A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3–5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.
Control methods are applied worldwide to reduce predation on livestock by European red foxes (Vulpes vulpes). Lethal methods can inflict suffering; however, moral debate about their use is lacking. Non-lethal methods can also inflict suffering and can unintentionally lead to death, and yet both the welfare consequences and ethical perspectives regarding their use are rarely discussed. The aim of this study was to investigate the animal welfare consequences, the level of humaneness, the ethical considerations and the moral implications of the global use of fox control methods according to Tom Regan’s animal rights view and Peter Singer’s utilitarian view. According to Regan, foxes ought not to be controlled by either lethal or potentially harmful non-lethal methods because this violates the right of foxes not to be harmed or killed. According to Singer, if an action maximises happiness or the satisfaction of preferences over unhappiness or suffering, then the action is justified. Therefore, if and only if the use of fox control methods can prevent suffering and death in livestock in a manner that outweighs comparable suffering and death in foxes is one morally obligated t
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Aim and method: To examine in obese people the potential effectiveness of a six-week, two times weekly aquajogging program on body composition, fitness, health-related quality of life and exercise beliefs. Fifteen otherwise healthy obese persons participated in a pilot study. Results: Total fat mass and waist circumference decreased 1.4 kg (p = .03) and 3.1 cm (p = .005) respectively. The distance in the Six-Minute Walk Test increased 41 meters (p = .001). Three scales of the Impact of Weight on Quality of Life-Lite questionnaire improved: physical function (p = .008), self-esteem (p = .004), and public distress (p = .04). Increased perceived exercise benefits (p = .02) and decreased embarrassment (p = .03) were observed. Conclusions: Aquajogging was associated with reduced body fat and waist circumference, and improved aerobic fitness and quality of life. These findings suggest the usefulness of conducting a randomized controlled trial with long-term outcome assessments.
While the creation of an energy deficit (ED) is required for weight loss, it is well documented that actual weight loss is generally lower than what expected based on the initially imposed ED, a result of adaptive mechanisms that are oppose to initial ED to result in energy balance at a lower set-point. In addition to leading to plateauing weight loss, these adaptive responses have also been implicated in weight regain and weight cycling (add consequences). Adaptions occur both on the intake side, leading to a hyperphagic state in which food intake is favored (elevated levels of hunger, appetite, cravings etc.), as well as on the expenditure side, as adaptive thermogenesis reduces energy expenditure through compensatory reductions in resting metabolic rate (RMR), non-exercise activity expenditure (NEAT) and the thermic effect of food (TEF). Two strategies that have been utilized to improve weight loss outcomes include increasing dietary protein content and increasing energy flux during weight loss. Preliminary data from our group and others demonstrate that both approaches - especially when combined - have the capacity to reduce the hyperphagic response and attenuate reductions in energy expenditure, thereby minimizing the adaptive mechanisms implicated in plateauing weight loss, weight regain and weight cycling. Past research has largely focused on one specific component of energy balance (e.g. hunger or RMR) rather than assessing the impact of these strategies on all components of energy balance. Given that all components of energy balance are strongly connected with each other and therefore can potentially negate beneficial impacts on one specific component, the primary objective of this application is to use a comprehensive approach that integrates all components of energy balance to quantify the changes in response to a high protein and high energy flux, alone and in combination, during weight loss (Fig 1). Our central hypothesis is that a combination of high protein intake and high energy flux will be most effective at minimizing both metabolic and behavioral adaptations in several components of energy balance such that the hyperphagic state and adaptive thermogenesis are attenuated to lead to superior weight loss results and long-term weight maintenance.
