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This study explored first-line managers’ leadership behavior profiles regarding their goals for utilizing the garden at residential care facilities for older people. Semi-structured interviews were conducted with a convenience sample of first-line managers (n = 12) in Sweden. Data were analyzed using deductive content analysis theoretically guided by the Three-dimensional Leadership Model. The results showed that the main leadership behavior profiles were related to the dimensions structure, relation and change. The managers emphasized workplace regulations and goals. They allowed staff to make decisions and encouraged them to see problems and opportunities. Validerad;2023;Nivå 2;2023-04-13 (sofila)

Aims Implantable cardioverter-defibrillator (ICD) treatment has expanded due to its effectiveness. However, there are concerns about complications, and use in the most elderly has been questioned. There is scarce data on qualitative aspects regarding experiences of living with an ICD among patients above the age of 80 years. The aim of this study was to explore octogenarians’ experience, knowledge, and attitude of living with an ICD. Method and results We used semi-structured interviews to collect data from 20 patients, aged 80–89 years (90% men). The data were then structured and analysed through deductive thematic analysis network approach using the ATLAS.ti v.8.4 software. The framework of the analysis was based on the Successful Aging Theory. Three main themes emerged regarding the patients’ experiences: Life goes on; Their Health, The Janus-Faced Device; Their attitudes, and Mind the gap; Their knowledge. None of the octogenarians regretted receiving their ICD, instead, they presented with feelings such as gratitude towards the device. However, a lack of knowledge about the devices was expressed, which can be a risk for potential complications, in turn causing suffering and unnecessary concerns. Conclusion Overall, the ICD did not pose a threat towards successful ageing. It was mainly considered a life-saving device. However, the lack of knowledge might hinder informed choices close to death and contribute to ethical dilemmas when deactivation of the ICD is a reasonable option.

Naxos disease is a rare entity that manifests with woolly hair, keratosis of extremities, and cardiac manifestations that resemble arrhythmogenic right ventricular cardiomyopathy. It is inherited in an autosomal recessive pattern and mutations affecting plakoglobin and desmoplakin have been identified. There is an increased risk of arrhythmias, including sudden cardiac death at a young age. Right ventricular systolic dysfunction often progresses and left ventricular involvement may also occur.This article reviews historic background, epidemiology, clinical characteristics, genetics, and pathogenesis as well as therapeutic management and future perspectives.The principles of evaluation and treatment are based on arrhythmogenic right ventricular cardiomyopathy (ARVC) and general heart failure guidelines, because specific data on Naxos disease are limited. Therefore, larger registries on Naxos disease are welcome in order to gain more knowledge about clinical course and risk stratification. Translational research on pathophysiological mechanisms has evolved, including promising approaches using stem cells for novel targets.

This paper focuses on the need for a widened definition of the notion of technology within the smart city discourse, with a particular focus on the “built environment”. The first part of the paper describes how current tendencies in urban design and architecture are inclined to prioritize high tech-solutions at the expense of low-tech functionalities and omits that information and communication technology (ICT) contrasts the art of building cities as an adaptable and habitually smart technology in itself. It continues with an elaboration on the need for expanding the limits of system boundaries for a better understanding of the energy and material telecouplings that are linked to ICT solutions and account for some perils inherent in smart technologies, such as rebound effects and the difficulty of measuring the environmental impacts of ICT solutions on a city level. The second part of the paper highlights how low-tech technologies and nature-based solutions can make cities smarter, representing a new technology portfolio in national and international policies for safeguarding biodiversity and the delivery of a range of ecosystem services, promoting the necessary climate-change adaption that cities need to prioritize to confer resilience.

Production, management, use, and end-of-life of buildings has a large impact on climate change. Therefore, environmental targets are set to lower the greenhouse gas (GHG) emissions from the building sector. To reach these targets building regulation and voluntary environmental assessment methods (EAMs) that evaluate and certify the building’s environmental impact are put forward as tools to push the building sector towards lower GHG emissions. In Sweden, building design is governed by building regulations and the dominant EAM is ‘Miljöbyggnad’ (MB) (“Environmental building”). Today, more than 1900 buildings have been certified by MB and it has influenced the building and property sector. In this chapter the potential impact MB and the linked Swedish building regulations have on building performance, energy use and GHG emissions, will be reviewed and discussed. The analysis investigates several of the MB’s indicators, evaluate to what degree EAMs can influence the design of the building and the energy system to lower the energy use and GHG emissions based on material choices. The analysis presents important aspects that may influence the design of the building and its energy system and what challenges and possibilities the indicators, criteria and regulations can have on buildings and climate change. In addition, some modification and suggestion for improvements are presented.

