Een onderzoek naar de verschillen tussen migranten en autochtonen bij de toepassing van de Wet op de Arbeidsongeschiktheidsverzekering op basis van broepszaken bij de Raden van Beroep

In deze, in het kader van het onderzoekprogramma van de Interdepartementale Coordinatiecommissie Minderhedenbeleid gestarte studie, is het verschijnsel indirect onderscheid nader onderzocht. Indirect onderscheid wordt veelal gedefinieerd als een situatie waarin een neutraal geformuleerd(e) criterium of regel in zijn toepassing leidt tot verschillen ten aanzien van etnische groeperingen, waarbij een samenhang tussen het criterium of de regel en het effect aanwezig moet zijn. Om een dergelijk onderzoek in begaanbare banen te leiden, is gekozen het toe te spitsen op een wet en wel 1 uit het sociale zekerheidsstelsel, de Wet op de Arbeidsongeschiktheidsverzekering (WAO). Aan de hand van de WAO is onderzocht in hoeverre zich bij de toepassing verschillen tussen autochtonen en migranten voordoen en door welke factoren deze verschillen veroorzaakt worden. De materiaal verzameling heeft plaatsgevonden door middel van literatuurstudie, interviews, en dossieranalyse. De gegevens van dit onderzoek, dat exploratief van aard was, laten zien dat op diverse momenten bij de toepassing van de WAO zich voor migranten meestal negatieve verschillen in effect of behandeling ten opzichte van autochtonen voordoen. De oorzaak voor het ontstaan van die verschillen lijkt voornamelijk gezocht te kunnen worden in enerzijds de wijze waarop de wet door instanties en functionarissen in de praktijk wordt uitgevoerd. Veelal is sprake van een wisselwerking tussen beide factoren. Tenslotte wordt aan de hand van de geconstateerde verschillen een vraagteken bij de (verdere) hanteerbaarheid van het begrip 'indirect onderscheid' geplaatst

Pengaruh Pemberian Ab Mix dan Probiotik Terhadap Ikan Lele Sangkuriang (Clarias gariepinus) dan Kangkung Air (Ipomoea aquatica) pada Sistem Akuaponik

Akuaponik merupakan teknik akuakultur sistem resirkulasi, yaitu air yang telah tercemar oleh sisa metabolisme pada budidaya ikan digunakan untuk budidaya tanaman (sebagai filter) sehingga dapat digunakan kembali dalam sistem tersebut. Permasalahan yang sering ditemukan dalam sistem akuaponik adalah ketidakseimbangan antara ketersediaan hara dari limbah anorganik sisa metabolisme ikan dengan unsur hara yang diperlukan untuk pertumbuhan tanaman, maupun keseimbangan antara kecepatan degradasi limbah anorganik dengan daya dukung media budidaya pada sistem tersebut. Penelitian ini bertujuan untuk mengetahui pengaruh pemberian AB Mix dan probiotik terhadap ikan lele sangkuriang (Clarias gariepinus) dan kangkung air (Ipomea aquatica) pada sistem akuaponik sebagai upaya untuk mengatasi permasalahan tersebut. Penelitian ini merupakan penelitian eksperimental dengan desain penelitian Rancangan Acak Lengkap Faktorial. Terdapat dua faktor sebagai variabel bebas dalam penelitian ini, yaitu ABmix (dengan 2 taraf, yaitu 0 mL/L dan 1 mL/L) dan probiotik (dengan 3 taraf, yaitu 0 mL/L, 1 mL/L, dan 2 mL/L) . Terdapat 6 perlakuan dalam penelitian ini, yaitu AB0P0 (kontrol), AB0P1, AB0P2, AB1P0, AB1P1, AB1P2, dengan ulangan sebanyak 3 kali untuk setiap perlakuan. AB mix dan probiotik diberikan setiap seminggu sekali. Parameter pengamatan dalam penelitian ini adalah laju pertumbuhan spesifik (SGR), kelangsungan hidup ikan (SR), berat akhir kangkung (BA), suhu, pH, Dissolved Oxygen (DO), Total Dissolved Solid (TDS), dan amonia. Data penelitian dianalisis menggunakan Two Way ANOVA dan dilanjutkan dengan uji Duncan menggunakan aplikasi SPSS versi 26. Hasil penelitian menunjukkan bahwa pemberian AB mix dan probiotik berpengaruh terhadap sistem Akuaponik Ikan Lele Sangkuriang (Clarias gariepinus) dan Kangkung Air (Ipomoea aquatica). Pemberian probiotik dengan dosis 1 mL/L mampu meningkatkan kadar DO dan menurunkan kadar TDS, namun belum berpengaruh terhadap suhu, pH, dan amonia pada sistem akuaponik. Pemberian AB mix dan probiotik juga belum memberikan pengaruh terhadap pertumbuhan ikan lele sangkuriang (Clarias gariepinus) dan kangkung air (Ipomea aquatica) ditinjau dari parameter laju pertumbuhan spesifik ikan lele sangkuriang, kelangsungan hidup ikan lele sangkuriang, dan berat akhir kangkung air

