BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
BackgroundSurvivors of critical illness experience long-term functional challenges, which are complex, heterogeneous, and multifactorial in nature. Although the importance of rehabilitation interventions after intensive care unit (ICU) discharge is universally recognized, evidence on feasibility and effectiveness of home-based rehabilitation programs is scarce and ambiguous. This study investigates the feasibility of an interdisciplinary rehabilitation program designed for patients with Post-Intensive Care Syndrome (PICS) who are discharged home.MethodsA mixed method, non-randomized, prospective pilot feasibility study was performed with a 6-month follow-up, comparing the intervention (REACH) with usual care. REACH was provided by trained professionals and included a patient-centered, interdisciplinary approach starting directly after hospital discharge. Primary outcomes were patient safety, satisfaction, adherence, referral need and health care usage. Secondary outcomes, measured at 3 timepoints, were functional exercise capacity, self-perceived health status, health-related quality of life (HRQoL), return to work and psychotrauma. Risk of undernutrition was assessed at baseline.Results43 patients with a median mechanical ventilation duration of 8 (IQR:10) days, were included in the study and 79.1% completed 6-month follow-up. 19 patients received the intervention, 23 received usual care. Groups were similar for gender distribution and ICU length of stay. No adverse events occurred. REACH participants showed higher satisfaction with treatment and reported more allied health professional visits, while the usual care group reported more visits to medical specialists. Qualitative analysis identified positive experiences among REACH-professionals related to providing state-of-the-art interventions and sharing knowledge and expertise within an interprofessional network. Similar recovery was seen between groups on all secondary outcomes, but neither group reached reference values for HRQoL at 6 months. Larger return to work rates were seen in the REACH group. Prevalence of undernutrition at hospital discharge was high in both groups (> 80%), warranting the need for careful tuning of physical therapy and nutritional interventions.ConclusionsThis study shows that providing early, home-based rehabilitation interventions for patients with PICS-related symptoms is feasible and perceived positively by patients and professionals. When provided in an interdisciplinary collaborative network state of the art, person-centered interventions can be tailored to individual needs potentially increasing patient satisfaction, adherence, and efficacy.Registered in the Dutch Trial register: NL7792: https://www.trialregister.nl/trial/7792, registered 7-06-2019.
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ClimateCafé is a field education concept involving dierent fields of science and practice for capacity building in climate change adaptation. This concept is applied on the eco-city of Augustenborg in Malmö, Sweden, where Nature-Based Solutions (NBS) were implemented in 1998.ClimateCafé Malmö evaluated these NBS with 20 young professionals from nine nationalities and seven disciplines with a variety of practical tools. In two days, 175 NBS were mapped and categorised in Malmö. Results show that the selected green infrastructure have a satisfactory infiltration capacity and low values of potential toxic element pollutants after 20 years in operation. The question “Is capacity building achieved by interdisciplinary field experience related to climate change adaptation?” was answered by interviews, collecting data of water quality, pollution, NBS and heat stress mapping, and measuring infiltration rates, followed by discussion. The interdisciplinary workshops with practical tools provide a tangible value to the participants and are needed to advance sustainabilityeorts. Long term lessons learnt from Augustenborg will help stormwater managers within planning of NBS. Lessons learned from this ClimateCafé will improve capacity building on climate change adaptation in the future. This paper oers a method and results to prove the German philosopher Friedrich Hegel wrong when he opined that “we learn from history that we do not learn from history”
The objective of this PD-pathway is pioneering an interdisciplinary composition practice in societal contexts, informed by the scientific field of psychology. Three immersive multi-medium, music-centered compositions involving music and choreography will be created within an existing interdisciplinary practice. The PD's contribution to knowledge lies in the (new) ways of merging music and choreography, the bridging of human psychology and the arts as well as its artistic research approach.
