The political economy of energy transition: The role of globalization and governance in the adoption of clean cooking fuels and technologies

The need for substantial economic, political, and social integration among economies and an effective domestic governance system to create a more inclusive and clean energy economy cannot be underestimated. Overreliance on biomass and other dirty fuels for cooking in developing countries has contributed to the global climate change challenge. In this study, we examine the impact of globalization and governance on adopting clean fuels and cooking technologies in sub-Saharan Africa (SSA). Regarding analytical approaches, we deploy econometric techniques such as Driscoll-Kraay and instrumental variable generalized method of moment techniques to control econometric issues such as autocorrelation, heteroskedasticity, cross-sectional dependence, and endogeneity. The findings indicate that globalization (economic, social, and political) and governance (government effectiveness, control of corruption, political stability, and the rule of law) drive the adoption of clean fuels and technologies for cooking. The results further reveal that right-wing political leaders contribute significantly to adopting clean cooking fuels and technologies in SSA, while left-wing and center-wing political leaders do not. These findings differ among the sub-regions in SSA. Furthermore, interaction and marginal effect analysis suggest that improving the governance system enhances the effect of globalization on access to clean cooking fuels and technologies. Hence, improving the efficacy of the domestic governance system would enable globalization to speed up the adoption of clean fuels and technologies for cooking in SSA

Finding the Evidence

This book will help you learn how to decide what clinical questions to ask, search for research evidence to answer them, and analyse the evidence to decide if the results are believable, important, and applicable. You will learn how to talk with patients about evidence and make collaborative decisions and how to approach evidence implementation at an individual and organisational level

Comparing dietary strategies to manage cardiovascular risk in primary care: a narrative review of systematic reviews

BACKGROUND: Nutrition care in general practice is crucial for cardiovascular disease (CVD) prevention and management, although comparison between dietary strategies is lacking.AIM: To compare the best available (most recent, relevant, and high-quality) evidence for six dietary strategies that are effective for primary prevention/absolute risk reduction of CVD.DESIGN AND SETTING: A pragmatic narrative review of systematic reviews of randomised trials focused on primary prevention of cardiovascular events.METHOD: Studies about: 1) adults without a history of cardiovascular events; 2) target dietary strategies postulated to reduce CVD risk; and 3) direct cardiovascular or all-cause mortality outcomes were included. Six dietary strategies were examined: energy deficit, Mediterranean-like diet, sodium reduction (salt reduction and substitution), the Dietary Approaches to Stop Hypertension (DASH) diet, alcohol reduction, and fish/fish oil consumption. Reviews were selected based on quality, recency, and relevance. Quality and certainty of evidence was assessed using GRADE.RESULTS: Twenty-five reviews met inclusion criteria; eight were selected as the highest quality, recent, and relevant. Three dietary strategies showed modest, significant reductions in cardiovascular events: energy deficit (relative risk reduction [RRR] 30%, 95% confidence interval [CI] = 13 to 43), Mediterranean-like diet (RRR 40%, 95% CI = 20 to 55), and salt substitution (RRR 30%, 95% CI = 7 to 48). Still, some caveats remain on the effectiveness of these dietary strategies. Salt reduction, DASH diet, and alcohol reduction showed small, significant reductions in blood pressure, but no reduction in cardiovascular events. Fish/fish oil consumption showed little or no effect; supplementation of fish oil alone showed small reductions in CVD events.CONCLUSION: For primary prevention, energy deficit, Mediterranean-like diets, and sodium substitution have modest evidence for risk reduction of CVD events. Strategies incorporated into clinical nutrition care should ensure guidance is person centred and tailored to clinical circumstances.</p

Using Machine Learning Techniques to Assess the Financial Impact of the COVID-19 Pandemic on the Global Aviation Industry

Prediction of financial distress is a crucial concern for decision-makers, especially in industries prone to external shocks, such as the aviation sector. This study employs machine learning techniques on a comprehensive global dataset of aviation companies to develop highly accurate financial distress prediction models. These models empower stakeholders with informed decision-making capabilities to navigate the aviation industry's challenges, most notably exemplified by the COVID-19 pandemic. The aviation industry holds substantial economic importance, contributing significantly to revenue, employment, and economic activity worldwide. However, its susceptibility to external factors underscores the need for robust predictive tools. Leveraging advances in machine learning, this study pioneers the application of data-driven, non-parametric solutions to the aviation sector, both before and after the pandemic. Importantly, this study addresses a gap in the field by conducting comparative evaluations of prediction models, which have been lacking in previous research efforts, often leading to inconclusive outcomes. Key findings of the study highlight the Random Forest and Stochastic Gradient Boosting models as the most accurate in forecasting financial distress within the aviation industry. Notably, the study identifies debt-to-equity, return on invested capital, and debt ratio as the most important predictors of financial distress in this context.<br/

Artificial Intelligence, Space Liability and Regulation for the Future: A Transcontinental Analysis of National Space Laws

