Blended online learning for oncologists to improve skills in shared decision making about palliative chemotherapy: a pre-posttest evaluation.

PURPOSE: To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format. METHODS: A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists' self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models. RESULTS: Oncologists (n = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists' beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller. CONCLUSION: Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.

Towards nationally harmonized mapping and quantification of ecosystem services.

The EU 2020 Biodiversity Strategy requests EU Member States to map and assess ecosystem services within national territories, and to promote and integrate these values into policy-making. This calls for standardized and harmonized data, indicators, and methods to assess ecosystem services within national boundaries. Current approaches for assessing ecosystem services often oversimplify cross-scale heterogeneity, sacrificing the spatial and thematic detail required to support the needs and expectations of decision-makers at different levels. Hence, nationally harmonized models for mapping and quantifying ecosystem services are needed. This paper presents the Natural Capital Model (NC-Model), a spatially-explicit set of models for quantifying and mapping ecosystem services within the Netherlands. Its aim is to support the integration of ecosystem services within spatial planning and policy-making at the national level, contributing to the fulfilment of national and international environmental policy targets. Models introduce previously unexplored combinations of explanatory variables for modelling ecosystem functions and the socioeconomic benefits they accrue, making use of publicly-available and high-resolution spatial data. To capture spatial and thematic heterogeneity across the urban-rural gradient, the NC-Model comprises a subset of ecosystem service models tailored to the urban environment. To demonstrate the model's application, we expand on six urban ecosystem service models and implement them to quantify and map ecosystem services for Municipality of Amsterdam. High-resolution ecosystem supply and use maps provide detailed spatial information useful for supporting spatial planners and decision-makers who wish to optimize the allocation of natural elements while supporting the needs of citizens. They paint a picture on the interlinkages that exist between natural elements, ecological functions, and socioeconomic well-being in a friendly manner, tailored to various audiences with differing priorities. Their open-access nature enables their customization, supporting the sharing of knowledge and data to endorse ecosystem service modelling efforts by external parties within and outside the Netherlands.

Precise determination of the unperturbed 8B neutrino spectrum.

A measurement of the final state distribution of the (8)B ß decay, obtained by implanting a (8)B beam in a double-sided silicon strip detector, is reported here. The present spectrum is consistent with a recent independent precise measurement performed by our collaboration at the IGISOL facility, Jyväskylä [O. S. Kirsebom et al., Phys. Rev. C 83, 065802 (2011)]. It shows discrepancies with previously measured spectra, leading to differences in the derived neutrino spectrum. Thanks to a low detection threshold, the neutrino spectrum is for the first time directly extracted from the measured final state distribution, thus avoiding the uncertainties related to the extrapolation of R-matrix fits. Combined with the IGISOL data, this leads to an improvement of the overall errors and the extension of the neutrino spectrum at high energy. The new unperturbed neutrino spectrum represents a benchmark for future measurements of the solar neutrino flux as a function of energy.

Toxocara and Ascaris seropositivity among patients suspected of visceral and ocular larva migrans in the Netherlands: trends from 1998 to 2009.

Toxocara canis, Toxocara cati and Ascaris suum are roundworms of dogs, cats and pigs, respectively, that can also infect humans. These zoonotic helminths have a worldwide distribution and are also endemic in the Netherlands. Infection with Toxocara sp. may result in visceral larva migrans (VLM) or ocular larva migrans (OLM) caused by the migrating larvae. Although A. suum has been reported to occasionally mature to the adult stage in humans, clinical cases of VLM suspected to be caused by A. suum have been described. Diagnosis of these helminth infections relies mainly on serology. Here we analyse the results from the Toxocara and Ascaris IgG-ELISA from a total of 2,838 serum samples from VLM and OLM suspected patients that were sent to our institution from 1998 to 2009. Results indicate that for each year the Ascaris seropositivity is significantly higher compared to the Toxocara seropositivity. Furthermore, while Toxocara seropositivity has decreased over time, the Ascaris seropositivity has not significantly changed for the past 12 years. The Ascaris and Toxocara seropositivity was also shown to increases with age and, while gender has no influence on the Ascaris seropositivity, males showed higher Toxocara seropositivity.

Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study.

The association between helminth infections and childhood atopic diseases remains controversial. The majority of studies have been carried out in tropical areas, whereas less information is available from western countries with low intensity of helminth infections. In the Netherlands, the infection of pigs with Ascaris suum is very common, particularly on pig farms with outdoor facilities. This helminth can also infect humans, causing visceral larva migrans. This study aims at determining the prevalence of antibodies against A. suum and its association with allergic symptoms and sensitisation in a population of 4-year-old children living in The Netherlands. Blood samples from 629 children from the prospective birth cohort Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study were examined for Ascaris antibodies. Data on allergic symptoms and sensitisation were collected using questionnaires and radioallergosorbent tests (RAST). A total of 45 out of 629 (7%) were found to be Ascaris-seropositive. In addition, a positive association between Ascaris seropositivity and wheeze in the last year, doctor-diagnosed asthma and food and aero-allergen sensitisation was found. These results support the hypothesis that low-level or transient infection with helminths enhances allergic reactivity.

Co-operative learning processes of students: a longitudinal multilevel perspective.

BACKGROUND: This article describes the outcomes of a longitudinal, multilevel observational study in which the relationship between the processes of co-operation and giving explanations was compared between classes trained in communication skills and classes that were untrained. AIMS: This study examined the effects of training in basic communication skills on the processes of co-operation and giving explanation in co-operative groups. In particular, the study investigated: (a) How the processes of co-operation and giving explanations develop over time; (b) How the underlying processes of co-operation and giving explanations are related; (c) Which factors at the student and class level facilitate or hinder these processes. SAMPLE: The study involved 192, Year 6 primary school children (mean age = 134.3 months) who worked in four-person, mixed ability, gender-balanced groups on a social studies unit of work for 12 weeks. RESULTS: The students in the trained classes were more co-operative and gave more explanations to each other than their peers in the untrained classes. Giving solicited explanations could be traced back to co-operation and this process was enhanced by ability. In other words, the higher the individual ability levels of the students, the more co-operation was transformed into giving solicited explanations. Furthermore, over and above the effects of student ability, the higher the class' ability level, the more explanations the students gave. CONCLUSION: The results of this study are useful in explaining why high-ability students benefit more from co-operative learning than low-ability students and why solicited explanations are more effective than unsolicited explanations. By opening the black box of co-operative learning, our analysis enables us to attribute the effects of co-operative learning to peer interactions with more able peers and this is promoted by class ability level. These factors have been mentioned in the literature as a possible explanation of 'contextual effects' but not investigated empirically.