Duurzaamheid als planningsopgave : gebiedsgerichte afstemming tussen de ruimtelijke ordening, het milieubeleid en het waterhuishoudkundig beleid voor het landelijk gebied

IntroductionSince the publication of 'Our Common Future' (1987) by the World Commission on Environment and Development, sustainability or sustainable development has become one of the most important aims of environmental policy throughout the world. But it has proved difficult to work out in a definition, in policy targets and in policy instruments. There are many definitions of sustainability for rural and urban regions, as well as for activities such as agriculture, nature conservation, outdoor recreation and water resource management; there seems to be no need for yet another.In this thesis, sustainability is defined as a task of planning. The central topic is, therefore, how sustainability is defined in planning, practice and implemented in plans. But what are planning practices lid what are plans? To answer these questions an analytical tool was developed by looking for a definition of Planning that can accommodate new developments in the relation between Dutch government and society. Inspired by Friedmann planning is defined in this thesis as an attempt to link knowledge to action in the public domain; this was elaborated for land use planning in Dutch rural areas. A distinction is made between three task: rural development, steering and planning. The first concerns the knowledge about the physical environment and the action (design and evaluation) taken to achieve the desired situation in the physical environment. The second involves transforming the visions of private actors and the concepts of policy makers into claims on the physical environment, so that it can be decided which claims are legitimate and feasible in relation to development. The third involves the making a plan by organizing the interaction between the development and the steering tasks within the framework of political institutions and regulations. It can be defined in different ways because the content of the tasks can vary. In this thesis, the term 'planning style' is used to describe this. A distinction is made between four such styles: planning as reform, planning as policy analysis, planning as a learning process and planning as exchange process. These styles are elaborated for the tasks of steering and of development, the definition of the plan and the relation between design and implementationTable I Styles of planningSource: this theses table 2.4Three planning systems deal with the physical environment in the Netherlands: spatial planning, environmental planning and water management They have a common goal: to achieve a sustainable physical environment.But their definitions of the tasks of steering and development differ, as do their planning traditions. These differences are not a problem as long as the planning systems have distinct planning practices. However, intensive land use in the rural areas (agriculture, bulb growing and horticulture) and a high population density is causing the planning practices to converge, bringing about the need for coordination and integration of planning practices and their concepts.Central topicThis thesis is a contribution to the debate about the opportunities and likelihood of coordinating and integrating of the existing planning traditions, embodied in the planning systems, into a new planning practice directed to sustainable development in Dutch rural areas. The central topic is to clarify the differences between the concepts of steering and the concepts of development and to construct a model for assessing and designing of integrated planning practices. To this end, the following research questions are posed:1. what are the features of the planning systems?2. what are the dominant concepts about the physical environment?3. what are the dominant concepts of steering in relation to the physical environment?4. who are the adressees of these planning systems?5. what conditions apply to the integrated planning practices and what are the main aspects for assessing existing planning practices?6. what conclusions can be drawn about the task of planning in the future and the usefulness of the evalution model?MethodSeveral methods were used to answer these questions. To detect the features of the planning systems the literature was studied, planning practices were evaluated and interviews were conducted. In an attempt to find possible connections between the dominant concepts of development an analysis was done of the water system approach (Ministerie Verkeer en Waterstaat, 1985), the 'environmental utilisztion space' (Opschoor, 1990) and the model of the spatial organization (Kleefmann, 1990), drawing on scientific literature and documents produced by the Dutch government. The same procedure was followed for the dominant concepts of steering: the classic model, the network model and the market model (Koppenjan et al. 1993) in relation to the adressees: the 'active citizen' in spatial planning, the 'target group' in environmental planning and the 'user of the land' in (regional) water management. A model based on these analyses was built for assessing and designing of integrated planning practices.Model for assessment and designThe relation between Dutch government and society has changed in the last decade and forms of network steering are becoming more important. As a result integrated planning practices can only succeed when there is a need to cope with diffuse pollution and a change in behaviour. Three changes have come about a) private actors are participating in the planning process, b) the existing concepts of development and steering are being transformed into wholly of partically new concepts and c) the plan is now a joint product containing a vision of how the region should develop. These aspects are elaborated in Table 11. In short, the planning process ought to have the signature of two styles: planning as learning process and/or planning as exchange process. Planning as policy analysis and planning as reform are less suitable.Table II. Aspects for assessing and designing planning practicesSource: this thesis table 9.3CasesA wide range of cases is needed in order to analyse the state of the art of integrated planning practices in the Netherlands. The cases were selected according to the following criteria. The plans had to express the willingness of government (national, provincial or local) to construct integrated planning practices. The selection had to contain plans of all three tiers government. The plans had to embody a relation between at least two concepts of development and a change in the concept of steering, compared with the pre- plan situation. Both regular and non-regular plans had to be included. This resulted in the following cases being selected (Table Ill): The National Memorandum on Environmental Policy II (Ministry of Housing, Spatial Planning and Environment, 1993); The Management Plan for the Waters of national importance (Ministry of Transport, Public Works and Water Management, 1992); especially for the IJsselmeergebied (Ministry of Transport, Public Works and Water Management, 1991), North Sea (Ministry of Traffic and Water Management, 1991) and the Rijntakken (Ministry of Transport, Public Work and Water Management, 1994); The Ammonia Reduction Plans for Southeast Friesland (forthcoming) and the Gelder Valley (1994); The coordination and integration between the Water Management Plan, the Environmental Policy Plan and the Spatial Plan of Gelderland Province (Provincie Gelderland, 1996abc); The vision for the Regge river basin (Goossensen et al., 1997).In cases one, two and three, seven plans were analysed and assessed. Cases four and five differ because the researcher participated in the planning processes. As a result the aspect of the design of integrated planning practices received more emphasis; an insider's assessment.Table III Cases of integrated planning practicesResultsThe results of the assessment have been compiled in Table IV. This overview shows that some planning practices can be classified as integrated: the Ammonia Reduction Plans and the vision for the Regge river basin. In the Ammonia Reduction Plans a combination of spatial zoning and a bulb (marketable emission rights) for the reduction of ammonia creates a new balance between agricultural development and protection of the nature conservation areas. The vision on the Regge river basin combines spatial hydrological zoning and the water management area defined as a bulb in which the problems of eutrophication and the fall in hydraulic head can be solved. In both planning practices, the participation of private actors is important in the discussion about the vision and the relation between this joint vision and the opportunities for fitting this in with the evryday practices of the private actors.Conclusions and discussion1. The three planning systems, current in the Netherlands today each have their own signature. In the last decade the development task has changed as a result of new insights into the relation between the components of the physical environment. The task of steering has changed too, as a result of a changing relation between Dutch government and society. The planning systems have reacted differently to these changes. The system of spatial planning is evolving from planning as policy analysis into planning as a learning process; environmental planning is evolving from planning as reform to planning as exchange process; water management is evolving from planning as reform to planning as policy analysis. The modernisation of the systems is proceeding in different directions.2. Interesting experiments are going on in Dutch planning practice in the countryside, where private and public actors are looking for a practical definition of sustainable development. It can be concluded that integrated planning practices can only succeed when public and private actors are able to achieve a creative combination of elements of the concepts of development and the concepts of steering and when this combination is based on clear relation between the steering and development task.3. The distinction between the planning task, the development task and the steering task and the combination in different styles of planning turns out to be a promising analytical tool for analysing planning practices with regard to the physical environment. But despite this there is a need for elaboration in more detail.</p

