Introduction Radical cystectomy (RC) is the standard treatment for patients with non-metastatic muscle-invasive bladder cancer, as well as for patients with therapy refractory high-risk non-muscle invasive bladder cancer. However, 50–65% of patients undergoing RC experience perioperative complications. The risk, severity and impact of these complications is associated with a patient’s preoperative cardiorespiratory fitness, nutritional and smoking status and presence of anxiety and depression. There is emerging evidence supporting multimodal prehabilitation as a strategy to reduce the risk of complications and improve functional recovery after major cancer surgery. However, for bladder cancer the evidence is still limited. The aim of this study is to investigate the superiority of a multimodal prehabilitation programme versus standard-of-care in terms of reducing perioperative complications in patients with bladder cancer undergoing RC.Methods and analysis This multicentre, open label, prospective, randomised controlled trial, will include 154 patients with bladder cancer undergoing RC. Patients are recruited from eight hospitals in The Netherlands and will be randomly (1:1) allocated to the intervention group receiving a structured multimodal prehabilitation programme of approximately 3–6 weeks, or to the control group receiving standard-of-care. The primary outcome is the proportion of patients who develop one or more grade ≥2 complications (according to the Clavien-Dindo classification) within 90 days of surgery. Secondary outcomes include cardiorespiratory fitness, length of hospital stay, health-related quality of life, tumour tissue biomarkers of hypoxia, immune cell infiltration and cost-effectiveness. Data collection will take place at baseline, before surgery and 4 and 12 weeks after surgery.Ethics and dissemination Ethical approval for this study was granted by the Medical Ethics Committee NedMec (Amsterdam, The Netherlands) under reference number 22–595/NL78792.031.22. Results of the study will be published in international peer-reviewed journals.Trial registration number NCT05480735.
The importance of leadership is increasingly recognized in relation to digital transformation. Therefore, middle management and top management must have the competencies required to lead such a transformation. The purpose of this paper is to investigate the relationship between the digital leader competencies as set out by the European e-competence framework (e-CF) and the digital transformation of organizations. Also, the relationship between digital leadership competency (DLC) and IT capability is examined. An empirical investigation is presented based on a sample of 433 respondents, analyzed using PLS-SEM. The results strongly support our hypotheses. DLC has a strong impact on organizational digital transformation. A post-hoc analysis showed this is predominantly the case for the e-CF competencies of business plan development, architecture design, and innovating while business change management and governance do not seem to affect organizational digital transformation. This is the first empirical study to conceptualize, operationalize and validate the concept of DLC, based on the e-competence framework, and its impact on digital transformation. These findings have significant implications for researchers and practitioners working on the transformation toward a digital organization.
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Our unilateral diet has resulted in a deficiency of specific elements/components needed for well-functioning of the human body. Especially the element magnesium is low in our processed food and results in neuronal and muscular malfunctioning, problems in bone heath/strength, and increased chances of diabetes, depression and cardiovascular diseases. Furthermore, it has also been recognized that magnesium plays an important role in cognitive functioning (impairment and enhancement), especially for people suffering from neurodegenerative diseases (Parkinson disease, Alzheimer, etc). Recently, it has been reported that magnesium addition positively effects sleep and calmness (anti-stress). In order to increase the bioavailability of magnesium cations, organic acids such as citrate, glycerophosphate and glycinate are often used as counterions. However, the magnesium supplements that are currently on the market still suffer from low bio-availability and often do not enter the brain significantly.The preparation of dual/multiple ligands of magnesium in which the organic acid not only functions as a carrier but also has synergistically/complementary biological effects is widely unexplored and needs further development. As a result, there is a strong need for dual/multiple magnesium supplements that are non-toxic, stable, prepared via an economically and ecologically attractive route, resulting in high bioavailability of magnesium in vivo, preferably positively influencing cognition/concentration
Due to societal developments, like the introduction of the ‘civil society’, policy stimulating longer living at home and the separation of housing and care, the housing situation of older citizens is a relevant and pressing issue for housing-, governance- and care organizations. The current situation of living with care already benefits from technological advancement. The wide application of technology especially in care homes brings the emergence of a new source of information that becomes invaluable in order to understand how the smart urban environment affects the health of older people. The goal of this proposal is to develop an approach for designing smart neighborhoods, in order to assist and engage older adults living there. This approach will be applied to a neighborhood in Aalst-Waalre which will be developed into a living lab. The research will involve: (1) Insight into social-spatial factors underlying a smart neighborhood; (2) Identifying governance and organizational context; (3) Identifying needs and preferences of the (future) inhabitant; (4) Matching needs & preferences to potential socio-techno-spatial solutions. A mixed methods approach fusing quantitative and qualitative methods towards understanding the impacts of smart environment will be investigated. After 12 months, employing several concepts of urban computing, such as pattern recognition and predictive modelling , using the focus groups from the different organizations as well as primary end-users, and exploring how physiological data can be embedded in data-driven strategies for the enhancement of active ageing in this neighborhood will result in design solutions and strategies for a more care-friendly neighborhood.
De technische en economische levensduur van auto’s verschilt. Een goed onderhouden auto met dieselmotor uit het bouwjaar 2000 kan technisch perfect functioneren. De economische levensduur van diezelfde auto is echter beperkt bij introductie van strenge milieuzones. Bij de introductie en verplichtstelling van geavanceerde rijtaakondersteunende systemen (ADAS) zien we iets soortgelijks. Hoewel de auto technisch gezien goed functioneert kunnen verouderde software, algorithmes en sensoren leiden tot een beperkte levensduur van de gehele auto. Voorbeelden: - Jeep gehackt: verouderde veiligheidsprotocollen in de software en hardware beperkten de economische levensduur. - Actieve Cruise Control: sensoren/radars van verouderde systemen leiden tot beperkte functionaliteit en gebruikersacceptatie. - Tesla: bij bestaande auto’s worden verouderde sensoren uitgeschakeld waardoor functies uitvallen. In 2019 heeft de EU een verplichting opgelegd aan automobielfabrikanten om 20 nieuwe ADAS in te bouwen in nieuw te ontwikkelen auto’s, ongeacht prijsklasse. De mate waarin deze ADAS de economische levensduur van de auto beperkt is echter nog onvoldoende onderzocht. In deze KIEM wordt dit onderzocht en wordt tevens de parallel getrokken met de mobiele telefonie; beide maken gebruik van moderne sensoren en software. We vergelijken ontwerpeisen van telefoons (levensduur van gemiddeld 2,5 jaar) met de eisen aan moderne ADAS met dezelfde sensoren (levensduur tot 20 jaar). De centrale vraag luidt daarom: Wat is de mogelijke impact van veroudering van ADAS op de economische levensduur van voertuigen en welke lessen kunnen we leren uit de onderliggende ontwerpprincipes van ADAS en Smartphones? De vraag wordt beantwoord door (i) literatuuronderzoek naar de veroudering van ADAS (ii) Interviews met ontwerpers van ADAS, leveranciers van retro-fit systemen en ontwerpers van mobiele telefoons en (iii) vergelijkend rij-onderzoek naar het functioneren van ADAS in auto’s van verschillende leeftijd en prijsklassen.
