SMART users guides: SMART_NL & SMS_NL

Instructions to install and to use the model SMART_NL are given, and how to use the model SMART_NL with SUMO included. Besides, a user manual for configuration management is given

Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease

BACKGROUND: Elderly patients with end-stage renal disease have to make a difficult decision whether or not to start dialysis. This study explores the considerations taken into account by these patients in decision-making regarding renal replacement therapy. METHOD: In-depth interviews were conducted to gain an enhanced understanding of the considerations in treatment decision-making. Fourteen patients aged 65 years or older participated in the interviews, of whom 8 patients had made the decision to start, and 6 patients the decision to decline, dialysis. RESULTS: All participating patients had a variety of health problems, but appeared to have normal cognitive functions. Patients who declined dialysis were older and more often men and widow(er)s compared with patients who accepted dialysis. Patients chose to start dialysis because they enjoyed life, were not prepared to face the end of life, felt they had no other choice or had care-giving responsibilities for family members. Patients declined dialysis because of the speculated loss of autonomy, their age-associated decrease in vitality, distance from dialysis center and reluctance to think about the future. CONCLUSION: Results suggest that patients' decisions to decline or accept dialysis are not based on the effectiveness of the treatment, but rather on personal values, beliefs and feelings toward life, suffering and death, and the expected difficulties in fitting the treatment into their life

Differences between physicians in the likelihood of referral and acceptance of elderly patients for dialysis-influence of age and comorbidity

BACKGROUND: Incidence of dialysis in elderly patients in the Netherlands is low compared to other countries. This study aims to assess the impact of patients' age and comorbidity on the likelihood of referral and acceptance of patients for dialysis and whether this is affected by physician characteristics. METHODS: A vignette study was performed among 209 primary care physicians, 162 non-nephrology specialists and 20 nephrologists working in the north of the Netherlands. Physicians were offered six vignettes concerning case-reports of patients with end-stage renal disease (ESRD) and varying comorbidities or circumstances and asked about the likelihood of referral/acceptance of the patient in the given circumstances. RESULTS: The likelihood of referral within groups of physicians varied widely, especially within the group of primary care physicians and non-nephrology specialists, but was not affected by characteristics of physicians. The likelihood of referral or acceptance of patients for dialysis depended on the patient's age, and type and severity of comorbidity. In general, primary care physicians and non-nephrology specialists were less likely to refer than nephrologists were to accept. Differences within and between groups of physicians were larger for 80- than for 65-year-old patients, and for patients with less severe shortness of breath and cognitive impairments and more severe diabetes and social impairments. Hardly any differences were found for patients with cancer. CONCLUSION: Patients' age and comorbidities affect the likelihood of referral. Differences between groups of physicians suggest that there is insufficient agreement on the extent to which these factors should affect the referral/acceptance of patients for dialysis. These findings underline the need for more research into circumstances under which patients might benefit from dialysis. Guidelines should be developed to improve the referral of elderly and less healthy patients

Verbeteringen voor de Natuurplanner

Tijdens de ontwikkeling en toepassing van de modellen SMART2, SUMO2 en MOVE, alle onderdeel van de Natuurplanner het modelinstrumentarium van het Milieu- en Natuurplanbureau1, is een aantal problemen aan het licht gekomen. In dit werkdocument wordt een aantal van deze problemen behandeld en wordt een oplossing gegeven of een oplossingsrichting aangegeve

