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[Display omitted] • Average hydraulic properties were obtained for thirty-six soil texture classes. • Static hydraulic properties were calculated for 368 Dutch soil profiles. • Soil profiles were clustered to obtain a map with 79 soil physical units. • Dynamically simulated transpiration reduction was well predicted within units. • This approach can be used for other locations and applications as well. Soils and their properties play an important role in land evaluation studies. Often such studies focus on larger scales ranging from watersheds up to the national scale or even larger. Soil properties are often known at smaller scales, sometimes at the level of individual soil samples. The aim of this study is to show how point information on soil hydraulic properties, i.e. , water retention and hydraulic conductivity characteristics, can be upscaled via soil textural classes to a soil physical units map of a region or nation. Base information is the Dutch soil map (1:50,000) and the hydraulic properties of individual soil samples. All individual soil samples for which hydraulic properties were measured were divided based on their texture into eighteen top-soils and eighteen sub-soils. For each of these thirty-six groups geometric average water retention and hydraulic conductivity characteristics were derived. In total 368 derived soil profiles are distinguished in the Dutch soil map consisting of soil layers that are linked to the thirty-six texture groups. For each soil profile eight static hydraulic properties were calculated. The soil profiles were then clustered based on these properties into seventy-nine clusters or units, which then make up a soil physical units map for the Netherlands. It has been demonstrated that dynamically simulated transpiration reduction for the clustered situation is similar to obtained for all individual soil profiles. At the Dutch national scale, the difference in simulated transpiration reduction between runs using all 368 soil profiles or the 79 soil physical units was less than 2.5 % percentage-points in 96 % of all plots or less than 5 % percentage-points in 99 % of all plots. Similar good correspondence was obtained for other water balance terms as well, including actual transpiration, actual evaporation at the soil surface, degree of saturation at 15 and 30 cm depth, the integrated water flux at 100 cm depth and surface runoff. [ABSTRACT FROM AUTHOR]

Buffer strips with no added fertilizers are a mitigation measure to reduce P loads from agricultural land to surface water. However, the experimental evidence on their effectiveness (BSE) has been from sloping locations with shallow flow and surface runoff. The aim of this experimental study was to quantify BSE for P on flat agricultural lowland, predominantly with deep flow. We selected sites characteristic of five major hydrogeological classes in the Netherlands and in each experimental field installed paired 5-m-wide unfertilized grass (BS) and reference treatments (REF) that abutted the ditch. The REF treatments were managed similar to the adjacent grass or maize field, but BS treatments were only harvested. Each treatment had a reservoir in the ditch to collect and measure discharge and flow-proportional P concentration for 3 or 4 yr. We also measured net P withdrawal, the P status of the soil and P concentration in upper groundwater. We found a significant BSE for P of 61% on the site with the shallowest flow and steepest slope (2%). At the other sites, BSE was low and statistically insignificant. We conclude that harvested unfertilized buffer strips reduce P loads from flat fields only in specific areas with high surface runoff and/or shallow flow, especially in combination with a high original soil P status. [ABSTRACT FROM AUTHOR]

Background: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs)., Objective: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs., Methods: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed., Results: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65% (24/37) of HCPs and 89% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61%; HCPs: 21/24, 88%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92%) and HCPs (22/24, 92%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82%) and HCPs (22/24, 92%) wanted to keep using the RMP in future, with 79% (19/24) of HCPs and 75% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden., Conclusions: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs., (©Martinus C Oppelaar, Yvette Emond, Michiel A G E Bannier, Monique H E Reijers, Hester van der Vaart, Renske van der Meer, Josje Altenburg, Lennart Conemans, Bart L Rottier, Marianne Nuijsink, Lara S van den Wijngaart, Peter J F M Merkus, Maud Heinen, Jolt Roukema. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.08.2024.)

