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Elk jaar verlaten veertigduizend kinderen de reguliere basisschool met een leesachterstand van twee jaar of meer. In het speciaal basisonderwijs bereikt de gemiddelde leerling een leesniveau tussen groep vier en vijf van het basisonderwijs. Eenmaal opgedane leesachterstand blijkt zeer moeilijk in te lopen te zijn. Remediëren is in die situatie uiterst gecompliceerd en weinig succesvol. Slechts een kwart van de leerlingen die in groep 5 tot de zwakke lezers behoort, slaagt erin deze achterstand in te halen (Grossen, 1997). Het gevolg is, dat ons land 250.000 volwassen functioneel analfabeten kent (Inspectie van het Onderwijs, 2003).
Disillusion with social media only stimulates the search for ever more refined techniques of manipulation. Detoxing won’t help, writes Geert Lovink: it is collective action, not will power, that can free us from the permanent state of distraction.
Safety and Security (S&S) have the same goal, that is to maintain the integrity of human, infrastructure, hardware, software, capital and intangible assets of a system. However, literature and practice indicate that the relationship between S&S has not yet been clearly defined and their boundaries remain blurry. The current paper presents a short review of academic and professional literature about the relationship between S&S. This relationship is examined by looking at the S&S dependencies, their similarities and differences, and the role of the human element in achieving and maintaining the desired S&S levels. The review of literature showed that (1) there is a tendency to emphasize on the effects of security on safety and underestimate the opposite, (2) human factors are not part of security training to the extent are addressed in safety training, (3) security and safety problems can be the result of both internal and external disturbances and agents, (4) the intentionality or not of outcomes, and not of the action, can stand as a valid criterion to classify an event as a security or a safety one correspondingly, (5) S&S issues can result in negative implications internally and externally to the system, and (6) the synergy between S&S is of paramount importance for achieving the optimum levels of system protection. The positions of this paper might comprise a basis for enriching educational programmes around S&S and igniting relevant research.
Op basis van de resultaten uit het onderzoek is gebleken dat cultureel erfgoed op dit moment veel betekent voor de bezoekers en bewoners in de regio IJsseldelta. Door deze betekenis onder de bewoners en bezoekers vast te houden en te optimaliseren kan het cultuurtoerisme binnen de IJsseldelta worden vergroot. Hiervoor dient de Provincie Overijssel met het GOBT en samen met de leisureketen en de lokale ondernemers wel actie te ondernemen doormiddel van het opstellen van een concreet actieplan met betrekking tot het bevorderen van het cultuurtoerisme in de IJsseldelta. Hierbij moet het behoud van het unieke karakter van de regio IJsseldelta een prominente rol spelen. Uit het onderzoek is namelijk gebleken dat bezoekers en bewoners de regio waarderen om haar unieke karakter. Vooral de natuurlijke omgeving speelt hierin een grote rol. Beoordeling: 7.
Objectives: To conduct a scoping review to 1) describe findings and determinants of physical functioning in children during and/or after PICU stay, 2) identify which domains of physical functioning are measured, 3) and synthesize the clinical and research knowledge gaps.Data Sources: A systematic search was conducted in PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines.Study Selection: Two investigators independently screened and included studies against predetermined criteria.Data Extraction: One investigator extracted data with review by a second investigator. A narrative analyses approach was used.Data Synthesis: A total of 2,610 articles were identified, leaving 68 studies for inclusion. Post-PICU/hospital discharge scores show that PICU survivors report difficulties in physical functioning during and years after PICU stay. Although sustained improvements in the long-term have been reported, most of the reported levels were lower compared with the reference and baseline values. Decreased physical functioning was associated with longer hospital stay and presence of comorbidities. A diversity of instruments was used in which mobility and self-care were mostly addressed.CONCLUSIONS: The results show that children perceive moderate to severe difficulties in physical functioning during and years after PICU stay. Longitudinal assessments during and after PICU stay should be incorporated, especially for children with a higher risk for poor functional outcomes. There is need for consensus on the most suitable methods to assess physical functioning in children admitted to the PICU.
