Abstract: Since the first Oxford Survey of Childhood Cancer’s results were published, people have become more aware of the risks associated with prenatal exposure from diagnostic x rays. As a result, it has since been the subject of many studies. In this review, the results of recent epidemiological studies are summarized. The current international guidelines for diagnostic x-ray examinations were compared to the review. All epidemiological studies starting from 2007 and all relevant international guidelines were included. Apart from one study that involved rhabdomyosarcoma, no statistically significant associations were found between prenatal exposure to x rays and the development of cancer during 2007–2020. Most of the studies were constrained in their design due to too small a cohort or number of cases, minimal x-ray exposure, and/or data obtained from the exposed mothers instead of medical reports. In one of the studies, computed tomography exposure was also included, and this requires more and longer follow-up in successive studies. Most international guidelines are comparable, provide risk coefficients that are quite conservative, and discourage abdominal examinations of pregnant women.
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In opdracht van het Veiligheidshuis Regio Utrecht zijn de justitiële registraties van de personen die op de Top X lijst staan geanalyseerd. Zowel bij de politie als bij het Openbaar Ministerie zijn gegevens verzameld over de personen die op 15 augustus 2015 op de Top X lijst van de regio stonden. De Top X lijst bestond op die datum uit 250 personen.
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Introduction: The Netherlands does not have a national guideline for performing radiographic examinations on pregnant patients. Radiographic examination is a generic term for all examinations performed using ionizing radiation, including but not limited to radiographs, fluoroscopy and computed tomography. A pilot study amongst radiographers (Medical Radiation Technologists (MRTs)) showed that standardized practice of radiographic examinations on pregnant women is not evident between Radiology departments and that there is a need for a national guideline as the varying practice methods may lead to confusion and uncertainty amongst both patients and MRTs. Methods: Focus groups consisting of MRTs from several Radiology departments within the Netherlands were used to map ideas and requirements as to what should be included in the national guideline. Nine focus group sessions were organized with a total of 52 participants. Using a previous review (Wit, Fleur; Vroonland, Colinda; Bijwaard H. Pre-natal X-ray exposure and the risk of developing paediatric cancer; a systematic review of risk factors and a comparison of international guidelines. Health Physics 2021; 121 (3):225e233), the following key points were chosen as discussion topics for the focus group sessions: dose reduction, confirming pregnancy and risk communication. Results: Results showed that the participating MRTs did not agree on the use of lead aprons. That the national guideline should include standardized methods to adjust parameters to decrease radiation dose. Focus group participants find it difficult to ask a patient's pregnancy status, especially when dealing with relatively young and old (er) patients. When communicating the level of risk associated with a radiographic examination the participating MRTs would like to be able to use examples and comparisons, preferably by means of a multilingual website. Conclusion: A national guideline must include information on justification, available alternatives, dose reductions methods and confirmation of pregnancy requirements when fetal dose is a significant risk. Implications for practice: A national guideline ensures standardized practice can be implemented in Radiology departments, increasing clarity of the issues for both patients and MRTs.
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Samenvatting: In het kader van een afstudeerproject zijn data van 33 kinderen verzameld die een X-abdomen onderzoek ondergingen in het Wilhelmina Kinderziekenhuis. Uit deze data zijn curves afgeleid van Dosis Oppervlakte Product (DOP) ten opzichte van het lichaamsgewicht om te dienen als Diagnostisch ReferentieNiveau (DRN). De spreiding in de data leidt echter tot onzekerheid over de beste DRN-curve. Die curve is bovendien slechts gebaseerd op de data van één ziekenhuis en is daarmee hooguit bruikbaar als lokaal DRN. Door deze studie te herhalen in andere ziekenhuizen en meer data te verzamelen zou een nationale DRN-curve afgeleid kunnen worden. Zo’n curve zou de toetsing van doses aan DRN’s voor kinderen vergemakkelijken.
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Diagnostic reference levels (DRLs) for medical x-ray procedures are being implemented currently in the Netherlands. By order of the Dutch Healthcare Inspectorate, a survey has been conducted among 20 Dutch hospitals to investigate the level of implementation of the Dutch DRLs in current radiological practice. It turns out that hospitals are either well underway in implementing the DRLs or have already done so. However, the DRLs have usually not yet been incorporated in the QAsystem of the department nor in the treatment protocols. It was shown that the amount of radiation used, as far as it was indicated by the hospitals, usually remains below the DRLs. A procedure for comparing dose levels to the DRLs has been prescribed but is not Always followed in practice. This is especially difficult in the case of children, as most general hospitals receive few children. Health Phys. 108(4):462–464; 2015
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1e alinea column: Wat is de les van Haren? Ik denk dat de les is dat Nederland zich niet kan verdedigen tegen dit soort agressie. En ik denk dat de agressor ook deze conclusie heeft getrokken .
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Sustainability transition research seeks to understand the patterns and dynamics of structural societal change as well as unearth strategies for governance. However, existing frameworks emphasize innovation and build-up over exnovation and break-down. This limits their potential in making sense of the turbulent and chaotic dynamics of current transition-in-the-making. Addressing this gap, our paper elaborates on the development and use of the X-curve framework. The X-curve provides a simplified depiction of transitions that explicitly captures the patterns of build-up, breakdown, and their interactions.Using three cases, we illustrate the X-curve’s main strength as a framework that can support groups of people to develop a shared understanding of the dynamics in transitions-in-the-making. This helps them reflect upon their roles, potential influence, and the needed capacities for desired transitions. We discuss some challenges in using the X-curve framework, such as participants’ grasp of ‘chaos’, and provide suggestions on how to address these challenges and strengthen the frameworks’ ability to support understanding and navigation of transition dynamics. We conclude by summarizing its main strength and invite the reader to use it, reflect on it, build on it, and judge its value for action research on sustainability transitions themselves.
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We have investigated the photoionization and photodissociation of free coronene cations C24H12+ upon soft X-ray photoabsorption in the carbon K-edge region by means of a time-of-flight mass spectrometry approach. Core excitation into an unoccupied molecular orbital (below threshold) and core ionization into the continuum both leave a C 1s vacancy, that is subsequently filled in an Auger-type process. The resulting coronene dications and trications are internally excited and cool down predominantly by means of hydrogen emission. Density functional theory was employed to determine the dissociation energies for subsequent neutral hydrogen loss. A statistical cascade model incorporating these dissociation energies agrees well with the experimentally observed dehydrogenation. For double ionization, i.e., formation of intermediate C24H123+trications, the experimental data hint at loss of H+ ions. This asymmetric fission channel is associated with hot intermediates, whereas colder intermediates predominantly decay via neutral H loss.
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X-TEAM D2D project is focused on integrating Air Traffic Management and Urban Air Mobility into an overall multimodal transport network to address the potential increase in efficiency of the overall transportation system in the future, considering the operational domain of the urban and extended urban environment up to a regional extent and passenger-centric perspective. This paper presents the analysis of the Door to Airport trajectory of business passengers until 2035. The results indicate the system's expected performance in 2035 under normal and disrupted scenarios providing insight on the expected impact of future technologies.
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