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RIVM rapport:Het Nationaal Hitteplan, dat in 2007 is opgesteld op verzoek van het ministerie van VWS, is sindsdien elk jaar gebruikt. Uit de evaluaties zijn enkele verbeterpunten naar voren gekomen die nog niet in de tekst van het Hitteplan waren opgenomen. Het RIVM heeft de tekst nu geactualiseerd. In het Hitteplan staat nu beter aangegeven welke verantwoordelijkheden de verschillende organisaties hebben tijdens een periode van aanhoudende hitte. In samenwerking met het KNMI is ook de nauwkeurigheid verbeterd waarmee de aanhoudende hitte wordt voorspeld, doordat de criteria voor de alarmering nu op vier dagen hitte zijn ingesteld in plaats van op vijf. Daarnaast is de praktische informatie over maatregelen overgeheveld naar de nieuwe GGDrichtlijn Gezondheidsrisico's van zomerse omstandigheden en de bijbehorende toolkit Hitte. Aanhoudende hitte vormt een risico voor de gezondheid van bepaalde groepen mensen, zoals ouderen, mensen in zorginstellingen, chronisch zieken en mensen met overgewicht. Deze risico's variëren van lichte verschijnselen, zoals vermoeidheid en jeuk tot ernstige aandoeningen met mogelijk levensbedreigende gevolgen. Het Nationaal Hitteplan heeft als doel organisaties er tijdig op te attenderen dat een periode van aanhoudend warm weer wordt verwacht. Dat zijn onder andere GGD'en, brancheorganisaties en het Nederlandse Rode Kruis. Zij waarschuwen vervolgens hun achterban en regionale contacten, die via het Hitteplan maatregelen aangereikt krijgen waarmee de gevolgen van de aanhoudende hitte kunnen worden beperkt., The Dutch National Heatwave Plan (Nationaal Hitteplan) that was developed in 2007, at the request of the Ministry of Health, Welfare and Sport (VWS), has been used every year since. Evaluations pointed out where the National Heatwave Plan could be improved, and RIVM has updated the text accordingly. The updated National Heatwave Plan more clearly states the various responsibilities of the different organisations during prolonged periods of excessively hot weather. The level of accuracy in predicting such weather conditions has also been improved, in collaboration with the Royal Netherlands Meteorological Institute (KNMI), with warning criteria having been set at four days of continuous heat, instead of five. In addition, the practical information on measures has been transferred to the new guideline of the Dutch Public Health Service (GGD) on summer-related health risks and the accompanying toolkit 'Hitte' ('heat'). Continuing hot weather poses a health risk for certain groups of people, such as the elderly, people in care institutions, and chronically ill and overweight people. Risks vary from light symptoms, such as fatigue or itchiness, to severe complaints with possibly life-threatening consequences. The purpose of the National Heatwave Plan is to provide organisations with a timely warning in case of an expected prolonged period of hot weather. Organisations include GGD branches, health organisations and the Dutch Red Cross. They will then warn their target groups and regional contacts, who will be provided through the Heat Plan with measures to limit the impact of such hot weather conditions.

RIVM rapport:In de fysieke omgeving is nog veel gezondheidswinst te behalen. Deze winst kan geboekt worden als het ministerie van Volksgezondheid Welzijn en Sport (VWS) geregeld optreedt als katalysator bij beleidsterreinen zoals milieu en ruimtelijk ontwerp. De meeste gezondheidswinst is te behalen met een integrale aanpak die aandacht heeft voor de samenhang tussen de diverse milieu- en omgevingsfactoren. Op verzoek van het ministerie van VWS heeft het RIVM een oriëntatie gemaakt van de beleidsmatige inzet die VWS op het terrein van de medische milieukunde (MMK) kan ontwikkelen. Het is uitdrukkelijk een verkenning, zowel voor wat betreft de inhoudelijke impact van de fysieke omgeving op gezondheid als voor wat betreft de beleidsmatige keuzes die hieruit voort komen. Om tot een afweging van beleidskeuzes te komen is een inventarisatie gemaakt van de gezondheidseffecten van MMK-thema's, zowel in de reguliere fase als in de 'warme fase' (ten tijde van een milieugerelateerde crisis). Als secundaire criteria zijn ook (maatschappelijke) actualiteit en de mate waarin VWS een rol kan spelen op deze terreinen meegewogen. Beleidsmatig is MMK namelijk sterk verbonden met taken van andere departementen, zoals het ministerie van Infrastructuur en Milieu (IenM), het ministerie van Binnenlandse zaken en Koninkrijkrelaties (BZK), het ministerie van Onderwijs, Cultuur en Wetenschap (OCW), het ministerie van Economische Zaken (EZ) en het ministerie van Sociale Zaken en Werkgelegenheid (SZW). De conclusie dat veel MMK-thema's in de praktijk met elkaar verbonden zijn, leidt ertoe dat VWS zich - samen met partijen uit het veld (departementen, gemeenten en GGD'en) - zou moeten toeleggen op het onderling verbinden van belangen. In de praktijk betekent dit het, vanuit een gezondheidsperspectief, actief bijdragen aan het verwezenlijken van de ambities van anderen. Gegeven de complexiteit en ambiguïteit van de het MMK-veld is het tevens van belang om te zorgen voor een breder maatschappelijk draagvlak, Many health benefits are still to be gained within the physical environment. These benefits can be realized if the Ministry of Health regularly acts as a catalyst in policy areas such as environmental and spatial design. Most of these health benefits can be obtained with an integrated approach that addresses the relationship between the various environmental and surrounding factors. At the request of the Ministry of Health, Welfare and Sport, the RIVM has developed an orientation of the policy commitment the Ministry of Health could develop within the field of environmental health. This is explicitly an exploration, both in terms of the substantive impact of the physical environment on health, as in terms of policy choices that result from it. To establish a consideration of policy choices, an inventory was made of the health effects of themes in environmental health, both in the regular phase and in the "hot phase" (in times of an environmental crisis). As secondary criteria we also considered (social) events, and the role the Ministry of Health could play in these areas. Policy concerning environmental health is after all strongly related to tasks performed by other departments, such as the Ministries of Infrastructure and the Environment, the Interior, Economic Affairs and Social Affairs. The conclusion that many themes in environmental health are connected in a practical sense, means that the Ministry of Health - together with other stakeholders (departments, municipalities and municipal health services) - should focus on the interconnection of interests. In a practical sense and from a health perspective, this means an active contribution to achieving the ambitions of others. Given the complexity and ambiguity of the field of environmental health it is also important to ensure broader public support, resulting in risk governance.

