Recent research has indicated an increase in the likelihood and impact of tree failure. The potential for trees to fail relates to various biomechanical and physical factors. Strikingly, there seems to be an absence of tree risk assessment methods supported by observations, despite an increasing availability of variables and parameters measured by scientists, arborists and practitioners. Current urban tree risk assessments vary due to differences in experience, training, and personal opinions of assessors. This stresses the need for a more objective method to assess the hazardousness of urban trees. The aim of this study is to provide an overview of factors that influence tree failure including stem failure, root failure and branch failure. A systematic literature review according to the PRISMA guidelines has been performed in databases, supported by backward referencing: 161 articles were reviewed revealing 142 different factors which influenced tree failure. A meta-analysis of effect sizes and p-values was executed on those factors which were associated directly with any type of tree failure. Bayes Factor was calculated to assess the likelihood that the selected factors appear in case of tree failure. Publication bias was analysed visually by funnel plots and results by regression tests. The results provide evidence that the factors Height and Stem weight positively relate to stem failure, followed by Age, DBH, DBH squared times H, and Cubed DBH (DBH3) and Tree weight. Stem weight and Tree weight were found to relate positively to root failure. For branch failure no relating factors were found. We recommend that arborists collect further data on these factors. From this review it can further be concluded that there is no commonly shared understanding, model or function available that considers all factors which can explain the different types of tree failure. This complicates risk estimations that include the failure potential of urban trees.
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Abstract: Background: Little is known about frailty among patients hospitalized with heart failure (HF). To date, the limited information on frailty in HF is based on a unidimensional view of frailty, in which only physical aspects are considered when determining frailty. The aims of this study were to study different dimensions of frailty (physical, psychological and social) in patients with HF and the effect of different dimensions of frailty on the incidence of heart failure. Methods: The study used a cross-sectional design and included 965 patients hospitalized for heart failure and 164 healthy controls. HF was defined according to the ESC guidelines. The Tilburg Frailty Indicator (TFI) was used to assess frailty. Probit regression analyses and chi-square statistics were used to examine associations between the occurrence of heart failure and TFI domains of frailty. Results: Patients diagnosed with frailty were 15.3% more likely to develop HF compared to those not diagnosed with frailty (p < 0.001). An increase in physical, psychological and social frailty corresponded to an increased risk of HF of 2.9% (p < 0.001), 4.4% (p < 0.001) and 6.6% (p < 0.001), respectively. Conclusions: We found evidence of the association between different dimensions of frailty and incidence of HF.
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Abstract Frailty syndrome (FS) is an independent predictor of mortality in cardiovascular disease and is found in 15-74% of patients with heart failure (HF). The syndrome has a complex, multidimensional aetiology and contributes to adverse outcomes. Proper FS diagnosis and treatment determine prognosis and support the evaluation of treatment outcomes. Routine FS assessment for HF patients should be included in daily clinical practice as an important prognostic factor within a holistic process of diagnosis and treatment. Multidisciplinary team members, particularly nurses, play an important role in FS assessment in hospital and primary care settings, and in the home care environment. Raising awareness of concurrent FS in patients with HF patients and promoting targeted interventions may contribute to a decreased risk of adverse events, and a better prognosis and quality of life.
