A comprehensive approach for quality assessment of breast cancer care

This thesis assessed the quality of breast cancer care on different level by analyzing data from a tertiary cancer center and multiple nationwide databases.In order to do so, we first provided insight into breast cancer patients changing hospital and the medical impact of a second opinion. The results demonstrated that a hospital transfer after diagnosis is a delaying factor for primary treatment, specifically for those who undergo surgery. Furthermore, we assessed in a reproducible manner that second opinions can have a significant impact on diagnostics and primary treatment strategies. In the second part, we assess the delaying impact of postmastectomy immediate breast reconstruction on the continuity of the adjuvant chemotherapy pathway. This part furthermore highlights the importance of timely initiation of adjuvant chemotherapy on survival in patients diagnosed with triple-negative breast cancer. Finally, we evaluate the use of breast‐contour preservation and safety of oncoplastic strategies on an (inter)national level. We demonstrate that a breast reconstruction using a direct‐to‐implant compared to a two‐stage technique is associated with a lower unplanned revision. Although the total breast‐contour preservation rate in the Netherlands is similar to Denmark, different strategies are used. Furthermore, oncoplastic techniques seem a safe option regarding re‐excision and conversion to mastectomy. Hereby, the findings in this thesis may contribute to different dimensions of the quality of breast cancer care.Dutch Institute for Clinical Auditing (DICA), Netherlands Comprehensive Cancer Organisation (IKNL), Nederlandse Vereniging voor Plastische Chirurgie (NVPC), SOLV Advocaten, Walaeus bibliotheek ‐ University Library

Mayor Bernardus Ledeboer, Having Received a Request from Electors in the City of Holland, Regarding the Construction of a Railroad to Holland, Set June 10 to Vote Upon the Issue

Mayor Bernardus Ledeboer, having received a request from electors in the City of Holland, regarding the construction of a railroad to Holland, set June 10 to vote upon the issue. It is signed by the same electors who signed the May 14 document.https://digitalcommons.hope.edu/vrp_1860s/1502/thumbnail.jp

Computational Aeroelastic Analysis of the Ares Launch Vehicle During Ascent

This paper presents the static and dynamic computational aeroelastic (CAE) analyses of the Ares crew launch vehicle (CLV) during atmospheric ascent. The influence of launch vehicle flexibility on the static aerodynamic loading and integrated aerodynamic force and moment coefficients is discussed. The ultimate purpose of this analysis is to assess the aeroelastic stability of the launch vehicle along the ascent trajectory. A comparison of analysis results for several versions of the Ares CLV will be made. Flexible static and dynamic analyses based on rigid computational fluid dynamic (CFD) data are compared with a fully coupled aeroelastic time marching CFD analysis of the launch vehicle

Si-compatible candidates for high-K dielectrics with the Pbnm perovskite structure

We analyze both experimentally (where possible) and theoretically from first-principles the dielectric tensor components and crystal structure of five classes of Pbnm perovskites. All of these materials are believed to be stable on silicon and are therefore promising candidates for high-K dielectrics. We also analyze the structure of these materials with various simple models, decompose the lattice contribution to the dielectric tensor into force constant matrix eigenmode contributions, explore a peculiar correlation between structural and dielectric anisotropies in these compounds and give phonon frequencies and infrared activities of those modes that are infrared-active. We find that CaZrO_3, SrZrO_3, LaHoO_3, and LaYO_3 are among the most promising candidates for high-K dielectrics among the compounds we considered.Comment: 17 pages, 9 figures, 4 tables. Supplementary information: http://link.aps.org/supplemental/10.1103/PhysRevB.82.064101 or http://www.physics.rutgers.edu/~sinisa/highk/supp.pd

Life-threatening biopsy of an iliopsoas pseudotumour in a patient with haemophilia: a case report

Iliopsoas pseudotumour is a serious complication of haemophilia. We present the case of a 20-year-old male patient with a six-month history of left leg weakness, limitation of movement and wasting of the muscles. Clinically he was diagnosed as having a psoas muscle rhabdomyosarcoma. During a computed tomography (CT) scan-guided Tru-cut biopsy he developed a serious and life-threatening bleeding from a retroperitoneal muscular haematoma. The patient underwent laparotomy prior to his final diagnosis of an Iliopsoas pseudotumour, which is a serious, as well as rare, complication of haemophilia

Implementation of an Ultra-Bright Thermographic Phosphor for Gas Turbine Engine Temperature Measurements

The overall goal of the Aeronautics Research Mission Directorate (ARMD) Seedling Phase II effort was to build on the promising temperature-sensing characteristics of the ultrabright thermographic phosphor Cr-doped gadolinium aluminum perovskite (Cr:GAP) demonstrated in Phase I by transitioning towards an engine environment implementation. The strategy adopted was to take advantage of the unprecedented retention of ultra-bright luminescence from Cr:GAP at temperatures over 1000 C to enable fast 2D temperature mapping of actual component surfaces as well as to utilize inexpensive low-power laser-diode excitation suitable for on-wing diagnostics. A special emphasis was placed on establishing Cr:GAP luminescence-based surface temperature mapping as a new tool for evaluating engine component surface cooling effectiveness

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple-negative breast cancer

Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype-dependent and that TTC within 30 days should be warranted in patients with triple-negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10-year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast-conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity-score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10-year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted

Nationwide population-based study of the impact of immediate breast reconstruction after mastectomy on the timing of adjuvant chemotherapy

Background: Initiation of adjuvant chemotherapy within 6–12 weeks after mastectomy is recommended by guidelines. The aim of this population-based study was to investigate whether immediate breast reconstruction (IBR) after mastectomy reduces the likelihood of timely initiation of adjuvant chemotherapy. Methods: All patients with breast cancer who had undergone mastectomy and adjuvant chemotherapy between 2012 and 2016 in the Netherlands were identified. Time from surgery to adjuvant chemotherapy was categorized as within 6 weeks or after more than 6 weeks, within 9 weeks or after more than 9 weeks, and within 12 weeks or after more than 12 weeks. The impact of IBR on the initiation of adjuvant chemotherapy for these three scenarios was estimated using propensity score matching to adjust for treatment by indication bias. Results: A total of 6300 patients had undergone primary mastectomy and adjuvant chemotherapy, of whom 1700 (27·0 per cent) had received IBR. Multivariable analysis revealed that IBR reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (odds ratio (OR) 0·76, 95 per cent c.i. 0·66 to 0·87) and 9 weeks (0·69, 0·54 to 0·87), but not within 12 weeks (OR 0·75, 0·48 to 1·17). Following propensity score matching, IBR only reduced the likelihood of receiving adjuvant chemotherapy within 6 weeks (OR 0·95, 0·90 to 0·99), but not within 9 weeks (OR 0·97, 0·95 to 1·00) or 12 weeks (OR 1·00, 0·99 to 1·01). Conclusion: Postmastectomy IBR marginally reduce