Identifying Dominant Stakeholder Perspectives on Sustainability Issues in Reefer Transportation

Driven by global climate concerns, seaports have formulated sustainability goals, which also require sustainability gains in the fast growing temperature-controlled logistics market—increasing energy e ciency, reducing waste, and streamlining logistics processes. This, however, requires cooperation and buy-in from a wide range of stakeholders. To explore the barriers and facilitators of such a transition, we map the interests and attitudes of cold chain actors in the Port of Rotterdam regarding sustainability issues in reefer transportation and cold chains. We identify a limited number of broadly shared perspectives using Q-methodology—a survey-based method to study subjective viewpoints (originating from psychology) that has been used only rarely in the freight transport field. The analysis yields four ‘dominant’ perspectives that together account for 46% of the variation among stakeholder viewpoints. We label these perspectives “sustainability as part of strategy”, “short term constraints”, “optimistic about technology, limited role for policy”, and “long run willingness under risk avoidance.” These perspectives are characterized by multiple factors, including the evaluation of organizational capabilities, expectations from policymakers and technology, and the time horizon stakeholder organizations consider regarding sustainability concerns. From the findings, we derive recommendations for managers and policy makers to facilitate stakeholder dialogue and possibly convergence and coalition building

Redefining Therapeutic Outcomes of Depression Treatment

Responses to evidence-based interventions for depression are divergent: Some patients benefit more than others during treatment and some do not benefit at all or even deteriorate. Tailoring interventions to the individual may improve outcomes. However, such personalization of evidence-based treatment in depression requires investigation of individual outcomes and the individual trajectories towards these outcomes. This theoretical paper provides a critical reflection on individual outcomes of depression treatment. First, it is argued that outcomes should be broadened, from a focus on mainly depressive symptomatology to recovery in different domains. It is acknowledged that recovery from depression reflects a personal journey that differs from person to person. Second, outcome measures should be lengthened beyond the acute treatment phase, taking a lifetime perspective on depression. The challenge then is to discover which trajectories of what measures during what interventions result in personalized sustainable recovery and for whom. Routine outcome monitoring systems may be used to inform this quest towards assessment of personalized sustainable therapeutic outcomes. Adaptations to broaden and lengthen measurements in routine outcome monitoring systems are proposed to identify predictors of personalized sustainable recovery. Routine outcome monitoring systems may eventually be used to implement personalized treatments for depression that result in personalized sustainable recovery

Divergent effects of container port choice incentives on users' behavior

Port choice decisions are often considered to be based on unambiguous choice criteria. The authors examine how port users' evaluation of these criteria can differ and how this may affect actors' incentive structure and decision making, and ultimately port performance. Apart from ports' physical characteristics, the paper considers port policy and freight market conditions as components of actors' incentive structures. As port users interact, each actor's decision making has consequences for the incentives offered to others – with an important role for strategic behavior. The aggregate of port users' decisions affects a port's throughput, cargo composition, and value added, and has implications for handling efficiency. This paper combines these insights within an overarching framework linking port characteristics, policy, and freight market conditions to port user choice behavior and the consequences for ports. The paper explores various facets of this framework using the case of how the Port of Rotterdam competes along the Hamburg–Le Havre range, drawing on port throughput data on various levels of detail and in-depth interviews with a representative selection of port stakeholders. It shows that there is a downside to ports being particularly attractive to carriers, in that the port that offers the most incentives to carriers disproportionately attracts relatively low-value activities: inefficient calls and a large share of empty containers, along with a strong import/export imbalance. Interview findings contextualize the findings from the data and elaborate further on the mechanisms underpinning these observations. Most importantly, the attractiveness of a port for carriers does not always translate into attractiveness for shippers. The challenge for port policy is to balance the port's positioning toward its different categories of users and achieve a congruent value proposition for all port users

The association of cannabis use with quality of life and psychosocial functioning in psychosis

BACKGROUND: Cannabis use is highly prevalent among people with a psychotic disorder. They often report sociality, coping with unpleasant affect and having positive experiences as important reasons for cannabis use, suggesting that cannabis improves their quality of life (QoL) and psychosocial functioning. However, based on previous studies we hypothesize that cannabis use is negatively associated with long-term subjective QoL and psychosocial functioning in people with a psychotic disorder. METHODS: We included 2994 people with a psychotic disorder (36.4% female), mean age 44.4 (SD 11.9), mean illness duration 17.2 years (SD 11.1), who participated in two yearly routine outcome assessments between 2014 and 2018 (interval 9-15 months) from the naturalistic PHAMOUS cohort study. Linear regression analyses were used to examine whether first assessment cannabis use was associated with QoL (ManSA) and psychosocial functioning (HoNOS). Changes in outcomes between assessments were analyzed with AN(C)OVA, to examine differences between continuers (n = 255), discontinuers (n = 85), starters (n = 83) and non-users (n = 2571). RESULTS: At first assessment, 11.4% was using cannabis. They had lower QoL (B = -2.93, p < 0.001) and worse psychosocial functioning (B = 1.03, p = 0.002) than non-users. After one year, changes in QoL and psychosocial functioning were not significantly different between continuers, starters, discontinuers and non-users. CONCLUSIONS: Cannabis users were less satisfied with their family relations and financial situation and showed more aggressive and disruptive behavior and self-harm than non-users. These differences are likely the result of patients having used cannabis for many years. Starting or discontinuing cannabis did not lead to changes in QoL and psychosocial functioning within one year

