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Although much is known about factors influencing short-term implementation, little is known about what factors are relevant for the long-term sustainment of innovations. In the Dutch National Quality Improvement Program for Palliative Care, innovations were implemented in 76 implementation projects.To give insight into the sustainment strategies used and factors facilitating and hindering sustainment.Online questionnaire with prestructured and open questions sent to the contact persons for 76 implementation projects, 2-6.5 years after the start.Information was gathered on 63 implementation projects (response 83%). Most projects took place in home care, general practices, and/or nursing homes. Sustainment was attained in 60% of the implementation projects. Six often applied strategies were statistically significantly related to sustainment: 1) realizing coherence between the innovation and the strategic policy of the organization; 2) arranging to have a specific professional responsible for the use of the innovation; 3) integrating the innovation into the organization's broader palliative care policy; 4) arranging accessibility of the innovation; 5) involving management in the implementation project; and 6) giving regular feedback about the implementation. In three-quarters of the projects, barriers and facilitators were encountered relating to characteristics of the care organizations, such as employee turnover and ratification of the project by the management.Applying the six strategies enhances sustainment. The organization plays a decisive role in the sustainment of innovations in palliative care. Engaging the management team in implementation projects from early onset is of utmost importance.

Abstract Since children are far more vulnerable than adults to the effects of air pollution and spend about a third of their day in school, strict control of indoor environments in educational buildings is paramount to properly identify, manage and mitigate putative environmental risks for children. In this context, this work aimed to provide a holistic view on the outcomes obtained from the national ARIA project, which was focused on broadening the knowledge on the effects on children’s health of the exposure to schools’ indoor air. In particular, this work performed a comprehensive investigation of the indoor air quality (IAQ) in 20 public primary schools located in Porto (Northern Region, Portugal). This paper presents the results of the investigation along with the recently published main outcomes of ARIA on (1) the characteristics of the environment surrounding the surveyed buildings, and (2) the school’s environment-related health effects in school-age children from the studied classrooms. The investigation consisted in an extensive assessment plan conducted in 71 classrooms to assess temperature, relative humidity, carbon monoxide and dioxide, particulate matter (PM2.5, PM10, and ultrafine particles), nitrogen dioxide, ozone, volatile organic compounds, formaldehyde, acetaldehyde, airborne fungi, bacteria and endotoxins, and investigate their respective sources, during the cold seasons of 2014–2015. A series of studies was also launched to investigate school environment-related health detriments in 916 children. The results showed that comfort and ventilation issues and/or indoor pollutant levels that exceeded recommended limits were found in a substantial number of the classrooms surveyed. The high density of occupants, deficient ventilation, soil characteristics, presence of indoor pollution sources (e.g. classroom materials and consumer products) and outdoor pollution were some of the factors that seemed to explain the high air stuffiness and/or indoor pollution load identified in classrooms. In fact, some of indoor pollutants detected, even at low exposure levels, were associated with the development of respiratory symptoms in school-age children. Moreover, results from this work have also shown that the characteristics of the environment surrounding the schools, namely the presence of green spaces and species richness, can be major determinants of respiratory health among school-age children. Overall, the body of evidence generated from the ARIA project can support new evidence-based perspectives for promotion of health in educational buildings.

BackgroundCaffeine is frequently consumed with ethanol to reduce the impairing effects induced by ethanol, including psychomotor slowing or incoordination. Both drugs modulate dopamine (DA)‐related markers in accumbens (Acb), and Acb DA is involved in voluntary locomotion and locomotor sensitization. The present study determined whether caffeine can affect locomotion induced by acute and repeated ethanol administration in adult male CD‐1 mice.MethodsAcute administration of caffeine (7.5 to 30.0 mg/kg) was evaluated for its effects on acute ethanol‐induced (1.5 to 3.5 g/kg) changes in open‐field horizontal locomotion, supported rearing, and rearing not supported by the wall. DA receptor‐dependent phosphorylation markers were assessed: extracellular signal‐regulated kinase (pERK), and dopamine‐and cAMP‐regulated phosphoprotein Mr32kDa phosphorylated at threonine 75 site (pDARPP‐32‐Thr75) in Acb core and shell. Acutely administered caffeine was also evaluated in ethanol‐sensitized (1.5 g/kg) mice.ResultsAcute ethanol decreased both types of rearing. Caffeine increased supported rearing but did not block ethanol ‐induced decreases in rearing. Both substances increased horizontal locomotion in a biphasic manner, and caffeine potentiated ethanol‐induced locomotion. Although ethanol administered repeatedly induced sensitization of locomotion and unsupported rearing, acute administration of caffeine to ethanol‐sensitized mice in an ethanol‐free state resulted in blunted stimulant effects compared with those seen in ethanol‐naïve mice. Ethanol increased pERK immunoreactivity in both subregions of the Acb, but coadministration with caffeine blunted this increase. There were no effects on pDARPP‐32(Thr75) immunoreactivity.ConclusionsThe present results demonstrated that, after the first administration, caffeine potentiated the stimulating actions of ethanol, but did not counteract its suppressant or ataxic effects. Moreover, our results show that caffeine has less activating effects in ethanol‐sensitized animals.

