Van normatieve professionalisering naar een integraal kader

Mijn scriptie ‘Van Normatieve Professionalisering naar een Integraal Kader’ is geschreven voor de Universiteit voor Humanistiek voor de afstudeerrichting ‘Kritische Organisatie en Interventie Studies (KOIS). Ik laat in ‘mijn genese tot mijn probleemstelling’ zien dat ik naast de UvH verschillende opleidingen gedaan heb die wat mij betreft het makkelijkst samen zijn te vatten onder de noemer: ‘persoonlijke ontwikkeling’. Ik laat hier zien dat ik al deze facetten van persoonlijke ontwikkeling kan plaatsen binnen het integrale kader van Ken Wilber én dat dit rust geeft. Tegelijkertijd problematiseer ik zijn kader wanneer we naar de context van professionals en organisaties kijken. Het kader van normatieve professionalisering is daar beter voor. Normatieve professionalisering is de plaats waar aspecten van persoonlijke ontwikkeling maar ook wetenschappelijke en praktische interdisciplinaire kennis samen komen. Ik probeer in deze scriptie ook zelf niet buiten schot te blijven en in die zin in te gaan op mijn eigen persoonlijke en wetenschappelijke kennis en anderzijds mijn praktische handelen. Normatieve professionalisering is een kader dat laat zien dat alhoewel de situaties binnen organisatorische contexten zeer complex zijn, dat zij in feite nog niet complex genoeg zijn. Er is meer complexiteit nodig. Deze complexiteit heeft met name te maken met ‘morele’ en ‘existentiële’ vraagstukken. Zelf bepleit ik dat ook existentiële vraagstukken niet genoeg zijn. Want deze vragen zijn slechts één aspect van de vragen die komen kijken bij het totale spectrum van persoonlijke ontwikkeling. Alleen, zoals ik laat zien, is het nú al complex voor zowel de student aan de UvH als de (normatieve) professional. Wanneer daar meer complexiteit aan toegevoegd wordt dreigt het gevaar van wat ik ‘gefragmenteerde hyperreflectie’ noem. Simpel gezegd betekent ‘gefragmenteerde hyperreflectie’, dat te veel reflecties elkaar in te hoog tempo opvolgen en waarin geen samenhang in te ontdekken valt. Met deze scriptie probeer ik een verbreding en een verdieping aan te brengen in het kader van normatieve professionalisering. Deze verbreding en verdieping probeer ik te doen aan de hand van drie theorieën. De eerste is het integrale kader over persoonlijke ontwikkeling van Ken Wilber. De tweede is Theory U van Otto Scharmer. Deze theorie is in feite een uitgebreide integrale communicatie en co-creatie theorie voor de context van organisaties. Spiritualiteit en hoogsensitiviteit hebben beiden een belangrijke plaats in deze Theory U. De twee perspectieven van Wilber en Scharmer zijn echter niet voldoende voor de context van organisaties. Dr. Martin Hetebrij, waarbij ik een van mijn twee stages heb gedaan, heeft mij in laten zien dat een perspectief op macht en besluitvormingprocessen van belangrijk zijn voor het krijgen van goed functionerende organisaties. Ik kom in deze scriptie, met behulp van deze drie theorieën tot een conclusie hoe ‘gefragmenteerde hyperreflectie’ tegen gegaan kan worden. Ik wijs enerzijds naar de voordelen van het hebben van een (integraal) cognitief organisatiekader en anderzijds het toepassen van postrationele bewustzijnstaten, zoals mindfullness en het groeien naar een postrationeel ontwikkelingsniveau. Deze ontwikkelingsniveaus vallen uiteen in pedagogische, psychologische en existentiele niveaus. Bewustzijnstaten komen en gaan. Je kunt maar één bewustzijnsstaat op hetzelfde moment hebben. Je kunt bijvoorbeeld niet nuchter en dronken op hetzelfde moment zijn. Een ontwikkelingsniveau gaat niet weg. Wanneer we bijvoorbeeld onze moeders taal geleerd hebben zal deze onder normale situaties altijd tot onze beschikking staan. Ook kom ik in deze scriptie tot de conclusie dat er een onderscheid bestaat tussen een integraal kader en een integraal handelen in de praktijk. ‘Normatieve professionalisering’ verwijst naar de noodzaak van het integreren van bestaanskennis in organisatorische contexten. Ik beargumenteer dat een integraal kader de praktische integratie van bestaanskennis kan voeden en ondersteune

