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Column-averaged dry-air mole fractions of carbon dioxide and methane have been retrieved from spectra acquired by the TANSO-FTS and SCIAMACHY instruments on board GOSAT and ENVISAT using a range of European retrieval algorithms. These retrievals have been compared with data from ground-based high-resolution Fourier Transform Spectrometers (FTS) from the Total Carbon Column Observing Network (TCCON). The participating algorithms are the Weighting Function Modified Differential Optical Absorption Spectroscopy (DOAS) algorithm (WFMD, University of Bremen), the Bremen Optimal Estimation DOAS algorithm (BESD, University of Bremen), the Iterative Maximum A Posteriori DOAS (IMAP, Jet Propulsion Laboratory (JPL) and Netherlands Institute for Space Research algorithm (SRON)), the proxy and full-physics versions of SRON's RemoTeC algorithm (SRPR and SRFP respectively) and the proxy and full-physics versions of the University of Leicester's adaptation of the OCO (Orbiting Carbon Observatory) algorithm (OCPR and OCFP respectively). The goal of this algorithm inter-comparison was to identify strengths and weaknesses of the various so-called Round Robin data sets generated with the various algorithms so as to determine which of the competing algorithms would proceed to the next round of the European Space Agency's (ESA) Greenhouse Gas Climate Change Initiative (GHGCCI) project, which is the generation of the so-called Climate Research Data Package (CRDP), which is the first version of the Essential Climate Variable (ECV) "Greenhouse Gases" (GHG). For CO2, all algorithms reach the precision requirements for inverse modelling (< 8 ppb), with only WFMD having a lower precision (4.7 ppm) than the other algorithm products (2.4-2.5 ppm). When looking at the seasonal relative accuracy (SRA, variability of the bias in space and time), none of the algorithms have reached the demanding< 0.5 ppm threshold. For CH4, the precision for both SCIAMACHY products (50.2 ppb for IMAP and 76.4 ppb for WFMD) fail to meet the< 34 ppb threshold, but note that this work focusses on the period after the 2005 SCIAMACHY detector degradation. The GOSAT XCH4 precision ranges between 18.1 and 14.0 ppb. Looking at the SRA, all GOSAT algorithm products reach the< 10 ppm threshold (values ranging between 5.4 and 6.2 ppb). For SCIAMACHY, IMAP and WFMD have a SRA of 17.2 ppb and 10.5 ppb respectively. [ABSTRACT FROM AUTHOR]

The influence maximization problem (IMP) as classically formulated is based on the strong assumption that "chosen" nodes always adopt the new product. In this paper we propose a new influence maximization problem, referred to as the "Link-based Influence Maximization Problem" (LIM), which differs from IMP in that the decision variable of the spreader has changed from choosing an optimal seed to selecting an optimal node to influence in order to maximize the spread. Based on our proof that LIM is NP-hard with a monotonic increasing and submodular target function, we propose a greedy algorithm, GLIM, for optimizing LIM and use numerical simulation to explore the performance in terms of spread and computation time in different network types. The results indicate that the performance of LIM varies across network types. We illustrate LIM by applying it in the context of a Dutch national health promotion program for prevention of youth obesity within a network of Dutch schools. GLIM is seen to outperform the other methods in all network types at the cost of a higher computation time. These results suggests that GLIM may be utilized to increase the effectiveness of health promotion programs., Competing Interests: The authors have declared that no competing interests exist.

