The 2014 EU Directive on Maritime Spatial Planning (MSP) lays down obligations for the EU Member States to establish a maritime planning process, resulting in a maritime spatial plan by 2020. Consultation should be carried out with local, national and transnational stakeholders. Stakeholder engagement in MSP is complex because of the great number and diversity of maritime stakeholders and the unfamiliarity of some of these stakeholders with MSP and its potential impact. To facilitate stakeholder engagement in MSP, the 'MSP Challenge' table top strategy game was designed and played as part of several stakeholder events in different European countries. The authors study the efficacy of the game for stakeholder engagement. Background and evaluation data of nineteen game sessions with a total of 310 stakeholders with different backgrounds were collected through post-game surveys. Furthermore, the efficacy of the game for stakeholder engagement processes, organised by competent MSP authorities in Scotland and Belgium, is studied in more detail. The results show that the board game, overall, has been a very efficient and effective way of familiarising a great diversity of stakeholders with MSP and to create meaningful interaction and learning among stakeholders in formal planning processes. However, the case studies also show that contextual factors-the level of familiarity with MSP and participants' perception to sustainability-influences the efficacy of the game.
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Previous research has shown clinical effectiveness of dermal substitution; however, in burn wounds, only limited effect has been shown. A problem in burn wounds is the reduced take of the autograft, when the substitute and graft are applied in one procedure. Recently, application of topical negative pressure (TNP) was shown to improve graft take. The aim of this study was to investigate if application of a dermal substitute in combination with TNP improves scar quality after burns. In a four-armed multicenter randomized controlled trial, a split-skin graft with or without a dermal substitute and with or without TNP was compared in patients with deep dermal or full-thickness burns requiring skin transplantation. Graft take and rate of wound epithelialization were evaluated. Three and 12 months postoperatively, scar parameters were measured. The results of 86 patients showed that graft take and epithelialization did not reveal significant differences. Significantly fewer wounds in the TNP group showed postoperative contamination, compared to other groups. Highest elasticity was measured in scars treated with the substitute and TNP, which was significantly better compared to scars treated with the substitute alone. Concluding, this randomized controlled trial shows the effectiveness of dermal substitution combined with TNP in burns, based on extensive wound and scar measurements.
