All aboard? A decision-making instrument for the future of the Brussels North-South railway connection

Administrative complexity is a major challenge in the planning of large-scale projects in Brussels. For want of an overarching authority, multiple actors with different functions or powers have to make and implement a concerted decision. The COMCA method is used to determine the support for multi-actor, multi-level projects and thus to assist policy makers in their decisions. The various players are classified according to their role in the project. Project alternatives are assessed on criteria established by each of the actors. The desirability of each alternative is evaluated for each actor, but also for every group of actors responsible for a specific task in the project. This article describes how the method was applied as a participatory component in a study on infrastructural alternatives for the Brussels North-South rail link. Variants allowing for new rail links appear to be more promising for further study than the frequently examined doubling variants of the current North-South axis. However, the purpose of the application at this stage is not to offer a final solution, but to design an evaluation and consultation structure that provides input for the political decision-making process.Dans le cadre de la planification de grands projets à Bruxelles, la complexité administrative représente un grand défi. En l’absence d’une autorité centrale, plusieurs acteurs aux fonctions et compétences différentes doivent prendre et exécuter une décision. La méthode COMCA permet de déterminer la portée de projets impliquant plusieurs acteurs et plusieurs niveaux et de soutenir ainsi les décideurs dans leur prise de position. Les différents acteurs sont répartis sur base de leur rôle dans le projet. Les divers aspects d’un projet sont testés selon les critères présentés par chacun des acteurs. Ainsi, l’opportunité de chaque aspect est évaluée pour chaque acteur, mais aussi pour chaque groupe d’acteurs, responsable d‘une tâche déterminée du projet. L’article décrit l’application de la méthode en tant que volet participatif d’une étude de solutions d’infrastructure pour la jonction ferroviaire Nord-Midi de Bruxelles. Ce ne sont pas tant les variantes, longuement examinées, de doublement de l’actuel axe nord-midi, mais plutôt celles qui rendent possibles de nouvelles liaisons ferroviaires qui paraissent prometteuses pour une prochaine étude. Le but de l’application, dans cette phase, n’est cependant pas d’offrir une solution définitive, mais de donner forme à une structure d’évaluation et de concertation susceptible d’amorcer le processus politique de prise de décision.De bestuurlijke complexiteit vormt een grote uitdaging voor grootschalige projecten in Brussel. Bij gebrek aan een overkoepelende autoriteit moeten meerdere actoren met uiteenlopende bevoegdheden gezamenlijk een beslissing maken en uitvoeren. De hier besproken methode beoogt het draagvlak te bepalen voor dergelijke multi-actor, multi-level-projecten. De verschillende actoren worden ingedeeld op basis van hun rol. Projectalternatieven worden getoetst op criteria die door elk van de actoren worden aangedragen. Hiermee wordt de wenselijkheid van elk alternatief ingeschat voor iedere actor, maar ook voor iedere groep actoren die verantwoordelijk is voor een bepaalde taak. De methode werd toegepast als participatief luik binnen een studie naar infrastructuur-alternatieven voor de Brusselse Noord-Zuid-spoorverbinding. Niet zozeer de veel-onderzochte verdubbelingsvarianten van de huidige noord-zuidas, maar vooral de varianten die nieuwe spoorverbindingen mogelijk maken lijken veelbelovend voor verdere studie. De studie streeft in deze fase niet naar een definitieve oplossing, maar een gemeenschappelijke basis voor het politieke besluitvormingsproces

Iedereen aan boord? Een besluitvormingsondersteunend instrument voor de Brusselse Noord-Zuid spoorverbinding

De bestuurlijke complexiteit vormt een grote uitdaging voor grootschalige projecten in Brussel. Bij gebrek aan een overkoepelende autoriteit moeten meerdere actoren met uiteenlopende bevoegdheden gezamenlijk een beslissing maken en uitvoeren. De hier besproken methode beoogt het draagvlak te bepalen voor dergelijke multi-actor, multi-level-projecten. De verschillende actoren worden ingedeeld op basis van hun rol.Projectalternatieven worden getoetst op criteria die door elk van de actoren worden aangedragen. Hiermee wordt de wenselijkheid van elk alternatief ingeschat voor iedere actor, maar ook voor iedere groep actoren die verantwoordelijk is voor een bepaalde taak. De methode werd toegepast als participatief luik binnen een studie naar infrastructuur-alternatieven voor de Brusselse Noord-Zuid-spoorverbinding. Niet zozeer de veel-onderzochte verdubbelingsvarianten van de huidige noord-zuidas, maar vooral de varianten die nieuwe spoorverbindingen mogelijk maken lijken veelbelovend voor verdere studie. De studie streeft in deze fase niet naar een definitieve oplossing, maar een gemeenschappelijke basis voor het politieke besluitvormingsproces.Dans le cadre de la planification de grands projets à Bruxelles, la complexité administrative représente un grand défi. En l’absence d’une autorité centrale, plusieurs acteurs aux fonctions et compétences différentes doivent prendre et exécuter une décision. La méthode COMCA permet de déterminer la portée de projets impliquant plusieurs acteurs et plusieurs niveaux et de soutenir ainsi les décideurs dans leur prise de position. Les différents acteurs sont répartis sur base de leur rôle dans le projet. Les divers aspects d’un projet sont testés selon les critères présentés par chacun des acteurs. Ainsi, l’opportunité de chaque aspect est évaluée pour chaque acteur, mais aussi pour chaque groupe d’acteurs, responsable d’une tâche déterminée du projet. L’article décrit l’application de la méthode en tant que volet participatif d’une étude de solutions d’infrastructure pour la jonction ferroviaire Nord-Midi de Bruxelles. Ce ne sont pas tant les variantes, longuement examinées, de doublement de l’actuel axe nord-midi, mais plutôt celles qui rendent possibles de nouvelles liaisons ferroviaires qui paraissent prometteuses pour une prochaine étude. Le but de l’application, dans cette phase, n’est cependant pas d’offrir une solution définitive, mais de donner forme à une structure d’évaluation et de concertation susceptible d’amorcer le processus politique de prise de décision.Administrative complexity is a major challenge in the planning of large-scale projects in Brussels. For want of an overarching authority, multiple actors with different functions or powers have to make and implement a concerted decision. The COMCA method is used to determine the support for multi-actor, multi-level projects and thus to assist policy makers in their decisions. The various players are classified according to their role in the project. Project alternatives are assessed on criteria established by each of the actors. The desirability of each alternative is evaluated for each actor, but also for every group of actors responsible for a specific task in the project. This article describes how the method was applied as a participatory component in a study on infrastructural alternatives for the Brussels North-South rail link. Variants allowing for new rail links appear to be more promising for further study than the frequently examined doubling variants of the current North-South axis. However, the purpose of the application at this stage is not to offer a final solution, but to design an evaluation and consultation structure that provides input for the political decision-making process

