Search

Patient-directed discharge letters (PDL) are letters sent to patients after hospital care. They are adjusted to patient needs in terms of language use and letter content. Their use is increasingly recommended and used in hospital care. Empirical research indicates their potential for improving care, HCP-patient relationships, and patient self-management. Yet, the ethical dimension of using has not been explored before. This thesis explores whether it is morally justified to use PDL, and if so, under what conditions. It employs the Normative Empirical Reflective Equilibrium as a method for moral reasoning. In this model, morally relevant facts, moral intuitions, ethical principles and background theories relevant for the use of PDL are considered. The analysis highlighted that negligent employment of PDL can risk reinforcing epistemic injustices or increasing health disparities. To avoid this, the use of PDL is justified under certain conditions. Based on these conditions, this ethical reflection concludes with a practical recommendation for just employment of PDL in hospital care, and an example PDL that meets these conditions.

Water, especially fresh water, plays an unmissable role in nature, agricultural activities or as drinking water. How much precipitation actually reaches the ground is therefore important to monitor. The number of official rain gauges is however limited. If present, weather radars are able to indicate rainfall with a high spatial and temporal resolution but do not grasp actual rainfall amounts. Therefore, in recent years methods are proposed to automatically quality control (QC) measurements of third party near real- time rain gauge networks by comparison of a measurement to measurements obtained nearby. Here, a method is proposed that includes weather radar observations to quality control an unprecedented large amount of measurements of rain gauges employed by Royal Netherlands Meteorological Institute (KNMI) and third parties as water boards and Personal Weather Stations (PWSs). Results show that the method is able to improve data quality of various real-time rain gauge networks. For PWS data of Netatmo collected in Amsterdam in 2018, the data set quality measured for 5-min rainfall accumulations is improved to a relative bias of 0.06 (-0.11 originally), a coefficient of variation of 6.8 (53.2 originally) and a Pearson correlation coefficient of 0.59 (0.07 originally) by removing 27.3% of all data. Application of the existing method however filters less data while yielding the same results. For water boards and KNMI data, this existing method cannot be applied due to the lack of nearby rain gauges. The newly proposed method however is able to improve all data sets, despite all differences in setup, maintenance and intrinsic quality. It is furthermore shown that with parameter optimization, it is able to filter 20%-point less measurements without quality loss, hence showing the wide applicability of the QC method if real-time weather radar data is present. Application of the proposed method on a national scale for 1 year of Netatmo data, shows that quality controlle

The province of South Holland is one of the biggest drivers of the Dutch economy with almost a quarter of the gross national product earned in this region. The agrifood sector is the largest contributor with an annual turnover of about € 5.5 billion. About half of the surface of the province is dedicated to this sector, entailing many jobs and steering innovation worldwide. In line with the ambitious target of the Dutch government the province aims to be fully circular in 2050. This means the agrifood sector is facing an enormous transition. However, the sector faces several major socio-spatial and environmental challenges. The current monoculture food landscapes contribute to 20% of GHG emissions, consumes 67% of fresh water, and results in subsidence, salination and lack of biodiversity. Additionally, with the challenge to build 230.000 houses and the space needed for energy transition and nature, the pressure on space increases. The distribution of these negative externalities results in socio-spatial inequality, placing a burden on mainly lower income communities, including a lower socio-economic position for farmers. Nature-inclusive agriculture has the potential to tackle these issues as an overarching framework. How can the agrifood sector in the Province of South Holland transition to a nature inclusive circular system? This project aims to have a 100% nature-inclusive agrifood sector in 2050.To reach this goal, this project starts by further investigating the current linear system and its environmental social and spatial issues It can be concluded that the socio-spatial challenges are most present in the fringes within the province. Hence, a regional vision and strategy are proposed that transform the linear-manufacture-waste model into a circular and nature-inclusive agrifood sector, through re-activation of the fringes in the province. The fringes offer a high potential for implementation of a variety of nature-inclusive and circular functions, that can b

