Schoon en voldoende zoetwater is van levensbelang voor mens en natuur. Maar in het waterrijke Nederland wordt schoon zoetwater steeds minder een vanzelfsprekendheid. Het oppervlakte- en grondwater komen steeds meer onder druk te staan door toename in gebruik, vervuiling, verzilting en klimaatverandering. Vanuit landelijk en Europees beleid zal steeds meer ingezet worden op de verbetering van de waterkwaliteit, waterbesparing en waterhergebruik. Hoe kan je als bedrijf of organisatie hier mee omgaan? Welke praktische voorbeelden zijn er? Over deze onderwerpen wordt gesproken in Early Morning talk. Eén van de gasten is Jantsje van Loon-Steensma, lector 'Nature Based River Management' aan hogeschool Van Hall Larenstein.
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Background: To avoid overexertion in critically ill patients, information on the physical demand, i.e., metabolic load, of daily care and active exercises is warranted. Objective: The objective of this study was toassess the metabolic load during morning care activities and active bed exercises in mechanically ventilated critically ill patients. Methods: This study incorporated an explorative observational study executed in a university hospital intensive care unit. Oxygen consumption (VO2) was measured in mechanically ventilated (≥48 h) critically ill patients during rest, routine morning care, and active bed exercises. We aimed to describe and compare VO2 in terms of absolute VO2 (mL) defined as the VO2 attributable to the activity and relative VO2 in mL per kilogram bodyweight, per minute (mL/kg/min). Additional outcomes achieved during the activity were perceived exertion, respiratory variables, and the highest VO2 values. Changes in VO2 and activity duration were tested using paired tests. Results: Twenty-one patients were included with a mean (standard deviation) age of 59 y (12). Median (interquartile range [IQR]) durations of morning care and active bed exercises were 26 min (21–29) and 7 min (5–12), respectively. Absolute VO2 of morning care was significantly higher than that of active bed exercises (p = 0,009). Median (IQR) relative VO2 was 2.9 (2.6–3.8) mL/kg/min during rest; 3.1 (2.8–3.7) mL/kg/min during morning care; and 3.2 (2.7–4) mL/kg/min during active bed exercises. The highest VO2 value was 4.9 (4.2–5.7) mL/kg/min during morning care and 3.7 (3.2–5.3) mL/kg/min during active bed exercises. Median (IQR) perceived exertion on the 6–20 Borg scale was 12 (10.3–14.5) during morning care (n = 8) and 13.5 (11–15) during active bed exercises (n = 6). Conclusion: Absolute VO2 in mechanically ventilated patients may be higher during morning care than during active bed exercises due to the longer duration of the activity. Intensive care unit clinicians should be aware that daily-care activities may cause intervals of high metabolic load and high ratings of perceived exertion.
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Each of us has a story that comes alive as we wake up in the morning, develops throughout the day, and holds layers of meaning as we lay our heads down at night – it might be called a narrative of our identity. When loss occurs, our story fragments into unfamiliar pieces, and who we identify as becomes scattered – sometimes even shattered. We must work to reconstruct meaning in our lives and to rebuild our identity. As leading author on this editorial, with an article of my own in this issue, I confronted this when my father died. I felt his story slipping away, becoming blurred, forgotten, and for some, erased – and the same held true for me. The chaos of my shattered identity exacerbated the deep pain of losing him and I experienced complicated grief. I had to reshape my narrative to remember the authentic parts of me and rebuild a new self in a fatherless world. This journey is in part what motivated me to become a symposium co-editor for the journal. All four of us editors of this special issue have experienced “living with loss” following the premature loss of either our father or spouse, and I wanted to see what lived experience and knowledge we could bring to the readers about loss in the fields of both guidance and counselling.
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The emergence of wearable sensor technology may provide opportunities for automated measurement of psychophysiological markers of mental and physical fitness, which can be used for personalized feedback. This study explores to what extent within-subject changes in resting heart rate variability (HRV) during sleep predict the perceived mental and physical fitness of military personnel on the subsequent morning. Participants wore a Garmin wrist-worn wearable and filled in a short morning questionnaire on their perceived mental and physical fitness during a period of up to 46 days. A custom-built smartphone app was used to directly retrieve heart rate and accelerometer data from the wearable, on which open-source algorithms for sleep detection and artefact filtering were applied. A sample of 571 complete observations in 63 participants were analyzed using linear mixed models. Resting HRV during sleep was a small predictor of perceived physical fitness (marginal R 2 = .031), but not of mental fitness. The items on perceived mental and physical fitness were strongly correlated (r = .77). Based on the current findings, resting HRV during sleep appears to be more related to the physical component of perceived fitness than its mental component. Recommendations for future studies include improvements in the measurement of sleep and resting HRV, as well as further investigation of the potential impact of resting HRV as a buffer on stress-related outcomes.
