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The EFSA Panel on Contaminants in the Food Chain (CONTAM Panel) carries out risk assessment on contaminants in food and feed. The presence of hazardous chemical contaminants or undesirable substances in food and feed is often unavoidable as these substances may occur ubiquitously or are of natural origin. Therefore, human and animal exposure to such substances is also unavoidable. The task of the CONTAM Panel is to assess whether or not exposure to a chemical contaminant in food is likely to be associated with adverse health effects in the European population. Similarly, the Panel assesses if the exposure to a contaminant in feed is likely to be associated with adverse health effects in farm animals, fish and pets in Europe, or to represent a risk to the consumer of foods of animal origin. In contrast to EFSA Panels dealing with regulated substances where inter alia applications are taken into account, the CONTAM Panel relies on scientific information that is in the public domain. EFSA often launches calls for data on occurrence of contaminants in food and feedstuffs where Member States and other interested stakeholders are invited to submit data. Whenever possible and required the CONTAM Panel establishes for a substance a health-based guidance value such as tolerable daily intake. For substances that are both genotoxic and carcinogenic, or for which the data are inadequate to establish a health-based guidance value, the margin of exposure approach is used. Recently the CONTAM Panel also used the threshold of toxicological concern approach. In addition, the CONTAM Panel considers inherent uncertainties in relation to objectives, exposure and hazard characterisation in its risk assessments. During 2003-2012, the CONTAM Panel published 107 scientific outputs (55 on food, 43 on feed, 9 on food and feed).

Background: Expanding the indication of already approved immuno-oncology drugs presents treatment opportunities for patients but also strains healthcare systems. Cost-based pricing models are discussed as a possibility for cost containment. This study focuses on two drugs, pembrolizumab (Keytruda) and daratumumab (Darzalex), to explore the potential effect of indication broadening on the estimated price when using the cost-based pricing (CBP) model proposed by Uyl-de Groot and Löwenberg (2018). Methods: The model was used to calculate cumulative yearly prices, cumulative prices per indication, and non-cumulative indication-based prices using inputs such as research and development (R&D) costs, manufacturing costs, eligible patient population, and a profit margin. A deterministic stepwise analysis and scenario analysis were conducted to examine how sensitive the estimated price is to the different input assumptions. Results: The yearly cumulative cost-based prices (CBPs) ranged from €52 to €885 for pembrolizumab per vial and €823 to €31,941 for daratumumab per vial. Prices were higher in initial years or indications due to smaller patient populations, decreased over time or after additional indications. Sensitivity analysis showed that the number of eligible patients had the most significant impact on the estimated price. In the scenario analysis the profit margin contributed most to a higher CBPs for both drugs. Lower estimates resulted from assumed lower R&D costs. Discussion: The estimated CBPs are consistently lower than Dutch list prices for pembrolizumab (€2,861), mainly resulting from larger patient populations in registered indications. However, daratumumab's list prices fall within the range of modeled CBPs depending on the year or indication (€4,766). Both CBPs decrease over time or with additional indications. The number of eligible patients and initial R&D costs have the most significant influence on the CBPs. These findings contribute to the ongoing discussions on pharmaceutical pricing, especially concerning cancer drugs with expanding indications. [ABSTRACT FROM AUTHOR]

This article describes the translation and qualitative assessment and small scale validation of two spirituality scales designed for children from English to Dutch and includes the translation and validation process and the results of the two most commonly used and best validated measurement instruments for spirituality in children: the Feeling Good, Living Life scale (FGLL) by Fisher (2004, 2009) and the Spirituality Sensitivity Scale for Children by Stoyles et al. (2012). The translation process was designed according to Beaton et al. (2000) and both the translation and the validation process followed the instructions of the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN, 2018). The qualitative validation was done by a three-step test-interview eliciting the face validity of both questionnaires. The results show that both instruments were reliably translated, are face valid with some minor alterations and structurally validated overall in the small-scale pilot. More attention from healthcare professionals and educators should be directed at using spiritual measuring instrument to develop the spiritual vocabulary of children. A larger study is needed to also confirm the cultural validity of the translated scales. • Spirituality is a vital part of children's lives and their health. • Includes an overview of available validated instruments • Explores these available measurement instruments on transferability in a different cultural context and different language • This study emphasizes the importance of studying the face validity in a qualitative manner of quantitative instruments [ABSTRACT FROM AUTHOR]

