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IntroductionAlthough antibiotic use and antimicrobial resistance in the Netherlands is comparatively low, inappropriate prescription of antibiotics is substantial, mainly for respiratory tract infections (RTIs). General practitioners (GPs) experience pressure from patients with an immigration background to prescribe antibiotics and have difficulty communicating in a culturally sensitive way. Multifaceted interventions including communication skills training for GPs are shown to be most effective in reducing antibiotic prescription. The PARCA study aims to reduce the number of antibiotic prescriptions for RTIs through implementing a culturally sensitive communication intervention for GPs and evaluate it in a randomised controlled trial (RCT).Methods and analysisA non-blinded RCT including 58 GPs (29 for each arm). The intervention consists of: (1) An E-learning with 4 modules of 10–15 min each; (2) A face-to-face training session in (intercultural) communication skills including role plays with a training actor and (3) Availability of informative patient-facing materials that use simple words (A2/B1 level) in multiple languages. The primary outcome measure is the number of dispensed antibiotic courses qualifying for RTIs in primary care, per 1000 registered patients. The secondary outcome measure is the number of all dispensed antibiotic courses, per 1000 registered patients. The intervention arm will receive the training in Autumn 2021, followed by an observation period of 6 winter months for which numbers of antibiotics will be collected for both trial arms. The GPs/practices in the control arm can attend the training after the observation period.Ethics and disseminationThe study protocol was approved by the Medical Ethics Review Committee of Erasmus MC, University Medical Center Rotterdam (MEC-2020-0142). The results of the trial will be published in international peer-reviewed scientific journals and will be disseminated through national and international congresses. The project is funded by The Netherlands Organisation for Health Research and Development (ZonMw).Trial registration numberNL9450.

BackgroundExamining the determinants of adolescent’s physical activity (PA) and how they may differ according to the intersection of gender and family socioeconomic status (SES) can support the development of tailored interventions to more effectively promote adolescents’ PA. This study explored how the influence of psychosocial, behavioural and environmental determinants on adolescent’s PA differed according to gender and family SES. MethodsThis study used data from the Dutch survey Health Monitor Youth 2015. Adolescents (n=9,068) aged 12-19 were included for the study. The associations between psychosocial, behavioural, and environmental determinants and PA (days per week engaging in at least one hour of PA) were examined with multilevel linear regression analysis. Potential interactions between these determinants, gender and family SES were explored.ResultsOn average, adolescents engaged in at least one hour of PA for 4,2 days per week. Poor self-perceived health, low peer social support, and a weak connection with the environment were all associated with lower PA in adolescents. Daily smoking, cannabis use, risk of problematic gaming and social media use, as well as lack of daily consumption of fruit, vegetables, water and breakfast were associated with lower PA, whereas binge drinking was not. Interactions revealed that poor self-perceived health was associated with lower PA in adolescents from moderate- and high-SES families, but not in low-SES adolescents, whereas cannabis use was only associated with lower PA amongst low-SES adolescents. Low peer social support was associated with lower PA across all groups, but it was most strongly associated with lower PA amongst male adolescents from low-SES families than in other subgroups. Amongst low-SES males, low peer social support was associated with a 1.47 reduction in days engaging in sufficient PA, compared with a 0.69 reduction for high-SES males.ConclusionsThis study identified several psychosocial, behavioural and environmental determinants that can be targeted to potentially increase adolescent’s PA. We also found that correlates of PA differed according to the intersection of gender and family SES. Our findings suggest that PA interventions should be tailored according to gender and SES to address the specific needs, barriers and facilitators of different subgroups.

