Background: Although the general assumption is that patients with rheumatoid arthritis (RA) have decreased levels of physical activity, no review has addressed whether this assumption is correct. Methods: Our objective was to systematically review the literature for physical activity levels and aerobic capacity (VO2max). in patients with (RA), compared to healthy controls and a reference population. Studies investigating physical activity, energy expenditure or aerobic capacity in patients with RA were included. Twelve studies met our inclusion criteria. Results: In one study that used doubly labeled water, the gold standard measure, physical activity energy expenditure of patients with RA was significantly decreased. Five studies examined aerobic capacity. Contradictory evidence was found that patients with RA have lower VO2max than controls, but when compared to normative values, patients scored below the 10th percentile. In general, it appears that patients with RA spend more time in light and moderate activities and less in vigorous activities than controls. Conclusion: Patients with RA appear to have significantly decreased energy expenditure, very low aerobic capacity compared to normative values and spend less time in vigorous activities than controls
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OBJECTIVE: To determine whether aerobic capacity is normal in boys with different types of hemophilia compared with healthy peers and whether the level of aerobic capacity correlates with the amount of physical activity, joint health status, muscle strength, and anthropometrics.STUDY DESIGN: 47 patients (mean [SD] age, 12.9 [3.2] years; age range, 8.2-17.4 years) from the "Van Creveldkliniek" of the University Medical Center Utrecht, participated. Anthropometry, muscle strength, joint impairment, functional ability, and aerobic capacity were measured. The amount of energy expenditure during daily living was assessed.RESULTS: All boys were able to perform at maximal or near-maximal level on exercise tests, and none of them reported bleeds or other adverse events. Relative peak oxygen, peak heart rate, and peak working capacity were significantly lower compared with healthy control subjects. 30% had Z-scores >2 for weight. Total muscle strength was normal, and almost no joint impairment and no decrease in functional ability were found.CONCLUSION: The aerobic capacity of children with hemophilia is still lower than the normal population, whereas their overall muscle strength is comparable with healthy peers. The functional ability does not differ from healthy peers, and joint health status showed very minor impairments. A substantial proportion of Dutch children with hemophilia was overweight, without showing a reduction in the amount of self-reported physical activities.
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Electrification of residential areas is increasingly common. Major areas of development include promoting rooftop solar panels, electric vehicles and heat pumps. However, existing grid components may have insufficient capacity to support the resulting electricity flows. Battery energy storage (BES) can be used to prevent transformer overloading resulting from electrification. Ideally, BES should be sized and placed such that it can prevent overloading with a minimum amount of storage capacity, but it is unclear how load characteristics affect BES capacity requirements. This study investigated how load simultaneity affects the minimum BES capacity required to prevent transformer overloading, comparing a central with a decentral BES configuration. It was found that as simultaneity increases, decentral storage requires relatively less capacity than central storage. This is likely due to the reduced ability of central BES to share capacity between connections with higher simultaneity, and the ability of decentral BES to better reduce transportation losses.
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The aim of this document is to outline the preliminary requirements and steps needed to fully establish frameworks for certification systems across Europe, specifically to support and incentivize the restoration of peatlands and to provide a framework for reducing GHG emissions from degraded and mismanaged peatlands on a large scale. This will ensure that peatlands across Europe fulfil their potential to become a net carbon sink by 2050, while optimizing ecosystem service provision in a way that is fully consistent with all the relevant European policies. This report covers the following topics: - Analysis of current Carbon Credit systems and other incentives to support wet peatlands. - Economic land use analysis relating to peatlands. - Outline of a framework to support rewetting and peatland restoration. - Recommendations for an Eco-Credit system across Europe.
