Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA) is a validated instrument to assess malnutrition and its risk factors in clinical populations. Its patient component, PG-SGA Short Form (SF), can be used as screening instrument. In this cross-sectional study we aimed to assess agreement between the PG-SGA SF, Malnutrition Universal Screening Tool (MUST), and Short Nutritional Assessment Questionnaire (SNAQ) in patients at the University Medical Center Groningen, The Netherlands.Methods: Malnutrition risk was assessed by PG-SGA SF, MUST, and SNAQ in 81 patients from the Departments Ear Nose Throat (ENT), Oral and Maxillofacial Surgery (OMS) and Orthopedics. Point scores of PG-SGA SF=4-8, MUST=1, and SNAQ=2 were classified as ‘medium malnutrition risk’, and PG-SGA SF≥9, MUST ≥2, and SNAQ ≥3 as ‘high malnutrition risk’. Agreement in classification for malnutrition risk was assessed by weighted kappa (κ) and intra-class correlation coefficient (ICC). A p-value of <0.05 was considered statistically significant.Results: According to the PG-SGA SF, MUST and SNAQ, respectively 65%, 81%, and 80% of all patients were classified as ‘low malnutrition risk’; 24%, 8% and 6% as ‘medium malnutrition risk’; 11%, 10% and 14% as ‘high malnutrition risk’.Agreement between PG-SGA SF and MUST (κ=0.452, ICC=0.448; p<0.001), and between PG-SGA SF and SNAQ (κ=0.395, ICC=0.395; p<0.001) were both fair. In patients from the Departments ENT and OMS, PG-SGA SF classified more patients at medium/high malnutrition risk (n=26) as compared to the MUST (n=12) or SNAQ (n=14).Conclusion: We found only fair agreement between the PG-SGA SF and MUST and SNAQ, respectively. The PG-SGA SF classified three and four times more patients at medium malnutrition risk, compared to MUST and SNAQ respectively, due to its scoring on symptoms and activities/functioning. Hence, the PG-SGA SF may help facilitate proactive prevention of malnutrition.
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BACKGROUND/OBJECTIVES: Traditional malnutrition screening instruments, including the Malnutrition Universal Screening Tool (MUST), strongly rely on low body mass index (BMI) and weight loss. In overweight/obese patients, this may result in underdetection of malnutrition risk. Alternative instruments, like the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF), include characteristics and risk factors irrespective of BMI. Therefore, we aimed to compare performance of MUST and PG-SGA SF in malnutrition risk evaluation in overweight/obese hospitalized patients.SUBJECTS/METHODS: We assessed malnutrition risk using MUST (≥1 = increased risk) and PG-SGA SF (≥4 = increased risk) in adult patients at hospital admission in a university hospital. We compared results for patients with BMI < 25 kg/m 2 vs. BMI ≥ 25 kg/m 2. RESULTS: Of 430 patients analyzed (58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m 2), 35% were overweight and 25% obese. Malnutrition risk was present in 16% according to MUST and 42% according to PG-SGA SF. In patients with BMI < 25 kg/m 2, MUST identified 31% as at risk vs. 52% by PG-SGA SF. In patients with BMI ≥ 25 kg/m 2, MUST identified 5% as at risk vs. 36% by PG-SGA SF. Agreement between MUST and PG-SGA SF was low (к = 0.143). Of the overweight/obese patients at risk according to PG-SGA SF, 83/92 (90%) were categorized as low risk by MUST. CONCLUSIONS: More than one-third of overweight/obese patients is at risk for malnutrition at hospital admission according to PG-SGA SF. Most of them are not identified by MUST. Awareness of BMI-dependency of malnutrition screening instruments and potential underestimation of malnutrition risk in overweight/obese patients by using these instruments is warranted.