Rainfall that exceeds the soil's maximum infiltration rate is prone to runoff, and the excess rainfall will flow toward open water systems. Nutrients, pesticides or other contaminants may be transported along with this overland flow, thus contaminating surface waters. There are various measures that can be implemented to prevent or reduce runoff, which involve either improving the soil's infiltration capacity or temporarily storing more water at the field scale. The aim of this study was to determine the effectiveness of two mitigation measures, i.e., micro-dams and edge-of-field trenches, in reducing the total number of runoff events and the runoff volume for specific rainfall events. For this purpose, numerical simulations were performed with a deterministic soil-water-atmosphere-plant model for reference situations and for situations involving either of the two mitigation measures. The mitigation measures are implemented as a change in the ponding threshold height above which the model predicts runoff. For this purpose, we considered several soil / groundwater level / crop / intrinsic field soil surface storage situations that are common in the Netherlands. For ridge-furrow cropping systems, micro-dams are more effective than edge-of-field trenches. Depending on the soil type (excluding sand), the minimum effectiveness is 70% and may be >90% in specific situations. For the edge-of-field trench, the reduction in runoff events was mostly in the 24-35% range, while the effectiveness for the runoff volume for a rainfall event that typically occurs once per year was in the 13-48% range (excluding sand). Due to the relatively high hydraulic conductivity at saturation for the sandy soils, runoff was simulated in only a few cases for these soils. The effectiveness was evidently dependent on intrinsic field soil surface storage and soil types, varied slightly between crop types and was very similar across the groundwater level classes considered., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Aims and Objective: To gain insight into nurse practitioners' (NP) leadership roles in Dutch hospital care, by exploring the perceptions regarding their current leadership role and the differences with their previous role as a registered specialised nurse., Background: To meet today's challenges of the increasing healthcare demands, the employment of NPs is proliferating. NPs have the ideal position to play a pivotal role within healthcare reforms, yet full expansion of their scope of practice and expertise is having limited success. Long-term sustainability of NPs depends on the ability to perform and develop a leading role., Design and Methods: This qualitative descriptive study was conducted in fifteen Dutch hospitals. Data were collected from April-July 2018, and purposive sampling was used for eighteen semi-structured interviews. This study is conducted and reported according to the COREQ checklist., Results: Three main themes concerning NPs' current leadership role emerged, and they were all linked to a successful positioning of NPs. All themes seemed to be of influence on NPs' scope of daily practice. Direct patient care was emphasised, and leadership on other levels appeared to be underused. Most NPs desired to reshape their profession. However, unprofitable use of their leadership skills especially on professional and organisational level and lack of supportive factors seemed to hinder them., Conclusions: An adequate use of leadership is crucial for role development and positioning of NPs. Further development of the NP profession can help to better differentiate between the tasks of registered specialised nurses and NPs., Relevance to Clinical Practice: Leadership in nursing contributes to the improvement of the quality and efficiency of health care. Further positioning of the NP profession depends on a profitable use of leadership competencies. Besides, NPs should collaborate with healthcare organisations, educational institutions and professional associations to value the NP profession in the current healthcare system., (© 2019 John Wiley & Sons Ltd.)

Background: General practitioners with more positive role security and therapeutic commitment towards patients with hazardous or harmful alcohol consumption are more involved and manage more alcohol-related problems than others. In this study we evaluated the effects of our tailored multi-faceted improvement implementation programme on GPs' role security and therapeutic commitment and, in addition, which professional related factors influenced the impact of the implementation programme., Methods: In a cluster randomised controlled trial, 124 GPs from 82 Dutch general practices were randomised to either the intervention or control group. The tailored, multi-faceted programme included combined physician, organisation, and patient directed alcohol-specific implementation strategies to increase role security and therapeutic commitment in GPs. The control group was mailed the national guideline and patients received feedback letters. Questionnaires were completed before and 12 months after start of the programme. We performed linear multilevel regression analysis to evaluate effects of the implementation programme., Results: Participating GPs were predominantly male (63%) and had received very low levels of alcohol related education before start of the study (0.4 h). The programme increased therapeutic commitment (p = 0.005; 95%-CI 0.13 - 0.73) but not role security (p = 0.58; 95%-CI -0.31 - 0.54). How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, contributed to the effect of the programme on therapeutic commitment., Conclusions: A tailored, multi-faceted programme aimed at improving GP management of patients with hazardous and harmful alcohol consumption improved GPs' therapeutic commitment towards patients with alcohol-related problems, but failed to improve GPs' role security. How important GPs thought it was to improve their care for problematic alcohol consumption, and the GPs' reported proportion of patients asked about alcohol consumption at baseline, both increased the impact of the programme on therapeutic commitment. It might be worthwhile to monitor proceeding of role security and therapeutic commitment throughout the year after the implementation programme, to see whether the programme is effective on short term but faded out on the longer term., Trial Registration: ClinicalTrials.gov Identifier: NCT00298220.

