The cultural tourism market has diversified and fragmented into many different niches. Previous attempts to segment cultural tourists have been largely unidimensional, failing to capture the complexity of cultural production and consumption. We employ multiple correspondence analysis to visualize the relationship between cultural consumers and attractions in a large data set (n = 12,905). This indicates that two dimensions describing the ranges between 'static' and 'dynamic' attractions and 'high-brow' and 'low brow' culture effectively discriminate different groups of arts and heritage tourists. The holiday structure itself seems to provide a context that influences the cultural consumption of actors. Thus higher levels of cultural capital are related to more accessible forms of culture, contrary to theoretical expectations. There is also evidence of the development of a cultural tourism 'travel career' with more dynamic cultural forms being characteristic of younger tourists and more high brow and static forms of culture being consumed in later life by those with higher levels of cultural capital.
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Background: Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods: Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results: Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions: Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation.
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We are currently in a transition moving from a linear economy grounded on economic value maximization based on material transformation to a circular economy. Core of this transition is organising value preservation from various yet interlinked perspectives. The underlying fundamental shift is to move away from mere financial value maximization towards multiple value creation (WCED, 1987; Jonker, 2014; Raworth, 2017). This implies moving from mere economic value creation, to simultaneously and in a balanced way creating ecological and social value. A parallel development supporting this transition can be observed in accounting & control. Elkington (1994) introduced the triple bottom line (TBL) concept, referring to the economic, ecological and social impact of companies. The TBL should be seen more as a conceptual way of thinking, rather than a practical innovative accounting tool to monitor and control sustainable value (Rambaud & Richard, 2015). However, it has inspired accounting & control practitioners to develop accounting tools that not only aim at economic value (‘single capital’ accounting) but also at multiple forms of capital (‘multi capital’ accounting or integrated reporting). This has led to a variety of integrated reporting platforms such as Global Reporting Initiative (GRI), International Integrated Reporting Framework (IIRC), Dow Jones Sustainable Indexes (DJSI), True Costing, Reporting 3.0, etc. These integrated reporting platforms and corresponding accounting concepts, can be seen as a fundament for management control systems focussing on multiple value creation. This leads to the following research question: How are management control systems designed in practice to drive multiple value creation?
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The aim of the study was to evaluate whether multiple sclerosis (MS) is associated with risk of cataract or glaucoma. We conducted a population-based cohort study utilizing the UK General Practice Research Database (1987–2009) linked to the national hospital registry of England (1997–2008). Incident MS patients (5576 cases) were identified and each was matched to six patients without MS (controls) by age, gender, and practice. Cox proportional hazard models were used to estimate hazard ratios (HRs) of incident cataract and glaucoma in MS. Time-dependent adjustments were made for age, history of diseases and drug use.
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This study investigated the urban growth dynamics of urban regions. The study area was the Marmara Region, one of the most densely populated and ecologically diverse areas in Turkey. Using CORINE land cover data for 2006, 2012, and 2018, the study utilized multiple correspondence analyses and cluster analyses, to analyze land cover changes. The resulting maps, visualized in GIS, revealed the rapid urban transformation of the regional structure, formerly comprised of four distinct areas, into a more complex structure, in which densification and sprawl occur simultaneously. Our findings demonstrated a dissonance between the spatial dynamics of the Marmara Region during the study period, and the capacity and scope of the simultaneously initiated regional policies and mega‐projects. This uncoordinated approach has endangered the region’s sustainable development. The paper, therefore, discusses the importance of land use planning and transboundary collaboration for sustainable regional development. Beyond the local case, the results contribute to critical theories in regional planning by linking theory and practice.
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Learning environment designs at the boundary of school and work can be characterised as integrative because they integrate features from the contexts of school and work. Many different manifestations of such integrative learning environments are found in current vocational education, both in senior secondary education and higher professional education. However, limited research has focused on how to design these learning environments and not much is known about their designable elements (i.e. the epistemic, spatial, instrumental, temporal and social elements that constitute the learning environments). The purpose of this study was to examine manifestations of two categories of integrative learning environment designs: designs based on incorporation; and designs based on hybridisation. Cross-case analysis of six cases in senior secondary vocational education and higher professional education in the Netherlands led to insights into the designable elements of both categories of designs. We report findings about the epistemic, spatial, instrumental, temporal and social elements of the studied cases. Specific characteristics of designs based on incorporation and designs based on hybridisation were identified and links between the designable elements became apparent, thus contributing to a deeper understanding of the design of learning environments that aim to connect the contexts of school and work.
