Groene diensten in Groen Waterland

Dit document levert achtergronddocumentatie bij het project "Groene diensten in Groen Waterland". In dit project zijn de mogelijkheden voor diensten op gebied van zorg, natuur- en milieu-educatie en waterbeheer in het landelijk gebied van Waterland verkend. Geïnventariseerd is, op welke activiteiten de geïnterviewde instellingen zich richten. Nadruk moet voor de boer op het werk liggen. Boer en boerin moeten werkgever zijn, geen therapeut of hulpverlener

The association between palliative care team consultation and hospital costs for patients with advanced cancer: An observational study in 12 Dutch hospitals

Background: Early palliative care team consultation has been shown to reduce costs of hospital care. The objective of this study was to investigate the association between palliative care team (PCT) consultation and the content and costs of hospital care in patients with advanced cancer. Material and Methods: A prospective, observational study was conducted in 12 Dutch hospitals.

Enzymatic glyceride synthesis in a foam reactor

We report the results of our study on Rhizomucor miehei lipaseâ catalyzed lauric acidâ glycerol esterification in a foam reactor. A satisfactory yield of glyceride synthesis can be achieved with an unusually high initial water content (50% w/w). We found that product formation could be regulated by controlling foaming. Foaming was a function of the air flow rate, reaction temperature, pH value, ionic strength, and substrate molar ratio. Monolaurin and dilaurin, which constituted nearly 80% of the total yield, were the two dominant products in this reaction; trilaurin was also formed at the initial stages of the reaction. A study of pH and ionic strength effects on an independent basis revealed that they affect the interfacial mechanism in different manners. On varying the ratio of lauric acid and glycerol, only a slight change in the degree of conversion was detected and the consumption rate of fatty acid was approximately the same.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141443/1/aocs0643.pd

Real-world palbociclib effectiveness in patients with metastatic breast cancer: Focus on neutropenia-related treatment modification strategies and clinical outcomes

INTRODUCTION: In addition to clinical trials, real-world data is needed to verify the effectiveness of the CDK 4/6 inhibitor palbociclib. The primary aim was to examine real-world variation in treatment modification strategies for neutropenia and its relation to progression-free survival (PFS). The secondary aim was to assess if there is a gap between real-world and clinical trial outcomes. MATERIALS AND METHODS: In this multicenter, retrospective observational cohort study 229 patients were analyzed who started palbociclib and fulvestrant as second- or later-line therapy for HR-positive, HER2-negative metastatic breast cancer in the Santeon hospital group in the Netherlands between September 2016 and December 2019. Data were manually retrieved from patients' electronic medical records. PFS was examined using the Kaplan-Meier method to compare neutropenia-related treatment modification strategies within the first three months after neutropenia grade 3 - 4 occurred, as well as patients' eligibility to have participated in the PALOMA-3 clinical trial or not. RESULTS: Even though treatment modification strategies differed from those in PALOMA-3 (dose interruptions: 26 vs 54%, cycle delays: 54 vs 36%, and dose reductions: 39 vs 34%), these did not influence PFS. Patients who were PALOMA-3 ineligible experienced a shorter median PFS than those who were eligible (10.2 vs. 14.1 months; HR 1.52; 95% CI 1.12 - 2.07). An overall longer median PFS was found compared to PALOMA-3 (11.6 vs. 9.5 months; HR 0.70; 95% CI 0.54 - 0.90). CONCLUSION: This study suggests no impact of neutropenia-related treatment modifications on PFS and confirms inferior outcomes outside clinical trial eligibility

Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer

Purpose: Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods: This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results: The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions: Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number: NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors: Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising

Scale-sensitive governance of the environment

Sensitivity to scales is one of the key challenges in environmental governance. Climate change, food production, energy supply, and natural resource management are examples of environmental challenges that stretch across scales and require action at multiple levels. Governance systems are typically ill-equipped for this task due to organisational and jurisdictional specialisation and short-term planning horizons. Further to this, scientific knowledge is fragmented along disciplinary lines and research traditions in academia and research institutions. State-of-the-art, Scale-Sensitive Governance of the Environment addresses these challenges by establishing the foundation for a new, trans-disciplinary research field. It brings together and reframes a variety of disciplinary approaches, using the idea of scales to create a conceptual and methodological basis for scale-sensitive governance of the environment from both a natural and social science perspective. This volume presents new visions, methods and innovative applications of thinking and decision making across scales in space and time to develop a holistic view on the subject. It is unique in providing: analysis on how spatial, temporal, and governance scales are constructed, politically and scientifically defined, institutionalized in governance practices, and strategically used in policy discourses details on how current environmental governance practices can be enriched by the use of theory on scale, with specific research themes to show the benefits of recognizing scales in empirical research, insightful case studies drawn from countries in the Americas, Eastern and Southern Africa, Europe, and South and Southeastern Asia, covering a wide range of environmental topics including biodiversity, climate change, commodities (tea and palm oil), cultural landscapes, energy, forestry, natural resource management, pesticides, urban development, and water management. With its comprehensive coverage of scale and scaling issues and convergence of widely different scientific approaches, this book is essential for environmental scientists, policy makers and planners, also conservation biologists and ecologists who are involved in modeling climate change impacts and sustainability. This reference will also benefit students of environmental studies, and all those who seek a response to the urgent environmental governance challenges for the decades ahead