The main goal of this study is to identify knowledge gaps and uncertainties in Quantitative Risk Assessments (QRA) for CO2 pipelines and to assess to what extent those gaps and uncertainties affect the final outcome of the QRA. The impact of methodological choices and uncertain values for input parameters on the results of QRA’s have been assessed through an extensive literature review and by using commercially available release, dispersion and effect models. It is made apparent that over the full life cycle of a QRA knowledge gaps and uncertainties are present that may have large scale impact on the accuracy of assessing risks of CO2 pipelines. These encompass the invalidated release and dispersion models, the currently used failure rates, choosing the type of release to be modeled and the dose-effect relationships assumed. Also recommendations are presented for the improvement of QRA’s for CO2 pipelines.
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Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000. Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances.
The essays collected here are based on two decades of engagement with the residents of the slums of Govindpuri in India’s capital, Delhi. The book presents stories of many kinds, from speculative treatises, via the recollection of a thousand everyday conversations, to an account of the making of a radio documentary.Zig-zagging through the lanes of Govindpuri, Listening into Others explores the vibrant sounds emanating from slum culture. Redefining ethnography as listening in passing, Chandola excels at narrating the stories of the everyday. The ubiquity of smartphones, sonic selfies, wailing, the ethics of wearing jeans, the crossroad rituals of elections, the political agency of slum-dwellers, the war of the sexes through bodily gestures, and conflicts over ownership of both property and sound generated in the slums — these are among the many encounters Chandola opens up to the reader.Slums are anxious spaces in the materiality, experience, and imagination of a city. They are the by-products of the violent and exploitative mechanisms of urbanization. What becomes of the slum-dwellers, who universally, across centuries, cities and continents, befall similar fates of being discriminated, reckoned to be the scum of the earth, and a burden on society? By listening to identified others and amplifying their voices in their own vocabularies and grammar, Tripta Chandola’s praxis creates a methodological, political, and poetic rupture. Slums, she finds, are not anathema to the city’s past, present, or future. They are an integral component of urbanization and a foundational part of the city.With Listening into Others, Tripta Chandola poses the question: ‘Who owns the slum, and who determines which voices are heard? From where you are, listen with me.’
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Bij veel (sport)blessures en orthopedische aandoeningen, zoals voorste kruisband (VKB-) rupturen en enkelfracturen, moeten patiënten na een operatieve ingreep een lang revalidatietraject ondergaan. Fysiotherapeuten, (mentale) coaches, inspanningsfysiologen en orthopedisch chirurgen constateren dat patiënten ondanks goede begeleiding veelal hun fysieke niveau van voor de blessure niet meer bereiken. Om kwalitatief betere zorg te kunnen bieden, willen deze professionals meer inzicht krijgen in het individuele herstel. Door een combinatie van lichamelijke en psychologische parameters intensief te monitoren, denken zij namelijk eerder de therapie aan te kunnen passen op (on)gewenste veranderingen in het beloop van herstel. De zorgprofessionals hebben echter onvoldoende tijd en mogelijkheden om patiënten intensief te monitoren. Bovendien denken zij het herstel verder te kunnen ondersteunen door patiënten zelf te laten meten omdat patiënten meer verantwoordelijkheid voor hun gezondheid nemen indien zij toegang krijgen tot hun eigen data. De zorgprofessionals vragen zich daarom af hoe zij een zelf-monitoringsysteem voor orthopedische patiënten kunnen inrichten, dat hen in staat stelt therapie op maat te geven gedurende het totale revalidatieproces (casus VKB-reconstructies). Centrale onderzoeksvraag is: Welke kennis en vaardigheden hebben zorgprofessionals en patiënten na een VKB-reconstructie nodig om een zelf-monitoringsysteem slim toe te kunnen passen in de zorgpraktijk? Deze onderzoeksvraag kent de volgende deelvragen: A. Hoe moet een zelf-monitoringsysteem volgens zorgprofessionals, technici/ontwerpers en patiënten worden ingericht en gebruikers getraind om de patiënten na een VKB-reconstructie in staat te stellen een kernset van lichamelijke en psychologische parameters zelfstandig te verzamelen en te delen? B. Hoe wordt het zelf-monitoringsysteem door zorgprofessionals en patiënten na een VKB-reconstructie in de praktijk gebruikt en hoe staat het gebruik in relatie tot herstel? C. Wat zijn de ervaringen van zowel de zorgprofessionals als patiënten na een VKB-reconstructie met het zelf-monitoringsysteem en wat zijn de belemmerende en/of bevorderende factoren bij het gebruik van het zelf-monitoringsysteem voor het revalidatietraject?
