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Summary: Background: Recurrent cutaneous squamous cell carcinoma (cSCC) has been associated with an increased risk of local functional and aesthetic comorbidity, metastasis and mortality. Objectives: To compare the risk of recurrence between Mohs micrographic surgery (MMS) and standard excision for cSCC of the head and neck. Methods: This was a retrospective cohort study of all patients with a cSCC treated with MMS or standard excision at the departments of dermatology of a secondary or tertiary care hospital in the Netherlands between 2003 and 2012. To detect all recurrences, patients were linked to the Dutch pathology registry. To compare the risk of recurrence between MMS and standard excision, hazard ratios (HRs) were used adjusted for clinical tumour size > 2 cm and deep tumour invasion. Results: A total of 579 patients with 672 cSCCs were included: 380 cSCCs were treated with MMS and 292 with standard excision. The risk of recurrence was 8% (22 of 292) after standard excision during a median follow‐up of 5·7 years [interquartile range (IQR) 3·5–7·8], which was higher than the 3% (12 of 380) after MMS during a median follow‐up of 4·9 years (IQR 2·3–6·0). The cumulative incidence of recurrence was higher for standard excision than for MMS during the entire follow‐up period of 8·6 years. Carcinomas treated with MMS were at a three times lower risk of recurrence than those treated with standard excision when adjusted for tumour size and deep tumour invasion (adjusted HR 0·31, 95% confidence interval 0·12–0·66). Conclusions: MMS might be superior to standard excision for cSCCs of the head and neck because of a lower rate of recurrence. What's already known about this topic? Recurrent cutaneous squamous cell carcinoma has been associated with an increased risk of local functional and aesthetic comorbidity, metastasis and mortality. What does this study add? Risk of recurrence was 8% after standard excision, which was higher than the 3% after Mohs micrographic surgery.Mohs micrographic surgery might be superior to standard excision for squamous cell carcinomas of the head and neck because of a lower rate of recurrence. Linked Editorial:Motley and Arron. Br J Dermatol 2019; 181:233–234. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

Objectives: To analyse the process and impact of confronting multidisciplinary teams (MTs) in primary care with the experiences of frail older patients through mirror meetings (MMs), with the aim of supporting teams to organize care in a more patient‐oriented way. Methods: Process and impact analyses were performed using a mixed‐method approach. MMs were held with 14 frail older patients and four MTs comprising 23 health‐care professionals (HCPs) in primary care in the Netherlands. Results: Mirror meetings were feasible for frail older people living at home, although their recruitment was time‐consuming. Interaction between the patients was scarce, but they valued the opportunity to share their stories. HCPs preferred MMs overwritten reports about patient experiences. An impact analysis revealed four dominant professional areas for improvement: improve alignment with patient goals, improved communication with patients both orally and in writing, developing new pathways to connect with informal caregivers and an increased understanding that most HCPs are relative strangers to their patients. Conclusions: Mirror meetings are a relatively simple and promising method for exploring the ways in which frail older patients experience care. Practice implications: Given the right conditions, MMs could result in valuable processes to enable MTs to improve their working methods. [ABSTRACT FROM AUTHOR]

Aim With the rapidly increasing number of basal cell carcinomas in Europe. a close look at Mohs Micrographic Surgery (MMS) is timely. Subject We report the results of MMS in the Netherlands, as treatment for extensive basal ccli carcinomas. Methods Patients (n = 198) with extensive basal cell carcinoma (n = 208) were treated with MMS. The mean follow up period was 6.4 years. Results Four of 208 BCCs recurred. Conclusions Considering a recurrence rate of only 2% for the treatment of extensive and mainly recurrent basal cell carcinomas, we suggest that MMS provides the best prospect for total tumour removal. [ABSTRACT FROM AUTHOR]

Introduction: The treatment of chronic functional nausea or nausea due to functional dyspepsia in children is generally symptomatic. Moreover, these disorders pose a risk for worse psychosocial and health outcomes in children. Hypnotherapy (HT), by its ability to positively influence gastrointestinal and psychosocial functioning, may be an effective treatment for chronic nausea., Methods and Analysis: To test efficacy, this multicentre, parallel, randomised controlled, open label trial evaluates whether gut-directed HT is superior to standard medical treatment (SMT) for reducing nausea. The study will be conducted at eleven academic and non-academic hospitals across the Netherlands. A total of 100 children (8-18 years), fulfilling the Rome IV criteria for chronic idiopathic nausea or functional dyspepsia with prominent nausea, will be randomly allocated (1:1) to receive HT or SMT. Children allocated to the HT group will receive six sessions of HT during 3 months, while children allocated to the SMT group will receive six sessions of SMT+supportive therapy during the same period. The primary outcome will be the difference in the proportion of children with at least 50% reduction of nausea, compared with baseline at 12 months' follow-up. Secondary outcomes include the changes in abdominal pain, dyspeptic symptoms, quality of life, anxiety, depression, school absences, parental absence of work, healthcare costs and adequate relief of symptoms, measured directly after treatment, 6 and 12 months' follow-up. If HT proves effective for reducing nausea, it may become a new treatment strategy to treat children with chronic functional nausea or functional dyspepsia with prominent nausea., Ethics and Dissemination: Results of the study will be publicly disclosed to the public, without any restrictions, in peer-reviewed journal and international conferences. The study is approved by the Medical Research Ethics Committees United (MEC-U) in the Netherlands., Trial Registration Number: NTR5814., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To evaluate the yield of routine laboratory tests and Dual Energy X-ray Absorptiometry (DEXA) scans in coeliac disease., Methods: A retrospective analysis of medical files of all followed-up patients with coeliac disease attending Rijnstate Hospital in 2016 was conducted with respect to blood tests of hemoglobin, vitamin B12, folate acid, iron status, calcium, vitamin D, glucose, thyroid function, DEXA-scans and related symptoms or signs of abnormalities. All patients had positive coeliac serology and/or biopsy-proven coeliac disease and attended regular visits after diagnosis. The chi-square test for trend was used for statistical analysis: a two-tailed probability of p < 0.05 was considered significant., Results: We analyzed 250 patients with a median follow-up of 7.8 (1-22) years. At diagnosis, we found anemia in 24.4%, iron deficiency in 38%, folic acid deficiency in 22.6% and vitamin B12 deficiency in 15.9%. All deficiencies recovered within 1-2 years with or without supplements. Deficiencies or autoimmune diseases occurred in 50 patients (37 possibly coeliac-related) during follow-up. Twelve cases of coeliac-related deficiencies or autoimmune diseases occurred in patients with normal values at diagnosis of whom 10 were asymptomatic (incidence 10/1000 patient years). Osteoporosis and osteopenia were present in 23.3% and 35% at diagnosis. In most patients bone mineral density (BMD) improved or stabilized during follow up (p < 0.05), 8% deteriorated., Conclusions: The incidence of asymptomatic coeliac-related deficiencies or autoimmune diseases is low in patients with normal values at diagnosis. Therefore, routine laboratory screening is not necessary in this group: attending regular follow-up visits should be sufficient. DEXA scans are recommended.

