Een van de belangrijkste oorzaken van problemen bij landverhuizen is culture shock. We laten zien dat in de literatuur vooral aandacht is voor de praktische en psychologische factoren die een rol spelen wanneer iemand van land wisselt. De aandacht voor de invloed van landverhuizen op relaties is relatief onderbelicht gebleven, terwijl er zowel in het land waaruit men vertrekt als in het land waar men naartoe verhuist veel mensen geraakt worden door de verhuizing. We laten zien hoe ontwikkelingswerkers die van land verhuizen, omgaan met culture shock die dat teweeg brengt en wat zij zeggen (in retrospectie) nodig te hebben. Tenslotte beschouwen we deze ervaringen vanuit de contextuele benadering
Background: Cardiac output measurements may inform diagnosis and provide guidance of therapeutic interventions in patients with hemodynamic instability. The FloTrac™ algorithm uses uncalibrated arterial pressure waveform analysis to estimate cardiac output. Recently, a new version of the algorithm has been developed. The aim was to assess the agreement between FloTrac™ and routinely performed cardiac output measurements obtained by critical care ultrasonography in patients with circulatory shock.Methods: A prospective observational study was performed in a tertiary hospital from June 2016 to January 2017. Adult critically ill patients with circulatory shock were eligible for inclusion. Cardiac output was measured simultaneously using FloTrac™ with a fourth-generation algorithm (COAP) and critical care ultrasonography (COCCUS). The strength of linear correlation of both methods was determined by the Pearson coefficient. Bland-Altman plot and four-quadrant plot were used to track agreement and trending ability.Result: Eighty-nine paired cardiac output measurements were performed in 17 patients during their first 24 h of admittance. COAP and COCCUS had strong positive linear correlation (r2 = 0.60, p < 0.001). Bias of COAP and COCCUS was 0.2 L min-1 (95% CI - 0.2 to 0.6) with limits of agreement of - 3.6 L min-1 (95% CI - 4.3 to - 2.9) to 4.0 L min-1 (95% CI 3.3 to 4.7). The percentage error was 65.6% (95% CI 53.2 to 77.3). Concordance rate was 64.4%.Conclusions: In critically ill patients with circulatory shock, there was disagreement and clinically unacceptable trending ability between values of cardiac output obtained by uncalibrated arterial pressure waveform analysis and critical care ultrasonography.Trial registration: Clinicaltrials.gov, NCT02912624, registered on September 23, 2016.
Atrial fibrillation (AF) is the most common clinical tachyarrhythmia associated with significant morbidity and mortality and is expected to affect approximately 30 million North Americans and Europeans by 2050. AF is a persistent disease, caused by progressive, often age-related, derailment of proteostasis resulting in structural remodeling of the atrial cardiomyocytes. It has been widely acknowledged that the progressive nature of the disease hampers the effective functional conversion to sinus rhythm in patients and explains the limited effect of current drug therapies. Therefore, research is directed at preventing new-onset AF by limiting the development of substrates underlying AF promotion. Upstream therapy refers to the use of drugs that modify the atrial substrate- or target-specific mechanisms of AF, with the ultimate aim to prevent the occurrence (primary prevention) and recurrence of the arrhythmia following (spontaneous) conversion and to prevent the progression of AF (secondary prevention). Recently, we observed that heat shock protein (HSP)-inducing drugs, such as geranylgeranylacetone, prevent derailment of proteostasis and remodeling of cardiomyocytes and thereby attenuate the AF substrate in cellular, Drosophila melanogaster, and animal experimental models. Also, correlative data from human studies were consistent with a protective role of HSPs in preventing the progression from paroxysmal AF to permanent AF and in the recurrence of AF. In this review, we discuss novel HSP-inducing compounds as emerging therapeutics for the primary and secondary prevention of AF. © 2012 Elsevier Inc.
Restoring rivers with an integrated approach that combines water safety, nature development and gravel mining remains a challenge. Also for the Grensmaas, the most southern trajectory of the Dutch main river Maas, that crosses the border with Belgium in the south of Limburg. The first plans (“Plan Ooievaar”) were already developed in the 1980s and were highly innovative and controversial, as they were based on the idea of using nature-based solutions combined with social-economic development. Severe floodings in 1993 and 1995 came as a shock and accelerated the process to implement the associated measures. To address the multifunctionality of the river, the Grensmaas consortium was set up by public and private parties (the largest public-private partnership ever formed in the Netherlands) to have an effective, scalable and socially accepted project. However, despite the shared long term vision and the further development of plans during the process it was hard to satisfy all the goals in the long run. While stakeholders agreed on the long-term goal, the path towards that goal remains disputed and depends on the perceived status quo and urgency of the problem. Moreover, internal and external pressures and disturbances like climate change or the economic crisis influenced perception and economic conditions of stakeholders differently. In this research we will identify relevant system-processes connected to the implementation of nature-based solutions through the lens of social-ecological resilience. This knowledge will be used to co-create management plans that effectively improve the long-term resilience of the Dutch main water systems.
The precarity in the cultural sector became exposed during the COVID-19 pandemic. With the lockdowns, the sources of income for cultural venues and cultural workers vanished overnight, intensifying an already challenging labour market. Particularly freelance cultural workers were hit hard. While the immediate shock of the pandemic on the cultural sector has been well documented, the effects on the sector in the aftermath of the pandemic are still to be revealed and repaired. This project tackles these issues by zooming in on the case of the performing arts scene in Groningen. This scene constitutes the part of the cultural sector that was affected the most by the lockdowns. Currently, venues and event organizers in Groningen lack qualified freelance staff as many left the industry during the pandemic. At the same time, self-employed cultural workers find it difficult to generate sufficient incomes and develop sustainable careers in the city. The municipality is eager to support the industry, including freelancers, but is unsure about how best to do so. With a consortium composed of the university, the municipality, a knowledge organisation specialised in cultural entrepreneurship, and a network for creative freelancers in the North of the Netherlands the project is well-equipped to reach its two-fold aims of investigating this current situation and coming up with suggestions for solutions. The core component of the project is an interview study with three groups of self-employed cultural freelancers: experienced production staff, experienced performers, and nascent freelancers (both production staff and performers). Based on data from this study, the project provides a multifaceted picture of the cultural ecosystem in Groningen, highlighting how this system is experienced. This establishes a solid foundation for staging discussions on working conditions in the sector, enabling the project to eventually conclude with recommendations on how to improve the situation.
