Incidence and mortality of acute and chronic pancreatitis in the Netherlands:A nationwide record-linked cohort study for the years 1995-2005

AIM:To analyze trends in incidence and mortality of acute pancreatitis(AP) and chronic pancreatitis(CP) in the Netherlands and for international standard populations.METHODS:A nationwide cohort is identified through record linkage of hospital data for AP and CP,accumulated from three nationwide Dutch registries:the hospital discharge register,the population register,and the death certificate register.Sex-and age-group specific incidence rates of AP and CP are defined for the period 2000-2005 and mortality rates of AP and CP for the period 1995-2005.Additionally,incidence and mortality rates over time are reported for Dutch and international(European and World Health Organization) standard populations.RESULTS:Incidence of AP per 100000 persons per year increased between 2000 and 2005 from 13.2(95%CI:12.6-13.8) to 14.7(95%CI:14.1-15.3).Incidence of AP for males increased from 13.8(95%CI:12.9-14.7) to 15.2(95%CI:14.3-16.1),for females from 12.7(95%CI:11.9-13.5) to 14.2(95%CI:13.4-15.1).Irregular patterns over time emerged for CP.Overall mean incidence per 100000 persons per year was 1.77,for males 2.16,and for females 1.4.Mortality for AP fluctuated during 1995-2005 between 6.9 and 11.7 per million persons per year and was almost similar for males and females.Concerning CP,mortality for males fluctuated between 1.1(95%CI:0.6-2.3) and 4.0(95%CI:2.8-5.8),for females between 0.7(95%CI:0.3-1.6) and 2.0(95%CI:1.2-3.2).Incidence and mortality of AP and CP increased markedly with age.Standardized rates were lowest for World Health Organization standard population.CONCLUSION:Incidence of AP steadily increased while incidence of CP fluctuated.Mortality for both AP and CP remained fairly stable.Patient burden and health care costs probably will increase because of an ageing Dutch population.

Adherence to surveillance guidelines for dysplasia and colorectal carcinoma in ulcerative and Crohn's colitis patients in the Netherlands

AIM: To study adherence to the widely accepted surveillance guidelines for patients with long-standing colitis in the Netherlands. METHODS: A questionnaire was sent to all 244 gastroenterologists in the Netherlands. RESULTS: The response rate was 63%. Of all gastroenterologists, 95% performed endoscopic surveillance in ulcerative colitis (UC) patients and 65% in patients with Crohn's colitis. The American Gastroenterological Association (AGA) guidelines were followed by 27%, while 27% and 46% followed their local hospital protocol or no specific protocol, respectively. The surveillance was correctly initiated in cases of pancolitis by 53%, and in cases of left-sided colitis by 44% of the gastroenterologists. Although guidelines recommend 4 biopsies every 10 cm, less than 30 biopsies per colonoscopy were taken by 73% of the responders. Only 31%, 68% and 58% of the gastroenterologists referred patients for colectomy when low-grade dysplasia, high-grade dysplasia (HGD) or Dysplasia Associated Lesion or Mass (DALM) was present, respectively. CONCLUSION: Most Dutch gastroenterologists performendoscopic surveillance without following international recommended guidelines. This practice potentially leads to a decreased sensitivity for dysplasia, rendering screening for colorectal cancer in this population highly ineffective.

Surveillance colonoscopy practice in Lynch syndrome in the Netherlands:A nationwide survey

Lynch syndrome, or hereditary nonpolyposis colorectal cancer (HNPCC), is the most common genetic disorder predisposing to colorectal cancer. As regular colonoscopic surveillance has been shown to reduce the incidence of colorectal cancer, this strategy is recommended worldwide. Recently, several advances in colonoscopic techniques have improved detection rates of neoplasia in Lynch syndrome. In this nationwide survey, we evaluated current surveillance colonoscopy practices for Lynch syndrome in the Netherlands and the extent to which advanced techniques have been adopted in routine clinical practice.

