Unravelling institutional work patterns:Planning offshore wind farms in contested space

Offshore wind farms (OWF) are considered important for a timely energy transition. However, offshore space is governed by sector-specific institutional frameworks representing various and sometimes conflicting interests. Therefore, institutional change towards improved cooperation and coordination between various stakeholders, their interests and alternative institutional frameworks is necessary. Institutional work is used as an analytical lens to explore patterns resulting from the interplay between different forms of institutional work by actors over time. Data was collected through participatory observation of the Dutch North Sea Dialogues (NSD) and focused on balancing interest in the context of multi-use of OFW. Institutional change in this case relied mostly on a highly subtle interplay between forms of creating and maintaining work that result in incremental changes to existing practices. Sustainability transitions could benefit from institutional harmonization as a pathway to institutional change for improved cross-sectoral coordination and cooperation

Does precipitation susceptibility vary with increasing cloud thickness in marine stratocumulus?

The relationship between precipitation rate and accumulation mode aerosol concentration in marine stratocumulus-topped boundary layers is investigated by applying the precipitation susceptibility metric to aircraft data obtained during the VOCALS Regional Experiment. A new method to calculate the precipitation susceptibility that incorporates non-precipitating clouds is introduced. The mean precipitation rate <i>R</i> over a segment of the data is expressed as the product of a drizzle fraction <i>f</i> and a drizzle intensity <i>I</i> (mean rate for drizzling columns). The susceptibility <i>S</i><sub>x</sub> is then defined as the fractional decrease in precipitation variable <i>x</i> = {<i>R</i>, <i>f</i>, <i>I</i>} per fractional increase in the concentration of aerosols with dry diameter >0.1 μm, with cloud thickness <i>h</i> held fixed. The precipitation susceptibility <i>S</i><sub>R</sub> is calculated using data from both precipitating and non-precipitating cloudy columns to quantify how aerosol concentrations affect the mean precipitation rate of all clouds of a given <i>h</i> range and not just the mean precipitation of clouds that are precipitating. <i>S</i><sub>R</sub> systematically decreases with increasing <i>h</i>, and this is largely because <i>S</i><sub>f</sub> decreases with <i>h</i> while <i>S</i><sub>I</sub> is approximately independent of <i>h</i>. In a general sense, <i>S</i><i>f</i> can be thought of as the effect of aerosols on the probability of precipitation, while <i>S</i><sub>I</sub> can be thought of as the effect of aerosols on the intensity of precipitation. Since thicker clouds are likely to precipitate regardless of ambient aerosol concentration, we expect <i>S</i><sub>f</sub> to decrease with increasing <i>h</i>. The results are broadly insensitive to the choice of horizontal averaging scale. Similar susceptibilities are found for both cloud base and near-surface drizzle rates. The analysis is repeated with cloud liquid water path held fixed instead of cloud thickness. Simple power law relationships relating precipitation rate to aerosol concentration or cloud droplet concentration do not capture this observed behavior

Editors' Review and Introduction: Learning Grammatical Structures: Developmental, Cross‐Species, and Computational Approaches

Human languages all have a grammar, that is, rules that determine how symbols in a language can be combined to create complex meaningful expressions. Despite decades of research, the evolutionary, developmental, cognitive, and computational bases of grammatical abilities are still not fully understood. “Artificial Grammar Learning” (AGL) studies provide important insights into how rules and structured sequences are learned, the relevance of these processes to language in humans, and whether the cognitive systems involved are shared with other animals. AGL tasks can be used to study how human adults, infants, animals, or machines learn artificial grammars of various sorts, consisting of rules defined typically over syllables, sounds, or visual items. In this introduction, we distill some lessons from the nine other papers in this special issue, which review the advances made from this growing body of literature. We provide a critical synthesis, identify the questions that remain open, and recognize the challenges that lie ahead. A key observation across the disciplines is that the limits of human, animal, and machine capabilities have yet to be found. Thus, this interdisciplinary area of research firmly rooted in the cognitive sciences has unearthed exciting new questions and venues for research, along the way fostering impactful collaborations between traditionally disconnected disciplines that are breaking scientific ground

Use of Benzodiazepines and Z-Drugs in Nursing Home Residents with Dementia:Prevalence and Appropriateness

