Investigating ‘Churnalism’ in real time news

Language Use in Past and Presen

Implementation of geriatric assessment and decision support in residential care homes: facilitating and impeding factors.

Background: Successfully introducing and maintaining care innovations may depend on the interplay between care setting, the intervention and specific circumstances. We studied the factors influencing the introduction and maintenance of a Multidisciplinary Integrated Care model in 10 Dutch residential care homes. Methods. Facilitating and impeding factors were studied and compared at the time of introduction of the interRAI-LTCF assessment method in residential care homes as well as three years later, by surveys and semi structured interviews among nurse staff, managers, and physicians. Results: Facilitating factors at introduction were positive opinions of staff and family physicians about the changes of the process of care and the anticipated improvement of quality of care. Staff was positive about the applicability of the software to support the interRAI-LTCF assessments. Impeding factors were time constraints to complete interRAI-LTCF assessments and insufficient computer equipment.In the maintenance phase, the positive attitude of the location manager and the perceived benefits of the care model and the interRAI-LTCF assessment method were most important. Impeding factors after 3 years remained the lack of time to complete the assessments and lack of sufficient computer equipment. Conclusions: Impeding and facilitating factors were comparable in the initial and maintenance phase. Adoption of the interRAI-LTCF assessment method depended on positive opinions of staff and management, continuing support of staff and the availability of sufficient computer equipment. © 2013 Boorsma et al.; licensee BioMed Central Ltd

Improving Alignment of Free-Space Coupling of Multi-Mode Fibres using Off-Axis Digital Holography

Off-axis digital holography is employed to align multi-mode fibers in a free-space optical setup that can be used for space-division multiplexing (SDM) transmission. We show that alignment based on power coupling measurements alone does not guarantee a low mode-dependent loss, limiting the system capacity. The alignment method we proposed previously enables reliable fiber coupling with low mode-dependent loss and cross-talk for few-mode to multimode fiber alignment, by using digital holography to capture the full complex optical field at the output of the fiber of interest. After capturing the full complex field, by means of digital demultiplexing, we can calculate relevantparameters such as mode-dependent loss and cross-talk. Here we extend these results with few-mode to few-mode fiber alignment measurements and look at alternative optimization metrics such as the cross-talk between the mode groups of interest and all guided modes. The proposed method allows for precise (automated) alignment of space-division multiplexing components, devices and subsystems

Alignment of Free-Space Coupling of Few-Mode Fibre to Multi-Mode Fibre using Digital Holography

Off-axis digital holography is used to align a few-mode fiber to a multi-mode fiber in a free-space optical setup. Alignment based on power coupling measurements alone cannot guarantee low mode-dependent loss. The proposed alignment method enables reliable fiber coupling with low mode-dependent loss and crosstalk

Tacrolimus versus mycophenolate for AutoImmune hepatitis patients with incompLete response On first-line therapy (TAILOR study): a study protocol for a phase III, open-label, multicentre, randomised controlled trial

Background: Autoimmune hepatitis (AIH) is a rare, chronic inflammatory disease of the liver. The treatment goal is reaching complete biochemical response (CR), defined as the normalisation of aspartate and alanine aminotransferases and immunoglobulin gamma. Ongoing AIH activity can lead to fibrosis and (decompensated) cirrhosis. Incomplete biochemical response is the most important risk factor for liver transplantation or liver-related mortality. First-line treatment consists of a combination of azathioprine and prednisolone. If CR is not reached, tacrolimus (TAC) or mycophenolate mofetil (MMF) can be used as second-line therapy. Both products are registered for the prevention of graft rejection in solid organ transplant recipients. The aim of this study is to compare the effectiveness and safety of TAC and MMF as second-line treatment for AIH. Methods: The TAILOR study is a phase IIIB, multicentre, open-label, parallel-group, randomised (1:1) controlled trial performed in large teaching and university hospitals in the Netherlands. We will enrol 86 patients with AIH who have not reached CR after at least 6 months of treatment with first-line therapy. Patients are randomised to TAC (0.07 mg/kg/day initially and adjusted by trough levels) or MMF (max 2000 mg/day), stratified by the presence of cirrhosis at inclusion. The primary endpoint is the difference in the proportion of patients reaching CR after 12 months. Secondary endpoints include the difference in the proportion of patients reaching CR after 6 months, adverse effects, difference in fibrogenesis, quality of life and cost-effectiveness. Discussion: This is the first randomised controlled trial comparing two second-line therapies for AIH. Currently, second-line treatment is based on retrospective cohort studies. The rarity of AIH is the main issue in clinical research for alternative treatment options. The results of this trial can be implemented in existing international clinical guidelines. Trial registration: ClinicalTrials.gov NCT05221411 . Retrospectively registered on 3 February 2022; EudraCT number 2021–003420-33. Prospectively registered on 16 June 2021