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Leontjevas R.,Radboud University Nijmegen | Leontjevas R.,Open Box | Gerritsen D.L.,Radboud University Nijmegen | Smalbrugge M.,VU University Amsterdam | And 3 more authors.
The Lancet | Year: 2013

Background Depression in nursing-home residents is often under-recognised. We aimed to establish the effectiveness of a structural approach to its management. Methods Between May 15, 2009, and April 30, 2011, we undertook a multicentre, stepped-wedge cluster-randomised trial in four provinces of the Netherlands. A network of nursing homes was invited to enrol one dementia and one somatic unit per nursing home. In enrolled units, nursing-home staff recruited residents, who were eligible as long as we had received written informed consent. Units were randomly allocated to one of five groups with computer-generated random numbers. A multidisciplinary care programme, Act in Case of Depression (AiD), was implemented at different timepoints in each group: at baseline, no groups were implenting the programme (usual care); the first group implemented it shortly after baseline; and other groups sequentially began implementation after assessments at intervals of roughly 4 months. Residents did not know when the intervention was being implemented or what the programme elements were; research staff were masked to intervention implementation, depression treatment, and results of previous assessments; and data analysts were masked to intervention implementation. The primary endpoint was depression prevalence in units, which was the proportion of residents per unit with a score of more than seven on the proxy-based Cornell scale for depression in dementia. Analyses were by intention to treat. This trial is registered with the Netherlands National Trial Register, number NTR1477. Findings 16 dementia units (403 residents) and 17 somatic units (390 residents) were enrolled in the course of the study. In somatic units, AiD reduced prevalence of depression (adjusted effect size -7•3%, 95% CI -13•7 to -0•9). The effect was not significant in dementia units (0•6, -5•6 to 6•8) and differed significantly from that in somatic units (p=0•031). Adherence to depression assessment procedures was lower in dementia units (69% [SD 19%]) than in somatic units (82% [15%]; p=0•045). Adherence to treatment pathways did not differ between dementia units (43% [SD 33%]) and somatic units (38% [40%]; p=0•745). Source

Tolba A.S.,Open Box
Expert Systems with Applications | Year: 2011

This paper introduces a novel hybrid approach for both defect detection and localization in homogeneous flat surface products. Real time defect detection in industrial products is a challenging problem. Fast production speeds and the variable nature of production defects complicate the process of automating the defect detection task. Speeding up the detection process is achieved in this paper by implementing a hybrid approach that is based on the statistical decision theory, multi-scale and multi-directional analysis and a neural network implementation of the optimal Bayesian classifier. The coefficient of variation is first used as a homogeneity measure for approximate defect localization. Second, features are extracted from the log Gabor filter bank response to accurately localize and detect the defect while reducing the complexity of Gabor based inspection approaches. A probabilistic neural network (PNN) is used for fast defect classification based on the maximum posterior probability of the Log-Gabor based statistical features. Experimental results show a major performance enhancement over existing defect detection approaches. © 2010 Elsevier Ltd. All rights reserved. Source

Springvloet L.,Maastricht University | Lechner L.,Open Box | Oenema A.,Maastricht University
BMC Public Health | Year: 2014

Background: Despite decades of nutrition education, the prevalence of unhealthy dietary patterns is still high and inequalities in intake between high and low socioeconomic groups still exist. Therefore, it is important to innovate and improve existing nutrition education interventions. This paper describes the development, design and evaluation protocol of a web-based computer-tailored nutrition education intervention for adults targeting fruit, vegetable, high-energy snack and fat intake. This intervention innovates existing computer-tailored interventions by not only targeting motivational factors, but also volitional and self-regulation processes and environmental-level factors. Methods/design. The intervention development was guided by the Intervention Mapping protocol, ensuring a theory-informed and evidence-based intervention. Two versions of the intervention were developed: a basic version targeting knowledge, awareness, attitude, self-efficacy and volitional and self-regulation processes, and a plus version additionally addressing the home environment arrangement and the availability and price of healthy food products in supermarkets. Both versions consist of four modules: one for each dietary behavior, i.e. fruit, vegetables, high-energy snacks and fat. Based on the self-regulation phases, each module is divided into three sessions. In the first session, feedback on dietary behavior is provided to increase awareness, feedback on attitude and self-efficacy is provided and goals and action plans are stated. In the second session goal achievement is evaluated, reasons for failure are explored, coping plans are stated and goals can be adapted. In the third session, participants can again evaluate their behavioral change and tips for maintenance are provided. Both versions will be evaluated in a three-group randomized controlled trial with measurements at baseline, 1-month, 4-months and 9-months post-intervention, using online questionnaires. Both versions will be compared with a generic nutrition information control condition. The primary outcomes are fruit, vegetable, high-energy snack and fat intake. Discussion. The evaluation study will provide insight into the short- and long-term efficacy of both intervention versions in adults. Additionally, differences in the efficacy among high- and low-educated people will be examined. If these interventions are effective, two well-developed interventions will become available for the implementation and promotion of healthy dietary patterns among both high- and low-educated adults in the Netherlands. Trial registration. Dutch Trial Registry NTR3396. © 2014 Springvloet et al.; licensee BioMed Central Ltd. Source

