Search

De Utrechtse Heuvelrug is een rijke bron van een grote hoeveelheid, helder en schoon water. Regen infiltreert in de zandige bodems boven op de Heuvelrug en komt in de lagergelegen flanken als kwel weer naar boven. Het water van de Heuvelrug dient vele functies. Al in de 17e eeuw werd het water gebruikt voor het vullen van de vijvers en grachten van buitenplaatsen en landgoederen. In de vennen, poelen en natte graslanden vormt kwel een onmisbare bron voor zeldzame planten, amfibieën en insecten. De Heuvelrug levert jaarlijks miljarden liters drinkwater van de hoogste kwaliteit. En water speelt een belangrijke rol voor de landbouw op de Heuvelrugflanken. Door de huidige knelpunten in combinatie met voortgaande klimaatverandering zijn er verschillende urgente uitdagingen voor het watersysteem van de Heuvelrug. Ook vanuit een actuele visie op circulariteit, integraliteit en duurzaamheid is er aanleiding om de huidige situatie opnieuw te beschouwen.

Objectives: On May 11, the Dutch Government allowed 26 nursing homes to welcome 1 visitor per resident, after 2 months of lockdown. The study aimed to monitor in-depth the feasibility of the regulations and their impact on the well-being of residents, their visitors, and healthcare staff. Design: Mixed-methods study in 5 of the 26 facilities; the facilities were affiliated to an academic network of nursing homes. Participants: Visitors and healthcare professionals. Intervention: Allowing visitors using local regulations based on national guidelines. Measurements: Digital questionnaire, analyzing documentation such as infection prevention control protocols, attending meetings of COVID-19 crisis teams, in-depth telephone or in-person interviews with visitors and healthcare professionals, and on-site observations. Results: National guidelines were translated with great variety into local care practice. Healthcare professionals agreed that reopening would increase the well-being of the residents and their loved ones. However, there were also great worries for increasing workload, increasing the risk of emotional exhaustion, and the risk of COVID-19 infections. Compliance with local regulations was generally satisfactory, but maintaining social distance and correctly wearing face masks appeared to be difficult. Care staff remained ambivalent for fear of infections. In general, allowing visitors was experienced as having a positive impact on the well-being of all stakeholders. Nevertheless, some residents with dementia showed negative effects. Conclusion: The complete lockdown of Dutch nursing homes had a substantial impact on the well-being of the residents. The reopening was welcomed by all stakeholders, but provided a high organizational workload as well as feelings of ambivalence among care staff. In the second wave, a more tailored approach is being implemented. However, facilities are

Background: Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship.Objectives: To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents. Design: A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities. Setting: Long-term residential care facilitiesParticipants: Long-term care facility staff, residents, and relatives Methods: The realist review, (i) was co-developed with stakeholders to determine initial programme the-ories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) vali-dated and refined emergent theory with stakeholder groups.Results: 66 research papers were included in the review. Three key findings explain the relationship be-tween staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an im-portant influence on how organisational resources (sufficient staff effectively deployed, with the knowl-edge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings.Conclusion: Leaders (at all levels) through their role-modelling behaviours can use organisational re-sources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.Crown Copyright (c) 2021 Published by Elsevier Ltd. All rights reserved.

Background: Little is known about how the workforce influences quality in long term care facilities for older people. Staff numbers are important but do not fully explain this relationship.Objectives: To develop theoretical explanations for the relationship between long-term care facility staffing and quality of care as experienced by residents. Design: A realist evidence synthesis to understand staff behaviours that promote quality of care for older people living in long-term care facilities. Setting: Long-term residential care facilitiesParticipants: Long-term care facility staff, residents, and relatives Methods: The realist review, (i) was co-developed with stakeholders to determine initial programme the-ories, (ii) systematically searched the evidence to test and develop theoretical propositions, and (iii) vali-dated and refined emergent theory with stakeholder groups.Results: 66 research papers were included in the review. Three key findings explain the relationship be-tween staffing and quality: (i) quality is influenced by staff behaviours; (ii) behaviours are contingent on relationships nurtured by long-term care facility environment and culture; and (iii) leadership has an im-portant influence on how organisational resources (sufficient staff effectively deployed, with the knowl-edge, expertise and skills required to meet residents' needs) are used to generate and sustain quality-promoting relationships. Six theoretical propositions explain these findings.Conclusion: Leaders (at all levels) through their role-modelling behaviours can use organisational re-sources to endorse and encourage relationships (at all levels) between staff, residents, co-workers and family (relationship centred care) that constitute learning opportunities for staff, and encourage quality as experienced by residents and families.Crown Copyright (c) 2021 Published by Elsevier Ltd. All rights reserved.

