The Additional value of microcirculatory imaging in critically ill patients

Abstract Hemodynamic monitoring is essential in the care of every critically ill patient. One of the main goals of hemodynamic support is to preserve tissue perfusion. It is however known that tissue perfusion is more related to microcirculatory perfusion than systemic hemodynamic perfusion. Monitoring of the microcirculation has long been difficult. Due to the recen

Public Private Partnerships: deciphering meaning message and phenomenon

__Abstract__ There is no doubt that Public private partnerships have been a dominant issue in governmental rhetoric’s but also in governmental practice. In many countries governments have turned to the idea of public private partnerships, or partnerships in general, as a vehicle to realize better policy outcomes, or to enhance investments in fields like infrastructure health or even social policy. However at the same time the concept and the idea of PPP has been a contested concept (see Hodge and Greve, 2005, Weihe, 2008). Even is we roughly define Public private partnership (PPP) as a “more or less sustainable cooperation between public and private actors in which joint products and/or services are developed and in which risks, costs and profits are shared” (Klijn and Teisman, 2003) we can still find many different forms under this heading. So PPP’s have been given many meanings, been used it quite a number of ways and we see many different manifestations. Now this is all very normal for many ideas and terms used both in the world of practice and in the world of science but in this case the confusion seems to even bigger than usual. In general we can find confusion on at least three areas, which of course are also connected to each other: - Confusion about the meaning of public private partnerships; not only do we find many different definitions but also many different appraisals and emotions. - Confusion about the argumentations and rationality of public private partnerships; there is a lot of discussion what precisely PPP’s should or could achieve (better value for money, more investments, innovations etc.) and these argumentations not seldom seems to be contradictory; - Confusion about what preferable or best form public private partnerships should have; both in the scientific literature and in the many policy documents that want to promote PPP we can find a wide variety of forms that are being seen as the best or the most workable form to cast the cooperation in. In this chapter we will elaborate on each of these confusions

Democratic legitimacy criteria in interactive governance and their empirical application

__Introduction:__ Governance and Democracy Whatever ‘governance’ is, it is certainly aimed at involving stakeholders. The literature gives various reasons for the necessity of involving stakeholders and thus why (interactive) governance can be more effective than more classical forms of steering. In general, they fall into three categories (see for instance Kooiman 1993; Kickert et al. 1997; Pierre 2000; Sorensen and Torfing 2007): 1. stakeholders have to be involved because governments are dependent on their resources (‘veto power’ argument); 2. stakeholders are involved because they have specific knowledge and can enhance the quality of the problem definition or even more so the quality and innovative character of the solutions (‘quality’ argument); 3. stakeholders have to be involved to enhance the democratic quality of decision-making in modern network societies (‘democratic legitimacy’ argument

It's the management, stupid! Over het belang van management bij complexe beleidsvraagstukken

De laatste jaren zien we steeds vaker politici vertellen dat we daadkracht nodig hebben en dat er nu eindelijk eens besluiten genomen moeten worden. Geluiden die gretig opgepikt worden door de media. Men zou zelfs met recht kunnen beweren dat de media zelf actief aan deze beeldvorming meedoen. Zo ontstaat wat inmiddels door verschillende commentatoren en wetenschappers is betiteld als een dramademocratie. Een democratie waarin politiek is gepersonifieerd en theater is geworden. Krachtige beelden en het regisseren van de voorstelling zijn voor politici belangrijker geworden dan de uitvoering van beleid. Deze dramademocratie staat echter op gespannen voet met de werkelijkheid van alledag, waarin complexe beleidsproblemen, zoals het herstructureren van een woonwijk, het realiseren van waterberging of het bevorderen van de kwaliteit van onderwijs, moeten worden opgelost. In die werkelijkheid willen betrokken partijen vaak andere dingen en zijn het niet eens over de aard van het probleem. Weten we ook vaak niet wat de goede oplossing is aan het begin van het proces en is kennis van het netwerk van partijen waarin de besluitvorming plaatsvindt, en van de uitvoeringsrealiteit onontbeerlijk. Cruciaal voor het vinden van goede maatschappelijke uitkomsten is het zorgvuldig managen van deze processen en het verzorgen van uiteenlopende vormen van democratische verankering. Dit vereist het betrekken van uiteenlopende partijen en een zekere toewijding voor het proces in plaats van krachtige, eenzijdige, politieke interventies. Professor dr. Erik-Hans Klijn is hoogleraar bestuurskunde bij de opleiding Bestuurskunde (Faculteit der Sociale Wetenschappen) van de Erasmus Universiteit Rotterdam

