What We Mean When We Talk About Adherence In Respiratory Medicine

The Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org) supported the Expert Adherence Panel Meeting at which many of the concepts presented in this paper were first discussed. REG also supported the manuscript submission costs. ALD, EvG, and MdB have received funding from the European Community's 7th Framework (FP7/2007-2013) under grant agreement no. 282593. Teva supported the meeting costs at which the concepts in this paper were discussed by the co-authors and the open access publication fee for this article. The authors had full editorial control over the ideas presented.Peer reviewedPublisher PD

Individual shifts toward safety explain age-related foraging distribution in a gregarious shorebird

Although age-related spatial segregation is ubiquitous, the underlying mechanisms are poorly understood. Here, we aim to elucidate the processes behind a previously established age-related foraging distribution of red knots (Calidris canutus canutus) in their main wintering area in West Africa (Banc d’Arguin, Mauritania). Based on 10 years of observations of 1232 uniquely color-ringed individuals of 1 to 18+ years old, we examined whether the observed age-related foraging distribution resulted from 1) spatial differences in mortality or 2) age-related shifts in habitat use. Using multistate capture–recapture modeling, we showed that with age foraging red knots moved away from the shoreline, that is, to areas with fewer surprise attacks by raptors. Considering uncertainties in the subjective gradient in predation danger with increasing distance from shore (as assessed from correlations between vigilance and distance from shore in foraging birds), we applied 2 different danger zone boundaries, at 40 m and 500 m from shore. Between years, red knots had a much higher chance to move from the dangerous nearshore area to the “safe” area beyond (71–78% and 26% for 40-m and 500-m danger zone boundary, respectively), than vice versa (4% and 14%). For neither danger zone boundary value did we find differences in annual mortality for individuals using either dangerous or safe zone, so the move away from the shore with age is attributed to individual careers rather than differential mortality. We argue that longitudinal studies like ours will reveal that ontogenetic shifts in habitat use are more common than so far acknowledged

Een situatieschets van mantelzorgers bereikt via leden van de vereniging van budgethouders Per Saldo

Een persoonsgebonden budget (PgB) is een som geld waarmee mensen die hulp en begeleiding nodig hebben als gevolg van een aandoening, deze zorg naar eigen inzicht kunnen inkopen. Het PgB wordt gezien als een belangrijk instrument om verder vorm te geven aan vraagsturing in de Nederlandse gezondheidszorg. Momenteel hebben ruim 35.000 mensen een PgB. Over mensen met een PgB, budgethouders, en hun mantelzorgers is tot op heden echter weinig bekend. Daarom heeft de Erasmus Universiteit Rotterdam, in samenwerking met het Rijksinstituut voor Volksgezondheid en Milieu en de vereniging van budgethouders Per Saldo, een onderzoek onder budgethouders en hun mantelzorgers uitgevoerd. Dit is het eerste onderzoek in Nederland van deze omvang onder budgethouders, hun primaire mantelzorger en het gebruik van het PgB in verschillende zorgsituaties. In totaal werkten 609 budgethouders en 522 mantelzorgers verspreid over het hele land mee aan dit onderzoek, dat werd uitgevoerd tussen december 2001 en februari 2002. Twee op de drie budget

Mantelzorg in Nederland

Mantelzorg is een belangrijke vorm van zorg. Nederland telt circa 1,5 miljoen mantelzorgers. De Erasmus Universiteit heeft samen met het Rijksinstituut voor Volksgezondheid en Milieu en de Steunpunten Mantelzorg een onderzoek naar mantelzorg uitgevoerd. In totaal werkten 950 mantelzorgers en 552 zorgvragers mee aan dit onderzoek. Een mantelzorger is vaak een gehuwde vrouw, en zorgt meestal thuis voor een familielid. Een aanzienlijk deel heeft thuiswonende kinderen. De meeste mantelzorgers zijn gepensioneerd of huisvrouw/-man. De zorgvragers zijn meestal ouder dan 60 jaar en gehuwd, één op de vijf is weduwe of weduwnaar. Ongeveer de helft van de zorgvragers is met pensioen, één op de vier is arbeidsongeschikt. Zorgvragers zijn als gevolg van hun gebrekkige gezondheid beperkt in hun activiteit en hebben dus ondersteuning nodig. Hiervoor zijn ze afhankelijk van mantelzorgers, thuiszorg en particuliere hulp. Ruim één op de drie zorgvragers is volledig afhankelijk van mantelzorg, en ongeveer één op de vijf zelfs va