Aim: The aim of this study was to develop a decision support tool for nurses to facilitate aging in place of people with dementia and to test its usability. Background: Nurses play an important role in detecting practical problems preventing persons with dementia (PwD) from aging in place and advising them on possible solutions. These are complex and challenging tasks for nurses. Methods: A mixed methods study was conducted. The content development of the App comprised a literature and intemet search, and individual and group interviews with professionals (n = 8) and researchers (n = 5). The technical development was an iterative process in which usability was tested by the project team (n = 4), experts (n = 6), and end-users (n = 9), using heuristic evaluation, a think-aloud approach, and a questionnaire (PSSUQ). Results: The App contains a structured problem assessment for three problem domains-self-reliance, safety, and informal care-based on validated questionnaires and self-formulated questions. The problem assessment is linked to an overview of possible solutions for the problems detected. Three prototypes have been developed. The users of the third prototype were overall satisfied with the App as they scored on average 1.7 on the PSSUQ (range 1-7 and lower scores indicating higher satisfaction). Conclusions: A user-friendly prototype of the decision support App is now available. Users indicated to be very willing to use to App in daily practice. However, besides further technical development, implementation of the App into practice requires evidence supporting its efficacy, feasibility and effectiveness.

Aim: The aim of this study was to develop a decision support tool for nurses to facilitate aging in place of people with dementia and to test its usability. Background: Nurses play an important role in detecting practical problems preventing persons with dementia (PwD) from aging in place and advising them on possible solutions. These are complex and challenging tasks for nurses. Methods: A mixed methods study was conducted. The content development of the App comprised a literature and intemet search, and individual and group interviews with professionals (n = 8) and researchers (n = 5). The technical development was an iterative process in which usability was tested by the project team (n = 4), experts (n = 6), and end-users (n = 9), using heuristic evaluation, a think-aloud approach, and a questionnaire (PSSUQ). Results: The App contains a structured problem assessment for three problem domains-self-reliance, safety, and informal care-based on validated questionnaires and self-formulated questions. The problem assessment is linked to an overview of possible solutions for the problems detected. Three prototypes have been developed. The users of the third prototype were overall satisfied with the App as they scored on average 1.7 on the PSSUQ (range 1-7 and lower scores indicating higher satisfaction). Conclusions: A user-friendly prototype of the decision support App is now available. Users indicated to be very willing to use to App in daily practice. However, besides further technical development, implementation of the App into practice requires evidence supporting its efficacy, feasibility and effectiveness.

Introduction: Heart failure (HF) is highly prevalent in nursing home residents. To diagnose HF properly, echocardiography is recommended by cardiology guidelines. In nursing homes, the nursing home physician (NHP) usually diagnoses HF based on history, clinical examination, electrocardiography (ECG) and levels of B-type natriuretic peptide only, which is in contrast to the cardiologist who probably always will apply for an echocardiogram. Therefore, we aimed (1) to investigate the agreement on the diagnosis of HF made by the NHP without echocardiography and (2) to determine the clinical characteristics that may contribute to the proper diagnosis of HF in nursing home residents.Materials and methods: The study followed a cross-sectional design. Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care, were included in the study. The NHP decided (stepwise) on the diagnosis of HF; first after anamnesis and physical examination, second after additional information on NTproBNP and ECG, and finally, on all available information, except echocardiography. An expert team consisting of two cardiologists and one hospital geriatrician decided on the final diagnosis, based on all available information.Results and conclusion: There was an overall agreement on both correctly identifying residents with HF and correctly excluding HF of 80.4% (kappa 0.57). Characteristics with a high contribution in predicting HF were a history of HF, a high NT-proBNP level, the presence of rales, arrhythmias and use of cardiac medication. NHPs are fairly capable of diagnosing HF in nursing home residents without echocardiography. (c) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

