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INTRODUCTION: The implementation of new drug safety information and Direct Healthcare Professional Communications (DHPCs) in hospitals is important for patient safety.OBJECTIVES: The aim of this study was to gain insight into which procedures and practices are in place to handle new drug safety information and particularly DHPCs in the Dutch hospital setting.METHODS: We first conducted focus groups including medical specialists and hospital pharmacists, focusing on handling of drug safety information at the individual and organisational level. A survey was then developed and distributed among hospital pharmacists in all Dutch hospitals to quantify the existence of specific procedures and committees to handle drug safety information and DHPCs.RESULTS: Eleven specialists and 14 pharmacists from six hospitals participated in focus groups. Drug safety information was usually considered before drugs were included in formularies or treatment protocols. Furthermore, drug safety information was consulted in response to patients experiencing adverse events. DHPCs were mostly dealt with by individual professionals. DHPCs could lead to actions but this was very uncommon. Completed surveys were received from 40 (53%) of the hospitals. In 32 (80%), the hospital pharmacy had procedures to deal with new drug safety information, whereas in 11 (28%) a hospital-wide procedure was in place. Drug safety was considered in committees concerning drug formulary decisions (69%) and antibiotic policies (63%). DHPCs were assessed by a hospital pharmacist in 50% of the hospitals.CONCLUSIONS: Drug safety information was used for evaluation of new treatments and in response to adverse events. Assessment of whether a DHPC requires action was primarily an individual task.

Human capital management is a complex and often misunderstood concept for today's military organization, which requires planning for accession, talent competition and cost controls within a dynamic environment. Throughout history, the manpower required to maintain a standing military during peacetime has always been subject to a combination of the external and internal effects of competing interests over budgetary concerns and the military requirement to support national strategy. Management science has shown how to design and implement the most effective policies, but in today's dynamic environment containing emerging threats and economic opportunity, military manpower struggles to meet strategic goals. This thesis fills a gap in the literature by examining human capital management from a warfare design perspective, with a systems approach interplay to address specific resource constraints and courses of action. Senior Master Sergeant, United States Air Force Approved for public release. Distribution is unlimited.

Background: The American Thyroid Association (ATA) recommended the establishment of population specific reference ranges for thyroid hormones during pregnancy. Initial studies conducted in the United Arab Emirates (UAE) in 2003 and 2004 on pregnant women published a considerably higher upper limit for thyroid stimulating hormone (TSH) than that proposed by ATA. The UAE was classified as a country with mild iodine deficiency at the time of this initial study. After the implementation of aggressive strategies to address iodine deficiency over the last decade, the UAE was recently declared as iodine sufficient. The current study re-evaluates the reference intervals for thyroid hormones for pregnant women in the UAE after the declaration of iodine sufficiency status. Methods: TSH and free thyroxin (FT4) from 414 UAE national pregnant females were analyzed to determine trimester specific reference ranges. Results: The upper limits of the TSH reference ranges were found to be significantly lower than previously reported, but still higher than those recommended by ATA in 2011.FT4 reference ranges were found to be slightly lower than previously reported. Conclusion: TSH trimester specific reference ranges in UAE national pregnant women are higher than those recommended by ATA in 2011 but in keeping with the latest guidelines published in 2017. This should be considered while interpreting thyroid function tests in this population. Further studies including urinary iodine measurement, body mass index and larger numbers per partition in this population are recommended. Keywords: Reference intervals, Gestation, Thyroid stimulating hormone, Pregnancy, Free thyroxin

Introduction: Excessive use of pesticides in agriculture is a major risk to respiratory health, especially for rural population. Sao Jose de Uba (SJU) is a small community and has its economy based...

About 90% of persons aged 55 and older would prefer to stay in their current residences as long as possible because older adults value their independence. However, aging-in-place is not always a choice. Recently, the Dutch government tightened the criteria for older adults to be admitted in a nursing home. Throughout the past 5 years TNO was requested by the trade association for building service contractors in the Netherlands to develop a number of tools for building service professionals. The 'dwelling check' was developed as a 'basic' check on the possibility for aging-in-place. A pilot study was conducted to assess the added value of the dwelling check for older adults. During this pilot study the occupants of over 200 dwellings were interviewed by 11 building services contractors using the dwelling check. Based on these interviews a personal advice was written. After which the interviewees were asked to evaluate this service, comprising the interview and written advice. The dwelling check contributed most to the awareness of and interest in possible alterations for aging-in-place. In a few cases the decision (17%) or even action (5%) was taken to make alterations. Overall the dwelling check was rated 8 out of 10 by the interviewees and may therefore be considered of added value.

Smart homes are considered a vital technology in an aging society as they compensate for a shortage in care workers. However, often smart homes do not perform well. Performance management is well known in the manufacturing industry but not common in the building industry. The performance approach is the practice of thinking and working in terms of ends rather than means. It is concerned with what a building or a building product is required to do, and not with prescribing how it is to be constructed. Performance based building (PBB) includes amongst others functional briefing and performance assessments. However, an overview of tasks in PBB is lacking and the principle has not yet been applied to smart homes. Aim of this research is to contribute to performance management in the construction of health smart homes by identifying tasks and proposing a task assignment. Tasks are identified by studying the extended reporting of the Performance Based Building Network (PeBBu). In conclusion we may say that PBB of health smart homes primarily differs from traditional building in the way tasks are performed. PBB demands that the client does not design (specify how to build) but restricts himself to specifying why he wants and why he wants it. PBB also demands that the designers and contractors are selected on both price and capabilities. Besides these alterations in how tasks are performed merely two tasks are added. These are the verification of the realized design and the monitoring of performance of the building in use.

The Mw 7.7 2007 November 14 earthquake had an epicentre located close to the city of Tocopilla, at the southern end of a known seismic gap in North Chile. Through modelling of Global Positioning System (GPS) and radar interferometry (InSAR) data, we show that this event ruptured the deeper part of the seismogenic interface (30-50 km) and did not reach the surface. The earthquake initiated at the hypocentre and was arrested similar to 150 km south, beneath the Mejillones Peninsula, an area already identified as an important structural barrier between two segments of the Peru-Chile subduction zone. Our preferred models for the Tocopilla main shock show slip concentrated in two main asperities, consistent with previous inversions of seismological data. Slip appears to have propagated towards relatively shallow depths at its southern extremity, under the Mejillones Peninsula. Our analysis of post-seismic deformation suggests that small but still significant post-seismic slip occurred within the first 10 d after the main shock, and that it was mostly concentrated at the southern end of the rupture. The post-seismic deformation occurring in this period represents similar to 12-19 per cent of the coseismic deformation, of which similar to 30-55 per cent has been released aseismically. Post-seismic slip appears to concentrate within regions that exhibit low coseismic slip, suggesting that the afterslip distribution during the first month of the post-seismic interval complements the coseismic slip. The 2007 Tocopilla earthquake released only similar to 2.5 per cent of the moment deficit accumulated on the interface during the past 130 yr and may be regarded as a possible precursor of a larger subduction earthquake rupturing partially or completely the 500-km-long North Chile seismic gap.