Over the past decade, teaching and learning in virtual worlds has been at the forefront of many higher education institutions around the world. The DEHub Virtual Worlds Working Group (VWWG) consisting of Australian and New Zealand higher education academics was formed in 2009. These educators are investigating the role that virtual worlds play in the future of education and actively changing the direction of their own teaching practice and curricula. 47 academics reporting on 28 Australian higher education institutions present an overview of how they have changed directions through the effective use of virtual worlds for diverse teaching and learning activities such as business scenarios and virtual excursions, role-play simulations, experimentation and language development. The case studies offer insights into the ways in which institutions are continuing to change directions in their teaching to meet changing demands for innovative teaching, learning and research in virtual worlds. This paper highlights the ways in which the authors are using virtual worlds to create opportunities for rich, immersive and authentic activities that would be difficult or not possible to achieve through more traditional approaches.

Over the past decade, teaching and learning in virtual worlds has been at the forefront of many higher education institutions around the world. The DEHub Virtual Worlds Working Group (VWWG) consisting of Australian and New Zealand higher education academics was formed in 2009. These educators are investigating the role that virtual worlds play in the future of education and actively changing the direction of their own teaching practice and curricula. 47 academics reporting on 28 Australian higher education institutions present an overview of how they have changed directions through the effective use of virtual worlds for diverse teaching and learning activities such as business scenarios and virtual excursions, role-play simulations, experimentation and language development. The case studies offer insights into the ways in which institutions are continuing to change directions in their teaching to meet changing demands for innovative teaching, learning and research in virtual worlds. This paper highlights the ways in which the authors are using virtual worlds to create opportunities for rich, immersive and authentic activities that would be difficult or not possible to achieve through more traditional approaches.

Van der Woude syndrome (VWS), caused by dominant IRF6 mutation, is the most common cleft syndrome. In 15% of the patients, lip pits are absent and the phenotype mimics isolated clefts. Therefore, we hypothesized that some of the families classified as having non-syndromic inherited cleft lip and palate could have an IRF6 mutation. We screened in total 170 patients with cleft lip with or without cleft palate (CL/P): 75 were syndromic and 95 were a priori part of multiplex non-syndromic families. A mutation was identified in 62.7 and 3.3% of the patients, respectively. In one of the 95 a priori non-syndromic families with an autosomal dominant inheritance (family B), new insights into the family history revealed the presence, at birth, of lower lip pits in two members and the diagnosis was revised as VWS. A novel lower lip sign was observed in one individual in this family. Interestingly, a similar lower lip sign was also observed in one individual from a 2nd family (family A). This consists of 2 nodules below the lower lip on the external side. In a 3rd multiplex family (family C), a de novo mutation was identified in an a priori non-syndromic CL/P patient. Re-examination after mutation screening revealed the presence of a tiny pit-looking lesion on the inner side of the lower lip leading to a revised diagnosis of VWS. On the basis of this data, we conclude that IRF6 should be screened when any doubt rises about the normality of the lower lip and also if a non-syndromic cleft lip patient (with or without cleft palate) has a family history suggestive of autosomal dominant inheritance.

Van der Woude syndrome (VWS), caused by dominant IRF6 mutation, is the most common cleft syndrome. In 15% of the patients, lip pits are absent and the phenotype mimics isolated clefts. Therefore, we hypothesized that some of the families classified as having non-syndromic inherited cleft lip and palate could have an IRF6 mutation. We screened in total 170 patients with cleft lip with or without cleft palate (CL/P): 75 were syndromic and 95 were a priori part of multiplex non-syndromic families. A mutation was identified in 62.7 and 3.3% of the patients, respectively. In one of the 95 a priori non-syndromic families with an autosomal dominant inheritance (family B), new insights into the family history revealed the presence, at birth, of lower lip pits in two members and the diagnosis was revised as VWS. A novel lower lip sign was observed in one individual in this family. Interestingly, a similar lower lip sign was also observed in one individual from a 2nd family (family A). This consists of 2 nodules below the lower lip on the external side. In a 3rd multiplex family (family C), a de novo mutation was identified in an a priori non-syndromic CL/P patient. Re-examination after mutation screening revealed the presence of a tiny pit-looking lesion on the inner side of the lower lip leading to a revised diagnosis of VWS. On the basis of this data, we conclude that IRF6 should be screened when any doubt rises about the normality of the lower lip and also if a non-syndromic cleft lip patient (with or without cleft palate) has a family history suggestive of autosomal dominant inheritance. Copyright © 2010 S. Karger AG., SCOPUS: ar.j, info:eu-repo/semantics/published