BACKGROUND: Early accurate assessment of burn depth is important to determine the optimal treatment of burns. The method most used to determine burn depth is clinical assessment, which is the least expensive, but not the most accurate.Laser Doppler imaging (LDI) is a technique with which a more accurate (>95%) estimate of burn depth can be made by measuring the dermal perfusion. The actual effect on therapeutic decisions, clinical outcomes and the costs of the introduction of this device, however, are unknown. Before we decide to implement LDI in Dutch burn care, a study on the effectiveness and cost-effectiveness of LDI is necessary.METHODS/DESIGN: A multicenter randomised controlled trial will be conducted in the Dutch burn centres: Beverwijk, Groningen and Rotterdam. All patients treated as outpatient or admitted to a burn centre within 5 days post burn, with burns of indeterminate depth (burns not obviously superficial or full thickness) and a total body surface area burned of ≤ 20% are eligible. A total of 200 patients will be included. Burn depth will be diagnosed by both clinical assessment and laser Doppler imaging between 2-5 days post burn in all patients. Subsequently, patients are randomly divided in two groups: 'new diagnostic strategy' versus 'current diagnostic strategy'. The results of the LDI-scan will only be provided to the treating clinician in the 'new diagnostic strategy' group. The main endpoint is the effect of LDI on wound healing time.In addition we measure: a) the effect of LDI on other patient outcomes (quality of life, scar quality), b) the effect of LDI on diagnostic and therapeutic decisions, and c) the effect of LDI on total (medical and non-medical) costs and cost-effectiveness.DISCUSSION: This trial will contribute to our current knowledge on the use of LDI in burn care and will provide evidence on its cost-effectiveness.TRIAL REGISTRATION: NCT01489540.
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Background: In patients with burns, an early accurate diagnosis of burn depth facilitates optimal treatment. Laser Doppler imaging combined with clinical assessment leads to an accurate estimate of burn depth. However, the actual effects of the introduction of laser Doppler imaging on therapeutic decisions, clinical outcomes, and costs are unknown. Methods: A randomized controlled trial was conducted in the Dutch burn centers, including 202 patients with burns of indeterminate depth. In the standard care group, estimation of burn depth was based on clinical assessment only; in the laser Doppler imaging group, clinical assessment and laser Doppler imaging were combined. Primary outcome was time to wound healing. Furthermore, therapeutic decisions and cost-effectiveness were analyzed. Results: Mean time to wound healing was 14.3 days (95 percent CI, 12.8 to 15.9 days) in the laser Doppler imaging group and 15.5 days (95 percent CI, 13.9 to 17.2 days) in the standard care group (p = 0.258). On the day of randomization, clinicians decided significantly more often on operative or nonoperative treatment in the laser Doppler imaging group (p < 0.001), instead of postponing their treatment choice. Analyses in a subgroup of admitted patients requiring surgery showed a significant earlier decision for surgery and a shorter wound healing time in the laser Doppler imaging group. Mean total costs per patient were comparable in both groups. Conclusions: Laser Doppler imaging improved therapeutic decisions. It resulted in a shorter wound healing time in the subgroup of admitted patients requiring surgery and has the potential for cost savings of €875 per scanned patient.
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This article will discuss the role of environmentalism in environmental education (EE) and education for sustainable development (ESD) in the context of ecopedagogy. Ecopedagogy calls for the remaking of capitalist practices and seeks to re-engage democracy to include multispecies interests in the face of our current global ecological crisis. In this article, the written reports by international business students on the documentary film If a Tree Falls about a radical environmental movement will be discussed. The aim of this article is to reflect upon the question of whether confrontational questions posed by radical environmentalism can move students to re-examine certain central assumptions within their own society and education. The analysis of students’ individual writing assignments after viewing the film is placed in the context of the discussion about the aims of education in relation to environmental advocacy. This case study seeks to provide an example of how environmental advocacy and the objective of pluralistic education can be combined as mutually supportive means of achieving both democratic learning and learning for environmental sustainability. https://doi.org/10.1177/0973408215569119 https://www.linkedin.com/in/helenkopnina/
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This article will discuss philosophical debates on economic growth and environmental sustainability, the role of management responsibility, and the risk of subversion to business as usual. This discussion will be framed using the concepts of Cradle to Cradle (C2C) and Circular Economy about sustainable production. The case study illustrating the danger of subversion of these progressive models discussed here is based on the assignments submitted by Masters students as part of a course related to sustainable production and consumption at Leiden University. The evaluation of the supposedly best practice cases placed on the website of the Ellen MacArthur Foundation or those awarded Cradle to Cradle certificate has led some students to conclude that these cases illustrated green-washing. Larger implications of identified cases of green-washing for the field of sustainable business and ecological management are discussed. “This is a post-peer-review, pre-copyedit version of an article published in 'Philosophy of Management'. The final authenticated version is available online at: https://doi.org/10.1007/s40926-019-00108-x LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Climate change is undermining the importance and sustainability of cooperatives as important organizations in small holder agriculture in developing countries. To adapt, cooperatives could apply carbon farming practices to reduce greenhouse gas emissions and enhance their business by increasing yields, economic returns and enhancing ecosystem services. This study aimed to identify carbon farming practices from literature and investigate the rate of application within cooperatives in Uganda. We reviewed scholarly literature and assed them based on their economic and ecological effects and trade-offs. Field research was done by through an online survey with smallholder farmers in 28 cooperatives across 19 districts in Uganda. We identified 11 and categorized them under three farming systems: organic farming, conservation farming and integrated farming. From the field survey we found that compost is the most applied CFP (54%), crop rotations (32%) and intercropping (50%) across the three categorizations. Dilemmas about right organic amendment quantities, consistent supplies and competing claims of residues for e.g. biochar production, types of inter crops need to be solved in order to further advance the application of CFPs amongst crop cooperatives in Uganda.
