7 research outputs found
Coastal management: Global change. global observation?
No full textThe theme of the present discussion is to consider coastal observation needs in the broader context of a sustainable, integrated management response to coastal change. Thus underlining the notion that observations are an element of a more comprehensive process. We will therefore first explore the process of ICZM, and find that deficits in international co-ordination and concertation are large. An overview of salient coastal zone issues emphasises the spatial, spectral and temporal diversity of observational needs, which is concluded to be an important reason for the relative underdevelopment of coastal zone observation systems. A "global" coastal observation effort should give due consideration to these aspects, and aim to help resolve this in concertation with national and international institutions carrying responsibility for a sustainable development of the coastal zone. The interpretation of the meaning of global appears to be twofold, global in the sense of a generic, universal need (although many coastal problems are local), and global in the sense of institutionalisation and co-ordination on a global level.Hydraulic EngineeringCivil Engineering and Geoscience
'Stay nearby or get checked' : a Covid-19 lockdown exit strategy
No full textPublished on 15 April 2020This paper repurposes the classic insight from network theory that long-distance connections drive disease propagation into a strategy for controlling a second wave of Covid-19. We simulate a scenario in which a lockdown is first imposed on a population and then partly lifted while long-range transmission is kept at a minimum. Simulated spreading patterns resemble contemporary distributions of Covid-19 across nations, regions, and provinces, providing some model validation. Results suggest that the proposed strategy may significantly flatten a second wave. We also find that post-lockdown flare-ups remain local longer, aiding geographical containment. Public policy may target long ties by heavily focusing medical testing and mobility tracking efforts on traffic and transport. This policy can be communicated to the general public as a simple and reasonable principle: Stay nearby or get checked
Adaptive design: Adaptation and adoption of patient safety practices in daily routines, a multi-site study
No full textBackground: Most interventions to improve patient safety (Patient Safety Practices (PSPs)), are introduced without engaging front-line professionals. Administrative staff, managers and sometimes a few professionals, representing only one or two disciplines, decide what to change and how. Consequently, PSPs are not fully adapted to the professionals' needs or to the local context and as a result, adoption is low. To support adoption, two theoretical concepts, Participatory Design and Experiential Learning were combined in a new model: Adaptive Design. The aim was to explore whether Adaptive Design supports adaptation and adoption of PSPs by engaging all professionals and creating time to (re) design, reflect and learn as a team. The Time Out Procedure (TOP) and Debriefing (plus) for improving patient safety in the operating theatre (OT) was used as PSP. Methods: Qualitative exploratory multi-site study using participatory action research as a research design. The implementation process consisted of four phases: 1) start-up: providing information by presentations and team meetings, 2) pilot: testing the prototype with 100 surgical procedures, 3) small scale implementation: with one or two surgical disciplines, 4) implementation hospital-wide: including all surgical disciplines. In iterations, teams (re) designed, tested, evaluated, and if necessary adapted TOPplus. Gradually all professionals were included. Adaptations in content, process and layout of TOPplus were measured following each iteration. Adoption was monitored until final implementation in every hospital's OT. Results: 10 Dutch hospitals participated. Adaptations varied per hospital, but all hospitals adapted both procedures. Adaptations concerned the content, process and layout of TOPplus. Both procedures were adopted in all OTs, but user participation and time to include all users varied between hospitals. Ultimately all users were actively involved and TOPplus was implemented in all OTs. Conclusions: Engaging all professionals in a structured bottom-up implementation approach with a focus on learning, improves adaptation and adoption of a PSP. As a result, all 10 participating hospitals implemented TOPplus with all surgical disciplines in all OTs. Adaptive Design gives professionals the opportunity to adapt the PSP to their own needs and their specific local context. All hospitals adapted TOPplus, but without compromising the essential features for its effectiveness
Rising tension in the Himalayas: A geospatial analysis of Chinese border incursions into India