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Regenerative forms of higher education are emerging, and required, to connect with some of the grand transition challenges of our times. This paper explores the lived experience of 21 students learning to navigate a regenerative form of higher education in the Mission Impact course at The Hague University of Applied Sciences. This semester-length course ran for two iterations with the intention of connecting the students with local transitions towards a more circular society, one where products are lasting and have multiple lives when they are shared, refurbished, or become a source for a new product. At the end of each iteration, the students reflected on their experience using the Living Spiral Framework, which served as basis for an interpretative phenomenological analysis of their journey navigating this transformative course. The results of this study include four themes; (1) Opting in—Choosing RHE, (2) Learning in Regenerative Ways, (3) Navigating Resistance(s), and (4) Transformative Impacts of RHE. These themes can be used by practitioners to design and engage with regenerative forms of higher education, and by scholars to guide further inquiry. van den Berg B, Poldner KA, Sjoer E, Wals AEJ. ‘Sweet Acid’ An Interpretative Phenomenological Analysis of Students’ Navigating Regenerative Higher Education. Education Sciences. 2022; 12(8):533. https://doi.org/10.3390/educsci12080533
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Background: Structured psychotherapy is recommended as the preferred treatment of personality disorders. A substantial group of patients, however, has no access to these therapies or does not benefit. For those patients who have no (longer) access to psychotherapy a Collaborative Care Program (CCP) is developed. Collaborative Care originated in somatic health care to increase shared decision making and to enhance self management skills of chronic patients. Nurses have a prominent position in CCP’s as they are responsible for optimal continuity and coordination of care. The aim of the CCP is to improve quality of life and self management skills, and reduce destructive behaviour and other manifestations of the personality disorder. Methods/design: Quantitative and qualitative data are combined in a comparative multiple case study. This makes it possible to test the feasibility of the CCP, and also provides insight into the preliminary outcomes of CCP. Two treatment conditions will be compared, one in which the CCP is provided, the other in which Care as Usual is offered. In both conditions 16 patients will be included. The perspectives of patients, their informal carers and nurses are integrated in this study. Data (questionnaires, documents, and interviews) will be collected among these three groups of participants. The process of treatment and care within both research conditions is described with qualitative research methods. Additional quantitative data provide insight in the preliminary results of the CCP compared to CAU. With a stepped analysis plan the ‘black box’ of the application of the program will be revealed in order to understand which characteristics and influencing factors are indicative for positive or negative outcomes. Discussion: The present study is, as to the best of our knowledge, the first to examine Collaborative Care for patients with severe personality disorders receiving outpatient mental health care. With the chosen design we want to examine how and which elements of the CC Program could contribute to a better quality of life for the patients.
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While research has shown the multiple benefits of single-bed patient rooms in hospitals, amongst which the experience of privacy and dignity, the majority of patient rooms in existing hospitals are shared. Transforming them into single-patient rooms can be time-consuming, costly or even impossible, which motivates this study looking into privacy in multiple-patient rooms. To share a hospital room, means to share sensitive information with total strangers. This may cause uncomfortable situations for both patients. Furthermore, the awareness of other ears in the room can withhold some patients from sharing important information during daily ward rounds The aim of this study was to investigate the acoustic effect and the acceptance of an adjustable sound masking system in a 4-bed patient room. The objective of the system is that when a doctor shares personal information with one patient, the other patients in the room are not able to understand the conversation.
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Background Parenting a child with profound intellectual and multiple disabilities has great implications. Parents generally rely heavily on healthcare and social welfare services in caring for the child at home. Previous studies indicated mismatch between what parents need to preserve family and personal wellbeing and what is typically provided by services. This study focused on the role of healthcare and social welfare services in childcare and aims to contribute to understanding how parents perceive their interactions with service providers. Methods We interviewed 25 Dutch parents who cared for their child at home. Data were analysed using Framework Method. Findings Two overarching themes were found: “Being the lifeline” addressed that parents had central roles in fragmented services, and “Losing ownership” highlighted that parents were constrained in living life according to own beliefs and values while interacting with providers. Conclusions Findings illuminated that many parents became overburdened and compromised heavily on agency over family thriving due to functioning of healthcare and social welfare services. Findings supported working with integrated family case managers, creating effective and proactive access to equipment and services, and enacting high quality facilities for help with childcare and respite. These are important conditions to enable parents to construct family life more autonomously and make their further contribution to society. This may also lead to improved connotations of dependence on healthcare and social welfare services.
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