Making Sense of EU State-aid Requirements; The case of Green Services

This article describes the establishment of a new local governance arrangement called `Green Service¿ in the Netherlands. Under this programme, farmers are financially rewarded - by both public and private bodies - for their nature and landscape management and development activities. Despite a general positive stance, it has taken considerable efforts and time for these programmes to take off, in particular due to uncertainties and discussions on whether these activities would be feasible under the EU state aid regime. The multi level setting in which these rules had to be complied with contributed much to the long lasting discussion on how to interpret these rules and threatened the credibility of this new governance arrangement. We will describe and explain this process by using a so-called `processual institutional¿ approach and more specifically by drawing on the socio-cognitive literature on conflict escalation (Pruitt and Rubin 1986; Rubin, Pruitt et al. 1994)

Characteristics differentiating problem representation synthesis between novices and experts

Background: Formulating a thoughtful problem representation (PR) is fundamental to sound clinical reasoning and an essential component of medical education. Aside from basic structural recommendations, little consensus exists on what characterizes high-quality PRs. Objectives: To elucidate characteristics that distinguish PRs created by experts and novices. Methods: Early internal medicine residents (novices) and inpatient teaching faculty (experts) from two academic medical centers were given two written clinical vignettes and were instructed to write a PR and three-item differential diagnosis for each. Deductive content analysis described the characteristics comprising PRs. An initial codebook of characteristics was refined iteratively. The primary outcome was differences in characteristic frequencies between groups. The secondary outcome was characteristics correlating with diagnostic accuracy. Mixed-effects regression with random effects modeling compared case-level outcomes by group. Results: Overall, 167 PRs were analyzed from 30 novices and 54 experts. Experts included 0.8 fewer comorbidities (p &lt;.01) and 0.6 more examination findings (p =.01) than novices on average. Experts were less likely to include irrelevant comorbidities (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2–0.8) or a diagnosis (OR = 0.3, 95% CI = 0.1–0.8) compared with novices. Experts encapsulated clinical data into higher-order terms (e.g., sepsis) than novices (p &lt;.01) while including similar numbers of semantic qualifiers (SQs). Regardless of expertise level, PRs following a three-part structure (e.g., demographics, temporal course, and clinical syndrome) and including temporal SQs were associated with diagnostic accuracy (p &lt;.01). Conclusions: Compared with novices, expert PRs include less irrelevant data and synthesize information into higher-order concepts. Future studies should determine whether targeted educational interventions for PRs improve diagnostic accuracy.</p

Functions of granulocytes after allogeneic bone marrow transplantation

Contains fulltext : 4329.pdf (publisher's version ) (Open Access

Characteristics differentiating problem representation synthesis between novices and experts

Background: Formulating a thoughtful problem representation (PR) is fundamental to sound clinical reasoning and an essential component of medical education. Aside from basic structural recommendations, little consensus exists on what characterizes high-quality PRs. Objectives: To elucidate characteristics that distinguish PRs created by experts and novices. Methods: Early internal medicine residents (novices) and inpatient teaching faculty (experts) from two academic medical centers were given two written clinical vignettes and were instructed to write a PR and three-item differential diagnosis for each. Deductive content analysis described the characteristics comprising PRs. An initial codebook of characteristics was refined iteratively. The primary outcome was differences in characteristic frequencies between groups. The secondary outcome was characteristics correlating with diagnostic accuracy. Mixed-effects regression with random effects modeling compared case-level outcomes by group. Results: Overall, 167 PRs were analyzed from 30 novices and 54 experts. Experts included 0.8 fewer comorbidities (p &lt;.01) and 0.6 more examination findings (p =.01) than novices on average. Experts were less likely to include irrelevant comorbidities (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.2–0.8) or a diagnosis (OR = 0.3, 95% CI = 0.1–0.8) compared with novices. Experts encapsulated clinical data into higher-order terms (e.g., sepsis) than novices (p &lt;.01) while including similar numbers of semantic qualifiers (SQs). Regardless of expertise level, PRs following a three-part structure (e.g., demographics, temporal course, and clinical syndrome) and including temporal SQs were associated with diagnostic accuracy (p &lt;.01). Conclusions: Compared with novices, expert PRs include less irrelevant data and synthesize information into higher-order concepts. Future studies should determine whether targeted educational interventions for PRs improve diagnostic accuracy.</p

The mathematics of french fries

Although the act of cutting a single potato (Solanum tuberosum) into french fries may appear to be trivial, the questions concerning the efficiency of this process on an industrial scale are quite daunting. Therefore, many producers are looking for a rigorous method to evaluate the market potential of a given potato crop by predicting the number and parameters of the fries that can be cut from it. Applying the methods of geometry and numerical analysis our group was able to propose several algorithms that can be directly incorporated into the existing production process. Keywords: French fries, geometry, cutting, Finite Fry Method, simulations, histogram

