The current study assessed (1) the importance of six caregiver interactions skills (sensitive responsiveness, respect for autonomy, structuring and limit setting, verbal communication, developmental ...stimulation, and fostering positive peer interactions) as rated by several stakeholders, (2) the quality of caregiver interactive skills, and (3) the effectiveness of a training program in early child care centers (children 0- to 6-year-olds) in Bangladesh. Using a quasi-experimental study design, 20 caregivers were allocated to the experimental condition (receiving a training) and 20 caregivers to the control condition (no training). Research Findings: Results showed that the importance of the six caregiver interactive skills was acknowledged by parents, managers/factory owners, and caregivers. Caregivers scored on average in the inadequate range for five out of the six CIP skills (except structuring and limit setting). Using a newly developed training program, quality of caregiver interactive skills improved. Finally, caregivers' overall training satisfaction as rated at posttest was high. The relatively low scores on caregiver interactive skills underscore that it is important to assess and monitor pedagogical quality in child care. Practice or Policy: Our findings indicate that the quality of caregiver-child interactions in the Bangladesh child care context can be strengthened by training.
Compensating for sensorimotor noise and for temporal delays has been identified as a major function of the nervous system. Although these aspects have often been described separately in the ...frameworks of optimal cue combination or motor prediction during movement planning, control-theoretic models suggest that these two operations are performed simultaneously, and mounting evidence supports that motor commands are based on sensory predictions rather than sensory states. In this letter, we study the benefit of state estimation for predictive sensorimotor control. More precisely, we combine explicit compensation for sensorimotor delays and optimal estimation derived in the context of Kalman filtering. We show, based on simulations of human-inspired eye and arm movements, that filtering sensory predictions improves the stability margin of the system against prediction errors due to low-dimensional predictions or to errors in the delay estimate. These simulations also highlight that prediction errors qualitatively account for a broad variety of movement disorders typically associated with cerebellar dysfunctions. We suggest that adaptive filtering in cerebellum, instead of often-assumed feedforward predictions, may achieve simple compensation for sensorimotor delays and support stable closed-loop control of movements.
The policy for listing and transplant for children with dilated cardiomyopathy (DCM) in The Netherlands has been conservative because of low donor availability. The effects of this policy on outcome ...are reported.
This was a multicenter, nationwide study performed in 148 children with DCM. The primary outcome was death or heart transplant.
Overall, 43 patients (29%) died or were transplanted. Within 1 year of diagnosis, 21 patients died, and only 4 underwent transplantation (3 on mechanical circulatory support). The 1-year survival was 85% (95% confidence interval CI = 79-91), and 5-year survival was 84% (95% CI = 78-90). Transplantation-free survival at 1 year was 82% (95% CI = 75-88) and at 5 years was 72% (95% CI = 64-80). Within 1 year of diagnosis, with death as the main end-point (21 of 25, 84%), intensive care unit admission (hazard ratio = 2.6, p = 0.05) and mechanical circulatory support (hazard ratio = 3.2, p = 0.03) were risk factors (multivariable Cox analysis); inotropic support was longer in patients reaching an end-point. At >1 year after diagnosis, with transplantation as the main end-point (15 of 18, 83%), age >6 years (hazard ratio = 6.1, p = 0.02) was a risk factor. There were 56 (38%) children who recovered, 50% within 1 year of diagnosis. Recovery was associated with younger age; was similar in patients with myocarditis (43%) and idiopathic disease (41%); and was similar in patients initially admitted to the intensive care unit, admitted to the ward, or treated as outpatients.
The transplantation rate in our cohort in the first year was low, with 1-year and 5-year survival rates similar to other cohorts. Our results suggest that a conservative approach to list children for transplantation early after presentation may be justifiable except for patients with prolonged intensive care unit or mechanical circulatory support.
In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of ...euthanasia, physician-assisted suicide, and other end-of-life practices.
We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%.
In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used.
The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation.
Model reference control design methods fail when the plant has one or more non-minimum phase zeros that are not included in the reference model, leading possibly to an unstable closed loop. This is a ...very serious problem for data-based control design methods, where the plant is typically unknown. In this paper, we extend the Virtual Reference Feedback Tuning method to non-minimum phase plants. This extension is based on the idea proposed in
Lecchini and Gevers (2002) for Iterative Feedback Tuning. We present a simple two-step procedure that can cope with the situation where the unknown plant may or may not have non-minimum phase zeros.
Over the past decade, solvent resistant nanofiltration (SRNF) has gained a lot of attention, as it is a promising energy- and waste-efficient unit process to separate mixtures down to a molecular ...level. This critical review focuses on all aspects related to this new burgeoning technology, occasionally also including literature obtained on aqueous applications or related membrane processes, if of relevance to understand SRNF better. An overview of the different membrane materials and the methods to turn them into suitable SRNF-membranes will be given first. The membrane transport mechanism and its modelling will receive attention in order to understand the process and the reported membrane performances better. Finally, all SRNF-applications reported so far - in food chemistry, petrochemistry, catalysis, pharmaceutical manufacturing - will be reviewed exhaustively (324 references).