Fiber-Reinforced Polymer Bridge Design in the Netherlands： Architectural Challenges toward Innovative, Sustainable, and Durable Bridges

This paper reviews the use of fiber-reinforced polymers （FRPs） in architectural and structural bridge design in the Netherlands. The challenges and opportunities of this relatively new material, both for the architect and the engineer, are discussed. An inventory of recent structural solutions in FRP is included, followed by a discussion on architectural FRP applications derived from the architectural practice of the author and of other pioneers.

Increasing the Adaptive Capacity in Unembanked Neighborhoods? An Exploration into Stakeholder Support for Adaptive Measures in Rotterdam, The Netherlands

Cities in deltas are vulnerable to climate change, especially their unembanked neighborhoods that are not protected by dikes. Rising sea levels and extreme water levels in the rivers can lead to the flooding of these urban areas. The Netherlands has a long history in water management. However, building dikes and the elevation of land are traditionally treated as rather stand-alone measures. Attention is rarely paid to the surrounding area, let alone to the complex context of cities and certainly not to disadvantaged neighborhoods. Yet, inner-city area redevelopment may provide opportunities to integrate flood management in these planning processes. In order to investigate the support of stakeholders for risk-reducing adaptive measures and more resilient measures, we did research in an unembanked inner-city area in the city of Rotterdam (The Netherlands), in which we conducted in-depth interviews with the central stakeholders. The main conclusion is that the most important barriers for integrating climate adaptation measures into that neighborhood are the fragmentation of water-safety policy (e.g. elevation of rebuilding locations) and the hierarchical governance arrangement in water management. This type of fragmentation led on its turn to fragmentation with other policy goals for the neighborhood. It also led to fragmentation between different areas in the same neighborhood that received political attention and those that are excluded from water-safety policy. This questions the approach in terms of social justice. An important side effect is that this governance arrangement also restricted innovation towards climate adaptation. Therefore, integrating water-safety policies in urban planning (in its capacity as a more integrative and comprehensive spatial approach) should be considered the best option to increase the adaptive capacity in delta cities. Not only can the negative effects in terms of policy fragmentation be dealt with effectively, but also spatial fragmentation can be tackled.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands

BACKGROUND: Emergency physicians have been successful in implementing procedural sedation and analgesia(PSA) to treat emergency department(ED) patients who need to undergo painful procedures.However, 25% of the EDs in the Netherlands are not staffed by emergency physicians.The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.METHODS: We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands.Data were gathered using a standardized questionnaire.RESULTS: The response rate was 34.3%(148/432).Of the respondents, 84/148(56.8%) provided adult PSA and 30/148(20.3%) provided paediatric PSA.Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure.The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.CONCLUSION: The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

SHAPING COURSE. The Development of the Strategy for the e-Depot of the Koninklijke Bibliotheek, National Library of the Netherlands, in a National and International Context

Operating an international archive for digital information resources by a relatively small organization as the Koninklijke Bibliotheek (KB) asks for a firm foundation of its policy. Continuing research and development efforts to secure permanent preservation and access to electronic information on a national and international scale require substantial financial, technical and staffing commitments. Cooperation in sharing resources and knowledge is called for. In the national context of the Netherlands the KB recently took the initiative to build the National Digital Preservation Coalition. All relevant sectors of Dutch society are represented. Its aim is to develop a national infrastructure and to assign clear responsibilities. In the European arena the KB, together with the British Library, started the European Alliance for Permanent Access to the Records of Science. The Alliance works towards the widespread and joint responsibility for maintaining the records of science by all major stakeholders, including national governments and the EU. In the global context the KB developed the concept of the "Safe Places Network" . This Network will include a limited number of institutions with certified digital archives for scientific publications, sharing responsibility for complete, world-wide coverage and allocate tasks accordingly.