Lakes are a fundamental feature of nature with brilliance, profoundness and complexity. Various of physical, chemical and biological changes take place three dimensionally in deep lakes, regulated by complicated boundary conditions. To understand and predict such aquatic systems is not an easy task, but scientists have endeavored to accomplish it by field measurements and numerical simulations, focusing on hydrodynamics, water quality and ecology. Although important to the aquatic system and human health, pathogen dynamics in lakes has not been addressed with priority in most studies about lakes, with even less attention for pathogenic virus in general, or specific virus genera or strains. In this study, we propose a coupled 3D hydrodynamic and particle tracking model, to study the fate and transport of the Enterovirus genus with twelve specific strains, followed by a Quantitative Microbial Risk Assessment model to estimate the risk of infection and illness for humans when interacting with lake water in many forms. Lake Geneva is chosen as the study site, as it is the biggest fresh water lake in Western Europe and used as a drinking water source for more than 800,000 people and a recreational site for habitants around it. The hydrodynamic simulation of the lake is validated by field measurement at observation platforms while the particle tracking module is validated by satellite images processed for water quality parameters. Decay of enterovirus is incorporated in the postprocessing part of the model, supported by previous researches in the literature and experiments in the laboratory, considering temperature, solar radiation and microbial activity as the major environmental stressors for enterovirus. Finally, the modeled concentration of enterovirus is employed as an input for a QMRA model to assess the risk of infection and illness to human beings that are exposed to this specific virus genus. Future environmental changes will definitely influence the fate and persistence of the virus and will also be simulated by the proposed model. The perspective of this research is to generate a robust tool to predict virus dynamics in deep lakes and investigate the potential risk concerning human interaction with the contaminated lake water. It is a novel endeavor in water quality modeling and will support decision makers to draw conclusions regarding safe usage of lake water resources.

Alcohol attentional bias has been pointed as a major marker of alcohol misuse. Recent evidence has revealed that brain functional connectivity (FC) may be a valuable index of the brain networks' integrity in young binge drinkers (BDs). However, there is no study to date examining the FC networks linked to the processing of alcohol-related images in this population. The present study aimed to explore the FC signatures underlying alcohol attention bias in young BDs. Thus, electroencephalographic (EEG) activity was recorded in 54 college students (55.5% females; 27 non/low-drinkers and 27 BDs) while performing a visual alcohol cue-reactivity task. We evaluated whole-brain FC profiles during the processing of alcoholic and non-alcoholic cues, as well as their potential relationship with craving and severity of alcohol use. Results showed that, at the behavioural level, BDs rated alcohol-related images as more pleasant/attractive than non/low-drinkers. Furthermore, at the electrophysiological level, BDs exhibited increased beta-band FC-particularly in the fronto-parieto-occipital network-when processing alcoholic cues. Conversely, they displayed reduced theta-band FC relatively to non/low-drinkers for non-alcoholic images. These hyper-/hypo-connectivity patterns were associated with higher alcohol craving levels. Findings are congruent with previous neurofunctional studies reporting an attentional bias towards alcohol-related information in BDs. These results may have important clinical implications as this neural reactivity to alcoholic cues may contribute to the maintenance and/or escalation of the drinking pattern. Finally, the present study constitutes the first evidence showing that FC networks may be a sensitive indicator to alcohol attentional bias in BDs. UCM-Santander, Grant/Award Number: CT18/17; European Regional Development Fund (FEDER); Fundação para a Ciência e a Tecnologia, Grant/Award Numbers: CEECIND/02979/2018, POCI01-0145-FEDER-028672, SFRH/ BD/146194/2019, UIDB/PSI/01662/2020

