867 research outputs found

    Climate Change and Critical Agrarian Studies

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    Climate change is perhaps the greatest threat to humanity today and plays out as a cruel engine of myriad forms of injustice, violence and destruction. The effects of climate change from human-made emissions of greenhouse gases are devastating and accelerating; yet are uncertain and uneven both in terms of geography and socio-economic impacts. Emerging from the dynamics of capitalism since the industrial revolution — as well as industrialisation under state-led socialism — the consequences of climate change are especially profound for the countryside and its inhabitants. The book interrogates the narratives and strategies that frame climate change and examines the institutionalised responses in agrarian settings, highlighting what exclusions and inclusions result. It explores how different people — in relation to class and other co-constituted axes of social difference such as gender, race, ethnicity, age and occupation — are affected by climate change, as well as the climate adaptation and mitigation responses being implemented in rural areas. The book in turn explores how climate change – and the responses to it - affect processes of social differentiation, trajectories of accumulation and in turn agrarian politics. Finally, the book examines what strategies are required to confront climate change, and the underlying political-economic dynamics that cause it, reflecting on what this means for agrarian struggles across the world. The 26 chapters in this volume explore how the relationship between capitalism and climate change plays out in the rural world and, in particular, the way agrarian struggles connect with the huge challenge of climate change. Through a huge variety of case studies alongside more conceptual chapters, the book makes the often-missing connection between climate change and critical agrarian studies. The book argues that making the connection between climate and agrarian justice is crucial

    Potential overtreatment during life-limiting illness and end of life in older adults

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    Background. A growing body of evidence suggests that older patients are subject to potential overtreatment at the end of life, characterised by disease modifying therapies, preventive medications, and frequent care transitions. This occurs even though many older patients express a preference for symptom management and tend to avoid curative therapies near death. Nowadays age-related chronic diseases and neurodegenerative conditions are the top causes of death leading to a more foreseeable trajectory of decline at the end of life compared to compared to those who die suddenly or prematurely due to global pandemics. However, drugs and procedures, with longer time-to-benefit than the seriously ill older patients’ life expectancy, are still administered causing potential adverse events, deteriorated quality of life and higher dependency. Aim. The present doctoral thesis aimed to evaluate the quality of end-of-life care in older adults, with a focus on potential overtreatment and life-limiting illness. The four individual studies of the thesis contributed to this aim from different, yet complimentary aspects. Study I. We identified overtreatment indicators in the existing literature and discovered that nearly half of them cannot be appropriately measured in administrative and healthcare data in Sweden. However, based on the 15 unique indicators that we could measure, we estimated that one third (36.9%) of patients with solid cancer received care in their last month of life deemed as potential overtreatment. Cancer-specific treatments were the most common form of potential overtreatment (27.0%), followed-by potentially futile non-cancer specific treatments (12.3%), and hospital transitions (9.4%). Study II. We found that older decedents had an average 1.7 unplanned hospitalisations during their last year of life, which corresponded to an incidence rate of 175 per 100 person-years. Those with a cancer trajectory had the highest incidence rate at 231 per 100 patient-years, whereas individuals on a trajectory of prolonged dwindling had the lowest rate at 99 per 100 patient-years. Unplanned hospitalisations were unevenly distributed throughout the last year of life. From the third month before death, the incidence rate started to increase, which is the point where the different patterns of hospitalisation between illness trajectories became evident. Study III. We reported that endocrine treatment, which is a systemic disease modifying treatment, was initiated by 5% in the last three months of life and continued by 39% of the older decedents with hormone receptor-positive metastatic breast cancer. We found several factors linked to continuation of treatment, for example, higher age (RR85+ years: 1.25 [1.12-1.41]), higher education (RRtertiary education: 0.89 [0.81-0.98]), and multi-dose drug dispensing (RR: 1.22 [1.13-1.32]). Initiation of treatment was associated with, for instance, number of hospitalised days (RR1-14 inpatient days: 1.81 [1.12-2.91]) and CDK4/6 use (3.16 [2.25- 4.44]). Study IV. Based on a self-controlled case series analysis, we discovered that the concomitant dispensation of cholinesterase inhibitors (ChEIs) and non-steroidal anti- inflammatory drugs (NSAIDs) resulted in a heightened risk of peptic ulcer disease (adjusted IRR: 9.0, 95% confidence interval: 6.8-11.8, E-value: 17.5) compared to periods without treatment. This risk was over and beyond the risks observed for NSAIDs alone (IRR 5.2, 4.4-6.0, E-value: 9.8). We found no evidence of increased risks associated with the use of ChEIs alone (IRR 1.0, 0.9-1.2, E-value: 1.2). Conclusions. Our findings suggest that older adults and seriously ill individuals are potentially exposed to various types of treatment near the end of life that may be deemed as overtreatment, which warrants further attention from policy makers, healthcare professionals, researchers, and the society as a whole. Overly intensive care, fuelled by disease modifying treatments, preventive therapies and frequent transitions close to death is generally against the preferences of older people. Important to note that reducing or eliminating these types of treatments is not about rationing healthcare or denying treatment, but rather about ensuring that patients spend their last months in good quality care, characterised by symptom management and avoidance of unnecessary and preventable risks factors and adverse effects