Contains fulltext : 221722.pdf (Publisher’s version ) (Open Access), BACKGROUND: Research requires high-quality ethical and governance scrutiny and approval. However, when research is conducted across different countries, this can cause challenges due to the differing ethico-legal framework requirements of ethical boards. There is no specific guidance for research which does not involve non-medicinal products. AIM: To describe and address differences in ethical and research governance procedures applied by research ethics committees for non-pharmaceutical palliative care studies including adult participants in collaborative European studies. DESIGN: An online survey analysed using descriptive statistics. SETTING/PARTICIPANTS: Eighteen principal investigators in 11 countries conducting one of three European-funded studies. RESULTS: There was variation in practice including whether ethical approval was required. The time to gain full approvals differed with the United Kingdom having governance procedures that took the longest time. Written consent was not required in all countries nor were data safety monitoring committees for trials. There were additional differences in relation to other data management issues. CONCLUSION: Researchers need to take the differences in research approval procedures into account when planning studies. Future research is needed to establish European-wide recommendations for policy and practice that dovetail ethical procedures and enhance transnational research collaborations.

When precipitation evaporates in a sub-saturated boundary layer, it cools the air and produces dense downdrafts, which sink towards the surface and can spread horizontally as a density current. These spreading “cold pools” (CPs) can trigger convection and thus new precipitation events due to dynamical and thermodynamical lifting mechanisms. Due to their role in the organization of convection, CP properties are currently being studied with the use of high-resolution numerical simulations. Measurement campaigns have been conducted over the ocean to validate the models. However, fewer studies have targeted ensembles of cold pools over land. We use the observational network of the Netherlands, specifically the 213m Cabauw boundary layer measurement tower and the Herwijnen polarimetric radar, to study CPs developing from summer convection and their role in triggering new convective events over land. We create an algorithm that detects the passage of a CP from the Cabauw tower time series to automatize the detection of CPs from a point measurement time series. The detected CP gust fronts and their generating precipitation cells are studied with imagery from the Herwijnen radar, situated in proximity to the Cabauw tower. We explore the characteristics of the CP gust fronts and interiors with the Cabauw tower time series, and specifically look for evidence of vortex rings, accumulated moisture in the leading edge and dry interiors. Gathering all the CP cases found, we show the measured CP properties in dependence of the precipitation intensity of the generating precipitation cell, and of the environmental conditions. We find positive correlations between the temperature drops and the wind gusts associated with the CPs, and explore the correlations between these properties, the precipitation intensity of the generating cells, and the mean atmospheric moisture before the event. These links will help gain more insight into the role of CPs in organizing convection over land.

The topic of extreme weather in the mid-latitudes remains a subject of discussion. The response of Rossby waves (and the jetstream that tracks them) to a warming climate is very uncertain, while this large scale flow is known to be the driver for synoptic weather. A comprehensive theory on Rossby wave growth and breaking is hard to determine due to its nonlinear nature. This study advocates for the use of vertical velocity relative to isentropic surfaces to describe the conversion of available potential energy into kinetic energy. It is found that large areas of baroclinic energy conversion (BEC) can be found in the mid-latitudes in the middle as well as the upper troposphere. Intense regions of (BEC) can be found along the meridional moving jetstream in the vicinity of relative vorticity minima and maxima, meaning this could play an important role in amplifying Rossby waves. In an Eulerian frame it is found that regions of BEC coincide with jetstreaks. Results from the Lagrangian framework suggest that BEC might be the energy source of the formation or strengthening of jetstreaks.

