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Uncovering the Dynamic System Driving Older Adults' Vitality: A Causal Loop Diagram Co-Created With Dutch Older Adults
No full textBackground: Most studies on older adults' vitality focus on linear connections between determinants and outcomes. To design more comprehensive and impactful approaches to support the vitality of older adults, a better understanding of the interplay among elements that shape their vitality is necessary. Objective: To uncover the underlying dynamic system that drives vitality in older adults, drawing directly from older adults' perspectives. Methods: During three group model-building sessions with 10–12 older adults (≥ 55 years old), a causal loop diagram with relevant feedback loops was developed through co-creation with older adults. The construction and analysis of the causal loop diagram were facilitated using the online modelling tools Vensim and Kumu. The group model-building sessions were guided by Scriptapedia, an online guide to conducting group model-building practices. Results: The final CLD consisted of 15 elements contributing to older adults' vitality, organised into three themes: ‘Psychological and emotional elements’, ‘Social connections and support’ and ‘Lifestyle and habits’. A total of 41 reinforcing feedback loops were identified, with 21 involving all three themes, 15 connecting two themes and 5 within a single theme. Conclusions: This study displays the complex interplay of elements influencing older adults' vitality, highlighting the critical roles of psychological, social and lifestyle-related elements. The participatory-led approach yielded co-produced insights that inform public health strategies, underscoring the need for comprehensive, multidisciplinary approaches to promote older adults' vitality. Such approaches must offer social opportunities and foster individuals' capacity and motivation to engage in meaningful social relationships. Patient or Public Contribution: The study was conducted in collaboration with a municipal policymaker and a coordinator of local community centres, who provided input on participant recruitment, materials, data interpretation, ethical considerations and result dissemination. During data collection, twelve older adults participated in three group model-building sessions, collaboratively developing a causal loop diagram to explore elements of vitality and their interconnections. Ongoing member checking with participants throughout the process ensured the analysis was refined and the researchers' interpretations were validated
The influence of ROS1 fusion partners and resistance mechanisms in ROS1-TKI-treated non-small cell lung cancer patients
No full textClinical outcomes in ROS1-fusion positive (ROS1+) non-small cell lung cancer (NSCLC) by fusion partner and resistance mechanisms are limited. This cohort study included 56 ROS1+ patients (FISH or NGS confirmed); fusion partners were identified in 27 cases, including CD74 (n = 10), EZR (n = 7), and SDC4 (n = 7). Clinical data were available for 50 patients (median age 62; 51% female; 32% never-smokers). Forty patients received tyrosine kinase inhibitors (TKIs), mostly crizotinib (n = 38). Crizotinib showed a 55% objective response rate (ORR) and a median progression-free survival (mPFS) of 5.3 months. Brain metastases (HR 2.65, 95% CI 1.06–6.60, P = 0.037) and prior chemotherapy (HR 3.17, 95% CI 1.35–7.45, P = 0.008) had a higher risk of progression. Sixteen patients received subsequent lorlatinib, with an ORR of 28% and mPFS of 3.7 months. G2032R and L2026M resistance mutations were identified in four lorlatinib non-responders, and in vitro studies confirmed resistance to lorlatinib. Fusion partners did not affect crizotinib outcomes. Lorlatinib was ineffective against on-target resistance. Real-world data showed lower TKI efficacy than clinical trials, highlighting the role of clinical and molecular factors in treatment response
Development and testing of a predictive model of symptoms for pain in community-dwelling frail older people in palliative care
No full textBackground: Pain assessment is a necessary step in pain management in older people in palliative care. In older people, pain assessment can be challenging due to underreporting and atypical pain manifestations by other distressing symptoms. Anxiety, fatigue, loss of appetite, nausea, insomnia, dyspnoea, and bowel problems correlate with pain in palliative care patients. Insight into these symptoms as predictors may help to identify the underlying presence of pain. This study aimed to develop and test a prediction model for pain in community-dwelling frail older people in palliative care. Methods: In this cross-sectional observational study, community-care nurses from multiple organizations across the Netherlands included eligible patients (life expectancy < 1 year, aged 65+, community-dwelling and frail). The outcome pain and symptoms were assessed by means of the Utrecht Symptom Diary. Also, demographic and illness information, including relevant