Background: Memantine, currently available for the treatment of Alzheimer's disease, is an uncompetitive antagonist of the N-methyl-D-aspartate type of glutamate receptors. Under normal physiologic conditions, these unstimulated receptor ion channels are blocked by magnesium ions, which are displaced after agonist-induced depolarization. In humans, memantine administration is associated with different gastrointestinal dysmotility side effects (vomiting, diarrhoea, constipation, motor-mediated abdominal pain), thus limiting its clinical use. Mechanism of these motility disorders has not been clarified yet. Pigs can be used in various preclinical experiments due to their relatively very similar gastrointestinal functions compared to humans. The aim of this study was to evaluate the impact of a single and repeated doses of memantine on porcine gastric myoelectric activity evaluated by means of electrogastrography (EGG). Methods: Six adult female experimental pigs (Sus scrofa f. domestica, mean weight 41.7±5.0 kg) entered the study for two times. The first EGG was recorded after a single intragastric dose of memantine (20 mg). In the second part, EGG was accomplished after 7-day intragastric administration (20 mg per day). All EGG recordings were performed under general anaesthesia. Basal (15 minutes) and study recordings (120 minutes) were accomplished using an EGG stand (MMS, Enschede, the Netherlands). Running spectral analysis based on Fourier transform was used. Results were expressed as dominant frequency of gastric slow waves (DF) and power analysis (areas of amplitudes). Results: Single dose of memantine significantly increased DF, from basic values (1.65±1.05 cycles per min.) to 2.86 cpm after 30 min. (p = 0.008), lasting till 75 min. (p = 0.014). Basal power (median 452; inter-quartile range 280–1312 μV^2) raised after 15 min. (median 827; IQR 224–2769; p = 0.386; NS), lasting next 30 min. Repetitively administrated memantine caused important gastric arrhythmia. Basal DF after single and repeated administration was not different, however, a DF increase in the second part was more prominent (up to 3.18±2.16 after 15 and 30 min., p<0.001). In comparison with a single dose, basal power was significantly higher after repetitively administrated memantine (median 3940; IQR 695–15023 μV^2; p<0.001). Next dose of 20 mg memantine in the second part induced a prominent drop of power after 15 min. (median 541; IQR 328–2280 μV^2; p<0.001), lasting till 120 min. (p<0.001). Conclusions: Both single and repeated doses of memantine increased DF. Severe gastric arrhythmia and long-lasting low power after repeated administration might explain possible gastric dysmotility side effects in the chronic use of memantine. [ABSTRACT FROM AUTHOR]

BACKGROUND The American Society for Dermatologic Surgery (ASDS) International Traveling Mentorship Program (ITMP) has initiated an International Mohs Fellowship Recognition Program, with 3 centers accredited to date. OBJECTIVE: To describe and compare the outcomes of Mohs micrographic surgery (MMS) at the three units. METHODS: From patient files, we extracted demographic information, as well as tumor type, location of tumor, tumor histology, stages of MMS, and outcomes. RESULTS: At the 3 units, 3,899 patients were treated withMMS over a 5-year period in the South African unit, and 1,141 cases in the Romanian unit. Over a 3-year period, 849 cases were treated in the Netherlands unit. Basal cell carcinomas (BCCs) constituted 78.9% (South African unit), 79% (Romanian unit), and 97.2% (Netherlands unit), and squamous cell carcinomas (SCCs) 17.7% (South African unit), 19% (Romanian unit), and 0.7% (Netherlands unit) of the tumors treated. The recurrence rate following MMS was low, at 0.1% (South African Unit) and 0.17% (Romanian Unit) of cases at the end of the study period, with a median follow-up time of 2 years. CONCLUSION: Mohs micrographic surgery is an effective treatment modality for removing BCC and SCC at ASDS ITMP-recognized International Mohs Fellowship units. [ABSTRACT FROM AUTHOR]

Dermatofibrosarcoma protuberans is a rare soft tissue tumour with a very low (< 0.5%) rate of metastasis. Rates of re-excision and recurrence were determined using data from the Netherlands Cancer Registry between 1989 and 2016. Of the 1,890 instances of dermatofibrosarcoma protuberans included, 87% were treated with excision, 4% with Mohs micrographic surgery, and 9% otherwise or unknown. Linked pathology data were retrieved for 1,677 patients. Half of all excisions (847/1,644) were incomplete and 29% (192/622) of all re-excisions were incomplete. The cumulative incidence of a recurrence was 7% (95% confidence interval (CI) 6-8) during a median followup of 11 years (interquartile range (IQR) 6-17). After Mohs micrographic surgery (n = 34), there were no recurrences during a median follow-up of 4 years (IQR 3-6). Due to the high rate of incomplete excisions and recurrences after excision, this study supports the European guideline, which recommends treating dermatofibrosarcoma protuberans with Mohs micrographic surgery in order to decrease the rate of recurrence. [ABSTRACT FROM AUTHOR]

Background: Quality indicators are used to benchmark and subsequently improve quality of healthcare. However, defining good quality indicators and applying them to high-volume care such as skin cancer is not always feasible. Objectives: To determine whether claims data could be used to benchmark high-volume skin cancer care and to assess clinical practice variation. Methods: All skin cancer care-related claims in dermatology in 2016 were extracted from a nationwide claims database (Vektis) in the Netherlands. Results: For over 220,000 patients, a skin cancer diagnosis-related group was reimbursed in 124 healthcare centres. Conventional excision reflected 75% of treatments for skin cancer but showed large variation between practices. Large practice variation was also found for 5-fluorouracil and imiquimod creams. The practice variation of Mohs micrographic surgery and photodynamic therapy was low under the 75th percentile, but outliers at the 100th percentile were detected, which indicates that few centres performed these therapies far more often than average. On average, patients received 1.8 follow-up visits in 2016. Conclusions: Claims data demonstrated large practice variation in treatments and follow-up visits of skin cancer and may be a valid and feasible data set to extract quality indicators. The next step is to investigate whether detected practice variation is unwarranted and if a reduction improves quality and efficiency of care. [ABSTRACT FROM AUTHOR]

