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1.  A Shift Toward Building with Nature in the Dredging and Port Development Industries: Managerial Implications for Projects in or Near Natura 2000 Areas 
Environmental Management  2014;54(1):3-13.
Building with Nature is a new approach to designing water infrastructure, one that seeks to realize socioeconomic project goals in harmony with the environment. The Dutch dredging industry is promoting its application in the Netherlands, but similar concepts are emerging internationally. The Working with Nature concept has been developed under the auspices of the World Association for Waterborne Transport Infrastructure, Engineering with Nature by the US Army Corps of Engineers, and Flanders Bays 2100 by a group of Belgian dredging companies and international consultants. The research discussed in this article focuses on the feasibility of implementing the Building with Nature approach in the context of EU Natura 2000 governance. The initial expectation of the industry was that Natura 2000 regulations would obstruct innovative Building with Nature attempts. The empirical evidence points to a shift toward Building with Nature have taken place on the governance and project levels, and the goals of Natura 2000 and Building with Nature converging in practice. Using specific project-level variables identified by researchers, guidance for project development in Natura 2000 areas was proposed. We conclude by discussing the implications of the research results for the dredging industry dealing with Natura 2000 regulations in Europe and similar overarching nature regulations elsewhere.
doi:10.1007/s00267-014-0285-z
PMCID: PMC4052005  PMID: 24809286
Dredging; Port development; Building with Nature; Natura 2000; Project management; North-West Europe
2.  Natural environments, ancestral diets, and microbial ecology: is there a modern “paleo-deficit disorder”? Part I 
Famed microbiologist René J. Dubos (1901–1982) was an early pioneer in the developmental origins of health and disease (DOHaD) construct. In the 1960s, he conducted groundbreaking experimental research concerning the ways in which early-life experience with nutrition, microbiota, stress, and other environmental variables could influence later-life health outcomes. He also wrote extensively on potential health consequences of a progressive loss of contact with natural environments (now referred to as green or blue space), arguing that Paleolithic experiences have created needs, particularly in the mental realm, that might not be met in the context of rapid global urbanization. He posited that humans would certainly adapt to modern urban landscapes and high technology, but there might be a toll to be paid in the form of higher psychological distress (symptoms of anxiety and depression) and diminished quality of life. In particular, there might be an erosion of humanness, exemplified by declines in altruism/empathy. Here in the first of a two-part review, we examine contemporary research related to natural environments and question to what extent Dubos might have been correct in some of his 50-year-old assertions.
doi:10.1186/s40101-015-0041-y
PMCID: PMC4318214  PMID: 25636731
3.  The early botanical medical movement as a reflection of life, liberty, and literacy in Jacksonian America* 
This paper describes a popular, grassroots health crusade initiated by Samuel Thomson (1769–1843) in the early decades of the nineteenth century and the ways the Thomsonians exemplified the inherent contradictions within the larger context of their own sociopolitical environment. Premised upon a unique brand of frontier egalitarianism exemplified in the Tennessee war-hero Andrew Jackson (1767–1845), the age that bore Jackson's name was ostensibly anti-intellectual, venerating “intuitive wisdom” and “common sense” over book learning and formal education. Likewise, the Thomsonian movement eschewed schooling and science for an empirical embrace of nature's apothecary, a populist rhetoric that belied its own complex and extensive infrastructure of polemical literature. Thus, Thomsonians, in fact, relied upon a literate public to explain and disseminate their system of healing. This paper contributes to the historiography of literacy in the United States that goes beyond typical census-data, probate-record, or will-signature analyses to look at how a popular medical cult was both heir to and promoter of a functionally literate populace.
PMCID: PMC128961  PMID: 12398251
4.  Neuro syphilis: Portrayals by Sir Arthur Conan Doyle 
Indian Journal of Psychiatry  2009;51(3):235-237.
The developments in neuro syphilis in the 19th century are integral parts of the history of psychiatry. The delineation of various aspects of neuro syphilis by Sir Arthur Conan Doyle in three of his stories is discussed in brief.
doi:10.4103/0019-5545.55103
PMCID: PMC2772218  PMID: 19881059
Neurosyphilis; history; fiction
6.  VIS MEDICATRIX NATURAE* 
PMCID: PMC1517776  PMID: 18739163
7.  Deployment of a Prototype Plant GFP Imager at the Arthur Clarke Mars Greenhouse of the Haughton Mars Project 
Sensors (Basel, Switzerland)  2008;8(4):2762-2773.
