Measuring, comparing and improving clinical outcomes in gastrointestinal cancer surgery

In this thesis, hospital variation concerning various surgical outcomes is illustrated, thereby exploring the usability of these outcomes for hospital comparisons, both from a clinical and methodological point of view. Moreover, the studies provide insight in risk factors for adverse events in colorectal and oesophageal cancer surgery, focusing on the mechanism behind postoperative complications leading to mortality or not.Printing of this thesis was financially supported by: ABN Amro, Applied Medical, Chipsoft, Covidien, Dutch Institute for Clinical Auditing, Erbe and OlympusLUMC / Geneeskund

Burgermeesterboek: Lokaal en duurzaam innoveren voor iedereen

Iedere tijd vraagt om zijn eigen manier van innoveren. Onze tijd vraagt om burge(r)meesters: bijzondere burgers met lef die een heldere visie hebben op de toekomst. Het Burge(r)meesterboek maakt duidelijk hoe deze burge(r)meesters samen met bestuurders, beleidsmedewerkers, ondernemers en inwoners aan een duurzaam Nederland kunnen werken. Pepik Henneman en Derk Loorbach beschrijven een methode waarbij initiatieven en ideeën van koplopers uit het bedrijfsleven, overheid en samenleving verbonden worden tot een gezamenlijke visie en aanpak. Deze benadering is gebaseerd op de laatste inzichten uit transitiemanagement, co-creatie en ervaringen met diverse succesvolle lokale pioniersprojecten en helpt gemeentes, provincies en lokale pioniers om samen innovatieprocessen te versnellen. Een boek over en vooral voor bijzondere, betrokken burgers, beleidsmakers én burgervaders, die samen de slag om morgen willen winnen voor de nieuwe generaties. Met veertien portretten van Burge(r)meesters

Short stature, hyperkalemia and acidosis: A defect in renal transport of potassium

Short stature, hyperkalemia, and acidosis: A defect in renal transport of potassium. An eleven-year-old boy presented with short stature, hyperkalemia, and metabolic acidosis. No endocrine cause for a short stature could be demonstrated. Renal function, as assessed by inulin and PAH clearances, concentrating and diluting capacity, and ability to acidify the urine and to excrete net acid, was normal. No defect was detected in adrenal secretion of, or renal responsiveness to, aldosterone. A low renal threshold for bicarbonate was documented which apparently explained the acidosis. However, correction of the acidosis by administration of sodium bicarbonate did not influence the hyperkalemia, making it unlikely that an abnormality in bicarbonate reabsorption was the primary defect. Chlorothiazide induced a fall in serum potassium and a rise in serum bicarbonate to normal levels. During bicarbonate loading the rates of excretion of potassium in urine were consistently below those observed in control subjects. It appeared, therefore, that the patient had a primary abnormality in potassium excretion. The resulting hyperkalemia caused urinary loss of bicarbonate and systemic acidosis. Correction of both the acidosis and hyperkalemia by chronic administration of chlorothiazide and sodium bicarbonate has resulted in resumption of normal growth.Retard de croissance, hyperkaliéme et acidose: Un déficit du transport rénal du potassium. Un enfant de 11 ans avait un retard de croissance, une hyperkaliémie et une acidose métabolique. Aucune cause endocrine du retard de croissance n'a été trouvée. La fonction rénale, estimée par les clearances de l'inuline et du PAH, la capacité de concentration et de dilution et la capacité d'acidifier l'urine, était normales. Aucun déficit de la secrétion d'aldostérone ou de la réponse rénale à l'aldostérone n'a été mis en évidence. Un seuil rénal bas des bicarbonates a été découvert, qui explique apparemment l'acidose. Cependant la correction de l'acidose par l'administration de bicarbonate de sodium n'a pas influencé l'hyperkaliémie, ce qui rend peu probable que le déficit de la réabsorption de bicarbonate soit la cause de l'ensemble. Le Chlorothiazide a déterminé une baisse de la kaliéme et une augmentation du bicarbonate plasmatique jusqu'à des valeurs normales. Pendant une charge en bicarbonate les débits d'excretion du potassium dans les urines ont été nettement inférieurs à ceux obtenus chez des sujets témoins. Il apparaît donc que le malade a une anomalie primitive de l'excrétion de potassium. L'hyperkaliémie qui en est la conséquence a déterminé une perte de bicarbonate dans les urines et une acidose systémique. La correction de l'acidose et de l'hyperkaliémie par l'administration permanente de Chlorothiazide et de bicarbonate de sodium a eu pour résultat une reprise de la croissance normale

