This dissertation describes a research project about the communication between communication vulnerable people and health care professionals in long-term care settings. Communication vulnerable people experience functional communication difficulties in particular situations, due to medical conditions. They experience difficulties expressing themselves or understanding professionals, and/or professionals experience difficulties understanding these clients. Dialogue conversations between clients and professionals in healthcare, which for example concern health-related goals, activity and participation choices, diagnostics, treatment options, and treatment evaluation, are, however, crucial for successful client-centred care and shared decision making. Dialogue conversations facilitate essential exchanges between clients and healthcare professionals, and both clients and professionals should play a significant role in the conversation. It is unknown how communication vulnerable people and their healthcare professionals experience dialogue conversations and what can be done to support successful communication in these conversations. The aim of this research is to explore how communication vulnerable clients and professionals experience their communication in dialogue conversations in long-term care and how they can best be supported in improving their communication in these conversations.
Communication problems are acknowledged as hazardous eventualities affecting operations negatively. However, a few systematic attempts have been made to understand the pattern of communication issues and their contribution to safety events. In this paper, we present the AVAC-COM communication model and taxonomy based on the cybernetics approach and a literature review. The model elements and taxonomy variables regard the actors, signals, coders, interference, direction and timing, predictability, decoders, and channels. To test the applicability and potential value of the AVAC-COM framework, we analysed 103 safety investigation reports from aviation published between 1997 and 2016 by the respective authorities of Canada, the United States, Australia, the United Kingdom and the Netherlands. The overall results of the 256 cases of communication flaws detected in the reports suggested that these regarded more frequently Human-Media and Human-Human interactions, verbal and local communications as well as unfamiliarity of the receivers with the messages transmitted. Further statistical tests revealed associations of the region, time period, event severity and operations type with various variables of the AVAC-COM taxonomy. Although the findings are only indicative, they showed the potential of the AVAC-COM model and taxonomy to be used to identify strong and weak communication elements and relationships in documented data such as investigation and hazard reports.
Vertical and horizontal alignment within organizations are seen as prerequisites for meeting strategic objectives and indications of effective management. In the area of safety management, the concept of vertical alignment has been followed through the introduction of hierarchical structures and bidirectional communication, but horizontal alignment has been given little attention. The principal goal of this study was the assessment of horizontal alignment within an aviation organization with the use of data from safety investigations, audits and meetings in order to explore the extent to which (1) causal factors recorded in safety investigation reports comprised topics discussed by safety committees and focus areas of internal safety auditors, and (2) the agendas of safety committees include weak points revealed during safety audits. The study employed qualitative and quantitative analysis of data collected over a 6 years’ period at three organizational levels. The results suggested a low horizontal alignment across the three pairs of the corresponding safety management activities within each organizational level. The findings were attributed to the inadequacy of procedures and lack of a safety information database for consistently sharing safety information, cultural factors and lack of planning for the coordination of safety management activities. The current research comprises a contribution to the literature and practice and introduces a technique to assess the intra-alignment of safety management initiatives within various organizational levels. Future research is needed in order to investigate the association between horizontal alignment of safety management practices and safety performance.
The project aims to improve palliative care in China through the competence development of Chinese teachers, professionals, and students focusing on the horizontal priority of digital transformation.Palliative care (PC) has been recognised as a public health priority, and during recent years, has seen advances in several aspects. However, severe inequities in the access and availability of PC worldwide remain. Annually, approximately 56.8 million people need palliative care, where 25.7% of the care focuses on the last year of person’s life (Connor, 2020).China has set aims for reaching the health care standards of the developed countries by 2030 through the Healthy China Strategy 2030, where one of the improvement areas in health care includes palliative care, thus continuing the previous efforts.The project provides a constructive, holistic, and innovative set of actions aimed at resulting in lasting outcomes and continued development of palliative care education and services. Raising the awareness of all stakeholders on palliative care, including the public, is highly relevant and needed. Evidence based practice guidelines and education are urgently required for both general and specialised palliative care levels, to increase the competencies for health educators, professionals, and students. This is to improve the availability and quality of person-centered palliative care in China. Considering the aging population, increase in various chronic illnesses, the challenging care environment, and the moderate health care resources, competence development and the utilisation of digitalisation in palliative care are paramount in supporting the transition of experts into the palliative care practice environment.General objective of the project is to enhance the competences in palliative care in China through education and training to improve the quality of life for citizens. Project develops the competences of current and future health care professionals in China to transform the palliative care theory and practice to impact the target groups and the society in the long-term. As recognised by the European Association for Palliative Care (EAPC), palliative care competences need to be developed in collaboration. This includes shared willingness to learn from each other to improve the sought outcomes in palliative care (EAPC 2019). Since all individuals have a right to health care, project develops person-centered and culturally sensitive practices taking into consideration ethics and social norms. As concepts around palliative care can focus on physical, psychological, social, or spiritual related illnesses (WHO 2020), project develops innovative pedagogy focusing on evidence-based practice, communication, and competence development utilising digital methods and tools. Concepts of reflection, values and views are in the forefront to improve palliative care for the future. Important aspects in project development include health promotion, digital competences and digital health literacy skills of professionals, patients, and their caregivers. Project objective is tied to the principles of the European Commission’s (EU) Digital Decade that stresses the importance of placing people and their rights in the forefront of the digital transformation, while enhancing solidarity, inclusion, freedom of choice and participation. In addition, concepts of safety, security, empowerment, and the promotion of sustainable actions are valued. (European Commission: Digital targets for 2030).Through the existing collaboration, strategic focus areas of the partners, and the principles of the call, the PalcNet project consortium was formed by the following partners: JAMK University of Applied Sciences (JAMK ), Ramon Llull University (URL), Hanze University of Applied Sciences (HUAS), Beijing Union Medical College Hospital (PUMCH), Guangzhou Health Science College (GHSC), Beihua University (BHU), and Harbin Medical University (HMU). As project develops new knowledge, innovations and practice through capacity building, finalisation of the consortium considered partners development strategy regarding health care, (especially palliative care), ability to create long-term impact, including the focus on enhancing higher education according to the horizontal priority. In addition, partners’ expertise and geographical location was also considered important to facilitate long-term impact of the results.Primary target groups of the project include partner country’s (China) staff members, teachers, researchers, health care professionals and bachelor level students engaging in project implementation. Secondary target groups include those groups who will use the outputs and results and continue in further development in palliative care upon the lifetime of the project.
