A Strategy for the Commons: Business-driven Networks for Collective Action and Policy Dialogue. The Example of Global Compact Local Networks

The current challenges involved with ensuring global sustainability are daunting. Climate change is increasing the incidence of severe weather events, natural resources are undergoing rapid depletion, labor conditions in global supply chains are often inhumane and degrading, and corruption around the globe is undermining competition and destroying wealth. These and other global challenges pose serious problems not only to mankind in general, but also to the sustainability of companies. Indeed, companies rely on enabling environments, local and global alike, for long-term success. Companies depend on a reliable legal framework conducive to investment and competition, a healthy and viable natural environment, and a secure social environment that facilitates the wellbeing of its inhabitants. However, given the overexploitation of shared resources, also known as the “tragedy of the commons,” companies often find it difficult to address global sustainability challenges and invest in enabling environments. All sustainability challenges face this tragedy: Although each societal actor ought to have an interest in creating or ensuring the viability of these common goods, the incentive to “free ride” on the efforts of others and let them bear the costs is exceedingly high. As a result, short-term profit maximization often damages the longterm growth prospects of companies. Since governments lack the capacity to address the complexity and global scope of sustainability challenges alone, a “strategy for the commons” is needed that allows companies, governments and other actors to overcome the free rider dilemma and invest in sustainable development

Invariant Causal Prediction for Nonlinear Models

An important problem in many domains is to predict how a system will respond to interventions. This task is inherently linked to estimating the system's underlying causal structure. To this end, Invariant Causal Prediction (ICP) (Peters et al., 2016) has been proposed which learns a causal model exploiting the invariance of causal relations using data from different environments. When considering linear models, the implementation of ICP is relatively straightforward. However, the nonlinear case is more challenging due to the difficulty of performing nonparametric tests for conditional independence. In this work, we present and evaluate an array of methods for nonlinear and nonparametric versions of ICP for learning the causal parents of given target variables. We find that an approach which first fits a nonlinear model with data pooled over all environments and then tests for differences between the residual distributions across environments is quite robust across a large variety of simulation settings. We call this procedure "invariant residual distribution test". In general, we observe that the performance of all approaches is critically dependent on the true (unknown) causal structure and it becomes challenging to achieve high power if the parental set includes more than two variables. As a real-world example, we consider fertility rate modelling which is central to world population projections. We explore predicting the effect of hypothetical interventions using the accepted models from nonlinear ICP. The results reaffirm the previously observed central causal role of child mortality rates

backShift: Learning causal cyclic graphs from unknown shift interventions

We propose a simple method to learn linear causal cyclic models in the presence of latent variables. The method relies on equilibrium data of the model recorded under a specific kind of interventions ("shift interventions"). The location and strength of these interventions do not have to be known and can be estimated from the data. Our method, called backShift, only uses second moments of the data and performs simple joint matrix diagonalization, applied to differences between covariance matrices. We give a sufficient and necessary condition for identifiability of the system, which is fulfilled almost surely under some quite general assumptions if and only if there are at least three distinct experimental settings, one of which can be pure observational data. We demonstrate the performance on some simulated data and applications in flow cytometry and financial time series. The code is made available as R-package backShift

Effects of Procedural Differences on the Performance of Mice on Impulsive Choice Tests

Due to its relevance to human diseases and behavioral disorders, delay discounting has become a topic of interest to researchers across a wide range of scientific disciplines. The within-sessions procedure is the most widely used procedure to assess delay discounting in nonhumans (Madden & Bickel, 2015). To date, most within-sessions procedures have been designed specifically for use with rats. However, mice are the organism of choice in biomedical and genetic research. Interdisciplinary research requires the standardization of assessments for mice. Only a few published studies have utilized the within-sessions procedure with mice, these have yielded disparate results. The present experiment investigated the impact of delay progression, number of trainings and delay length on resultant performance of Balb-c mice on the within-sessions impulsive choice test. The findings suggest that each of these factors influence performance. Mice show greater preference for the large reward and greater sensitivity to delay lengths when delays are gradually increased over time as compared to when they are not. Mice show a greater sensitivity to delay length when delays are kept shorter (maximum delay of 8 s) verses longer (maximum delay of 12 s). Finally, the number of trainings that animals receive impact resultant performance. The present data support the notion that the within-sessions procedure must be specifically calibrated for use with mice and the findings herein can help to guide further development in this important area of research