BACKGROUND: Guidelines worldwide recommend restricted prescription of benzodiazepine receptor agonists (BZRAs), i.e., benzodiazepines and Z-drugs, for the treatment of dementia-associated behavioral and psychological symptoms and insomnia. OBJECTIVE: To assess the prevalence and appropriateness of BZRA use among nursing home residents with dementia. METHODS: This is a post-hoc analysis of BZRA prescriptions from two intervention studies on psychotropic drug use, conducted from 2016 to 2018. It includes 1,111 residents of dementia special care units from 24 Dutch long-term care organizations. We assessed the prevalence of use of continuous and as-needed BZRA prescriptions and their association with registered symptoms. Continuous BZRA prescriptions were evaluated for appropriateness, i.e., whether indication, dosage, duration, and evaluation accorded with guidelines for the treatment of challenging behavior in dementia and sleep disorders. RESULTS: The prevalence of BZRA use is 39.2% (95% CI: 36.3%–42.0%): continuous 22.9%; only as-needed 16.3%. Combinations of preferred BZRAs and appropriate indications occur in 19.0% of continuous anxiolytic prescriptions and 44.8% of hypnotic prescriptions. Frequently registered inappropriate indications are aggression/agitation for anxiolytics (continuous: 75.7%; as-needed: 75.2%) and nighttime agitation for hypnotics (continuous: 40.3%; as-needed: 26.7%). None of the continuous prescriptions with appropriate indications were appropriate for all other items. For most of the prescriptions, duration and time to evaluation exceeded 4 weeks. CONCLUSION: BZRA use in nursing home residents with dementia is highly frequent. A large proportion of prescriptions do not follow the guidelines with regard to indication, exceed the recommended duration and are not evaluated in a timely manner. The discrepancy between evidence-based guidelines and daily practice calls for an exploration of factors maintaining inappropriate use

Feasibility, usability and clinical value of intensive longitudinal diary assessments in older persons with cognitive impairment and depressive symptoms

OBJECTIVES: To evaluate the feasibility, usability and clinical value of daily diary assessments combined with actigraphy in older persons with cognitive impairment.METHODS: For 63 days, patients ≥60 years with cognitive impairments filled out a daily diary (including standardized questionnaires and cognitive test battery), and wore an actiwatch (sleep). After the study, participants and clinicians received personal feedback about patterns and daily triggers of depressive symptoms, sleep and cognitive performance. We assessed feasibility (participation rate, compliance and subjective burden), usability (variability and floor- or ceiling effects) and clinical value for patients and their clinicians (questionnaires).RESULTS: Of 96 eligible patients, 13 agreed to participate (13.5%). One patient dropped out after 2 days, another after 37 days, and another did not complete the cognitive test battery. Compliance rate was high (6.7-10% missing values). Subjective burden was relatively low. Time-series data showed sufficient variability and no floor- or ceiling effects, except for one relevant ceiling effect on the One Back task. The personal feedback report was considered insightful by 4 out of 11 participants and 5 out of 7 clinicians.CONCLUSION: Daily assessments are suitable for a minority of cognitively impaired older persons, but is helpful to increase insight into their symptoms.</p

A longitudinal study of the impact of social network size and loneliness on cognitive performance in depressed older adults

Objectives: To examine the association of social network size and loneliness with cognitive performance and -decline in depressed older adults. Method: A sample of 378 older adults [70.7 (7.4) years] with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of current depressive disorder were recruited from primary care and specialized mental health care. Cognitive performance was assessed at baseline and 2 years follow-up with the Stroop colored-word test, a modified version of the Auditory Verbal Learning Task and the Digit Span subtest from the Wechsler Adult Intelligence Scale, encompassing four cognitive domains; processing speed, interference control, memory, and working memory. Social network size was assessed with the Close Person Inventory and loneliness with the de Jong Gierveld Loneliness Scale at baseline. Results: After adjusting for baseline working memory performance, loneliness was associated with impaired working memory after 2 years [B = −0.08 (−0.17 to 0.00)]. This association was no longer significant after adjusting for age, sex, education level, physical activity, alcohol use and depressive symptom severity [B = −0.07 (−0.16 to 0.03)]. A backward elimination procedure revealed education level to be the only covariable to explain this association. Loneliness was not associated with impairments or decline in other cognitive domains. Social network size was not associated with cognitive impairments or decline. Conclusion: Social network size and loneliness do not predict cognitive decline in depressed older adults