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Despite its widespread occurrence, the topic of failure is barely addressed in entrepreneurship education. Consequently, students are given an incomplete and unrealistic picture of the complexity of being entrepreneurs. This study explores the pedagogical potential of introducing vicarious learning about failure in educational programs rather than focusing solely on starting, growing and success. Taking a qualitative approach, this study examined students’ reflective reports written after an interview with an entrepreneur on their experience of failure. Using concepts emerging from these reports and theoretical constructs, it was established whether and how students drew lessons and reflections from the failure stories. The findings show that interviewing and reflecting about the experiences of entrepreneurs allow for vicarious learning from failure, yet without students having to experience it themselves. The lessons learned and the reflections feed each other in a continuous loop. Students recognized that entrepreneurship involves trial and error instead of one straight road. Important lessons include the importance of adaptable behavior, access to key resources, insights in business development and the benefits of networking. Hence, this article contributes to the pedagogy of entrepreneurial education and provides initial suggestions for educators to introduce vicarious learning about failure as a topic in their programs.--Malgré sa fréquence élevée, le sujet de l’échec est à peine abordé dans l’enseignement de l’entrepreneuriat. En conséquence, il est communiqué aux étudiants une image incomplète et irréaliste de la complexité d’être un entrepreneur. Cette étude explore le potentiel pédagogique de l’apprentissage par procuration sur l’échec dans les programmes éducatifs, plutôt qu’une focalisation seulement sur le démarrage, la croissance et la réussite. En adoptant une approche qualitative, l’étude a examiné les rapports de réflexions rédigés par les étudiants à la suite d’un entretien avec un entrepreneur, centré sur son expérience de l’échec. À l’aide de concepts émergeant de ces rapports et de constructions théoriques, la manière dont les étudiants tiraient des leçons et des réflexions des récits d’échec – si tel était le cas - a été établie. Les résultats montrent que les entretiens et la réflexion sur l’expérience des entrepreneurs permettent un apprentissage par procuration concernant l’échec, sans pour autant que les étudiants aient eux-mêmes à vivre un échec. Les leçons apprises et les réflexions se nourrissent mutuellement dans une boucle continue. Les étudiants ont reconnu que l’entrepreneuriat a pour implication des épreuves et des erreurs, plutôt qu’une ligne toute droite. Parmi les leçons apprises majeures, citons l’importance des comportements adaptatifs, l’accès aux ressources-clés, les connaissances en matière de développement commercial et les avantages du travail en réseau. Ainsi, cet article contribue à la pédagogie de l’éducation sur l’entrepreneuriat et fait des suggestions pour les enseignants afin qu’ils introduisent l’apprentissage par procuration sur l’échec en tant que sujet à aborder dans leurs programmes.
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The prevention and diagnosis of frailty syndrome (FS) in cardiac patients requires innovative systems to support medical personnel, patient adherence, and self-care behavior. To do so, modern medicine uses a supervised machine learning approach (ML) to study the psychosocial domains of frailty in cardiac patients with heart failure (HF). This study aimed to determine the absolute and relative diagnostic importance of the individual components of the Tilburg Frailty Indicator (TFI) questionnaire in patients with HF. An exploratory analysis was performed using machine learning algorithms and the permutation method to determine the absolute importance of frailty components in HF. Based on the TFI data, which contain physical and psychosocial components, machine learning models were built based on three algorithms: a decision tree, a random decision forest, and the AdaBoost Models classifier. The absolute weights were used to make pairwise comparisons between the variables and obtain relative diagnostic importance. The analysis of HF patients’ responses showed that the psychological variable TFI20 diagnosing low mood was more diagnostically important than the variables from the physical domain: lack of strength in the hands and physical fatigue. The psychological variable TFI21 linked with agitation and irritability was diagnostically more important than all three physical variables considered: walking difficulties, lack of hand strength, and physical fatigue. In the case of the two remaining variables from the psychological domain (TFI19, TFI22), and for all variables from the social domain, the results do not allow for the rejection of the null hypothesis. From a long-term perspective, the ML based frailty approach can support healthcare professionals, including psychologists and social workers, in drawing their attention to the nonphysical origins of HF.