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Background and aims: Malnutrition screening is a first step in the nutrition care process for hospitalized patients, to identify those at risk of malnutrition and associated worse outcome, preceding further assessment and intervention. Frequently used malnutrition screening tools including the Malnutrition Universal Screening Tool (MUST) mainly screen for characteristics of malnutrition, while the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) additionally includes risk factors for development of malnutrition, yielding a higher percentage of patients at risk. To investigate whether this translates into higher risk of worse outcome, we aimed to determine the predictive validity of MUST and PG-SGA SF for prolonged hospitalization >8 days, readmission, and mortality <6 months after hospital discharge.Methods: In this observational study, MUST was performed according to university hospital protocol. Additional screening using PG-SGA SF was performed within 24 h of hospital admission (high risk: MUST ≥ 2, PG_SGA SF ≥ 9). Associations of MUST and PG-SGA SF with outcomes were analyzed by logistic- and Cox PH-regression.Results: Of 430 patients analyzed (age 58 ± 16 years, 53% male, BMI 26.9 ± 5.5 kg/m2), MUST and PG-SGA SF identified 32 and 80 at high risk, respectively. One-hundred-eight patients had prolonged hospitalization, 109 were readmitted and 20 died. High risk by MUST was associated with mortality (HR = 3.9; 95% CI 1.3–12.2, P = 0.02), but not with other endpoints. High risk by PG-SGA SF was associated with prolonged hospitalization (OR = 2.5; 95% CI 1.3–5.0, P = 0.009), readmission (HR = 1.9; 95% CI 1.1–3.2, P = 0.03), and mortality (HR = 34.8; 95% CI 4.2–289.3, P = 0.001), independent of age, sex, hospital ward and previous hospitalization <6 months. In the 363/430 patients classified as low risk by MUST, high risk by PG-SGA SF was independently associated with higher risk of readmission (HR = 1.9; 95% CI 1.0–3.5, P = 0.04) and mortality (HR = 19.5; 95% CI 2.0–189.4, P = 0.01).Conclusions: Whereas high malnutrition risk by MUST was only associated with mortality, PG-SGA SF was associated with higher risk of prolonged hospitalization, readmission, and mortality. In patients considered as low risk by MUST, high malnutrition risk by PG-SGA SF was also predictive of worse outcome. Our findings support the use of PG-SGA SF in routine care to identify patients at risk of malnutrition and worse outcome, and enable proactive interventions.
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Progetto Ustica is an experiment in "civically-engaged game design" and addresses the Ustica Massacre ("Strage di Ustica"), where 81 people lost their lives as an air-to-air missile hit a civilian aircraft in 1980. Progetto Ustica has been developed as part of an Action Research effort with the objective of preserving and transmitting the historical memory of the event. With this post-mortem essay, we reflect on the game design challenges that Progetto Ustica faced, we introduce different conceptualizations of "memory" emerging from our design practice, and we synthesize some lessons learned (implications for design) towards other "civically-engaged games" for socio-cultural heritage.
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There now exists a general scientific consensus that anthropogenic climate change is an inescapable reality (IPCC, 2007). The climate science has been subject to, and withstood, “withering scrutiny” (Garnaut, 2008). The consequences of climate change - social, economic, environmental - will be far reaching (Stern, 2007). The critical challenge that must be taken up without delay is to achieve “radical emission reductions” in all sectors of the economy, and across all aspects of society. The climate crisis, which demands the transformation of our lives and societies (Monbiot, 2007), raises difficult questions for consumer-based neoliberal western societies (Harvey, 2011; Stern, 2007). One important but problematic aspect of the required transformation relates to contemporary western mobility (Gössling et al., 2010). In singling out transport, Cuenot (2013, p. 22) of The International Energy Agency suggests that “Transport offers the easiest path for reducing oil dependency in theory: simple readily available solutions promise a 30% to 50% improvement in fuel economy, depending on the country, while reducing carbon emissions by several gigatonnes of CO2 each year”. Wheeller (2012, p. 39), however, focusing on tourist transport, unpacks a simple paradox: “All tourism involves travel: all travel involves transport: no form of transport is sustainable: so how on earth can we have sustainable tourism?” While some modes of transport (e.g. human, electrical, solar powered) are more sustainable than others, the sustainability of high volume, high velocity, long distance transportation is clearly coming under increasing scrutiny (Peeters and Dubois, 2010). The situation is particularly acute in the case of discretionary air travel (Cohen et al., 2011; Gössling et al., 2010). Monbiot (2007) highlights the considerable challenge associated with mitigating aviation greenhouse gas (GHG) emissions, given high current and projected growth in demand for air travel, and the absence of significant scope for further technical gains in aircraft efficiency (Scott et al., 2010). In the absence of “game-changing” innovations in transport technology, it is clearly evident that the United Nations World Tourism Organization (UNWTO) Tourism Barometer 2012 forecast of 1.8 billion international travellers by 2030 is incompatible with carbon mitigation. Western governments and the industry have to date been unwilling - or unable - to make meaningful responses to the tourism transport emissions challenge. The continuing inability to bring aviation into emission trading schemes (ETS) is indicative of this impasse (Duval, 2013). As many other sectors actively respond to the call for radical emissions reduction (Scott, 2011; Scott et al., 2012), tourism could find itself generating up to 40 per cent of global carbon emissions by 2050 (Dubois and Ceron, 2006; Gössling and Peeters, 2007). This failure of response is producing an industry of environmental disregard and neglect, with contemporary tourism that may be considered profligate and dissolute. It is clearly evident that “technology and management will not be sufficient to achieve even modest absolute emission reductions” (Gössling et al., 2010, p. 119). This, according to Gössling et al. (2010), confirms that social and behavioural change is necessary to achieve climatically sustainable tourism. Indeed the UNWTO concedes that climatically sustainable tourism requires fundamental shifts in consumer behaviour (UNWTO-UNEP-WMO, 2008). However, reliance upon shifts in behaviour raises its own issues and challenges (Semenza et al., 2008). Despite evidence of growing public awareness of the impacts of air transport on climate change (Hares et al., 2010; Higham and Cohen, 2011) there remains an alarming disconnection between attitudes and (tourist) behaviour (Miller et al., 2010). Thus, an increasingly informed and concerned public, which is beginning to internalise the realities of the climate crisis (Cohen and Higham, 2011), displays few signs of behaviour change (Barr et al., 2010; Higham et al., 2014; McKercher et al., 2010). The efficacy of individual consumers bearing the costs (social, economic) and responsibilities (psychological, behavioural) of a profoundly (environmentally) unsustainable industry is clearly open to question. From this overall context, the Freiburg 2012 workshop, held in Freiburg im Breisgau in southern Germany (3-5 July, 2012) set out to explore the psychological and social factors that both contribute to and inhibit behaviour change vis-à-vis sustainable (tourist) mobility. The workshop provided an opportunity to advance a rigorous and theoretically informed knowledge base and research agenda for effective policy interventions to address tourism’s contribution to climate change. Such insights are of importance to policy makers, as policy interventions will be less effective if not based on a rigorous understanding of tourist behaviour and psychology. These understandings are needed to negotiate or remove barriers that policy makers may perceive in implementing stronger mitigation measures by signalling how such measures can be made palatable to the public. The psychological and behavioural insights achieved during the workshop informed discussion of government approaches and policy measures that are required to both (a) support the efforts of individuals/consumers to respond to the emission reduction challenge, and (b) conflate the onus of responsibility (and the anxieties of consumption fuelled climate change) from the level of the individual, to the collective levels of government, industry and economy.
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Presentation at seminar: What struggles and opportunities do youth face in relation to their participation in sport and physical activities? This question is the starting point of the seminar 'Youth sport participation at the intersection of gender, ethnic and religious identifications' that will be held at Utrecht School of Governance on December 8 2017.
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Slim laden biedt – naar verwachting – de mogelijkheid om grote aantallen elektrische auto’s te laden op zoveel mogelijk duurzame energie uit zon en wind. Daarnaast biedt het de mogelijkheid om de energievraag te accommoderen binnen de kaders van het elektriciteitssysteem. In deze studie doen CE Delft en APPM in opdracht van Enpuls, en in samenwerking met Hogeschool van Amsterdam en ElaadNL, onderzoek naar de maatschappelijke kosten en baten van slim laden.
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