Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2–4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2–1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73–0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79–0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64–0.90 for 60-day mortality and HR 0.80, 95%CI 0.68–0.93 for 6-month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.
DOCUMENT
Amsterdam faces the challenge of accommodating 50,000 to 90,000 new homes in the next five to ten years. That is equivalent to 10% of the city’s current total housing stock. The new homes have to be built within the existing urban fabric. This will entail high densities and the construction of new ‘un-Dutch’ typologies with high-rise residential buildings. Densification is currently accelerating in many Western cities and high-rise living environments are gaining ground as today’s typology. Yet these new typologies come with potentially serious risks to the liveability of cities in general and those new environments in particular (Asgarzadeh et al. 2012; Lindal and Hartig 2013; Gifford 2007). Urban designers and (landscape) architects are challenged to prevent and soften the negative impact that is often associated with extremely densified environments. This entails mitigating contradictive demands: to create high-density capacity andshape streetscapes that relate to a human scale. Designers might resort to the large body of applied design solutions and theories, yet these tend to be derived from more traditional urban fabrics of low-density developments (for example: e.g. Sennett 2018; Haas 2008; Jacobs 1993; Banerjee and Southworth 1990; Alexander et.al. 1977; Jacobs 1961).Therefore, the question of the research project Sensing Streetscape is if the classical design solutions are without any alterations, applicable in these new high density settings and able to create streetscapes with a human scale. A combination of emerging technologies and principles from both worlds; neuroscience and architecture offer the opportunity to investigate this question in-depth as a relation between the designed and the visually perceived streetscape.
DOCUMENT
The purpose of this paper is to propose a research by design strategy, focusing on the generation of innovative climate adaptation solutions by utilizing the Design Thinking Process. The proposed strategy has been developed and tested in a research and design studio, which took place in 2020 at a Master of Architecture degree program in the Netherlands. The studios focused on the sparsely populated, high flood risk region of the Lake District, UK. The Lake District faces urgent climate change challenges that demand effective solutions. On the other hand, the area is a UNESCO heritage site, characterized by massive tourism and tending towards museumification (sic). Three indicative design research projects were selected to illustrate the proposed research by design strategy. The results reveal that this strategy facilitates the iterative research by design process and hence offers a systematic approach to convert the threats of climate change into opportunities by unraveling the potentials of the study area. The findings lay the groundwork for more systematic studies on research by design as an effective strategy for climate change adaptation design. Beyond the local case, the results contribute to the critical theories on climate adaptation design and research by design methodologies.
DOCUMENT
Background and objectivesBefore the Covid-19 pandemic, important social studies already indicated the severe negative feedback associated with high-rise developments. During the Covid-19 pandemic, citizens were confronted with their neighbourhoods’ insufficient restorative capacity to maintain their health and well-being. New methods are urgently required to analyse and learn from existing high-density developments to prevent a repetition of past mistakes and to catalyse the salutary effects of architecture in new developments.Process and methods (for empirical research)The Sensing Streetscapes research investigated the potential of emerging biometric technologies to examine the effects of commonly applied urban design principles in six western cities. In one outdoor and four laboratory tests, eye-tracking technology with sound-recording and Galvanic Skin Response captured subjects’ (un)conscious attention patterns and arousal levels when viewing streets on eye level. Triangulation with other techniques, such as mouse tracking to record participants’ appreciation value and expert panels from spatial design practice, showed the positive and negative impact of stimuli.Main results (or main arguments in the case of critical reviews)The preliminary results provide a dynamic understanding of urban experience and how it is affected by the presence or absence of design principles. The results suggest that streets with high levels of detail and variety may contribute to a high level of engagement with the built environment. It also shows that traffic is likely an important factor in causing stress and diminishing the restorative capacity society seeks.Implications for research and practice/policy | Importance and originality of the contributionThe research study led to the development of a Dynamic User Experience Assessment (D-UXA) tool that supports researchers and designers in understanding the impact of design decisions on users’ experience, spatial perception and (walking) behaviour. D-UXA enables a human-centred analysis and is designed to fill the gap between traditional empirical methods and aspirations for an evidence-based promotion of human health and wellbeing in (high-density) urban developments.
