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Key Points Question: Is the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) tool valid for guiding skin cancer screening in solid organ transplant recipients (SOTRs)? Findings: This prognostic study found good prognostic discrimination in a European cohort of 3421 SOTRs. The observed skin cancer incidences were similar to those predicted from the US SOTR population for each risk group. Meaning: These findings suggest that the SUNTRAC tool can be transported to different populations to stratify SOTRs into distinct skin cancer risk groups and identify those at a very high risk, opening the door to efficient and effective preventive measures.This prognostic study assesses the Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) tool to validate it in different populations of solid organ transplant recipients.Importance: The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) tool has been developed in the US to facilitate the identification of solid organ transplant recipients (SOTRs) at a higher risk of developing skin cancer. However, it has not yet been validated in populations other than the one used for its creation. Objective: To provide an external validation of the SUNTRAC tool in different SOTR populations. Design, Setting, and Participants: This retrospective external validation prognostic study used data from a prospectively collected cohort of European SOTRs from transplant centers at teaching hospitals in the Netherlands (1995-2016) and Spain (2011-2021). Participants were screened and followed up at dermatology departments. Data were analyzed from September to October 2021. Main Outcomes and Measures: The discrimination ability of the SUNTRAC tool was assessed via a competing risk survival analysis, cumulative incidence plots, and Wolbers concordance index. Calibration of the SUNTRAC tool was assessed through comparison of projected skin cancer incidences. Skin cancer diagnoses included squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. Results: A total of 3421 SOTRs (median age at transplant, 53 [quartile 1: 42; quartile 3: 62] years; 2132 [62.3%] men) were assessed, including 72 Asian patients (2.1%), 137 Black patients (4.0%), 275 Latinx patients (8.0%), 109 Middle Eastern and North African patients (3.2%), and 2828 White patients (82.7%). With a total of 23213 years of follow-up time, 603 patients developed skin cancer. The SUNTRAC tool classified patients into 4 groups with significantly different risks of developing skin cancer during follow-up. Overall, the relative rate for developing skin cancer estimated using subdistribution hazard ratios (SHRs) and using the low-risk group as the reference group, increased according to the proposed risk group (medium-risk group: SHR, 6.8 [95% CI, 3.8-12.1]; P

Contains fulltext : 237836.pdf (Publisher’s version ) (Closed access) Events during the last decade of the twentieth century, such as the fall of the Berlin Wall, have triggered an interest in the role of formal institutions and culture in the desired design and performance of economies. Culture refers to norms and values shared by a group. Empirical studies have investigated the link between dominant values in countries, measured by answers on questionnaires, formal institutions, and the national economies’ performance. In these studies, the academic researcher acts as an impartial observer. This is a questionable assumption as academics are human beings and thus subject to similar cognitive biases and limitations as others. This chapter, therefore, argues that the ideas of economists correlate with those of other people in a country. Similarly, economic policy will reflect the national culture and economic ideas. This book studies the interaction between these three areas – economic ideas, national culture, and policy – for three countries, namely the United States of America, Germany, and France. These countries represent, respectively, the free or liberal market economy, the coordinated market economy, and the hierarchical market economy. For each of the countries, the book investigates the labour market, financial system, competition policy, and monetary policy.

Contains fulltext : 237718.pdf (Publisher’s version ) (Closed access) This chapter describes the national culture of the three countries concerned by means of a brief review of each country’s history and its scores on different cultural dimensions and other indicators of dominant attitudes. The United States’ culture is still predominantly influenced by the first settlers’ attitudes, who see the individual as someone fighting against nature and the powerful. As a result, the individual is in high regard, concentration of power is rejected, and US inhabitants accept uncertainty relatively easily. Many wars have been fought on the soil of present-day Germany. Moreover, the country and its predecessors have many neighbours with whom they have had to cooperate. This history is reflected in a high score on Uncertainty Avoidance, an obedience to preset rules, and a relatively large willingness to cooperate. France has the longest history as an independent state. The state is also the most centralized one and ruled by the elite. The country’s high score on Power Distance suggests that the lower classes accept the difference between the classes – an observation that is confirmed by the significant differences in virtues to be taught to children between the highest and lowest education classes. Cooperation appears to be difficult for the French.

