Background: Due to differences in the definition of frailty, many different screening instruments have been developed. However, the predictive validity of these instruments among community-dwelling older people remains uncertain. Objective: To investigate whether combined (i.e. sequential or parallel) use of available frailty instruments improves the predictive power of dependency in (instrumental) activities of daily living ((I)ADL), mortality and hospitalization. Design, setting and participants: A prospective cohort study with two-year followup was conducted among pre-frail and frail community-dwelling older people in the Netherlands. Measurements: Four combinations of two highly specific frailty instruments (Frailty Phenotype, Frailty Index) and two highly sensitive instruments (Tilburg Frailty Indicator, Groningen Frailty Indicator) were investigated. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for all single instruments as well as for the four combinations, sequential and parallel. Results: 2,420 individuals participated (mean age 76.3 ± 6.6 years, 60.5% female) in our study. Sequential use increased the levels of specificity, as expected, whereas the PPV hardly increased. Parallel use increased the levels of sensitivity, although the NPV hardly increased. Conclusions: Applying two frailty instruments sequential or parallel might not be a solution for achieving better predictions of frailty in community-dwelling older people. Our results show that the combination of different screening instruments does not improve predictive validity. However, as this is one of the first studies to investigate the combined use of screening instruments, we recommend further exploration of other combinations of instruments among other study populations.
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Abstract: Technological innovation in the healthcare sector is increasing, but integration of information technology (IT) in the care process is difficult. Healthcare workers are important agents in this IT integration. The purpose of this study is to explore factors that feed motivation to use IT. Self-determination theory (SDT) is applied to study how motivational factors impact effective IT use among frontline caregivers in residential care settings. As the team is very important to these caregivers, the team is our unit of analysis. In an embedded single case study design, interviews were conducted with all nine members of a team effectively using IT. All three basic psychological needs from SDT - autonomy, competence and relatedness - were found to have impact on effective IT use, though autonomy was primarily experienced at team level. Conversely, the effective use of an IT collaboration tool influences relatedness.
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In dit artikel wordt gekeken naar de relatie tussen het gebruik van mobiele applicaties en fysieke activiteit en gezonde leefstijl. Dit is gedaan op basis van een vragenlijst onder deelnemers aan een hardloopevenement, de Dam tot Damloop. Er werden aparte analyses gedaan voor 8km lopers en 16 km lopers. Een positieve relatie werd gevonden tussen app gebruik en meer bewegen en zich gezonder voelen. App gebruik was ook positief gerelateerd aan beter voelen over zichzelf, je voelen als een atleet, anderen motiveren om te gaan hardlopen en afvallen. Voor de 16 km lopers was app gebruik gerelateerd aan gezonder eten, zich meer energieker voelen en een hogere kans om het sportgedrag vol te houden. De resultaten van dit onderzoek laten zien dat app gebruik mogelijk een ondersteunende rol kunnen hebben in de voorbereiding op een hardloopevenemen, aangezien het gezondheid en fysieke activiteit stimuleert.
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Abstract: Combined lifestyle interventions (CLI) are focused on guiding clients with weight-related health risks into a healthy lifestyle. CLIs are most often delivered through face-to-face sessions with limited use of eHealth technologies. To integrate eHealth into existing CLIs, it is important to identify how behavior change techniques are being used by health professionals in the online and offline treatment of overweight clients. Therefore, we conducted online semi-structured interviews with providers of online and offline lifestyle interventions. Data were analyzed using an inductive thematic approach. Thirty-eight professionals with (n = 23) and without (n = 15) eHealth experience were interviewed. Professionals indicate that goal setting and action planning, providing feedback and monitoring, facilitating social support, and shaping knowledge are of high value to improve physical activity and eating behaviors. These findings suggest that it may be beneficial to use monitoring devices combined with video consultations to provide just-in-time feedback based on the client’s actual performance. In addition, it can be useful to incorporate specific social support functions allowing CLI clients to interact with each other. Lastly, our results indicate that online modules can be used to enhance knowledge about health consequences of unhealthy behavior in clients with weight-related health risks.
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Objective: The aim of this study was to obtain insight in specific elements influencing the use, non-use, satisfaction, and dissatisfaction of ankle foot orthoses (AFOs) and the presence of underexposed problems with respect to AFOs. Methods: A questionnaire was composed to obtain information from AFO users to investigate the variables associated with satisfaction and the relation between these variables. A specific feature of this study was the systematic analysis of the remarks made by the respondents about their AFO. Quantitative data analyses were used for analysing the satisfaction and qualitative analyses were used analysing the remarks of the respondents. A total of 211 users completed the questionnaire. Results: Our survey showed that 1 out of 15 AFOs were not used at all. About three quarters of the AFO users were satisfied and about one quarter was dissatisfied. Females and users living alone reported relatively high levels of dissatisfaction, especially in the field of dimensions, comfort, weight, safety and effectiveness. Dissatisfaction with respect to off-the-shelf AFOs for the item durability was higher than that for custom-made AFOs. In the delivery and maintenance process the items ‘maintenance’, ‘professionalism’ and ‘delivery follow-up’ were judged to be unsatisfactory. A large number of comments were made by the respondents to improve the device or process, mainly by the satisfied AFO users. These comments show that even satisfied users experience many problems and that a lot of problems of AFO users are ‘underexposed’. Conclusion: To improve user satisfaction, the user practice has to be identified as an important sub-process of the whole orthopaedic chain especially in the diagnosis and prescription, delivery tuning and maintenance, and evaluation phase.
