Background: Patient participation and goal setting appear to be difficult in daily physiotherapy practice, and practical methods are lacking. An existing patient-specific instrument, Patient-Specific Complaints (PSC), was therefore optimized into a new Patient Specific Goal-setting method (PSG). The aims of this study were to examine the feasibility of the PSG in daily physiotherapy practice, and to explore the potential impact of the new method. Methods: We conducted a process evaluation within a non-controlled intervention study. Community-based physiotherapists were instructed on how to work with the PSG in three group training sessions. The PSG is a six-step method embedded across the physiotherapy process, in which patients are stimulated to participate in the goal-setting process by: identifying problematic activities, prioritizing them, scoring their abilities, setting goals, planning and evaluating. Quantitative and qualitative data were collected among patients and physiotherapists by recording consultations and assessing patient files, questionnaires and written reflection reports. Results: Data were collected from 51 physiotherapists and 218 patients, and 38 recordings and 219 patient files were analysed. The PSG steps were performed as intended, but the ‘setting goals’ and ‘planning treatment’ steps were not performed in detail. The patients and physiotherapists were positive about the method, and the physiotherapists perceived increased patient participation. They became aware of the importance of engaging patients in a dialogue, instead of focusing on gathering information. The lack of integration in the electronic patient system was a major barrier for optimal use in practice. Although the self-reported actual use of the PSG, i.e. informing and involving patients, and client-centred competences had improved, this was not completely confirmed by the objectively observed behaviour. Conclusion: The PSG is a feasible method and tends to have impact on increasing patient participation in the goal-setting process. However, its full potential for shared goal setting has not been utilized yet. More implementation effort is needed to achieve the required behaviour change and a truly client-centred attitude, to make physiotherapists totally ready for shared goal setting.
Small and Medium Enterprises (SME) comprise 99% of the European-economy, though, most research and implementation methods concerning Business Process Management Systems (BPMS) focus on large enterprises. We create a BPMS implementation method that is suitable for SMEs. Based on three existing BPMS implementation methods and by incorporating differentiators of SMEs and large enterprises a BPMS implementation method is constructed. The constructed method is validated through a series of interviews with BPMS implementation experts. Experts agree with the constructed method though discussion arise on a more detailed level of activities in the method.
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Wind turbines are usually clustered in wind farms which causes the downstream turbines to operate in the turbulent wakes of upstream turbines. As turbulence is directly related to increased fatigue loads, knowledge of the turbulence in the wake and its evolution are important. Therefore, the main objective of this study is a comprehensive exploration of the turbulence evolution in the wind turbine’s wake to identify characteristic turbulence regions. For this, we present an experimental study of three model wind turbine wake scenarios that were scanned with hot-wire anemometry with a very high downstream resolution. The model wind turbine was exposed to three inflows: laminar inflow as a reference case, a central wind turbine wake, and half of the wake of an upstream turbine. A detailed turbulence analysis reveals four downstream turbulence regions by means of the mean velocity, variance, turbulence intensity, energy spectra, integral and Taylor length scales, and the Castaing parameter that indicates the intermittency, or gustiness, of turbulence. In addition, a wake core with features of homogeneous isotropic turbulence and a ring of high intermittency surrounding the wake can be identified. The results are important for turbulence modeling in wakes and optimization of wind farm wake control
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Coastal nourishments, where sand from offshore is placed near or at the beach, are nowadays a key coastal protection method for narrow beaches and hinterlands worldwide. Recent sea level rise projections and the increasing involvement of multiple stakeholders in adaptation strategies have resulted in a desire for nourishment solutions that fit a larger geographical scale (O 10 km) and a longer time horizon (O decades). Dutch frontrunner pilot experiments such as the Sandmotor and Ameland inlet nourishment, as well as the Hondsbossche Dunes coastal reinforcement project have all been implemented from this perspective, with the specific aim to encompass solutions that fit in a renewed climate-resilient coastal protection strategy. By capitalizing on recent large-scale nourishments, the proposed Coastal landSCAPE project C-SCAPE will employ and advance the newly developed Dynamic Adaptive Policy Pathways (DAPP) approach to construct a sustainable long-term nourishment strategy in the face of an uncertain future, linking climate and landscape scales to benefits for nature and society. Novel long-term sandy solutions will be examined using this pathways method, identifying tipping points that may exist if distinct strategies are being continued. Crucial elements for the construction of adaptive pathways are 1) a clear view on the long-term feasibility of different nourishment alternatives, and 2) solid, science-based quantification methods for integral evaluation of the social, economic, morphological and ecological outcomes of various pathways. As currently both elements are lacking, we propose to erect a Living Lab for Climate Adaptation within the C-SCAPE project. In this Living Lab, specific attention is paid to the socio-economic implications of the nourished landscape, as we examine how morphological and ecological development of the large-scale nourishment strategies and their design choices (e.g. concentrated vs alongshore uniform, subaqueous vs subaerial, geomorphological features like artificial lagoons) translate to social acceptance.
