Dit rapport bevat de resultaten van de tweede ronde procesevaluaties van zes cyberweerbaarheidsprojecten binnen de City Deal Lokale Weerbaarheid Cybercrime. De evaluaties zijn uitgevoerd door onderzoekers van meerdere hogescholen en richten zich op hoe lokale en regionale initiatieven werken aan het versterken van cyberweerbaarheid onder burgers, bedrijven en overheden. Het doel van het rapport is om inzicht te geven in: de voortgang van de projecten; succesfactoren en belemmeringen; lessen voor toekomstige (samenwerkings)projecten op het gebied van cyberweerbaarheid.
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Deze rapportage is het resultaat van een praktijkgericht onderzoek naar een bijzonder project De Kunst van Delen. In samenwerking met het Grijze Koppen Orkest, hebben diverse organisaties uit Utrecht door middel van het project De Kunst van Delen een bijdrage geleverd aan Utrecht als Age Friendly Cultural City (AFCC). Deze onderzoeksrapportage is als volgt opgebouwd: In het eerste hoofdstuk schetsen we de achtergrond en context van het project De Kunst van Delen en het onderzoeksdoel en de onderzoeksvraag worden gepresenteerd. In hoofdstuk 2 staan de eerste onderzoeksstap, de participerende observaties, en de tussenresultaten daarvan beschreven. Hoofdstuk 3 behandelt de tweede onderzoeksstap: de individuele interviews en de tussenresultaten ervan, in de vorm van de belangrijkste voorwaarden van het project De Kunst van Delen voor de ontwikkeling van stad Utrecht als Age Friendly Cultural City. In hoofdstuk 4 is te lezen hoe de validering van die voorwaarden heeft plaatsgevonden en wat deze validering heeft opgeleverd. Dat is de derde stap in het onderzoek. Als vierde en laatste stap in het onderzoeksproces, is op basis van die gevalideerde voorwaarden een verkennend literatuur-onderzoek uitgevoerd. Dit literatuuronderzoek is te lezen in hoofdstuk 5. In hoofdstuk 6 zijn tot slot de conclusie en aanbevelingen van dit verkennend praktijkgericht onderzoek te vinden.
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Dit verkennende praktijkgerichte onderzoek is gericht op het systematisch onderzoeken en onderbouwen van de (on)mogelijkheden van het project De kunst van delen dat een begin moet maken met de ontwikkeling van Utrecht als Age Friendly Cultural City. Utrecht wil een stad zijn waar cultuurparticipatie door ouderen verduurzaamt. Hierbij staan samenwerking tussen cultuur, zorg en welzijn en het bouwen aan een stevig lokaal netwerk centraal. Deze tussenrapportage richt zich op het beschrijven en in beeld brengen van de werkwijze, de uitdagingen en de do’s en dont’s die uit de eerste module van het project De kunst van delen naar voren komen.
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The phenomena of urbanization and climate change interact with the growing number of older people living in cities. One of the effects of climate change is an increased riverine flooding hazard, and when floods occur this has a severe impact on human lives and comes with vast economic losses. Flood resilience management procedures should be supported by a combination of complex social and environmental vulnerability assessments. Therefore, new methodologies and tools should be developed for this purpose. One way to achieve such inclusive procedures is by incorporating a social vulnerability evaluation methodology for environmental and flood resilience assessment. These are illustrated for application in the Polish city of Wrocław. Socio-environmental vulnerability mapping, based on spatial analyses using the poverty risk index, data on the ageing population, as well as the distribution of the areas vulnerable to floods, was conducted with use of a location intelligence system combining Geographic Information System (GIS) and Business Intelligence (BI) tools. The new methodology allows for the identification of areas populated by social groups that are particularly vulnerable to the negative effects of flooding. C 2018 SETAC Original Publication: Integr Environ Assess Manag 2018;14:592–597. DOI: https://doi.org/10.1002/ieam.4077
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ABSTRACT Objective: To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. Methods: Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. Results: The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. Conclusions: Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
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Dit artikel biedt een tussenstand van een lopend onderzoek naar het functioneren van de wijkteams die vorm gaven aan de eerste fase van het Haagse krachtwijkenbeleid. De focus ligt op het professionele handelen van ambtenaren met ‘één been in het stadhuis en één been in de wijk’. Als conceptueel kader maak ik gebruik van het concept tussenfuncties, gedefinieerd als functies binnen de organisatie van de bureaucratie die niet passen bij de logica van diezelfde bureaucratie. In de zoektocht naar wat dit bewegen tussen verschillende schurende logica’s vraagt van de vakbekwaamheid van deze ambtenaren, biedt het concept praktische wijsheid goede handvatten. Waar competenties al snel ‘ontaarden’ in mechanische, gestandaardiseerde lijstjes, verlegt praktische wijsheid de focus naar persoonlijke capaciteiten die succesvol handelen in een specifieke werkpraktijk mogelijk maken en die in die praktijk verder ontwikkeld kunnen worden. Abstract This article provides an intermediate report on an ongoing research into the functioning of teams of community civil servants who implemented the first phase of the krachtwijken (power neighbourhoods) policy in the city of The Hague in which the focus is on the professional skills of civil servants who work with ‘one foot in city hall and one foot in the community’. As a conceptual framework, I used the concept of a tussenfunctie, (in-between position) defined as position within the organisation of a bureaucracy that does not fit the logic of that bureaucracy. In the search for what this moving back and forth between different logics requires from these civil servants in terms of professional expertise, the concept of practical wisdom is useful. Whereas the use of competencies easily degenerates into mechanical one-size-fits-all lists, practical wisdom shifts the focus to personal capabilities that enable one to deal successfully with specific situations and that can be developed by acquiring hands-on experience.
