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Ageing-in-place for persons with dementia and informal care-givers is encouraged by governments and society. However, individuals with non-Western migration backgrounds are at higher risk of dementia yet underrepresented in research and care. This study aims to identify ageing-in-place care preferences of persons with dementia and their informal care-givers in the Netherlands. Semi-structured interviews (n = 8 participants with dementia, n = 20 informal care-givers) were analyzed using reflexive thematic analysis. Findings reveal that informal care-givers feel a strong duty to care, assisting with various daily tasks. While they desire shared care with professionals, identifying concrete care needs is challenging, highlighting the need for proactive professional support. Participants also emphasized the importance of culturally sensitive in-home care, home adaptations, social care and accessible dementia information. Additionally, the emotional impact of dementia on care recipients and care-givers underscores the need for emotional support. These insights enhance understanding of the care preferences of persons with dementia and their informal care-givers, aiding more efficient and culturally responsive health service planning.
Obstetric complications (OCs) are associated with cognitive and brain abnormalities observed in patients with schizophrenia. Gyrification, a measure of cortical integrity sensitive to events occurring during the prenatal and perinatal periods, is also altered in first-episode psychosis (FEP). We examined the relationship between OCs and gyrification in FEP, as well as whether gyrification mediates the relationship between OCs and cognition.
Methods
We examined differences in the Local Gyrification Index (LGI) for the frontal, parietal, temporal, occipital, and cingulate cortices between 139 FEP patients and 125 healthy controls (HCs). Regression analyses explored whether OCs and diagnosis interact to explain LGI variation. Parametric mediation analyses were conducted to assess the effect of LGI on the relationship between OCs and cognition for FEP and HC.
Results
Significant LGI differences were observed between FEP patients and HC in the left parietal and bilateral cingulate and occipital cortices. There was a significant interaction between OCs and diagnosis on the left cingulate cortex (LCC) that was specific to males (p = 0.04) and was driven by gestational rather than intrauterine OCs.
In HCs, OCs had a direct effect on working memory (WM) (p = 0.048) in the mediation analysis, whereas in FEP, we observed no significant effect of OCs on either verbal or WM.
Conclusions
OCs interact with diagnosis to predict LCC gyrification, such that males with FEP exposed to OCs exhibit the lowest LGI. OCs influence WM, and LCC gyrification may mediate this relation only in HC, suggesting a differential neurodevelopmental process in psychosis.
A diagnostic flexible laryngoscopy using a flexible endoscope (FE) without a working channel can become contaminated when inserted through the nose to inspect the throat. Microbiological surveillance is necessary to ensure adequate reprocessing. A lack of knowledge exists about the most accurate way to assess microbiological contamination on the surface of FEs without a working channel. A scoping review of research on sampling techniques for FEs without a working channel was done to identify frequently used sampling techniques and to determine the best way to assess microbiological contamination.
Methods:
PubMed, Embase, Cochrane Library, and CINAHL databases were searched. Data related to the sampling technique and bacterial contamination were extracted.
Results:
Twelve of the 378 studies met the inclusion criteria. None compared sampling techniques, most studies investigated the efficacy of several disinfection methods. Retrieved sampling techniques were immersion, swabbing, and wiping. Immersion and wiping could detect bacterial contamination on contaminated FEs without a working channel. Two out of six studies using a swabbing method found bacterial contamination on contaminated FEs without a working channel. Three studies using the swabbing method detected bacterial contamination after disinfection. One study did not retrieve microorganisms after disinfection using the swabbing method.
Conclusions:
Three different sampling techniques were extracted: immersion, wiping, and swabbing, which could all detect microbiological contamination on contaminated FEs without a working channel. However, this scoping review identified significant gaps in literature. Additional research is needed to determine the best sampling technique(s) for FEs without a working channel to detect microbiological contamination.