We derive an exact expression for the photocurrent of photo-emission spectroscopy using timedependent current density functional theory (TDCDFT). This expression is given as an integral over the Kohn-Sham spectral function renormalized by effective potentials that depend on the exchange-correlation kernel of current density functional theory. We analyze in detail the physical content of this expression by making a connection between the density-functional expression and the diagrammatic expansion of the photocurrent within many-body perturbation theory. We further demonstrate that the density functional expression does not provide us with information on the kinetic energy distribution of the photo-electrons. Such information can, in principle, be obtained from TDCDFT by exactly modeling the experiment in which the photocurrent is split into energy contributions by means of an external electromagnetic field outside the sample, as is done in standard detectors. We find, however, that this procedure produces very nonlocal correlations between the exchange-correlation fields in the sample and the detector. [ABSTRACT FROM AUTHOR]

The non-vanishing of the natural orbital (NO) occupation numbers of the one-particle density matrix of many-body systems has important consequences for the existence of a density matrix-potential mapping for nonlocal potentials in reduced density matrix functional theory and for the validity of the extended Koopmans' theorem. On the basis of Weyl's theorem we give a connection between the differentiability properties of the ground state wavefunction and the rate at which the natural occupations approach zero when ordered as a descending series. We show, in particular, that the presence of a Coulomb cusp in the wavefunction leads, in general, to a power law decay of the natural occupations, whereas infinitely differentiable wavefunctions typically have natural occupations that decay exponentially. We analyze for a number of explicit examples of two-particle systems that in case the wavefunction is non-analytic at its spatial diagonal (for instance, due to the presence of a Coulomb cusp) the natural orbital occupations are non-vanishing. We further derive a more general criterium for the non-vanishing of NO occupations for two-particle wavefunctions with a certain separability structure. On the basis of this criterium we show that for a two-particle system of harmonically confined electrons with a Coulombic interaction (the so-called Hookium) the natural orbital occupations never vanish. [ABSTRACT FROM AUTHOR]

The aim of this work is to provide a physical model to relate the polarizability per unit cell of oligomers to that of their corresponding infinite polymer chains. For this we propose an extrapolation method for the polarizability per unit cell of oligomers by fitting them to a physical model describing the dielectric properties of polymer chains. This physical model is based on the concept of a dielectric needle in which we assume a polymer chain to be well described by a cylindrically shaped nonconducting rod with a radius much smaller than its length. With this model we study in which way the polarizability per unit cell approaches the limit of the infinite chain. We show that within this model the macroscopic contribution of the induced electric field to the macroscopic electric field vanishes in the limit of an infinite polymer chain, i.e., there is no macroscopic screening. The macroscopic electric field becomes equal to the external electric field in this limit. We show that this identification leads to a relation between the polarizability per unit cell and the electric susceptibility of the infinite polymer chain. We test our dielectric needle model on the polarizability per unit cell of oligomers of the hydrogen chain and polyacetylene obtained earlier using time-dependent current-density-functional theory in the adiabatic local-density approximation and with the Vignale-Kohn functional. We also perform calculations using the same theory on truly infinite polymer chains by employing periodic boundary conditions. We show that by extrapolating the oligomer results according to our dielectric needle model we get good agreement with our results from calculations on the corresponding infinite polymer chains. [ABSTRACT FROM AUTHOR]

We provide a successful approach towards the solution of the longstanding problem of the large overestimation of the static polarizability of conjugated oligomers obtained using the local density approximation within density-functional theory. The local approximation is unable to describe the highly nonlocal exchange and correlation effects found in these quasi-one-dimensional systems. Time-dependent current-density-functional theory enables us to describe ultranonlocal exchange-correlation effects within a local current description. Recently a brief account was given of the application of the Vignale-Kohn current-functional [G. Vignale and W. Kohn, Phys. Rev. Lett. 77, 2037 (1996)] to the axial polarizability of oligomer chains [M. van Faassen, P. L. de Boeij, R. van Leeuwen, J. A. Berger, and J. G. Snijders, Phys. Rev. Lett. 88, 186401 (2002)]. With the exception of the model hydrogen chain, our results were in excellent agreement with best available wavefunction methods. In the present work we further outline the underlying theory and describe how the Vignale-Kohn functional was implemented. We elaborate on earlier results and present new results for the oligomers of polyethylene, polysilane, polysilene, polymethineimine, and polybutatriene. The adiabatic local density approximation gave good results for polyethylene, which were slightly modified by the Vignale-Kohn functional. In all other cases the Vignale-Kohn functional gave large improvements upon the adiabatic local density approximation. The VignaleKohn results were in agreement with best available data from wave function methods. We further analyze the hydrogen chain model for different bond length alternations. In all these cases the Vignale-Kohn correction upon the adiabatic local density approximation was too small. Arguments are given that further improvements of the functional are needed. [ABSTRACT FROM AUTHOR]

