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Spelling has been found to be influenced by the frequency with which certain orthographic patterns occur. We examined whether Grades 2–5 children were already sensitive to orthographic frequency in spelling present tense verb inflections that sound the same but are spelled differently. Children were asked to spell present tenses in two homophonous forms; both inflections are pronounced with final /t/ but are spelled with final -d (“ik vind,” I find) or -dt (“hij/zij vindt,” he/she finds). Previous research has shown that adolescents and adults make inflection errors based on the relative frequency within a pair; as “vind’ is more frequent than “vindt,” “vind” is often used incorrectly. The children showed low correct scores for third person singular spellings, and overall better performance for -d dominant verbs. Surprisingly, they did make errors related to homophone inflection but in the wrong place, marking the wrong time: homophone-based errors occurred in present tense non-homophone verbs and in past tenses. We take our findings to mean that the children were not sensitive to homophone dominance. Furthermore, the findings illustrate the importance of specific graphotactic patterns in literacy development and call for attention to these patterns in models and teaching of spelling.
Observational studies suggest that hormonal contraceptive use may increase depressive symptoms in women, but it is unclear whether the effect is causal.
To quantitatively examine the evidence from randomised clinical trials for the link between hormonal contraceptive use and depressive symptoms.
We performed a systematic review and network meta-analysis of randomised clinical trials comparing women randomised to any form of a hormonal contraceptive with women randomised to any other form of a (non-)hormonal contraceptive or placebo. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, EMCare and EMBASE, from inception to 1 May 2020. Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. A random-effect Bayesian network meta-analysis was conducted, with change in depressive symptoms between baseline and three cycles as outcome.
This review identified 3492 records, of which 14 trials were eligible and 12 could be included in the network meta-analysis. These trials included 5833 participants (mean age per study range: 16.8–32.4 years) and compared 10 different interventions. Compared with placebo, hormonal contraceptive use did not cause worsening of depressive symptoms (standardised mean difference: median, −0.04; range, −0.17 [95% credible interval −0.46 to 0.13] to 0.13 [95% credible interval −0.28 to 0.56]).
This study suggests that hormonal contraceptive use does not lead to an increase in depressive symptoms in adult women. Future studies should include first-time users, to confirm the results in young women.
Preserving personal dignity is an important aim of palliative care. Little is known about how physicians perceive and preserve dignity of patients from non-western migration backgrounds. Insight in this is important given the increased demand for culturally sensitive palliative care.
To gain insight in how Dutch physicians perceive and preserve dignity in the last phase of life for patients from non-western migration backgrounds.
Qualitative thematic analysis of semi-structured interviews.
Fifteen physicians experienced in palliative care.
Physicians experienced dilemmas in preserving dignity of non-western patients in three situations: (a) relief of suffering in the terminal phase, (b) termination of interventions and treatment, and (c) disclosure of diagnosis. Physicians wanted to grant the needs of patients in the last phase of their lives, which was central to physicians’ view on dignity, but dilemmas arose when this conflicted with physicians’ other personal and professional values. To make the dilemmas manageable, physicians assessed whether needs of patients were authentic, but due to linguistic, cultural, and communication barriers, this was difficult with non-western patients. To find a way out of the dilemmas, physicians had three strategies: accept and go along with patient's wishes, convince or overrule the patient or family, or seek solutions that were acceptable for all.
Physicians encounter dilemmas providing palliative care for people from non-western backgrounds. Future physicians can be trained in connective strategies and seeking middle grounds to optimally preserve patients’ dignity while being in concordance with their personal and professional values.
This chapter focuses on developments in governance in European higher education, with a focus on Western Europe. It presents an overview of the literature on this topic, including the various modes of governance as well as the changes in European higher education in recent decades. The chapter starts by describing different conceptual models used to address and analyse higher education governance. Next, it portrays general tendencies with regard to governance and shows that states have been delegating some of their powers to other levels in the higher education system in four directions: an upward shift to the supranational level, a horizontal shift to ‘independent’ agencies, a downward shift to the institutions (‘autonomy’), and an outward shift (‘privatization, contracting’). As a result of these shifts, often cited as a move from government to governance, the modes of system steering and coordination have become more complex and dynamic, including more stakeholders at different policy levels. The chapter then considers that governance configurations in European higher education not only have similarities, but also differ in various ways.