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tract Micro wind turbines can be structurally integrated on top of the solid base of noise barriers near highways. A number of performance factors were assessed with holistic experiments in wind tunnel and in the field. The wind turbines underperformed when exposed in yawed flow conditions. The theoretical cosθ theories for yaw misalignment did not always predict power correctly. Inverter losses turned out to be crucial especially in standby mode. Combination of standby losses with yawed flow losses and low wind speed regime may even result in a net power consuming turbine. The micro wind turbine control system for maintaining optimal power production underperformed in the field when comparing tip speed ratios and performance coefficients with the values recorded in the wind tunnel. The turbine was idling between 20%–30% of time as it was assessed for sites with annual average wind speeds of three to five meters per second without any power production. Finally, the field test analysis showed that inadequate yaw response could potentially lead to 18% of the losses, the inverter related losses to 8%, and control related losses to 33%. The totalized loss led to a 48% efficiency drop when compared with the ideal power production measured before the inverter. Micro wind turbine’s performance has room for optimization for application in turbulent wind conditions on top of noise barriers. https://doi.org/10.3390/en14051288
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Adaptive governance describes the purposeful collective actions to resist, adapt, or transform when faced with shocks. As governments are reluctant to intervene in informal settlements, community based organisations (CBOs) self-organize and take he lead. This study explores under what conditions CBOs in Mathare informal settlement, Nairobi initiate and sustain resilience activities during Covid-19. Study findings show that CBOs engage in multiple resilience activities, varying from maladaptive and unsustainable to adaptive, and transformative. Two conditions enable CBOs to initiate resilience activities: bonding within the community and coordination with other actors. To sustain these activities over 2.5 years of Covid-19, CBOs also require leadership, resources, organisational capacity, and network capacity. The same conditions appear to enable CBOs to engage in transformative activities. How-ever, CBOs cannot transform urban systems on their own. An additional condition, not met in Mathare, is that governments, NGOs, and donor agencies facilitate, support, and build community capacities. This is the peer reviewed version of the following article: Adaptive governance by community-based organisations: Community resilience initiatives during Covid‐19 in Mathare, Nairobi. which has been published in final form at doi/10.1002/sd.2682. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions
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Objective: There are widespread shortages of personal protective equipment as a result of the COVID-19 pandemic. Reprocessing filtering facepiece particle (FFP)-type respirators may provide an alternative solution in keeping healthcare professionals safe. Design: Prospective, bench-to-bedside. Setting: A primary care-based study using FFP-2 respirators without exhalation valve (3M Aura 1862+ (20 samples), Maco Pharma ZZM002 (14 samples)), FFP-2 respirators with valve (3M Aura 9322+ (six samples) and San Huei 2920V (16 samples)) and valved FFP type 3 respirators (Safe Worker 1016 (10 samples)). Interventions: All masks were reprocessed using a medical autoclave (17 min at 121°C with 34 min total cycle time) and subsequently tested up to three times whether these respirators retained their integrity (seal check and pressure drop) and ability to filter small particles (0.3–5.0 µm) in the laboratory using a particle penetration test. Results: We tested 33 respirators and 66 samples for filter capacity. All FFP-2 respirators retained their shape, whereas half of the decontaminated FFP-3 respirators showed deformities and failed the seal check. The filtering capacity of the 3M Aura 1862 was best retained after one, two and three decontamination cycles (0.3 µm: 99.3%±0.3% (new) vs 97.0±1.3, 94.2±1.3% or 94.4±1.6; p<0.001). Of the other FFP-2 respirators, the San Huei 2920 V had 95.5%±0.7% at baseline vs 92.3%±1.7% vs 90.0±0.7 after one-time and two-time decontaminations, respectively (p<0.001). The tested FFP-3 respirator (Safe Worker 1016) had a filter capacity of 96.5%±0.7% at baseline and 60.3%±5.7% after one-time decontamination (p<0.001). Breathing and pressure resistance tests indicated no relevant pressure changes between respirators that were used once, twice or thrice. Conclusion: This small single-centre study shows that selected FFP-2 respirators may be reprocessed for use in primary care, as the tested masks retain their shape, ability to retain particles and breathing comfort after decontamination using a medical autoclave.