Introduction: Heart failure (HF) is highly prevalent in nursing home residents. To diagnose HF properly, echocardiography is recommended by cardiology guidelines. In nursing homes, the nursing home physician (NHP) usually diagnoses HF based on history, clinical examination, electrocardiography (ECG) and levels of B-type natriuretic peptide only, which is in contrast to the cardiologist who probably always will apply for an echocardiogram. Therefore, we aimed (1) to investigate the agreement on the diagnosis of HF made by the NHP without echocardiography and (2) to determine the clinical characteristics that may contribute to the proper diagnosis of HF in nursing home residents.Materials and methods: The study followed a cross-sectional design. Nursing home residents in the southern part of the Netherlands, aged over 65 years and receiving long-term somatic or psychogeriatric care, were included in the study. The NHP decided (stepwise) on the diagnosis of HF; first after anamnesis and physical examination, second after additional information on NTproBNP and ECG, and finally, on all available information, except echocardiography. An expert team consisting of two cardiologists and one hospital geriatrician decided on the final diagnosis, based on all available information.Results and conclusion: There was an overall agreement on both correctly identifying residents with HF and correctly excluding HF of 80.4% (kappa 0.57). Characteristics with a high contribution in predicting HF were a history of HF, a high NT-proBNP level, the presence of rales, arrhythmias and use of cardiac medication. NHPs are fairly capable of diagnosing HF in nursing home residents without echocardiography. (c) 2016 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.

The process of development occurs according to the pattern established by the genetic potential but is also influenced by environmental factors. These environments provide important possibilities for undertaking action (`affordances'), which are supplied from objects, events or places in the environment. Since young children spend the majority of their time at home, the affordances in the home environment are crucial for motor development. There has been minimal research examining the relationship between motor development and the affordances in the home environment. The presence of toys provides an important possibility for undertaking action. Siblings could also have an important influence in reaching motor milestones. However, the literature study showed no consensus about the influence of the presence of siblings and also the influence of the number of siblings on early motor development. Therefore the present study was designed tot investigate whether the two distinguished affordances ‘availability of toys’ and ‘presence of siblings’ can be seen as predictors in ages of achievement of the motor milestones sitting, independent standing and self locomotion by children from 9 up to 20 months of age. The influence of the amount of siblings was also examined. Regression analyses was used to investigate to what extent the ‘availability of toys’ and the ‘presence of siblings’ can predict the age of achievement of the distinguished motor milestones. The results of the regression analyses showed that the ‘availability of toys’ and the ‘presence of siblings’ can not be seen as precursors of the age on which the motor milestones are reached. Follow-up studies are necessary to further clarify to what extent the factors ‘presence of siblings’ and the ‘availability of toys'’ predict the age on which the motor milestones are reached. Samenvatting De ontwikkeling van kinderen is enerzijds toe te schrijven aan genetische factoren, anderzijds hebben omgevingsfactoren ee

The process of development occurs according to the pattern established by the genetic potential but is also influenced by environmental factors. These environments provide important possibilities for undertaking action (`affordances'), which are supplied from objects, events or places in the environment. Since young children spend the majority of their time at home, the affordances in the home environment are crucial for motor development. There has been minimal research examining the relationship between motor development and the affordances in the home environment. The presence of toys provides an important possibility for undertaking action. Siblings could also have an important influence in reaching motor milestones. However, the literature study showed no consensus about the influence of the presence of siblings and also the influence of the number of siblings on early motor development. Therefore the present study was designed tot investigate whether the two distinguished affordances ‘availability of toys’ and ‘presence of siblings’ can be seen as predictors in ages of achievement of the motor milestones sitting, independent standing and self locomotion by children from 9 up to 20 months of age. The influence of the amount of siblings was also examined. Regression analyses was used to investigate to what extent the ‘availability of toys’ and the ‘presence of siblings’ can predict the age of achievement of the distinguished motor milestones. The results of the regression analyses showed that the ‘availability of toys’ and the ‘presence of siblings’ can not be seen as precursors of the age on which the motor milestones are reached. Follow-up studies are necessary to further clarify to what extent the factors ‘presence of siblings’ and the ‘availability of toys'’ predict the age on which the motor milestones are reached. Samenvatting De ontwikkeling van kinderen is enerzijds toe te schrijven aan genetische factoren, anderzijds hebben omgevingsfactoren ee