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By supporting creation of protected areas, conservation projects are known to bring economic prosperity to the local communities, but also incite criticism. A common theme in the critique of conservation organizations is the proximity to neoliberal agencies seeking to capitalize on environment, which disadvantage the local communities. Community participation has been proposed as a panacea for neoliberal conservation. However, conservation efficacy is not always contingent on the community involvement and reliance on ‘traditional’ practices in protected areas has not always benefitted biodiversity. Simultaneously, critique of conservation ignores evidence of indigenous activism as well as alternative forms of environmentalism which provide a broader ethical support base for conservation. This article highlights the challenges and contradictions, as well as offers hopeful directions in order to more effectively ground compassionate conservation. https://doi.org/10.1080/23251042.2015.1048765 https://www.linkedin.com/in/helenkopnina/
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In deze rede zal ik vanuit het heden via de theorie en de wijze waarop theorie en praktijk verbonden zijn, een sprong maken naar de toekomst. Eerst zal ik een korte uiteenzetting geven over de positie van Nederland op het gebied van innovatie en ondernemerschap. Daarna zal ik een schets geven van het theoretische kader en de paradigma´s die naar mijn mening denken en doen in relatie tot innovatie en ondernemerschap bepalen. Tot slot wil ik een brug slaan naar de toekomst en de rol die het lectoraat Ondernemen en Innoveren (O&I) zal spelen om vernieuwing tot stand te brengen en het concept ondernemend innoveren vorm te geven.
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Biodiversity preservation is often viewed in utilitarian terms that render non-human species as ecosystem services or natural resources. The economic capture approach may be inadequate in addressing biodiversity loss because extinction of some species could conceivably come to pass without jeopardizing the survival of the humans. People might be materially sustained by a technological biora made to yield services and products required for human life. The failure to address biodiversity loss calls for an exploration of alternative paradigms. It is proposed that the failure to address biodiversity loss stems from the fact that ecocentric value holders are politically marginalized and underrepresented in the most powerful strata of society. While anthropocentric concerns with environment and private expressions of biophilia are acceptable in the wider society, the more pronounced publicly expressed deep ecology position is discouraged. “Radical environmentalists” are among the least understood of all contemporary opposition movements, not only in tactical terms, but also ethically. The article argues in favor of the inclusion of deep ecology perspective as an alternative to the current anthropocentric paradigm. https://doi.org/10.1080/1943815X.2012.742914 https://www.linkedin.com/in/helenkopnina/
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This article reflects on implications of presenting nature as a social construction, and of commodification of nature. The social construction of nature tends to limit significance of nature to human perception of it. Commodification presents nature in strict instrumental terms as ‘natural resources’, ‘natural capital’ or ‘ecosystem services’. Both construction and commodification exhibit anthropocentric bias in denying intrinsic value of non-human species. This article will highlight the importance of a deep ecology perspective, by elaborating upon the ethical context in which construction and commodification of nature occur. Finally, this article will discuss the implications of this ethical context in relation to environmental education (EE) and education for sustainable development (ESD). https://doi.org/10.3384/cu.2000.1525.146931 https://www.linkedin.com/in/helenkopnina/
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Life on the Brink is an unusual volume in that it allows non-‐academic, activist voices as well as politicians, environmental studies scholars, and social scientists to participate in the argument that concerns us all, the argument about the future of our planet and of humanity. The common thread running through the essays of two dozen nature writers and activists hailing from a range of disciplines and offering varied perspectives is their shared concern about population growth. All contributors see population growth as a major force behind our most serious ecological problems, including global climate change, habitat loss and species extinctions, air and water pollution, and food and water scarcity. Despite the differences in perspectives, all contributors argue that ending population growth worldwide is a moral imperative that deserves renewed commitment. https://www.linkedin.com/in/helenkopnina/
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