Het proefproces als collectieve actie

The Legitimacy and Effectiveness of Law & Governance in a World of Multilevel Jurisdiction

Game-based meditation therapy to improve posttraumatic stress and neurobiological stress systems in traumatized adolescents:Protocol for a randomized controlled trial

Background: Many adolescents in residential care have been exposed to prolonged traumatic experiences such as violence, neglect, or abuse. Consequently, they suffer from posttraumatic stress. This not only negatively affects psychological and behavioral outcomes (eg, increased anxiety, depression, and aggression) but also has adverse effects on physiological outcomes, in particular on their neurobiological stress systems. Although current evidence-based treatment options are effective, they have their limitations. An alternative to traditional trauma treatment is meditation-based treatment that focuses on stress regulation and relaxation. Muse is a game-based meditation intervention that makes use of adolescents’ intrinsic motivation. The neurofeedback element reinforces relaxation abilities. Objective: This paper describes the protocol for a randomized controlled trial in which the goal is to examine the effectiveness of Muse (InteraXon Inc) in reducing posttraumatic stress and normalizing neurobiological stress systems in a sample of traumatized adolescents in residential care. Methods: This will be a multicenter, multi-informant, and multimethod randomized controlled trial. Participants will be adolescents (N=80), aged 10 to 18 years, with clinical levels of posttraumatic symptoms, who are randomized to receive either the Muse therapy sessions and treatment as usual (intervention) or treatment as usual alone (control). Data will be collected at 3 measurement instances: pretest (T1), posttest (T2), and at 2-month follow-up. Primary outcomes will be posttraumatic symptoms (self-report and mentor report) and stress (self-report) at posttest. Secondary outcomes will be neurobiological stress parameters under both resting and acute stress conditions, and anxiety, depression, and aggression at posttest. Secondary outcomes also include all measures at 2-month follow-up: posttraumatic symptoms, stress, anxiety, depression aggression, and neurobiological resting parameters. Results: The medical-ethical committee Arnhem-Nijmegen (NL58674.091.16) approved the trial on November 15, 2017. The study was registered on December 2, 2017. Participant enrollment started in January 2018, and the results of the study are expected to be published in spring or summer 2021. Conclusions: Study results will demonstrate whether game-based meditation therapy improves posttraumatic stress and neurobiological stress systems, and whether it is more effective than treatment as usual alone for traumatized adolescents

Diagnostic value of post-bronchodilator pulmonary function testing to distinguish between stable, moderate to severe COPD and asthma

Daphne C Richter1, James R Joubert1, Haylene Nell1, Mace M Schuurmans2, Elvis M Irusen21Tiervlei Trial Centre, Karl Bremer Hospital, Bellville, RSA; 2Respiratory Research Unit, Department of Internal Medicine, Faculty of Health Sciences, University of Stellenbosch, RSAObjective: The GOLD guidelines suggest that the presence of a post-bronchodilator forced expiratory volume in one second (FEV1) 80% of the predicted value in combination with a FEV1/forced vital capacity (FVC) < 70% confirms the diagnosis of COPD. Limited data exist regarding the accuracy of these criteria to distinguish between COPD and asthma. The aim of this study therefore was to investigate the diagnostic value of post-bronchodilator lung function parameters in obstructive lung disease.Methods: The pulmonary function tests of 43 (22 = COPD, 21 = asthma) patients with similar baseline characteristics were evaluated (baseline FEV1 were 55.7% + 7.6%, and 59.3% + 8.4% predicted for COPD and asthma, respectively). Bronchodilator responsiveness (BDR) was calculated according to three recognized pulmonary function test criteria.Results: The first criteria, post-bronchodilator FEV1 < 80% of the predicted value in combination with a post-bronchodilator FEV1/FVC ratio of <70%, had an accuracy of 70% to diagnose COPD. This combination was very sensitive (100%) in diagnosing COPD, but it was not specific (38%). The second BDR criteria, defined as an increase of <12% and 200 mL of initial FEV1 and criterion number 3, an increase of <9% of predicted FEV1, were less sensitive (55% and 59%, respectively), but more specific (81% and 76% respectively) to diagnose COPD. Our findings suggest that the current recommended spirometric indices are not optimal in differentiating between COPD and asthma.Keywords: obstructive lung disease, diagnosis, post-bronchodilator pulmonary function tes

Towards Investigating Global Warming Impact on Human Health Using Derivatives of Photoplethysmogram Signals

Recent clinical studies show that the contour of the photoplethysmogram (PPG) wave contains valuable information for characterizing cardiovascular activity. However, analyzing the PPG wave contour is difficult; therefore, researchers have applied first or higher order derivatives to emphasize and conveniently quantify subtle changes in the filtered PPG contour. Our hypothesis is that analyzing the whole PPG recording rather than each PPG wave contour or on a beat-by-beat basis can detect heat-stressed subjects and that, consequently, we will be able to investigate the impact of global warming on human health. Here, we explore the most suitable derivative order for heat stress assessment based on the energy and entropy of the whole PPG recording. The results of our study indicate that the use of the entropy of the seventh derivative of the filtered PPG signal shows promising results in detecting heat stress using 20-second recordings, with an overall accuracy of 71.6%. Moreover, the combination of the entropy of the seventh derivative of the filtered PPG signal with the root mean square of successive differences, or RMSSD (a traditional heart rate variability index of heat stress), improved the detection of heat stress to 88.9% accuracy