Cardiac computed tomography (CT) is a valuable tool for functional mechanical heart valve (MHV) assessment. An important aspect of bileaflet MHV assessment is evaluation and measurement of leaflet opening and closing angles. Performed manually, however, it is a laborious and time consuming task. In this paper, we propose an automated approach for bileaflet MHV leaflet angle computation. This method consists of four steps. After a one click selection of the MHV region on an axial image, an automatic MHV extraction using thresholding, and a connected component analysis based on voxel intensities is performed. Then, the MHV component (valve ring and two leaflets) positions are identified using random sample consensus and least square fitting. Finally, the angles are automatically computed based on the orientation of the components in each timeframe. Five multiphase CT scans from patients with a bileaflet MHV containing between 14 and 17 timepoints were used for development and another 15 were used for evaluation. The detected MHV components were scored for their overlap with real components as successful or unsuccessful. For successful results, the angles were compared to those measured by a radiologist. Qualitatively evaluated on a data set of 222 images, a total of 398 out of 444 angle computations (89.6%) were rated as successful. Compared to the angles measured by the radiologist, the successful angles showed a mean difference of 0.54° ± 3.63° from the manual calculations. The method provides a high success rate and an accurate computation of leaflet opening angles compared to manual measurements.

Reports are the standard way of communication between the radiologist and the referring clinician. Efforts are made to improve this communication by, for instance, introducing standardization and structured reporting. Natural Language Processing (NLP) is another promising tool which can improve and enhance the radiological report by processing free text. NLP as such adds structure to the report and exposes the information, which in turn can be used for further analysis. This paper describes pre-processing and processing steps and highlights important challenges to overcome in order to successfully implement a free text mining algorithm using NLP tools and machine learning in a small language area, like Dutch. A rule-based algorithm was constructed to classify T-stage of pulmonary oncology from the original free text radiological report, based on the items tumor size, presence and involvement according to the 8th TNM classification system. PyContextNLP, spaCy and regular expressions were used as tools to extract the correct information and process the free text. Overall accuracy of the algorithm for evaluating T-stage was 0,83 in the training set and 0,87 in the validation set, which shows that the approach in this pilot study is promising. Future research with larger datasets and external validation is needed to be able to introduce more machine learning approaches and perhaps to reduce required input efforts of domain-specific knowledge. However, a hybrid NLP approach will probably achieve the best results. [ABSTRACT FROM AUTHOR]

Translational research is conducted to achieve a predefined set of economic or societal goals. As a result, investment decisions on where available resources have the highest potential in achieving these goals have to be made. In this paper, we first describe how multicriteria decision analysis can assist in defining the decision context and in ensuring that all relevant aspects of the decision problem are incorporated in the decision making process. We then present the results of a case study to support priority setting in a translational research consortium aimed at reducing the burden of disease of type 2 diabetes. During problem structuring, we identified four research alternatives (primary, secondary, tertiary microvascular, and tertiary macrovascular prevention) and a set of six decision criteria. Scoring of these alternatives against the criteria was done using a combination of expert judgement and previously published data. Lastly, decision analysis was performed using stochastic multicriteria acceptability analysis, which allows for the combined use of numerical and ordinal data. We found that the development of novel techniques applied in secondary prevention would be a poor investment of research funds. The ranking of the remaining alternatives was however strongly dependent on the decision maker's preferences for certain criteria.

Background: Optimizing transitional care by practicing family-centered care might reduce unplanned events for patients who undergo major abdominal cancer surgery. However, it remains unknown whether involving family caregivers in patients' healthcare also has negative consequences for patient safety. This study assessed the safety of family involvement in patients' healthcare by examining the cause of unplanned events in patients who participated in a family involvement program (FIP) after major abdominal cancer surgery. Methods: This is a secondary analysis focusing on the intervention group of a prospective cohort study conducted in the Netherlands. Data were collected from April 2019 to May 2022. Participants in the intervention group were patients who engaged in a FIP. Unplanned events were analyzed, and root causes were identified using the medical version of a prevention- and recovery-information system for monitoring and analysis (PRISMA) that analyses unintended events in healthcare. Unplanned events were compared between patients who received care from family caregivers and patients who received professional at-home care after discharge. A Mann-Whitney U test was used to analyze data. Results: Of the 152 FIP participants, 68 experienced an unplanned event and were included. 112 unplanned events occurred with 145 root causes since some unplanned events had several root causes. Most root causes of unplanned events were patient-related factors (n = 109, 75%), such as patient characteristics and disease-related factors. No root causes due to inadequate healthcare from the family caregiver were identified. Unplanned events did not differ statistically (interquartile range 1–2) (p = 0.35) between patients who received care from trained family caregivers and those who received professional at-home care after discharge. Conclusion: Based on the insights from the root-cause analysis in this prospective multicenter study, it appears that unplanned emergency room visits and hospital readmissions are not related to the active involvement of family caregivers in surgical follow-up care. Moreover, surgical follow-up care by trained family caregivers during hospitalization was not associated with increased rates of unplanned adverse events. Hence, the concept of active family involvement by proficiently trained family caregivers in postoperative care appears safe and feasible for patients undergoing major abdominal surgery. [ABSTRACT FROM AUTHOR]

