: Overall, 17.9% (59/328) of survey respondents reported having contact with fellow patients via social media. Moreover, 78% (46/59) of forum users made use of GIST patient forums. We found no statistically significant differences for age, sex, socioeconomic status, and time since diagnosis between forum users (n=46) and nonusers (n=273). Patient forum users did differ significantly in (self-reported) treatment phase from nonusers (P=.001). Of the 46 forum users, only 2 (4%) were cured and not being monitored; 3 (7%) were on adjuvant, curative treatment; 19 (41%) were being monitored after adjuvant treatment; and 22 (48%) were on palliative treatment. In contrast, of the 273 patients who did not use disease-specific forums to communicate with fellow patients, 56 (20.5%) were cured and not being monitored, 31 (11.3%) were on curative treatment, 139 (50.9%) were being monitored after treatment, and 42 (15.3%) were on palliative treatment. The odds of being on a patient forum were 2.8 times as high for a patient who is being monitored compared with a patient that is considered cured. The odds of being on a patient forum were 1.9 times as high for patients who were on curative (adjuvant) treatment and 10 times as high for pa

Contains fulltext : 236305.pdf (Publisher’s version ) (Open Access), Chronic stress is associated with dysregulations in the physiological stress system, resulting in diverse negative developmental outcomes. Since adolescence is a period characterized by increased stress-sensitivity, and schools are an important environment for the developing adolescent, school-based interventions promoting psychosocial functioning are of particular interest to prevent adverse outcomes. The present study therefore aimed to investigate the effectiveness of such interventions on hypothalamic pituitary adrenal-axis (i.e., cortisol) and cardiovascular (i.e., blood pressure [BP] and heart rate [HR]/heart rate variability [HRV]) parameters of stress in adolescents, and examined moderators of effectiveness. The search resulted in the inclusion of k = 9 studies for cortisol, k = 16 studies for BP, and k = 20 studies for HR/HRV. The results indicated a significant small overall effect on reducing BP, but no significant effect for HR/HRV. For cortisol, large methodological variation in the few primary studies did not allow for quantitative analyses, but a qualitative review demonstrated inconsistent results. For BP and HR/HRV, larger effects were observed for intervention programs with a mindfulness and/or meditation component, for interventions without a cognitive-behavioural component and for interventions with a higher intensity. Providing adolescents with techniques to improve indicators of physiological stress may prevent emerging mental health problems.

Item does not contain fulltext, BACKGROUND: Previous high tibial osteotomy (HTO), and tibial plateau fractures (TPF) may cause problems in subsequent total knee arthroplasty (TKA) due to altered metaphyseal bone structure. Higher rates of loosening of the tibial component have been described. In post-HTO and TPF cases, a more durable fixation could be achieved by tibial sleeves. This study investigates the preliminary short-to-midterm clinical and radiographic results in a cohort of these cases. METHODS: A cohort of 28 patients was selected, 11 following HTO, and 17 following TPF. Standard clinical and radiologic follow-up was performed at 6 weeks, and one and two years. Revision with removal of primary prosthesis for any reason was the primary outcome. Patient reported pre- and postoperative pain, satisfaction and general health scores were collected at one and two years. Postoperative radiographs were analyzed for radiolucent lines. RESULTS: There were no cases of aseptic loosening. Survival for all reasons was 96.4% (CI 77.2%-99.5%). One progressive radiolucent line was seen. Numerical rating scale (NRS) for pain with and without weightbearing at 2-year follow-up improved from 8 to 3 and from 5 to 2 points respectively. Overall general health scores improved with a median of 70 at ≥ 2 years, compared to 63 pre-operatively. CONCLUSION: With no revision for aseptic loosening the use of tibial sleeves in primary TKA seems a safe and reliable method for fixation of the tibial component in metaphyseal bone with altered bone structure at short and mid-term follow-up. LEVEL OF EVIDENCE: Level IV, cohort study.

