Green Exercise Linking Nature, Health and Well-being

The concept of Green Exercise has now been widely adopted and implies a synergistic health benefit of being active in the presence of nature. This book provides a balanced overview and synthesis text on all aspects of Green Exercise and integrates evidence from many different disciplines including physiology, ecology, psychology, sociology and the environmental sciences, and across a wide range of countries. It describes the impact of Green Exercise on human health and well-being through all stages of the lifecourse and covers a wide spectrum from cellular processes such as immune function through to facilitating human behavioural change. It demonstrates the value of Green Exercise for activity and education purposes in both schools and the workplace, as well as its therapeutic properties. Green Exercise is an effective intervention for vulnerable groups and promoting healthy ageing, with activities including wilderness therapy, therapeutic horticulture and the use of forests and water. Chapters also integrate cross-cutting key themes which are relevant to all stages of the lifecourse and have significantly contributed to the Green Exercise research base, such as forest bathing and blue exercise. The book also explores the future of Green Exercise, the way in which research can be used to influence green design and planning and how health, social care and environmental agendas can be integrated to enable Green Exercise to be more widely used as a mechanism for improving health

Walks4Work: Assessing the role of the natural environment in a workplace physical activity intervention

Objectives The primary aim of this study was to examine the impact of physical activity (PA) in the natural environment (eg, "green exercise") on resting autonomic function in the Walks4Work intervention. A secondary aim was to assess the feasibility of Walks4Work in terms of adherence, change in PA levels, and cardiovascular health parameters. Methods In an 8-week randomized control trial, 94 office workers in an international company were allocated to one of three groups: control, nature (NW), or built (BW) lunchtime walking route. Both walking groups were required to undertake two lunchtime walks each week. The NW route centered around trees, maintained grass, and public footpaths. In contrast, the BW consisted of pavement routes through housing estates and industrial areas. Data were collected at baseline and following the intervention. To investigate the impact of the intervention, mixed-design analysis of variance (ANOVA) were performed. Results A total of 73 participants completed the intervention (drop-out rate of 22%). No difference was observed in resting autonomic function between the groups. Self-reported mental health improved for the NW group only. PA levels increased at the intervention mid-point for all groups combined but adherence to the intervention was low with rates of 42% and 43% within the BW and NW groups, respectively. Conclusion Accompanying a guideline of two active lunchtimes per week with low facilitator input appears inadequate for increasing the number of active lunchtimes and modifying cardiovascular health parameters in an office population. However, this population fell within normal ranges for cardiovascular measures and future research should consider investigating at-risk populations, particularly hypertensive individuals

Brain mass estimation by head circumference and body mass methods in neonatal glycaemic modelling and control

Introduction: Hyperglycaemia is a common complication of stress and prematurity in extremely low-birth-weight infants. Model-based insulin therapy protocols have the ability to safely improve glycaemic control for this group. Estimating non-insulin-mediated brain glucose uptake by the central nervous system in these models is typically done using population-based body weight models, which may not be ideal. Method: A head circumference-based model that separately treats small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) infants is compared to a body weight model in a retrospective analysis of 48 patients with a median birth weight of 750g and median gestational age of 25 weeks. Estimated brain mass, model-based insulin sensitivity (SI) profiles, and projected glycaemic control outcomes are investigated. SGA infants (5) are also analyzed as a separate cohort. Results: Across the entire cohort, estimated brain mass deviated by a median 10% between models, with a per-patient median difference in SI of 3.5%. For the SGA group, brain mass deviation was 42%, and per-patient SI deviation 13.7%. In virtual trials, 87-93% of recommended insulin rates were equal or slightly reduced (δ<0.16mU/h) under the head circumference method, while glycaemic control outcomes showed little change. Conclusion: The results suggest that body weight methods are not as accurate as head circumference methods. Head circumference-based estimates may offer improved modelling accuracy and a small reduction in insulin administration, particularly for SGA infants. © 2014 Elsevier Ireland Ltd

Model-based insulin-nutrition administration for glycemic control in Malaysian critical care: First pilot trial