MULTIFILE
Swarm planning is a theory and practical approach to deal with uncertain futures. By anticipating scenarios such as a ‘post-carbon’ world and a ‘pre-adaptive’ landscape, it offers an alternative pathway to prepare for medium-term incremental and step changes. The focus is on the regional scale with a planning process to move from an unstable state (i.e. due to external impacts of climate change) towards a state of higher adaptive capacity. It increases the flexibility of spatial systems in two ways: assisting change in spatial land use over time; and catalysing the emergence of autonomous and more resilient developments. Swarm planning theory is used in two pilot designs and compared with regular planning processes. The results are presented in the form of new landscapes: the ‘Zero-Fossil Region’, where the design provides a spatial framework for a complete renewable energy supply, and the ‘Net Carbon Capture Landscape’, in which adaptation and mitigation strategies are designed to become carbon positive. The comparison illuminates the potential advantage of swarm planning to tackle climate change threats. La planification en essaims est une théorie et une approche pratique visant à traiter des avenirs incertains. Au moyen de scénarios prospectifs tels que celui d'un monde « post-carbone » et d'un paysage « préadaptatif », elle offre une voie alternative pour se préparer à des changements progressifs ou radicaux à moyen terme. L'accent est mis sur l’échelle régionale, avec un processus de planification permettant de passer d'un état instable (c'est-à-dire dû aux incidences extérieures du changement climatique) à un état présentant une plus grande capacité adaptative. Cela accroît de deux manières la flexibilité des systèmes spatiaux : en favorisant le changement dans l'utilisation spatiale des terrains au fil du temps; et en catalysant l’émergence de développements autonomes et plus résilients. La théorie de la planification en essaims est utilisée dans deux conceptions pilotes et comparée aux processus de planification habituels. Les résultats sont présentés sous la forme de nouveaux paysages : la « Région Zéro Energie Fossile », dans laquelle la conception fournit un cadre spatial permettant un approvisionnement énergétique entièrement renouvelable, et le « Paysage à Séquestration Nette de Carbone », dans lequel des stratégies d'adaptation et d'atténuation sont conçues pour assurer un bilan carbone positif. Cette comparaison se révèle éclairante quant à l'avantage potentiel de la planification en essaims pour s'attaquer aux menaces posées par le changement climatique. Mots clés: adaptation capacité adaptative cadre bâti résilience conception spatiale planification en essaims incertitude
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Renewable energy sources have an intermittent character that does not necessarily match energy demand. Such imbalances tend to increase system cost as they require mitigation measures and this is undesirable when available resources should be focused on increasing renewable energy supply. Matching supply and demand should therefore be inherent to early stages of system design, to avoid mismatch costs to the greatest extent possible and we need guidelines for that. This paper delivers such guidelines by exploring design of hybrid wind and solar energy and unusual large solar installation angles. The hybrid wind and solar energy supply and energy demand is studied with an analytical analysis of average monthly energy yields in The Netherlands, Spain and Britain, capacity factor statistics and a dynamic energy supply simulation. The analytical focus in this paper differs from that found in literature, where analyses entirely rely on simulations. Additionally, the seasonal energy yield profile of solar energy at large installation angles is studied with the web application PVGIS and an hourly simulation of the energy yield, based on the Perez model. In Europe, the energy yield of solar PV peaks during the summer months and the energy yield of wind turbines is highest during the winter months. As a consequence, three basic hybrid supply profiles, based on three different mix ratios of wind to solar PV, can be differentiated: a heating profile with high monthly energy yield during the winter months, a flat or baseload profile and a cooling profile with high monthly energy yield during the summer months. It is shown that the baseload profile in The Netherlands is achieved at a ratio of wind to solar energy yield and power of respectively Ew/Es = 1.7 and Pw/Ps = 0.6. The baseload ratio for Spain and Britain is comparable because of similar seasonal weather patterns, so that this baseload ratio is likely comparable for other European countries too. In addition to the seasonal benefits, the hybrid mix is also ideal for the short-term as wind and solar PV adds up to a total that has fewer energy supply flaws and peaks than with each energy source individually and it is shown that they are seldom (3%) both at rated power. This allows them to share one cable, allowing “cable pooling”, with curtailment to -for example-manage cable capacity. A dynamic simulation with the baseload mix supply and a flat demand reveals that a 100% and 75% yearly energy match cause a curtailment loss of respectively 6% and 1%. Curtailment losses of the baseload mix are thereby shown to be small. Tuning of the energy supply of solar panels separately is also possible. Compared to standard 40◦ slope in The Netherlands, facade panels have smaller yield during the summer months, but almost equal yield during the rest of the year, so that the total yield adds up to 72% of standard 40◦ slope panels. Additionally, an hourly energy yield simulation reveals that: façade (90◦) and 60◦ slope panels with an inverter rated at respectively 50% and 65% Wp, produce 95% of the maximum energy yield at that slope. The flatter seasonal yield profile of “large slope panels” together with decreased peak power fits Dutch demand and grid capacity more effectively.
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The growing sophistication, frequency and severity of cyberattacks targeting all sectors highlight their inevitability and the impossibility of completely protecting the integrity of critical computer systems. In this context, cyber-resilience offers an attractive alternative to the existing cybersecurity paradigm. We define cyber-resilience as the capacity to withstand, recover from and adapt to the external shocks caused by cyber-risks. This article seeks to provide a broader organizational understanding of cyber-resilience and the tensions associated with its implementation. We apply Weick's (1995) sensemaking framework to examine four foundational tensions of cyber-resilience: a definitional tension, an environmental tension, an internal tension, and a regulatory tension. We then document how these tensions are embedded in cyber-resilience practices at the preparatory, response and adaptive stages. We rely on qualitative data from a sample of 58 cybersecurity professionals to uncover these tensions and how they reverberate across cyber-resilience practices.
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