Werkgelegenheid en gespreide verantwoordelijkheid

Gesprek met als thema: Wat moet de inzet van het CDA zijn op sociaal-economisch terrein bij de komende verkiezingen voor de Tweede Kame

From crayons to canvas: the enlightenment of children at an arts festival.

From crayons to paintings: Arts festivals and the promotion of children's art "Every child is an artist, but the problem is how to stay an artist when we grow up - Pablo Picasso". Art forms part of cultural history and education (Hetland & Winner, 2001), but also has valuable meaning for young people (Giddens, 1991) by expressing themselves about things they reflect on themselves and the world in which they live (Dobbs, 1998.) It is also a form of communication of how visual arts are seen as language and the how the artists opinions, feelings of expressing their ideas is brought to the fore. Bowen et al. (2013) state that although recent trends reduce exposure to art, it may be primarily due to the curtailment of school-based art programs. The latter proposes that children should be exposed to art by visiting museums, art galleries and cultural institutions and that it is important to teach them how to interpret and create visual arts messages at an early age (National Art Education, 2016). Only a small percentage of parents take their children to these types of institutions as artificial exposure and learn to experience art. While tourism research is increasing, including the perspectives of children, the voices of young preschool children are still lacking. Due to the government's constraints on funding for the arts, this has led to the rise of arts festivals. The private sector has also entered the market strongly, although not everyone can afford to do so. Festivals are just one platform whereby artists can promote their art, including singing, dance, visual arts and theatre. One such festival is Aardklop National Arts Festival, which has been held in South Africa since 1998. In 2016, Aardklop created an art safari to expose visual arts to young children between the ages of 6 and 13 years. The aim of this study was thus to determine the exposure that children find in art and whether they have learned something about visual arts either formally or as a leisure activity. A qualitative, experimental method of data collection was used to gather information from participating children, through a semi-structured interview before and after the art safari

De rol van de overheid

Gesprek met als onderwerp: De rol van de overheid in de huidige verzorgingsstaa

Does oncological outcome differ between restorative and nonrestorative low anterior resection in patients with primary rectal cancer?

Aim Nonrestorative low anterior resection (n-rLAR) (also known as low Hartmann's) is performed for rectal cancer when a poor functional outcome is anticipated or there have been problems when constructing the anastomosis. Compared with restorative LAR (rLAR), little oncological outcome data are available for n-rLAR. The aim of this study was to compare oncological outcomes between rLAR and n-rLAR for primary rectal cancer. Method This was a nationwide cross-sectional comparative study including all elective sphincter-saving LAR procedures for nonmetastatic primary rectal cancer performed in 2011 in 71 Dutch hospitals. Oncological outcomes of patients undergoing rLAR and n-rLAR were collected in 2015; the data were evaluated using Kaplan-Meier survival analysis and the results compared using log-rank testing. Uni- and multivariable Cox regression analysis was used to evaluate the association between the type of LAR and oncological outcome measures. Results A total of 1197 patients were analysed, of whom 892 (75%) underwent rLAR and 305 (25%) underwent n-rLAR. The 3-year local recurrence (LR) rate was 3% after rLAR and 8% after n-rLAR (P <0.001). The 3-year disease-free survival and overall survival rates were 77% (rLAR) vs 62% (n-rLAR) (P <0.001) and 90% (rLAR) vs 75% (n-rLAR) (P <0.001), respectively. In multivariable Cox analysis, n-rLAR was independently associated with a higher risk of LR (OR = 2.95) and worse overall survival (OR = 1.72). Conclusion This nationwide study revealed that n-rLAR for rectal cancer was associated with poorer oncological outcome than r-LAR. This is probably a noncausal relationship, and might reflect technical difficulties during low pelvic dissection in a subset of those patients, with oncological implications

Influence of Conversion and Anastomotic Leakage on Survival in Rectal Cancer Surgery; Retrospective Cross-sectional Study