Introduction: The current economic, social and environmental problems faced by society are some of the most emerging concerns of the main governmental institutions. In this sense, Education for Sustainable Development and integration of the Sustainable Development Goals (SDGs) into the education system seems to be a key link for its mitigation. Within education, physical education (PE) could provide positive synergy and contribute to achieve the SDGs. However, the relationship between PE and Sustainable Development is still in its nascent stage. Objective: Overall, we aim to explore the ways in which the literature has addressed the SDGs and PE. To this end, this scoping review has two objectives. The first is to provide a synthesis of the research to date on PE and the SDGs, presenting the results in terms of the types of literature, methods, samples, provenance of authorship and the main findings. The second is to investigate which specific SDGs and targets have appeared most frequently in research within the field of PE. Method: Due to the emergent nature of the topic under examination, we present a scoping review. After identifying the parameters to be analysed, we redefined the topic of study. We applied a number of criteria and selected relevant studies the introduction of the SDGs (2015) until June 2022. We searched Web of Science, SPORTdiscus, Scopus, Google Scholar and PROquest using words such as ‘Sustainable Development’, ‘SDGs’ and ‘PE’. Results and discussion: We reviewed 22 papers that met the inclusion criteria. We noted several characteristics in these studies. Most studies published between 2015 and 2022 come from international institutions (Commonwealth, UNESCO, etc.), and critical view articles, which theorise about the potential relation between PE and the SDGs. Beginning in 2021, there has been much more empirical research, mainly in the form of qualitative and quantitative cross-sectional studies. Most of this empirical research has been developed with undergraduate students in Physical Education Teacher Education (PETE). Some researchers have used pedagogical models such as service learning and cooperative learning as valid didactic tools to work on the SDGs. On the other hand, the countries that seem to show the greatest interest in research on the SDGs and PE are European, especially Spain and Sweden. Finally, SDGs 3 (Health and Wellbeing), 4 (Quality-Education) and 5 (Gender-Equality) have the greatest relationship with PE, specifically target 4.5 on inclusion and equity, target 5.1 to avoid discrimination based on sex and target 3.6 concerning physical and mental health. Conclusions: The relationship between PE and the SDGs is an emerging topic. While papers published within the five years after definition of the SDGs have a strong theoretical character, empirical research has begun to predominate since 2021. The focus of future research should be to deepen the ways in which PE can contribute to the SDGs (pedagogical perspectives, content, objectives …). Researchers should use practice-based models to look for more sustainability-related content and, above all, to try to get students to reflect on how their daily actions can contribute to a more sustainable and durable world. This work was supported by ODSEF PROJECT. Design and implementation of the Sustainable Development Goals for Physical Education (University of Alicante) [REDES ICE-2021-5489].

As emphasised by the crisis caused by the COVID-19 pandemic, medical oxygen is an essential health commodity. The purpose of this study is the application of Renewable Energy Sources (RES)-based (photovoltaic-powered) water electrolysis plant for oxygen production in hospitals to self-produce the amount of oxygen they need, and - in particular - to define when this choice could be economically competitive with the current medical gas market. The proposed plant is able to produce oxygen and to store energy in hydrogen form at the same time, proposing a new approach in RES applications. Therefore, we calculated as a function of the hospital size (number of beds, up to 500) what should be the market price of oxygen above which the self-production of oxygen is economically profitable (assuming a break-event point of 15 years). Hydrogen is considered a by-product allowing to increase the system efficiency and supplying extra services. The results demonstrated that, assuming a selling price of 3 EUR/kg for the hydrogen (co)-produced by the plant, the on-site production of medical oxygen could be an interesting alternative compared to purchasing from the local gas resellers, if its market price is higher than 3-4 EUR/kg. Since this value is in line with current prices established for ex-factory oxygen by some national regulatory authorities (e.g., AIFA), we can conclude that the proposed RES-based electrolysis system is a green and economically feasible solution for oxygen production in hospitals, able also to increase hospital resilience against energy and oxygen shortage.

AbstractAdopting eco‐friendly diets will demand the consumption of more plant‐based protein food sources such as legumes. However, assessing the impact of such a dietary shift on the dietary and nutritional intake of traditionally omnivorous populations is needed. The objective of this study was to assess the impact of substituting a traditional omnivorous‐based lunch for a vegetarian, legume‐based meal on the daily dietary and nutritional intake in a group of omnivorous adults in the city of Porto, Portugal. Nineteen, non‐vegetarian, healthy young adults consumed a vegetarian, legume‐based meal from Monday to Friday, for 8 consecutive weeks. Socio‐demographic data, health status, lifestyle‐related information and anthropometric parameters were recorded. Three‐day food records were used to collect food intake at baseline and week 8. European Food Safety Authority and World Health Organization reference values were used to assess nutritional inadequacies. Variables were described as medians (P25 and P75). Wilcoxon signed‐rank and Mann–Whitney tests were used for statistical comparisons. A p‐value of <0.05 was considered statistically significant. Participants consumed 38.0 (P25 = 35.0; P75 = 40.0) meals, resulting in an intake of 84.5 g (P25 = 74.9; P75 = 98.4) of cooked legumes per meal, meaning 11 subjects (57.9%) met the Portuguese guidelines for legume consumption (≥80 g/day of legumes). The current dietary intervention did not seem to aggravate the prevalence of nutritional inadequacies for the macro‐ and micronutrients tested, except for the case of vitamin B12 (52.6% [95% CI: 28.9–75.6] vs. 78.9% [95% CI: 54.4–94.0]). This could be linked to the reduction of dietary sources of this vitamin which is an expected consequence of vegetarian meals. Dietary changes towards grain legume‐based diets are desirable yet need to be carefully implemented to prevent exacerbating potential nutrient inadequacies, especially of vitamin B12.