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Spending time in nature is known to benefit human health and well-being, but evidence is mixed as to whether biodiversity or perceptions of biodiversity contribute to these benefits. Perhaps more importantly, little is known about the sensory modalities by which humans perceive biodiversity and obtain benefits from their interactions with nature. Here, we used a ‘phantom birdsong chorus' consisting of hidden speakers to experimentally increase audible birdsong biodiversity during ‘on' and ‘off' (i.e. ambient conditions) blocks on two trails to study the role of audition in biodiversity perception and self-reported well-being among hikers. Hikers exposed to the phantom chorus reported higher levels of restorative effects compared to those that experienced ambient conditions on both trails; however, increased restorative effects were directly linked to the phantom chorus on one trail and indirectly linked to the phantom chorus on the other trail through perceptions of avian biodiversity. Our findings add to a growing body of evidence linking mental health to nature experiences and suggest that audition is an important modality by which natural environments confer restorative effects. Finally, our results suggest that maintaining or improving natural soundscapes within protected areas may be an important component to maximizing human experiences.

There is moderate evidence that women who receive breastfeeding support interventions are more likely to continue breastfeeding up to 6 months postpartum; these interventions also appear to increase exclusive breastfeeding (i.e., breast milk is the only form of nutrition).

Environmental noise knows no boundaries, affecting even protected areas. Noise pollution, originating from both external and internal sources, imposes costs on these areas. It is associated with adverse health effects, while natural sounds contribute to cognitive and emotional improvements as ecosystem services. When it comes to parks, individual visitors hold unique perceptions of soundscapes, which can be shaped by various factors such as their motivations for visiting, personal norms, attitudes towards specific sounds, and expectations. In this study, we utilized linear models and geospatial data to evaluate how visitors’ personal norms and attitudes, the park’s acoustic environment, visitor counts, and the acoustic environment of visitors’ neighborhoods influenced their perception of soundscapes at Muir Woods National Monument. Our findings indicate that visitors’ subjective experiences had a greater impact on their perception of the park’s soundscape compared to purely acoustic factors like sound level of the park itself. Specifically, we found that motivations to hear natural sounds, interference caused by noise, sensitivity to noise, and the sound levels of visitors’ home neighborhoods influenced visitors’ perception of the park’s soundscape. Understanding how personal factors shape visitors’ soundscape perception can assist urban and non-urban park planners in effectively managing visitor experiences and expectations.

BackgroundDespite accumulating evidence of the important health benefits of bariatric surgery in morbidly obese patients in general, bariatric surgery outcomes are less clear in higher-risk, high-priority populations of patients with BMI ≥ 50 kg/m2. To help the Department of Veterans Affairs (VA) Health Services Research & Development Service (HSR&D) develop a research agenda, we conducted a rapid evidence review to better understand bariatric surgery outcomes in adults with BMI ≥ 50 kg/m2.MethodsWe searched MEDLINE®, the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, and ClinicalTrials.gov through June 2016. We included trials and observational studies. We used pre-specified criteria to select studies, abstract data, and rate internal validity and strength of the evidence (PROSPERO registration number CRD42015025348). All decisions were completed by one reviewer and checked by another.ResultsAmong 1892 citations, we included 23 studies in this rapid review. Compared with usual care, one large retrospective VA study provided limited evidence that bariatric surgery can lead to increased mortality in the first year, but decreased mortality long-term among super obese veterans. Studies that compared different bariatric surgical approaches suggested some differences in weight loss and complications. Laparoscopic gastric bypass generally resulted in greater short-term proportion of excess weight loss than did other procedures. Duodenal switch led to greater long-term weight loss than did gastric bypass, but with more complications.ConclusionsThe published literature that separates the super obese is insufficient for determining the precise balance of benefits and harms of bariatric surgery in this high-risk subgroup. Future studies should evaluate a more complete set of key outcomes with longer follow-up in larger samples of more broadly representative adults.

