Presented at 7th International Conference on the Assessment of Animal Welfare at farm group level
IntroductionIt is unknown how awake prone positioning was practiced in patients with COVID–19 in the second wave of the national outbreak in the Netherlands.ObjectivesWe studied the practice of awake prone positioning in COVID–19 patients admitted to the ICU because of acute hypoxemic respiratory failure, and determined associations with demographics and outcomes.MethodsInvestigator–initiated, national, multicenter study in 16 hospitals in the Netherlands. Patients that received awake prone positioning were compared to patients that did not receive this intervention. The primary endpoint was a composite of various aspects of awake prone positioning practice. The secondary endpoint was ‘treatment failure’, a composite of intubation for invasive ventilation and death before day 28. We used propensity matching to control for observed confounding factors.ResultsIn 546 non–intubated patients, awake prone positioning was used in 88 (16.1%) patients, within median 1 [0 to 2] days after ICU admission, for median 1.0 [0.8–1.4] days and median 12.0 [8.4–14.5] hours per day. High–flow oxygen therapy was the most often used oxygen interface at start of awake prone positioning. Patients in the awake prone positioning group less often had a history of cardiovascular disease. In unmatched analysis, treatment failure occurred more often in patients that received awake prone positioning (HR, 1.80 [1.41–2.31]; P<0.001); in matched analysis, differences remained present, but did no longer reach statistical significance (HR, 1.17 [0.87-1.59]; P=0.30). ConclusionsIn this national cohort of COVID–19 patients in the second wave of the national outbreak, awake prone positioning was used in one in six patients. Awake prone positioning started early, but was often discontinued because of need for intubation. Patients that received awake prone positioning had higher risk for treatment failure.
Talk by members of executive hospital boards influences the organizational positioning of nurses. Talk is a relational leadership practice. Using a qualitative‐ interpretive design we organized focus group meetings wherein members of executive hospital boards (7), nurses (14), physicians (7), and managers (6), from 15 Dutch hospitals, discussed the organizational positioning of nursing during COVID crisis. We found that members of executive hospital boards consider the positioning of nursing in crisis a task of nurses themselves and not as a collective, interdependent, and/or specific board responsibility. Furthermore, members of executive hospital boards talk about the nursing profession as (1) more practical than strategic, (2) ambiguous in positioning, and (3) distinctive from the medical profession. Such talk seemingly contrasts with the notion of interdependence that highlights how actors depend on each other in interaction. Interdependence is central to collaboration in hospital crises. In this paper, therefore, we depart from the members of executive hospital boards as leader and “positioner,” and focus on talk— as a discursive leadership practice—to illuminate leadership and governance in hospitals in crisis, as social, interdependent processes.
Various companies in diagnostic testing struggle with the same “valley of death” challenge. In order to further develop their sensing application, they rely on the technological readiness of easy and reproducible read-out systems. Photonic chips can be very sensitive sensors and can be made application-specific when coated with a properly chosen bio-functionalized layer. Here the challenge lies in the optical coupling of the active components (light source and detector) to the (disposable) photonic sensor chip. For the technology to be commercially viable, the price of the disposable photonic sensor chip should be as low as possible. The coupling of light from the source to the photonic sensor chip and back to the detectors requires a positioning accuracy of less than 1 micrometer, which is a tremendous challenge. In this research proposal, we want to investigate which of the six degrees of freedom (three translational and three rotational) are the most crucial when aligning photonic sensor chips with the external active components. Knowing these degrees of freedom and their respective range we can develop and test an automated alignment tool which can realize photonic sensor chip alignment reproducibly and fully autonomously. The consortium with expertise and contributions in the value chain of photonics interfacing, system and mechanical engineering will investigate a two-step solution. This solution comprises a passive pre-alignment step (a mechanical stop determines the position), followed by an active alignment step (an algorithm moves the source to the optimal position with respect to the chip). The results will be integrated into a demonstrator that performs an automated procedure that aligns a passive photonic chip with a terminal that contains the active components. The demonstrator is successful if adequate optical coupling of the passive photonic chip with the external active components is realized fully automatically, without the need of operator intervention.
In 2017, renowned Prof Kate Raworth from Oxford University and Amsterdam University introduced Doughnut Economics, an economic model to enable humans to thrive within the planetary boundaries and resources. Several private and public actors, including the city of Amsterdam, adopted the model in their circular economy development's strategies. Doughnut-Architecture aims to develop further the AREA (Atelier for Resilient Environmental Architecture) Framework, a tool designed by graduating students Charlotte Uiterwaal, Isabella van der Griend, Ryan McGaffney, Karolina Bäckman, at the faculty of Architecture, Delft University of Technology (TU-Delft), under the supervision of Henri van Bennekom. AREA-Framework support architects to intervene in the built environment taking as a reference the Doughnut Economics model. The AREA-Framework is at an initial stage, and its categories and subcategories are only qualitative. TU-Delft, the architectural practices Space&Matter and SuperuseStudios, in collaboration with the interdepartmental research group Circular Built Environment Hub (CBEH) and architectural practices from the network of 400 construction companies belonging to the Ex'tax project, the advice from Kate Raworth and the Amsterdam-Donut-Coalitie will further develop the AREA-Framework primarily quantitatively and also qualitatively. TU-Delft, Space&Matter, SuperuseStudios, other architectural practices from the Ex'tax-network will test the framework on different phases of real projects, interdepartmental research and education. The ultimate goal is to develop the framework further, to increase the number of architectural practices successfully implementing the Doughnut Economics in the built environment at a national level. The framework will contribute to positioning the architectural practices concerning Doughnut Economics and the Circular Economy. The project results are firstly an online open-access publication about the further developed Framework to be applied by architects; secondly, the preparation and submission of a follow-up research proposal about the extended development and implementation of the Framework applicable to the built environment by all the Ex'tax construction sector companies.
Logistics companies struggle to keep their supply chain cost-effective, reliable and sustainable, due to changing demand, increasing competition and growing service requirements. To remain competitive, processes must be efficient with low costs. Of the entire supply chain, the first and last mile logistics may be the most difficult aspect due to low volumes, high waiting and shipping times and complex schedules. These inefficiencies account for up to 40% of total transport costs. Connected Automated Transport (CAT) is a technological development that allows for safer, more efficient and cleaner transport, especially for the first- and last-mile. The Connected Automated Driving Roadmap (ERTRAC) states that CAT can revolutionize the way fleets operate. The CATALYST Project (NWO) already shows the advantages of CAT. SAVED builds on several projects and transforms the challenges and solutions that were identified on a strategic level to a tactical and operational (company) level. Despite the high-tech readiness of CAT, commercial acceptance is lacking due to issues regarding profitable integration into existing logistics processes and infrastructures. In-depth research on automated hub-to-hub freight transport is needed, focusing on ideal vehicle characteristics, logistic control of the vehicles (planning, routing, positioning, battery management), control modes (central, decentralized, hybrid), communication modes (vehicle-to-vehicle, vehicle-to-infrastructure) and automation of loading and unloading, followed by the translation of this knowledge into valid business models. Therefore, SAVED focuses on the following question: “How can automated and collaborative hub-to-hub transport be designed, and what is the impact in terms of People, Planet and Profit (PPP) on the logistics value chain of industrial estates of different sizes, layouts and different traffic situations (mixed/unmixed infrastructure)?“ SAVED results in knowledge of the applicability of CAT and the impact on the logistics value chain of various industrial estates, illustrated by two case studies.