The use of engineered plants as biosensors has made elegant strides in the past decades, providing keen insights into the health of plants in general and particularly in the nature and cellular location of stress responses. However, most of the analytical procedures involve laboratory examination of the biosensor plants. With the advent of the green fluorescence protein (GFP) as a biosensor molecule, it became at least theoretically possible for analyses of gene expression to occur telemetrically, with the gene expression information of the plant delivered to the investigator over large distances simply as properly processed fluorescence images. Spaceflight and other extraterrestrial environments provide unique challenges to plant life, challenges that often require changes at the gene expression level to accommodate adaptation and survival. Having previously deployed transgenic plant biosensors to evaluate responses to orbital spaceflight, we wished to develop the plants and especially the imaging devices required to conduct such experiments robotically, without operator intervention, within extraterrestrial environments. This requires the development of an autonomous and remotely operated plant GFP imaging system and concomitant development of the communications infrastructure to manage dataflow from the imaging device. Here we report the results of deploying a prototype GFP imaging system within the Arthur Clarke Mars Greenhouse (ACMG) an autonomously operated greenhouse located within the Haughton Mars Project in the Canadian High Arctic. Results both demonstrate the applicability of the fundamental GFP biosensor technology and highlight the difficulties in collecting and managing telemetric data from challenging deployment environments.
PMCID: PMC3673444
Green Fluorescent Protein; telemetry; Mars; astrobiology; analog environments
9.  The Relationship between Perceived Health and Physical Activity Indoors, Outdoors in Built Environments, and Outdoors in Nature 
Background:
A body of evidence shows that both physical activity and exposure to nature are connected to improved general and mental health. Experimental studies have consistently found short term positive effects of physical activity in nature compared with built environments. This study explores whether these benefits are also evident in everyday life, perceived over repeated contact with nature. The topic is important from the perspectives of city planning, individual well-being, and public health.
Methods:
National survey data (n = 2,070) from Finland was analysed using structural regression analyses. Perceived general health, emotional well-being, and sleep quality were regressed on the weekly frequency of physical activity indoors, outdoors in built environments, and in nature. Socioeconomic factors and other plausible confounders were controlled for.
Results:
Emotional well-being showed the most consistent positive connection to physical activity in nature, whereas general health was positively associated with physical activity in both built and natural outdoor settings. Better sleep quality was weakly connected to frequent physical activity in nature, but the connection was outweighed by other factors.
Conclusion:
The results indicate that nature provides an added value to the known benefits of physical activity. Repeated exercise in nature is, in particular, connected to better emotional well-being.
doi:10.1111/aphw.12031
PMCID: PMC4233975  PMID: 25044598
Finland; mental health; natural environment; physical activity; sleep; well-being
10.  How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it: A phenomenographic study 
Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents’ view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.
doi:10.3402/qhw.v7i0.19716
PMCID: PMC3522873  PMID: 23237629
Aged; care of older people; mental health promotion; municipal care; nursing; phenomenography; primary health care
11.  A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice 
The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria.
doi:10.1186/1747-5341-7-2
PMCID: PMC3282636  PMID: 22243976
Psychiatry, DSM; classification; nosology; psychopathology; mental disorders; historicity
12.  Placebo and other psychological interactions in headache treatment 
The Journal of Headache and Pain  2012;13(3):191-198.
We present a theory according which a headache treatment acts through a specific biological effect (when it exists), a placebo effect linked to both expectancy and repetition of its administration (conditioning), and a non-specific psychological effect. The respective part of these components varies with the treatments and the clinical situations. During antiquity, suggestions and beliefs were the mainstays of headache treatment. The word placebo appeared at the beginning of the eighteenth century. Controversies about its effect came from an excessive interpretation due to methodological bias, inadequate consideration of the variation of the measure (regression to the mean) and of the natural course of the disease. Several powerful studies on placebo effect showed that the nature of the treatment, the associated announce, the patients’ expectancy, and the repetition of the procedures are of paramount importance. The placebo expectancy is associated with an activation of pre-frontal, anterior cingular, accumbens, and periacqueducal grey opioidergic neurons possibly triggered by the dopaminergic meso-limbic system. In randomized control trials, several arms design could theoretically give information concerning the respective part of the different component of the outcome and control the natural course of the disease. However, for migraine and tension type headache attacks treatment, no three arm (verum, placebo, and natural course) trial is available in the literature. Indirect evidence of a placebo effect in migraine attack treatment, comes from the high amplitude of the improvement observed in the placebo arms (28% of the patients). This figure is lower (6%) when using the harder criterium of pain free at 2 h. But these data disregard the effect of the natural course. For prophylactic treatment with oral medication, the trials performed in the last decades report an improvement in 21% of the patients in the placebo arms. However, in these studies the duration of administration was limited, the control of attacks uncertain as well as the evolution of the co-morbid psycho-pathology. Considering the reviews and meta-analysis of complex prophylactic procedures, it must be concluded that their effect is mostly linked to a placebo and non-specific psychological effects. Acupuncture may have a slight specific effect on tension type headache, but not on migraine. Manual therapy studies do not exhibit difference between manipulation, mobilization, and controls; touch has no proven specific effect. A comprehensive efficacy review of biofeedback studies concludes to a small specific effect on tension type headache but not on migraine. A review of behavioral treatment conclude to an interesting mean improvement but did not demonstrated a specific effect with the exception of a four arm study including a pseudo meditation control group. Expectation-linked placebo, conditioning, and non-specific psychological effects vary according clinical situations and psychological context; likely low in RCT, high after anempathic medical contact, and at its maximum with a desired charismatic healer. The announcements of doctors strongly influence the beliefs of patients, and in consequence their pain and anxiety sensibilities; this modulates the amplitude of the placebo and the non-specific psychological effects and is therefore a major determinant of the therapeutic success. Furthermore, any repetitive contact, even through a placebo, may interfere positively with the psychopathological co-morbidity. One has to keep in mind that the non-specific psychological interactions play a major role in the improvement of the majority of the headache sufferers.