In this paper we present a new approach to calculate optical spectra, which for the first time uses a polarization dependent functional within current density functional theory (CDFT), which was proposed by Vignale and Kohn [Phys. Rev. Lett. 77, 2037 (1996)]. This polarization dependent functional includes exchange-correlation (xc) contributions in the effective macroscopic electric field. This functional is used to calculate the optical absorption spectrum of several common semiconductors. We achieved in all cases good agreement with experiment. © 2001 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Following a period of clinical outbreaks of very virulent infectious bursal disease virus (vvIBDV) in Denmark, the histological bursal lesion score (HBLS) was used on a national scale to screen broiler flocks vaccinated with intermediate IBD vaccines for lesions indicative of IBDV challenge. High lesion scores were detected in a high percentage of healthy and well performing flocks despite the lack of other indications of the presence of vvIBDV. RT-PCR and subsequent sequencing showed the frequent presence of H253Q and H253N IBDV strains that were genetically close to the sequence of the intermediate vaccines with a relative risk ratio of 13.0 (P < 0.0001) in intermediate vaccine A or B vaccinated flocks compared to unvaccinated flocks. The relevance of these H253Q and H253N strains was tested under experimental conditions using a protocol derived from the European Pharmacopoeia for safety of live IBD vaccines. The results confirmed the higher pathogenicity for the bursa of these strains compared to intermediate vaccines as well as the negative effect on antibody response to a Newcastle disease (ND) vaccination performed at the peak of the bursa damage. The efficacy of the ND vaccination was still 100% showing that the H253N and H253Q IBDV strains would be considered as safe vaccine viruses. In conclusion, the use of the HBLS to screen commercial broiler flocks vaccinated with intermediate IBD vaccines for the presence of vvIBDV does not seem to be a reliable method due to the frequent occurrence of H253N and H253Q strains in those flocks. For screening of IBD vaccinated flocks for the presence of vvIBDV or other field strains, the RT-PCR with subsequent sequencing seems to be most suitable. [ABSTRACT FROM AUTHOR]

Apart from relativistic effects originating from high kinetic energy of an electron in a flat potential, which are treated in first order by the Pauli Hamiltonian, there are relativistic effects even for low-energy electrons if they move in a strong Coulomb potential. The latter effects can be accurately treated already in the zeroth order of an expansion of the Foldy–Wouthuysen transformation, if the expansion is carefully chosen to be nondivergent for r→0 even for Coulomb potentials, as shown by Van Lenthe et al. [J. Chem. Phys. 99, 4597 (1993)] (cf. also Heully et al. [J. Phys. B 19, 2799 (1986)] and Chang et al. [Phys. Scr. 34, 394 (1986)]). In the present paper, it is shown that the solutions of the zeroth order of this two-component regular approximate (ZORA) equation for hydrogen-like atoms are simply scaled solutions of the large component of the Dirac wave function for this problem. The eigenvalues are related in a similar way. As a consequence, it is proven that under some restrictions, the ZORA Hamiltonian is bounded from below for Coulomb-like potentials. Also, an exact result for the first order regular approximate Hamiltonian is given. The method can also be used to obtain exact results for regular approximations of scalar relativistic equations, like the Klein–Gordon equation. The balance between relativistic effects originating from the Coulombic singularity in the potential (typically core penetrating s and p valence electrons in atoms and molecules) and from high kinetic energy (important for high-energy electrons in a flat potential and also for core-avoiding high angular momentum (d, f, and g states in atoms) are discussed. [ABSTRACT FROM AUTHOR]

