Use of neoadjuvant chemotherapy in locally advanced breast cancer in the Netherlands

Use of neoadjuvant chemotherapy in locally advanced breast cancer in the Netherlands P.E.R. Spronk1, A.C.M. Van Bommel1, S. Siesling2,3, M.J.T. Baas- Vrancken Peeters4, C.H. Smorenburg5. 1Leiden University Medical Centre, Surgery, Leiden, Netherlands; 2Comprehensive Cancer Centre the Netherlands IKNL, Epidemiology, Utrecht, Netherlands; 3University of Twente, MIRA Biomedical science and Technical Medicine, Twente, Netherlands; 4Netherlands Cancer Institute/Antoni van Leeuwenhoek, Surgery, Amsterdam, Netherlands; 5Netherlands Cancer Institute/Antoni van Leeuwenhoek, Medical Oncology, Amsterdam, Netherlands Background: Neoadjuvant chemotherapy (NAC) is the treatment of choice for patients with locally advanced breast cancer (LABC). The aim of this study is to examine the use of NAC for LABC in all Dutch hospitals participating in breast cancer care and to assess what patient, tumour and hospital characteristics influence its use. Material and Methods: Data were derived from the national multidisciplinary NABON Breast Cancer Audit (NBCA), regarding all women aged >18 years and newly diagnosed with LABC from January 2011 to September 2013. Multivariable logistic regression was used to assess the association between the use of NAC and patient, tumour and hospital related factors. Results: Of 1419 woman diagnosed with LABC, 70% were treated with NAC. This percentage varied from 12.5% to 90% between hospitals and did not increase over time. Factors associated with the use of NAC included young age, large tumour size, more advanced nodal disease and triple negative or hormone-receptor negative tumours. Also patients treated in hospitals with a multidisciplinary preoperative work-up and participation in neoadjuvant studies were more likely to receive NAC. However, considerable variation between hospitals remained after casemix correction. Table 1. Multivariable odds ratios (ORs) for receipt of NAC among 1419 stage III patients 2011 through 2013 OR 95% CI P-value Age 0.000 5 cm 5.68 2.34−13.79 Clinical nodal status 0.000 cNx/N0 ref. cN1 1.32 0.86−2.04 cN2 2.93 1.18−7.29 cN3 10.28 4.18−25.25 Receptor status 0.000 Triple negative 2.35 1.40−3.93 HR−, Her2+ 3.37 1.67−6.78 HR+, Her2+ 0.91 0.51−1.60 HR+, Her2− ref. Type of surgery 0.026 Breast conservation therapy 2.05 1.09−3.84 Mastectomy ref. Multidisciplinary team 0.021 Yes 1.98 1.11−3.53 No ref. Type of hospital 0.569 General 1.20 0.73−1.98 Top clinical ref. Academic 1.50 0.64−3.47 Hospital surgical volume 0.729 200 1.27 0.70−2.31 Study participation 0.005 Yes 1.80 1.20−2.70 No ref. Conclusions: There is considerable variation in the use of NAC for LABC in the Netherlands. Although various patient, tumor and institutional factors are associated with the use of NAC in LABC, these can only explain part of the observed variation in treatment patterns between hospitals

Kaasmakersregistratiekaart is nuttig

Voor boerenkaasbereiders is door het PR een registratiekaart ontwikkeld als hulpmiddel bij de controle van de kaasbereiding. Deze kaart is getest door zestien kaasmakers en de gebruikservaringen zijn positief