Low temperature adaption of wheat post head-emergence in northern Australia

OBJECTIVE: More than 50% of patients with cancer experience pain. Patient empowerment has been highlighted as central to success in pain management. Up to now, no clear model for this patient group exists, yet several strategies to empower patients have been used in clinical practice. This review examines how empowerment or related concepts have been described in relation to pain management in patients with cancer. With the help of a conceptual model, recommendations for clinical practice are provided. METHODS: An integrative review was conducted, using the databases PubMed, CINAHL and PsycINFO. We evaluated papers discussing empowerment or related concepts in relation to pain management in patients with cancer. We analyzed the term 'empowerment' semantically. RESULTS: From a total of 5984 identified papers, 34 were included for analysis. Empowerment has been described with the concepts self-efficacy, active patient participation, increasing abilities, and control of life. Most papers focus on pain treatment induced by the professional caregiver or on the active involvement of the patient, and not on the combination of both. The following elements of empowerment could be discriminated: role of the patient, role of the professional, resources, self-efficacy, active coping, and shared decision making. CONCLUSIONS: On the basis of these findings, we propose a conceptual model to empower patients in controlling cancer pain. We recommend focusing on pain treatment given by the professional, on the active involvement of the patient, and on the interaction of both. Our model might also be useful for other patient groups or specific contexts, especially in symptom management. Copyright (c) 2014 John Wiley & Sons, Ltd

A transition perspective on Energy Communities: A systematic literature review and research agenda

The advantages of Energy Communities (ECs) range from giving energy end-consumers an active role in the energy market to the increase of renewable energy sources and increased efficiency. Yet, the emergence of ECs is not taking place across countries and regions at the same scale or speed. Reasons for this were studied but remain fragmented, as a comprehensive overview of these studies is missing. This study aims to identify the studied factors for the emergence of ECs. We used the Multi-Level Perspective as a framework to structure EC literature. Therefore, a systematic literature review was conducted to identify the gaps. The review consists of a 1) bibliometric analysis, 2) content analysis, 3) geographic analysis. Building on this overview, the authors highlight the current research gap and propose potential pathways for future research to facilitate the diffusion of ECs. It was found that although ECs are studied context-specific, generic factors have contributed to the emergence of ECs independently from their location, such as appropriate policy schemes and support for practitioners. Factors, such as the geographies of the transition, and cognitive-cultural factors remain less studied

Voitures de société et mobilité durable. Diagnostic et enjeux

La voiture de société est, sans aucun doute, un des avantages de toute nature (ATN) les plus fréquemment proposés par les entreprises à leurs employés. Combien compte-t-on de voitures de société en Belgique ? Quels sont les profils des usagers ? Et quels sont les impacts sociétaux, environnementaux et économiques de cet « avantage »

Automated telephone communication systems for preventive healthcare and management of long-term conditions

Background Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients using either their telephone’s touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention. Objectives To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes. Search methods We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL; Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses, Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between 1980 and June 2015. Selection criteria Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any preventive healthcare or long term condition management role were eligible. Data collection and analysis We used standard Cochrane methods to select and extract data and to appraise eligible studies. Main results We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome reporting to be unclear. For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR) 1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR 1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI 0.53 to 9.02; 2 studies, N = 1743; very low certainty). For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462; high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care. It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36, 95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR (RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening. Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions (25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS, compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage) related to adherence, but only a small number of studies contributed clinical outcome data. The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS varied, including by the type of ATCS intervention in use. Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity, weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure, hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/ substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia, obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers. Only four trials (3%) reported adverse events, and it was unclear whether these were related to the intervention

Patient empowerment by interactive cancer pain management. Bridging the gap between patient and caregiver

Contains fulltext : 145299.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 23 november 2015Promotores : Vernooij-Dassen, M.J.F.J., Vissers, K.C.P. Co-promotor : Engels, Y.M.P