In this research, the creation, use and spread of knowledge acquired in Building with Nature pilot projects is researched, with the goal of providing recommendations to improve this use and spread in future Building with Nature pilot projects. To achieve this, a case study with the Sand Engine as the subject is performed. In addition to this, a literature review and interviews were undertaken, and two System Dynamics models were created which were applied to the Sand Engine case. As a results, seven recommendations for future pilots were found: First, ensuring the internal success of the pilot is crucial. 2. Including knowledge creation and spread as design factors in the pilot project design, 3. Designing the pilot project to be multi-functional, 4. Ensuring the pilot project fits the long-term policy plans and strategy of important stakeholders, 5. Involving champions of knowledge, who are able to turn over the project at the right time, 6. Implementing knowledge programs within the pilot project and 7. Ensuring the free sharing of knowledge between stakeholders and interested parties. Recommendations for further research and policy include performing complementary case studies on other Building with Nature pilot projects, expanding the number and variety of interviewees, and implementing a new format of data collection, management and storage in Building with Nature pilot projects.

BACKGROUND AND PURPOSE: Infants born preterm are commonly diagnosed with structural brain lesions known to affect long-term neurodevelopment negatively. Yet, the effects of preterm birth on brain development in the absence of intracranial lesions remain to be studied in detail. In this study, we aim to quantify long term consequences of preterm birth on brain development in this specific group. MATERIALS AND METHODS: Neonatal cranial sonography and follow-up T1-weighted MR imaging and DTI were performed to evaluate whether the anatomic characteristics of the cerebrum and cerebellum in a cohort of school-aged children (6 -12 years of age) were related to gestational age at birth in children free of brain lesions in the perinatal period. RESULTS: In the cohort consisting of 36 preterm (28-37 weeks' gestational age) and 66 term-born infants, T1-weighted MR imaging and DTI at 6-12 years revealed a reduction of cerebellar white matter volume (β=0.387, P=.001), altered fractional anisotropy of cerebellar white matter (β=-0.236, P=.02), and a reduction of cerebellar gray and white matter surface area (β=0.337, P=.001;β=0.375, P<.001, respectively) in relation to birth age. Such relations were not observed for the cerebral cortex or white matter volume, surface area, or diffusion quantities. CONCLUSIONS: The results of our study show that perinatal influences that are not primarily neurologic are still able to disturb long-term neurodevelopment, particularly of the developing cerebellum. Including the cerebellum in future neuroprotective strategies seems therefore essential.

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