Terwijl we inmiddels bij elektriciteit en gas met centrale planning werken, wil de minister de benodigde investeringen in de waterstofinfra juist aan de markt overlaten. Martien Visser waarschuwt voor onbalans in het energiesysteem.
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Digital technologies permeate and transform organisational practices. As a society, we need means to explore the uncharted terrain that lies ahead and the desirability and consequences of possible courses of action to move forward. We investigate a design approach, called ‘future probing’, to envision and critically analyse possible futures around digital technologies. We first reconstruct our journey and describe related insights on the process, content and context level. Reflecting on the journey, we then extract a key insight revolving around the challenge for participants to link back from exploring the future to their present practice. In a first attempt at theorizing these difficulties, we see future probing as a practice that opens up adaptive space (Uhl-Bien & Arena, 2017) in which people from different backgrounds engage in dialogue about possible futures of digital technologies. We found that adaptive processes, like semi structuring, temporary decentralisation, and collaboration (Uhl-Bien & Arena, 2018) were supported by the future probing practices and seemed to create space for employees to engage in exploration. There was still a lack of compelling acts of brokering and network cohesion (Uhl-Bien & Arena, 2018). This may indicate why linking back to daily practice is challenging. We assume that organising for adaptability requires a deliberate act of connecting far future explorations with present action, and propose that besides explorative skills, ‘adaptive anticipating’ action is needed to make the connection and that linking back through near future experiments might be a way to achieve this.
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"Snapt u wat u ziet? Of zijn we gevangen in een nieuwe ideologie? " Lector Frans van der Reep daagde de toehoorders bij de Pieter Teyler van der Hulstlezing bij Inholland Haarlem uit tot kritische reflectie op innovatie en het recht op offline leven. "Pas vanuit een begrip wat er gebeurt als gevolg van nieuwe tech, en dat wij de crowd zijn, kunnen we positie kiezen en onszelf echt organiseren."
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Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.
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Background: Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective: This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods: The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results: Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions: The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy.
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Background: Patient education, advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. Therefore we have developed e-Exercise LBP, a blended intervention in which a smartphone application is integrated within face-to-face care. E-Exercise LBP aims to improve patient self-management skills and adherence to exercise and physical activity recommendations and consequently improve the effectiveness of physiotherapy on patients’ physical functioning. The aim of this study is to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP in comparison to usual primary care physiotherapy in patients with LBP. Methods: This paper presents the protocol of a prospective, multicentre cluster randomized controlled trial. In total 208 patients with LBP pain were treated with either e-Exercise LBP or usual care physiotherapy. E-Exercise LBP is stratified based on the risk for developing persistent LBP. Physiotherapists are able to monitor and evaluate treatment progress between face-to-face sessions using patient input from the smartphone application in order to optimize physiotherapy care. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. The primary outcome is physical functioning at 12-months follow-up. Secondary outcomes include pain intensity, physical activity, adherence to prescribed (home-based) exercises and recommended physical activity behaviour, self-efficacy, patient activation and health-related quality of life. All measurements will be performed at baseline, 3, 12 and 24months after inclusion. An economic evaluation will be performed from the societal and the healthcare perspective and will assess cost-effectiveness of e-Exercise LBP compared to usual physiotherapy at 12 and 24months. Discussion: A multi-phase development and implementation process using the Center for eHealth Research Roadmap for the participatory development of eHealth was used for development and evaluation. The findings will provide evidence on the effectiveness of blended care for patients with LBP and help to enhance future implementation of blended physiotherapy.