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Abstract: Due to rapidly aging human populations, frailty has become an essential concept, as it identifies older people who have higher risk of adverse outcomes, such as disability, institutionalization, lower quality of life, and premature death. The Tilburg Frailty Indicator (TFI) is a user-friendly questionnaire based on a multidimensional approach to frailty, assessing physical, psychologic, and social aspects of human functioning. This review aims to explore the efficiency of the TFI in assessing frailty as a means to carry out research into the antecedents and consequences of frailty, and its use both in daily practice and for future intervention studies. Using a multidimensional approach to frailty, in contexts where health care professionals or researchers may have no time to interview or examine the client, we recommend employing the TFI because there is robust evidence of its reliability and validity and it is easy and quick to administer. More studies are needed to establish whether the TFI is suitable for intervention studies not only in the community, but also for specific groups such as patients in the hospital or admitted to an emergency department. We conclude that it is important to not only determine the deficits that frail older people may have, but also to assess their balancing strengths and resources. In order to be able to meet the individual needs of frail older persons, traditional and often fragmented elderly care should be developed toward a more proactive elderly care, in which frail older persons and their informal network are in charge.
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Objective: To predict mortality by disability in a sample of 479 Dutch community-dwelling people aged 75 years or older. Methods: A longitudinal study was carried out using a follow-up of seven years. The Groningen Activity Restriction Scale (GARS), a self-reported questionnaire with good psychometric properties, was used for data collection about total disability, disability in activities in daily living (ADL) and disability in instrumental activities in daily living (IADL). The mortality dates were provided by the municipality of Roosendaal (a city in the Netherlands). For analyses of survival, we used Kaplan–Meier analyses and Cox regression analyses to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: All three disability variables (total, ADL and IADL) predicted mortality, unadjusted and adjusted for age and gender. The unadjusted HRs for total, ADL and IADL disability were 1.054 (95%-CI: [1.039;1.069]), 1.091 (95%-CI: [1.062;1.121]) and 1.106 (95%-CI: [1.077;1.135]) with p-values <0.001, respectively. The AUCs were <0.7, ranging from 0.630 (ADL) to 0.668 (IADL). Multivariate analyses including all 18 disability items revealed that only “Do the shopping” predicted mortality. In addition, multivariate analyses focusing on 11 ADL items and 7 IADL items separately showed that only the ADL item “Get around in the house” and the IADL item “Do the shopping” significantly predicted mortality. Conclusion: Disability predicted mortality in a seven years follow-up among Dutch community-dwelling older people. It is important that healthcare professionals are aware of disability at early stages, so they can intervene swiftly, efficiently and effectively, to maintain or enhance the quality of life of older people.
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Background: Modern modeling techniques may potentially provide more accurate predictions of dichotomous outcomes than classical techniques. Objective: In this study, we aimed to examine the predictive performance of eight modeling techniques to predict mortality by frailty. Methods: We performed a longitudinal study with a 7-year follow-up. The sample consisted of 479 Dutch community-dwelling people, aged 75 years and older. Frailty was assessed with the Tilburg Frailty Indicator (TFI), a self-report questionnaire. This questionnaire consists of eight physical, four psychological, and three social frailty components. The municipality of Roosendaal, a city in the Netherlands, provided the mortality dates. We compared modeling techniques, such as support vector machine (SVM), neural network (NN), random forest, and least absolute shrinkage and selection operator, as well as classical techniques, such as logistic regression, two Bayesian networks, and recursive partitioning (RP). The area under the receiver operating characteristic curve (AUROC) indicated the performance of the models. The models were validated using bootstrapping. Results: We found that the NN model had the best validated performance (AUROC=0.812), followed by the SVM model (AUROC=0.705). The other models had validated AUROC values below 0.700. The RP model had the lowest validated AUROC (0.605). The NN model had the highest optimism (0.156). The predictor variable “difficulty in walking” was important for all models. Conclusions: Because of the high optimism of the NN model, we prefer the SVM model for predicting mortality among community-dwelling older people using the TFI, with the addition of “gender” and “age” variables. External validation is a necessary step before applying the prediction models in a new setting.
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