Special issue: Land Use and Sustainable Mobility

Concerns about the sustainability of current land use and transportation practices are increasingly issues of policy concern in most countries of the world. There is a call for better coordination between land use and transport. A number of factors motivate such attention (Gorham, 1998) Firstly, growth in car ownership and use show no signs of abating. Secondly, technology seems unable to fully solve the environmental and other problems associated with motorized transport. Problems have remained with respect to CO2, noise and the nonemissions related impacts of vehicles. Thirdly, the building costs of new infrastructure have increased, whereas the benefits provided by such infrastructure, are increasingly questioned (Cervero, 2003). In cases where new road infrastructure is provided primarily to relieve congestion, these roads tend to provide at best only temporary relief. The increased capacity tends to induce new traffic in the relatively short run through spatial, temporal, and modal changes in travel patterns and, in the longer run, through land-use changes caused by changes in overall accessibility levels (Downs 1992; Goodwin, 1996). These insights have increased the attention for measures other than infrastructure construction (Banister, 2002). Fourthly, just one strategy, e.g. completely based on technology or pricing, cannot solve the problems alone. For example, price signals, clearly being a necessary part of any strategy to restrain the growth of car use, cannot be relied upon as the sole element of this strategy. Substantial increases in the cost of car use would be required for having a meaningful change in travel behavior, technology acquisition, or a restructuring of social activities. This appears to have insufficient public and political support

A sector-wide response to national policy on client-centred care and support:A document analysis of the development of a range of instruments to assess clients’ experiences in the care and support for people with (intellectual) disabilities

BACKGROUND: Client-centred care serves as the foundation for healthcare policy. Indeed, various instruments for assessing clients’ experiences of care and support are increasingly used to provide insights into the quality, and client-centred nature, of the care and support provided, which, in turn, aids the development of subsequent improvements. The unique characteristics of care and support for people with intellectual disabilities (ID), such as the need for both lifelong and life-wide care and support across all aspects of clients’ lives, led to an initiative within Dutch ID care to jointly develop a range of instruments to assess the experiences of clients receiving ID care and support. Individual clients’ experiences and suggestions for improvement, which are embedded in clients’ care plan cycles, constitute the foundation of this Range of Instruments. This paper provides a unique, bottom-up, exhaustive account of the process of developing the Range of instruments used to assess the experiences of clients in the field of Dutch ID care. METHODS: Relevant documents at three levels (i.e. 1) national documents, such as policy papers and governmental reports, 2) documents and reports from the Dutch Association of Healthcare Providers for People with Disabilities (VGN) along with minutes from the meetings of the expert Committee who assessed the instruments, and 3) correspondence between the Committee and developers as well as the forms used in the assessment process for each instrument) were qualitatively analysed by two researchers who had no affiliation with the development of the Range of instruments used to assess clients’ experiences in ID care and support. All of the documents were inductively coded using a thematic analytical approach. Informants who were either currently or previously involved in the development of these instruments were asked to provide clarification over the documents themselves and to explain the context in which they were produced. RESULTS: The development of the range of instruments can be classified into four phases, namely: 1) supporting the bottom-up development of initiatives to assess clients’ experiences, 2) focusing on learning and further development, 3) stimulating exchange between the developers and users of the instruments and the Committee responsible for assessing them, and 4) further development in response to the changing times and new landscape. CONCLUSIONS: The range of instruments were found to be appropriate for a variety of clients in ID care and support, specifically in terms of assessing their individual experiences and gaining insight into their suggestions for improvement, and effective in terms of collaboratively improving the quality of ID care and support. In so doing, these instruments potentially provide an avenue through which clients’ experiences can be embedded in the process of ID care and support. Other specific features in the development of these instruments, namely their incremental adoption, ongoing evaluation and strong practice orientation, were also found to be suitable for other care contexts’ attempts to respond to the top-down policy objectives of client-centeredness and translating outcomes into direct care practice