Many adolescents use their electronic devices to send each other sexually explicit texts, photos, and videos of themselves—commonly known as sexting. This can be fun and is not usually problematic. However, if the intended recipient decides to share these sexts with a broader audience, the consequences for the depicted can be detrimental. The purpose of this study was to investigate the prevalence of (non-consensual) sext-sharing among Dutch adolescents and explore the characteristics of those who do, to gain a better understanding of factors involved in dissemination. We used data from “Sex under the age of 25,” a representative national survey on sexual health among a sample of 20,834 Dutch 12–24-year-olds. The prevalence of sext-sharing was estimated using Complex Samples. Logistic regressions were used to assess associations between demographics, school-based sexting education, sexual- and online behavior, and mental health and sext-sharing. About 4% of the adolescents reported having shared someone else's sext in the last six months. Being male, aged 12–14 years, frequent social media usage, watching online porn, sexual experience, and being subjected to sext-sharing themselves associated most strongly with sext-sharing. Our findings show that the likelihood of sext-sharing is lower in older adolescents and that it associates with the extent of adolescents' sexual curiosity and online activity. The overlap between sharing sexts of others and having one's own sext shared suggests that dissemination of personal sexual content might be normalized or used as an act of retribution. Further research could be helpful to explain the mechanisms underlying this overlap. The results of this study illustrate the importance of exposing adolescents to evidence based preventive educational interventions on sexting from 12 years onwards and not just within the context of traditional school-based sex education, but also as a part of the (online) media-literacy curriculum.

Objective: Ethnic minorities in the Netherlands experience worse (mental) health than Dutch natives. So far, socioeconomic factors, discrimination, and the migration process have been identified as underlying factors, neglecting the potential role of health-related behaviours. This study investigates the mediating effect of lack of physical activity, smoking and alcohol consumption on ethnic inequalities in (mental) health in the Netherlands.Design: Data from a municipal health survey (2012) in the four largest cities in the Netherlands, including 15,633 Dutch natives, 1,297 Surinamese, 850 Turks and 779 Moroccans were analysed. Mediation analyses were performed on the associations between ethnicity and psychological distress (range 10–50) and self-rated health (range 1–5).Results: Being from an ethnic minority was associated with higher distress and poorer self-rated health, especially for Turks (higher distress 4.69, 95%CI 4.22–5.16; poorer health 0.35, 95%CI 0.30–0.40). Moroccans and Turks were the least physically active, Turks smoked the most, and Dutch natives drank the most. Lack of physical activity partially mediated the association between Turks (6% respectively 11%) and Moroccans (13% respectively 9%) for psychological distress and self-rated health. Smoking played a mediating role (3%) in Turks.Conclusion: Lower physical activity and smoking more cigarettes partly explained ethnic health inequalities in the Netherlands. The current findings suggest that intervening and facilitating certain ethnic groups in engaging in health behaviours could contribute to improving their health and reduce ethnic health inequalities.

Potocki Lupski ve Smith Magenis sendromları insan 17. kromozom kısa kolu (11.2 bandı) ile ilişkili sendromlardır. Bu bölgenin duplikasyonu Potocki Lupski, delesyonu ise Simth Magenis sendromu olarak tanımlanmaktadır. Çocukluk çağında nadir görülen bu hastalıkların tipik fenotipik özellikleri olsa da tanı ileri genetik analizlerle konulmaktadır. Bu makalede nörolojik gelişimsel gerilik başta olmak üzere bu iki sendromun neden olduğu diğer nörolojik komplikasyonları belirtmeyi ve pediyatri klinisyenlerinin bu sendromlara dikkatini çekmeyi amaçladık. Potocki Lupski and Smith Magenis syndromes are associated with the human 17th chromosome short arm (11.2 band). Duplication of this region is defined as Potocki Lupski syndrome, and its deletion is defined as Smith Magenis syndrome. Although these diseases, which are rare in childhood, have typical phenotypic features, the diagnosis is made with advanced genetic analysis. In this article, we aimed to point out especially neurological developmental delay and other neurological complications caused by these two syndromes and draw the attention of pediatric clinicians to these syndromes., Potocki-Lupski and Smith-Magenis syndromes are associated with the human 17th chromosome short arm (11.2 band). Duplication of this region is defined as Potocki-Lupski syndrome, and its deletion is defined as Smith-Magenis syndrome. Although these diseases, which are rare in childhood, have typical phenotypic features, the diagnosis is made with advanced genetic analysis. In this article, we aimed to point out especially neurological developmental delay and other neurological complications caused by these two syndromes and draw the attention of pediatric clinicians to these syndromes.

