Standard SARS-CoV-2 testing protocols using nasopharyngeal/throat (NP/T) swabs are invasive and require trained medical staff for reliable sampling. In addition, it has been shown that PCR is more sensitive as compared to antigen-based tests. Here we describe the analytical and clinical evaluation of our in-house RNA extraction-free saliva-based molecular assay for the detection of SARS-CoV-2. Analytical sensitivity of the test was equal to the sensitivity obtained in other Dutch diagnostic laboratories that process NP/T swabs. In this study, 955 individuals participated and provided NP/T swabs for routine molecular analysis (with RNA extraction) and saliva for comparison. Our RT-qPCR resulted in a sensitivity of 82,86% and a specificity of 98,94% compared to the gold standard. A false-negative ratio of 1,9% was found. The SARS-CoV-2 detection workflow described here enables easy, economical, and reliable saliva processing, useful for repeated testing of individuals.
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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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The aim of this study was to assess the predictive ability of the frailty phenotype (FP), Groningen Frailty Indicator (GFI), Tilburg Frailty Indicator (TFI) and frailty index (FI) for the outcomes mortality, hospitalization and increase in dependency in (instrumental) activities of daily living ((I)ADL) among older persons. This prospective cohort study with 2-year follow-up included 2420 Dutch community-dwelling older people (65+, mean age 76.3±6.6 years, 39.5% male) who were pre-frail or frail according to the FP. Mortality data were obtained from Statistics Netherlands. All other data were self-reported. Area under the receiver operating characteristic curves (AUC) was calculated for each frailty instrument and outcome measure. The prevalence of frailty, sensitivity and specifcity were calculated using cutoff values proposed by the developers and cutoff values one above and one below the proposed ones (0.05 for FI). All frailty instruments poorly predicted mortality, hospitalization and (I)ADL dependency (AUCs between 0.62–0.65, 0.59–0.63 and 0.60–0.64, respectively). Prevalence estimates of frailty in this population varied between 22.2% (FP) and 64.8% (TFI). The FP and FI showed higher levels of specifcity, whereas sensitivity was higher for the GFI and TFI. Using a different cutoff point considerably changed the prevalence, sensitivity and specifcity. In conclusion, the predictive ability of the FP, GFI, TFI and FI was poor for all outcomes in a population of pre-frail and frail community-dwelling older people. The FP and the FI showed higher values of specifcity, whereas sensitivity was higher for the GFI and TFI.
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Author supplied: "Six commercial peanut enzyme-linked immunosorbent assay kits were assessed for their ability to recover peanut from the standard reference material 2387 peanut butter and also for their specificity in detecting four major peanut allergens, Ara h 1, Ara h 2, Ara h 3, and Ara h 6. The percentage recovery of peanut from peanut butter differed across different kits as well as at different sample concentrations. The highest recovery was observed with the Romer and R-Biopharm kits, while four other kits were found to underestimate the protein content of the reference peanut butter samples. Five of the kits were most sensitive in detecting Ara h 3 followed by Ara h 1, while hardly recognizing Ara h 2 and Ara h 6. The other kit showed the highest sensitivity to Ara h 2 and Ara h 6, while Ara h 1 and Ara h 3 were poorly recognized. Although Ara h 2 and Ara h 6 are known to be heat stable and more potent allergens, antisera specific to any of these four peanut proteins/allergens may serve as good markers for the detection of peanut residues."
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Abstract Aim Screening is one of the most important ways for early frailty detection that contributes to its prevention and timely treatment. The aim of this study was to determine the diagnostic value of the Persian version of the Tilburg Frailty Indicator (P-TFI) in the frailty screening. Method This is a diagnostic test accuracy study that uses known group method. It was designed based on a STARD statement and performed on 175 elderly people in the City of Kashan, Iran. The subjects were selected among older people available in health centers affiliated to Kashan University of Medical Sciences using purposive sampling. Data analysis was carried out using SPSS v16. Descriptive statistics were used to describe the characteristics of the research subjects. Independent t-test was used to determine the ability of the P-TFI to discriminate frail and non-frail individuals, and to evaluate the cut-off point and instrument accuracy, the receiver operating characteristic (ROC) curve was used. The best cut-off point was determined among the proposed points using Youden index. At the determined cut-off point, the diagnostic value parameters of the P-TFI (sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, accuracy, and diagnostic odds ratio) were calculated and their range was estimated with 95 % confidence interval. Findings A total of 74.3 % of the sample was male and their mean age was 68.6 ± 54.44 years. The area under the ROC curve was calculated 0.922, indicating high accuracy of the instrument. The sensitivity and specificity of this instrument at the cut-off point of 4.5 were 0.95 and 0.86, respectively. Positive and negative predictive values were calculated 0.68 and 0.98, respectively, and the accuracy of the instrument was reported to be 0.88. Conclusion The P-TFI can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in older people.
