BACKGROUND: It is generally unknown to what extent organ transplant recipients can be physically challenged. During an expedition to Mount Kilimanjaro, the tolerance for strenuous physical activity and high-altitude of organ transplant recipients after various types of transplantation was compared to non-transplanted controls.METHODS: Twelve organ transplant recipients were selected to participate (2 heart-, 2 lung-, 2 kidney-, 4 liver-, 1 allogeneic stem cell- and 1 small bowel-transplantation). Controls comprised the members of the medical team and accompanying family members (n = 14). During the climb, cardiopulmonary parameters and symptoms of acute mountain sickness were recorded twice daily. Capillary blood analyses were performed three times during the climb and once following return.RESULTS: Eleven of the transplant participants and all controls began the final ascent from 4700 meters and reached over 5000 meters. Eight transplant participants (73%) and thirteen controls (93%) reached the summit (5895m). Cardiopulmonary parameters and altitude sickness scores demonstrated no differences between transplant participants and controls. Signs of hyperventilation were more pronounced in transplant participants and adaptation to high-altitude was less effective, which was related to a decreased renal function. This resulted in reduced metabolic compensation.CONCLUSION: Overall, tolerance to strenuous physical activity and feasibility of a high-altitude expedition in carefully selected organ transplant recipients is comparable to non-transplanted controls.
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Stefan Bengtsson's commentary about policy hegemony discusses the alternative discourses of socialism, nationalism, and globalism. However, Stefan does not adequately demonstrate how these discourses can overcome the Dominant Western Worldview (DWW), which is imbued with anthropocentrism. It will be argued here that most policy choices promoting sustainability, and education for it, are made within a predetermined system in which the already limiting notion of environmental protection is highly contingent on human welfare. What would really contest the dominant assumptions of Vietnamese policy and, more specifically, education for sustainable development (ESD) is an alternative discourse that challenges the DWW. That alternative discourse embraces philosophical ecocentrism and practices of ecological justice between all species, and deep ecology theory - all perspectives fundamentally committed to environmental protection. https://doi.org/10.1080/00958964.2015.1048502 LinkedIn: https://www.linkedin.com/in/helenkopnina/
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Across the globe, linguistically heterogeneous populations increasingly define school systems at the same time that developing the ability to communicate cross-culturally is becoming essential for internationalized economies. While these trends seem complimentary, they often appear in paradoxical opposition as represented in the content and execution of nationwide education policies. Given the differing geopolitical contexts within which school systems function, wide variation exists with regard to how policymakers address the challenges of providing language education, including how they frame goals and design programs to align with those goals. Here we present a cross-continental examination of this variation, which reveals parallel tensions among aims for integrating immigrant populations, closing historic achievement gaps, fostering intercultural understanding, and developing multilingual competencies. To consider implications of such paradoxes and parallels in policy foundations, we compare language education in the US and in the EU, focusing on the Netherlands as an illustrative case study.
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When children drop out of school, either temporarily or permanently, this poses a significant problem for both children and society. In the Netherlands, care farms offering care-education programs for school dropouts are emerging. While there is evidence for their effectiveness, models explaining how such outdoor interventions may facilitate positive developments of children and their return to school are lacking. Using the generic Context-Intervention-Mechanisms-Outcome Model as an overarching deductive frame, this study inductively examines how care-educational programs facilitate the positive development of children who have dropped out of school.
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The carbon sink capacity of tropical forests is substantially affected by tree mortality. However, the main drivers of tropical tree death remain largely unknown. Here we present a pan-Amazonian assessment of how and why trees die, analysing over 120,000 trees representing > 3800 species from 189 long-term RAINFOR forest plots. While tree mortality rates vary greatly Amazon-wide, on average trees are as likely to die standing as they are broken or uprooted—modes of death with different ecological consequences. Species-level growth rate is the single most important predictor of tree death in Amazonia, with faster growing species being at higher risk. Within species, however, the slowest-growing trees are at greatest risk while the effect of tree size varies across the basin. In the driest Amazonian region species-level bioclimatic distributional patterns also predict the risk of death, suggesting that these forests are experiencing climatic conditions beyond their adaptative limits.These results provide not only a holistic pan-Amazonian picture of tree death but largescale evidence for the overarching importance of the growth–survival trade-off in driving tropical tree mortality.
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Abstract Aims: Medical case vignettes play a crucial role in medical education, yet they often fail to authentically represent diverse patients. Moreover, these vignettes tend to oversimplify the complex relationship between patient characteristics and medical conditions, leading to biased and potentially harmful perspectives among students. Displaying aspects of patient diversity, such as ethnicity, in written cases proves challenging. Additionally, creating these cases places a significant burden on teachers in terms of labour and time. Our objective is to explore the potential of artificial intelligence (AI)-assisted computer-generated clinical cases to expedite case creation and enhance diversity, along with AI-generated patient photographs for more lifelike portrayal. Methods: In this study, we employed ChatGPT (OpenAI, GPT 3.5) to develop diverse and inclusive medical case vignettes. We evaluated various approaches and identified a set of eight consecutive prompts that can be readily customized to accommodate local contexts and specific assignments. To enhance visual representation, we utilized Adobe Firefly beta for image generation. Results: Using the described prompts, we consistently generated cases for various assignments, producing sets of 30 cases at a time. We ensured the inclusion of mandatory checks and formatting, completing the process within approximately 60 min per set. Conclusions: Our approach significantly accelerated case creation and improved diversity, although prioritizing maximum diversity compromised representativeness to some extent. While the optimized prompts are easily reusable, the process itself demands computer skills not all educators possess. To address this, we aim to share all created patients as open educational resources, empowering educators to create cases independently.
