DOCUMENT
Background Providing individualized care based on the context and preferences of the patient is important. Knowledge on both prognostic risk stratification and blended eHealth care in musculoskeletal conditions is increasing and seems promising. Stratification can be used to match patients to the most optimal content and intensity of treatment as well as mode of treatment delivery (i.e. face-to-face or blended with eHealth). However, research on the integration of stratified and blended eHealth care with corresponding matched treatment options for patients with neck and/or shoulder complaints is lacking. Methods This study was a mixed methods study comprising the development of matched treatment options, followed by an evaluation of the feasibility of the developed Stratified Blended Physiotherapy approach. In the first phase, three focus groups with physiotherapists and physiotherapy experts were conducted. The second phase investigated the feasibility (i.e. satisfaction, usability and experiences) of the Stratified Blended Physiotherapy approach for both physiotherapists and patients in a multicenter single-arm convergent parallel mixed methods feasibility study. Results In the first phase, matched treatment options were developed for six patient subgroups. Recommendations for content and intensity of physiotherapy were matched to the patient’s risk of persistent disabling pain (using the Keele STarT MSK Tool: low/medium/high risk). In addition, selection of mode of treatment delivery was matched to the patient’s suitability for blended care (using the Dutch Blended Physiotherapy Checklist: yes/no). A paperbased workbook and e-Exercise app modules were developed as two different mode of treatment delivery options, to support physiotherapists. Feasibility was evaluated in the second phase. Physiotherapists and patients were mildly satisfied with the new approach. Usability of the physiotherapist dashboard to set up the e-Exercise app was considered ‘OK’ by physiotherapists. Patients considered the e-Exercise app to be of ‘best imaginable’ usability. The paper-based workbook was not used. Conclusion Results of the focus groups led to the development of matched treatment options. Results of the feasibility study showed experiences with integrating stratified and blended eHealth care and have informed amendments to the Stratified Blended Physiotherapy approach for patients with neck and/or shoulder complaints ready to use within a future cluster randomized trial.
DOCUMENT
Background: Neck and shoulder complaints are common in primary care physiotherapy. These patients experience pain and disability, resulting in high societal costs due to, for example, healthcare use and work absence. Content and intensity of physiotherapy care can be matched to a patient’s risk of persistent disabling pain. Mode of care delivery can be matched to the patient’s suitability for blended care (integrating eHealth with physiotherapy sessions). It is hypothesized that combining these two approaches to stratified care (referred to from this point as Stratified Blended Approach) will improve the effectiveness and cost-effectiveness of physiotherapy for patients with neck and/or shoulder complaints compared to usual physiotherapy. Methods: This paper presents the protocol of a multicenter, pragmatic, two-arm, parallel-group, cluster randomized controlled trial. A total of 92 physiotherapists will be recruited from Dutch primary care physiotherapy practices. Physiotherapy practices will be randomized to the Stratified Blended Approach arm or usual physiotherapy arm by a computer-generated random sequence table using SPSS (1:1 allocation). Number of physiotherapists (1 or > 1) will be used as a stratification variable. A total of 238 adults consulting with neck and/or shoulder complaints will be recruited to the trial by the physiotherapy practices. In the Stratified Blended Approach arm, physiotherapists will match I) the content and intensity of physiotherapy care to the patient’s risk of persistent disabling pain, categorized as low, medium or high (using the Keele STarT MSK Tool) and II) the mode of care delivery to the patient’s suitability and willingness to receive blended care. The control arm will receive physiotherapy as usual. Neither physiotherapists nor patients in the control arm will be informed about the Stratified Blended Approach arm. The primary outcome is region-specific pain and disability (combined score of Shoulder Pain and Disability Index & Neck Pain and Disability Scale) over 9 months. Effectiveness will be compared using linear mixed models. An economic evaluation will be performed from the societal and healthcare perspective. Discussion: The trial will be the first to provide evidence on the effectiveness and cost-effectiveness of the Stratified Blended Approach compared with usual physiotherapy in patients with neck and/or shoulder complaints.
DOCUMENT
This paper reports on the effects of an e-cycling incentive program in the province of North-Brabant, The Netherlands, in which commuters could earn monetary incentives when using their e-bike. The study used a longitudinal design allowing to observe behaviour change and mode shifts. The program appeared to be highly effective in stimulating e-bike use, as one month after the start of the program, the share of commute trips made by e-bike increased from 0% to 68%, with an increase up to 73% after half a year of participating. The environmental, congestion and health benefits of this shift are however mixed. Half of the e-bike trips substitute car trips, with positive effects on environment, congestion and health. The other half substitutes conventional cycling trips, implying fever health benefits. Our analyses further suggest that distance is an important factor for adopting e-cycling, where e-bike has a larger acceptable distance than a conventional bike. Nevertheless, we observed that the likelihood to use the e-bike decreased as commuting distance increased. Multivariate analyses suggest that a shift to e-cycling is affected by age, gender, physical condition, car ownership and household composition. Our study did find support for the hypothesis that having a strong car-commuting habit decreases the probability of mode shift to a new mode alternative. In contrast, multimodality may increase the likelihood of e-bike use as a result of openness to other travel options and a more deliberate mode choice. Lastly, dissatisfaction with the current travel mode positively influences mode shift towards the e-bike. Our results imply that stimulating e-cycling may be a promising way of stimulating physical activity, but that it will be most effective if targeted at specific groups who are not currently engaging in active travel.
