Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
When corporate social responsibility (CSR) as a sensemaking process is assessed from a corporate governance perspective, this implies that stakeholders do not only influence companies by promoting and enforcing regulations and other corporate guidelines. They also influence companies by promoting regulation on influence pathways, by demanding that companies develop formal mechanisms that allow companies and stakeholders to discuss and in some cases agree on changes to principles and policies. This perspective suggests that regulation is an outcome of power relations and is, as such, a reflection of certain mental models. As such, mental models reveal the political bias in corporate governance perspectives. For this reason, CSR research needs to be clear about the underlying assumptions about corporate governance, and corporate governance research needs to disclose which mental models of CSR influence the outcomes. Taking a governance perspective on the development of mental models of CSR helps to understand the interaction between CSR and processes of sensemaking at the institutional, organizational and individual levels.
IMPORTANCE People with a severe mental illness (SMI) have a life expectancy reduced by 10 to 20 years compared with the general population, primarily attributable to cardiometabolic disorders. Lifestyle interventions for people with SMI can improve health and reduce cardiometabolic risk. OBJECTIVE To evaluate the effectiveness of a group-based lifestyle intervention among people with SMI in outpatient treatment settings compared with treatment as usual (TAU). DESIGN, SETTING, AND PARTICIPANTS The Severe Mental Illness Lifestyle Evaluation (SMILE) study is a pragmatic cluster randomized clinical trial performed in 8 mental health care centers with 21 flexible assertive community treatment teams in the Netherlands. Inclusion criteria were SMI, age of 18 years or older, and body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or greater. Data were collected from January 2018 to February 2020, and data were analyzed from September 2020 to February 2023. INTERVENTIONS Weekly 2-hour group sessions for 6 months followed by monthly 2-hour group sessions for another 6 months, delivered by trained mental health care workers. The intervention targeted overall lifestyle changes, emphasizing establishing a healthy diet and promoting physical activity. TAU (control) did not include structured interventions or advice on lifestyle. MAIN OUTCOMES AND MEASURES Crude and adjusted linear mixed models and multivariable logistic regression analyses were performed. The main outcome was body weight change. Secondary outcomes included changes in body mass index, blood pressure, lipid profiles, fasting glucose level, quality of life, self-management ability, and lifestyle behaviors (physical activity and health, mental health, nutrition, and sleep). RESULTS The study population included 11 lifestyle intervention teams (126 participants) and 10 TAU teams (98 participants). Of 224 included patients, 137 (61.2%) were female, and the mean (SD) age was 47.6 (11.1) years. From baseline to 12 months, participants in the lifestyle intervention group lost 3.3 kg (95%CI, −6.2 to −0.4) more than those in the control group. In the lifestyle intervention group, people with high attendance rates lost more weight than participants with medium and low rates (mean [SD] weight loss: high, −4.9 [8.1] kg; medium, −0.2 [7.8] kg; low, 0.8 [8.3] kg). Only small or no changes were found for secondary outcomes. CONCLUSIONS AND RELEVANCE In this trial, the lifestyle intervention significantly reduced weight from baseline to 12 months in overweight and obese adults with SMI. Tailoring lifestyle interventions and increasing attendance rates might be beneficial for people with SMI. TRIAL REGISTRATION Netherlands Trial Register Identifier: NTR6837
The transition towards an economy of wellbeing is complex, systemic, dynamic and uncertain. Individuals and organizations struggle to connect with and embrace their changing context. They need to create a mindset for the emergence of a culture of economic well-being. This requires a paradigm shift in the way reality is constructed. This emergence begins with the mindset of each individual, starting bottom-up. A mindset of economic well-being is built using agency, freedom, and responsibility to understand personal values, the multi-identity self, the mental models, and the individual context. A culture is created by waving individual mindsets together and allowing shared values, and new stories for their joint context to emerge. It is from this place of connection with the self and the other, that individuals' intrinsic motivation to act is found to engage in the transitions towards an economy of well-being. This project explores this theoretical framework further. Businesses play a key role in the transition toward an economy of well-being; they are instrumental in generating multiple types of value and redefining growth. They are key in the creation of the resilient world needed to respond to the complex and uncertain of our era. Varta-Valorisatielab, De-Kleine-Aarde, and Het Groene Brein are frontrunner organizations that understand their impact and influence. They are making bold strategic choices to lead their organizations towards an economy of well-being. Unfortunately, they often experience resistance from stakeholders. To address this resistance, the consortium in the proposal seeks to answer the research question: How can individuals who connect with their multi-identity-self, (via personal values, mental models, and personal context) develop a mindset of well-being that enables them to better connect with their stakeholders (the other) and together address the transitional needs of their collective context for the emergence of a culture of the economy of wellbeing?
The increasing amount of electronic waste (e-waste) urgently requires the use of innovative solutions within the circular economy models in this industry. Sorting of e-waste in a proper manner are essential for the recovery of valuable materials and minimizing environmental problems. The conventional e-waste sorting models are time-consuming processes, which involve laborious manual classification of complex and diverse electronic components. Moreover, the sector is lacking in skilled labor, thus making automation in sorting procedures is an urgent necessity. The project “AdapSort: Adaptive AI for Sorting E-Waste” aims to develop an adaptable AI-based system for optimal and efficient e-waste sorting. The project combines deep learning object detection algorithms with open-world vision-language models to enable adaptive AI models that incorporate operator feedback as part of a continuous learning process. The project initiates with problem analysis, including use case definition, requirement specification, and collection of labeled image data. AI models will be trained and deployed on edge devices for real-time sorting and scalability. Then, the feasibility of developing adaptive AI models that capture the state-of-the-art open-world vision-language models will be investigated. The human-in-the-loop learning is an important feature of this phase, wherein the user is enabled to provide ongoing feedback about how to refine the model further. An interface will be constructed to enable human intervention to facilitate real-time improvement of classification accuracy and sorting of different items. Finally, the project will deliver a proof of concept for the AI-based sorter, validated through selected use cases in collaboration with industrial partners. By integrating AI with human feedback, this project aims to facilitate e-waste management and serve as a foundation for larger projects.
PBL is the initiator of the Work Programme Monitoring and Management Circular Economy 2019-2023, a collaboration between CBS, CML, CPB, RIVM, TNO, UU. Holidays and mobility are part of the consumption domains that PBL researches, and this project aims to calculate the environmental gains per person per year of the various circular behavioural options for both holiday behaviour and daily mobility. For both behaviours, a range of typical (default) trips are defined and for each several circular option explored for CO2 emissions, Global warming potential and land use. The holiday part is supplied by the Centre for Sustainability, Tourism and Transport (CSTT) of the BUas Academy of Tourism (AfT). The mobility part is carried out by the Urban Intelligence professorship of the Academy for Built Environment and Logistics (ABEL).The research question is “what is the environmental impact of various circular (behavioural) options around 1) holidays and 2) passenger mobility?” The consumer perspective is demarcated as follows:For holidays, transportation and accommodation are included, but not food, attractions visited and holiday activitiesFor mobility, it concerns only the circular options of passenger transport and private means of transport (i.e. freight transport, business travel and commuting are excluded). Not only some typical trips will be evaluated, but also the possession of a car and its alternatives.For the calculations, we make use of public databases, our own models and the EAP (Environmental Analysis Program) model developed by the University of Groningen. BUAs projectmembers: Centre for Sustainability, Tourism and Transport (AT), Urban Intelligence (ABEL).