Left ventricular strain-volume loops in bicuspid aortic valve disease:new insights in cardiomechanics

AIMS: By combining temporal changes in left ventricular (LV) global longitudinal strain (GLS) with LV volume, LV strain-volume loops can assess cardiac function across the cardiac cycle. This study compared LV strain-volume loops between bicuspid aortic valve (BAV) patients and controls, and investigated the loop’s prognostic value for clinical events.METHODS AND RESULTS: From a prospective cohort of congenital heart disease patients, BAV patients were selected and compared with healthy volunteers, who were matched for age and sex at group level. GLS7 analysis from apical views were used to construct strain-volume loops. Associations with clinical events, i.e. a composite of all-cause mortality, heart failure, arrhythmias and aortic valve replacement, were assessed by Cox regression. 113 BAV patients were included (median age 32 years, 40% female). BAV patients demonstrated lower Sslope (0.21%/mL, [Q1-Q3: 0.17-0.28] vs. 0.27%/mL [0.24-0.34], p&lt;0.001) and ESslope (0.19%/mL [0.12-0.25] vs. 0.29%/mL [0.21-0.43], p&lt;0.001) compared to controls, but also greater uncoupling during early (0.48±1.29 vs. 0.06±1.2, p=0.018) and late diastole (0.66±1.01 vs -0.06±1.09, p&lt;0.001). Median follow-up duration was 9.9 [9.3-10.4] years. Peak aortic jet velocity (HR 1.22, p=0.03), enlarged left atrium (HR 3.16, p=0.003), E/e’ ratio (HR 1.17, p=0.002), GLS (HR 1.16, p=0.008) and ESslope (HR 0.66, p=0.04) were associated with the occurrence of clinical events.CONCLUSION: Greater uncoupling and lower systolic and diastolic slopes were observed in BAV patients compared to healthy controls, suggesting presence of altered LV cardiomechanics. Moreover, lower ESslope was associated with clinical events, highlighting the strain-volume loop’s potential as prognostic marker

Left ventricular strain-volume loops in bicuspid aortic valve disease:new insights in cardiomechanics

AIMS: By combining temporal changes in left ventricular (LV) global longitudinal strain (GLS) with LV volume, LV strain-volume loops can assess cardiac function across the cardiac cycle. This study compared LV strain-volume loops between bicuspid aortic valve (BAV) patients and controls, and investigated the loop’s prognostic value for clinical events.METHODS AND RESULTS: From a prospective cohort of congenital heart disease patients, BAV patients were selected and compared with healthy volunteers, who were matched for age and sex at group level. GLS7 analysis from apical views were used to construct strain-volume loops. Associations with clinical events, i.e. a composite of all-cause mortality, heart failure, arrhythmias and aortic valve replacement, were assessed by Cox regression. 113 BAV patients were included (median age 32 years, 40% female). BAV patients demonstrated lower Sslope (0.21%/mL, [Q1-Q3: 0.17-0.28] vs. 0.27%/mL [0.24-0.34], p&lt;0.001) and ESslope (0.19%/mL [0.12-0.25] vs. 0.29%/mL [0.21-0.43], p&lt;0.001) compared to controls, but also greater uncoupling during early (0.48±1.29 vs. 0.06±1.2, p=0.018) and late diastole (0.66±1.01 vs -0.06±1.09, p&lt;0.001). Median follow-up duration was 9.9 [9.3-10.4] years. Peak aortic jet velocity (HR 1.22, p=0.03), enlarged left atrium (HR 3.16, p=0.003), E/e’ ratio (HR 1.17, p=0.002), GLS (HR 1.16, p=0.008) and ESslope (HR 0.66, p=0.04) were associated with the occurrence of clinical events.CONCLUSION: Greater uncoupling and lower systolic and diastolic slopes were observed in BAV patients compared to healthy controls, suggesting presence of altered LV cardiomechanics. Moreover, lower ESslope was associated with clinical events, highlighting the strain-volume loop’s potential as prognostic marker

Improved survival for adolescents and young adults with Hodgkin lymphoma and continued high survival for children in the Netherlands: a population-based study during 1990–2015

Population-based studies that assess long-term patterns of incidence, major aspects of treatment and survival are virtually lacking for Hodgkin lymphoma (HL) at a younger age. This study assessed the progress made for young patients with HL (<25 years at diagnosis) in the Netherlands during 1990–2015. Patient and tumour characteristics were extracted from the population-based Netherlands Cancer Registry. Time trends in incidence and mortality rates were evaluated with average annual percentage change (AAPC) analyses. Stage at diagnosis, i