Power analysis, sample size, and assessment of statistical assumptions—improving the evidential value of lighting research

The reporting of accurate and appropriate conclusions is an essential aspect of scientific research, and failure in this endeavor can threaten the progress of cumulative knowledge. This is highlighted by the current reproducibility crisis, and this crisis disproportionately affects fields that use behavioral research methods, as in much lighting research. A sample of general and topic-specific lighting research papers was reviewed for information about sample sizes and statistical reporting. This highlighted that lighting research is generally underpowered and, given median sample sizes, is unlikely to be able to reveal small effects. Lighting research most commonly uses parametric statistical tests, but assessment of test assumptions is rarely carried out. This risks the inappropriate use of statistical tests, potentially leading to type I and type II errors. Lighting research papers also rarely report measures of effect size, and this can hamper cumulative science and power analyses required to determine appropriate sample sizes for future research studies. Addressing the issues raised in this article related to sample sizes, statistical test assumptions, and reporting of effect sizes can improve the evidential value of lighting research

Can asthma control be improved by understanding the patient's perspective?

Clinical trials show that asthma can be controlled in the majority of patients, but poorly controlled asthma still imposes a considerable burden. The level of asthma control achieved reflects the behaviour of both healthcare professionals and patients. A key challenge for healthcare professionals is to help patients to engage in self-management behaviours with optimal adherence to appropriate treatment. These issues are particularly relevant in primary care, where most asthma is managed. An international panel of experts invited by the International Primary Care Respiratory Group considered the evidence and discussed the implications for primary care practice

Keratinocytes as Depository of Ammonium-Inducible Glutamine Synthetase: Age- and Anatomy-Dependent Distribution in Human and Rat Skin

In inner organs, glutamine contributes to proliferation, detoxification and establishment of a mechanical barrier, i.e., functions essential for skin, as well. However, the age-dependent and regional peculiarities of distribution of glutamine synthetase (GS), an enzyme responsible for generation of glutamine, and factors regulating its enzymatic activity in mammalian skin remain undisclosed. To explore this, GS localization was investigated using immunohistochemistry and double-labeling of young and adult human and rat skin sections as well as skin cells in culture. In human and rat skin GS was almost completely co-localized with astrocyte-specific proteins (e.g. GFAP). While GS staining was pronounced in all layers of the epidermis of young human skin, staining was reduced and more differentiated among different layers with age. In stratum basale and in stratum spinosum GS was co-localized with the adherens junction component ß-catenin. Inhibition of, glycogen synthase kinase 3β in cultured keratinocytes and HaCaT cells, however, did not support a direct role of ß-catenin in regulation of GS. Enzymatic and reverse transcriptase polymerase chain reaction studies revealed an unusual mode of regulation of this enzyme in keratinocytes, i.e., GS activity, but not expression, was enhanced about 8–10 fold when the cells were exposed to ammonium ions. Prominent posttranscriptional up-regulation of GS activity in keratinocytes by ammonium ions in conjunction with widespread distribution of GS immunoreactivity throughout the epidermis allows considering the skin as a large reservoir of latent GS. Such a depository of glutamine-generating enzyme seems essential for continuous renewal of epidermal permeability barrier and during pathological processes accompanied by hyperammonemia