The incidence and nature of in-hospital adverse events: a systematic review

INTRODUCTION: Adverse events in hospitals constitute a serious problem with grave consequences. Many studies have been conducted to gain an insight into this problem, but a general overview of the data is lacking. We performed a systematic review of the literature on in-hospital adverse events. METHODS: A formal search of Embase, Cochrane and Medline was performed. Studies were reviewed independently for methodology, inclusion and exclusion criteria and endpoints. Primary endpoints were incidence of in-hospital adverse events and percentage of preventability. Secondary endpoints were adverse event outcome and subdivision by provider of care, location and type of event. RESULTS: Eight studies including a total of 74 485 patient records were selected. The median overall incidence of in-hospital adverse events was 9.2%, with a median percentage of preventability of 43.5%. More than half (56.3%) of patients experienced no or minor disability, whereas 7.4% of events were lethal. Operation- (39.6%) and medication-related (15.1%) events constituted the majority. We present a summary of evidence-based interventions aimed at these categories of events. CONCLUSIONS: Adverse events during hospital admission affect nearly one out of 10 patients. A substantial part of these events are preventable. Since a large proportion of the in-hospital events are operation- or drug-related, interventions aimed at preventing these events have the potential to make a substantial differenc

An acoustic-phonetic study of retraction of /s/ in Moroccan Dutch and endogenous Dutch

In Moroccan Dutch, /s/ has been claimed to be pronounced as retracted [s] (towards /ʃ/) in certain consonant clusters. Recently, retracted s-pronunciation has also been attested in endogenous Dutch. We tested empirically whether Moroccan Dutch [s] is indeed more retracted than endogenous Dutch [s] in relevant clusters. Additionally, we tested whether the inter-speaker variation of /s/ is smaller between Moroccan Dutch speakers than between endogenous Dutch speakers, as expected if retraction of /s/ would be used as identity marker in in-group conversations in Moroccan Dutch. The [s] realizations of 21 young, male Moroccan Dutch and 21 endogenous Dutch speakers were analyzed. Analyses of the spectral centre of gravity (CoG) show that both groups of speakers had more retracted pronunciations of [s] in typically retracting contexts than in typically non-retracting contexts. However, Moroccan Dutch speakers had higher CoG in both contexts than endogenous Dutch speakers, refuting the stronger retraction expected in Moroccan Dutch speakers. The inter-speaker variation was larger between Moroccan Dutch speakers than between endogenous-Dutch speakers, refuting the expected usage of /s/ retraction as a group identity marker.NWOTheoretical and Experimental Linguistic

/s/-retraction in Moroccan Dutch and endogenous Dutch

NWOTheoretical and Experimental Linguistic

Heating mechanisms in radio frequency driven ultracold plasmas

Several mechanisms by which an external electromagnetic field influences the temperature of a plasma are studied analytically and specialized to the system of an ultracold plasma (UCP) driven by a uniform radio frequency (RF) field. Heating through collisional absorption is reviewed and applied to UCPs. Furthermore, it is shown that the RF field modifies the three body recombination process by ionizing electrons from intermediate high-lying Rydberg states and upshifting the continuum threshold, resulting in a suppression of three body recombination. Heating through collisionless absorption associated with the finite plasma size is calculated in detail, revealing a temperature threshold below which collisionless absorption is ineffective.Comment: 14 pages, 7 figure

Microbunching instability characterization via temporally modulated laser pulses

High-brightness electron bunches, such as those generated and accelerated in free-electron lasers (FELs), can develop small-scale structure in the longitudinal phase space. This causes variations in the slice energy spread and current profile of the bunch which then undergo amplification, in an effect known as the microbunching instability. By imposing energy spread modulations on the bunch in the low-energy section of an accelerator, using an undulator and a modulated laser pulse in the center of a dispersive chicane, it is possible to manipulate the bunch longitudinal phase space. This allows for the control and study of the instability in unprecedented detail. We report measurements and analysis of such modulated electron bunches in the 2D spectrotemporal domain at the Fermi FEL, for three different bunch compression schemes. We also perform corresponding simulations of these experiments and show that the codes are indeed able to reproduce the measurements across a wide spectral range. This detailed experimental verification of the ability of codes to capture the essential beam dynamics of the microbunching instability will benefit the design and performance of future FELs