Purpose. We aimed to evaluate the potential for implementing exercise interventions for patients with breast cancer in the Netherlands, based on findings of the Dutch randomized controlled trials in this population. Methods. We evaluated the implementation of four Dutch exercise trials retrospectively, using the five dimensions of the RE-AIM framework: Reach (exercise participation rate), Effectiveness for physical fitness, fatigue, quality of life, and physical function, Adoption (e.g., satisfaction of physical therapists guiding the exercise intervention), Implementation (cost-effectiveness and exercise adherence correlates thereof), and Maintenance (maintenance of exercise levels by individual patients and sustainability of exercise delivery at organization level). Thereby, we reflect on these results using (international) literature to gain better insight in overall barriers, facilitators, and opportunities for further implementation of exercise interventions. Results. Participation rates of 44-52% not only indicated acceptable Reach in the context of a trial but also indicated room for improvement. Effectiveness of exercise during and after treatment was demonstrated in most trials showing benefits for aerobic fitness, physical fatigue, quality of life and physical function, and high patient satisfaction. Adoption of the exercise interventions by physical therapists was adequate (satisfaction score: 7.5 out of 10). Evaluation of Implementation indicated adequate adherence to supervised exercise, inconsistent findings on potential correlates of adherence, and promising results on cost-effectiveness. Currently, reimbursement for exercise programs is lacking. Maintenance of intervention effects at the patient level was limited and inconsistent. Maintenance of intervention availability at the organizational level was facilitated by an extensive network of specially trained physical therapists, but better communication and collaboration between different healthcare professionals are desired. Conclusions. Improved implementation could particularly be achieved by increasing reach and improved focus on exercise maintenance on both the patient and organizational level.
Strengthening sustainability in global supply chains requires producers, buyers, and nonprofit organizations to collaborate in transformative cross-sector partnerships (CSPs). However, the role played by nature in such partnerships has been left largely unattended in literature on CSPs. This article shows how strategizing nature helps CSPs reach their transformative potential. Strategizing nature entails the progressive revealing and reconciling of temporal tensions between “plants, profits, and people.” We show how a CSP took a parallel approach—recognizing the divergent temporalities of plants, people, and profits as interlaced and mutually determined—toward realizing their objective of implementing living wages in a sub-Saharan African country’s the tea industry, simultaneously driven by the revitalization of tea plantations. The promise of better quality tea leaves allowed partners to take a “leap of faith” and to tackle pressing issues before the market would follow. Our findings thus show the potential of CSPs in driving regenerative organizing.
This paper presents a mixed methods study in which 77 students and 3 teachers took part, that investigated the practice of Learning by Design (LBD). The study is part of a series of studies, funded by the Netherlands Organisation for Scientific Research (NWO), that aims to improve student learning, teaching skills and teacher training. LBD uses the context of design challenges to learn, among other things, science. Previous research showed that this approach to subject integration is quite successful but provides little profit regarding scientific concept learning. Perhaps, when the process of concept learning is better understood, LBD is a suitable method for integration. Through pre- and post-exams we measured, like others, a medium gain in the mastery of scientific concepts. Qualitative data revealed important focus-related issues that impede concept learning. As a result, mainly implicit learning of loose facts and incomplete concepts occurs. More transparency of the learning situation and a stronger focus on underlying concepts should make concept learning more explicit and coherent.