MULTIFILE
Western cities are rapidly densifying, and new building typologies are being invented to mitigate high-rise and balance residential, commercial and recreational functions. This vertical urbanization requires rethinking the traditional design of public space to promote citizens’ well-being. While the scarce studies on high-rise environments indicate several risks, including social fragmentation (Henderson-Wilson 2008; Love et al., 2014), mental stress and undermining attention restoration (Mazumder et al., 2020; Lindal & Hartig 2013), evidence on the potential salutary and mitigating effects of architectural design qualities is limited (Suurenbroek & Spanjar 2023).The Building for Well-being research project combines biometric and social data-collection techniques to address this gap. It builds on studies investigating how built environments allow user engagement (Mallgrave 2013; Simpson 2018) and afford important activities (Gibson 1966). This case study focuses on the experiences of predominant users of the NDSM Wharf in Amsterdam as it is transformed from a post-industrial site into a high-density, mixed-use neighborhood. Using eye-tracking, field and laboratory-based surveys, it explores how residents, passers-by and visitors visually experience, appreciate and perceive the restorative value of the wharf’s recently developed urban spaces.Thirty-six university students were randomly recruited as test subjects for the laboratory test and assigned to one of the three user groups. The resident and passer-by groups were primed for familiarity. Each group was assigned a distinct walking mode and participants were told to imagine they were strolling (residents), rushing (passers-by) or exploring (visitors). The exposure time to visual stimuli of participants was five seconds per image. Afterwards, they reported on the perceived restorative quality of ten urban spaces, focusing on: (1) sense of being away, (2) level of complexity-compatibility and (3) fascination, based on an adapted Restorative Components Scale (RCS, Yin et al. 2022; Laumann et al. 2001). Self-reported appreciation per scene was measured on a 10-point Likert scale and subjects indicated elements in the ten urban spaces they liked or disliked (see Figure 1). A semi-structured on-site survey was also carried out to investigate user experiences further and for triangulation. Thirty-one users, consisting of residents, passers-by and visitors to the NDSM Wharf, rated their appreciation of the site and its perceived restorative and design qualities (following Ewing & Clemente, 2013) on a 10-point Likert scale.The meta-data analysis of RCS statistics, appreciation values, eye-tracking metrics and heatmaps reveals distinct visual patterns among user groups. This points to the influence of environmental tasks and roles (see Figure 2). Strolling and exploring resulted in a comprehensive visual exploration of scenes with a higher mean total fixation count and shorter mean total fixation duration than goal-oriented walking. It suggests that walking mode determines the level of openness to the environment and that architectural attributes can also steer visual exploration. Scenes with the highest appreciation scores correlated with the RCS outcomes. They displayed coherence and opportunities for social engagement, contrasting with scenes with inconsistent industrial and contemporary features. These findings provide spatial designers with insights into the subliminal experiences of predominant user groups to promote well-being in urban transformation.
DOCUMENT
Western cities are rapidly densifying, and new building typologies are beinginvented to mitigate high-rise and balance residential, commercial andrecreational functions. This vertical urbanization requires rethinking thetraditional design of public space to promote citizens’ well-being. While the scarce studies on high-rise environments indicate several risks, including social fragmentation and privatization of public functions (Henderson-Wilson 2008; Love et al., 2014), mental stress and undermining attention restoration (Mazumder et al., 2020; Lindal & Hartig 2013), evidence on the potential salutary and mitigating effects of architectural design qualities is limited (Suurenbroek & Spanjar 2023).The Building for Well-being research project combines biometric and socialdata-collection techniques to address this gap. It builds on studies investigatinghow built environments allow user engagement (Mallgrave 2013; Simpson2018) and afford important activities (Gibson 1966). This case study focuseson the experiences of predominant users of the NDSM Wharf in Amsterdamas it is transformed from a post-industrial site into a high-density, mixeduseneighborhood. Using eye-tracking, field and laboratory-based surveys, itexplores how residents, passers-by and visitors visually experience, appreciateand perceive the restorative value of the wharf’s recently developed urbanspaces.Thirty-six university students were randomly recruited as test subjects for thelaboratory test and assigned to one of the three user groups. The residentand passer-by groups were primed for familiarity. Each group was assigneda distinct walking mode and participants were told to imagine they werestrolling (residents), rushing (passers-by) or exploring (visitors). The exposuretime to visual stimuli of participants was five seconds per image. Afterwards,they reported on the perceived restorative quality of ten urban spaces,focusing on: (1) sense of being away, (2) level of complexity-compatibilityand (3) fascination, based on an adapted Restorative Components Scale (RCS,Yin et al. 2022; Laumann et al. 2001). Self-reported appreciation per scenewas measured on a 10-point Likert scale and subjects indicated elements inthe ten urban spaces they liked or disliked (see Figure 1). A semi-structuredon-site survey was also carried out to investigate user experiences furtherand for triangulation. Thirty-one users, consisting of residents, passers-byand visitors to the NDSM Wharf, rated their appreciation of the site and itsperceived restorative and design qualities (following Ewing & Clemente, 2013)on a 10-point Likert scale.The meta-data analysis of RCS statistics, appreciation values, eye-trackingmetrics and heatmaps reveals distinct visual patterns among user groups. Thispoints to the influence of environmental tasks and roles (see Figure 2). Strollingand exploring resulted in a comprehensive visual exploration of scenes with ahigher mean total fixation count and shorter mean total fixation duration thangoal-oriented walking. It suggests that walking mode determines the level ofopenness to the environment and that architectural attributes can also steervisual exploration. Scenes with the highest appreciation scores correlatedwith the RCS outcomes. They displayed coherence and opportunities forsocial engagement, contrasting with scenes with inconsistent industrial andcontemporary features. These findings provide spatial designers with insightsinto the subliminal experiences of predominant user groups to promote wellbeing in urban transformation.