AKS-452, a subunit vaccine comprising an Fc fusion of the ancestral wild-type (WT) SARS-CoV-2 virus spike protein receptor binding domain (SP/RBD), was evaluated without adjuvant in a single cohort, non-randomized, open-labelled phase II study (NCT05124483) at a single site in The Netherlands for safety and immunogenicity. A single 90 µg subcutaneous booster dose of AKS-452 was administered to 71 adults previously primed with a registered mRNA- or adenovirus-based vaccine and evaluated for 273 days. All AEs were mild and no SAEs were attributable to AKS-452. While all subjects showed pre-existing SP/RBD binding and ACE2-inhibitory IgG titers, 60–68% responded to AKS-452 via ≥2-fold increase from days 28 to 90 and progressively decreased back to baseline by day 180 (days 28 and 90 mean fold-increases, 14.7 ± 6.3 and 8.0 ± 2.2). Similar response kinetics against RBD mutant proteins (including omicrons) were observed but with slightly reduced titers relative to WT. There was an expected strong inverse correlation between day-0 titers and the fold-increase in titers at day 28. AKS-452 enhanced neutralization potency against live virus, consistent with IgG titers. Nucleocapsid protein (Np) titers suggested infection occurred in 66% (46 of 70) of subjects, in which only 20 reported mild symptomatic COVID-19. These favorable safety and immunogenicity profiles support booster evaluation in a planned phase III universal booster study of this room-temperature stable vaccine that can be rapidly and inexpensively manufactured to serve vaccination at a global scale without the need of a complex distribution or cold chain. [ABSTRACT FROM AUTHOR]

Background: Impaired cognition, poor health-related quality of life (HRQoL) and depressive symptoms are common in older patients with kidney failure. Understanding what influences HRQoL is important, as older patients regard HRQoL as a health priority. This study examines whether cognitive functioning is associated with HRQoL and whether depressive symptoms mediate this effect in older patients with kidney failure., Methods: Outpatients aged ≥ 65 years from 35 Dutch and Belgian hospitals with eGFR 20-10 mL/min/1.73 m 2 were included from the ongoing DIALOGICA study. Cognitive functioning was assessed using the Montreal Cognitive Assessment. Depressive symptoms were screened with 2 Whooley Questions and thereafter assessed with the 15-item Geriatric Depression Scale. HRQoL was assessed using the 12-item Short-Form Health Survey. To assess whether cognitive functioning is associated with HRQoL, cross-sectional multivariable linear regression analyses were performed. Subsequent mediation analyses were performed with PROCESS using the product method., Results: In total, 403 patients were included, with a mean age of 76.5 years (SD 5.8) and estimated glomerular filtration rate (eGFR) of 14.5 mL/min/1.73 m 2 (SD 3.0). Cognitive functioning was associated with mental HRQoL (adjusted β 0.30, 95% CI 0.05;0.55) but not physical HRQoL (adjusted β 0.18, 95% CI -0.09;0.44). This effect is mediated by depressive symptoms (adjusted β 0.14, 95% CI 0.04;0.25)., Conclusion: Lower cognitive functioning was negatively associated with mental HRQoL, which was mediated by depressive symptoms in older patients with kidney failure. Future research should explore whether cognitive interventions and treatment of depression improve HRQoL in this vulnerable patient population., (© 2024. The Author(s).)

Basal cell carcinoma (BCC) is a slowly growing nonmelanoma type of skin cancer that often is located on the face. Different therapies are available to treat BCC, of which surgical excision (SE) and Mohs micrographic surgery (MMS) are the most frequently used surgical procedures. To examine which attributes of a surgical treatment the general public values as important and to determine the incremental willingness to pay for MMS versus SE. A discrete-choice experiment (DCE) was conducted among members of the general public to examine which attributes of a surgical treatment for primary BCC are valued as important. In addition, based on the attributes included in the experiment, the willingness to pay for MMS versus SE was determined. Respondents ( N=312) preferred a treatment with a lower recurrence rate, shorter surgery time, shorter travelling time, shorter waiting time, no risk for re-excision, and lower cost. The incremental willingness to pay for MMS was 847 euro ($1,203). Results from this DCE indicate that, when outcome and process attributes are considered from a societal perspective, MMS is preferred over SE for primary BCC. The authors have indicated no significant interest with commercial supporters. [ABSTRACT FROM AUTHOR]

Background Rates of recurrence of facial basal-cell carcinoma are consistently lower after Mohs' micrographic surgery (MMS) than after other treatments, such as surgical excision (SE). However, MMS is more time-consuming and therefore more expensive than SE. We investigated the types of facial basal-cell carcinomas in which MMS was more effective than SE. Methods 408 primary and 204 recurrent facial carcinomas (374 and 191 patients, respectively) were analysed separately in this prospective randomised study. Patients were assigned SE or MMS (each 204 primary, 102 recurrent), and received treatment at two hospitals in the Netherlands. The primary outcome was recurrence of carcinoma. Analysis was by intention to treat. Findings Of the basal-cell carcinomas included in the trial, 397 primary (198 MMS, 199 SE) and 201recurrent (99, 102) tumours were actually treated. Of patients with primary carcinomas, 21 had both MMS and SE on different tumours. Nine with recurrent carcinomas had both treatments on different skin tumours. 66 primary and 13 recurrent carcinomas were lost to follow-up. Of the primary carcinomas, five (3%) recurred after SE compared with three (2%) after MMS during 30 months of follow-up. Of the recurrent carcinomas, three (3%) recurred after SE and none after MMS during 18 months of follow-up. Four recurrent carcinomas randomly assigned to the SE group were treated with MMS. Although both differences favoured MMS, they were not significant (primary, difference 1% [95% CI --2.5% to 3.7%], p=0.724; recurrent, 3.2% [-2.0% to 5.0%], p=0.119). Total operative costs of MMS were higher than those of SE (primary €405.79 vs €216.86, recurrent €489.06 vs €323.49; both p<0.001). Interpretation No definitive conclusion on recurrence rates of primary or recurrent basal-cell carcinomas is yet possible. Although recurrence rates were lower after MMS than after SE, the differences were not significant. [ABSTRACT FROM AUTHOR]

In this article, we investigated the influence of mother's occupational status on her child's educational outcomes and to what extent this depends on father's occupational status. Based on the Breen and Goldthorpe (1997) model, we expected that mother's occupational status positively affects the educational outcomes of her child, although this influence may be weaker than father's influence due to remains of traditional gender roles in the Netherlands. Second, we expected that daughters benefit more from mother's occupational status than sons. Finally, we derived from the dominance model (Erikson, 1984) that the positive influence of mother's occupational status becomes weaker when father's occupational status is higher. The three hypotheses were tested with datasets from the LISS panel in 2012 on 1.176 Dutch participants who grew up in dual earner households. The results of multilevel regression analyses show that mother's occupational status indeed has a moderately positive effect on her child's education level. This effect does not differ between sons and daughters and is independent of fathers' occupational status. Unexpectedly, father's occupational status does not affect his child's educational level when mother's occupational status is taken into account. This suggests that in dual earner households mother's occupational status is more relevant than father's occupational status. [ABSTRACT FROM AUTHOR]

Today's universities are, accordingly to Clark's entrepreneurial model, sustained by managerialism, whereas collegialism may remain in contrast or work in a different way. More recent literature suggests the clash such as the potential for coexistence between managerialism and collegialism. The study analyses data from a survey of 26 universities in 8 European countries, focusing on middle managers (MMs). The results show that at the level of the individual institutions, there are notable positive correlations between the presence of collegial and of managerial cultures. Multilevel regressions at institutional level are analysed, to "predict" collegiality in light of the universities' managerial culture and other factors affecting organizational change: accountability; distribution of discretional power; funding; impact of quality assurance (QA) and evaluation. The results illustrate that in more managerial universities, collegial culture increases above all when MMs believe that distance-steering tools (QA and evaluation) have had positive impacts. We find that collegiality can indeed thrive, even when "managerially led."