Interpretation of Trends in Land Transformations—A Case of Green Heart Region (The Netherlands)

The sprawl-versus-containment debate relates to many different aspects of the broad concept of sustainability, and as such the answers found by research are rarely decisive, compact cities have advantages in some respects, but disadvantages in others. The present study focuses on the patterns of urbanization process in Netherlands as a whole and within the “Green Heart” in particular. The present study finds over the last decades, the Green Heart is under attack from suburbanization of larger and smaller settlements as several political concessions have been made to local development needs. The Green Heart is also affected by the construction of new roads and railway lines. This infrastructure is built for tangential transport of an increasing volume of commuters. The spatial policies for preserving green spaces suffer from a dilemma between two contradicting functions of green space in a regional context: to be a separator of urban and rural areas and to be an integrator towards the Regional City of “Green Metropolis”.

On attitudes about colorectal cancer screening among gastrointestinal specialists and general practitioners in the Netherlands

AIM： To find out whether there are differences in attitudes about colorectal cancer （CRC） screening among gastrointestinal （GI） specialists and general practitioners （GPs） and which method is preferred in a national screening program METHODS： Four hundred and twenty Dutch GI specialists in the Netherlands and 400 GPs in Amsterdam were questioned in 2004. Questions included demographics, affiliation, attitude towards screening both for the general population and themselves, methods of screening, family history and individual risk. RESULTS： Eighty-four percent of the GI specialists returned the questionnaire in comparison to 32% of the GPs （P〈0.001）. Among the GI specialists, 92% favoured population screening whereas 51% of GPs supported population screening （P〈0.001）. Of the GI specialists 95% planned to be screened themselves, while 30% of GPs intended to do so （P〈0.001）. Regarding the general population, 72% of the GI specialists preferred colonoscopy as the screening method compared to 27% of the GPs （P〈0.001）. The method preferred for personal screening was colonoscopy in 97% of the GI specialists, while 29% of the GPs favoured colonoscopy （P〈0.001）. CONCLUSION： Screening for CRC is strongly supported by Dutch GI specialists and less by GPs. The major health issue is possibly misjudged by GPs. Since GPs play a crucial role in a successful national screening program, CRC awareness should be realized by increasing knowledge about the incidence and mortality, thus increasing awareness of the need for screening among GPs.

Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands

Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.

Current surgical treatment of diverticular disease in the Netherlands

AIM: To evaluate the development of diagnostic tools, indications for surgery and treatment modalities concerning diverticular disease (DD) in the Netherlands. METHODS: Data were collected from 100 patients who underwent surgery for DD in three Dutch hospitals. All hospitals used the same standardized data base. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into two groups, one undergoing elective surgery (elective group) and the other undergoing acute surgery (acute group). RESULTS: Two hundred and ninety-nine patients were admitted between 2000 and 2007. One hundred and seventy-eight patients underwent acute surgery and 121 patients received elective operations. The median age of the 121 patients was 69 years (range: 28-94 years), significantly higher in acute patients (P = 0.010). Laparoscopic resection was performed in 31% of elective patients. In the acute setting, 61% underwent a Hartmann procedure. The overall morbidity and mortality were 51% and 10%, and 60% and 16% in the acute group, which were significantly higher than in the elective group (36% and 1%). Only 35% of the temporary ostomies were restored. CONCLUSION: This study gives a picture of current surgical practice for DD in the Netherlands. New developments are implemented in daily practice, resulting in acceptable morbidity and mortality rates.

Health insurance and switching behavior: Evidence from the Netherlands

Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.

Ghanaian Migration to the Netherlands:Status Paradox?

Migration continues to serve as platform for financial and social empowerment in many countries including Ghana.There are many constraints associated with the life of migrants;however,the quest to be socially acknowledged enables them to adopt certain survival strategies.Using qualitative methodology,this paper examines Ghanaians migration to the Netherlands using the concept of“burger”.This research work highlights that some Ghanaian migrants travel with the goal of earning money to meet their personal and family needs,and so engage in any available job to build and maintain their new burger status.As burgers,they have to obtain enough money to maintain their elevated social status but need to ensure that relatives and friends in Ghana do not know how this money is obtained.To maintain the new“privilege”social status often ascribed to Ghanaians living abroad,migrants are compelled to juggle their work,income,and lifestyle in the Netherlands and(mis)-representation of themselves in Ghana.

