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Contains fulltext : 290128.pdf (Publisher’s version ) (Open Access)

Curative treatment of low-risk prostate cancer (LR-PCa) does not improve cancer specific survival and active surveillance (AS) is recommended. Although AS is cost-effective and reduces treatment-related complications, it requires psychosocial support. Research on psychosocial interventions specifically focused on men undergoing AS is limited. Aim of this study is to reach consensus amongst relevant stakeholders on selecting interventions offering psychosocial support to PCa patients during AS.In accordance with the RAND/UCLA method, a modified Delphi approach was used to establish consensus on selecting interventions. During phase one, interventions were identified through a literature review and open survey among all participants. During phase two, three consensus rounds were conducted to rate potential interventions and obtain statistical consensus. The IQ healthcare consensus tool was used to calculate statistical consensus.After the first consensus round, 31 participants scored individual interventions on relevance using a 9-point Likert scale resulting in the selection of six interventions. During the second consensus round 13 discussion items were reviewed during a focus group. After the third consensus round, seven additional interventions were selected by 23 participants.In total, 13 interventions were selected for inclusion in a support program. This included four interventions within the domain information and education, three within coping and support, one intervention within physical wellbeing and four within the domain lifestyle.

BACKGROUND: Gait deficits in people with Parkinson's disease (PD) are triggered by circumstances requiring gait adaptation. The effects of gait adaptation training on a split-belt treadmill (SBT) are unknown in PD. OBJECTIVE: We investigated the effects of repeated SBT versus tied-belt treadmill (TBT) training on retention and automaticity of gait adaptation and its transfer to over-ground walking and turning. METHODS: We recruited 52 individuals with PD, of whom 22 were freezers, in a multi-center randomized single-blind controlled study. Training consisted of 4 weeks of supervised treadmill training delivered three times per week. Tests were conducted pre- and post-training and at 4-weeks follow-up. Turning (primary outcome) and gait were assessed over-ground and during a gait adaptation protocol on the treadmill. All tasks were performed with and without a cognitive task. RESULTS: We found that SBT-training improved gait adaptation with moderate to large effects sizes (P

BACKGROUND: Although most patients with Parkinson's disease (PD) present difficulties of bed mobility, the contributing factors to impaired bed mobility in PD are unknown. OBJECTIVE: To compare bed mobility and muscle strength between PD patients and healthy controls, and investigate the determinants of bed mobility in PD. METHODS: Sixteen patients with PD and ten age- and sex-matched healthy controls (HC) were enrolled. Time and pattern to get out of bed to their preferred side at usual speed, muscle torque in lower extremities and motor symptom burden were also measured. RESULTS: PD exhibited significantly slower speed in bed mobility and lower torque in the hip adductor/abductor/flexor muscle than HC. Slower movement time in PD was correlated with weaker hip adductor torque on the more affected side (Rs = -0.56, p

SIGNIFICANCE: Functional near-infrared spectroscopy (fNIRS) is increasingly employed in studies requiring repeated measurements, yet test-retest reliability is largely unknown. AIM: To investigate test-retest reliability during a postural and a finger-tapping task with and without cap-removal. APPROACH: Twenty healthy older adults performed a postural and a finger-tapping task. The tasks were repeated twice in one session and once the next day. A portable fNIRS system measured cortical hemodynamics (HbO2) in five regions of interest for the postural task and in the hand motor region for finger-tapping. RESULTS: Test-retest reliability without cap-removal was excellent for the prefrontal cortex (PFC), the premotor cortex (PMC) and the somatosensory cortex (SSC) (intraclass correlation coefficient (ICC)≥0.78), and fair for the frontal eye fields (FEF) and the supplementary motor area (SMA) (ICC≥0.48). After cap-removal, reliability reduced for PFC and SSC (ICC≥0.50), became poor for SMA (ICC=0.01) and PMC (ICC=0.00) and remained good for FEF (ICC=0.64). Similarly, good reliability (ICC=0.66) was apparent for the hand motor region without cap-removal, which deteriorated after cap-removal (ICC=0.38). CONCLUSIONS: Test-retest reliability of fNIRS measurements during two separate motor tasks in healthy older adults was fair to excellent when the cap remained in place. However, removing the fNIRS cap between measurements compromised reliability. ispartof: Neurophotonics vol:10 issue:2 pages:025010- ispartof: location:United States status: published

Background Our earlier work showed that automaticity and retention of writing skills improved with intensive writing training in Parkinson’s disease (PD). However, whether this training changed the resting-state networks in the brain and how these changes underlie retention of motor learning is currently unknown. Objective To examine changes in resting-state functional connectivity (rs-FC) and their relation to behavioral changes immediately after writing training and at 6 week follow-up. Methods Twenty-five PD patients underwent resting-state fMRI (ON medication) before and after 6 weeks writing training. Motor learning was evaluated with a dual task paradigm pre- and post-training and at follow-up. Next, pre-post withinnetwork changes in rs-FC were identified by an independent component analysis. Significant clusters were used as seeds in ROI-to-ROI analyses and rs-FC changes were correlated with changes in behavioral performance over time. Results Similar to our larger cohort findings, writing accuracy in single and dual task conditions improved post-training and this was maintained at follow-up. Connectivity within the dorsal attentional network (DAN) increased pre-post training, particularly with the right superior and middle temporal gyrus (rS/MTG). This cluster also proved more strongly connected to parietal and frontal areas and to cerebellar regions. Behavioral improvements from pre- to post-training and follow-up correlated with increased rs-FC between rS/MTG and the cerebellum. Conclusions Training-driven improvements in dual task writing led to functional reorganization within the DAN and increased connectivity with cerebellar areas. These changes were associated with the retention of writing gains and could signify task-specific neural changes or an inability to segregate neural networks. ispartof: Journal Of Neurology vol:269 issue:9 pages:4696-4707 ispartof: location:Germany status: Published online