The exchange-correlation potentials vxc which are currently fashionable in density functional theory (DFT), such as those obtained from the local density approximation (LDA) or generalized gradient approximations (GGAs), all suffer from incorrect asymptotic behavior. In atomic calculations, this leads to substantial overestimations of both the static polarizability and the frequency dependence of this property. In the present paper, it is shown that the errors in atomic static dipole and quadrupole polarizabilities are reduced by almost an order of magnitude, if a recently proposed model potential with correct Coulombic long-range behavior is used. The frequency dependence is improved similarly. The model potential also removes the overestimation in molecular polarizabilities, leading to slight improvements for average molecular polarizabilities and their frequency dependence. For the polarizability anisotropy we find that the model potential results do not improve over the LDA and GGA results. Our method for calculating frequency-dependent molecular response properties within time-dependent DFT, which we described in more detail elsewhere, is summarized. © 1996 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Background: Acute cerebellitis is a rare disease with the majority of cases described in children. Little is known about the clinical characteristics and outcome in adults. Case presentation: A 37-year-old Caucasian woman presented with headache, nausea, and photophobia, and was diagnosed as having a migraine attack. Two days later, she subsequently returned with aggravated headache, dysarthria and horizontal nystagmus. Magnetic resonance imaging (MRI) showed a swollen cerebellum and hydrocephalus and the patient was diagnosed with acute cerebellitis. Cerebrospinal fluid (CSF) examination showed an elevated leukocyte count and protein. Blood serology showed the presence of immunoglobulin M and immunoglobulin G for both Epstein--Barr virus and cytomegalovirus. The patient was treated with dexamethasone and discharged to a rehabilitation center, where she fully recovered. We searched the literature for adult cases of acute cerebellitis. Including our patient, we identified 35 patients with a median age of 36 years. The etiology was unknown in 34% of cases. The most common clinical presentation consisted of headache, nausea/vomiting and ataxia. Six patients presented with only headache and nausea and subsequently returned with cerebellar signs. In 9 cases, the cerebellitis was complicated by hydrocephalus. Half of the patients ended up with neurological sequelae, while follow-up MRI was abnormal in 71%. Conclusion: Acute cerebellitis in adults is a rare disorder which mainly presents with headache, nausea/vomiting and ataxia. To diagnose cerebellitis, imaging of the brain (preferably MRI) is required and CSF examination may be necessary to narrow the differential diagnosis. The treatment depends on the widely diverse etiology, and treatment with steroids is recommended in the case of cerebellar oedema and hydrocephalus. Neurosurgical intervention may be necessary to prevent brain herniation. [ABSTRACT FROM AUTHOR]

Provides information on a study which investigated the spatial modulation of the magnetic moment in cobalt/palladium superlattices by polarized neutron reflectivity. Nature of spin interactions in transition metals; Structural characteristics of the superlattice; Results of polarized-neutron scanning.

We investigate the effect of mechanical strain on the dynamics of thin MoS2 nanodrum resonators. Using a piezoelectric crystal, compressive and tensile biaxial strain is induced in initially flat and buckled devices. In the flat device, we observe a remarkable strain-dependence of the resonance line width, while the change in the resonance frequency is relatively small. In the buckled device, the strain-dependence of the damping is less pronounced, and a clear hysteresis is observed. The experiment suggests that geometric imperfections, such as microscopic wrinkles, could play a role in the strong dissipation observed in nanoresonators fabricated from 2-D materials. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of ranibizumab in the treatment of diabetic macular edema has been proven with large clinical trials. For bevacizumab only two clinical trials have been published and a head-to-head comparison is lacking to date. However, if proved non-inferior to ranibizumab, use of the off-label bevacizumab could reduce costs enormously without a loss in visual acuity. A cost-effectiveness study has been designed to substantiate this hypothesis. Aim: To compare the effectiveness and costs of 1.25 mg of bevacizumab to 0.5 mg ranibizumab given as monthly intravitreal injections during 6 months in patients with diabetic macular edema. It is hypothesized that bevacizumab is non-inferior to ranibizumab regarding its effectiveness. Design: This is a randomized, controlled, double masked, clinical trial in 246 patients in seven academic trial centres in The Netherlands. Outcomes: The primary outcome measure is the change in best-corrected visual acuity (BCVA) in the study eye from baseline to month 6. Secondary outcomes are the proportions of patients with a gain or loss of 15 letters or more or a BCVA of 20/40 or more at 6 months, the change in leakage on fluorescein angiography and the change in foveal thickness by optical coherence tomography at 6 months, the number of adverse events in 6 months, and the costs per quality adjusted life-year of the two treatments. [ABSTRACT FROM AUTHOR]

