The Physical Internet (PI) is probably the most ambitious and visionary concept towards efficiency and sustainability in transport logistics. PI proposes a full consolidation of logistics flows from independent shippers using vertical and horizontal collaboration. The objective of this paper is to evaluate where the implementation of the Physical Internet concept stands in the practice of city logistics. From our research, it can be concluded that Hubs, Networks, and Extended Inter-networks are developing sufficiently. Access and Adoption, as well as Governance of platforms, seem still to be too complex for big steps on the roadmap.
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Abstract gepubliceerd in Elsevier: Introduction: Recent research has identified the issue of ‘dose creep’ in diagnostic radiography and claims it is due to the introduction of CR and DR technology. More recently radiographers have reported that they do not regularly manipulate exposure factors for different sized patients and rely on pre-set exposures. The aim of the study was to identify any variation in knowledge and radiographic practice across Europe when imaging the chest, abdomen and pelvis using digital imaging. Methods: A random selection of 50% of educational institutes (n ¼ 17) which were affiliated members of the European Federation of Radiographer Societies (EFRS) were contacted via their contact details supplied on the EFRS website. Each of these institutes identified appropriate radiographic staff in their clinical network to complete an online survey via SurveyMonkey. Data was collected on exposures used for 3 common x-ray examinations using CR/DR, range of equipment in use, staff educational training and awareness of DRL. Descriptive statistics were performed with the aid of Excel and SPSS version 21. Results: A response rate of 70% was achieved from the affiliated educational members of EFRS and a rate of 55% from the individual hospitals in 12 countries across Europe. Variation was identified in practice when imaging the chest, abdomen and pelvis using both CR and DR digital systems. There is wide variation in radiographer training/education across countries.
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Om goede en verantwoorde zorg te kunnen bieden, streeft de paramedicus naar evidence-based practice. Evidence-based practice is het zorgvuldig, expliciet en oordeelkundig gebruik van het huidige beste bewijsmateriaal en evidence om beslissingen te nemen met individuele patiënten om de zorgverlening te verbeteren. De praktijk van evidence-based practice impliceert het integreren van individuele professionele kennis van de paramedicus met de wens en voorkeur van de patiënt en het beste externe bewijsmateriaal dat vanuit systematisch onderzoek beschikbaar is. De voorkeuren, wensen en verwachtingen van de patiënt spelen bij de besluitvorming een centrale rol.
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The Smart Current Limiter is a switching DC to DC converter that provides a digitally pre-set input current control for inrush limiting and power management. Being able to digitally adjust the current level in combination with external feedback can be used for control systems like temperature control in high power DC appliances. Traditionally inrush current limiting is done using a passive resistance whose resistance changes depending on the current level. Bypassing this inrush limiting resister with a Mosfet improves efficiency and controllability, but footprint and losses remain large. A switched current mode controlled inrush limiter can limit inrush currents and even control the amount of current passing to the application. This enables power management and inrush current limitation in a single device. To reduce footprint and costs a balance between losses and cost-price on one side and electromagnetic interference on the other side is sought and an optimum switching frequency is chosen. To reduce cost and copper usage, switching happens on a high frequency of 300kHz. This increases the switching losses but greatly reduces the inductor size and cost compared to switching supplies running on lower frequencies. Additional filter circuits like snubbers are necessary to keep the control signals and therefore the output current stable.
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RATIONALE: Current developments drive dieticians in the primary care setting to demonstrate their effectiveness to both patients and stakeholders. Working with SMART (Specific, Measurable, Attainable, Realistic, Time-bound) goal setting may increase effectiveness. This study describes the current dietetic practice in the primary care setting in The Netherlands with regard to goal setting.