Vervangingsopgave natte kunstwerken in het hoofdwatersysteem en hoofdvaarwegennet in Nederland

De vervangingsopgave natte kunstwerken: een strategische opgave voor Rijkswaterstaat – Rijkswaterstaat beheert als asset manager op duurzame wijze het Nederlandse hoofdwegennet, hoofdvaarwegennet en hoofdwatersysteem. Daarbij werkt Rijkswaterstaat aan de vlotte en veilige doorstroming van het (weg- en scheepvaart)verkeer, aan een veilig, schoon en gebruikersgericht watersysteem, aan de bescherming van Nederland tegen overstromingen en aan de leefbaarheid van Nederland. Rijkswaterstaat heeft in het verleden veel geïnvesteerd in de aanleg van infrastructuur in het watersysteem (het hoofdvaarwegennet en het hoofdwatersysteem)

Parturition mode recommendation and symptoms of pelvic floor disorders after obstetric anal sphincter injuries

Introduction and hypothesis: Our primary objective was to evaluate parturition mode (PM) recommendations following obstetric anal sphincter injuries (OASIs) and adherence to these recommendations and to evaluate recurrence of OASIs in women who had a subsequent vaginal delivery (VD). The hypothesis was that adherence to the PM recommendations leads to a reasonable OASI recurrence rate. Methods: This was a retrospective observational cohort study of patients with previous OASIs between 2010 and 2016. After an outpatient visit including 3D transperineal ultrasound to screen for pelvic floor and anal sphincter injuries, all patients received recommendations for a subsequent PM. Patients were invited to complete validated questionnaires 2 to 5 years post-OASIs. Results: The majority of invited patients (265/320) attended follow-up, with 264 receiving a recommendation for PM. Only 5.6% did not adhere to the received recommendation. One hundred sixty-one patients delivered again, 58% had a VD, and 42% had a cesarean section (CS). Recurrence of OASIs was observed in 4.3% of the patients that had a VD. Fecal incontinence occurred in 4.9%, however any form of anal incontinence in 48% of patients. While dyspareunia was common in patients with residual external anal sphincter (EAS) injuries and levator ani muscle (LAM) avulsions, anal pain occurred more frequently in EAS injuries and fecal incontinence in LAM avulsions. Conclusions: This study showed that the vast majority of patients followed PM recommendations, and this resulted in a low recurrence of OASIs with a high CS rate. Fecal incontinence after OASIs was correlated with the degree of OASIs

