Shoulder Pain in Persons With Tetraplegia and the Association With Force Application During Manual Wheelchair Propulsion

Objective: To investigate the association between propulsion biomechanics, including force application and spatio-temporal characteristics, and shoulder pain in persons with tetraplegia. Design: Cross-sectional, observational study. Setting: Non-university research institution. Participants: 16 community dwelling, wheelchair dependent persons with a chronic tetraplegia between C4 and C7, with and without shoulder pain (age, 49.1±11.7 years; 94% men, 23.4±9.5 years past injury). Interventions: Not applicable. Main Outcome Measures: Force application and spatio-temporal characteristics of wheelchair propulsion on a treadmill (0.56 m/s, 10W and 0.83 m/s, 15W). Participants were stratified in groups with low, moderate, and high pain based on their Wheelchair User Shoulder Pain Index (WUSPI) score on the day of measurement. Results: The mixed-effect multilevel analysis showed that wheelchair users with high levels of shoulder pain applied propulsion force more effectively (and with a lower medial component) and over a longer push angle, thus shortening the recovery time as compared with persons with low or moderate levels of shoulder pain. Conclusions: In contrast with previous results from persons with a paraplegia, persons with tetraplegia and high levels of shoulder pain propel their wheelchair more optimal with regard to risk factors for shoulder pain. Our results therefore affirm that there is a different interaction of shoulder pain and propulsion biomechanics in persons with a tetraplegia which should be considered when further analyzing risk factors for shoulder pain in wheelchair users or applying literature results to different patient populations

Pan-African Seaports Database

Database of Pan-African seaports and their (physical) characteristics derived from Satellite Imagery. The database consists of 161 seaports with information on port construction date, coastline orientation, shore-normal breakwater length, longshore wave power, presence of nearby sediment sources and sinks, sheltering setting, presence of coastal protection structures, and adjacent beach changes

Barriers to realizing a stewardship relation between client and vendor: the Best Value approach

This study identifies barriers to realizing a stewardship relation instead of a classic principal–agent relation between client and vendor through implementation of an innovative procurement and risk management method, the Best Value approach. This approach focuses on calculus-based trust development through the use of metrics and alignment of goals and risks between client and vendor. Barriers to realizing a stewardship relation are analysed with the use of a theoretical framework that incorporates agency theory and stewardship theory. Data was collected in 2013 and 2014 through project documentation and interviews for four case studies at the Dutch Highways Agency. Collected data was used to analyse the roles of the client and vendor, the scope and level of the products and the overall process of the clarification phase of the Best Value approach to identify barriers in practice. Case study findings are analysed and explained by agency theory and stewardship theory. From a theoretical perspective the Best Value approach shows large similarities with stewardship theory. In practice, however, the cases show that the often traditional background of project teams and the lack of experience with Best Value result in a control-oriented relationship between client and vendor characterized by information asymmetry, lack of transparency and distrust. These characteristics of the relationship between client and vendor inhibit the realization of a stewardship relation using the Best Value approach