Self-perceived relations between artistic creativity and mental illness:A study into lived experiences

Aim: To explore the self-perceived relationships between experiences of creativity and mental illness and to understand the meanings behind these relationships.Background: The idea that mental illness and artistic creativity are somehow related dates back to ancient times. There is some evidence for an actual correlation, but many questions remain unanswered on the nature and direction of the relationship. Qualitative contributions to the debate are scarce, and mainly focus on the potential benefits of participation in the arts for people with mental illness.Design: An explorative, interpretive study.Methods: Twenty-four professional and semi-professional artists with self-reported experience with mental illness, were recruited purposively. Unstructured in-depth interviews were conducted and transcripts were subjected to interpretive analysis, guided by a hermeneutic phenomenological frame.Results: Participants experience a range of interactions between artistic creativity and mental illness. Three constitutive patterns describe what these interactions look like: “flow as a powerful force”; “ambiguous self-manifestation”; and “narrating experiences of suffering.”Conclusion: The findings show that both the concept of creativity and the concept of mental illness, as well as their interrelationships, are layered and complex phenomena that can take on different meanings in people’s lives. The findings provide starting points for further research that goes beyond the polarized academic debate. Understanding the experiences of artists with mental illness can help shape the role of art in public mental health and mental health care

Exploration of alternative models to calculate wheather effects on nitrate concentration : Comparison of the models ONZAT, HYDRUS-1D and SWAP

Het Landelijk Meetnet effecten Mestbeleid (LMM) meet sinds 1992 de nitraatconcentraties in het bovenste grondwater om de effecten van overheidsbeleid op de concentraties in beeld te brengen. De hoogte van de gemeten nitraatconcentraties is afhankelijk van het weer, vooral van de hoeveelheid neerslag in de voorafgaande jaren. Na een aantal regenrijke jaren is de nitraatconcentratie door verdunning bijvoorbeeld meestal lager dan normaal. Het RIVM verwerkt deze weerseffecten in de meetresultaten, zodat de effecten van het beleid nauwkeuriger zichtbaar zijn. Dit wordt gedaan met een rekenmodel. SWAP-model geschikter voor indexcontratie Tot op heden gebruikt het RIVM voor de berekening van de indexconcentraties het zelf ontwikkelde model ONZAT, een model dat berekent in welke mate stoffen door de bodem naar en in het bovenste grondwater worden getransporteerd. ONZAT wordt echter niet meer verder ontwikkeld of onderhouden. Hierdoor ontstond de behoefte bij het RIVM om over te stappen op een algemener gebruikt model. Na vergelijking van enkele modellen komt het zogeheten SWAP-model (Soil, Water, Atmosphere and Plant) als het meest geschikt naar voren als vervanging voor ONZAT. De migratie van het ONZAT-model naar SWAP blijkt geen significant effect te hebben op de weerscorrectie van de nitraatmetingen, ondanks de verschillen tussen de modellen.The Minerals Policy Monitoring Programme (LMM) has measured the nitrate concentrations in the upper groundwater since 1992 in order to show the effects of the national minerals policies on concentrations. However, these nitrate concentrations are also subject to weather influences, especially the precipitation excess in previous years. After a couple of years with high precipitation excess the measured nitrate concentration usually is lower than normal due to dilution. RIVM accounts for these weather influences on measurement so that policy effects on trends in water quality become more distinct. This is done by using a hydrological process model. SWAP model more suitable for index concentration RIVM still uses the ONZAT model, developed by RIVM, for the calculations of the index concentration. However, ONZAT, a model to calculate transport of substances through the soil towards and through groundwater, is no longer updated or maintained. Therefore, RIVM considered it desirable to select and use another, more generally applied process model for the computation of index concentrations. The model comparisons showed that SWAP (Soil, Water, Atmosphere and Plant) was the most suitable successor for ONZAT to calculate index concentrations. The migration of the ONZAT model to SWAP does not have a significant effect on the weather corrections of the nitrate measurements, notwithstanding the differences between these models.Ministerie van I&

New methodological perspectives on the valuation of ecosystem services: toward a dynamic-integrated valuation approach.

