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Background Seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and location using data from the Global Burden of Diseases, Injuries, and Risk Factors Study. Methods We assessed the burden of epilepsy in 195 countries and territories from 1990 to 2016. Burden was measured as deaths, prevalence, and disability-adjusted life-years (DALYs; a summary measure of health loss defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability), by age, sex, year, location, and Socio-demographic Index (SDI; a compound measure of income per capita, education, and fertility). Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). Findings In 2016, there were 45.9 million (95% UI 39. 9-54 .6) patients with all-active epilepsy (both idiopathic and secondary epilepsy globally; age-standardised prevalence 621.5 per 100 000 population; 540.1-737.0). Of these patients, 24.0 million (20.4-27.7) had active idiopathic epilepsy (prevalence 3 26 7 per 100 000 population; 278.4-378.1). Prevalence of active epilepsy increased with age, with peaks at 5-9 years (374.8 [280 .1-490 .0]) and at older than 80 years of age (545.1 [444. 2-652. 0]). Age-standardised prevalence of active idiopathic epilepsy was 329.3 per 100 000 population (280.3-381. 2) in men and 318.9 per 100 000 population (271.1-369.4) in women, and was similar among SDI quintiles. Global age-standardised mortality rates of idiopathic epilepsy were 1.74 per 100 000 population (1.64-1.87; 1.40 per 100 000 population [1. 23-1.54] for women and 2.09 per 100 000 population [1.96-2.25] for men). Age-standardised DALYs were 182.6 per 100 000 population (149. 0-223 .5; 163.6 per 100 000 population [130.6-204.3] for women and 201.2 per 100 000 population [166. 9-241. 4] for men). The higher DALY rates in men were due to higher YLL rates compared with women. Between 1990 and 2016, there was a non-significant 6.0% (-4.0 to 16.7) change in the age-standardised prevalence of idiopathic epilepsy, but a significant decrease in age-standardised mortality rates (24.5% [10.8 to 31.8]) and age-standardised DALY rates (19.4% [9.0 to 27.6]). A third of the difference in age-standardised DALY rates between low and high SDI quintile countries was due to the greater severity of epilepsy in low-income settings, and two-thirds were due to a higher YLL rate in low SDI countries. Interpretation Despite the decrease in the disease burden from 1990 to 2016, epilepsy is still an important cause of disability and mortality. Standardised collection of data on epilepsy in population representative surveys will strengthen the estimates, particularly in countries for which we currently have no or sparse data and if additional data is collected on severity, causes, and treatment. Sizeable gains in reducing the burden of epilepsy might be expected from improved access to existing treatments in low-income countries and from the development of new effective drugs worldwide. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.

Gedurende de afgelopen jaren zijn veel nieuwe marketingconcepten opgedoken, waarvan klantgerichtheid een van de meest besproken onderwerpen is (Shah et al., 2006). Klantgerichtheid is dus zeker geen nieuw concept. De bijbehorende voordelen die het met zich meebrengt, verkrijgen in de literatuur alsook in de bedrijfswereld aanzienlijk veel aandacht. Toch valt in de realiteit op te merken dat veel ondernemingen moeite hebben met het implementeren van een klantgerichte visie. Momenteel hanteren de meeste organisaties nog een productgericht beleid met daarrond invloeden van klantgerichtheid. Allereerst is het dus belangrijk de concepten product- en klantgerichtheid duidelijk te definiëren en vervolgens te vergelijken met elkaar (Shah et al., 2006). Hierop volgend voorziet deze masterproef een uiteenzetting van vier bouwstenen die noodzakelijk zijn binnen een klantgerichte onderneming, namelijk: de organisatiecultuur, de organisatiestructuur, de processen en de prestatie indicatoren. Deze vier bouwstenen dient de organisatie zo klantgericht mogelijk in te vullen. Tot slot worden deze theoretische bouwstenen getoetst aan de realiteit door middel van drie casestudie bij Limburgse KMO's (Berghoff, Porsche Center Paal en Van Zon). De resultaten die hieruit voortvloeien bieden een antwoord op de centrale onderzoeksvraag die luidt: "Hoe klantgericht zijn Limburgse KMO's?".

Integrated systems research is one of the pillars in the nutrition-sensitive landscapes (NSL) approach that is being implemented in case-study sites in Zambia and Kenya. This chapter describes systems and systematically explores windows of opportunity for sustainable redesign and innovation in landscape and farm systems for improved nutrition using whole-farm and landscape models for each site. It discusses the strengths and challenges of systems approaches in agricultural research based on interactions with smallholder communities from the three diverse settings. The NSL approach investigates how improved land-use and management of resources in farms and landscapes can improve the livelihoods of rural people, their nutritional status and the ecosystem services that landscapes provide. To address and include the culture, values and priorities of people in nutrition-sensitive landscapes during the investigation and support of the envisioned development pathways, an inclusive approach to learning cycles is used.

Results of this study suggests that as the teacher is attempting to find the source of a young child's reading difficulties he might have the child's level of ocular development examined. (Authors)