Background: Most epidemiological studies show a decrease of internalizing disorders at older ages, but it is unclear how the prevalence exactly changes with age, and whether there are different patterns for internalizing symptoms and traits, and for men and women. This study investigates the impact of age and sex on the point prevalence across different mood and anxiety disorders, internalizing symptoms, and neuroticism. Methods: We used cross-sectional data on 146 315 subjects, aged 18–80 years, from the Lifelines Cohort Study, a Dutch general population sample. Between 2012 and 2016, five current internalizing disorders – major depression, dysthymia, generalized anxiety disorder, social phobia, and panic disorder – were assessed according to DSM-IV criteria. Depressive symptoms, anxiety symptoms, neuroticism, and negative affect (NA) were also measured. Generalized additive models were used to identify nonlinear patterns across age, and to investigate sex differences. Results: The point prevalence of internalizing disorders generally increased between the ages of 18 and 30 years, stabilized between 30 and 50, and decreased after age 50. The patterns of internalizing symptoms and traits were different. NA and neuroticism gradually decreased after age 18. Women reported more internalizing disorders than men, but the relative difference remained stable across age (relative risk ~1.7). Conclusions: The point prevalence of internalizing disorders was typically highest between age 30 and 50, but there were differences between the disorders, which could indicate differences in etiology. The relative gap between the sexes remained similar across age, suggesting that changes in sex hormones around the menopause do not significantly influence women's risk of internalizing disorders. [ABSTRACT FROM AUTHOR]

Background Regular follow-up after treatment for breast cancer is crucial to detect potential recurrences and second contralateral breast cancer in an early stage. However, information about follow-up patterns in the Netherlands is scarce. Patients and Methods Details concerning diagnostic procedures and policlinic visits in the first 5 years following a breast cancer diagnosis were gathered between 2009 and 2019 for 9916 patients from 4 large Dutch hospitals. This information was used to analyze the adherence of breast cancer surveillance to guidelines in the Netherlands. Multivariable logistic regression was used to relate the average number of a patient's imaging procedures to their demographics, tumor–treatment characteristics, and individual locoregional recurrence risk (LRR), estimated by a risk-prediction tool, called INFLUENCE. Results The average number of policlinic contacts per patient decreased from 4.4 in the first to 2.0 in the fifth follow-up year. In each of the 5 follow-up years, the share of patients without imaging procedures was relatively high, ranging between 31.4% and 33.6%. Observed guidelines deviations were highly significant (P <.001). A higher age, lower UICC stage, and having undergone radio- or chemotherapy were significantly associated with a higher chance of receiving an imaging procedure. The estimated average LRR-risk was 3.5% in patients without any follow-up imaging compared with 2.3% in patients with the recommended number of 5 imagings. Conclusion Compared to guidelines, more policlinic visits were made, although at inadequate intervals, and fewer imaging procedures were performed. The frequency of imaging procedures did not correlate with the patients' individual risk profiles for LRR. [ABSTRACT FROM AUTHOR]

Background: The use of surgical loupes has not been well‐documented in dermatological surgery. Objectives: An online questionnaire was developed to characterize the use of loupes in dermatological surgery. Methods: The questionnaire was circulated to the memberships of the British Society of Dermatological Surgery, the European Society of Micrographic Surgery, and the Australasian College of Dermatologists. Responses were analyzed with a mixed methods approach using quantitative data analysis and inductive content analysis. Results: One‐hundred twenty‐five valid responses were received from 20 nations. Most respondents were from England (40%; 50/125), Australia (16%; 20/125), and the Netherlands (14.4%; 18/125). Overall, 71.2% (89/125) of respondents were consultants/Facharzt/attending. Furthermore, 55.2% (69/125) of respondents were Mohs surgeons. In dermatological surgery 38.4% (48/125) of respondents used surgical loupes routinely. The mode magnification level for loupes was 2.5× (67.5%; 27/40), with 3× second place (12.5%; 5/40). Exactly half (20/40) used through‐the‐lens style loupes and 40% (16/40) used flip‐up‐loupes. Inductive content analysis of the 51 free‐text responses from nonloupe users uncovered several deterring factor themes, including expense (18/51), can manage without/don't need (14/51), and narrow field of view a(11/51), and uncomfortable/too heavy (9/51). Conclusions: This is the first time the use of surgical loupes in dermatological surgery has been internationally characterized. [ABSTRACT FROM AUTHOR]

Objetives: To determine the prevalence of malnutrition and its relation to various factors in community-dwelling elderly with newly diagnosed Alzheimer’s disease (AD). Design: Retrospective crosssectional study. Setting: Memory clinic in a rural part of the Netherlands. Participants: 312 Community-dwelling AD patients, aged 65 years or older, were included. Measurements: At the time the diagnosis AD was made, socio-demographic characteristics and data on nutritional status (Mini Nutritional Assessment (MNA)), cognitive function (Mini Mental State Examination (MMSE), Cambridge Cognitive Examination (Camcog)), functional status (Interview for Deterioration in Daily Living Activities in Dementia (IDDD), Barthel Index (BI)) and behaviour (Revised Memory and Behaviour Problems Checklist (RMBPC)) were assessed. Characteristics of well-nourished patients (MNA score >23.5) were compared to characteristics of patients at risk of malnutrition (MNA score 17–23.5). Linear regression analysis was performed to assess the effect of various factors on nutritional status. Results: The prevalence of malnutrition was 0% and 14.1% was at risk of malnutrition. AD patients at risk of malnutrition were more impaired in basic and complex daily functioning than well-nourished AD patients (median IDDD score 41.5 [25th–75th percentile 38.8–48.0] versus median IDDD score 40.0 [25th–75th percentile 37.0–43.0], p = 0.028). The degree of impairment in basic and complex daily functioning (IDDD) was independently related to nutritional status (MNA) (p = 0.001, B = −0.062). Conclusion: One in seven community-dwelling elderly with newly diagnosed AD is at risk of malnutrition. The degree of impairment in daily functioning is independently related to nutritional status. Therefore, assessment of the nutritional status should be included in the comprehensive assessment of AD patients. The relation between daily functioning, nutritional status and AD warrants further investigation. [ABSTRACT FROM AUTHOR]

Loneliness is seen as an important problem, contributing to serious health problems. As a baseline measurement for the evaluation of a community project aimed at reducing loneliness in Rotterdam, loneliness was measured, as well as potential correlates. This article describes models of social and emotional loneliness among older adults. This study was conducted among 3,821 randomly selected community dwelling citizens of 65 years and older. Loneliness was measured by using the Jong-Gierveld loneliness questionnaire/scale. As potential correlates demographic, health and psychological and social variables were included. Data were subjected to multiple hierarchically regression analysis. Emotional loneliness was reported by 60% and social loneliness by 47% of the sample. Women were more emotionally lonely than men , while men reported more social loneliness than women. Emotional social support and quality of life were strongest in predicting emotional loneliness and social capital in the neighbourhood, companionship and instrumental support were strongest predictors for social loneliness. Demographic variables predicted variability in emotional loneliness. The strength of the correlates differed between the two dimensions of loneliness. In the design of interventions to prevent and reduce loneliness among older adults, strategies should be developed aimed at the specific dimensions of loneliness. [ABSTRACT FROM AUTHOR]