The integration of renewable energy resources, controllable devices and energy storage into electricity distribution grids requires Decentralized Energy Management to ensure a stable distribution process. This demands the full integration of information and communication technology into the control of distribution grids. Supervisory Control and Data Acquisition (SCADA) is used to communicate measurements and commands between individual components and the control server. In the future this control is especially needed at medium voltage and probably also at the low voltage. This leads to an increased connectivity and thereby makes the system more vulnerable to cyber-attacks. According to the research agenda NCSRA III, the energy domain is becoming a prime target for cyber-attacks, e.g., abusing control protocol vulnerabilities. Detection of such attacks in SCADA networks is challenging when only relying on existing network Intrusion Detection Systems (IDSs). Although these systems were designed specifically for SCADA, they do not necessarily detect malicious control commands sent in legitimate format. However, analyzing each command in the context of the physical system has the potential to reveal certain inconsistencies. We propose to use dedicated intrusion detection mechanisms, which are fundamentally different from existing techniques used in the Internet. Up to now distribution grids are monitored and controlled centrally, whereby measurements are taken at field stations and send to the control room, which then issues commands back to actuators. In future smart grids, communication with and remote control of field stations is required. Attackers, who gain access to the corresponding communication links to substations can intercept and even exchange commands, which would not be detected by central security mechanisms. We argue that centralized SCADA systems should be enhanced by a distributed intrusion-detection approach to meet the new security challenges. Recently, as a first step a process-aware monitoring approach has been proposed as an additional layer that can be applied directly at Remote Terminal Units (RTUs). However, this allows purely local consistency checks. Instead, we propose a distributed and integrated approach for process-aware monitoring, which includes knowledge about the grid topology and measurements from neighboring RTUs to detect malicious incoming commands. The proposed approach requires a near real-time model of the relevant physical process, direct and secure communication between adjacent RTUs, and synchronized sensor measurements in trustable real-time, labeled with accurate global time-stamps. We investigate, to which extend the grid topology can be integrated into the IDS, while maintaining near real-time performance. Based on topology information and efficient solving of power flow equation we aim to detect e.g. non-consistent voltage drops or the occurrence of over/under-voltage and -current. By this, centrally requested switching commands and transformer tap change commands can be checked on consistency and safety based on the current state of the physical system. The developed concepts are not only relevant to increase the security of the distribution grids but are also crucial to deal with future developments like e.g. the safe integration of microgrids in the distribution networks or the operation of decentralized heat or biogas networks.
The SPRONG group, originating from the CoE KennisDC Logistiek, focuses on 'Low Impact in Lastmile Logistics' (LILS). The LILS group conducts practical research with local living labs and learning communities. There is potential for more collaboration and synergy for nationwide scaling of innovations, which is currently underutilized. LILS aims to make urban logistics more sustainable and facilitate necessary societal transitions. This involves expanding the monodisciplinary and regional scope of CoE KennisDC Logistiek to a multidisciplinary and supra-regional approach, incorporating expertise in spatial planning, mobility, data, circularity, AI, behavior, and energy. The research themes are:- Solutions in scarce space aiming for zero impact;- Influencing behavior of purchasers, recipients, and consumers;- Opportunities through digitalization.LILS seeks to increase its impact through research and education beyond its regions. Collaboration between BUas, HAN, HR, and HvA creates more critical mass. LILS activities are structured around four pillars:- Developing a joint research and innovation program in a roadmap;- Further integrating various knowledge domains on the research themes;- Deepening methodological approaches, enhancing collaboration between universities and partners in projects, and innovating education (LILS knowledge hub);- Establishing an organizational excellence program to improve research professionalism and quality.These pillars form the basis for initiating and executing challenging, externally funded multidisciplinary research projects. LILS is well-positioned in regions where innovations are implemented and has a strong national and international network and proven research experience.Societal issue:Last-mile logistics is crucial due to its visibility, small deliveries, high costs, and significant impact on emissions, traffic safety, and labor hours. Lastmile activities are predicted to grow a 20% growth in the next decade. Key drivers for change include climate agreements and energy transitions, urban planning focusing on livability, and evolving retail landscapes and consumer behavior. Solutions involve integrating logistics with spatial planning, influencing purchasing behavior, and leveraging digitalization for better data integration and communication. Digital twins and the Physical Internet concept can enhance efficiency through open systems, data sharing, asset sharing, standardization, collaboration protocols, and modular load units.Key partners: Buas, HR, HAN, HvAPartners: TNO, TU Delft, Gemeente Rotterdam, Hoger Onderwijs Drechtsteden, Significance, Metropolitan Hub System, evofenedex, Provincie Gelderland, Duurzaam Bereikbaar Heijendaal, Gemeente Alphen aan den Rijn, Radboud Universiteit, I&W - DMI, DHL, TLN, Noorderpoort, Fabrications, VUB, Smartwayz, RUG, Groene Metropoolregio.
