Study protocol: EXERcise and Cognition In Sedentary adults with Early-ONset dementia (EXERCISE-ON)

<p>Abstract</p> <p>Background</p> <p>Although the development of early-onset dementia is a radical and invalidating experience for both patient and family there are hardly any non-pharmacological studies that focus on this group of patients. One type of a non-pharmacological intervention that appears to have a beneficial effect on cognition in older persons without dementia and older persons at risk for dementia is exercise. In view of their younger age early-onset dementia patients may be well able to participate in an exercise program. The main aim of the EXERCISE-ON study is to assess whether exercise slows down the progressive course of the symptoms of dementia.</p> <p>Methods/Design</p> <p>One hundred and fifty patients with early-onset dementia are recruited. After completion of the baseline measurements, participants living within a 50 kilometre radius to one of the rehabilitation centres are randomly assigned to either an <it>aerobic exercise program in a rehabilitation centre</it> or a <it>flexibility and relaxation program in a rehabilitation centre</it>. Both programs are applied three times a week during 3 months. Participants living outside the 50 kilometre radius are included in a feasibility study where participants join in a <it>daily physical activity program set at home making use of pedometers</it>. Measurements take place at baseline (entry of the study), after three months (end of the exercise program) and after six months (follow-up). Primary outcomes are cognitive functioning; psychomotor speed and executive functioning; (instrumental) activities of daily living, and quality of life. Secondary outcomes include physical, neuropsychological, and rest-activity rhythm measures.</p> <p>Discussion</p> <p>The EXERCISE-ON study is the first study to offer exercise programs to patients with early-onset dementia. We expect this study to supply evidence regarding the effects of exercise on the symptoms of early-onset dementia, influencing quality of life.</p> <p>Trial registration</p> <p>The present study is registered within The Netherlands National Trial Register (ref: NTR2124)</p

Challenges to implementing a sustainable strategic evaluation framework of industrial parks: Mexican case

Industrial parks are essential in driving regional development, but how and how much do they benefit their regions? These questions motivated us to develop and implement a framework to evaluate the outputs of industrial parks (I.P.). Previous research developed the integrative framework Sustainable Strategic Evaluation Framework (SSEF) based on Managerial and Contextual Governance components. Relevant indicators for sustainability make part of the framework and can be adapted to match the availability of specific/local data. In this article, we report on implementing the Contextual Governance component of the SSEF to explain the dependency influence of contextual governance characteristics upon sustainability indicators for the regional impact of I.P. By analyzing the challenges during the implementation phase of the qualitative research, we bring new knowledge that can contribute to further developing sustainable strategic evaluation frameworks of I.P. We selected the case study approach to implement the SSEF, which includes an in-depth analysis. The industrial park Guanajuato Puerto Interior (GPI) in Mexico was chosen as sustainability principles have been embedded in this I.P. since its creation. The findings of this first SSEF implementation show that the Contextual Governance component was evaluated as RED restrictive in the criteria of Flexibility and Intensity of two governance dimensions: (i) Levels & scales and; (ii) Problem perspectives & goal ambitions. The other criteria were evaluated as YELLOW moderative, and only in the criteria of Extent related to the governance dimensions Levels& scales and Strategies and instruments was a GREEN enabling evaluation. The challenges identified during the SSEF implementation were directly associated with having a clear definition of the contextual governance factors and processes that simultaneously allow the identification of data to monitor the sustainability performance of the I.P

Thromboelastography and Rotational Thromboelastometry in Bleeding Patients with Coagulopathy: Practice Management Guideline from the Eastern Association for the Surgery of Trauma.

BACKGROUND: Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests: thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical and critically ill patients. METHODS: Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM to non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients. RESULTS: Utilizing TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. TEG/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. TEG/ROTEM -guided transfusions were associated with a reduction in mortality in trauma patients. CONCLUSION: In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and patients with critical illness. LEVEL OF EVIDENCE: Level II TYPE OF STUDY: Therapeutic

Thromboelastography and rotational thromboelastometry in bleeding patients with coagulopathy: Practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: Assessment of the immediate need for specific blood product transfusions in acutely bleeding patients is challenging. Clinical assessment and commonly used coagulation tests are inaccurate and time-consuming. The goal of this practice management guideline was to evaluate the role of the viscoelasticity tests: thromboelastography (TEG) and rotational thromboelastometry (ROTEM), in the management of acutely bleeding trauma, surgical and critically ill patients. METHODS: Systematic review and meta-analyses of manuscripts comparing TEG/ROTEM to non-TEG/ROTEM-guided blood products transfusions strategies were performed. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the level of evidence and create recommendations for TEG/ROTEM-guided blood product transfusions in adult trauma, surgical, and critically ill patients. RESULTS: Utilizing TEG/ROTEM-guided blood transfusions in acutely bleeding trauma, surgical, and critically ill patients was associated with a tendency to fewer blood product transfusions in all populations. TEG/ROTEM-guided transfusions were associated with a reduced number of additional invasive hemostatic interventions (angioembolic, endoscopic, or surgical) in surgical patients. TEG/ROTEM -guided transfusions were associated with a reduction in mortality in trauma patients. CONCLUSION: In patients with ongoing hemorrhage and concern for coagulopathy, we conditionally recommend using TEG/ROTEM-guided transfusions, compared with traditional coagulation parameters, to guide blood component transfusions in each of the following three groups: adult trauma patients, adult surgical patients, and patients with critical illness. LEVEL OF EVIDENCE: Level II TYPE OF STUDY: Therapeutic

Multiancestry association study identifies new asthma risk loci that colocalize with immune-cell enhancer marks.

We examined common variation in asthma risk by conducting a meta-analysis of worldwide asthma genome-wide association studies (23,948 asthma cases, 118,538 controls) of individuals from ethnically diverse populations. We identified five new asthma loci, found two new associations at two known asthma loci, established asthma associations at two loci previously implicated in the comorbidity of asthma plus hay fever, and confirmed nine known loci. Investigation of pleiotropy showed large overlaps in genetic variants with autoimmune and inflammatory diseases. The enrichment in enhancer marks at asthma risk loci, especially in immune cells, suggested a major role of these loci in the regulation of immunologically related mechanisms

Scrooge posing as Mother Teresa: How hypocritical social responsibility strategies hurt employees and firms

Extant research provides compelling conceptual and empirical arguments that company-external (e.g., philanthropic) as well as company-internal (i.e., employee-directed) CSR efforts positively affect employees, but does so largely in studies assessing effects from the two CSR types independently of each other. In contrast, this paper investigates external–internal CSR jointly, examining the effects of (in)consistent external–internal CSR strategies on employee attitudes, intentions, and behaviors. The research takes a social and moral identification theory view and advances the core hypothesis that inconsistent CSR strategies, defined as favoring external over internal stakeholders, trigger employees’ perceptions of corporate hypocrisy which, in turn, lead to emotional exhaustion and turnover. In Study 1, a cross-industry employee survey (n = 3410) indicates that inconsistent CSR strategies with larger external than internal efforts increase employees’ turnover intentions via perceived corporate hypocrisy and emotional exhaustion. In Study 2, a multi-source secondary dataset (n = 1902) demonstrates that inconsistent CSR strategies increase firms’ actual employee turnover. Combined, the two studies demonstrate the importance of taking into account the interests of both external and internal stakeholders of the firm when researching and managing CSR