In the Dutch stratified secondary educational system, schools vary in how many tracks are offered. While the tendency in the Netherlands is for schools to become smaller, a relevant policy question is whether multi‐track school settings promote equality of educational opportunity. Comparing single‐track schools at the pre‐university and pre‐vocational levels with multi‐track schools offering the same exams, and using relative geographical distance as an instrument of school choice, the analyses showed that single‐track pre‐university schools enhance the probability of obtaining a pre‐university diploma without delay, but more strongly so for students from disadvantaged backgrounds (who have a lower chance of going to such schools). The single‐track pre‐vocational schools were associated with a lower likelihood of achieving a diploma at a level higher than pre‐vocational education. Multi‐track schools within a varied system will not automatically enhance equal opportunities, as middle‐class children will also benefit from the additional options that multi‐track schools provide. [ABSTRACT FROM AUTHOR]

Background: The Multicenter Selective Lymphadenectomy Trial (MSLT-1) comparing survival after a sentinel lymph node biopsy (SLNB) versus nodal observation in melanoma patients did not show a significant benefit favoring SLNB. However, in subgroup analyses melanoma-specific survival among patients with nodal metastases seemed better. Aim: To evaluate the association of performing a SLNB with overall survival in intermediate thickness melanoma patients in a Dutch population-based daily clinical setting. Methods: Survival, excess mortality adjusted for age, gender, Breslow-thickness, ulceration, histological subtype, location, co-morbidity and socioeconomic status were calculated in a population of 1,989 patients diagnosed with malignant cutaneous melanoma (1.2–3.5 mm) on the trunk or limb between 2000–2016 in ten hospitals in the South East area, The Netherlands. Results: A SLNB was performed in 51% of the patients (n = 1008). Ten-year overall survival after SLNB was 75% (95%CI, 71%-78%) compared to 61% (95%CI 57%-64%) following observation. After adjustment for risk factors, a lower risk on death (HR = 0.80, 95%CI 0.66–0.96) was found after SLNB compared to observation only. Conclusions: SLNB in patients with intermediate-thickness melanoma on trunk or limb resulted in a 14% absolute and significant 10-year survival difference compared to those without SLNB. [ABSTRACT FROM AUTHOR]

This research investigated whether and to what extent Dutch society is polarized in its attitudes towards refugees and migrants. We further investigated what factors were linked to polarization by testing an integrated three‐dimensional model. A latent profile analysis of a representative Dutch sample (N = 1897) suggested that society is indeed polarized, with two substantial groups—anti (16.5%) and pro (18.7%)—at opposite ends. The middle was also divided into people with critical (31.8%) and lenient (33%) attitudes. The three dimensions of our model, (1) the individual and social self (education, political orientation, relative deprivation), (2) perceptions and experience regarding refugees and migrants (perceived cultural distance and contact), and (3) the societal context (societal discontent), were all significantly associated with polarized attitudes. Interestingly, perceived cultural distance from Islam was most strongly linked to polarized attitudes. Organizing different factors into an integrated model offers new insights into the complexity of polarization in society. [ABSTRACT FROM AUTHOR]

Mapping 3D vegetation structure in wetlands is important for conservation and monitoring. Openly accessible country‐wide Airborne Laser Scanning (ALS) data—using light detection and ranging (lidar) technology—are increasingly becoming available and allow us to quantify 3D vegetation structures at fine resolution and across broad spatial extents. Here, we develop a new, open‐source workflow for classifying wetland‐related land cover types and habitats using fine‐scale lidar metrics derived from country‐wide ALS data. We developed a case study in the Netherlands with a workflow consisting of four routines: (1) pre‐processing of ALS data, (2) calculation of lidar metrics (i.e. 31 features representing cover, 3D shape, vertical variability, horizontal variability and height of vegetation as well as microtopography), (3) assessing feature importance of lidar metrics for classifying wetland habitats, and (4) applying a Random Forest algorithm for mapping and prediction. We used an expert‐based vegetation map for annotation and generated 100, 500 and 1000 annotation points for each class. Using a three‐level hierarchical approach, we differentiated at level 1 planar surfaces (e.g. roads and agricultural fields) from wetland vegetation with 82% mean overall accuracy, using predominantly height and horizontal variability metrics. At level 2, we classified wetland vegetation into four land cover types (forest, grassland, reedbeds, shrubs) with 71% mean overall accuracy, using lidar metrics related to vegetation height and horizontal and vertical variability. At level 3, we differentiated two types of land reed as well as water reed with 78% mean overall accuracy, using predominantly vertical variability metrics. Our results demonstrate that lidar metrics (related to vegetation height, cover, vertical and horizontal variability) derived from country‐wide ALS data can differentiate land cover types and habitats within wetlands at high resolution. Given appropriate annotation data, our workflow can be up‐scaled to a country‐wide extent to allow the comprehensive mapping and monitoring of wetlands at national scales. [ABSTRACT FROM AUTHOR]

Resilient against shame sexting and sextortion. Towards starting points for sharpened education about the risks of sexting among Dutch minors. Adolescents have been taking suggestive and explicitly sexual pictures of themselves for others since instant cameras were around. But since the introduction of smartphones and social media platforms, the speed of making and sending material and the opportunity for sharing have risen strongly. Sexting comes with risks, though. Although general risk communication has made adolescents more aware of the general risks of sexting, they should become more aware of the fact that sext receivers can make screenshots and might share this material at some point with others, without permission. To gather insight into adolescents' sexting-related risk awareness, perceptions, and behaviors and how schools can design effective education to make students more resilient against the risks of shame sexting (making and/or spreading sexual images or videos without permission of the featured person) and sextorting (the use of such images and videos as means of coercion to gain money or sexual acts from the victim), we conducted a questionnaire-based study involving a population sample (N = 188) of young people between fifteen and twenty-one years of age at a school for intermediate vocational education in the eastern part of the Netherlands. The students prefer education about the risks of sexting based on authentic victim stories and want to know who to turn to in case of falling victim of shame sexting or sextortion. We raise suggestions on how to realize effective education on the risks of sexting in classrooms and supply possibilities for future research. [ABSTRACT FROM AUTHOR]

