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ObjectivesHospice care in the Netherlands is provided in three different types of hospice facilities: volunteer-driven hospices (VDH), stand-alone hospices (SAHs) and hospice unit nursing homes (HU). The organisational structures range from care directed by trained volunteers in VDH to care provided by multiprofessional teams in SAH and HU units.This study aims to characterise the patient populations who access Dutch hospices and describe the patient profiles in different hospice types.MethodsA retrospective cohort study using clinical records of adult hospice inpatients in 2017–2018 from a random national sample of hospices.ResultsIn total 803 patients were included from 51 hospices, mean age 76.1 (SD 12.4). 78% of patients had a primary diagnosis of cancer, 3% identified as non-Dutch cultural background and 17% were disorientated on admission. At admission, all patients were perceived to have physical needs. Psychological needs were reported in 37%, 36% and 34%, social needs by 53%, 52% and 62%, and existential needs by 23%, 30% and 18% of patients in VDH, SAH, HU units, respectively. 24%, 29% and 27% of patients from VDHs, SAHs and HUs had care needs in three dimensions, and 4%, 6% and 3% in all four dimensions.ConclusionsPeople who access Dutch hospices predominantly have cancer, and have a range of physical, psychological, social and existential needs, without substantial differences between hospice types. Patients with non-malignant disease and non-Dutch cultural backgrounds are less likely to access hospice care, and future policy would ideally focus on facilitating their involvement.

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder that is characterized by low platelet count and increased bleeding risk. COVID-19 vaccination has been described as a risk factor for de novo ITP, but the effects of COVID-19 vaccination in patients with ITP are unknown. We aimed to investigate the effects of COVID-19 vaccination in patients with ITP on platelet count, bleeding complications, and ITP exacerbation (≥50% decline in platelet count, or nadir platelet count < 30 × 109/L with a >20% decrease from baseline, or use of rescue therapy). Platelet counts in patients with ITP and healthy controls were collected immediately before and 1 and 4 weeks after the first and second vaccinations. Linear mixed-effects modeling was applied to analyze platelet counts over time. We included 218 patients with ITP (50.9% female; mean age, 55 years; and median platelet count, 106 × 109/L) and 200 healthy controls (60.0% female; mean age, 58 years; median platelet count, 256 × 109/L). Platelet counts decreased by 6.3% after vaccination. We did not observe any difference in decrease between the groups. Thirty patients with ITP (13.8%; 95% confidence interval [CI], 9.5-19.1) had an exacerbation and 5 (2.2%; 95% CI, 0.7-5.3) suffered from a bleeding event. Risk factors for ITP exacerbation were platelet count < 50 × 109/L (odds ratio [OR], 5.3; 95% CI, 2.1-13.7), ITP treatment at time of vaccination (OR, 3.4; 95% CI, 1.5-8.0), and age (OR, 0.96 per year; 95% CI, 0.94-0.99). Our study highlights the safety of COVID-19 vaccination in patients with ITP and the importance of the close monitoring of platelet counts in a subgroup of patients with ITP. Patients with ITP with exacerbation responded well on therapy.

Study Design: A multicenter, retrospective case series.Objective: In the past several years, screw fixation of the cervical spine has become commonplace. For the most part, this is a safe, low-risk procedure. While rare, screw backout or misplaced screws can lead to morbidity and increased costs. We report our experiences with this uncommon complication.Methods: A multicenter, retrospective case series was undertaken at 23 institutions in the United States. Patients were included who underwent cervical spine surgery from January 1, 2005, to December 31, 2011, and had misplacement of screws requiring reoperation. Institutional review board approval was obtained at all participating institutions, and detailed records were sent to a central data center.Results: A total of 12?903 patients met the inclusion criteria and were analyzed. There were 11 instances of screw backout requiring reoperation, for an incidence of 0.085%. There were 7 posterior procedures. Importantly, there were no changes in the health-related quality-of-life metrics due to this complication. There were no new neurologic deficits; a patient most often presented with pain, and misplacement was diagnosed on plain X-ray or computed tomography scan. The most common location for screw backout was C6 (36%).Conclusions: This study represents the largest series to tabulate the incidence of misplacement of screws following cervical spine surgery, which led to revision procedures. The data suggest this is a rare event, despite the widespread use of cervical fixation. Patients suffering this complication can require revision, but do not usually suffer neurologic sequelae. These patients have increased cost of care. Meticulous technique and thorough knowledge of the relevant anatomy are the best means of preventing this complication.