In Nederland is een watertransitie nodig om te kunnen blijven voldoen aan de toenemende drinkwatervraag en tegelijkertijd robuuste watersystemen te creëren. Drinkwaterbedrijven nemen daarvoor al maatregelen op het gebied van water vasthouden en infiltreren, van ASR-systemen voor tijdelijke opslag van zoet grondwater (met veel potentie in West-Nederland) tot water infiltreren nabij winningen om de effecten van winningen op met name natuur te beperken (op zandgronden) en waterconservering door sloten te dempen en winningen te verdiepen, wat in beekdalen kan zorgen voor herstel van kwel en het vernatten van natuur. Deze ‘best practices’ zijn slechts enkele voorbeelden van succesvolle toepassingen van watertransitie-gerelateerde projecten. Voor dit onderzoek zijn ze verzameld en geanalyseerd om de leerpunten te kunnen gebruiken voor toekomstige projecten. Juist nu inventariseren de drinkwaterbedrijven immers op grote schaal waar zij maatregelen kunnen nemen die bijdragen aan de watertransitie en zetten zij initiatieven en projecten op.

Dat boomverzorgers pioniers zijn weten we al 40 jaar. Het vak boomverzorger is uit nieuwsgierigheid geboren, is in de praktijk ontkiemd en heeft in de loop der jaren verschillende vertakkingen gekregen in het onderwijs. Vorige keer schreven we op deze plek al over het kwalificatiedossier waardoor boomverzorging als opleiding binnen het MBO stevig staat. Na deze mijlpaal zet de VHG samen met het onderwijs de volgende piketpaal uit om een doorlopende leerlijn Boomverzorging gestalte te geven.

Risk management has reduced vulnerability to floods and droughts globally, yet their impacts are still increasing. An improved understanding of the causes of changing impacts is therefore needed, but has been hampered by a lack of empirical data. On the basis of a global dataset of 45 pairs of events that occurred within the same area, we show that risk management generally reduces the impacts of floods and droughts but faces difficulties in reducing the impacts of unprecedented events of a magnitude not previously experienced. If the second event was much more hazardous than the first, its impact was almost always higher. This is because management was not designed to deal with such extreme events: for example, they exceeded the design levels of levees and reservoirs. In two success stories, the impact of the second, more hazardous, event was lower, as a result of improved risk management governance and high investment in integrated management. The observed difficulty of managing unprecedented events is alarming, given that more extreme hydrological events are projected owing to climate change.

De grondwaterkwaliteit staat onder druk door klimaatverandering en maatschappelijke en technologische ontwikkelingen. In de bodem en ondergrond beschermen drie van nature aanwezige ‘barrières’ het grondwater tegen verontreinigingen. Afsluitende lagen zorgen voor een fysieke barrière; reactieve bestanddelen in de ondergrond vormen door afbraak, omzettingen en binding een geochemische barrière; en afbraak door micro-organismen in de bovengrond fungeert als een biologische barrière. In het project Kennisimpuls grondwaterkwaliteit is de beschermende werking van deze barrières in beeld gebracht en zijn risico’s voor aantasting van de barrières geanalyseerd.

In de strijd tegen af- en uitspoeling van meststoffen is het laaghangend fruit inmiddels wel geplukt. Om een effectieve gebiedsgerichte aanpak te ondersteunen is een innovatieve, intensieve monitoringsmethode opgezet in twee gebieden: het stroomgebied van de Vuursteentocht (Flevopolder, kleigrond) en van de Vinkenloop (Noord-Brabant, zandgrond). Welke nieuwe kennis levert dit op en welke handelingsperspectieven volgen hieruit voor een gebiedsgerichte verdere aanpak van nutriëntenverliezen?

Een groep pluimveehouders richtte onlangs de Unie van Pluimvee Producenten (UPP) op. Doel is een beter verdienmodel door gezamenlijk eieren en vleeskuikens te verkopen. Met als resultaat meer zekerheid en marge voor de pluimveehouder.