Aim: Weight loss success is highly variable among individuals. Cluster analysis contributes to future intervention development by recognising this individual variability and identifying different weight loss patterns. Identifying determinants that differentiate between these patterns would explain the source of variability. Thus, we aimed to identify weight loss patterns and their determinants in adults with overweight and obesity. Methods: The present study is a secondary analysis of data from the PortionControl@HOME study. The weight of 175 adults was measured at 0, 3 and 12 months and potential determinants were self‐reported using validated questionnaires at 0 and 3 months. Weight loss patterns were identified based on percent weight change during Phase 1 (0–3 months) and Phase 2 (3–12 months) using cluster analysis. Determinants were assessed using multinomial logistic regression. Results: We identified three weight loss patterns: (i) low success, demonstrating low weight loss achievement, (ii) moderate success, demonstrating successful weight loss in Phase 1 followed by partial regain in Phase 2 and (iii) high success, demonstrating weight loss in Phase 1 followed by continued weight loss in Phase 2. Compared to the moderate success pattern, the low success pattern was negatively associated with power of food at baseline (i.e. the appetitive drive to consume highly palatable food) (odds ratio, OR = 0.42, 95% CI = 0.21–0.86) and change in portion control behaviour (i.e. the use of behavioural strategies to control the amount of food consumed) (OR = 0.28, 95% CI = 0.10–0.78). Conclusions: Three weight loss patterns were identified in adults with overweight and obesity. Adults with greater power of food and increased portion control behaviour were less likely to exhibit an unsuccessful weight loss pattern. [ABSTRACT FROM AUTHOR]

Aim: We aimed to explore the utility of the Multiple Array Probe Leiden (MAPLe) device to assess pelvic floor muscle activity in men with lower urinary tract symptoms (LUTS). Methods: This was an observational cohort study performed at the urology outpatient department of a large teaching hospital in the Netherlands between April and October 2018. We recruited male patients referred for the assessment of LUTS, without a history of prostate surgery, if they had an International Prostate Symptom Score greater than or equal to 8. The MAPLe device was then used to assess the puborectalis, pubococcygeus, iliococcygeus, urogenital diaphragm, and the internal and external anal sphincters during three tasks: a rest period (1 minute), five maximum voluntary contractions (held for 3 seconds each), and three maximal endurance contractions (held for 15 seconds each). Results: In total, 57 patients were included, 5 of which had diabetes mellitus. Muscle activity at rest was significantly lower than during either contraction task and did not differ between the muscle groups. By contrast, the external anal sphincter had significantly less activity than any other muscle group during the endurance task, and the internal anal sphincter and puborectalis had significantly less activity during the maximum voluntary contraction task. No association was found between pelvic floor muscle activity and LUTS severity during any task. Conclusion: Pelvic floor muscle activity and LUTS severity appear to be unrelated, but this does not completely exclude the possibility of muscle involvement in the development or experience of symptoms. Further research is needed. [ABSTRACT FROM AUTHOR]

In the last decade, the call for improved estimates of lesbians, gay men and bisexual (LGB) populations has grown steadily. This is related to the increasing visibility of same-sex unions and the rapidly evolving changes in the legal and normative institutional frameworks regarding same-sex relationships in Western countries. The aim of this article is to present the sampling strategy and discuss the quality of a recently conducted probability-based survey in the Netherlands that targeted mixed-sex and same-sex couples with and without children. The core questions addressed are (1) whether the sampling strategy paid off in terms of identifying same-sex households and (2) whether the collected sample is representative of the target population. While the sampling strategy has success in identifying same-sex households, the question of representativeness remains a challenging task in surveying LGB populations and couples in particular. Especially, aspects related to the sampling strategy, the survey mode and the covered topic of the research are central to understanding observed selection patterns in the examined mixed- and same-sex samples. [ABSTRACT FROM AUTHOR]

Abstract: Background: Recent reports show increasing incidence of achalasia in some populations. The aim of this study was to estimate incidence, prevalence, and healthcare costs of achalasia in a large cohort in The Netherlands. Methods: Data were obtained from the largest Dutch healthcare insurance company (±4.4 million insured). Adult achalasia patients were identified between 2006 and 2014 when having an achalasia diagnosis code registered. A total of 907 achalasia patients were identified and included in our database, along with 9068 control patients (non‐achalasia patients), matched by age and gender. Key Results: The mean incidence over the 9‐year period was 2.2 per 100 000 persons and the mean prevalence was 15.3 per 100 000 persons. Mean age of achalasia patients was 54 (range 18‐98) years. Male to female ratio was 1:1. Socio‐economic status distribution was similar in achalasia patients and controls. Prior to the diagnosis, 74% of achalasia patients received proton pump inhibitors and 26% received anti‐emetic medication. The first year after diagnosis median total direct medical costs of achalasia patients were €2283 (IQR 969‐3044) per year. Patients above the 90th percentile of €4717 were significantly older than other patients below the 90th percentile (mean age 63 vs 57); P = .005. Conclusion & Inferences: In this large study that used a database comprising about 25% of all inhabitants of The Netherlands, it is confirmed that achalasia affects individuals of both genders and all ages. The costs associated with diagnosis and treatment of new cases of achalasia increase with increasing age. [ABSTRACT FROM AUTHOR]

Background The incidence of eosinophilic esophagitis (EoE) has increased rapidly. Most epidemiologic data were gathered in single-center studies over a short timeframe, possibly explaining the heterogeneous incidences. Aim The aim of this study was to retrospectively estimate the Dutch nationwide incidence of EoE over the last 20 years. Methods The Dutch pathology registry ( PALGA) was queried to identify pathology reports describing esophageal eosinophilia from 1996 to 2016. Cases were eligible if EoE was confirmed by the pathologist. Using the annual Dutch population data, the incidence of EoE was calculated. Key Results The search yielded 11 288 reports of which 5080 described esophageal eosinophilia. Eosinophilic esophagitis was diagnosed in 2161 patients, 1574 (73%) males and 365 (17%) children. The incidence increased from 0.01 (95% CI 0-0.02) in 1996 to 2.07 (95% CI 2.05-2.23) per 100 000 inhabitants in 2015. The incidence was higher in males than in females, 3.02 (95% CI 2.66-3.41) vs 1.14 (95% CI 0.93-1.38), odds ratio ( OR) 2.66 (95% CI 2.10-3.36) and higher in adults than in children, 2.23 (95% CI 1.99-2.49) vs 1.46 (95% CI 1.09-1.91), OR 1.78 (95% CI 1.32-2.40). Incidence of EoE increased more than 200-fold, whereas endoscopy rates only tripled, from 30 in 1996 to 105 per 100 000 inhabitants in 2015. We observed no seasonal variation. Conclusions and Inferences In the last decades, the Dutch EoE incidence has increased tremendously and still continues to rise. This expansion is only partially driven by increased endoscopy rates. [ABSTRACT FROM AUTHOR]

