Background: Acquiring the theoretical and practical knowhow of conducting patient and public involvement (PPI) in research is not part of the traditional curriculum of researchers. Zuyd University of Applied Sciences and Huis voor de Zorg, a regional umbrella patient organization, therefore started a 1.5-year coaching programme. Objective: To establish a community of practice by developing a PPI coaching programme for senior and junior health services researchers of Zuyd University. The context consisted of research projects conducted by the participants. Methods: A participatory action research methodology. Data were collected from reports of thematic group meetings and individual sessions with participants, field notes and regular reflection meetings with the project team. Data were analysed by reflexive deliberation. Findings: The programme comprised a kick-off meeting (52 attendees), followed by 7 group meetings with 11 junior and 9 senior researchers. The project team constructed a serious game based on the concept of the participation ladder. Questions and concerns differed for junior and senior researchers, and separate tailored meetings were organized for both groups. Between group meetings, participants received individual assignments. Group meetings were accompanied by individual coaching sessions to provide tailor-made feedback. The programme concluded with a combined meeting with all stakeholders. Conclusion: Building a community of PPI practice through action research facilitates the development of a coaching programme that fosters social learning, empowerment and the development of a shared identity concerning PPI. The role and responsibilities of senior researchers should be distinguished from those of junior researchers.
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This paper analyses Amsterdam’s Startup-in-Residence (SiR) programme as new type of policy to engage startups in the development of urban innovation through a challenge-based public procurement of innovation (PPI) process. The programme is being mimicked by other cities and government agencies, but so far there has not been a rigorous, theoretically-informed analysis of the approach. In this paper, we specify and focus on the role of city-based, public-affiliated intermediaries as initiators, moderators and influencers of conversations between startups and the local government. The main contribution of SiR as a PPI intermediation programme has been to launch new types of fruitful conversations on several levels, that lead to institutional innovations rather than direct solutions for urban problems or startup development. In this sense, SiR fulfils a role inquiring and ascribing urban challenges with values and notions of “worth” that preceded and shaped innovation directions. We also suggest that engaging startups is effective for only a limited bandwidth urban challenges; different types of intermediation are required to foster collaborative innovation in more complex settings.
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In the past decade, the fast and transient coupling and uncoupling of functionally related brain regions into networks has received much attention in cognitive neuroscience. Empirical tools to study network coupling include functional magnetic resonance imaging (fMRI)-based functional and/or effective connectivity, and electroencephalography (EEG)/magnetoencephalography-based measures of neuronal synchronization. Here we use simultaneously recorded EEG and fMRI to assess whether fMRI-based connectivity and frequency-specific EEG power are related. Using data collected during resting state, we studied whether posterior EEG alpha power fluctuations are correlated with connectivity within the visual network and between the visual cortex and the rest of the brain. The results show that when alpha power increases, BOLD connectivity between the primary visual cortex and occipital brain regions decreases and that the negative relation of the visual cortex with the anterior/medial thalamus decreases and the ventral–medial prefrontal cortex is reduced in strength. These effects were specific for the alpha band, and not observed in other frequency bands. The decreased connectivity within the visual system may indicate an enhanced functional inhibition during a higher alpha activity. This higher inhibition level also attenuates long-range intrinsic functional antagonism between the visual cortex and the other thalamic and cortical regions. Together, these results illustrate that power fluctuations in posterior alpha oscillations result in local and long-range neural connectivity changes.
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Waste from raw materials has a direct influence on the final price of a product. However, since waste has no added value to products, customers are unwilling to pay for it. Reducing waste along the production process and supply chain allows companies to decrease costs and remain competitive in product prices. This research is conducted in a medical device manufacturing company located in Tijuana (Mexico). The company found a negative variation in part number 9540, a metallic foil used for hot stamping. During inventory cycle counts, the company found that they were purchasing rawer material than necessary due to a 50% of waste generated along the production process. We implemented two process improvement methodologies, namely Practical Process Improvement (PPI) and the Plan-Do-Check-Act model, to eliminate 100% of the raw material waste, specifically regarding the foil's waste. The improvement project comprised two phases: a) adjusting the parameters of the hot foil stamping machine and b) replacing the hot foil stamping machine with a pad printing machine. In our research, the PPI methodology is presented in 8 detailed stages as a simple problem-solving method, in contrast with five stages reported in other documented cases. This case study presents how a company can apply continuous improvement programs and its managerial implications, even without having a structured and defined systems for quality, such as Six Sigma or Lean Manufacturing implemented. After the two implementation phases, the improvement project led to economic savings of $\$ $ 165,000 in a year.