The Importance of Implementing Oral Health Care Education in the Lehigh Valley

The Importance of Implementing Oral Health Care Education in the Lehigh Valley Kayla Birde*1 and Christina Peters*1 Patricia Atno CDA, Charles Incalcaterra DMD 1 Lehigh Valley Health Network Dental Clinic- 17th Street * Authors both contributed equally Abstract A severe need for dental hygiene education in low-income areas is apparent. The dental clinics associated with Lehigh Valley Health Network are representative of low-income areas throughout the nation. Many of the conditions treated at the clinic are a result of poor oral hygiene and are clearly preventable. The purpose of this quality improvement project was to propose an effective patient education system to teach the importance of essential oral care and explain techniques necessary to maintain good oral health. Observation was done at the 17th Street Dental Clinic; and an informational pamphlet and video tutorial are proposed to provide better patient education. The improved pamphlet and video are intended to create an effective means to inform patients about the risks associated with poor oral health; and, help patients access the information needed to establish a proper daily oral hygiene routine. It is expected that after the implementation of the subject proposals there will be a decrease in the number of patients with preventable dental problems, such as periodontal disease and caries. For the future it is recommended that alongside an informative pamphlet, a multi-lingual video tutorial on routine oral hygiene be presented systematically to patients, for example in waiting areas or during treatment. Introduction Education is arguably one of the most important, and effective aspects of health and physical wellness. Not only does being educated help a person understand their body, it also provides the specific information necessary to make better life choices. In dental medicine it appears that, the need for patient education is pressing. In the Lehigh Valley Health Network, two dental clinics serve as the main resources for dental care to low-income residents. The majority of the patients are uninsured or financially unstable; and that patient base is expanding every year creating increasing pressure on an already burdened program. Poor oral hygiene is an epidemic throughout the world including the United States. In the United States the Center for Disease Control (2012) reports that, one out of every two American adults over the age of 30 has periodontal disease. Periodontal Disease is a bacterial infection of the soft tissue supporting the teeth (Eke, Dye, Wei, Thornton-Evans, & Genco, 2012). A recent study done by the CDC had astounding results. In 2009 and 2010 it was estimated that 47.2% or 63.8 million of American adults suffer from mild, moderate, or severe cases of periodontitis (Eke et. al, 2012). People suffering from periodontitis are 40% more likely to have chronic disease (Barker, 2012). The reason that the bacteria build up on the teeth creates an area that is likely to become re-infected. The immune response will attack the infection and cause chronic gum inflammation (Barker, 2012). Chronic inflammation of the mouth will ultimately weaken the body’s ability to fight off infection and lead to other conditions, for example, diabetes. Dental caries is another common disease in patients with poor oral hygiene. Caries, or a cavity, is characterized by decay in the tooth enamel, caused by bacteria. Although this is a manageable condition without a proper oral hygiene compliance program the caries will continue to occur (Hygiene-related diseases, 2014). Many seemingly unrelated health conditions may result from poor oral hygiene, which may have profound negative affects on the overall health of our population. According to a database regarding “Adult Health” done by the Mayo Clinic (2013), chronic diseases linked to poor oral health include: endocarditis, cardiovascular disease, premature birth and pregnancy issues, diabetes, HIV/AIDS, osteoporosis, and Alzheimer’s diseases. All of these chronic diseases can arise from or be aggravated by poor oral hygiene. Oral disease is a neglected epidemic because little has been done to create a sense of urgency about getting preventative care to those having the greatest risk. Therefore, it is critical that the population is educated about the consequences of poor oral hygiene and what those individuals can do about it. Awareness of the information and making dental care a more prominent part of social consciousness will improve overall health significantly (Allukian, 2008). The figure below is data from a survey done in 2008 by the Center for Disease Control (Bloom, Simile, Adams, & Cohen, 2012). The graph shows seven different categories with the percentage of adults between the ages of 18-64 years with mouth or tooth problems that did not seek dental care in the preceding six months. The categories are divided up into the reasons for not seeking the care. Out of the categories only 3 are related to the patients not having adequate resources, those 3 are; “could not afford/no insurance, waiting for an appointment, and not having transportation”. The other 4 categories representing 57% of the patients are related to the patient not knowing about oral hygiene, those categories include “didn’t think it was a problem, the problem went away, fear, and those who didn’t think a dentist could fix it are all not properly educated in regards to dental medicine”. If they were better educated about the risk factors and importance of maintaining proper oral hygiene then it is believed there will be a decrease in the percentage of people who do not go to the dental office when they have an issue. Figure 1. Chart of the data collected from the CDC of adults aged 18-64 within a 6-month period with dental related problem who did not seek professional help or advice This data suggests that an important component of any education program should also include information about resources for those who cannot afford care or have the means to get to the dentist. The information provided in the pamphlet should include the options for assistance with paying for dental care, as well as other types of resources available to them through the hospital to ensure better health. Finding a unique way to reach out to this specific population in the Lehigh Valley Health Network about the significance of oral hygiene and ways to improve their oral health will reduce the number of patients with urgent and severe dental problems, as well as reduce their chronic diseases. This would reduce the number of