A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3–5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.
The concepts of metacognitive refection, refection, and metacognition are distinct but have undergone shifts in meaning as they migrated into medical education. Conceptual clarity is essential to the construction of the knowledge base of medical education and its educational interventions. We conducted a theoretical integrative review across diverse bodies of literature with the goal of understanding what metacognitive refection is. We searched PubMed, Embase, CINAHL, PsychInfo, and Web of Science databases, including all peer-reviewed research articles and theoretical papers as well as book chapters that addressed the topic, with no limitations for date, language, or location. A total of 733 articles were identified and 87 were chosen after careful review and application of exclusion criteria. The work of conceptually and empirically delineating metacognitive reflection has begun. Contributions have been made to root metacognitive refection in the concept of metacognition and moving beyond it to engage in cycles of refection. Other work has underscored its affective component, transformational nature, and contextual factors. Despite this merging of threads to develop a richer conceptualization, a theory of how metacognitive refection works is elusive. Debates address whether metacognition drives refection or vice versa. It has also been suggested that learners evolve along on a continuum from thinking, to task-related refection, to self-refection, and finally to metacognitive refection. Based on prior theory and research, as well as the findings of this review, we propose the following conceptualization: Metacognitive refection involves heightened internal observation, awareness, monitoring, and regulation of our own knowledge, experiences, and emotions by questioning and examining cognition and emotional processes to continually refine and enhance our perspectives and decisions while thoughtfully accounting for context. We argue that metacognitive refection brings a shift in perspective and can support valuable reconceptualization for lifelong learning.
LINK
OBJECTIVE: The increasing prevalence of diabetes suggests a gap between real world and controlled trial effectiveness of lifestyle interventions, but real-world investigations are rare. Electronic medical registration facilitates research on real-world effectiveness, although such investigations may require specific methodology and statistics. We investigated the effects of real-world primary care for patients with type 2 diabetes mellitus (T2DM). STUDY DESIGN AND SETTING: We used medical records of patients (n=2,549) with T2DM from 10 primary health care centers. A mixed-effects regression model for repeated measurements was used to evaluate the changes in weight and Hemoglobin A1c (HbA1c) over time. RESULTS: There was no statistically significant change in weight (+0.07 kg, P=0.832) and HbA1c (+0.03%, P=0.657) during the observation period of 972 days. Most patients maintained their physical activity level (70%), and 54 % had an insufficient activity level. The variability in the course of weight and HbA1c was because of differences between patients and not between health care providers. CONCLUSION: Despite effective lifestyle interventions in controlled trial settings, we found that real-world primary care is only able to stabilize weight and HbA1c in patients with T2DM over time. Medical registration can be used to monitor the actual effectiveness of interventions in primary care.
In greenhouse horticulture harvesting is a major bottleneck. Using robots for automatic reaping can reduce human workload and increase efficiency. Currently, ‘rigid body’ robotic grippers are used for automated reaping of tomatoes, sweet peppers, etc. However, this kind of robotic grasping and manipulation technique cannot be used for harvesting soft fruit and vegetables as it will cause damage to the crop. Thus, a ‘soft gripper’ needs to be developed. Nature is a source of inspiration for temporary adhesion systems, as many species, e.g., frogs and snails, are able to grip a stem or leave, even upside down, with firm adhesion without leaving any damage. Furthermore, larger animals have paws that are made of highly deformable and soft material with adjustable grip size and place holders. Since many animals solved similar problems of adhesion, friction, contact surface and pinch force, we will use biomimetics for the design and realization of the soft gripper. With this interdisciplinary field of research we aim to model and develop functionality by mimicking biological forms and processes and translating them to the synthesis of materials, synthetic systems or machines. Preliminary interviews with tech companies showed that also in other fields such as manufacturing and medical instruments, adjustable soft and smart grippers will be a huge opportunity in automation, allowing the handling of fragile objects.
Inleiding en praktijkvraag Het in 2012 opgerichte Saxion lectoraat Mechatronica is destijds gestart met het genomineerde RAAK-PRO project Medical Robotics. De ontwikkelde mechatronische kennis (vision, autonome navigatie, robotarmen) zijn enkel toegepast in de zorg en service robotica, maar kan worden toegepast in de industrie. Noord-oost Nederland staat bekend om zijn HTSM industrieën (VMI, WWINN, Bronkhorst, AWL, Norma, Thales, ed) en deze willen concreet en projectmatig samenwerken met kennisinstellingen binnen een netwerk van bedrijven. Projectdoelstelling Doelstelling is om met een breed netwerk van bedrijven de gezamenlijke onderzoeksbehoefte te identificeren. Diverse bedrijven, waaronder IMS en MetricControl, hebben reeds concreet hierom gevraagd. De doelstelling van het project BOARDing (“come-on-board”) is dan ook: “Identificeren van de gezamenlijke onderzoeksbehoefte en projectmatig deze samen op te lossen met de kennisinstellingen”. De hoofddoelstelling wordt beantwoord door de deliverables uit de volgende subdoelstellingen: 1. (her-)oprichten van de Mechatronica Vally Twente 2. Definitie gezamenlijke onderzoeksroadmap vanuit de individuele technologie roadmaps 3. Nieuwe onderzoeksprojectvoorstellen (min 1) uit deze onderzoeksroadmap. Bijdrage aan topsector SMART Industry Het lectoraat en de deelnemende bedrijfspartners IMS en MetricControl willen bewerkstelligen dat er concreet en projectmatig daadwerkelijke invulling wordt gegeven aan de regionale kennisagenda van de topsector SMART Industry: “Boost – Actieagenda Smart Industry Oost-Nederland”1. Projectmatig samenwerken en kennisdeling binnen de (her-)op te richten stichting Mechatronia voor een lange duur is daarbij de gezamenlijke visie. Vraagsturing, Netwerkvorming & Bijdrage aan innovatie Reeds 8 bedrijven hebben gevraagd om een gezamenlijke onderzoeksroadmap en zichzelf verplicht tot actieve onderzoeks- en kennisdeelname en streeft, onder deze voorwaarde, een groeimodel na in het geloof dat gezamenlijke onderzoek kosteneffectief is en de innovatie wordt gestimuleerd door onderlinge kennisontwikkeling en kennisdeling. Activiteitenplan & Projectorganisatie Het project wordt met name uitgevoerd door de lector Dr. Ir. D.A.Bekke en de deelnemende CEO’s van IMS en MetricControl.
An important line of research within the Center of Expertise HAN BioCentre is the development of the nematode Caenorhabditis elegans as an animal testing replacement organism. In the context of this, us and our partners in the research line Elegant! (project number. 2014-01-07PRO) developed reliable test protocols, data analysis strategies and new technology, to determine the expected effects of exposure to specific substances using C. elegans. Two types of effects to be investigated were envisaged, namely: i) testing of possible toxicity of substances to humans; and ii) testing for potential health promotion of substances for humans. An important deliverable was to show that the observed effects in the nematode can indeed be translated into effects in humans. With regard to this aspect, partner Preventimed has conducted research in obesity patients during the past year into the effect of a specific cherry extract that was selected as promising on the basis of the study with C. elegans. This research is currently being completed and a scientific publication will have to be written. The Top Up grant is intended to support the publication of the findings from Elegant! and also to help design experimental protocols that enable students to become acquainted with alternative medical testing systems to reduce the use of laboratory animals during laboratory training.