Intraobserver and interobserver variability and spatial differences in histologic examination of carotid endarterectomy specimens

IntroductionStudies using histologic examination and protein analysis of atherosclerotic plaques are increasingly being performed, but reproducibility of plaque histology and variation of plaque composition among different parts of the plaque, which are key to reliability of these studies, are relatively unexplored. Therefore, this study investigated the intraobserver and interobserver variability of plaque histology and spatial variability in plaque composition.MethodsAtherosclerotic plaques (n = 100) obtained during carotid endarterectomy were divided into 0.5-cm segments. Paraffin sections were stained and semiquantitatively analyzed (four categories: no, minor, moderate, and heavy) for fat, macrophages, smooth muscle cells, collagen, calcification, thrombus, and overall phenotype. First, to determine the intraobserver and interobserver reproducibility, two independent observers independently analyzed the plaques. Second, to investigate spatial variability in plaque composition, histologic appearances of the culprit lesions (0-segment) were compared with the histologic appearances of adjacent (+5 mm) and more distant (+10 mm) plaque segments of 30 specimens.ResultsThe κ values for intraobserver variability of fat, macrophages, smooth muscle cells, collagen, calcifications, thrombus, and overall phenotype were 0.83, 0.85, 0.71, 0.63, 0.81, 0.80, and 0.86, respectively, and κ values for interobserver variability were 0.68, 0.74, 0.54, 0.59, 0.82, 0.75, and 0.71, respectively. Comparison of the histologic scorings of adjacent segments revealed a mean κ of 0.40 (range, 0.33 to 0.60). When the culprit segment was compared with the more distant segment, the mean κ was 0.24; however, in 91% of cases, the difference between the culprit segment and the distal segment was one category or less.ConclusionSemiquantitative analysis of carotid atherosclerotic plaque histology was well reproducible, both intraobserver and interobserver. Although variation between different plaque segments in histologic appearance was observed, differences were small in almost all cases. Variability in histologic examination needs to be taken into account in studies comparing plaque imaging with histopathology and plaque research studies

Development of patient-specific osteosynthesis including 3D-printed drilling guides for medial tibial plateau fracture surgery

Purpose: A substantial proportion of conventional tibial plateau plates have a poor fit, which may result in suboptimal fracture reduction due to applied -uncontrolled- compression on the bone. This study aimed to assess whether patient-specific osteosyntheses could facilitate proper fracture reduction in medial tibial plateau fractures. Methods: In three Thiel embalmed human cadavers, a total of six tibial plateau fractures (three Schatzker 4, and three Schatzker 6) were created and CT scans were made. A 3D surgical plan was created and a patient-specific implant was designed and fabricated for each fracture. Drilling guides that fitted on top of the customized plates were designed and 3D printed in order to assist the surgeon in positioning the plate and steering the screws in the preplanned direction. After surgery, a postoperative CT scan was obtained and outcome was compared with the preoperative planning in terms of articular reduction, plate positioning, and screw direction. Results: A total of six patient-specific implants including 41 screws were used to operate six tibial plateau fractures. Three fractures were treated with single plating, and three fractures with dual plating. The median intra-articular gap was reduced from 6.0 (IQR 4.5–9.5) to 0.9 mm (IQR 0.2–1.4), whereas the median step-off was reduced from 4.8 (IQR 4.1–5.3) to 1.3 mm (IQR 0.9–1.5). The median Euclidean distance between the centre of gravity of the planned and actual implant was 3.0 mm (IQR: 2.8–3.7). The lengths of the screws were according to the predetermined plan. None of the screws led to screw penetration. The median difference between the planned and actual screw direction was 3.3° (IQR: 2.5–5.1). Conclusion: This feasibility study described the development and implementation of a patient-specific workflow for medial tibial plateau fracture surgery that facilitates proper fracture reduction, tibial alignment and accurately placed screws by using custom-made osteosynthesis plates with drilling guides.</p

