Components for a guidance document on groundwaterprotection

To improve the protection of the groundwater quality, policy should be more focused on local conditions, such as soil and groundwater. To increase this focus RIVM has proposed a generic framework for a groundwater protection policy that can be elaborated for each site in an area dossier. This dossier contains all relevant information on what measures can be developed on the basis of the desired effects. In the effort to achieve more uniformity and effectiveness in the Dutch groundwater protection policy, the Ministry of Housing, Spatial Planning and the Environment (VROM) is planning to derive a guidance document on groundwater protection. On commission of VROM, RIVM has elaborated several components to be used in describing policy, such as the risks of contamination with pathogens, the use of pesticides, the use of energy storage systems and actions on old contaminations. Additionally, RIVM has charted the legal demands set down by the new Water Framework Directive for the protection of industrial (private) abstractions for human consumption, such as the production of soda.Om de kwaliteit van het grondwater beter te kunnen beschermen moet het beleid meer worden toegespitst op lokale omstandigheden, zoals de natuurlijke opbouw van de bodem. Daarom pleit het RIVM voor het opstellen van een algemeen geldend kader voor grondwaterbeschermingsbeleid, dat per locatie nader kan worden uitgewerkt in een gebiedsdossier. Een gebiedsdossier bevat alle relevante informatie op basis waarvan een pakket maatregelen wordt ontwikkeld, gebaseerd op de gewenste effecten. Om meer uniformiteit en effectiviteit in het grondwaterbeschermingsbeleid te brengen is VROM van plan om in de komende jaren een Leidraad Grondwaterbescherming op te stellen. Het RIVM heeft in opdracht van het Ministerie van VROM een aantal van deze lacunes uitgewerkt, zoals de risico's van microbiologische besmetting, het gebruik van pesticiden, het toepassen van bodemenergiesystemen en het omgaan met van oudsher ontstane bodemverontreinigingen. Daarnaast heeft het instituut de juridische consequenties in beeld gebracht van de invoering van de Europese Kaderrichtlijn Water voor de bescherming van industriele grondwateronttrekkingen voor menselijke consumptie, zoals de productie van frisdranken

In-depth investigation of the molecular pathogenesis of bladder cancer in a unique 26-year old patient with extensive multifocal disease: A case report

Background. The molecular characteristics and the clinical disease course of bladder cancer (BC) in young patients remain largely unresolved. All patients are monitored according to an intensive surveillance protocol and we aim to gain more insight into the molecular pathways of bladder tumors in young patients that could ultimately contribute to patient stratification, improve patient quality of life and reduce associated costs. We also determined whether a biomarker-based surveillance could be feasible. Case Presentation. We report a unique case of a 26-year-old Caucasian male with recurrent non-muscle invasive bladder tumors occurring at a high frequency and analyzed multiple tumors (maximal pTaG2) and urine samples of this patient. Analysis included FGFR3 mutation detection, FGFR3 and TP53 immunohistochemistry, mircosatellite analysis of markers on chromosomes 8, 9, 10, 11 and 17 and a genome wide single nucleotide polymorphism-array (SNP). All analyzed tumors contained a mutation in FGFR3 and were associated with FGFR3 overexpression. None of the tumors showed overexpression of TP53. We found a deletion on chromosome 9 in the primary tumor and this was confirmed by the SNP-array that showed regions of loss on chromosome 9. Detection of all recurrences was possible by urinary FGFR3 mutation analysis. Conclusions. Our findings would suggest that the BC disease course is determined by not only a patient's age, but also by the molecular characteristics of a tumor. This young patient contained typical genetic changes found in tumors of older patients and implies a clinical disease course comparable to older patients. We demonstrate that FGFR3 mutation analysis on voided urine is a simple non-invasive method and could serve as a feasible follow-up approach for this young patient presenting with an FGFR3 mutant tumor

Feasibility of Narrative Exposure Therapy in an outpatient day treatment program for refugees: Improvement in symptoms and global functioning

Background  Refugees are at high risk for developing post-traumatic stress disorder (PTSD). Narrative exposure therapy (NET) is an evidence-based treatment of PTSD, designed for patients exposed to (multiple) traumatic events and recommended for patients with culturally diverse backgrounds. In clinical practice, adherence to the NET-protocol has been challenged because of psychosocial complexities and comorbid disorders.  Objective:  The current study investigated the feasibility of NET embedded in an outpatient day treatment programme for refugees and examined reduction in PTSD symptoms and improvement of global functioning as well as correlates of change.  Method Participants were patients who consecutively entered an outpatient daytreatment programme from 2013-2017. The majority had a history of prior unsuccessful treatment. PTSD was assessed with the Clinically Administered PTSD Scale (CAPS) before and after finishing NET. Global Assessment of Functioning (GAF) was used to examine changes in functioning. Changes in PTSD scores and functioning were analyzed using paired t-tests and reliable change indices. Patients showing significant improvement were compared to those who did not, on patient and treatment characteristics, including sex, age, region of origin, childhood trauma and treatment duration and dosage of NET.  Results:  Of 97 patients, 76 (78.4%) completed NET. Completers had a longer residency and were more likely to have a partner. Significant reductions in PTSD symptoms and improvements in global functioning were observed. Twenty-eight percent showed reliable improvement with large effect sizes. Four patients did no longer meet the criteria for PTSD. No strong moderators for changes were found. Patients who did not improve more often had a history of childhood trauma. Conclusions NET embedded in an outpatient day treatment programme appears to be feasible. In those who improved, a substantial decline in symptoms and improvement of functioning were observed. The findings suggest that a socially supportive living environment enhances acceptability of trauma-focused treatment in refugees