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Today, Intellectual Capital plays a principal role in the delivery of corporate performance. This importance is reflected in the fact that companies, without the force of any regulations, start to produce intellectual capital statements to communicate their performance; accounting guidelines are being developed and standards are being questioned and reviewed; software companies such as SAP, Hyperion, Oracle, or Peoplesoft are developing applications to address this, and even governments are beginning to measure the intellectual capital of cities, regions, and countries. Accenture writes that today's economy depends on the ability of companies to create, capture, and leverage intellectual capital faster than the competition. Cap Gemini Ernst & Young believes that intangibles are the key drivers for competitive advantage. KPMG states that most general business risks derive from intangibles and organizations therefore need to manage their intangibles very carefully. PricewaterhouseCoopers writes that in a globalized world, the intellectual capital in any organization becomes essential and its correct distribution at all organizational levels requires the best strategy integrated solutions, processes and technology. Even though the leading management consulting firms recognize the importance of intellectual capital – they seem to suffer from the same predicament as the field as a whole. Intellectual capital is defined differently and the concept is often fuzzy. In this special issue of the leading journal in the field we would like to bring together the definitions, approaches, and tools offered by the leading management consulting firms. It will be a unique opportunity to disseminate your understanding of this critical area of management and allow you to illustrate your approaches and tools.
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DOEL. Dit artikel beoogt een kritische analyse te geven van de manier waarop het begrip Evidence Based Practice in de literatuur doorgaans wordt ingevuld, waarna mogelijkheden worden geschetst de in het artikel geconstateerde bezwaren te ondervangen. METHODE. Er is literatuuronderzoek gedaan naar de manier waarop EBP in de literatuur wordt ingevuld. RESULTAAT. Hoewel in de literatuur met betrekking tot EBP wordt aangegeven dat het handelen van professionals gebaseerd zou moeten zijn op een integratie van wetenschappelijk onderzoek, klinische expertise en cliëntenvoorkeuren, krijgt de bron van het wetenschappelijk onderzoek de meeste nadruk. Binnen dit wetenschappelijk onderzoek wordt kwantitatief onderzoek bovendien doorgaans hoger gewaardeerd dan kwalitatief onderzoek. De andere kennisbronnen (deskundigheid van de cliënt en expertise van de verpleegkundige) die bij EBP worden onderscheiden, blijven veelal onderbelicht. DISCUSSIE EN CONCLUSIE. De manier waarop EBP meestal wordt ingevuld en geïmplementeerd brengt een aantal beperkingen met zich mee. Voorbeelden hiervan zijn de beperkte aandacht voor: de kern van het verplegen, de interactie tussen de cliënt en de verpleegkundige, de context of de cultuur waarin de zorgverlening plaatsvindt, het benutten van de ervaringsdeskundigheid van de cliënt en de expertise van de verpleegkundige zelf. In het artikel worden suggesties gegeven om deze beperkingen te ondervangen, zodat EBP inderdaad de integratie wordt van de verschillende kennisbronnen die in de literatuur worden onderscheiden en EBP met mogelijk meer succes kan worden geïmplementeerd.
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Abstract: Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
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The model of the Best Practice Unit (BPU) is a specific form of practice based research. It is a variation of the Community of Practice (CoP) as developed by Wenger, McDermott and Snyder (2002) with the specific aim to innovate a professional practice by combining learning, development and research. We have applied the model over the past 10 years in the domain of care and social welfare in the Netherlands. Characteristics of the model are: the interaction between individual and collective learning processes, the development of (new or better) working methods, and the implementation of these methods in daily practice. Multiple knowledge sources are being used: experiential knowledge, professional knowledge and scientific knowledge. Research is serving diverse purposes: articulating tacit knowledge, documenting the learning and innovation process, systematically describing the revealed or developed ways of working, and evaluating the efficacy of new methods. An analysis of 10 different research projects shows that the BPU is an effective model.
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Academic design research often fails to contribute to design practice. This dissertation explores how design research collaborations can provide knowledge that design professionals will use in practice. The research shows that design professionals are not addressed as an important audience between the many audiences of collaborative research projects. The research provides insight in the learning process by design professionals in design research collaborations and it identifies opportunities for even more learning. It shows that design professionals can learn about more than designing, but also about application domains or project organization.
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