Quantitative Three-Dimensional Measurements of Acetabular Fracture Displacement Could Be Predictive for Native Hip Survivorship

This study aims to develop a three-dimensional (3D) measurement for acetabular fracture displacement, determine the inter- and intra-observer variability, and correlate the measurement with clinical outcome. Three-dimensional models were created for 100 patients surgically treated for acetabular fractures. The ‘3D gap area’, the 3D surface between all the fracture fragments, was developed. The association between the 3D gap area and the risk of conversion to a total hip arthroplasty (THA) was determined by an ROC curve and a Cox regression analysis. The 3D gap area had an excellent inter-observer and intra-observer reliability. The preoperative median 3D gap area for patients without and with a THA was 1731 mm2 versus 2237 mm2. The median postoperative 3D gap area was 640 mm2 versus 845 mm2. The area under the curve was 0.63. The Cox regression analysis showed that a preoperative 3D gap area > 2103 mm2 and a postoperative 3D gap area > 1058 mm2 were independently associated with a 3.0 versus 2.4 times higher risk of conversion to a THA. A 3D assessment of acetabular fractures is feasible, reproducible, and correlates with clinical outcome. Three-dimensional measurements could be added to the current classification systems to quantify the level of fracture displacement and to assess operative results

Heavy metal distribution in some French forest soils: evidence for atmospheric contamination

This study is one of very few dealing with the distribution and the origin of heavy metals in French soils from a priori non-polluted forest areas. The abundance of heavy metals measured in these soils decreases as follows: Cr) Zn)Pb)Ni)Cu)Co4Cd. Total concentrations of Pb, Cr and Ni in some soils exceed the European thresholds for non-polluted soils and even the French association of normalization critical values for sludge spreading. The lowest heavy metal contents are observed in acid soils while the highest concentrations are in the calcaric cambisol and in the mollic andosol, which is rather scarce as compared with the other French forest soils. With the exception of the podzol, Cr and Ni concentrations increase with depth in all soil profiles. The distribution pattern of Co, Cu, Zn depends on the soil characteristics. In some acid soils, however, Cu and Zn decrease with depth. Pb and Cd are accumulated in the upper soil horizons. Heavy metals accumulate in deep soil horizons in relation to important clay content in the dystric planosol and stagnic luvisol. The concentration of each heavy metal is always controlled by different parameters (soil pH, iron and aluminum oxide content, clay content, organic matter and cation exchange capacity), which are heavy metal specific. This study highlights the metal-trapping character of andosol and calcaric soil, the weak heavy metal retention in acid soils, the leaching and trapping character in leached clayed soils, and the migration of heavy metals in the podzol. Pb and Cr concentrations indicate a significant enrichment in surface horizons from various soils in areas which receive significant acid atmospheric pollution. Particularly, the highest Pb content is observed in a soil located in the N-NE part of France. Lead isotope ratios measured in the cambic podzol and the calcaric cambisol, exhibit the importance of the anthropogenic sources and particularly the influence of global atmospheric inputs from leaded gasoline compared to regional and local industrial emissions. The anthropogenic Pb contribution is estimated to 83, 30 and 11%, respectively, for surface, intermediate and deep horizons of the cambic podzol located in the northern part of France, and to 68% in surface horizon of the calcaric cambisol located in the Alps

