Climate change and changing land use challenge the livability and flood safety of Dutch cities. One option cities have to become more climate-proof is to increase infiltration of stormwater into soil through permeable pavement and thus reduce discharge of stormwater into sewer systems. To analyze the market receptivity for permeable pavements in the Netherlands, this article focuses on the perception of end-users towards key transition factors in the infrastructure transformation processes. Market receptivity was studied on two levels: (1) on the system level, by analyzing 20 key factors in the Dutch urban water sector that enable wider application of permeable pavements; and (2) on the technology level, by analyzing 12 key factors that explain why decision makers select permeable pavements or not. Results show that trust between cooperating partners was perceived as the system level key factor that needs to be improved most to facilitate the wider uptake of permeable pavements. Additionally, the association of end-users with permeable pavement, particularly their willingness to apply these technologies and their understanding of what kinds of benefits these technologies could bring, was regarded the most important receptivity attribute. On the technology level, the reliability of permeable pavement was regarded as the most important end-user consideration for selecting this technology.
Background: Intravenous (IV) therapy using short peripheral IV catheters (PIVC) is commonplace with neonatal patients. However, this therapy is associated with high complication rates including the leakage of infused fluids from the vasculature into the surrounding tissues; a condition referred to as, peripheral IV infiltration/extravasation (PIVIE). Objective: The quality improvement project aimed to identify the prevalence of known risk factors for PIVIE in the neonatal intensive care unit (NICU) and explore the feasibility of using novel optical sensor technology to aid in earlier detection of PIVIE events. Methods: The plan, do, study, act (PDSA) model of quality improvement (QI) was used to provide a systematic framework to identify PIVIE risks and evaluate the potential utility of continuous PIVC monitoring using the ivWatch model 400® system. The site was provided with eight monitoring systems and consumables. Hospital staff were supported with theoretical education and bedside training about the system operations and best use practices. Results: In total 113 PIVIE's (graded II-IV) were recorded from 3476 PIVCs, representing an incidence of 3.25%. Lower birth weight and gestational age were statistically significant factors for increased risk of PIVIE (p = 0.004); all other known risk factors did not reach statistical significance. Piloting the ivWatch with 21 PIVCs using high-risk vesicant solutions over a total of 523.9 h (21.83 days) detected 11 PIVIEs (graded I-II). System sensitivity reached 100%; 11 out of 11 PIVIEs were detected by the ivWatch before clinician confirmation. Conclusions: Prevailing risk factors for PIVIE in the unit were comparable to those published. Continuous infusion site monitoring using the ivWatch suggests this technology offers the potential to detect PIVIE events earlier than relying on intermittent observation alone (i.e. the current standard of care). However, large-scale study with neonatal populations is required to ensure the technology is optimally configured to meet their needs.
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Over the past decades, various types of permeable pavements have been implemented in different municipalities in the Netherlands in order to improve infiltration capacity in urban areas and therewith being able to better treat stormwater runoff. With initial promising results, this adaptation measure seemed to be the solution for urban flooding due to extreme precipitation.However, in practice, foreseen infiltration capacities were usually not met, often due to unknown reasons. To better understand the functioning of permeable pavements in practice, we have studied - as part of the project Infiltrating Cities - over 100 existing permeable pavement installations in the Netherlands. At each location, infiltration capacity was tested through a full-scale infiltration testing procedure (flooded area about 40 m2) while conditional on-site factors were collected (location, age, type of permeable pavement, street-type, traffic density, vicinity of urban green, regular maintenance regime, etc.). By coupling this information we analyzed how these factors influence the infiltration capacity of permeable pavements in practice, e.g. through accelerated deterioration of infiltration capacity through time. In addition, we evaluated for a selected number of installations, how various types of maintenance may counteract this deterioration, hence improving the infiltration capacity of permeable pavements.