Dit jaar bestaat de Brabantse Waterschapsbond 90 jaar. Dit jubileum markeert de samenwerking tussen de Brabantse waterschappen en hun unieke positie in het Brabantse ecosysteem. Om dit te vieren hebben de besturen van de Brabantse waterschappen ervoor gekozen om hun blik vooruit te richten: om te jubileren door vooruit te zien. Om het verleden recht te doen, kijken zij naar de toekomst. Welk waterschap is nodig als we tien jaar vooruitkijken en wat kunnen we nu doen om dat dan te bereiken? Wat zijn de trends en patronen, waar bewegen ze heen, welke kiemen dienen zich aan, en wat zou dat alles kunnen betekenen voor Brabantse waterschappen en hun omgeving? Wat kunnen we doen om samen met de omgeving ecosystemen te bouwen die te midden van die toekomstige omstandigheden kunnen overleven en excelleren? In dit essay presenteren we de opbrengst van een traject waarin we met een grote groep betrokkenen hebben nagedacht over de toekomst van de Brabantse wateropgave en de rol van de Brabantse waterschappen daarin.

Webinar met een introductie op het onderwerp en samenvatting van de Groen Kennisnet WIKI 'Effects of cultivation practices on the nutritional value of crops' door Sander van Delden (Wageningen Plant Research, minerale plantenvoeding) en Julian Verdonk (Wageningen Plant Research, post harvest en fytochemicals). Presentatie Gerry Kouwenhoven (Hogeschool Inholland) van het OnderwijsVernieuwingsprogramma. Dit webinar is mogelijk gemaakt door het OnderwijsVernieuwingsProgramma (OVP) en WURKS.

Understanding the uncertainty of every spatial analysis is a required step to be aware of its usefulness and limitations. The chosen scale of analysis determines part of this uncertainty. Thematic resolution refers to the grain component of scale, regarding the thematic detail at which categorical maps are made. The higher the thematic detail or resolution, the larger the amount of information we have and the more complex the analysis will be. Through this paper, we aim to assess how the calibration of a Land Use Cover Change (LUCC) model differs according to variation of the thematic resolution of input Land Use Land Cover (LULC) maps. To achieve this objective, we have set up four modelling exercises in Metronamica, each one calibrated with maps at different thematic resolutions. Obtained simulations were compared in terms of allocation of changes, modelled quantities, explanatory power of the model and pattern of simulated changes. Results show that the model behaves differently depending on the selected thematic resolution. Lower thematic resolution led to simpler simulations that, however, get better validation scores. High thematic resolution maps introduce more complexity and information in the analysis. If not correctly managed, this complexity and information can translate to model noise, worsening the model performance. The paper ends with a proposal of criteria to follow to aid modellers and researchers in the selection of the proper thematic resolution for their analyses., Agencia Estatal de Investigación, Universidad de Granada, Depto. de Geografía, Fac. de Geografía e Historia, TRUE, pub

Contains fulltext : 207107.pdf (publisher's version ) (Open Access), Exercising in a hot and humid environment increases core body temperature, which may limit exercise performance. The risk of exercise-induced hyperthermia and associated performance decrement in Olympic sailing athletes is largely unknown. Therefore, this study aimed to compare thermoregulatory responses and performance indicators of elite sailors in a cool versus hot and humid environment. Seven elite athletes from four different Olympic sailing classes (Laser, RS:X, Finn, 470) performed cycling and/or rowing exercise in a cool (18 degrees C) and hot (33 degrees C) environment, while core body temperature (TC), skin temperature (TSK), exercise performance (covered distance), and rating of perceived exertion were measured continuously. TC increased significantly more in the hot environment (37.6 +/- 0.2 degrees C to 39.1 +/- 0.1 degrees C) compared to the cool environment (37.5 +/- 0.1 degrees C to 38.5 +/- 0.2 degrees C; p = 0.002), but the increase in TC between conditions differed substantially within individuals (range: 0.3 degrees C - 0.9 degrees C). Exercise performance decreased by 6.2 +/- 2.9% in the hot environment (p = 0.013, range: 2.3%-9.5%), but more importantly, exercise performance was strongly inversely related to peak TC (R = -0.78, p = 0.039). Rating of perceived exertion (cool: 14.2 +/- 0.6; hot: 13.9 +/- 1.2) and increase in TSK (cool: 0.5 +/- 1.0 degrees C; hot: 0.9 +/- 0.3 degrees C) did not differ between conditions (p = 0.59 and p = 0.36, respectively). To conclude, a larger increase in TC and substantial exercise performance decrement were observed in the hot versus cool environment. As a further matter, large inter-individual differences were observed across athletes with an inverse relationship between TC and exercise performance, which stresses the importance of appropriate and personalized interventions to reduce thermoregulatory burden of elite sailors during exercise in the heat.