Stroke, social support and the partner

Stroke is one of the most common conditions with about 45,000 people suffering a first stroke in the Netherlands each year. Although survival after stroke has increased in recent decades, a substantial part of the survivors of stroke remain physically or cognitively impaired and in need of support in their everyday life. This has a tremendous impact on the patient’s environment as well, in particular on the partner of the stroke patient. Often the partner is the main support provider. Caring takes time and physical and emotional efforts, and may come with feelings of burden and decreased quality of life. Most studies have focused on the negative impact of caregiving, although positive caregiving experiences, such as enhanced self-esteem and satisfaction, have also been reported. The general aim of this Thesis, was to explore the interrelationships between the stroke patient and the partner. We examined the patient’s social support (Part I) and the partner’s experienced burden and quality of life (Part II) using data of two cohort studies (FuPro-stroke study and Restore4Stroke Cohort study). Part I presents a systematic review of the literature. Positive, but not consistent, relations between social support and higher patients’ health-related quality of life were described. Emotional support was the most often investigated subtype of social support and showed stronger relationships with higher health-related quality of life, compared to other subtypes such as informational or instrumental support. Subsequently, we analysed data from the FuPro-Stroke study to elucidate the relationship between the amount of received social support reported by stroke patients and their level of depressive symptoms. More than one-third of the participants showed depressive symptoms. The amount of perceived social support declined significantly from inpatient rehabilitation until three years post-stroke. We found divergent relationships between subtypes of social support and depressive symptoms. Everyday support and esteem support were associated with less depressive symptoms, whereas support in problem situations was a predictor of more depressive symptoms. In Part II, we found positive and negative caregiver experiences to co-exist and be related to partners’ life satisfaction three years post-stroke. Positive caregiving experiences mediated the impact of negative caregiving experiences on life satisfaction, which underlines the importance of positive caregiving experiences. Many partners in the Restore4Stroke Cohort study suffered from high levels of burden, anxiety and depressive symptoms. Only anxiety decreased between two months and one year post-stroke. High levels of partner burden, anxiety and depressive symptoms at two months were the strongest predictors of high levels of partner outcomes at one year post-stroke. Besides these partner variables, patient variables were important: patients’ anxiety symptoms at two month post-stroke was a significant predictor in the prediction of partners’ burden and anxiety symptoms at one year post-stroke. Based on the results of our studies, we recommend a dyadic perspective in stroke care, as patient and partners are interdependent in their relationship. Stroke patients and their partners should be followed up to the chronic phase regarding quality of life and partner burden to provide them with appropriate support and counselling. Also social support and both negative and positive caregiving experiences should be taken into consideration

Stroke, social support and the partner

Stroke is one of the most common conditions with about 45,000 people suffering a first stroke in the Netherlands each year. Although survival after stroke has increased in recent decades, a substantial part of the survivors of stroke remain physically or cognitively impaired and in need of support in their everyday life. This has a tremendous impact on the patient’s environment as well, in particular on the partner of the stroke patient. Often the partner is the main support provider. Caring takes time and physical and emotional efforts, and may come with feelings of burden and decreased quality of life. Most studies have focused on the negative impact of caregiving, although positive caregiving experiences, such as enhanced self-esteem and satisfaction, have also been reported. The general aim of this Thesis, was to explore the interrelationships between the stroke patient and the partner. We examined the patient’s social support (Part I) and the partner’s experienced burden and quality of life (Part II) using data of two cohort studies (FuPro-stroke study and Restore4Stroke Cohort study). Part I presents a systematic review of the literature. Positive, but not consistent, relations between social support and higher patients’ health-related quality of life were described. Emotional support was the most often investigated subtype of social support and showed stronger relationships with higher health-related quality of life, compared to other subtypes such as informational or instrumental support. Subsequently, we analysed data from the FuPro-Stroke study to elucidate the relationship between the amount of received social support reported by stroke patients and their level of depressive symptoms. More than one-third of the participants showed depressive symptoms. The amount of perceived social support declined significantly from inpatient rehabilitation until three years post-stroke. We found divergent relationships between subtypes of social support and depressive symptoms. Everyday support and esteem support were associated with less depressive symptoms, whereas support in problem situations was a predictor of more depressive symptoms. In Part II, we found positive and negative caregiver experiences to co-exist and be related to partners’ life satisfaction three years post-stroke. Positive caregiving experiences mediated the impact of negative caregiving experiences on life satisfaction, which underlines the importance of positive caregiving experiences. Many partners in the Restore4Stroke Cohort study suffered from high levels of burden, anxiety and depressive symptoms. Only anxiety decreased between two months and one year post-stroke. High levels of partner burden, anxiety and depressive symptoms at two months were the strongest predictors of high levels of partner outcomes at one year post-stroke. Besides these partner variables, patient variables were important: patients’ anxiety symptoms at two month post-stroke was a significant predictor in the prediction of partners’ burden and anxiety symptoms at one year post-stroke. Based on the results of our studies, we recommend a dyadic perspective in stroke care, as patient and partners are interdependent in their relationship. Stroke patients and their partners should be followed up to the chronic phase regarding quality of life and partner burden to provide them with appropriate support and counselling. Also social support and both negative and positive caregiving experiences should be taken into consideration