The process of development occurs according to a pattern established by the genetic potential but is also influenced by environmental factors. The environment provides important possibilities for undertaking action (‘affordances’), which are supplied by objects, events or places in the environment. Since young children spend the majority of their time at home, the affordances in the home environment are crucial for their global development. This study focuses on one particular part of development, motor development. Minimal research has been done in examining the relationship between motor development and the affordances in the home environment. The presence of various apparatus at home provides an important possibility for undertaking action. The frequency of stimulation in- and outside of the home environment by parents might also have an important influence in reaching motor milestones. However, literature study showed no consensus about the influence of obstacles and stimulation in the home environment on motor development. Therefore the present study was designed to investigate in which extent the two distinguished affordances ‘psychical environment’ and ‘variety of stimulants’ can be seen as predictors of the age of achieving the motor milestones by children aged from 9 to 20 months. The results from the regression analyses showed that ‘psychical environment’ cannot predict the achievement of the motor milestones ‘sitting’ and ‘standing’. The factor ‘psychical environment’ can be seen as predictor of the age in which the motor milestone ‘self locomotion’ will be reached. ‘Variety of stimulants’ can be seen as precursor of the age in which the motor milestones are reached. Follow-up studies are necessary to further clarify to what extent the factors ‘psychical environment’ and ‘variety of stimulants’ predict the age in which the motor milestones are reached by children.

The process of development occurs according to the pattern established by the genetic potential but is also influenced by environmental factors. These environments provide important possibilities for undertaking action (`affordances'), which are supplied from objects, events or places in the environment. Since young children spend the majority of their time at home, the affordances in the home environment are crucial for motor development. There has been minimal research examining the relationship between motor development and the affordances in the home environment. The presence of toys provides an important possibility for undertaking action. Siblings could also have an important influence in reaching motor milestones. However, the literature study showed no consensus about the influence of the presence of siblings and also the influence of the number of siblings on early motor development. Therefore the present study was designed tot investigate whether the two distinguished affordances ‘availability of toys’ and ‘presence of siblings’ can be seen as predictors in ages of achievement of the motor milestones sitting, independent standing and self locomotion by children from 9 up to 20 months of age. The influence of the amount of siblings was also examined. Regression analyses was used to investigate to what extent the ‘availability of toys’ and the ‘presence of siblings’ can predict the age of achievement of the distinguished motor milestones. The results of the regression analyses showed that the ‘availability of toys’ and the ‘presence of siblings’ can not be seen as precursors of the age on which the motor milestones are reached. Follow-up studies are necessary to further clarify to what extent the factors ‘presence of siblings’ and the ‘availability of toys'’ predict the age on which the motor milestones are reached. Samenvatting De ontwikkeling van kinderen is enerzijds toe te schrijven aan genetische factoren, anderzijds hebben omgevingsfactoren ee

The process of development occurs according to a pattern established by the genetic potential but is also influenced by environmental factors. The environment provides important possibilities for undertaking action (‘affordances’), which are supplied by objects, events or places in the environment. Since young children spend the majority of their time at home, the affordances in the home environment are crucial for their global development. This study focuses on one particular part of development, motor development. Minimal research has been done in examining the relationship between motor development and the affordances in the home environment. The presence of various apparatus at home provides an important possibility for undertaking action. The frequency of stimulation in- and outside of the home environment by parents might also have an important influence in reaching motor milestones. However, literature study showed no consensus about the influence of obstacles and stimulation in the home environment on motor development. Therefore the present study was designed to investigate in which extent the two distinguished affordances ‘psychical environment’ and ‘variety of stimulants’ can be seen as predictors of the age of achieving the motor milestones by children aged from 9 to 20 months. The results from the regression analyses showed that ‘psychical environment’ cannot predict the achievement of the motor milestones ‘sitting’ and ‘standing’. The factor ‘psychical environment’ can be seen as predictor of the age in which the motor milestone ‘self locomotion’ will be reached. ‘Variety of stimulants’ can be seen as precursor of the age in which the motor milestones are reached. Follow-up studies are necessary to further clarify to what extent the factors ‘psychical environment’ and ‘variety of stimulants’ predict the age in which the motor milestones are reached by children.