© 2018, Springer Science+Business Media Singapore. Stress-induced hyperglycemia is prevalent in critical care, even in patients with no history of diabetes. Control of blood glucose level with tight insulin therapy has been shown to reduce incidences of hyperglycemia leading to reduced mortality and improved clinical outcomes. STAR is a tablet-based glucose control protocol with a specialized user interface into which insulin and nutrition information can be entered and predicted. This research describes the first clinical pilot trial of STAR approach in International Islamic University Hospital, Kuantan, Malaysia. The clinically specified target for blood glucose level is between 4.4 and 8.0 mmol/L. Seven episodes (of 359 h) were recruited based on the need for glucose control. Overall, 43.93% of measurement are in the range of 4.4–8.0 mmol/L band. The blood glucose median is 8.30 [6.32–10.00] mmol/L with only 1 patient having below than 2.22 mmol/L which is the guaranteed minimum risk level. This pilot study shows that STAR protocol is a patient specific approach that provides a good glycemic control in critically ill patients. Nevertheless, its implementation in Malaysian intensive care environments requires modifications and improvements in certain areas

The Ecological Impacts of Contaminated Sediment from Abandoned Metal Mines

Contains public sector information licensed under the Open Government Licence v3.0. The OGL requires that users acknowledge the information provider and/or source of the information with an attribution statement.Pollution from abandoned non-coal (i.e. metal) mines is a serious impediment to rivers meeting the water quality targets set out in River Basin Management Plans. Recent work has identified the mines most likely to be causing a significant environmental impact and hence where efforts to prevent pollution need to be focussed. Yet, it is not clear to what extent rivers, and the animal and plant life they support, are impacted by the legacy of past pollution still bound up in river sediments. Work will be undertaken to reduce toxic metals in mine waters before they enter the river. However, if riverbed sediments are already contaminated and affecting life in rivers, the planned clean-up of mine water sources may not result in recovery of ecological condition. A controlled laboratory experiment was undertaken where river invertebrates (mayfly larvae) from an uncontaminated site were incubated with contaminated riverbed sediment collected downstream of an abandoned metal mine. Concentrations of metals in the tissues of the mayflies increased over the duration of the incubation, particularly those metals that were in high concentrations in the sediment, i.e. cadmium, copper and zinc. As the sediment was the only substantial source of metals in the experiment, it is apparent that the contaminated riverbed sediment was acting as a source of bioavailable metals. It is likely that contaminated sediments, including riverbed sediment, will act as a source of bioavailable metals, at least to benthic organisms, even where mine drainage water is treated to reduce metal concentrations. Metal toxicity occurs when the rate of metal uptake into an organism exceeds the combined rates of excretion and physiological detoxification. Current tests of metal toxicity on biota typically do not match in scale (temporal, spatial and taxonomic range) with assessments of ecological quality undertaken for management, which raises questions regarding the adequacy of environmental limits based on laboratory testing. Existing data were compiled describing geochemistry of riverbed sediment and the Biological Quality Elements invertebrates, diatoms, macrophytes and fish, collected by the regulatory authorities to assess the condition of rivers. As toxic effects of trace metals were not expected at low concentrations, the biological response to sediment metal concentration was determined using a threshold model. Thresholds were found for biotic metrics based on species richness, but other metrics (diatom EQR, macrophyte EQR and invertebrate ASPT) displayed implausible positive relationships with sediment metal concentrations and should not be relied upon for classification of ecological status in waterbodies affected by mining. New data were collected from 20 spatially-independent river catchments in areas affected by metal mine facilities, including samples of the macroinvertebrate community, bioavailability of metals (assessed as metal concentrations in the body tissue of tolerant taxa), and sediment metal concentrations. There were strong correlations between sediment metal concentrations and measured bioavailability, particularly for copper and lead. Measurements of bioavailable metals were related to changes in taxon richness in the invertebrate samples. The data were used to develop a new biotic index (MetTol), which can be used to assess the extent of ecological damage from metal contamination using standard invertebrate monitoring data, and to construct dose response curves based on species sensitivities. A number of approaches were used to establish tolerable limits for sediment metal concentrations based on ecological data, and the results compared with existing Canadian sediment quality guidelines. The limits for copper derived from ecological data were most consistent with existing sediment guidelines. The limits for other metals (silver, arsenic, cadmium, nickel, lead and zinc) derived from ecological data were up to an order of magnitude above the Canadian interim sediment quality guidelines. These existing guidelines, based on toxicological data, may be too precautionary, and we suggest that guideline sediment concentrations based on ecological data may provide a more appropriate level of protection for the environment