Informal care in the Netherlands. A situational sketch of informal caregivers reached via Informal Care Centres

Informal care is a very important form of care. There are approximately 1.5 million informal caregivers in the Netherlands. Despite this large number, little is known about those providing this important service. To address this lack of knowledge, Erasmus University Rotterdam, in collaboration with the National Institute of Public Health and the Environment (RIVM) and the regional Informal Care Centres, carried out a study of informal care in the Netherlands. This is the first study of any size in the Netherlands to survey both the providers and recipients of informal care. A total of 950 informal caregivers took part in the study, which was carried out between November 2001 and February 2002. This report presents some first results

Praktische Beispiele für Planungsansätze: Vorgehensweisen, Probleme, Perspektiven - das Beispiel München

Das Projekt "Siedlung - Kultur - Landschaft" verfolgt die Idee, die Bedeutung des Schutzes der Kulturlandschaft der Region Münchner Norden und ihrer Entwicklung in das Bewusstsein der handelnden Akteure in Politik und Wirtschaft, vor allem aber auch in das Bewusstsein der vor Ort lebenden Bevölkerung zu bringen. Die "Bundesgartenschau 2005, in der Region - mit der Region" soll als positiv besetztes Großereignis unter dem Motto „Nachhaltigkeit und Perspektivenwechsel“ quasi als Katalysator dienen, um über zahlreiche dezentrale Projekte die Kulturlandschaft erfahrbar zu machen und den Lebensraum vor Ort neu zu entdecken. Außerdem ermöglicht es die Bundesgartenschau durch Symposien, die Ergebnisse dieser Projekte einem breiten Publikum unter Einbeziehung der lokalen Akteure vorzustellen. Das eröffnet die einmalige Chance, die Öffentlichkeit für "ihre Kulturlandschaft" zu interessieren und zu begeistern. Auf diesem Wege kann eine Verbundenheit mit dem Lebensraum und ein neuer Ansatz eines "Heimatgefühls" geschaffen werden. Das Projekt "Siedlung - Kultur - Landschaft“ soll darüber hinaus den politischen Entscheidungsträgern und den Planern verdeutlichen, dass die herausgestellten kulturlandschaftlichen Belange bei künftigen raumwirksamen Maßnahmen schon im Interesse der Bürger mehr Beachtung finden müssen.The basic idea underlying the "Settlement-Culture-Landscape Project" is to communicate the importance of protecting and developing the cultural landscape of the Munich North region to the various actors in the political and business spheres, and, more especially, to bring it to the attention of the people who live in this region. The 2005 Bundesgartenschau (Federal garden exhibition), which uses the slogan "In the region - with the region", is a major event with very positive connotations, and which - under the watchword of "Sustainability and a change of perspective" - is intended, through a host of decentralised projects, to serve as a catalyst to allow people to experience the cultural landscape and to see the area they live in with new eyes. With a programme of symposiums, the Bundesgartenschau also provides a forum to involve local actors in presenting the results of these projects to a broader public. This makes it a unique opportunity to arouse the interest and enthusiasm of the local population for "their own cultural landscape". This is a means of establishing a sense of connectedness between local residents and the space they live in, and of creating a new sense of "Heimat". A further aim of the "Settlement-Culture-Landscape Project" is to make it clear to political decisionmakers and planners that - in the interests of the general public – they need to pay considerably more attention to matters relating to cultural landscapes in the future as they develop measures with spatial impacts

