An operational amplifier based instrumentation amplifier (IA) with a common-mode rejection ratio (CMRR) independent of resistance tolerances is presented in this paper. The CMRR is determined by the operational amplifier characteristics. The IA shows a high CMRR up to 100 kHz. Moreover, since the presented IA operates in the current domain, no large internal voltage swings occur, making it an interesting choice for low-voltage applications in situations where common-mode disturbances may affect the signal processing.
DOCUMENT
Abstract: Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
DOCUMENT
Objective: In myocardial perfusion single-photon emission computed tomography (SPECT), abdominal activity often interferes with the evaluation of perfusion in the inferior wall, especially after pharmacological stress. In this randomized study, we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images (MPI) studies. Methods: A total of 467 MIBI studies were randomized into a carbonated water group and a water group. The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers. Furthermore, a semiquantitative analysis was performed in the adenosine subgroup,using a count ratio of the inferior myocardial wall and adjacent abdominal activity. Results: The need for repeated SPECT in the adenosine studies was 5.3 % in the carbonated water group versus 19.4 % in the still water group (p = 0.019). The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group (2.11 ± 1.00 vs. 1.72 ± 0.73, p\0.001). The effect of carbonated water during rest and after exercise was not significant. Conclusions: This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI. Keywords: Extra-cardiac radioactivity, Myocardial SPECT, Image quality enhancement, Carbonated water
DOCUMENT
Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization’s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations’ inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects.
DOCUMENT
Background:The last decade has seen a substantial increase in the use of mobile health apps and research into the effects of those apps on health and health behaviors. In parallel, research has aimed at identifying population subgroups that are more likely to use those health apps. Current evidence is limited by two issues. First, research has focused on broad health apps, and little is known about app usage for a specific health behavior. Second, research has focused on comparing current users and current nonusers, without considering subgroups of nonusers.Objective:We aimed to provide profile distributions of current users, previous users, and informed nonusers, and to identify predictor variables relevant for profile classification.Methods:Data were available from 1683 people who participated in a Dutch walking event in Amsterdam that was held in September 2017. They provided information on demographics, self-reported walking behavior, and walking app usage, as well as items from User Acceptance of Information Technology, in an online survey. Data were analyzed using discriminant function analysis and multinomial logistic regression analysis.Results:Most participants were current walking app users (899/1683, 53.4%), while fewer participants were informed nonusers (663/1683, 39.4%) and very few were previous walking app users (121/1683, 7.2%). Current walking app users were more likely to report walking at least 5 days per week and for at least 30 minutes per bout (odds ratio [OR] 1.44, 95% CI 1.11-1.85; P=.005) and more likely to be overweight (OR 1.72, 95% CI 1.24-2.37; P=.001) or obese (OR 1.49, 95% CI 1.08-2.08; P=.005) as compared with informed nonusers. Further, current walking app users perceived their walking apps to be less boring, easy to use and retrieve information, and more helpful to achieve their goals. Effect sizes ranged from 0.10 (95% CI 0.08-0.30) to 1.58 (95% CI 1.47-1.70).Conclusions:The distributions for walking app usage appeared different from the distributions for more general health app usage. Further, the inclusion of two specific subgroups of nonusers (previous users and informed nonusers) provides important information for health practitioners and app developers to stimulate continued walking app usage, including making information in those apps easy to understand and making it easy to obtain information from the apps, as well as preventing apps from becoming boring and difficult to use for goal attainment.
DOCUMENT
Enhancing sweetness of vegetables by addition of sucrose or sweeteners can increase acceptance but is not necessarily desirable. An alternative strategy could be to combine vegetables with other vegetables. By offering combinations of vegetables it might be possible to suppress bitterness, enhance sweetness and provide texture variety leading to increased acceptance. The aim of this study was to determine the influence of combining vegetables with other vegetables on sensory properties and acceptance. Carrot (sweet), cucumber (neutral), green bell pepper (bitter) and red bell pepper (sour) were assessed individually and in combination with the other three vegetables in two mixing ratios (1:2 and 2:1). Additionally, four combinations of three vegetables (mixing ratio 1:1:1) were assessed. A trained panel (n = 24) evaluated taste, flavour and texture and a consumer panel (n = 83) evaluated acceptance of all vegetables and combinations. Combining green bell pepper with carrot (1:2 and 2:1) increased sweetness and decreased bitterness. Combining cucumber, carrot or red bell pepper with green bell pepper (1:2) increased bitterness. Mainly sweetness and bitterness were associated with acceptance whereas texture (crunchiness, firmness and juiciness) did not strongly influence acceptance. Cucumber was the most accepted vegetable followed by carrot, red bell pepper and green bell pepper. Acceptance of vegetable combinations can differ from acceptance of individual vegetables depending on vegetable type and mixing ratio. Only 3 of 16 vegetable combinations had higher acceptance compared to the least accepted vegetable in the combination and similar acceptance as the more accepted vegetable in the combination. For 13 of 16 vegetable combinations acceptance did not increase compared to acceptance of individual vegetables. These findings suggest that strategies aimed at increasing vegetable consumption can be devised using specific combinations of vegetables.
