4,407 research outputs found

    Resilience and food security in a food systems context

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    This open access book compiles a series of chapters written by internationally recognized experts known for their in-depth but critical views on questions of resilience and food security. The book assesses rigorously and critically the contribution of the concept of resilience in advancing our understanding and ability to design and implement development interventions in relation to food security and humanitarian crises. For this, the book departs from the narrow beaten tracks of agriculture and trade, which have influenced the mainstream debate on food security for nearly 60 years, and adopts instead a wider, more holistic perspective, framed around food systems. The foundation for this new approach is the recognition that in the current post-globalization era, the food and nutritional security of the world’s population no longer depends just on the performance of agriculture and policies on trade, but rather on the capacity of the entire (food) system to produce, process, transport and distribute safe, affordable and nutritious food for all, in ways that remain environmentally sustainable. In that context, adopting a food system perspective provides a more appropriate frame as it incites to broaden the conventional thinking and to acknowledge the systemic nature of the different processes and actors involved. This book is written for a large audience, from academics to policymakers, students to practitioners

    k-Means

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    Mainstreaming of Nature-Based Solutions for the mitigation of hydro-meteorological hazard: governance analysis of a socio- technical change

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    The Nature-Based Solutions (NBS) concept and approach were developed to simultaneously face challenges such as risk mitigation and biodiversity conservation and restoration. NBSs have been endorsed by major International Organizations such as the EU, the FAO and World Bank that are pushing to enable a mainstreaming process. However, a shift from traditional engineering “grey” solutions to wider and standard adoption of NBS encounters technical, social, cultural, and normative barriers that have been identified with a qualitative content analysis of policy documents, reports and expert interviews. The case of the region Emilia-Romagna was studied by developing an analytical framework that brought together the social-ecological context, the governance system and the characteristics of specific NBSs

