Effectiveness and characteristics of interventions to improve work participation in adults with chronic physical conditions: a systematic review

Purpose: Chronic physical conditions often negatively affect work participation. The objective of this systematic review is to investigate the effectiveness and characteristics of vocational rehabilitation interventions for people with a chronic physical condition. Methods: Searches in five databases up to April 2020 identified 30 studies meeting our inclusion criteria. Two reviewers independently assessed and extracted data. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) framework was used to evaluate quality of evidence for three outcome measures related to work participation. Results: All vocational rehabilitation interventions consisted of multiple components, but their characteristics varied widely. Analysis of 22 trials yielded a moderate positive effect with moderate certainty of interventions on work status; analysis of five trials with low risk of bias showed a large positive effect with moderate certainty (risk ratio 1.33 and 1.57, respectively). In addition, in eight studies we found a moderate to small positive effect with low certainty on work attitude (standardized mean difference = 0.59 or 0.38, respectively). We found no effect on work productivity in nine studies. Conclusion: The systematic review of the literature showed positive effects of vocational rehabilitation interventions on work status and on work attitude; we found no effect on work productivity.Implications for rehabilitation In rehabilitation, addressing work participation of persons with a chronic physical condition using targeted inte

Disruptive life event or reflexive instrument? On the regulation of hospital mergers from a quality of care perspective

Purpose – Despite the continuation of hospital mergers in many western countries, it is uncertain if and how hospital mergers impact the quality of care. This poses challenges for the regulation of mergers. The purpose of this paper is to understand: how regulators and hospitals frame the impact of merging on the quality and safety of care and how hospital mergers might be regulated, given their uncertain impact on quality and safety of care. Design/methodology/approach –This paper studies the regulation of hospital mergers in The Netherlands. In a qualitative study design, it draws on 30 semi-structured interviews with inspectors from the Dutch Health and Youth Care Inspectorate (Inspectorate) and respondents from three hospitals that merged between 2013 and 2015. This paper draws from literature on process-based regulation to understand how regulators can monitor hospital mergers. Findings – This paper finds that inspectors and hospital respondents frame the process of merging as potentially disruptive to daily care practices. While inspectors emphasise the dangers of merging, hospital respondents report how merging stimulated them to reflect on their care practices and how it afforded learning between hospitals. Although the Inspectorate considers mergers a risk to quality of care, their regulatory practices are hesitant. Originality/value – This qualitative study sheds light on how merging might affect key hospital processes and daily care practices. It offers opportunities for the regulation of hospital mergers that acknowledges rather than aims to dispel the uncertain and potentially ambiguous impact of mergers on quality and safety of car

Convergence to SPDEs in Stratonovich form

We consider the perturbation of parabolic operators of the form $\partial_t+P(x,D)$ by large-amplitude highly oscillatory spatially dependent potentials modeled as Gaussian random fields. The amplitude of the potential is chosen so that the solution to the random equation is affected by the randomness at the leading order. We show that, when the dimension is smaller than the order of the elliptic pseudo-differential operator $P(x,D)$, the perturbed parabolic equation admits a solution given by a Duhamel expansion. Moreover, as the correlation length of the potential vanishes, we show that the latter solution converges in distribution to the solution of a stochastic parabolic equation with a multiplicative term that should be interpreted in the Stratonovich sense. The theory of mild solutions for such stochastic partial differential equations is developed. The behavior described above should be contrasted to the case of dimensions that are larger than or equal to the order of the elliptic pseudo-differential operator $P(x,D)$. In the latter case, the solution to the random equation converges strongly to the solution of a homogenized (deterministic) parabolic equation as is shown in the companion paper [2]. The stochastic model is therefore valid only for sufficiently small space dimensions in this class of parabolic problems.Comment: 21 page

