Midwives’ perceived barriers in communicating about depression with ethnic minority clients

Objective: This study aimed to assess the most influential barriers midwives perceive in communicating about depression-related symptoms with ethnic minority clients. Methods: In-depth interviews were held with midwives (N = 8) and Moroccan-Dutch women (N = 6) suffering from perinatal depression to identify the most salient communication barriers. Subsequently, an online survey among midwives (N = 60) assessing their perceived barriers and the occurrence of these barriers in practice was administered. Composite scores using the QUOTE methodology were calculated to determine influential barriers. Results: Three types of barriers emerged from the interviews. Educational-related barriers, client-related barriers and midwife-related barriers. Results of the survey showed that the most influential barriers were educational-related barriers (e.g. lack of culturally sensitive depression screening instruments) and client-related barriers (e.g. cultural taboo about talking about depression). Conclusion: Culturally sensitive screening instruments for depression and patient education materials should be developed to mitigate the educational-related barriers to communicating about depression. Patient education materials should also target the clients’ social environment (e.g. husbands) to help break the cultural taboo about depression. Practice implications: Based on this study's results, communication strategies to empower both midwives and ethnic minority clients with depression can be developed in a collaborative approach

Knotlike Cosmic Strings in The Early Universe

In this paper, the knotlike cosmic strings in the Riemann-Cartan space-time of the early universe are discussed. It has been revealed that the cosmic strings can just originate from the zero points of the complex scalar quintessence field. In these strings we mainly study the knotlike configurations. Based on the integral of Chern-Simons 3-form a topological invariant for knotlike cosmic strings is constructed, and it is shown that this invariant is just the total sum of all the self-linking and linking numbers of the knots family. Furthermore, it is also pointed out that this invariant is preserved in the branch processes during the evolution of cosmic strings

Coping with the emergence of new sovereignties over sustainability: Dilemmas and decision-making of the Indonesian state in a plural legal order

This paper describes how the Indonesian state copes with the emergence of global networks of business and civil society as new sovereigns over sustainability of an economically very important activity on its territory: the production of palm oil. Indonesia is the largest producer and exporter of palm oil in the world and plans to double its current production of Crude Palm Oil by 2020, mainly by expanding palm oil production. Global networks of business and civil society fear that this will lead to further loss of forest, biodiversity and peat soils, and herewith increase of greenhouse gas emissions. Local NGOs and smallholder movements expect that expansion of palm oil production will fuel new land conflicts between communities and plantation companies. To map the plural legal order that has evolved as a result of non-state actors claiming political legitimacy to define sustainability of palm oil production in Indonesia, three types of sovereignties are distinguished (based on Comaroff and Comaroff 2009): sovereignties over territory and its inhabitants, sovereignties over transactional spheres and commodity flows, and sovereignties over people conjoined in faith or culture. To describe the dilemma’s and strategies of the Indonesian state in political decision-making over sustainability in a plural legal order, the concepts of the cunning state (Randeria 2003) and the ecological state (Eckersley 2004) are used, examined and adapted. Our analysis suggests that Indonesian state actors both challenge and reproduce the global sustainability regime framed and dominated by European non-state actors. They do so by competing and cooperating with global private-civil networks and by establishing agreements with other states and intergovernmental agencies

How participatory design works:mechanisms and effects

We argue that the distinguishing features of Participatory Design are not the participatory activities as such but the mechanisms used, the effects produced and the way in which these are sustained. We use program theory to illuminate how participatory design works and how it may be understood as more than a collection of methods or a matter of configuring user participation. Program theory operates by formulating the causal relations between the planned inputs, the process and the effects in terms of output, outcome and impact. While participatory design might appear similar to co-design or user-centered design on the level of design activities, PD differs in terms of the mechanisms employed and how effects and their sustainment are conceived. Looking at participatory design through the lens of program theory highlights how particular mechanisms work towards not only the designed product but also towards generating gains and lasting effects for participants

Algebraic theories of brackets and related (co)homologies

A general theory of the Frolicher-Nijenhuis and Schouten-Nijenhuis brackets in the category of modules over a commutative algebra is described. Some related structures and (co)homology invariants are discussed, as well as applications to geometry.Comment: 14 pages; v2: minor correction

Mitochondrial DNA copy number in colorectal cancer: between tissue comparisons, clinicopathological characteristics and survival

Low mitochondrial DNA (mtDNA) copy number in tumors has been associated with worse prognosis in colorectal cancer (CRC). This study further deciphers the role of mtDNA copy number in CRC by comparing mtDNA copy number between healthy, adenoma and carcinoma tissue, by investigating its association according to several clinicopathological characteristics in CRC, and by relating it to CRC-specific survival in CRC patients. A hospital-based series of samples including cancer, adenoma and adjacent histologically normal tissue from primary CRC patients (n = 56) and recurrent CRC (n = 16) was studied as well as colon mucosa samples from healthy subjects (n = 76). Furthermore, mtDNA copy number was assessed in carcinomas of 693 CRC cases identified from the population-based Netherlands Cohort Study (NLCS). MtDNA copy number was significantly lower in carcinoma tissue (P = 0.011) and adjacent tissue (P <0.001) compared to earlier resected adenoma tissue and in primary CRC tissue compared to recurrent CRC tissue (P = 0.011). Within both study populations, mtDNA copy number was significantly lower in mutated BRAF (P = 0.027 and P = 0.006) and in microsatellite unstable (MSI) tumors (P = 0.033 and P <0.001) and higher in KRAS mutated tumors (P = 0.004). Furthermore, the association between mtDNA and survival seemed to follow an inverse U-shape with the highest HR observed in the second quintile of mtDNA copy number (HR = 1.70, 95% CI = 1.18, 2.44) compared to the first quintile. These results might reflect an association of mtDNA copy number with various malignant processes in cancer cells and warrants further research on tumor energy metabolism in CRC prognosis