Background:Primary high-risk human papillomavirus (hrHPV) testing in cervical cancer screening shows relatively low specificity, which makes triage testing necessary. In this study, DNA methylation analysis was compared with cytology for triage testing in hrHPV-positive women. Moreover, feasibility of DNA methylation analysis directly on brush-based self-sampled specimens was assessed.Methods:Non-responding women from population-based screening were invited to self-collect a cervico-vaginal specimen for hrHPV testing; hrHPV-positive women were referred to a physician for triage liquid-based cytology. DNA methylation analysis was performed on 128 hrHPV-positive physician-collected triage samples and 50 matched brush self-samples with QMSP for C13ORF18, EPB41L3, JAM3 and TERT.Results:In physician-taken triage material, DNA methylation analysis of JAM3 showed the highest combined specificity (88%) and sensitivity (82%) for detection of CIN3+, whereas cytology showed a specificity of 48% and a sensitivity of 91%. Out of 39 women with abnormal cytology and normal histology (false-positive by cytology), 87% were negative for JAM3 and 90% for C13ORF18 methylation. Agreement between DNA methylation analysis performed directly on the matched self-sampled material and physician-taken samples was 88% for JAM3 (κ=0.75, P<0.001) and 90% for C13ORF18 (κ=0.77; P<0.001).Conclusions:DNA methylation analysis as a triage test in hrHPV-positive women is an attractive alternative to cytology. Furthermore, DNA methylation is feasible directly on brush-based self-samplers and showed good correlation with matched physician-taken samples. Direct molecular triage on self-collected specimens could optimise the screening program, especially for non-responders, as this would eliminate the need for an additional physician-taken scraping for triage testing. [ABSTRACT FROM AUTHOR]

We measure the energy relaxation rate of single- and few-layer molybdenum disulphide (MoS2) nanomechanical resonators by detecting the resonator ring-down. Recent experiments on these devices show a remarkably low quality (Q)-factor when taking spectrum measurements at room temperature. The origin of the low spectral Q-factor is an open question, and it has been proposed that besides dissipative processes, frequency fluctuations contribute significantly to the resonance line-width. The spectral measurements performed thus far however, do not allow one to distinguish these two processes. Here, we use time-domain measurements to quantify the dissipation. We compare the Q-factor obtained from the ring-down measurements to those obtained from the thermal noise spectrum and from the frequency response of the driven device. In few-layer and single-layer MoS2 resonators, the two are in close agreement, which demonstrates that the spectral line-width in MoS2 membranes at room temperature is limited by dissipation, and that excess spectral broadening plays a negligible role. [ABSTRACT FROM AUTHOR]

We study the dynamics of a nonlinear electromechanical oscillator with delayed feedback. Compared to their linear counterparts, we find that the dynamics is dramatically different. The well-known Barkhausen stability criterion ceases to exist, and two modes of operation emerge: one characterized by hysteresis in combination with a bistable frequency and amplitude; the other, by self-stabilization of the oscillation frequency and amplitude. The observed features are captured by a model based on a Duffing equation with delayed force feedback. Nonlinear oscillators with delayed force feedback are exemplary for a large class of dynamic systems. [ABSTRACT FROM AUTHOR]

Background:Potential drug-drug interactions (PDDIs) in patients with cancer are common, but have not previously been quantified for oral anticancer treatment. We assessed the prevalence and seriousness of potential PDDIs among ambulatory cancer patients on oral anticancer treatment.Methods:A search was conducted in a computer-based medication prescription system for dispensing oral anticancer drugs to outpatients in three Dutch centres. Potential drug-drug interactions were identified using electronic (Drug Interaction Fact software) and manual screening methods (peer-reviewed reports).Results:In the 898 patients included in the study, 1359 PDDIs were identified in 426 patients (46%, 95% confidence interval (CI)=42-50%). In 143 patients (16%), a major PDDI was identified. The drug classes most frequently involved in a major PDDI were coumarins and opioids. The majority of cases concerned central nervous system interactions, PDDIs that can cause gastrointestinal toxicity and prolongation of QT intervals. In multivariate analysis, concomitant use of more drugs (odds ratio (OR)=1.66, 95% CI=1.54-1.78, P<0001) and genito-urinary cancer (OR=0.25, 95% CI=0.12-0.52, P<0001) were risk factors.Conclusion:Potential drug-drug interactions are very common among cancer patients on oral cancer therapy. Physicians and pharmacists should be more aware of these potential interactions. [ABSTRACT FROM AUTHOR]

We present a local control scheme to construct the external potential v that, for a given initial state, produces a prescribed time-dependent density in an interacting quantum many-body system. This numerical method is efficient and stable even for large and rapid density variations irrespective of the initial state and the interactions. It can at the same time be used to answer fundamental v-representability questions in density functional theory. In particular, in the absence of interactions, it allows us to construct the exact time-dependent Kohn-Sham potential for arbitrary initial states. We illustrate the method in a correlated one-dimensional two-electron system with different interactions, initial states and densities. For a Kohn-Sham system with a correlated initial state we demonstrate the interplay between memory and initial-state dependence as well as the failure of any adiabatic approximation. [ABSTRACT FROM AUTHOR]