Automation and data processing with the immucor Galileo (R) system in a university blood bank

Background: The implementation of automated techniques improves the workflow and quality of immuno-hematological results. The workflows of our university blood bank were reviewed during the implementation of an automated immunohematological testing system. Methods: Work impact of blood grouping and subgrouping, cross- matching and antibody search using the Immucor Galileo system was compared to the previous used standard manual and semi- automated methods. Results: The redesign of our workflow did not achieve a significant reduction of the specimen's working process time, the operator's time however was reduced by 23%. Corresponding results were achieved for blood grouping, Rhesus typing, antibody screen and for autocontrol when changing from two semi- automated to the Galileo system. Because of the higher sensitivity of the Immucor antibody detection system, the rate of the initial positive antibody screens rose from 4 to 6% Conclusion: The Immucor Galileo system automates routine blood bank testing with high reliability, specificity and higher sensitivity compared to our previous used standard manual and semi- automated methods

Spelling in adolescents with dyslexia: errors and modes of assessment

In this study we focused on the spelling of high-functioning students with dyslexia. We made a detailed classification of the errors in a word and sentence dictation task made by 100 students with dyslexia and 100 matched control students. All participants were in the first year of their bachelor’s studies and had Dutch as mother tongue. Three main error categories were distinguished: phonological, orthographic, and grammatical errors (on the basis of morphology and language-specific spelling rules). The results indicated that higher-education students with dyslexia made on average twice as many spelling errors as the controls, with effect sizes of d ≥ 2. When the errors were classified as phonological, orthographic, or grammatical, we found a slight dominance of phonological errors in students with dyslexia. Sentence dictation did not provide more information than word dictation in the correct classification of students with and without dyslexia

Bounds on transverse momentum dependent distribution and fragmentation functions

We give bounds on the distribution and fragmentation functions that appear at leading order in deep inelastic 1-particle inclusive leptoproduction or in Drell-Yan processes. These bounds simply follow from positivity of the defining matrix elements and are an important guidance in estimating the magnitude of the azimuthal and spin asymmetries in these processes.Comment: 5 pages, Revtex, 3 Postscript figures, version with minor changes, to be published in Physical Review Letter

Initial-State Interactions in the Unpolarized Drell-Yan Process

We show that initial-state interactions contribute to the $\cos 2 \phi$ distribution in unpolarized Drell-Yan lepton pair production $p p$ and $p \bar p \to \ell^+ \ell^- X$, without suppression. The asymmetry is expressed as a product of chiral-odd distributions $h_1^\perp(x_1,\bm{p}_\perp^2)\times \bar h_1^\perp(x_2,\bm{k}_\perp^2)$, where the quark-transversity function $h_1^\perp(x,\bm{p}_\perp^2)$ is the transverse momentum dependent, light-cone momentum distribution of transversely polarized quarks in an {\it unpolarized} proton. We compute this (naive) $T$-odd and chiral-odd distribution function and the resulting $\cos 2 \phi$ asymmetry explicitly in a quark-scalar diquark model for the proton with initial-state gluon interaction. In this model the function $h_1^\perp(x,\bm{p}_\perp^2)$ equals the $T$-odd (chiral-even) Sivers effect function $f^\perp_{1T}(x,\bm{p}_\perp^2)$. This suggests that the single-spin asymmetries in the SIDIS and the Drell-Yan process are closely related to the $\cos 2 \phi$ asymmetry of the unpolarized Drell-Yan process, since all can arise from the same underlying mechanism. This provides new insight regarding the role of quark and gluon orbital angular momentum as well as that of initial- and final-state gluon exchange interactions in hard QCD processes.Comment: 22 pages, 6 figure

A polarized version of the CCFM equation for gluons

A derivation for a polarized CCFM evolution equation which is suitable to describe the scaling behavior of the the unintegrated polarized gluon density is given. We discuss the properties of this polarized CCFM equation and compare it to the standard CCFM equation in the unpolarized case.Comment: 15 pages, 6 figures, RevTeX, some minor typos corrected, version to appear in Phys. Rev.