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The goal of a local energy community (LEC) is to create a more sustainable, resilient, and efficient energy system by reducing dependence on centralized power sources and enabling greater participation and control by local communities and individuals. LEC requires transformations in local energy systems, and strongly depends on the preferences and actions of the local actors involved. The necessity for extensive stakeholder involvement adds complexity to the energy transition, posing a significant challenge for all involved parties. The municipality of Leidschendam-Voorburg has committed to the national decision for energy transition. It has taken a strategic approach by proceeding De Heuvel/Amstelwijk as the pioneer in this initiative, leading the way for other neighborhoods to follow. It is crucial to devise strategies that effectively facilitate stakeholder engagement. To this end, a thorough stakeholder analysis is needed. Such an analysis can focus on the identification of key stakeholders, their interests, their influence, and their behavioral characteristics in relation to the energy transition. Additionally, it's crucial to uncover the challenges encountered by these stakeholders and finally develop appropriate strategies to address them hence enhance their engagement. This thesis begins with an introduction to the research background, including a presentation of the case study and a statement of the problem identified in the field, followed by the research questions underpinning the study. A thorough literature review ensues, providing a robust synthesis of existing research relating to stakeholder engagement in LECs, with a view to expediting energy transitions. The literature review not only forms the foundation for the research methods adopted in this study but also promotes in the construction of the conceptual model. Subsequent to the literature review, the research method is detailed. The filed research is conducted in five steps: Step 1 - identification of stakeholders, Step 2 - prioritization of stakeholders, Step 3 - interviewing, Step 4 - data analysis, including stakeholder profiling with mapping and addressing challenges, and finally, Step 5 - proposal of strategies for stakeholder engagement enhancement based on the expected and current levels of stakeholders engagement. This research collects necessary information to understand the profiles of stakeholders in De Heuvel/Amstelwijk, tackle challenges faced by different stakeholders, propose strategies to increase stakeholders engagement. It not only aims to enrich the depth of theoretical knowledge on the subject matter but also strives to aid in the development of a localized energy strategy that is optimally suited for the De Heuvel/Amstelwijk neighborhood as good example for other neighborhoods.
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Baseline data on anthropogenic seafloor debris contamination in the year 2000 is provided for 24 submersible video transects at depths of 80–900 m, off the Dutch ABC-islands (Aruba, Bonaire, Curaçao), in the southeastern Caribbean Sea. In total, 202 objects were documented from a combined 21,184 m of transect, ranging from sandy lower island-slope to rocky upper island-slope habitat. Debris densities differed significantly with depth. Highest debris accumulation (0.459 items 100 m−2 or 4590 items per km2) occurred at depths of 300–600 m on more shallow-sloping (20–30°) sand and silt bottoms. The overall average debris density was 0.27 objects per 100 m2 (or 2700 items per km2), which is an order of magnitude higher than most other deepwater debris studies. What we describe may be representative for other small, populated, steep volcanic Caribbean islands. Food and beverage-related items were the single largest usage category identified (44% of objects; mostly glass beverage bottles).
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Background and aim ʹ Many countries signed the Paris Agreement to mitigate global average temperature rise. In this context, Dutch government decided to realize a reduction of 50% using resources and raw materials in 2030. This paper explores how practice-based research into facility operations can contribute to this aim. Methods / Methodology ʹ Practice-based research which includes direct observations, desk research, and participatory action research. Results ʹ This explorative research presents principles and suggestions for facility managers and procurement managers on how they can embed sustainable materials management in the organisation and how to take control of waste. The proposed suggestions are derived from practice-based research and presented as topics of attention for facility professionals. Originality ʹ Within education of Dutch universities of applied sciences and daily professional facility practices, the phenomenon of materials management is underexposed. To contribute to the national and international climate objectives, (future) facility professionals need better support to reduce waste. Bachelor students were involved throughout this research. This approach gave refreshing insights into waste at the end of the supply chain (control separation units) that can improve informed decisionmaking at the beginning of the supply chain. Practical or social implications ʹ Facility management professionals have an important role to play in the mitigation of global average temperature rise, because of their leading role in procurement, service operations, and materials management. However, they struggle to find sustainable solutions. This paper seeks to inspire professionals with interventions that have proven effectiveness on the reduction of waste. Type of paper ʹ Short research paper.
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Deze publicatie is ontwikkeld door het lectoraat Communicatie, Participatie en Sociaal-Ecologisch Leren (CoPSEL) in samenwerking met partneruniversiteiten als een eindresultaat van het Invest4Excellence project. Het magazine onderzoekt de complexiteit en dynamiek van Living Labs door met een drietal metaforen (koken, reizen en Do-It-Yourself) te reflecteren op Living Labs zowel in Nederland, Europa en daarbuiten.
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