Contains fulltext : 237641.pdf (Publisher’s version ) (Closed access) This chapter investigates the origins and development of central banking and the role of monetary policy in three types of market economies: the free market economy, the coordinated market economy, and the hierarchical market economy. The United States, Germany, and France are examples of each of these types of economies. In particular, attention is paid to the evolution of the concept of an independent central bank. In the United States, the discussion about central bank independence centred on finding the right balance between the powers of the states and those of the federal level, and between public and private (banks) interests. The Bundesbank’s high degree of independence was enforced by the public who wanted to shield the central bank against political influences. The French central bank was part of the ministry of finance and thus very dependent. Since 1999, the German and French central banks have been part of the European Central Bank. A separate section is devoted to the question of whether traces of differences in national cultures and economic ideas can be found in the discussions about monetary policy within the ECB.

Contains fulltext : 237652.pdf (Publisher’s version ) (Closed access) An increasing awareness of the embeddedness of national institutions in deeper layers of values can be discerned. However, in the meantime, internationalization and globalization have led to a dominance of international and thus common standards. Consequently, the chances are high that national influences are trumped by international ones. This certainly seems to hold for financial systems as these are designed according to international agreements. This chapter describes the evolution of the financial systems in the United States, Germany, and France with a view to investigating whether these systems still resemble the national characteristics which were so obvious during the first decades after the Second World War. It appears that some subsectors of the financial systems, such as the financing of residential housing, still reflect differences in national cultures.

This chapter summarizes the findings of this volume. The idea of free market economists is that the free exchange of transactions liberates the individual from arbitrary assignments of resources and income based on gender, race, or legal status. The individual is in high regard, concentration of power is disliked, and equality of opportunity is important. These traits are also found in the public’s preferences and policies. Less attention is given to the fact that a policy of providing equal opportunities to everyone can lead to a concentration of power and wealth. The German ordoliberals have an eye for the consequences of the market process. For them the market is a legal order that should prevent the concentration of power with the government or large private companies. In this way, the well-being of all individuals should be enhanced. Consequently, the German public and politicians are often concerned with the consequences of policies in the long term. For the French economic engineers, the market is a theoretical construct that helps them to advise the political elite, which also has a great influence in the private sector. The population relatively easily accepts the resulting concentration of power and wealth as long as this serves them.

Item does not contain fulltext Clinical characteristics and outcomes among older patients with a SARS-CoV-2 infection differ greatly from those seen in younger patients. Here we highlight atypical presentations of this fulminant infectious disease COVID-19, based on a clinical case and a cohort of 19 patients admitted to a geriatric ward. The degree of frailty, resilience and number of co-morbidities caused COVID-19 to present as acute geriatric syndrome events such as falls, delirium and dehydration in these patients. Clinical laboratory results considered typical for COVID-19 were present less often in this frail older population. As in other countries, morbidity and mortality is most severe among frail male patients; therefore, assessment of changes suggestive of typical acute geriatric syndromes in frail older patients with chronic diseases should lead to a careful clinical examination for a SARS-CoV-2 infection. Protocols for diagnosis, and contact isolation measures, should take these atypical presentations into account.

