challenges and institutional arrangements

Adaptation to climate change has become an integral part of climate change policies across the world. Based on the limited literature on the governance of climate change adaptation, the paper first highlights four key challenges governments face in this context, i.e. (i) how to better integrate adaptation policies horizontally across policy sectors and (ii) vertically across levels of government, (iii) how to integrate knowledge in adaptation policy decisions, and (iv) how to involve stakeholders in adaptation decisions. The paper then shows how selected OECD countries address these challenges when developing and implementing adaptation policies and instruments. We identify the most important governance mechanisms on the national level which constitute a distinct governance structure in each surveyed country, and highlight their objectives and specific foci on one or more governance challenges. The paper analyses dominant modes of emerging interaction patterns in the respective governance arrangements.Draft pape

Theory of change for the delivery of talking therapies by lay workers to survivors of humanitarian crises in low-income and middle-income countries: protocol of a systematic review.

INTRODUCTION: There is a severe shortage of specialist mental healthcare providers in low-income and middle-income countries (LMICs) affected by humanitarian crises. In these settings, talking therapies may be delivered by non-specialists, including lay workers with no tertiary education or formal certification in mental health. This systematic review will synthesise the literature on the implementation and effectiveness of talking therapies delivered by lay workers in LMICs affected by humanitarian crises, in order to develop a Theory of Change (ToC). METHODS AND ANALYSIS: Qualitative, quantitative and mixed-methods studies assessing the implementation or effectiveness of lay-delivered talking therapies for common mental disorders provided to adult survivors of humanitarian crises in LMICs will be eligible for inclusion. Studies set in high-income countries will be excluded. No restrictions will be applied to language or year of publication. Unpublished studies will be excluded. Seven electronic databases will be searched: MEDLINE, Embase, PsycINFO, PsycEXTRA, Global Health, Cochrane Library and ClinicalTrials.gov. Contents pages of three peer-reviewed journals will be hand-searched. Sources of grey literature will include resource directories of two online mental health networks (MHPSS.net and MHInnovation.net) and expert consultation. Forward and backward citation searches of included studies will be performed. Two reviewers will independently screen studies for inclusion, extract data and assess study quality. A narrative synthesis will be conducted, following established guidelines. A ToC map will be amended iteratively to take into account the review results and guide the synthesis. ETHICS AND DISSEMINATION: Findings will be presented in a manuscript for publication in a peer-reviewed journal and disseminated through a coordinated communications strategy targeting knowledge generators, enablers and users. PROSPERO REGISTRATION NUMBER: CRD42017058287

Reproducibility of a new signal processing technique to assess joint sway during standing

Postural control strategies can be investigated by kinematic analysis of joint movements. However, current research is focussing mainly on the analysis of centre of pressure excursion and lacks consensus on how to assess joint movement during postural control tasks. This study introduces a new signal processing technique to comprehensively quantify joint sway during standing and evaluates its reproducibility. Fifteen patients with non-specific low back pain and ten asymptomatic participants performed three repetitions of a 60-second standing task on foam surface. This procedure was repeated on a second day. Lumbar spine movement was recorded using an inertial measurement system. The signal was temporally divided into six sections. Two outcome variables (mean absolute sway and sways per second) were calculated for each section. The reproducibility of single and averaged measurements was quantified with linear mixed-effects models and the generalizability theory. A single measurement of ten seconds duration revealed reliability coefficients of 0.75 for mean absolute sway and 0.76 for sways per second. Averaging a measurement of 40 seconds duration on two different days revealed reliability coefficients higher than 0.90 for both outcome variables. The outcome variables’ reliability compares favourably to previously published results using different signal processing techniques or centre of pressure excursion. The introduced signal processing technique with two outcome variables to quantify joint sway during standing proved to be a highly reliable method. Since different populations, tasks or measurement tools could influence reproducibility, further investigation in other settings is still necessary. Nevertheless, the presented method has been shown to be highly promising

Effects of Activin and TGFβ on p21 in Colon Cancer

Activin and TGFβ share SMAD signaling and colon cancers can inactivate either pathway alone or simultaneously. The differential effects of activin and TGFβ signaling in colon cancer have not been previously dissected. A key downstream target of TGFβ signaling is the cdk2 inhibitor p21 (p21cip1/waf1). Here, we evaluate activin-specific effects on p21 regulation and resulting functions. We find that TGFβ is a more potent inducer of growth suppression, while activin is a more potent inducer of apoptosis. Further, growth suppression and apoptosis by both ligands are dependent on SMAD4. However, activin downregulates p21 protein in a SMAD4-independent fashion in conjunction with increased ubiquitination and proteasomal degradation to enhance migration, while TGFβ upregulates p21 in a SMAD4-dependent fashion to affect growth arrest. Activin-induced growth suppression and cell death are dependent on p21, while activin-induced migration is counteracted by p21. Further, primary colon cancers show differential p21 expression consistent with their ACVR2/TGFBR2 receptor status. In summary, we report p21 as a differentially affected activin/TGFβ target and mediator of ligand-specific functions in colon cancer, which may be exploited for future risk stratification and therapeutic intervention

