The work environment of healthcare professionals is important for good patient care and is receiving increasing attention in scientific research. A clear and unambiguous understanding of a positive ...work environment, as perceived by healthcare professionals, is crucial for gaining systematic objective insights into the work environment. The aim of this study was to gain consensus on the concept of a positive work environment in the hospital.
This was a three-round Delphi study to establish consensus on what defines a positive work environment. A literature review and 17 semi-structured interviews with experts (transcribed and analyzed by open and thematic coding) were used to generate items for the Delphi study.
The literature review revealed 228 aspects that were clustered into 48 work environment elements, 38 of which were mentioned in the interviews also. After three Delphi rounds, 36 elements were regarded as belonging to a positive work environment in the hospital.
The work environment is a broad concept with several perspectives. Although all 36 elements are considered important for a positive work environment, they have different perspectives. Mapping the included elements revealed that no one work environment measurement tool includes all the elements.
We identified 36 elements that are important for a positive work environment. This knowledge can be used to select the right measurement tool or to develop interventions for improving the work environment. However, the different perspectives of the work environment should be considered.
This narrative review discusses quantitative indices measuring differences between alphabetic languages that are related to the process of word recognition. The specific orthography that a child is ...acquiring has been identified as a central element influencing reading acquisition and dyslexia. However, the development of reliable metrics to measure differences between language scripts hasn’t received much attention so far. This paper therefore reviews metrics proposed in the literature for quantifying orthographic transparency, syllabic complexity, and morphological complexity of alphabetic languages. The review included searches of Web of Science, PubMed, PsychInfo, Google Scholar, and various online sources. Search terms pertained to orthographic transparency, morphological complexity, and syllabic complexity in relation to reading acquisition, and dyslexia. Although the predictive value of these metrics is promising, more research is needed to validate the value of the metrics discussed and to understand the ‘developmental footprint’ of orthographic transparency, morphological complexity, and syllabic complexity in the lexical organization and processing strategies.
The COVID-19 pandemic has prompted many countries to formulate guidelines on how to deal with a worst-case scenario in which the number of patients needing intensive care unit (ICU) care exceeds the ...number of available beds. This study aims to explore the experiences of triage teams when triaging fictitious patients with the Dutch triage guidelines. It provides an overview of the factors that influence decision-making when performing ICU triage with triage guidelines. Eight triage teams from four hospitals were given files of fictitious patients needing intensive care and instructed to triage these patients. Sessions were observed and audio-recorded. Four focus group interviews with triage team members were held to reflect on the sessions and the Dutch guidelines. The results were analyzed by inductive content analysis. The Dutch triage guidelines were the main basis for making triage decisions. However, some teams also allowed their own considerations (outside of the guidelines) to play a role when making triage decisions, for example to help avoid using non-medical criteria such as prioritization based on age group. Group processes also played a role in decision-making: triage choices can be influenced by the triagists' opinion on the guidelines and the carefulness with which they are applied. Intensivists, being most experienced in prognostication of critical illness, often had the most decisive role during triage sessions. Using the Dutch triage guidelines is feasible, but there were some inconsistencies in prioritization between teams that may be undesirable. ICU triage guideline writers should consider which aspects of their criteria might, when applied in practice, lead to inconsistencies or ethically questionable prioritization of patients. Practical training of triage team members in applying the guidelines, including explanation of the rationale underlying the triage criteria, might improve the willingness and ability of triage teams to follow the guidelines closely.
A child's school achievement is influenced by environmental factors. The environmental factors, when represented by socio-economic status (SES) of the family, have been demonstrated to be related to ...the reading skills of a child. The neural correlates of the relation between SES and reading have been less thoroughly investigated. The present study expands current research by exploring the relation between SES, quantified by paternal educational level, reading of the offspring and the structure of white matter pathways in the left hemisphere as derived from DTI-based tractography analyses. Therefore, three dorsal white matter pathways, i.e. the long, anterior and posterior segments of the arcuate fasciculus (AF), and three ventral white matter pathways, i.e. the inferior fronto-occipital fasciculus (IFOF), the inferior longitudinal fasciculus (ILF) and the uncinate fasciculus (UF), were manually dissected in the left hemisphere of 34 adolescents with a wide range of reading skills. The results demonstrated a relation between word reading, SES quantified by paternal educational level, and fractional anisotropy (FA) within the left dorsal AF segment and the left ventral UF. Thus, the present study proposes a relationship between paternal educational level and a specific white matter pathway that is important for reading, aiming to guide future research that can determine processes underlying this relationship.
COPD-diagnosis is confirmed by post-bronchodilator (BD) spirometry. However, epidemiological studies often rely on pre-BD spirometry, self-reports, or medical records. This population-based study ...aims to determine COPD-prevalence based on four different operational definitions and their level of agreement, and to compare associations between COPD-definitions and risk factors.
COPD-prevalence in 1,793 adults from the general Dutch population (aged 18-70 years) was assessed based on self-reported data, Electronic Medical Records (EMR), and post-BD spirometry: using the FEV1/FVC below the lower limit of normal (LLN) and GOLD fixed cut-off (FEV1/FVC <0.70). Using spirometry as a reference, sensitivity was calculated for self-reported and EMR-based COPD. Associations between COPD and known risk factors were assessed with logistic regression. Data were collected as part of the cross-sectional VGO study (Livestock Farming and Neighboring Residents' Health Study).