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Purpose Worldwide, there are 30 million people with dementia (PWD) in 2009 and 100 million in 2050, respectively.These numbers show the need for a change in care for PWD. Leisure is one of these care aspects. Leisure activities can support PWD in several ways: meeting basic needs, providing comfort and social interaction, and reducing boredom, agitation, and isolation. An exemplary activity targeted at meeting these needs is ‘De Klessebessers (KB)’ (The Chitchatters), which aims to stimulate social interaction among PWD and provide comfort with supporting technology. This is innovative since technology for PWD generally concentrates on safety and monitoring activities. The activity comprises a radio, television, telephone, and treasure box. Method This study’s focus follows from the original aim of the KB-designers; to stimulate social interaction. In a nursing home and day care centre, the KB game was played with different groups of PWD (n=21: 12 females, 9 males, mean MMSE=17, range 3-28). In the morning KB (with technology), and in the afternoon an activity called ‘Questiongame’ (without technology) were played for 45 minutes. These activities were played twice in a two-month period, and outcomes were compared in terms of impact on social interaction. Group sizes ranged from 3 to 8 PWD assisted by 1 or 2 activity therapists. Two researchers observed the players during the activity with the Oshkosh Social Behavior Coding (OSBC) scale, which encompasses both verbal and nonverbal social and nonsocial behaviour. These behaviours can have a person-initiated and otherinitiated character (quantitative study). A total of 6 activity therapists were interviewed on the KB afterwards (qualitative study). Results & Discussion The quantitative results showed significantly higher scores for KB for the total of social interaction compared to Questiongame. Most of the behaviour is other-initiated (activity therapist). PWD with a lower MMSE score showed more non-verbal behaviour. For PWD with a MMSE score below 7, there was no difference in social interaction between the two activities. According to the qualitative research, KB triggered more social interaction, since the movies and music were stimulating the players to initiate a conversation, to which other players responded. The results of this research correspond with earlier research, which concludes that leisure activities with technology can show positive results on well-being.
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Background: Multiple sclerosis often leads to fatigue and changes in physical behavior (PB). Changes in PB are often assumed as a consequence of fatigue, but effects of interventions that aim to reduce fatigue by improving PB are not sufficient. Since the heterogeneous nature of MS related symptoms, levels of PB of fatigued patients at the start of interventions might vary substantially. Better understanding of the variability by identification of PB subtypes in fatigued patients may help to develop more effective personalized rehabilitation programs in the future. This study aimed to identify PB subtypes in fatigued patients with multiple sclerosis based on multidimensional PB outcome measures. Methods: Baseline accelerometer (Actigraph) data, demographics and clinical characteristics of the TREFAMS-ACE participants (n = 212) were used for secondary analysis. All patients were ambulatory and diagnosed with severe fatigue based on a score of ≥35 on the fatigue subscale of the Checklist Individual Strength (CIS20r). Fifteen PB measures were used derived from 7 day measurements with an accelerometer. Principal component analysis was performed to define key outcome measures for PB and two-step cluster analysis was used to identify PB types. Results: Analysis revealed five key outcome measures: percentage sedentary behavior, total time in prolonged moderate-to-vigorous physical activity, number of sedentary bouts, and two types of change scores between day parts (morning, afternoon and evening). Based on these outcomes three valid PB clusters were derived. Conclusions: Patients with severe MS-related fatigue show three distinct and homogeneous PB subtypes. These PB subtypes, based on a unique set of PB outcome measures, may offer an opportunity to design more individually-tailored interventions in rehabilitation.