Evaluation of a novel quantitative canine species-specific point-of-care assay for C-reactive protein

Background: Species-specific point-of-care tests (POCT) permit a rapid analysis of canine C-reactive protein (CRP), enabling veterinarians to include CRP in clinical decisions. Aim of the study was to evaluate a novel POCT for canine CRP (Point Stripâ TM Canine CRP Assay) run on a small in-house-analyzer (Point Reader TM V) using lithium heparin plasma and to compare assay performance to an already established canine CRP assay (Gentian Canine CRP Immunoassay) run on two different bench top analyzers serving as reference methods (ABX Pentra 400, AU 5800). Linearity was assessed by stepwise dilution of plasma samples with high CRP concentrations. Limit of quantification (LoQ) was determined by repeated measurements of samples with low CRP concentrations. Coefficient of variation (CV) at low (10-50 mg/l), moderate (50-100 mg/l), and high (100-200 mg/l) CRP concentrations was investigated as well as possible interferences. Method comparison study was performed using 45 samples of healthy and diseased dogs. Quality criteria were fulfilled if the total observed error (TEobs=2CV%+bias%) was below the minimal total allowable error of 44.4% (TE min). Additionally, a reference range (n =60 healthy dogs) was established. Results: Linearity was present at CRP concentrations of 10-132 mg/l (&#8793; 361 mg/l CRP with reference method) with a LoQ set at 10 mg/l. At moderate to high CRP concentrations, intra- and inter-assay CVs were< =8% and <=11% respectively, while CVs<=22% and <=28% were present at low concentrations. No interferences were observed at concentrations of 4 g/l hemoglobin, 800 mg/l bilirubin and 8 g/l triglycerides. Method comparison study demonstrated an excellent correlation with both reference methods (r =0.98 for ABX Pentra 400; 0.99 for AU 5800), though revealing a proportional bias of 19.7% (ABX Pentra 400) and 10.7% (AU 5800) respectively. TEobs was 26.7-31.9% and 16.7-21.9% and thus < TEmin. Healthy dogs presented with CRP values <=11.9 mg/l. Conclusions The POCT precisely detects canine CRP at clinically relevant moderate and high CRP concentrations. The assay correlates well with both reference methods. Due to the bias, however, follow-up examinations should be performed with the same assay and analyzer

Altered dietary salt intake for people with chronic kidney disease (Review)

Backgroun

Eating As Treatment (EAT): A Stepped-Wedge, Randomized Controlled Trial of a Health Behavior Change Intervention Provided by Dietitians to Improve Nutrition in Patients With Head and Neck Cancer Undergoing Radiation Therapy (TROG 12.03)

Purpose: Malnutrition in head and neck cancer (HNC) treatment is common and associated with poorer morbidity and mortality outcomes. This trial aimed to improve nutritional status during radiation therapy (RT) using a novel method of training dietitians to deliver psychological techniques to improve nutritional behaviors in patients with HNC. Methods and Materials: This trial used a stepped-wedge, randomized controlled design to assess the efficacy of the Eating As Treatment (EAT) program. Based on motivational interviewing and cognitive behavioral therapy, EAT was designed to be delivered by oncology dietitians and integrated into their clinical practice. During control steps, dietitians provided treatment as usual, before being trained in EAT and moving into the intervention phase. The training was principles based and sought to improve behavior-change skills rather than provide specific scripts. Patients recruited to the trial (151 controls, 156 intervention) were assessed at 4 time points (the first and the final weeks of RT, and 4 and 12 weeks afterward). The primary outcome was nutritional status at the end of RT as measured by the Patient-Generated Subjective Global Assessment. Results: Patients who received the EAT intervention had significantly better scores on the primary outcome of nutritional status at the critical end-of-treatment time point (β = −1.53 [−2.93 to −.13], P =.03). Intervention patients were also significantly more likely than control patients to be assessed as well-nourished at each time point, lose a smaller percentage of weight, have fewer treatment interruptions, present lower depression scores, and report a higher quality of life. Although results were not statistically significant, patients who received the intervention had fewer and shorter unplanned hospital admissions. Conclusions: This trial is the first of its kind to demonstrate the effectiveness of a psychological intervention to improve nutrition in patients with HNC who are receiving RT. The intervention provides a means to ameliorate malnutrition and the important related outcomes and consequently should be incorporated into standard care for patients receiving RT for HNC