Designing a Smartphone Exergame for Children with Cerebral Palsy in the Home Environment

Children with cerebral palsy must perform daily exercise which is a tedious and energy consuming task. Exergames can make this routine more engaging, which can increase the compliance of the patient. This research explores the feasibility of an exergame device called the Squid Monster. The device is the result of a research through design process, and it is designed to be played on smartphones in the home environment. It operates on the smartphone's integrated sensors and two external squeeze sensors, making it accessible and cost-effective. We conceptualize how the design can be supported using a machine learning adaptive difficulty system, aiming to increase flow and therapeutic adherence of the device. Ultimately, guidelines are provided to designers for future work in this field

Life support functies van de bodem: operationalisering t.b.v. het biodiversiteitsbeleid

Ter uitvoering van actiepunt NMW1a uit het Strategisch Plan van Aanpak biodiversiteit (SPA; LNV, VROM, V&amp;W, OCW, EZ, BZ, 1995) en als onderdeel van actie N59 uit het NMP-2, is eerder een studie uitgevoerd naar de mogelijkheden om een indicatorsysteem op te stellen voor biodiversiteit van de bodem in relatie tot Life support functies (LSF). In een pilotproject is het indicatorsysteem vervolgens getest binnen de infrastructuur van het Landelijk Meetnet Bodemkwaliteit (LMB). Het indicatorsysteem, en de daaruit af te leiden bodembiologische indicator, bestaat uit een aantal deelindicatoren. De vragen van het onderzoek waren.- kan de gekozen indicatorset worden toegepast in een meetnet; hebben de deelindicatoren van de set voldoende onderscheidend vermogen; kunnen de resultaten worden ingepast in de huidige diagnostische en prognostische gereedschappen van het RIVM (Natuurplanner en EKI).De resultaten en conclusies uit de pilot zijn in dit beleidsgerichte rapport kort beschreven. Een meer gedetailleerde uitwerking van de onderzoeksresultaten verschijnt in het achtergrond-rapport. De pilot heeft aangetoond dat de geselecteerde deelindicatoren gevoelig en onderscheidend zijn voor verschillende combinaties van bodemtype en landgebruik. Als een mogelijke vorm voor het weergeven van de resultaten behaald met de bodembiologische indicator, is een AMOEBE gemaakt voor graslanden op zeeklei. Hierbij is gebruik gemaakt van een gekozen (voorlopige) referentie. De gegevens zijn verder geaggregeerd tot een Bodemkwaliteitsindex (BKX). Op deze wijze zou aan een ecologische bodembeoordeling vorm gegeven kunnen worden. Door systematisch onderzoek aan LSF-deelindicatoren in het Landelijk Meetnet Bodemkwaliteit (40 locaties per jaar) kan in 5 jaar een database opgebouwd worden waarmee responsrelaties voor bodemeigenschappen, systeemeigen- en systeemvreemde stoffen zijn af te leiden. Hiermee kan een LSF-module (prognostisch instrument) worden opgenomen in een decision support systeem als de Natuurplanne

Cisgenic apple trees; development, characterization, and performance

Two methods were developed for the generation of cisgenic apples. Both have been successfully applied producing trees. The first method avoids the use of any foreign selectable marker genes; only the gene-of-interest is integrated between the T-DNA border sequences. The second method makes use of recombinase-based marker excision. For the first method we used the MdMYB10 gene from a red-fleshed apple coding for a transcription factor involved in regulating anthocyanin biosynthesis. Red plantlets were obtained and presence of the cisgene was confirmed. Plantlets were grafted and grown in a greenhouse. After 3 years, the first flowers appeared, showing red petals. Pollination led to production of red-fleshed cisgenic apples. The second method used the pM(arker)F(ree) vector system, introducing the scab resistance gene Rvi6, derived from apple. Agrobacterium-mediated transformation, followed by selection on kanamycin, produced genetically modified apple lines. Next, leaves from in vitro material were treated to activate the recombinase leading to excision of selection genes. Subsequently, the leaf explants were subjected to negative selection for marker-free plantlets by inducing regeneration on medium containing 5-fluorocytosine. After verification of the marker-free nature, the obtained plants were grafted onto rootstocks. Young trees from four cisgenic lines and one intragenic line, all containing Rvi6, were planted in an orchard. Appropriate controls were incorporated in this trial. We scored scab incidence for three consecutive years on leaves after inoculations with Rvi6-avirulent strains. One cisgenic line and the intragenic line performed as well as the resistant control. In 2014 trees started to overcome their juvenile character and formed flowers and fruits. The first results of scoring scab symptoms on apple fruits were obtained. Apple fruits from susceptible controls showed scab symptoms, while fruits from cisgenic and intragenic lines were free of scab