Uit de Weerd D.R.,Open Box | Uit de Weerd D.R.,Netherlands Center for Biodiversity Naturalis | Gittenberger E.,Netherlands Center for Biodiversity Naturalis
Molecular Phylogenetics and Evolution | Year: 2013

Clausiliidae is one of the most speciose and best-studied families of land snails. The family contributes to land snail diversity on a global scale, with three main centres of diversity: (1) western Eurasia (six subfamilies recognized), (2) East Asia (two subfamilies recognized) and (3) the neotropics (one subfamily recognized i.e. Neniinae). Despite a wealth of shell-morphological and anatomical studies, a well-supported phylogeny is lacking for the family.To provide a phylogenetic framework and reevaluate morphological and biogeographic observations on the family, we compiled a dataset consisting of partial 28S rRNA, histone H3 and histone H4 nucleotide sequences covering all clausiliid subfamilies, and 23 out of 25 tribes. Our analyses (MrBayes, BEAST, PhyML) divide the family into seven highly supported clades, which were retrieved by at least two of the three markers used, and which are more or less geographically confined. Three of these clades coincide with subfamilies recognized in the current classification (Alopiinae, Garnieriinae, Laminiferinae). The monophyly of four of the remaining six hitherto accepted subfamilies is not supported, with the New World subfamily Neniinae divided across two clades. All shell-morphological characters used in classical clausiliid classification were homoplasious at the subfamily level, with the exception of the type of shell aperture formation. In contrast to previous interpretations, our results suggest that the so-called 'apostrophic' aperture found in the neotropical clausiliids, and in a European (Laminiferinae) and a SE Asian (Garnieriinae) subfamily, is in fact the plesiomorphic condition among extant Clausiliidae. The widespread and fragmented geographic distribution of this type of aperture may therefore be considered relictual. Based on an inferred Late Cretaceous or Early Cenozoic European origin of the clade of extant Clausiliidae, the ancestor(s) of the neotropical Clausiliidae must have colonized the New World after the Atlantic Ocean had opened. A taxonomic revision is proposed. © 2013 Elsevier Inc. Source

De Vries H.,Maastricht University | Eggers S.M.,Maastricht University | Bolman C.,Open Box
BMC Public Health | Year: 2013

Background: Several studies have reemphasized the role of action planning. Yet, little attention has been paid to the role of plan enactment. This study assesses the determinants and the effects of action planning and plan enactment on smoking cessation. Methods. One thousand and five participants completed questionnaires at baseline and at follow-ups after one and six months. Factors queried were part of the I-Change model. Descriptive analyses were used to assess which plans were enacted the most. Multivariate linear regression analyses were used to assess whether the intention to quit smoking predicted action planning and plan enactment, and to assess which factors would predict quitting behavior. Subsequently, both multivariate and univariate regression analyses were used to assess which particular action plans would be most effective in predicting quitting behavior. Similar analyses were performed among a subsample of smokers prepared to quit within one month. Results: Smokers who intended to quit smoking within the next month had higher levels of action planning than those intending to quit within a year. Additional predictors of action planning were being older, being female, having relatively low levels of cigarette dependence, perceiving more positive and negative consequences of quitting, and having high self-efficacy toward quitting. Plan enactment was predicted by baseline intention to quit and levels of action planning. Regression analysis revealed that smoking cessation after six months was predicted by low levels of depression, having a non-smoking partner, the intention to quit within the next month, and plan enactment. Only 29% of the smokers who executed relatively few plans had quit smoking versus 59% of the smokers who executed many plans. The most effective preparatory plans for smoking cessation were removing all tobacco products from the house and choosing a specific date to quit. Conclusion: Making preparatory plans to quit smoking is important because it also predicts plan enactment, which is predictive of smoking cessation. Not all action plans were found to be predictive of smoking cessation. The effects of planning were not very much different between the total sample and smokers prepared to quit within one month. © 2013 de Vries et al.; licensee BioMed Central Ltd. Source

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