Diffie ve Hellman [1] tarafından ortaya konulan Açık Anahtarlı Şifreleme günümüz haberleşme sistemlerinde yaygınca kulanılmaktadır. RSA ve eliptik eğri tabanlı kriptosistemleri modüler çarpma işlemine dayanmaktadır. Geniş sayılarla modüler çarpma işlemi bu sistemlerdeki ana hesap kısmını oluşturmaktadır. Geleneksel modüler çarpma, bölme işlemi içerdiği için pahalı bir operasyondur. Bölme işleminden kurtulmak için, literatürde Montgomery ve Barrett algoritmaları [5], [27] öne sürülmüştür. Bu algoritmalar bölme işlemi yerine, çarpma ve kaydırma işlemini kullanmaktadır.Bu tezde, ilk olarak, hane tabanlı ve FPGA'nın DSP kaynaklarını kullanan bir Montgomery çarpıcısı tasarlanmıştır. Tasarlanan donanım, Verilog diliyle yazılmıştır ve bir 528 bit Mongomery carpma işlemini Virtex-7 xc7vx330tffg1157-3 çipinde 0.43us'de bir 1056 bit Montgomery çarpma işlemini 1.09 us'de hesaplamaktadır. Sonra, DSP kaynaklarını kullanan bir tam kelime Barrett çarpıcısı öne sürülmüştür. Öne sürülen donanım, bir 528 bit Barrett çarpma işlemini Virtex-7 xc7vx330tffg1157-3 çipinde 0.49 us'de bir 1056 bit Barrett çarpma işlemini 1.88 us'de hesaplamaktadır.Daha sonra, öne sürülen Montgomery çarpıcısına dayanan eliptik eğri nokta çarpıcısı (ECPM) tasarlanmıştır. Tasarlanan ECPM donanımı Virtex-7 xc7vx330tffg1157-3 çipinde, bir adet 528 bit ECPM işlemini herhangi bir asal eğri için 4.06 ms'de, NIST p-521 eğrisi için 2.79 ms'de hesaplamaktadır. Son olarak, Montgomery ve Barrett algoritmaları Vivado HLS aracıyla gerçeklenmiştir. Montgomery ve Barrett algoritmalarının HLS gerçeklemeleri bir 528 bit modüler çarpma işlemini, Virtex-7 xc7vx330tffg1157-3 çipinde, sırasıyla 1.34 us ve 2.57 us'de hesaplamaktadır. Public-key cryptography (PKC) introduced by Diffie and Hellman [1], is widely used in today's communication systems. RSA and elliptic curve based public-key cryptosystems heavily depend on modular multiplication. Modular multiplication operation with large integers is the main computation part in these systems. Conventional modular multiplication is an expensive operation because it requires division. In order to overcome this difficulty, effective modular multiplication algorithms are proposed in the literature. Most common ones are Montgomery and Barrett algorithms [5], [27] which replace division with multiplication and shift operations. Therefore, in this thesis, we first designed a fast digit based Montgomery multiplier using DSP resources of FPGAs. The proposed hardware is implemented Verilog HDL and it takes 0.43 us to compute one 528 bit Montgomery modular multiplication and 1.09 us to compute one 1056 bit Montgomery modular multiplication in Virtex-7 xc7vx330tffg1157-3. We then, proposed full-word Barrett multiplier using DSP resources. It takes 0.49 us to compute one 528 bit Barrett modular multiplication and 1.88 us to compute one 1056 bit Barrett modular multiplication in Virtex-7 device xc7vx330tffg1157-3.We, then designed ECPM hardware based on the proposed Montgomery multiplier. It takes 4.06 ms to compute one 528 bit ECPM in any prime field and 2.79 ms to compute NIST p-521 ECPM in Virtex-7 xc7vx330tffg1157-3.Finally, we implemented Montgomery and Barrett algorithms using Vivado HLS tool. HLS implementation of Montgomery and Barrett algorithm takes 1.34 us and 2.57 us to compute one 528 bit modular multiplication in Virtex-7 device xc7vx330tffg1157-3 respectively. 74

