Search

NLDA Bachelor Eindstudie, Al sinds het einde van de Koude Oorlog hebben de NAVO en Rusland nooit echt een toenadering tot elkaar kunnen vinden. Sinds de Russische annexatie van de Krim in 2014 zijn de spanningen tussen de NAVO en Rusland opnieuw gestegen. Deze spanningen hebben er bij de NAVO uiteindelijk toe geleidt dat zij hun militaire capaciteiten bij de grens met Rusland gingen vergroten. Ook Rusland heeft haar militaire capaciteiten bij de grens vergroot. Dit gedrag kan volgens het veiligheidsdilemma leiden tot een wapenwedloop. Het doel van dit onderzoek is het in kaart brengen van een mogelijke wapenwedloop tussen de NAVO en Rusland. Dit doe ik door een analyse te maken van de militaire budgetten en de stationering van troepen van NAVO en Rusland in de Baltische Regio, sinds de start van de Enhanced Forward Presence (eFP) in 2017. Hiervoor is de volgende onderzoeksvraag opgesteld: In hoeverre zijn de NAVO en Rusland op dit moment bezig met een wapenwedloop? Er is sprake van een wapenwedloop wanneer twee of meer natiestaten op een ogenschijnlijk competitieve of interactieve manier de kwantiteit of kwaliteit van oorlogsmateriaal en/of bewapende personen laten toenemen. Verder zijn er twee eisen: een wapenwedloop moet minimaal vier jaar duren en deze begint in een jaar waarin de militaire uitgaven stijgen en vijandigheid jegens een vijandige actor is uitgeroepen tot overheidsbeleid. Om antwoord te kunnen geven op de onderzoeksvraag heb ik het theoretisch raamwerk van het veiligheidsdilemma, beschreven door Booth and Wheeler, toegepast op de casus NAVO-Rusland. Beide actoren zijn vatbaar voor dit veiligheidsdilemma. De theorie leert ons dat wanneer beide actoren vatbaar zijn voor dit dilemma er mogelijk een wapenwedloop tussen deze twee actoren kan plaatsvinden. Dit is zichtbaar in het feit dat de NAVO de eFP missie is gestart als antwoord op de Russische oorlogshandelingen op de Krim en in Oost-Oekraïne. Ook Rusland investeert in haar krijgsmacht in het westelijk militair district. Echt

Contains fulltext : 239057.pdf (Publisher’s version ) (Open Access), BACKGROUND: Esophagectomy has major effects on health-related quality of life (HR-QoL). Postoperative complications might contribute to a decreased HR-QOL. This population-based study aimed to investigate the difference in HR-QoL between patients with and without complications after esophagectomy for cancer. METHODS: A prospective comparative cohort study was performed with data from the Netherlands Cancer Registry (NCR) and Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). All patients with esophageal and gastroesophageal junction (GEJ) cancer after esophagectomy in the period 2015-2018 were enrolled. The study investigated HR-QoL at baseline, then 3, 6, 9, 12, 18, and 24 months postoperatively, comparing patients with and without complications as well as with and without anastomotic leakage. RESULTS: The 486 enrolled patients comprised 270 patients with complications and 216 patients without complications. Significantly more patients with complications had comorbidities (69.6% vs 57.3%; p = 0.001). No significant difference in HR-QoL was found over time between the patients with and without complications. In both groups, a significant decline in short-term HR-QoL was found in various HR-QoL domains, which were restored to the baseline level during the 12-month follow-up period. No significant difference was found in HR-QoL between the patients with and without anastomotic leakage. The patients with grades 2 and 3 anastomotic leakage reported significantly more "choking when swallowing" at 6 months (ß = 14.5; 95% confidence interval [CI], - 24.833 to - 4.202; p = 0.049), 9 months (ß = 22.4, 95% CI, - 34.259 to - 10.591; p = 0.007), and 24 months (ß = 24.6; 95% CI, - 39.494 to - 9.727; p = 0.007) than the patients with grade 1 or no anastomotic leakage. CONCLUSION: In general, postoperative complications were not associated with decreased short- or long-term HR-QoL for patients after esophagectomy for esophageal or GEJ cancer. The

Contains fulltext : 239063.pdf (Publisher’s version ) (Open Access), BACKGROUND: Accumulating evidence of trials demonstrates that patient-reported health-related quality of life (HRQoL) at diagnosis is prognostic for overall survival (OS) in oesophagogastric cancer. However, real-world data are lacking. Moreover, differences in disease stages and tumour-specific symptoms are usually not taken into consideration. The aim of this population-based study was to assess the prognostic value of HRQoL, including tumour-specific scales, on OS in patients with potentially curable and advanced oesophagogastric cancer. METHODS: Data were derived from the Netherlands Cancer Registry and the patient reported outcome registry (POCOP). Patients included in POCOP between 2016 and 2018 were stratified for potentially curable (cT1-4aNallM0) or advanced (cT4b or cM1) disease. HRQoL was measured with the EORTC QLQ-C30 and the tumour-specific OG25 module. Cox proportional hazards models assessed the impact of HRQoL, sociodemographic and clinical factors (including treatment) on OS. RESULTS: In total, 924 patients were included. Median OS was 38.9 months in potentially curable patients (n = 795) and 10.6 months in patients with advanced disease (n = 129). Global Health Status was independently associated with OS in potentially curable patients (HR 0.89, 99%CI 0.82-0.97), together with several other HRQoL items: appetite loss, dysphagia, eating restrictions, odynophagia, and body image. In advanced disease, the Summary Score was the strongest independent prognostic factor (HR 0.75, 99%CI 0.59-0.94), followed by fatigue, pain, insomnia and role functioning. CONCLUSION: In a real-world setting, HRQoL was prognostic for OS in patients with potentially curable and advanced oesophagogastric cancer. Several HRQoL domains, including the Summary Score and several OG25 items, could be used to develop or update prognostic models.

Contains fulltext : 202136.pdf (publisher's version ) (Open Access)

Contains fulltext : 190038.pdf (publisher's version ) (Open Access), Background: The increasing sub-classification of cancer patients due to more detailed molecular classification of tumors, and limitations of current trial designs, require innovative research designs. We present the design, governance and current standing of three comprehensive nationwide cohorts including pancreatic, esophageal/gastric, and colorectal cancer patients (NCT02070146). Multidisciplinary collection of clinical data, tumor tissue, blood samples, and patient-reported outcome (PRO) measures with a nationwide coverage, provides the infrastructure for future and novel trial designs and facilitates research to improve outcomes of gastrointestinal cancer patients.Material and methods: All patients aged ≥18 years with pancreatic, esophageal/gastric or colorectal cancer are eligible. Patients provide informed consent for: (1) reuse of clinical data; (2) biobanking of primary tumor tissue; (3) collection of blood samples; (4) to be informed about relevant newly identified genomic aberrations; (5) collection of longitudinal PROs; and (6) to receive information on new interventional studies and possible participation in cohort multiple randomized controlled trials (cmRCT) in the future.Results: In 2015, clinical data of 21,758 newly diagnosed patients were collected in the Netherlands Cancer Registry. Additional clinical data on the surgical procedures were registered in surgical audits for 13,845 patients. Within the first two years, tumor tissue and blood samples were obtained from 1507 patients; during this period, 1180 patients were included in the PRO registry. Response rate for PROs was 90%. The consent rate to receive information on new interventional studies and possible participation in cmRCTs in the future was >85%. The number of hospitals participating in the cohorts is steadily increasing.Conclusion: A comprehensive nationwide multidisciplinary gastrointestinal cancer cohort is feasible and surpasses the limitations of classical study designs. With this