Motor control of automatized and overlearned sequences, such as writing, is affected in Parkinson's disease (PD), impacting patients' daily life. Medication effects on motor performance are not only task-specific, but also variable within tasks. The nature of this variance is still unclear. This study aimed to investigate whether medication affects writing sequences differently when producing up- or downstrokes. Writing was assessed in healthy controls (HC) (N = 31) and PD (N = 32), when ON and OFF medication in a randomized order (interspersed by two months). Subjects wrote a sequential pattern with an increasing size on a digital tablet. Writing outcomes were movement vigor (amplitude and velocity), error and end-point variability, and sequence continuation, calculated separately for up- and downstrokes. Results showed that PD patients OFF-medication reduced movement vigor (amplitude) for up- and downstrokes compared to HC. Clear deficits were found for up- but not for downstroke error in PD patients in OFF, suggesting a directional bias. Dopaminergic medication improved motor vigor by increasing writing amplitude and upstroke continuation, but this occurred at the cost of the downstroke trajectory. Other writing outcomes did not improve with medication intake. In conclusion, we interpret these findings as that the impact of dopamine is complex, highly task-specific, supporting the most highly energy demanding components of a writing sequence. As medication did not regulate downstroke writing, we recommend supplementary training to address task demands that were less modulated by dopamine (registration: https://osf.io/gk5q8/ , 17 July 2018).

Contains fulltext : 248095.pdf (Publisher’s version ) (Open Access) Since coronavirus disease 2019 (COVID-19) entered the Netherlands, the older adults (aged 70 or above) were recommended to isolate themselves, resulting in less social contact and possibly increased loneliness. The aim of this qualitative study was to explore independently living older adults' perceptions of social and emotional well-being during the COVID-19-related self-isolation, and their motivation to expand their social network in the future. Semi-structured phone interviews were held with 20 community-dwelling adults (age range 56-87; 55% female) between April and June 2020 in the Netherlands. The interviews were audio recorded and transcribed verbatim. Open coding process was applied to identify categories and themes. Participants said to use more digital technologies to maintain contacts and adapt to the government measurements. Most participants missed the lack of social contacts, while some participants had no problems with the reduced social contacts. The emotional well-being of most participants did not change. Some participants felt unpleasant or mentioned that the mood of other people had changed. Participants were not motivated to expand their social network because of existing strong networks. The relatively vital community-dwelling older adults in this study were able to adapt to the government recommendations for self-isolation with limited negative impact on their socio-emotional well-being.

The complex care needs of frail older persons living at home is a major challenge for health care systems worldwide. One possible solution is to employ a primary care physician (PCP) with additional geriatric expertise. In the Netherlands, elderly care physicians (ECPs), who traditionally work in nursing homes, are increasingly encouraged to utilize their expertise within primary care. However, little is known about how PCPs and ECPs collaborate. Therefore, we aimed to unravel the nature of the current PCP-ECP collaboration in primary care for frail older persons, and to identify key concepts for success.A qualitative multiple case study with semistructured interviews.A selection of 22 participants from 7 "established collaboration practices" within the primary care setting in the Netherlands, including at least 1 ECP, 1 PCP, and 1 other health care professional for every included established collaboration practice.Transcripts of individual interviews were analyzed using largely double and independent open and axial coding, and formulation of themes and subthemes.Data analysis revealed 4 key concepts for success: (1) clarification of roles and expectations (ie, patient-centered care and embedding in existing care networks), (2) trust, respect, and familiarity as drivers for collaboration (ie, mutual trust through knowing each other and having shared goals); (3) framework for regular communication (ie, structural meetings and a shared vision); and (4) government, payer, and organization support (ie, financial support and emphasis on the collaboration's urgency by organizations and national policy makers).For a successful generalist-specialist collaboration, health care professionals need to invest in building relationships and mutual trust, and incorporating their efforts in the existing care networks to guarantee patient-centeredness. When provided with reimbursement and appreciation, this collaboration is a promising change in general practice to improve the care and outcomes of frail older persons.

Cancer cells make extensive use of the folate cycle to sustain increased anabolic metabolism. Multiple chemotherapeutic drugs interfere with the folate cycle, including methotrexate and 5-fluorouracil that are commonly applied for the treatment of leukemia and colorectal cancer (CRC), respectively. Despite high success rates, therapy-induced resistance causes relapse at later disease stages. Depletion of folylpolyglutamate synthase (FPGS), which normally promotes intracellular accumulation and activity of both natural folates and methotrexate, is linked to methotrexate and 5-fluorouracil resistance and its association with relapse illustrates the need for improved intervention strategies. In this study, we characterize a novel antifolate (C1) that, like methotrexate, potently inhibits dihydrofolate reductase (DHFR) and downstream one-carbon metabolism. Contrary to methotrexate, however, C1 displays optimal efficacy in FPGS-deficient contexts, due to decreased competition with intracellular folate concentrations for interaction with DHFR. Indeed, we show that FPGS-deficient patient-derived CRC organoids display enhanced sensitivity to C1-induced growth inhibition, while FPGS-high CRC organoids are more sensitive to methotrexate. Our results thus argue that polyglutamylation-independent antifolates can be applied to exert selective pressure on FPGS-deficient cells during chemotherapy, employing a vulnerability created by polyglutamylation deficiency.

Contains fulltext : 290631.pdf (Publisher’s version ) (Open Access) INTRODUCTION: Care integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting in the Netherlands. METHODS: In a cross-sectional study, the RMIC-MT, a 36-item questionnaire covering all domains of the Rainbow Model of Integrated Care (RMIC), was sent out to local networks of primary elderly care professionals. Confirmatory factor analysis with maximum likelihood estimation was used for the validation of the factor structure of the RMIC-MT. Model fit was assessed by the chi-square test and fit indices. RESULTS: The RMIC-MT was completed by 323 professionals, primarily general practitioners, community nurses, practice nurses, and case managers. Confirmatory factor analysis and corresponding fit indices showed moderate to good fit, thereby confirming a nine factor model with a total of 36 items. CONCLUSIONS: The RMIC-MT is promising for the primary elderly care setting in the Netherlands. It can be used for evaluating integrated care initiatives in a primary care setting, thereby contributing to implementation of integrated primary elderly care.

