Poortwachters van de Nederlandse arbeidsmarkt. Arbeidsvoorziening en de verlening van tewerkstellingsvergunningen . Reeks Recht en Samenleving 12

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Verblijfsrecht en gebruik van collectieve voorzieningen door immigranten

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Aan de grenzen van de verzorgingsstaat: Verblijfsrecht en het gebruik van collectieve voorzieningen

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Off-line balanced forward-flyback converter

Due to the flybacks' indirect characteristic of energy transfer, the transformer size increases for high power levels. Providing an additional direct energy transfer path can decrease its size. Parallel forward-flyback converters offer such functionality and outperform forward converters with regard to PFC functionality. A balanced forward-flyback converter is a variation on this kind of parallel converter. The forward and flyback sub-converters share a transformer winding and an additional balancing capacitor enables even better AC line voltage utilization. This paper starts with an in-depth analysis of the balanced forward-flyback converter, and introduces ten operating modes in which this converter can operate. A boundary-conduction mode (BCM) controller for the magnetization current is developed and presented, and through simulations the PFC performance of the converter is tested with a constant switch on-time controller. Moreover, a prototype is designed and built with both a dissipative R-C-D snubber and two-switch clamp configuration. Experimental results from the 100W/120–373V AC/DC prototype were obtained to prove the converter operation and BCM controller concept. The balanced forward-flyback converter in BCM offers good PFC performance and manages a THD of input current between 1.69% and 4.38%

Responsiveness of the Patient-Reported Outcome Measure-Haemorrhoidal Impact and Satisfaction Score in patients with haemorrhoidal disease

Aim: In this study we aimed to assess the responsiveness of the symptom score of the recently developed Patient-Reported Outcome Measure-Haemorrhoidal Impact and Satisfaction Score (PROM-HISS). Furthermore, the minimally relevant difference (MRD) was determined. Method: The responsiveness of PROM-HISS was tested using a criterion-based (i.e. anchor) and construct-based (i.e. hypotheses testing) approach. Patients with haemorrhoidal disease (HD) completed the PROM-HISS before and 1 week after treatment in hospital. A global self-assessment of change question (SCQ) was administered 1-week after treatment and functioned as the criterion. The following analyses were performed: (1) correlation between the PROM-HISS symptom score and the criterion (SCQ) and (2) hypotheses testing. The MRD was determined as change in symptoms of the subgroup reporting ‘somewhat fewer complaints’ on the SCQ. Results: Between February and August 2022, 94 patients with grade II–IV HD from three hospitals were included. The correlation between the SCQ and a change on the PROM-HISS symptom score was 0.595 indicating that an improvement on the SCQ corresponds to an improvement on the PROM-HISS symptom score. As hypothesized, the mean change in PROM-HISS scores was significantly different between subgroups of patients based on their SCQ responses. Patients reporting a small change in HD symptoms on the SCQ corresponded to a mean change of 0.3 on the PROM-HISS symptom score. Conclusion: The PROM-HISS symptom score is a responsive instrument as it identifies change in HD symptoms because of treatment. The estimated MRD of 0.3 can be used to inform clinical research and practice

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups