Since the 1950s, Europe has undergone large shifts in climate and land cover. Previous assessments of past and future changes in evapotranspiration or streamflow have either focussed on land ...use/cover or climate contributions or on individual catchments under specific climate conditions, but not on all aspects at larger scales. Here, we aim to understand how decadal changes in climate (e.g. precipitation, temperature) and land use (e.g. deforestation/afforestation, urbanization) have impacted the amount and distribution of water resource availability (both evapotranspiration and streamflow) across Europe since the 1950s. To this end, we simulate the distribution of average evapotranspiration and streamflow at high resolution (1 km.sup.2) by combining (a) a steady-state Budyko model for water balance partitioning constrained by long-term (lysimeter) observations across different land use types, (b) a novel decadal high-resolution historical land use reconstruction, and (c) gridded observations of key meteorological variables. The continental-scale patterns in the simulations agree well with coarser-scale observation-based estimates of evapotranspiration and also with observed changes in streamflow from small basins across Europe. We find that strong shifts in the continental-scale patterns of evapotranspiration and streamflow have occurred between the period around 1960 and 2010.
Accurate monitoring and prediction of surface evaporation become more crucial for adequate water management in a changing climate. Given the distinct differences between characteristics of a land ...surface and a water body, evaporation from water bodies requires a different parameterization in hydrological models. Here we compare six commonly used evaporation methods that are sensitive to different drivers of evaporation, brought about by a different choice of parameterization. We characterize the (dis)agreement between the methods at various temporal scales ranging from hourly to 10-yearly periods, and we evaluate how this reflects in differences in simulated water losses through evaporation of Lake IJssel in the Netherlands. At smaller timescales the methods correlate less (r=0.72) than at larger timescales (r=0.97). The disagreement at the hourly timescale results in distinct diurnal cycles of simulated evaporation for each method. Although the methods agree more at larger timescales (i.e. yearly and 10-yearly), there are still large differences in the projected evaporation trends, showing a positive trend to a more (i.e. Penman, De Bruin–Keijman, Makkink, and Hargreaves) or lesser extent (i.e. Granger–Hedstrom and FLake). The resulting discrepancy between the methods in simulated water losses of the Lake IJssel region due to evaporation ranges from −4 mm (Granger–Hedstrom) to −94 mm (Penman) between the methods. This difference emphasizes the importance and consequence of the evaporation method selection for water managers in their decision making.
Background
Head and neck cancer (HNC) patients often suffer from distress attributed to their cancer diagnosis which may disturb their sleep. However, there is lack of research about poor sleep ...quality among newly diagnosed HNC patients. Therefore, our aim was to investigate the prevalence and the associated factors of poor sleep quality among HNC patients before starting treatment.
Materials and methods
A cross-sectional study was conducted using the baseline data from NET-QUBIC study, an ongoing multi-center cohort of HNC patients in the Netherlands. Poor sleep quality was defined as a Pittsburgh Sleep Quality Index (PSQI) total score of > 5. Risk factors examined were sociodemographic factors (age, sex, education level, living situation), clinical characteristics (HNC subsite, tumor stage, comorbidity, performance status), lifestyle factors, coping styles, and HNC symptoms.
Results
Among 560 HNC patients, 246 (44%) had poor sleep quality before start of treatment. Several factors were found to be significantly associated with poor sleep: younger age (odds ratio OR for each additional year 0.98, 95% CI 0.96–1.00), being female (OR 2.6, 95% CI 1.7–4.1), higher passive coping style (OR 1.18, 95% CI 1.09–1.28), more oral pain (OR 1.10, 95% CI 1.01–1.19), and less sexual interest and enjoyment (OR 1.13, 95% CI 1.06–1.20).
Conclusion
Poor sleep quality is highly prevalent among HNC patients before start of treatment. Early evaluation and tailored intervention to improve sleep quality are necessary to prepare these patients for HNC treatment and its consequences.
Purpose
To measure utilities among cancer patients, a cancer-specific utility instrument called the European Organization for Research and Treatment of Cancer (EORTC) QLU-C10D has been developed ...based on EORTC quality of life core module (QLQ-C30). This study aimed to provide Dutch utility weights for the QLU-C10D.
Methods
A cross-sectional valuation study was performed in 1017 participants representative in age and gender of the Dutch general population. The valuation method was a discrete choice experiment containing 960 choice sets, i.e. pairs of QLU-C10D health states, each health state described in terms of the 10 QLU-C10D domains and the duration of that health state. Each participant considered 16 choice sets, choosing their preferred health state from each pair. Utility scores were derived using generalized estimation equation models. Non-monotonic levels were combined.
Results
Utility decrements were generated for all 10 QLU-C10D domains, with largest decrements for pain (− 0.242), physical functioning (− 0.228), and role functioning (− 0.149). Non-monotonic levels of emotional functioning, pain, fatigue, sleep problems, and appetite loss were combined. No decrement in utility was seen in case of a little or quite a bit impairment in emotional functioning or a little pain. The mean QLU-C10D utility score of the participants was 0.85 (median = 0.91, interquartile range = 0.82 to 0.96).
Conclusion
Dutch utility decrements were generated for the QLU-C10D. These are important for evaluating the cost-utility of new cancer treatments and supportive care interventions. Further insight is warranted into the added value of the QLU-C10D alongside other utility instruments.
For an exercise intervention to be successful, it is important that cancer survivors adhere to the prescribed program. To be able to improve adherence and to preserve achieved beneficial effects, ...insights into the relevant and modifiable determinants is important. Therefore, we aimed to systematically review determinants of exercise adherence and maintenance in cancer survivors using a socio-ecological approach.Studies were identified in PubMed, Embase, PsycINFO and SPORTDiscus up to July 2013. We included full-text articles that: 1) were conducted among adult cancer survivors; 2) quantitatively assessed factors associated with intervention adherence and maintenance, and 3) were published in English. The methodological quality of the selected studies was examined. A best evidence synthesis was applied. Eighteen studies were included. Median methodological quality was 53% and ranged from 21-78% of maximum score. Twelve studies focused on determinants of exercise adherence and evaluated 71 potential determinants: 29 demographic and clinical, 27 psychological, ten physical, four social factors, and one environmental factor. Six studies focused on determinants of exercise maintenance after completion of an intervention, and investigated 63 factors: 22 demographic and clinical, 28 psychosocial, nine physical, three social and one environmental factor. We found moderate evidence for a positive association between exercise history and exercise adherence. Inconsistent findings were found for age, gender and education as well as for psychological factors such as stage of change, perceived behavioral control, self-efficacy, extraversion, attitude, intention, fatigue, and quality of life, and physical factors including cardiovascular fitness, body mass index, and baseline physical activity.Exercise history is positively associated with exercise adherence. Future trials should further study the influence of social and environmental determinants on exercise adherence and maintenance in addition to demographic, psychological and physical determinants.
We study the controls on open water evaporation of a large lowland reservoir in the Netherlands. To this end, we analyse the dynamics of open water evaporation at two locations, Stavoren and ...Trintelhaven, at the border of Lake IJssel (1100 km.sup.2 ); eddy covariance systems were installed at these locations during the summer seasons of 2019 and 2020. These measurements were used to develop data-driven models for both locations. Such a statistical model is a clean and simple approach that can provide a direct indication of (and insight into) the most relevant input parameters involved in explaining the variance in open water evaporation, without making a priori assumptions regarding the process itself. We found that a combination of wind speed and the vertical vapour pressure gradient can explain most of the variability in observed hourly open water evaporation. This is in agreement with Dalton's model, which is a well-established model often used in oceanographic studies for calculating open water evaporation.
Land cover controls the land‐atmosphere exchange of water and energy through the partitioning of solar energy into latent and sensible heat. Observations over all land cover types at the regional ...scale are required to study these turbulent flux dynamics over a landscape. Here, we aim to study how the control of daily and midday latent and sensible heat fluxes over different land cover types is distributed along three axes: energy availability, water availability and exchange efficiency. To this end, observations from 19 eddy covariance flux tower sites in the Netherlands, covering six different land cover types located within the same climatic zone, were used in a regression analysis to explain the observed dynamics and find the principle drivers. The resulting relative position of these sites along the three axes suggests that land cover partly explains the variance of daily and midday turbulent fluxes. We found that evaporation dynamics from grassland, peatland swamp and cropland sites could mostly be explained by energy availability. Forest evaporation can mainly be explained by water availability, urban evaporation by water availability and exchange efficiency, and open water evaporation can almost entirely be explained by exchange efficiency. We found that the sensible heat flux is less sensitive to land cover type. This demonstrates that the land‐atmosphere interface plays an active role in the shedding of sensible heat. Our results contribute to a better understanding of the dynamics of evaporation over different land cover types and may help to optimize, and potentially simplify, models to predict evaporation.
Plain Language Summary
At the land surface solar energy is divided into evaporation and warming of the air (sensible heat). Land cover controls the land‐atmosphere exchange of water and energy through this division. Over the past years, there is a growing interest in how land use management can be used to optimize local water and climate services by influencing this division. However, this requires a good understanding of the drivers of evaporation and sensible heat. In this study, we aim to study the role of land cover type on the drivers of daily and midday evaporation and sensible heat during warm seasons. Therefore, we used fields observations, the eddy covariance technique, from 19 sites in the Netherlands covering six different land cover types in a regression analysis. The drivers are expressed along three axes: energy availability, water availability and exchange efficiency. We found that evaporation dynamics from grassland, peatland swamp and cropland sites could mostly be explained by energy availability. Forest evaporation can mainly be explained by water availability, urban evaporation by water availability and exchange efficiency, and open water evaporation can almost entirely be explained by exchange efficiency. We also found that sensible heat fluxes are less sensitive to land cover type.
