Economic development for an exploding population

A journal article on economic development for an expanding population.I could use this occasion to come up with lots of facts and figures on population explosion and economic development. Alternatively, I could expand on the nature and use of mathematical computer models of population or socioeconomic development, which is my field of research. I am not going to do either of these. What I am going to do is to look at the development needs and problems of a country faced with an exploding population from my personal point of view, and on the assumption that Rhodesia, or if you prefer Zimbabwe, will emerge from its present political problems with a stable government, whatever its political flavour might be. I do believe that this symposium was organised in the spirit of this assumption, and with this hope, for where there is no hope there is no way

Travel medicine : knowledge, attitude, practice and immunisation

In an epoch where every generation travels more frequently and at longer distances than the previous generation, with a mean increase of 30 million travellers per year from 1995 until today, physicians throughout the world are confronted with new diseases. In absolute numbers, this implies that each year, roughly 4 million travellers appeal to specialised health care, either abroad or at home, because of systemic febrile illness, diarrhoea or dermatologic disorders. During the last decades, travel medicine has evolved into a distinct discipline of Infectious Diseases, eventhough transmission of infectious agents into vulnerable populations through travel has been well know for centuries. Improvement of of protection against travel-related diseases can be achieved through knowledge on the following topics; 1. Epidemiology of travel-related diseases, 2. Morbidity and mortality of these illnesses in specific groups of travellers, 3. Adherence to travel health precautions, 4. Responsivity against vaccination, and 5. Availability of preventive measures, such as vaccines. The research described in this thesis addresses these various topics.Schlumberger, Bronovo hospital, Jurriaanse stichting, GlaxoSmithKlineUBL - phd migration 201

Patient flow analysis in pain rehabilitation care

Background: Rehabilitation Care is a treatment process that involves multiple disciplines, which are affiliated with different departments and use different planning horizons. This often results in planning difficulties and long waiting lists. In order to increase efficiency the Rehabilitation Centre "Het Roessingh" in the Netherlands has introduced the concept of treatment plans. Purposes: We support Het Roessingh to make their organizational process ready for implementation of treatment plans with the managerial purpose to prospectively assess the consequences of various interventions, without experimenting on the real-world system. Methods: We use mathematical models based on techniques from Operations Research and Management Science. A simulation model is used to analyze the integral impact of proposed organizational solutions on the patient flows. Findings: First, given the number of referrals per week, a necessary number of intake slots is determined in order to satisfy the access time requirements. Second, we quantify capacity losses resulting from cancellations of interdisciplinary meetings,. Third, we conclude that several disciplines are going to form bottlenecks in patient flow once the treatment plans are implemented. Fourth, a balanced staffing rule is computed for each discipline, by which bottlenecks will be avoided and higher efficiency will be achieved,. Finally, we show that the system cannot function at demand/capacity ratios close to 100% because disciplines affect each other. Practice Implications: A sufficient number of intake slots must be planned weekly. The interdisciplinary meetings are of great importance and must have top priority for practitioners. When the treatment plans are implemented, the proposed balanced staffing rule enables a higher efficiency than the current staffing rule. It must be accepted by the management that multidisciplinary care cannot function with 100% efficiency, because of the necessity to buffer for variation in demand, and the interdependency between the disciplines in each patient treatment

Regulation of the Ets transcription factor Tel

In this thesis we report novel studies on the molecular regulation of the transcriptional repressor Tel (Translocation Ets Leukemia). The work in this thesis is presented as follows: Chapter 1 is an introduction which summarizes the literature about Tel and its Drosophila orthologue Yan as it was known prior to the work presented here. Chapter 2 shows that Tel is modified by SUMO (Small Ubiquitin-like Modifier) on the highly conserved lysine 11 (K11), which serves to inhibit DNA binding of Tel. Chapter 3 describes the regulation of Tel and Yan by the F-box protein Fbl6, which mediates ubiquitination and subsequent degradation of Tel/Yan. Chapter 4 reports that Tel regulates angiogenesis through recruitment of the generic corepressor C-terminal Binding Protein (CtBP). This complex integrates intracellular Vascular Endothelial Growth Factor (VEGF) signaling and intercellular Delta-like 4 (Dll4)/Notch signaling. The impact of these findings is discussed in the general discussion in Chapter 5. Taken together the work in this thesis provides significant advances in the molecular details of Tel regulation. Furthermore, the work in chapter 4 should be of considerable importance to the field of angiogenesis.UBL - phd migration 201