Background: An operating room (OR) department has adopted an efficient business model and subsequently investigated how efficiency could be further improved. The aim of this study is to show the efficiency improvement of lowering organizational barriers and applying advanced mathematical techniques., Methods: We applied advanced mathematical algorithms in combination with scenarios that model relaxation of various organizational barriers using prospectively collected data. The setting is the main inpatient OR department of a university hospital, which sets its surgical case schedules 2 wk in advance using a block planning method. The main outcome measures are the number of freed OR blocks and OR utilization., Results: Lowering organizational barriers and applying mathematical algorithms can yield a 4.5% point increase in OR utilization (95% confidence interval 4.0%-5.0%). This is obtained by reducing the total required OR time., Conclusions: Efficient OR departments can further improve their efficiency. The paper shows that a radical cultural change that comprises the use of mathematical algorithms and lowering organizational barriers improves OR utilization.

This paper presents a dynamic programming algorithm to draw optimal intermodal freight routing with regard to international logistics of container cargo for export and import. This study looks into the characteristics of intermodal transport using multi-modes, and presents a Weighted Constrained Shortest Path Problem (WCSPP) model. This study draws Pareto optimal solutions that can simultaneously meet two objective functions by applying the Label Setting algorithm, a type of Dynamic Programming algorithms, after setting the feasible area. To improve the algorithm performance, pruning rules have also been presented. The algorithm is applied to real transport paths from Busan to Rotterdam, as well as to large-scale cases. This study quantitatively measures the savings in both transport cost and time by comparing single transport modes with intermodal transport paths. Last, this study applies a mathematical model and MADM model to the multiple Pareto optimal solutions to estimate the solutions. [ABSTRACT FROM AUTHOR]

On the market several systems exist for collecting spent ammunition data for forensic investigation. These databases store images of cartridge cases and the marks on them. Image matching is used to create hit lists that show which marks on a cartridge case are most similar to another cartridge case. The research in this paper is focused on the different methods of feature selection and pattern recognition that can be used for optimizing the results of image matching. The images are acquired by side light images for the breech face marks and by ring light for the firing pin impression. For these images a standard way of digitizing the images used. For the side light images and ring light images this means that the user has to position the cartridge case in the same position according to a protocol. The positioning is important for the sidelight, since the image that is obtained of a striation mark depends heavily on the angle of incidence of the light. In practice, it appears that the user positions the cartridge case with +/-10 degrees accuracy. We tested our algorithms using 49 cartridge cases of 19 different firearms, where the examiner determined that they were shot with the same firearm. For testing, these images were mixed with a database consisting of approximately 4900 images that were available from the Drugfire database of different calibers.In cases where the registration and the light conditions among those matching pairs was good, a simple computation of the standard deviation of the subtracted gray levels, delivered the best-matched images. For images that were rotated and shifted, we have implemented a "brute force" way of registration. The images are translated and rotated until the minimum of the standard deviation of the difference is found. This method did not result in all relevant matches in the top position. This is caused by the effect that shadows and highlights are compared in intensity. Since the angle of incidence of the light will give a different intensity profile, this method is not optimal. For this reason a preprocessing of the images was required. It appeared that the third scale of the "à trous" wavelet transform gives the best results in combination with brute force. Matching the contents of the images is less sensitive to the variation of the lighting. The problem with the brute force method is however that the time for calculation for 49 cartridge cases to compare between them, takes over 1 month of computing time on a Pentium II-computer with 333MHz. For this reason a faster approach is implemented: correlation in log polar coordinates. This gave similar results as the brute force calculation, however it was computed in 24h for a complete database with 4900 images.A fast pre-selection method based on signatures is carried out that is based on the Kanade Lucas Tomasi (KLT) equation. The positions of the points computed with this method are compared. In this way, 11 of the 49 images were in the top position in combination with the third scale of the à trous equation. It depends however on the light conditions and the prominence of the marks if correct matches are found in the top ranked position. All images were retrieved in the top 5% of the database. This method takes only a few minutes for the complete database if, and can be optimized for comparison in seconds if the location of points are stored in files. For further improvement, it is useful to have the refinement in which the user selects the areas that are relevant on the cartridge case for their marks. This is necessary if this cartridge case is damaged and other marks that are not from the firearm appear on it.