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(1) Background: Recent research showed that subtypes of patients with type 2 diabetes may differ in response to lifestyle interventions based on their organ-specific insulin resistance (IR). (2) Methods: 123 Subjects with type 2 diabetes were randomized into 13-week lifestyle intervention, receiving either an enriched protein drink (protein+) or an isocaloric control drink (control). Before and after the intervention, anthropometrical and physiological data was collected. An oral glucose tolerance test was used to calculate indices representing organ insulin resistance (muscle, liver, and adipose tissue) and β-cell functioning. In 82 study-compliant subjects (per-protocol), we retrospectively examined the intervention effect in patients with muscle IR (MIR, n = 42) and without MIR (no-MIR, n = 40). (3) Results: Only in patients from the MIR subgroup that received protein+ drink, fasting plasma glucose and insulin, whole body, liver and adipose IR, and appendicular skeletal muscle mass improved versus control. Lifestyle intervention improved body weight and fat mass in both subgroups. Furthermore, for the MIR subgroup decreased systolic blood pressure and increased VO2peak and for the no-MIR subgroup, a decreased 2-h glucose concentration was found. (4) Conclusions: Enriched protein drink during combined lifestyle intervention seems to be especially effective on increasing muscle mass and improving insulin resistance in obese older, type 2 diabetes patients with muscle IR.
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Artificial intelligence (AI) integration in Unmanned Aerial Vehicle (UAV) operations has significantly advanced the field through increased autonomy. However, evaluating the critical aspects of these operations remains a challenge. In order to address this, the current study proposes the use of a combination of the 'Observe-Orient-Decide-Act (OODA)' loop and the 'Analytic Hierarchy Process (AHP)' method for evaluating AI-UAV systems. The integration of the OODA loop into AHP aims to assess and weigh the critical components of AI-UAV operations, including (i) perception, (ii) decision-making, and (iii) adaptation. The research compares the results of the AHP evaluation between different groups of UAV operators. The findings of this research identify areas for improvement in AI-UAV systems and guide the development of new technologies. In conclusion, this combined approach offers a comprehensive evaluation method for the current and future state of AI-UAV operations, focusing on operator group comparison.
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Optimizing physical performance is a major goal in current physiology. However, basic understanding of combining high sprint and endurance performance is currently lacking. This study identifies critical determinants of combined sprint and endurance performance using multiple regression analyses of physiologic determinants at different biologic levels. Cyclists, including 6 international sprint, 8 team pursuit, and 14 road cyclists, completed a Wingate test and 15-km time trial to obtain sprint and endurance performance results, respectively. Performance was normalized to lean body mass2/3 to eliminate the influence of body size. Performance determinants were obtained from whole-body oxygen consumption, blood sampling, knee-extensor maximal force, muscle oxygenation, whole-muscle morphology, and muscle fiber histochemistry of musculus vastus lateralis. Normalized sprint performance was explained by percentage of fast-type fibers and muscle volume (R2 = 0.65; P < 0.001) and normalized endurance performance by performance oxygen consumption (V̇o2), mean corpuscular hemoglobin concentration, and muscle oxygenation (R2 = 0.92; P < 0.001). Combined sprint and endurance performance was explained by gross efficiency, performance V̇o2, and likely by muscle volume and fascicle length (P = 0.056; P = 0.059). High performance V̇o2 related to a high oxidative capacity, high capillarization × myoglobin, and small physiologic cross-sectional area (R2 = 0.67; P < 0.001). Results suggest that fascicle length and capillarization are important targets for training to optimize sprint and endurance performance simultaneously.-Van der Zwaard, S., van der Laarse, W. J., Weide, G., Bloemers, F. W., Hofmijster, M. J., Levels, K., Noordhof, D. A., de Koning, J. J., de Ruiter, C. J., Jaspers, R. T. Critical determinants of combined sprint and endurance performance: an integrative analysis from muscle fiber to the human body.
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In media audience research we tend to assume that media are engaged with when they are used, however ‘light’ such engagement might be. Once ‘passive media use’ was banned as a reference to media use, being a media audience member became synonymous with being a meaning producer. In audience research however I find that media are not always the object of meaning making in daily life and that media texts can be hardly meaningful. Thinking about media and engagement, there is a threefold challenge in relation to audience research. The coming into being of platform media and hence of new forms of media production on a micro level that come out of and are woven into practices of media use, suggests that we need to redraft the repertoire of terms used in audience research (and maybe start calling it something else). Material and immaterial media production, the unpaid labour on the part of otherwise audience members should for instance be taken into account. Then, secondly, there is the continuing challenge to further develop heuristically strong ways of linking media use and meaning making, and most of all to do justice, thirdly, to those moments and ways in which audiences truly engage with media texts without identifying them with those texts.
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This paper will describe the rationale and findings from a multinational study of online uses and gratifications conducted in the United States, Korea, and the Netherlands in spring 2003. A survey research method of study was conducted using a questionnaire developed in three languages and was presented to approximately 400 respondents in each country via the Web. Web uses and gratifications were analyzed cross-nationally in a comparative fashion and focused on the perceived involvement in different types of on-line communities. Findings indicate that demographic characteristics, cultural values, and Internet connection type emerged as critical factors that explain why the same technology is adopted differently. The analyses identified seven major gratifications sought by users in each country: social support, surveillance & advice, learning, entertainment, escape, fame & aesthetic, and respect. Although the Internet is a global medium, in general, web use is more local and regional. Evidence of media use and cultural values reported by country and online community supports the hypothesis of a technological convergence between societies, not a cultural convergence.
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