The increasing rate of urbanization along with its socio-environmental impact are major global challenges. Therefore, there is a need to assess the boundaries to growth for the future development of cities by the inclusion of the assessment of the environmental carrying capacity (ECC) into spatial management. The purpose is to assess the resource dependence of a given entity. ECC is usually assessed based on indicators such as the ecological footprint (EF) and biocapacity (BC). EF is a measure of the biologically productive areas demanded by human consumption and waste production. Such areas include the space needed for regenerating food and fibers as well as sequestering the generated pollution, particularly CO2 from the combustion of fossil fuels. BC reflects the biological regeneration potential of a given area to regenerate resources as well to absorb waste. The city level EF assessment has been applied to urban zones across the world, however, there is a noticeable lack of urban EF assessments in Central Eastern Europe. Therefore, the current research is a first estimate of the EF and BC for the city of Wrocław, Poland. This study estimates the Ecological Footprint of Food (EFF) through both a top-down assessment and a hybrid top-down/bottom-up assessment. Thus, this research verifies also if results from hybrid method could be comparable with top-down approach. The bottom-up component of the hybrid analysis calculated the carbon footprint of food using the life cycle assessment (LCA) method. The top-down result ofWrocław’s EFF were 1% greater than the hybrid EFF result, 0.974 and 0.963 gha per person respectively. The result indicated that the EFF exceeded the BC of the city of Wrocław 10-fold. Such assessment support efforts to increase resource efficiency and decrease the risk associated with resources—including food security. Therefore, there is a need to verify if a city is able to satisfy the resource needs of its inhabitants while maintaining the natural capital on which they depend intact. Original article at: https://doi.org/10.3390/resources7030052 © 2018 by the authors. Licensee MDPI.
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BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients.METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands.DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised.TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
Objectives: Promoting unstructured outside play is a promising vehicle to increase children’s physical activity (PA). This study investigates if factors of the social environment moderate the relationship between the perceived physical environment and outside play. Study design: 1875 parents from the KOALA Birth Cohort Study reported on their child’s outside play around age five years, and 1516 parents around age seven years. Linear mixed model analyses were performed to evaluate (moderating) relationships among factors of the social environment (parenting influences and social capital), the perceived physical environment, and outside play at age five and seven. Season was entered as a random factor in these analyses. Results: Accessibility of PA facilities, positive parental attitude towards PA and social capital were associated with more outside play, while parental concern and restriction of screen time were related with less outside play. We found two significant interactions; both involving parent perceived responsibility towards child PA participation. Conclusion: Although we found a limited number of interactions, this study demonstrated that the impact of the perceived physical environment may differ across levels of parent responsibility.
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