Study Design: Retrospective multicenter case series study.Objective: Because cervical dural tears are rare, most surgeons have limited experience with this complication. A multicenter study was performed to better understand the presentation, treatment, and outcomes following cervical dural tears.Methods: Multiple surgeons from 23 institutions retrospectively identified 21 rare complications that occurred between 2005 and 2011, including unintentional cervical dural tears. Demographic data and surgical history were obtained. Clinical outcomes following surgery were assessed, and any reoperations were recorded. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), Nurick classification (NuC), and Short-Form 36 (SF36) scores were recorded at baseline and final follow-up at certain centers. All data were collected, collated, and analyzed by a private research organization.Results: There were 109 cases of cervical dural tears among 18?463 surgeries performed. In 101 cases (93%) there was no clinical sequelae following successful dural tear repair. There were statistical improvements (P< .05) in mJOA and NuC scores, but not NDI or SF36 scores. No specific baseline or operative factors were found to be associated with the occurrence of dural tears. In most cases, no further postoperative treatments of the dural tear were required, while there were 13 patients (12%) that required subsequent treatment of cerebrospinal fluid drainage. Analysis of those requiring further treatments did not identify an optimum treatment strategy for cervical dural tears.Conclusions: In this multicenter study, we report our findings on the largest reported series (n = 109) of cervical dural tears. In a vast majority of cases, no subsequent interventions were required and no clinical sequelae were observed.

Study Design: Retrospective multi-institutional case series.Objective: The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.Methods: A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17?625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, inclusive, were reviewed to identify the occurrence of 21 predefined treatment complications. Patients who underwent an ACDF were identified in the database and reviewed for the occurrence of postoperative anterior cervical infections.Results: A total of 8887 patients were identified from a retrospective database analysis of 21 centers providing data for postoperative anterior cervical infections (17/21, 81% response rate). A total of 6 postoperative infections after ACDF were identified for a mean rate of 0.07% (range 0% to 0.39%). The mean age of patients identified was 57.5 (SD = 11.6, 66.7% female). The mean body mass index was 22.02. Of the total infections, half were smokers (n = 3). Two patients presented with myelopathy, and 3 patients presented with radiculopathic-type complaints. The mean length of stay was 4.7 days. All patients were treated aggressively with surgery for management of this complication, with improvement in all patients. There were no mortalities.Conclusion: The incidence of postoperative infection in ACDF is exceedingly low. The management has historically been urgent irrigation and debridement of the surgical site. However, due to the rarity of this occurrence, guidance for management is limited to retrospective series.

Study Design: A multicenter, retrospective review of C5 palsy after cervical spine surgery.Objective: Postoperative C5 palsy is a known complication of cervical decompressive spinal surgery. The goal of this study was to review the incidence, patient characteristics, and outcome of C5 palsy in patients undergoing cervical spine surgery.Methods: We conducted a multicenter, retrospective review of 13?946 patients across 21 centers who received cervical spine surgery (levels C2 to C7) between January 1, 2005, and December 31, 2011, inclusive. Pvalues were calculated using 2-sample ttest for continuous variables and ?2tests or Fisher exact tests for categorical variables.Results: Of the 13?946 cases reviewed, 59 patients experienced a postoperative C5 palsy. The incidence rate across the 21 sites ranged from 0% to 2.5%. At most recent follow-up, 32 patients reported complete resolution of symptoms (54.2%), 15 had symptoms resolve with residual effects (25.4%), 10 patients did not recover (17.0%), and 2 were lost to follow-up (3.4%).Conclusion: C5 palsy occurred in all surgical approaches and across a variety of diagnoses. The majority of patients had full recovery or recovery with residual effects. This study represents the largest series of North American patients reviewed to date.

Study Design: A multicenter, retrospective cohort study.Objective: To evaluate clinical outcomes in patients with reintubation after anterior cervical spine surgery.Methods: A total of 8887 patients undergoing anterior cervical spine surgery were enrolled in the AOSpine North America Rare Complications of Cervical Spine Surgery study. Patients with or without complications after surgery were included. Demographic and surgical information were collected for patients with reintubation. Patients were evaluated using a variety of assessment tools, including the modified Japanese Orthopedic Association scale, Nurick score, Neck Disability Index, and Short Form-36 Health Survey.Results: Nine cases of postoperative reintubation were identified. The total prevalence of this complication was 0.10% and ranged from 0% to 0.59% across participating institutions. The time to development of airway symptoms after surgery was within 24 hours in 6 patients and between 5 and 7 days in 3 patients. Although 8 patients recovered, 1 patient died. At final follow-up, patients with reintubation did not exhibit significant and meaningful improvements in pain, functional status, or quality of life.Conclusions: Although the prevalence of reintubation was very low, this complication was associated with adverse clinical outcomes. Clinicians should identify their high-risk patients and carefully observe them for up to 2 weeks after surgery.

