Background: Patient education, advice on returning to normal activities and (home-based) exercise therapy are established treatment options for patients with non-specific low back pain (LBP). However, the effectiveness of physiotherapy interventions on physical functioning and prevention of recurrent events largely depends on patient self-management, adherence to prescribed (home-based) exercises and recommended physical activity behaviour. Therefore we have developed e-Exercise LBP, a blended intervention in which a smartphone application is integrated within face-to-face care. E-Exercise LBP aims to improve patient self-management skills and adherence to exercise and physical activity recommendations and consequently improve the effectiveness of physiotherapy on patients’ physical functioning. The aim of this study is to investigate the short- (3 months) and long-term (12 and 24 months) effectiveness on physical functioning and cost-effectiveness of e-Exercise LBP in comparison to usual primary care physiotherapy in patients with LBP. Methods: This paper presents the protocol of a prospective, multicentre cluster randomized controlled trial. In total 208 patients with LBP pain were treated with either e-Exercise LBP or usual care physiotherapy. E-Exercise LBP is stratified based on the risk for developing persistent LBP. Physiotherapists are able to monitor and evaluate treatment progress between face-to-face sessions using patient input from the smartphone application in order to optimize physiotherapy care. The smartphone application contains video-supported self-management information, video-supported exercises and a goal-oriented physical activity module. The primary outcome is physical functioning at 12-months follow-up. Secondary outcomes include pain intensity, physical activity, adherence to prescribed (home-based) exercises and recommended physical activity behaviour, self-efficacy, patient activation and health-related quality of life. All measurements will be performed at baseline, 3, 12 and 24months after inclusion. An economic evaluation will be performed from the societal and the healthcare perspective and will assess cost-effectiveness of e-Exercise LBP compared to usual physiotherapy at 12 and 24months. Discussion: A multi-phase development and implementation process using the Center for eHealth Research Roadmap for the participatory development of eHealth was used for development and evaluation. The findings will provide evidence on the effectiveness of blended care for patients with LBP and help to enhance future implementation of blended physiotherapy.
In this report, the details of an investigation into the e ect of the low induction wind turbines on the Levelised Cost of Electricity (LCoE) in a 1GW o shore wind farm is outlined. The 10 MW INNWIND.EU conventional wind turbine and its low induction variant, the 10 MW AVATAR wind turbine, are considered in a variety of 10x10 layout configurations. The Annual Energy Production (AEP) and cost of electrical infrastructure were determined using two in-house ECN software tools, namely FarmFlow and EEFarm II. Combining this information with a generalised cost model, the LCoE from these layouts were determined. The optimum LCoE for the AVATAR wind farm was determined to be 92.15 e/MWh while for the INNWIND.EU wind farm it was 93.85 e/MWh. Although the low induction wind farm o ered a marginally lower LCoE, it should not be considered as definitive due to simple nature of the cost model used. The results do indicate that the AVATAR wind farms require less space to achieve this similar cost performace, with a higher optimal wind farm power density (WFPD) of 3.7 MW/km2 compared to 3 MW/km2 for the INNWIND.EU based wind farm.
On-time departure performance is important for airlines that seek the highest satisfaction of their passengers. The main component of achieving on-time departure is being able to complete the turnaround operations of an aircraft within the scheduled time. To address this problem, the present paper examined planning and scheduling of turnaround operations in the low cost airline industry. A mathematical model, named 'TurnOper_LP' was developed for a low-cost Turkish airline to identify the critical path of turnaround operations and the optimal turnaround time. The results of the model in terms of optimised turnaround times are then analysed and an example of schedule of turnaround operations is presented.