Contains fulltext : 215431.pdf (publisher's version ) (Closed access), BACKGROUND: Regenerative Medicine (RM) techniques aimed at the musculoskeletal system are increasingly translated to clinical trials and patient care. This revolutionary era in science raises novel ethical challenges. One of these challenges concerns the appropriate choice of the comparator in (randomized controlled) trials, including the ethically contentious use of sham procedures. To date, only general guidelines regarding the choice of the comparator exist. OBJECTIVE: To provide specific guidelines for clinical trial comparator choice in musculoskeletal RM. METHODS: In this manuscript, we discuss the ethics of comparator selection in RM trials. First, we make a classification of RM interventions according to different health states from disease prevention, return to normal health, postponing RM treatment, supplementing RM treatment, substituting RM treatment, improving RM outcome, and slowing progression. Subsequently, per objective, the accompanying ethical points to consider are evaluated with support from the available literature. RESULTS: a sham procedure is demonstrated to be an ethically acceptable comparator in RM trials with certain objectives, but less appropriate for musculoskeletal RM interventions that aim at preventing disease or substituting a surgical treatment. The latter may be compared to 'standard of care'. CONCLUSION: From a scientific perspective, choosing the correct comparator based on ethical guidelines is a step forward in the success of musculoskeletal RM.

Launched on August 22th of 2018, the Atmospheric Dynamics Mission - Aeolus of the European Space Agency (ESA) carries a direct detection Doppler Wind Lidar (DWL) to measure wind profiles in the atmosphere from space. The primary product of this Earth observation satellite is the measurement of profiles of the horizontally projected line-of-sight (HLOS) wind component, resulting into a single wind component measurement rather than the complete wind vector. The main motivation of the Aeolus mission is to reduce the deficiency in the current global coverage of wind observations, as part of the current Global Observing System (GOS) of the World Meteorological Organization (WMO). Aeolus is a next step in the aim for a homogeneous spatial and temporal global network of wind observations. In this study, HLOS wind observations of Aeolus have been validated with independent and high-resolution aircraft-derived Mode-S EHS wind observations, together with the Numerical Weather Prediction (NWP) model of the European Centre for Medium-Range Weather Forecasts (ECMWF). Validation is a challenge for a unique instrument which is still in its commissioning phase, meaning that observed winds have not yet been well-calibrated, hence not yet suitable for operational use in NWP. Nevertheless, the main validation results are very promising ; demonstrating a high agreement between Aeolus, Mode-S EHS and ECMWF with correlation values exceeding 0.9. The known systematic, and slowly drifting over time, bias in the order of 2 m/s is observed and confirmed from standard statistics as well as from the more advanced triple collocation technique.

The Gulf Stream (GS) is a region with large mesoscale activity, as strong sea surface temperature gradients and oceanic eddies are developed in the area. These mesoscale features force the atmosphere by affecting the near surface wind. In this study, we investigate this mesoscale air-sea interaction using several air-sea coupled configurations of the Global Climate Models: ECMWF-IFS, HadGEM3 and MPI-ESM. The climatology and the internal variability of variables such as sea surface temperature (SST), turbulent heat fluxes, precipitation and near surface wind divergence are studied for the time period between 1951 and 2049. The horizontal resolution of the oceanic component of the models seems to be determinant factor for the accurate representation of the air-sea coupling. We find that the models with eddy parameterized oceanic component are incapable of accurately describing several atmospheric fields over this region. Also, only the eddy resolving oceanic component is capable of describing correctly the separation of GS at Cape Hatteras, whereas the rest of the configurations shift the GS path northwards. Even though the atmospheric resolution does not seem to be important for the climatology, it is significant for the variability of many atmospheric fields. Next, we focus on the two main mechanisms which explain the wind response to the SST fronts. These are: the Vertical Mixing (VMM) and Pressure Adjustment (PAM) mechanisms. In accordance with the VMM, the destabilization of the atmosphere over the warmer SSTs leads to intensification of the vertical mixing in the boundary layer. Thus, large momentum from aloft is transported downwards resulting in acceleration of the near surface wind. On the other hand, the PAM suggests that the differential heating of the atmosphere at each side of the SST front generates pressure gradient forces. These pressure anomalies are responsible for the convergence and divergence zones on the warm and cold flank of GS respectively. Th

