BackgroundIn a global effort to design better hospital buildings for people and organizations, some design principles are still surrounded by great mystery. The aim of this online study was to compare anxiety in an existing single-bed inpatient hospital room with three redesigns of this room in accordance with the principles of Golden Ratio, Feng Shui, and Evidence-Based Design.MethodsIn this online multi-arm parallel-group randomized trial participants were randomly assigned (1:1:1:1) to one of four conditions, namely Golden Ratio condition, Feng Shui condition, Evidence-Based Design condition, or the control condition. The primary outcomes were anxiety, sense of control, social support, positive distraction, and pleasantness of the room.FindingsBetween June 24, 2022, and August 22, 2022, 558 individuals were randomly assigned to one of the four conditions, 137 participants to the control condition, 138 participants to the Golden Ratio condition, 140 participants to the Feng Shui condition, and 143 participants to the Evidence-Based Design condition. Compared with baseline, participants assigned to the Evidence-Based Design condition experienced less anxiety (mean difference -1.35, 95% CI -2.15 to -0.55, Cohen’s d = 0.40, p < 0.001). Results also showed a significant indirect effect of the Feng Shui condition on anxiety through the pleasantness of the room (B = -0.85, CI = -1.29 to -0.45) and social support (B = -0.33, CI = -0.56 to -0.13). Pleasantness of the room and social support were mediators of change in anxiety in the Evidence-Based Design and Feng Shui conditions. In contrast, application of the design principle Golden Ratio showed no effect on anxiety and remains a myth.InterpretationTo our knowledge, this is the first randomized controlled trial linking design principles directly to anxiety in hospital rooms. The findings of our study suggest that Feng Shui and Evidence-Based Design hospital rooms can mitigate anxiety by creating a pleasant looking hospital room that fosters access to social support.
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Objectives: Decline in the performance of instrumental activities of daily living (IADL) and mobility may be preceded by symptoms the patient experiences, such as fatigue. The aim of this study is to investigate whether self-reported non-task-specific fatigue is a long-term risk factor for IADL-limitations and/or mobility performance in older adults after 10 years. Methods: A prospective study from two previously conducted cross-sectional studies with 10-year follow-up was conducted among 285 males and 249 females aged 40–79 years at baseline. Fatigue was measured by asking “Did you feel tired within the past 4 weeks?” (males) and “Do you feel tired?” (females). Self-reported IADLs were assessed at baseline and follow-up. Mobility was assessed by the 6-minute walk test. Gender-specific associations between fatigue and IADL-limitations and mobility were estimated by multivariable logistic and linear regression models. Results: A total of 18.6% of males and 28.1% of females were fatigued. After adjustment, the odds ratio for fatigued versus non-fatigued males affected by IADL-limitations was 3.3 (P=0.023). In females, the association was weaker and not statistically significant, with odds ratio being 1.7 (P=0.154). Fatigued males walked 39.1 m shorter distance than those non-fatigued (P=0.048). For fatigued females, the distance was 17.5 m shorter compared to those non-fatigued (P=0.479). Conclusion: Our data suggest that self-reported fatigue may be a long-term risk factor for IADL-limitations and mobility performance in middle-aged and elderly males but possibly not in females.
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Objectives Patients who underwent corrective surgery for tetralogy of Fallot (TOF) have increased long-term risk of cardiovascular morbidity and mortality. Yet, limited information is available on how to evaluate the risk in this population. Therefore, the aim of this study was to investigate the prognostic value of aerobic exercise capacity, along with other related parameters, at medium-term follow-up in adult patients with tetralogy of Fallot. Methods and results Between 2000 and 2003, 92 adults (age 26.2 ± 7.8 years; 63 male) with corrected TOF or TOF-type morphology underwent a cardiopulmonary exercise test (CPET) until exhaustion and echocardiography. During a mean follow-up of 7.3 ± 1.2 years (range 0.9 to 9.3 years), 2 patients died and 26 patients required at least 1 cardiac-related intervention at a mean age of 28.9 ± 7.9 years. Event-free survival tended to be higher in patients with the classical type of TOF (P = 0.061). At multivariate Cox analysis, age at CPET [hazard ratio (HR): 1.13, P = 0.006], age at correction (HR: 0.82, P = 0.037), right ventricular (RV) function (HR: 4.94, P = 0.001), QRS duration (HR: 1.02, P = 0.007), percentage of predicted peak oxygen uptake (peak VO2%) (HR: 0.96, P = 0.029) and ventilatory effi ciency slope (VE/VCO2 slope) (HR: 1.13, P = 0.021) were signifi cantly related to the incidence of death/cardiac-related intervention during medium follow-up. Conclusions Early corrective surgery and a well-preserved RV are associated with a better outcome in adults with corrected TOF. Furthermore, CPET provides important prognostic information; peak VO2% and VE/VCO2 slope are independent predictors for event-free survival in patients with corrected TOF.