patients coming into the clinic with a dental problem and therefore benefit the overall network. Because there are so many patients that require care, it is important that dental issues that can be prevented are prevented. A first step to prevention is education about good daily practices. It may be difficult to reach out to patients outside our comprehensive care program, in the Lehigh Valley Health Network, due to a lack of access to technology or a means of communication; however, it may be possible to educate current and new patients. The goal of this effort would be to see a reduction in the number and severity of cases and an overall improvement in patient oral health. Methods Our observation of clinical practice at the 17th Street clinic in Allentown, PA provided better understanding of patient population, level of education, and nature of their dental problems. While the clinic has a pamphlet for oral hygiene education, its’ content and distribution could be improved. The current program pamphlet needs to be revised and adapted for the current patient pool, according to their respective reading skills and language. During observation, it was noted that a large population of the Lehigh Valley are not native English speakers and are unable to read; therefore it is imperative that this is taken into account for the new pamphlet. When improving the content and information it must be informative and representative of proper oral hygiene in the simplest way possible. Ideally the improved pamphlet will also include pictorials for visual understanding. The pamphlet will need to include information regarding proper daily routine, possible consequences of not following a routine, and understanding overall oral health. In addition to improving the written information, distribution of the pamphlet is equally important. In order for the program to be successful it needs to reach as many patients as possible and, preferably be reviewed with the patient by a trained professional. Creating a multi-lingual video tutorial to supplement the proposed pamphlet would also help get the information across to patients more effectively. The information needs to be understood by as many people in the community as possible. To insure the information is reaching the patients it would be beneficial to have the video playing in the waiting areas, as well as the treatment rooms encouraging questions. The video will be beneficial for patients whose respective reading skills and language are not as strong. Alongside the pamphlet and video, the ultimate step to implement the program and follow-up with patients. Expected Results According to a study done in the Journal of Clinical Periodontology, patients who undergo a specific preventative program were seen to have reduced gingivitis and a reduced progression of periodontitis and caries, while patients who just underwent dental care had no change in symptoms (Axellson, 1981). This shows that some form of education is crucial in making the right steps towards proper oral health. After the new program is executed, we expect that patients will be more educated about the topic and therefore aware of the importance, ultimately resulting in a reduced number of patients who will need follow-up treatment. Another study done by the International Dental Journal on the Problems and Proposals for recording gingivitis and plaque states that a system that allows patients to physically see the healthiness of their mouth would increase patient compliance and prevention for the future. This proposal states that, for oral hygiene in particular, recording the frequency of occurrences of dental surfaces that are covered in plaque, as well as the occurrence of inflamed or bleeding gums would help patients become more aware. By using these parameters, patients would be able to visibly see and understand what should and should not be present in their mouths. (Ainamo, J.). Using the results of this study, it is assumed that after the proposed education plan were to be implemented in the Lehigh Valley; patients would become more aware of their oral health. Hopefully, through more education, patients will see the need to continue and maintain proper dental health. Conclusion In order for there to be significant improvement the plan needs to be implemented and reviewed with the entire staff in the dental clinic. To assess the new proposed programs impact on the clinic patients it is necessary to collect data and analyze it to see statistical change. The data will hopefully show how many of the patients went through the proposed education program had improved oral hygiene. Analyzing the data regarding the need for follow-up care following the education will also indicate whether or not the patients are improving their oral hygiene. The program can only help the clinic and patients become healthier and more aware of the importance the oral cavity has on one’s overall body. The conclusions from this data analysis will either show that the education the patients receive is improving the overall oral health of the Lehigh Valley or that it is not and there may be adjustments or more improvements that would need to take place. However, initially the simplest information is predicted to show significant improvements. This proposed program with help the entire Lehigh Valley Health Network community improve the quality of life for patients. Acknowledgements We would like to thank everyone who supported us throughout this project. Thank you Patricia Atno and Dr. Charles Incalcaterra for creating this opportunity and for serving as our mentors, as well as all of the staff at the 17th Street Dental Clinic. References Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975 Dec;25(4) 229-235. Adult health. (2013). Mayo Clinic. Allukian, M. (2008). The Neglected Epidemic and the Surgeon General’s Report: A Call to Action for Better Oral Health. American Journal of Public Health, 98(Suppl 1), S82–S85. Axelsson, P., Lindhe, J. (1981). Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. Journal of Clinical Periodontology, 8(3), 239-248. Barker, J. (2012). Oral Health: The Mouth-Body Connection. Bloom, B., Simile, C. M., Adams, P. F., & Cohen, R. A. (2012). Oral health status and access to oral health care for US adults aged 18-64: National Health Interview Survey, 2008. Vital and health statistics. Series 10, Data from the National Health Survey, (253), 1-22. Hygiene-related Diseases. (2014, December 16). P.I. Eke, B.A. Dye, L. Wei, G.O. Thornton-Evans, and R.J. Genco. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J DENT RES 0022034512457373, first published on August 30, 201

