De invloed van de ontwikkelingen op de arbeidsmarkt voor het arbeidsrecht (hoofdstuk 9)

Hervorming Sociale Regelgevin

The Public Playground Paradox: "Child’s Joy" or Heterotopia of Fear?

Literature depicts children of the Global North withdrawing from public space to“acceptable islands”. Driven by fears both of and for children, the publicplayground – one such island – provides clear-cut distinctions between childhoodand adulthood. Extending this argument, this paper takes the original approach oftheoretically framing the playground as a heterotopia of deviance, examining –for the first time – three Greek public playground sites in relation to adjacentpublic space. Drawing on an ethnographic study in Athens, findings show fear tounderpin surveillance, control and playground boundary porosity. Normativeclassification as “children’s space” discourages adult engagement. However, in anovel and significant finding, a paradoxical phenomenon sees the playground’spresence simultaneously legitimizing playful behaviour in adjacent public spacefor children and adults. Extended playground play creates alternate orderings andnegotiates norms and hierarchies, suggesting significant wider potential toreconceptualise playground-urban design for an intergenerational public realm

Instantaneous transport of a passive scalar in a turbulent separated flow

The results of large-eddy simulations of flow and transient solute transport over a backward facing step and through a 180° bend are presented. The simulations are validated successfully in terms of hydrodynamics and tracer transport with experimental velocity data and measured residence time distribution curves confirming the accuracy of the method. The hydrodynamics are characterised by flow separation and subsequent recirculation in vertical and horizontal directions and the solute dispersion process is a direct response to the significant unsteadiness and turbulence in the flow. The turbulence in the system is analysed and quantified in terms of power density spectra and covariance of velocity fluctuations. The injection of an instantaneous passive tracer and its dispersion through the system is simulated. Large-eddy simulations enable the resolution of the instantaneous flow field and it is demonstrated that the instabilities of intermittent large-scale structures play a distinguished role in the solute transport. The advection and diffusion of the scalar is governed by the severe unsteadiness of the flow and this is visualised and quantified. The analysis of the scalar mass transport budget quantifies the mechanisms controlling the turbulent mixing and reveals that the mass flux is dominated by advection

Radiokemoterapija i intersticijska brahiterapija kao terapijski pristup karcinomu vrata maternice i njezin utjecaj na kvalitetu života bolesnica