In this work, we analyse and model a real life financial loan application belonging to a sample bank in the Netherlands. The event log is robust in terms of data, containing a total of 262 200 event logs, belonging to 13 087 different credit applications. The goal is to work out a decision model, which represents the underlying tasks that make up the loan application service. To this end we study the impact of incomplete event logs (for instance workers forget to register their tasks). The absence of data is translated into a drastic decrease of precision and compromises the decision models, leading to biased and unrepresentative results. We use non-classical probability to show we can better reduce the error percentage of inferences as opposed to classical probability. [ABSTRACT FROM AUTHOR]

During the outbreak of a disease caused by a pathogen with unknown characteristics, the uncertainty of its progression parameters can be reduced by devising methods that, based on rational assumptions, exploit available information to provide actionable insights. In this study, performed a few (~6) weeks into the outbreak of COVID-19 (caused by SARS-CoV-2), one of the most important disease parameters, the average time-to-recovery, was calculated using data publicly available on the internet (daily reported cases of confirmed infections, deaths, and recoveries), and fed into an algorithm that matches confirmed cases with deaths and recoveries. Unmatched cases were adjusted based on the matched cases calculation. The mean time-to-recovery, calculated from all globally reported cases, was found to be 18.01 days (SD 3.31 days) for the matched cases and 18.29 days (SD 2.73 days) taking into consideration the adjusted unmatched cases as well. The proposed method used limited data and provided experimental results in the same region as clinical studies published several months later. This indicates that the proposed method, combined with expert knowledge and informed calculated assumptions, could provide a meaningful calculated average time-to-recovery figure, which can be used as an evidence-based estimation to support containment and mitigation policy decisions, even at the very early stages of an outbreak. [ABSTRACT FROM AUTHOR]

During the last decade, rainfall monitoring using signal-level data from commercial microwave links (CMLs) in cellular communication networks has been proposed as a complementary way to estimate rainfall for large areas. Path-averaged rainfall is retrieved between the transmitting and receiving cellular antennas of a CML. One rainfall estimation algorithm for CMLs is RAINLINK, which has been employed in different regions (e.g., Brazil, Italy, the Netherlands, and Pakistan) with satisfactory results. However, the RAINLINK parameters have been calibrated for a unique optimum solution, which is inconsistent with the fact that multiple similar or equivalent solutions may exist due to uncertainties in algorithm structure, input data, and parameters. Here, we show how CML rainfall estimates can be improved by calibrating all parameters of the algorithm systematically and simultaneously with the stochastic particle swarm optimization method, which is used for the numerical maximization of the objective function. An open dataset of approximately 2800 sub-links of minimum and maximum received signal levels over 15 min intervals covering the Netherlands (∼ 35 500 km 2) is employed: 12 d are used for calibration and 3 months for validation. A gauge-adjusted radar rainfall dataset is utilized as a reference. Verification of path-average daily rainfall shows a reasonable improvement for the stochastically calibrated parameters with respect to RAINLINK's default parameter settings. Results further improve when averaged over the Netherlands. Moreover, the method provides a better underpinning of the chosen parameter values and is therefore of general interest for calibration of RAINLINK's parameters for other climates and cellular communication networks. [ABSTRACT FROM AUTHOR]

