Efficientie boven water

Benchmarking heeft de efficiëntie van de drinkwatersector in de afgelopen jaren aanzienlijk verbeterd. Het introduceren van ingrijpendere vormen van marktwerking ligt niet voor de hand

Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis: A Systematic Review and Meta-analysis

Importance: Current clinical guidelines recommend selecting diagnostic tests for giant cell arteritis (GCA) based on pretest probability that the disease is present, but how pretest probability should be estimated remains unclear. Objective: To evaluate the diagnostic accuracy of symptoms, physical signs, and laboratory tests for suspected GCA. Data Sources PubMed, EMBASE, and the Cochrane Database of Systematic Reviews were searched from November 1940 through April 5, 2020. Study Selection: Trials and observational studies describing patients with suspected GCA, using an appropriate reference standard for GCA (temporal artery biopsy, imaging test, or clinical diagnosis), and with available data for at least 1 symptom, physical sign, or laboratory test. Data Extraction and Synthesis: Screening, full text review, quality assessment, and data extraction by 2 investigators. Diagnostic test meta-analysis used a bivariate model. Main Outcome(s) and Measures: Diagnostic accuracy parameters, including positive and negative likelihood ratios (LRs). Results: In 68 unique studies (14 037 unique patients with suspected GCA; of 7798 patients with sex reported, 5193 were women [66.6%]), findings associated with a diagnosis of GCA included limb claudication (positive LR, 6.01; 95% CI, 1.38-26.16), jaw claudication (positive LR, 4.90; 95% CI, 3.74-6.41), temporal artery thickening (positive LR, 4.70; 95% CI, 2.65-8.33), temporal artery loss of pulse (positive LR, 3.25; 95% CI, 2.49-4.23), platelet count of greater than 400 × 103/μL (positive LR, 3.75; 95% CI, 2.12-6.64), temporal tenderness (positive LR, 3.14; 95% CI, 1.14-8.65), and erythrocyte sedimentation rate greater than 100 mm/h (positive LR, 3.11; 95% CI, 1.43-6.78). Findings that were associated with absence of GCA included the absence of erythrocyte sedimentation rate of greater than 40 mm/h (negative LR, 0.18; 95% CI, 0.08-0.44), absence of C-reactive protein level of 2.5 mg/dL or more (negative LR, 0.38; 95% CI, 0.25-0.59), and absence of age over 70 years (negative LR, 0.48; 95% CI, 0.27-0.86). Conclusions and Relevance: This study identifies the clinical and laboratory features that are most informative for a diagnosis of GCA, although no single feature was strong enough to confirm or refute the diagnosis if taken alone. Combinations of these symptoms might help direct further investigation, such as vascular imaging, temporal artery biopsy, or seeking evaluation for alternative diagnoses

Aanpassing GVS risicovol

Het kabinetsplan om de vergoedingslimieten van geneesmiddelen drastisch te verlagen, kan ernstige bijwerkingen hebben

Concurrentie bevordert onderwijsrendement niet

Keuzevrijheid bestaat al jaren in het voortgezet onderwijs en maakt dat scholen onderling concurreren. Door de beschikbaarheid van meer informatie kunnen ouders en leerlingen steeds beter kiezen. Concurrentie tussen scholen leidt echter niet tot meer onderwijsrendement in termen van cijfers of slagingspercentages

School Choice and Competition

The literature suggests that competition among schools might increase quality. However, not much empirical evidence is present as only a few countries allow competition at a large scale. One exception is the Netherlands. Free parental choice is the leading principle of the Dutch education system since the beginning of the 20th century. Based on panel data for the Netherlands we show that there is a relation between competition and student achievement in upper secondary education, but that it is negative. In addition, private schools have higher quality levels

Visual Attention toward Human Face Recognizing for Autism Spectrum Disorder and Normal Developing Children: An Eye Tracking Study

© 2020 ACM. The paper discusses an eye tracking analysis study to let us understand the visual behavior and pattern of Normal Developing children and Autistic children while viewing human face stimulus. An eye tracking experiment consists of displaying different images with human face embedded in different locations (left, center and right) and the eye tracker captured and tracked the child\u27s eye gaze movements, then analyzed to identify where specifically in the stimulus is the child looking at. The finding indicates a significant difference was found between the two groups viewing patterns and behavior when they presented with a scene that have human face. The study also reveals that large percentage of Autistic participants expressed minimum interest and time looking at face area, evident by significant time spent fixations on non-face regions, comparing to the normal developing children. The results can be used to improve the life style of other children who have a risk to develop Autism as well as discover earlier signs of ASD

Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands

BACKGROUND: Centralization of pancreatic surgery in high-volume hospitals is under debate in many countries. In the western part of the Netherlands, the professional network of surgical oncologists agreed to centralize all pancreatic surgery from 2006 in two high-volume hospitals. Our aim is to evaluate whether centralization of pancreatic surgery has improved clinical outcomes and has changed referral patterns. MATERIALS AND METHODS: Data of the Comprehensive Cancer Centre West (CCCW) of all 249 patients who had a resection for suspected pancreatic cancer between 1996 and 2008 in the western part of the Netherlands were analyzed. Multivariable modeling was used to evaluate survival for 3 time periods; 1996–2000, 2001–2005 (introduction of quality standards), and 2006–2008 (after centralization). In addition, the differences in referral pattern were analyzed. RESULTS: From 2006, all pancreatic surgery was centralized in 2 hospitals. The 2-year survival rate increased after centralization from 39% to 55% (P = .09) for all patients who had a pancreatic resection for pancreatic cancer. After adjustment for age, tumor location, stage, histology, and adjuvant treatment, the latter period was significantly associated with improved survival (hazard ratio [HR] 0.50; 95% confidence interval [95% CI] 0.34–0.73). CONCLUSIONS: Centralization of pancreatic surgery was successful and has resulted in improved clinical outcomes in the western part of the Netherlands, demonstrating the effectiveness of centralization

Case study on the efficacy of a lanthanum-enriched clay (Phoslock®) in controlling eutrophication in Lake Het Groene Eiland (The Netherlands)

Lake Het Groene Eiland was created in the beginning of 2008 by construction of dikes for isolating it from the surrounding 220-ha water body. This so-called claustrum of 5 ha was treated using lanthanum-modified clay (Phoslock®) to control eutrophication and mitigate cyanobacterial nuisance. Cyanobacteria chlorophyll-a were significantly lower in the claustrum than those in the reference water body, where a massive bloom developed in summer, 2008. However, PO4-P and TP did not statistically differ in these two waters. TN and NO3-N were significantly lower in the claustrum, where dense submerged macrophytes beds developed. Lanthanum concentrations were elevated after the applications of the modified clay in the claustrum, but filterable lanthanum dropped rapidly below the Dutch standard of 10.1 μg l−1. During winter, dozens of Canada geese resided at the claustrum. Geese droppings contained an average of 2 mg PO4-P g−1 dry weight and 12 mg NH3-N g−1 dry weight and might present a growing source of nutrients to the water. Constructing the claustrum enabled unrestricted bathing in subsequent three summers, as no swimming bans had to be issued due to cyanobacteria blooms. However, the role of the modified clay in this positive outcome remains unclear, and longevity of the measures questionable.