INNAX heeft binnen het RED kantoren project in samenwerking met VABI, TNO en E-nolis (Energy Navigator) de Paris Proof monitor ontwikkeld. Deze internet portal biedt de mogelijkheid inzicht te krijgen in de verduurzaming van uw kantorenportefeuille richting de Paris Proof-norm. De Paris Proof norm is ontwikkeld door de Dutch Green Building Council en gaat ervan uit dat voor een volledig duurzame energievoorziening een kantoorgebouw straks nog maar 50 kWh per vierkante meter per jaar mag verbruiken. Doel van de Paris Proof Monitor is de verduurzaming van kantoren te versnellen door advisering te vergemakkelijken en te automatiseren. Nu wordt voor de verduurzaming van een kantoorpand een maatwerkadvies gemaakt door een EPA adviseur. Dat is zeer arbeidsintensief en tijdrovend. De Paris Proof monitor kan de advisering automatiseren en maakt het mogelijk om niet naar 1 kantoorpand te kijken, maar naar een portefeuille van kantoren. Daarmee wordt de vastgoedeigenaar ondersteund in het proces van prioritering: welke panden ga ik het eerste verduurzamen, in welke panden neem ik welke maatregelen en wanneer? De tool geeft inzicht in de kenmerken van gebouwen die voor de verduurzaming van belang zijn: het energiegebruik, de informatieplicht, energielabels en te verwachten besparing en investeringskosten van alle maatregelen voor verschillende ambitieniveaus: de erkende maatregelen in het kader van de Wet Milieubeheer, het voor kantoren verplicht label C en de Paris Proof norm van 50 kWh/m2 op basis van het werkelijke gemeten energieverbruik. In het dashboard kan met een filter de informatie worden toegepast op één, meerdere of alle geselecteerde gebouwen.

The use of a biorefinery co-product, such as humins, in combination with an iron precursor in a solvent-free method yields a catalytic material with potential use in selective oxidative cleavage reactions. In particular, this catalyst was found active in the hydrogen-peroxide assisted oxidation of a naturally extracted molecule, isoeugenol, to high added-value flavouring agent, vanillin. By carrying out the reaction in continuous flow, not only a better understanding of the reaction mechanism and of the catalyst deactivation can be achieved, but also important insights for optimised conditions can be developed. The findings of this paper could pave the way to a more sustainable process for the production of a valuable food and perfume additive, vanillin.

Contains fulltext : 181792pub.pdf (Publisher’s version ) (Closed access) BACKGROUND: Patients with inflammatory bowel disease (IBD) are at increased risk to develop malignant melanoma and this risk may increase with use of anti-tumor necrosis factor (TNF) therapy. Impaired survival of immunosuppressed melanoma patients is reported in transplant and rheumatology patients. This study aims to (1) identify risk factors for melanoma development in patients with IBD, (2) compare clinical characteristics of melanoma in patients with IBD to the general population, and (3) assess the influence of immunosuppressive medication on survival. METHODS: We retrospectively searched the Dutch Pathology Database to identify all Dutch patients with IBD with cutaneous melanoma between January 1991 and December 2011. We then performed 2 case-control studies. To identify risk factors for melanoma development in IBD, we compared patients with IBD with melanoma to the general IBD population. To compare outcome and survival after melanoma diagnosis, we compared cases with non-IBD melanoma patients. RESULTS: We included 304 patients with IBD with melanoma, 1800 IBD controls, and 8177 melanoma controls. IBD cases had more extensive IBD (ulcerative colitis: pancolitis: cases 44.5% versus IBD controls without melanoma 28.1%; P < 0.01; Crohn's disease: ileal and colonic disease: cases 57.9% versus controls 48.9%; P = 0.02). Despite a lower Nodes (N)-stage in patients with IBD (N1+ 8.3% versus 18.2%; P < 0.01) with comparable Tumor (T) and Metastasis (M) stages, survival was similar between groups, regardless of immunosuppressive or anti-TNF therapy. CONCLUSIONS: This study showed that IBD extent is a risk factor for melanoma development. Despite the lower N-stage in patients with IBD, we could not confirm impaired survival after melanoma in patients with IBD, regardless of anti-TNF and/or thiopurine use.

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Item does not contain fulltext Immunocompromised patients are especially at risk for developing chronic hepatitis E virus (HEV) infection, which may result in progressive liver disease and cirrhosis. In addition, treatment of chronic HEV infection in these patients often includes dose reduction of immunosuppressive therapy and this may lead to severe flare-ups of the underlying condition or even rejection of transplant material. Therefore prevention of HEV transmission is being more and more recognised as an essential step to stop increasing HEV seroprevalence. The Dutch National Institute for Public Health and the Environment (RIVM) has recently warned immunocompromised patients following haematopoietic stem cell and solid organ transplantations for the risk of infection by HEV through eating of contaminated products from pig meat. Furthermore, the Dutch blood bank recently decided to start screening all blood products for HEV to prevent iatrogenic transmission of HEV. We describe two patients with HEV infection and discuss risk of infection for immunocompromised patients, transmission routes and the importance of prevention of iatrogenic transfusion related transmission.

