Background: The prescription of physical activity (PA) in clinical care has been advocated worldwide. This “exercise is medicine” (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to severalchallenges, E=M is not yet routinely implemented in clinical care. Objective: This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care.Methods: PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, ageneric E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. Results: This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. Conclusions: The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronicdisease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients’ health, while minimizing the burden on clinicians.
Falls and fall-related injuries among older adults are associated with decreased health. Therefore, fall prevention programs (FPPs) are increasingly important. However, the translation of such complex programs into clinical practice lacks insight into factors that influence implementation. Therefore, the aim of this study was to identify how to optimize and further implement a widely used group-based FPP in the Netherlands among participants, therapists and stakeholders using a mixed methods study. FPP participants and therapists filled out a questionnaire about their experiences with the FPP. Moreover, three focus groups were conducted with FPP participants, one with therapists and one with other stakeholders. Data were analysed according to the thematic analysis approach of Braun and Clarke. Overall, 93% of the 104 FPP participants were satisfied with the FPP and 86% (n = 12) of the therapists would recommend the FPP to older adults with balance or mobility difficulties. Moreover, six themes were identified regarding further implementation: (1) recruiting and motivating older adults to participate; (2) structure and content of the program; (3) awareness, confidence and physical effects; (4) training with peers; (5) funding and costs; and (6) long-term continuation. This study resulted in practical recommendations for optimizing and further implementing FPPs in practice.
While digitalisation requires facilities management (FM) organisations to change at an increasing rate, little is known about the mechanisms that create ownership and enable individuals to implement changes in everyday FM practice. In this study, these mechanisms are explored from a stewardship perspective. The purpose of this paper is to provide insights in the dynamics of organisational change in FM by analysing how stewardship behaviour leads to change.A process model for implementing organisational change is constructed, based on existing theoretical insights from stewardship and intrapreneurship literature. The model is evaluated in a case study through analysis of critical events. Interviewing was the key data collection method.The process model gives an event-driven explanation of change through psychological ownership. Analysis of multiple critical events suggests that the model explains intra-organisational as well as inter-organisational change. The case data further suggests that, compared to intra-organisational change, tailored relational and motivational support is more important for inter-organisational change because of the higher risks involved. Job crafting emerged as an unanticipated finding that offers interesting prospects for future FM research.The process model offers guidance for leaders in FM organisations on providing tailored support to internal and external employees during periods of organisational change.Stewardship and intrapreneurship are combined to provide insights on organisational change in FM. The study demonstrates how intrapreneurial behaviour and stewardship behaviour can be linked to create innovation within and between organisations.
Due to the existing pressure for a more rational use of the water, many public managers and industries have to re-think/adapt their processes towards a more circular approach. Such pressure is even more critical in the Rio Doce region, Minas Gerais, due to the large environmental accident occurred in 2015. Cenibra (pulp mill) is an example of such industries due to the fact that it is situated in the river basin and that it has a water demanding process. The current proposal is meant as an academic and engineering study to propose possible solutions to decrease the total water consumption of the mill and, thus, decrease the total stress on the Rio Doce basin. The work will be divided in three working packages, namely: (i) evaluation (modelling) of the mill process and water balance (ii) application and operation of a pilot scale wastewater treatment plant (iii) analysis of the impacts caused by the improvement of the process. The second work package will also be conducted (in parallel) with a lab scale setup in The Netherlands to allow fast adjustments and broaden evaluation of the setup/process performance. The actions will focus on reducing the mill total water consumption in 20%.
At gas stations, tetrahydrothiophene (THT) is added to odorless biogas (and natural gas) for quick leak detection through its distinctive smell. However, for low bio and natural gas velocities, evaporation is not complete and the odorization process is compromised, causing odor fluctuations and undesired liquid accumulation on the pipeline. Inefficient odorization not only endangers the safety and well-being of gas users, but also increases gas distribution companies OPEX. To enhance THT evaporation during low bio and natural gas flow, an alternative approach involves improve the currently used atomization process. Electrohydrodynamic Atomization (EHDA), also known as Electrospray (ES), is a technology that uses strong electric fields to create nano and micro droplets with a narrow size distribution. This relatively new atomization technology can improve the odorization process as it can manipulate droplet sizes according to the natural and bio gas flow. BiomEHD aims to develop, manufacture, and test an EHDA odorization system for applying THT in biogas odorization.
The developments of digitalization and automation in freight transport and logistics are expected to speed-up the realization of an adaptive, seamless, connected and sustainable logistics system. CATALYST determines the potential and impact of Connected Automated Transport (CAT) by testing and implementing solutions in a real-world environment. We experiment on smart yards and connected corridors, to answer research questions regarding supply chain integration, users, infrastructure, data and policy. Results are translated to overarching lessons on CAT implementations, and shared with potential users and related communities. This way, CATALYST helps logistic partners throughout the supply chain prepare for CAT and accelerates innovation.