Action at a Distance

The mediality of transmission and the materiality of communication result today more than ever in "acting at a distance" - an action whose agency lies in a medium. This book provides an overview into this crucial phenomenon, thereby introducing urgent questions of human interaction, the binding and breaking of time and space, and the entanglement of the material and the immaterial. Three vivid inquiries deal with histories and theories of mediality and materiality

Studies of Reactive Halogen Species (RHS) in the Marine and mid-Latitudinal Boundary Layer by Active Longpath Differential Optical Absorption Spectroscopy

Untersuchungen von Reaktiven Halogenverbindungen (RHS) in der Maritimen Grenzschicht und in Mittleren Breiten mit der Aktiven Langpfad DOAS Methode Die Relevanz reaktiver Halogenverbindungen in der Troposphare ist einerseits belegt durch den gravierenden Ein uss auf Ozon, welcher zum ersten Mal wahrend des polaren Sonnenaufgangs in der vollstandigen Zerstorung bodennahem Ozons durch reaktive Bromverbindungen beobachtet wurde. Weiterhin werden reaktive Iodverbindungen in Zusammenhang mit aktuell beobachteter Partikelbildung in Kustengebieten gebracht. Da Partikel in der Atmosphare die mikrophysikalischen Eigenschaften von Stratocumulus Wolken beein ussen, kann in diesen Beobachtungen eine groe Bedeutung fur das Klima liegen. Im Rahmen der vorliegenden Arbeit wurden drei Feldmesskampagnen unter Verwendung der aktiven Langpfad DOAS Messmethode durchgefuhrt, um das Vorkommen von reaktiven Halogenverbindungen, speziell BrO, IO, OIO und I2 in verschiedenen mittlereren Breiten zu untersuchen. Wahrend bodengebunder Messungen in der arktisch beein ussten Region der Hudson Bay, Kanada wurden bis zu 35 ppt des BrO Radikals detektiert zeitgleich zur fast vollstandigen Zerstorung des bodennahen Ozons. Bei zwei weiteren Feldmesskampagnen zur Untersuchung der RHS in maritim beein ussten Gebieten an der deutschen Nordseekuste und der franzosischen Atlantikkuste wurde IO als einziges Halogenoxid in beiden Umgebungen gefunden mit maximalen Konzentrationen von 7.70.5 ppt. In dieser maritimen Umgebung konnte BrO nicht oberhalb der Nachweisgrenze von 1.5 ppt nachgewiesen werden, ebenso verblieben OIO und auch I2 unterhalb der Nachweisgrenze. Eine Reanalyse von DOAS Spektren, die wahrend einer vorangegangenen Kampagne 1998 in Mace Head, Irland gewonnen wurden, ergaben 6112 ppt I2 wahrend der Nacht und besonders tiefem Wasserstand wahrend Springtide. Diese Beobachtungen werden erklart unter der Annahme, dass Laminaria Algen, die den unteren Intertidenbereich bewohnen, wahrend dieser Zeit in Kontakt mit der Atmosphare molekulares Iod emittieren