__Background:__ Neighbourhood inequalities in psychological distress are well reported, but underlying mechanisms remain poorly understood. The main purposes of this study were to investigate associations between structural neighbourhood conditions and psychological distress, and to explore the potential mediating role of neighbourhood social cohesion. __Methods:__ Cross-sectional questionnaire study on a random sample of 18 173 residents aged ≥16 years (response 49%) from the four largest cities in the Netherlands. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). Structural environmental factors under study were neighbourhood socio-economic status (SES), neighbourhood green, urbanity and home maintenance. Neighbourhood social cohesion was measured by five statements and aggregated to the neighbourhood level by using ecometrics methodology. Multilevel linear regression analysis was used to investigate associations of neighbourhoods characteristics with psychological distress, adjusted for individual level characteristics. __Results:__ High neighbourhood SES and neighbourhood social cohesion were associated with decreased psychological distress. Adjusted for individual level characteristics and neighbourhood SES, only neighbourhood social cohesion remained significantly associated with psychological distress. Neighbourhood social cohesion accounted for 38% of the differences in the association between neighbourhood SES and psychological distress. __Conclusions:__ High neighbourhood social cohesion is significantly associated with decreased psychological distress among residents of the four largest cities in the Netherlands. Reducing neighbourhood inequalities in psychological distress may require increasing social interactions among neighbourhood residents.

The main purpose of this study was to investigate whether neighborhood ethnic diversity moderated the association between ethnicity and psychological distress in the four largest cities of Netherlands. Multilevel linear regression analysis was used to assess whether the association between ethnicity and psychological distress differed by levels of neighborhood ethnic diversity. Results showed that the Turkish and Moroccan residents reported significantly higher psychological distress than native Dutch and Surinamese residents. In high ethnic diverse neighborhoods Turkish residents reported significantly less psychological distress than in low ethnic diverse neighborhoods. Ethnic diversity amplifies the risk of depression for some but not all ethnic minorities.

American Society of Hematology

Background: Perinatal morbidity rates are relatively high in the Netherlands, and significant inequalities in perinatal morbidity and mortality can be found across neighborhoods. In socioeconomically deprived areas, 'Western' women are particularly at risk for adverse birth outcomes. Almost all studies to date have explained the disparities in terms of individual determinants of birth outcomes. This study examines the influence of neighborhood contextual characteristics on birth weight (adjusted for gestational age) and preterm birth. We focused on the influence of neighborhood social capital - measured as informal socializing and social connections between neighbors - as well as ethnic (minority) density. Methods: Data on birth weight and prematurity were obtained from the Perinatal Registration Netherlands 2000-2008 dataset, containing 97% of all pregnancies. Neighborhood-level measurements were obtained from three different sources, comprising both survey and registration data. We included 3.422 neighborhoods and 1.527.565 pregnancies for the birth weight analysis and 1.549.285 pregnancies for the premature birth analysis. Linear and logistic multilevel regression was performed to assess the associations of individual and neighborhood level variables with birth weight and preterm birth. Results: We found modest but significant neighborhood effects on birth weight and preterm births. The effect of ethnic (minority) density was stronger than that of neighborhood social capital. Moreover, ethnic (minority) density was associated with higher birth weight for infants of non-Western ethnic minority women compared to Western women (15 grams; 95% CI: 12,4/17,5) as well as reduced risk for prematurity (OR 0.97; CI 0,95/0,99). Conclusions: Our results indicate that neighborhood contexts are associated with birth weight and preterm birth in the Netherlands. Moreover, ethnic (minority) density seems to be a protective factor for non-Western ethnic minority women, but not for Western women. This helps explain the increased risk of Western women in deprived neighborhoods for adverse birth outcomes found in previous studies. © 2014 Schölmerich et al.