LINK
Background: The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods: We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results: In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions: We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
DOCUMENT
E-Exercise is an effective 12-week blended intervention consisting of around five face-to-face physiotherapy sessions and a web-based application for patients with hip/knee osteoarthritis. In order to facilitate effective implementation of e-Exercise, this study aims to identify physiotherapists' experiences and determinants related to the usage of e-Exercise. Methods: An explanatory sequential mixed methods design embedded in a randomized controlled trial comparing e-Exercise with usual physiotherapy in patients with hip/knee osteoarthritis. Usage of e-Exercise was based on recruitment rates of 123 physiotherapists allocated to e-Exercise and objective web-based application usage data. Experiences and determinants related to e-Exercise usage were investigated with a questionnaire and clarified with semi-structured interviews. Results: Of the 123 physiotherapists allocated to e-Exercise, 54 recruited more than one eligible patient, of whom 10 physiotherapists continued using e-Exercise after the study period. Physiotherapists had mixed experiences with e-Exercise. Determinants related to intervention usage were appropriateness, added value, time, workload, professional autonomy, environmental factors, and financial consequences. Physiotherapists recommended to improve the ability to tailor e-Exercise to the individual needs of the patient patients' individual needs. Discussion: Determinants related to the usage of e-Exercise provided valuable information for the implementation of e-Exercise on broader scale. Most importantly, the flexibility of e-Exercise needs to be improved. Next, there is a need for education on how to integrate an online program within physiotherapy
DOCUMENT
Recent developments in digital technology and consumer culture have created new opportunities for retail and brand event concepts which create value by offering more than solely marketing or transactions, but rather a place where passion is shared. This chapter will define the concept of ‘fashion space’ and consumer experience, and delves into strategies for creating experiences that both align with a brand’s ethos and identity and build brand communities. It will provide insight on creating strong shared brand experiences that integrate physical and digital spaces, AR and VR. These insights can be used for consumer spaces but also for media and buyer events, runway shows, test labs and showrooms. Since its launch in 2007, international fashion brand COS has focused on creating fashion spaces that build and reinforce a COS fashion community. COS retail stores with their extraordinary architecture, both traditional and contemporary, contribute stories and facilitate intense brand experiences. Moreover, COS’ dedication to share the artistic inspirations of its people led to collaborating on interactive and multi-sensory installations which allow consumers to affectively connect to the brand’s personality and values. Thus, the brand was able to establish itself firmly in the lifestyle of its customers, facilitating and developing their aesthetics and values. This is an Accepted Manuscript of a book chapter published by Routledge/CRC Press in "Communicating Fashion Brands. Theoretical and Practical Perspectives" on 03-03-2020, available online: https://www.routledge.com/Communicating-Fashion-Brands-Theoretical-and-Practical-Perspectives/Huggard-Cope/p/book/9781138613560. LinkedIn: https://nl.linkedin.com/in/overdiek12345
MULTIFILE
Blended learning, a teaching format in which face-to-face and online learning is integrated, nowadays is an important development in education. Little is known, however, about its affordances for teacher education, and for domain specific didactical courses in particular. To investigate this topic, we carried out a design research project in which teacher educators engaged in a co-design process of developing and field-testing open online learning units for mathematics and science didactics. The preliminary results concern descriptions of the work processes by the design teams, of design heuristics, and of typical ways of collaborating. These findings are illustrated for the case of two of the designed online units on statistics didactics and mathematical thinking, respectively.
LINK
The anthocyanin composition of five purple leaves cultivars of Ocimum basilicum L. was investigated by reversed-phase HPLC with mass-spectrometric detection by ESI mode with ion partial fragmentation as well as preparation of dried differently colored forms of anthocyanins encapsulated into maltodextrinmatrix. Analysis of the mass spectra revealed that according to the chromatographic profile the set of basil cultivar anthocyanins under investigation may be divided into two groups with the common feature being ahigh level of acylation with (mainly) p-coumaric, ferulic and malonic acids of the same base: cyanidin-3-dihexoside-5-hexoside. The presence of acylation with substituted cinnamic acids permits us to obtain solutions not only with a red color (the property of the flavylium form) but also with blue shades of coloration due to quinonoid and negatively charged quinonoid forms. All forms except that of flavylium are not stable in solution but stable enough to prepare dried encapsulated forms by lyophilization. Although the loss of anthocyaninswith drying is not negligible, the final product is characterized with high stability for storage in a refrigerator.
DOCUMENT
Bio-aromatics (benzene, toluene, xylenes, BTX) were prepared by the catalytic pyrolysis of six different black liquors using both in situ and ex situ approaches. A wide range of catalysts was screened and conditions were optimized in microscale reactors. Up to 7 wt % of BTX, based on the organic fraction of the black liquors, was obtained for both the in situ and ex situ pyrolysis ( T = 500-600 °C) using a Ga-modified H-ZSM-5 catalyst. The in situ catalytic pyrolysis of black liquors from hardwood paper mills afforded slightly higher yields of aromatics/BTX than softwood black liquors, a trend that could be confirmed by the results obtained in the ex situ catalytic pyrolysis. An almost full deoxygenation of the lignin and carbohydrate fraction was achieved and both organic fractions were converted to a broad range of (substituted) aromatics. The zeolite catalyst used was remarkably stable and even after 100 experiments in batch mode with intermittent oxidative catalyst regeneration, the yields and selectivity toward BTX remained similar. The ex situ pyrolysis of black liquor has potential for large-scale implementation in a paper mill without disturbing the paper production process.
MULTIFILE