Measuring negative and positive caregiving experiences: A psychometric analysis of the Caregiver Strain Index Expanded

Objective: To compare the psychometric properties of the Caregiver Strain Index Expanded with those of the original Caregiver Strain Index among partners of stroke patients. Design and subjects: Cross-sectional validation study among 173 caregivers of stroke patients six months post-stroke. Main measures: Outcome measure: Caregiver Strain Index Expanded. Reference measures: Hospital Anxiety and Depression Scale, two questions on life satisfaction, Barthel Index and Montreal Cognitive Assessment. Additionally, National Institutes of Health Stroke Scale. Results: Neither the Caregiver Strain Index Expanded nor the original Caregiver Strain Index showed floor or ceiling effects. The sum score of the positive items showed a ceiling effect and was skewed to the right (2.20). Principal component analysis revealed no clear underlying item clustering. Alpha values of the Caregiver Strain Index Expanded and the original Caregiver Strain Index were good (0.82 and 0.83), but the alpha value of the positive subscale of the Caregiver Strain Index Expanded was too low (0.51). Convergent validity was confirmed for the Caregiver Strain Index Expanded, the original Caregiver Strain Index and the positive subscale. The Caregiver Strain Index Expanded and the original Caregiver Strain Index showed nearly identical correlations with the reference measures. Negative caregiving experiences were more strongly related to partners’ mood and life satisfaction than positive caregiving experiences. In the regression analyses, the positive subscale showed little added value in predicting partners’ mood and life satisfaction. Conclusion: The addition of five positively phrased items does not improve the psychometric properties of the Caregiver Strain Index

Indicators for photoreactivation and dark repair studies following ultraviolet disinfection

Journal of Industrial Microbiology and Biotechnology356533-541JIMB

Provided support, caregiver burden and well-being in partners of persons with spinal cord injury 5 years after discharge from first inpatient rehabilitation

Study design Cross-sectional study. Objectives To describe type and regularity of support given by partners for individuals with paraplegia versus tetraplegia 5 years after discharge from first inpatient rehabilitation; to describe perceived caregiver burden, mental health and life satisfaction among partners; and to analyse determinants of perceived burden and the partner's mental health and life satisfaction. Setting The Netherlands. Methods Participants were partners of persons with spinal cord injury (SCI) 5 years after discharge from first inpatient rehabilitation (N = 67). Participants completed a self-report questionnaire. Provided support was assessed with an existing scale consisting of 25 activities for which partners could indicate how often they provide support to the patient. Caregiver burden was assessed with the Caregiver Strain Index. Mental health was measured with the Short-Form Health Survey 36 (mental health subscale), and life satisfaction was measured with the Life Satisfaction Questionnaire. Results Five years after inpatient rehabilitation, partners provided support with a large variety of activities. How often and in which activities partners provided support was associated with lesion level. About 43% of the partners experienced high levels of caregiver burden. Provided support was related to perceived burden (r s = 0.58) and life satisfaction (r s = -0.24), and burden was negatively related to mental health (r s = -0.47) and life satisfaction (r s = -0.67). Conclusions High levels of perceived burden among partners and the associations between higher burden with lower wellbeing show the importance to prevent caregiver overload in partners of individuals with SCI. Monitoring burden during regular rehabilitation visits may help to early detect burden