637 research outputs found
De rechtspositie van financiële instellingen ten aanzien van richtsnoeren en aanbevelingen van European Supervisory Authorities: Europese pseudowetgeving?
Article / Letter to editorInstituut voor Publiekrech
De rechtspositie van financiële instellingen ten aanzien van richtsnoeren en aanbevelingen van European Supervisory Authorities: Europese pseudowetgeving?
Article / Letter to editorInstituut voor Publiekrech
CRISP Spectropolarimetric Imaging of Penumbral Fine Structure
We discuss penumbral fine structure in a small part of a pore, observed with
the CRISP imaging spectropolarimeter at the Swedish 1-m Solar Telescope (SST),
close to its diffraction limit of 0.16 arcsec. Milne-Eddington inversions
applied to these Stokes data reveal large variations of field strength and
inclination angle over dark-cored penumbral intrusions and a dark-cored light
bridge. The mid-outer part of this penumbra structure shows 0.3 arcsec wide
spines, separated by 1.6 arcsec (1200 km) and associated with 30 deg
inclination variations. Between these spines, there are no small-scale magnetic
structures that easily can be be identified with individual flux tubes. A
structure with nearly 10 deg more vertical and weaker magnetic field is seen
midways between two spines. This structure is co-spatial with the brightest
penumbral filament, possibly indicating the location of a convective upflow
from below.Comment: Accepted for publication in ApJL 17 Oct 2008. One Figure adde
Study protocol: a randomised controlled trial on the clinical effects of levothyroxine treatment for subclinical hypothyroidism in people aged 80 years and over
Background:
Subclinical hypothyroidism is common in older people and its contribution to health and disease needs to be elucidated further. Observational and clinical trial data on the clinical effects of subclinical hypothyroidism in persons aged 80 years and over is inconclusive, with some studies suggesting harm and some suggesting benefits, translating into equipoise whether levothyroxine therapy provides clinical benefits. This manuscript describes the study protocol for the Institute for Evidence-Based Medicine in Old Age (IEMO) 80-plus thyroid trial to generate the necessary evidence base.
Methods:
The IEMO 80-plus thyroid trial was explicitly designed as an ancillary experiment to the Thyroid hormone Replacement for Untreated older adults with Subclinical hypothyroidism randomised placebo controlled Trial (TRUST) with a near identical protocol and shared research infrastructure. Outcomes will be presented separately for the IEMO and TRUST 80-plus groups, as well as a pre-planned combined analysis of the 145 participants included in the IEMO trial and the 146 participants from the TRUST thyroid trial aged 80 years and over.
The IEMO 80-plus thyroid trial is a multi-centre randomised double-blind placebo-controlled parallel group trial of levothyroxine treatment in community-dwelling participants aged 80 years and over with persistent subclinical hypothyroidism (TSH ≥4.6 and ≤ 19.9 mU/L and fT4 within laboratory reference ranges). Participants are randomised to levothyroxine 25 or 50 micrograms daily or matching placebo with dose titrations according to TSH levels, for a minimum follow-up of one and a maximum of three years.
Primary study endpoints: hypothyroid physical symptoms and tiredness on the thyroid-related quality of life patient-reported outcome (ThyPRO) at one year. Secondary endpoints: generic quality of life, executive cognitive function, handgrip strength, functional ability, blood pressure, weight, body mass index, and mortality. Adverse events will be recorded with specific interest on cardiovascular endpoints such as atrial fibrillation and heart failure.
Discussion:
The combined analysis of participants in the IEMO 80-plus thyroid trial with the participants aged over 80 in the TRUST trial will provide the largest experimental evidence base on multimodal effects of levothyroxine treatment in 80-plus persons to date
Hormone replacement therapy and intima-media thickness of the common carotid artery: the Rotterdam study
BACKGROUND AND PURPOSE: Observational data suggest that hormone
replacement therapy (HRT) reduces morbidity and mortality from
cardiovascular disease in healthy postmenopausal women. The mechanisms
underlying this protection are not entirely clear but may include
inhibition of the atherosclerotic process. METHODS: We studied the
association between ever use of HRT and intima-media thickness (IMT) of
the common carotid artery in 1103 naturally menopausal women, aged 55 to
80 years, in the Rotterdam Study, a community-based cohort study in a
suburban area of Rotterdam, Netherlands. Mean and maximum IMT of the
common carotid artery were measured noninvasively with B-mode ultrasound.
RESULTS: Ever use of HRT for >/=1 year was associated with a decreased
mean and maximum IMT compared with never users (mean IMT, 0.719 mm [SE
0.01] versus 0. 742 mm [SE 0.004], P=0.03; maximum IMT, 0.952 mm [SE
0.015] versus 0. 983 mm [SE 0.006], P=0.04), after adjustment for age,
smoking, educational level, systolic blood pressure, and body mass index.