Background: Resistance to antibiotic drugs, also called antimicrobial resistance (AMR) is a serious threat to (public) health. Surveillance reports throughout the world show that formation and spread of highly resistant microorganisms (HRMOs) continues to be substantial. In The Netherlands, 10 regional collaborative networks on AMR have been established among healthcare institutions to mitigate the existing risks concerning HRMO by collaborative actions in antibiotic stewardship and infection prevention. Objective: We sought to determine whether the healthcare institutions in one of the regional collaborative networks in The Netherlands contribute adequately to reducing the risks of formation and/or spread of HRMO. Methods: The Health and Youth Care Inspectorate in The Netherlands visited 37 institutions in the region of Limburg (the southern province). The following healthcare sectors were included: hospitals (n = 5), rehabilitation clinics (n = 2), long-term care facilities (n = 5), homecare institutions (n = 4), mental healthcare institutions (n = 2), dental care clinics (n = 4), general practitioners (GPs; n = 10), municipal health services (n = 2) and healthcare facilities for mentally disabled people (n = 3). In each visit, 5 topics were addressed: antibiotic policy, infection prevention, information transfer, governance and collaboration in the region. Results and Conclusions: In general, the healthcare institutions had an adequate to good score. Good results were seen in antibiotic policy (ie, the use of diagnostic tools to avoid the use of antibiotics); information transfer among GPs and in homecare institutions; and infection prevention in homecare institutions and dental care clinics. Exceptions with inadequate scores were observed in several areas: absence of prescription guidance specifically for antibiotics in various sectors; infection prevention among GPs, and dental care clinics. In 4 cases (ie, 3 GPs and 1 dental care clinic), we stopped using the autoclave because of lack of proof of proper maintenance.
Personalised nutrition, the tailoring of nutrition products, services or advice to individual characteristics such as genetics, phenotype, nutritional intake and/or exercise routine, is increasingly attracting the interest of industry, consumers and researchers. This article provides an overview of the current European Union (EU) regulatory framework as applying to personalised nutrition and draws attention to the important role of EU food law in the regulation of this innovative approach to nutrition. It is argued that personalised nutrition challenges the regulatory borderline between health and lifestyle products or services and, furthermore, also pushes the boundaries of current food safety and health claims legislation.
Health care coverage decisions may employ many different considerations, which are brought together across two phases. The assessment phase examines the available scientific evidence, such as the cost-effectiveness, of the technology. The appraisal then contextualises this evidence to arrive at an (advised) coverage decision, but little is known about how this is done.
In the Netherlands, the appraisal is set up to achieve a societal weighing and is the primary place where need- and solidarity-related (‘necessity’) argumentations are used. To elucidate how the Dutch appraisal committee ‘constructs necessity’, we analysed observations and recordings of two appraisal committee meetings at the National Health Care Institute, the corresponding documents (five), and interviews with committee members and policy makers (13 interviewees in 12 interviews), with attention to specific necessity argumentations.
The Dutch appraisal committee constructs necessity in four phases: (1) allowing explicit criteria to steer the process; (2) allowing patient (representative) contributions to challenge the process; (3) bringing new argumentations in from outside and weaving them together; and (4) formulating recommendations to societal stakeholders. We argue that in these ways, the appraisal committee achieves societal weighing rationality, as the committee actively uses argumentations from society and embeds the decision outcome in society.
Chapter 3 addresses the relationship between the various tasks carried out in the Critique of Pure Reason by analyzing Kant’s multifaceted use of the term ‘transcendental.’ Challenging the received view, it maintains that Kant’s seemingly divergent accounts of the subject hinge on his conception of transcendental philosophy proper and transcendental critique as first-order and second-order branches of transcendental cognition, respectively. Drawing on a brief account of the seventeenth- and eighteenth-century history of the term ‘transcendental,’ the chapter seeks to show that Wolffian ontology and transcendental philosophy proper have more in common than is widely assumed: both disciplines can be said to provide a comprehensive account of the cognitive elements presupposed in any cognition of objects. On this account, the novelty of the Critique consists primarily in the second-order investigation into metaphysics that Kant calls transcendental critique. The chapter concludes by examining Kant’s criticism of the way his predecessors and contemporaries understood the terms ‘ontology’ and ‘transcendental philosophy.’
