Product Policy as an Instrument for Water Quality Management.

A main reason for the persistence of current water pollution lies in the diffuse character of many of its sources. For a large part such diffuse pollution is related to the production, use and waste of various kinds of products. For the reduction of this pollution, a product oriented policy strategy, based on interaction with stakeholders could be more successful than the traditional measures of direct regulation that were devised for point source reduction. In this article we identify different types of product policy, and explore the potential benefits and costs for water quality management. The methods that can be used in a product policy approach are illustrated with some examples. Although the specific advantages for water quality management have not been quantified yet, governments increasingly recognise the potential positive effects. In this context, the European Water Framework Directive, in stimulating product policy by enhancing public and stakeholders’ participation, can be considered to be part of a general development towards interactive water management

The effect of a goal-setting strategy with integrated feedback on goal attainment in inflammatory arthritis patients:a mixed method study

Patients with Inflammatory Arthritis (IA) often experience difficulties in daily life as a result of their disease. Unfortunately, outpatient consultations in daily practice tend to focus on medical topics, thereby ignoring the impact of the disease on patients’ daily lives. Patient-Reported Outcomes (PROs) can be used to understand this impact, but they are not enough for offering person-centered care. Because the patient’s true values and goals can only be ascertained during a proper conversation, which should include both medical as well as patient goals. Therefore, the aim of the study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in IA patients. IA patients with an active disease were given the opportunity to set and follow-up goals. In addition to goal setting, patients were asked to complete online questionnaires on various PROs, including HRQoL. Ninety-two IA patients participated in the study. The mean age was 51 years and most of them had rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. In the entire population, HRQoL did not change over time, but patients who did not meet their goals tended to report a lower HRQoL. Incorporating a feedback mechanism in a goal-setting strategy has a positive effect on goal attainment. Yet no effect was seen on HRQoL, but this may due to the fact that general HRQoL measurement are not sensitive or specific enough to detect changes that are accompanied with goal setting and attainment.</p

Integrating the soybean‑maize‑chicken value chains to attain nutritious diets in Tanzania

Open Access Article; Published online: 09 Sep 2021In Tanzania, diets are dominated by starchy staple crops such as maize, levels of malnutrition are high and largely attributed to lack of dietary diversity. We employed fuzzy cognitive mapping to understand the current soybean, maize and chicken value chains, to highlight stakeholder relationships and to identify entry points for value chain integration to support nutritious diets in Tanzania. The fuzzy cognitive maps were constructed based on information gathered during household interviews with 569 farming households, followed by a participatory workshop with 54 stakeholders involved in the three value chains. We found that the soybean, maize and chicken value chains were interconnected, particularly at the level of the smallholder farming systems and at processing facilities. Smallholder farming households were part of one or more value chains. Chicken feed is an important entry point for integrating the three value chains, as maize and soybean meal are the main sources of energy and protein for chicken. Unlike maize, the utilization of soybean in chicken feed is limited, mainly due to inadequate quality of processing of soybean grain into meal. As a result, the soybean grain produced by smallholders is mainly exported to neighbouring countries for further processing, and soybean meal is imported at relatively high prices. Enhancing local sourcing and adequate processing of soybean, coupled with strengthening the integration of smallholder farmers with other soybean, maize and chicken value chain actors offers an important opportunity to improve access to nutritious diets for local people. Our method revealed the importance of interlinkages that integrate the value chains into a network within domestic markets

Non-adherence to guideline recommendations for insulins:: a qualitative study amongst primary care practitioners

