Background. Barefoot plantar pressure measurements are routinely used in the risk evaluation for ulceration in diabetic patients with neuropathy. The aim was to compare three step-protocols commonly used for pressure assessment in these patients. Methods. Dynamic barefoot plantar pressures were measured in 14 diabetic neuropathic patients (vibration perception threshold >35 V) contacting a pressure platform on the first, second or third step after gait initiation. Ten repeated trials per step-protocol were collected. The 3-step protocol was regarded the reference protocol. Peak pressure, pressure-time integral and contact time were calculated for each of six anatomical foot regions. Intraclass correlation coefficients (ICC) were calculated to assess reliability in each protocol. Findings. Regional peak pressures and pressure-time integrals were not significantly different between protocols. Contact time was significantly different in the heel region between the 1-step and 3-step protocol only (P < 0.05). Intraclass correlation coefficients for the maximum 10 repeated trials were high (>0.87) and similar between protocols. Reliable estimates (ICC > 0.85) of peak pressure were achieved with three repeated trials in the 2-step protocol, and four in the other two; for pressure-time integral these numbers were 7 (1-step), 4 (2-step), and 5 trials (3-step). Interpretation. Barefoot plantar pressures in the diabetic neuropathic foot can be assessed in a reproducible manner with any of the step-protocols used. For this purpose, the 1-step and 2-step protocols prove to be valid methods. A 2-step protocol requires the least amount of repeated trials for obtaining reliable pressure data and may be recommended for assessment of these patients.
The Co-Design Pressure Cooker was set up to gather knowledge on co-design in product development activities of Small-to-Medium Enterprises(SMEs). This booklet gives an impression of ten projects conducted in the Province of Utrecht, the Netherlands. In these ten projects, a total of 22 companies were involved. 5000 booklets have already been printed in Dutch and handed out to SMEs for knowledge dissemination. We have received ample requests from the international community, which leads us to believe that there is an international audience for the cases conducted and knowledge gathered. This is why we decided to publish an English version of this booklet. The booklet will be followed by a scientific publication on the knowledge gathered for the academic community. Feel free to contact us for more information on this project
BackgroundOcclusions of intravenous (IV) tubing can prevent vital and time-critical medication or solutions from being delivered into the bloodstream of patients receiving IV therapy. At low flow rates (≤ 1 ml/h) the alarm delay (time to an alert to the user) can be up to 2 h using conventional pressure threshold algorithms. In order to reduce alarm delays we developed and evaluated the performance of two new real-time occlusion detection algorithms and one co-occlusion detector that determines the correlation in trends in pressure changes for multiple pumps.MethodsBench-tested experimental runs were recorded in triplicate at rates of 1, 2, 4, 8, 16, and 32 ml/h. Each run consisted of 10 min of non-occluded infusion followed by a period of occluded infusion of 10 min or until a conventional occlusion alarm at 400 mmHg occurred. The first algorithm based on binary logistic regression attempts to detect occlusions based on the pump’s administration rate Q(t) and pressure sensor readings P(t). The second algorithm continuously monitored whether the actual variation in the pressure exceeded a threshold of 2 standard deviations (SD) above the baseline pressure. When a pump detected an occlusion using the SD algorithm, a third algorithm correlated the pressures of multiple pumps to detect the presence of a shared occlusion. The algorithms were evaluated using 6 bench-tested baseline single-pump occlusion scenarios, 9 single-pump validation scenarios and 7 multi-pump co-occlusion scenarios (i.e. with flow rates of 1 + 1, 1 + 2, 1 + 4, 1 + 8, 1 + 16, and 1 + 32 ml/h respectively). Alarm delay was the primary performance measure.ResultsIn the baseline single-pump occlusion scenarios, the overall mean ± SD alarm delay of the regression and SD algorithms were 1.8 ± 0.8 min and 0.4 ± 0.2 min, respectively. Compared to the delay of the conventional alarm this corresponds to a mean time reduction of 76% (P = 0.003) and 95% (P = 0.001), respectively. In the validation scenarios the overall mean ± SD alarm delay of the regression and SD algorithms were respectively 1.8 ± 1.6 min and 0.3 ± 0.2 min, corresponding to a mean time reduction of 77% and 95%. In the multi-pump scenarios a correlation > 0.8 between multiple pump pressures after initial occlusion detection by the SD algorithm had a mean ± SD alarm delay of 0.4 ± 0.2 min. In 2 out of the 9 validation scenarios an occlusion was not detected by the regression algorithm before a conventional occlusion alarm occurred. Otherwise no occlusions were missed.ConclusionsIn single pumps, both the regression and SD algorithm considerably reduced alarm delay compared to conventional pressure limit-based detection. The SD algorithm appeared to be more robust than the regression algorithm. For multiple pumps the correlation algorithm reliably detected co-occlusions. The latter may be used to localize the segment of tubing in which the occlusion occurs.
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Due to their diverse funding sources, theatres are under increasing pressure to demonstrate impact on society. The Raad voor Cultuur (2023) for example advised the secretary of state to include societal impact as an additional evaluation measure next to artistic value. Many theaters, such as the Chassé Theater and Parkstad Limburg Theaters, have reformulated their missions to focus on impact of performances on visitors. This is a profound transformation from merely selling tickets and filling seats, and requires new measurement instruments to monitor, manage, and improve impact. Currently available instruments are insufficient, and effective monitoring is crucial to larger future projects that theaters are currently planning to systematically broaden impacts of performances on their communities. The specific goal of this project is to empower theaters to monitor and improve impact by developing a brief experience impact questionnaire, taking existing data from student projects conducted at the Chassé Theater about performing arts experiences on one hand, and experience impact theory innovations on the other, as starting points. We will develop potential items to measure and benchmark against established measures of valued societal outcomes, such as subjective well-being and quality of life. These will be measured in questionnaires developed with project partners Chassé Theater and Parkstad Limburg Theaters and administered before and after performances across a wide range of genres. The resulting data will enable comparison of new questionnaire items with benchmarked measures of valued societal outcomes. The final product of the project will be a brief impact questionnaire, which within several brief self-report instruments and just a few minutes can effectively be used to quantify the impact of a performing arts experience. A workshop and practice-oriented article will make this questionnaire implementable, thereby mobilizing the key enabling methodology of monitoring and impact measurement in the performing arts sector.