Age-related difficulties and quarantine restrictions impede the possibilities to maintain contact with one’s social network. Maintaining these contacts may be supported by digital games. To develop effective and feasible digital tools to foster social interaction, we aimed to explore what older adults find important in social contact and what barriers and enablers they foresee in digital gaming interventions as network support aids. Two focus groups and 20 semi-structured interviews (N = 29) with older adults (aged 55–87) were held to explore the research questions. Furthermore, a questionnaire was administered (N = 29) containing measures of loneliness, frailty, and social network size. Participants found ‘reciprocity’, ‘in-person contact’, and ‘personal connection’ important in contact with strong ties. Online games were not used much for socializing but may be used in the future, particularly by less mobile older adults. Future social gaming interventions should be challenging, user-friendly, and offer the possibility to communicate. Digital co-designed interventions that are feasible, challenging, intuitive, and trigger meaningful communication may strengthen social interactions in older adults. They may be a relevant social support tool in periods of interaction limitations due to functional impairment or social isolation.

Highlights•Parkinson’s disease studies historically focus on selective subgroups and motor symptoms.•We examined 33 Parkinson’s disease studies at a single center between 2003 and 2021.•We observed no temporal changes in adequate representation by sex, age or ethnicity.•It was equivocal whether assessment of non-motor symptoms increased over time.•Improved representation and non-motor assessments are warranted in future studies.AbstractBackgroundFemales, people with young-onset PD and older individuals, and non-white populations are historically underrepresented in clinical Parkinson’s disease (PD) research. Furthermore, research traditionally focused predominantly on motor symptoms of PD. Including a representative and diverse group of people with PD and also studying non-motor symptoms is warranted to better understand heterogeneity in PD and to generalize research findings.ObjectiveThis project aimed to determine whether, within a consecutive series of PD studies performed within a single center in the Netherlands: (1) the proportion of included females, mean age and proportion of native Dutch people changed over time; and 2) reports of the ethnicity of participants and the proportion of studies with non-motor outcomes changed over time.MethodsCharacteristics of participants and non-motor outcomes were analyzed using a unique dataset of summary statistics of studies with a large number of participants conducted at a single center during a 19-year period (2003–2021).ResultsResults indicate no relationship between calendar time and proportion of females (mean 39 %), mean age (66 years), proportion of studies that reported ethnicity, and proportion of native Dutch people in studies (range 97–100 %). The proportion of participants in whom non-motor symptoms were assessed increased, but this difference was consistent with chance.ConclusionStudy participants in this center reflect the PD population in the Netherlands in terms of sex, but older individuals and non-native Dutch individuals are under-represented. We have still a lot to do in ensuring adequate representation and diversity in PD patients within our research.

Contains fulltext : 290694.pdf (Publisher’s version ) (Open Access) Age-related difficulties and quarantine restrictions impede the possibilities to maintain contact with one's social network. Maintaining these contacts may be supported by digital games. To develop effective and feasible digital tools to foster social interaction, we aimed to explore what older adults find important in social contact and what barriers and enablers they foresee in digital gaming interventions as network support aids. Two focus groups and 20 semi-structured interviews (N = 29) with older adults (aged 55-87) were held to explore the research questions. Furthermore, a questionnaire was administered (N = 29) containing measures of loneliness, frailty, and social network size. Participants found 'reciprocity', 'in-person contact', and 'personal connection' important in contact with strong ties. Online games were not used much for socializing but may be used in the future, particularly by less mobile older adults. Future social gaming interventions should be challenging, user-friendly, and offer the possibility to communicate. Digital co-designed interventions that are feasible, challenging, intuitive, and trigger meaningful communication may strengthen social interactions in older adults. They may be a relevant social support tool in periods of interaction limitations due to functional impairment or social isolation.

Contains fulltext : 292325.pdf (Publisher’s version ) (Open Access) Communication and coordination between primary healthcare professionals and informal caregivers involved in the care for frail older adults is suboptimal and could benefit from interprofessional digital communication tools. Implementation in daily practice however frequently fails. We aim to identify generic barriers and facilitators experienced by healthcare professionals and informal caregivers during implementation of interprofessional communication tools to improve their long-term use. Qualitative content analysis using individual semi-structured interviews was used for evaluating three different digital communication tools used by interprofessional primary care networks for frail older adults by 28 professionals and 10 caregivers. After transcription and open coding, categories and themes were identified. Barriers and facilitators were related to: tool characteristics, context of use, involvement of professionals and caregivers. The tool improved availability, approachability and users' involvement. The large number of digital systems professionals simultaneously use, and different work agreements hampered tool use. The tools facilitated care coordination, and professionals declared to be better informed about patients' current situations. Overall, interprofessional digital communication tools can facilitate communication in networks for primary elderly care. However, integration between digital systems is needed to reduce the number of tools. Organizations and policy makers have an important role in realizing the tools' long-term use.

We show how to find all $k$ marked elements in a list of size $N$ using the optimal number $O(\sqrt{N k})$ of quantum queries and only a polylogarithmic overhead in the gate complexity, in the setting where one has a small quantum memory. Previous algorithms either incurred a factor $k$ overhead in the gate complexity, or had an extra factor $\log(k)$ in the query complexity. We then consider the problem of finding a multiplicative $\delta$-approximation of $s = \sum_{i=1}^N v_i$ where $v=(v_i) \in [0,1]^N$, given quantum query access to a binary description of $v$. We give an algorithm that does so, with probability at least $1-\rho$, using $O(\sqrt{N \log(1/\rho) / \delta})$ quantum queries (under mild assumptions on $\rho$). This quadratically improves the dependence on $1/\delta$ and $\log(1/\rho)$ compared to a straightforward application of amplitude estimation. To obtain the improved $\log(1/\rho)$ dependence we use the first result., Comment: 25 pages, minor edits and typo corrections

