Communication in cross-cultural consultations in primary care in Europe: the case for improvement. The rationale for the RESTORE FP 7 project

The purpose of this paper is to substantiate the importance of research about barriers and levers to the implementation of supports for cross-cultural communication in primary care settings in Europe. After an overview of migrant health issues, with the focus on communication in cross-cultural consultations in primary care and the importance of language barriers, we highlight the fact that there are serious problems in routine practice that persist over time and across different European settings. Language and cultural barriers hamper communication in consultations between doctors and migrants, with a range of negative effects including poorer compliance and a greater propensity to access emergency services. It is well established that there is a need for skilled interpreters and for professionals who are culturally competent to address this problem. A range of professional guidelines and training initiatives exist that support the communication in cross-cultural consultations in primary care. However, these are commonly not implemented in daily practice. It is as yet unknown why professionals do not accept or implement these guidelines and interventions, or under what circumstances they would do so. A new study involving six European countries, RESTORE (REsearch into implementation STrategies to support patients of different ORigins and language background in a variety of European primary care settings), aims to address these gaps in knowledge. It uses a unique combination of a contemporary social theory, normalisation process theory (NPT) and participatory learning and action (PLA) research. This should enhance understanding of the levers and barriers to implementation, as well as providing stakeholders, with the opportunity to generate creative solutions to problems experienced with the implementation of such interventions

Amplitude Modulation and Relaxation-Oscillation of Counterpropagating Rolls within a Broken-Symmetry Laser-Induced Electroconvection Strip

We report a liquid-crystal pattern-formation experiment in which we break the lateral (translational) symmetry of a nematic medium with a laser-induced thermal gradient. The work is motivated by an improved measurement (reported here) of the temperature dependence of the electroconvection threshold voltage in planar-nematic 4-methoxybenzylidene-4-butylaniline (MBBA). In contrast with other broken-symmetry-pattern studies that report a uniform drift, we observe a strip of counterpropagating rolls that collide at a sink point, and a strong temporally periodic amplitude modulation within a width of 3-4 rolls about the sink point. The time dependence of the amplitude at a fixed position is periodic but displays a nonsinusoidal relaxation-oscillation profile. After reporting experimental results based on spacetime contours and wavenumber profiles, along with a measurement of the change in the drift frequency with applied voltage at a fixed control parameter, we propose some potential guidelines for a theoretical model based on saddle-point solutions for Eckhaus-unstable states and coupled complex Ginzburg-Landau equations. Published in PRE 73, 036317 (2006).Comment: Published in Physical Review E in March 200

Diermeel in diervoeders? : een methodische discussie met stakeholders

In dit rapport wordt verslag gedaan van een workshop die ten doel had een beter inzicht te krijgen in de belangen van de Nederlandse samenleving met betrekking tot de vraag of het beleid ten aanzien van dierlijke eiwitten in diervoeders versoepeld kan worden. Daarbij is gebruik maakt van een nieuwe, brede afwegingsmethodiek (TRAK) waarmee het mogelijk is verschillende beleidsscenario's' aan de hand van verschillende waarden te beoordelen en te scoren

Instabilities in the Envelopes and Winds of Very Massive Stars

The high luminosity of Very Massive Stars (VMS) means that radiative forces play an important, dynamical role both in the structure and stability of their stellar envelope, and in driving strong stellar-wind mass loss. Focusing on the interplay of radiative flux and opacity, with emphasis on key distinctions between continuum vs. line opacity, this chapter reviews instabilities in the envelopes and winds of VMS. Specifically, we discuss how: 1) the iron opacity bump can induce an extensive inflation of the stellar envelope; 2) the density dependence of mean opacity leads to strange mode instabilities in the outer envelope; 3) desaturation of line-opacity by acceleration of near-surface layers initiates and sustains a line-driven stellar wind outflow; 4) an associated line-deshadowing instability leads to extensive small-scale structure in the outer regions of such line-driven winds; 5) a star with super-Eddington luminosity can develop extensive atmospheric structure from photon bubble instabilities, or from stagnation of flow that exceeds the "photon tiring" limit; 6) the associated porosity leads to a reduction in opacity that can regulate the extreme mass loss of such continuum-driven winds. Two overall themes are the potential links of such instabilities to Luminous Blue Variable (LBV) stars, and the potential role of radiation forces in establishing the upper mass limit of VMS.Comment: 44 pages, 13 figures. Chapter to appear in the book "Very Massive Stars in the Local Universe", Springer, J.S. Vink, e