The PhD research by Joris Weijdom studies the impact of collective embodied design techniques in collaborative mixed-reality environments (CMRE) in art- and engineering design practice and education. He aims to stimulate invention and innovation from an early stage of the collective design process.Joris combines theory and practice from the performing arts, human-computer interaction, and engineering to develop CMRE configurations, strategies for its creative implementation, and an embodied immersive learning pedagogy for students and professionals.This lecture was given at the Transmedia Arts seminar of the Mahindra Humanities Center of Harvard University. In this lecture, Joris Weijdom discusses critical concepts, such as embodiment, presence, and immersion, that concern mixed-reality design in the performing arts. He introduces examples from his practice and interdisciplinary projects of other artists.About the researchMultiple research areas now support the idea that embodiment is an underpinning of cognition, suggesting new discovery and learning approaches through full-body engagement with the virtual environment. Furthermore, improvisation and immediate reflection on the experience itself, common creative strategies in artist training and practice, are central when inventing something new. In this research, a new embodied design method, entitled Performative prototyping, has been developed to enable interdisciplinary collective design processes in CMRE’s and offers a vocabulary of multiple perspectives to reflect on its outcomes.Studies also find that engineering education values creativity in design processes, but often disregards the potential of full-body improvisation in generating and refining ideas. Conversely, artists lack the technical know-how to utilize mixed-reality technologies in their design process. This know-how from multiple disciplines is thus combined and explored in this research, connecting concepts and discourse from human-computer interaction and media- and performance studies.This research is a collaboration of the University of Twente, Utrecht University, and HKU University of the Arts Utrecht. This research is partly financed by the Dutch Research Council (NWO).Mixed-reality experiences merge real and virtual environments in which physical and digital spaces, objects, and actors co-exist and interact in real-time. Collaborative Mix-Reality Environments, or CMRE's, enable creative design- and learning processes through full-body interaction with spatial manifestations of mediated ideas and concepts, as live-puppeteered or automated real-time computer-generated content. It employs large-scale projection mapping techniques, motion-capture, augmented- and virtual reality technologies, and networked real-time 3D environments in various inter-connected configurations.This keynote was given at the IETM Plenary meeting in Amsterdam for more than 500 theatre and performing arts professionals. It addresses the following questions in a roller coaster ride of thought-provoking ideas and examples from the world of technology, media, and theatre:What do current developments like Mixed Reality, Transmedia, and The Internet of Things mean for telling stories and creating theatrical experiences? How do we design performances on multiple "stages" and relate to our audiences when they become co-creators?Contactjoris.weijdom@hku.nl / LinkedIn profileThis research is part of the professorship Performative Processes
The primary objective of this research is to develop the new practical methodology of "Vocalising Resonance", as a development of existing methods. The approach intends to involve artists and citizens in a multi-sensory engagement with their surrounding environment, by collectively utilizing the 'physical', non-semantic voice as a tool for communication. This methodology's creation is rooted in the application of artistic research to well-formulated arguments within contemporary humanities studies. It also incorporates existing approaches for engaging with sound and voice in a multisensory and multidisciplinary manner. Musicologist, Nina Eidsheim argues that music research should not solely focus on the figure of sound, but should also delve into the materiality of sound as vibration (Eidsheim, Sensing Sound). Similarly, this research aims to explore the voice as an experience connected to the whole body and senses, rather than simply hearing. Several existing strategies offer starting points. The second objective of this research is to investigate how the proposed methodology of "Vocalising Resonance" may have a transformative impact on participants' consciousness, by increasing their exposure to diversity and facilitating their realisation that persons in the literal meaning of the word are “the speaking through - sonare + per- the masks that make up our social selves”(Scapp, A Question of Voice). Broadening the scope beyond traditional norms, the project paves the way for a more inclusive, sensorially rich understanding of performing arts, inviting a holistic approach that goes beyond typical categorisations, enhancing the immersive nature of performances. It prompts reflections on the significance of an audience to define a voice, the essence of a voice irrespective of language, and how the non-semantic use of voice serves as a powerful interdisciplinary communication tool within abstract performance contexts. This process seeks to offer a new perspective and transform our practices.