Landscape character can be defined as the presence, variety and arrangement of landscape features, which give a landscape a specific identity and make it stand out from surrounding landscapes. Landscape character contributes to the esthetical and perceptional value of an area, which is important for the development of non-production functions in the countryside as demanded by society. In this paper we present a new methodology for landscape character assessment using the pattern of landscape features as stored in a GIS to delineate, characterize and evaluate landscapes using a region growing algorithm. We have applied this methodology in a case study area in the north of the Netherlands and compared the results with a series of expert classifications of the study area. The results of the region growing algorithms were good and interpretable in relation to the underlying data. The resemblance between the expert classification and the classification based on the region growing results varied between 34% and 100% for the different landscape types. The differences between the two data sets can be explained in terms of input data and knowledge about the study area. The classification of the region growing algorithm was more consistent than the expert classification throughout the study area. The presented methodology for landscape character assessment is proposed as support for spatial planning processes and policy development for landscape conservation by providing a quantitative tool to analyze landscape patterns, to discriminate between the various landscapes in a study area and by elucidating features that are important for the identity of a region. [Copyright &y& Elsevier]

[Display omitted] • We simulate renewables pathways under different support phase-out scenarios. • We extend an investment algorithm by preferences and calibrated returns. • Our improved algorithm incorporates more heterogeneity resulting in stronger effects. • Further auction support is necessary for most capacity targets in the case countries. • Countries should coordinate policy changes due to cross-border effects. Support schemes have been central to the expansion of renewable electricity globally and in the European Union. As technologies mature, individual member states may decide to phase out these policies. While previous research has shown that such policy changes affect investors' decisions, we investigate how they affect pathways and electricity prices by simulating investment decisions in an agent-based model in two case countries. This paper contributes and applies an adapted investment decision algorithm that incorporates empirically observed technology and return preferences and is calibrated by return observations. The new algorithm yields more refined and stronger effects compared to its predecessor. Results show that the phase-out of auctions in Germany and the Netherlands slows down their deployment of renewable capacity by up to ∼60% and ∼35%, respectively. With the exception of photovoltaics and onshore wind projects in the Netherlands, the targeted capacities can only be reached by continuing support in both countries. Furthermore, ending support in a large country like Germany leads to higher electricity prices and fosters a market-driven but insufficient capacity expansion in smaller neighbours like the Netherlands. As the electricity grids in many countries are strongly interconnected, such cross-border effects are of international relevance. Our findings suggest that continued auctions may be necessary and that countries should coordinate policy changes to stay on track for meeting their renewables targets. [ABSTRACT FROM AUTHOR]

The presence of significant biases in real-time radar quantitative precipitation estimations (QPEs) limits its use in hydrometeorological forecasting systems. Here, we introduce CARROTS (Climatology-based Adjustments for Radar Rainfall in an OperaTional Setting), a set of fixed bias reduction factors, which vary per grid cell and day of the year. The factors are based on a historical set of 10 years of 5 min radar and reference rainfall data for the Netherlands. CARROTS is both operationally available and independent of real-time rain gauge availability and can thereby provide an alternative to current QPE adjustment practice. In addition, it can be used as benchmark for QPE algorithm development. We tested this method on the resulting rainfall estimates and discharge simulations for 12 Dutch catchments and polders. We validated the results against the operational mean field bias (MFB)-adjusted rainfall estimates and a reference dataset. This reference consists of the radar QPE, that combines an hourly MFB adjustment and a daily spatial adjustment using observations from 32 automatic and 319 manual rain gauges. Only the automatic gauges of this network are available in real time for the MFB adjustment. The resulting climatological correction factors show clear spatial and temporal patterns. Factors are higher away from the radars and higher from December through March than in other seasons, which is likely a result of sampling above the melting layer during the winter months. The MFB-adjusted QPE outperforms the CARROTS-corrected QPE when the country-average rainfall estimates are compared to the reference. However, annual rainfall sums from CARROTS are comparable to the reference and outperform the MFB-adjusted rainfall estimates for catchments away from the radars, where the MFB-adjusted QPE generally underestimates the rainfall amounts. This difference is absent for catchments closer to the radars. QPE underestimations are amplified when used in the hydrological model simulations. Discharge simulations using the QPE from CARROTS outperform those with the MFB-adjusted product for all but one basin. Moreover, the proposed factor derivation method is robust. It is hardly sensitive to leaving individual years out of the historical set and to the moving window length, given window sizes of more than a week. [ABSTRACT FROM AUTHOR]

