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Dit artikel gaat in op vragen rondom wils(on)bekwaamheid en veranderende wensen van mensen met dementie. Het is soms lastig om te beoordelen of sprake is van wilsonbekwaamheid bij een cliënt. In welke gevallen moet een wijkverpleegkundige de wilsbekwaamheid van de cliënt beoordelen? En hoe kan een wijkverpleegkundige vanuit de norm van ‘goed hulpverlenerschap’ omgaan met de veranderende wensen van een cliënt met dementie?

Aims: To explore potential areas of low-value home-based nursing care practices, their prevalence and related influencing factors of nurses and nursing assistants working in home-based nursing care. Design: A quantitative, cross-sectional design. Methods: An online survey with questions containing scaled frequencies on five-point Likert scales and open questions on possible related influencing factors of low-value nursing care. The data collection took place from February to April 2022. Descriptive statistics and linear regression were used to summarize and analyse the results. Results: A nationwide sample of 776 certified nursing assistants, registered nurses and nurse practitioners responded to the survey. The top five most delivered low-value care practices reported were: (1) ‘washing the client with water and soap by default’, (2) ‘application of zinc cream, powders or pastes when treating intertrigo’, (3) ‘washing the client from head to toe daily’, (4) ‘re-use of a urinary catheter bag after removal/disconnection’ and (5) ‘bladder irrigation to prevent clogging of urinary tract catheter’. The top five related influencing factors reported were: (1) ‘a (general) practitioner advices/prescribes it’, (2) ‘written in the client's care plan’, (3) ‘client asks for it’, (4) ‘wanting to offer the client something’ and (5) ‘it is always done like this in the team’. Higher educational levels and an age above 40 years were associated with a lower provision of low-value care. Conclusion: According to registered nurses and certified nursing assistants, a number of low-value nursing practices occurred frequently in home-based nursing care and they experienced multiple factors that influence the provision of low-value care such as (lack of) clinical autonomy and handling clients' requests, preferences and demands. The results can be used to serve as a starting point for a multifaceted de-implement

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 synthetase (FPGS), which normally promotes intracellular accumulation and activity of natural folates and methotrexate, is linked to methotrexate and 5-fluorouracil resistance and its association with relapse illustrates the need for improved intervention strategies. Here, we describe a novel antifolate (C1) that, like methotrexate, potently inhibits dihydrofolate reductase and downstream one-carbon metabolism. Contrary to methotrexate, C1 displays optimal efficacy in FPGS-deficient contexts, due to decreased competition with intracellular folates for interaction with dihydrofolate reductase. We show that FPGS-deficient patient-derived CRC organoids display enhanced sensitivity to C1, whereas FPGS-high CRC organoids are more sensitive to methotrexate. Our results argue that polyglutamylation-independent antifolates can be applied to exert selective pressure on FPGS-deficient cells during chemotherapy, using a vulnerability created by polyglutamylation deficiency.

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.

Bijna een miljard euro investeerde Saoedi-Arabië afgelopen zomer in voetballers. Dat is pas het begin, denkt de Britse sporteconoom Paul Widdop. ‘Het voelt bijna alsof we op dit moment in het Wilde Westen leven.’

Item does not contain fulltext, 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.

Item does not contain fulltext, BACKGROUND: Females, 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. OBJECTIVE: This 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. METHODS: Characteristics 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). RESULTS: Results 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. CONCLUSION: Study 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.

Item does not contain fulltext, 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.

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Radboud University, 13 januari 2023, Promotor : Olde Rikkert, M.G.M. Co-promotores : Perry, M., Nieuwboer, M.S., Contains fulltext : 286392.pdf (Publisher’s version ) (Open Access)

Contains fulltext : 290680.pdf (Publisher’s version ) (Open Access), BACKGROUND: Females, 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. OBJECTIVE: This 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. METHODS: Characteristics 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). RESULTS: Results 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. CONCLUSION: Study 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.

