Unraveling postgraduate communication learning: from transfer to transformative learning

Poor doctor-patient communication is a global concern. Much effort and finances are invested in communication skills training in medical schools around the world with only marginal effects on clinical communication in daily practice. This thesis addresses the problem from an educational view-point. It analyses why the current forms of training do not establish enough transfer of learned skills from training to daily practice. Moreover it provides insight in the learning process itself. It appears that residents/clinicians learn and improve their communication along five phases: confrontation, becoming aware, seeking alternatives, personalisation and internalisation & integration. Van den Eertwegh provides evidence-based recommendations that lead to more effective forms of training and learning resulting in more awareness and better integration of doctor-patient communication in the daily work of the busy physician

Water and nutrient budgets at field and regional scale : travel times of drainage water and nutrient loads to surface water

Keywords : water and nutrient budget, travel time of drainage water, dual-porosity concept, agricultural nutrient losses, loads to surface water, field-scale experiments, regional-scale approach. Nitrogen and phosphorus loads to surface waters have caused eutrophication problems in the Netherlands. Currently, surface water quality standards are not met due to loads from point and diffuse sources. Linking agricultural nutrient budget surpluses to observed losses of nutrients to the surface water by drainage requires water and nutrient balances as well as a travel time distribution of drainage water. In this research the travel time of drainage water was estimated by using steady-state flow analysis as well as transient modeling i.e., using a 2D dual-porosity water flow and solute transport code . To analyze and estimate nutrient loads to the surface water, this research covered both field-scale analyses as well as a regional-scale approach .At the Flevoland field experimental site , arable crops were grown on clay soil. The presence of a non-ripened clay layer in the soil profile appeared to be a key factor in the division of total drainage into tile drainage, drainage through a collecting and draining ditch, and drainage through the regional surface water. Tile drainage in the 1992-1994 period was between 50% and 85% of the total drainage. Nutrient losses by drainage were 55-86 kg ha -1 a -1 N and less than 0.5 kg ha -1 a -1 P and measured nutrient loads of drainage water exceeded the nutrient balance surpluses. The travel time distribution was first estimated by using a steady-state approach, and then confirmed by transient modeling, with some deviations, mainly during dry years. The travel time distribution of drainage showed that 50-60% of the local drainage water had a travel time of less than two years. Taking the travel time distribution into account, the observed N-loads of drainage water could be reasonably predicted. The P-surplus was almost fully adsorbed by the clay soil. The Hupsel-Assink field experimental site was located on grassland on a loamy sand. About 70% of total drainage was discharged by tile drains in the 1993-1994 period. N-losses by drainage were 165 kg ha -1 a -1N and the calculated P-loads were unreliable. About 50-70% of the drainage water had a travel time of less than two years. The travel time distribution was estimated by using a simple steady-state approach, and then confirmed by transient modeling. Using the travel time distribution, the observed drainage N-loads could be reasonably predicted. The P-surplus was almost fully adsorbed by the loamy sand. Both field experiments showed the relevance and importance of a thorough data analysis and of the travel time distribution of drainage water, which is needed to interpret and link agricultural practices to nutrient losses by drainage.The Regional scale approach estimated annual water flow and solute loads to the regional surface water, taking point sources and groundwater seepage into account. Annual water, salt, nitrogen, and phosphorus budgets were calculated for the Hoge Afdeling region in the Flevopolder area (1988-1999) and the Hupsel brook basin (1985-1994). A regional-scale travel time distribution of drainage water was estimated. Annual averages of nutrient loads to the regional surface water were well predicted. Nutrient losses by drainage from agricultural land and groundwater seepage were important sources in the Hoge Afdeling region, whereas in the Hupsel brook basin, nutrient losses by drainage from agricultural land were the main source. Accurate solute load estimates of the regional surface water based on well-designed surface-water-quality monitoring programs proved beneficial

In vivo T-B cell interactions and cytokine production in the murine spleen

During life, man encounters a large variety of infectious agents such as bacteriae, fungi, viruses and parasites. The cytopathogenic effects of these micro-organisms may have detrimental consequences on body functions, and may eventually lead to severe damages or even the death of the infected host. The fact that most of the time these organisms do not get the opportunity to harm our body, is largely due to our immune system. The immune system consists of a specific and a non-specific part. The latter, also called innate immune system, is the primary defense against micro-organisms and consist of a.o. the skin, shedding of epithelial cells, cilia lining the trachea, mucus, acid in the stomach, cytolytic enzymes in secretions, phaQocytes, acute phase proteins, etc. The second line. of defense is formed by the specific (adaptive) immune system, which can be divided into a cellular and a humoral part. Cellular immunit

LEFT BEHIND: MONITORING THE SOCIAL INCLUSION OF YOUNG AUSTRALIANS WITH SELF- REPORTED LONG TERM HEALTH CONDITIONS, IMPAIRMENTS OR DISABILITIES 2001 - 2009

Adolescents and young adults with disabilities are at heightened risk of social exclusion. Exclusion leads to poor outcomes in adulthood which in turn affects individuals’ health and wellbeing and that of their families and society through loss of productive engagement in their communities. Australia’s Social Inclusion Indicators Framework provides indices in domains of participation, resources and multiple and entrenched disadvantage to monitor and report on social inclusion. The Household Income and Labour Dynamics in Australia survey provides data over time on households in Australia. Using these tools we report here on the extent of social inclusion/exclusion of young disabled Australians over the past decade. Relative to their non-disabled peers, young disabled Australians are significantly less likely to do well on participation indicators.Centre for Disability Research and Polic

Religion Value in Novel: Ketika Cinta Bertasbih” Karya Habiburrahman El Shirazy ( Structural Genetic Approach)

This research is aimed at searching for the religious values on Habburrahman El Shirazy\u27s novel entitled Ketika Cinta Bertasbih by applying Genetic Structuralism using descriptive method and content analysis technique. The approaches used in this research were the sociology of literature and religiousness of literature. The religious values existing on this novel included as one of missionary endeavor forms, which gave valuable learning and enrich moral value. By means of his work of art, novel in this case, the author tried to present the sociological condition within his society. He also tried to deliver a missionary endeavor by using familiar language expressions, it was because the language of the novel was easily understood by the readers and the theme of the novel was closely related to the society condition. Sociological approach depicted that Ketika Cinta Bertasbih really influenced social values existed within the society, and the reverse. An author\u27s background absolutely gave great influence a novel, so did on this novel. Therefore, the social life of Habiburrahman El Shirazy had close relationship with his novel, Ketika Cinta Bertasbih