Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are low in many countries. Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC rates through an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland and Italy. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education of clinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annual hospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October 2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940 women. Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was no statistically significant difference in the change in the proportion of women having a VBAC between intervention sites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences between intervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI: 0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited women with birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782 in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000. Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS in multiparous women, interventions that are feasible and safe and that have been shown to lead to decreasing repeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. This may best be done using an implementation science approach that can modify evidence-based interventions in response to changing clinical circumstances.
Built environments are increasingly vulnerable to the impacts of climate change. Most European towns and cities have developed horizontally over time but are currently in the process of further densification. High-rise developments are being built within city boundaries at an unprecedented rate to accommodate a growing urban population. This densification contributes to the Urban Heat Island phenomenon and can increase the frequency and duration of extreme heat events locally. These new build-up areas, in common with historic city centres, consist mainly of solid surfaces often lacking open green urban spaces.The Intervention Catalogue is the third publication in a series produced by the Cool Towns project and has been designed as a resource for decision makers, urban planners, landscape architects, environmental consultants, elected members and anyone else considering how to mitigate heat stress and increase thermal comfort in urban areas. Technical information on the effectiveness of the full array of intervention types from trees to water features, shading sails to green walls, has been assessed for their heat stress mitigation properties, expressed in Physiological Equivalent Temperature (PET). The results shown in factsheets will help the process of making an informed, evidence based, choice so that the most appropriate intervention for the specific spatial situation can be identified.
The adoption of tablets by young children has raised enthusiasm and concern among speech and language pathologists. This study investigated whether tablet games can be used as effectively as real play objects in vocabulary intervention for children with developmental language disorder (DLD). A randomized, controlled non-inferiority trial was conducted with 70 3-year-old children with DLD. The novel intervention group (n = 35) received 12 10-min scripted intervention sessions with symbolic play using a tablet game spread out over 8–9 weeks. The standard intervention group (n = 35) received the same amount of intervention with real objects using the same vocabulary scripts. In each session, children were exposed to 22 target words. The primary outcome was the number of new target words learned. This was measured using a picture selection task including 22 target words and 22 control words at 3 time intervals: before the intervention, immediately post-intervention, and 5 weeks later. In both intervention groups, the children learned significantly more target words than control words. No significant differences in gains between the two intervention conditions were found. This study provides evidence that vocabulary intervention for toddlers with DLD using a tablet game is equally as effective as an intervention using real objects.
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A fast growing percentage (currently 75% ) of the EU population lives in urban areas, using 70% of available energy resources. In the global competition for talent, growth and investments, quality of city life and the attractiveness of cities as environments for learning, innovation, doing business and job creation, are now the key parameters for success. Therefore cities need to provide solutions to significantly increase their overall energy and resource efficiency through actions addressing the building stock, energy systems, mobility, and air quality.The European Energy Union of 2015 aims to ensure secure, affordable and climate-friendly energy for EU citizens and businesses among others, by bringing new technologies and renewed infrastructure to cut household bills, create jobs and boost growth, for achieving a sustainable, low carbon and environmentally friendly economy, putting Europe at the forefront of renewable energy production and winning the fight against global warming.However, the retail market is not functioning properly. Many household consumers have too little choices of energy suppliers and too little control over their energy costs. An unacceptably high percentage of European households cannot afford to pay their energy bills. Energy infrastructure is ageing and is not adjusted to the increased production from renewables. As a consequence there is still a need to attract investments, with the current market design and national policies not setting the right incentives and providing insufficient predictability for potential investors. With an increasing share of renewable energy sources in the coming decades, the generation of electricity/energy will change drastically from present-day centralized production by gigawatt fossil-fueled plants towards decentralized generation, in cities mostly by local household and district level RES (e.g PV, wind turbines) systems operating in the level of micro-grids. With the intermittent nature of renewable energy, grid stress is a challenge. Therefore there is a need for more flexibility in the energy system. Technology can be of great help in linking resource efficiency and flexibility in energy supply and demand with innovative, inclusive and more efficient services for citizens and businesses. To realize the European targets for further growth of renewable energy in the energy market, and to exploit both on a European and global level the expected technological opportunities in a sustainable manner, city planners, administrators, universities, entrepreneurs, citizens, and all other relevant stakeholders, need to work together and be the key moving wheel of future EU cities development.Our SolutionIn the light of such a transiting environment, the need for strategies that help cities to smartly integrate technological solutions becomes more and more apparent. Given this condition and the fact that cities can act as large-scale demonstrators of integrated solutions, and want to contribute to the socially inclusive energy and mobility transition, IRIS offers an excellent opportunity to demonstrate and replicate the cities’ great potential. For more information see the HKU Smart Citieswebsite or check out the EU-website.
Movebite aims to combat the issue of sedentary behavior prevalent among office workers. A recent report of the Nederlandse Sportraad reveal a concerning trend of increased sitting time among Dutch employees, leading to a myriad of musculoskeletal discomforts and significant health costs for employers due to increased sick leave. Recognizing the critical importance of addressing prolonged sitting in the workplace, Movebite has developed an innovative concept leveraging cutting-edge technology to provide a solution. The Movebite app seamlessly integrates into workplace platforms such as Microsoft Teams and Slack, offering a user-friendly interface to incorporate movement into their daily routines. Through scalable AI coaching and real-time movement feedback, Movebite assists individuals in scheduling and implementing active micro-breaks throughout the workday, thereby mitigating the adverse effects of sedentary behavior. In collaboration with the Avans research group Equal Chance on Healthy Choices, Movebite conducts user-centered testing to refine its offerings and ensure maximum efficacy. This includes testing initiatives at sports events, where the diverse crowd provides invaluable feedback to fine-tune the app's features and user experience. The testing process encompasses both quantitative and qualitative approaches based on the Health Belief Model. Through digital questionnaires, Movebite aims to gauge users' perceptions of sitting as a health threat and the potential benefits of using the app to alleviate associated risks. Additionally, semi-structured interviews delve deeper into user experiences, providing qualitative insights into the app's usability, look, and feel. By this, Movebite aims to not only understand the factors influencing adoption but also to tailor its interventions effectively. Ultimately, the goal is to create an environment encouraging individuals to embrace physical activity in small, manageable increments, thereby fostering long-term engagement promoting overall well-being.Through continuous innovation and collaboration with research partners, Movebite remains committed to empowering individuals to lead healthier, more active lifestyles, one micro-break at a time.
This PPS provides insights into long-term effects of real-life interventions to eat in a more healthy and sustainable manner.The focus of this research in the field of hospitality lies on: • food choice and satisfaction of clients • the consequent effect on wellbeing and vitality, how one experiences healthiness himself, impact on employee motivation as well as the environment from a hospitality management perspective • impact on all stakeholders involved (& partner organisations) in implementing the interventionsPartners Accor Hotels, CELTH, Wageningen (WUR) Economic Research and NHL Stenden University of Applied Sciences
