Over persoonsgerichte zorg. Een kwalitatieve studie naar de ontwikkeling van competenties bij Verpleegkunde studenten.

De gezondheidszorg in Nederland is aan sterke veranderingen onderhevig. De eigen regie van patiënten en cliënten komt meer op de voorgrond te staan, intramurale zorg verschuift naar meer extramurale -en eerstelijnszorg en een brede opvatting van gezondheid komt centraal te staan. Dit perspectief op gezondheid benaderd het vermogen van mensen om zich te kunnen verhouden tot wat er zich in hun leven voordoet. Door deze ontwikkelingen is er vraag ontstaan naar een ander type zorg verlenende relatie. Persoonsgerichte zorg biedt antwoordt op het humaniseren van de gezondheidszorg en het verbeteren van de kwaliteit van zorg. Door de relatie centraal te stellen, ontstaat er een partnerschap tussen de zorgprofessional en zorgvrager, waarbij de unieke behoeftes en overtuigingen van de zorgvrager uitgangspunt zijn in het verlenen van zorg. Deze ontwikkelingen geven ook richting aan een nieuwe visie op de rol van (toekomstige) zorgprofessionals. Het Hoger Gezondheidszorg Onderwijs in Nederland die deze zorgprofessionals opleiden gaan mee in deze transitie en proberen koers te bepalen ten midden van deze complexe dynamiek. Voor het opleiden van persoonsgerichte zorgprofessionals bestaat alleen nog geen opleidingsmodel. In het kader van deze thesis is het raamwerk ‘Person Centred Nursing’ (McCormack & McCance, 2010) voor dit doeleinde als leidraad gebruikt. In deze kwalitatieve studie is door middel van een casestudy van 1e jaars Verpleegkunde studenten aan Fontys Hogescholen Eindhoven onderzocht welke competenties deze studenten op het terrein van persoonsgerichte zorg ontwikkelen door het volgen van een module ‘persoonsgerichte zorg’. Daar de transitie naar het humaniseren van de gezondheidszorg nog in de beginfase staat, is er weinig bekend of de veranderingen in het opleidingsaanbod ook daadwerkelijk resulteren in een ander type zorgprofessional. Uit de onderzoeksresultaten komt naar voren dat studenten interpersoonlijke vaardigheden ontwikkelen. In interactie met medestudenten worden ze zich bewust van verschillen en in reactie hierop worden ze zich gewaar van hun eigen aanwezigheid in die relatie. Wanneer er direct wordt gericht intrapersoonlijke vaardigheden laten de studenten weerstand of ontwijkend gedrag zien. Door de focus op de ander in de relatie blijft de eigen betekenisgeving dun. De studenten hebben theoretische kennis opgedaan over persoonsgerichte zorg. Ook herkennen ze in persoonsgerichte zorg de tendens tot humanisering van de gezondheidszorg en willen een actieve bijdrage leveren aan deze transitie. Hiermee erkennen ze hun eigen verandervermogen. Naast de ontwikkeling in competenties is er ook gekeken naar de invloed van het leerproces van deze studenten en de hierbij bevorderende en belemmerende factoren. Hieruit komt naar voren dat studenten in deze fase van hun opleiding behoefte hebben aan zekerheid en duidelijkheid. In reactie hierop richten ze zich op de functionele afrondingscriteria en de eindstukken laten een kennistheoretische interpretatie van de module en reproductief karakter zien. De bevorderende factoren die hierbij opspelen zijn het leren door interactie met medestudenten en het integreren van praktijkervaring. De belemmerende factoren worden gevonden in een mis-match tussen de inhoud van de module en het verwachtingspatroon van studenten over het toekomstige beroep, het gebrek aan reflectievaardigheden en de situering van de module. In deze thesis worden de onderwijstheorieën ‘deep learning’ (fullan & Langworthy, 2014) en ‘subjectificatie en socialisatie’ in het onderwijs (Biesta, 2012) opgevoerd om aanknopingspunten te vinden voor het persoonsgericht opleiden van zorgprofessionals. In dit verlengde worden aanbevelingen gedaan waarvoor de wenselijke leerprocessen en wenselijke uitkomsten van onderwijs, een relationeel perspectief op onderwijs, ervaringsgericht onderwijs en verbreding van de opleidingscontext verder worden uitgelicht. Ook wordt een eerste aanzet tot een persoonsgericht opleidingsmodel gedaan