Feasibility of Imaging-Based 3-Dimensional Models to Design Patient-Specific Osteosynthesis Plates and Drilling Guides

Importance: In acetabular fracture surgery, achieving an optimal reconstruction of the articular surface decreases the risk of osteoarthritis and the subsequent need for total hip arthroplasty. However, no one-size-fits-all osteosynthesis plate is available owing to differences in fracture patterns and variations in pelvic anatomy. Currently, osteosynthesis plates need to be manually contoured intraoperatively, often resulting in inadequate reduction and fixation of the fractured segments. Objective: To determine the feasibility and accuracy of a novel concept of fast-track 3-dimensional (3-D) virtual surgical planning and patient-specific osteosynthesis for complex acetabular fracture surgery. Design, Setting, and Participants: This case series study examines the use of patient-specific osteosynthesis plates for patients needing operative treatment for displaced associated-type acetabular fractures at a tertiary university-affiliated referral center and level 1 trauma center between January 1, 2017, and December 31, 2018. Models were created in 3-D based on computed tomography (CT) data, fractures were virtually reduced, and implant positions were discussed in a multidisciplinary team of clinicians and engineers. Patient-specific osteosynthesis plates with drilling guides were designed, produced, sterilized and clinically applied within 4 days. Data were analyzed at the 1-year follow-up. Exposures: Development and clinical implementation of personalized fracture surgery. Main Outcomes and Measures: The primary outcome was the quality of the reduction as determined by the postoperative CT scan. The secondary outcomes were accuracy of the screw placement and clinical outcome using patient-reported outcome measures. Results: Ten patients with a median (range) age of 63 (46-79) years with an acetabular fracture were included. The median (interquartile range [IQR]) preoperative gap was 20 (15-22) mm, and the median (IQR) step-off was 5 (3-11) mm. Postoperatively, the median (IQR) gap was reduced to 3 (2-5) mm (P = .005), and the median (IQR) step-off was reduced to 0 (0-2) mm (P = .01), indicating good fracture reduction, indicating good fracture reduction. The mean difference between the preoperative and postoperative gap was 14.6 (95% CI, 10-19) mm, and the mean difference in step-off was 5.7 (95% CI, 2-9) mm. The median (IQR) difference in screw direction between the planning and actual surgery was only 7.1° (7°-8°). All patients retained their native hip and reported good physical functioning at follow-up. Conclusions and Relevance: These findings suggest that 3-D virtual surgical planning, manufacturing, and clinical application of patient-specific osteosynthesis plates and drilling guides was feasible and yielded good clinical outcomes. Fast-track personalized surgical treatment could open a new era for the treatment of complex injuries

Accuracy of Patient-Specific Drilling Guides in Acetabular Fracture Surgery:A Human Cadaver Study

Due to the complex anatomical shape of the pelvis, screw placement can be challenging in acetabular fracture surgery. This study aims to assess the accuracy of screw placement using patient-specific surgical drilling guides applied to pre-contoured conventional implants in acetabular fracture surgery. CT scans were made of four human cadavers to create 3D models of each (unfractured) pelvis. Implants were pre-contoured on 3D printed pelvic models and optically scanned. Following virtual preoperative planning, surgical drilling guides were designed to fit on top of the implant and were 3D printed. The differences between the pre-planned and actual screw directions (degrees) and screw entry points (mm) were assessed from the pre- and postoperative CT-scans. The median difference between the planned and actual screw direction was 5.9° (IQR: 4–8°) for the in-plate screws and 7.6° (IQR: 6–10°) for the infra-acetabular and column screws. The median entry point differences were 3.6 (IQR: 2–5) mm for the in-plate screws and 2.6 (IQR: 2–3) mm for the infra-acetabular and column screws. No screws penetrated into the hip joint or caused soft tissue injuries. Three-dimensional preoperative planning in combination with surgical guides that envelope pre-contoured conventional implants result in accurate screw placement during acetabular fracture surgery