    Music and musicality in brain surgery:The effect on delirium and language

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    Delirium is a neuropsychiatric clinical syndrome with overlapping symptoms withthe neurologic primary disease. This is why delirium is such a difficult and underexposedtopic in neurosurgical literature. Delirium is a complication which mightaffect recovery after brain surgery, hence we describe in Chapter 2 a systematicreview which focuses on how delirium is defined in the neurosurgical literature.We included twenty-four studies (5589 patients) and found no validation studiesof screening instruments in neurosurgical papers. Delirium screening instruments,validated in other cohorts, were used in 70% of the studies, consisting of theConfusion Assessment Method (- Intensive Care Unit) (45%), Delirium ObservationScreening Scale (5%), Intensive Care Delirium Screening Checklist (10%), Neelonand Champagne Confusion Scale (5%), and Nursing Delirium Screening Scale (5%).Incidence of post-operative delirium after intracranial surgery was 19%, ranging from12 – 26% caused by variation in clinical features and delirium assessment methods.Our review highlighted the need of future research on delirium in neurosurgery,which should focus on optimizing diagnosis, and assessing prognostic significanceand management.It is unclear what the impact of delirium is on the recovery after brain surgery,as delirium is often a self-limiting and temporary complication. In Chapter 3 wetherefore investigated the impact of delirium, by means of incidence and healthoutcomes, and identified independent risk factors by including 2901 intracranialsurgical procedures. We found that delirium was present in 19.4% with an averageonset (mean/SD) within 2.62/1.22 days and associated with more Intensive CareUnit (ICU) admissions and more discharge towards residential care. These numbersconfirm the impact of delirium with its incidence rates, which were in line with ourprevious systematic review, and significant health-related outcomes. We identifiedseveral independent non-modifiable risk factors such as age, pre-existing memoryproblems, emergency operations, and modifiable risk factors such as low preoperativepotassium and opioid and dexamethasone administration, which shed lighton the pathophysiologic mechanisms of POD in this cohort and could be targetedfor future intervention studies.10As listening to recorded music has been proven to lower delirium-eliciting factors inthe surgical population, such as pain, we were interested in the size of analgesic effectand its underlying mechanism before applying this into our clinical setting. In Chapter4 we describe the results of a two-armed experimental randomized controlled trial inwhich 70 participants received increasing electric stimuli through their non-dominantindex finger. This study was conducted within a unique pain model as participantswere blinded for the outcome. Participants in the music group received a 20-minutemusic intervention and participants in the control group a 20-minute resting period.Although the effect of the music intervention on pain endurance was not statisticallysignificant in our intention-to-treat analysis (p = 0.482, CI -0.85; 1.79), the subgroupanalyses revealed an increase in pain endurance in the music group after correcting fortechnical uncertainties (p = 0.013, CI 0.35; 2.85). This effect on pain endurance couldbe attributed to increased parasympathetic activation, as an increased Heart RateVariability (HRV) was observed in the music vs. the control group (p=0.008;0.032).As our prior chapters increased our knowledge on the significance of delirium on thepost-operative recovery after brain surgery and the possible beneficial effects of music,we decided to design a randomized controlled trial. In Chapter 5 we describe theprotocol and in Chapter 6 we describe the results of this single-centered randomizedcontrolled trial. In this trial we included 189 patients undergoing craniotomy andcompared the effects of music administered before, during and after craniotomy withstandard of clinical care. The primary endpoint delirium was assessed by the deliriumobservation screening scale (DOSS) and confirmed by a psychiatrist accordingto DSM-5 criteria. A variety of secondary outcomes were assessed to substantiatethe effects of music on delirium and its clinical implications. Our results supportthe efficacy of music in preventing delirium after craniotomy, as found with DOSS(OR:0.49, p=0.048) but not after DSM-5 confirmation (OR:0.47, p=0.342). Thispossible beneficial effect is substantiated by the effect of music on pre-operativeautonomic tone, measured with HRV (p=0.021;0.025), and depth of anesthesia(p=&lt;0.001;0.022). Our results fit well within the current literature and support theimplementation of music for the prevention of delirium within the neurosurgicalpopulation. However, delirium screening tools should be validated and the long-termimplications should be evaluated after craniotomy to assess the true impact of musicafter brain surgery.Musicality and language in awake brain surgeryIn the second part of this thesis, the focus swifts towards maintaining musicality andlanguage functions around awake craniotomy. Intra-operative mapping of languagedoes not ensure complete maintenance which mostly deteriorates after tumor resection.Most patients recover to their baseline whereas other remain to suffer from aphasiaaffecting their quality of life. The level of musical training might affect the speed andextend of postoperative language recovery, as increased white matter connectivity inthe corpus callosum is described in musicians compared to non-musicians. Hence,in Chapter 7 we evaluate the effect of musicality on language recovery after awakeglioma surgery in a cohort study of forty-six patients. We divided the patients intothree groups based on the musicality and compared the language scores between thesegroups. With the first study on this topic, we support that musicality protects againstlanguage decline after awake glioma surgery, as a trend towards less deterioration oflanguage was observed within the first three months on the phonological domain (p= 0.04). This seemed plausible as phonology shares a common hierarchical structurebetween language and singing. Moreover, our results support the hypothesis ofmusicality induced contralateral compensation in the (sub-) acute phase through thecorpus callosum as the largest difference of size was found in the anterior corpuscallosum in non- musicians compared to trained musicians (p = 0.02).In Chapter 8 we addressed musicality as a sole brain function and whether it canbe protected during awake craniotomy in a systematic review consisting of tenstudies and fourteen patients. Isolated music disruption, defined as disruption duringmusic tasks with intact language/speech and/or motor functions, was identified intwo patients in the right superior temporal gyrus, one patient in the right and onepatient in the left middle frontal gyrus and one patient in the left medial temporalgyrus. Pre-operative functional MRI confirmed these localizations in three patients.Assessment of post-operative musical function, only conducted in seven patients bymeans of standardized (57%) and non-standardized (43%) tools, report no loss ofmusical function. With these results we concluded that mapping music is feasibleduring awake craniotomy. Moreover, we identified certain brain regions relevant formusic production and detected no decline during follow-up, suggesting an addedvalue of mapping musicality during awake craniotomy. A systematic approach to mapmusicality should be implemented, to improve current knowledge on the added valueof mapping musicality during awake craniotomy.<br/

    Patenting Genetic Information

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    The U.S. biotechnology industry got its start and grew to maturity over roughly three decades, beginning in the 1980s. During this period genes were patentable, and many gene patents were granted. University researchers performed basic research— often funded by the government—and then patented the genes they discovered with the encouragement of the Bayh-Dole Act, which sought to encourage practical applications of basic research by allowing patents on federally funded inventions and discoveries. At that time, when a researcher discovered the function of a gene, she could patent it such that no one else could work with that gene in the laboratory without a license. She had no right, however, to control genes in nature, including in human bodies. Universities licensed their researchers’ patents to industry, which brought in significant revenue for further research. University researchers also used gene patents as the basis for obtaining funding for start-up enterprises spun out of university labs. It was in this environment that many of today’s biotechnology companies started. In 2013, the Supreme Court held that naturally occurring genes could no longer be patented. This followed a 2012 decision that disallowed patents on many diagnostic processes. These decisions significantly changed the intellectual property protections in the biotechnology industry. Nevertheless, the industry has continued to grow and thrive. This Article investigates two questions. First, if some form of exclusive rights still applied to genes, would the biotech industry be even more robust, with more new entrants in addition to thriving, well-established companies? Second, does the current lack of protection for gene discoveries incentivize keeping such discoveries secret for the many years that it can take to develop a therapeutic based thereon—to the detriment of patients who could benefit from knowledge of the genetic associations, even before a treatment is developed? The Article concludes by analyzing what protection for discovering genetic associations, if any, will most increase social welfare
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