A Field-Scale Decision Support System for Assessment and Management of Soil Functions

peer-reviewedAgricultural decision support systems (DSSs) are mostly focused on increasing the supply of individual soil functions such as, e.g., primary productivity or nutrient cycling, while neglecting other important soil functions, such as, e.g., water purification and regulation, climate regulation and carbon sequestration, soil biodiversity, and habitat provision. Making right management decisions for long-term sustainability is therefore challenging, and farmers and farm advisors would greatly benefit from an evidence-based DSS targeted for assessing and improving the supply of several soil functions simultaneously. To address this need, we designed the Soil Navigator DSS by applying a qualitative approach to multi-criteria decision modeling using Decision Expert (DEX) integrative methodology. Multi-criteria decision models for the five main soil functions were developed, calibrated, and validated using knowledge of involved domain experts and knowledge extracted from existing datasets by data mining. Subsequently, the five DEX models were integrated into a DSS to assess the soil functions simultaneously and to provide management advices for improving the performance of prioritized soil functions. To enable communication between the users and the DSS, we developed a user-friendly computer-based graphical user interface, which enables users to provide the required data regarding their field to the DSS and to get textual and graphical results about the performance of each of the five soil functions in a qualitative way. The final output from the DSS is a list of soil mitigation measures that the end-users could easily apply in the field in order to achieve the desired soil function performance. The Soil Navigator DSS has a great potential to complement the Farm Sustainability Tools for Nutrients included in the Common Agricultural Policy 2021–2027 proposal adopted by the European Commission. The Soil Navigator has also a potential to be spatially upgraded to assist decisions on which soil functions to prioritize in a specific region or member state. Furthermore, the Soil Navigator DSS could be used as an educational tool for farmers, farm advisors, and students, and its potential should be further exploited for the benefit of farmers and the society as a whole

Patients’ Perspectives, Experiences, and Concerns With Perianal Fistulae:Insights From Online Targeted-Disease Forums

Background: Perianal fistulae can undermine physical, emotional, and social well-being in patients with Crohn’s disease and are challenging to manage. Social media offers a rich opportunity to gain an in-depth understanding of the impact of perianal fistulae on patients’ daily lives outside of controlled environments. In this study, we conducted social media analytics to examine patients’ experiences with perianal fistulae and assessed the impact of perianal fistulae on patients’ behavior and overall well-being. Methods: We used a mixed-method approach to examine 119 986 publicly available posts collected from 10 Crohn’s disease forums in the United States between January 01, 2010 and January 01, 2020. Discussions related to Crohn’s perianal fistulae were retrieved. We randomly selected 700 posts and qualitatively analyzed them using an inductive thematic approach. We then applied a latent Dirichlet allocation probabilistic topic model to explore themes in an unsupervised manner on the collection of 119 986 posts. Results: In the qualitative analysis, 5 major themes were identified: (1) burden of perianal fistula; (2) challenges associated with treatment; (3) online information seeking and sharing; (4) patient experiences with treatments; and (5) patients’ apprehension about treatments. In the quantitative analysis, the percentages of posts related to the major themes were (1) 20%, (2) 29%, (3) 66%, and (4) 28%, while the topic model did not identify theme 5. Conclusions: Social media reveals a dynamic range of themes governing patients’ perspectives and experiences with Crohn’s perianal fistulae. In addition to the biopsychosocial burden, patients frequently express dissatisfaction with current treatments and often struggle to navigate among available management options.</p

Numerical Simulations of Penetration and Overshoot in the Sun

We present numerical simulations of convective overshoot in a two-dimensional model of the solar equatorial plane. The simulated domain extends from 0.001 R_sun to 0.93 R_sun, spanning both convective and radiative regions. We show that convective penetration leads to a slightly extended, mildly subadiabatic temperature gradient beneath the convection zone below which there is a rapid transition to a strongly subadiabatic region. A slightly higher temperature is maintained in the overshoot region by adiabatic heating from overshooting plumes. This enhanced temperature may partially account for the sound speed discrepancy between the standard solar model and helioseismology. Simulations conducted with tracer particles suggest that a fully mixed region exists down to at least 0.687 R_sun.Comment: 24 pages, 8 figures, submitted to Ap