ObjectivesDecisions regarding implantable cardioverter defibrillators (ICDs) must consider information about presumed health-related quality of life (HRQL). The purpose of the study was to assess HRQL in patients with ICD and compare it to a Swedish age-matched and sex-matched population.DesignCross-sectional observational trial.SettingSwedish ICD cohort.InterventionsShort form 36 (SF-36) questionnaires from ICD recipients implanted 2007–2017 (response rate 77.2%) were analysed using Mann-Whitney U test and effect size (ES).ResultsIn total, 223 patients (mean age 71.1±9.7 years, 82.1% men) were included. In most SF-36 domains (physical functioning (PF), role physical, general health (GH), vitality, social functioning and mental health), the score for patients with ICD was significantly lower (ES range 0.23–0.41, ie, small difference) than norms, except for bodily pain and role emotional. Both the physical component summary (PCS) and the mental component summary (MCS) scores had ES=0.31. Men and women had similar scores. Primary and secondary prevention patients scored similarly, except for worse GH in primary prevention (p=0.016, ES=0.35). Atrial fibrillation was associated with worse PF (ES=0.41) and PCS (ES=0.38). Appropriate therapy, inappropriate shock or complications requiring surgery were not associated with lower scores in any domain. In primary prevention due to ischaemic versus non-ischaemic cardiomyopathy, no domain was significantly different. PCS decreased with higher age strata (p=0.002) in contrast to MCS (p=0.986).ConclusionsPatients with ICDs have lower physical and mental HRQL than age-matched and sex-matched norms; however, the ESs are small. HRQL is similar regardless of sex, primary/secondary prevention indication, appropriate therapy, inappropriate shock or complications, but decreases with advancing age.

Key Clinical Message Peripartum cardiomyopathy is challenging to diagnose as it mimics symptoms present in normal pregnancy. The clinical course and prognosis are various. In selected cases, a cardioverter implantable defibrillator with/without cardiac resynchronization therapy, mechanical ventricular assist device treatment, and transplantation is indicated.

The way by which various sources of external information interact in their effects on judgment is rarely investigated. Here, we report two experiments that examine how two sources of external information—an anchor (a reference price) and an eco-label—influence judgments of an objective fact (product price) and a subjective preference (willingness-to-pay for the product). Participants’ price judgments were drawn in the direction of the anchor point, whereas the eco-label resulted in higher judgments of objective fact (Experiment 1) but did not influence subjective preference (Experiment 2). Interestingly, the eco-label seemed to strengthen the effect of the high anchor in judgments of objective fact. Further, participants with higher environmental concern answered a higher price on the subjective preference questions when they received a high anchor, as well as a lower price when they received a low anchor in comparison to the low environmental concern group. This study demonstrates that various external information sources can strengthen each other’s effects on consumer belief about products, while the effects are weaker for consumers’ preferences. The implications of the results for decision making are discussed.

Certification systems for sustainable neighbourhoods started to emerge around a decade ago. This study analysed the content, structure, weighting and indicators of two established certification sys ...

Limited exposure to direct nature experiences is a worrying sign of urbanization, particularly for children. Experiencing nature during childhood shapes aspects of a personal relationship with nature, crucial for sustainable decision-making processes in adulthood. Scholars often stress the need to &lsquo, reconnect&rsquo, urban dwellers with nature, however, few elaborate on how this can be achieved. Here, we argue that nature reconnection requires urban ecosystems, with a capacity to enable environmental learning in the cognitive, affective and psychomotor domains, i.e., learning that occurs in the head, heart and hands of individuals. Drawing on environmental psychology, urban ecology, institutional analysis and urban planning, we present a theoretical framework for Human&ndash, Nature Connection (HNC), discuss the importance of nurturing HNC for children, elaborate on the role of property-rights and the importance of creating collective action arenas in cities for the promotion of urban resilience building. As values and environmental preconceptions underly environmental behavior, there are limits to achieving HNC in cities, as presumptive sentiments toward nature not always are positive. We end by discussing the role of new digital technologies in relation to HNC, and conclude by summarizing the major points brought forward herein, offering policy recommendations for HNC as a resilience strategy that can be adopted in cities throughout the world.