Leven met onzekerheid: Besluitvorming over duurzame stedelijke ontwikkeling

Cahier Reeks duurzame stedelijke vernieuwin

Application of ultraviolet, visible, and infrared light imaging in protein-based biopharmaceutical formulation characterization and development studies

Imaging is increasingly more utilized as analytical technology in biopharmaceutical formulation research, with applications ranging from subvisible particle characterization to thermal stability screening and residual moisture analysis. This review offers a comprehensive overview of analytical imaging for scientists active in biopharmaceutical formulation research and development, where it presents the unique information provided by the ultraviolet (UV), visible (Vis), and infrared (IR) sections in the electromagnetic spectrum. The main body of this review consists of an outline of UV, Vis, and IR imaging techniques for several (bio)physical properties that are commonly determined during protein-based biopharmaceutical formulation characterization and development studies. The review concludes with a future perspective of applied imaging within the field of biopharmaceutical formulation research

Influence of image analysis strategy, cooling rate, and sample volume on apparent protein cloud-point temperature determination

The protein cloud-point temperature (T$_{Cloud}$) is a known representative of protein–protein interaction strength and provides valuable information during the development and characterization of protein-based products, such as biopharmaceutics. A high-throughput low volume T$_{Cloud}$ detection method was introduced in preceding work, where it was concluded that the extracted value is an apparent T$_{Cloud}$ (T$_{Cloud,app}$). As an understanding of the apparent nature is imperative to facilitate inter-study data comparability, the current work was performed to systematically evaluate the influence of 3 image analysis strategies and 2 experimental parameters (sample volume and cooling rate) on T$_{Cloud,app}$ detection of lysozyme. Different image analysis strategies showed that T$_{Cloud,app}$ is detectable by means of total pixel intensity difference and the total number of white pixels, but the latter is also able to extract the ice nucleation temperature. Experimental parameter variation showed a T$_{Cloud,app}$ depression for increasing cooling rates (0.1–0.5 °C/min), and larger sample volumes (5–24 μL). Exploratory thermographic data indicated this resulted from a temperature discrepancy between the measured temperature by the cryogenic device and the actual sample temperature. Literature validation confirmed that the discrepancy does not affect the relative inter-study comparability of the samples, regardless of the image analysis strategy or experimental parameters. Additionally, high measurement precision was demonstrated, as T$_{Cloud,app}$ changes were detectable down to a sample volume of only 5 μL and for 0.1 °C/min cooling rate increments. This work explains the apparent nature of the T$_{Cloud}$ detection method, showcases its detection precision, and broadens the applicability of the experimental setup

The impact of contract characteristics on the performance of public–private partnerships (PPPs)

Four significant features of public–private partnership (PPP) contracts are analysed to understand their impact on performance. These are whether the contract allows sanctions to be imposed; its complexity; its flexibility; and whether renegotiation is possible. The effects of these characteristics were investigated by surveying participants in all of the PPP projects in The Netherlands. The only feature considered to have any significant impact on perceived performance was the possibility of imposing sanctions. The authors’ findings cast doubt on earlier research into managing PPP performance and suggest that researchers, governments and the private sector need to look beyond contract terms to prop

Institutional Design

Within public administration and policy sciences the concept of policy networks nowadays is well accepted. Not much attention has been paid so far to strategies aimed at institutional design. Therefore, in this article, we develop a conceptual framework to study institutional design more thoroughly. We do this by specifying the nature and variety of institutional rules that guide the behaviour of actors within networks. Given this categorization of rules, we identify possible strategies to change network rules. Next, we focus on the strategic context of attempts to influence the nature of instit

Partnership Arrangements: Governmental Rhetoric or Governance Scheme?

It has become popular to advocate partnership arrangements. Such partnerships may be seen as new forms of governance, which fit in with the imminent network society. However, the idea of partnership is often introduced without much reflection on the need to reorganize policy-making processes and to adjust existing institutional structures. In this contribution, we discuss the ambiguity of partnerships. An empirical basis is provided by means of an analysis of the policy making on the expansion of the Rotterdam harbor. This case indicates that although new governance schemes are being proposed and explored, they still have to comply with the existing procedures in which they are imbedded. Governments especially are not prepared to adjust to governance arrangements. Policy making continues to be based on selfreferential organizational decisions, rather than on joint interorganizational policy making. This raises questions about the added value of intended cooperative governance processes