This study presents the Precipitation Estimation from Remotely Sensed Information Using Artificial Neural Networks–Dynamic Infrared Rain Rate (PDIR-Now) near-real-time precipitation dataset. This dataset provides hourly, quasi-global, infrared-based precipitation estimates at 0.04° × 0.04° spatial resolution with a short latency (15–60 min). It is intended to supersede the PERSIANN–Cloud Classification System (PERSIANN-CCS) dataset previously produced as the near-real-time product of the PERSIANN family. We first provide a brief description of the algorithm's fundamentals and the input data used for deriving precipitation estimates. Second, we provide an extensive evaluation of the PDIR-Now dataset over annual, monthly, daily, and subdaily scales. Last, the article presents information on the dissemination of the dataset through the Center for Hydrometeorology and Remote Sensing (CHRS) web-based interfaces. The evaluation, conducted over the period 2017–18, demonstrates the utility of PDIR-Now and its improvement over PERSIANN-CCS at all temporal scales. Specifically, PDIR-Now improves the estimation of rain/no-rain days as demonstrated by a critical success index (CSI) of 0.53 compared to 0.47 of PERSIANN-CCS. In addition, PDIR-Now improves the estimation of seasonal and diurnal cycles of precipitation as well as regional precipitation patterns erroneously estimated by PERSIANN-CCS. Finally, an evaluation is carried out to examine the performance of PDIR-Now in capturing two extreme events, Hurricane Harvey and a cluster of summer thunderstorms that occurred over the Netherlands, where it is shown that PDIR-Now adequately represents spatial precipitation patterns as well as subdaily precipitation rates with a correlation coefficient (CORR) of 0.64 for Hurricane Harvey and 0.76 for the Netherlands thunderstorms. [ABSTRACT FROM AUTHOR]

Background: We investigated the association of symptoms and disease severity of shigellosis patients with genetic determinants of infecting Shigella and entero-invasive Escherichia coli (EIEC), because determinants that predict disease outcome per individual patient could be used to prioritize control measures. For this purpose, genome wide association studies (GWAS) were performed using presence or absence of single genes, combinations of genes, and k-mers. All genetic variants were derived from draft genome sequences of isolates from a multicenter cross-sectional study conducted in the Netherlands during 2016 and 2017. Clinical data of patients consisting of binary/dichotomous representation of symptoms and their calculated severity scores were also available from this study. To verify the suitability of the methods used, the genetic differences between the genera Shigella and Escherichia were used as control. Results: The isolates obtained were representative of the population structure encountered in other Western European countries. No association was found between single genes or combinations of genes and separate symptoms or disease severity scores. Our benchmark characteristic, genus, resulted in eight associated genes and > 3,000,000 k-mers, indicating adequate performance of the algorithms used. Conclusions: To conclude, using several microbial GWAS methods, genetic variants in Shigella spp. and EIEC that can predict specific symptoms or a more severe course of disease were not identified, suggesting that disease severity of shigellosis is dependent on other factors than the genetic variation of the infecting bacteria. Specific genes or gene fragments of isolates from patients are unsuitable to predict outcomes and cannot be used for development, prioritization and optimization of guidelines for control measures of shigellosis or infections with EIEC. [ABSTRACT FROM AUTHOR]

