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Item does not contain fulltext, OBJECTIVE: Previous studies have shown low adherence to surgical staging guidelines in patients with clinical early-stage ovarian carcinoma. The aim of this study was to identify guideline adherence for surgical staging and to show the distribution of each surgical item within the study population. In addition, we examined whether regional variation in the Netherlands exists for complete surgical staging. METHODS: Patients with ovarian cancer and surgical staging registered in the Dutch Gynecological Oncology Audit between January 1, 2015 and December 31, 2019 in the Netherlands were included. Complete surgical staging was defined according to the Dutch evidence-based guideline. Surgical items were ranked and illustrated. Variation in complete surgical staging for eight regional cancer networks was shown in funnel plots. Manual validation of registered data was performed in three gynecological oncology centers. RESULTS: 604 patients underwent surgical staging, 365 (60%) underwent an incomplete staging procedure, 295 (81%) were registered with early-stage disease (International Federation of Gynecology and Obstetrics I-IIA) and, of these patients, 115 (39%) received adjuvant chemotherapy. Patients with incomplete surgical staging were operated more often with minimal invasive techniques (laparoscopy or robot) compared with patients in the complete staging group (p<0.001). Sampling of cytology/ascites was the most frequently lacking factor (29%). Manual validation of data in three gynecological oncology centers identified reasons for incomplete staging, the most common being 'perioperative findings' such as dense adhesions between tumor and peritoneum, consistent with advanced stage disease (≥IIA). Regional variation for complete surgical staging showed two regions performing outside the confidence intervals (12.5% and 25.5%, mean 40%). CONCLUSION: Guideline adherence for staging was lower than expected and validation of data gave additional insights into the reasons

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In the literature, the junction temperature of a light-emitting diode (LED) has been considered having a uniform distribution over the whole chip. Such a perception is based on the assumption that the die attach adhesive (DAA) covers the whole bottom of the LED chip with a uniform thickness. However, in reality, there may be insufficient DAA during the chip mounting process. As a result, non-uniform junction temperature may be induced and hot spots could occur. Therefore, it is essential to investigate the effect of DAA on the creation of hot spots at the LED junction. In the present study, LED chips were mounted with various amounts of DAA on a leadframe designed for high power LED. A high resolution infra-red (IR) camera was used to measure the temperature on the surface of the LED chip. The obtained IR images were calibrated carefully in order to eliminate the influence from IR emissivity. Hot spots were observed at the junction areas where DAA was missing. Detailed analysis for illustrating the effect of DAA distribution on hot spots is presented and reasons for such a phenomenon are discussed. © 2012 IEEE.

Wereldwijd staan delta’s onder druk door bevolkingsgroei, industrialisatie en klimaatverandering. In de Delta Alliance zijn nu tien delta’s uit Noord- en Zuid-Amerika, Afrika, Azië en Nederland verenigd, en een tiental andere Afrikaanse en Aziatische delta’s zoeken nog aansluiting. ‘Men wil weten hoe andere delta’s met problemen omgaan’, verklaart programmamanager Wim van Driel de belangstelling. In juni 2011 is de stichting Delta Alliance International opgericht om het geheel meer slagkracht te geven en de Delta Alliance als onafhankelijk netwerk te kunnen profileren.

High Power RF electronics is one of the essential parts for wireless communication, including the personal communication, broadcasting, microwave radar, etc. Moreover, high efficient high power electronics has entered the ISM market, such as the power generator of microwave oven. Power electronics requires a close co-development of digital-analog mixed circuit design, high power IC manufacturing technologies, and high power packaging design/process, in order to guarantee their performance and lifetime. In this paper, we overviewed our works on the packaging/assembly development of high power packages, including three parts: (1) Thermal simulation and die bond defect control (2) Mechanical integrity model for soft package heatsink implementation (3) Al wire multiphysics modeling and reliability of plastic power package.

This Strategic Framework outlines the objectives, working strategy and financial plan for the development of the Delta Alliance network organization. The central motivation for creating Delta Alliance is to provide a foundation and framework for successful international cooperation that will support more effective and efficient responses to increasing pressures in river deltas worldwide. In short, to improve the resilience of the world’s deltas.