Purpose: Ethnic density, the proportion of people of the same ethnic group in the neighbourhood, has been identified as a protective factor with regard to mental health in ethnic minorities. Research on the putative intermediating factors, exposure to discrimination and improved social support, has not yielded conclusive evidence. We investigated the association between ethnic density and psychological well-being in three ethnic minority groups in the Netherlands. We also assessed whether a protective ethnic density effect is related to the degree to which each group experiences discrimination and social support at group level.Methods: Using multi-level linear regression modelling, we studied the influence of ethnic density at neighbourhood level on psychological distress, measured with the Kessler Psychological Distress scale (K10), in 13,864 native Dutch, 1,206 Surinamese-Dutch, 978 Turkish-Dutch and 784 Moroccan-Dutch citizens of the four major cities in the Netherlands. Based on a nationwide survey among ethnic minorities on social integration, ethnic groups were ordered with respect to the intermediating factors.Results: Ethnic density was not associated with psychological distress in any of the three ethnic minority groups. As a consequence, we found no support for either experiences of discrimination or for own-group social interactions at group level as intermediating factors. In all three ethnic minority groups, as well as in the native Dutch group, individual demographic and socio-economic factors emerged as the main explanations for individuals’ mental well-being.Conclusions: These results suggest that individual demographic and socio-economic risk characteristics outweigh the influence of neighbourhood attributes on mental health.

High Efficiency Video Coding (HEVC), a recently developed international standard for video compression, offers significantly better video compression efficiency than previous international standards. However, this coding gain comes with an increase in computational complexity. Therefore, in this thesis, we first designed a high performance hardware architecture for deblocking filter algorithm used in HEVC standard. Two parallel datapaths are used in the hardware to increase its performance. The proposed hardware is implemented in Verilog HDL. The Verilog RTL code is mapped to a Xilinx XC6VLX240T FPGA, and it is verified to work correctly on a Xilinx ML605 FPGA board which includes a Xilinx XC6VLX240T FPGA. The FPGA implementation can work at 108 MHz, and it can code 30 full HD (1920x1080) video frames per second. We then proposed an energy reduction technique for Sum of Absolute Transformed Difference (SATD) based HEVC intra mode decision algorithm. We designed an efficient hardware architecture for SATD based HEVC intra mode decision algorithm including the proposed technique. The proposed hardware is implemented in Verilog HDL. The Verilog RTL code is mapped to a Xilinx XC6VLX365T FPGA, and it is verified with post place & route simulations. The FPGA implementation can work at 116 MHz, and it can code 21 HD (1280x720) video frames per second. The proposed technique reduced its energy consumption up to 64.6% on this FPGA without any PSNR loss.