The wide adoption of occupational shoulder exoskeletons in industrial settings remains limited. Passive exoskeletons were proved effective in a limited amount of application scenarios, such as (quasi-)static overhead handling tasks. Quasi-active devices, albeit representing an improved version of their passive predecessors, do not allow full modulation of the amount of assistance delivered to the user, lacking versatility and adaptability in assisting various dynamic tasks. Active occupational shoulder exoskeletons could overcome these limitations by controlling the shape of the delivered torque profile according to the task they aim to assist. However, most existing active devices lack compactness and wearability. This prevents their implementation in working environments. In this work, we present a new active shoulder exoskeleton, named Active Exo4Work (AE4W). It features a new flexible shaft-driven remote actuation unit that allows the positioning of the motors close to the wearer’s center of mass while it maintains a kinematic structure that is compatible with the biological motion of the shoulder joint. in vitro and in vivo experiments have been conducted to investigate the performance of AE4W. Experimental results show that the exoskeleton is kinematically compatible with the user’s workspace since it does not constrain the natural range of motion of the shoulder joint. Moreover, this device can effectively provide different types of assistance while the user executes various dynamic tasks, without altering perceived comfort.
Partial remission after major depressive disorder (MDD) is common and a robust predictor of relapse. However, it remains unclear to which extent preventive psychological interventions reduce depressive symptomatology and relapse risk after partial remission. We aimed to identify variables predicting relapse and to determine whether, and for whom, psychological interventions are effective in preventing relapse, reducing (residual) depressive symptoms, and increasing quality of life among individuals in partial remission. This preregistered (CRD42023463468) systematic review and individual participant data meta-analysis (IPD-MA) pooled data from 16 randomized controlled trials (n = 705 partial remitters) comparing psychological interventions to control conditions, using 1- and 2-stage IPD-MA. Among partial remitters, baseline clinician-rated depressive symptoms (p = .005) and prior episodes (p = .012) predicted relapse. Psychological interventions were associated with reduced relapse risk over 12 months (hazard ratio [HR] = 0.60, 95% confidence interval [CI] 0.43–0.84), and significantly lowered posttreatment depressive symptoms (Hedges’ g = 0.29, 95% CI 0.04–0.54), with sustained effects at 60 weeks (Hedges’ g = 0.33, 95% CI 0.06–0.59), compared to nonpsychological interventions. However, interventions did not significantly improve quality of life at 60 weeks (Hedges’ g = 0.26, 95% CI -0.06 to 0.58). No moderators of relapse prevention efficacy were found. Men, older individuals, and those with higher baseline symptom severity experienced greater reductions in symptomatology at 60 weeks. Psychological interventions for individuals with partially remitted depression reduce relapse risk and residual symptomatology, with efficacy generalizing across patient characteristics and treatment types. This suggests that psychological interventions are a recommended treatment option for this patient population.
Whenever statistical analyses are applied to multiply imputed datasets, specific formulas are needed to combine the results into one overall analysis, also called combination rules. In the context of regression analysis, combination rules for the unstandardized regression coefficients, the t-tests of the regression coefficients, and the F-tests for testing \documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$R^{2}$$\end{document} for significance have long been established. However, there is still no general agreement on how to combine the point estimators of \documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$R^{2}$$\end{document} in multiple regression applied to multiply imputed datasets. Additionally, no combination rules for standardized regression coefficients and their confidence intervals seem to have been developed at all. In the current article, two sets of combination rules for the standardized regression coefficients and their confidence intervals are proposed, and their statistical properties are discussed. Additionally, two improved point estimators of \documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$R^{2}$$\end{document} in multiply imputed data are proposed, which in their computation use the pooled standardized regression coefficients. Simulations show that the proposed pooled standardized coefficients produce only small bias and that their 95% confidence intervals produce coverage close to the theoretical 95%. Furthermore, the simulations show that the newly proposed pooled estimates for \documentclass[12pt]{minimal}\usepackage{amsmath}\usepackage{wasysym}\usepackage{amsfonts}\usepackage{amssymb}\usepackage{amsbsy}\usepackage{mathrsfs}\usepackage{upgreek}\setlength{\oddsidemargin}{-69pt}\begin{document}$$R^{2}$$\end{document} are less biased than two earlier proposed pooled estimates.