Objectives: Value of information (VOI) analysis provides information on opportunity cost of a decision in healthcare by estimating the cost of reducing parametric uncertainty and quantifying the value of generating additional evidence. This study is an application of the VOI methodology to the problem of choosing between home telemonitoring and nurse telephone support over usual care in chronic heart failure management in the Netherlands. Methods: The expected value of perfect information (EVPI) and the expected value of partially perfect information (EVPPI) analyses were based on an informal threshold of €20K per quality-adjusted life-year. These VOI-analyses were applied to a probabilistic Markov model comparing the 20-year costs and effects in three interventions. The EVPPI explored the value of decision uncertainty caused by the following group of parameters: treatment-specific transition probabilities between New York Heart Association (NYHA) defined disease states, utilities associated with the disease states, number of hospitalizations and ER visits, health state specific costs, and the distribution of patients per NYHA group. We performed the analysis for two population sizes in the Netherlands—patients in all NYHA classes of severity, and patients in NYHA IV class only. Results: The population EVPI for an effective population of 2,841,567 CHF patients in All NYHA classes of severity over the next 20 years is more than €4.5B, implying that further research is highly cost-effective. In the NYHA IV only analysis, for the effective population of 208,003 patients over next 20 years, the population EVPI at the same informal threshold is approx. €590M. The EVPPI analysis showed that the only relevant group of parameters that contribute to the overall decision uncertainty are transition probabilities, in both All NYHA and NYHA IV analyses. Conclusions: Results of our VOI exercise show that the cost of uncertainty regarding the decision on reimbursement of telehealth interventions for chronic heart failure patients is high in the Netherlands, and that future research is needed, mainly on the transition probabilities. [ABSTRACT FROM AUTHOR]

Background The article examines gender differences in happy life expectancy at age 50 (LE50) and computes the age-specific contributions of mortality and happiness effects to gender differences in happy LE50 in 16 European countries. Methods Abridged life tables and happy LE50 were calculated using conventional life tables and Sullivan's method. Age-specific death rates were calculated from deaths and population exposures in the Human Mortality Database. Happiness prevalence was estimated using the 2010–11 Survey of Health, Ageing and Retirement in Europe. Happiness was defined using a single question about life satisfaction on a scale of 0–10. A decomposition algorithm was applied to estimate the exact contributions of the differences in mortality and happiness to the overall gender gap in happy LE50. Results Gender differences in happy LE50 favour women in all countries except Portugal (0.43 years in Italy and 3.55 years in Slovenia). Generally, the contribution of the gender gap in happiness prevalence is smaller than the one in mortality. The male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE50. Gender differences in unhappy life years make up the greatest share of the gender gap in total LE50 in all countries except Denmark, Germany, Netherlands, Slovenia and Sweden. Conclusion Countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. The remaining years of life of women are expected to be spent not only in unhealthy but also in unhappy state. [ABSTRACT FROM AUTHOR]

Objectives: Diagnosis Related Group (DRG) systems aim to classify patients into mutually exclusive groups of patients, with the patients in each group having the same expected length of stay (LOS). We examined the ability of current classification variables to explain LOS variation between DRG-like Diagnosis Treatment Combination (DBC)s for ten episodes of care in the Netherlands, including breast cancer, stroke and inguinal hernia repair. Additionally, we assessed the predictive ability of some other classification variables. Methods: For each episode of care, the relevant DBC codes of all hospitalizations in 2008 were identified and all available determinants that may serve as classification variables were acquired from the national database. Ordinary least squares regression was used to examine the predictive ability of these classification variables. Results: The current classification variables are not sufficiently distinct to classify patients into mutually exclusive groups of patients. ICU admissions and hospital type may serve as valuable classification variables. Additionally, episode-specific variables may improve the Dutch grouping algorithm. Conclusions: Although it may not be feasible in the short term, grouping algorithms would benefit greatly from the introduction of classification variables tailored to the needs of specific episodes of care. A first step would be to focus on 'general' classification variables meaningful for specific episodes of care. [ABSTRACT FROM AUTHOR]