Efficacy of SEBCLAIRA® Cream for Moderate Seborrhoeic Dermatitis on The Face as An Adjuvant Therapy (Randomised Clinical Trial, Double Blind)

Background: Seborrhoeic dermatitis (SD) is a chronic papulosquamous inflammatory disease which resistant to medical treatment. Various treatment such as topical corticosteroid, antifungal and calcineurin inhibitor has been widely practiced and gives varying results Objective: Our objective was to compare the efficacy of Sebclaira® and topical hydrocortisone 2,5% for management of moderate SD on the face Methods: A randomised clinical trial, controlled, double blind study was performed for four weeks. We assessed the efficacy and side effects of these topical treatment. The severity of SD was evaluated using Seborrhea Area Severity Index-Facial (SASI-F) score. The severity of pruritus was evaluated using Visual Analogue Scale. Demographic characteristics, baseline SASI-F and VAS were recorded in the medical record. Results: A 34 patients (14 males, 20 females) with moderate SD on the face completed the four weeks study. The mean of SASI T2 and VAS score of the Sebclaira® group was significantly lower than Hydrocortisone 2.5% group with p = 0.000 and p = 0.000 respectively. Tolerance between Sebclaira® and Hydrocortisone 2.5% showed insignificant results (p = 1.000) Conclusions: The longer application of Sebclaira® was significantly more effective to improve moderate S

The Effectiveness Of K-W-L Technique To Increase Students’ Reading Comprehension Achievement Through Reading Descriptive Text For Grade 8 of SMP Negeri 1 Cisarua

The purpose of this study is to find out whether there is a significant difference in reading comprehension achievement between those who are taught using the K-W-L (Know-Want to know-Learn) technique and those who are taught using the Conventional technique. In this study, the researcher used quantitative research. The participants of this study were students at SMP Negeri 1 Cisarua, Bandung. This study was conducted in ten meetings. This research was conducted in four steps: Pilot test, Pre-test, treatment (K-W-L technique) and post-test. After analyzing the data from the result of pre-test and post-test score it showed that there is significant difference in reading comprehension between those who are taught using K-W-L technique and those who are taught using conventional technique. Therefore, it can be concluded that the K-W-L technique as a teaching material has a positive impact in reading comprehension achievement.Key Word: K-W-L technique, Effectiveness, and Reading Comprehension

Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial

Background: The peritoneum is the second most common site of recurrence in colorectal cancer. Early detection of peritoneal carcinomatosis (PC) by imaging is difficult. Patients eventually presenting with clinically apparent PC have a poor prognosis. Median survival is only about five months if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CR/HIPEC). However, the effectiveness depends highly on the extent of disease and the treatment is associated with a considerable complication rate. Methods/Design: The aim of this study is to determine the effectiveness of adjuvant HIPEC in preventing the development of PC in patients with colon cancer at high risk of peritoneal recurrence. This study will be performed in the nine Dutch HIPEC centres, starting in April 2015. Eligible for inclusion are patients who underwent curative resection for T4 or intra-abdominally perforated cM0 stage colon cancer. After resection of the primary tumour, 176 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously or shortly after the primary resection. Oxaliplatin will be used as chemotherapeutic agent, for 30 min at 42-43 °C. Just before HIPEC, 5-fluorouracil and leucovorin will be administered intravenously. Primary endpoint is peritoneal disease-free survival at 18 months. Diagnostic laparoscopy will be performed routinely after 18 months postoperatively in both arms of the study in patients without evidence of disease based on routine follow-up using CT imaging and CEA. Discussion: Adjuvant HIPEC is assumed to reduce the expected 25 % absolute risk of PC in patients with T4 or perforated colon cancer to a risk of 10 %. This reduction is likely to translate into a prolonged overall survival. Trial registration number: NCT02231086 (Clinicaltrials.gov)

Neoadjuvant chemoradiotherapy plus surgery versus active surveillance for oesophageal cancer: A stepped-wedge cluster randomised trial