The proof of Theorem 3.14 contains an unsubstantiated claim. To overcome this problem, we add a hypothesis to the statement of 3.14 and we provide a new valid proof. We adjust Theorem 3.15, Corollary 3.16, Proposition 4.23, Theorem 4.26, Corollary 4.29, and Corollary 4.32 accordingly.
The conventional approach to trade liberalization has been to liberalize trade through international agreement and address subsequent domestic fallout and spillovers through domestic policies. In consequence, international obligations in trade liberalization are not legally connected with ‘flanking’ measures to address their negative effects. We discuss the shortcomings of this conventional approach with respect to labor adjustment and environmental protection: for political reasons, trade liberalization requires today the simultaneous regulation of labor and environmental spillovers. We suggest a novel approach to trade liberalization that includes the necessary flanking policies as part of, or linked to, the international agreement itself. This novel approach seeks to achieve the best of both worlds: reaping the benefits of international trade while making sure that negative spillovers are effectively addressed. To illustrate the intricacies of this approach, we introduce a new conceptual framework covering the negative effects of trade liberalization and flanking or mitigating policies, and a proposed novel approach in the form of trade liberalization packages and package treaties. Trade liberalization packages and package treaties are currently emerging around the world (e.g. sustainable palm oil in EFTA–Indonesia) and deserve our close attention.
Showering is one of the most water-intensive behaviours in urban households, accounting for 20–30% of water use. Real-time feedback from smart devices has been proven to significantly reduce water consumption in showers. Still, it is not known whether these devices have spillover effects on other water use behaviours. For the first time, we provide empirical evidence for a significant and negative within-domain spillover effect from the use of such devices, showing an increase in water use in other activities by 2.5% per day per household. Up to one-third of conservation effects are eroded by such spillovers, resulting in a two steps forward, one step back situation. Overall, however, net water use is still reduced by 4.7% in the 385 households that were observed. This study points out an important behavioural limit on the use of such smart shower devices and suggests that such use be accompanied by informational or other campaigns to reduce the large negative spillovers.
In the field of 3D model reconstruction, manifold methods have been developed that derive CAD models from 3D scan data. Opposed to classical CAD modelling, where surface and solid modelling exist, a further diversification of modelling techniques is observed, caused by different methods to build up the geometry. This research introduces a new classification, the so-called Level of Complexities. It can be applied to the complete Reverse Engineering process chain and lays the foundation for further research on how to match requirements arising from all process steps and downstream applications.
Payroll management is a critical business task that is subject to a large number of rules, which vary widely between companies, sectors, and countries. Moreover, the rules are often complex and change regularly. Therefore, payroll management systems must be flexible in design. In this paper, we suggest an approach based on a flexible answer set programming (ASP) model and an easy-to-read tabular representation based on the decision model and notation standard. It allows HR consultants to represent complex rules without the need for a software engineer and to ultimately design payroll systems for a variety of different scenarios. We show how the multi-shot solving capabilities of the clingo ASP system can be used to reach the performance that is necessary to handle real-world instances.
Although behavioral mechanisms in the association among depression, anxiety, and cancer are plausible, few studies have empirically studied mediation by health behaviors. We aimed to examine the mediating role of several health behaviors in the associations among depression, anxiety, and the incidence of various cancer types (overall, breast, prostate, lung, colorectal, smoking-related, and alcohol-related cancers).
Methods
Two-stage individual participant data meta-analyses were performed based on 18 cohorts within the Psychosocial Factors and Cancer Incidence consortium that had a measure of depression or anxiety (N = 319 613, cancer incidence = 25 803). Health behaviors included smoking, physical inactivity, alcohol use, body mass index (BMI), sedentary behavior, and sleep duration and quality. In stage one, path-specific regression estimates were obtained in each cohort. In stage two, cohort-specific estimates were pooled using random-effects multivariate meta-analysis, and natural indirect effects (i.e. mediating effects) were calculated as hazard ratios (HRs).