Radboud University, 13 januari 2023, Promotor : Olde Rikkert, M.G.M. Co-promotores : Perry, M., Nieuwboer, M.S., Contains fulltext : 286392.pdf (Publisher’s version ) (Open Access)

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.

Item does not contain fulltext, 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.

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Contains fulltext : 294524.pdf (Publisher’s version ) (Open Access), The concept of resilience, i.e., the capacity of a system to bounce back after a stressor, is gaining interest across many fields of science, policy, and practice. To date, resilience research in people with cognitive decline has predominantly addressed the early stages of decline. We propose that: (1) resilience is a relevant concept in all stages of cognitive decline; and (2) a socio-ecological, multisystem perspective on resilience is required to advance understanding of, and care and support for people with cognitive decline and their support networks. We substantiate our position with literature and examples. Resilience helps understand differences in response to risk factors of (further) cognitive decline and informs personalised prevention. In a curative context, interventions to strengthen resilience aim to boost recovery from cognitive decline. In care for people with dementia, resilience-focused interventions can strengthen coping mechanisms to maintain functioning and well-being of the individual and their support network. A good example of improving resilience in the social and policy context is the introduction of age-friendly cities and dementia-friendly communities. Good care for people with cognitive decline requires a health and social care system that can adapt to changes in demand. Given the interdependency of resilience at micro-, meso- and macro-levels, an integrative socio-ecological perspective is required. Applying the concept of resilience in the field of cognitive decline opens new horizons for research to improve understanding, predicting, intervening on health and social care needs for the increasing population with cognitive decline.

Contains fulltext : 297291.pdf (Publisher’s version ) (Open Access)

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

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: 29 pages, accepted in Quantum

When dredging rock using a Cutter Suction Dredger the high amount of spillage is problematic, since it prevents an energy efficient removal process. This papers presents a coupled DEM-FVM method to simulate spillage, that can be used for optimizing the design and working method of the Cutter Suction Dredger. In these simulations, the challenge was to model relatively large particles in a complex and rotating geometry. To ensure stability and reduce computational time we used smoothing kernels to map the forces and the concentration between the discrete elements and the fluid mesh. The method is validated for the fluid flow in the rotating cutter head. This model incorporates all physical processes to predict flow induced spillage in cutter heads within feasible calculation times., Offshore and Dredging Engineering

Tensor networks have a gauge degree of freedom on the virtual degrees of freedom that are contracted. A canonical form is a choice of fixing this degree of freedom. For matrix product states, choosing a canonical form is a powerful tool, both for theoretical and numerical purposes. On the other hand, for tensor networks in dimension two or greater there is only limited understanding of the gauge symmetry. Here we introduce a new canonical form, the minimal canonical form, which applies to projected entangled pair states (PEPS) in any dimension, and prove a corresponding fundamental theorem. Already for matrix product states this gives a new canonical form, while in higher dimensions it is the first rigorous definition of a canonical form valid for any choice of tensor. We show that two tensors have the same minimal canonical forms if and only if they are gauge equivalent up to taking limits; moreover, this is the case if and only if they give the same quantum state for any geometry. In particular, this implies that the latter problem is decidable - in contrast to the well-known undecidability for equality of PEPS on grids. We also provide rigorous algorithms for computing minimal canonical forms. To achieve this we draw on geometric invariant theory and recent progress in theoretical computer science in non-commutative group optimization.

Tensor networks have a gauge degree of freedom on the virtual degrees of freedom that are contracted. A canonical form is a choice of fixing this degree of freedom. For matrix product states, choosing a canonical form is a powerful tool, both for theoretical and numerical purposes. On the other hand, for tensor networks in dimension two or greater there is only limited understanding of the gauge symmetry. Here we introduce a new canonical form, the minimal canonical form, which applies to projected entangled pair states (PEPS) in any dimension, and prove a corresponding fundamental theorem. Already for matrix product states this gives a new canonical form, while in higher dimensions it is the first rigorous definition of a canonical form valid for any choice of tensor. We show that two tensors have the same minimal canonical forms if and only if they are gauge equivalent up to taking limits; moreover, this is the case if and only if they give the same quantum state for any geometry. In particular, this implies that the latter problem is decidable - in contrast to the well-known undecidability for equality of PEPS on grids. We also provide rigorous algorithms for computing minimal canonical forms. To achieve this we draw on geometric invariant theory and recent progress in theoretical computer science in non-commutative group optimization.