Bijdrage tot de kennis van wezen en waarde der volkscultuur

Rede Wageningen, 24 Maart 194

Performance of self-diagnosis and standby treatment of malaria in international oilfield service employees in the field

<p>Abstract</p> <p>Background</p> <p>Falciparum malaria remains a major occupational illness that accounts for several deaths per year and numerous lost working days among the expatriate population, working or living in high-risk malarious areas. Compliance to preventive strategies is poor in travellers, especially business travellers, expatriates and long-term travellers.</p> <p>Methods</p> <p>In this cross-sectional, web-based study the adherence to and outcome of a preventive malaria programme on knowledge, attitudes and practices, including the practice of self-diagnosis and standby treatment (curative malaria kit, CMK) was evaluated in 2,350 non-immune expatriates, who had been working in highly malaria endemic areas.</p> <p>Results</p> <p>One-third (N = 648) of these expatriates visited a doctor for malaria symptoms and almost half (29 of 68) of all hospitalizations were due to malaria. The mandatory malaria training for non-immunes was completed by 92% of those who visited or worked in a high risk malaria country; 70% of the respondents at risk also received the CMK. The malaria awareness training and CMK significantly increased malaria knowledge [relative risk (RR) of 1.5, 95%CI 1.2–2.1], attitudes and practices, including compliance to chemoprophylaxis [RR = 2.2, 95%CI 1.6–3.2]. Hospitalization for malaria tended to be reduced by the programme [RR = 0.4, 95%CI 0.1–1.1], albeit not significantly. Respondents who did not receive instructions on the rapid diagnostic test were two times [RR = 2.3, 95%CI 1.6–3.3] more likely to have difficulties. Those who did receive instructions adhered poorly to the timing of repeating the test. Moreover, 6% (31 of 513) of those with a negative test result were diagnosed with malaria by a local doctor. 77% (N = 393) of the respondents with a negative test result did not take curative medication. 57% (252 of 441) of the respondents who took the curative medication that was included in the kit did not have a positive self-test or clinical malaria diagnosis made by a doctor.</p> <p>Conclusion</p> <p>This survey demonstrated that a comprehensive programme targeting malaria prevention in expatriates can be effectively implemented and that it significantly increased malaria awareness.</p

Intradermally Administered Yellow Fever Vaccine at Reduced Dose Induces a Protective Immune Response: A Randomized Controlled Non-Inferiority Trial

Background:Implementation of yellow fever vaccination is currently hampered by limited supply of vaccine. An alternative route of administration with reduced amounts of vaccine but without loss of vaccine efficacy would boost vaccination programmes.Methods and Findings:A randomized, controlled, non-inferiority trial was conducted in a Dutch university center between August 2005 and February 2007. A total of 155 primary vaccinated and 20 previously vaccinated volunteers participated. Participants were randomly assigned in a 1:1 ratio to receive intradermal (i.d.) vaccination with live attenuated yellow fever 17D vaccine at a reduced dose (1/5th; 0·1 mL) or the conventional subcutaneous (s.c.) vaccination (0·5 mL). Antibody neutralization titers were determined at 2, 4 and 8 weeks and 1 year after vaccination by counting the reduction in virus-induced plaques in the presence of serial serum dilutions. Adverse events were documented in a 3-week dairy. Viraemia was measured 5 days after vaccination. From 2 weeks up to one year after vaccination, the maximum serum-dilution at which 80% of the virus plaques were neutralized, which indicates protection against yellow fever, did not differ between those given a reduced i.d. dose or standard s.c. dose of vaccine. In all cases the WHO standard of seroprotection (i.e. 80% virus neutralization) was reached (in 77/77 and 78/78, respectively). Similar results were found in the previously vaccinated individuals. Viraemia was detected in half of the primary vaccinated participants, which was not predictive of serological response. In revaccinees no viraemia was detected.Conclusions:Intradermal administration of one fifth of the amount of yellow fever vaccine administered subcutaneously results in protective seroimmunity in all volunteers. Albeit this vaccination route should enable vaccination of five-times as many individuals at risk for disease, these results should now be confirmed in field studies in areas with potential yellow fever virus transmission to change vaccination policy.Trial Registration:Nederlands Trial Register ISRCTN46326316