ABSTRACT Parks and protected areas (PPAs) are crucial for providing society with essential ecosystem services, encompassing both tangible and intangible benefits derived from healthy ecosystems. While previous research has predominantly focused on material-based ecosystem services, limited attention has been devoted to the impact of non-material cultural ecosystem services (CES), such as recreation and cultural-historic aspects, on visitor loyalty. Visitor loyalty refers to an individual’s commitment and willingness to repeatedly visit a PPA. CES can significantly shape these attitudes, as many visitors are drawn to specific PPAs due to their cultural significance or scenic beauty. This study investigated how CES influences visitor loyalty attitudes and intention-to-return at the Great Bay National Estuarine Research Reserve (GBE). In the summer of 2022, data were collected from 645 GBE visitors using a population sampling approach. Structural equation modeling analyses revealed a robust link between various CES factors, visitor loyalty attitudes, and intention-to-return. For instance, findings suggest that education and the sense of place exert a strong and consistent influence on visitor attitudes regarding referrals, financial support, volunteerism, and advocacy. Additionally, positive visitor attitudes toward referrals strongly and independently predicted their overall intent to revisit the GBE. This research contributes to the advancement of both CES and visitor loyalty frameworks, offering empirical insights for natural resource managers. By acknowledging the significance and trade-offs associated with CES elements, like education and the sense of place, resource managers can enhance visitor loyalty and secure the long-term sustainability of natural resources worldwide.

Deprived communities in many cities are exposed to higher levels of outdoor air pollution, and there is increasing evidence of similar disparities for indoor air pollution exposure. There is a need to understand the drivers for this exposure disparity in order to develop effective interventions aimed at improving population health and reducing health inequities. With a focus on London, UK, this paper assembles evidence to examine why indoor exposure to PM , NO and CO may disproportionately impact low-income groups. In particular, five factors are explored, namely: housing location and ambient outdoor levels of pollution; housing characteristics, including ventilation properties and internal sources of pollution; occupant behaviours; time spent indoors; and underlying health conditions. Evidence is drawn from various sources, including building physics models, modelled outdoor air pollution levels, time-activity surveys, housing stock surveys, geographical data, and peer-reviewed research. A systems framework is then proposed to integrate these factors, highlighting how exposure to high levels of indoor air pollution in low-income homes is in large part due to factors beyond the control of occupants, and is therefore an area of systemic inequality. There is increasing public and political awareness of the impact of air pollution on public health. Strong scientific evidence links exposure to air pollution with morbidity and mortality. Deprived communities may be more affected, however, with limited evidence on how deprivation may influence their personal exposure to air pollution, both outdoors and indoors. This paper describes different factors that may lead to low-income households being exposed to higher levels of indoor air pollution than the general population, using available data and models for London ( . living in areas of higher outdoor air pollution, in poor-quality housing, undertaking more pollution-generating activities indoors and spending more time indoors). A systems approach is used to show how these factors lead to systemic exposure inequalities, with low-income households having limited opportunities to improve their indoor air quality. This paper can inform actions and public policies to reduce environmental health inequalities, considering both indoor and outdoor air.

Background Minimizing relative hypotension, or mean arterial pressure (MAP) deficit, by targeting patients’ own pre-illness MAP (individualized MAP) during vasopressor therapy is a potential strategy to improve outcomes among ICU patients with shock. We conducted a prospective, open label, parallel-group, pilot RCT to assess feasibility and safety of this intervention compared to standard care. Methods Thirty-seven eligible patients, aged 40 years or older and receiving vasopressor support for shock, were randomly allocated to individualized MAP target ( N  = 17) or standard MAP target ( N  = 20) at two multidisciplinary ICUs in Australia and Ireland. Pre-specified endpoints were time-weighted average MAP-deficit (i.e., percentage difference between patients’ pre-illness MAP and achieved-MAP), percentage time spent with > 20% MAP-deficit, major adverse kidney events (MAKE-14), 14-day and 90-day all-cause mortality, and cardiovascular adverse events within 28 days of randomization. All comparisons of efficacy outcomes were exploratory. Results The median MAP-deficit and percentage time with > 20% MAP-deficit with individualized MAP vs. standard MAP were 7% [interquartile range: 2–16] vs. 18% [9–23] ( p  = 0.048), and 8% [0–43] vs. 53% [14–75] ( p  = 0.03), respectively. MAKE-14 (2/17 (12%) vs. 4/20 (20%), p  = 0.67), 14-day mortality (1/17 (6%) vs. 3/20 (15%), p  = 0.61), 90-day mortality (2/17 (12%) vs. 4/20 (20%), p  = 0.67) and cardiovascular adverse events were similar for both groups. Conclusions This pilot RCT demonstrated that an individualized MAP target strategy was feasible to implement. No adverse safety signals were evident. These data and study procedures helped inform the design of a definitive RCT on the question of individualized MAP targets among critically ill patients with shock. Study registration : ACTRN12618000571279.

