Quality assurance in rectal cancer treatment

This thesis focuses on quality assurance of rectal cancer treatment, in particular of the surgical treatment. Both oncological short-term and long-term outcome parameters are studied, but also other end-points which are important for quality assurance are investigated, such as anastomotic leakage and stoma reversal. The introduction of total mesorectal excision (TME) surgery resulted in an improved survival of patients with rectal cancer. However, survival of the elderly patients and patients treated with an abdominoperineal resection improved less. For frail elderly patients, postoperative mortality is an important competitive risk factor and other treatment schedules might be more appropriate. The abdominoperineal resection itself was associated with a nonradical resection, decreased local control and decreased survival compared to patients treated with a low anterior resection. To improve these results, in selected cases preoperative treatment should consist of chemoradiotherapy and/or a widened resection. Anastomotic leakage is a feared complication after colorectal surgery. After surviving this complication, the overall survival rate in the long-term is still reduced. However, oncological outcome was not significantly affected. The presence of a stoma resulted in a lower symptomatic leakage rate. 20% of stomas was never reversed. Standardised postoperative surveillance resulted in an earlier confirmation of the diagnosis anastomotic leakage.UBL - phd migration 201

La escuela, un vehículo para la introducción de tecnologías alternativas en un contexto de participación comunitaria

En la siguiente presentación, expondremos los principales ejes del proyecto de extensión, "La escuela, un vehículo para la introducción de tecnologías alternativas en un contexto de participación comunitaria". Este consiste en la realización de una experiencia piloto en una escuela del Delta Bonaerense, que permita la recuperación y el perfeccionamiento de las formas tradicionales de producción, mediante la introducción y difusión de tecnologías alternativas, con especial énfasis en el aprovechamiento de la energía solar, favoreciendo de esta manera el desarrollo de nuevas estrategias productivas. Un componente fundamental para la ejecución de dicha experiencia es la elaboración y propuesta a la comunidad de un menú tecnológico que estará sujeto a la constante evaluación y revisión critica por parte de la población receptora. En este sentido, se plantea la puesta en práctica de un concepto innovador de participación social, que este presente en todas las etapas del proyecta (diagnóstico, ejecución y monitorco). De aquí que la presente ponencia enfatize los aspectos metodológicos que dicho concepto de participación social introduce en el proceso de transferencia tecnológica a realizar.Tema: Educación en Energías Renovables.Asociación Argentina de Energía Sola

La escuela, un vehículo para la introducción de tecnologías alternativas en un contexto de participación comunitaria

En la siguiente presentación, expondremos los principales ejes del proyecto de extensión, "La escuela, un vehículo para la introducción de tecnologías alternativas en un contexto de participación comunitaria". Este consiste en la realización de una experiencia piloto en una escuela del Delta Bonaerense, que permita la recuperación y el perfeccionamiento de las formas tradicionales de producción, mediante la introducción y difusión de tecnologías alternativas, con especial énfasis en el aprovechamiento de la energía solar, favoreciendo de esta manera el desarrollo de nuevas estrategias productivas. Un componente fundamental para la ejecución de dicha experiencia es la elaboración y propuesta a la comunidad de un menú tecnológico que estará sujeto a la constante evaluación y revisión critica por parte de la población receptora. En este sentido, se plantea la puesta en práctica de un concepto innovador de participación social, que este presente en todas las etapas del proyecta (diagnóstico, ejecución y monitorco). De aquí que la presente ponencia enfatize los aspectos metodológicos que dicho concepto de participación social introduce en el proceso de transferencia tecnológica a realizar.Tema: Educación en Energías Renovables.Asociación Argentina de Energía Sola

Exploring the relation between preoperative physical functioning and the impact of major complications in patients following pancreatic resection

