Population scenarios 2010-2050 for MED11 countries: a MEDPRO WP3 research report

The focus of this report is on population and development scenarios of MED11 countries for the period 2010-2050. More specifically, we address (1) design aspects of the MEDPRO population and development scenarios, and projection methodology, (2) main results of population scenarios for MED11 countries, including comparison with results of the UN medium variant projection and EUROSTAT EU-27 population projection, and (3) we reflect on the implications of the scenarios for policy and planning, and elaborate on what the effect of the current dramatic political and societal events in the region might be on the results of our population scenarios. Section 2 describes the MEDPRO framework for development scenarios. Sections 3 and 4 describe how demographic behaviour might respond if people in MED11 countries would live in four different macro-economic and political contexts. Focus in section 3 is on developing story lines, i.e. qualitative population scenarios, about how demographic behaviour may change if the development context change, and we operationalize these in the form of quantitative population scenarios. In section 4 we briefly describe the population projection methodology and we present and analyse main results of the population scenarios 2010-2050 for MED11 countries. In section 5 we discuss address the implications of the population scenarios and reflect on the plausibility of the results in light of the dramatic political transitions in the region.

Perspective: Advancing the research agenda for improving understanding of cyanobacteria in a future of global change

Harmful cyanobacterial blooms (=cyanoHABs) are an increasing feature of many waterbodies throughout the world. Many bloom-forming species produce toxins, making them of particular concern for drinking water supplies, recreation and fisheries in waterbodies along the freshwater to marine continuum. Global changes resulting from human impacts, such as climate change, over-enrichment and hydrological alterations of waterways, are major drivers of cyanoHAB proliferation and persistence. This review advocates that to better predict and manage cyanoHABs in a changing world, researchers need to leverage studies undertaken to date, but adopt a more complex and definitive suite of experiments, observations, and models which can effectively capture the temporal scales of processes driven by eutrophication and a changing climate. Better integration of laboratory culture and field experiments, as well as whole system and multiple-system studies are needed to improve confidence in models predicting impacts of climate change and anthropogenic over-enrichment and hydrological modifications. Recent studies examining adaptation of species and strains to long-term perturbations, e.g. temperature and carbon dioxide (CO2) levels, as well as incorporating multi-species and multi-stressor approaches emphasize the limitations of approaches focused on single stressors and individual species. There are also emerging species of concern, such as toxic benthic cyanobacteria, for which the effects of global change are less well understood, and require more detailed study. This review provides approaches and examples of studies tackling the challenging issue of understanding how global changes will affect cyanoHABs, and identifies critical information needs for effective prediction and management

Two versus five days of antibiotics after appendectomy for complex acute appendicitis (APPIC): Study protocol for a randomized controlled trial

Background: Acute appendicitis is one of the most common indications for emergency surgery. In patients with a complex appendicitis, prolonged antibiotic prophylaxis is recommended after appendectomy. There is no consensus regarding the optimum duration of antibiotics. Guidelines propose 3 to 7 days of treatment, but shorter courses may be as effective in the prevention of infectious complications. At the same time, the global issue of increasing antimicrobial resistance urges for optimization of antibiotic strategies. The aim of this study is to determine whether a short course (48 h) of postoperative antibiotics is non-inferior to current standard practice of 5 days. Methods: Patients of 8 years and older undergoing appendectomy for acute complex appendicitis - defined as a gangrenous and/or perforated appendicitis or appendicitis in presence of an abscess - are eligible for inclusion. Immunocompromised or pregnant patients are excluded, as well as patients with a contraindication to the study antibiotics. In total, 1066 patients will be randomly allocated in a 1:1 ratio to the experimental treatment arm (48 h of postoperative intravenously administered (IV) antibiotics) or the control arm (5 days of postoperative IV antibiotics). After discharge from the hospital, patients participate in a productivity-cost-questionnaire at 4 weeks and a standardized telephone follow-up at 90 days after appendectomy. The primary outcome is a composite endpoint of infectious complications, including intra-abdominal abscess (IAA) and surgical site infection (SSI), and mortality within 90 days after appendectomy. Secondary outcomes include IAA, SSI, restart of antibiotics, length of hospital stay (LOS), reoperation, percutaneous drainage, readmission rate, and cost-effectiveness. The non-inferiority margin for the difference in the primary endpoint rate is set at 7.5% (one-sided test at α 0.025). Both per-protocol and intention-to-treat analyses will be performed. Discussion: This trial will provide evidence on whether 48 h of postoperative antibiotics is non-inferior to a standard course of 5 days of antibiotics. If non-inferiority is established, longer intravenous administration following appendectomy for complex appendicitis can be abandoned, and guidelines need to be adjusted accordingly

SimFirms:demography of firms: a microsimulation model

The outline of this thesis is as follows. Starting from the simple question ‘How many firms are there?’ the available data in the Netherlands is discussed, compared and described in chapter 2. This chapter gives a general overview on the several aspects of ‘firmography’ in the Netherlands and concludes with an international comparison. The chapters 3 through 6 and 8 cover the firmographic events that are later on used in the simulation model. For each of the events, the data and developments are described, theories are applied and models are sought for that explain variations and trends. The models should not only be able to describe the data but should also be able to predict the future events. These five chapters use the LISA database for the province of Gelderland as input. Chapter 3 covers the event of start-up firms, and chapter 4 the event of the termination of establishments. Chapter 5 handles the migration of firms. Since both events migration and start-ups are based on a two step decision, namely first the decision to migrate (or start), and next the location choice, the location choice is covered in a separate chapter (chapter 6: where to?). Chapter 7 continues with the spatial aspects of SimFirms. In this chapter it is analysed how the firmographic events start-ups and closures influence the clustering of firms, using spatial analysis techniques originally developed within the field of epidemiology. Chapter 8 handles the last event, the growth of firms (in terms of numbers of employees). In chapter 9 all the models described in chapters 3 through 8 are brought together in the full simulation model SimFirms. This chapter describes the validation, calibration and randomness issues that were encountered. In this chapter we further explain how we dealt with the labour market tension mentioned earlier, and we give some initial results of the baseline model. In chapter 10 three different scenarios are formulated and used as input in SimFirms to estimate different developments. These scenarios are labelled: ‘improved investment climate’, ‘attraction of the city-region’ and ‘credit crunch’. The effects of the scenarios are discussed. This thesis ends with chapter 11 in which conclusions are drawn and the most important findings are being evaluated.

Who dies of what in Europe before the age of 65

High life expectancy but large differences in mortality. An "Atlas on Mortality in the European Union" has just been published. This "Statistics in Focus" highlights important causes of avoidable mortality below age 65, namely ischaemic heart disease, lung cancer, alcohol-related mortality, suicide, transport accidents, cervical cancer and AIDS. These causes of death are described at NUTS 2 level in 2002-2004. In the EU, men lost twice as many life years before age 65 as women. In the Baltic regions, men lost more than twice the number of years as compared to the EU-27 average. The lowest mortality in women before age 65 was found in the Mediterranean regions of Italy, Spain, Cyprus and Greece.