Validation of a set of design principles to promote knowledge productivity and innovation

This study explores the learning processes that contribute to knowledge productivity: gradual improvement and radical innovation of an organisation’s procedure and products and services, based on the development and application of new knowledge. The research is based on the assumption that innovation is the result of a series of powerful social learning processes. Based on previous case study research we formulated a set of twelve design principles. Those principles reflect key factors relevant to the innovation processes. The study at hand presents the validation of this set of design principles. The method used is a set of circular scales with which people involved in innovation practices analysed their innovation process. From the data it reveals that the design principles do not miss elements that are essential for innovation practices. The two design principles that seem to be ambiguous and need further elaboration are principles 11 and 12. Furthermore it became clear that reflecting upon an innovation practice works best when doing it together instead of doing this individually

Determinants of trajectories of fatigability and mobility among older medical patients during and after hospitalization; an explorative study

BACKGROUND: Fatigability is an important marker of functional decline in community dwelling older people, yet its relationship with functional decline after hospitalization is unclear. The objectives of this study were to identify trajectories of fatigability and mobility over time and to examine the association between demographic and clinical characteristics and these trajectories in medical patients aged 70 years and older admitted to a Dutch tertiary care teaching hospital. METHODS: In this prospective cohort study with baseline (in-hospital), discharge, three-, and six-months post discharge follow-up measurements, fatigability was assessed by the physical subscale of the Pittsburgh Fatigability Scale (PFS). Mobility was assessed by the De Morton Mobility Index (DEMMI). Group-based trajectory modeling was used to identify joint trajectories of fatigability and mobility. Covariates included demographic (age, sex, living situation, education) and clinical characteristics (functional status, frailty status, depression, comorbidity, length of hospital stay). RESULTS: Among 44 patients, three distinct fatigability trajectories and two mobility trajectories were identified over the course from hospital admission up to six months after discharge. Subsequently, three joint trajectories were identified, including low fatigability and high mobility (11%), improving fatigability and high mobility (52%), and high fatigability and low mobility (36%). Controlling for baseline functional status, patients with a lower comorbidity score (OR: 0.27, 95%CI 0.10; 0.74) and higher frailty status (OR: 1.36, 95%CI: 1.07; 1.74) were more likely to be a member of the high fatigability and low mobility trajectories. CONCLUSIONS: From hospital admission up to six months after discharge, three distinct trajectories of fatigability and mobility were identified among older medical patients. Our results should be interpreted with caution due to the small sample size, but may inspire other researchers to determine the value of fatigability assessment in identifying older medical patients at risk for developing mobility problems. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02714-9

Translation and validation of the Dutch Pittsburgh Fatigability Scale for older adults

Background The original Pittsburgh Fatigability Scale (PFS) was developed to assess perceived fatigability in older adults. The objective of this study was to translate the PFS into Dutch and investigate its validity and reliability among hospitalized older adults aged >= 70 years. Methods The PFS was translated into Dutch and pretested for comprehensibility by the Three-Step Test Interview method. The factor structure underlying the final version was evaluated by confirmatory factor analysis (CFA) and exploratory factor analyses (EFA). Internal consistency of the identified subscales was evaluated by Cronbach's alpha. Construct validity was evaluated by hypothesis testing. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC) and Bland Altman plots. Results The validation sample included 233 patients. CFA of the original factor structure resulted in poor model fit in our Dutch sample. EFA of PFS physical and mental subscales resulted in a two-factor solution underlying the data with good internal consistency of the identified subscales (Cronbach's alpha: 0.80-0.92). Five out of six hypotheses were confirmed, indicating good construct validity. Retest assessments were performed among 50 patients and showed good reliability for both the physical (ICC: 0.80, 95%CI: 0.68; 0.88) and mental subscale (ICC: 0.81, 95%CI: 0.68; 0.89). Conclusion The Dutch PFS is a valid and reliable instrument to assess fatigability in older hospitalized patients

Trajectories of Self-Rated Health in an Older General Population and Their Determinants: The Lifelines Cohort Study