Technical documentation of the soil model VSD+ : Status A

VSD+ is een model om de gevolgen te berekenen van atmosferische depositie en klimaatverandering voorbodemverzuring, de beschikbaarheid van voedingsstoffen en het vastleggen van koolstof. Het model isontwikkeld ter onderbouwing van strategieën om de uitstoot van zwavel (S) en stikstof (N) in Europa teverminderen. Dit document biedt een samenvatting van de theorie waar het model op gestoeld is, detechnische documentatie hiervan alsmede een beschrijving van het testen, het valideren en de sensitiviteitsanalysevan het model. De processen zoals beschreven in het artikel over VSD+ zijn met goed gevolg getest.De gevoeligheidsanalyse gaf aan dat de constante voor het evenwicht tussen H+ en Al3+ in de bodemoplossingen de Ca-verweringssnelheid de parameters zijn, die voor een groot gedeelte de waarde van degesimuleerde pH bepalen. Voor basenverzadiging zijn de belangrijkste parameters de uitwisselingsconstantetussen H+ en basische kationen en de verwering van Ca. Voor de C/N ratio van bodemorganische stof zijn Cen N in het strooisel en de opname van N zeer bepalende factoren. De nitraatconcentratie hangt sterk samenmet het nerslagoverschot en de netto input van N---VSD+ is a model to calculate effects of atmospheric deposition and climate change on soil acidification,nutrient availability and carbon sequestration. The model has been developed to support emission abatementstrategies of sulphur (S) and nitrogen (N) in Europe. This document contains a summary of the modeltheory, technical documentation and descriptions of testing, validations and the sensitivity analysis of themodel. The processes described in the paper about VSD+ have been tested successfully. The sensitivityanalysis showed that the constant for the equilibrium between H+ and Al3+ in the soil solution and theweathering rate of Ca are the parameters that to a large extent determine the value of the simulated pH. Forbase saturation, most important parameters are the exchange constant between H+ and base cations andthe weathering of Ca. For the C/N ratio of soil organic matter, litterfall of C and N and the uptake of N areimportant influencing factors. The nitrate concentration strongly depends on the leaching flux and the net N inpu

Prediction of plant species occurrence as affected by nitrogen deposition and climate change on a European scale

Plant species occurrence in Europe is affected by changes in nitrogen deposition and climate. Insight into potential future effects of those changes can be derived by a model approach based on field-based empirical evidence on a continental scale. In this paper, we present a newly developed empirical model PROPS, predicting the occurrence probabilities of plant species in response to a combination of climatic factors, nitrogen deposition and soil properties. Parameters included were temperature, precipitation, nitrogen deposition, soil pH and soil C/N ratio. The PROPS model was fitted to plant species occurrence data of about 800,000 European relevés with estimated values for pH and soil C/N ratio and interpolated climate and modelled N deposition data obtained from the Ensemble meteo data set and EMEP model results, respectively. The model was validated on an independent data set. The test of ten species against field data gave an average Pearson's r-value of 0.79. PROPS was applied to a grassland and a heathland site to evaluate the effect of scenarios for nitrogen deposition and climate change on the Habitat Suitability Index (HSI), being the average of the relative probabilities, compared to the maximum probability, of all target species in a habitat. Results for the period 1930–2050 showed that an initial increase and later decrease in nitrogen deposition led to a pronounced decrease in HSI, and with dropping nitrogen deposition to an increase of the HSI. The effect of climate change appeared to be limited, resulting in a slight increase in HSI

What Factors are Associated with Flourishing? Results from a Large Representative National Sample

Flourishing is the ultimate end-state in psychology and a key-concept in the field of positive psychology research. Flourishers are those individuals with both high levels of hedonic well-being and eudaimonic well-being. Although many researchers have focused on one or another of these domains, only a few have investigated the comprehensive state of flourishing. The purpose of this study was to examine the prevalence of flourishing and its association with socio-demographics, personality traits and situational factors. This study used data from the second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a national representative sample of adults in The Netherlands (n = 5303; 2010–2012). Findings were compared to having either high hedonic well-being or high eudaimonic well-being. Results showed that 37 % of the respondents were flourishers, mainly characterized by high levels of conscientiousness and extraversion and low levels of neuroticism. The situational factors of social support and positive life-events were significantly associated with flourishing when the analysis was controlled for socio-demographics and personality traits. Flourishing was most distinct from high hedonic well-being and showed parallelism with high eudaimonic well-being. More research is needed to establish a preferred flourishing instrument with validated cut-off points for flourishing and to understand the processes of situational factors that may underlie the promotion of flourishing. We recommend longitudinal designs and experience sampling studies to investigate the unique and modifiable predictors of flourishing. In addition, future research should include intervention studies that examine through which hedonic and eudaimonic pathways flourishing can be achieve