BACKGROUND: This study aimed to evaluate the association between preoperative level of physical functioning and time to recovery of physical functioning, postoperative complications, and the impact of postoperative major complications in patients undergoing elective pancreatic resection. Additionally, prediction models to identify high-risk patients for developing a major complication were externally validated. METHODS: Perioperative data of patients who underwent pancreatic resection were analysed. Primary outcomes were time to recovery of physical functioning and postoperative major complications. Impact of a major complication was explored by evaluating its effect on time to recovery of physical functioning. Risk-prediction models were retrieved following a systematic review. RESULTS: Multivariable analysis (n = 63) showed that ASA grade III (OR 3.498) and preoperative platelet count (OR 1.005) were associated with major complications, whereas aerobic capacity (OR 0.347) was associated with time to recovery of physical functioning. Age, preoperative aerobic capacity, functional mobility, and perceived level of functional capacity were associated with the impact of a major complication. The AUC of two risk prediction models were 0.556 and 0.701. CONCLUSION: Preoperative parameters of physical function were associated with postoperative outcomes and may be useful in outcome prediction, although future approaches should not only register the incidence of major complications but also take the impact of a complication on a patient's physical functioning into account

Chorioamnionitis induces hepatic inflammation and time-dependent changes of the enterohepatic circulation in the ovine fetus

Chorioamnionitis, inflammation of fetal membranes, is an important cause of preterm birth and a risk factor for the development of adverse neonatal outcomes including sepsis and intestinal pathologies. Intestinal bile acids (BAs) accumulation and hepatic cytokine production are involved in adverse intestinal outcomes. These findings triggered us to study the liver and enterohepatic circulation (EHC) following intra-amniotic (IA) lipopolysaccharide (LPS) exposure. An ovine chorioamnionitis model was used in which circulatory cytokines and outcomes of the liver and EHC of preterm lambs were longitudinally assessed following IA administration of 10 mg LPS at 5, 12 or 24h or 2, 4, 8 or 15d before preterm birth. Hepatic inflammation was observed, characterized by increased hepatic cytokine mRNA levels (5h – 2d post IA LPS exposure) and increased erythropoietic clusters (at 8 and 15 days post IA LPS exposure). Besides, 12h after IA LPS exposure, plasma BA levels were increased, whereas gene expression levels of several hepatic BA transporters were decreased. Initial EHC alterations normalized over time. Concluding, IA LPS exposure induces significant time-dependent changes in the fetal liver and EHC. These chorioamnionitis induced changes have potential postnatal consequences and the duration of IA LPS exposure might be essential herein

Is green space in the living environment associated with people's feelings of social safety?

Abstract. The authors investigate whether the percentage of green space in people's living environ- ment affects their feelings of social safety positively or negatively. More specifically they investigate the extent to which this relationship varies between urban and rural areas, between groups in the community that can be identified as more or less vulnerable, and the extent to which different types of green space exert different influences. The study includes 83736 Dutch citizens who were interviewed about their feelings of social safety. The percentage of green space in the living environment of each respondent was calculated, and data analysed by use of a three-level latent variable model, controlled for individual and environmental background characteristics. The analyses suggest that more green space in people's living environment is associated with enhanced feelings of social safetyöexcept in very strongly urban areas, where enclosed green spaces are associated with reduced feelings of social safety. Contrary to the common image of green space as a dangerous hiding place for criminal activity which causes feelings of insecurity, the results suggest that green space generally enhances feelings of social safety. The results also suggest, however, that green space in the most urban areas is a matter of concern with respect to social safety.

VLA multifrequency observations of RS CVn binaries

We present multiepoch Very Large Array (VLA) observations at 1.4 GHz, 4.9 GHz, 8.5 GHz and 14.9 GHz for a sample of eight RS CVn binary systems. Circular polarization measurements of these systems are also reported. Most of the fluxes observed are consistent with incoherent emission from mildly relativistic electrons. Several systems show an increase of the degree of circular polarization with increasing frequency in the optically thin regime, in conflict with predictions by gyrosynchrotron models. We observed a reversal in the sense of circular polarization with increasing frequency in three non-eclipsing systems: EI Eri, DM Uma and HD 8358. We find clear evidence for coherent plasma emission at 1.4 GHz in the quiescent spectrum of HD 8358 during the helicity reversal. The degrees of polarization of the other two systems could also be accounted for by a coherent emission process. The observations of ER Vul revealed two U-shaped flux spectra at the highest frequencies. The U-shape of the spectra may be accounted for by an optically thin gyrosynchrotron source for the low frequency part whereas the high frequency part is dominated by a thermal emission component.Comment: 12 pages, 8 figures, LaTeX, uses aa.cls. Accepted for publication in A&