Clusters development takes place in an increasingly changing and complex context where global and local developments are interconnected. Various regional and innovation studies recognized the need for place-based studies to include the larger context in which clusters and regions are found. Interest and discourse on the value of complexity approaches to cluster studies has been increasing, with the aim to gain deeper understanding of processes taking place in complex cluster development (Martin & Sunley, 2003; Cooke, 2012) Work in this area of research is limited and empirical study could add to understanding the complexity of cluster development.
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Clusters development takes place in an increasingly changing and complex context where global and local developments are interconnected. Various regional and innovation studies recognize the need for place-based studies to include the larger context in which clusters and regions are found. Interest and discourse on the value of complexity approaches to cluster studies is increasing, with the aim to gain deeper understanding of processes taking place in complex cluster development. This discourse was initiated by Martin & Sunley (2003) and explored extensively by Cooke (2012) in his study of ‘complex adaptive innovation systems’. Work in this area of research is limited and empirical study could add to understanding the complexity of cluster development.
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Background: The concept of Functional Independence (FI), defined as ‘functioning physically safe and independent from other persons, within one’s context”, plays an important role in maintaining the functional ability to enable well-being in older age. FI is a dynamic and complex concept covering four clinical outcomes: physical capacity, empowerment, coping flexibility, and health literacy. As the level of FI differs widely between older adults, healthcare professionals must gain insight into how to best support older people in maintaining their level of FI in a personalized manner. Insight into subgroups of FI could be a first step in providing personalized support This study aims to identify clinically relevant, distinct subgroups of FI in Dutch community-dwelling older people and subsequently describe them according to individual characteristics. Results: One hundred fifty-three community-dwelling older persons were included for participation. Cluster analysis identified four distinctive clusters: (1) Performers – Well-informed; this subgroup is physically strong, well-informed and educated, independent, non-falling, with limited reflective coping style. (2) Performers – Achievers: physically strong people with a limited coping style and health literacy level. (3) The reliant- Good Coper representing physically somewhat limited people with sufficient coping styles who receive professional help. (4) The reliant – Receivers: physically limited people with insufficient coping styles who receive professional help. These subgroups showed significant differences in demographic characteristics and clinical FI outcomes. Conclusions: Community-dwelling older persons can be allocated to four distinct and clinically relevant subgroups based on their level of FI. This subgrouping provides insight into the complex holistic concept of FI by pointing out for each subgroup which FI domain is affected. This way, it helps to better target interventions to prevent the decline of FI in the community-dwelling older population.
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The research explored how a Dutch energy cluster embedded within a larger context of European and global developments reflected complex dynamics due to changes in its context. The case study explored Energy Valley of the Netherlands, a peripheral region that meets the challenge of energy transition, regional development and national economic interests. The research engaged complex adaptive systems approach to gain insights into complex cluster dynamics to contribute to cluster study and policy.The research captured insights into increased complexity of an energy cluster due to energy transition and other developments in the cluster context, exacerbated by differences in perceptions and responses of stakeholders to the new challenges. Findings on cluster developments included insights into cluster context, cluster condition, cluster dynamics and cluster transformations, and the interconnectedness of such developments based on Energy Valley and supplementary cases of Karlstad and Silicon Valley. The research findings led to insights into cluster systems developments and a model capturing cluster emergence.The research contributed to cluster theory by developing a CAS approach for cluster study that developed a whole systems approach to understand cluster dynamics, offering to the field of cluster study a qualitative understanding of cluster systems developments. Insights into interconnected developments at the micro, macro and inter-systemic levels, and into energy clusters in the context of energy transition were results of the research. The broad scope and nature of the study meant limitations were inherent and therefore recommendations for future research were included. EU Cluster Policy motivated the research and hence recommendations for policy developments were also part of the research contribution
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Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Background: Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods: Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results: Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions: Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation.
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Clusters are the magic answer to regional economic development. Firms in clusters are more innovative; cluster policy dominates EU policy; ‘top-sectors’ and excellence are the choice of national policy makers; clusters are ‘in’. But, clusters are complex, clusters are ‘messy’; there is no clear logic and no one agrees to how it can be successful.
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A previous study found a variety of unusual sexual interests to cluster in a five-factor structure, namely submission/masochism, forbidden sexual activities, dominance / sadism, mysophilia, and fetishism (Schippers et al., 2021). The current study was an empirical replication to examine whether these findings generalized to a representative population sample. An online, anonymous sample (N = 256) representative of the Dutch adult male population rated 32 unusual sexual interests on a scale from 1 (very unappealing) to 7 (very appealing). An exploratory factor analysis assessed whether similar factors would emerge as in the original study. A subsequent confirmatory factor analysis served to confirm the factor structure. Four slightly different factors of sexual interest were found: extreme, illegal and mysophilic sexual activities; light BDSM without real pain or suffering; heavy BDSM that may include pain or suffering; and illegal but lower-sentenced and fetishistic sexual activities. The model fit was acceptable. The representative replication sample was more sexually conservative and showed less sexual engagement than the original convenience sample. On a fundamental level, sexual interest in light BDSM activities and extreme, forbidden, and mysophilic activities seem to be relatively separate constructs.
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This study explores how households interact with smart systems for energy usage, providing insights into the field's trends, themes and evolution through a bibliometric analysis of 547 relevant literature from 2015 to 2025. Our findings discover: (1) Research activity has grown over the past decade, with leading journals recognizing several productive authors. Increased collaboration and interdisciplinary work are expected to expand; (2) Key research hotspots, identified through keyword co-occurrence, with two (exploration and development) stages, highlighting the interplay between technological, economic, environmental, and behavioral factors within the field; (3) Future research should place greater emphasis on understanding how emerging technologies interact with human, with a deeper understanding of users. Beyond the individual perspective, social dimensions also demand investigation. Finally, research should also aim to support policy development. To conclude, this study contributes to a broader perspective of this topic and highlights directions for future research development.
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his paper develops a new, broader, and more realistic lens to study (lacking) linkages between government policy and school practices. Drawing on recent work in organization theory, we advance notions on cluster of organization routines and the logic of complementarities underlying organizational change. This lens allows looking at how schools do (not) change a cluster of organization routines in response to multiple, simultaneous demands posed by government policies. Thirteen purposively selected Dutch secondary schools responding to three central government policies calling for concurrent change were analyzed, taking the schedule of a school as an exemplary case of a cluster of organization routines. Five distinct responses were distinguished, which can be sorted according to their impact on the whole organization. The study fnds that ten of the thirteen schools did not change anything in response to at least one of the three policies we studied. However, all schools changed their cluster of organization routines, which impacted the whole organization in response to at least one of the three government policies. Therefore, looking at combinations of responses and considering the impact of change on school organizations qualifes ideas about schools being resistant to policy or unwilling to change and improve.
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