Case finding of mild cognitive impairment and dementia and subsequent care; results of a cluster RCT in primary care

Purpose Despite a call for earlier diagnosis of dementia, the diagnostic yield of case finding and its impact on the mental health of patients and relatives are unclear. This study assessed the effect of a two-component intervention of case finding and subsequent care on these outcomes. Methods In a cluster RCT we assessed whether education of family physicians (FPs; trial stage 1) resulted in more mild cognitive impairment (MCI) and dementia diagnoses among older persons in whom FPs suspected cognitive decline and whether case finding by a practice nurse and the FP (trial stage 2) added to this number of diagnoses. In addition, we assessed mental health effects of case finding and subsequent care (trial stage 2). FPs of 15 primary care practices (PCPs = clusters) judged the cognitive status of all persons ≤ 65 years. The primary outcome, new MCI and dementia diagnoses by FPs after 12 months as indicated on a list, was assessed among all persons in whom FPs suspected cognitive impairment but without a formal diagnosis of dementia. The secondary outcome, mental health of patients and their relatives, was assessed among persons consenting to participate in trial stage 2. Trial stage 1 consisted of either intervention component 1: training FPs to diagnose MCI and dementia, or control: no training. Trial stage 2 consisted of either intervention component 2: case finding of MCI and dementia and care by a trained nurse and the FP, or control: care as usual. Results Seven PCPs were randomized to the intervention; eight to the control condition. MCI or dementia was diagnosed in 42.3 (138/326) of persons in the intervention, and in 30.5 (98/321) in the control group (estimated difference GEE: 10.8, OR: 1.51, 95-CI 0.60-3.76). Among patients and relatives who consented to stage 2 of the trial (n = 145; 25), there were no differences in mental health between the intervention and control group. Conclusions We found a non-significant increase in the number of new MCI diagnoses. As we cannot exclude a clinically relevant effect, a larger study is warranted to replicate ours. Trial Registration Nederlands Trial Register NTR3389 © 2016 van den Dungen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Managing digital coordination of design: emerging hybrid practices in an institutionalized project setting

What happens when digital coordination practices are introduced into the institutionalized setting of an engineering project? This question is addressed through an interpretive study that examines how a shared digital model becomes used in the late design stages of a major station refurbishment project. The paper contributes by mobilizing the idea of ‘hybrid practices’ to understand the diverse patterns of activity that emerge to manage digital coordination of design. It articulates how engineering and architecture professions develop different relationships with the shared model; the design team negotiates paper-based practices across organizational boundaries; and diverse practitioners probe the potential and limitations of the digital infrastructure. While different software packages and tools have become linked together into an integrated digital infrastructure, these emerging hybrid practices contrast with the interactions anticipated in practice and policy guidance and presenting new opportunities and challenges for managing project delivery. The study has implications for researchers working in the growing field of empirical work on engineering project organizations as it shows the importance of considering, and suggests new ways to theorise, the introduction of digital coordination practices into these institutionalized settings

Virtual Resection: A New Tool for Preparing for Nephron-Sparing Surgery in Wilms Tumor Patients

Nephron-sparing surgery (NSS) in Wilms tumor (WT) patients is a surgically challenging procedure used in highly selective cases only. Virtual resections can be used for preoperative planning of NSS to estimate the remnant renal volume (RRV) and to virtually mimic radical tumor resection. In this single-center evaluation study, virtual resection for NSS planning and the user experience were evaluated. Virtual resection was performed in nine WT patient cases by two pediatric surgeons and one pediatric urologist. Pre- and postoperative MRI scans were used for 3D visualization. The virtual RRV was acquired after performing virtual resection and a questionnaire was used to assess the ease of use. The actual RRV was derived from the postoperative 3D visualization and compared with the derived virtual RRV. Virtual resection resulted in virtual RRVs that matched nearly perfectly with the actual RRVs. According to the questionnaire, virtual resection appeared to be straightforward and was not considered to be difficult. This study demonstrated the potential of virtual resection as a new planning tool to estimate the RRV after NSS in WT patients. Future research should further evaluate the clinical relevance of virtual resection by relating it to surgical outcome

Progesterone for prevention of preterm birth in women with short cervical length : 2-year infant outcomes