BackgroundHyperbaric oxygen therapy (HBOT) is used to treat various wound types. However, the possible beneficial and harmful effects of HBOT for acute wounds are unclear.MethodsWe undertook a systematic review to evaluate the effectiveness of HBOT compared to other interventions on wound healing and adverse effects in patients with acute wounds. To detect all available randomized controlled trials (RCTs) we searched five relevant databases up to March 2010. Trial selection, quality assessment, data extraction, and data synthesis were conducted by two of the authors independently.ResultsWe included five trials, totaling 360 patients. These trials, with some methodologic flaws, included different kinds of wound and focused on different outcome parameters, which prohibited meta-analysis. A French trial (n = 36 patients) reported that significantly more crush wounds healed with HBOT than with sham HBOT [relative risk (RR) 1.70, 95% confidence interval (CI) 1.11–2.61]. Moreover, there were significantly fewer additional surgical procedures required with HBOT (RR 1.60, 95% CI 1.03–2.50), and there was significantly less tissue necrosis (RR 1.70, 95% CI 1.11–2.61). In one of two American trials (n = 141) burn wounds healed significantly quicker with HBOT (P < 0.005) than with routine burn care. A British trial (n = 48) compared HBOT with usual care. HBOT resulted in a significantly higher percentage of healthy graft area in split skin grafts (RR 3.50, 95% CI 1.35–9.11). In a Chinese trial (n = 145) HBOT did not significantly improve flap survival in patients with limb skin defects.ConclusionsHBOT, if readily available, appears effective for the management of acute, difficult to heal wounds.
A growing interest in person-centered care from a biopsychosocial perspective has led to increased attention to structural screening. The aim of this study was to develop an easy-to-comprehend screening instrument using single items to identify a broad range of health-related problems in adult burn survivors. This study builds on earlier work regarding content generation. Focus groups and expert meetings with healthcare providers informed content refinement, resulting in the Aftercare Problem List (APL). The instrument consists of 43 items divided into nine health domains: scars, daily life functioning, scars treatment, body perceptions, stigmatization, intimacy, mental health, relationships, financial concerns, and a positive coping domain. The APL also includes a Distress Thermometer and a question inquiring about preference to discuss the results with a healthcare provider. Subsequently, the APL was completed by 102 outpatients. To test face validity, a linear regression analysis showed that problems in three health domains, i.e., scars, mental health, and body perceptions, were significantly related to higher distress. Qualitative results revealed that a minority found the items difficult which led to further adjustment of the wording and the addition of illustrations. In summation, this study subscribes to the validity of using single items to screen for burn-related problems.
Pain in critically ill adults with burns should be assessed using structured pain behavioural observation measures. This study tested the clinimetric qualities and usability of the behaviour pain scale (BPS) and the critical-care pain observation tool (CPOT) in this population. This prospective observational cohort study included 132 nurses who rated pain behaviour in 75 patients. The majority of nurses indicated that BPS and CPOT reflect background and procedural pain-specific features (63–72 and 87–80%, respectively). All BPS and CPOT items loaded on one latent variable (≥0.70), except for compliance ventilator and vocalisation for CPOT (0.69 and 0.64, respectively). Internal consistency also met the criterion of ≥0.70 in ventilated and non-ventilated patients for both scales, except for non-ventilated patients observed by BPS (0.67). Intraclass correlation coefficients (ICCs) of total scores were sufficient (≥0.70), but decreased when patients had facial burns. In general, the scales were fast to administer and easy to understand. Cut-off scores for BPS and CPOT were 4 and 1, respectively. In conclusion, both scales seem valid, reliable, and useful for the measurement of acute pain in ICU patients with burns, including patients with facial burns. Cut-off scores associated with BPS and CPOT for the burn population allow professionals to connect total scores to person-centred treatment protocols.