covariates age, sex and living situation, was collected. Multivariable logistic regression and minimum Akaike Information Criterion(AIC) were used for model development and Receiver Operating Characteristics(ROC)-analysis for model performance. Additionally, predicted probability of pain are given for groups differing in age and sex. Results: A total of 157 patients were included. The final model consisted of insomnia(Odds Ratio[OR] = 2.13, 95% Confidence Interval[CI] = 1.01–1.30), fatigue(OR = 3.47, 95% CI = 1.11–1.43), sex(female)(OR = 3.83, 95% CI = 2.11–9.81) and age(OR=-1.59, 95% CI = 0.92–1.01) as predicting variables. There is an overall decreasing trend for age, older persons suffer less from pain and females have a higher probability of experiencing pain. Model performance was indicated as fair with a sensitivity of 0.74(95% CI = 0.64–0.83) and a positive predictive value of 0.80(95% CI = 0.70–0.88). Conclusions: Insomnia and fatigue are predicting symptoms for pain, especially in women and younger patients. Further testing of the model in external cohorts is needed before clinical adoption
Home-based prehabilitation for frail patients awaiting liver transplant:Preliminary results of the Fit4Cirrhotics@home study
No full textIntroductionReduced aerobic capacity and frailty are highly prevalent in liver transplant candidates and are associated with increased morbidity and mortality. Although exercise-based prehabilitation is safe and effective, adherence remains a challenge. Home-based prehabilitation may improve participation, especially when tailored to the patient’s fitness level and remotely monitored. This type of prehabilitation has shown promising results in other surgical groups1,2. However, their feasibility and effect in frail liver transplant candidates remain largely unknown. This study addresses this knowledge gap and contributes to the broader question of how best to prehabilitate highly frail patients. The aim of this study is to evaluate the effectiveness and feasibility of a remotely monitored bimodal (exercise + nutrition) prehabilitation program in frail patients with liver cirrhosis awaiting transplantation.MethodsThis ongoing investigator-initiated, single-center, single-arm, prospective clinical trial started in October 2024 at the University Medical Center Groningen, the Netherlands. Eligible patients with reduced aerobic capacity (i.e., VO₂ at the ventilatory anaerobic threshold ≤13 ml/kg/min and/or VO₂peak ≤18 ml/kg/min) participate in the bimodal lifestyle program. The program includes high-intensity interval training and endurance training based on Steep Ramp Test (SRT) results, resistance training, inspiratory muscle training, and protein supplementation. The SRT is regularly performed at home to monitor progress and adjust training intensity. Training includes two six-week home-based periods (12 weeks total, or until transplantation), followed by a final assessment at 18 weeks to evaluate the durability of the program’s effects.Primary outcome: Change in VO₂ at the ventilatory threshold and VO₂peak after six weeks of training.Secondary outcomes: Changes in sarcopenia (ultrasound, Liver Frailty Index), functional mobility, perceived fatigue, quality of life, number of hospital admissions, incidence of hepatic encephalopathy, microbiome composition, blood biomarkers, and postoperative outcomes. Feasibility is assessed through participation rate, adherence to prescribed training sessions and protein intake, and safety. ResultsAt the time of submission, 41 patients were screened and 9 were included. The majority of exclusions were due to either adequate fitness or underlying liver disease without cirrhosis (e.g., ADPKD). The participation rate was 82%. Among those included, three have completed the first training period with available primary outcome data, three are currently in training, and three underwent liver transplantation before the first reassessment. While the primary outcomes showed variable patterns, consistent improvements in SRT performance were observed (figure 1). Adherence varied due to disease-related instability and intercurrent hospital admissions. It appears safe, since there have been no intervention-related adverse events until now. The other secondary outcomes are not available to present yet.ConclusionThis early-phase study demonstrates that home-based, remotely monitored prehabilitation is feasible and acceptable in frail liver transplant candidates. Although consistent improvements in CPET outcomes could not be demonstrated because of variable results and incomplete data, measurable improvements in functional capacity were seen when assessed with the Steep Ramp Test. Conducting structured research in this vulnerable population was challenging, as clinical instability and hospital admissions often disrupted the intervention and assessments. However, these difficulties reflect the real-world fragility of liver transplant candidates. These interim findings underscore the need for flexible, patient-centered prehabilitation and support the potential