A new flood risk assessment framework for evaluating the effectiveness of policies to improve urban flood resilience

This is the author accepted manuscript. The final version is available from Taylor & Francis via the DOI in this record.To better understand the impacts of flooding such that authorities can plan for adapting measures to cope with future scenarios, we have developed a modified Drivers-Pressures-State-Impact-Response (DPSIR) framework to allow policy makers to evaluate strategies for improving flood resilience in cities. We showed that this framework proved an effective approach to assessing and improving urban flood resilience, albeit with some limitations. This framework has difficulties in capturing all the important relationships in cities, especially with regards to feedbacks. There is therefore a need to develop improved techniques for understanding components and their relationships. While this research showed that risk assessment is possible even at the mega-city scale, new techniques will support advances in this field. Finally, a chain of models engenders uncertainties. However, the resilience approach promoted in this research, is an effective manner to work with uncertainty by providing the capacity to cope and respond to multiple scenariosResearch on the CORFU (Collaborative research on flood resilience in urban areas) project was funded by the European Commission through Framework Programme 7, Grant Number 244047. The work in this paper was partially funded by the PEARL (Preparing for Extreme And Rare events in coastaL regions) project, supported by the European Union's Seventh Framework Programme under Grant Agreement No 603663

Shared decision-making in mental health care using routine outcome monitoring : results of a cluster randomised-controlled trial

PURPOSE: To investigate the effects of Shared Decision-Making (SDM) using Routine Outcome Monitoring (ROM) primary on patients' perception of Decisional Conflict (DC), which measures patients' engagement in and satisfaction with clinical decisions, and secondary on working alliance and treatment outcomes. METHOD: Multi-centre two-arm matched-paired cluster randomised-controlled trial in Dutch specialist mental health care. SDM using ROM (SDMR) was compared with Decision-Making As Usual (DMAU). Outcomes were measured at baseline (T0) and 6 months (T1). Multilevel regression and intention-to-treat analyses were used. Post hoc analyses were performed on influence of subgroups and application of SDMR on DC. RESULTS: Seven teams were randomised to each arm. T0 was completed by 186 patients (51% intervention; 49% control) and T1 by 158 patients (51% intervention, 49% control). DC, working alliance, and treatment outcomes reported by patients did not differ significantly between two arms. Post hoc analyses revealed that SDMR led to less DC among depressed patients (p = 0.047, d =- 0.69). If SDMR was applied well, patients reported less DC (SDM: p = 0.000, d = - 0.45; ROM: p = 0.021, d = - 0.32), which was associated with better treatment outcomes. CONCLUSION: Except for patients with mood disorders, we found no difference between the arms for patient-reported DC. This might be explained by the less than optimal uptake of this generic intervention, which did not support patients directly. Regarding the positive influence of a higher level of applying SDM and ROM on less DC and better treatment outcomes, the results are encouraging for further investments in patient-oriented development and implementation of SDMR

Early prediction of outcome of activities of daily living after stroke: a systematic review

Background and Purpose-Knowledge about robust and unbiased factors that predict outcome of activities of daily living (ADL) is paramount in stroke management. This review investigates the methodological quality of prognostic studies in the early poststroke phase for final ADL to identify variables that are predictive or not predictive for outcome of ADL after stroke. Methods-PubMed, Ebsco/Cinahl and Embase were systematically searched for prognostic studies in which stroke patients were included = 3 months poststroke. Risk of bias scores were used to distinguish high-and low-quality studies and a qualitative synthesis was performed. Results-Forty-eight of 8425 identified citations were included. The median risk of bias score was 17 out of 27 (range, 6-22) points. Most studies failed to report medical treatment applied, management of missing data, rationale for candidate determinants and outcome cut-offs, results of univariable analysis, and validation and performance of the model, making the predictive value of most determinants indistinct. Six high-quality studies showed strong evidence for baseline neurological status, upper limb paresis, and age as predictors for outcome of ADL. Gender and risk factors such as atrial fibrillation were unrelated to this outcome. Conclusions-Because of insufficient methodological quality of most prognostic studies, the predictive value of many clinical determinants for outcome of ADL remains unclear. Future cohort studies should focus on early prediction using simple models with good clinical performance to enhance application in stroke management and research. (Stroke. 2011;42:1482-1488.

The effects of integrated care: a systematic review of UK and international evidence

BACKGROUND: Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS: The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS: One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS: Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION: Prospero registration number: 42016037725

Estimating the impacts of urban growth on future flood risk: A comparative study

The unprecedented growth of cities has a significant impact on future flood risk that might exceed the impacts of climate change in many metropolitan areas across the world. Although the effects of urbanisation on flood risk are well understood, assessments that include spatially explicit future growth projections are limited. This comparative study provides insight in the long term development of future riverine and pluvial flood risk for 18 fast growing megacities. For these cities a spatially explicit urban growth model has been developed capable to identify and extrapolate spatial development trends into growth projections for the short, medium and long term. For some cities like Dhaka or Lahore, the outcomes are alarming while others show an implicit tendency for flood adverse urban growth. The outcomes not only provide a baseline absent in current practise, but also a strategic outlook that might better establish the role of urban planning in limiting future flood risk.Dissertation submitted in fulfillment of the requirements of the Board for Doctorates of Delft University of Technology and of the Academic Board of the UNESCO-IHE Institute for Water Education.Hydraulic Structures and Flood Ris