359 precisely reduced meteor orbits are presented that are the result of the Dutch Meteor Society's Photographic Meteor Survey in the period 1981 until 1993. Orbits include those of major and minor showers, doubling the number of known precise orbits of some meteor streams. From the spread in solutions of all possible sets of two photographic stations, we derive the measurement uncertainties from which we are able to calculate the intrinsic scatter in the Perseid meteor stream. The new Geminid orbits are compared to those obtained in similar surveys in the 1950's. This first measurement of the rate of change of Geminid orbits over time agrees well with model predictions.

Abstract—In this paper, we provide an overview of meteors with high beginning height. During the recent Leonid meteor storms, as well as within the regular double station video observations of other meteor showers, we recorded 164 meteors with a beginning height above 130 km. We found that beginning heights between 130 and 150 km are quite usual, especially for the Leonid meteor shower. Conversely, meteors with beginning heights above 160 km are very rare even among Leonids. From the meteor light curves, we are able to distinguish two different processes that govern radiation of the meteors at different altitudes. Light curves vary greatly above 130 km and exhibit sudden changes in meteor brightness. Sputtering from the meteoroid surface is the dominating process during this phase of the meteor luminous trajectory. Around 130 km, the process switches to ablation and the light curves become similar to the light curves of standard meteors. The sputtering model was successfully applied to explain the difference in the beginning heights of high‐altitude Leonid and Perseid meteors. We show also that this process in connection with high altitude fragmentation could explain the anomalously high beginning heights of several relatively faint meteors.

The reliability of fine‐needle aspiration cytology (FNAC) of breast masses in males could be compromised by lack of experience because breast carcinoma is rare in males and FNAC is not often used. In addition, FNAC of the more often encountered gynecomastia may lead to overdiagnosis. Therefore, in the current study the authors evaluated their experience with FNAC of breast masses occurring in males.A total of 153 FNACs of the male breast obtained between 1985 until the end of 2000 were retrieved from the electronic files of the study institution. A total of 141 FNACs were taken from unilateral lesions in men age > 24 years, the group of men believed to be most at risk for breast carcinoma. Histologic follow‐up was retrieved from the same files and was available for 72 FNACs. For specimens without histologic follow‐up the nationwide pathology database was consulted and no cases of breast carcinoma were found.The inadequate rate was 13%. When inadequate FNACs were included in the calculations, the sensitivity was found to be 87% and the specificity 78%. When the inadequate FNACs were excluded from the calculations the sensitivity was reported to be 100% and the specificity 89%. The positive predictive value of a diagnosis of malignancy was 100%. During the study period the authors' institution examined approximately 10,000 FNAC specimens from male and female breasts and 399 resection specimens from the breasts of men age > 24 years with unilateral lesions. In this last group, preoperative FNAC reduced the benign‐to‐malignant ratio from 19.8:1 to 3.5:1.FNAC of the male breast is a reliable procedure in a setting in which sufficient numbers of FNACs of the breast are examined. The authors believe FNAC should be used more often in the preoperative evaluation of breast lesions occurring in males. Cancer (Cancer Cytopathol) 2002;96:000–000. © 2002 American Cancer Society.

Abstract—In this paper, we study the extremely high beginning parts of atmospheric trajectories of seven Leonid meteors recorded by sensitive TV systems equipped with image intensifiers up to apparent magnitude +6.5. For all seven cases, we observed comet‐like diffuse structures with sizes on the order of kilometers that developed quickly during the meteoroids' descent through the atmosphere. For the brightest event with a maximum absolute magnitude of −12.5, we observed an arc similar to a solar protuberance and producing a jet detectable several kilometers sideways from the brightest parts of the meteor head, and moving with a velocity over 100 km/s. These jets are common features for the seven studied meteors. Precise position in trajectory, velocity, and brightness at each point is available for all seven meteors, because of double‐station records on 85 km base‐line. When these meteoroids reached 130 km height, their diffuse structures of the radiation quickly transformed to the usual meteor appearance resembling moving droplets, and meteor trains started to develop. These meteor phenomena above 130 km were not recognized before our observations, and they cannot be explained by standard ablation theory.

The social rental sector has become a major segment of the housing market in the Netherlands (forming 44 per cent of the stock in 1988). Until recently, its management by non-profit housing associations and municipalities posed no major problems: the stock was relatively new, the general housing shortage was severe, and middle-income groups accounted for a substantial share of the tenants of social rental housing. This situation has changed; especially the older multi-family housing in the cities has slipped into a lower position in the urban housing hierarchy, and lower-income households predominate in this type of housing. At the same time, part of the older stock is in need of renovation. This article reports on interviews with managers of non-profit housing associations about their strategies to keep the housing in good shape and to find tenants. It also reports on interviews with tenants in newly renovated housing complexes.

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Several letters to the editor are presented that comment on issues related to television programs including reality shows, "Ugly Betty" and "CSI: Crime Scene Investigation."