Effecten milieudifferentiatie basistarieven kilometerprijs

De Nederlandse overheid heeft vergevorderde plannen ontwikkeld voor Anders Betalen voor Mobiliteit. Daarbij worden aankoop- en jaarlijkse bezitsbelastingen afgeschaft en een heffing per gereden kilometer geïntroduceerd. Deze ‘kilometerprijs’ wordt nationaal ingevoerd op alle wegen. De prijs bestaat uit een basistarief met differentiatie naar de milieukenmerken van de auto. Daarnaast wordt een spitstarief op bepaalde filegevoelige locaties geïntroduceerd. In het paper worden de effecten van het basistarief op het autopark, het autogebruik en de emissies beschreven. Het dynamische automarktmodel Dynamo versie 2.1 is gebruikt om de effecten te bepalen. Het paper laat zien dat op langere termijn het autobezit met 2% zal groeien en het totaal aantal autokilometers met 12-13% zal dalen als gevolg van invoering van het basistarief. Daarnaast zijn de effecten op het autopark alsmede op vervuiling aanzienlijk

Preoperative Posturing of Patients with Macula-On Retinal Detachment Reduces Progression Toward the Fovea

Purpose: Traditionally, preoperative posturing consisting of bed rest and positioning is prescribed to patients with macula-on retinal detachment (RD) to prevent RD progression and detachment of the fovea. Execution of such advice can be cumbersome and expensive. This study aimed to investigate if preoperative posturing affects the progression of RD. Design: Prospective cohort study. Participants: Ninety-eight patients with macula-on RD were included. Inclusion criteria were volume optical coherence tomography (OCT) scans could be obtained with sufficient quality; and the smallest distance from the fovea to the detachment border was 1.25 mm or more. Methods: Patients were admitted to the ward for bed rest in anticipation of surgery and were positioned on the side where the RD was mainly located. At baseline and before and after each interruption for meals or toilet visits, a 37°×45° OCT volume scan was performed using a wide-angle Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). The distance between the nearest point of the RD border and fovea was measured using a custom-built measuring tool. Main Outcome Measures: The RD border displacement and the average RD border displacement velocity moving toward (negative) or away (positive) from the fovea were determined for intervals of posturing and interruptions. Results: The median duration of intervals of posturing was 3.0 hours (interquartile range [IQR], 1.8-14.0 hours; n = 202) and of interruptions 0.37 hours (IQR, 0.26-0.50 hours; n = 197). The median RD border displacement was 2 μm (IQR, -65 to +251 μm) during posturing and -61 μm (IQR, -140 to 0 μm) during interruptions, a statistically significant difference (P < 0.001, Mann-Whitney U test). The median RD border displacement velocity was +1 μm/hour (IQR, -21 to +49 μm/hour) during posturing and -149 μm/hour (IQR, -406 to +1 μm/hour) during interruptions, a statistically significant difference (P < 0.001). Conclusions: By making use of usual interruptions of preoperative posturing we were able to show, in a prospective and ethically acceptable manner, that RD stabilizes during posturing and progresses during interruptions in patients with macula-on RD. Preoperative posturing is effective in reducing progression of RD

Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study

Contains fulltext : 108486.pdf (publisher's version ) (Open Access)BACKGROUND: Standard treatment of advanced ovarian cancer is surgery and chemotherapy. The goal of surgery is to remove all macroscopic tumour, as the amount of residual tumour is the most important prognostic factor for survival. When removal off all tumour is considered not feasible, neoadjuvant chemotherapy (NACT) in combination with interval debulking surgery (IDS) is performed. Current methods of staging are not always accurate in predicting surgical outcome, since approximately 40% of patients will have more than 1 cm residual tumour after primary debulking surgery (PDS). In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer. METHODS: Multicentre randomized controlled trial, including all gynaecologic oncologic centres in the Netherlands and their affiliated hospitals. Patients are eligible when they are planned for PDS after conventional staging. Participants are randomized between direct PDS or additional diagnostic laparoscopy. Depending on the result of laparoscopy patients are treated by PDS within three weeks, followed by six courses of platinum based chemotherapy or with NACT and IDS 3-4 weeks after three courses of chemotherapy, followed by another three courses of chemotherapy. Primary outcome measure is the proportion of PDS's leaving more than one centimetre tumour residual in each arm. In total 200 patients will be randomized. Data will be analysed according to intention to treat. DISCUSSION: Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis. However, there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high. Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS. Despite the absence of strong evidence and despite the possible complications, laparoscopy is already implemented in many countries. We propose a randomized multicentre trial to provide evidence on the effectiveness of laparoscopy before primary surgery for advanced stage ovarian cancer patients. TRIAL REGISTRATION: Netherlands Trial Register number NTR2644

