Green Care: a Conceptual Framework. A Report of the Working Group on the Health Benefits of Green Care

‘Green Care’ is a range of activities that promotes physical and mental health and well-being through contact with nature. It utilises farms, gardens and other outdoor spaces as a therapeutic intervention for vulnerable adults and children. Green care includes care farming, therapeutic horticulture, animal assisted therapy and other nature-based approaches. These are now the subject of investigation by researchers from many different countries across the world

Conditions currently associated with erythema nodosum in Swiss children

A review was made of the 36 paediatric patients in whom the diagnosis of erythema nodosum had been established between 1977 and 1996 at the Department of Paediatrics, University of Bern, Switzerland. Infectious diseases were associated with erythema nodosum in 20 (including 10 streptococcal infections) and non-infectious inflammatory diseases in 8 patients. None of the 36 patients had tuberculosis or had been exposed to sulphonamides, phenytoin or hormonal contraceptives. There were eight patients in whom either the associated disease was not diagnosed, or there was no other disease. Conclusion Most cases of erythema nodosum are nowadays caused by non-mycobacterial infectious diseases or by non-infectious inflammatory disease

What is a good level of soil organic matter? An index based on organic carbon to clay ratio

Simple measures of appropriate levels of soil organic matter are needed for soil evaluation, management and monitoring, based on readily‐measurable soil properties. We test an index of soil organic matter based on the soil organic carbon (SOC) to clay ratio, defined by thresholds of SOC/clay ratio for specified levels of soil structural quality. The thresholds were originally delineated for a small number of Swiss soils. We assess the index using data from the initial sampling (1978–83) of the National Soil Inventory of England and Wales, covering 3809 sites under arable land, grassland and woodland. Land use, soil type, annual precipitation and soil pH together explained 21% of the variance in SOC/clay ratio in the dataset, with land use the most important variable. Thresholds of SOC/clay ratio of 1/8, 1/10 and 1/13 indicated the boundaries between ‘very good’, ‘good’, ‘moderate’ and ‘degraded’ levels of structural condition. On this scale, 38.2, 6.6, and 5.6% of arable, grassland and woodland sites, respectively, were degraded. The index gives a method to assess and monitor soil organic matter at national, regional or sub‐regional scales based on two routinely measured soil properties. Given the wide range of soils and land uses across England and Wales in the dataset used to test the index, we suggest it should apply to other European soils in similar climate zones

Effectiviteit van ervarend leren op de boerderij

In Noord-Brabant zijn individuele woon-werktrajecten op boerderijen ontwikkeld voor jongeren tussen de 16 en 20 jaar met ernstige problemen. Er is sprake van problemen en ruzie in het gezin, de jongeren gaan niet meer naar school en ze hebben geen goede vrijetijdsinvulling. De jongeren verblijven een half jaar op de boerderij. Daarna volgt nog een nabegeleiding van een half jaar. De resultaten van de door de jongeren ingevulde vragenlijsten laten zien dat het traject met name een positief effect heeft op probleemgedrag en zelfwaardering en in iets mindere mate op het copinggedrag. De positieve veranderingen zijn ook een half jaar na afsluiting van het nabegeleidingstraject nog zichtbaar. Uit de scores van de begeleiders blijkt dat er verbeteringen opgetreden zijn in het contact met het gezin, schooluitval, politiecontact, drugsgebruik, vrijetijdsbesteding, welzijn, gedragsproblemen en zelfvertrouwen

Discovering and Visualizing Disease-Specific Electrocardiogram Features Using Deep Learning: Proof-of-Concept in Phospholamban Gene Mutation Carriers

BACKGROUND: ECG interpretation requires expertise and is mostly based on physician recognition of specific patterns, which may be challenging in rare cardiac diseases. Deep neural networks (DNNs) can discover complex features in ECGs and may facilitate the detection of novel features which possibly play a pathophysiological role in relatively unknown diseases. Using a cohort of PLN (phospholamban) p.Arg14del mutation carriers, we aimed to investigate whether a novel DNN-based approach can identify established ECG features, but moreover, we aimed to expand our knowledge on novel ECG features in these patients. METHODS: A DNN was developed on 12-lead median beat ECGs of 69 patients and 1380 matched controls and independently evaluated on 17 patients and 340 controls. Differentiating features were visualized using Guided Gradient Class Activation Mapping++. Novel ECG features were tested for their diagnostic value by adding them to a logistic regression model including established ECG features. RESULTS: The DNN showed excellent discriminatory performance with a c-statistic of 0.95 (95% CI, 0.91-0.99) and sensitivity and specificity of 0.82 and 0.93, respectively. Visualizations revealed established ECG features (low QRS voltages and T-wave inversions), specified these features (eg, R- and T-wave attenuation in V2/V3) and identified novel PLN-specific ECG features (eg, increased PR-duration). The logistic regression baseline model improved significantly when augmented with the identified features (P<0.001). CONCLUSIONS: A DNN-based feature detection approach was able to discover and visualize disease-specific ECG features in PLN mutation carriers and revealed yet unidentified features. This novel approach may help advance diagnostic capabilities in daily practice

Work-Related Well-Being Among Dutch Cardiologists - A National Survey

This is the first study to provide a holistic examination of cardiologists' well-being, investigating positive and negative dimensions, and its determinants. We conducted a national, multicenter, self-administered web-based questionnaire. We used frequencies to depict scores on three well-being indicators (professional fulfillment, work exhaustion and interpersonal disengagement) and performed three multiple regression analyses to elucidate their determinants. Cardiologists' mean scores (scale 1 to 5) were 3.85 (SD = 0.62) for professional fulfillment, 2.25 (SD = 0.97) for work exhaustion and 2.04 (SD = 0.80) for interpersonal disengagement. Workload, work-home interference and team atmosphere predicted the negative dimensions of well-being. Autonomy predicted cardiologists' professional fulfillment. Physician-patient interactions, person-job fit and individual resilience affected both dimensions. Dutch cardiologists score relatively high on professional fulfillment and average on work exhaustion and interpersonal disengagement. In order to foster cardiologists' well-being it is critical to increase energy providing work- and individual aspects

Bioreactors as engineering support to treat cardiac muscle and vascular disease

Cardiovascular disease is the leading cause of morbidity and mortality in the Western World. The inability of fully differentiated, load-bearing cardiovascular tissues to in vivo regenerate and the limitations of the current treatment therapies greatly motivate the efforts of cardiovascular tissue engineering to become an effective clinical strategy for injured heart and vessels. For the effective production of organized and functional cardiovascular engineered constructs in vitro, a suitable dynamic environment is essential, and can be achieved and maintained within bioreactors. Bioreactors are technological devices that, while monitoring and controlling the culture environment and stimulating the construct, attempt to mimic the physiological milieu. In this study, a review of the current state of the art of bioreactor solutions for cardiovascular tissue engineering is presented, with emphasis on bioreactors and biophysical stimuli adopted for investigating the mechanisms influencing cardiovascular tissue development, and for eventually generating suitable cardiovascular tissue replacements