Residential mobility and local housing-market differences

The authors extend previous literature on variations in mobility rates across local housing markets by examining the linkage of mobility rates at the household level to the structure of local housing markets. The results suggest that residential mobility rates differ widely across local housing markets, substantiating the view that residential relocation is intimately intertwined with conditions at the local level. Local housing-market conditions also have different effects on mobility rates for renters and owner-occupiers. The results suggest that variation in residential mobility rates across housing markets can be in part explained by level of urbanization, the tenure structure, the degree of government intervention, and the size of the housing market. Remarkably, these differences in local housing markets cannot be seen to be related to housing-market features only. The results suggest that these differences can also be attributed to the behavior or attitude of households with respect to housing

Ultrasound Doppler Flow in Patients With Chronic Midportion Achilles Tendinopathy

OBJECTIVES: Ultrasound assessments of patients with chronic midportion Achilles tendinopathy include determining the degree of neovascularization using Doppler flow. A frequently used measure to quantify neovascularization is the modified Öhberg score. It is unknown whether the semiquantitative modified Öhberg score (0-4+) has higher reliability than a quantified measure of Doppler flow (0-100%). The purpose of this cross-sectional study was to evaluate the interobserver reliability of the modified Öhberg score and a surface area quantification (SAQ) method for Doppler flow in patients with chronic midportion Achilles tendinopathy. METHODS: Two observers examined the degree of Doppler flow independently using SAQ and the modified Öhberg score during a single consultation. The intraclass correlation coefficient, standard error of measurement, and minimal detectable difference were determined to evaluate the reliability and measurement properties of the SAQ method and the modified Öhberg score. RESULTS: In total, 28 consecutive patients with chronic midportion Achilles tendinopathy participated. The intraclass correlation coefficient for interobserver reliability of the SAQ method was 0.81 (95% confidence interval, 0.58-0.91), compared to 0.64 (95% confidence interval, 0.45-0.81) for the modified Öhberg score. The standard error of measurement and minimal detectable difference values for the SAQ method were 2.9% and 8.0%, respectively, and for the modified Öhberg score, they were 0.55 and 1.53 points. CONCLUSIONS: The SAQ method shows good reliability to evaluate the degree of Doppler flow in patients with chronic midportion Achilles tendinopathy, and it overcome

The State of the Art in Language Workbenches. Conclusions from the Language Workbench Challenge

Language workbenches are tools that provide high-level mechanisms for the implementation of (domain-specific) languages. Language workbenches are an active area of research that also receives many contributions from industry. To compare and discuss existing language workbenches, the annual Language Workbench Challenge was launched in 2011. Each year, participants are challenged to realize a given domain-specific language with their workbenches as a basis for discussion and comparison. In this paper, we describe the state of the art of language workbenches as observed in the previous editions of the Language Workbench Challenge. In particular, we capture the design space of language workbenches in a feature model and show where in this design space the participants of the 2013 Language Workbench Challenge reside. We compare these workbenches based on a DSL for questionnaires that was realized in all workbenches

Which treatment is most effective for patients with Achilles tendinopathy?:A living systematic review with network meta-analysis of 29 randomised controlled trials

Objective: To provide a consistently updated overview of the comparative effectiveness of treatments for Achilles tendinopathy. Design: Living systematic review and network meta-analysis. Data sources: Multiple databases including grey literature sources were searched up to February 2019. Study eligibility criteria: Randomised controlled trials examining the effectiveness of any treatment in patients wit

HIV Types, Groups, Subtypes and Recombinant Forms: Errors in Replication, Selection Pressure and Quasispecies

HIV-1 is a chimpanzee virus which was transmitted to humans by several zoonotic events resulting in infection with HIV-1 groups M P, and in parallel transmission events from sooty mangabey monkey viruses leading to infections with HIV-2 groups A H. Both viruses have circulated in the human population for about 80 years. In the infected patient, HIV mutates, and by elimination of some of the viruses by the action of the immune system individual quasispecies are formed. Along with the selection of the fittest viruses, mutation and recombination after superinfection with HIV from different groups or subtypes have resulted in the diversity of their patterns of geographic distribution. Despite the high variability observed, some essential parts of the HIV genome are highly conserved. Viral diversity is further facilitated in some parts of the HIV genome by drug selection pressure and may also be enhanced by different genetic factors, including HLA in patients from different regions of the world. Viral and human genetic factors influence pathogenesis. Viral genetic factors are proteins such as Tat, Vif and Rev. Human genetic factors associated with a better clinical outcome are proteins such as APOBEC, langerin, tetherin and chemokine receptor 5 (CCR5) and HLA B27, B57, DRB1{*}1303, KIR and PARD3B. Copyright (C) 2012 S. Karger AG, Base