DOCUMENT
DOCUMENT
The (pre)school environment is an important setting to improve children’s health. Especially, the (pre)school playground provides a major opportunity to intervene. This review presents an overview of the existing evidence on the value of both school and preschool playgrounds on children’s health in terms of physical activity, cognitive and social outcomes. In addition, we aimed to identify which playground characteristics are the strongest correlates of beneficial effects and for which subgroups of children effects are most distinct. In total, 13 experimental and 17 observational studies have been summarized of which 10 (77%) and 16 (94%) demonstrated moderate to high methodological quality, respectively. Nearly all experimental studies (n = 11) evaluated intervention effects on time spent in different levels of physical activity during recess. Research on the effects of (pre)school playgrounds on cognitive and social outcomes is scarce (n = 2). The experimental studies generated moderate evidence for an effect of the provision of play equipment, inconclusive evidence for an effect of the use of playground markings, allocating play space and for multi-component interventions, and no evidence for an effect of decreasing playground density, the promotion of physical activity by staff and increasing recess duration on children’s health. In line with this, observational studies showed positive associations between play equipment and children’s physical activity level. In contrast to experimental studies, significant associations were also found between children’s physical activity and a decreased playground density and increased recess duration. To confirm the findings of this review, researchers are advised to conduct more experimental studies with a randomized controlled design and to incorporate the assessment of implementation strategies and process evaluations to reveal which intervention strategies and playground characteristics are most effective. https://doi.org/10.1186/1479-5868-11-59 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.
MULTIFILE
The nasopharyngeal commensal Streptococcus pneumoniae can become invasive and cause metastatic infection. This requires the pneumococcus to have the ability to adapt, grow, and reside in diverse host environments. Therefore, we studied whether the likelihood of severe disease manifestations was related to pneumococcal growth kinetics. For 383 S. pneumoniae blood isolates and 25 experimental mutants, we observed highly reproducible growth curves in nutrient-rich medium. The derived growth features were lag time, maximum growth rate, maximum density, and stationary-phase time before lysis. First, the pathogenicity of each growth feature was probed by comparing isolates from patients with and without marked preexisting comorbidity. Then, growth features were related to the propensity of causing severe manifestations of invasive pneumococcal disease (IPD). A high maximum bacterial density was the most pronounced pathogenic growth feature, which was also an independent predictor of 30-day mortality (P = 0.03). Serotypes with an epidemiologically higher propensity for causing meningitis displayed a relatively high maximum density (P < 0.005) and a short stationary phase (P < 0.005). Correspondingly, isolates from patients diagnosed with meningitis showed an especially high maximum density and short stationary phase compared to isolates from the same serotype that had caused uncomplicated bacteremic pneumonia. In contrast, empyema-associated strains were characterized by a relatively long lag phase (P < 0.0005), and slower growth (P < 0.005). The course and dissemination of IPD may partly be attributable to the pneumococcal growth features involved. If confirmed, we should tailor the prevention and treatment strategies for the different infection sites that can complicate IPD.
DOCUMENT
Tomato varieties used at present for commercial production in Dutch glasshouses have a high density of glandular trichomes on the stem, but a very low density on the leaves. The two-spotted spider mite, Tetranychus urticae Koch, and the predatory mite, Phytoseiulus persimilis Athias-Henriot, usually disperse from leaf to leaf via the stem, thereby incurring high risks of entrapment (and death) in the exudate of the glandular trichomes. These risks have been quantified on the tomato cv. 'Turbo' and an accession of Lycopersicon peruvianum almost free of glandular trichomes. The possible consequences for biological control are discussed and new perspectives for predator release strategies and for plant breeding are considered. © 1987 Elsevier Science Publishers B.V.
DOCUMENT