Greenhouse gas emissions from burning fossil fuels are routinely counted in energy and climate policies, yet the immediate health burden of air pollution emissions from combusting these fuels is rarely quantified alongside. Particularly, the European Union (EU) comprises countries with diverse energy mixes, emission characteristics, reduction technologies, and policy frameworks, leading to large variations in the impacts of energy consumption on climate, air quality, and public health. Understanding these country-level variations is critical to optimize regional energy policies and reduce climate and health disparities in the EU. This study quantifies the regional variations in both climate and health impacts of energy consumption across EU countries. In countries where coal or oil dominates power supply, the health impacts of electricity consumption can be larger than climate impacts by more than ten times (e.g. Bulgaria, Romania, and Greece), highlighting the necessity of incorporating health impacts into climate and energy policies. We found a significant variability in health impacts per electricity usage (1.4–1508 € MWh−1) among EU countries, largely driven by their energy source mix. The health benefits of sustainable energy strategies can be notably higher in Eastern Europe countries than those in Western or Northern Europe. For instance, saving the same amount of electricity in Estonia could achieve health benefits 1043 times greater than in Sweden. Furthermore, our results suggest that energy policies and reports with biomass lumped into renewables can overlook its potential health burden. The dataset of climate and health impact factors produced in this study can be useful for future research, practice, and policymaking to quantify the burdens of energy consumption or assess the benefits of energy efficiency measures in the EU.

Burgeoning urbanization, development and human activities have led to reduced opportunities for nature experience in quiet acoustic environments. Increasing noise affects both humans and wildlife alike. We experimentally altered human‐caused sound levels in a paired study using informational signs that encouraged quiet behaviours in week‐on, week‐off blocks on the trail system of Muir Woods National Monument, California, USA to test if the soundscape influences both wildlife and human experiences. Using continuous measurements from acoustic recording units (n = 13) spatially distributed within the park, we found signs significantly lowered sound levels by approximately 1.2 decibels (A‐weighted), thereby increasing listening area by 24% and bird availability by approximately 5.8% for every 1 decibel decrease. Visitor‐intercept surveys (n = 537) revealed that our mitigation increased the number of birds perceived by visitors, rankings of soundscape pleasantness, and importantly, preferences for soundscape management. By lowering human‐caused sound levels, we created an acoustic environment equivalent to a ~21% reduction in visitors. The positive feedback cycle we describe may lead to increased conservation support in a time when the extinction of nature experience looms. A free Plain Language Summary can be found within the Supporting Information of this article. A free Plain Language Summary can be found within the Supporting Information of this article.

Continuum surface methods, including the Sendova–Walton theory, offer a novel approach to fracture modeling in which boundary mechanics are used to augment the classical linear elastic fracture mechanics model for improved prediction of material behavior near fracture surfaces. These methods would be extremely useful in design simulations, but would require numerical implementation which to date has not been available. This has not been previously addressed due to the higher-order tangential derivatives appearing in the fracture surface boundary conditions which make standard implementation techniques, such as the finite element method, a challenge to implement. We propose a method for this implementation which involves reformulating the fracture boundary conditions to remove these higher-order derivatives in the case of mode-III fracture. We also present the initial results of our finite element implementation, which verify the improved stress and displacement field predictions near fracture surfaces.