Regional variation in breast cancer treatment in the Netherlands and the role of external peer review: a cohort study comprising 63,516 women

Background Treatment variation is an important issue in health care provision. An external peer review programme for multidisciplinary cancer care was introduced in 1994 in the Netherlands to improve the multidisciplinary organisation of cancer care in hospitals. So far the clinical impact of external quality assessment programmes such as external peer review and accreditation remains unclear. Our objective was to examine the degree of variation in treatment patterns and the possible effect of external peer review for multidisciplinary cancer care for breast cancer patients. Methods Patients with breast cancer were included from 23 hospitals from two ‘intervention regions’ with the longest experience with the programme and 7 hospitals that never participated (control group). Data on tumour and treatment characteristics were retrieved from the Netherlands Cancer Registry. Treatment modalities investigated were: the completeness of breast conserving therapy, introduction of the sentinel node biopsy, radiotherapy after breast conserving surgery for ductal carcinoma in situ (DCIS), adjuvant radiotherapy for locally advanced breast cancer (T3/M0 or any T,N2-3/M0), adjuvant chemotherapy for early stage breast cancer (T1-2/N+/M0) and neo-adjuvant chemotherapy for T4/M0 breast cancer. Hospitals from the two intervention regions were dichotomised based on their implementation proportion (IP) of recommendations from the final reports of each peer review (high IP vs. low IP). This was regarded as a measure of how well a hospital participated in the programme. Results 63,516 female breast cancer patients were included (1990-2010). Variation in treatment patterns was observed between the intervention regions and control group. Multidisciplinary treatment patterns were not consistently better for patients from hospitals with a high IP. Conclusions There is no relationship between the external peer review programme for multidisciplinary cancer care and multidisciplinary treatment patterns for breast cancer patients. Regional factors seem to exert a stronger effect on treatment patterns than hospital participation in external peer revie

Blood group probabilities by next of kin

For rare blood groups the recruitment of donor relatives, for example siblings, is expected to be effective, since the probability of a similar rare blood group is likely. However, the likelihood differs between blood groups and is not commonly available. This paper provides a unified mathematical formulation to calculate such likelihoods. From a mathematical and probabilistic point of view, it is shown that these likelihoods can be obtained from the computation of a stationary genotype distribution. This, in turn, can be brought down to a system of quadratic stochastic operators. A generic mathematical approach is presented which directly leads to a stationary genotype distribution for arbitrary blood groups. The approach enables an exact computation for the effectiveness of recruiting next of kin for blood donorship. Next to an illustration of computations for ‘standard’ ABO and Rhesus-D blood groups, it is particularly illustrated for the extended Rhesus blood group system. Also other applications requiring next of kin blood group associations can be solved directly by using the unified mathematical formulation

Smart Environments for Collaborative Design, Implementation, and Interpretation of Scientific Experiments

Ambient intelligence promises to enable humans to smoothly interact with their environment, mediated by computer technology. In the literature on ambient intelligence, empirical scientists are not often mentioned. Yet they form an interesting target group for this technology. In this position paper, we describe a project aimed at realising an ambient intelligence environment for face-to-face meetings of researchers with different academic backgrounds involved in molecular biology “omics” experiments. In particular, microarray experiments are a focus of attention because these experiments require multidisciplinary collaboration for their design, analysis, and interpretation. Such an environment is characterised by a high degree of complexity that has to be mitigated by ambient intelligence technology. By experimenting in a real-life setting, we will learn more about life scientists as a user group

An economic model for offshore cultivation of macroalgae

Algae biomass is considered as a potential non-fossil source of raw materials to produce fuel, feed, chemicals and materials. For this purpose microalgae as well as macroalgae can be used, and in this report we focus on the latter. More than 99% of the world production of aquatic plants is produced in Asia (FAO 2012, Table 1). From the remaining 1% about 4% is cultivated in Europe. Important European countries with commercial seaweed cultivation are Denmark, Ireland and France. Depending on their pigmentation seaweed species are commonly grouped in brown, red and green seaweeds

Effect van organische stofbeheer op opbrengst, bodemkwaliteit en stikstofverliezen op een zuidelijke zandgrond : Resultaten van de gangbare bedrijfssystemen van het project Bodemkwaliteit op zand in de periode 2011-2016