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Ons recente onderzoek laat zien hoe de eeuwenoude wijsheid zoals Feng Shui en moderne wetenschappelijke benaderingen zoals Evidence-Based Design kunnen bijdragen aan het verminderen van stress. De resultaten van deze studie tonen geen voordelen van ziekenhuiskamers die volgens de Gulden Snede zijn ingericht. De resultaten van dit onderzoek zijn onlangs gepubliceerd in het wetenschappelijke tijdschrift PLOS ONE.
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In order to achieve a level of community involvement and physical independence, being able to walk is the primary aim of many stroke survivors. It is therefore one of the most important goals during rehabilitation. Falls are common in all stages after stroke. Reported fall rates in the chronic stage after stroke range from 43 to 70% during one year follow up. Moreover, stroke survivors are more likely to become repeated fallers as compared to healthy older adults. Considering the devastating effects of falls in stroke survivors, adequate fall risk assessment is of paramount importance, as it is a first step in targeted fall prevention. As the majority of all falls occur during dynamic activities such as walking, fall risk could be assessed using gait analysis. It is only recent that technology enables us to monitor gait over several consecutive days, thereby allowing us to assess quality of gait in daily life. This thesis studies a variety of gait assessments with respect to their ability to assess fall risk in ambulatory chronic stroke survivors, and explores whether stroke survivors can improve their gait stability through PBT.
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Societal one-way directed approaches of sustainable primary school building design cause persistent physical building problems. It affects the performances of the societal challenge of designing real sustainable school buildings, as well as the educational and social processes, and its end-user performances. Conventional building construction approaches build traditionally their designs on a syntheses of dialogues and consensus during decision-making processes, due to a variety of different interests. Principals define their ambitions and requirements into a team of mainly technical domain related disciplines. There are no design methods available that connect human systems and ecosystems integrated and balance the dynamic multi-level scaled mechanisms of human needs and sustainability development factors. The presented analytic framework recognizes similarity patterns between these multi-level scaled social systems, ecosystems and sustainable development entities, qualitatively as well as quantitatively. It delivers a new polarity based dynamic system that contributes to the client briefs and physical building morphological factors from a more sustainable development base. This theoretical approach establishes Sustainability-Centered Guidelines for primary schools (SCGs) design and building.
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This is the second edition of the Startup Workbook. This workbook is different from the first version. The first version, which was made with a so called touch-grant from Saxion, was primarily a digital version. In addition, the book was printed as a deluxe edition in a limited number of copies. The eBook has quickly been downloaded thousands of times through the website (www.startupwerkboek.nl). By using the Startup Work-book by Startups in the Startup Center Saxion (part of the Center for Entrepreneurship) it was revealed that one has a need to really use it as a workbook. That is, the questions that are in the book, must be filled in. Some Startups printed out the downloaded version, to be able to use it for writing answers. The printed version has therefore become a real book. That means that the questions can be answered directly in the book. It is in a writable form. If you have access to the Toolbox, you can also fill in the online questionnaire after each step, which you then will get mailed back. If required we can then remotely assist you with your cus-tomer development based on your reply. Another change in this version is that the business devel-opment trajectory isn’t spread over 12 weeks, but spread over 12 steps. A startup probably needs a week for a certain step, whereas another startup may sometimes need more time. This second edition is still primarily an eBook, which is free to download. The advantage of the eBook is that adjustments can be made quickly (the knowledge and methodologies for startups go so fast), and direct links to other website can be used easier when presented in an electronic way.
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De kredietcrisis. Wat is dat nou eigenlijk? Welke oorzaken zijn daarvoor aan te wijzen? En wat zijn maatregelen om zoiets in de toekomst te voorkomen? Op deze vragen zal ik in dit essay antwoord geven. Hierin zal ik mijn visie geven op de oorzaken van de kredietcrisis en de meningen van deskundigen bespreken. Mijn stelling is dat er veel oorzaken zijn die bijgedragen hebben aan het ontstaan van de kredietcrisis, maar dat ze eigenlijk allemaal terug te voeren zijn op het gedrag van mensen. Onder dit menselijk gedrag versta ik het gedrag van alsmaar meer willen. Meer is in dit opzicht: meer financiële producten verkopen, meer macht, geld en winst. Dit is te vatten in de term menselijke hebzucht.
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