Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
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Background and purpose: Automatic approaches are widely implemented to automate dose optimization in radiotherapy treatment planning. This study systematically investigates how to configure automatic planning in order to create the best possible plans. Materials and methods: Automatic plans were generated using protocol based automatic iterative optimization. Starting from a simple automation protocol which consisted of the constraints for targets and organs at risk (OAR), the performance of the automatic approach was evaluated in terms of target coverage, OAR sparing, conformity, beam complexity, and plan quality. More complex protocols were systematically explored to improve the quality of the automatic plans. The protocols could be improved by adding a dose goal on the outer 2 mm of the PTV, by setting goals on strategically chosen subparts of OARs, by adding goals for conformity, and by limiting the leaf motion. For prostate plans, development of an automated post-optimization procedure was required to achieve precise control over the dose distribution. Automatic and manually optimized plans were compared for 20 head and neck (H&N), 20 prostate, and 20 rectum cancer patients. Results: Based on simple automation protocols, the automatic optimizer was not always able to generate adequate treatment plans. For the improved final configurations for the three sites, the dose was lower in automatic plans compared to the manual plans in 12 out of 13 considered OARs. In blind tests, the automatic plans were preferred in 80% of cases. Conclusions: With adequate, advanced, protocols the automatic planning approach is able to create high-quality treatment plans.
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This article presents a variety of treatment approaches based on an understanding of four components of communication, and describes cluttering intervention focusing on problem identification, speech rate reduction, appropriate pausing, appropriate monitoring, and addressing story narrating skills. Therapeutic considerations, taking into account the specific characteristics of cluttering, will also be presented. Finally, building clients’ confidence, emotional skills, and sense of accomplishment will turn the therapeutic process into awareness of realistic expectations and motivation to pursue challenging goals. Cluttering is a disorder of speech fluency in which people are not capable of adequately adjusting their speech rate to the syntactical or phonological demands of the moment (van Zaalen, 2009). When language production is relatively easy, people with cluttering (PWC) are capable of producing fluent and intelligible speech. When language production demands are more complex, the speech rate should be adjusted to the language complexity. PWC tend to have difficulties doing so. This reduced ability of PWC to control their speech rate results in either a higher than normal frequency of disfluencies or multiple speech errors. This article presents various intervention approaches based on an understanding of four components of communication: cognitive, emotional, verbal-motor, and communicative. The article focuses on problem identification, speech rate reduction, appropriate pausing, and addressing monitoring and story narrating skills. Therapeutic considerations, taking into account the specific characteristics of cluttering, will also be presented.
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This paper investigates how management accounting and control systems (operationalized by using Simons’ (1995a) levers of control framework) can be used as devices to support public value creation and as such it contributes to the literature on public value accounting. Using a mixed methods case study approach, including documentary analysis and semi-structured interviews, we found diverging uses of control systems in the Dutch university of applied sciences we investigated. While belief and interactive control systems are used intensively for strategy change and implementation, diagnostic controls were used mainly at the decentral level and seen as devices to make sure that operational and financial boundaries were not crossed. Therefore, belief and interactive control systems lay the foundation for the implementation of a new strategy, in which concepts of public value play a large role, using diagnostic controls to constrain actions at the operational level. We also found that whereas the institution wanted to have interaction with the external stakeholders, in daily practice this takes place only at the phase of strategy formulation, but not in the phase of intermediate strategy evaluation.
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Studies on city‐building games as educational tools show positive results in addressing different learning objectives, but also identify a missing link to reality, as they are mostly computer‐based. Given the differences between existing games and their capabilities, the exact function of these games in an urban planning curriculum is unclear. The city‐building game Cities: Skylines currently has three different versions (Digital, Tabletop, VR). Through an affordance analysis of the game’s three versions, this study analyses how the versions afford four primary knowledge dimensions, and in doing so identifies different educational applications for each version of Cities: Skylines in different planning disciplines. The results show that: (a) the board game is strong in fostering player participation and critical thinking more suited for the social and health studies, public policy, and citizen participation domains of urban planning; (b) the digital version functions as moddable simulator, ensuring familiarity with existing systems and monitoring their effects, useful in logistics and transportation planning; (c) the VR form viscerally involves players in the simulated processes, applicable in design‐focused segments of urban planning, such as sustainable design theory, housing, and land‐use management. The results of this study can help urban planning educators identify possible uses for different versions of Cities: Skylines.
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This report is the final report for the FPGA accelerated PID controller, part of the Distributed Control Systems project. This project runs within the Lectoraat Robotics and High Tech Mechatronics of Fontys Hogeschool Engineering Eindhoven. The Lectoraat has the goal to develop applicable knowledge to support education and industry. This knowledge is acquired with projects run in conjunction with the industry. The report will go into detail for the software designed for this project, not the hardware design. This report is intended for follow up students working on the Distributed Control Systems project. Within this report the assumption is made that the reader is at least familiar with the terms EtherCAT, FPGA, Linux and PID controllers. However for each part a small basic introduction is included. For readers looking for the accomplishments in this project, the results are in chapter six. Following are short descriptions of the chapters in this report. The first chapter will give a short introduction to the project. It talks about why the project was conceived, where the project was done and what the expected end result is. The second chapter, the problem definition, talks about how the project has been defined, what is included and what is not and how the customer expects the final product to function and look like. The third chapter details the methodology used during this project. All the research preformed for this project will be described in the forth chapter. This chapter goes into the research into the Xilinx Zynq 7000 chip, Beckhoff's EtherCAT system, how the Serial Peripheral Interface works and how a PID controller functions. Following in chapter five the design is expanded upon. First the toolchain for building for the Zynq chip is explained. This is followed by and explanation of the different software parts that have been designed. Finally chapters six and seven provide the results and the conclusions and recommendations for this project.