Background: Guideline adherence is generally high in Dutch general practices. However, the prescription of insulins to type 2 diabetes mellitus patients is often not in line with the guideline, which recommends NPH insulin as first choice and discourages newer insulins. This qualitative study aimed to identify the reasons why primary care healthcare professionals prescribe insulins that are not recommended in guidelines. Methods: Digital focus groups with primary care practitioners were organised. A topic list was developed, based on reasons for preferred insulins obtained from literature and a priori expert discussions. The discussions were video and audio-recorded, transcribed verbatim and coded with a combination of inductive and deductive codes. Codes were categorized into an existing knowledge, attitudes and behaviour model for guideline non-adherence. Results: Four focus groups with eleven general practitioners, twelve practice nurses, six pharmacists, four diabetes nurses and two nurse practitioners were organised. The prescription of non-recommended insulins was largely driven by argumentation in the domain of attitudes. Lack of agreement with the guideline was the most prominent category. Most of those perspectives did not reflect disagreement with the guideline recommendations in general, but were about advantages of non-recommended insulins, which led, according to the healthcare professionals, to better applicability of those insulins to specific patients. The belief that guideline-recommended insulins were less effective, positive experience with other insulins and marketing from pharmaceutical companies were also identified as attitude-related barriers to prescribe guideline-recommended insulins. One additional category in the domain of attitudes was identified, namely the lack of uniformity in policy between healthcare professionals in the same practice. Only a small number of external barriers were identified, focusing on patient characteristics that prevented the use of recommended insulins, the availability of contradictory guidelines and other, mostly secondary care, healthcare providers initiating non-recommended insulins. No knowledge-related barriers were identified. Conclusions: The prescription of non-recommended insulins in primary care is mostly driven by lack of agreement with the guideline recommendations and different interpretation of evidence. These insights can be used for the development of interventions to stimulate primary care practitioners to prescribe guideline-recommended insulins

Paired and clustered quantum Hall states

We briefly summarize properties of quantum Hall states with a pairing or clustering property. Their study employs a fundamental connection with parafermionic Conformal Field Theories. We report on closed form expressions for the many-body wave functions and on multiplicities of the fundamental quasi-hole excitations.Comment: 13 pages, Contribution to the proceedings of the NATO Advanced Research Workshop "Statistical Field Theories" Como (Italy), June 18-23 200

Prognostic value of patient-reported quality of life for survival in oesophagogastric cancer:Analysis from the population-based POCOP study

BACKGROUND: Accumulating evidence of trials demonstrates that patient-reported health-related quality of life (HRQoL) at diagnosis is prognostic for overall survival (OS) in oesophagogastric cancer. However, real-world data are lacking. Moreover, differences in disease stages and tumour-specific symptoms are usually not taken into consideration. The aim of this population-based study was to assess the prognostic value of HRQoL, including tumour-specific scales, on OS in patients with potentially curable and advanced oesophagogastric cancer. METHODS: Data were derived from the Netherlands Cancer Registry and the patient reported outcome registry (POCOP). Patients included in POCOP between 2016 and 2018 were stratified for potentially curable (cT1-4aNallM0) or advanced (cT4b or cM1) disease. HRQoL was measured with the EORTC QLQ-C30 and the tumour-specific OG25 module. Cox proportional hazards models assessed the impact of HRQoL, sociodemographic and clinical factors (including treatment) on OS. RESULTS: In total, 924 patients were included. Median OS was 38.9 months in potentially curable patients (n = 795) and 10.6 months in patients with advanced disease (n = 129). Global Health Status was independently associated with OS in potentially curable patients (HR 0.89, 99%CI 0.82-0.97), together with several other HRQoL items: appetite loss, dysphagia, eating restrictions, odynophagia, and body image. In advanced disease, the Summary Score was the strongest independent prognostic factor (HR 0.75, 99%CI 0.59-0.94), followed by fatigue, pain, insomnia and role functioning. CONCLUSION: In a real-world setting, HRQoL was prognostic for OS in patients with potentially curable and advanced oesophagogastric cancer. Several HRQoL domains, including the Summary Score and several OG25 items, could be used to develop or update prognostic models

One-Sided Position-Dependent Smoothness-Increasing Accuracy-Conserving (SIAC) Filtering Over Uniform and Non-Uniform Meshes

In this paper, we introduce a new position-dependent Smoothness-Increasing Accuracy-Conserving (SIAC) filter that retains the benefits of position dependence while ameliorating some of its shortcomings. As in the previous position-dependent filter, our new filter can be applied near domain boundaries, near a discontinuity in the solution, or at the interface of different mesh sizes; and as before, in general, it numerically enhances the accuracy and increases the smoothness of approximations obtained using the discontinuous Galerkin (dG) method. However, the previously proposed position-dependent one-sided filter had two significant disadvantages: (1) increased computational cost (in terms of function evaluations), brought about by the use of $4k+1$ central B-splines near a boundary (leading to increased kernel support) and (2) increased numerical conditioning issues that necessitated the use of quadruple precision for polynomial degrees of $k\ge 3$ for the reported accuracy benefits to be realizable numerically. Our new filter addresses both of these issues --- maintaining the same support size and with similar function evaluation characteristicsas the symmetric filter in a way that has better numerical conditioning --- making it, unlike its predecessor, amenable for GPU computing. Our new filter was conceived by revisiting the original error analysis for superconvergence of SIAC filters and by examining the role of the B-splines and their weights in the SIAC filtering kernel. We demonstrate, in the uniform mesh case, that our new filter is globally superconvergent for $k=1$ and superconvergent in the interior (e.g., region excluding the boundary) for $k\ge2$. Furthermore, we present the first theoretical proof of superconvergence for postprocessing over smoothly varying meshes, and explain the accuracy-order conserving nature of this new filter when applied to certain non-uniform meshes cases. We provide numerical examples supporting our theoretical results and demonstrating that our new filter, in general, enhances the smoothness and accuracy of the solution. Numerical results are presented for solutions of both linear and nonlinear equation solved on both uniform and non-uniform one- and two-dimensional meshes