In het bedrijfssysteemonderzoek Bodemkwaliteit op zand op WUR-proeflocatie Vredepeel worden twee gangbare bedrijfssystemen met elkaar vergeleken gedurende de periode 2011-2016: één systeem met een gebruikelijke organische stofaanvoer met gebruik van drijfmest (STANDAARD) en één systeem met een lage organische stofaanvoer met gebruik van meststoffen zonder of met een laag gehalte organische stof (LAAG). Systeem LAAG heeft een 5% lagere totale droge stofproductie (p<0,05) en een lager risico op stikstofuitspoeling. De nitraatconcentraties in het grondwater (n.s.), de N-min voorraden in de bodem in het najaar (p<0,1), en het stikstofoverschot (n.s.) zijn in LAAG in alle gevallen lager dan STANDAARD. In beide systemen ligt de nitraatconcentratie in het grondwater boven de norm in de Europese nitraatrichtlijn (50 mg/l). Het organisch stofgehalte in LAAG is 0,4%-punt lager dan STANDAARD (p<0,01). Andere bodemparameters zijn in de loop van de tijd van de proef niet veranderd. Er kon geen duidelijk verband afgeleid worden tussen de aanvoer van organische stof en lachgasemissies. Aanvoer van extra organische stof in de vorm van compost in zowel LAAG als STANDAARD leidt tot hogere opbrengsten (n.s.), met name in systeem LAAG, maar geen verhoging van de uitspoeling. De opbrengsten in STANDAARD liggen gemiddeld 15% lager dan de praktijkopbrengsten op de proeflocatie, mogelijk veroorzaakt door de strikte bemestingsstrategie sinds de start van het bedrijfssystemenonderzoek in 1988. Met de indicaties voor lagere stikstofverliezen, hoewel nog steeds boven de nitraatnorm, bij een lagere aanvoer van organische stof, maar tegelijkertijd lagere opbrengsten geeft dit onderzoek een dilemma weer tussen een belangrijk milieuaspect en de economie van het boerenbedrijf

Energy expenditure and dietary intake in professional football players in the Dutch Premier League:Implications for nutritional counselling

Selecting effective dietary strategies for professional football players requires comprehensive information on their energy expenditure (EE) and dietary intake. This observational study aimed to assess EE and dietary intake over a 14-day period in a representative group (n = 41) of professional football players playing in the Dutch Premier League (Eredivisie). Daily EE, as assessed by doubly labelled water, was 13.8 ± 1.5 MJ/day, representing a physical activity level (PAL) of 1.75 ± 0.13. Weighted mean energy intake (EI), as assessed by three face-to-face 24-h recalls, was 11.1 ± 2.9 MJ/day, indicating 18 ± 15% underreporting of EI. Daily EI was higher on match days (13.1 ± 4.1 MJ) compared with training (11.1 ± 3.4 MJ; P < 0.01) and rest days (10.5 ± 3.1 MJ; P < 0.001). Daily carbohydrate intake was significantly higher during match days (5.1 ± 1.7 g/kg body mass (BM)) compared with training (3.9 ± 1.5 g/kg BM; P < 0.001) and rest days (3.7 ± 1.4 g/kg BM; P < 0.001). Weighted mean protein intake was 1.7 ± 0.5 g/kg BM. Daytime distribution of protein intake was skewed, with lowest intakes at breakfast and highest at dinner. In conclusion, daily EE and PAL of professional football players are modest. Daily carbohydrate intake should be increased to maximize performance and recovery. Daily protein intake seems more than adequate, but could be distributed more evenly throughout the day

RNF168 Ubiquitinates K13-15 on H2A/H2AX to Drive DNA Damage Signaling

SummaryUbiquitin-dependent signaling during the DNA damage response (DDR) to double-strand breaks (DSBs) is initiated by two E3 ligases, RNF8 and RNF168, targeting histone H2A and H2AX. RNF8 is the first ligase recruited to the damage site, and RNF168 follows RNF8-dependent ubiquitination. This suggests that RNF8 initiates H2A/H2AX ubiquitination with K63-linked ubiquitin chains and RNF168 extends them. Here, we show that RNF8 is inactive toward nucleosomal H2A, whereas RNF168 catalyzes the monoubiquitination of the histones specifically on K13-15. Structure-based mutagenesis of RNF8 and RNF168 RING domains shows that a charged residue determines whether nucleosomal proteins are recognized. We find that K63 ubiquitin chains are conjugated to RNF168-dependent H2A/H2AX monoubiquitination at K13-15 and not on K118-119. Using a mutant of RNF168 unable to target histones but still catalyzing ubiquitin chains at DSBs, we show that ubiquitin chains per se are insufficient for signaling, but RNF168 target ubiquitination is required for DDR

Psychosocial function of Dutch children with cancer and their caregivers during different phases of the COVID-19 pandemic

We compared psychosocial functioning of children with cancer and their caregivers in several phases of the coronavirus disease 2019 (COVID-19) pandemic to before COVID-19. One or more questionnaires on health-related quality of life (HRQoL) or fatigue of children or distress of their caregivers was available from 1644 families. In children with cancer, HRQoL was stable throughout the COVID-19 pandemic. Fatigue was slightly lower and sleep somewhat better during the pandemic than before. Caregiver distress was lower in the first pandemic phase, but increased to pre-COVID-19 levels in later phases, indicating that the length and consequences of the pandemic may be weighing on them