Empowerment according to Persons with Severe Mental Illness: Development of the Netherlands Empowerment List and Its Psychometric Properties

Objectives. It is unclear whether and to what extent purportedly empowering practices in mental health care, like rehabilitation programs, recovery-supporting mental health care environments and peer-run services, contribute to the process of empowerment. Several American empowerment questionnaires have been developed in recent years, facilitating the measurement of empowerment outcomes. Given likely major transatlantic cultural differences in a value-sensitive concept such as empowerment, this article describes the development of the Netherlands Empowerment List (NEL) and its psychometric properties. Methods. Patients in Dutch mental health services provided meaning to the empowerment concept from which the NEL was derived. Based on 531 completed questionnaires, analyses in agreement with COSMIN criteria examined aspects of internal consistency, content validity, structural validity, convergent validity, discriminant validity, reproducibility and responsiveness of the NEL. Results. The NEL is a 40-item self-report questionnaire with six subscales: Social support, Professional help, Connectedness, Confidence and purpose, Self-management and Caring community. Internal consistency (Cronbach’s alpha = 0.94), aspects of validity, reproducibility (intraclass correlation = 0.79) and responsiveness were good. Correlation with existing scales was the highest for the Mental Health Confidence Scale (r = 0.78) and the lowest for the Boston Empowerment Scale (r = 0.61). Conclusion. The NEL appears to be a suitable instrument to capture the dimension of empowerment in European mental health settings.

Recognition and Enforcement of Chinese Money Judgments in Civil and Commercial Matters in the Netherlands: Law and Practice

Ⅰ.Enforcement of foreign judgments? Article 431 DCCP In the absence of a treaty in w hich the mutual recognition and enforcement of judgments in civil and commercial matters is regulated,the recognition and enforcement of a foreign judgment in the Netherlands is governed by general private international law.

A Coaching Program for Recently Licensed Young Drivers in the Netherlands： Which Drivers Are Attracted？

In line with European developments, a Dutch second phase coaching program, referred to as the DX- （Driver Xperience） program, was developed for young novice drivers to counteract their high accident risk. More specifically, the aim of the DX-program was to enable young drivers to make responsible decisions and develop positive attitudes regarding four levels of the driving task： combining life style and driving, planning and navigation, participating in different traffic situations and handling the vehicle. In this paper, the design principles of the program are described. The empirical study focused on the entry characteristics of the participating young drivers （n = 3,117） as compared to a reference group of young drivers （n = 345）. Results show that the DX-program attracted young drivers that, in some respects, showed a more risky profile than average young drivers in terms of speed violations, anger and the number of fines. In addition, four groups of participants with sharply differing driving styles could be distinguished. Implications for educational design and follow-up research are discussed within the theoretical framework of self-regulated learning.

Insights from Stakeholders of Five Residential Smart Grid Pilot Projects in the Netherlands

This paper presents insights and perceptions of stakeholders involved in the development and implementation of residential smart grid pilot projects in the Netherlands, adding to the limited information that is currently available in this area, while expectations about the potential benefits of smart grids are high. The main research questions of this study are: (1) How have some typical residential smart grid pilots in the Netherlands been set up? (2) Which stakeholders are involved in these pilots in the year 2014? (3) What are their views and perceptions with regards to the development and performance of residential smart grids? and (4) What do these stakeholders think about the products and services that may support an active participation of end-users in a smart energy home? To obtain information, we evaluated five residential smart grid pilot projects where smart energy products and services have been implemented. Semi-structured interviews were conducted with nine stakeholders involved in these projects. The Strategic Niche management framework was used to identify the present state of development and implementation of smart grid pilots. Our study shows that in the Netherlands residential smart grid pilots have been set-up and funded mainly by the government and grid operators. Other stakeholders involved include energy suppliers, end-users (as an energy cooperative or individual household), product and service suppliers, Information and Communication Technology (ICT) companies, and knowledge institutes. Currently a technology-push approach exists which barely includes an integrated approach towards smart grids products and services development. To the opinion of the interviewed stakeholders, current products and services offered in residential smart grid pilots are functionally attractive, but often too technically complex for the understanding of end-users. Hence, the general view held by respondents is that end-users should be the starting point in the development of smart grid products and services at the residential areas.

