Bringing the pieces together:Integrating cardiac and geriatric care in older patients with heart disease

Due to the increasing aging population, the number of older cardiac patients is also expected to rise in the next decades. The treatment of older cardiac patients is complex due to the simultaneously presence of comorbidities and polypharmacy, and geriatric conditions such as functional impairment, fall risk and malnutrition. However, the assessment of geriatric conditions is not part of the medical routine in cardiology and therefore these conditions are frequently unrecognized although they have a significant impact on treatment and on outcomes. In addition, treatments are mostly based on single-disease oriented guidelines and inadequately take other conditions into account. This may lead to conflicting recommendations and treatments that do not address important outcomes for older patients such as daily functioning, symptom relief and quality of life. Thus, the care of older cardiac patients is currently suboptimal which increases the risk of functional loss, readmission and mortality. The overall aim of the work described in this thesis is to explore the integration of cardiac and geriatric care for older patients with heart disease. First, by examining how hospitalized older cardiac patients at high risk for adverse events could be identified. Second, by investigating lifestyle-related secondary prevention of cardiovascular complications in older cardiac patients. And third, by developing a transitional care intervention for older cardiac patients and evaluating the effect on unplanned hospital readmission and mortality

Preservice Teachers\u27 Perceptions of Their Knowledge and Application of Response to Intervention

Response to Intervention (RTI) is a model for providing instructional and scientific-based interventions to all children who struggle. RTI uses data-based decision making for the interventions, instructional evaluation, intervention intensity and length of time, and evaluation and recommendations for any adjustments needed in instruction in both the problem-solving and standard protocol models. The difference between the two models of RTI is that the interventions are individualized for each student in the problem-solving model, but not the standard protocol model. RTI has been used by schools and agencies with research to support that it meets the needs of children and is successful when treatment integrity is evaluated. While many studies have been completed on the positive learning results of children served in RTI, few studies have been conducted on inservice teachers’ perceptions regarding knowledge and implementation of RTI, and fewer yet have been done on preservice teachers’ perceptions of knowledge and implementation of RTI. With some researchers concerned about treatment integrity in RTI, this is an area where further research was needed. The purpose of this current study was to explore preservice teachers’ perceptions of their knowledge and implementation of RTI. Specifically, would the number of field placements or the number of specific courses such as special education courses, assessment courses, or the number of methods courses impact preservice teachers’ perceptions of their knowledge and implementation of RTI? A Likert-type survey was developed that included 15 questions regarding knowledge of RTI, scaffolding, differentiating instruction, and formative assessment; this survey also included four open-ended questions. Thirty two elementary and secondary preservice teachers from one upper plains university, not included in the current study, participated in the pilot. In this current study, 104 elementary and secondary preservice teachers from three upper plains universities were enrolled. The construct of knowledge by the number of practica and the number of student teaching placements (field placements) were both found to be significant. Also significant were the constructs of scaffolding and formative assessment by the number of assessment courses. No significance was found in the construct of differentiating instruction by either the number of field placements or number of courses taken. These findings suggest that the number of field placements can affect preservice teachers’ perceptions of knowledge of RTI, and the number of assessment classes can affect preservice teachers’ perceptions of implementing RTI in the areas of scaffolding and formative assessment

Performance of markets for European renewable energy certificates

To address the problem of information asymmetry in renewable electricity markets, European governments have introduced certification schemes. While certification appears to be an increasingly important trade mechanism for renewable electricity, it is unclear to what extent certificate markets are functioning properly. In addition, countries have chosen very different designs for their certification schemes. In order to assess the performance of markets for Guarantee of Origin certificates in twenty European countries, we construct four market performance indicators and analyse their development over 2001-2016: the churn rate, price volatility, the certification rate and the expiration rate. We also investigate the relationship between market performance and two design features of certification schemes: the public/private nature of the certifier and presence of an international standard. We find that, despite increasing shares of renewable electricity are being certified, certificate markets suffer from poor liquidity and very volatile prices. In addition, we conclude that adopting an international standard fosters the development of certificate systems

The Role of the Noradrenergic System in the Exploration–Exploitation Trade-Off: A Psychopharmacological Study

Animal research and computational modeling have indicated an important role for the neuromodulatory locus coeruleus–norepinephrine (LC–NE) system in the control of behavior. According to the adaptive gain theory, the LC–NE system is critical for optimizing behavioral performance by regulating the balance between exploitative and exploratory control states. However, crucial direct empirical tests of this theory in human subjects have been lacking. We used a pharmacological manipulation of the LC–NE system to test predictions of this theory in humans. In a double-blind parallel-groups design (N = 52), participants received 4 mg reboxetine (a selective norepinephrine reuptake inhibitor), 30 mg citalopram (a selective serotonin reuptake inhibitor), or placebo. The adaptive gain theory predicted that the increased tonic NE levels induced by reboxetine would promote task disengagement and exploratory behavior. We assessed the effects of reboxetine on performance in two cognitive tasks designed to examine task (dis)engagement and exploitative versus exploratory behavior: a diminishing-utility task and a gambling task with a non-stationary pay-off structure. In contrast to predictions of the adaptive gain theory, we did not find differences in task (dis)engagement or exploratory behavior between the three experimental groups, despite demonstrable effects of the two drugs on non-specific central and autonomic nervous system parameters. Our findings suggest that the LC–NE system may not be involved in the regulation of the exploration–exploitation trade-off in humans, at least not within the context of a single task. It remains to be examined whether the LC–NE system is involved in random exploration exceeding the current task context

Effects of advice on experienced-based learning in adolescents and adults

Recent studies that compared effects of pre-learning advice on experience-based learning in adolescents and adults have yielded mixed results. Previous studies on this topic used choice tasks in which age-related differences in advice-related learning bias and exploratory choice behavior are difficult to dissociate. Moreover, these studies did not examine whether effects of advice depend on working memory load. In this preregistered study (in adolescents [13-15 years old] and adults [18-31 years old]), we addressed these issues by factorially combining advice and working memory load manipulations in an estimation task that does not require choices and hence eliminates the influence of known age-related differences in exploration. We found that advice guided participants' initial estimates in both age groups. When advice was correct, this improved estimation performance, especially in adolescents when working memory load was high. When advice was incorrect, it had a longer-lasting effect on adolescents' performance than on adults' performance. In contrast to previous findings in choice tasks, we found no evidence that advice biased learning in either age group. Taken together, our results suggest that learning in an estimation task improves between adolescence and adulthood but that the effects of advice on learning do not differ substantially between adolescents and adults