Met verstandige regels is er tot 2025 voor 50 miljard euro extra begrotingsruimte

Hervorming Sociale Regelgevin

Translation and validation of the Dutch version of the Effective Consumer Scale (EC-17)

PURPOSE: The Effective Consumer Scale (EC-17) measures the skills of musculoskeletal patients in managing their own healthcare. The objectives of this study were to translate the EC-17 into Dutch and to further evaluate its psychometric properties. METHODS: The EC-17 was translated and cognitively pretested following cross-cultural adaptation guidelines. Two hundred and thirty-eight outpatients (52 % response rate) with osteoarthritis or fibromyalgia completed the EC-17 along with other validated measures. Three weeks later, 101 patients completed the EC-17 again. RESULTS: Confirmatory factor analysis supported the unidimensional structure of the scale. The items adequately fit the Rasch model and only one item demonstrated differential item functioning. Person reliability was high (0.92), but item difficulty levels tended to cluster around the middle of the scale, and measurement precision was highest for moderate and lower levels of skills. The scale demonstrated adequate test-retest reliability (ICC = 0.71), and correlations with other measures were largely as expected. CONCLUSION: The results supported the validity and reliability of the Dutch version of the EC-17, but suggest that the scale is best targeted at patients with relatively low levels of skills. Future studies should further examine its sensitivity to change in a clinical trial specifically aimed at improving effective consumer skills

Smooth HI Low Column Density Outskirts In Nearby Galaxies

This is an author-created, un-copyedited version of an article published in The Astronomical Journal. The Version of Record is available online at https://doi.org/10.3847/1538-3881/aabbaa.The low column density gas at the outskirts of galaxies as traced by the 21 cm hydrogen line emission (H i) represents the interface between galaxies and the intergalactic medium, i.e., where galaxies are believed to get their supply of gas to fuel future episodes of star formation. Photoionization models predict a break in the radial profiles of H i at a column density of ∼5 × 10 19 cm -2 due to the lack of self-shielding against extragalactic ionizing photons. To investigate the prevalence of such breaks in galactic disks and to characterize what determines the potential edge of the H i disks, we study the azimuthally averaged H i column density profiles of 17 nearby galaxies from the H i Nearby Galaxy Survey and supplemented in two cases with published Hydrogen Accretion in LOcal GAlaxieS data. To detect potential faint H i emission that would otherwise be undetected using conventional moment map analysis, we line up individual profiles to the same reference velocity and average them azimuthally to derive stacked radial profiles. To do so, we use model velocity fields created from a simple extrapolation of the rotation curves to align the profiles in velocity at radii beyond the extent probed with the sensitivity of traditional integrated H i maps. With this method, we improve our sensitivity to outer-disk H i emission by up to an order of magnitude. Except for a few disturbed galaxies, none show evidence of a sudden change in the slope of the H i radial profiles: the alleged signature of ionization by the extragalactic background.Peer reviewedFinal Accepted Versio

Opereren binnen zorguitgavenkaders

Door het wettelijk recht op zorg kan vooraf geen volledige zekerheid worden geboden dat zorguitgaven onder alle omstandigheden binnen de grenzen van het Budgettair Kader Zorg blijven. Wel zijn aanvullende maatregelen mogelijk om marktpartijen maximaal te prikkelen binnenskaders te blijven. Hierdoor worden de uitgaven voor medisch-specialistische zorg aanzienlijk beter beheersbaar dan nu het geval is

Needs assessment to strengthen capacity in water and sanitation research in Africa:experiences of the African SNOWS consortium

Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in Africa. This paper focuses on the research training needs of the consortium as identified during the first three years of the project

Population overlap and habitat segregation in wintering Black-tailed Godwits Limosa limosa

Distinct breeding populations of migratory species may overlap both spatially and temporally, but differ in patterns of habitat use. This has important implications for population monitoring and conservation. To quantify the extent to which two distinct breeding populations of a migratory shorebird, the Black-tailed Godwit Limosa limosa, overlap spatially, temporally and in their use of different habitats during winter. We use mid-winter counts between 1990 and 2001 to identify the most important sites in Iberia for Black-tailed Godwits. Monthly surveys of estuarine mudflats and rice-fields at one major site, the Tejo estuary in Portugal in 2005-2007, together with detailed tracking of colour-ringed individuals, are used to explore patterns of habitat use and segregation of the Icelandic subspecies L. l. islandica and the nominate continental subspecies L. l. limosa. In the period 1990-2001, over 66 000 Black-tailed Godwits were counted on average in Iberia during mid-winter (January), of which 80% occurred at just four sites: Tejo and Sado lower basins in Portugal, and Coto Dontildeana and Ebro Delta in Spain. Icelandic Black-tailed Godwits are present throughout the winter and forage primarily in estuarine habitats. Continental Black-tailed Godwits are present from December to March and primarily use rice-fields. Iberia supports about 30% of the Icelandic population in winter and most of the continental population during spring passage. While the Icelandic population is currently increasing, the continental population is declining rapidly. Although the estuarine habitats used by Icelandic godwits are largely protected as Natura 2000 sites, the habitat segregation means that conservation actions for the decreasing numbers of continental godwits should focus on protection of rice-fields and re-establishment of freshwater wetlands

Chiral Transparency

Color transparency is the vanishing of initial and final state interactions, predicted by QCD to occur in high momentum transfer quasielastic nuclear reactions. For specific reactions involving nucleons, the initial and final state interactions are expected to be dominated by exchanges of pions. We argue that these interactions are also suppressed in high momentum transfer nuclear quasielastic reactions; this is ``chiral transparency". We show that studies of the $e ^3He \to e'\Delta^{++} nn$ reaction could reveal the influence of chiral transparency.Comment: 20 pages, three figures available by fax from [email protected]; submitted to Phys. Rev.

Do Fleas Affect Energy Expenditure of Their Free-Living Hosts?

Parasites can cause energetically costly behavioural and immunological responses which potentially can reduce host fitness. However, although most laboratory studies indicate that the metabolic rate of the host increases with parasite infestation, this has never been shown in free-living host populations. In fact, studies thus far have shown no effect of parasitism on field metabolic rate (FMR).We tested the effect of parasites on the energy expenditure of a host by measuring FMR using doubly-labelled water in free-living Baluchistan gerbils (Gerbillus nanus) infested by naturally occurring fleas during winter, spring and summer. We showed for the first time that FMR of free-living G. nanus was significantly and positively correlated with parasite load in spring when parasite load was highest; this relationship approached significance in summer when parasite load was lowest but was insignificant in winter. Among seasons, winter FMRs were highest and summer FMRs were lowest in G. nanus.The lack of parasite effect on FMR in winter could be related to the fact that FMR rates were highest among seasons. In this season, thermoregulatory costs are high which may indicate that less energy could be allocated to defend against parasites or to compensate for other costly activities. The question about the cost of parasitism in nature is now one of the major themes in ecological physiology. Our study supports the hypothesis that parasites can elevate FMR of their hosts, at least under certain conditions. However, the effect is complex and factors such as season and parasite load are involved

The difference that tenure makes

This paper argues that housing tenures cannot be reduced to either production relations or consumption relations. Instead, they need to be understood as modes of housing distribution, and as having complex and dynamic relations with social classes. Building on a critique of both the productionist and the consumptionist literature, as well as of formalist accounts of the relations between tenure and class, the paper attempts to lay the foundations for a new theory of housing tenure. In order to do this, a new theory of class is articulated, which is then used to throw new light on the nature of class-tenure relations