Assessment of adaptation measures against flooding in the city of Dhaka, Bangladesh

Dhaka is one of the world’s largest megacities with a high rate of urbanization. Due to the setting of greater Dhaka in a deltaic plain, it is extremely prone to detrimental flooding. Risks associated with flood are expected to increase in the coming years because of the global climate change impacts as well as the high rate of urbanization the city is facing. The low lying part of Dhaka (Dhaka East) faces most severe risk of flooding. Traditionally, this part has been efficiently storing the excess water caused by excessive rainfall and the canals connected to the rivers gradually drained the water to the rivers. But the alarmingly increasing population of Dhaka is leading towards the encroachment of these water retention areas because of the land scarcity. The natural drainage for the city is not performing well and the area is still unprotected from flooding, which causes major threats to its inhabitants. This situation increases the urgency to effectively adapt to current floods caused by climate variability and to the impacts of future climate changes. The government is planning several adaptive measures to protect the area whereas a systematic framework to analyze and assess them is lacking. The objective of the paper is to develop an integrated framework for the assessment of various (current and potential) adaptation measures aimed at protecting vulnerable areas from flooding. The study firstly assesses current and future risks from flooding in the most sensitive region of the city. Subsequently, the study identifies, analyses and assesses adaptive initiatives and measures to address flood risks in the Eastern fringe area. Adaptation assessment is conducted within the framework of Multi Criteria Analysis methodology which allows both normative judgment and technical expertise in the assessment process. Based on the assessment and analysis, adaptive measures are prioritized to enable more effective action. Such a participatory integrated assessment of adaptation options is a new approach in flood management in least developed countries and in Bangladesh in particular. A framework for prioritization of adaptation measures is lacking in the decision making process in Bangladesh which could immensely assist in informed and structured decisions while developing adaptation strategies

De meerwaarde van HKZ-certificering voor GGZ-instellingen

Het certificeren van instellingen is een instrument geworden om de kwaliteit van zorg van instellingen te verbeteren. Certificeren behelst het beoordelen van een organisatie op voorgeschreven normen door een onafhankelijke derde en het afgeven van een certificaat wanneer aan de normen wordt voldaan. Instellingen worden in toenemende mate verplicht certificaten te halen. Maar heeft certificeren wel meerwaarde? Het onderzoek waarover wordt gerapporteerd stelt deze vraag centraal. En wel: Wat is de meerwaarde van HKZ-certificering op de geleverde kwaliteit van zorg in GGZ-instellingen? Gekozen is voor HKZ als certificeringinstrument en de geestelijke gezondheidszorg als sector. Deelvragen van het onderzoek zijn: 1. Welke waarde ontlenen zorgprofessionals (hulpverleners), kwaliteitsfunctionarissen, managers en medewerkers van stafafdelingen aan HKZ-certificering? 2. Presteren GGZ-instellingen met (zicht op) een HKZ-certificaat beter op relevante indicatoren dan GGZ-instellingen die niet (of nog niet) HKZ-gecertificeerd zijn? 3. Vanwege welke redenen leidt HKZ-certificering tot betere of slechtere prestaties

Better implementation of improvements in chronic care

We know more about the effectiveness of chronic care itself than we know about how to implement these effective practices and care models. The result of this mismatch is that too often the implementation of inherently good innovations fails. Luckily, this is recognised as a problem and we are beginning to use methods which combine implementation with research so that we can more quickly improve care and learn about what works best for whom and where. This report presents a synthesis of what a diverse group of experts across the European Union see as research priorities to speed up and spread improvements to chronic care. It will contribute to the future EU Research Agenda and also seeks to stimulate research funding for rigorous and timely implementation research in chronic care. But it is also of immediate use to improvers and researchers across Europe for the insights and discussions about implementation, chronic care and improvement science and practice

Implementing a Personalized Integrated Stepped-Care Method (STIP-Method) to Prevent and Treat Neuropsychiatric Symptoms in Persons With Dementia in Nursing Homes:Protocol for a Mixed Methods Study

