Een handreiking voor familieleden over palliatieve zorg bij dementie: evaluatie door zorgverleners en familieleden.

De familie van verpleeghuisbewoners met dementie is meestal betrokken bij de zorg en bij behandelbeslissingen over de bewoner. Hiertoe dienen familieleden geïnformeerd te zijn over het beloop van dementie en mogelijkheden tot palliatieve zorg. Op basis van een Canadese brochure ontwikkelden wij een handreiking met schriftelijke informatie toegesneden op de Nederlandse situatie. Deze handreiking en mogelijke toepassing werden beoordeeld door specialisten ouderengeneeskunde (n = 30), verzorging/verpleging (n = 38), en familieleden (n = 59) na het overlijden van de bewoner. Alle respondenten gaven aan dat er grote behoefte bestaat aan een dergelijke handreiking. De meeste familieleden (93%) hadden de handreiking eerder willen hebben. De verzorging/verpleging dacht vergeleken met specialisten oudergeneeskunde vaker dat de handreiking nuttig zou zijn voor alle of veel families (p = 0,04). De acceptatie van de handreiking onder de respondenten, gemeten op een schaal met 8 stellingen, was het grootst onder familieleden en het kleinst onder specialisten ouderengeneeskunde. Veel respondenten beoordeelden het nut positief (gemiddeld 7,9 tot 8,3 op een schaal van 0-10; SD 0,9 tot 1,4) en het nut verschilde niet tussen de respondentgroepen (p = 0,29). Alle respondenten zagen een rol voor zorgverleners in het overhandigen van de handreiking. Daarnaast vond de helft van de respondenten (53%; geen significant verschil tussen de groepen) dat de handreiking ook zonder tussenkomst van zorgverleners beschikbaar moet zijn; soms zelfs al vóór opname. Concluderend is er grote behoefte aan schriftelijke uitleg over palliatieve zorg bij dementie. De handreiking wordt geschikt gevonden. Een op punten aangepaste versie kan mogelijk zorgverleners en familie in de praktijk ondersteunen

Comparative assessment of the vulnerability and resilience of deltas, extended version with 14 deltas : work document

Worldwide, deltas host dense populations and are important centres of agricultural and industrial production, and economic activity. Many deltas are areas of great ecological importance as well, featuring wetlands of high and unique biodiversity. Deltas are vulnerable to changes by natural forces and human activities. Major drivers of change are population growth, economic development, climate change and subsidence

Estimation and application of the thermodynamic properties of aqueous phenanthrene and isomers of methylphenanthrene at high temperature

Estimates of standard molal Gibbs energy (ΔGf°) and enthalpy (ΔHf°) of formation, entropy (S°), heat capacity (Cp°) and volume (V°) at 25 °C and 1 bar of aqueous phenanthrene (P) and 1-, 2-, 3-, 4- and 9-methylphenanthrene (1-MP, 2-MP, 3-MP, 4-MP, 9-MP) were made by combining reported standard-state properties of the crystalline compounds, solubilities and enthalpies of phenanthrene and 1-MP, and relative Gibbs energies, enthalpies and entropies of aqueous MP isomers from published quantum chemical simulations. The calculated properties are consistent with greater stabilities of the β isomers (2-MP and 3-MP) relative to the α isomers (1-MP and 9-MP) at 25 °C. However, the metastable equilibrium values of the abundance ratios 2-MP/1-MP (MPR) and (2-MP + 3-MP)/(1-MP + 9-MP) (MPI-3) decrease with temperature, becoming <1 at ~375–455 °C. The thermodynamic model is consistent with observations of reversals of these organic maturity parameters at high temperature in hydrothermal and metamorphic settings. Application of the model to data reported for the Paleoproterozoic Here’s Your Chance (HYC) Pb–Zn–Ag ore deposit (McArthur River, Northern Territory, Australia) indicates a likely effect of high-temperature equilibration on reported values of MPR and MPI-3, but this finding is contingent on the location within the deposit. If metastable equilibrium holds, a third aromatic maturity ratio, 1.5 × (2-MP + 3-MP)/(P + 1-MP + 9-MP) (MPI-1), can be used as a proxy for oxidation potential. Values of log aH2(aq) determined from data reported for HYC and for a sequence of deeply buried source rocks are indicative of more reducing conditions at a given temperature than those inferred from data reported for two sets of samples exposed to contact or regional metamorphism. These results are limiting-case scenarios for the modeled systems that do not account for effects of non-ideal mixing or kinetics, or external sources or transport of the organic matter.Nevertheless, quantifying the temperature dependence of equilibrium constants of organic reactions enables the utilization of organic maturity parameters as relative geothermometers at temperatures higher than the nominal limits of the oil window

