This review paper investigates and presents generalized answers to the two basic questions of port governance, namely how to govern and for what purpose. The study is based on a total sample of 118 studies on port governance. The results from the analysis of these studies show that port devolution and port re-centralization are the main governance tools at the institutional level. At the strategical level, the main governance tools are port co-opetition, port regionalization, port integration, stakeholder management strategy, and corporate governance. While at the managerial level, the main governance tools are port pricing, port concession, port user/customer relationship management, monitoring and measuring, regulatory control, port security management, and information and communication technologies. The institutional governance tools are generally used by governmental organizations to set the fundamental regulative rules for the port governance system, while strategical tools are applied by port organizations in gaining competitive advantages and increasing market share in the long term. Managerial tools are related to the port business operations and management. Furthermore, The study clearly shows that the main objective of port governance is the improvement of port efficiency and port effectiveness. However, the choice of efficiency-oriented or effectiveness-oriented configuration is largely determined by the port organization's external operating environment, strategies and structures.
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Background: Impaired upper extremity function due to muscle paresis or paralysis has a major impact on independent living and quality of life (QoL). Assistive technology (AT) for upper extremity function (i.e. dynamic arm supports and robotic arms) can increase a client’s independence. Previous studies revealed that clients often use AT not to their full potential, due to suboptimal provision of these devices in usual care. Objective: To optimize the process of providing AT for impaired upper extremity function and to evaluate its (cost-)effectiveness compared with care as usual. Methods: Development of a protocol to guide the AT provision process in an optimized way according to generic Dutch guidelines; a quasi-experimental study with non-randomized, consecutive inclusion of a control group (n = 48) receiving care as usual and of an intervention group (optimized provision process) (n = 48); and a cost-effectiveness and cost-utility analysis from societal perspective will be performed. The primary outcome is clients’ satisfaction with the AT and related services, measured with the Quebec User Evaluation of Satisfaction with AT (Dutch version; D-QUEST). Secondary outcomes comprise complaints of the upper extremity, restrictions in activities, QoL, medical consumption and societal cost. Measurements are taken at baseline and at 3, 6 and 9 months follow-up.
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Learning teams in higher education executing a collaborative assignment are not always effective. To remedy this, there is a need to determine and understand the variables that influence team effectiveness. This study aimed at developing a conceptual framework, based on research in various contexts on team effectiveness and specifically team and task awareness. Core aspects of the framework were tested to establish its value for future experiments on influencing team effectiveness. Results confirmed the importance of shared mental models, and to some extent mutual performance monitoring for learning teams to become effective, but also of interpersonal trust as being conditional for building adequate shared mental models. Apart from the importance of team and task awareness for team effectiveness it showed that learning teams in higher education tend to be pragmatic by focusing primarily on task aspects of performance and not team aspects. Further steps have to be taken to validate this conceptual framework on team effectiveness.
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The authors demonstrate how simulation games can be used to test and explore initial infrastructure designs before they are implemented. Games can provide important learning experiences for (future) designers and managers. The case study of a computer-supported simulation game, SIM Maasvlakte 2 (SIM MV2), uses a game whose object is to design and allocate land for the Maasvlakte 2 port area, to be built between 2006 and 2036 in the Port of Rotterdam, the Netherlands. The evaluation aimed at improving the game, examining the system complexity of the seaport, and establishing corresponding learning effects among the participants.
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Background/Objectives: Homecare staff often take over activities instead of “doing activities with” clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the “Stay Active at Home” (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior. Design: Cluster randomized controlled trial (c-RCT). Setting: Dutch homecare (10 nursing teams comprising a total of 313 staff members). Participants: 264 clients (aged ≥65 years). Intervention: SAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual. Measurements: Sedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed. Results: We found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] 22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI 1.5, 2.6], p = 0.589) or for most secondary outcomes. Conclusion: Our c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.