No full textThe China-India border is the longest disputed border in the world. The countries went to war in 1962 and there have been recurring border skirmishes ever since. Reports of Chinese incursions into Indian territory are now a frequent occurrence. This rising tension between the world’s most populous countries not only poses risks for global security and the world economy, but also has a negative impact on the unique ecology of the Himalayas, because of the expanding military infrastructure. We have assembled a unique data set of the dates and locations of the major incursions over the past 15 years. We find that the conflict can be separated into two independent conflicts, the western and eastern sectors. The incursions in these sectors are statistically independent. However, major incidents do lead to an increased tension that persists for years all along the entire Line of Actual Control (LAC). This leads us to conclude that an agreement on the exact location of a limited number of contested regions, such as the Doklam plateau on the China-Bhutan border, has the potential to significantly defuse the conflict, and could potentially settle the dispute at a further date. Building on insights from game theory, we find that the Chinese incursions in the west are strategically planned and may aim for a more permanent control over specific contested areas. This finding is in agreement with other studies into the expansionist strategy of the current Chinese government.Applied Probabilit
Discrepant perceptions of communication, teamwork and situation awareness among surgical team members
No full textObjective To assess surgical team members’ differences in perception of non-technical skills. Design Questionnaire design. Setting Operating theatres (OTs) at one university hospital, three teaching hospitals and one general hospital in the Netherlands. Participants Sixty-six surgeons, 97 OT nurses, 18 anaesthetists and 40 nurse anaesthetists. Methods All surgical team members, of five hospitals, were asked to complete a questionnaire and state their opinion on the current state of communication, teamwork and situation awareness at the OT. Results Ratings for ‘communication’ were significantly different, particularly between surgeons and all other team members (P ? 0.001). The ratings for ‘teamwork’ differed significantly between all team members (P ? 0.005). Within ‘situation awareness’ significant differences were mainly observed for ‘gathering information’ between surgeons and other team members (P < 0.001). Finally, 72–90% of anaesthetists, OT nurses and nurse anaesthetists rated routine team briefings and debriefings as inadequate. Conclusions This study shows discrepancies on many aspects in perception between surgeons and other surgical team members concerning communication, teamwork and situation awareness. Future research needs to ascertain whether these discrepancies are linked to greater risk of adverse events or to process as well as systems failures. Establishing this link would support implementation and use of complex team interventions that intervene at multiple levels of the healthcare systemIndustrial Design Engineerin
Breeding against osteochondrosis : phenotypic and genetic analyses in horses and pigs
No full text Osteochondrosis (OC) is a disturbance in the process of endochondral ossification during skeletal growth. The objectives of this thesis were to assess the prevalence and genetic parameters of OC, and to facilitate optimization of breeding against OC in horses and pigs. In the Dutch warm blood horse, 70% of individuals showed joint abnormalities in at least one of the 28 locations examined. Joint abnormalities were divided into flattened bone contours and bone fragments. Genetic parameters were estimated for flattened bone contours, fragments and overall OC. Heritability was 0.08 for flattened bone contours, 0.22 for fragments, and 0.23 for overall OC. In fattening pigs, the prevalence of OC was 41%, and 12% of the individuals had severe OC. The prevalence was highest for individuals kept on a concrete, partially slatted floor with ad libitum feeding (58%), and lowest for individuals kept on a deep litter floor with restricted feeding (34%). These results demonstrate that the prevalence of OC can be reduced by applying deep litter floors and restricted feeding. The differences in growth patterns between pigs with and without OC were investigated also. After 28 days of age, piglets with severe OC at slaughter started to grow faster, and were significantly heavier after 70 days of age than pigs without OC at slaughter. These results suggest that OC might be related to high growth rates during a specific time period. To evaluate prospects for breeding against OC, selection responses were compared between breeding schemes using phenotypic selection based on own performance or progeny testing and genomic selection. The results show that, when genomic information has an equal accuracy as phenotypic information before selection, it will have a lower equilibrium response to selection because it has a larger Bulmer effect. Especially for low heritable traits, genomic selection was of additional value over traditional selection. The general discussion argues that OC has both economical and practical relevance for the current horse industry. Simulations showed potential for genomic selection compared to the current breeding program in the Dutch warmblood horse (KWPN), even with small reference populations. In pigs, OC is a more serious problem in sows than in fattening pigs, because sows live longer. A decrease in OC prevalence will, therefore, yield larger economic and welfare benefits then apparent from results on fattening pigs. Also for pigs, simulations indicated possibilities for genomic selection. The final section of the general discussion proposes directions for future research.</p