The main objective of this paper is to present what is considered as methodological perspectives in the field of valuation of ecosystem services. The contributions presented here are based on the general assumption that if, on the one hand, we can recognize the inadequacy of the isolated use of the valuation methods, on the other we assume that efforts to refine and expand the scope of ecosystem services valuation should consider the progress already made, not ignoring altogether methods already used. Based on the stance that there should be a joining of efforts to improve the accuracy of ecosystem services valuation and starting from the assumption that the complexity and uncertainty surrounding ecosystem services require a trans-disciplinary analysis, the contribution beckons an approach referred to here as dynamic-integrated. It is dynamic because it considers the trajectory of ecosystem services over time in terms of its main drivers of change (land use dynamic, for example), and integrated in that it takes into account not just the economic values but other dimensions of ecosystem services values

Mapping nitrate leaching to upper groundwater in the sandy regions of The Netherlands, using conceptual knowledge

The European Community asks its Member States to provide a comprehensive and coherent overview of their groundwater chemical status. It is stated that simple conceptual models are necessary to allow assessments of the risks of failing to meet quality objectives. In The Netherlands two monitoring networks (one for agriculture and one for nature) are operational, providing results which can be used for an overview. Two regression models, based upon simple conceptual models, link measured nitrate concentrations to data from remote sensing images of land use, national forest inventory, national cattle inventory, fertiliser use statistics, atmospheric N deposition, soil maps and weather monitoring. The models are used to draw a nitrate leaching map and to estimate the size of the area exceeding the EU limit value in the early 1990s. The 95% confidence interval for the fraction nature and agricultural areas where the EU limit value for nitrate (50 mg/l) was exceeded amounted to 0.77–0.85 while the lower 97.5% confidence limit for the fraction agricultural area where the EU limit value was exceeded amounted to 0.94. Although the two conceptual models can be regarded as simple, the use of the models to give an overview was experienced as complex

The placebo response rate in pharmacological trials in patients with irritable bowel syndrome: a systematic review and meta-analysis

Findings Between June 16, 2014, and July 28, 2017, 122 patients were eligible for screening and a total of 95 patients were randomly assigned to the infliximab-continued group (n=48) or the infliximab-discontinued group (n=47). 92 patients (n=46 for both groups) were included in the full analysis set. 37 (80.4% [95% CI 66.1-90.6]) of 46 patients in the infliximab-continued group and 25 (54.3% [39.0-69.1]) of 46 patients in the infliximab-discontinued group were in remission at week 48. The between-group difference was 26.1% (95% CI 7.7-44.5; p=0.0076) before adjustment and 27.3% (95% CI 8.0-44.1; p=0.0059) after adjustment for stratification factors. Eight (17%) of 48 patients in the infliximab-continued group and six (13%) of 47 in the infliximab-discontinued group developed adverse events (between-group difference 3.9% [95% CI -10.3 to 18.1]; p=0.59). In the infliximab-continued group, one patient had an infusion reaction and two patients had psoriatic skin lesions. Eight (66.7%, 95% CI 34.9-90.1) of the 12 patients in the infliximab-discontinuation group who were re-treated with infliximab after relapsing were in remission within 8 weeks of re-treatment; none had infusion reactions.Background Anti-tumour necrosis factor (TNF) agents are the mainstay of long-term treatment for refractory ulcerative colitis. However, long-term use of anti-TNF therapy might lead to an increased risk of malignancy or infection. To date, no randomised controlled trial has evaluated whether anti-TNF agents can be safely discontinued in patients with ulcerative colitis in remission. We therefore aimed to compare outcomes in these patients who continued infliximab with those who discontinued infliximab.Methods We did a multicentre, open-label randomised controlled trial at 24 specialist centres in Japan. We enrolled patients with ulcerative colitis who were in remission, had been treated with intravenous infliximab (5 mg/kg) every 8 weeks, and had started infliximab at least 14 weeks before study enrolment. No restrictions regarding age and comorbidities were used to exclude participation. Patients who were confirmed to be in remission for more than 6 months, to be corticosteroid-free, and to have a Mayo Endoscopic Subscore (MES) of 0 or 1 were centrally randomised. An independent organisation randomly assigned patients (1:1) into either the infliximab-continued group or infliximab-discontinued group, using a computer-generated stratified randomisation procedure. The stratified factors were the use of immunomodulators (yes or no) and MES (0 or 1). Neither patients nor health-care providers were masked to the randomisation. The primary endpoint was the remission rate at week 48 in the full analysis set, which was based on the intention-to-treat principle and excluded participants with no efficacy data after randomisation. This study was registered with the University Hospital Medical Information Network Center Trials registry, UMIN000012092. Findings Between June 16, 2014, and July 28, 2017, 122 patients were eligible for screening and a total of 95 patients were randomly assigned to the infliximab-continued group (n=48) or the infliximab-discontinued group (n=47). 92 patients (n=46 for both groups) were included in the full analysis set. 37 (80.4% [95% CI 66.1-90.6]) of 46 patients in the infliximab-continued group and 25 (54.3% [39.0-69.1]) of 46 patients in the infliximab-discontinued group were in remission at week 48. The between-group difference was 26.1% (95% CI 7.7-44.5; p=0.0076) before adjustment and 27.3% (95% CI 8.0-44.1; p=0.0059) after adjustment for stratification factors. Eight (17%) of 48 patients in the infliximab-continued group and six (13%) of 47 in the infliximab-discontinued group developed adverse events (between-group difference 3.9% [95% CI & minus;10.3 to 18.1]; p=0.59). In the infliximab-continued group, one patient had an infusion reaction and two patients had psoriatic skin lesions. Eight (66.7%, 95% CI 34.9-90.1) of the 12 patients in the infliximab-discontinuation group who were re-treated with infliximab after relapsing were in remission within 8 weeks of re-treatment; none had infusion reactions.Interpretation Maintenance of remission was significantly more common in patients who continued infliximab than in those who discontinued. Discontinuing infliximab should therefore be discussed with caution, taking both risk of relapse and efficacy of re-treatment into account.Funding Mitsubishi Tanabe Pharma Corporation and the Intractable Disease Project of the Ministry of Health, Labour and Welfare of Japan.Copyright (c) 2021 Elsevier Ltd. All rights reserved