Background: The aim of this study was to evaluate implantable loop recorders (ILRs) in an unselected cohort in order to determine diagnostic yield, time to pacemaker/implantable cardioverter-defibrillator (ICD) implantation, predictors thereof, safety issues, and syncope management including usage of preceding diagnostic tools. Methods: Patients who underwent ILR evaluation in any of three centers in Region Gavleborg, Swe­den, between April 2007 and April 2013 were included and their medical records retrieved. Logistic regression was used to evaluate predictors of pacemaker/ICD outcome expressed as odds ratios (ORs) and Kaplan-Meier estimates for time-dependent analysis. Results: A total of 173 patients (52.6% females) with a mean age of 56.2 years received an ILR dur­ing a mean follow-up of 605 days. In the 146 patients evaluated for syncope/presyncope, 28.1% received a pacemaker (n = 39) or ICD (n = 2). The cumulative incidence at 6, 12, and 18 months were 8.8%, 21.3%, and 26.7%, respectively. Age > 75 years was the only significant predictor for outcome (p = 0.010) and the following variables showed a tendency toward significance: abnormal elevation of the biomarker B-type natriuretic peptide (OR 2.05, p = 0.100), a history of trauma (OR 1.71, p = 0.179), and patho­logic electrocardiogram (OR 1.68, p = 0.231). A computerized tomography of the skull was performed in 52.1% of the syncope cases. Conclusions: In syncope evaluation in an unselected cohort, 28.1% were diagnosed with an arrhyth­mia necessitating a pacemaker/ICD. The only significant predictor was advanced age. Time to diag­nosis is unpredictable and prolonged ILR monitoring is warranted in addition to optimal use of other diagnostic tools.

The built environment is responsible for a large proportion of the global use of energy, natural resources, and emissions. Architects and other urban design professionals are key actors in the building process whose behavior and decisions will influence these impacts. Because environmental attitudes are linked to pro-environmental behavior, this study aims to measure environmental worldview among urban design professionals involved in the architectural competition ‘A New City Center for Kiruna’. The mean score registered for the New Environmental Paradigm (NEP) scale was 3.68 (standard deviation 0.51) and there were no significant differences with regard to age (mean 41.3 years) or gender (64.7% males). The ecological worldview of the participants was similar to most other samples from diverse countries, but a lower score was reported in comparison to environmentalists. The score ranged from 2.53 to 4.67 which shows heterogeneity at an individual level. Thus, future efforts to improve environmental attitudes among urban design professionals are needed.

Globally, wind power is growing fast and in Sweden alone more than 3000 turbines have been installed since the mid-1990s. Although the number of decommissioned turbines so far is few, the high installation rate suggests that a similarly high decommissioning rate can be expected at some point in the future. If the waste material from these turbines is not handled sustainably the whole concept of wind power as a clean energy alternative is challenged. This study presents a generally applicable method and quantification based on statistics of the waste amounts from wind turbines in Sweden. The expected annual mean growth is 12% until 2026, followed by a mean increase of 41% until 2034. By then, annual waste amounts are estimated to 240,000 tonnes steel and iron (16% of currently recycled materials), 2300 tonnes aluminium (4%), 3300 tonnes copper (5%), 340 tonnes electronics (

To understand the reasons behind the large environmental impact from buildings the whole life cycle needs to be considered. Therefore, this study evaluates the carbon dioxide emissions in all stage ...

