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.
This paper highlights the use of State Space Grids (SSGs) for studying real-time classroom discourse in an intervention targeting professional development. State Space Grid analysis is both a powerful way to visualise patterns in interactional data, and a starting point for further quantitative analysis. In the present study SSGs were used to explore patterns in teacher–student interactions. The study shows the importance of using micro-level time-serial data and illustrates how change in interactions during and after an intervention can be studied. SSG analysis was applied to study interaction in terms of the coupling of a teacher and a student variable: autonomy support and musical creativity. Video data from 40 music lessons of five teachers and their classes was used as input for plotting teacher–student interactions in SSGs, consisting of two dimensions. SSGs allow visualising change in the situation of interactions in the grid and identifying change in patterns to different grid areas. The findings show how interactions tended to settle in areas representing more productive interaction for all but one class. We discuss the benefits of using SSGs in intervention studies and the implications for educational practice and research of using this time-serial approach.
Empowerment is een centraal begrip in het hedendaagse pedagogisch denken en handelen. In dit artikel wordt empowerment besproken in het licht van de positieve psychologie: een stroming in de psychologie die bestudeerd hoe het welbevinden en optimaal functioneren van mensen kan worden bevorderd.In de positieve psychologie heeft recent een paradigmaverschuiving plaatsgevonden. De interactie tussen individu en omgeving wordt niet langer begrepen in termen van causaliteit maar vanuit het narratief van complexiteit. In dit narratief wordt de interactie tussen individu en omgeving opgevat als een complex dynamisch systeem waarin er zelden sprake is vandirecte oorzaak-gevolg relaties (lineaire causaliteit). Bij het ontstaan van empowerment spelen zowel multi-causaliteit, multi-finaliteit als circulaire causaliteit een rol. Empowerment wordt in dit artikel dan ook niet beschouwd als een inherent psychisch kenmerk van een individu, maar als iets dat zich vormt op basis van iemands dagelijkse ervaringen in interactie met zijn socialeomgeving.In dit artikel onderzoeken we wat het denken vanuit het perspectief van complex dynamische systemen betekent voor de pedagogische visie op empowerment en welke gevolgen dit heeft voor interventies in de pedagogische praktijk.TREFWOORDENEmpowerment, Complexiteit, Complex Dynamische Systemen, Positieve Psychologie, Sociale interventies, Zelfregie, Eigen Kracht, AgencyABSTRACT- ENGLISHIn the Netherlands, empowerment plays a major role in the daily work of pedagogues and in social policies. Empowerment is closely related to the assumptions of positive psychology. This is a scientific approach that focuses on strengths instead of weaknesses, building the good in life instead of repairing the bad. Empowerment also is about taking control of one’s life and by doingso enhancing wellbeing. Therefore empowerment fits the concept of positive psychology.Recently there has been a paradigm shift in positive psychology where research is going beyond the individual person as the primary focus of enquiry and is looking more deeply at the groups and systems in which people are embedded: less in terms of causality and more as a narrative of complexity. In this narrative, the interaction between individuals and the environment is seen as a complex dynamic system.In this article we discuss empowerment and agency in the light of complexity and the implications for the daily work of pedagogues.
The increasing amount of electronic waste (e-waste) urgently requires the use of innovative solutions within the circular economy models in this industry. Sorting of e-waste in a proper manner are essential for the recovery of valuable materials and minimizing environmental problems. The conventional e-waste sorting models are time-consuming processes, which involve laborious manual classification of complex and diverse electronic components. Moreover, the sector is lacking in skilled labor, thus making automation in sorting procedures is an urgent necessity. The project “AdapSort: Adaptive AI for Sorting E-Waste” aims to develop an adaptable AI-based system for optimal and efficient e-waste sorting. The project combines deep learning object detection algorithms with open-world vision-language models to enable adaptive AI models that incorporate operator feedback as part of a continuous learning process. The project initiates with problem analysis, including use case definition, requirement specification, and collection of labeled image data. AI models will be trained and deployed on edge devices for real-time sorting and scalability. Then, the feasibility of developing adaptive AI models that capture the state-of-the-art open-world vision-language models will be investigated. The human-in-the-loop learning is an important feature of this phase, wherein the user is enabled to provide ongoing feedback about how to refine the model further. An interface will be constructed to enable human intervention to facilitate real-time improvement of classification accuracy and sorting of different items. Finally, the project will deliver a proof of concept for the AI-based sorter, validated through selected use cases in collaboration with industrial partners. By integrating AI with human feedback, this project aims to facilitate e-waste management and serve as a foundation for larger projects.
