The impact of pre-transplantation nephrectomy on quality of life in patients with autosomal dominant polycystic kidney disease

PURPOSE: In selected ADPKD patients, a nephrectomy is required in the work-up for a kidney transplantation. Because the impact of this procedure is unknown, we investigated the effect of pre-transplantation nephrectomy on quality of life in this group.METHODS: In this retrospective cohort study all ADPKD patients, ≥ 18 years, who received a kidney transplantation in 2 ADPKD expertise centers between January 2000 and January 2016, were asked to participate. Quality of life was assessed using three validated questionnaires on three time points. Nephrectomy was performed in preparation for transplantation.RESULTS: Two hundred seventy-six ADPKD patients (53 ± 9 years, 56.2% male) were included. 98 patients (35.5%) underwent native nephrectomy in preparation for transplantation, of which 43 underwent bilateral nephrectomy. Pre-transplantation, ADPKD-IS scores were worse in the nephrectomy group vs. no-nephrectomy group (physical: 2.9 vs. 2.3, p &lt; 0.001; emotional: 2.0 vs. 1.8, p = 0.03; fatigue: 3.0 vs. 2.3, p = 0.01). Post-transplantation and post-nephrectomy, ADPKD-IS scores improved significantly in both groups, with a significantly higher improvement in the nephrectomy group. During follow-up, all scores were still better compared to pre-transplantation. Observed physical QoL (ADPKD-IS physical 1.3 vs. 1.7, p = 0.04; SF-36 physical 50.0 vs. 41.3, p = 0.03) was better post-transplantation after bilateral nephrectomy compared to unilateral nephrectomy. In retrospect, 19.7% of patients would have liked to undergo a nephrectomy, while the decision not to perform nephrectomy was made by the treating physician.CONCLUSION: This study shows that pre-transplantation nephrectomy improves quality of life in selected ADPKD patients. Bilateral nephrectomy may be preferred, although the risk of additional complications should be weighted.</p

Intensity standardization methods in magnetic resonance imaging of head and neck cancer

BACKGROUND AND PURPOSE: Conventional magnetic resonance imaging (MRI) poses challenges in quantitative analysis because voxel intensity values lack physical meaning. While intensity standardization methods exist, their effects on head and neck MRI have not been investigated. We developed a workflow based on healthy tissue region of interest (ROI) analysis to determine intensity consistency within a patient cohort. Through this workflow, we systematically evaluated intensity standardization methods for MRI of head and neck cancer (HNC) patients.MATERIALS AND METHODS: Two HNC cohorts (30 patients total) were retrospectively analyzed. One cohort was imaged with heterogenous acquisition parameters (HET cohort), whereas the other was imaged with homogenous acquisition parameters (HOM cohort). The standard deviation of cohort-level normalized mean intensity (SD NMI c), a metric of intensity consistency, was calculated across ROIs to determine the effect of five intensity standardization methods on T2-weighted images. For each cohort, a Friedman test followed by a post-hoc Bonferroni-corrected Wilcoxon signed-rank test was conducted to compare SD NMI c among methods. RESULTS: Consistency (SD NMI c across ROIs) between unstandardized images was substantially more impaired in the HET cohort (0.29 ± 0.08) than in the HOM cohort (0.15 ± 0.03). Consequently, corrected p-values for intensity standardization methods with lower SD NMI c compared to unstandardized images were significant in the HET cohort (p &lt; 0.05) but not significant in the HOM cohort (p &gt; 0.05). In both cohorts, differences between methods were often minimal and nonsignificant. CONCLUSIONS: Our findings stress the importance of intensity standardization, either through the utilization of uniform acquisition parameters or specific intensity standardization methods, and the need for testing intensity consistency before performing quantitative analysis of HNC MRI.</p

Capacity-building for a strong public health nutrition workforce in lowresource countries

Neglected for several decades, nutrition is now firmly on the development agenda. Important landmarks are the initiation of the Scaling Up Nutrition movement in 2010; the adoption by the World Health Assembly of the Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition in 2014; and the World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases for 2013–2020. Public health nutrition has to meet multiple new challenges, including the shift from the millennium development goals to the sustainable development goals (SDGs), together with growing issues such as climate change, globalization, urbanization, socioeconomic disparities, migration and wars.