Dit artikel beschrijft de gevolgen van eeuwenlang waterbeheer, de milieutechnische en landschappelijke problemen op een met infrastructuur doorsneden IJsselmonde en Rotterdam Zuid, en het vooruitzicht voor de toekomst als er op deze voet wordt doorgegaan. Toch is dit artikel geen beschrijving van de ondergang van Rotterdam. Het toont namelijk aan dat een verandering van denken en handelen ten opzichte van water een ommekeer kan betekenen, en water in een laaggelegen, verstedelijkte delta geen last maar een grote kans kan zijn. Een uitwerking hiervan is het concept 'watermachine' voor eiland IJsselmonde, uitgewerkt in een ontwerp van een nieuw watersysteem voor de wijken Pendrecht en Zuidwijk. De uitkomst is een 'climate-proof' IJsselmonde, aantrekkelijk om te recreëren, gezond om te wonen en voorbereid op de toekomst. (N.B. Ondanks de Engelstalige titel, is dit artikel in het Nederlands geschreven)

Fonemisch bewustzijn is van belang voor het toekomstige lees- en spellingsproces. De onderwijsinspectie heeft gesignaleerd dat er onvoldoende aandacht is voor het fonemisch bewustzijn van kleuters. In dit artikel wordt verslag gedaan van een effectonderzoek naar een stimuleringsprogramma voor het fonemisch bewustzijn bij kleuters. Er is gebruik gemaakt van een aantal toetsen, waar na een factoranalyse de onderdelen uit zijn gehaald die verondersteld worden fonemisch bewustzijn te meten. Er zijn twee deelonderzoeken uitgevoerd, één naar het lange termijn effect en één naar het korte termijn effect. In beide deelonderzoeken zijn er twee groepen gevormd, een experimentele groep waar het programma wekelijks is ingezet en een controlegroep waar dat niet gebeurde. In het eerste deelonderzoek is geen significant verschil gevonden tussen de experimentele en controlegroep. In het tweede deelonderzoek is er wel ondersteuning gevonden voor het korte termijn effect. Als beide onderzoeken samen worden genomen is er geen significant verschil gevonden tussen kinderen waar de klankkast niet of wekelijks is ingezet op de vooruitgang van het fonemisch bewustzijn. Er is een groot verschil gevonden tussen afzonderlijke klassen. De kinderen bij leerkrachten die heel regelmatig (dagelijks) spelletjes deden met betrekking tot klanken scoorden hoger dan kinderen waarbij dat niet gebeurde. De resultaten van het onderzoek worden in de discussie aan een nadere beschouwing onderworpen en er worden aanbevelingen voor verder onderzoek gedaan.

Fonemisch bewustzijn is van belang voor het toekomstige lees- en spellingsproces. De onderwijsinspectie heeft gesignaleerd dat er onvoldoende aandacht is voor het fonemisch bewustzijn van kleuters. In dit artikel wordt verslag gedaan van een effectonderzoek naar een stimuleringsprogramma voor het fonemisch bewustzijn bij kleuters. Er is gebruik gemaakt van een aantal toetsen, waar na een factoranalyse de onderdelen uit zijn gehaald die verondersteld worden fonemisch bewustzijn te meten. Er zijn twee deelonderzoeken uitgevoerd, één naar het lange termijn effect en één naar het korte termijn effect. In beide deelonderzoeken zijn er twee groepen gevormd, een experimentele groep waar het programma wekelijks is ingezet en een controlegroep waar dat niet gebeurde. In het eerste deelonderzoek is geen significant verschil gevonden tussen de experimentele en controlegroep. In het tweede deelonderzoek is er wel ondersteuning gevonden voor het korte termijn effect. Als beide onderzoeken samen worden genomen is er geen significant verschil gevonden tussen kinderen waar de klankkast niet of wekelijks is ingezet op de vooruitgang van het fonemisch bewustzijn. Er is een groot verschil gevonden tussen afzonderlijke klassen. De kinderen bij leerkrachten die heel regelmatig (dagelijks) spelletjes deden met betrekking tot klanken scoorden hoger dan kinderen waarbij dat niet gebeurde. De resultaten van het onderzoek worden in de discussie aan een nadere beschouwing onderworpen en er worden aanbevelingen voor verder onderzoek gedaan.

An applied research and development program has been conducted on prepackaged hybrid propellant systems suitable for application to advanced tactical missile requirements. An 18-in.-diameter flight configuration hybrid motor has been designed, fabricated, and tested. A high density, high specific impulse, hybrid propellant combination has been formulated; and a fuel grain geometry has been developed which will provide nearly constant fuel flow rate and permit nearly complete fuel utilization. Dual-thrust oxidizer injectors have been developed and successfully tested. A simple thrust control system has been designed, which will control the motor thrust at two levels and will permit multiple starts at either thrust level. The results of the program indicate that high density impulse hybrid propulsion systems are feasible for application to advanced tactical missiles. (Author)