Interior-point methods offer a highly versatile framework for convex optimization that is effective in theory and practice. A key notion in their theory is that of a self-concordant barrier. We give a suitable generalization of self-concordance to Riemannian manifolds and show that it gives the same structural results and guarantees as in the Euclidean setting, in particular local quadratic convergence of Newton's method. We analyze a path-following method for optimizing compatible objectives over a convex domain for which one has a self-concordant barrier, and obtain the standard complexity guarantees as in the Euclidean setting. We provide general constructions of barriers, and show that on the space of positive-definite matrices and other symmetric spaces, the squared distance to a point is self-concordant. To demonstrate the versatility of our framework, we give algorithms with state-of-the-art complexity guarantees for the general class of scaling and non-commutative optimization problems, which have been of much recent interest, and we provide the first algorithms for efficiently finding high-precision solutions for computing minimal enclosing balls and geometric medians in nonpositive curvature., Comment: 85 pages. v2: Merged with independent work arXiv:2212.10981 by Hiroshi Hirai

Background: Freezing of gait (FOG) is a complex symptom in Parkinson’s disease (PD) which is both elusive to elicit and varied in its presentation. These complexities present a challenge to measuring FOG in a sensitive and reliable way, precluding therapeutic advancement. Objective: We investigated the reliability, validity and responsiveness of manual video-annotations of the turning in place task and compared it to the sensor-based FOG ratio. Methods: Forty-five optimally medicated people with PD and FOG performed rapid alternating 360° turns without and with an auditory stroop dual task, thrice over two consecutive days.Tasks were recorded with video and inertial sensors placed on the lower back and shins.Interrater reliability between three raters, criterion validity with self-reported FOG, and responsiveness to single-session split-belt treadmill (SBT) training were investigated and contrasted with the sensor-based FOG ratio. Results: Visual ratings showed excellent agreement between raters for the percent time frozen (%TF) (ICC = 0.99), the median duration of a FOG episode (ICC = 0.90) and the number of FOG episodes (ICC = 0.86). Dual tasking improved the sensitivity and validity of visual FOG ratings resulting in increased FOG detection, criterion validity with self-reported FOG ratings, and responsiveness to a short SBT intervention. The sensor-based FOG ratio on the other hand, showed complex FOG presentation-contingent relationships with visual and self-reported FOG ratings, and limited responsiveness to SBT training. Conclusions: Manual video-annotations of FOG during dual task turning in place generate reliable, valid, and sensitive outcomes for investigating therapeutic effects on FOG. ispartof: Movement Disorders vol:37 issue:2 pages:269-278 ispartof: location:United States status: published

ispartof: MOVEMENT DISORDERS vol:37 issue:2 pages:264-267 ispartof: location:United States status: published

Background Although deep neural networks (DNNs) are showing state of the art performance in clinical gait analysis, they are considered to be black-box algorithms. In other words, there is a lack of direct understanding of a DNN’s ability to identify relevant features, hindering clinical acceptance. Interpretability methods have been developed to ameliorate this concern by providing a way to explain DNN predictions. Methods This paper proposes the use of an interpretability method to explain DNN decisions for classifying the movement that precedes freezing of gait (FOG), one of the most debilitating symptoms of Parkinson’s disease (PD). The proposed two-stage pipeline consists of (1) a convolutional neural network (CNN) to model the reduction of movement present before a FOG episode, and (2) layer-wise relevance propagation (LRP) to visualize the underlying features that the CNN perceives as important to model the pathology. The CNN was trained with the sagittal plane kinematics from a motion capture dataset of fourteen PD patients with FOG. The robustness of the model predictions and learned features was further assessed on fourteen PD patients without FOG and fourteen age-matched healthy controls. Results The CNN proved highly accurate in modelling the movement that precedes FOG, with 86.8% of the strides being correctly identified. However, the CNN model was unable to model the movement for one of the seven patients that froze during the protocol. The LRP interpretability case study shows that (1) the kinematic features perceived as most relevant by the CNN are the reduced peak knee flexion and the fixed ankle dorsiflexion during the swing phase, (2) very little relevance for FOG is observed in the PD patients without FOG and the healthy control subjects, and (3) the poor predictive performance of one subject is attributed to the patient’s unique and severely flexed gait signature. Conclusions The proposed pipeline can aid clinicians in explaining DNN decisions in clinical gait analysis and aid machine learning practitioners in assessing the generalization of their models by ensuring that the predictions are based on meaningful kinematic features.

Hoewel er internationaal steeds meer aandacht is voor de rechten van oudere personen, staat het onderzoek naar deze doelgroep binnen de rechtswetenschap nog in de kinderschoenen. Het European Law and Ageing Network (ELAN) beoogt hier op Europees niveau verandering in te brengen. Op vrijdag 26 augustus 2022 vond de tweede fysieke bijeenkomst van dit netwerk plaats in Amsterdam. Tijdens deze bijeenkomst was aandacht voor de ontwikkelingen op het terrein van ouderenrecht in zowel Nederland als Europa.

Introduction: Implementing integrated care in primary care settings is essential to establish a sustainable health care system for older adults living at home. Measuring integrated care performance facilitates implementation and improvement of integrated care services in daily practice, yet valid instruments are still lacking. Based on the Rainbow Model of Integrated Care (RMIC) a measurement tool (MT) has been validated for renal care patients and care providers. In the present study we aimed to validate the RMIC-MT for healthcare professionals working in an integrated primary elderly care setting.Theory/Methods: The RMIC-MT is a 36-item questionnaire, covering all aspects of integrated care according to the RMIC. Per integration domain professionals are asked to rate a set of questions. In a cross-sectional study, the RMIC-MT was sent to local networks of primary elderly care professionals in the Netherlands by email between February 2020 and February 2021. Confirmatory factor analysis (CFA) was used to build upon the previous results of the RMIC-MT for renal care by using the standard fit indices: root-mean-square error of approximation (RMSEA) (≤0.06), standardized root-mean-square residual (SRMR) (≤0.08), comparative fit index (CFI) (≥0.90) and Tucker-Lewis index (TLI) (≥0.90). Maximum likelihood was used to estimate the model parameters and goodness-of-fit indices.Results: 323 professionals filled out the RMIC-MT, the majority were general practitioners, community nurses, practice nurses and case managers. Median time needed to complete the RMIC-MT was 14 minutes. Some professionals did not complete the questionnaire because the questionnaire was too long or perceived as irrelevant. The model passed the goodness-to-fit test by confirmatory factor analysis: RMSEA=0.046, SRMR=0.055, CFI=0.895, TLI=0.882. The factor structure of 9 categories with a total of 36 items was thereby confirmed. Conclusions: We successfully validated the RMIC-MT for the primary elderly care setting. We adjusted the name of one category from ‘triple aim’ to ‘outcome measurements’. Application of the RMIC-MT enables professional networks in this setting to evaluate and improve their care integration and contribute to better quality and more sustainable primary elderly care. Implications for applicability/transferability, sustainability, and limitations: The sample size was small but sufficient for the CFA. Recruitment was difficult which may reflect difficulties in future use in daily practice. The RMIC-MT was considered too long by some professionals. Developing a shorter version may be a promising strategy to increase completion in daily practice. RMIC-MT application can enable professionals to improve people-centered integrated primary care by using the feedback reports for improvement plans. Feasibility and added value of the tool should be studied after this small-scale implementation. Broader implementation of the RMIC-MT for elderly care should be investigated, including other contexts and countries.

Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older participants comparing any medication review or deprescribing intervention with usual care and reporting falls as an outcome. Study records title/abstract and full-text screening by two reviewers. Risk of bias Cochrane Collaboration revised tool. Data synthesis results reported separately for different settings and sufficiently comparable studies meta-analysed. Results forty-nine heterogeneous studies were included. Community meta-analyses of medication reviews resulted in a risk ratio (RR) of 1.05 (95% confidence interval, 0.85–1.29, I2 = 0%, 3 studies(s)) for number of fallers, in an RR = 0.95 (0.70–1.27, I2 = 37%, 3 s) for number of injurious fallers and in a rate ratio (RaR) of 0.89 (0.69–1.14, I2 = 0%, 2 s) for injurious falls. Hospital meta-analyses assessing medication reviews resulted in an RR = 0.97 (0.74–1.28, I2 = 15%, 2 s) and in an RR = 0.50 (0.07–3.50, I2 = 72% %, 2 s) for number of fallers after and during admission, respectively. Long-term care meta-analyses investigating medication reviews or deprescribing plans resulted in an RR = 0.86 (0.72–1.02, I2 = 0%, 5 s) for number of fallers and in an RaR = 0.93 (0.64–1.35, I2 = 92%, 7 s) for number of falls. Conclusions the heterogeneity of the interventions precluded us to estimate the exact effect of medication review and deprescribing as a single intervention. For future studies, more comparability is warranted. These interventions should not be implemented as a stand-alone strategy in falls prevention but included in multimodal strategies due to the multifactorial nature of falls. PROSPERO registration number: CRD42020218231

Contains fulltext : 291595.pdf (Publisher’s version ) (Open Access)

Background falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. Objectives to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. Methods a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. Recommendations all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. Conclusions the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Background The gait initiation (GI) process can be characterized by anticipatory postural adjustments (APAs) and first step characteristics. However, even within a constrained environment, it is unclear how many trials are necessary to obtain a reliable measurement of the GI process within one assessment. Research question How many gait initiation trials are necessary to reliably detect APAs and first step characteristics in healthy elderly (HC) and people with Parkinson’s disease with Freezing of Gait (PD + FOG) under single (ST) and dual task (DT) conditions and are there any potential systematic errors? Methods Thirty-eight PD + FOG (ON-medication) and 30 HC performed 5 trials of GI under ST and DT (auditory stroop test). APAs and first-step-outcomes were captured with IMUs placed on the lower back and on each foot. Intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM) were computed to investigate reliability and mixed model analysis to find potential systematic errors. Additionally, we computed an estimation for the number of necessary trials to reach acceptable reliability (ICC = 0.75) for each outcome. Results ICCs varied from low reliability to excellent reliability across outcomes in PD + FOG and HC. ICCs were comparable under ST and DT for most outcomes. SEM results confirmed the ICC results. A systematic error was found for the first trial in first step ROM. Number of necessary trials varied largely across outcomes. Significance Within-session reliability varied across outcomes but was similar for PD + FOG and HC, and ST and DT. ML size of APA and first step ROM were most reliable, whereas APA duration and latency were least reliable. Depending on the outcome of interest, future studies should conduct multiple trials of GI to increase reliability. ispartof: Gait & Posture vol:88 issue:July 2021 pages:126-131 ispartof: location:England status: Published online

Contains fulltext : 238527.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is not clear how specific gait measures reflect disease severity across the disease spectrum in Parkinson's disease (PD). OBJECTIVE: To identify the gait and mobility measures that are most sensitive and reflective of PD motor stages and determine the optimal sensor location in each disease stage. METHODS: Cross-sectional wearable-sensor records were collected in 332 patients with PD (Hoehn and Yahr scale I-III) and 100 age-matched healthy controls. Sensors were adhered to the participant's lower back, bilateral ankles, and wrists. Study participants walked in a ~15-meter corridor for 1 minute under two walking conditions: (1) preferred, usual walking speed and (2) walking while engaging in a cognitive task (dual-task). A subgroup (n = 303, 67% PD) also performed the Timed Up and Go test. Multiple machine-learning feature selection and classification algorithms were applied to discriminate between controls and PD and between the different PD severity stages. RESULTS: High discriminatory values were found between motor disease stages with mean sensitivity in the range 72%-83%, specificity 69%-80%, and area under the curve (AUC) 0.76-0.90. Measures from upper-limb sensors best discriminated controls from early PD, turning measures obtained from the trunk sensor were prominent in mid-stage PD, and stride timing and regularity were discriminative in more advanced stages. CONCLUSIONS: Applying machine-learning to multiple, wearable-derived features reveals that different measures of gait and mobility are associated with and discriminate distinct stages of PD. These disparate feature sets can augment the objective monitoring of disease progression and may be useful for cohort selection and power analyses in clinical trials of PD. © 2021 International Parkinson and Movement Disorder Society.

