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Introduction: Diagnosis of vitamin B12 deficiency is difficult, as there is no conclusive single test for this disorder. We evaluated the association of serum B12 and methylmalonic acid (MMA) with haematologic parameters and physical and cognitive functioning in an effort to use such clinical parameters to improve the interpretation of serum values. Methods: We used data of participants > 19 years of age from NHANES 2011-2012 and 2013-2014, a cross-sectional survey in the United States. Functional status was assessed with questionnaires on current health condition, disability, hospital utilisation, cognitive functioning, mental health and depression, and physical functioning. Muscle strength assessed with a handgrip dynamometer was used as a performance parameter. Results were evaluated both for the entire population and participants of Western European descent. Because renal function influences MMA concentrations and is a proxy for both frailty and comorbidity, all results were additionally stratified for individuals with normal vs impaired renal function (eGFR < 60 ml/min). Results: In total, data of 9645 participants (mean age 49 (SD 17) years, 49.3% males) were included. Out of all participants with serum B12 < 140, 140-300, and 301-1000 pmol/l, 56.2%, 13.5%, and 4.1%, respectively had elevated MMA. MMA concentrations were more strongly associated with poor functional status and physical performance than serum B12. We identified a significant and independent association of MMA concentrations, as well as haemoglobin and co-morbidity with muscle strength. Conclusions/interpretations: A large proportion of individuals with a decreased serum B12 concentration still has normal MMA concentrations. Elevated MMA concentrations were more strongly associated with poor functional performance than serum B12.

The recent development and dissemination of Information and Communications Technology (ICT) has a key role to drive cities to be smarter. The economic growth needs of cities that become smarter, sustainable, more efficient and liveable. Smart water represents a key core of the smart cities and the application of smart solutions will allow the cities to use ICT and big data to improve infrastructure and services (i.e. network efficiency, protection from contamination, etc.). In the water sector, the integration and implementation of novel technologies for water systems monitoring (drinking, distribution, sea, river water, etc.) as smart meters and sensors together with cloud computing systems introduce an innovative management that transform the traditional water networks into modern Smart WAter Networks (SWAN). The introduction of innovative on-line sensors in the water system can contribute to monitor and control many water quantitative (e.g. flow, pressure, etc.) and quality (e.g. residual chlorine, PH, organic matter, etc.) parameters providing smart water management solutions contributing to prompt Smart Water Network as subsystem of the Smart City, recently recognized by the scientific and technical international community. In fact, the use of innovative on-line sensors allows to overcome the traditional management of water networks and to handle important issues such as reduction of water losses, analysis of big data, improvement of water quality, etc. The Ctrl+SWAN (Cloud Technologies & ReaL time monitoring+Smart WAter Network) Action Group (AG) was created within the European Innovation Partnership on Water, in order to promote innovation in the water sector by advancing existing solutions. The vision of the AG consists of treating water network not as a traditional system with devices trivially added, but as a SWAN featuring new applications to promote optimal management and protection. The paper presents an update of a previous work on the state of the art on the best On-line Measuring Sensors (OMS) already available on the market and innovative technologies in the Research and Development (R&D) phases. Ctrl+SWAN membership bring up to date the list of parameters measured with innovative on-line sensors, the new sensor technologies and their innovative applications.

The Technical Reports are intended mainly for internal use within the COSMO group (COSMO = Consortium for Small Scale Modeling), but also to inform other groups on model changes and research activities. The purpose of the Technical Reports is 1. to document scientific research activities, 2. to document technical changes to the model system, 3. to give an overview on new components of the model system.