Antiferromagnetic hysteresis above the spin-flop field

Magnetocrystalline anisotropy is essential in the physics of antiferromagnets and commonly treated as a constant, not depending on an external magnetic field. However, we demonstrate that in CoO the anisotropy should necessarily depend on the magnetic field, which is shown by the spin Hall magnetoresistance of the CoO|Pt device. Below the Néel temperature CoO reveals a spin-flop transition at 240 K at 7.0 T, above which a hysteresis in the angular dependence of magnetoresistance unexpectedly persists up to 30 T. This behavior is shown to agree with the presence of the unquenched orbital momentum, which can play an important role in antiferromagnetic spintronics.</p

Insights into Autism Spectrum Disorder Genomic Architecture and Biology from 71 Risk Loci

Analysis of de novo CNVs (dnCNVs) from the full Simons Simplex Collection (SSC) (N = 2,591 families) replicates prior findings of strong association with autism spectrum disorders (ASDs) and confirms six risk loci (1q21.1, 3q29, 7q11.23, 16p11.2, 15q11.2-13, and 22q11.2). The addition of published CNV data from the Autism Genome Project (AGP) and exome sequencing data from the SSC and the Autism Sequencing Consortium (ASC) shows that genes within small de novo deletions, but not within large dnCNVs, significantly overlap the high-effect risk genes identified by sequencing. Alternatively, large dnCNVs are found likely to contain multiple modest-effect risk genes. Overall, we find strong evidence that de novo mutations are associated with ASD apart from the risk for intellectual disability. Extending the transmission and de novo association test (TADA) to include small de novo deletions reveals 71 ASD risk loci, including 6 CNV regions (noted above) and 65 risk genes (FDR ≤ 0.1). Through analysis of de novo mutations in autism spectrum disorder (ASD), Sanders et al. find that small deletions, but not large deletions/duplications, contain one critical gene. Combining CNV and sequencing data, they identify 6 loci and 65 genes associated with ASD. © 2015 Elsevier Inc

Samenvatting project Proefimplementatie TraJect

In dit project is de interventie TraJect geïmplementeerd in twee nieuwe revalidatiecentra en is een derde centrum getraind om de interventie te geven. Doelstellingen van het huidige project waren A) het ontwikkelen en toepassen van de train-de-trainer cursus, B) lokale netwerk vorming in revalidatie en reintegratieveld, en C) monitoring en evaluatie van de interventie. In dit implementatieproject is veel ervaring en kennis opgedaan over de implementatie van de in Rotterdam ontwikkelde interventie in revalidatiecentra buiten Rotterdam

Factors influencing hemoglobin variability and its association with mortality in hemodialysis patients

Purpose. We aimed to investigate the factors influencing hemoglobin variability with inflammatory and nutritional parameters and its associations with all-cause mortality among hemodialysis patients. Methods. One hundred and sixty-nine patients during the entire 12 months were enrolled into the study. Fasting plasma glucose, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH), C-reactive protein (CRP), serum iron, serum iron-binding capacity, and transferrin saturation were analyzed. We defined six groups: low, target range, high, low-Amplitude fluctuation with low hemoglobin levels, low-Amplitude fluctuation with high hemoglobin levels, and high-Amplitude fluctuation. Body mass index (BMI), malnutrition-inflammation score (MIS), and Charlson Comorbidity Index were evaluated. Results. Hemoglobin variability was significantly correlated with age, platelet count, and number of hospitalization instances and inversely correlated with erythropoietin dose per body surface area. The coefficient of variation of hemoglobin showed a correlation with MIS and ferritin. The absolute level of hemoglobin showed a negative correlation between PTH, CRP, MIS, number of hospitalization instances and a positive correlation with albumin and BMI. High, low, and target-range groups showed survival advantage compared to the other three groups. In regression analysis, age, CRP levels, MIS, and BMI were the predictors of mortality. Conclusion. Inflammation and duration of anemia were the major predictors of hemoglobin variability. High-Amplitude fluctuation predicts high mortality; on the contrary low-Amplitude fluctuations is related to better survival. MIS was independently associated with mortality. This trial is registered with NCT03454906. © 2018 Zeynep Bal et al