Theoretical study of dark resonances in micro-metric thin cells

We investigate theoretically dark resonance spectroscopy for a dilute atomic vapor confined in a thin (micro-metric) cell. We identify the physical parameters characterizing the spectra and study their influence. We focus on a Hanle-type situation, with an optical irradiation under normal incidence and resonant with the atomic transition. The dark resonance spectrum is predicted to combine broad wings with a sharp maximum at line-center, that can be singled out when detecting a derivative of the dark resonance spectrum. This narrow signal derivative, shown to broaden only sub-linearly with the cell length, is a signature of the contribution of atoms slow enough to fly between the cell windows in a time as long as the characteristic ground state optical pumping time. We suggest that this dark resonance spectroscopy in micro-metric thin cells could be a suitable tool for probing the effective velocity distribution in the thin cell arising from the atomic desorption processes, and notably to identify the limiting factors affecting desorption under a grazing incidence.Comment: 12 pages, 11 figures theoretical articl

Be Your Own Curator with the CHIP Tour Wizard [html]

Web 2.0 enables increased access to the museum digital collection. More and more, users will spend time preparing their visits to the museums and reflecting on them after the visits. In this context, the CHIP (Cultural Heritage Information Personalization) project offers tools to the users to be their own curator, e.g. planning a personalized museum tour, discovering interesting artworks they want to see in a 'virtual' or a 'real' tour and quickly finding their ways in the museum. In this paper we present the new additions to the CHIP tools, which target the above functionality - a Web-based Tour Preparation Wizard and an export of a personalized tour to an interactive Mobile Guide used in the physical museum space. In addition, the user interactions during a real museum visit are stored and synchronized with the user model, which is maintained at the museum Web site

The association between prescription change frequency, chronic disease score and hospital admissions: a case control study

BACKGROUND: The aim of this study was to assess the association between prescription changes frequency (PCF) and hospital admissions and to compare the PCF to the Chronic Disease Score (CDS). The CDS measures comorbidity on the basis of the 1-year pharmacy dispensing data. In contrast, the PCF is based on prescription changes over a 3-month period. METHODS: A retrospective matched case–control design was conducted. 10.000 patients were selected randomly from the Dutch PHARMO database, who had been hospitalized (index date) between July 1, 1998 and June 30, 2000. The primary study outcome was the number of prescription changes during several three-month time periods starting 18, 12, 9, 6, and 3 months before the index date. For each hospitalized patient, one nonhospitalized patient was matched for age, sex, and geographic area, and was assigned the same index date as the corresponding hospitalized patient. We classified four mutually exclusive types of prescription changes: change in dosage, switch, stop and start. RESULTS: The study population comprised 8,681 hospitalized patients and an equal number of matched nonhospitalized patients. The odds ratio of hospital admission increased with an increase in PCF category. At 3 months before the index date from PCF=1 OR 1.4 [95% CI 1.3-1.5] to PCF= 2–3 OR 2.2 [95% CI 1.9-2.4] and to PCF ≥ 4 OR 4.1 [95% CI 3.1-5.1]. A higher CDS score was also associated with an increased odds ratio of hospitalization: OR 1.3 (95% CI 1.2-1.4) for CDS 3–4, and OR 3.0 (95% CI 2.7-3.3) for CDS 5 or higher. CONCLUSION: The prescription change frequency (PCF) is associated with hospital admission, like the CDS. Pharmacists and other healthcare workers should be alert when the frequency of prescription changes increases. Clinical rules could be helpful to make pharmacists and physicians aware of the risk of the number of prescription changes

Validity of the Empatica E4 wristband to measure heart rate variability (HRV) parameters:A comparison to electrocardiography (ECG)

Wearable monitoring devices are an innovative way to measure heart rate (HR) and heart rate variability (HRV), however, there is still debate about the validity of these wearables. This study aimed to validate the accuracy and predictive value of the Empatica E4 wristband against the VU University Ambulatory Monitoring System (VU-AMS) in a clinical population of traumatized adolescents in residential care. A sample of 345 recordings of both the Empatica E4 wristband and the VU-AMS was derived from a feasibility study that included fifteen participants. They wore both devices during two experimental testing and twelve intervention sessions. We used correlations, cross-correlations, Mann-Whitney tests, difference factors, Bland-Altman plots, and Limits of Agreement to evaluate differences in outcomes between devices. Significant correlations were found between Empatica E4 and VU-AMS recordings for HR, SDNN, RMSSD, and HF recordings. There was a significant difference between the devices for all parameters but HR, although effect sizes were small for SDNN, LF, and HF. For all parameters but RMSSD, testing outcomes of the two devices led to the same conclusions regarding significance. The Empatica E4 wristband provides a new opportunity to measure HRV in an unobtrusive way. Results of this study indicate the potential of the Empatica E4 as a practical and valid tool for research on HR and HRV under non-movement conditions. While more research needs to be conducted, this study could be considered as a first step to support the use of HRV recordings provided by wearables