DOCUMENT
This paper presents a mixed methods study in which 77 students and 3 teachers took part, that investigated the practice of Learning by Design (LBD). The study is part of a series of studies, funded by the Netherlands Organisation for Scientific Research (NWO), that aims to improve student learning, teaching skills and teacher training. LBD uses the context of design challenges to learn, among other things, science. Previous research showed that this approach to subject integration is quite successful but provides little profit regarding scientific concept learning. Perhaps, when the process of concept learning is better understood, LBD is a suitable method for integration. Through pre- and post-exams we measured, like others, a medium gain in the mastery of scientific concepts. Qualitative data revealed important focus-related issues that impede concept learning. As a result, mainly implicit learning of loose facts and incomplete concepts occurs. More transparency of the learning situation and a stronger focus on underlying concepts should make concept learning more explicit and coherent.
DOCUMENT
Challenges that surveys are facing are increasing data collection costs and declining budgets. During the past years, many surveys at Statistics Netherlands were redesigned to reduce costs and to increase or maintain response rates. From 2018 onwards, adaptive survey design has been applied in several social surveys to produce more accurate statistics within the same budget. In previous years, research has been done into the effect on quality and costs of reducing the use of interviewers in mixed-mode surveys starting with internet observation, followed by telephone or face-to-face observation of internet nonrespondents. Reducing follow-ups can be done in different ways. By using stratified selection of people eligible for follow-up, nonresponse bias may be reduced. The main decisions to be made are how to divide the population into strata and how to compute the allocation probabilities for face-to-face and telephone observation in the different strata. Currently, adaptive survey design is an option in redesigns of social surveys at Statistics Netherlands. In 2018 it has been implemented in the Health Survey and the Public Opinion Survey, in 2019 in the Life Style Monitor and the Leisure Omnibus, in 2021 in the Labour Force Survey, and in 2022 it is planned for the Social Coherence Survey. This paper elaborates on the development of the adaptive survey design for the Labour Force Survey. Attention is paid to the survey design, in particular the sampling design, the data collection constraints, the choice of the strata for the adaptive design, the calculation of follow-up fractions by mode of observation and stratum, the practical implementation of the adaptive design, and the six-month parallel design with corresponding response results.
DOCUMENT
Among other things, learning to write entails learning how to use complex sentences effectively in discourse. Some research has therefore focused on relating measures of syntactic complexity to text quality. Apart from the fact that the existing research on this topic appears inconclusive, most of it has been conducted in English L1 contexts. This is potentially problematic, since relevant syntactic indices may not be the same across languages. The current study is the first to explore which syntactic features predict text quality in Dutch secondary school students’ argumentative writing. In order to do so, the quality of 125 argumentative essays written by students was rated and the syntactic features of the texts were analyzed. A multilevel regression analysis was then used to investigate which features contribute to text quality. The resulting model (explaining 14.5% of the variance in text quality) shows that the relative number of finite clauses and the ratio between the number of relative clauses and the number of finite clauses positively predict text quality. Discrepancies between our findings and those of previous studies indicate that the relations between syntactic features and text quality may vary based on factors such as language and genre. Additional (cross-linguistic) research is needed to gain a more complete understanding of the relationships between syntactic constructions and text quality and the potential moderating role of language and genre.
DOCUMENT
Abstract gepubliceerd in Elsevier: Introduction: Recent research has identified the issue of ‘dose creep’ in diagnostic radiography and claims it is due to the introduction of CR and DR technology. More recently radiographers have reported that they do not regularly manipulate exposure factors for different sized patients and rely on pre-set exposures. The aim of the study was to identify any variation in knowledge and radiographic practice across Europe when imaging the chest, abdomen and pelvis using digital imaging. Methods: A random selection of 50% of educational institutes (n ¼ 17) which were affiliated members of the European Federation of Radiographer Societies (EFRS) were contacted via their contact details supplied on the EFRS website. Each of these institutes identified appropriate radiographic staff in their clinical network to complete an online survey via SurveyMonkey. Data was collected on exposures used for 3 common x-ray examinations using CR/DR, range of equipment in use, staff educational training and awareness of DRL. Descriptive statistics were performed with the aid of Excel and SPSS version 21. Results: A response rate of 70% was achieved from the affiliated educational members of EFRS and a rate of 55% from the individual hospitals in 12 countries across Europe. Variation was identified in practice when imaging the chest, abdomen and pelvis using both CR and DR digital systems. There is wide variation in radiographer training/education across countries.
DOCUMENT