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In this study we measured the performance times on the Wheelchair Mobility Performance (WMP) test during different test conditions to see if the performance times changed when wheelchair settings were changed. The overall performance time on the WMP test increased when the tire pressure was reduced and also when extra mass was attached to the wheelchair. It can be concluded that the WMP test is sensitive to changes in wheelchair settings. It is recommended to use this field-based test in further research to investigate the effect of wheelchair settings on mobility performance time. Objective: The Wheelchair Mobility Performance (WMP) test is a reliable and valid measure to assess mobility performance in wheelchair basketball. The aim of this study was to examine the sensitivity to change of the WMP test by manipulating wheelchair configurations. Methods: Sixteen wheelchair basketball players performed the WMP test 3 times in their own wheelchair: (i) without adjustments (“control condition”); (ii) with 10 kg additional mass (“weighted condition”); and (iii) with 50% reduced tyre pressure (“tyre condition”). The outcome measure was time (s). If paired t-tests were significant (p < 0.05) and differences between conditions were larger than the standard error of measurement, the effect sizes (ES) were used to evaluate the sensitivity to change. ES values ≥0.2 were regarded as sensitive to change. Results: The overall performance times for the manipulations were significantly higher than the control condition, with mean differences of 4.40 s (weight – control, ES = 0.44) and 2.81 s (tyre – control, ES = 0.27). The overall performance time on the WMP test was judged as sensitive to change. For 8 of the 15 separate tasks on the WMP test, the tasks were judged as sensitive to change for at least one of the manipulations. Conclusion: The WMP test can detect change in mobility performance when wheelchair configurations are manipulated. https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-2341
MULTIFILE
Objective: Due to the multidimensional nature of resonance disorders, multivariate diagnostic assessment is advisable. The nasality severity index (NSI) is based on this point of view. Because of the influence of personal and environmental variables on the current NSI, this study aims to refine this index. Design: Prospective case-control study. Setting: Tertiary university hospital. Patients: Forty-two patients with cleft lip and palate and 50 children without resonance disorders were tested. Interventions: Resonance was investigated by perceptual as well as objective measurements. A Nasometer was used to score nasalance, and spectral speech characteristics of a sustained sound /i:/ were determined, among which the voice low tone to high tone ratio (VLHR). Binary logistic regression analysis was performed to calculate the optimal index to discriminate patients from control children. Additionally, the validity of the index was determined based on data from an independent patient and control group. Results: The NSI 2.0, a weighted linear combination of three variables, can be obtained using the equation NSI 2.0 = 13.20 − (.0824 × nasalance /u:/ [%]) − (.260 × nasalance oral text [%]) − (.242 × VLHR 4.47*F0 [dB]). The NSI has a sensitivity of 92% and a specificity of 100%. Moreover, it has excellent validity (sensitivity 88%, specificity 89%). Conclusions: The NSI 2.0 discriminates patients from control children with high sensitivity, specificity, and validity. This multiparametric method can offer a more powerful approach in the assessment and treatment planning of individuals with hypernasality.