Chronische pijn is een groot, complex en duur probleem en heeft een grote impact op de kwaliteit van leven van patiënten, dagelijks functioneren, stemming en ziekteverzuim. Er zijn verschillende interventies ontwikkeld die met name gericht zijn op het beïnvloeden en veranderen van het gedrag waarbij zelfmanagement een belangrijke rol speelt. Echter het bestendigen van resultaten op lange termijn blijkt een groot probleem en leidt zelfs tot terugval naar “oud” gedrag waardoor patiënten opnieuw vaak kostbare hulp gaan zoeken. Er zijn twee additionele interventies ontwikkeld in een eerder RAAK-project (SOLACE) ter voorkoming van deze terugval: “Do It Your Self” en “Waarde gerichte Doelen” , echter de werkzaamheid van deze interventies op de lange termijn is niet onderzocht. Een eerste feasibility studie lijkt veelbelovend met positieve effecten naar de bruikbaarheid van deze interventies in de betrokken revalidatiecentra. Vanuit dit werkveld maar ook vanuit de patiënten kwam nadrukkelijk de vraag om deze interventies op effectiviteit te toetsen. Dit heeft geleid tot de onderzoeksvraag; “Is een additionele interventie (do it yourself en/of waarde gerichte doelen) gericht op het blijven toepassen van aangeleerde vaardigheden na een succesvol doorlopen pijn programma effectief in het bestendigen van de resultaten op de lange termijn en leidt dit tot een afname van het zorggebruik.” Het onderzoek wordt uitgevoerd in twee werkpakketten; (1) het ontwikkelen van een bruikbare app voor de ontwikkelde interventies in samenwerking met DIO Design en (2) een effectiviteit studie in de revalidatiecentra Adelante in Hoensbroek en Maastricht, Libra R&A locatie Weert en Heliomare Revalidatie in Wijk aan Zee. De doelstelling van het consortium is om de samen met zorgprofessionals, patiënten, beroepsvereniging en ontwerpers een product ter voorkoming van terugval verder te ontwikkelen en te toetsen. Na afronding van dit project zijn de op effectiviteit getoetste additionele interventies, DIY en WD, klaar om landelijk te worden uitgerold.
“Empowering learners to create a sustainable future” This is the mission of Centre of Expertise Mission-Zero at The Hague University of Applied Sciences (THUAS). The postdoc candidate will expand the existing knowledge on biomimicry, which she teaches and researches, as a strategy to fulfil the mission of Mission-Zero. We know when tackling a design challenge, teams have difficulties sifting through the mass of information they encounter. The candidate aims to recognize the value of systematic biomimicry, leading the way towards the ecosystems services we need tomorrow (Pedersen Zari, 2017). Globally, biomimicry demonstrates strategies contributing to solving global challenges such as Urban Heat Islands (UHI) and human interferences, rethinking how climate and circular challenges are approached. Examples like Eastgate building (Pearce, 2016) have demonstrated successes in the field. While biomimicry offers guidelines and methodology, there is insufficient research on complex problem solving that systems-thinking requires. Our research question: Which factors are needed to help (novice) professionals initiate systems-thinking methods as part of their strategy? A solution should enable them to approach challenges in a systems-thinking manner just like nature does, to regenerate and resume projects. Our focus lies with challenges in two industries with many unsustainable practices and where a sizeable impact is possible: the built environment (Circularity Gap, 2021) and fashion (Joung, 2014). Mission Zero has identified a high demand for Biomimicry in these industries. This critical approach: 1) studies existing biomimetic tools, testing and defining gaps; 2) identifies needs of educators and professionals during and after an inter-disciplinary minor at The Hague University; and, 3) translates findings into shareable best practices through publications of results. Findings will be implemented into tangible engaging tools for educational and professional settings. Knowledge will be inclusive and disseminated to large audiences by focusing on communication through social media and intervention conferences.