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Various guidelines for minor head injury focus on patients with a Glasgow Coma Scale (GCS) score of 13-15 and loss of consciousness (LOC) or post-traumatic amnesia (PTA), while clinical management for patients without LOC or PTA is often unclear. We aimed to investigate the effect of presence and absence of LOC or PTA on intracranial complications in minor head injury. A prospective multi-center cohort study of all patients with blunt head injury and GCS score of 15 was conducted at six Dutch centers between 2015 and 2017. Five centers used the national guideline and one center used a local guideline-both based on the CT in Head Injury Patients (CHIP) prediction model-to identify patients in need of a computed tomography (CT) scan. We studied the presence of traumatic findings and neurosurgical interventions in patients with and without LOC or PTA. In addition, we assessed the association of LOC and PTA with traumatic findings with logistic regression analysis and the additional predictive value of LOC and PTA compared with other risk factors in the CHIP model. Of 3914 patients, 2249 (58%) experienced neither LOC nor PTA and in 305 (8%) LOC and PTA was unknown. Traumatic findings were present in 153 of 1360 patients (11%) with LOC or PTA and in 67 of 2249 patients (3%) without LOC and PTA. Five patients without LOC and PTA had potential neurosurgical lesions and one patient underwent a neurosurgical intervention. LOC and PTA were strongly associated with traumatic findings on CT, with adjusted odds ratios of 2.9 (95% confidence interval [CI] 2.2-3.8) and 3.5 (95% CI 2.7-4.6), respectively. To conclude, patients who had minor head injury with neither LOC nor PTA are at risk of intracranial complications. Clinical guidelines should include clinical management for patients without LOC and PTA, and they should include LOC and PTA as separate risk factors rather than as diagnostic selection criteria.

Contains fulltext : 112086.pdf (Publisher’s version ) (Closed access) International Monetary Fund (IMF)-supported programmes catalyse private capital to non-defaulting countries. We find the IMF to be effective in stimulating private capital flows to middle-income countries that participate in a Fund programme, but do not restructure their debt. IMF-supported programmes help non-defaulting countries to signal their willingness to reform and repay debts, thereby catalysing private capital. This signalling role appears to be more important for Fund catalysis, than the size of IMF lending. 21 p.

Contains fulltext : 51672.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To identify risk factors for surgical site infection (SSI) in patients with rheumatoid arthritis (RA) with special attention for anti-tumor necrosis factor (anti-TNF) treatment. METHODS: All patients with RA who had undergone elective orthopedic surgery since introduction of anti-TNF were included in a retrospective parallel-cohort study with a one-year followup. Primary endpoint was a SSI according to the 1992 Centers for Disease Control and Prevention criteria and/or antibiotic use. Cohort 1 did not use anti-TNF, cohort 2 used anti-TNF but had either stopped (2A) or continued anti-TNF preoperatively (2B), the cutoff point being set at 4 times the half-life time of the drug. Infection rates were compared between cohorts, and logistic regression analysis was performed to examine risk factors. RESULTS: In total, 1219 (768 patients) procedures were included, and crude infection risks were 4.0% (41/1023), 5.8% (6/104), and 8.7% (8/92) in cohorts 1, 2A, and 2B, respectively. Elbow surgery (OR 4.1, 95% CI 1.6-10.1), foot/ankle surgery (OR 3.2, 95% CI 1.6-6.5), and prior skin or wound infection (OR 13.8, 95% CI 5.2-36.7) were associated with increased risk of SSI, whereas duration of surgery (OR 0.42, 95% CI 0.23-0.78) and sulfasalazine use (OR 0.21, 95% CI 0.05-0.89) were associated with decreased risk. Perioperative use of anti-TNF was not significantly associated with an increase in SSI rates (OR 1.5, 95% CI 0.43-5.2). CONCLUSION: The most important risk factor for SSI is history of SSI or skin infection. Although our study was not powered to detect small differences in infection rates, perioperative continuation of anti-TNF does not seem to be an important risk factor for SSI.