Effectiveness of a process-oriented patient-tailored outpatient neuropsychological rehabilitation programme for patients in the chronic phase after ABI

The objective of this prospective cohort study was to examine the effectiveness of an outpatient neuropsychological rehabilitation programme for patients with acquired brain injury (ABI) and their relatives. The participants were 26 ABI patients with a mean age of 44.7 (SD 11.7) years and 24 caregivers. Mean time since injury was 3.0 (SD 3.6) years. The intervention consisted of a patient-tailored process-oriented neuropsychological rehabilitation programme focusing on facilitation of the adaptation process. Repeated measurements were taken prior to treatment (T0), directly after treatment (T1) and 6 months later (T2). Primary outcome measures were cognitive failures (CFQ), quality of life (SA-SIP30), and individualised goals (GAS). Patients improved significantly on individualised goals between T0 and T1 (p<.01). This effect retained at T2. There were no significant differences on CFQ and SA-SIP30. The programme had a positive effect on attainment of the patient's individual goals. This was not associated with a higher level of participation or a better quality of life

Histopathology laboratory operations analysis and improvement

Histopathology laboratories aim to deliver high quality diagnoses based on patient tissue samples. Indicators for quality are the accuracy of the diagnoses and the diagnostic turnaround times. However, challenges exist regarding employee workload and turnaround times in the histopathology laboratory. This paper proposes a decomposed planning and scheduling method for the histopathology laboratory using (mixed) integer linear programming ((M)ILP) to improve the spread of workload and reduce the diagnostic turnaround times. First, the batching problem is considered, in which batch completion times are equally divided over the day to spread the workload. This reduces the peaks of physical work available in the laboratory. Thereafter, the remaining processes are scheduled to minimize the tardiness of orders. Preliminary results show that using this decomposition method, the peaks in histopathology workload in UMC Utrecht, a large university medical center in the Netherlands, are potentially reduced with up to 50% by better spreading the workload over the day. Furthermore, turnaround times are potentially reduced with up to 20% compared to current practices

Supernovae data and perturbative deviation from homogeneity

We show that a spherically symmetric perturbation of a dust dominated $\Omega=1$ FRW universe in the Newtonian gauge can lead to an apparent acceleration of standard candles and provide a fit to the magnitude-redshift relation inferred from the supernovae data, while the perturbation in the gravitational potential remains small at all scales. We also demonstrate that the supernovae data does not necessarily imply the presence of some additional non-perturbative contribution by showing that any Lemaitre-Tolman-Bondi model fitting the supernovae data (with appropriate initial conditions) will be equivalent to a perturbed FRW spacetime along the past light cone.Comment: 8 pages, 3 figures; v2: 1 figure added, references added/updated, minor modifications and clarifications, matches published versio

Light propagation in statistically homogeneous and isotropic universes with general matter content

We derive the relationship of the redshift and the angular diameter distance to the average expansion rate for universes which are statistically homogeneous and isotropic and where the distribution evolves slowly, but which have otherwise arbitrary geometry and matter content. The relevant average expansion rate is selected by the observable redshift and the assumed symmetry properties of the spacetime. We show why light deflection and shear remain small. We write down the evolution equations for the average expansion rate and discuss the validity of the dust approximation.Comment: 42 pages, no figures. v2: Corrected one detail about the angular diameter distance and two typos. No change in result

Validity of the Patient Experiences and Satisfaction with Medications (PESaM) Questionnaire

Background: This study assessed the validity and reliability of the generic module of the recently developed Patient Experiences and Satisfaction with Medications (PESaM) questionnaire in a sample of patients in the Netherlands. Methods: The generic module of the PESaM questionnaire consists of 18 items related to the domains effectiveness, side effects and ease of use of medications. It assesses patients’ experiences regarding the impact of the medication on daily life, health and satisfaction. In 2017, the PESaM questionnaire was sent out to idiopathic pulmonary fibrosis patients using pirfenidone or nintedanib, atypical haemolytic uraemic syndrome patients receiving eculizumab and patients using tacrolimus after kidney transplantation. Mean scores for each domain were calculated applying a scoring algorithm. Construct validity and reliability were assessed using recommended methods. Results: 188 participants completed the generic module, of whom 48% used pirfenidone, 36% nintedanib, 11% tacrolimus and 5% eculizumab. The generic module has good structural properties. Internal consistency values of the domains were satisfactory (i.e. Cronbach’s coefficient alpha above 0.7). Confirmatory factor analysis provided further evidence for construct validity, with good convergent and discriminant validity. The PESaM questionnaire also showed different scores for patients using different medications, in line with expectations, and was therefore able to differentiate between patient groups. Test–retest reliability of the items and domains were rated as moderate to fair (i.e. intraclass coefficients ranged between 0.18 and 0.76). Conclusions: The PESaM questionnaire is a unique patient-reported outcome measure evaluating patient experiences and satisfaction with medications. It has been developed in conjunction with patients, ensuring coverage of domains and issues relevant from the patient’s perspective. This study has shown promising validity of the generic module of the PESaM questionnaire. Further research is recommended to assess reliability in greater detail as well as the responsiveness of the measure. Trial registration: The study

Astronomical Distance Determination in the Space Age: Secondary Distance Indicators

The formal division of the distance indicators into primary and secondary leads to difficulties in description of methods which can actually be used in two ways: with, and without the support of the other methods for scaling. Thus instead of concentrating on the scaling requirement we concentrate on all methods of distance determination to extragalactic sources which are designated, at least formally, to use for individual sources. Among those, the Supernovae Ia is clearly the leader due to its enormous success in determination of the expansion rate of the Universe. However, new methods are rapidly developing, and there is also a progress in more traditional methods. We give a general overview of the methods but we mostly concentrate on the most recent developments in each field, and future expectations. © 2018, The Author(s)

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221