Background: Neuropsychiatric symptoms occur frequently in many nursing home residents with dementia. Despite the availability of multidisciplinary guidelines, neuropsychiatric symptoms are often inadequately managed. Three proven effective methods for managing neuropsychiatric symptoms were integrated into a single intervention method: the STIP-Method, a personalized integrated stepped-care method to prevent and treat neuropsychiatric symptoms. The STIP-Method comprises 5 phases of clinical reasoning to neuropsychiatric symptoms and 4 stepped-care interventions and is supported with a web application. Objective: This study aims to identify the facilitators and barriers in the implementation of the STIP-Method in nursing homes. Methods: A mixed methods design within a participatory action research was used to implement the STIP-Method in 4 facilities of 2 Dutch nursing home organizations. In total, we aimed at participation of 160-200 persons with dementia and expected an intervention fidelity of 50% or more, based on earlier studies regarding implementation of effective psychosocial interventions to manage neuropsychiatric symptoms. All involved managers and professionals were trained in the principles of the STIP-Method and in using the web application. An advisory board of professionals, managers, and informal caregivers in each facility supported the implementation during 21 months, including an intermission of 6 months due to the COVID-19 pandemic. In these 6-weekly advisory board meetings, 2 researchers stimulated the members to reflect on progress of the implementation by making use of available data from patient records and the web application. Additionally, the 2 researchers invited the members to suggest how to improve the implementation. Data analysis will involve (1) analysis of facilitators and barriers to the implementation derived from verbatim text reports of advisory board meetings to better understand the implementation process; (2) analysis of patient records in accordance with multidisciplinary guidelines to neuropsychiatric symptoms: personalized, interdisciplinary, and proactive management of neuropsychiatric symptoms; (3) evaluation of the web application in terms of usability scores; (4) preand postimplementation analysis of patient records and the web application to evaluate the impact of the STIP-Method, such as changes in neuropsychiatric symptoms and informal caregiver burden. Results: We enrolled 328 persons with dementia. Data collection started in July 2019 and ended in December 2021. The first version of this manuscript was submitted in October 2021. The first results of data analysis are expected to be published in December 2022 and final results in June 2023. Conclusions: Our study may increase understanding of facilitators and barriers to the prevention and treatment of neuropsychiatric symptoms in nursing home residents with dementia by implementing the integrated STIP-Method. The need for well-designed implementation studies is of importance to provide nursing homes with optimal tools to prevent and treat neuropsychiatric symptoms

Hoor de Hofbogen: een onderzoek naar de geluidsbeleving

Research in and through artistic practic

Accurate assessment of abdominal aortic aneurysm with intravascular ultrasound scanning: Validation with computed tomographic angiography

AbstractPurpose: The purpose of this study was to assess the accuracy of intravascular ultrasound (IVUS) parameters of abdominal aortic aneurysm, used for endovascular grafting, in comparison with computed tomographic angiography (CTA). Methods: This study was designed as a descriptive study. Between March 1997 and March 1998, 16 patients with abdominal aortic aneurysms were studied with angiography, IVUS (12.5 MHz), and CTA. The length of the aneurysm and the length and lumen diameter of the proximal and distal neck obtained with IVUS were compared with the data obtained with CTA. The measurements with IVUS were repeated by a second observer to assess the reproducibility. Tomographic IVUS images were reconstructed into a longitudinal format. Results: IVUS results identified 31 of 32 renal arteries and four of five accessory renal arteries. A comparison of the length measurements of the aneurysm and the proximal and distal neck obtained with IVUS and CTA revealed a correlation of 0.99 (P < .001), with a coefficient of variation of 9%. IVUS results tended to underestimate the length as compared with the CTA results (0.48 ± 0.52 cm; P < .001). A comparison of the lumen diameter measurements of the proximal and distal neck derived from IVUS and CTA showed a correlation of 0.93 (P < .001), with a coefficient of variation of 9%. IVUS results tended to underestimate aneurysm neck diameter as compared with CTA results (0.68 ± 1.76 mm; P = .006). Interobserver agreement of IVUS length and diameter measurements showed a good correlation (r = 1.0; P < .001), with coefficients of variation of 3% and 2%, respectively, and no significant differences (0.0 ± 0.16 cm and 0.06 ± 0.36 mm, respectively). The longitudinal IVUS images displayed the important vascular structures and improved the spatial insight in aneurysmal anatomy. Conclusion: Intravascular ultrasound scanning results provided accurate and reproducible measurements of abdominal aortic aneurysm. The longitudinal reconstruction of IVUS images provided additional knowledge on the anatomy of the aneurysm and its proximal and distal neck. (J Vasc Surg 1999;29:631-8.

Hoe klinkt het Hofplein, nu en in de toekomst?: Een onderzoek naar de geluidsbeleving

Research in and through artistic practic