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BACKGROUND:: Physical activity is the only nonpharmacological therapy that is proven to be effective in heart failure (HF) patients in reducing morbidity. To date, little is known about the levels of daily physical activity in HF patients and about related factors. OBJECTIVE:: The objectives of this study were to (a) describe performance-based daily physical activity in HF patients, (b) compare it with physical activity guidelines, and (c) identify related factors of daily physical activity. METHODS:: The daily physical activity of 68 HF patients was measured using an accelerometer (SenseWear) for 48 hours. Psychological characteristics (self-efficacy, motivation, and depression) were measured using questionnaires. To have an indication how to interpret daily physical activity levels of the study sample, time spent on moderate- to vigorous-intensity physical activities was compared with the 30-minute activity guideline. Steps per day was compared with the criteria for healthy adults, in the absence of HF-specific criteria. Linear regression analyses were used to identify related factors of daily physical activity. RESULTS:: Forty-four percent were active for less than 30 min/d, whereas 56% were active for more than 30 min/d. Fifty percent took fewer than 5000 steps per day, 35% took 5000 to 10 000 steps per day, and 15% took more than 10 000 steps per day. Linear regression models showed that New York Heart Association classification and self-efficacy were the most important factors explaining variance in daily physical activity. CONCLUSIONS:: The variance in daily physical activity in HF patients is considerable. Approximately half of the patients had a sedentary lifestyle. Higher New York Heart Association classification and lower self-efficacy are associated with less daily physical activity. These findings contribute to the understanding of daily physical activity behavior of HF patients and can help healthcare providers to promote daily physical activity in sedentary HF patients.PMID:23416939DOI: 10.1097/JCN.0b013e318283ba14
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Subcutaneous emphysema, pneumothorax and pneumomediastinum are well-known complications of invasive ventilation in patients with acute hypoxemic respiratory failure. We determined the incidences of air leaks that were visible on available chest images in a cohort of critically ill patients with acute hypoxemic respiratory failure due to coronavirus disease of 2019 (COVID-19) in a single-center cohort in the Netherlands. A total of 712 chest images from 154 patients were re-evaluated by a multidisciplinary team of independent assessors; there was a median of three (2–5) chest radiographs and a median of one (1–2) chest CT scans per patient. The incidences of subcutaneous emphysema, pneumothoraxes and pneumomediastinum present in 13 patients (8.4%) were 4.5%, 4.5%, and 3.9%. The median first day of the presence of an air leak was 18 (2–21) days after arrival in the ICU and 18 (9–22)days after the start of invasive ventilation. We conclude that the incidence of air leaks was high in this cohort of COVID-19 patients, but it was fairly comparable with what was previously reported in patients with acute hypoxemic respiratory failure in the pre-COVID-19 era.
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Abstract People over 65 years of age constitute over 80% of patients with heart failure (HF) and the incidence of HF is 10 per 1,000 in people aged above 65 years. Approximately 25% of older patients with HF exhibit evidence of frailty. Frail patients with cardiovascular disease (CVD) have a worse prognosis than non-frail patients, and frailty is an independent risk factor for incident HF among older people. Planning the treatment of individuals with HF and concomitant frailty, one should consider not only the limitations imposed by frailty syndrome (FS) but also those associated with the underlying heart disease. It needs to be emphasized that all patients with HF and concomitant FS require individualized treatment.
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Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed. Guideline development A systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria. Clinical and research recommendations Recommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR. Applicability and implementation issues This guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation. Conclusion This guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.
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BACKGROUND: Patients' self-care behaviour is still suboptimal in many heart failure (HF) patients and underlying mechanisms on how to improve self-care need to be studied.AIMS: (1) To describe the trajectory of patients' self-care behaviour over 1 year, (2) to clarify the relationship between the trajectory of self-care and clinical outcomes, and (3) to identify factors related to changes in self-care behaviour.METHODS: In this secondary analysis of the COACH-2 study, 167 HF patients (mean age 73 years) were included. Self-care behaviour was assessed at baseline and after 12 months using the European Heart Failure Self-care Behaviour scale. The threshold score of ⩾70 was used to define good self-care behaviour.RESULTS: Of all patients, 21% had persistent poor self-care behaviour, and 27% decreased from good to poor. Self-care improved from poor to good in 10%; 41% had a good self-care during both measurements. Patients who improved self-care had significantly higher perceived control than those with persistently good self-care at baseline. Patients who decreased their self-care had more all-cause hospitalisations (35%) and cardiovascular hospitalisations (26%) than patients with persistently good self-care (2.9%, p < 0.05). The prevalence of depression increased at 12 months in both patients having persistent poor self-care (0% to 21%) and decreasing self-care (4.4% to 22%, both p < 0.05).CONCLUSION: Perceived control is a positive factor to improve self-care, and a decrease in self-care is related to worse outcomes. Interventions to reduce psychological distress combined with self-care support could have a beneficial impact on patients decreasing or persistently poor self-care behaviour.
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