    30th European Congress on Obesity (ECO 2023)

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    This is the abstract book of 30th European Congress on Obesity (ECO 2023

    An Epidemiological and Pharmacokinetic-pharmacodynamic Investigation into the Impact of Carbapenem-resistant Enterobacterales

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    Background: According to the 2019 CDC Antibiotic Resistance Threats Report, more than 2.8 million antibiotic-resistant infections occur in the United States each year, leading to more than 35,000 deaths. Among the most urgent threats identified by the CDC are carbapenem-resistant Enterobacterales (CRE). Despite efforts to control the spread of these organisms, the number of estimated cases between 2012 and 2017 remained stable. In 2017, an estimated 13,100 hospitalized cases of CRE led to approximately 1,100 deaths and $130 million attributable healthcare costs. This dissertation seeks to address this issue from both a pharmacokinetic/pharmacodynamic and epidemiological perspective. Methods: We evaluated the susceptibility of 140 CRE clinical isolates against novel agents eravacycline and plazomicin using techniques standardized by the Clinical and Laboratory Standards Institute. We performed in-vitro static time-kill assays in 8 Verona Integron-encoded metallo-beta-lactamase (VIM)-producing CRE using single and combination exposures of cefepime, meropenem, piperacillin/tazobactam, amikacin, and plazomicin along with aztreonam and aztreonam/avibactam. Additionally, we performed a 10-year, inverse probability of treatment weighting adjusted retrospective cohort study comparing the risk in observing a composite outcome of all-cause mortality or discharge to hospice in patients having CRE vs. carbapenem-susceptible Enterobacterales (CSE) infections after 14 and 30 days. In this cohort, we also reported on the prevalence of CRE across the decade. Additionally, we compared the organism composition and susceptibilities of isolates cultured in both the CRE and CSE groups. Results: Plazomicin showed higher susceptibility than eravacycline against our CRE isolates. In time kill studies, plazomicin was bactericidal against 5/8 isolates as monotherapy. Meropenem/amikacin or meropenem/plazomicin were bactericidal in all experiments, except for one isolate which regrew against meropenem/plazomicin. Aztreonam/avibactam was bactericidal in all experiments tested. Neither cefepime nor piperacillin/tazobactam improved the activity of plazomicin against our isolates. Cefepime with amikacin showed inconsistent activity. In the retrospective cohort study, the overall incidence of CRE infections was 1.8%. CRE isolates exhibited higher resistance across all routinely tested antimicrobials classes compared to CSE. The CRE population appeared to be largely non-carbapenemase-producing given the high susceptibility of meropenem and the high prevalence of E. cloacae, a known AmpC-producer. Overall, the risk of composite outcome only appeared to be increased among patients with a bloodstream infection on the index date and could only be assessed when utilizing an exposure of carbapenem-non-susceptible Enterobacterales (CNSE) due to insufficient sample size. However, the results were inconclusive as they were not statistically significant. Conclusions: Novel antimicrobial agents plazomicin and aztreonam/avibactam were highly active against a collection of CRE including both Klebsiella pneumoniae carbapenemase (KPC) and VIM. Aztreonam/avibactam, meropenem/amikacin, and meropenem/plazomicin all exhibited comparably bactericidal activity. Furthermore, at an academic medical center in a non-endemic region for CRE, it appears that CRE infection may have increased the risk of experiencing the composite outcome after both 14 and 30 days, but definitive conclusions may not be drawn given the lack of statistical significance and imprecision in the estimation of the effect. The difficulties in drawing definitive conclusions from this study owing to limited sample size in the CRE or CNSE group stresses the importance of developing novel strategies and performing larger, multicenter studies when investigating highly resistant infections with low prevalence

    Generating And Validating A Global Framework Of Pharmaceutical Development Goals And Corresponding Indicators

