Sensemaking of real estate management using real options and scenario planning

Healthcare across the world is facing many uncertainties. In Dutch healthcare, a recent policy change forces health organisations to deal more efficiently with real estate which makes flexibility more necessary. In order to support real estate managers in decision making in flexibility, we developed a method combining scenario planning and real options. This method is aimed to enhance sensemaking on both the consequences of future uncertainties on the organisation which influences real estate management, and on the types of flexibility needed to enable adapting to these changes. In this way, better real estate strategies can be developed. Through testing the method in one pilot case, this study shows sensemaking had taken place. Based on these results, propositions are developed focusing on the relation between real options, backcasting scenario planning and sensemaking

Applying the real options theory for identifying flexibility in project delivery of health organisations

Healthcare is influenced by many uncertainties. Uncertainties affecting health organisations also influence real estate since this facilitates the primary process. Within real estate management, decisions have to be made today while there is little knowledge about the future. Therefore, flexibility is needed in the process of designing, constructing and operating real estate. A case study has been done to gain insight about how health organisations deal with flexibility. The real options approach is used to show what types of flexibility have been used, and that uncertainty can also generate opportunities. Of the five types of flexibility, only in two types real options were identified in the case study. These were stage, abandon, defer and scale within process flexibility and the options growth and switch within product flexibility. This is partly a result of the fact that the project in the case study is not further advanced than the preliminary design phase. Nevertheless it can be concluded that project managers already act as using real options. Consciously using this concept might create even more real options to be used in project management

Real options and scenario planning as a way to gain insight into flexibility in health care real estate management, a first exploration

Real estate management in health care faces many uncertainties, and more specific in the Netherlands even more because of changing regulations regarding\ud the financing of capital costs. Therefore we propose, based on literature and a\ud survey, to use scenario planning in combinations with the real option approach to deal with these uncertainties. The survey shows that limited use is made of future uncertainties and options for flexibility in the responded Dutch hospitals. Real options provide insight for real estate managers into opportunities for flexibility when making strategic decisions in real estate management, such as choosing for a building organisation form

Metabolic risk factors in depressive and anxiety disorders

The aim of this thesis was to clarify which aspects of depression and anxiety are related to an increased metabolic risk, and which factors contribute to these associations. Taken together, our findings indicate that people with more severe symptoms of depression and anxiety are at particular risk of progressive dyslipidemia and (abdominal) obesity. The higher rates of smoking and systemic inflammation among people with depression or anxiety partially accounted for their adverse metabolic profile. Dysregulations of the autonomic nervous system partly explained why users of tricyclic antidepressants displayed an increased risk of dyslipidemia and (abdominal) obesity as well, and also of hypertension. These important findings shed light on useful avenues for future research, and on preventive and therapeutic insights and directions.UBL - phd migration 201

INTERMED-Self Assessment (IMSA): Validity and preliminary applications in research

Introduction The INTERMED Self-Assessment questionnaire (IM-SA) was developed as an alternative to the INTERMED Complexity Assessment Grid interview (IM-CAG) to assess biopsychosocial complexity and health care needs in order to optimize care. The aim of this study was to discuss possible applications of IMSA to routine clinical work in a CL psychiatry setting, after presenting IM-SA’s feasibility, reliability, validity and predictive value for health care utilization (HCU) and quality of life (QoL) as emerged by the IMSA Study. Methods The IMSA Study was an international multicentric prospective observational cohort study, involving 850 participants who completed both the IM-SA and IM-CAG. Feasibility by percentages of missing values, reliability by Cronbach's alpha, interrater agreement by intraclass correlation coefficients (ICCs) and convergent validity of IM-SA scores with mental health (SF-36 mental health subscale and HADS) and medical health (CIRS) and discriminant validity of IM-SA scores with QoL (EQ-5D) by Spearmans rank correlations were determined. Predictive validity of IM-SA scores with HCU and QoL was examined by (generalized) linear mixed models. At Modena University Hospital, IMSA was included in several clinical research protocols to support screening procedures. Results Feasibility, face validity and reliability (Cronbach’s alpha 0.80) were satisfactory. ICC between IM-SA and IM-CAG total scores was .78 (95% CI .75–.81). Correlations of the IM-SA with the SF-36, HADS, CIRS and EQ-5D were -.65, .002, .28 and -.59 respectively. The IM-SA predicted HCU and QoL after 3- and 6-month follow-up. Seven subjects suffering from comorbid HIV and depression and 30 subjects undergoing colonoscopy for screening were also tested with IM-SA. Mean baseline score was 17.14 (SD = 8.71) for the depressed HIV subjects, with 2 subjects overcoming the cutoff of 21, suggesting clinical complexity. Mean score was 7.72 (SD = 4.19) for subjects undergoing colonoscopy, none of whom reached a score suggesting clinical complexity. Conclusion The IM-SA may efficiently support healthcare professionals in the assessment of patient’s biopsychosocial complexity aimed at providing integrated, personalized multidisciplinary care. Inclusion of IM-SA as a routine screening tool may be advised in different clinical in- and out-patient contexts