Due to their diverse funding sources, theatres are under increasing pressure to demonstrate impact on society. The Raad voor Cultuur (2023) for example advised the secretary of state to include societal impact as an additional evaluation measure next to artistic value. Many theaters, such as the Chassé Theater and Parkstad Limburg Theaters, have reformulated their missions to focus on impact of performances on visitors. This is a profound transformation from merely selling tickets and filling seats, and requires new measurement instruments to monitor, manage, and improve impact. Currently available instruments are insufficient, and effective monitoring is crucial to larger future projects that theaters are currently planning to systematically broaden impacts of performances on their communities.The specific goal of this project is to empower theaters to monitor and improve impact by developing a brief experience impact questionnaire, taking existing data from student projects conducted at the Chassé Theater about performing arts experiences on one hand, and experience impact theory innovations on the other, as starting points. We will develop potential items to measure and benchmark against established measures of valued societal outcomes, such as subjective well-being and quality of life. These will be measured in questionnaires developed with project partners Chassé Theater and Parkstad Limburg Theaters and administered before and after performances across a wide range of genres. The resulting data will enable comparison of new questionnaire items with benchmarked measures of valued societal outcomes. The final product of the project will be a brief impact questionnaire, which within several brief self-report instruments and just a few minutes can effectively be used to quantify the impact of a performing arts experience. A workshop and practice-oriented article will make this questionnaire implementable, thereby mobilizing the key enabling methodology of monitoring and impact measurement in the performing arts sector.Societal issueThe specific goal of this project is to empower theaters to monitor and improve impact by developing a brief experience impact questionnaire, taking existing data about performing arts experiences on one hand, and experience impact theory innovations on the other, as starting points. Benefit to societyWe will develop potential items to measure and benchmark against established measures of valued societal outcomes, such as subjective well-being and quality of life. Collaborative partnersChassé Theater N.V., Parkstad Limburg Theaters N.V.
Client: Foundation Innovation Alliance (SIA - Stichting Innovatie Alliantie) with funding from the ministry of Education, Culture and Science (OCW) Funder: RAAK (Regional Attention and Action for Knowledge circulation) The RAAK scheme is managed by the Foundation Innovation Alliance (SIA - Stichting Innovatie Alliantie) with funding from the ministry of Education, Culture and Science (OCW). Early 2013 the Centre for Sustainable Tourism and Transport started work on the RAAK-MKB project ‘Carbon management for tour operators’ (CARMATOP). Besides NHTV, eleven Dutch SME tour operators, ANVR, HZ University of Applied Sciences, Climate Neutral Group and ECEAT initially joined this 2-year project. The consortium was later extended with IT-partner iBuildings and five more tour operators. The project goal of CARMATOP was to develop and test new knowledge about the measurement of tour package carbon footprints and translate this into a simple application which allows tour operators to integrate carbon management into their daily operations. By doing this Dutch tour operators are international frontrunners.Why address the carbon footprint of tour packages?Global tourism contribution to man-made CO2 emissions is around 5%, and all scenarios point towards rapid growth of tourism emissions, whereas a reverse development is required in order to prevent climate change exceeding ‘acceptable’ boundaries. Tour packages have a high long-haul and aviation content, and the increase of this type of travel is a major factor in tourism emission growth. Dutch tour operators recognise their responsibility, and feel the need to engage in carbon management.What is Carbon management?Carbon management is the strategic management of emissions in one’s business. This is becoming more important for businesses, also in tourism, because of several economical, societal and political developments. For tour operators some of the most important factors asking for action are increasing energy costs, international aviation policy, pressure from society to become greener, increasing demand for green trips, and the wish to obtain a green image and become a frontrunner among consumers and colleagues in doing so.NetworkProject management was in the hands of the Centre for Sustainable Tourism and Transport (CSTT) of NHTV Breda University of Applied Sciences. CSTT has 10 years’ experience in measuring tourism emissions and developing strategies to mitigate emissions, and enjoys an international reputation in this field. The ICT Associate Professorship of HZ University of Applied Sciences has longstanding expertise in linking varying databases of different organisations. Its key role in CARMATOP was to create the semantic wiki for the carbon calculator, which links touroperator input with all necessary databases on carbon emissions. Web developer ibuildings created the Graphical User Interface; the front end of the semantic wiki. ANVR, the Dutch Association of Travel Agents and Tour operators, represents 180 tour operators and 1500 retail agencies in the Netherlands, and requires all its members to meet a minimum of sustainable practices through a number of criteria. ANVR’s role was in dissemination, networking and ensuring CARMATOP products will last. Climate Neutral Group’s experience with sustainable entrepreneurship and knowledge about carbon footprint (mitigation), and ECEAT’s broad sustainable tourism network, provided further essential inputs for CARMATOP. Finally, most of the eleven tour operators are sustainable tourism frontrunners in the Netherlands, and are the driving forces behind this project.
