Temporal variations of bicycle demand in the Netherlands: The influence of weather on cycling

The variability in bicycle demand depends strongly on weather. This paper describes a ‘weather’ model that makes demand forecasting possible. The model is based on flow time-series of many years, collected at 16 cycle paths in the Dutch cities of Gouda and Ede. The model is bi-level. The lower level describes how cyclists value the weather. The upper level is the relation between demand and this weather value. The observations show that most cyclists value the weather in a similar way, but recreational demand is much more sensitive to weather than utilitarian demand. Most fluctuations are described by the model, but a significant fraction is still not covered. From a correlation analysis of the residuals, we conclude that about 70% of the remaining variation is locally constrained, and can therefore not be described by a generic model. However, about 30% of this variation is not driven by local effects. The cause of this variation is not yet known. Besides uncovering trends in cycling, the model can also be employed to evaluate the effect of cycling policy interventions, and to correct flow measurements as input in traffic models

Management of heart failure in the Netherlands

In The Netherlands, the incidence and prevalence of heart failure are rising as is the case in most other European countries. Overall, there are 200,000 patients with heart failure in The Netherlands and around 25,000 hospitalisations annually with a discharge diagnosis of heart failure. Most of these patients are managed in primary care, often together with a cardiologist.There is an active guideline program in different professional organisations (e.g. general practitioners, cardiologists) and in 2002 a collaborative multidisciplinary guideline for management of chronic heart failure was developed. However, there is clearly room for improvement in the adherence to these guidelines both with regard to the diagnosis and the treatment of HF patients. For example, ACE-I and beta-blockers are still under-prescribed. In particular, the more severely ill patients seem to be under treated. At present, general practitioners and cardiologists differ in their views on heart failure, resulting in differences in diagnosis and management. In addition to the multidisciplinary guidelines, several other initiatives have been developed to improve outcomes in these patients, such as rapid access clinics and outpatient heart failure clinics. (C) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.</p

De Bergsche Maasveren anno 2001. Maatschappelijke betekenis en effecten van door Rijkswaterstaat voorgestelde maatregelen

Eind negentiende eeuw is in het Noorden van de provincie Noord-Brabant ten behoeve van een betere waterafvoer de Bergsche Maas gegraven. Omdat hierdoor het Land van Heusden en Altena in tweeën werd gesplitst, heeft Rijkswaterstaat ter compensatie van de nadelen een aantal veerponten in de vaart gebracht. Later zijn ook twee bruggen aangelegd. Rijkswaterstaat (directie Noord-Brabant) wil nu in het kader van bezuinigingen de pontveren afstoten. De Vereniging De Bergse Maasveren heeft aan de Wetenschapswinkel van Wageningen UR gevraagd om een onderzoek te bemiddelen dat inzicht verschaft in de maatschappelijke betekenis van de Bergsche Maasveren en mogelijke verkeerskundige, economische, duurzaamheids- en leefbaarheidseffecten van de voorgestelde maatregelen. De Vereniging De Bergse Maasveren wil het onderzoek gebruiken om bezwaren tegen het besluit van Rijkswaterstaat te onderbouwen. Het onderzoek wordt als afstudeerstudie verricht bij de Leerstoelgroep Landgebruiksplanning van Wageningen Universiteit

Health-related quality of life and anemia in hospitalized patients with heart failure

AbstractBackgroundAnemia is a serious and highly prevalent co-morbidity in chronic heart failure (HF) patients. Its influence on health-related quality of life (HR-QoL) has rarely been studied, and no data is available regarding the role it plays in hospitalized HF patients.MethodsBaseline data from the COACH study (Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure) were used. HR-QoL was assessed by means of generic and disease-specific questionnaires. Analyses were performed using ANOVA and ANCOVA, with covariates of age, gender, eGFR, diabetes, and NYHA class.ResultsIn total, 1013 hospitalized patients with a mean age of 71 (SD 11) years were included; 70% of these patients had no anemia (n=712), 14% had mild anemia (n=141), and 16% had moderate-to-severe anemia (n=160). Independent associations were found between anemia and physical functioning (p=0.019), anemia and role limitations due to physical functioning (p=0.002), anemia and general health (p=0.024), and anemia and global well-being (p=0.003).ConclusionIn addition to the burden of HF itself, anemia is an important factor which influences HR-QoL in hospitalized HF patients, and one that is most pronounced in the domain related to physical functioning and general health

Patient and professional factors that impact the perceived likelihood and confidence of healthcare professionals to discuss Implantable Cardioverter Defibrillator deactivation in advanced heart failure: Results from an international factorial survey

Background: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. Aim: The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation. Methods and Results: Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making. Conclusions: Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.Funding Agencies|HFA Nurse Fellowship training grant; Public Health Agency NI (Research &amp; Development Division)</p

Duurzame mobiliteit en vrijetijdsverkeer in het metropolitane buitengebied: paradox of realiseerbaar? Op weg naar een onderzoeksagenda

Met het verder verstedelijken van ons land vervagen de traditionele grenzen tussen stad en land. Door deze ontwikkeling naar een metropolitaan landschap wordt de open ruimte tussen grote steden, het metropolitane buitengebied, steeds belangrijker voor de stedeling als ruimte om zich te bewegen en te ontspannen. Echter, de bereikbaarheid en de aantrekkelijkheid van dit landschap staat damee onder druk. Uiteindelijk komt de stedeling (met het bereiken van deze gebieden en de benodigde infrastructuur) in conflict met zijn eigen wense

To guide or to follow? Teaching visual problem solving at the workplace

Visual problem solving is essential to highly visual and knowledge-intensive professional domains such as clinical pathology, which trainees learn by participating in relevant tasks at the workplace (apprenticeship). Proper guidance of the visual problem solving of apprentices by the master is necessary. Interaction and adaptation to the expertise level of the learner are identified as key ingredients of this guidance. This study focuses on the effect of increased participation of the learner in the task on the interaction and adaptation of the guidance by masters. Thirteen unique dyads consisting of a clinical pathologist (master) and a resident (apprentice) discussed and diagnosed six microscope images. Their dialogues were analysed on their content. The dyads were divided in two groups according to the experience of the apprentice. For each dyad, master and apprentice both operated the microscope for half of the cases. Interaction was operationalised as the equal contribution of both master and apprentice to the dialogue. Adaptation was operationalised as the extent to which the content of the dialogues was adapted to the apprentice’s level. The main hypothesis stated that the interaction and adaptation increase when apprentices operate the microscope. Most results confirmed this hypothesis: apprentices contributed more content when participating more and the content of these dialogues better reflected expertise differences of apprentices. Based on these results, it is argued that, for learning visual problem solving in a visual and knowledge-intensive domain, it is not only important to externalise master performance, but also that of the apprentice