The highest prevalence was found based on spirometry (GOLD: 10.9%, LLN: 5.9%), followed by self-report (4.6%) and EMR (2.9%). Self-reported or EMR-based COPD identified less than 30% of all COPD-cases based on spirometry. The direction of association between known risk factors and COPD was similar across the four definitions, however, magnitude and significance varied. Especially indicators of allergy were more strongly associated with self-reported COPD compared to the other definitions.
COPD-prevalence varied depending on the used definition. A substantial number of subjects with spirometry-based COPD cannot be identified with questionnaires or medical records which can cause underestimation of COPD-prevalence. The influence of the different COPD-definitions on associations with known risk factors was limited.
Reading is an essential skill in modern societies, yet not all learners necessarily become proficient readers. Theoretical concepts (e.g., the orthographic depth hypothesis; the grain size theory) as ...well as empirical evidence suggest that certain orthographies are easier to learn than others. The present paper reviews the literature on orthographic transparency, morphological complexity, and syllabic complexity of alphabetic languages. These notions are elaborated to show that differences in reading acquisition reflect fundamental differences in the nature of the phonological recoding and reading strategies developing in response to the specific orthography to be learned. The present paper provides a narrative, cross-linguistic and integrated literature review, thereby contributing to the development of universal reading models and at the same time pointing out the important differences between orthographies at the more detailed level. Our review also yields suggestions to devise language-specific instruction and interventions for the development of the specific reading strategies required by the characteristics of the orthography being acquired.
In poultry several Chlamydia species have been detected, but Chlamydia psittaci and Chlamydia gallinacea appear to be most prevalent and important. Chlamydia psittaci is a well-known zoonosis and is ...considered to be a pathogen of poultry. Chlamydia gallinacea has been described more recently. Its avian pathogenicity and zoonotic potential have to be further elucidated. Within the Netherlands no data were available on the presence of Chlamydia on poultry farms. As part of a surveillance programme for zoonotic pathogens in farm animals, we investigated pooled faecal samples from 151 randomly selected layer farms. On a voluntary base, 69 farmers, family members or farm workers from these 151 farms submitted a throat swab. All samples were tested with a generic 23S Chlamydiaceae PCR followed by a species specific PCR for C. avium, C. gallinacea and C. psittaci. C. avium and psittaci DNA was not detected at any of the farms. At 71 farms the positive result could be confirmed as C. gallinacea. Variables significantly associated with the presence of C. gallinacea in a final multivariable model were 'age of hens,' 'use of bedding material' and 'the presence of horses.' The presence of C. gallinacea was associated with neither clinical signs, varying from respiratory symptoms, nasal and ocular discharges to diarrhoea, nor with a higher mortality rate the day before the visit. All throat swabs from farmers, family members or farm workers tested negative for Chlamydia DNA, giving no further indication for possible bird-to-human (or human-to-bird) transmission.
Previous research conducted in 2009 found a significant positive association between pneumonia in humans and living close to goat and poultry farms. However, as this result might have been affected ...by a large goat-related Q fever epidemic, the aim of the current study was to re-evaluate this association, now that the Q-fever epidemic had ended. In 2014/15, 2,494 adults (aged 20-72 years) living in a livestock-dense area in the Netherlands participated in a medical examination and completed a questionnaire on respiratory health, lifestyle and other items. We retrieved additional information for 2,426/2,494 (97%) participants from electronic medical records (EMR) from general practitioners. The outcome was self-reported, physician-diagnosed pneumonia or pneumonia recorded in the EMR in the previous three years. Livestock license data was used to determine exposure to livestock. We quantified associations between livestock exposures and pneumonia using odds ratios adjusted for participant characteristics and comorbidities (aOR). The three-year cumulative frequency of pneumonia was 186/2,426 (7.7%). Residents within 2,000m of a farm with at least 50 goats had an increased risk of pneumonia, which increased the closer they lived to the farm (2,000m aOR 1.9, 95% CI 1.4-2.6; 500m aOR 4.4, 95% CI 2.0-9.8). We found no significant associations between exposure to other farm animals and pneumonia. However, when conducting sensitivity analyses using pneumonia outcome based on EMR only, we found a weak but statistically significant association with presence of a poultry farm within 1,000m (aOR: 1.7, 95% CI 1.1-2.7). Living close to goat and poultry farms still constitute risk factors for pneumonia. Individuals with pneumonia were not more often seropositive for Coxiella burnetii, indicating that results are not explained by Q fever. We strongly recommend identification of pneumonia causes by the use of molecular diagnostics and investigating the role of non-infectious agents such as particulate matter or endotoxins.
In the Age of Goethe major legal reforms occurred, which are reflected in the works of numerous writers. One of these authors is Heinrich von Kleist, who brings together different legal concepts in ...his novella Michael Kohlhaas (1810) and sets them in a conflicting relationship. Kleist, who is usually seen as being ahead of his time, not only reflects on the procedural reforms of the Age of Goethe but also anticipates reforms that will soon follow. What is often overlooked in discussions of Michael Kohlhaas is that the protagonist of the novella is not a typical avenger; he does not ignore current law in order to take the law into his own hands, rather he tries to draw attention to a corrupted juridical system in need of reform. As "one of the most righteous individuals of his time," Kohlhaas insists on a fair legal procedure and even accepts a death sentence as its consequence. It is not by chance that Kleist chooses the genre of the novella for his adaption of a historical case story: in German, Novelle can name the literary genre, as well as a revision of current law (Gesetzesnovelle).
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