of home-based approaches not only in liver transplant candidates but also in other highly vulnerable surgical populations. Recruitment is ongoing toward a target of 24 patients.IntroductionReduced aerobic capacity and frailty are highly prevalent in liver transplant candidates and are associated with increased morbidity and mortality. Although exercise-based prehabilitation is safe and effective, adherence remains a challenge. Home-based prehabilitation may improve participation, especially when tailored to the patient’s fitness level and remotely monitored. This type of prehabilitation has shown promising results in other surgical groups1,2. However, their feasibility and effect in frail liver transplant candidates remain largely unknown. This study addresses this knowledge gap and contributes to the broader question of how best to prehabilitate highly frail patients. The aim of this study is to evaluate the effectiveness and feasibility of a remotely monitored bimodal (exercise + nutrition) prehabilitation program in frail patients with liver cirrhosis awaiting transplantation.MethodsThis ongoing investigator-initiated, single-center, single-arm, prospective clinical trial started in October 2024 at the University Medical Center Groningen, the Netherlands. Eligible patients with reduced aerobic capacity (i.e., VO₂ at the ventilatory anaerobic threshold ≤13 ml/kg/min and/or VO₂peak ≤18 ml/kg/min) participate in the bimodal lifestyle program. The program includes high-intensity interval training and endurance training based on Steep Ramp Test (SRT) results, resistance training, inspiratory muscle training, and protein supplementation. The SRT is regularly performed at home to monitor progress and adjust training intensity. Training includes two six-week home-based periods (12 weeks total, or until transplantation), followed by a final assessment at 18 weeks to evaluate the durability of the program’s effects.Primary outcome: Change in VO₂ at the ventilatory threshold and VO₂peak after six weeks of training.Secondary outcomes: Changes in sarcopenia (ultrasound, Liver Frailty Index), functional mobility, perceived fatigue, quality of life, number of hospital admissions, incidence of hepatic encephalopathy, microbiome composition, blood biomarkers, and postoperative outcomes. Feasibility is assessed through participation rate, adherence to prescribed training sessions and protein intake, and safety. ResultsAt the time of submission, 41 patients were screened and 9 were included. The majority of exclusions were due to either adequate fitness or underlying liver disease without cirrhosis (e.g., ADPKD). The participation rate was 82%. Among those included, three have completed the first training period with available primary outcome data, three are currently in training, and three underwent liver transplantation before the first reassessment. While the primary outcomes showed variable patterns, consistent improvements in SRT performance were observed (figure 1). Adherence varied due to disease-related instability and intercurrent hospital admissions. It appears safe, since there have been no intervention-related adverse events until now. The other secondary outcomes are not available to present yet.ConclusionThis early-phase study demonstrates that home-based, remotely monitored prehabilitation is feasible and acceptable in frail liver transplant candidates. Although consistent improvements in CPET outcomes could not be demonstrated because of variable results and incomplete data, measurable improvements in functional capacity were seen when assessed with the Steep Ramp Test. Conducting structured research in this vulnerable population was challenging, as clinical instability and hospital admissions often disrupted the intervention and assessments. However, these difficulties reflect the real-world fragility of liver transplant candidates. These interim findings underscore the need for flexible, patient-centered prehabilitation and support the potential of home-based approaches not only in liver transplant candidates but also in other highly vulnerable surgical populations. Recruitment is ongoing toward a target of 24 patients
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No full textBlog over Talentenkracht in de KunsteducatieBlog on the Curious Minds approach in arts educatio
Laat de nuance terugkomen in de energietransitie
No full textDe energietransitie is misschien wel het meest ingrijpende project van onze tijd. Op verjaardagen zijn zonnepanelen en energiebesparing inmiddels belangrijke gespreksthema’s. Nederland is aardig op weg, ziet Martien Visser. “Zo is de broeikasgasemissie al met 35% gereduceerd en het aandeel hernieuwbare energie is al ruim boven de 20%. Ondertussen blijkt de transitie uitdagender dan soms gedacht. We zien ook steeds meer de consequenties voor onze leefomgeving. Voorheen was het energiesysteem vooral ondergronds en geconcentreerd op een beperkt aantal locaties; nu wordt het steeds zichtbaarder en daarmee neemt de overlast toe. Bovendien wordt het allemaal duurder.
