Colorectal liver metastases: Surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial

Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted techniques to eliminate small unresectable colorectal liver metastases (CRLM). Although previous studies labelled thermal ablation inferior to surgical resection, the apparent selection bias when comparing patients with unresectable disease to surgical candidates, the superior safety profile, and the competitive overall survival results for the more recent reports mandate the setup of a randomized controlled trial. The objective of the COLLISION trial is to prove non-inferiority of thermal ablation compared to hepatic resection in patients with at least one resectable and ablatable CRLM and no extrahepatic disease. Methods: In this two-arm, single-blind multi-center phase-III clinical trial, six hundred and eighteen patients with at least one CRLM (≤3cm) will be included to undergo either surgical resection or thermal ablation of appointed target lesion(s) (≤3cm). Primary endpoint is OS (overall survival, intention-to-treat analysis). Main secondary endpoints are overall disease-free survival (DFS), time to progression (TTP), time to local progression (TTLP), primary and assisted technique efficacy (PTE, ATE), procedural morbidity and mortality, length of hospital stay, assessment of pain and quality of life (QoL), cost-effectiveness ratio (ICER) and quality-adjusted life years (QALY). Discussion: If thermal ablation proves to be non-inferior in treating lesions ≤3cm, a switch in treatment-method may lead to a reduction of the post-procedural morbidity and mortality, length of hospital stay and incremental costs without compromising oncological outcome for patients with CRLM. Trial registration:NCT03088150 , January 11th 2017

The dynamisation and subsequent vulnerability of the Dutch owner‑occupied sector. An analysis of 1986‑2012

This article investigates the backgrounds to changing residential mobility of Dutch owner-occupiers from 1986-2006 and during the 2008-2018 crisis. The Oaxaca-Blinder decomposition is used to disentangle the main factors at work. Households of all age groups and family types have become more mobile in 1986-2006, with the highest increase amongst the youngest age groups. Nonetheless, ageing of owner-occupiers has dampened the growth between 1986 and 2006, because older owner-occupiers usually move less frequently than younger age groups. Had this ageing process not taken place, the overall increase in mobility would have been much higher (about 3.5 percentage points) than the 1.4 percentage point observed. The overall compositional effect remains negative despite a shift from traditional families with children towards more singles and couples without children, who are more mobile. During the crisis of 2008-2012, high residential mobility rates amongst the young age groups took a sharp negative turn. Combined with their increased presence among owner-occupiers, this implies that the contemporary Dutch owner occupied sector is more vulnerable to economic shocks.Dol Kees, van der Heijden Harry. The dynamisation and subsequent vulnerability of the Dutch owner‑occupied sector. An analysis of 1986‑2012. In: Economie et Statistique / Economics and Statistics, n°500-502, 2018. Housing and housing markets. pp. 139-156

Armoederisico na woonuitgaven. Verkenning van de mogelijkheden, met het oog op het bepalen van de positie van Vlaanderen in de Europese Unie

Deze studie heeft tot doel na te gaan of het zinvol is voor het Vlaamse woonbeleid een indicator te definiëren die het effect van wonen (woonuitgaven) nagaat op de kans om in een situatie van armoederisico te geraken. Deze indicator is berekend door de groep huishoudens die vóór aftrek van de woonuitgaven (dus op basis van het besteedbaar inkomen) in een situatie van armoederisico verkeert in mindering te brengen op de groep die na aftrek van de woonuitgaven (op basis van het residuele inkomen) in een situatie van armoederisico geraakt. De gedachte die ten grondslag lag aan het gebruik van deze indicator was om de effecten bloot te leggen van het woonbeleid op de relatie tussen woonuitgaven en het verkeren of geraken in een situatie van armoederisico. Deze indicator zou een bijdrage kunnen leveren aan het monitoren van de sociale insluiting van huishoudens: hoe kan het woonbeleid bijdragen in het terugdringen van armoede en sociale uitsluiting om te komen tot meer sociale insluiting? De berekeningen voor deze oefening zijn met de EU-SILC verricht. Naast het verkennen van de mogelijkheden en beperkingen van een dergelijke indicator, was het doel ook om de mogelijkheden en beperkingen van dit databestand en het maken van een internationale vergelijking te onderzoeken.nrpages: 53status: publishe

Tenants in poverty risk based on residual income. Analyses with EU-SILC

Combating poverty and social exclusion is a core policy issue in the European Union. The Statistics on Income and Living Conditions (EU-SILC) database facilitates comprehensive analyses of the extent of poverty and social exclusion. According to its definition, any household with an income less than 60% of the median equivalized household income in a country is at risk of poverty. A fundamental question not covered by EU-SILC indicators concerns the impact of housing expenditure on poverty. The concept of residual income – disposable income after deducting housing expenses – can be used to compose an indicator to identify households at risk of poverty as a direct result of their housing expenses. They comprise the group deemed at risk of poverty in view of their residual income but not their equivalized disposable income. In terms of affordability, housing is deemed unaffordable when residual income is below 60% of the median residual equivalized income. This paper discusses the usefulness of calculating a relative instead of an absolute norm for determining whether consumption is affordable. It then analyzes the possibility of using the EU-SILC to make such calculations. The focus is on the consumption of rental housing.status: publishe

Western European housing systems and the impact of the international financial crisis

The central proposition advanced in this paper is that differences in the structure of housing systems, and specifically the differences between dynamic and static housing systems, are crucial to an explanation of the varying impacts between countries of the international financial crisis. The proposition is illustrated with reference to Ireland, England, the Netherlands, Belgium and Germany. The impacts on housing markets and housing policies are considered and it is shown that these are more significant in dynamic than in static systems. It is argued that whilst the classification of housing systems as dynamic and static adds an important new explanation for the varying impacts of the crisis, this is most usefully viewed as a complementary, rather than an alternative, perspective to other sets of explanations.OTB ResearchOTB Research Institute for the Built Environmen