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    INTRODUCTION: The imperative of meeting current global healthcare challenges requires advancing pharmacy practice in a global context. This research aimed to design and develop a valid and consented set of global goal-oriented pharmaceutical development frameworks and corresponding indicators to support and guide systematic practice transformation needed to meet the national and global pharmaceutical healthcare demands of changing population demographics. METHODS: Part 1 of the research project This research used a mixed-methods approach. A series of international expert focus groups were conducted to evaluate the acceptance of a set of proposed global pharmaceutical development goals (PDGs). This was followed by recruiting global pharmacy leaders who participated in a modified nominal group technique to further develop the content of the initial PDGs framework. In a subsequent study, a qualitative modified Delphi approach was employed by a panel of international experts to ensure the credibility and content validity of the framework outputs and generate consensus on a final matrix of the proposed global PDGs. Part 2 of the research project A content analysis of the relevant collated data followed by a Delphi process of an international Expert Group was performed to identify and establish initial consensus on potential indicators aligned with the published PDGs framework. Delphi method’s outcomes were used to conduct a global cross-sectional online questionnaire to assess and validate the relevancy and availability of the proposed indicators. RESULTS: Part 1 of the research project A globally validated and consented set of systematic PDGs (systematic framework) for development comprising 21 PDGs along with their descriptions and mechanisms to shape and guide global pharmacy practice transformation. Part 2 of the research project A set of correlated and validated transnational evidence-based indicators that will monitor national-level progress and measure the advancement of the 21 PDGs worldwide across workforce/education, practice, and pharmaceutical science. CONCLUSION: A systematic and globally consented set of PDGs, along with evidence-based progress indicators, was generated to monitor the sustainable advancement of pharmaceutical practice and support a needs-based roadmap for pharmacy practice transformation

    Exploring new avenues for the meta-analysis method in personality and social psychology research