Estimating the joint survival probabilities of married individuals

We estimate the joint survival probability of spouses using a large random sample drawn from a Dutch census. As benchmarks we use two bivariate Weibull models. We consider more flexible models, using a semi-nonparametric approach, by extending the independent Weibull distribution using squared polynomials. Also based on a nonparametric comparison, we find that extending the independent Weibull distribution by a squared third order polynomial shows the best performance. We illustrate our model by calculating remaining life expectancies and annuity values. We find that the husbands life expectancy at birth is generally increasing with his wifes age of death and the wifes life expectancy at birth is generally increasing with her husbands age of death. Ignoring the dependence between the remaining lifetimes of spouses may lead to an underestimation of the value of a joint annuity and an overestimation of the value of a single-life annuity, but less than suggested on the basis of the previous literature

Capacity-building for a strong public health nutrition workforce in low-resource countries

CITATION: Delisle, H. et al. 2017. Capacity-building for a strong public health nutrition workforce in low-resource countries. Bulletin of the World Health Organization, 95:385-388. doi:10.2471/BLT.16.174912The original publication is available at http://www.who.int/bulletin/en/INTRODUCTION: Neglected for several decades, nutrition is now firmly on the development agenda. Important landmarks are the initiation of the Scaling Up Nutrition movement in 2010; the adoption by the World Health Assembly of the Comprehensive Implementation Plan for Maternal, Infant and Young Child Nutrition in 2014; and the World Health Organization’s (WHO) Global Action Plan for the Prevention and Control of Noncommunicable Diseases for 2013–2020. Public health nutrition has to meet multiple new challenges, including the shift from the millennium development goals to the sustainable development goals (SDGs), together with growing issues such as climate change, globalization, urbanization, socioeconomic disparities, migration and wars.Publisher's versio

Het complete plaatje?: Onderzoek naar het gebruik van iconen als middel voor inclusievere gemeentelijke communicatie in Nederland en Vlaanderen

Tijdens de coronacrisis moest er voortdurend worden gecommuniceerd over allerlei nieuwe maatregelen waaraan burgers zich moesten houden, bijvoorbeeld ‘houd 1.5 meter afstand’ en ‘vermijd drukte’. Het was belangrijk om deze informatie op een begrijpelijke manier te delen, ook met burgers voor wie het Nederlands niet de moedertaal is, of voor wie het geschreven woord een barrière kan vormen. Iconen zouden kunnen helpen om de communicatie met deze groepen te optimaliseren. Het idee hierachter is dat beelden makkelijker te begrijpen zijn dan geschreven taal. Maar is dat ook zo? Het doel van dit onderzoek was daarom om inzicht te krijgen in het gebruik van iconen als middel voor inclusievere gemeentelijke communicatie in Nederland en Vlaanderen

MR-Guided Adaptive Radiotherapy for OAR Sparing in Head and Neck Cancers

MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) methods on MR-Linac devices directed towards the sparing of organs at risk (OAR) and a view of future adaptive techniques seeking to improve the therapeutic ratio. This ratio expresses the relationship between the probability of tumor control and the probability of normal tissue damage and is thus an important conceptual metric of success in the sparing of OARs. Increasing spatial conformity of dose distributions to target volume and OARs is an initial step in achieving therapeutic improvements, followed by the use of imaging and clinical biomarkers to inform the clinical decision-making process in an ART paradigm. Pre-clinical and clinical findings support the incorporation of biomarkers into ART protocols and investment into further research to explore imaging biomarkers by taking advantage of the daily MR imaging workflow. A coherent understanding of this road map for RT in HNC is critical for directing future research efforts related to sparing OARs using image-guided radiotherapy (IGRT)

MR-Guided Adaptive Radiotherapy for OAR Sparing in Head and Neck Cancers

MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) methods on MR-Linac devices directed towards the sparing of organs at risk (OAR) and a view of future adaptive techniques seeking to improve the therapeutic ratio. This ratio expresses the relationship between the probability of tumor control and the probability of normal tissue damage and is thus an important conceptual metric of success in the sparing of OARs. Increasing spatial conformity of dose distributions to target volume and OARs is an initial step in achieving therapeutic improvements, followed by the use of imaging and clinical biomarkers to inform the clinical decision-making process in an ART paradigm. Pre-clinical and clinical findings support the incorporation of biomarkers into ART protocols and investment into further research to explore imaging biomarkers by taking advantage of the daily MR imaging workflow. A coherent understanding of this road map for RT in HNC is critical for directing future research efforts related to sparing OARs using image-guided radiotherapy (IGRT)

Het complete plaatje?: Onderzoek naar het gebruik van iconen als middel voor inclusievere gemeentelijke communicatie in Nederland en Vlaanderen

Tijdens de coronacrisis moest er voortdurend worden gecommuniceerd over allerlei nieuwe maatregelen waaraan burgers zich moesten houden, bijvoorbeeld ‘houd 1.5 meter afstand’ en ‘vermijd drukte’. Het was belangrijk om deze informatie op een begrijpelijke manier te delen, ook met burgers voor wie het Nederlands niet de moedertaal is, of voor wie het geschreven woord een barrière kan vormen. Iconen zouden kunnen helpen om de communicatie met deze groepen te optimaliseren. Het idee hierachter is dat beelden makkelijker te begrijpen zijn dan geschreven taal. Maar is dat ook zo? Het doel van dit onderzoek was daarom om inzicht te krijgen in het gebruik van iconen als middel voor inclusievere gemeentelijke communicatie in Nederland en Vlaanderen