Multisystemic engagement & nephrology based educational intervention: A randomized controlled trial protocol on the kidney team at home-study

Background: Living donor kidney transplantation (LDKT) is the most successful form of renal replacement therapy in terms of wait time and survival rates. However, we observed a significant inequality in the number of LDKT performed between the Dutch and the non-Dutch patients. The objective of this study is to adapt, implement and test an educational home-based intervention to contribute to the reduction of this inequality. Our aim is to establish this through guided communication together with the social network of the patients in an attempt that well-informed decisions regarding renal replacement therapy can be made: Multisystemic Engagement & Nephrology. This manuscript is a detailed description of the Kidney Team At Home-study protocol. Methods and design. All patients (>18 yrs) that are referred to the pre-transplantation outpatient clinic are eligible to participate in the study. Patients will be randomly assigned to either an experimental or a control group. The control group will continue to receive standard care. The experimental group will receive standard care plus a home-based educational intervention. The intervention consists of two sessions at the patient's home, an initial session with the patient and a second session for which individuals from their social network are invited to take part. Based on the literature and behavioural change theories we hypothesize that reducing hurdles in knowledge, risk perception, subjective norm, self-efficacy, and communication contribute to well-informed decision making and reducing inequality in accessing LDKT programs. A change in these factors is consequently our primary outcome-measure. Based on power calculations, we aim to include 160 patients over a period of two years. Discussion. If we are able to show that this home-based group educational intervention contributes to 1) achieving well-informed decision regarding treatment and 2) reducing the inequality in LDKT, the quality of life of patients will be improved while healthcare costs are reduced. As the intervention is investigated in a random heterogeneous patient group in daily practice, the transfer to clinical practice in other kidney transplant centers should be relatively easy

Soundscape Optimization in Nursing Homes Through Raising Awareness in Nursing Staff With MoSART+

Introduction: Soundscapes in nursing homes are often suboptimal for residents. This can cause them feeling anxious and unsafe, or develop behavioral and psychological problems. Residents with dementia cannot adapt nursing home environments to their needs due to cognitive and physical limitations. It is up to the staff of psycho-geriatric wards to improve the soundscape. We evaluated the effect of the sound awareness intervention Mobile Soundscape Appraisal and Recording Technology (MoSART+) on soundscapes in nursing homes. Methods: The MoSART+ intervention was carried out in four nursing homes and took three months in each home. The MoSART+ intervention involved training ambassadors, assessing the soundscape with the MoSART application by the nursing staff to raise their sound awareness on random time points, discussing the measurements, and implementing micro-interventions. Soundscapes were assessed from 0 to 100 on four attributes: pleasantness, eventfulness, complexity, and range of affordances. Based on these scores, soundscapes were classified in four dimensions: calm, lively, boring, and chaotic. Nursing staff graded the environment on a scale of 0 to 10. T-test and Z-tests were used to analyze data. Results: Staff recorded 1882 measurements with the MoSART app. "People," "music, TV, and radio," and "machines and appliances" were the most prevalent sound sources before and after the implementation of micro-interventions. Post-implementation of micro-interventions, soundscapes were pleasant (median 69.0; IQR 54.0-81.0), of low complexity (33.0; 18.0-47.0), uneventful (27.0; 14.0-46.5), and gave moderate affordances (50.0; 35.0-67.0). Changes in attributes were statistically significant (p < 0.01). The proportion of the dimension calm increased (z = 12.7, p < 0.01), the proportion of chaotic decreased (z = 15.0, p < 0.01), and the proportion of lively decreased not statically significant (z = 0.68, p = 0.79). The proportion of boring was unchanged. The proportion of grades ≥6 increased after implementation of the micro-interventions (z = 15.3, p < 0.01). The micro-interventions focused on removing or reducing disturbing sounds and were unique for each nursing home. Discussion: The MoSART+ intervention resulted in a statistically significantly improvement of soundscapes, and more favorable evaluations of the nursing staff. The intervention empowered staff to adapt soundscapes. Nursing homes can improve soundscapes by raising sound awareness among staff. Trial Registration: Netherlands National Trial Register (NL6831)