Abundance estimates based on adequate survey design and count methodology are needed for population monitoring and modelling, and for assessing the results of conservation actions taken to boost or maintain population size at desired target levels. We monitored Bonaire's population of yellow‐shouldered parrot Amazona barbadensis rothschildi using systematic distance sampling surveys in 2009–2017, and developed a Bayesian state‐space logistic model to predict changes in abundance resulting from increased human‐induced mortality in 2018–2066. Survey‐based abundance estimates (mean ± bootstrapped SE) were 0.172 ± 0.020 parrots ha‐1 and 2924 ± 340 parrots at a survey region covering 17 000 ha. Model‐based posterior distribution estimates (mean ± MCMC SD) of maximum population growth rate, maximum sustainable mortality rate, maximum sustainable mortality, population carrying capacity and equilibrium population size were 0.179 ± 0.129, 0.090 ± 0.064, 219 ± 135, 5623 ± 2043 and 2811 ± 1022 parrots. With low to moderate mortality rates (0.001– 0.100, 0.101–0.250), predicted population sizes (mean ± MCMC SD) were 2963 ± 668 and 2703 ± 1660 parrots in 2018, and 2754 ± 690 and 2297 ± 1301 parrots in 2066. With high mortality rates (0.251–0.500), predicted population sizes were 1780 ± 1160 parrots in 2018 and 26 ± 139 parrots in 2066. Because the relative importance and magnitude of human–parrot conflicts are unknown but may be unsustainable, we consider the parrot population vulnerable to the risk of extinction during the modelled time horizon. Therefore, we recommend long‐term monitoring and modelling for assessing changes in abundance and the results of conservation actions taken to keep the population above 2800 parrots in the survey region (i.e. population size N > 2.5% percentile of the posterior distribution of population carrying capacity K). [ABSTRACT FROM AUTHOR]

In the history of Dutch education, 1968 is a landmark for several reasons. the introduction of a democratic, or, as some prefer, meritocratic school system, no longer upholding the social classes, and the disappearance of the HBS are among them. this history has been described from a political, socioeconomical and from a pedagogical point of view. this paper discusses the same shift as a cultural history. Changing perspectives in the role of the HBS in the Netherlands, 1900-1968 are discussed from two points of view. the first point of view is that of pupils and their parents; the second point of view is that of the teachers. It is shown that according to these two groups, the HBS, certainly in its original form and intention, was decaying during the interwar years, and had already disappeared in the 1950s. For most of them the reforms in 1968 'only' casted into law what had already grown to be classroom practice -- for some the new law didn't even achieve that. [ABSTRACT FROM AUTHOR]

Chiari-like malformation (CM), syringomyelia (SM) and middle ear effusion (also called PSOM) are three conditions that frequently occur in Cavalier King Charles Spaniels (CKCS). Both CM and SM are currently screened in the Netherlands prior to breeding and are graded according to the British Veterinary Association’s Kennel Club (BVA/KC) scheme. This study evaluated the prevalence and estimated genetic parameter of CM, SM and middle ear effusion from 12 years of screening results. For SM, the classical method using the BVA/KC scheme, was compared with exact measuring of the central canal dilation. For CM, the BVA/KC scheme was compared with a more detailed scheme. Next to this the presence of microchip artifacts was assessed. 1249 screening of 1020 dogs were re-evaluated. Results indicated the presence of CM in all dogs, suggesting it has become a breed-specific characteristic. And although different grades of CM were observed, the condition did not deteriorate over time. SM was present in 39% of the dogs and a clear age effect was demonstrated, with SM increasing with age. This emphasizes the importance of screening at appropriate age, since SM can worsen with increasing age. One alternative is to promote repeated measures. The presence of middle ear effusion in this study was 19%–21% for dogs younger than 3 years, and 32%–38% for dogs older than 3 years. In as much as 60%, microchip artifacts were noticed, leading to the recommendation to place microchips in another location in breeds that are susceptible to developing SM. Finally, this study estimated the heritability of CM in this population, due to the lack of phenotypic variance, to be very low at 0.02–0.03. The heritability for SM central canal dilatation to be 0.30, compared to 0.13 for the classical BVA/KC method, using a model including the age effect and the combined effect of veterinary clinic and year of the evaluation. Genetic correlations were rather small, ranging from 0.16–0.33. As a conclusion, screening for SM and CM in the entire population should be maintained, and a selection scheme against SM should be based on estimated breeding values for the exact measurement of the central canal dilatation. [ABSTRACT FROM AUTHOR]

Background:Progress tests (PT) are used to assess students on topics from all medical disciplines. Progress testing is usually one of the assessment methods of the cognitive domain. There is limited knowledge on how positioning of the PT in a program of assessment (PoA) influences students’ PT scores, use of PT feedback and perceived learning value. Methods:We compared PT total scores and use of a PT test feedback (ProF) system in two medical courses, where the PT is either used as a summative assessment or embedded in a comprehensive PoA and used formatively. In addition, an interview study was used to explore the students’ perception on use of PT feedback and perceived learning value. Results:PT total scores were higher, with considerable effect sizes (ESs) and students made more use of ProF when the PT was embedded in a comprehensive PoA. Analysis of feedback in the portfolio stimulated students to look for patterns in PT results, link the PT to other assessment results, follow-up on learning objectives, and integrate the PT in their learning for the entire PoA. Conclusions:Embedding the PT in an assessment program designed according to the principles of programmatic assessment positively affects PT total scores, use of PT feedback, and perceived learning value. [ABSTRACT FROM PUBLISHER]

When teaching emotionally taxing and historically complex topics, many teachers rely on history textbooks. The Holocaust, being a mandatory subject in the Netherlands from the 1960s onwards, is such a topic. In most of the textbooks that I have analyzed from the period 1960-2010, representations of the Holocaust ignore the complexity of the Holocaust. Factual renditions are inaccurate, the historical context of Judaism is completely absent and the 'perpetrator narrative' is still the most dominant viewpoint of the Holocaust in most textbooks. In most cases, the Holocaust is seen as a by-product of World War Two, an event in itself but not as the most tragic part of Jewish life and culture in Europe. The richness of Jewish culture and the difficulties in the long-lasting relation between Jews and non-Jews in the Netherlands is mostly marginalized or not mentioned at all. Dutch society after 1945 was being reconstructed and entangled into the Cold War. The contradistinction to a new form of totalitarianism or the celebration of the heroic 'active' victims offered significant value to this resurrection of the nation. The Dutch continued to witness themselves as victims of the German occupation. It was not until the 1980s that the passive victims, in particular the Jews, gradually obtained more attention in public commemorations. In the textbooks however, representations of the Holocaust basically remain incomplete, unmethodical and serving the national narrative. [ABSTRACT FROM AUTHOR]