Abstract redeneren tijdens programmeerlessen:Een empirisch onderzoek met inzichten voor de praktijk
Get PDFDigitale vaardigheden is een belangrijk en nieuw onderwijsgebied in het basisonderwijs. Onderdeel hiervan is computational thinking, wat leerlingen helpt bij het oplossen van problemen door elementen uit de informatica te gebruiken. Abstractie speelt hierbij een belangrijke rol. Abstractie is een complex concept. Onze inspanningen hebben ertoe geleid dat het makkelijker wordt om abstractie te herkennen en observeren, aan de hand van abstractielagen. Hiermee kunnen leerlingen op het juiste moment adequate ondersteuningen krijgen. We bespreken twee onderzoeken: in het eerste onderzoek hebben we observeerbaar gedrag gekoppeld aan abstractie, en in het tweede onderzoek hebben we bovenbouwleerlingen laten programmeren en daarin ook de link gelegd met abstractie. Tijdens het tweede onderzoek hebben we gebruikgemaakt van PRIMM, een lesopzet specifiek voor programmeerlessen in het basisonderwijs, die gezien kan worden als een vorm van structuur en scaffolding. Uit beide onderzoeken komen interessante uitkomsten: patronen in hoe leerlingen op verschillende abstractielagen redeneren en hoe leerlingen elkaar kunnen beïnvloeden. Aan de hand van een aantal voorbeelden lichten we de resultaten nader toe. We zijn nog niet klaar, want de uiteindelijke stap is kijken hoe een leerkracht een interventie kan toepassen in dit proces. We hebben met onze onderzoeken wel een duidelijke richting in hoe we die interventie kunnen vormgeven
A dynamic view on the musical development of young children in education
Get PDFDit artikel bespreekt een dynamische benadering van de muzikale (talent)ontwikkeling bij jonge kinderen (Steenbeek, Van Geert & Van Dijk, 2011). Volgens een theoretisch, dynamisch kader is ontwikkeling een emergente eigenschap. Talent kan bij elk kind ontstaan als er een opwaarts dynamisch proces tot stand komt in de interactie tussen kind, volwassene en de activiteit. Het gebruik van Expressed Pedagogical Content Knowledge (EPCK; vgl. Geveke, 2017) door de volwassene is de sleutel om een positieve talentspiraal tot stand te brengen. Een dynamische kijk op ontwikkeling gaat terug op het werkvan pedagogen als Vygotsky, Piaget, Bruner en Dewey, en is verbonden met het sociaal-constructivisme. Daarnaast hebben de ecologische theorieën van Bronfenbrenner en Gibson er een belangrijke invloed op gehad. Verder is deze visie op macro-theoretisch niveau verwant aan theorieën over motivatie, zelfbeschikking en zelfregulering (Deci & Ryan, 2000), en over self-efficacy (Eraut, 2004). Het doel van deze studie is het beschrijven en evalueren van een inventarisatie van onderzoek naar muziekeducatieve praktijken voor jonge kinderen vanuit een dynamisch perspectief. Bij wijze van kwalitatieve inhoudsanalyse is een literatuurstudie uitgevoerd naar muziekeducatieve praktijken bij jonge kinderen. Deze studie heeft verschillende voorbeelden opgeleverd van veelbelovende praktijken die dynamische kenmerken vertonen. De resultaten geven aan dat onderzoek vanuit een dynamisch oogpunt naar betekenisvolle muziek-educatieve praktijken internationaal ‘in de lucht hangt’. Door een gebrek aan gedetailleerde analyses binnen de studies van activiteiten op de microtijdschaal blijft de kracht van EPCK echter meestal een blinde vlek. Door te focussen op EPCK kan onderzoek bijdragen aan kennis over hoe professionals meer ontwikkelingskansen voor kinderen kunnen creëren.Dutch-language article containing a literature review of articles on music education based on a dynamic view of musical development
Polyhydroxyalkanoate (PHA) production by thermophilic Caldimonas thermodepolymerans comb. nov. from xylan
Get PDFFor the future circular economy, renewable carbon feedstocks manifest considerable promise for synthesizing sustainable and biodegradable polyhydroxyalkanoate (PHA). In this study, 16 wt% and 30 wt% PHA (cell dry weight) are respectively produced by thermophilic Caldimonas thermodepolymerans from beechwood xylan and wheat arabinoxylan as the sole carbon source. Moreover, an in silico study of the potential xylan-degrading proteins was conducted using proteome sequencing and CAZyme specialized bioinformatic tools. This study demonstrates the feasibility of utilizing complex polysaccharide substrates for PHA biosynthesis, thereby potentially eliminate additional processing steps and reducing overall production costs for sustainable plastic