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This applied research is an attempt to analyse the effectiveness of milk marketing and facilitate developing a sustainable milk value chain for dairy farmer’s groups in Punakha district. Both quantitative and qualitative methods of survey, key informant interviews and focus group discussion were used as research strategies to obtain relevant information. The survey was conducted using both open and closed-ended structured questionnaire in seven subdistricts of Barp, Dzomi, Guma, Kabisa, Shelnga-Bjemi, Talog and Toedwang. A total of 60 respondents; 30 existing milk suppliers and 30 non-milk suppliers were drawn using a simple random sampling technique. One-to-one interviews were conducted following semi-structured questions with eight key informants in the chain. One focus group interview was conducted with the existing dairy farmer groups representatives to triangulate and discover in-depth information about the situation of the milk value chain in the district. The survey data was analysed using the Statistical Package for Social Sciences software version 20. A method of grounded theory design was used to analyse the qualitative data of interviews and focus group discussion. Value chain mapping was employed for assessing the operational situation of the current milk chain. The mean cost of milk production was estimated at Nu.27.53 per litre and the maximum expenses were incurred in animal feeds which were estimated to be 46.34% of the total cost of milk production. In this study, milk producers had the highest share of added value and profit which were estimated at 45.45% and 44.85% respectively. Limited information and coordination amongst stakeholders have contributed to slow progression in the formal milk market. The finding reveals that 90% of nondairy farmer groups respondents were interested in joining formal milk marketing. The average morning milk available for supply from this group would be 4.41 ± 3.07 litres daily by each household. The study also found that 50% of the respondents were interested in supplying evening milk with an average of 4.43 ± 2.25 litres per day per household. Based on the result of this study, it was concluded that there are possibilities of expanding the milk value chain in the district. However, there is a need to enhance consistent milk supply through a quality-based milk payment system, access to reasonable input supplies, and facilitate strong multi-stakeholder processes along the milk value chain.
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Het aantal kwetsbare ouderen in Nederland neemt toe en huisartsen voelen vaak de behoefte om negatieve gezondheidsuitkomsten bij deze patiënten voor te zijn. Er zijn diverse screeningsinstrumenten ontwikkeld, waaronder veel vragenlijsten. Kwetsbaarheidsvragenlijsten waar onderzoek naar is gedaan, blijken negatieve gebeurtenissen echter niet beter te voorspellen dan de huisarts zelf. Het heeft dan ook geen zin om kwetsbaarheid te scoren met een standaard vragenlijst.
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Do young adolescents enjoy long distance cycling to school? An exploratory research to understand attitudes and behavior in the NetherlandsIntroduction The change from primary to secondary school has a negative impact on physical activity levels of adolescents. Cycling is an easy way of integrating physical activity into adolescents’ daily life. In the Netherland, cycling is rather common and around 80% of adolescents are cycling to school every day although they have to travel around 9km; however, the percentage dropped dramatically for adults. To maintain the habits of cycling is important to understand the attitude towards cycling and other mode of travel. This study aimed to uncover factors that makes young adolescents cycling to school unpleasant for them , using qualitative method.MethodsAn online interactive map-based questionnaire (Maptionnaire), focus group discussions, carrying a GPS logger and an online travel diary for 5 days, were used to understand attitudes and behavior towards long distance cycling to school in 36 adolescents (12-15 years). ResultsAlthough the majority of participants were cycling to school, only 30% of them chose cycling as their favorite travel mode. More than 80% of participants stated that the car is a more convenient travel mode, because protects you in bad weather and is faster than bicycle. Also, 70% of participants thought cycling in rural areas and along busy roads in city is not safe. A lot of adolescents stated that crowded cycling pathways around the school especially in the morning, makes cycling stressful. Almost half of adolescents doubted whether cycling to school is good for their health. They stated that it is stressful to cycle in overcrowded cycling pathways around the school in the morning. Long distance cycling on windy/rainy days, lack of traffic safety, and crowded cycling pathways around the school in the morning were mentioned as main reasons to make adolescents’ cycling to school unpleasant for them.ConclusionCycling intervention should focus on improving adolescents’ traffic safety perceptions, and to take urgent steps to improve over-crowded cycle lanes at rush hours. Also it is important to educate adolescents on health benefits of cycling. It will help to maintain adolescents’ habit of cycling after reaching the age at which it is possible to ride a moped/car.
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Patiënten hebben het recht om hun eigen huisartsendossier in te zien. Dat heeft allerlei voordelen – zo krijgen patiënten een groter inzicht in hun eigen gezondheidstoestand en kunnen ze zich beter voorbereiden op het gesprek met de huisarts. Sommige huisartsen maken zich echter zorgen, want patiënten kunnen de informatie ook verkeerd begrijpen en nodeloos ongerust worden. Zijn dergelijke zorgen terecht?
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