Smart Solar Charging： Bi-Directional AC Charging （V2G） in the Netherlands

It is to be expected that the number of electric vehicles will be growing in the near future. This trend comes together with the development of smaller decentralized generation units, like PV （photo voltaic）. Together with the change on demand side that comes with the global ＂electrification＂, this can lead to serious grid congestion in low voltage grids and massive grid investments in solving this congestion. Smart charging can partly solve this issue, but with using a connected EV （electric vehicle） as a small distribution unit, combined with bi-directional charging or V2G （vehicle-to-grid） technology, these investments can be reduced to a minimum. In Lombok, Utrecht, the Netherlands, an innovative pilot was initiated with smart solar charging stations, shared electric vehicles and AC （alternating current） V2G technology. This unique combination proves that EVs are an opportunity for the grid rather than a threat. A unique partnership with OEM Renault was established to develop an AC V2G vehicle product line and work on open standardized communication between the EV, the charging station and the grid.

Material point method simulation of hydro-mechanical behaviour in twophase porous geomaterials: A state-of-the-art review

The material point method(MPM)has been gaining increasing popularity as an appropriate approach to the solution of coupled hydro-mechanical problems involving large deformation.In this paper,we survey the current state-of-the-art in the MPM simulation of hydro-mechanical behaviour in two-phase porous geomaterials.The review covers the recent advances and developments in the MPM and their extensions to capture the coupled hydro-mechanical problems involving large deformations.The focus of this review is aiming at providing a clear picture of what has or has not been developed or implemented for simulating two-phase coupled large deformation problems,which will provide some direct reference for both practitioners and researchers.

A facile strategy for tuning the density of surface-grafted biomolecules for melt extrusion-based additive manufacturing applications

Melt extrusion-based additive manufacturing(ME-AM)is a promising technique to fabricate porous scaffolds for tissue engi-neering applications.However,most synthetic semicrystalline polymers do not possess the intrinsic biological activity required to control cell fate.Grafting of biomolecules on polymeric surfaces of AM scaffolds enhances the bioactivity of a construct;however,there are limited strategies available to control the surface density.Here,we report a strategy to tune the surface density of bioactive groups by blending a low molecular weight poly(ε-caprolactone)5k(PCL5k)containing orthogonally reactive azide groups with an unfunctionalized high molecular weight PCL75k at different ratios.Stable porous three-dimensional(3D)scaf-folds were then fabricated using a high weight percentage(75 wt.%)of the low molecular weight PCL 5k.As a proof-of-concept test,we prepared films of three different mass ratios of low and high molecular weight polymers with a thermopress and reacted with an alkynated fluorescent model compound on the surface,yielding a density of 201-561 pmol/cm^(2).Subsequently,a bone morphogenetic protein 2(BMP-2)-derived peptide was grafted onto the films comprising different blend compositions,and the effect of peptide surface density on the osteogenic differentiation of human mesenchymal stromal cells(hMSCs)was assessed.After two weeks of culturing in a basic medium,cells expressed higher levels of BMP receptor II(BMPRII)on films with the conjugated peptide.In addition,we found that alkaline phosphatase activity was only significantly enhanced on films contain-ing the highest peptide density(i.e.,561 pmol/cm^(2)),indicating the importance of the surface density.Taken together,these results emphasize that the density of surface peptides on cell differentiation must be considered at the cell-material interface.Moreover,we have presented a viable strategy for ME-AM community that desires to tune the bulk and surface functionality via blending of(modified)polymers.Furthermore,the use of alkyne-azide“click”chemistry enables spatial control over bioconjugation of many tissue-specific moieties,making this approach a versatile strategy for tissue engineering applications.