Development of a blended communication training program for managing medically unexplained symptoms in primary care using the intervention mapping approach

Background: General practice (GP) training in how to communicate with patients with medically unexplained symptoms (MUS) is limited. Objective: Development, implementation and evaluation of an evidence-based communication training program for GP residents focused on patients with MUS in primary care. Methods: We used the intervention mapping (IM) framework to systematically develop the MUS training program. We conducted a needs assessment to formulate change objectives and identified teaching methods for a MUS communication training program. Next, we developed, implemented and evaluated the training program with 46 residents by assessing their self-efficacy and by exploring their experiences with the training. Results: The resulting program is a blended training with an online course and two training days. After attending the training program, GP residents reported significantly higher self-efficacy for communication with patients with MUS at four weeks follow up compared to baseline. Furthermore, GP residents experienced the training program as useful and valued the combination of the online course and training days. Conclusion and practice implications: We developed an evidence-based communication training program for the management of patients with MUS in primary care. Future research should examine the effect of the training on GP residents' communication skills in MUS consultations in daily practice. (C) 2021 The Author(s). Published by Elsevier B.V

Corneal Pachymetry by AS-OCT after Descemet's Membrane Endothelial Keratoplasty

Corneal thickness (pachymetry) maps can be used to monitor restoration of corneal endothelial function, for example after Descemet's membrane endothelial keratoplasty (DMEK). Automated delineation of the corneal interfaces in anterior segment optical coherence tomography (AS-OCT) can be challenging for corneas that are irregularly shaped due to pathology, or as a consequence of surgery, leading to incorrect thickness measurements. In this research, deep learning is used to automatically delineate the corneal interfaces and measure corneal thickness with high accuracy in post-DMEK AS-OCT B-scans. Three different deep learning strategies were developed based on 960 B-scans from 50 patients. On an independent test set of 320 B-scans, corneal thickness could be measured with an error of 13.98 to 15.50 micrometer for the central 9 mm range, which is less than 3% of the average corneal thickness. The accurate thickness measurements were used to construct detailed pachymetry maps. Moreover, follow-up scans could be registered based on anatomical landmarks to obtain differential pachymetry maps. These maps may enable a more comprehensive understanding of the restoration of the endothelial function after DMEK, where thickness often varies throughout different regions of the cornea, and subsequently contribute to a standardized postoperative regime.Comment: Fixed typo in abstract: The development set consists of 960 B-scans from 50 patients (instead of 68). The B-scans from the other 18 patients were used for testing onl

Turning round the telescope. Centre-right parties and immigration and integration policy in Europe

This is an Author's Original Manuscript of 'Turning round the telescope. Centre-right parties and immigration and integration policy in Europe', whose final and definitive form, the Version of Record, has been published in the Journal of European Public Policy 15(3):315-330, 2008 [copyright Taylor & Francis], available online at: http://www.tandfonline.com/doi.org/10.1080/13501760701847341

Development of a Synthetic Earth Gravity Model by 3D mass optimisation based on forward modelling

Several previous Synthetic Earth Gravity Model (SEGM) simulations are based on existing information about the Earth’s internal mass distribution. However, currently available information is insufficient to model the Earth’s anomalous gravity field on a global scale. The low-frequency information is missing when modelling only topography, bathymetry and crust (including the Mohorovičić discontinuity), but the inclusion of information on the mantle and core does not seem to significantly improve this situation. This paper presents a method to determine a more realistic SEGM by considering simulated 3D mass distributions within the upper mantle as a proxy for all unmodelled masses within the Earth.The aim is to improve an initial SEGM based on forward gravity modelling of the topography, bathymetry and crust such that the missing low-frequency information is now included. The simulated 3D mass distribution has been derived through an interactive and iterative mass model optimisation algorithm, which minimises geoid height differences with respect to a degree-360 spherical harmonic expansion of the EGM2008 global external gravity field model. We present the developed optimisation algorithm by applying it to the development of a global SEGM that gives a reasonably close fit to EGM2008, and certainly closer than a SEGM based only on the topography, bathymetry and crust

Spillover Effects of Studying with Immigrant Students; A Quantile Regression Approach

Abstract: We analyze how the share of immigrant children in the classroom aects the educational attainment of native Dutch children in terms of their language and math performance at the end of primary school. Our paper studies the spill-over effects at different parts of the test score distribution of native Dutch students using a quantile regression approach. We fi nd no evidence of negative spillover effects of the classroom presence of immigrant children at the median of the test score distribution. In addition, there is no indication that these spill-over effects are present at other parts of the distribution.