In early design phases, architects, landscape architects and urban planners are key actors whose decisions determine the environmental impact of planning and building projects. Environmental and sustainability assessment tools for buildings and neighbourhoods have been developed to promote sustainable building, but their usage has not been thoroughly evaluated. This study investigated self-reported knowledge and usage of such tools among competitors and jury group from 10 European countries involved in the international architectural competition ‘A New City Centre for Kiruna’ in Sweden. The questionnaire revealed that 13% used environmental assessment tools or management systems in the competition, although 47% had used them previously. Tool users reported greater knowledge of how to handle environmental impacts than non-users. However, the self-rated experience of handling various environmental impacts, in the competition and in general, was low for both groups. Nevertheless, the self-rated importance of environmental impacts was high among all participants. Based on this study, it is concluded that environmental assessment tools, issues and goals can be better integrated into the processes of early design in planning and building projects, and in architectural competitions. Furthermore, to limit environmental impacts in building and planning projects, professionals need to be educated about environmental strategies and solutions.

This study examined whether simplified life cycle-based calculations of climate change contributions can provide better decision support for building design. Contributions to climate change from a ...

Environmental assessment tools for buildings are emerging rapidly in many countries. Do different assessment tools influence the design process and also guide ‘green’ building projects in different ...

Urban design professionals are key actors in early design phases and have the possibility to influence urban development and direct it in a more sustainable direction. Therefore, gender differences in environmental perspectives among urban design professionals may have a marked effect on urban development and the environment. This study identified gender differences in environment-related attitudes among urban design professionals involved in the international architectural competition ‘A New City Centre for Kiruna’ in northern Sweden. Participants’ self-rated possibility to influence environmental aspects was higher for males than for females. Conversely, the importance placed on environmental aspects had higher ratings among females, although the differences regarding the rating of personal responsibility were small. The gap between the participants’ self-rated belief in their ability to influence and rated importance of environmental aspects was larger among female participants. Females placed great importance on environmental aspects even though they felt that their possibility to influence these was rather low. Conversely, male participants felt that they had the greatest possibility to influence, although some males rated the importance of environmental aspects thelowest. The gender differences identified are important from an equality and environmental perspective as they may influence pro-environmental behavior among urban design professionals and ultimately influence the environmental performance of the built environment.

Marita Walhagen, Mauritz Glaumann and Ulla Westerberg Tools for assessing building sustainability. Transnational comparison Environmental assessment tools for buildings are rapidly being developed in many countries. They all claim to assess the environmental quality or the sustainability of buildings, according to rating systems that award a maximum number of points for factors that are sustainable in one way or another. For the time being, however, there is no consensus, in terms of criteria and indicators, on the meaning of the words "green" or "sustainable". What are the existing indicators designed to assess ? Three assessment tools were analysed : America's LEED-NC, Britain's Code for Sustainable Homes (CSH) and Sweden's EcoEffect . They all cover three main areas of assessment : energy, interior environment, and use of materials and waste management. Nonetheless, their contents differ. These tools were compared in terms of their aims, content and the manner in which the various items are incorporated. They were tested on a new building several storeys high. The results of their being applied to this building differ, thus raising the question of how to define genuinely effective assessment tools., Marita Walhagen, Mauritz Glaumann and Ulla Westerberg Tools for assessing building sustaina-bility. Transnational comparison Environmental assessment tools for buildings are rapidly being developed in many countries. They all claim to assess the environmental quality or the sustainability of buildings, according to rating systems that award a maximum number of points for factors that are sustainable in one way or another. For the time being, however, there is no consensus, in terms of criteria and indicators, on the meaning of the words "green" or "sustainable". What are the existing indicators designed to assess ? Three assessment tools were analysed : America's LEED-NC, Britain's Code for Sustainable Homes (CSH) and Sweden's EcoEffect . They all cover three main areas of assessment : energy, interior environment, and use of materials and waste management. Nonetheless, their contents differ. These tools were compared in terms of their aims, content and the manner in which the various items are incorporated. They were tested on a new building several storeys high. The results of their being applied to this building differ, thus raising the question of how to define genuinely effective assessment tools., Wallhagen Marita, Glaumann Mauritz, Westerberg Ulla. Les outils de mesure de la durabilité des bâtiments. Comparaison transnationale. In: Les Annales de la recherche urbaine, N°105, 2008. Thème libre. pp. 94-103.