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This is a report of the research done during the Summer School 2022 at the Digital Methods Initiative (UvA). The work and the report were developed in collaboration with the participants in the datasprint: Gabrielle Aguilar // Federica Bardelli // Laura Bruschi // Miranda García // Giulia Giorgi // Matthew Hanchard // Bakar Abdul-Rashid Jeduah // Natalie Kerby // Goran Kusić // Bruno Mattos // Samir van Oeijen Rodríguez // Alessandro Quets // Eivind Røssaak // Miazia Schueler // Zijing Xu // Xin Zhou // Chloe Sussan-Molson // Maud Borie // Alireza Hashemzadegan // Misha Velthuis. Abstract:Sea-level rise has long been one of the most locally tangible impacts of climate change, both now and in the future. Due to accelerating climate change, the annual rate of sea-level rise has almost tripled over the last century, and the mean sea level rise is expected to rise 0.3m-1.0m by 2100 (Duijndam et al., 2021). The IPCC states that risks include increased flooding, erosion, loss of ecosystems and permanent submergence (Oppenheimer et al., 2019). In the UK, there are fierce debates over whether to protect or surrender coastal homes threatened by sea-level rise (Fisher, 2022), while in the Netherlands the trust in its strong water management and engineering tradition has led to the so-called myth of the dry feet—the idea that sea-level rise in the Netherlands, a country that in part lies below sea-level, can be countered by merely building higher dams (Schuttenhelm, 2020). Scenarios for the future of the Netherlands include new adaptation strategies of living with the water, in which parts of the land are given back to nature to preserve larger cities (Deltares, 2019). Globally, some of the world’s most populous cities, such as New York, Bangkok and Shanghai are amongst the most vulnerable (C40 Cities, 2018), while the existential threats to small islands such as Kiribati, Seychelles and the Maldives could result in entire states disappearing from the world (Martyr-Koller et al., 2021). Emblematic images of people wading through the flooded streets of Venice holding up their shopping bags or stopping for a coffee travelled the news and social media outlets as an illustration of the climate crisis, and the collision of rising sea levels, a sinking city, surging seasonal winds and failing governance as the city experienced its worst floods in 50 years (National Geographic, 2019).There have been some notable efforts to visualise scientific projections of sea-level rise (e.g. Climate Central, 2015), as well as more creative attempts to communicate the threat such as the iconic Der Spiegel depicting a submerged Koln Cathedral (Mahony, 2016). Yet it is argued that sea-level rise remains a relatively low public concern given the huge potential risks to ecosystems and human habitats (Akerlof et al., 2017), while a recent advanced review of digital media research on climate communication found no research focused on the issue (Pearce et al., 2019). In this project, we will try to fill this gap, looking to see how both present and future sea-level rise is being imagined and interpreted on social media platforms, in terms of textual and visual content, information sources, locations, and point in time (i.e., future or present).
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Will China’s policymakers return to pragmatism and will the entrepreneurs strike a balance between the central control and market logic? In this analysis, Yuxi Nie explores the situation.
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Phantom limb pain following amputation is highly prevalent as it affects up to 80% of amputees. Many amputees suffer from phantom limb pain for many years and experience major limitations in daily routines and quality of life. Conventional pharmacological interventions often have negative side-effects and evidence regarding their long-term efficacy is low. Central malplasticity such as the invasion of areas neighbouring the cortical representation of the amputated limb contributes to the occurrence and maintenance of phantom limb pain. In this context, alternative, non-pharmacological interventions such as mirror therapy that are thought to target these central mechanisms have gained increasing attention in the treatment of phantom limb pain. However, a standardized evidence-based treatment protocol for mirror therapy in patients with phantom limb pain is lacking, and evidence for its effectiveness is still low. Furthermore, given the chronic nature of phantom limb pain and suggested central malplasticity, published studies proposed that patients should self-deliver mirror therapy over several weeks to months to achieve sustainable effects. To achieve this training intensity, patients need to perform self-delivered exercises on a regular basis, which could be facilitated though the use of information and communication technology such as telerehabilitation. However, little is known about potential benefits of using telerehabilitation in patients with phantom limb pain, and controlled clinical trials investigating effects are lacking. The present thesis presents the findings from the ‘PAtient Centered Telerehabilitation’ (PACT) project, which was conducted in three consecutive phases: 1) creating a theoretical foundation; 2) modelling the intervention; and 3) evaluating the intervention in clinical practice. The objectives formulated for the three phases of the PACT project were: 1) to conduct a systematic review of the literature regarding important clinical aspects of mirror therapy. It focused on the evidence of applying mirror therapy in patients with stroke, complex regional pain syndrome and phantom limb pain. 2) to design and develop a clinical framework and a user-centred telerehabilitation for mirror therapy in patients with phantom limb pain following lower limb amputation. 3) to evaluate the effects of the clinical framework for mirror therapy and the additional effects of the teletreatment in patients with phantom limb pain. It also investigated whether the interventions were delivered by patients and therapists as intended.
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Closing the loop of products and materials in Product Service Systems (PSS) can be approached by designers in several ways. One promising strategy is to invoke a greater sense of ownership of the products and materials that are used within a PSS. To develop and evaluate a design tool in the context of PSS, our case study focused on a bicycle sharing service. The central question was whether and how designers can be supported with a design tool, based on psychological ownership, to involve users in closing the loop activities. We developed a PSS design tool based on psychological ownership literature and implemented it in a range of design iterations. This resulted in ten design proposals and two implemented design interventions. To evaluate the design tool, 42 project members were interviewed about their design process. The design interventions were evaluated through site visits, an interview with the bicycle repairer responsible, and nine users of the bicycle service. We conclude that a psychological ownership-based design tool shows potential to contribute to closing the resource loop by allowing end users and service provider of PSS to collaborate on repair and maintenance activities. Our evaluation resulted in suggestions for revising the psychological ownership design tool, including adding ‘Giving Feedback’ to the list of affordances, prioritizing ‘Enabling’ and ‘Simplification’ over others and recognize a reciprocal relationship between service provider and service user when closing the loop activities.
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