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BACKGROUND: Hospital stays are associated with high levels of sedentary behavior and physical inactivity. To objectively investigate physical behavior of hospitalized patients, these is a need for valid measurement instruments. The aim of this study was to assess the criterion validity of three accelerometers to measure lying, sitting, standing and walking. METHODS: This cross-sectional study was performed in a university hospital. Participants carried out several mobility tasks according to a structured protocol while wearing three accelerometers (ActiGraph GT9X Link, Activ8 Professional and Dynaport MoveMonitor). The participants were guided through the protocol by a test leader and were recorded on video to serve as reference. Sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) were determined for the categories lying, sitting, standing and walking. RESULTS: In total 12 subjects were included with a mean age of 49.5 (SD 21.5) years and a mean body mass index of 23.8 kg/m2 (SD 2.4). The ActiGraph GT9X Link showed an excellent sensitivity (90%) and PPV (98%) for walking, but a poor sensitivity for sitting and standing (57% and 53%), and a poor PPV (43%) for sitting. The Activ8 Professional showed an excellent sensitivity for sitting and walking (95% and 93%), excellent PPV (98%) for walking, but no sensitivity (0%) and PPV (0%) for lying. The Dynaport MoveMonitor showed an excellent sensitivity for sitting (94%), excellent PPV for lying and walking (100% and 99%), but a poor sensitivity (13%) and PPV (19%) for standing. CONCLUSIONS: The validity outcomes for the categories lying, sitting, standing and walking vary between the investigated accelerometers. All three accelerometers scored good to excellent in identifying walking. None of the accelerometers were able to identify all categories validly.
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Internationalizing curricula. Needs and wishes of alumni and employers with regard to international competencies. Internationalization has become of great importance for universities acrossthe globe. The labour market is becoming international, with internationalopportunities and international competition. Emerging markets such as India, China and Russia are gaining economic power. Global challenges demand world-wide solutions. Production and marketing networks span the globe and various forms of migration have resulted in a large cultural diversity within nations. As a result, societies and labour markets are changing as well. In order to deal with these societal changes adequately and to succeed in today’s labour market, graduates need to be equipped with international competencies. In a survey among 500 chief executives, ICM Research (on behalf of Think Global and The British Council, 2011) showed that employers strongly value staff members who are able to work in an international and multicultural environment. Similar results were found in Diamond et al. (2011), in which ‘multicultural teamwork’ was considered most important. The Hague University of Applied Sciences seeks to prepare its students adequately for the world of tomorrow. The University’s development plans (e.g. HogeschoolOntwikkelingsPlan, HOP 7, 2009-2013 and HOP 8, 2014-2017) indicate that its vision is to train students to be globally-minded professionals with an international and multicultural perspective, who are world-citizens, interested in global issues and able to deal with diversity in a constructive manner. They are to be professionals, who possess the competencies to function well in an international and intercultural environment. Internationalization is therefore high on the agenda of The Hague University of Applied Sciences (THUAS) which is illustrated by the fact that, as of 2014, new students in all academies have to fill 12.5% (30 ECTS) of their four-year Bachelor program with international activities. These activities can range from an internship or semester abroad (student mobility) to participating in full programs of study or minors in which English is the medium of instruction, or an internationally themed minor (Internationalization at Home, IaH). And this is only the beginning. Internationalization is a means, not an end. All THUAS courses are looking into ways in which they can internationalize their curriculum. And in doing so, they need to be innovative (Leask, 2009) and keep in mind the specific needs and wishes of alumni and their employers with regard to international competences. The THUAS research group International Cooperation supports these internationalization policy objectives by investigating various aspects, such as: • The acquisition and development of international competencies among students. • The extent to which lecturers possess international competencies and what their needs and wishes are for further development. • The international competencies THUAS graduates have acquired as part of their degree and how THUAS has stimulated this development. • The international competencies that employers and alumni consider important. Although international competencies and employability have received growing attention in internationalization research, existing studies have mainly focused on: • The effects of study abroad on the development of international competence (cf. Hoven & Walenkamp, 2013). • The effects of an experience abroad (study, internship, voluntary work) on employability. • A more general analysis of the skills employers look for in prospective employees.
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Set up: Focus on ethical agency, of which ethical sensitivity is a part Best practice unit (i.e. a community of practice with inquisitive objectives): cooperation of 12 social workers (of 6 different welfare organizations) and 2 researchers (UAS teachers) Practice based co-research: involving social workers as reflective and inquisitive professionals with regard to their own practice Phenomenological design: focus on (interpreting) experiences
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