Results
Smoking (HRs range 1.04–1.10) and physical inactivity (HRs range 1.01–1.02) significantly mediated the associations among depression, anxiety, and lung cancer. Smoking was also a mediator for smoking-related cancers (HRs range 1.03–1.06). There was mediation by health behaviors, especially smoking, physical inactivity, alcohol use, and a higher BMI, in the associations among depression, anxiety, and overall cancer or other types of cancer, but effects were small (HRs generally below 1.01).
Conclusions
Smoking constitutes a mediating pathway linking depression and anxiety to lung cancer and smoking-related cancers. Our findings underline the importance of smoking cessation interventions for persons with depression or anxiety.
The straightening–unstraightening correspondence of Grothendieck–Lurie provides an equivalence between cocartesian fibrations between $(\infty, 1)$-categories and diagrams of $(\infty, 1)$-categories. We provide an alternative proof of this correspondence, as well as an extension of straightening–unstraightening to all higher categorical dimensions. This is based on an explicit combinatorial result relating two types of fibrations between double categories, which can be applied inductively to construct the straightening of a cocartesian fibration between higher categories.
As the popularity of adhesive joints in industry increases, so does the need for tools to support the process of selecting a suitable adhesive. While some such tools already exist, they are either too limited in scope or offer too little flexibility in use. This work presents a more advanced tool, that was developed together with a team of adhesive experts. We first extract the experts’ knowledge about this domain and formalize it in a Knowledge Base (KB). The IDP-Z3 reasoning system can then be used to derive the necessary functionality from this KB. Together with a user-friendly interactive interface, this creates an easy-to-use tool capable of assisting the adhesive experts. To validate our approach, we performed user testing in the form of qualitative interviews. The experts are very positive about the tool, stating that, among others, it will help save time and find more suitable adhesives.
The objective of the present study is to expand our understanding of visual complaints in people with multiple sclerosis (MS) with the aim of exploring potential rehabilitation approaches for treating visual complaints. Visual complaints are increasingly recognized as a core manifestation of MS. Up to 90% of people with MS report all kinds of visual complaints, such as blurry vision, double vision, being blinded by bright light, a reduced visual field and having trouble with depth perception. Since intact vision is quintessential to many activities of daily life, such as reading or car driving, these complaints affect independent participation to a great extent. The complaints cannot be fully explained by optical neuritis (a common symptom of MS) or other treatable visual or ophthalmological disorders. Moreover, there are no rehabilitation programs available for visual complaints in people with MS. However, the complaints are not yet understood well enough to develop effective rehabilitation strategies to reduce the impact of the visual complaints.
Participants and Methods:
Visual complaints were assessed using the Screening Visual Complaints questionnaire. 68 people with MS with visual complaints, and 37 with hardly any visual complaints received a standard visual function assessment and a neuropsychological assessment. Correlations between the visual complaints, visual functions and cognitive functions were calculated. In addition, correlations were calculated between several visual functions and a composite score of the neuropsychological assessment.
Results:
Only some specific visual measures related to visual complaints, with small to moderate effect sizes. While most specific cognitive functions did not show correlations, measures indicative of overall cognitive capacity in people with MS (such as motor speed) consistently correlated with different kinds of visual complaints. Additionally, visual functions that related to visual complaints also correlated with the composite score for cognitive functioning.
Conclusions:
Our study serendipitously showed that in developing or composing effective rehabilitation strategies for visual complaints, we should look beyond a person’s visual functioning: first, the overall cognitive capacity should be taken into account. Second, visual functioning and cognitive functioning are closely related. These results indicate that visual complaints may be a result of a general decline of the visual and/or cognitive system as one. When treating these complaints, low vision rehabilitation and neuropsychological rehabilitation strategies may be combined. Strategies should not focus on specific visual or cognitive functions, but at making the visual world more easily accessible, or more easily visible, to reduce the impact on the visual system and cognitive capacity. Strategies could range from applying more contrast in the environment to psycho-education. Future research should focus on developing rehabilitation programs and assessing their effectiveness in people with MS or with other types of non-acquired brain injuries.
