Higher education is tasked with preparing students for a culturally diverse and globalizing world. Additionally, western nations have an increasingly diverse student population and know the success of their students will depend in part on being able to navigate diversity. There is therefore good reason for institutions of higher learning to promote and facilitate the development of ‘global citizens’ – people who can work and relate across borders and boundaries, both real and perceived. However, teachers are not necessarily equipped to foster this learning. Many teachers are used to a reproductive way of teaching while the learning that is needed here is identity learning, directed at dialogue, internally as well as externally. This chapter proposes the potential of creative, expressive and reflective writing as a way in which personal development – a form of a reflexive internal dialogue – can be fostered to promote cultural healing and global citizenship. The writing method will be described and a case study on cultural healing in the context of Canada’s reconciliation efforts with Aboriginal people will be used to illustrate the learning process involved. The processes of writing the self and re-narrating identity has several promising benefits for both students and teachers in higher education. First it allows us to learn more about ourselves and what blocks our learning (i.e. promotes self-reflection). Second, it allows us to change our story and our identifications and therefore choose differently (i.e. self-direction). Third, it is a companion on the road of life where we literally learn to talk and listen to ourselves and articulate the tacit knowledge that can be unearthed through narrative, journal, and poetic writing. Fourth, the method is playful and creative and although tears are frequently shed in the process, students report a great enjoyment in writing and sharing their stories with others. It is a meaningful dialogue about experience and also has the potential of promoting cultural (Lengelle, Jardine, & Bonnar, 2018) healing in the context of a very diverse student body (Banks, 2015). It also has the potential for creating new bonds in the classroom and allows teachers in higher education to engage in the difficult work of facilitating global citizenship learning. The internal dialogue described here also allows us to ‘clean up’ judgements and become aware of the need to reach out to others. Not only the actual sharing of vulnerable writing in a class or online setting shows us we are not alone, but ‘writing the self’ focuses deliberately on where we have become fearful about our own and others’ identities and allows us a learning process to unearth those things, heal them in order to reach out to others.
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Background Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. Methods In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks’ gestation in 2010–2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman’s rank correlations. Findings Intrapartum referral rates varied between 55–68% (nulliparous) and 20–32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6–16% (nulliparous) and 16–31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14–42% (nulliparous) and 3–13% (multiparous) and in obstetrician-led births from 46–67% and 14–28% respectively. Rates of postpartum oxytocin varied between 59–88% (nulliparous) and 50–85% (multiparous) and artificial rupture of membranes between 43–52% and 54–61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. Conclusions Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.
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STUDY DESIGN: Meta-analysis.OBJECTIVES: To define the accuracy of clinical tests for assessing anterior cruciate ligament (ACL) ruptures.BACKGROUND: The cruciate ligaments, and especially the ACL, are among the most commonly injured structures of the knee. Given the increasing injury prevalence, there is undoubtedly a growing need for clinical decision making of health care providers. We reviewed the literature to analyze the diagnostic accuracy of the clinical examination for assessing ACL ruptures.METHODS AND MEASURES: MEDLINE (1966 to April 2005), EMBASE (1989 to April 2005), and CINAHL (1982 to April 2005) searches were performed. Also reference lists of the included studies were reviewed. Studies selected for data extraction were those that addressed the accuracy of at least 1 physical diagnostic test for ACL rupture and compared the performance of the clinical examination of the knee with a reference standard, such as arthroscopy, arthrotomy, or MRI. Searching was limited to English, German, and Dutch languages.RESULTS: Twenty-eight studies that assessed the accuracy of clinical tests for diagnosing ACL ruptures met the inclusion criteria. Study results were, however, heterogeneous. The Lachman test is the most valid test to determine ACL tears, showing a pooled sensitivity of 85% (95% confidence interval [CI], 83-87) and a pooled specificity of 94% (95% CI, 92-95). The pivot shift test is very specific, namely 98% (95% CI, 96-99), but has a poor sensitivity of 24% (95% CI, 21-27). The anterior drawer test shows good sensitivity and specificity in chronic conditions, respectively 92% (95% CI, 88-95) and 91% (95% CI, 87-94), but not in acute conditions.CONCLUSION: In case of suspected ACL injury it is recommended to perform the Lachman test. Because the pivot shift test is very specific both in acute as well as in chronic conditions, it is recommended to perform the pivot shift test as well.