Occupational Linguistic Niches and the Wage Growth of Latino Immigrants

Does the concentration of recent Latino immigrants into occupational linguistic niches--occupations with large numbers of other Spanish speakers—restrict their wage growth? On the one hand, it is possible that Latino immigrants who are concentrated in jobs with large numbers of Spanish speakers may have less onthe- job exposure to English, which may isolate them socially and linguistically and limit their subsequent economic mobility. On the other hand, working in linguistic niches can also be beneficial for upwardly mobile immigrants if it allows them to gain a foothold in the United States while they improve their English skills and develop labor market experience. Using data from the 1996, 2001 and 2004 panels of the Survey of Income and Program Participation (SIPP), we test for the effect of working in occupational linguistic niches on wages and wage growth. The results show that while workers in linguistic niche occupations earn lower wages on average, they do not experience lower rates of wage growth over time. Moreover, we find that about 20 percent of workers who start the 4-year SIPP panel in linguistic niches experience occupational mobility that reduces the percentage of workers speaking Spanish in their occupation by over 10 percent over the course of the study, and these ﾓmoversﾔ have higher levels of wage growth than other workers in the sample

Inter-comparison of phytoplankton functional type phenology metrics derived from ocean color algorithms and Earth System Models

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordOcean color remote sensing of chlorophyll concentration has revolutionized our understanding of the biology of the oceans. However, a comprehensive understanding of the structure and function of oceanic ecosystems requires the characterization of the spatio-temporal variability of various phytoplankton functional types (PFTs), which have differing biogeochemical roles. Thus, recent bio-optical algorithm developments have focused on retrieval of various PFTs. It is important to validate and inter-compare the existing PFT algorithms; however direct comparison of retrieved variables is non-trivial because in those algorithms PFTs are defined differently. Thus, it is more plausible and potentially more informative to focus on emergent properties of PFTs, such as phenology. Furthermore, ocean color satellite PFT data sets can play a pivotal role in informing and/or validating the biogeochemical routines of Earth System Models. Here, the phenological characteristics of 10 PFT satellite algorithms and 7 latest-generation climate models from the Coupled Model Inter-comparison Project (CMIP5) are inter-compared as part of the International Satellite PFT Algorithm Inter-comparison Project. The comparison is based on monthly satellite data (mostly SeaWiFS) for the 2003–2007 period. The phenological analysis is based on the fraction of microplankton or a similar variable for the satellite algorithms and on the carbon biomass due to diatoms for the climate models. The seasonal cycle is estimated on a per-pixel basis as a sum of sinusoidal harmonics, derived from the Discrete Fourier Transform of the variable time series. Peak analysis is then applied to the estimated seasonal signal and the following phenological parameters are quantified for each satellite algorithm and climate model: seasonal amplitude, percent seasonal variance, month of maximum, and bloom duration. Secondary/double blooms occur in many areas and are also quantified. The algorithms and the models are quantitatively compared based on these emergent phenological parameters. Results indicate that while algorithms agree to a first order on a global scale, large differences among them exist; differences are analyzed in detail for two Longhurst regions in the North Atlantic: North Atlantic Drift Region (NADR) and North Atlantic Subtropical Gyre West (NASW). Seasonal cycles explain the most variance in zonal bands in the seasonally-stratified subtropics at about 30° latitude in the satellite PFT data. The CMIP5 models do not reproduce this pattern, exhibiting higher seasonality in mid and high-latitudes and generally much more spatially homogeneous patterns in phenological indices compared to satellite data. Satellite data indicate a complex structure of double blooms in the Equatorial region and mid-latitudes, and single blooms on the poleward edges of the subtropical gyres. In contrast, the CMIP5 models show single annual blooms over most of the ocean except for the Equatorial band and Arabian Sea.NASAEuropean Space Agency (ESA

Application of the Beer–Lambert Model to Attenuation of Photosynthetically Active Radiation in a Shallow, Eutrophic Lake