Contains fulltext : 245934.pdf (Publisher’s version ) (Open Access)

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Item does not contain fulltext, 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.

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.

Background Most people with Parkinson's disease (PD) experience at least one fall during the course of their disease. Several interventions designed to reduce falls have been studied. An up-to-date synthesis of evidence for interventions to reduce falls in people with PD will assist with informed decisions regarding fall-prevention interventions for people with PD. Objectives To assess the effects of interventions designed to reduce falls in people with PD. Search methods CENTRAL, MEDLINE, Embase, four other databases and two trials registers were searched on 16 July 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. We also conducted a top-up search on 13 October 2021. Selection criteria We included randomised controlled trials (RCTs) of interventions that aimed to reduce falls in people with PD and reported the effect on falls. We excluded interventions that aimed to reduce falls due to syncope. Data collection and analysis We used standard Cochrane Review procedures. Primary outcomes were rate of falls and number of people who fell at least once. Secondary outcomes were the number of people sustaining one or more fall-related fractures, quality of life, adverse events and economic outcomes. The certainty of the evidence was assessed using GRADE. Main results This review includes 32 studies with 3370 participants randomised. We included 25 studies of exercise interventions (2700 participants), three studies of medication interventions (242 participants), one study of fall-prevention education (53 participants) and three studies of exercise plus education (375 participants). Overall, participants in the exercise trials and the exercise plus education trials had mild to moderate PD, while participants in the medication trials included those with more advanced disease. All studies had a high or unclear risk of bias in one or more items. Illustrative risks demonstrating the absolute impact of each

Contains fulltext : 252084.pdf (Publisher’s version ) (Closed access), BACKGROUND: Most people with Parkinson's disease (PD) experience at least one fall during the course of their disease. Several interventions designed to reduce falls have been studied. An up-to-date synthesis of evidence for interventions to reduce falls in people with PD will assist with informed decisions regarding fall-prevention interventions for people with PD. OBJECTIVES: To assess the effects of interventions designed to reduce falls in people with PD. SEARCH METHODS: CENTRAL, MEDLINE, Embase, four other databases and two trials registers were searched on 16 July 2020, together with reference checking, citation searching and contact with study authors to identify additional studies. We also conducted a top-up search on 13 October 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of interventions that aimed to reduce falls in people with PD and reported the effect on falls. We excluded interventions that aimed to reduce falls due to syncope. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Review procedures. Primary outcomes were rate of falls and number of people who fell at least once. Secondary outcomes were the number of people sustaining one or more fall-related fractures, quality of life, adverse events and economic outcomes. The certainty of the evidence was assessed using GRADE. MAIN RESULTS: This review includes 32 studies with 3370 participants randomised. We included 25 studies of exercise interventions (2700 participants), three studies of medication interventions (242 participants), one study of fall-prevention education (53 participants) and three studies of exercise plus education (375 participants). Overall, participants in the exercise trials and the exercise plus education trials had mild to moderate PD, while participants in the medication trials included those with more advanced disease. All studies had a high or unclear risk of bias in one or more items. Illustrative risks demonstrating the absolute impact of

Contains fulltext : 245934.pdf (Publisher’s version ) (Open Access)

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.

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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.

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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.

Backgroundfalls 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.Objectivesto 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.Methodsa 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.Recommendationsall 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.Conclusionsthe core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.