A repeated measures experiment of school playing environment to increase physical activity and enhance self esteem in UK school children

School playtime provides daily opportunities for children to be active outdoors, but only makes small contributions to physical activity (PA) requirements. Natural environments facilitate unstructured PA and children report a preference for play in nature. Thus, play on the school field might encourage children to be more active during playtime. The primary aim of this study was to examine the impact of the school playing environment on children's PA. Descriptive data and fitness were assessed in 25 children aged 8–9 years from a single primary school. Over two consecutive weeks participants were allocated to either play on the school field or playground during playtime. The order of play in the two areas was randomised and counterbalanced. Moderate to vigorous PA (MVPA) was assessed during playtime on the last two days of each week using accelerometers. There was a significant interaction of environment and sex on MVPA during morning play (F(1,22) = 6.27; P0.05; np2 = 0.060) or all of playtime combined (P>0.05; np2 = 0.140). During morning play boys were significantly more active than girls on the playground (t(23) = 1.32; P0.05; n2 = 0.071). For lunch (F(1,22) = 24,11; P<0.001; np2 = 0.523) and all of playtime combined (F(1,22) = 33.67; P<0.001; np2 = 0.616) there was a significant effect of environment. There was also a significant main effect of sex during lunch (F(1,22) = 11.56; P<0.01; np2 = 0.344) and all of playtime combined (F(1,22) = 12.37; P<0.01; np2 = 0.371). MVPA was higher on the field and boys were more active than girls. Play on the field leads to increases in MVPA, particularly in girls. The promising trend for the effect of the natural environment on MVPA indicates that interventions aimed at increasing MVPA should use the natural environment and that schools should encourage greater use of their natural areas to increase PA

Next-generation, personalised, model-based critical care medicine : a state-of-the art review of in silico virtual patient models, methods, and cohorts, and how to validation them

© 2018 The Author(s). Critical care, like many healthcare areas, is under a dual assault from significantly increasing demographic and economic pressures. Intensive care unit (ICU) patients are highly variable in response to treatment, and increasingly aging populations mean ICUs are under increasing demand and their cohorts are increasingly ill. Equally, patient expectations are growing, while the economic ability to deliver care to all is declining. Better, more productive care is thus the big challenge. One means to that end is personalised care designed to manage the significant inter- and intra-patient variability that makes the ICU patient difficult. Thus, moving from current "one size fits all" protocolised care to adaptive, model-based "one method fits all" personalised care could deliver the required step change in the quality, and simultaneously the productivity and cost, of care. Computer models of human physiology are a unique tool to personalise care, as they can couple clinical data with mathematical methods to create subject-specific models and virtual patients to design new, personalised and more optimal protocols, as well as to guide care in real-time. They rely on identifying time varying patient-specific parameters in the model that capture inter- and intra-patient variability, the difference between patients and the evolution of patient condition. Properly validated, virtual patients represent the real patients, and can be used in silico to test different protocols or interventions, or in real-time to guide care. Hence, the underlying models and methods create the foundation for next generation care, as well as a tool for safely and rapidly developing personalised treatment protocols over large virtual cohorts using virtual trials. This review examines the models and methods used to create virtual patients. Specifically, it presents the models types and structures used and the data required. It then covers how to validate the resulting virtual patients and trials, and how these virtual trials can help design and optimise clinical trial. Links between these models and higher order, more complex physiome models are also discussed. In each section, it explores the progress reported up to date, especially on core ICU therapies in glycemic, circulatory and mechanical ventilation management, where high cost and frequency of occurrence provide a significant opportunity for model-based methods to have measurable clinical and economic impact. The outcomes are readily generalised to other areas of medical care

Estimating food production in an urban landscape

There is increasing interest in urban food production for reasons of food security, environmental sustainability, social and health benefits. In developed nations urban food growing is largely informal and localised, in gardens, allotments and public spaces, but we know little about the magnitude of this production. Here we couple own-grown crop yield data with garden and allotment areal surveys and urban fruit tree occurrence to provide one of the first estimates for current and potential food production in a UK urban setting. Current production is estimated to be sufficient to supply the urban population with fruit and vegetables for about 30 days per year, while the most optimistic model results suggest that existing land cultivated for food could supply over half of the annual demand. Our findings provide a baseline for current production whilst highlighting the potential for change under the scaling up of cultivation on existing land