Des pratiques enseignantes qui font obstacle au rôle des modèles dans la construction des savoirs scientifiques

Dans une perspective comparatiste, des didacticiens de plusieurs disciplines (biologie, chimie, histoire de l’art, mathématique et physique) ont étudié des pratiques enseignantes faisant obstacle au rôle des modèles dans la construction des savoirs scientifiques. Leur réflexion croisée les a amenés à considérer des niveaux élevés de l’échelle de codétermination didactique de Chevallard (2012) pour identifier des indicateurs d’une certaine forme de positivisme empirique dans l’épistémologie spontanée des enseignants. Cette posture s’exprime plus ou moins différemment d’une discipline à l’autre mais le fait que les modèles et théories enseignées ont fait ou non l’objet d’une standardisation au sein de communautés scientifiques savantes déterminent fortement leur transposition didactique. De ce point de vue, l’exemple de l’histoire de l’art a joué un rôle méthodologique important permettant de contraster et de questionner les pratiques dans les autres disciplines. Ce questionnement s’inscrit dans un objectif à plus long terme qui est la reproblématisation (au sens de Orange, 2005) d’enseignements relatifs aux disciplines enseignées

Alpha, Betti and the Megaparsec Universe: on the Topology of the Cosmic Web

We study the topology of the Megaparsec Cosmic Web in terms of the scale-dependent Betti numbers, which formalize the topological information content of the cosmic mass distribution. While the Betti numbers do not fully quantify topology, they extend the information beyond conventional cosmological studies of topology in terms of genus and Euler characteristic. The richer information content of Betti numbers goes along the availability of fast algorithms to compute them. For continuous density fields, we determine the scale-dependence of Betti numbers by invoking the cosmologically familiar filtration of sublevel or superlevel sets defined by density thresholds. For the discrete galaxy distribution, however, the analysis is based on the alpha shapes of the particles. These simplicial complexes constitute an ordered sequence of nested subsets of the Delaunay tessellation, a filtration defined by the scale parameter, $\alpha$. As they are homotopy equivalent to the sublevel sets of the distance field, they are an excellent tool for assessing the topological structure of a discrete point distribution. In order to develop an intuitive understanding for the behavior of Betti numbers as a function of $\alpha$, and their relation to the morphological patterns in the Cosmic Web, we first study them within the context of simple heuristic Voronoi clustering models. Subsequently, we address the topology of structures emerging in the standard LCDM scenario and in cosmological scenarios with alternative dark energy content. The evolution and scale-dependence of the Betti numbers is shown to reflect the hierarchical evolution of the Cosmic Web and yields a promising measure of cosmological parameters. We also discuss the expected Betti numbers as a function of the density threshold for superlevel sets of a Gaussian random field.Comment: 42 pages, 14 figure

Measuring Patient-Reported Outcomes Adaptively: Multidimensionality Matters!

As there is currently a marked increase in the use of both unidimensional (UCAT) and multidimensional computerized adaptive testing (MCAT) in psychological and health measurement, the main aim of the present study is to assess the incremental value of using MCAT rather than separate UCATs for each dimension. Simulations are based on empirical data that could be considered typical for health measurement: a large number of dimensions (4), strong correlations among dimensions (.77-.87), and polytomously scored response data. Both variable- (SE <.316, SE <.387) and fixed-length conditions (total test length of 12, 20, or 32 items) are studied. The item parameters and variance–covariance matrix Φ are estimated with the multidimensional graded response model (GRM). Outcome variables include computerized adaptive test (CAT) length, root mean square error (RMSE), and bias. Both simulated and empirical latent trait distributions are used to sample vectors of true scores. MCATs were generally more efficient (in terms of test length) and more accurate (in terms of RMSE) than their UCAT counterparts. Absolute average bias was highest for variable-length UCATs with termination rule SE <.387. Test length of variable-length MCATs was on average 20% to 25% shorter than test length across separate UCATs. This study showed that there are clear advantages of using MCAT rather than UCAT in a setting typical for health measurement