Based on the model outcomes, Houtlaan’s energy transition will likely result in congestion and curtailmentproblems on the local electricity grid within the next 5-7 years, possibly sooner if load imbalance between phasesis not properly addressed.During simulations, the issue of curtailment was observed in significant quantities on one cable, resulting in aloss of 8.292 kWh of PV production per year in 2030. This issue could be addressed by moving some of thehouses on the affects cable to a neighboring under-utilized cable, or by installing a battery system near the end ofthe affected cable. Due to the layout of the grid, moving the last 7 houses on the affected cable to the neighboringcable should be relatively simple and cost-effective, and help to alleviate issues of curtailment.During simulations, the issue of grid overloading occurred largely as a result of EV charging. This issue can bestbe addressed by regulating EV charging. Based on current statistics, the bulk of EV charging is expected to occurin the early evening. By prolonging these charge cycles into the night and early morning, grid overloading canlikely be prevented for the coming decade. However, such a control system will require some sort of infrastructureto coordinate the different EV charge cycles or will require smart EV chargers which will charge preferentiallywhen the grid voltage is above a certain threshold (i.e., has more capacity available).A community battery system can be used to increase the local consumption of produced electricity within theneighborhood. Such a system can also be complemented by charging EV during surplus production hours.However, due to the relatively high cost of batteries at present, and losses due to inefficiencies, such a systemwill not be financially feasible without some form of subsidy and/or unless it can provide an energy service whichthe grid operator is willing to pay for (e.g. regulating power quality or line voltage, prolonging the lifetime of gridinfrastructure, etc.).A community battery may be most useful as a temporary solution when problems on the grid begin to occur, untila more cost-effective solution can be implemented (e.g. reinforcing the grid, implementing an EV charge controlsystem). Once a more permanent solution is implemented, the battery could then be re-used elsewhere.The neighborhood of Houtlaan in Assen, the Netherlands, has ambitious targets for reducing the neighborhood’scarbon emissions and increasing their production of their own, sustainable energy. Specifically, they wish toincrease the percentage of houses with a heat pump, electric vehicle (EV) and solar panels (PV) to 60%, 70%and 80%, respectively, by the year 2030. However, it was unclear what the impacts of this transition would be onthe electricity grid, and what limitations or problems might be encountered along the way.Therefore, a study was carried out to model the future energy load and production patterns in Houtlaan. Thepurpose of the model was to identify and quantify the problems which could be encountered if no steps are takento prevent these problems. In addition, the model was used to simulate the effectiveness of various proposedsolutions to reduce or eliminate the problems which were identified
Brandweermensen lopen het meeste gevaar als ze onder tijdsdruk een gebouw moeten verkennen, of een brand moeten blussen terwijl de situatie nog niet goed kan worden overzien. Omvallende muren, instortende plafonds of gewoon gestruikeld over door de rook onzichtbare brokstukken leiden tot vermijdbare letsels of zelfs slachtoffers. Met name de inzet bij branden in stedelijke parkeergarages onder woontorens vormen een enorm risico. Het inzetten van onbemande, op afstand bestuurbare voertuigen voor verkenning en bluswerk is een oplossing die binnen de brandweer breed wordt gedragen. De brandweer moet deze innovatieve technologie echter zien te omarmen. Zij werken nu vanuit hun intuïtie en weten direct hoe te acteren op basis van wat zij waarnemen. Praktijkgericht onderzoek heeft echter uitgewezen dat scepsis over de inzet van blusplatforms bij incidenten plaats heeft gemaakt voor zeker vertrouwen. Een blusplatform, voorzien van juiste sensoren kan de Officier van Dienst (OVD) ondersteunen bij het nemen van een beslissing om al dan niet tot een ‘aanval’ over te gaan. Praktijktesten hebben echter laten zien dat de huidige blusplatforms nog niet optimaal functioneren om als volwaardig ‘teamlid’ te kunnen worden ingezet. Dit heeft enerzijds met technologische ontwikkelingen (sensoren en communicatieverbindingen) te maken, maar anderzijds moet de informatievoorziening (human-machine interfacing) naar de brandweer beter worden afgestemd. In dit project gaan Saxion, het instituut fysieke veiligheid, de universiteit Twente, het bedrijfsleven en vijf veiligheidsregio’s onderzoeken hoe en wanneer innovatieve blusplatforms op een intuïtieve manier kunnen worden ingezet door training én (kleine) productaanpassing zodat deze een volwaardig onderdeel kunnen zijn van het brandweerkorps. Een blusplatform kan letselschade en slachtoffers voorkomen, mits goed ingezet en vertrouwd door de mensen die daarvan afhankelijk zijn. Het vak van brandweer, als beroeps of vrijwilliger, is een van de gevaarlijkste die er is. Laten we er samen voor zorgen dat het iets veiliger kan worden.