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Objective. Hospital in Motion is a multidimensional implementation project aiming to improve movement behavior during hospitalization. The purpose of this study was to investigate the effectiveness of Hospital in Motion on movement behavior. Methods. This prospective study used a pre-implementation and post-implementation design. Hospital in Motion was conducted at 4 wards of an academic hospital in the Netherlands. In each ward, multidisciplinary teams followed a 10-month step-by-step approach, including the development and implementation of a ward-specific action plan with multiple interventions to improve movement behavior. Inpatient movement behavior was assessed before the start of the project and 1 year later using a behavioral mapping method in which patients were observed between 9:00 am and 4:00 pm. The primary outcome was the percentage of time spent lying down. In addition, sitting and moving, immobility-related complications, length of stay, discharge destination home, discharge destination rehabilitation setting, mortality, and 30-day readmissions were investigated. Differences between pre-implementation and post-implementation conditions were analyzed using the chi-square test for dichotomized variables, the Mann Whitney test for non-normal distributed data, or independent samples t test for normally distributed data. Results. Patient observations demonstrated that the primary outcome, the time spent lying down, changed from 60.1% to 52.2%. For secondary outcomes, the time spent sitting increased from 31.6% to 38.3%, and discharges to a rehabilitation setting reduced from 6 (4.4%) to 1 (0.7%). No statistical differences were found in the other secondary outcome measures. Conclusion. The implementation of the multidimensional project Hospital in Motion was associated with patients who were hospitalized spending less time lying in bed and with a reduced number of discharges to a rehabilitation setting. Impact. Inpatient movement behavior can be influenced by multidimensional interventions. Programs implementing interventions that specifically focus on improving time spent moving, in addition to decreasing time spent lying, are recommended.
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Integrating physical therapy sessions and an online application (e-Exercise) might support people with hip osteoarthritis (OA), knee OA, or both (hip/knee OA) in taking an active role in the management of their chronic condition and may reduce the number of physical therapy sessions. The objective of this study was to investigate the short- and long-term effectiveness of e-Exercise compared to usual physical therapy in people with hip/knee OA. The design was a prospective, single-blind, multicenter, superiority, cluster-randomized controlled trial. e-Exercise is a 3-month intervention in which about 5 face-to-face physical therapy sessions were integrated with an online application consisting of graded activity, exercise, and information modules. Usual physical therapy was conducted according to the Dutch physical therapy guidelines on hip and knee OA. Primary outcomes, measured at baseline after 3 and 12 months, were physical functioning and free-living physical activity. Secondary outcome measures were pain, tiredness, quality of life, self-efficacy, and the number of physical therapy sessions.
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AbstractHistorically, epidemics and plagues are repeatedly reported to have happened since the ancient civilizations (Egypt, Greece, Rome and imperial China). Most known examples of a devastating global pandemics in recent history are the ‘Black Death’ (14th century) and the global influenza (1918-1919), also known as ‘Spanish Flu’, that has killed nearly 50 million people in the world. Even thoughpandemics may vary in their dimensions, length (short vs. long), scope (local/regional, national, global) and severity of effects (minimal effects or maximal effects), they all represent distinct exogenous and endogenous shocks that have far reaching effects on population, health, economy and other societal domains.Currently, the Covid-19 pandemic has relentlessly spreaded around the world, leaving behind destructive marks on health, populations, economies and societies. The Covid-19 could spread quickly around the globe because of the current structure of the global economy, which is highly interconnected through sophisticated global transport networks. An important characteristic of a suchnetworked complex system is it vulnerability to unattended events of systemic risk such as the Covid-19 pandemic for example. These systemic risks cause substantial cascading effects, which lead to extreme outcomes that could permanently alter economic, environmental, and social systems.In this article, we first, present, discuss and analyze the potential impacts of the Covid-19 on global economy, trade and supply chains, by focusing on Europe and/or the Netherlands. Second, we examine the effects of the Covid-19 crisis on the shipping industry and on the hub ports and the policy measures that have been applied by different countries around the world.
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It has been established that normative social influence can be used effec-tively in persuasive technology. However, it is unknown whether the application of more social pressure makes it more effective. To test this hypothesis, a quantitative experiment was conducted on the online social network Facebook. Although evidence to support the hypothesis was found, it cannot be concluded from this experiment that more intense persuasion is more effective, when utilizing normative social influence in persuasive technology.
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In this study we measured the effect of COIL on intercultural competence development using a quasi-experimental design. Our sample consisted of 108 undergraduate students from two universities, one located in the Netherlands (NL) and one in the United States (US). Students’ self-reported intercultural competence was measured using a pre-post survey which included the Cultural Intelligence Scale (CQS) and Multicultural Personality Questionnaire (MPQ). Qualitative data were collected to complement our quantitative findings and to give a deeper insight into the student experience. The data showed a significantly bigger increase in intercultural competence for the US experimental group compared to the US control group, supporting our hypothesis that COIL develops intercultural competence. This difference was not observed for the NL students, possibly due to the NL control group being exposed to other international input during the course.
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