In prediction error identification, the information matrix plays a central role. Specifically, when the system is in the model set, the covariance matrix of the parameter estimates converges ...asymptotically, up to a scaling factor, to the inverse of the information matrix. The existence of a finite covariance matrix thus depends on the positive definiteness of the information matrix, and the rate of convergence of the parameter estimate depends on its ¿size¿. The information matrix is also the key tool in the solution of optimal experiment design procedures, which have become a focus of recent attention. Introducing a geometric framework, we provide a complete analysis, for arbitrary model structures, of the minimum degree of richness required to guarantee the nonsingularity of the information matrix. We then particularize these results to all commonly used model structures, both in open loop and in closed loop. In a closed-loop setup, our results provide an unexpected and precisely quantifiable trade-off between controller degree and required degree of external excitation.
Aims
The need for permanent pacemakers (PMs) after heart transplantation (HT) is increasing. The aim was to determine the influence of cardiac allograft vasculopathy (CAV), donor age, and other risk ...factors on PM implantations early and late after HT and its effect on survival.
Methods and results
A retrospective, single‐centre study was performed including HTs from 1984 to July 2018. Early PM was defined as PM implantation ≤90 days and late PM as PM > 90 days. Risk factors for PM and survival after PM were determined with (time‐dependent) multivariable Cox regression. Out of 720 HTs performed, 62 were excluded (55 mortalities ≤30 days and 7 retransplantations). Of the remaining 658 patients, 95 (14%) needed a PM: 38 (6%) early and 57 (9%) late during follow‐up (median 9.3 years). Early PM risk factors were donor age hazard ratio (HR) 1.06, P < 0.001, ischaemic time (HR 1.01, P < 0.001), and in adults amiodarone use before HT (HR 2.02, P = 0.045). Late PM risk factors were donor age (HR 1.03, P = 0.024) and CAV (HR 3.59, P < 0.001). Late PM compromised survival (HR 2.05, P < 0.001), while early PM did not (HR 0.77, P = 0.41).
Conclusions
Risk factors for early PM implantation were donor age, ischaemic time, and in adults amiodarone use before HT. Late PM implantation risk factors were donor age and CAV. Late PM diminished survival, which is probably a surrogate marker for underlying progressive cardiac disease.
This study investigates whether crafting of job demands and resources relates positively to extra-role behavior (i.e. contextual performance and creativity) through work engagement and flourishing. ...We collected data from 294 employees and their supervisors regarding employees' contextual performance and creativity. Results show that seeking resources had a positive indirect relationship with contextual performance through work engagement, and with creativity through work engagement and flourishing. Reducing demands had negative indirect relationships with both contextual performance and creativity through work engagement. We conclude that particularly seeking resources has important implications for extra-role behavior and discuss the practical implications of these findings.
•Work engagement shows stronger associations with supervisor-rated extra-role behavior than flourishing.•Job crafting both favorably and unfavorably affects work engagement and flourishing.•Seeking resources favorably affects contextual performance and creativity through work engagement.•Reducing demands unfavorably affects contextual performance and creativity through work engagement.
Efforts to explain children's nutrition behavior or weight often involve investigating the parent-child relationship, typically studying the associations between food parenting practices (FPPs) and ...child outcomes. However, these behaviors are embedded in a broader system: general parenting (GP, the general emotional climate at home), and the family health climate (an aspect of the broader family system in the context of health). In the current study, we combined the parent-child measures of parenting (FPPs and GP) and the nutritional dimension of the family health climate (family nutrition climate, FNC) to get a broader view of how these concepts are interrelated. The current study had two aims: predicting FPPs using GP and FNC as predictor variables, and investigating the relationship between FPPs and children's weight in different groups of parents, based on low and high GP and FNC scores.
We collected cross-sectional data via an online survey panel. Mothers of 267 children aged 5-12 years filled out a questionnaire assessing demographics (e.g., children's weight and height), GP, FPPs, and FNC. Bivariate correlation coefficients were calculated between all constructs. Structural equation modeling was performed to test the hypothesized relationships between GP, FNC and FPPs. Hereafter, different groups of parents were identified, using median split, based on a low or high score on GP or a low or high score on FNC. Bivariate correlation coefficients were calculated between FPPs and children's BMI z-score for these different groups.
GP and FNC were consistently positively correlated (all r's ≥.177), and both concepts were positively associated with healthy FPPs (all r's ≥.214). In families with a positive context (i.e. scoring high on GP and on FNC), healthy FPPs were associated with lower BMI z-scores of the children (r -.229). This association was not found for children with a more negative family context.
FNC and GP are valuable additional concepts to investigate relationships between FPPs and child outcomes. We recommend that more studies, next to investigating the parent-child system, include a measure of the broader family system, in order to get a broader view of the mechanisms explaining child health behaviors and weight status.
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