Smoothness-Increasing Accuracy-Conserving (SIAC) filtering and quasi interpolation: A unified view

Filtering plays a crucial role in postprocessing and analyzing data in scientific and engineering applications. Various application-specific filtering schemes have been proposed based on particular design criteria. In this paper, we focus on establishing the theoretical connection between quasi-interpolation and a class of kernels (based on B-splines) that are specifically designed for the postprocessing of the discontinuous Galerkin (DG) method called Smoothness-Increasing Accuracy-Conserving (SIAC) filtering. SIAC filtering, as the name suggests, aims to increase the smoothness of the DG approximation while conserving the inherent accuracy of the DG solution (superconvergence). Superconvergence properties of SIAC filtering has been studied in the literature. In this paper, we present the theoretical results that establish the connection between SIAC filtering to long-standing concepts in approximation theory such as quasi-interpolation and polynomial reproduction. This connection bridges the gap between the two related disciplines and provides a decisive advancement in designing new filters and mathematical analysis of their properties. In particular, we derive a closed formulation for convolution of SIAC kernels with polynomials. We also compare and contrast cardinal spline functions as an example of filters designed for image processing applications with SIAC filters of the same order, and study their properties

Phase II Feasibility and Biomarker Study of Neoadjuvant Trastuzumab and Pertuzumab With Chemoradiotherapy for Resectable Human Epidermal Growth Factor Receptor 2-Positive Esophageal Adenocarcinoma:TRAP Study

PURPOSE: Approximately 15% to 43% of esophageal adenocarcinomas (EACs) are human epidermal growth factor receptor 2 (HER2) positive. Because dual-agent HER2 blockade demonstrated a survival benefit in breast cancer, we conducted a phase II feasibility study of trastuzumab and pertuzumab added to neoadjuvant chemoradiotherapy (nCRT) in patients with EAC. PATIENTS AND METHODS: Patients with resectable HER2-positive EAC received standard nCRT with carboplatin and paclitaxel and 41.4 Gy of radiotherapy, with 4 mg/kg of trastuzumab on day 1, 2 mg/kg per week during weeks 2 to 6, and 6 mg/kg per week during weeks 7, 10, and 13 and 840 mg of pertuzumab every 3 weeks. The primary end point was feasibility, defined as ≥ 80% completion of treatment with both trastuzumab and pertuzumab. An exploratory comparison of survival with a propensity score-matched cohort receiving standard nCRT was performed, as were exploratory pharmacokinetic and biomarker analyses. RESULTS: Of the 40 enrolled patients (78% men; median age, 63 years), 33 (83%) completed treatment with trastuzumab and pertuzumab. No unexpected safety events were observed. R0 resection was achieved in all patients undergoing surgery, with pathologic complete response in 13 patients (34%). Three-year progression-free and overall survival (OS) were 57% and 71%, respectively (median follow-up, 32.1 months). Compared with the propensity score-matched cohort, a significantly longer OS was observed with HER2 blockade (hazard ratio, 0.58; 95% CI, 0.34 to 0.97). Results of pharmacokinetic analysis and activity on [18F]fluorodeoxyglucose positron emission tomography scans did not correlate with survival or pathologic response. Patients with HER2 3+ overexpression or growth factor receptor-bound protein 7 (Grb7) -positive tumors at baseline demonstrated significantly better survival (P = .007) or treatment response (P = .016), respectively. CONCLUSION: Addition of trastuzumab and pertuzumab to nCRT in patients with HER2-positive EAC is feasible and demonstrates potentially promising activity compared with historical controls. HER2 3+ overexpression and Grb7 positivity are potentially predictive for survival and treatment response, respectively