Yakın tarihte geliştirilmiş uluslararası bir standard olan Yüksek Verimlilikli Video Kodlama (YVVK), kendinden önceki standartlara göre belirgin şekilde daha iyi sıkıştırma verimi sunmaktadır. Ancak bu kodlama kazancı beraberinde işlem miktarında önemli bir artış getirmektedir. Bu tezde ilk olarak YVVK video standardında kullanılan blok giderici filtre (BGF) algoritması için yüksek performanslı bir donanım mimarisi tasarlandı. Donanımın performansını artırmak için iki paralel veriyolu kullanıldı. Önerilen donanım Verilog HDL kullanılarak gerçeklendi. Verilog RTL kodu Xilinx XC6VLX240T FPGA?ne yerleştirildi ve Xilinx XC6VLX240T FPGA içeren bir Xilinx ML605 FPGA kartında doğrulandı. FPGA gerçeklemesi 108 MHz hızla çalışabilmekte ve saniyede 30 tam HD (1920x1080) çerçevesini kodlayabilmektedir. Daha sonra, Mutlak Dönüşüm Fark Toplamı (MDFT) tabanlı YVVK çerçeve içi kip seçimi için özgün bir enerji azaltma tekniği önerildi. Önerilen tekniği de içeren MDFT tabanlı YVVK çerçeve içi kip seçimi için verimli bir donanım mimarisi tasarlandı. Önerilen donanım Verilog HDL kullanılarak gerçeklendi. Verilog RTL kodu Xilinx XC6VLX365T FPGA?ne yerleştirildi ve yerleştirme sonrası RTL simulasyonları ile doğrulandı. FPGA gerçeklemesi 116 MHz hızla çalışabilmekte ve saniyede 21 HD (1280x720) çerçevesini kodlayabilmektedir. Önerilen teknik, donanımın enerji tüketimini bu FPGA?da herhangi bir PSNR kaybı olmaksızın %64.6 azaltmıştır. High Efficiency Video Coding (HEVC), a recently developed international standard for video compression, offers significantly better video compression efficiency than previous international standards. However, this coding gain comes with an increase in computational complexity.Therefore, in this thesis, we first designed a high performance hardware architecture for deblocking filter algorithm used in HEVC standard. Two parallel datapaths are used in the hardware to increase its performance. The proposed hardware is implemented in Verilog HDL. The Verilog RTL code is mapped to a Xilinx XC6VLX240T FPGA, and it is verified to work correctly on a Xilinx ML605 FPGA board which includes a Xilinx XC6VLX240T FPGA. The FPGA implementation can work at 108 MHz, and it can code 30 full HD (1920x1080) video frames per second.We then proposed an energy reduction technique for Sum of Absolute Transformed Difference (SATD) based HEVC intra mode decision algorithm. We designed an efficient hardware architecture for SATD based HEVC intra mode decision algorithm including the proposed technique. The proposed hardware is implemented in Verilog HDL. The Verilog RTL code is mapped to a Xilinx XC6VLX365T FPGA, and it is verified with post place & route simulations. The FPGA implementation can work at 116 MHz, and it can code 21 HD (1280x720) video frames per second. The proposed technique reduced its energy consumption up to 64.6% on this FPGA without any PSNR loss. 51

Bu çalışmanın amacı, Türk Kamu Yönetiminde ve Güvenlik Hizmetlerinde hesap verebilirlik ilkesinin incelenmesidir. Çalışmanın birinci bölümünde, hesap verebilirlik kavramı ele alınarak, hesap verebilirlik türlerine değinilmiştir. Kamu yönetimi kapsamında geleneksel ve modern anlayış içerisinde hesap verebilirliğin yeri araştırılmış ve güvenlik sektöründe hesap verebilirlik kavramı üzerinde durulmuştur. İkinci bölümde güvenlik kavramı ve dünyadan hesap verebilirlik örnekleri incelenmiş, bu örneklerin olumlu ve sakıncalı yanları ortaya konulmuştur. Üçüncü bölümde Türkiye'de kamu yönetimi ve özellikle emniyet teşkilatı açısından hesap verebilirlik kavramının nasıl algılandığı irdelenerek, dünyada kamu yönetiminde reform hareketlerine değinilmiş ve Türkiye'de reform hareketleri kapsamında hesap verebilirlik uygulamaları incelenmiştir. Neticede yapılan literatür çalışması sonucunda Türkiye'de özellikle son yıllarda kamu yönetiminde ve güvenlik hizmetlerinde hesap verebilirlik kavramı üzerinde hassasiyetle durulduğu fakat uygulamada henüz istenilen düzeye ulaşılamadığı tespit edilmiştir. This study aims to examine the principle of accountability in Turkish public administration and security services. In the first part of the study, the concept of accountability was examined and types of accountability were mentioned. Accountability was researched from the perspective of public administration in the traditional and modern understanding and focused on the concept of accountability in the security services. In the second part, the concept of security and examples of accountability around the world were examined and advantages and disadvantages of these samples were determined. In the third part, perceptions for the concept of accountability in the public administration in Turkey, especially for the police organization were examined and addressed public administration reform movements in the world and investigated accountability practices in Turkey within the scope of reform movements. As a result, it was determined that the concept of accountability in public administration and security services has already been discussed and also made some legal arrangements, especially in recent years in Turkey, but it has not reached desired level in practice yet. 98