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The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times more

Objective To examine the appropriateness and necessity of colonoscopy across Europe. Design Prospective observational study. Setting A total of 21 gastrointestinal centers from 11 countries. Participants Consecutive patients referred for colonoscopy at each center. Intervention Appropriateness criteria developed by the European Panel on the Appropriateness of Gastrointestinal Endoscopy, using the RAND appropriateness method, were used to assess the appropriateness of colonoscopy. Main outcome measure Appropriateness of colonoscopy. Results A total of 5213 of 6004 (86.8%) patients who underwent diagnostic colonoscopy and had an appropriateness rating were included in this study. According to the criteria, 20, 26, 27, or 27% of colonoscopies were judged to be necessary, appropriate, uncertain, or inappropriate, respectively. Older patients and those with a major illness were more likely to have an appropriate or necessary indication for colonoscopy as compared to healthy patients or patients who were 45-54 years old. As compared to screening patients, patients who underwent colonoscopy for iron-deficiency anemia [OR: 30.84, 95% CI: 19.79-48.06] or change in bowel habits [OR: 3.69, 95% CI: 2.74-4.96] were more likely to have an appropriate or necessary indication, whereas patients who underwent colonoscopy for abdominal pain [OR: 0.64, 95% CI: 0.49-0.83] or chronic diarrhea [OR: 0.54, 95% CI: 0.40-0.75] were less likely to have an appropriate or necessary indication. Conclusions This study identified significant proportions of inappropriate colonoscopies. Prospective use of the criteria by physicians referring for or performing colonoscopies may improve appropriateness and quality of care, especially in younger patients and in patients with nonspecific symptoms

Quality of medical assessment of work incapacity has been poorly investigated, despite the enormous costs engendered by transient incapacity of work and permanent disability. This study examined some indices of quality from a stratified, random sample (n=120) of assessments performed by expert assessors of the Swiss disability insurance. The distribution of work incapacity (WI) percentages over a 100% scale showed a clustering around key values significantly associated with financial disability benefits. The precision of WI, expressed as the level of quantitative exactness, was found to be high in 74% (95% CI: 66-82%) of current WI assessments, and in 62% (95% Cl: 53-71%) of maximal WI assessments. Disagreement was observed in 17% of cases when comparing two ways of expressing WI by the same physician (95% CI: 10-23%). This exploratory study is limited by the general lack of objective criteria and standards. Further theoretical and expirical developments are needed to determine standardized criteria and clear guidelines for medical assessments of WI, as well as for evaluating their quality. Copyright © 1996 Elsevier Science Ltd

Modelers involved in environmental policy assessments are commonly confronted with the lack of uptake of model output by policy actors. Actors have different expectations of models, condensed into three quality criteria: credibility, salience, and legitimacy. The fulfilment of quality criteria is also dynamic as expectations vary, change, and possibly counteract each other. We present a checklist for modelers involved in model-based assessments that is aimed at the identification and monitoring of issues, limitations and trade-offs regarding model quality criteria. It draws upon the literature of integrated assessments as well as case study analysis of environmental policy assessments for the Dutch government, based on expert interviews and embedded experience. The checklist is intended to be consulted during assessments; its application may result in greater awareness among modelers involved in assessments regarding model quality criteria, and may positively affect the uptake of model-based knowledge from environmental policy assessments by policy actors.

This study examines practices in which groups of local people (citizens’ initiatives) take the lead in natureconservation and landscape management projects. In three cases studies the significance of green selfgovernancewas examined by studying knock-on effects: the relations with related practices and therelations between practices and structures at the regime level, such as institutional working practices andpolicies. The bonds and dynamics in these relations – between green self-governance practices, betweengreen self-governance practices and related practices, and between green self-governance practices and theregime level – were found to be considerable. The actual level of influence is hard to determine because thedynamics play out within a changing context. An important lesson for the interaction between citizens andgovernment is that both can learn by working together, In deze studie staan praktijken van natuur- en landschapsbeheer waarin groepen burgers(burgerinitiatieven) de ‘lead’ hebben in het realiseren, beschermen en/of beheren van natuur en landschapcentraal. In drie praktijken van groene zelf-governance is gekeken naar de betekenis, door in te gaan op deolievlekwerking die uitgaat van deze praktijken: de relaties met aangrenzende praktijken en naar de relatiestussen praktijken en structuren op regimeniveau, zoals bijvoorbeeld de werkwijzen en het beleid vaninstituties. Het blijkt dat de wederzijdse verwevenheid en dynamiek groot is: tussen praktijken van groenezelf-governance, tussen een praktijk van groene zelf-governance en aanverwante praktijken, en tussen eenpraktijk van groene zelf-governance. De daadwerkelijke invloed is moeilijk vast te stellen omdat dedynamiek zich afspeelt zich een context van veranderingen. Een belangrijke les voor de interactie burgeroverheidis dat er geleerd wordt door samen te doen

The socio-economic future of agriculture in the Dutch province of Zuid-Holland is partly linked to the perspectives of the agrocluster, the combination of agricultural and horticultural firms, fishery, food and luxury industry and the firms that supply these sectors. The importance of this cluster for Zuid- Holland is described, with a focus on the primary sectors, and especially on the agricultural firms. The current situation of these firms is presented, including the developments in the recent decade and the perspectives for the next decade. Attention is also paid to the (economic) perspectives of short supply chains and innovation for agriculture in Zuid-Holland., De sociaaleconomische positie van de grondgebonden landbouw in de provincie Zuid-Holland hangt deels samen met de perspectieven van het agrocluster, zijnde het totaal van land- en tuinbouwbedrijven, visserij, voedings- en genotmiddelenindustrie en de aan deze sectoren toeleverende bedrijven. Het belang van het grondgebonden landbouwcluster voor Zuid-Holland is in kaart gebracht, met een accent op de primaire sectoren en vooral de land- en tuinbouwbedrijven. De huidige situatie van deze bedrijven is in beeld gebracht, evenals de ontwikkelingen in de afgelopen tien jaar en de perspectieven voor de komende tien jaar. Daarnaast is specifiek gekeken naar de (economische) perspectieven van korte ketens en innovatie voor de grondgebonden landbouw in Zuid- Holland.

Biomimicry , de ontwerpfilosofie die de natuur als inspiratiebron ziet voor innovaties, kan grote ecologische en economische voordelen opleveren voor onze samenleving wanneer het bre ed wordt ingezet ten behoeve van maatschappelijke en wetenschappelijke vraagstukken. Het biedt ook veel toepassingsmogelijkheden voor een groot aantal sectoren , zoals bouw, industrie en landbouw . Om aan een kennisinfrastructuur voor biomimicry te kunn en werken, is het van belang om te weten welke kennis diverse partijen in ons land in huis hebben, welke ze willen delen en welke kennislacunes er zijn. Deze kennisagenda is met dat doel opgesteld. De kennisagenda agendeert een aantal vraagstukken voor de komende periode waaraan betrokken stakeholders in onderlinge samenwerking gericht kunnen werken om de toepassing van biomimicry in ons land de komende jaren op een hog er plan te brengen. Deze kennisagenda geeft daarmee richting aan biomimicry -innovaties die de komende jaren (wellicht) met voorrang opgepakt worden.