Richtlijn schizofrenie 2012: basiszorg op het gebied van psychosociale interventies en verpleegkundige zorg.

Background An updated version of the Dutch multidisdplinaiy guideline on schizophrenia was published in 2012. aim We aim to provide an overview of the psychosocial interventions and nursing care which, according to the guideline, should be included in basic care programmes for patients with schizophrenia. We consider which interventions are effective and which are optional. In addition, we argue for continuous updating of the guideline so that it rejlects current developments. method We conducted a systematic review on the basis of specific predefined search terms. We included articles published up to February 2010. We used the methodfor evidence-based guideline development in order to formulate treatment recommendations. conclusion Cognitive behavioural therapy and Jamily interventions are scientifically proven interventions that should be included in the care programmes. Although there is no clear evidence that psycho-education is effective, it is nevertheless recommended. Optional interventions are peer support groups and, in the case of negative symptoms, psychomotor therapy. Although scientific evidence concerning nursing care is limited, we do make some recommendations. We are strongly in/avour of a 'living guideline' that is constantly developed and updated

Risk factors and oral health-related quality of life: A case–control comparison between patients after a first-episode psychosis and people from general population

INTRODUCTION: No research is available about the oral health risk factors and oral health-related quality of life (OHRQoL) in patients diagnosed with a psychotic disorder. AIM: To compare oral health risk factors and OHRQoL in patients diagnosed with a psychotic disorder (first-episode) to people with no history of psychotic disorder. METHOD: A case-control comparison (1:2) multivariable linear regression analysis and an estimation of prevalence of impact on OHRQoL. RESULTS: Patients diagnosed with a psychotic disorder (first-episode) have lower OHRQoL with more associated risk factors. Of the patients diagnosed with a psychotic disorder (first-episode), 14.8% reported a negative impact on OHRQoL, higher than the prevalence of 1.8% found in people from the general population. DISCUSSION: The high prevalence rate of a negative impact on OHRQoL in patients diagnosed with a psychotic disorder (first-episode) shows the importance of acting at an early stage to prevent a worse outcome. IMPLICATIONS FOR PRACTICE: The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening) in order to improve the OHRQoL

Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial

BACKGROUND: For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation. QUESTIONS/PURPOSES: Does minimally invasive hip arthroplasty result in superior clinical outcomes? PATIENTS AND METHODS: In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year. RESULTS: For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group. CONCLUSIONS: The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year. LEVEL OF EVIDENCE: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidenc

Longitudinal assessments of therapeutic alliance predict work performance in vocational rehabilitation for persons with schizophrenia

OBJECTIVES: To promote functional recovery in persons diagnosed with a psychotic disorder, vocational interventions have emerged over the last few decades which range from sheltered employment to supported employment in the community.DESIGN: Using data from a 6-month vocational rehabilitation programme, we examined whether assessments of the therapeutic alliance were related to the quality of work performed in this work placement. Our first hypothesis was that stronger alliances would be related to better work performance. Second, we expected that client assessments of the TA would better predict outcomes than therapist assessments. Third, we expected that the discrepancy between assessment scores from the client and therapist (client rating minus therapist rating) would be a better predictor for outcome than individual assessments by the therapists or clients.RESULTS: Clients systematically rated the alliance higher than therapists. Modelling the data longitudinally, we found both therapist and client ratings predictive of outcome, though client assessments over time were inversely related to work performance.CONCLUSIONS: Discrepancy in scores was also shown to be predictive of work performance during the program. Clinicians are advised to routinely assess the therapeutic alliance from both client and therapist perspectives and calculate the discrepancy between them as they may indicate ruptures are occurring and thus hamper the intervention.PRACTITIONER POINTS: Clinicians are advised to regularly assess the therapeutic alliance from both their own and the client's perspective. Growing discrepancy in scores may impede intervention effectiveness. Therapeutic alliance may help buffer against work stresses experienced by participants in a vocational programme. Be aware that therapists tend to rate the alliance lower than their clients.</p