Remote sensing for Mapping TSM concentration in Mahakam Delta: an analytical approach

The Indonesian coastal zones have always been under heavy pressures, including those from fisheries, oil industries and sea transportation. The presence of these activities carry a large portion of risk in damaging the environment as well as in destroying the marine resources, leading to the need for an integrated management approach based on an environmental information system that is comprehensive and multi-disciplinary in nature. The Mahakam Delta has the same general problems as other coastal regions in Indonesia. The method is based on bio optical modeling. The forward water analysis comprised the laboratory measurements of water quality (TSM and Chl) and Inherent Optical Properties (IOPs) to derive Spesific Inherent Optical properties (SIOPs). SIOPs (of water, TSM, Chl and CDOM), coefficient f and B were used to developed R(0-) model. The inverse atmosphere analysis comprised the image preprocessing (i.e. geometric correction, atmospheric correction, air-water interface correction). The last step is inverse water analysis, which comprised the development of algorithm and image processing to develop TSM concentration maps. The spectrometer measurements collected in the field were used for obtaining the subsurface irradiance reflectance. The subsurface irradiance reflectance R(0-) is the ratio of upwelling (Ewu) and downwelling irradiance (Ewd) just beneath the water surface. There are some discrepancies from matching R(0-) model and R(0-) measured in the field, especially in the blue region and NIR region. The reason of the discrepancies could be due to the fact that the Q factor (the angular distribution factor of spectral radiance) is still not understood completely. This model is very susceptible to the decrease of the proportional factor f, and to the increase of the backscattering probability B. The results indicates that red band of satellite sensor is sensitive to detect higher TSM concentration. For Mahakam Delta, red band algorithm was used to derive TSM map, since higher TSM concentration occurred in the delta

Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

Contains fulltext : 97982.pdf (postprint version ) (Open Access)ABSTRACT: BACKGROUND: Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. METHODS: A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. RESULTS: We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. CONCLUSIONS: Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings

A cluster randomized controlled trial aimed at implementation of local quality improvement collaboratives to improve prescribing and test ordering performance of general practitioners: Study Protocol

<p>Abstract</p> <p>Background</p> <p>The use of guidelines in general practice is not optimal. Although evidence-based methods to improve guideline adherence are available, variation in physician adherence to general practice guidelines remains relatively high. The objective for this study is to transfer a quality improvement strategy based on audit, feedback, educational materials, and peer group discussion moderated by local opinion leaders to the field. The research questions are: is the multifaceted strategy implemented on a large scale as planned?; what is the effect on general practitioners' (GPs) test ordering and prescribing behaviour?; and what are the costs of implementing the strategy?</p> <p>Methods</p> <p>In order to evaluate the effects, costs and feasibility of this new strategy we plan a multi-centre cluster randomized controlled trial (RCT) with a balanced incomplete block design. Local GP groups in the south of the Netherlands already taking part in pharmacotherapeutic audit meeting groups, will be recruited by regional health officers. Approximately 50 groups of GPs will be randomly allocated to two arms. These GPs will be offered two different balanced sets of clinical topics. Each GP within a group will receive comparative feedback on test ordering and prescribing performance. The feedback will be discussed in the group and working agreements will be created after discussion of the guidelines and barriers to change. The data for the feedback will be collected from existing and newly formed databases, both at baseline and after one year.</p> <p>Discussion</p> <p>We are not aware of published studies on successes and failures of attempts to transfer to the stakeholders in the field a multifaceted strategy aimed at GPs' test ordering and prescribing behaviour. This pragmatic study will focus on compatibility with existing infrastructure, while permitting a certain degree of adaptation to local needs and routines.</p> <p>Trial registration</p> <p>Nederlands Trial Register ISRCTN40008171</p

Ethiek in architectuur en bouw

Building LawEthics & Philosophy of Technolog

Internationale vergelijking financiering en kostenverhaal bij organische gebiedsontwikkeling (International comparison of funding and cost recovery in organic area development)

Report commissioned by Ministry of Infrastructure and the Environment (Netherlands). International comparison of funding and cost recovery - Chapter on England (written by Askew, A and Sheppard, A); planning gain, planning obligations and the Community Infrastructure Levy