OBJECTIVES: Poor self-rated health (SRH) is a strong predictor of premature mortality in older adults. Trajectories of poor SRH are associated with multimorbidity and unhealthy behaviours. Whether trajectories of SRH are associated with deviating physiological markers is unclear. This study identified trajectories of SRH and investigated the associations of trajectory membership with chronic diseases, health risk behaviours and physiological markers in community-dwelling older adults. STUDY DESIGN AND SETTING: Prospective general population cohort. PARTICIPANTS: Trajectories of SRH over 5 years were identified using data of 11 600 participants aged 65 years and older of the Lifelines Cohort Study. OUTCOME MEASURES: Trajectories of SRH were the main outcome. Covariates included demographics (age, gender, education), chronic diseases, health-risk behaviour (physical activity, smoking, drinking) and physiological markers (body mass index, cardiovascular function, lung function, glucose metabolism, haematological condition, endocrine function, renal function, liver function and cognitive function). RESULTS: Four stable trajectories were identified, including excellent (n=607, 6%), good (n=2111, 19%), moderate (n=7677, 65%) and poor SRH (n=1205, 10%). Being women (OR: 1.4; 95% CI: 1.0 to 1.9), low education (OR: 2.1; 95% CI: 1.5 to 3.0), one (OR: 10.4; 95% CI: 7.4 to 14.7) or multiple chronic diseases (OR: 37.8; 95% CI: 22.4 to 71.8), smoking (OR: 1.8; 95% CI: 1.0 to 3.2), physical inactivity (OR: 3.1; 95% CI: 1.8 to 5.2), alcohol abstinence (OR: 2.2; 95% CI: 1.4 to 3.2) and deviating physiological markers (OR: 1.5; 95% CI: 1.1 to 2.0) increase the odds for a higher probability of poor SRH trajectory membership compared with excellent SRH trajectory membership. CONCLUSION: SRH of community-dwelling older adults is stable over time with the majority (65%) having moderate SRH. Older adults with higher probabilities of poor SRH often have unfavourable health status

Reproducibility and responsiveness of the Frailty Index and Frailty Phenotype in older hospitalized patients

BACKGROUND: There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuring change scores over time to determine the effectiveness of interventions. The aim of this prospective cohort study was to determine reproducibility and responsiveness properties of the Frailty Index (FI) and Frailty Phenotype (FP) in acutely hospitalized medical patients aged 70 years and older. METHODS: Reproducibility was assessed by Intra-Class Correlation Coefficients (ICC), standard error of measurement (SEM) and smallest detectable change (SDC); Responsiveness was assessed by the standardized response mean (SRM), and area under the receiver operating characteristic curve (AUC). RESULTS: At baseline, 243 patients were included with a median age of 76 years (range 70–98). The analytic samples included 192 and 187 patients in the three and twelve months follow-up analyses, respectively. ICC of the FI were 0.85 (95 % confidence interval [CI]: 0.76; 0.91) and 0.84 (95% CI: 0.77; 0.90), and 0.65 (95% CI: 0.49; 0.77) and 0.77 (95% CI: 0.65; 0.84) for the FP. SEM ranged from 5 to 13 %; SDC from 13 to 37 %. SRMs were good in patients with unchanged frailty status (< 0.50), and doubtful to good for deteriorated and improved patients (0.43–1.00). AUC’s over three months were 0.77 (95% CI: 0.69; 0.86) and 0.71 (95% CI: 0.62; 0.79) for the FI, and 0.68 (95% CI: 0.58; 0.77) and 0.65 (95% CI: 0.55; 0.74) for the FP. Over twelve months, AUCs were 0.78 (95% CI: 0.69; 0.87) and 0.82 (95% CI: 0.73; 0.90) for the FI, and 0.78 (95% CI: 0.69; 0.87) and 0.75 (95% CI: 0.67; 0.84) for the FP. CONCLUSIONS: The Frailty Index showed better reproducibility and responsiveness properties compared to the Frailty Phenotype among acutely hospitalized older patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-021-02444-y

Late Holocene current patterns in the northern Patagonian fjords recorded by sediment drifts in Aysén Fjord