The purpose of this study was to describe the experiences among children with cancer using music in hospital care. The data were collected at a certain university hospital and in children’s cancer and hematology ward. A total of 15 personal interviews were performed. Interviews in this study were performed at least once with each of the school-aged children (n = 9). Six children were interviewed in the second round of interviews. The data were analyzed through the use of inductive content analysis. Children had diverse musical experiences during hospitalization, which related to listening to the music and to the music workshop activities arranged on the ward. Music during hospitalization had an activating and psychological effect and it was a part of the children’s identity. Music was a form of entertainment and provided something for the children to do. It increased the children’s feelings of satisfaction, provided them with various experiences and helped them manage their emotions. Music had a role in the personality of the hospitalized children and it promoted the learning and inspiration of the children. Children had feasible ideas on how to develop and implement the music workshop activities and also regards to the musical equipment on the ward. This study produces new knowledge about the use of music and the music workshop activities arranged in hospital from the perspective of children. The findings can be utilized in developing pediatric care to better respond to the children’s needs while receiving hospital care. Tiivistelmä Tutkimuksen tarkoituksena oli kuvata syöpää sairastavien lasten kokemuksia musiikin käytöstä sairaalahoidon aikana. Tutkimusaineisto kerättiin erään yliopistollisen sairaalan lasten veri- ja syöpätautien osastolta yksilöhaastatteluina. Yhteensä tutkimushaastatteluita toteutui 15. Osallistujat olivat kouluikäisiä lapsia (n=9), joita haastateltiin vähintään kerran. Toiseen haastattelukertaan heistä osallistui kuusi. Aineisto analysoitiin induktiivisella sisällönanalyysilla. Lapsilla oli monipuolisia musiikillisia kokemuksia sairaalahoidossa ja ne liittyivät musiikin kuunteluun sekä osastolla toimivaan musapajatoimintaan. Sairaalassa musiikilla oli lapsille toiminnallinen ja psyykkinen merkitys. Se oli myös osa lasten identiteettiä. Musiikki toimi ajanviettotapana, se tarjosi lapsille tekemistä, lisäsi lasten tyytyväisyyttä, helpotti erilaisten tunteiden käsittelyä sekä mahdollisti erilaisia elämyksiä. Musiikki myös ilmensi sairaalahoidossa olevien lasten persoonallisuutta, edisti oppimista ja oivaltamista. Lapsilla oli toteuttavissa olevia kehitysideoita liittyen musapajatoiminnan monipuolistumiseen ja osaston musiikilliseen välineistöön. Tutkimus tuotti uutta hoitotieteellistä tietoa musiikin käytöstä ja musapajatoiminnasta sairaalassa lasten näkökulmasta. Tuloksia voidaan hyödyntää lasten hoitotyön kehittämisessä, jotta voidaan vastata paremmin lasten yksilöllisiin tarpeisiin sairaalahoidon aikana.

Introduction: Anticholinergic and sedative drugs from various therapeutic classes are frequently prescribed to older people. These drugs are known to impair cognitive and physical function in the short-term. However, long-term exposure to these drugs remains less examined. Methods: Data from the Longitudinal Aging Study Amsterdam, a Dutch nationally representative cohort study, collected over twenty years (1992-2012) at seven occasions, were analyzed. On each occasion, cumulative exposure to anticholinergic and sedative drugs was quantified with the Drug Burden Index (DBI), a linear additive pharmacological dose-response model. The relationships between the DBI and outcomes of cognitive function (MMSE, Alphabet Coding Task, 15-Words Test) and physical function (Walking Test, Chair Stands Test, Cardigan Test, and Functional Independence Scale) were examined using linear mixed models adjusted for sex, marital status, age, education, smoking status, drugs not included in DBI, body mass index, depression, and co-morbidities. Results: At baseline, there were 2896 individuals (52% women; mean age 70±9 years). Of them, 62% had no exposure to anticholin-ergic and sedative drugs (DBI=0), 24% moderate exposure (DBI =0-1), and 14% high exposure (DBI >1). Significant independent associations were found between the DBI and physical function (Walking Test log transformed: B=0.02 [95% CI: 0.01; 0.03], Cardigan Test log transformed: B=0.02 [95% CI: 0.01; 0.03], Chair Stands Test B=0.48 [95% CI: 0.20; 0.76], and Functional Independence: B=-0.89 [95% CI:-1.22;-0.55]). No associations were found between the DBI and cognitive function. Conclusions: Over 20 years, higher anticholinergic and sedative exposure is associated with poorer physical but not poorer cognitive function.