The Tower of London is commonly used to assess planning ability. Deficient outcomes may however have different causes: A participant may not have the ability to think a sufficient number of steps into the future, or may become, for example, impatient to evaluate different possible paths. Outcomes are thus not pure measures of the "planning" construct of primary interest, which may have contributed to findings of low reliability and low validity of these outcomes in the literature. The advent of computerized testing combined with computational modeling potentially allows to go beyond traditional outcomes such as "total number of moves" and "total time taken" and disentangle different processes that are of primary interest. The goal of the current study is to establish whether a model that consists of "planning ability" and "response inhibition" parameters can be used to describe Tower of London data.
Participants and Methods:
We constructed an algorithm that produces Tower of London data, and a computational model that uses every single decision of a participant as input (e.g., whether a participant moves the red or the blue ball to the right peg in setting 15 when trying to get to setting 28). There are 210 unique decision situations that participants can encounter. Our algorithm and Bayesian hierarchical model uses two parameters for each participant as well as a guessing rule, that together determine the participant's decision at every step. The appropriateness of the model was evaluated in a simulation study, where the simulated distribution of data implied by this model is compared to the empirical distribution of total number of moves observed in real datasets. Data were simulated for 10 items with a sample size of 200 participants.
Results:
Our simulation study shows that with our model the empirical distribution of total number of moves is successfully replicated in the distribution of the simulated data.
Conclusions:
Computational modeling provides a new window into Tower of London performance by identifying different processes. Modeling thus allows us to go beyond aspecific descriptions of planning ability. Furthermore, using the high-resolution data of computerized testing allows us to estimate these parameters reliably without requiring "big data", keeping participant burden low. This study will be followed up in three ways. First, predictions will be preregistered and tested for these new cognitive outcomes in several large oncological patient samples. Second, the model will be extended to include reaction times, to include an additional metric of cognitive computation. Third, the new cognitive process outcomes will be analyzed in conjunction with cognitive process outcomes on other tests to establish process communalities.
Cognitive impairment is an often-overlooked issue that non-CNS cancer survivors face. Our current understanding of their issues is lacking, as traditional memory sum scores grant us little insight into the underlying cognitive processes of memory and its impairment. We can improve the informativity of memory impairment studies by isolating which cognitive processes are impaired.
Participants and Methods:
Participants were breast cancer survivors who received chemotherapy (n=68), and women controls (n=157). The participants completed the Amsterdam Cognition Scan (ACS), in which classical neuropsychological tests are digitally recreated for online at-home administration. Online administration reduces the burden on patients and allows for recording measurements with greater precision. The specific test used to illustrate the effectiveness of our computational modeling approach was the ACS equivalent of the Rey Auditory Verbal Learning Test, in which participants are tasked with recalling a list of 15 words five times. We formulated a Hierarchical Bayesian Cognitive Model to replace traditional sum scores and disentangle performance into the more theoretically meaningful concepts of 'memory storage’ and 'memory retrieval'.
Results:
A traditional analysis of the sum of trials 1-5 indicated no significant difference between patients and controls (t(223)=-0.99, p = 0.323), with a small effect size (Cohen’s d = -0.14).
For the newly isolated cognitive process “memory storage”, a non-significant difference was found between patients and controls (d=0.10, 95% credible interval on Cohen’s d: [0.25, 0.43]). On the “memory retrieval” process, a medium significant difference was found between patients and controls (d = -0.57, 95% credible interval on Cohen’s d: [-1.00, -0.19]).
Conclusions:
The results indicate that the impaired memory processes in cancer patients are not a general impairment across all memory functions, but rather a selective impairment of memory retrieval. Our method of analysis revealed information that would have been left unnoticed had we relied on traditional sum over trials 1-5.