Background: Neoadjuvant chemoradiotherapy (nCRT) plus surgery is a standard treatment for locally advanced oesophageal cancer. With this treatment, 29% of patients have a pathologically complete response in the resection specimen. This provides the rationale for investigating an active surveillance approach. The aim of this study is to assess the (cost-)effectiveness of active surveillance vs. standard oesophagectomy after nCRT for oesophageal cancer. Methods: This is a phase-III multi-centre, stepped-wedge cluster randomised controlled trial. A total of 300 patients with clinically complete response (cCR, i.e. no local or disseminated disease proven by histology) after nCRT will be randomised to show non-inferiority of active surveillance to standard oesophagectomy (non-inferiority margin 15%, intra-correlation coefficient 0.02, power 80%, 2-sided α 0.05, 12% drop-out). Patients will undergo a first clinical response evaluation (CRE-I) 4-6 weeks after nCRT, consisting of endoscopy with bite-on-bite biopsies of the primary tumour site and other suspected lesions. Clinically complete responders will undergo a second CRE (CRE-II), 6-8 weeks after CRE-I. CRE-II will include 18F-FDG-PET-CT, followed by endoscopy with bite-on-bite biopsies and ultra-endosonography plus fine needle aspiration of suspected lymph nodes and/or PET- positive lesions. Patients with cCR at CRE-II will be assigned to oesophagectomy (first phase) or active surveillance (second phase of the study). The duration of the first phase is determined randomly over the 12 centres, i.e., stepped-wedge cluster design. Patients in the active surveillance arm will undergo diagnostic evaluations similar to CRE-II at 6/9/12/16/20/24/30/36/48 and 60 months after nCRT. In this arm, oesophagectomy will be offered only to patients in whom locoregional regrowth is highly suspected or proven, without distant dissemination. The main study parameter is overall survival; secondary endpoints include percentage of patients who do not undergo surgery, quality of life, clinical irresectability (cT4b) rate, radical resection rate, postoperative complications, progression-free survival, distant dissemination rate, and cost-effectiveness. We hypothesise that active surveillance leads to non-inferior survival, improved quality of life and a reduction in costs, compared to standard oesophagectomy. Discussion: If active surveillance and surgery as needed after nCRT leads to non-inferior survival compared to standard oesophagectomy, this organ-sparing approach can be implemented as a standard of care

Angiogenesis inhibitors in clinical development; where are we now and where are we going?

Angiogenesis is crucial for tumour growth and the formation of metastases. Various classes of angiogenesis inhibitors that are each able to inhibit one of the various steps of this complex process can be distinguished. Results from clinical studies with these agents are summarised. In general, it has been shown that most angiogenesis inhibitors can be safely administered, but that tumour regressions are rare. Combining angiogenesis inhibitors with cytotoxic chemotherapy can enhance anticancer activity. Recently, some promising data with regard to clinical efficacy have been presented. While performing clinical studies with angiogenesis inhibitors, defining biological activity is crucial, but thus far no validated techniques are available. It is conceivable that in the near future various classes of angiogenesis inhibitors will be combined in an attempt to further improve antiangiogenic and anticancer activity

Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial

Background: The peritoneum is the second most common site of recurrence in colorectal cancer. Early detection of peritoneal carcinomatosis (PC) by imaging is difficult. Patients eventually presenting with clinically apparent PC have a poor prognosis. Median survival is only about five months if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CR/HIPEC). However, the effectiveness depends highly on the extent of disease and the treatment is associated with a considerable complication rate. These clinical problems underline the need for effective adjuvant therapy in high-risk patients to minimize the risk of outgrowth of peritoneal micro metastases. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) seems to be suitable for this purpose. Without the need for cytoreductive surgery, adjuvant HIPEC can be performed with a low complication rate and short hospital stay. Methods/Design: The aim of this study is to determine the effectiveness of adjuvant HIPEC in preventing the development of PC in patients with colon cancer at high risk of peritoneal recurrence. This study will be performed in the nine Dutch HIPEC centres, starting in April 2015. Eligible for inclusion are patients who underwent curative resection for T4 or intra-abdominally perforated cM0 stage colon cancer. After resection of the primary tumour, 176 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously or shortly after the primary resection. Oxaliplatin will be used as chemotherapeutic agent, for 30 min at 42-43 degrees C. Just before HIPEC, 5-fluorouracil and leucovorin will be administered intravenously. Primary endpoint is peritoneal disease-free survival at 18 months. Diagnostic laparoscopy will be performed routinely after 18 months postoperatively in both arms of the study in patients without evidence of disease based on routine follow-up using CT imaging and CEA. Discussion: Adjuvant HIPEC is assumed to reduce the expected 25 % absolute risk of PC in patients with T4 or perforated colon cancer to a risk of 10 %. This reduction is likely to translate into a prolonged overall survival

RAS and BRAF mutations in cell-free DNA are predictive for outcome of cetuximab monotherapy in patients with tissue-tested RAS wild-type advanced colorectal cancer

In metastatic colorectal cancer, RAS and BRAF mutations cause resistance to anti-EGFR therapies, such as cetuximab. Heterogeneity in RAS and BRAF mutations might explain nonresponse in a subset of patients receiving cetuximab. Analyzing mutations in plasma-derived circulating tumor DNA (ctDNA) could provide a more comprehensive overview of the mutational landscape as compared to analyses of primary and/or metastatic tumor tissue. Therefore

Neo-adjuvant chemotherapy followed by surgery versus surgery alone in high-risk patients with resectable colorectal liver metastases: The CHARISMA randomized multicenter clinical trial

Background: Efforts to improve the outcome of liver surgery by combining curative resection with chemotherapy have failed to demonstrate de