Models of primary production in aquatic systems must include a means to estimate subsurface light. Such models often use the Beer–Lambert law, assuming exponential attenuation of light with depth. It is further assumed that the diffuse attenuation coefficient may be estimated as a summation of scattering/absorbing constituent concentrations multiplied by their respective specific attenuation coefficients. While theoretical deviations from these assumptions have been documented, it is useful to consider the empirical performance of this common approach. Photosynthetically active radiation (PAR) levels and water quality conditions were recorded weekly from six to eight monitoring stations in western Lake Erie between 2012 and 2016. Exponential PAR extinction models yielded a mean attenuation coefficient of 1.55 m (interquartile range = 0.74–1.90 m). While more complex light attenuation models are available, analysis of residuals indicated that the simple Beer–Lambert model is adequate for shallow, eutrophic waters similar to western Lake Erie (R2 > 0.9 for 96% of samples). Three groups of water quality variables were predictive of PAR attenuation: total and nonvolatile suspended particles, dissolved organic substances (dissolved organic carbon and chromophoric dissolved organic matter), and organic solids (volatile suspended solids and chlorophyll). Multiple regression models using these variables predicted 3–90% of the variability in PAR attenuation, with a median adjusted R2 = 0.86. Explanatory variables within these groups may substitute for each other while maintaining similar model performance, indicating that various combinations of water quality variables may be useful to predict PAR attenuation, depending on availability within a model framework or monitoring program.Key PointsThe Beer–Lambert law effectively models photosynthetically active radiation in western Lake Erie, despite some systematic deviationsField‐obtained water quality parameters can predict photosynthetically active radiation attenuation with a high degree of confidenceSuspended particle concentration is most predictive of photosynthetically active radiation attenuation in this turbid, eutrophic basinPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147097/1/wrcr23654_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147097/2/wrcr23654-sup-0001-2018WR023024-SI.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147097/3/wrcr23654.pd

Obtaining Phytoplankton Diversity from Ocean Color: A Scientific Roadmap for Future Development

To improve our understanding of the role of phytoplankton for marine ecosystems and global biogeochemical cycles, information on the global distribution of major phytoplankton groups is essential. Although algorithms have been developed to assess phytoplankton diversity from space for over two decades, so far the application of these data sets has been limited. This scientific roadmap identifies user needs, summarizes the current state of the art, and pinpoints major gaps in long-term objectives to deliver space-derived phytoplankton diversity data that meets the user requirements. These major gaps in using ocean color to estimate phytoplankton community structure were identified as: (a) the mismatch between satellite, in situ and model data on phytoplankton composition, (b) the lack of quantitative uncertainty estimates provided with satellite data, (c) the spectral limitation of current sensors to enable the full exploitation of backscattered sunlight, and (d) the very limited applicability of satellite algorithms determining phytoplankton composition for regional, especially coastal or inland, waters. Recommendation for actions include but are not limited to: (i) an increased communication and round-robin exercises among and within the related expert groups, (ii) the launching of higher spectrally and spatially resolved sensors, (iii) the development of algorithms that exploit hyperspectral information, and of (iv) techniques to merge and synergistically use the various streams of continuous information on phytoplankton diversity from various satellite sensors' and in situ data to ensure long-term monitoring of phytoplankton composition

Obtaining phytoplankton diversity from ocean color: A scientific roadmap for future development

This is the final version. Available from Frontiers Media via the DOI in this record.To improve our understanding of the role of phytoplankton for marine ecosystems and global biogeochemical cycles, information on the global distribution of major phytoplankton groups is essential. Although algorithms have been developed to assess phytoplankton diversity from space for over two decades, so far the application of these data sets has been limited. This scientific roadmap identifies user needs, summarizes the current state of the art, and pinpoints major gaps in long-term objectives to deliver space-derived phytoplankton diversity data that meets the user requirements. These major gaps in using ocean color to estimate phytoplankton community structure were identified as: (a) the mismatch between satellite, in situ and model data on phytoplankton composition, (b) the lack of quantitative uncertainty estimates provided with satellite data, (c) the spectral limitation of current sensors to enable the full exploitation of backscattered sunlight, and (d) the very limited applicability of satellite algorithms determining phytoplankton composition for regional, especially coastal or inland, waters. Recommendation for actions include but are not limited to: (i) an increased communication and round-robin exercises among and within the related expert groups, (ii) the launching of higher spectrally and spatially resolved sensors, (iii) the development of algorithms that exploit hyperspectral information, and of (iv) techniques to merge and synergistically use the various streams of continuous information on phytoplankton diversity from various satellite sensors' and in situ data to ensure long-term monitoring of phytoplankton composition.ESA SEOM SY-4Sci Synergy projectNAS

Medication-Taking Practices of Patients on Antiretroviral HIV Therapy: Control, Power, and Intentionality