Tensor networks have a gauge degree of freedom on the virtual degrees of freedom that are contracted. A canonical form is a choice of fixing this degree of freedom. For matrix product states, choosing a canonical form is a powerful tool, both for theoretical and numerical purposes. On the other hand, for tensor networks in dimension two or greater there is only limited understanding of the gauge symmetry. Here we introduce a new canonical form, the minimal canonical form, which applies to projected entangled pair states (PEPS) in any dimension, and prove a corresponding fundamental theorem. Already for matrix product states this gives a new canonical form, while in higher dimensions it is the first rigorous definition of a canonical form valid for any choice of tensor. We show that two tensors have the same minimal canonical forms if and only if they are gauge equivalent up to taking limits; moreover, this is the case if and only if they give the same quantum state for any geometry. In particular, this implies that the latter problem is decidable - in contrast to the well-known undecidability for PEPS on grids. We also provide rigorous algorithms for computing minimal canonical forms. To achieve this we draw on geometric invariant theory and recent progress in theoretical computer science in non-commutative group optimization., Comment: 51 pages, more than 8 figures

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.

Randomised controlled clinical trials (RCTs) offer a unique opportunity to obtain controlled efficacy and safety data to support clinical decisions. However, most RCT reporting has a stronger focus on efficacy rather than safety. This study aimed to identify the safety profile of both probiotic and drug interventions in irritable bowel syndrome (IBS). In connection to this paper, an accompanying paper was published in which a meta-analysis was conducted to evaluate the efficacy of probiotic interventions compared to that of drug interventions in IBS. Together, these two studies provide a first assessment regarding the feasibility to determine a burden to benefit ratio for both probiotic and drug interventions in IBS. RCTs including participants (>18 years old) with IBS and comparing probiotic or drugs interventions with control groups were identified by a systematic search of MEDLINE (January 2015 - Jan 2021). Reported safety profiles in drug studies were completer and more detailed as compared with studies on probiotics. Several inconsistencies in safety reporting were identified between and within drug and probiotic studies, such as: didn't report on safety; only reported adverse reactions (ARs) or adverse events (AEs) with a certain severity; didn't report the total number of AEs; didn't split in the control- or experimental arm; didn't specify AEs; and used different thresholds for 'common' AEs. Hence, it is difficult to compare safety data from drug and probiotic RCTs across and between different studies. On the current approaches to safety reporting, we could not establish an unambiguous safety profile for neither probiotic and drug interventions in IBS. These shortcomings hamper a critical comparison of the burden to benefit ratio for IBS intervention.

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.

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.

Due to an increased demand for transport, ships become larger, needing a larger navigable depth. For these reasons a waterway needs to be dredged and a Cutter Suction Dredger is a vessel suitable for this operation. A Cutter Suction Dredger is a floating vessel which removes sand, clay or soft rock from sea or river beds. It has a cutter head with pickpoints attached to it. By rotating and swinging, the pickpoints are pushed into the soil, disintegrating it. The soil enters the cutter head where it is mixed with water. From inside the cutter head it is hydraulically transported to the vessel via the suction mouth and pipe. The rotational speed of the cutter head can be varied by the vessel operator. When increasing the rotational velocity and swing speed, more production can be obtained. However, this leads to an outflow of water and dredged material near the ring, spilling the soil. When the Cutter Suction Dredger is employed for cutting sand, the sand particles are easily kept in suspension due to the rotating motion before it is sucked up. A cutter suction dredger is also used for cutting rock, leading to large pieces, which are more influenced by gravity and the centrifugal force. Due to these forces, the pieces are thrown out of the cutter head more easily than smaller sand particles. The pieces of rock which are thrown out of the cutter are considered spilled. This spillage is unfavourable since this material has to be dredged a second time or is left on the sea floor. When the material is left on the sea floor, a larger layer of soil needs to be dredged for creating the same navigable depth. To reduce spillage, the processes contributing to spillage should be quantified in order to design a better cutter head or working method. This dissertation contributes to this goal by presenting a validated model for simulating the spillage of rock particles inside a rotating cutter head. Such a model can be used to quantify different process, Offshore and Dredging Engineering