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Engelse vertaling van Anthonis de Roovere's droom over de dood van hertog Karel de Stoute
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The World Hunt: An Environmental History of the Commodification of Animals is written by John F. Richards, a ‘pioneer in environmental history’ as J. R. McNeill calls him in his introduction to the volume. This introduction explains how this unique yet not always easily accessible text exploring the environmental and socio-economic dimensions of commercial exploitation of non-humans came into being, and how it can be seen in the contexts of the history of human relationships to the environment and of contemporary ethics. The World Hunt is an unusual volume in that it blends environmental history, the dispassionate narrative of facts, with a voice that is at times full of hurt, as it expresses genuine concern for the voiceless victims of hunters’ increasingly global pursuits. The volume is essentially an extract from the meticulously researched and finely detailed history of hunting, fishing and whaling presented in Richards’ exhaustive The Unending Frontier. https://doi.org/10.1016/j.biocon.2014.09.025 https://www.linkedin.com/in/helenkopnina/
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Due to the ageing population, the prevalence of musculoskeletal disorders will continue to rise, as well as healthcare expenditure. To overcome these increasing expenditures, integration of orthopaedic care should be stimulated. The Primary Care Plus (PC+) intervention aimed to achieve this by facilitating collaboration between primary care and the hospital, in which specialised medical care is shifted to a primary care setting. The present study aims to evaluate the referral decision following orthopaedic care in PC+ and in particular to evaluate the influence of diagnostic tests on this decision. Therefore, retrospective monitoring data of patients visiting PC+ for orthopaedic care was used. Data was divided into two periods; P1 and P2. During P2, specialists in PC+ were able to request additional diagnostic tests (such as ultrasounds and MRIs). A total of 2,438 patients visiting PC+ for orthopaedic care were included in the analysis. The primary outcome was the referral decision following PC+ (back to the general practitioner (GP) or referral to outpatient hospital care). Independent variables were consultation- and patient-related predictors. To describe variations in the referral decision, logistic regression modelling was used. Results show that during P2, significantly more patients were referred back to their GP. Moreover, the multivariable analysis show a significant effect of patient age on the referral decision (OR 0.86, 95% CI = 0.81– 0.91) and a significant interaction was found between the treating specialist and the period (p = 0.015) and between patient’s diagnosis and the period (p < 0.001). Despite the significant impact of the possibility of requesting additional diagnostic tests in PC+, it is important to discuss the extent to which the availability of diagnostic tests fits within the vision of PC+. In addition, selecting appropriate profiles for specialists and patients for PC+ are necessary to further optimise the effectiveness and cost of care.
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In dit artikel vertalen de auteurs vier liedjes uit het Antwerps Liedboek (1544) in rijmend hedendaags Engels.
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Purpose: The aim of this study was to assess physiotherapists’ clinical use and acceptance of a novel telemonitoring platform to facilitate the recording of measurements during rehabilitation of patients following anterior cruciate ligament reconstruction. Additionally, suggestions for platform improvement were explored. Methods: Physiotherapists from seven Dutch private physiotherapy practices participated in the study. Data were collected through log files, a technology acceptance questionnaire and focus group meetings using the “buy a feature” method. Data regarding platform use and acceptance (7-point/11-point numeric rating scale) were descriptively analysed. Total scores were calculated for the features suggested to improve the platform, based on the priority rating (1 = nice to have, 2 = should have, 3 = must have). Results: Participating physiotherapists (N = 15, mean [SD] age 33.1 [9.1] years) together treated 52 patients during the study period. Platform use by the therapists was generally limited, with the number of log-ins per patient varying from 3 to 73. Overall, therapists’ acceptance of the platform was low to moderate, with average (SD) scores ranging from 2.5 (1.1) to 4.9 (1.5) on the 7-point Likert scale. The three most important suggestions for platform improvement were: (1) development of a native app, (2) system interoperability, and (3) flexibility regarding type and frequency of measurements. Conclusions: Even though health care professionals were involved in the design of the telemonitoring platform, use in routine care was limited. Physiotherapists recognized the relevance of using health technology, but there are still barriers to overcome in order to successfully implement eHealth in routine care.
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Jan Van der Noot (c.1540-c.1601) is a central figure in Dutch literature, widely regarded as the first true Renaissance poet in the Netherlands. He was the earliest Dutch poet to imitate Ronsard, Baïf, and Petrarch, and the first to use the sonnetform. Van der Noot also has vital links with sixteenth-century England and English literature. While living in London (1567-72), he produced the source-text for Spenser and Roest's Theatre of Voluptuous Worldlings. Yet despite this contribution, he is frequently overlooked by English-speaking critics. Even when he does receive consideration, he is seldom viewed as a poet in his own right. As an attempt to redress this, we offer here fresh translations from Van der Noot's work, lightly annotated throughout, concentrating on the sonnets that are the lynchpin of his reputation.
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