Objectives: This study aimed to evaluate survival and recurrence data as well as the QoL data in cervical cancer patients following radiochemotherapy (RCT) and brachytherapy as definitive treatment. The goal was to identify factors that can be modified to enhance overall survival and QoL for these patients. Materials and methods: Between 2003 and 2023, a total of 132 patients with advanced cervical cancer were evaluated for possible treatment at the Coburg Cancer Center. For this retrospective analysis, 81 patients were excluded due to various reasons (post-operative RCT, radiotherapy without brachytherapy, neoadjuvant RCT, palliative RCT, treatment of cancer recurrence, simultaneous treatment of other malignancy). Thus, 51 patients were included in this study. Analysis of patient data was primarily focused on age at initial diagnosis, menstrual status, FIGO stage, histology, overall survival, remission, occurrence of distant metastases or pelvic recurrence, total dose of radiation, brachytherapy, and concurrent chemotherapy, and occurrence of acute or late toxicities. Additionally, QoL was assessed prospectively by patient self-completion of the EORTC-QLQ-C30 and EORTC-QLQ-CX24. For the analysis of the statistical data IMB SPSS Statistics 29 for macOS (IBM Corp, 2022) was used. Survival rates were calculated by the Kaplan-Meier method, and the log-rank test was used to compare survival rates between different groups of patients. Qualitative data were expressed as whole numbers and percentages, while quantitative data were expressed as mean ± standard deviation or mean and interquartile range. For analysis of the EORTC questionnaires, all data were summarized in descriptive statistics. To compare differences between two groups, the t-test was performed. The chi-square test was applied to compare two categorical variables, and regression analysis was used to examine the influence of certain variables on QoL. Results: 5-year overall survival, NED-survival, and pelvic-recurrence-free survival rates were 48±9%, 68±14% and 52±10%, respectively. A significant impact on 5-year overall survival rates was seen for FIGO-stage (IIA-IIIA: 74±13% vs IIIB-IVA: 29±12%, p=0.027) for distant metastases (W/o DM: 75±12% vs with DM: 25±11%, p=0.05). Neither development of pelvic recurrence nor histology had significant impact survival rates. QoL-questionnaire evaluation resulted in a score of 63/100 for the overall QoL of patients. Cognitive function was the least impaired with a score of 84, while role functioning was the worst with a score of 67. On the symptom scale, Insomnia (46/100), Fatigue (41/100), Dyspnea (32/100), and Pain (26/100) scored the worst. Financial difficulties also burdened some patients and achieved a score of 25/100. Diarrhea, constipation, appetite loss, and nausea/vomiting were rated as less distressing by patients. The cervical cancer-specific questions of the EORTC-QLQ-CX24 questionnaire revealed that peripheral neuropathy, score of 36/100, and lymphedema, score of 32/100, occurred most frequently. Patients also reported that their sexual/vaginal functioning was impaired (32/100) and that their own body image (22/100) was also affected. The functional sexual activity scale could only be completed by 5 patients who had been sexually active in the last four weeks. This showed that only one third of them could enjoy sex. Comparing the result of evaluation of the EORTC-questionnaires showed no significant differences in the QoL of patients above and under the age of 58 years, and there was also no difference seen in patients diagnosed with FIGO stage <IIIB and ≥IIIB. However, there was a tendency for QoL to be less limited at an earlier stage of diagnosis. Conclusion: In patients with advanced inoperable cervical carcinoma a combination of radiochemotherapy and brachytherapy is able to cure around 50% of the patients. Advanced stages IIIB and IVA according to FIGO and the development of distant metastases have a significantly negative impact on outcome. In terms of patient reported long-term quality of life specific support is needed to alleviate symptoms including lymphedema, peripheral neuropathy, and impaired sexual activity.Ciljevi: Ova studija imala je za cilj procijeniti podatke o preživljenju i recidivu, kao i podatke o kvaliteti života kod pacijenata s rakom vrata maternice nakon radiokemoterapije (RCT) i brahiterapije kao konačnog liječenja. Cilj je bio identificirati čimbenike koji se mogu modificirati kako bi se poboljšalo ukupno preživljenje i QoL za ove pacijente. Materijali i metode: Između 2003. i 2023. ukupno 132 pacijentice s uznapredovalim rakom vrata maternice procijenjene su za moguće liječenje u Centru za rak u Coburgu. Za ovu retrospektivnu analizu isključen je 81 pacijent zbog različitih razloga (postoperativni RCT, radioterapija bez brahiterapije, neoadjuvantni RCT, palijativni RCT, liječenje recidiva raka, istovremeno liječenje drugih malignih bolesti). Tako je u ovo istraživanje bio uključen 51 pacijent. Analiza podataka pacijenata prvenstveno je bila usmjerena na dob pri početnoj dijagnozi, menstrualni status, stadij FIGO, histologiju, ukupno preživljenje, remisiju, pojavu udaljenih metastaza ili recidiva u zdjelici, ukupnu dozu zračenja, brahiterapiju i istodobnu kemoterapiju te pojavu akutne ili kasne toksičnosti. Dodatno, QoL je procijenjen prospektivno samoispunjavanjem EORTC-QLQ-C30 i EORTC-QLQ-CX24 pacijenta. Za analizu statističkih podataka korišten je IMB SPSS Statistics 29 za macOS (IBM Corp, 2022.). Stope preživljenja izračunate su Kaplan-Meier metodom, a log-rank test korišten je za usporedbu stopa preživljenja između različitih skupina bolesnika. Kvalitativni podaci izraženi su kao cijeli brojevi i postoci, dok su kvantitativni podaci izraženi kao srednja vrijednost ± standardna devijacija ili srednja vrijednost i interkvartilni raspon. Za analizu EORTC upitnika svi podaci su sažeti u deskriptivnu statistiku. Za usporedbu razlika između dviju skupina proveden je t-test. Hi-kvadrat test primijenjen je za usporedbu dviju kategoričkih varijabli, a regresijskom analizom ispitan je utjecaj pojedinih varijabli na QoL. Rezultati: Stope 5-godišnjeg ukupnog preživljenja, NED-preživljenja i stope preživljenja bez recidiva u zdjelici bile su 48±9%, 68±14% odnosno 52±10%. Značajan utjecaj na petogodišnje ukupne stope preživljenja primijećen je za stadij FIGO (IIA-IIIA: 74±13% u odnosu na IIIBIVA: 29±12%, p=0,027) za udaljene metastaze (bez DM: 75± 12% u odnosu na DM: 25±11%, p=0,05). Niti razvoj recidiva u zdjelici niti histologija nisu značajno utjecali na stope preživljavanja. 66 Procjena QoL-upitnika rezultirala je rezultatom od 63/100 za ukupni QoL pacijenata. Najmanje je oštećena kognitivna funkcija s ocjenom 84, dok je funkcioniranje uloga najlošije s ocjenom 67. Na ljestvici simptoma nesanica (46/100), umor (41/100), dispneja (32/100), i Bol (26/100) je dobio najlošiju ocjenu. Financijske poteškoće također su opteretile neke pacijente te su postigle ocjenu 25/100. Pacijenti su proljev, zatvor, gubitak apetita i mučninu/povraćanje ocijenili kao manje uznemirujuće. Pitanja specifična za rak vrata maternice iz upitnika EORTCQLQ-CX24 otkrila su da su se najčešće javljali periferna neuropatija, rezultat 36/100, i limfedem, rezultat 32/100. Pacijenti su također izjavili da je njihova spolna/vaginalna funkcija bila oslabljena (32/100) te da je također bila pogođena slika vlastitog tijela (22/100). Ljestvicu funkcionalne seksualne aktivnosti moglo je ispuniti samo 5 pacijenata koji su bili spolno aktivni u posljednja četiri tjedna. To je pokazalo da samo jedna trećina njih može uživati u seksu. Usporedba rezultata evaluacije EORTC-upitnika nije pokazala značajne razlike u QoL bolesnika starijih i mlađih od 58 godina, a također nije bilo razlike uočenih u bolesnika s dijagnosticiranim FIGO stadijem <IIIB i ≥IIIB. Međutim, postojala je tendencija da QoL bude manje ograničen u ranijoj fazi dijagnoze. Zaključak: U bolesnika s uznapredovalim inoperabilnim karcinomom vrata maternice kombinacija radiokemoterapije i brahiterapije može izliječiti oko 50% bolesnika. Uznapredovali stadiji IIIB i IVA prema FIGO te razvoj udaljenih metastaza imaju značajno negativan utjecaj na ishod. Što se tiče dugotrajne kvalitete života koju su pacijenti prijavili, potrebna je posebna podrška za ublažavanje simptoma uključujući limfedem, perifernu neuropatiju i oslabljenu seksualnu aktivnost