Introduction: Inappropriate prescribing is a prevalent problem in nursing home residents that is associated with cognitive and physical impairment. Few interventions have been shown to reduce inappropriate prescribing. The aim was therefore to examine successful discontinuation of inappropriate medication. Methods: A cluster randomized controlled trial was conducted. Fifty-nine wards were randomly assigned to the intervention or to "care as usual". The intervention was a Multidisciplinary Multi-step Medication Review (3MR), consisting of an assessment of the patient perspective, a medical history, a critical appraisal of medication, a meeting between the elderly care physician and a pharmacist, and the execution of medication changes. The primary outcome was successful discontinuation of ≥1 inappropriate drug(s), without relapse or severe withdrawal symptoms. Secondary outcomes included neuropsychiatric symptoms, cognitive function and quality of life. Nursing home residents with a life expectancy of >4 weeks who did not refuse treatment with medication were included. Data were collected at baseline and at an average follow-up of 144 days. Results: A total of 426 nursing home residents participated (intervention group: N=233 and control group: N=193). Generalized linear mixed models (logit link function) showed that for 91 (39.1%) of the residents in the intervention group ≥1 inappropriate drugs could be successfully discontinued vs. 57 (29.5%) of residents in the control group (adjusted odds-ratio: 1.57, 95% CI: 1.03 to 2.39). There was no deterioration on secondary outcomes. Conclusions: The 3MR is effective in discontinuing inappropriate medication in nursing home residents whilst probably not compromising their wellbeing.

Introduction: A variety of drugs, which are frequently prescribed to older people, have anticholinergic and sedative effects whereby they may impair cognitive and physical function. Although substantial inter-individual variation in anticholinergic and sedative exposure has been documented, little is known about subpopulations with distinct trajectories of exposure. Methods: Data from the Longitudinal Aging Study Amsterdam (LASA), an ongoing Dutch population-based cohort study, collected over 20 years (1992-2012) at seven occasions, were analyzed. On each occasion, cumulative anticholinergic and sedative exposure was quantified with the Drug Burden Index, a linear additive pharmacological dose-response model. The most likely number of trajectories were empirically derived with Latent Class Growth Analysis using "Goodness of fit" statistics. Trajectories were then compared on physical and cognitive function. Results: A total of 763 participants completed all follow-ups (61% women; mean age 83, ±6). "Goodness of fit" statistics (Bayesian In-formation Criterion = 22916, Bootstrapped Likelihood Ratio Test of 3 vs. 2 classes = 514.12 p

Computerized Adaptive Testing (CAT) of cognitive function, selects for every individual patient, only items of appropriate difficulty to estimate his or her level of cognitive impairment. Therefore, CAT has the potential to combine brevity with precision. We retrospectively examined the evaluation of treatment effects of cholinesterase inhibitors by CAT using longitudinal data from 643 patients from a Dutch teaching hospital who were diagnosed with Alzheimer disease or Lewy Body disease. The Cambridge Cognitive Examination (CAMCOG) was administered before treatment initiation and after intervals of six months of treatment. A previously validated CAT was simulated using 47 CAMCOG items. Results demonstrated that the CAT required a median number of 17 items (inter-quartile range 16-20), or a corresponding 64% test reduction, to estimate patients' global cognitive impairment levels. At the same time, intraclass correlations between global cognitive impairment levels as estimated by CAT or based on all 47 CAMCOG items, ranged from 0.93 at baseline to 0.91-0.94 at follow-up measurements. Slightly more people had substantial decline on the original CAMCOG (N = 31/285, 11%) than on the CAT (N = 17/285, 6%). We conclude that CAT saves time, does not lose much precision, and therefore deserves a role in the evaluation of treatment effects in dementia. Copyright © 2015 John Wiley & Sons, Ltd.