Space-related activities are being transformed by NewSpace innovations. The ongoing commercialization of the space sector offers a series of opportunities, from increased funding to support space exploration missions, to assisting with the mitigation of space debris, to digitalization and access to the Internet across developing countries. The private sector also facilitates the deployment of emerging technologies, such as artificial intelligence, which is currently used for satellite collision avoidance, autonomous docking, assistance to astronauts, spacecraft operations management, among others.Notwithstanding their benefits, technological advancements introduced by the private sector may also challenge the adequacy of traditional space law to address some complex issues. The increasing autonomy of AI-deployed space objects, coinciding with the associated reduced role of human 'control', does not sit squarely in sync with existing space law concepts, particularly with respect to liability for damage caused by space objects, and the obligations of States regarding continuing supervision of national activities in space as well as for controlling space objects. In this regard, the role of national legislation becomes even more important, premised as it is on a balancing of the interests of both private actors and States to provide appropriate safeguards for the general public, while aiming to promote further technological innovations. This paper will analyze the concept of liability for damage caused by space objects that incorporate AI through the lens of national space legislation. We undertake a brief transcontinental analysis of examples from diverse parts of the world: The Netherlands, Indonesia, Australia, South Korea and the United Arab Emirates. Based on our analysis, we provide recommendations de lege ferenda as to potential solutions for regulating AI liability caused in the context of space activities with humans 'out of the loop', taking account also of the AI Act proposed by the European Commission in April 2021, and the European Parliament's resolution on a civil liability regime for AI issued in October 2020.</p

Digital Medication Management in Polypharmacy

BACKGROUND: Inappropriate drug prescriptions for patients with polypharmacy can have avoidable adverse consequences. We studied the effects of a clinical decision-support system (CDSS) for medication management on hospitalizations and mortality.METHODS: This stepped-wedge, cluster-randomized, controlled trial involved an open cohort of adult patients with polypharmacy in primary care practices (=clusters) in Westphalia-Lippe, Germany. During the period of the intervention, their medication lists were checked annually using the CDSS. The CDSS warns against inappropriate prescriptions on the basis of patient-related health insurance data. The combined primary endpoint consisted of overall mortality and hospitalization for any reason. The secondary endpoints were mortality, hospitalizations, and high-risk prescription. We analyzed the quarterly health insurance data of the intention-to-treat population with a mixed logistic model taking account of clustering and repeated measurements. Sensitivity analyses addressed effects of the COVID-19 pandemic and other effects.RESULTS: 688 primary care practices were randomized, and data were obtained on 42 700 patients over 391 994 quarter years. No significant reduction was found in either the primary endpoint (odds ratio [OR] 1.00; 95% confidence interval [0.95; 1.04]; p = 0.8716) or the secondary endpoints (hospitalizations: OR 1.00 [0.95; 1.05]; mortality: OR 1.04 [0.92; 1.17]; high-risk prescription: OR 0.98 [0.92; 1.04]).CONCLUSION: The planned analyses did not reveal any significant effect of the intervention. Pandemic-adjusted analyses yielded evidence that the mortality of adult patients with polypharmacy might potentially be lowered by the CDSS. Controlled trials with appropriate follow-up are needed to prove that a CDSS has significant effects on mortality in patients with polypharmacy.</p

Is exercise therapy the right treatment for rotator cuff-related shoulder pain: Uncertainties, theory, and practice

BACKGROUND: Exercise therapy is a popular non-surgical treatment to help manage individuals with rotator cuff-related shoulder pain (RCRSP) and is recommended in all clinical practice guidelines. Due to modest effect sizes, low quality evidence, uncertainty relating to efficacy, and mechanism(s) of benefit, exercise as a therapeutic intervention has been the subject of increasing scrutiny.AIMS: The aim of this critical review is to lay out where the purported uncertainties of exercise for RCRSP exist by exploring the relevant quantitative and qualitative literature. We conclude by offering theoretical and practical considerations to help reduce the uncertainty of delivering exercise therapy in a clinical environment.RESULTS AND DISCUSSION: Uncertainty underpins much of the theory and practice of delivering exercise therapy for individuals with RCRSP. Nonetheless, exercise is an often-valued treatment by individuals with RCRSP, when provided within an appropriate clinical context. We encourage clinicians to use a shared decision-making paradigm and embrace a pluralistic model when prescribing therapeutic exercise. This may take the form of using exercise experiments to trial different exercise approaches, adjusting, and adapting the exercise type, load, and context based on the individual's symptom irritability, preferences, and goals.CONCLUSION: We contend that providing exercise therapy should remain a principal treatment option for helping individuals with RCRSP. Limitations notwithstanding, exercise therapy is relatively low cost, accessible, and often valued by individuals with RCRSP. The uncertainty surrounding exercise therapy requires ongoing research and emphasis could be directed towards investigating causal mechanisms to better understand how exercise may benefit an individual with RCRSP.</p

Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis

BACKGROUND: Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances.METHODS: A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL.RESULTS: Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], p = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, p &lt; 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values. CONCLUSION: While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors.IMPLICATION: As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.</p

Common barriers and enablers to the use of non-drug interventions for managing common chronic conditions in primary care: an overview of reviews

BACKGROUND: Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care.METHODS: We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews.RESULTS: From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion.CONCLUSIONS: We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously.TRIAL REGISTRATION: This study was registered in PROSPERO (CRD42022357583).</p