Background: To date, only a few risk factors for pancreatic cancer have been established. We examined prospectively relations between several medical conditions and pancreatic cancer incidence., Methods: In 1986, 120 852 participants completed a baseline questionnaire on cancer risk factors, including several self-reported physician diagnosed medical conditions. At baseline, a random subcohort of 5000 participants was selected using a case-cohort approach for analysis. After 16.3 years of follow-up, 448 pancreatic cancer cases (63% microscopically confirmed) were available for analysis., Results: Diabetes mellitus type II and hepatitis were positively associated with pancreatic cancer risk (multivariable-adjusted hazard ratio: 1.79; 95% confidence interval: 1.12-2.87 and hazard ratio: 1.37; 95% confidence interval: 1.04-1.81, respectively). Furthermore, a positive trend in risk with increasing years of diagnosis of diabetes (P=0.004) and of hepatitis (P=0.02) was observed. However, an inverse association was observed between hypertension and pancreatic cancer risk, this was found among microscopically confirmed cases only (hazard ratio: 0.66; 95% confidence interval: 0.49-0.90), while years since diagnosis of hypertension significantly decreased cancer risk (P for trend=0.02)., Conclusion: In this prospective study, a positive association was observed between self-reported physician diagnosed diabetes mellitus type II and hepatitis and pancreatic cancer risk, whereas an inverse association was observed with hypertension.

Our fragmented health care systems are insufficiently equipped to provide frail older people with high quality of care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), an e-health intervention which aims (1) to facilitate self-management by frail older people and informal caregivers and (2) to improve collaboration among professionals. The ZWIP is a personal conference table, accessible through a secure internet connection, for multidisciplinary communication and information exchange for frail older people, their informal caregivers and professionals. After development, the ZWIP was implemented in seven general practices, and this process was evaluated by means of a mixed-methods study. Eventually, 290 frail older people and 169 professionals participated in the ZWIP. Most professionals were positive about its implementation. Facilitators for the implementation were the experienced need for improvement of interprofessional collaboration and the user-friendliness of the ZWIP. Barriers were the low computer-literacy of frail older people, start-up problems, preferring personal contact, and limited use of the ZWIP by other professionals. In sum, this article describes the successful development and implementation of the ZWIP, an e-health intervention which can reduce fragmentation in the care of frail older people.

Background: Patient involvement in clinical decision making is increasingly advocated. Although older patients may be more reluctant to become involved, most do appreciate being informed. However, knowledge about their experiences with and preferences for receiving information is limited, and even less is known about these topics for frail older people., Objective: To explore the experiences of frail older people and informal caregivers with receiving information from health care professionals as well as their preferences for receiving information., Methods: We conducted semi-structured interviews with frail older people (n = 11, 65-90 years) and informal caregivers (n = 11, 55-87 years). Interviews were transcribed verbatim and analysed using a grounded theory approach., Results: Frail older people and informal caregivers varied in their information needs and discussed both positive and negative experiences with receiving information. They preferred receiving verbal information from their physician during the consultation; yet would appreciate receiving brief, clearly written information leaflets in addition. They employed several strategies to enhance the information provided, i.e. advocacy, preparing for a consultation and searching their own information. Contextual factors for receiving information, such as having enough time and having a good relationship with professionals involved, were considered of great importance., Conclusions: Participants described a wide range of experiences with and preferences for receiving information. However, even if the information provided would meet all their preferences, this would be of limited significance if not provided within the context of an ongoing trusting relationship with a professional, such as a GP or practice nurse, who genuinely cared for them.

Aim: This study explores the relevance of the International Classification of Functioning, Disability and Health (ICF) to nursing diagnoses., Background: As a multidisciplinary classification of human functioning, the ICF (previously known as ICIDH-2) is potentially relevant to nursing care. However, nurses have rarely used the classification during the 23 years of its existence., Method: In part 1 of the study, 51 nursing diagnoses from anonymous patients were deliberately selected for diversity from an existing database. The 427 diagnostic elements from these diagnoses (problem statements, aetiological factors, signs and symptoms) were classified, using the ICF, by a panel of six nurses. In part 2 of the study, the panel classified 223 elements from 30 diagnoses of patients they had actually cared for., Results: Nearly all diagnostic elements could be classified, most often in the sub-dimensions of body functions and activities. Agreement on appropriate ICF components was 61% for anonymous patients and 75% for familiar patients. Agreement at the more detailed 3-digit level of the classification was 42% for anonymous and 60% for familiar patients., Conclusion: The ICF has relevance to nursing care. As a general classification, it was not designed by nurses or specifically for nursing care. This can explain some difficulties in using the classification that were identified in this study, as well as the rather low levels of agreement. To resolve these issues and to further improve the classification, nurses should further explore the use of the ICF and participate in future revision processes.