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    This dissertation addresses theoretical validity and bias in meta-analytic research in personality and social psychology research. The conceptual starting point of the dissertation is research on ego depletion (Baumeister et al., 1998). In this line of research, hundreds of studies documented an experimental effect that probably does not exist, as was later revealed by extensive replication work (Hagger et al., 2010, 2016). This debacle has presumably been caused by dysfunctional structures and procedures in psychological science, such as widespread publication bias (Carter & McCullough, 2014). Unfortunately, these dysfunctionalities were (and in some cases still are) also prevalent in other areas of psychological research beside ego depletion (Ferguson & Brannick, 2012; Open Science Collaboration, 2015). Because extensive replication research is too costly to be repeated for all past work, it has been a contentious question what to do with research data that has been generated during an era of questionable research practices: should this research be abandoned or can some of it be salvaged? In four research papers, this dissertation project attempts to address these questions. In part I of the dissertation project, two papers highlight and analyze challenges when summarizing past research in social psychology and personality research. Paper 1 (Friese et al., 2017) attempted to find summary evidence for the effectiveness of self-control training, a research field related to ego depletion, but came to a sobering conclusion: The summary effect was small, likely inflated by publication bias, and could not be attributed beyond doubt to a theoretical mechanism. Paper 2 (Friese & Frankenbach, 2020) reported on a simulation study that showed how multiple sources of bias (publication bias, p-hacking) can interact with contextual factors and each other to create significant meta-analytic evidence from very small or even zero true effects. Part II of the dissertation project is an attempt to advance social-psychological and personality theory with meta-scientific work despite an unknowable risk of bias in the literature. In part II, two papers (Frankenbach et al., 2020, 2022) make use of one key idea: Re-using existing raw research data to test novel theoretical ideas in secondary (meta-)analyses. Results revealed that this idea helps towards both goals of the dissertation project, that is, advancing theory while reducing risk-of-bias. The general discussion analyses promises and limitations of such secondary data analyses in more detail and attempts to situate the idea more broadly in the psychological research toolkit by contrasting integrative versus innovative research. Further discussion covers how conceptual and technological innovations may facilitate more secondary data analyses in the future, and how such advances may pave the way for a slower, more incremental, but truly valid and cumulative psychological science.Die vorliegende Dissertation behandelt theoretischen Validität und Verzerrung (Bias) von meta-analytischer Forschung in der Persönlichkeits- und Sozialpsychologie. Der konzeptuelle Ausgangspunkt der Dissertation ist die Forschung zu „Ego Depletion“ (Baumeister et al., 1998). In dieser Forschungslinie haben hunderte von Studien einen Effekt belegt, der, wie sich später durch umfangreiche Replikationsarbeiten (Hagger et al., 2010, 2016) herausstellte, vermutlich nicht existiert. Dieses Debakel wurde mutmaßlich mitverursacht durch dysfunktionale Strukturen und Prozesse in der psychologischen Forschung, insbesondere Publikationsbias („publication bias“). Unglücklicherweise lagen (und liegen) diese Dysfunktionalitäten neben Ego Depletion auch in anderen psychologischen Forschungsbereichen vor (Ferguson & Brannick, 2012; Open Science Collaboration, 2015). Da aus Kostengründen nicht alle Forschungsarbeiten der Vergangenheit repliziert werden können, ergibt sich eine kritische Frage: Wie soll mit psychologischer Forschung umgegangen werden, die unter mutmaßlich verzerrenden Bedingungen generiert wurde? Sollte diese Forschung ad acta gelegt werden oder können Teile davon weiterverwendet werden? Das vorliegende Dissertationsprojekt versucht im Rahmen von vier Forschungsbeiträgen sich diesen Fragen anzunähern. Im ersten Teil der Dissertation beleuchten und analysieren zwei Forschungsbeiträge Probleme und Herausforderungen, die sich bei der Zusammenfassung von bestehender Forschung der Sozial- und Persönlichkeitspsychologie ergeben. Der erste Beitrag (Friese et al., 2017) versucht in einer Meta-Analyse Evidenz für die Wirksamkeit von Selbstkontrolltrainings zu finden, aber kommt zu einem ernüchternden Ergebnis: Die Gesamteffekte sind klein, mutmaßlich durch Publikationsbias fälschlich überhöht und können überdies nicht zweifelsfrei einem theoretischen Kausalmechanismus zugeordnet werden. Der zweite Beitrag (Friese & Frankenbach, 2020) umfasst eine Simulationsstudie, die aufzeigt, wie verschiedene Formen von Bias (Publikationsbias und sog. „p-hacking“) miteinander und mit Kontextfaktoren interagieren können, wodurch signifikante, meta-analytische Effekte aus sehr kleinen wahren Effekten oder sogar Nulleffekten entstehen können. Der zweite Teil der Dissertation versucht, trotz eines unbestimmbaren Bias-Risikos, Fortschritte in der sozial- und persönlichkeitspsychologischen Theorie zu erzielen. Zu diesem Zweck wird in zwei Forschungsbeiträgen (Frankenbach et al., 2020, 2022) auf eine Schlüssel-Idee zurückgegriffen: Die Testung von neuen theoretischen Hypothesen unter Wiederverwendung von existierenden Forschungsdaten in Sekundärdatenanalysen. Die Ergebnisse zeigen, dass dieser Ansatz tatsächlich dazu beitragen kann, theoretische Fortschritte mit vermindertem Verzerrungsrisiko zu machen. Die anschließende, übergreifende Diskussion behandelt Möglichkeiten und Limitationen solcher Sekundärdatenanalysen und versucht, den Ansatz in einer Gegenüberstellung von integrativer und innovativer Forschung übergreifender in die psychologische Forschungsmethodik einzuordnen. Im Weiteren wird diskutiert, wie konzeptuelle und technologische Entwicklungen in der Zukunft Sekundärdatenanalysen erleichtern könnten und wie solche Fortschritte den Weg ebnen könnten für eine langsamere, inkrementelle, aber wahrhaft valide und kumulative psychologische Wissenschaft.German Research Foundation (DFG): "Die Rolle mentaler Anstrengung bei Ego Depletion

    Examining the Relationships Between Distance Education Students’ Self-Efficacy and Their Achievement

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    This study aimed to examine the relationships between students’ self-efficacy (SSE) and students’ achievement (SA) in distance education. The instruments were administered to 100 undergraduate students in a distance university who work as migrant workers in Taiwan to gather data, while their SA scores were obtained from the university. The semi-structured interviews for 8 participants consisted of questions that showed the specific conditions of SSE and SA. The findings of this study were reported as follows: There was a significantly positive correlation between targeted SSE (overall scales and general self-efficacy) and SA. Targeted students' self-efficacy effectively predicted their achievement; besides, general self- efficacy had the most significant influence. In the qualitative findings, four themes were extracted for those students with lower self-efficacy but higher achievement—physical and emotional condition, teaching and learning strategy, positive social interaction, and intrinsic motivation. Moreover, three themes were extracted for those students with moderate or higher self-efficacy but lower achievement—more time for leisure (not hard-working), less social interaction, and external excuses. Providing effective learning environments, social interactions, and teaching and learning strategies are suggested in distance education

    Drug policies in Western Europe

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