Metabolic syndrome in patients with bipolar disorder: Comparison with major depressive disorder and non-psychiatric controls

Objective: We aimed to investigate the prevalence of the metabolic syndrome (MetS) and its individual components in subjects with bipolar disorder (BD) compared to those with major depressive disorder (MDD) and non-psychiatric controls. Methods: We examined 2431 participants (mean age 44.3. ±. 13.0, 66.1 female), of whom 241 had BD; 1648 had MDD; and 542 were non-psychiatric controls. The MetS was ascertained according to NCEP ATP III criteria. Multivariable analyses were adjusted for age, sex, ethnicity, level of education, smoking status and severity of depressive symptoms, and in the case of BD subjects, also for psychotropic medication use. Results: Subjects with BD had a significantly higher prevalence of MetS when compared to subjects with MDD and non-psychiatric controls (28.4 vs. 20.2 and 16.5, respectively, p<. 0.001), also when adjusted for sociodemographic and lifestyle factors (OR 1.52, 95 CI: 1.09-2.12, p= 0.02 compared to MDD; OR 1.79, 95 CI: 1.20-2.67, p= 0.005 compared to non-psychiatric controls). The differences between BD subjects with controls could partly be ascribed to a higher mean waist circumference (91.0. cm vs. 88.8, respectively, p= 0.03). In stratified analysis, the differences in the prevalence of MetS between patients with BD and MDD were found in symptomatic but not in asymptomatic cases. Conclusion: This study confirms a higher prevalence of MetS in patients with BD compared to both MDD patients and controls. Specifically at risk are patients with a higher depression score and abdominal obesity. © 2015 Elsevier Inc

Chronic unpredictable stress regulates visceral adipocyte-mediated glucose metabolism and inflammatory circuits in male rats

Chronic psychological stress is a prominent risk factor involved in the pathogenesis of many complex diseases, including major depression, obesity, and type II diabetes. Visceral adipose tissue is a key endocrine organ involved in the regulation of insulin action and an important component in the development of insulin resistance. Here, we examined for the first time the changes on visceral adipose tissue physiology and on adipocyte-associated insulin sensitivity and function after chronic unpredictable stress in rats. Male rats were subjected to chronic unpredictable stress for 35 days. Total body and visceral fat was measured. Cytokines and activated intracellular kinase levels were determined using high-throughput multiplex assays. Adipocyte function was assessed via tritiated glucose uptake assay. Stressed rats showed no weight gain, and their fat/lean mass ratio increased dramatically compared to control animals. Stressed rats had significantly higher mesenteric fat content and epididymal fat pad weight and demonstrated reduced serum glucose clearing capacity following glucose challenge. Alterations in fat depot size were mainly due to changes in adipocyte numbers and not size. High-throughput molecular screening in adipocytes isolated from stressed rats revealed activation of intracellular inflammatory, glucose metabolism, and MAPK networks compared to controls, as well as significantly reduced glucose uptake capacity in response to insulin stimulation. Our study identifies the adipocyte as a key regulator of the effects of chronic stress on insulin resistance, and glucose metabolism, with important ramifications in the pathophysiology of several stress-related disease states