doi:10.1007/s10194-012-0422-0
PMCID: PMC3311834  PMID: 22367630
Migraine; Placebo; Headache treatment
13.  Placebo and other psychological interactions in headache treatment 
The Journal of Headache and Pain  2012;13(3):191-198.
We present a theory according which a headache treatment acts through a specific biological effect (when it exists), a placebo effect linked to both expectancy and repetition of its administration (conditioning), and a non-specific psychological effect. The respective part of these components varies with the treatments and the clinical situations. During antiquity, suggestions and beliefs were the mainstays of headache treatment. The word placebo appeared at the beginning of the eighteenth century. Controversies about its effect came from an excessive interpretation due to methodological bias, inadequate consideration of the variation of the measure (regression to the mean) and of the natural course of the disease. Several powerful studies on placebo effect showed that the nature of the treatment, the associated announce, the patients’ expectancy, and the repetition of the procedures are of paramount importance. The placebo expectancy is associated with an activation of pre-frontal, anterior cingular, accumbens, and periacqueducal grey opioidergic neurons possibly triggered by the dopaminergic meso-limbic system. In randomized control trials, several arms design could theoretically give information concerning the respective part of the different component of the outcome and control the natural course of the disease. However, for migraine and tension type headache attacks treatment, no three arm (verum, placebo, and natural course) trial is available in the literature. Indirect evidence of a placebo effect in migraine attack treatment, comes from the high amplitude of the improvement observed in the placebo arms (28% of the patients). This figure is lower (6%) when using the harder criterium of pain free at 2 h. But these data disregard the effect of the natural course. For prophylactic treatment with oral medication, the trials performed in the last decades report an improvement in 21% of the patients in the placebo arms. However, in these studies the duration of administration was limited, the control of attacks uncertain as well as the evolution of the co-morbid psycho-pathology. Considering the reviews and meta-analysis of complex prophylactic procedures, it must be concluded that their effect is mostly linked to a placebo and non-specific psychological effects. Acupuncture may have a slight specific effect on tension type headache, but not on migraine. Manual therapy studies do not exhibit difference between manipulation, mobilization, and controls; touch has no proven specific effect. A comprehensive efficacy review of biofeedback studies concludes to a small specific effect on tension type headache but not on migraine. A review of behavioral treatment conclude to an interesting mean improvement but did not demonstrated a specific effect with the exception of a four arm study including a pseudo meditation control group. Expectation-linked placebo, conditioning, and non-specific psychological effects vary according clinical situations and psychological context; likely low in RCT, high after anempathic medical contact, and at its maximum with a desired charismatic healer. The announcements of doctors strongly influence the beliefs of patients, and in consequence their pain and anxiety sensibilities; this modulates the amplitude of the placebo and the non-specific psychological effects and is therefore a major determinant of the therapeutic success. Furthermore, any repetitive contact, even through a placebo, may interfere positively with the psychopathological co-morbidity. One has to keep in mind that the non-specific psychological interactions play a major role in the improvement of the majority of the headache sufferers.