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Introduction: From the patient and staff perspective, care delivery for patients experiencing a mental health problem in ambulance and emergency department (ED) settings is challenging. There is no uniform and internationally accepted concept to reflect people with a mental health problem who require emergency care, be it for, or as a result of, a mental health or physical health problem. On initial presentation to the emergency service provider (ambulance or ED), the cause of their healthcare condition/s (mental health and/or physical health) is often initially unknown. Due to this (1) the prevalence and range of underlying causes (mental and/or physical) of the patients presenting condition is unknown; (2) misattribution of physical symptoms to a mental health problem can occur and (3) diagnosis and treatment of the initial somatic complaint and cause(s) of the mental/physical health problem may be hindered.This study will name and define a new concept: 'mental dysregulation' in the context of ambulance and ED settings. Methods and analysis: A Delphi study, informed by a rapid literature review, will be undertaken. For the literature review, a steering group (ie, persons with lived experience, ED and mental health clinicians, academics) will systematically search the literature to provide a working definition of the concept: mental dysregulation. Based on this review, statements will be generated regarding (1) the definition of the concept; (2) possible causes of mental dysregulation and (3) observable behaviours associated with mental dysregulation. These statements will be rated in three Delphi rounds to achieve consensus by an international expert panel (comprising persons with lived experience, clinicians and academics). Ethics and dissemination: This study has been approved by the Medical Ethical Committee of the University of Applied Sciences Utrecht (reference number: 258-000-2023_Geurt van der Glind). Results will be disseminated via peer-reviewed journal publication(s), scientific conference(s) and to key stakeholders.
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In this paper, the performance gain obtained by combining parallel peri- odic real-time processes is elaborated. In certain single-core mono-processor configurations, for example, embedded control systems in robotics comprising many short processes, process context switches may consume a considerable amount of the available processing power. For this reason, it can be advantageous to combine processes, to reduce the number of context switches and thereby increase the performance of the application. As we consider robotic applications only, often consisting of processes with identical periods, release times and deadlines, we restrict these configurations to periodic real-time processes executing on a single-core mono-processor. By graph-theoretical concepts and means, we provide necessary and sufficient conditions so that the number of context switches can be reduced by combining synchronising processes.
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Fully aware of the unusual timing of submitting a commentary 30 years later, we want to reflect on the June edition of the British Journal of Clinical Pharmacology (BJCP) (1993), which featured four research articles on education in clinical pharmacology and therapeutics (CPT) written by our former professor, Theo de Vries, and an editorial highlighting the imperative to improve CPT education, specifically by paying more attention to rational drug prescribing for common diseases.1–5 This plea was illustrated by five cartoons (Figure 1) and formed the basis for the World Health Organization's (WHO) Guide to Good Prescribing and its 6-step. The first four cartoons portrayed the suboptimal state of CPT education as a metaphorical ‘Clinical Pharmacology Continent’ (CPC) and a ‘General Practitioners Island’ (GPI), with a large gap between them. While clinical pharmacologists investigated new drug therapies, general practitioners frequently found themselves unprepared when making rational treatment decisions.1 The final cartoon introduced a solution: problembased learning education, depicted as a bridge connecting the continent and the island. Over the past 30 years, considerable progress has been achieved in bridging the gap. Therefore, we intend to illustrate this transformation with a similar cartoon (Figure 2).
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Horizontal collaborative purchasing (HCP) has often been cited as a way for hospitals to address the challenges of the rising healthcare costs. However, hospitals do not seem to utilize horizontal collaborative purchasing on any large scale, and recent initiatives have had mixed results. Focusing on Dutch hospitals, in this paper we present major impediments for collaborative purchasing, resulting in a first component of our proposed electronic horizontal collaborative purchasing model for hospitals; as a second component it contains a collaborative purchasing typology. A first validation round with hospital purchasing professionals, described separately in Kusters and Versendaal (2011), confirmed four applicable purchasing types and fourteen salient collaborative purchasing impediments. The model is operationalized by including possible information technology (IT) solutions that address the specific fourteen impediments. This model is validated through methodological triangulation of four different validation techniques. We conclude that IT has the potential to support, or overcome, the impediments of HCP. The validation also reveals the need to distinguish between more processrelated, as opposed to social-related, obstacles; the immediate potential for IT solutions is greater for the process-related impediments. Ultimately, we conclude that the collaborative epurchasing model (e-HCP) and implementation roadmap can be used by healthcare consortia, branche organizations, partnering healthcare institutes and multi-site healthcare institutes as a means to help identifying strategies to initiate, manage and evaluate collaborative purchasing practices
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Onderzoek in opdracht projectgroep Leef en Leer! (bestaand uit ObA, gemeente Amsterdam, E-TV en AT5) om onderzoek te doen naar de kwaliteit van netwerkvorming en netwerkintelligentie en de manier waarop die netwerkvorming ondersteund kan worden met een goed hanteerbare communicatiestructuur. Leef en Leer! wil in de wijken digitale geletterdheid van Amsterdammers in aandachtsgroepen versterken. Onderzoek is gebaseerd op kwalitatieve interviews met stakeholders en adviseert over verdere netwerkvorming in de eerste uitrolfase van de Leef en leer! pas aan eindgebruikers. Analyse is gebaseerd op de verschillende manieren waarop betrokkenen meenden dat zijzelf of anderen iets 'moesten'. Het 'moeten' werpt ligt op de normatieve en idealistische kant aan het Leef en Leer! netwerk en op haar meer disciplinaire kant. Dit valt terug te voeren op het langzaam duidelijker worden van de aard van het Leef en leer! netwerk. Het idealisme van de stuurgroep en later aangesloten wijkpartners verhoudt zich goed tot een transformatief netwerk en slecht tot een netwerk dat gericht is op institutionalisering.
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