Silicon central pattern generators for cardiac diseases

Belgium Herbarium image of Meise Botanic Garden

Silicon central pattern generators for cardiac diseases

Cardiac rhythm management devices provide therapies for both arrhythmias and resynchronisation but not heart failure, which affects millions of patients worldwide. This paper reviews recent advances in biophysics and mathematical engineering that provide a novel technological platform for addressing heart disease and enabling beat-to-beat adaptation of cardiac pacing in response to physiological feedback. The technology consists of silicon hardware central pattern generators (hCPGs) that may be trained to emulate accurately the dynamical response of biological central pattern generators (bCPGs). We discuss the limitations of present CPGs and appraise the advantages of analog over digital circuits for application in bioelectronic medicine. To test the system, we have focused on the cardio-respiratory oscillators in the medulla oblongata that modulate heart rate in phase with respiration to induce respiratory sinus arrhythmia (RSA). We describe here a novel, scalable hCPG comprising physiologically realistic (Hodgkin–Huxley type) neurones and synapses. Our hCPG comprises two neurones that antagonise each other to provide rhythmic motor drive to the vagus nerve to slow the heart. We show how recent advances in modelling allow the motor output to adapt to physiological feedback such as respiration. In rats, we report on the restoration of RSA using an hCPG that receives diaphragmatic electromyography input and use it to stimulate the vagus nerve at specific time points of the respiratory cycle to slow the heart rate. We have validated the adaptation of stimulation to alterations in respiratory rate. We demonstrate that the hCPG is tuneable in terms of the depth and timing of the RSA relative to respiratory phase. These pioneering studies will now permit an analysis of the physiological role of RSA as well as its any potential therapeutic use in cardiac disease

The downward spiral of mental disorders and educational attainment: a systematic review on early school leaving.

BACKGROUND: Most psychiatric disorders present symptom patterns that cause severe impairment on the emotional, cognitive and social level. Thus, adolescents who suffer from a mental disorder risk finding themselves in a downward spiral caused by the reciprocal association of psychological symptoms and negative school experiences that may culminate in early school leaving. In addition to previous collective work that mainly focused on school refusing behaviour among children and was presented as an expert's opinion, the following systematic review fills the knowledge gap by providing a structured overview of the bidirectional association between mental health and secondary school dropout based on a sound methodology and with a particular focus on mediating factors. METHODS: Four electronic databases were searched from January 1990 until June 2014. Selected references were assessed for study details, main results, mediating factors and methodological limitations. Standardized risk of bias assessment was conducted. RESULTS: Mood and anxiety disorders seemed to have a less consequential direct effect on early school leaving than substance use and disruptive behaviour disorders. The association between externalizing disorders and educational attainment was even stronger when the disorder occurred early in life. On the other hand, internalizing disorders were reported to develop as a consequence of school dropout. Only few studies had addressed gender differences, with discrepant results. Socio-economic background, academic achievement and family support were identified as significant mediating factors of the association between mental disorders and subsequent educational attainment. CONCLUSIONS: Findings suggested a strong association between mental health and education, in both directions. However, most studies focused on mediating factors that could not be targeted by intervention programs

Kinderen met een licht verstandelijke beperking in het passend onderwijs: visie op ondersteuning in de klas

Om zich op een positieve manier te kunnen ontwikkelen hebben kinderen met een licht verstandelijke beperking in het passend onderwijs gepaste begeleiding en zorg nodig. Daarvoor is het van groot belang dat schoolbesturen, leerkrachten en interne begeleiders een visie ter ondersteuning formuleren en toepassen. Dit boek biedt concrete handvatten om met de ontwikkeling van zo’n visie aan de slag te gaan. Hierbij gaat ruime aandacht naar de relatie tussen onderzoek en praktijk. De ondersteuning van deze kinderen en hun ouders stoelt op drie pijlers: de vroegsignalering van onderwijsleerproblemen, de waarborging van de positieve effecten van inclusief onderwijs en het mogelijk maken van sociale integratie in de klas en daarbuiten. Jeugdhulp en passend onderwijs moeten worden verbonden, waarbij rekening wordt gehouden met verschillen tussen kinderen, veel waarde wordt gehecht aan de participatie van ouders en vertrouwen wordt gegeven aan de deskundigheid van de leerkracht

Kinderen met een licht verstandelijke beperking binnen het regulier onderwijs: Een visie op M-decreet en Passend onderwijs

Pathways through Adolescenc