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) is crucial for health, but patients face numerous challenges achieving sustained lifetime adherence. We conducted six focus groups with 56 PLWH regarding ART adherence barriers and collected sociodemographics and ART histories. Participants were recruited through clinics and AIDS service organizations in North Carolina. Dedoose software was used to support thematic analysis. Participants were 59% male, 77% black, aged 23–67 years, and living with HIV 4–20 years. Discussions reflected the fluid, complex nature of ART adherence. Maintaining adherence required participants to indefinitely assert consistent control across multiple areas including: their HIV disease, their own bodies, health care providers, and social systems (e.g., criminal justice, hospitals, drug assistance programs). Participants described limited control over treatment options, ART's impact on their body, and inconsistent access to ART and subsequent inability to take ART as prescribed. When participants felt they had more decision-making power, intentionally choosing whether and how to take ART was not exclusively a decision about best treating HIV. Instead, through these decisions, participants tried to regain some amount of power and control in their lives. Supportive provider relationships assuaged these struggles, while perceived side-effects and multiple co-morbidities further complicated adherence. Adherence interventions need to better convey adherence as a continuous, changing process, not a fixed state. A perspective shift among care providers could also help address negative consequences of the perceived power struggles and pressures that may drive patients to exert control via intentional medication taking practices

Phytoplankton functional types from Space.

The concept of phytoplankton functional types has emerged as a useful approach to classifying phytoplankton. It finds many applications in addressing some serious contemporary issues facing science and society. Its use is not without challenges, however. As noted earlier, there is no universally-accepted set of functional types, and the types used have to be carefully selected to suit the particular problem being addressed. It is important that the sum total of all functional types matches all phytoplankton under consideration. For example, if in a biogeochemical study, we classify phytoplankton as silicifiers, calcifiers, DMS-producers and nitrogen fix- ers, then there is danger that the study may neglect phytoplankton that do not contribute in any significant way to those functions, but may nevertheless be a significant contributor to, say primary production. Such considerations often lead to the adoption of a category of “other phytoplankton” in models, with no clear defining traits assigned them, but that are nevertheless necessary to close budgets on phytoplankton processes. Since this group is a collection of all phytoplankton that defy classification according to a set of traits, it is difficult to model their physi- ological processes. Our understanding of the diverse functions of phytoplankton is still growing, and as we recognize more functions, there will be a need to balance the desire to incorporate the increasing number of functional types in models against observational challenges of identifying and mapping them adequately. Modelling approaches to dealing with increasing functional diversity have been proposed, for example, using the complex adaptive systems theory and system of infinite diversity, as in the work of Bruggemann and Kooijman (2007). But it is unlikely that remote-sensing approaches might be able to deal with anything but a few prominent functional types. As long as these challenges are explicitly addressed, the functional- type concept should continue to fill a real need to capture, in an economic fashion, the diversity in phytoplankton, and remote sensing should continue to be a useful tool to map them. Remote sensing of phytoplankton functional types is an emerging field, whose potential is not fully realised, nor its limitations clearly established. In this report, we provide an overview of progress to date, examine the advantages and limitations of various methods, and outline suggestions for further development. The overview provided in this chapter is intended to set the stage for detailed considerations of remote-sensing applications in later chapters. In the next chapter, we examine various in situ methods that exist for observing phytoplankton functional types, and how they relate to remote-sensing techniques. In the subsequent chapters, we review the theoretical and empirical bases for the existing and emerging remote-sensing approaches; assess knowledge about the limitations, assumptions, and likely accuracy or predictive skill of the approaches; provide some preliminary comparative analyses; and look towards future prospects with respect to algorithm development, validation studies, and new satellite mis- sions

Determinants of non- response to a second assessment of lifestyle factors and body weight in the EPIC-PANACEA study.

BACKGROUND: This paper discusses whether baseline demographic, socio-economic, health variables, length of follow-up and method of contacting the participants predict non-response to the invitation for a second assessment of lifestyle factors and body weight in the European multi-center EPIC-PANACEA study. METHODS: Over 500.000 participants from several centers in ten European countries recruited between 1992 and 2000 were contacted 2-11 years later to update data on lifestyle and body weight. Length of follow-up as well as the method of approaching differed between the collaborating study centers. Non-responders were compared with responders using multivariate logistic regression analyses. RESULTS: Overall response for the second assessment was high (81.6%). Compared to postal surveys, centers where the participants completed the questionnaire by phone attained a higher response. Response was also high in centers with a short follow-up period. Non-response was higher in participants who were male (odds ratio 1.09 (confidence interval 1.07; 1.11), aged under 40 years (1.96 (1.90; 2.02), living alone (1.40 (1.37; 1.43), less educated (1.35 (1.12; 1.19), of poorer health (1.33 (1.27; 1.39), reporting an unhealthy lifestyle and who had either a low (25, 1.08 (1.06; 1.10); especially ≥30 kg/m2, 1.26 (1.23; 1.29)). CONCLUSIONS: Cohort studies may enhance cohort maintenance by paying particular attention to the subgroups that are most unlikely to respond and by an active recruitment strategy using telephone interviews.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are