Chapter 1 elaborates on the historical context within which Kant developed his critique of early post-Leibnizian philosophy. It presents the pertinent elements of Wolff’s highly influential metaphysics and theory of cognition as well as the main thrust of Crusius’s critique of Wolff. Since Kant targeted both Wolff, Crusius, and those who followed in their wake, the chapter also discusses the main tenets of Crusius’s own metaphysics and the controversies that resulted from efforts among early post-Wolffian philosophers to reconcile Leibnizian monadology and Newtonian physics.
Chapter 4 seeks to resolve the apparent contradictions in Kant's account of the thing in itself and related terms by interpreting the relevant passages in light of his critique of Wolffian metaphysics. The chapter departs from both the two-aspect view defended by Allison and the two-object view that Guyer attributes to Kant. Moving beyond this opposition, the chapter dissociates Kant’s remarks on the objects that affect our senses from his use of the term ‘thing in itself’ and its cognates in the context of his critique of Wolffian and post-Wolffian metaphysics. In the latter context, it is argued, the term refers to things that can be thought but cannot constitute objects of cognition. The chapter shows that Kant’s account of the thing in itself in this sense and, hence, the distinction between phenomena and noumena allows him at once to limit the scope of former ontology to possible objects of experience and to affirm the ideas of the soul, the world as such, and God as noumena that can be thought but not known.
Chapter 8 is devoted to the positive goal of Kant’s reform of the theoretical part of metaphysics, namely, the system of pure reason he intended to elaborate on the basis of the propaedeutic investigation carried out in the Critique of Pure Reason. Drawing on the Architectonic, the Transcendental Dialectic, the Metaphysical Foundations of Natural Science, Kant’s lectures on metaphysics, and other texts, the chapter maintains that the Critique paves the way not only for a reformed version of general metaphysics or ontology but also for a reformed version of special metaphysics, namely, rational physics, rational psychology, rational cosmology, and rational theology. The chapter argues that the Critique does not preclude the possibility of a comprehensive account of the purely intellectual determinations of the ideas of reason themselves and, hence, is much less detrimental to former special metaphysics than is generally assumed. Thus, it seeks to bring out the common ground of Kant’s projected system and the metaphysical systems put forward by Wolff and Baumgarten. The chapter concludes by arguing that Kant’s later accounts of his intentions accord with his original plan.
Chapter 7 analyzes the Appendix to the Transcendental Analytic entitled “On the Amphiboly of the Concepts of Reflection.” Using Leibniz’s monadology as a prism, Kant here seeks to account for the ultimate premises of his critique and intended reform of metaphysics. More specifically, the chapter conceives of this critique as a variety of transcendental reflection that is guided by four pairs of concepts, including sameness and difference. In order to contextualize this account, the chapter briefly discusses Wolff’s and Baumgarten’s treatment of these concepts. Commentators generally assume that the activity called transcendental reflection is carried out in the Critique of Pure Reason alone. The chapter argues, by contrast, that Kant distinguishes the version of transcendental reflection that informs the ontology of his predecessors from the critical version enacted in the Critique. On this basis, it outlines Kant’s understanding of the difference between a Leibnizian employment of the concepts of reflection and his own.
Kant’s critical philosophy is reputed to impose strict limits on the cognitive activities carried out by the human mind. The mind is said to be able to generate empirical knowledge by means of two forms of intuition and twelve categories, and to delude itself whenever it illicitly ventures beyond these limits in search of a priori knowledge of the soul, the world as such, and God. Even if Kant may have been unable to demonstrate all of the claims he advances in the Critique of Pure Reason, we can be satisfied with the epistemological modesty his work proclaims: it allows us to pit Kant’s work against the extravagancies of philosophers such as Fichte and Hegel as well as to follow his beacon in our own even more modest pursuits.