ACKNOWLEDGMENTS The Triple P study is registered as NL1961. https://www.trialregister.nl/trial/1961 The original Triple P study was funded by ZonMW number 120620030. The follow-up study was funded by the Amsterdam UMC, Academic Medical Center. BWM is supported by a NHMRC Investigatorgrant (GNT1176437). BWM reports consultancy for ObsEva, Merck Merck KGaA, iGenomix and Guerbet.Peer reviewedPublisher PD

Work Motivation and Employment Outcomes in People with Severe Mental Illness

Purpose To study associations between the level of self-reported work motivation and employment outcomes in people with severe mental illness (SMI) enrolled in a vocational rehabilitation program. Methods Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Multiple logistic regression, linear regression and cox regression analyses were performed to analyse the association between the level of work motivation at baseline and job obtainment, duration of job, and time until job obtainment during the 30-month follow-up period. Results No statistically significant associations were found between the level of work motivation and job obtainment (OR 1.83, 95% CI 0.55-6.06, p = 0.32), job duration (B = - 0.74, 95% CI - 2.37 to 0.89, p = 0.37, R-squared = 0.03), or time until job obtainment (HR = 1.53, 95% CI 0.64-3.68, p = 0.34). Conclusions The results of this study show no statistically significant associations between the level of work motivation and employment outcomes in people with SMI enrolled in a vocational rehabilitation program. These associations may be underestimated due to range restriction of the work motivation's level. Further research is recommended to increase knowledge on the associations between work motivation and employment outcomes, as it could be relevant for further understanding success in vocational rehabilitation

A refined stable restriction theorem for vector bundles on quadric threefolds

Let E be a stable rank 2 vector bundle on a smooth quadric threefold Q in the projective 4-space P. We show that the hyperplanes H in P for which the restriction of E to the hyperplane section of Q by H is not stable form, in general, a closed subset of codimension at least 2 of the dual projective 4-space, and we explicitly describe the bundles E which do not enjoy this property. This refines a restriction theorem of Ein and Sols [Nagoya Math. J. 96, 11-22 (1984)] in the same way the main result of Coanda [J. reine angew. Math. 428, 97-110 (1992)] refines the restriction theorem of Barth [Math. Ann. 226, 125-150 (1977)].Comment: Ann. Mat. Pura Appl. 201

The Fundamental Plane and the evolution of the M/L ratio of early-type field galaxies up to z~1

We analyse the Fundamental Plane (FP) of 26 strong gravitational lens galaxies with redshifts up to z~1, using tabulated data from Kochanek et al. (2000) and Rusin et al. (2003). The lens galaxies effectively form a mass-selected sample of early-type galaxies in environments of relatively low density. We analyse the FP and its evolution in the restframe Johnson B and Gunn r bands. Assuming that early-type galaxies are a homologous family, the FP then provides a direct measurement of the M/L ratio evolution. If we assume that the M/L ratios of field early-type galaxies evolve as power-laws, we find for the lens galaxies an evolution rate dlog(M/L)/dz of -0.62 +/-0.13 in restframe B, corresponding to a mean stellar formation redshift of =1.8 (-0.5/+1.4). This formation epoch does not differ significantly from that of cluster galaxies =2.0 (-0.2/+0.3), obtained by van Dokkum & Franx (2001) after correction for maximum progenitor bias. However, if we impose the constraint that lens and cluster galaxies that are of the same age have equal M/L ratios and we do not correct for progenitor bias, we find that the stellar populations of the lens galaxies are 10-15 % younger. We find that both the M/L ratios as well as the restframe colors of the lens galaxies show significant scatter. About half of the lens galaxies are consistent with an old cluster-like stellar populations, but the other galaxies are bluer and best fit by single burst models with younger stellar formation redshifts as low as z*~1. Moreover, the scatter in color is correlated with the scatter in M/L ratio. We interpret this as evidence of a significant age spread among the stellar populations of lens galaxies, whereas the ages of the stellar populations of the cluster galaxies are well approximated by a single formation epoch.Comment: 12 pages (5 figures), accepted by MNRAS, abstract abridged; substantial changes from previous version: new data added, color evolution presented (Fig. 4, left), analysis completely in flat cosmology (Omega_M=0.3, Omega_L=0.7

Philippine crocodile attacks on humans in the Northern Sierra Madre

Conservation Biology - ol