BACKGROUND: Freezing of gait (FOG) is a highly incapacitating symptom that affects many people with Parkinson's disease (PD). Cueing triggered upon real-time FOG detection (on-demand cueing) shows promise for FOG treatment. Yet, the feasibility of implementation and efficacy in daily life is still unknown. Therefore, this study aims to investigate the effectiveness of DeFOG: a smartphone and sensor-based on-demand cueing solution for FOG. METHODS: Sixty-two PD patients with FOG will be recruited for this single-blind, multi-center, randomized controlled phase II trial. Patients will be randomized into either the intervention group or the active control group. For four weeks, both groups will receive feedback about their physical activity using the wearable DeFOG system in daily life. In addition, the intervention group will also receive on-demand auditory cueing and instructions. Before and after the intervention, home-based assessments will be performed to evaluate the primary outcome, i.e., "percentage time frozen" during a FOG-provoking protocol. Secondary outcomes include the training effects on physical activity monitored over 7 days and the user-friendliness of the technology. DISCUSSION: The DeFOG trial will investigate the effectiveness of personalized on-demand cueing in a controlled design, delivered for 4 weeks in the patient's home environment. We anticipate that DeFOG will reduce FOG to a greater degree than in the control group and we will explore the impact of the intervention on physical activity levels. We expect to gain in-depth insight into whether and how patients control FOG using cueing methods in their daily lives. TRIAL REGISTRATION: Clinicaltrials.gov NCT03978507. ispartof: CONTEMPORARY CLINICAL TRIALS COMMUNICATIONS vol:24 ispartof: location:Netherlands status: published

De recente COVID-19-pandemie heeft de noodzaak van online begeleiding benadrukt. Om de kwaliteit van begeleiding te bepalen, kan de therapeutische alliantie beoordeeld worden. Deze bestaat uit een persoonlijke band tussen cliënt en hulpverlener en overeenstemming over taken en doelen. Dit concept is uitgebreid onderzocht als het gaat om persoonlijke begeleiding. Er is echter geen tool beschikbaar om alliantie tussen jongeren en hulpverlener in een online setting te beoordelen. Daarom hebben wij het Online Alliantie Assessment ontwikkeld. In dit onderzoek beoordelen we de constructvaliditeit van deze maatstaf, of de componenten van alliantie congruent gemeten worden tussen cliënten en hulpverleners in een studentensteekproef en of deze groepen verschillen in hun beoordelingen van allianties. Een Multiple Group Confirmatory Factor Analysis (MGCFA) bevestigt dat er ten minste twee componenten van alliantie aanwezig zijn en dat de constructvaliditeit is bereikt. Bovendien worden de constructen congruent gemeten en is de vragenlijst wederkerig. Analyse van de sum scores toont enige verdeeldheid over taak- en doelafspraken binnen cliënt-hulpverlener-paren. Wij adviseren verder onderzoek met representatieve steekproeven en meer evenwicht in de vragenlijst te brengen, zodat elke factor gelijkwaardiger en betrouwbaarder wordt weergegeven.

Background Freezing of gait (FOG) is a common and debilitating gait impairment in Parkinson’s disease. Further insight into this phenomenon is hampered by the difficulty to objectively assess FOG. To meet this clinical need, this paper proposes an automated motion-capture-based FOG assessment method driven by a novel deep neural network. Methods Automated FOG assessment can be formulated as an action segmentation problem, where temporal models are tasked to recognize and temporally localize the FOG segments in untrimmed motion capture trials. This paper takes a closer look at the performance of state-of-the-art action segmentation models when tasked to automatically assess FOG. Furthermore, a novel deep neural network architecture is proposed that aims to better capture the spatial and temporal dependencies than the state-of-the-art baselines. The proposed network, termed multi-stage spatial-temporal graph convolutional network (MS-GCN), combines the spatial-temporal graph convolutional network (ST-GCN) and the multi-stage temporal convolutional network (MS-TCN). The ST-GCN captures the hierarchical spatial-temporal motion among the joints inherent to motion capture, while the multi-stage component reduces over-segmentation errors by refining the predictions over multiple stages. The proposed model was validated on a dataset of fourteen freezers, fourteen non-freezers, and fourteen healthy control subjects. Results The experiments indicate that the proposed model outperforms four state-of-the-art baselines. Moreover, FOG outcomes derived from MS-GCN predictions had an excellent (r = 0.93 [0.87, 0.97]) and moderately strong (r = 0.75 [0.55, 0.87]) linear relationship with FOG outcomes derived from manual annotations. Conclusions The proposed MS-GCN may provide an automated and objective alternative to labor-intensive clinician-based FOG assessment. Future work is now possible that aims to assess the generalization of MS-GCN to a larger and more varied verification cohort.

IntroductionCrisis admissions of persons with dementia are more prevalent due to the rising number of people with dementia living longer at home. Better collaboration between primary care professionals could prevent crisis situations. Therefore, the DementiaNet program focuses on a transition towards integrated care by supporting interdisciplinary networks of primary care professionals from the medical, care and social services to improve their collaboration. This study aims to determine the effect of the DementiaNet program on the number of crisis admissions.Theory/MethodsDementiaNet networks started from 2015 onwards. This 2-year program is based on the Rainbow Model of Integrated Care and consists of coaching and support to help the networks go from ad hoc collaboration to a structured collaboration. Collaboration, network leadership, interdisciplinary education and quality improvement cycles are key elements to help networks improve their quality of care for the persons with dementia and their caregivers. Yearly, networks collect patient data on five quality of care indicators, and on admission to a hospital or nursing home due to a crisis. The data collection took place between 2015 and 2020. We compared the number of crisis admissions of advanced networks (>2 years active) with the number of crisis admissions of starting networks (