The Cabauw Experimental Site for Atmospheric Research (CESAR) observatory hosts a unique collection of instruments related to precipitation measurement. The data collected by these instruments are stored in a database that is freely accessible through a Web interface. The instruments present at the CESAR site include three disdrometers (two on the ground and one at 200 m above ground level), a dense network of rain gauges, three profiling radars (1.3, 3.3, and 35 GHz), and an X-band Doppler polarimetric scanning radar. In addition to these instruments, operational weather radar data from the nearby (∼∼25 km) De Bilt C-band Doppler radar are also available. The richness of the datasets available is illustrated for a rainfall event, where the synergy of the different instruments provides insight into precipitation at multiple spatial and temporal scales. These datasets, which are freely available to the scientific community, can contribute greatly to our understanding of precipitation-related atmospheric and hydrologic processes. [ABSTRACT FROM AUTHOR]

Background: The costs and benefits of controlling nosocomial spread of antibiotic-resistant bacteria are unknown. Methods: We developed a mathematical algorithm to determine cost-effectiveness of infection control programs and explored the dynamical interactions between different epidemiological variables and cost-effectiveness. The algorithm includes occurrence of nosocomial infections, attributable mortality, costs and efficacy of infection control and how antibiotic-resistant bacteria affect total number of infections: do infections with antibiotic-resistant bacteria replace infections caused by susceptible bacteria (replacement scenario) or occur in addition to them (addition scenario). Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was used for illustration using observational data on S. aureus bacteremia (SAB) in our hospital (n = 189 between 2001-2004, all being methicillin-susceptible S. aureus [MSSA]). Results: In the replacement scenario, the costs per life year gained range from € 45,912 to € 6590 for attributable mortality rates ranging from 10% to 50%. Using € 20,000 per life year gained as a threshold, completely preventing MRSA would be cost-effective in the replacement scenario if attributable mortality of MRSA is ⩾21%. In the addition scenario, infection control would be cost saving along the entire range of estimates for attributable mortality. Conclusions: Cost-effectiveness of controlling antibiotic-resistant bacteria is highly sensitive to the interaction between infections caused by resistant and susceptible bacteria (addition or replacement) and attributable mortality. In our setting, controlling MRSA would be cost saving for the addition scenario but would not be cost-effective in the replacement scenario if attributable mortality would be <21%. [ABSTRACT FROM AUTHOR]

Background: There is a need for brief instruments to ascertain the diagnosis of major depressive disorder. In this study, we present the reliability, construct validity and accuracy of the PHQ-9 and PHQ-2 to detect major depressive disorder in primary care. Methods: Cross-sectional analyses within a large prospective cohort study (PREDICT-NL). Data was collected in seven large general practices in the centre of the Netherlands. 1338 subjects were recruited in the general practice waiting room, irrespective of their presenting complaint. The diagnostic accuracy (the area under the ROC curve and sensitivities and specificities for various thresholds) was calculated against a diagnosis of major depressive disorder determined with the Composite International Diagnostic Interview (CIDI). Results: The PHQ-9 showed a high degree of internal consistency (ICC = 0.88) and test-retest reliability (correlation = 0.94). With respect to construct validity, it showed a clear association with functional status measurements, sick days and number of consultations. The discriminative ability was good for the PHQ-9 (area under the ROC curve = 0.87, 95% CI: 0.84-0.90) and the PHQ-2 (ROC area = 0.83, 95% CI 0.80-0.87). Sensitivities at the recommended thresholds were 0.49 for the PHQ-9 at a score of 10 and 0.28 for a categorical algorithm. Adjustment of the threshold and the algorithm improved sensitivities to 0.82 and 0.84 respectively but the specificity decreased from 0.95 to 0.82 (threshold) and from 0.98 to 0.81 (algorithm). Similar results were found for the PHQ-2: the recommended threshold of 3 had a sensitivity of 0.42 and lowering the threshold resulted in an improved sensitivity of 0.81. Conclusion: The PHQ-9 and the PHQ-2 are useful instruments to detect major depressive disorder in primary care, provided a high score is followed by an additional diagnostic work-up. However, often recommended thresholds for the PHQ-9 and the PHQ-2 resulted in many undetected major depressive disorders. [ABSTRACT FROM AUTHOR]