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Accumulating evidence suggests that spoken word production requires different amounts of top-down control depending on the prevailing circumstances. For example, during Stroop-like tasks, the interference in response time (RT) is typically larger following congruent trials than following incongruent trials. This effect is called the Gratton effect, and has been taken to reflect top-down control adjustments based on the previous trial type. Such control adjustments have been studied extensively in Stroop and Eriksen flanker tasks (mostly using manual responses), but not in the picture–word interference (PWI) task, which is a workhorse of language production research. In one of the few studies of the Gratton effect in PWI, Van Maanen and Van Rijn (2010) examined the effect in picture naming RTs during dual-task performance. Based on PWI effect differences between dual-task conditions, they argued that the functional locus of the PWI effect differs between post-congruent trials (i.e., locus in perceptual and conceptual encoding) and post-incongruent trials (i.e., locus in word planning). However, the dual-task procedure may have contaminated the results. We therefore performed an electroencephalography (EEG) study on the Gratton effect in a regular PWI task. We observed a PWI effect in the RTs, in the N400 component of the event-related brain potentials, and in the midfrontal theta power, regardless of the previous trial type. Moreover, the RTs, N400, and theta power reflected the Gratton effect. These results provide evidence that the PWI effect arises at the word planning stage following both congruent and incongruent trials, while the amount of top-down control changes depending on the previous trial type.
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In urban planning, 3D modeling and virtual reality (VR) provide new means for involving citizens in the planning process. For municipal government, it is essential to know how effective these means are, to justify investments. In this study, we present a case of using VR in a municipal process of civic participation concerning the redesign of a public park. The process included codesign activities and involved citizens in decision-making through a ballot, using 3D-rendered versions of competing designs. In codesign, 3D-modeling tools were instrumental in empowering citizens to negotiate design decisions, to discuss the quality of designs with experts, and to collectively take decisions. This paper demonstrates that, in a ballot on competing designs with 1302 citizens, VR headsets proved to be equally effective compared to other display technologies in informing citizens during decision making. The results of an additional, controlled experiment indicate that VR headsets provide higher engagement and more vivid memories than viewing the designs on non-immersive displays. By integrating research into a municipal process, we contribute evidence of cognitive and engagement effects of using 3D modeling and immersive VR technologies to empower citizens in participatory urban planning. The case described in the paper concerns a public park; a similar approach could be applied to the design of public installations including media architecture.
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We are currently in a transition moving from a linear economy grounded on economic value maximization based on material transformation to a circular economy. Core of this transition is organising value preservation from various yet interlinked perspectives. The underlying fundamental shift is to move away from mere financial value maximization towards multiple value creation (WCED, 1987; Jonker, 2014; Raworth, 2017). This implies moving from mere economic value creation, to simultaneously and in a balanced way creating ecological and social value. A parallel development supporting this transition can be observed in accounting & control. Elkington (1994) introduced the triple bottom line (TBL) concept, referring to the economic, ecological and social impact of companies. The TBL should be seen more as a conceptual way of thinking, rather than a practical innovative accounting tool to monitor and control sustainable value (Rambaud & Richard, 2015). However, it has inspired accounting & control practitioners to develop accounting tools that not only aim at economic value (‘single capital’ accounting) but also at multiple forms of capital (‘multi capital’ accounting or integrated reporting). This has led to a variety of integrated reporting platforms such as Global Reporting Initiative (GRI), International Integrated Reporting Framework (IIRC), Dow Jones Sustainable Indexes (DJSI), True Costing, Reporting 3.0, etc. These integrated reporting platforms and corresponding accounting concepts, can be seen as a fundament for management control systems focussing on multiple value creation. This leads to the following research question: How are management control systems designed in practice to drive multiple value creation?
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The Maritime Spatial Planning (MSP) Challenge simulation platform helps planners and stakeholders understand and manage the complexity of MSP. In the interactive simulation, different data layers covering an entire sea region can be viewed to make an assessment of the current status. Users can create scenarios for future uses of the marine space over a period of several decades. Changes in energy infrastructure, shipping, and the marine environment are then simulated, and the effects are visualized using indicators and heat maps. The platform is built with advanced game technology and uses aspects of role-play to create interactive sessions; it can thus be referred to as serious gaming. To calculate and visualize the effects of planning decisions on the marine ecology, we integrated the Ecopath with Ecosim (EwE) food web modeling approach into the platform. We demonstrate how EwE was connected to MSP, considering the range of constraints imposed by running scientific software in interactive serious gaming sessions while still providing cascading ecological feedback in response to planning actions. We explored the connection by adapting two published ecological models for use in MSP sessions. We conclude with lessons learned and identify future developments of the simulation platform.
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