IntroductionCrisis admissions of persons with dementia are more prevalent due to the rising number of people with dementia living longer at home. Moreover, societal dependency on informal care grows, which negatively impacts caregivers’ wellbeing. This is often a direct reason for crisis admission of the person with dementia. Therefore, we developed REMIND, a digital tool for frequent monitoring of wellbeing and resilience of caregivers, which enables case managers to provide timely support, thereby preventing deterioration in caregiver wellbeing and eventually crisis admissions. The aim of this pilot study is to explore the usability and acceptability of REMIND.Theory/MethodsDuring a 3-month period case manager-caregiver duo’s used REMIND. The monitor was developed in co-creation with end-users during focus groups. The pilot version of REMIND consisted of a weekly set of questions on social support, reciprocity, burden, wellbeing, own activities and small crises, filled in via a chat on a smartphone or computer. Caregiver wellbeing was displayed in graphs on a dashboard for case managers to act upon. Usability and acceptability of the tool were explored in semi-structured interviews with the caregivers and case managers. Two independent researchers applied content analysis on the transcripts.ResultsEight case managers and fourteen caregivers participating considered the tool easy to use. Caregivers appreciated REMIND, because it stimulated self-reflection regarding the burden of their caregiving processes. Case managers valued the tool’s ability to gain better insight in the actual wellbeing of caregivers, because some caregivers find it hard to acknowledge themselves being burdened during a face-to-face conversation. The fact that REMIND provided insight in wellbeing patterns over time instead of a single assessment during a monthly home visit, was highly appreciated by case managers. The monitor outcomes were therefore considered a suitable starting point for conversations with caregivers. Suggestions for improvements included, more diverse set of questions and additional functions including peers support. DiscussionsIn this pilot, REMIND was found highly usable and acceptable for both caregivers and casemanagers. The use a co-design approach in the development likely contributed to these findings. ConclusionsPilot evaluation of digital monitor for caregivers and case managers showed that the tool was easy to use and stimulated self-reflection in caregivers. For case managers it provided a starting point for conversations. The tool is able to monitor wellbeing of caregivers and thereby has the potential to prevent crisis.Lessons learnedDeveloping a monitoring tool for caregivers of persons with dementia in a co-creation design process with end-users led to a well-accepted and easy-to-use device. LimitationsCasemanagers in this pilot study were early adopters. Further research should include a more diverse group of case managers. Suggestions for future researchA future randomized controlled study with longer follow-up may determine whether its use prevents (small) crises.

Balance and walking are fundamental to support common daily activities. Relatively accurate characterizations of normal and impaired gait features were attained at the kinematic and muscular levels. Conversely, the neural processes underlying gait dynamics still need to be elucidated. To shed light on gait-related modulations of neural activity, we collected high-density electroencephalography (hdEEG) signals and ankle acceleration data in young healthy participants during treadmill walking. We used the ankle acceleration data to segment each gait cycle in four phases: initial double support, right leg swing, final double support, left leg swing. Then, we processed hdEEG signals to extract neural oscillations in alpha, beta, and gamma bands, and examined event-related desynchronization/synchronization (ERD/ERS) across gait phases. Our results showed that ERD/ERS modulations for alpha, beta, and gamma bands were strongest in the primary sensorimotor cortex (M1), but were also found in premotor cortex, thalamus and cerebellum. We observed a modulation of neural oscillations across gait phases in M1 and cerebellum, and an interaction between frequency band and gait phase in premotor cortex and thalamus. Furthermore, an ERD/ERS lateralization effect was present in M1 for the alpha and beta bands, and in the cerebellum for the beta and gamma bands. Overall, our findings demonstrate that an electrophysiological source imaging approach based on hdEEG can be used to investigate dynamic neural processes of gait control. Future work on the development of mobile hdEEG-based brain-body imaging platforms may enable overground walking investigations, with potential applications in the study of gait disorders. ispartof: HUMAN BRAIN MAPPING vol:43 issue:11 pages:3404-3415 ispartof: location:United States status: published

Kan de techniek van virtual reality gebruikt worden om sociaal werkers te trainen in alliantievaardigheden? Uit onderzoek blijkt dat de technologie in andere vakgebieden toegepast wordt voor de training van inter- en intrapersoonlijke vaardigheden. Dat biedt kansen voor het sociaal werk.

Background Community nurses and general practitioners evaluate their patient-related communication to be poor. However, their actual communication has hardly been investigated and specific strategies for improvement are unclear. Objectives To explore actual community nurse-general practitioner communication in primary care and gain insights into communication style, and conversation structure and their determinants. Methods A mixed-methods design was applied. Telephone conversations between community nurses and general practitioners in the Netherlands were recorded and transcribed verbatim. We measured structure and the duration of their conversations, and community nurses’ self-confidence towards general practitioners and their trust in and familiarity with the conversation partner. A thematic analysis was applied to the transcripts of the conversations. Correlations between these determinants were calculated using Spearman’s correlation coefficient. Results The 18 community nurses recorded 23 conversations with general practitioners. Qualitative analysis revealed that many conversations lacked structure and conciseness, i.e. the nurses started conversations without a clearly articulated question and did not provide adequate background information. The mean duration of their conversations with doctors was 8.8 min. Community nurses with higher self-confidence towards doctors communicated in a more structured way (p = 0.01) and general practitioners were more satisfied about the conversations (p = 0.01). Conclusion This exploratory study of actual community nurse-doctor telephone conversations in primary care identified communication structure and nurse self-confidence towards general practitioners as key targets for the improvement of interprofessional communication, which may increase the effectiveness of community nurse-general practitioner collaboration.

Background Physical activity is linked to many positive health outcomes, stimulating the development of exercise programs. However, many falls occur while walking and so promoting activity might paradoxically increase fall rates, causing injuries, and worse quality of life. The relationship between activity exposure and fall rates remains unclear. We investigated the relationship between walking activity (exposure to risk) and fall rates before and after an exercise program (V-TIME). Methods One hundred and nine older fallers, 38 fallers with mild cognitive impairment (MCI), and 128 fallers with Parkinson’s disease (PD) were randomly assigned to one of two active interventions: treadmill training only or treadmill training combined with a virtual reality component. Participants were tested before and after the interventions. Free-living walking activity was characterized by volume, pattern, and variability of ambulatory bouts using an accelerometer positioned on the lower back for 1 week. To evaluate that relationship between fall risk and activity, a normalized index was determined expressing fall rates relative to activity exposure (FRA index), with higher scores indicating a higher risk of falls per steps taken. Results At baseline, the FRA index was higher for fallers with PD compared to those with MCI and older fallers. Walking activity did not change after the intervention for the groups but the FRA index decreased significantly for all groups (p ≤ .035). Conclusions This work showed that V-TIME interventions reduced falls risk without concurrent change in walking activity. We recommend using the FRA index in future fall prevention studies to better understand the nature of intervention programs.

