Background: Multimodal prehabilitation programs are effective at reducing complications after colorectal surgery in patients with a high risk of postoperative complications due to low aerobic capacity and/or malnutrition. However, high implementation fidelity is needed to achieve these effects in real-life practice. This study aimed to investigate the implementation fidelity of an evidence-based prehabilitation program in the real-life context of a Dutch regional hospital.Methods: In this observational cohort study with multiple case analyses, all patients who underwent colorectal surgery from January 2023 to June 2023 were enrolled. Patients meeting the criteria for low aerobic capacity or malnutrition were advised to participate in a prehabilitation program. According to recent scientific insights and the local care context, this program consisted of four exercise modalities and three nutrition modalities. Implementation fidelity was investigated by evaluating: (1) coverage (participation rate), (2) duration (number of days between the start of prehabilitation and surgery), (3) content (delivery of prescribed intervention modalities), and (4) frequency (attendance of sessions and compliance with prescribed parameters). An aggregated percentage of content and frequency was calculated to determine overall adherence.Results: Fifty-eight patients intended to follow the prehabilitation care pathway, of which 41 performed a preoperative risk assessment (coverage 80%). Ten patients (24%) were identified as high-risk and participated in the prehabilitation program (duration of 33-84 days). Adherence was high (84-100%) in five and moderate (72-73%) in two patients. Adherence was remarkably low (25%, 53%, 54%) in three patients who struggled to execute the prehabilitation program due to multiple physical and cognitive impairments.Conclusion: Implementation fidelity of an evidence-based multimodal prehabilitation program for high-risk patients preparing for colorectal surgery in real-life practice was moderate because adherence was high for most patients, but low for some patients. Patients with low adherence had multiple impairments, with consequences for their preparation for surgery. For healthcare professionals, it is recommended to pay attention to high-risk patients with multiple impairments and further personalize the prehabilitation program. More knowledge about identifying and treating high-risk patients is needed to provide evidence-based recommendations and to obtain higher effectiveness.
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The increasing demand for Prunus africana resources is an opportunity for its conservation and commercial use to support livelihoods in Africa. The objective for this study was to investigate major steps to advance production of P. africana for long-term commercial use in Uganda. Specific objectives were to explore potential production schemes, setbacks in production and strategies to advance it. The study was done by review of literature, documents and interviews with experts. Results indicated Agroforestry and large plantations to be useful schemes for production. Identified setbacks are: low trade in P. africana, unknown returns from production, competing land uses, long growth period, limited market assurance and information. The lack of a resource assessment for P. africana in forests contributes to its low trade which undermines related economic benefits for national development and incentives to commercial production. We propose that a national Quantitative resource assessment of P. africana in forests is one of the crucial steps that should be undertaken to carefully organise and advance sustainable trade to provide rational incentives for commercial production. Subsequently, production should be localised in suitable sites and producers be organised into cooperatives. Further research to improve returns from commercial production of P. africana is needed.
MULTIFILE
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
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%.
Background:Many business intelligence surveys demonstrate that Digital Realities (Virtual reality and Augmented Reality) are becoming a huge market trend in many sectors, and North America is taking the lead in this emerging domain. Tourism is no exception and the sector in Europe must innovate to get ahead of the curve of this technological revolution, but this innovation needs public support.Project partnership:In order to provide labs, startups and SMEs willing to take this unique opportunity with the most appropriate support policies, 9 partner organizations from 8 countries (FR, IT, HU, UK, NO, ES, PL, NL) decided to work together: regional and local authorities, development agencies, private non-profit association and universities.Objective of the project:Thanks to their complementary experiences and know-how, they intend to improve policies of the partner regions (structural funds and regional policies), in order to foster a tourist channeled innovation in the Digital Realities sector.Approach:All partners will work together on policy analysis tasks before exchanging their best initiatives and transferring them from one country to another. This strong cooperation will allow them to build the best conditions to foster innovation thanks to more effective structural funds policies and regional policies.Main activities & outputs:8 policy instruments are addressed, among which 7 relate to structural funds programmes. Basis for exchange of experience: Reciprocal improvement analysis and 8 study trips with peer-review of each partner’s practices. Video reportages for an effective dissemination towards other territories in Europe.Main expected results:At least 16 good practices identified. 8 targeted policy instruments improved. At least 27 staff members will transfer new capacities in their intervention fields. At least 8 involved stakeholders with increased skills and knowledge from exchange of experience. Expected 17 appearances in press and media, including at European level.
Within the framework of resource efficiency it is important to recycle and reusematerials, replace fossil fuel based products with bio-based alternatives and avoidthe use of toxic substances. New applications are being sought for locally grownbiomass. In the area of Groningen buildings need reinforcement to guarantee safetyfor its users, due to man-induced earthquakes. Plans are to combine the workneeded for reinforcement with the improvement of energy performance of thesebuildings. The idea is to use bio-based building materials, preferably grown andprocessed in the region.In this study it is investigated whether it is feasible to use Typha (a swap plant) as abasis for a bio-based insulation product. In order to start the activities necessary tofurther develop this idea into a commercial product and start a dedicated company,a number of important questions have to be answered in terms of feasibility. Thisstudy therefore aims at mapping economic, organisational and technical issues andassociated risks and possibilities. On the basis of these results a developmenttrajectory can be started to set up a dedicated supply chain with the appropriatepartners, research projects can be designed to develop the missing knowledge andthe required funding can be acquired.