Present-day circulation patterns in the southeastern Pacific Ocean are driven by the Antarctic Circumpolar Current, directing subantarctic surface water into the Patagonian fjords since at least the early Holocene. In this way, bottom current patterns in the area are regulated by the regional climate, although the complex bathymetry of the fjords has a significant impact as well. To understand the potential interplay of climate, seafloor topography and circulation patterns, we study the sedimentary infill of Aysén Fjord (~45°S) and reveal the first active sediment drifts in the region. These allow constraining the present-day circulation patterns in northern Patagonia and show an incoming (southward) as well as returning (northward) flow direction. While the general sedimentary evolution of the fjord (and thus also the sediment drifts) is climate-driven (i.e., it reflects variability in southern westerly wind strength), the onset of drift formation at ~3.7 ka does not seem to have originated from an abrupt change in regional climate. Instead, we propose that a megathrust earthquake described in paleoseismic records in the area could have resulted in subsidence of one (or more) of the many bathymetric highs in the Patagonian fjords, thus contributing to enhanced spilling of subantarctic water into the fjord. This study underscores the importance of multidisciplinary research to understand past and present bottom current circulation patterns and disentangle different possible feedback mechanisms

How “elderly-proof” are the current medical specialist guidelines in the Netherlands?

De prevalentie van multimorbiditeit stijgt met de leeftijd: ruim 70% van de 75-plussers heeft drie of meer chronische aandoeningen, veelal gecombineerd met kwetsbaarheid. In de huidige medische praktijk vormt evidence-based medicine met evidence-based richtlijnen de basis voor de behandeling. Het doel van deze studie is nagaan hoe toepasbaar de huidige medisch specialistische richtlijnen in de praktijk zijn bij de heterogene groep ouderen. Alle richtlijnen uit de Nederlandse Richtlijnendatabase werden onderzocht. De twaalf ouderen-specifieke richtlijnen werden vergeleken met de aanbevelingen uit de ‘methodiek’. In 117 richtlijnen (54%) werden algemene termen, zoals “oudere(n)” gevonden. Een leeftijdsgrens werd vermeld in 26 richtlijnen (12%). De term “kwetsbaarheid” werd genoemd in 38 richtlijnen (18%), de term “comorbiditeit” in 107 (50%) en “cognitieve problemen” in acht (4%). Vijf ouderen-specifieke richtlijnen maakten een onderscheid tussen wel en niet kwetsbare ouderen. Drie richtlijnen bespraken relevante uitkomstmaten voor ouderen. De resultaten laten zien dat de huidige richtlijnen in de praktijk niet optimaal toepasbaar zijn bij de diverse groepen ouderen. Ons inziens is aanpassing van de richtlijnen bij voorkeur door middel van implementatie van de ontwikkelde richtlijnmethodiek een noodzakelijke eerste stap in het bruikbaar maken van de huidige evidence-based richtlijnen uit de tweede lijn in Nederland voor de groeiende groep kwetsbare en multimorbide ouderen

Twenty-three unsolved problems in hydrology (UPH) – a community perspective

This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure involved a public consultation through on-line media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focussed on process-based understanding of hydrological variability and causality at all space and time scales. Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come

Grain size, magnetic susceptibility and radiocarbon data for sediment cores MD07-3114 and MD07-3115, Aysén Fjord, Chilean Patagonia

Two Calypso sediment cores (MD07-3114 and MD07-3115) were taken in the outer Aysén Fjord during the PACHIDERME survey in February 2007 on board RV Marion-Dufresne. Both cores were scanned using the on-board multi-sensor core logger for magnetic susceptibility at a 2 cm interval. Grain-size distributions were measured using a Malvern Mastersizer 3000 after chemical pre-treatment to remove organic matter, calcium carbonate and biogenic silica and thus isolate the terrigenous fraction. A sampling resolution of 20 cm was applied throughout core MD07-3114 and increased to 10 or even 5 cm in specific areas of interest. Only the first 3.5 m of core MD07-3115 were sampled for grain-size analysis, with samples retrieved every 4 cm (when possible). Grains with a diameter larger than 1 mm were excluded for analysis by sieving. Radiocarbon ages for selected depths in both cores have been obtained using a combination of plant remains and shells. Samples were measured at the National Ocean Sciences Accelerator Mass Spectrometer (NOSAMS) facility of the Woods Hole Oceanographic Institution in Woods Hole, Massachusetts and the Leibniz AMS facility of the Christian Albrechts University in Kiel, Germany. All radiocarbon ages were corrected for 13C. A reservoir age of 550 years is considered for the marine samples, to which we add an uncertainty of 40 years—corresponding to the average error on the radiocarbon ages themselves