No association was found for use <1 year (mean IMT, 0.739 mm [SE 0.013]
versus 0.742 mm [SE 0.004], P=0.69; maximum IMT, 0.990 mm [SE 0.019]
versus 0.983 mm [SE 0.006], P=0.75). Additional adjustment for diabetes,
frequency of visits to healthcare facilities, or total and HDL cholesterol
did not change these results. CONCLUSIONS: The findings of this
population-based study show that ever use of HRT is associated with a
decreased IMT in the common carotid artery in elderly women
Harmful communication behaviors in cancer care:A systematic review of patients and family caregivers perspectives
ObjectiveIssues regarding clinician communication remain an important source of complaints within healthcare. This systematic review aims to determine cancer patients' and their family caregivers' views on which clinicians' communication behaviors can harm (i.e. eliciting negative feelings/consequences for patients/family caregivers).MethodsWe searched for all types of peer-reviewed studies that determined adult (≥18 years) cancer patients' and/or family caregivers' perspectives on which clinicians' communication behaviors can harm in several databases (PubMed, Embase, Web of Science, Cochrane Library, Emcare, PsycINFO and Academic Search Premier), supplemented by expert-consultation. Studies were screened using the Artificial intelligence screening tool of ASReview and data was analyzed using Thematic Analysis. To assess the quality of the studies the Qualsyst critical appraisal tool was used.ResultsA total of 47 studies were included. Four main themes of harmful communication behaviors were identified: (1) Lack of tailored information provision (e.g. giving too little or too much/specific information) (2) Lack of tailored decision making (ranging from; patient exclusion, to the patients' responsibility, and/or haste) (3) Lack of feeling seen and heard (seen as a disease, not as a human being; not listened to concerns and emotions) (4) Lack of feeling held and remembered (forgotten agreements; lack of care continuity).ConclusionsOur results reveal an overview of patients' and family caregivers' perspectives on which clinicians' communication behaviors can harm. Harm could be prevented when information and decision involvement are tailored and patients' and family caregivers' needs to feel seen, heard, held and remembered are met
New horizons: Reablement - supporting older people towards independence
As the overwhelming majority of older people prefer to remain in their own homes and communities, innovative service provision aims to promote independence of older people despite incremental age associated frailty. Reablement is one such service intervention that is rapidly being adopted across high-income countries and projected to result in significant cost-savings in public health expenditure by decreasing premature admission to acute care settings and long-term institutionalisation. It is an intensive, time-limited intervention provided in people's homes or in community settings, often multi-disciplinary in nature, focussing on supporting people to regain skills around daily activities. It is goal-orientated, holistic and person-centred irrespective of diagnosis, age and individual capacities. Reablement is an inclusive approach that seeks to work with all kinds of frail people but requires skilled professionals who are willing to adapt their practise, as well as receptive older people, families and care staff. Although reablement may just seem the right thing to do, studies on the outcomes of this knowledge-based practice are inconsistent-yet there is an emerging evidence and practice base that suggests that reablement improves performance in daily activities. This innovative service however may lead to hidden side effects such as social isolation and a paradoxical increase in hospital admissions. Some of the necessary evaluative research is already underway, the results of which will help fill some of the evidence gaps outlined here
What are the effects of maternal and pre-adult environments on ageing in humans, and are there lessons from animal models?
An open issue in research on ageing is the extent to which responses to the environment during development can influence variability in life span in animals, and the health profile of the elderly in human populations. Both affluence and adversity in human societies have profound impacts on survivorship curves, and some of this effect may be traceable to effects in utero or in infancy. The Barker Hypothesis that links caloric restriction in very early life to disruptions of glucose-insulin metabolism in later life has attracted much attention, as well as some controversy, in medical circles. It is only rarely considered by evolutionary biologists working on phenotypic plasticity, or by biogerontologists studying model organisms such as C. elegans or Drosophila. One crucial mechanism by which animals can respond in an adaptive manner to adverse conditions, for example in nutrition or infection, during development is phenotypic plasticity. Here we begin with a discussion of adaptive plasticity in animals before asking what such phenomena may reveal of relevance to rates of ageing in animals, and in humans. We survey the evidence for effects on adult ageing of environmental conditions during development across mammalian and invertebrate model organisms, and ask whether evolutionary conserved mechanisms might be involved. We conclude that the Barker Hypothesis is poorly supported and argue that more work in human populations should be integrated with multi-disciplinary studies of ageing-related phenomena in experimental populations of different model species that are subjected to nutritional challenges or infections during pre-adult development
VFISV: Very Fast Inversion of the Stokes Vector for the Helioseismic and Magnetic Imager
In this paper we describe in detail the implementation and main properties of
a new inversion code for the polarized radiative transfer equation (VFISV: Very
Fast inversion of the Stokes vector). VFISV will routinely analyze pipeline
data from the Helioseismic and Magnetic Imager (HMI) on-board of the Solar
Dynamics Observatory (SDO). It will provide full-disk maps (40964096
pixels) of the magnetic field vector on the Solar Photosphere every 10 minutes.
For this reason VFISV is optimized to achieve an inversion speed that will
allow it to invert 16 million pixels every 10 minutes with a modest number
(approx. 50) of CPUs. Here we focus on describing a number of important
details, simplifications and tweaks that have allowed us to significantly speed
up the inversion process. We also give details on tests performed with data
from the spectropolarimeter on-board of the Hinode spacecraft.Comment: 23 pages, 9 figures (2 color). Submitted for publication to Solar
Physic
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