Key Points
The drivers of latent and sensible heat fluxes in the Netherlands were studied over various land cover types based on regression analyses
Drivers of evaporation associated with energy availability, water availability, exchange efficiency vary substantially per land cover type
In natural landscape mosaics limitation of evaporation by water availability, energy availability and exchange efficiency coexist
Purpose
Before and after treatment for head and neck cancer (HNC), many patients have problems with mastication, swallowing, and salivary flow. The aim of this study was to investigate the ...association between objective test outcomes of mastication, swallowing, and salivary flow versus patient-reported outcomes (PROs) measuring mastication-, swallowing-, and salivary flow–related quality of life.
Methods
Data of the prospective cohort “Netherlands Quality of Life and Biomedical Cohort Study” was used as collected before treatment, and 3 and 6 months after treatment. Spearman’s rho was used to test the association between objective test outcomes of the mixing ability test (MAT) for masticatory performance, the water-swallowing test (WST) for swallowing performance, and the salivary flow test versus PROs (subscales of the EORTC QLQ-H&N35, Swallow Quality of Life questionnaire (SWAL-QoL-NL) and Groningen Radiation-Induced Xerostomia (GRIX)).
Results
Data of 142 patients were used, and in total, 285 measurements were performed. No significant correlations were found between the MAT or WST and subscales of the EORTC QLQ-H&N35. Significant but weak correlations were found between the MAT or WST and 4 subscales of the SWAL-QoL-NL. Weak to moderate correlations were found between the salivary flow test and GRIX at 3 and 6 months after treatment, with the highest correlation between salivary flow and xerostomia during the day (Spearman’s rho = − 0.441,
p
= 0.001).
Conclusion
The association between objective test outcomes and PROs is weak, indicating that these outcome measures provide different information about masticatory performance, swallowing, and salivary flow in patients with HNC.
Background
Gliomas are associated with significant healthcare burden, yet reports of costs are scarce. While many costs are unavoidable there may be treatable symptoms contributing to higher costs. ...We describe healthcare and societal costs in glioma patients at high risk for depression and their family caregivers, and explore relationships between costs and treatable symptoms.
Methods
Data from a multicenter randomized trial on effects of internet-based therapy for depressive symptoms were used (NTR3223). Costs of self-reported healthcare utilization, medication use, and productivity loss were calculated for patients and caregivers separately. We used generalized linear regression models to predict costs with depressive symptoms, fatigue, cognitive complaints, tumor grade (low-/high-grade), disease status (stable or active/progression), and intervention (use/non-use) as predictors.
Results
Multiple assessments from baseline through 12 months from 91 glioma patients and 46 caregivers were used. Mean overall costs per year were
M
= €20,587.53 (
sd
= €30,910.53) for patients and
M
= €5,581.49 (
sd
= €13,102.82) for caregivers.
In patients
, higher healthcare utilization costs were associated with more depressive symptoms; higher medication costs were associated with active/progressive disease.
In caregivers
, higher overall costs were linked with increased caregiver fatigue, cognitive complaints, and lower patient tumor grade. Higher healthcare utilization costs were related to more cognitive complaints and lower tumor grade. More productivity loss costs were associated with increased fatigue (all
P
< 0.05).
Conclusions
There are substantial healthcare and societal costs for glioma patients and caregivers. Associations between costs and treatable psychological symptoms indicate that possibly, adequate support could decrease costs.
Trial registration
Netherlands Trial Register NTR3223.
Purpose
To investigate the course of health-related quality of life (HRQOL) from diagnosis to 2 years follow-up among patients with oropharyngeal cancer (OPSCC), in relation to human papilloma virus ...(HPV) status.
Methods
This study included 270 OPSCC patients. Age, sex, tumor sublocation, tumor stage, HPV status, treatment modality, comorbidity, smoking, and alcohol use were retrieved from medical records. HPV status was positive when p16 and HPV DNA tests were both positive. HRQOL was assessed using the EORTC QLQ-C30/QLQ-H&N35 pretreatment and at 6 weeks, 6, 12, 18, and 24 months after treatment. To compare the course of HRQOL between patients with an HPV-positive versus HPV-negative tumor, linear and logistic mixed models were used.
Results
Patients with an HPV-positive tumor (29%) were more often male, diagnosed with a tumor of the tonsil or base of the tongue, treated with single treatment, had fewer comorbidities, were less often current smokers and had lower alcohol consumption. Adjusted for confounders, the course of global quality of life, physical, role, and social functioning, fatigue, pain, insomnia, and appetite loss was significantly different: patients with an HPV-positive tumor scored better before treatment, worsened during treatment, and recovered better and faster at follow-up, compared to patients with an HPV-negative tumor. The course of emotional functioning and oral pain was also significantly different between the two groups, but with other trajectories.
Conclusion
The course of HRQOL is different in patients with an HPV-positive tumor versus an HPV-negative tumor, adjusted for sociodemographic, clinical, and lifestyle confounders.
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