Purpose:To assess the measurement properties of the Falls Efficacy Scale-International (FES-I) in patients after a hip fracture aged ≥ 65 years.Methods:In a sample of 100 patients, we examined the structural validity, internal consistency and construct validity. For the structural validity a confirmatory factor analysis was carried out. For construct validity predetermined hypotheses were tested. In a second sample of 21 older patients the inter-rater reliability was evaluated.Results:The factor analysis yielded strong evidence that the FES-I is uni-dimensional in patients with a hip fracture; the Cronbach’s alpha was 0.94. When testing the reliability, the intra-class correlation coefficient was 0.72, while the Standard Error of Measurement was 6.4 and the Smallest Detectable Change was 17.7 (on a scale from 16 to 64). The Spearman correlation of the FES-I with the one-item fear of falling instrument was high (r = 0.68). The correlation was moderate with instruments measuring functional performance constructs and low with instruments measuring psychological constructs.Conclusions:Reliability and structural validity of the FES-I in patients after a hip fracture are good. The construct validity appears more closely related to functional performance constructs than to psychological constructs, suggesting that the concept measured by the FES-I may not capture all aspects of fear of falling.Implications for RehabilitationThe Falls Efficacy Scale-International (FES-I), which is commonly used to measure fear of falling in community-dwelling older persons, can also be used to assess fear of falling in patients after a hip fracture.The reliability and the structural validity of the FES-I for these hip patients are good, whereas the construct validity of the FES-I is not optimal.The FES-I may not capture all aspects of fear of falling and may be more closely related to functional performance than to psychological concepts such as anxiety. [ABSTRACT FROM PUBLISHER]

Background: The goals of intentional curative pediatric epilepsy surgery are to achieve seizure-freedom and antiepileptic drug (AED) freedom. Retrospective cohort studies have indicated that early postoperative AED withdrawal unmasks incomplete surgical success and AED dependency sooner, but not at the cost of long-term seizure outcome. Moreover, AED withdrawal seemed to improve cognitive outcome. A randomized trial is needed to confirm these findings. We hypothesized that early AED withdrawal in children is not only safe, but also beneficial with respect to cognitive functioning.Design: This is a multi-center pragmatic randomized clinical trial to investigate whether early AED withdrawal improves cognitive function, in terms of attention, executive function and intelligence, quality of life and behavior, and to confirm safety in terms of eventual seizure freedom, seizure recurrences and "seizure and AED freedom." Patients will be randomly allocated in parallel groups (1:1) to either early or late AED withdrawal. Randomization will be concealed and stratified for preoperative IQ and medical center. In the early withdrawal arm reduction of AEDs will start 4 months after surgery, while in the late withdrawal arm reduction starts 12 months after surgery, with intended complete cessation of drugs after 12 and 20 months respectively. Cognitive outcome measurements will be performed preoperatively, and at 1 and 2 years following surgery, and consist of assessment of attention and executive functioning using the EpiTrack Junior test and intelligence expressed as IQ (Wechsler Intelligence Scales). Seizure outcomes will be assessed at 24 months after surgery, and at 20 months following start of AED reduction. We aim to randomize 180 patients who underwent anticipated curative epilepsy surgery below 16 years of age, were able to perform the EpiTrack Junior test preoperatively, and have no predictors of poor postoperative seizure prognosis (multifocal magnetic resonance imaging (MRI) abnormalities, incomplete resection of the lesion, epileptic postoperative electroencephalogram (EEG) abnormalities, or more than three AEDs at the time of surgery).Discussion: Growing experience with epilepsy surgery has changed the view towards postoperative medication policy. In a European collaboration, we designed a multi-center pragmatic randomized clinical trial comparing early with late AED withdrawal to investigate benefits and safety of early AED withdrawal. The TTS trial is supported by the Dutch Epilepsy Fund (NL 08-10) ISRCTN88423240/ 08/05/2013. [ABSTRACT FROM AUTHOR]

Coastal and inland dunes provide various ecosystem services that are related to groundwater, such as drinking water production and biodiversity. To manage groundwater in a sustainable manner, knowledge of actual evapotranspiration (ETa) for the various land covers in dunes is essential. Aiming at improving the parameterization of dune vegetation in hydrometeorological models, this study explores the magnitude of energy and water fluxes in an inland dune ecosystem in the Netherlands. Hydrometeorological measurements were used to parameterize the Penman-Monteith evapotranspiration model for four different surfaces: bare sand, moss, grass and heather. We found that the net longwave radiation (Rnl) was the largest energy flux for most surfaces during daytime. However, modeling this flux by a calibrated FAO-56 Rnl model for each surface and for hourly time steps was unsuccessful. Our Rnl model, with a novel submodel using solar elevation angle and air temperature to describe the diurnal pattern in radiative surface temperature, improved Rnl simulations considerably. Model simulations of evaporation from moss surfaces showed that the modulating effect of mosses on the water balance is species-dependent. We demonstrate that dense moss carpets (Campylopus introflexus) evaporate more (5%, C14 mm) than bare sand (total of 258mm in 2013), while more open-structured mosses (Hypnum cupressiforme) evaporate less (-30%, -76 mm) than bare sand. Additionally, we found that a drought event in the summer of 2013 showed a pronounced delayed signal on lysimeter measurements of ETa for the grass and heather surfaces, respectively. Due to the desiccation of leaves after the drought event, and their feedback on the surface resistance, the potential evapotranspiration in the year 2013 dropped by 9% (-37 mm) and 10% (-61 mm) for the grass and heather surfaces, respectively, which subsequently led to lowered ETa of 8% (-29 mm) and 7% (-29 mm). These feedbacks are of importance for water resources, especially during a changing climate with an increasing number of drought days. Therefore, such feedbacks need to be integrated into a coupled plant physiological and hydrometeorological model to accurately simulate ETa. In addition, our study showed that groundwater recharge in dunes can be increased considerably by promoting moss vegetation, especially of open-structured moss species. [ABSTRACT FROM AUTHOR]

The article presents abstracts of research papers submitted at the 16th European Congress of Trauma and Emergency Surgery from May 10-12, 2015 in Amsterdam, The Netherlands, including surgical treatment of flail chest, rib fracture management and treatment of instable trunk injuries.

BACKGROUND The European Union requires growers to implement the principles of integrated pest management ( IPM) by 2014. This paper provides a quantitative overview of the costs and effectiveness of voluntary IPM measures in 15 crops in the Netherlands. The authors will focus on aquatic risks and define effectiveness as the potential to reduce the risks posed to aquatic organisms. They further identify which of these measures have actually been adopted by growers and why certain measures have not been adopted. RESULTS Of the 105 measures evaluated, the most effective measures with respect to risk reduction were emission reduction and replacement of high-risk pesticides (each up to 80% reduction). IPM measures directed towards lowering pesticide use generally showed a smaller risk-reducing potential. However, 40% of these measures reduced the overall cost of pest management. About 60% of all 105 measures were voluntarily implemented by growers. The most commonly adopted measures were pest prevention, low-dose spraying and spray drift reduction. Cost appeared to be an important incentive for adoption; however, other factors such as risk perception, education and practicability were equally important. CONCLUSIONS Voluntary IPM measures have significantly contributed to reducing aquatic risks (15-50% risk reduction, depending on crop type). Further risk reduction could be achieved if more growers were to adopt the most effective measures, such as spray drift reduction and replacement of high-risk pesticides. However, IPM has hardly reduced the number of pesticide applications, and therefore the dependence on chemical crop protection continues to be high. © 2014 Society of Chemical Industry [ABSTRACT FROM AUTHOR]