In the National Water Plan of 2010, the Netherlands has formulated its ambitions for its international water programme, called ‘Water Mondiaal’ (Global Water). This programme (2010-2015) envisages the Netherlands to co-operate actively with countries in low-lying delta areas. Objectives of the programme are to reduce vulnerability against floods and the effects of climate change and ensuring supply of sufficient and clean water. The Water Mondiaal programme will focus its attention on five deltas and envisions long term co-operation agreements with the countries of these deltas. In view of the implementation of the Water Mondiaal Programme a pre-identification mission has visited Bangladesh from April 24 till 30 2010 in order to define jointly with the Bangladesh government and water sector institutions and organisations (private sector, knowledge institutes, civil society and government) priority fields of cooperation. The present identification mission for (the preparation of ) the Knowledge to Knowledge component (K2K identification mission) is a direct follow up of the Water Mondiaal preidentification mission of April 2010. The K2K identification mission builds on the established contacts, findings and conclusions of the Water Mondiaal pre-identification mission.

RIVM rapport:Om de kwaliteit van thuisbevallingen in Nederland in kaart te brengen en te verbeteren, is een set van 23 indicatoren gedefinieerd. Voorbeelden zijn het percentage bevallingen waarbij de verloskundige niet aanwezig is, het percentage doorverwijzingen naar een specialist en het percentage bevallingen waarbij de kraamhulp niet op tijd aanwezig is. Het onderzoek is uitgevoerd in opdracht van de Inspectie voor de Gezondheidszorg (IGZ), die in overleg met de beroepsgroepen indicatoren zal overnemen om beter toezicht te kunnen houden. De indicatoren zijn bepaald door een werkgroep bestaande uit vertegenwoordigers van de beroepsgroepen, de IGZ en het RIVM. De Koninklijke Nederlandse Organisatie van Verloskundigen (KNOV) heeft enkele jaren geleden instrumenten ingevoerd (het kwaliteitsregister, het praktijkanalyse-instrument en praktijkcertificering) om de kwaliteit van de verloskundigepraktijk te verbeteren. Een volgende stap is de kwaliteit van de zorg zichtbaar maken aan de hand van indicatoren. Indicatoren kunnen een meer gedetailleerd inzicht geven in onderdelen van de zorg dan de bestaande kwaliteitstoets. Het zijn meetbare elementen van zorgverlening die een aanwijzing geven over de kwaliteit van die zorg. Om tot de indicatoren te komen, zijn eerst de risicogebieden binnen de eerstelijnsverloskunde bepaald. Vervolgens zijn op basis van literatuurgegevens en richtlijnen conceptindicatoren samengesteld. Daarna is de groslijst voorgelegd aan experts uit het veld. Zij beoordeelden de conceptindicatoren op kwaliteit en haalbaarheid in de dagelijkse praktijk., In order to monitor the quality of home care deliveries in the Netherlands, a set of 23 quality indicators has been defined. The quality indicators include percentages for deliveries without the presence of a midwife, referrals to an obstetrician and deliveries without the presence of a maternity assistant. This research was commissioned by the Netherlands Health Care Inspectorate (IGZ), which, after consultation and agreement with professional groups, will adopt some indicators for their surveillance purposes. The indicators were defined by a steering committee comprising members of the Royal Dutch Organization of Midwives (KNOV), the Association of Obstetric Active General Practitioners (VVAH), a practising midwife, the IGZ, and researchers from the National Institute for Public Health and the Environment (RIVM). Several years ago, the KNOV introduced methods to improve the quality of midwifery care; these included the quality register and practice accreditation. In line with this, the next step will be to use indicators to monitor the quality of midwifery care. Compared to existing quality instruments, indicators are useful for gaining detailed insight into certain aspects of midwifery care. Indicators are measures that reflect, or indicate, the state of health care. The steering committee first identified thirteen quality domains. Subsequently, based on the literature and existing guidelines, a list of possible indicators was generated. This list was then judged by experts from the field. The indicators were judged on their relevance to clinical practice. In addition, their feasibility for the health care professional for deriving information from routinely collected data was judged.

Verslag van een inventarisatie (op grond van een chemische analyse van enige duizenden bodemmonsters) van het voorkomen van cadmium in verschillende Nederlandse bodemtypen