The performance of HARMONIE on simulating convective storms has been studied by comparing simulated and observed three-dimensional radar reflectivity fields and satellite images. This comparison was performed over two domains; one over the Netherlands and one over the Central US. Case studies lead to a list of five (potential) issues. Most important are the severe underestimation of the number of simulated shallow showers, a potential problem with initiating severe thunderstorms under the turbulence scheme HARATU, and a large underestimation (overestimation) of the area covered by weak (intense) precipitation. The underestimation of the number of shallow showers is related to the shallow convection scheme, and it has been shown that this scheme adjusts vertical temperature and dew point profiles in a way that is unfavourable for initiating showers. For the potential issue with initiating severe thunderstorms it has been shown that using HARATU leads to a drier boundary layer and steeper temperature lapse rates just above the boundary layer, effects that influence initiation of storms. Results of a detailed analysis of distributions of observed and simulated radar reflectivity confirm that the model greatly underestimates the area covered by relatively weak stratiform precipitation, and greatly overestimates the area covered by the more intense convective precipitation. It is shown that the model’s horizontal resolution has very little effect on these distributions, suggesting that improvement should mainly come from improvement of the microphysics. Literature suggests that a better representation of convective regions within storms is critical for improving on this issue, as is switching to a double-moment microphysics scheme.

Sudden Stratospheric Warmings (SSWs) are events in which the middle stratosphere, where it is usually very cold, warms up by 30 to even 50 degrees Celcius. SSWs lead to a displacement or split of the polar vortex, a low pressure system above the Poles which is created every autumn and disappears every spring by the changing temperature differences between the equator and the poles. In many papers and literature, these stratospheric events are related to drastic changes in the general circulation in the troposphere. Increase of surface pressure at northern latitudes (negative AO and NAO) and weakening, meandering and southward displacement of the jet stream are frequently observed after a SSW. There are accepted theories on the cause of SSWs. However, there is still much unclear how these disturbances in the stratosphere alter the general circulation in the troposphere. An SSW is defined as the reversal of the zonal mean zonal wind at a height of 10 hPa at a latitude of 60N. One of the shortcomings of the current definition of the SSW is that it does not take the vertical extent of the event into account since it is only restricted to a height of 10 hPa. In response to the Arctic air outbreak of 2018 in Europe, KNMI published a report where an improved definition with additional requirements regarding the depth of a SSW was proposed: the Deep Stratospheric Warming (DSW). A DSW is de?ned as a reversal of the zonal mean zonal wind in a layer between 10-100 hPa for at least 5 days, averaged between 60-70N. On at least 2 days, the layer thickness must be minimal 80 hPa. Since DSWs cover a much deeper layer of the stratosphere, there is a bigger chance that they influence the general tropospheric circulation significantly. The downward propagation of perturbations coming from an SSW are investigated in this thesis. Five cases of SSWs, of which 4 cases are also DSWs, are thoroughly analyzed in order to provide an explanation for the downward effects which possibly affects

De gehaltes vitamines, mineralen en andere gezonde stoffen in veel soorten groenten en fruit zijn in de loop van de tijd gedaald. Als gevolg van snelle gewasgroei worden ze als het ware verdund. Maar daar is best iets aan te doen. De aanknopingspunten zijn rassenkeuze, bemesting, lichte stress en belichting.