We present a compact and simplified proof of a generalized Wick theorem to calculate the Green's function of bosonic and fermionic systems in an arbitrary initial state. It is shown that the decomposition of the noninteracting n-particle Green's function is equivalent to solving a boundary problem for the Martin-Schwinger hierarchy; for noncorrelated initial states, a one-line proof of the standard Wick theorem is given. Our result leads to new self-energy diagrams, and an elegant relation with those of the imaginary-time formalism is derived. The theorem is easy to use and can be combined with any ground-state numerical technique to calculate time-dependent properties. [ABSTRACT FROM AUTHOR]

We benchmark many-body perturbation theory by studying neutral, as well as non-neutral, excitations of finite lattice systems. The neutral excitation spectra are obtained by time-propagating the Kadanoff-Baym equations in the Hartree-Fock and the second Born approximations. Our method is equivalent to solving the Bethe-Salpeter equation with a high-level kernel while respecting self-consistency, which guarantees the fulfillment of a frequency sum rule. As a result, we find that a time-local method, such as Hartree-Fock, can give incomplete spectra, while already the second Born approximation, which is the simplest time-non-local approximation, reproduces well most of the additional excitations, which are characterized as double excitations. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the natural course of recurrent vestibulopathy. Study design: Retrospective analysis. Patients: One hundred and five adult patients with attacks of vertigo without auditory or neurological symptoms. Methods: A structured interview was conducted over the telephone, 12 to 62 months after the patient's first visit to the out-patient department. Results: Two-thirds of patients experienced spontaneous resolution of vertigo, while one-third continued to have symptoms. The diagnosis was subsequently changed to migraine in 2 per cent of patients and to Ménière's disease in 1 per cent. Conclusion: The prognosis for patients with recurrent vestibulopathy is good. In a few cases, the diagnosis is provisional and will be subsequently changed to migraine or Ménière's disease. [ABSTRACT FROM AUTHOR]

Aim. This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses' competencies in providing spiritual care.Background. Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature.Design. Survey.Method. The participants were students from Bachelor-level nursing schools in the Netherlands (n = 197) participating in a cross-sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach's alpha and the average inter-item correlation. In addition, the test-retest reliability of the instrument was determined at a two-week interval between baseline and follow-up (n = 109).Results. The spiritual care competence scale comprises six spiritual-care-related nursing competencies. These domains were labelled:1 assessment and implementation of spiritual care (Cronbach's alpha 0.82)2 professionalisation and improving the quality of spiritual care (Cronbach's alpha 0.82)3 personal support and patient counseling (Cronbach's alpha 0.81)4 referral to professionals (Cronbach's alpha 0.79)5 attitude towards the patient's spirituality (Cronbach's alpha 0.56)6 communication (Cronbach's alpha 0.71). These subscales showed good homogeneitywith average inter-item correlations > 0.25 and a good test-retest reliability.Conclusion. This study conducted in a nursing-student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale.Relevance to clinical practice. The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care. [ABSTRACT FROM AUTHOR]

This study describes the learning effects of thematic peer-review discussion groups (Hendriksen, 2000. Begeleid intervisie model, Collegiale advisering en probleemoplossing, Nelissen, Baarn.) on developing nursing students' competence in providing spiritual care. It also discusses the factors that might influence the learning process. The method of peer-review is a form of reflective learning based on the theory of experiential learning (Kolb, 1984. Experiential learning, Experience as the source of learning development. Englewoods Cliffs, New Jersey, Prentice Hill). It was part of an educational programme on spiritual care in nursing for third-year undergraduate nursing students from two nursing schools in the Netherlands. Reflective journals (n=203) kept by students throughout the peer-review process were analysed qualitatively The analysis shows that students reflect on spirituality in the context of personal experiences in nursing practice. In addition, they discuss the nursing process and organizational aspects of spiritual care. The results show that the first two phases in the experiential learning cycle appear prominently; these are 'inclusion of actual experience' and 'reflecting on this experience'. The phases of 'abstraction of experience' and 'experimenting with new behaviour' are less evident. We will discuss possible explanations for these findings according to factors related to education, the students and the tutors and make recommendations for follow-up research. [ABSTRACT FROM AUTHOR]