Financial outcomes of adolescent and young adult cancer survivors:A longitudinal population-based registry study

Background: The patterns and determinants of long-term income among adolescent and young adult (AYA) cancer survivors, and the differences compared with peers, have not yet been fully explored. This study investigated the long-term effects of cancer on the income of AYA cancer survivors. Methods: The Netherlands Cancer Registry identified all AYA cancer patients (aged 18-39 years) diagnosed in 2013 and alive 5 years postdiagnosis. Clinical data of the selected AYA patients were linked to individual, administrative real-world labor market data of Statistics Netherlands. The control group consisted of a random sample of individuals of the same age, sex, and migration background without cancer. Data on 2434 AYA cancer patients and 9736 controls were collected annually from 2011 until 2019. Changes in income level were measured and compared with the control group using difference-in-difference regression models. Results: AYA cancer survivors experience, on average, an 8.5% decrease in annual earnings, relative to the control population. The effects are statistically significant and permanent (P < .01). Younger AYAs (those aged 18-25 years 15.5% income reduction), married cancer survivors (12.3%), females (11.6%), those diagnosed with stage IV disease (38.1%), and central nervous system (15.7%) cancer patients experienced the largest decline in income, on average, relative to controls, all else constant. Conclusion: Although dependent on the sociodemographic and clinical characteristics, a cancer diagnosis at AYA age has significant implications on the income of cancer patients. Awareness of vulnerable groups and the development of policies to mitigate the financial impact of cancer are critical

From Business Model to Business Modelling: Modularity and Manipulation

The concept of modularity has gained considerable traction in technology studies as a way to conceive, describe and innovate complex systems, such as product design or organizational structures. In the recent literature, technological modularity has often been intertwined with business model innovation, and scholarship has started investigating how modularity in technology affects changes in business models, both at the cognitive and activity system levels. Yet we still lack a theoretical definition of what modularity is in the business model domain. Business model innovation also encompasses different possibilities of modeling businesses, which are not clearly understood nor classified. We ask when, how and if modularity theory can be extended to business models in order to enable effective and efficient modeling. We distinguish theoretically between modularity for technology and for business models, and investigate the key processes of modularization and manipulation. We introduce the basic operations of business modeling via modular operators adapted from the technological modularity domain, using iconic examples to develop an analogical reasoning between modularity in technology and in business models. Finally, we discuss opportunities for using modularity theory to foster the understanding of business models and modeling, and develop a challenging research agenda for future investigations

ifo Konjunkturprognose 2017/2018: Deutsche Wirtschaft stark und stabil

Der Aufschwung, in dem sich die deutsche Wirtschaft seit nunmehr 2013 befindet, gewinnt an Stärke und Breite. Das ifo Institut rechnet mit einem Zuwachs des realen Bruttoinlandsprodukts von 1,8% im laufenden und 2,0% im kommenden Jahr. Wie schon in den vergangenen Jahren wird die konjunkturelle Entwicklung von der weiter lebhaften Konsumnachfrage der privaten Haushalte und der regen Bautätigkeit bestimmt. Einen zunehmenden Beitrag zum Aufschwung werden die Exporte leisten