Background Conversion and anastomotic leakage in colorectal cancer surgery have been suggested to have a negative impact on long-term oncologic outcomes. The aim of this study in a large Dutch national cohort was to analyze the influence of conversion and anastomotic leakage on long-term oncologic outcome in rectal cancer surgery. Methods Patients were selected from a retrospective cross-sectional snapshot study. Patients with a benign lesion, distant metastasis, or unknown tumor or metastasis status were excluded. Overall (OS) and disease-free survival (DFS) were compared between laparoscopic, converted, and open surgery as well as between patients with and without anastomotic leakage. Results Out of a database of 2095 patients, 638 patients were eligible for inclusion in the laparoscopic, 752 in the open, and 107 in the conversion group. A total of 746 patients met the inclusion criteria and underwent low anterior resection with primary anastomosis, including 106 (14.2%) with anastomotic leakage. OS and DFS were significantly shorter in the conversion compared to the laparoscopic group (p = 0.025 and p = 0.001, respectively) as well as in anastomotic leakage compared to patients without anastomotic leakage (p = 0.002 and p = 0.024, respectively). In multivariable analysis, anastomotic leakage was an independent predictor of OS (hazard ratio 2.167, 95% confidence interval 1.322-3.551) and DFS (1.592, 1077-2.353). Conversion was an independent predictor of DFS (1.525, 1.071-2.172), but not of OS. Conclusion Technical difficulties during laparoscopic rectal cancer surgery, as reflected by conversion, as well as anastomotic leakage have a negative prognostic impact, underlining the need to improve both aspects in rectal cancer surgery

Do pregnant women know how to correct inverted nipples?

Inverted nipples occur in an estimated 9 to 10 percent of women globally, contributing to the number of women who are not exclusively breastfeeding their infants. Women with inverted nipples may want to breastfeed, but infants may be unable to latch to the breast. Inverted nipples can be corrected, but it is unclear if women know about suitable interventions. This study assessed if pregnant women knew about the available techniques to correct inverted nipples. We conducted individual interviews with nine pregnant women with inverted nipples in a tertiary hospital in South Africa. Data were analysed using an inductive content analysis. Most of the women had very limited knowledge of exclusive breastfeeding or inverted nipples and knew very little about correcting devices. These women thought that their infants would be unable to latch and that exclusive breastfeeding would be impossible. Pregnant women with inverted nipples should be educated about methods to correct their nipples.http://www.journals.co.za/content/journal/ajpherd1am2017Nursing Scienc

A deep learning masked segmentation alternative to manual segmentation in biparametric MRI prostate cancer radiomics

OBJECTIVES: To determine the value of a deep learning masked (DLM) auto-fixed volume of interest (VOI) segmentation method as an alternative to manual segmentation for radiomics-based diagnosis of clinically significant (CS) prostate cancer (PCa) on biparametric magnetic resonance imaging (bpMRI). MATERIALS AND METHODS: This study included a retrospective multi-center dataset of 524 PCa lesions (of which 204 are CS PCa) on bpMRI. All lesions were both semi-automatically segmented with a DLM auto-fixed VOI method (averaging < 10 s per lesion) and manually segmented by an expert uroradiologist (averaging 5 min per lesion). The DLM auto-fixed VOI method uses a spherical VOI (with its center at the location of the lowest apparent diffusion coefficient of the prostate lesion as indicated with a single mouse click) from which non-prostate voxels are removed using a deep learning-based prostate segmentation algorithm. Thirteen different DLM auto-fixed VOI diameters (ranging from 6 to 30 mm) were explored. Extracted radiomics data were split into training and test sets (4:1 ratio). Performance was assessed with receiver operating characteristic (ROC) analysis. RESULTS: In the test set, the area under the ROC curve (AUCs) of the DLM auto-fixed VOI method with a VOI diameter of 18 mm (0.76 [95% CI: 0.66-0.85]) was significantly higher (p = 0.0198) than that of the manual segmentation method (0.62 [95% CI: 0.52-0.73]). CONCLUSIONS: A DLM auto-fixed VOI segmentation can provide a potentially more accurate radiomics diagnosis of CS PCa than expert manual segmentation while also reducing expert time investment by more than 97%. KEY POINTS: * Compared to traditional expert-based segmentation, a deep learning mask (DLM) auto-fixed VOI placement is more accurate at detecting CS PCa. * Compared to traditional expert-based segmentation, a DLM auto-fixed VOI placement is faster and can result in a 97% time reduction. * Applying deep learning to an auto-fixed VOI radiomics approach can be valuable