doi:10.1007/s10194-012-0422-0
PMCID: PMC3311834  PMID: 22367630
Migraine; Placebo; Headache treatment
14.  The great outdoors: how a green exercise environment can benefit all 
The studies of human and environment interactions usually consider the extremes of environment on individuals or how humans affect the environment. It is well known that physical activity improves both physiological and psychological well-being, but further evidence is required to ascertain how different environments influence and shape health. This review considers the declining levels of physical activity, particularly in the Western world, and how the environment may help motivate and facilitate physical activity. It also addresses the additional physiological and mental health benefits that appear to occur when exercise is performed in an outdoor environment. However, people’s connectedness to nature appears to be changing and this has important implications as to how humans are now interacting with nature. Barriers exist, and it is important that these are considered when discussing how to make exercise in the outdoors accessible and beneficial for all. The synergistic combination of exercise and exposure to nature and thus the ‘great outdoors’ could be used as a powerful tool to help fight the growing incidence of both physical inactivity and non-communicable disease.
doi:10.1186/2046-7648-2-3
PMCID: PMC3710158  PMID: 23849478
Green exercise; Physiology; Natural environment; Physical activity; Motivation; Health
15.  Re-evaluation of the diagnosis of porphyria cutanea tarda in Admiral Sir Francis Beaufort 
JRSM Short Reports  2010;1(1):13.
Objectives
Two biographies of Admiral Francis Beaufort (1774–1857) have stated that, aged 20–25 years, he suffered from porphyria cutanea tarda (PCT) that was ‘cured’ following severe blood loss during a naval skirmish. We have examined the evidence concerning the nature of his skin disease.
Design
Primary records, most notably Beaufort's correspondence with his family, his journals and his father's diaries were sought out and analysed.
Setting
This case report is discussed in the context of 18th-century naval medicine and concepts and treatment of skin disease.
Results
The description of his lesions, their age of onset, their progression and response to treatment, particularly topical tar and associated features are quite inconsistent with a diagnosis of PCT. His mother, Mary Waller Beaufort (1739–1821), consulted Dr Robert Darwin in 1803 about a painful skin disease affecting her legs. Detailed description of the lesions and a contemporary diagnosis are not available but possible diagnoses include chronic psoriasis and stasis eczema.
Conclusions
A more tenable diagnosis is that Francis Beaufort had chronic plaque psoriasis remitted by bed rest and convalescence in the sunny Mediterranean climate with cessation of alcohol consumption and improved nutrition as well as topical and oral medications.
doi:10.1258/shorts.2009.090366
PMCID: PMC2984337  PMID: 21103105
16.  Green Perspectives for Public Health: A Narrative Review on the Physiological Effects of Experiencing Outdoor Nature 
Natural environments offer a high potential for human well-being, restoration and stress recovery in terms of allostatic load. A growing body of literature is investigating psychological and physiological health benefits of contact with Nature. So far, a synthesis of physiological health outcomes of direct outdoor nature experiences and its potential for improving Public Health is missing. We were interested in summarizing the outcomes of studies that investigated physiological outcomes of experiencing Nature measuring at least one physiological parameter during the last two decades. Studies on effects of indoor or simulated Nature exposure via videos or photos, animal contact, and wood as building material were excluded from further analysis. As an online literature research delivered heterogeneous data inappropriate for quantitative synthesis approaches, we descriptively summarized and narratively synthesized studies. The procedure started with 1,187 titles. Research articles in English language published in international peer-reviewed journals that investigated the effects of natural outdoor environments on humans by were included. We identified 17 relevant articles reporting on effects of Nature by measuring 20 different physiological parameters. We assigned these parameters to one of the four body systems brain activity, cardiovascular system, endocrine system, and immune function. These studies reported mainly direct and positive effects, however, our analyses revealed heterogeneous outcomes regarding significance of results. Most of the studies were conducted in Japan, based on quite small samples, predominantly with male students as participants in a cross-sectional design. In general, our narrative review provided an ambiguous illustration of the effects outdoor nature exerted on physiological parameters. However, the majority of studies reported significant positive effects. A harmonizing effect of Nature, especially on physiological stress reactions, was found across all body systems. From a Public Health perspective, interdisciplinary work on utilizing benefits of Nature regarding health promotion, disease prevention, and nature-based therapy should be optimized in order to eventually diminish given methodological limitations from mono-disciplinary studies.
doi:10.3390/ijerph110505445
PMCID: PMC4053896  PMID: 24852391
blood pressure; brain activity; cardiovascular activity; cortisol; endocrine system; forest; heart rate; immune function; outdoor nature; physiology
22.  Sir Arthur Keith 
PMCID: PMC1825546  PMID: 20324993
23.  Sir Arthur Ellis 
PMCID: PMC1822900  PMID: 20324792
24.  Medical History: Sir Arthur Keith Centenary 
British Medical Journal  1966;1(5486):537.
Images
PMCID: PMC1843801  PMID: 20790846
25.  Sir Arthur Thomson Trust 
British Medical Journal  1963;2(5366):1148.
PMCID: PMC1874083  PMID: 20790000

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