Homocysteine and Familial Longevity: The Leiden Longevity Study

Homocysteine concentrations are a read-out of methionine metabolism and have been related to changes in lifespan in animal models. In humans, high homocysteine concentrations are an important predictor of age related disease. We aimed to explore the association of homocysteine with familial longevity by testing whether homocysteine is lower in individuals that are genetically enriched for longevity. We measured concentrations of total homocysteine in 1907 subjects from the Leiden Longevity Study consisting of 1309 offspring of nonagenarian siblings, who are enriched with familial factors promoting longevity, and 598 partners thereof as population controls. We found that homocysteine was related to age, creatinine, folate, vitamin B levels and medical history of hypertension and stroke in both groups (all p<0.001). However, levels of homocysteine did not differ between offspring enriched for longevity and their partners, and no differences in the age-related rise in homocysteine levels were found between groups (p for interaction 0.63). The results suggest that homocysteine metabolism is not likely to predict familial longevity

Vitamin B-12 deficiency stimulates osteoclastogenesis via increased homocysteine and methylmalonic acid

The risk of nutrient deficiencies increases with age in our modern Western society, and vitamin B(12) deficiency is especially prevalent in the elderly and causes increased homocysteine (Hcy) and methylmalonic acid (MMA) levels. These three factors have been recognized as risk factors for reduced bone mineral density and increased fracture risk, though mechanistic evidence is still lacking. In the present study, we investigated the influence of B(12), Hcy, and MMA on differentiation and activity of bone cells. B(12) deficiency did not affect the onset of osteoblast differentiation, maturation, matrix mineralization, or adipocyte differentiation from human mesenchymal stem cells (hMSCs). B(12) deficiency caused an increase in the secretion of Hcy and MMA into the culture medium by osteoblasts, but Hcy and MMA appeared to have no effect on hMSC osteoblast differentiation. We further studied the effect of B(12), Hcy, and MMA on the formation of multinucleated tartrate-resistant acid phosphatase-positive osteoclasts from mouse bone marrow. We observed that B(12) did not show an effect on osteoclastogenesis. However, Hcy as well as MMA were found to induce osteoclastogenesis in a dose-dependent manner. On the basis of these results, we conclude that B(12) deficiency may lead to decreased bone mass by increased osteoclast formation due to increased MMA and Hcy levels

Book Review: Handbook of Transport Geography and Spatial Systems (D. Hensher, K. Button, K. Haynes and P. Sopher (eds.))

This is the fifth volume in the series ‘Handbooks in Transport’. The series is developed to be a reference work for researchers, practitioners and students within transport and logistics. In almost 700 pages this volume provides an overview of many geographical aspects of transportation. The editors aim at providing a useful manual or guidebook, especially for those who are unfamiliar within this area of work. In their introduction, the editors introduce some of their focal points within the book. They point at new technological changes, such as GIS, GPS and ITS which do have impacts on spatial systems, but which also can be of value in research (data collection and analysis). They point at the importance of institutional factors yielding the traditional disconnection between land use and transportation planning and hope that GIS may be an integrating factor. And they seem to be surprised that many urban areas still have no formal land use modelling capability

A panel data switching regression model of mobility and car ownership

The objective of this paper is to present a panel data model of car ownership and mobility. Unobserved heterogeneity is controlled for by including correlated random effects in the equations describing car ownership and mobility. A mass-points approach is adopted to control for unobserved heterogeneity. The results show that decisions concerning the first car in the household are difficult to affect; a large number of households are inclined to keep one car. Second car ownership may be more sensitive to changes in the observed contributing factors. This suggests that in The Netherlands policies aimed at changing second car ownership will be more successful than those aimed at influencing decisions concerning the first car in households. A major part of the correlation between the unobservables in the car ownership and the mobility equations is attributable to random effects. The time-variant errors of the mobility equations are not significantly correlated to car ownership decisions. This implies that mobility can only be influenced to a small extent by policy makers without measures aimed at reducing (second) car ownership.