There has been a growing appreciation for freezing of gait as a disabling symptom that causes a significant burden in Parkinson's disease. Previous research has highlighted some of the key components that underlie the phenomenon, but these reductionist approaches have yet to lead to a paradigm shift resulting in the development of novel treatment strategies. Addressing this issue will require greater integration of multi-modal data with complex computational modeling, but there are a number of critical aspects that need to be considered before embarking on such an approach. This paper highlights where the field needs to address current gaps and shortcomings including the standardization of definitions and measurement, phenomenology and pathophysiology, as well as considering what available data exist and how future studies should be constructed to achieve the greatest potential to better understand and treat this devastating symptom. ispartof: TRANSLATIONAL NEURODEGENERATION vol:11 issue:1 ispartof: location:England status: published

Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson's disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor-cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II-III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment. ispartof: FRONTIERS IN AGING NEUROSCIENCE vol:13 ispartof: location:Switzerland status: published

Background: The development of optimal strategies to treat impaired mobility related to ageing and chronic disease requires better ways to detect and measure it. Digital health technology, including body worn sensors, has the potential to directly and accurately capture real-world mobility. Mobilise-D consists of 34 partners from 13 countries who are working together to jointly develop and implement a digital mobility assessment solution to demonstrate that real-world digital mobility outcomes have the potential to provide a better, safer, and quicker way to assess, monitor, and predict the efficacy of new interventions on impaired mobility. The overarching objective of the study is to establish the clinical validity of digital outcomes in patient populations impacted by mobility challenges, and to support engagement with regulatory and health technology agencies towards acceptance of digital mobility assessment in regulatory and health technology assessment decisions. Methods/design: The Mobilise-D clinical validation study is a longitudinal observational cohort study that will recruit 2400 participants from four clinical cohorts. The populations of the Innovative Medicine Initiative-Joint Undertaking represent neurodegenerative conditions (Parkinson's Disease), respiratory disease (Chronic Obstructive Pulmonary Disease), neuro-inflammatory disorder (Multiple Sclerosis), fall-related injuries, osteoporosis, sarcopenia, and frailty (Proximal Femoral Fracture). In total, 17 clinical sites in ten countries will recruit participants who will be evaluated every six months over a period of two years. A wide range of core and cohort specific outcome measures will be collected, spanning patient-reported, observer-reported, and clinician-reported outcomes as well as performance-based outcomes (physical measures and cognitive/mental measures). Daily-living mobility and physical capacity will be assessed directly using a wearable device. These four clinical cohorts were chosen to obtain generalizable clinical findings, including diverse clinical, cultural, geographical, and age representation. The disease cohorts include a broad and heterogeneous range of subject characteristics with varying chronic care needs, and represent different trajectories of mobility disability. Discussion: The results of Mobilise-D will provide longitudinal data on the use of digital mobility outcomes to identify, stratify, and monitor disability. This will support the development of widespread, cost-effective access to optimal clinical mobility management through personalised healthcare. Further, Mobilise-D will provide evidence-based, direct measures which can be endorsed by regulatory agencies and health technology assessment bodies to quantify the impact of disease-modifying interventions on mobility. Trial registration: ISRCTN12051706. This work was supported by the Mobilise-D project that has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 820820. This JU receives support from the European Union's Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA). The funding bodies do not have ultimate authority over any activities (study design, collection, management, analysis, interpretation of data, writing of reports and decision to submit for publication. A draft protocol for the clinical validation was provided as part of the grant/funding application. Content in this publication reflects the authors’ view and neither IMI nor the European Union, EFPIA, or any Associated Partners are responsible for any use that may be made of the information contained herein. ISGlobal acknowledges support from the Spanish Ministry of Science, Innovation and Universities through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. Heleen Demeyer is a post-doctoral fellow of the FWO Flanders. Heiko Gaßner is supported by the Fraunhofer Internal Programs under Grant No. Attract 044-602140 and 044-602150

Studentsucces hangt samen met studiesucces en participatie. Studentsucces behelst zowel het succesvol studeren (hoe goed doet de student het opschool qua doorlopen van de studie?) als participeren (hoe goed ontwikkelt de student in maatschappelijk opzicht zich persoonlijk en professioneel?). In het hoger onderwijs ligt dit studentsucces onder studenten met een niet-westerse migratieachtergrond lager dan onder studenten zonder migratieachtergrond. Welke factoren bepalend zijn, en hoe studentsucces bevorderd kan worden, waren de twee onderzoeksvragen in dit kwalitatieve, exploratieve actieonderzoek. Op basis van de perceptiesvan 248 respondenten tussen 17 en 29 jaar, twee interviews met professionals, en feedback en check op de uitkomsten door 15 leden van de klankbordgroep, die de betrokkenen vertegenwoordigen, blijken drie factoren doorslaggevend te zijn voor de student met een niet-westerse migratieachtergrond: familie, persoonlijke alliantie en sociale veiligheid op school. In dit artikel worden de factoren beschreven waar de respondenten, die bestaan uit studenten op het mbo-4 en hbo met of zonder migratieachtergrond, tijdens hun studie blij van worden of waar ze van ‘balen’. Ook worden de resultaten van deze groepen met elkaar vergeleken. Tot slot volgen de acties op het gebied van ‘delen, ontmoeten en verbinden’ als antwoord op hoe hun studentsucces gestimuleerd kan worden.

In oktober vond de internationale conferentie ‘Autonomy and Protection of Adults? Striking the Right Balance’ plaats. Deze conferentie werd georganiseerd door het Academisch Netwerk Family Law in Europe (FL-EUR) in samenwerking met the Swiss Institute of Comparative Law en de Universiteit van Genève. In deze bijdrage wordt van deze conferentie verslag gedaan.