Fußball und Identitäten in Brasilien aus transnationaler Perspektive, 1894–1930

Fußball ist heute selbstverständlicher Teil brasilianischer Identitätsentwürfe. Diese identitätsstiftende Funktion erhielt Fußball sofort nach seiner Verbreitung nach Brasilien Ende des 19. Jahrhunderts. Zur Zeit der Ersten Republik verhandelten Menschen unterschiedlicher sozialer Herkunft über diesen Sport nationale, regionale und »rassische« Kategorien; zugleich wurde er Teil der diplomatischen Außendarstellung des Landes. Wie die Autorin Christina Peters argumentiert, entstanden diese Identitätskonstruktionen in den Städten Rio de Janeiro und São Paulo erst unter transnationalen Bezugnahmen und Interaktionen. Sie zeigt damit, wie Brasilien zu Beginn des 20. Jahrhunderts über den Fußball in globale kulturelle Zusammenhänge eingebunden wird

Radionuclide method for evaluating the performance of hemodialysis in vivo

Radionuclide method for evaluating the performance of hemodialysis in vivo.BackgroundSpecifications of dialyzer performance are generally based on in vitro measurements. There is, however, a shortage of data on dialyzer performance in vivo. The aim of this study was to use continuous measurement of technetium-99m-diethyltriaminepentaacetic acid (Tc-99m-DTPA) blood concentration as a means of continuously monitoring dialyzer function in vivo in patients undergoing routine hemodialysis.MethodsThe study population comprised 15 patients (45 to 80 years old; 13 males). Tc-99m-DTPA was administered intravenously 90 minutes before obtaining a blood sample and starting dialysis. Blood Tc-99m-DTPA activity was continuously monitored by passing the line carrying blood from the patient to the dialyzer close to a scintillation probe mounted in a shielded housing. At the end of hemodialysis, lasting 180 to 300 minutes, chromium-51-ethylenediaminetetraacetic acid (Cr-51-EDTA) was given intravenously and a blood sample taken 90 minutes later. Baseline dialyzer blood flow (Qb) and dialysate flow (Qd) were 250 to 350mL/min and 500mL/min, respectively. The rate constant, α, of the decrease in blood Tc-99m-DTPA activity was used as the measure of moment-to-moment dialyzer function. Pre- and postdialysis extracellular fluid volumes were calculated from the blood Tc-99m-DTPA and Cr-51-EDTA concentrations (VDTPA and VEDTA) before and after dialysis. Tc-99m-DTPA clearance was measured as the product of α and VDTPA. Dialyzer urea clearance was calculated from pre- and postdialysis urea nitrogen concentrations and the time of dialysis. The effects of brief changes in Qb and Qd on dialyzer function were assessed from the associated changes in α.ResultsThe Tc-99m-DTPA clearance profile was biexponential, becoming monoexponential about 1 hour after starting hemodialysis, with α remaining constant for as long as dialysis continued in five patients in whom Qb and Qd were left unaltered. Mean (SEM) plasma Tc-99m-DTPA clearance averaged over the entire period of dialysis in all 15 patients was 110 (3.1)mL/min. It correlated with urea clearance (r = 0.71) (P < 0.01) which was 225 (9.5)mL/min based on a total body water of 2.5 that of VDTPA and 212 (13)mL/min scaled to 40 L/1.73m2. Extracellular fluid volume decreased by 1.73 (0.74) l over dialysis, which was comparable to the change in weight [1.48 (0.57) kg]. The extraction fraction of Tc-99m-DTPA across the artificial kidney, directly measured from afferent and efferent blood samples under baseline Qb and Qd, was 0.5 (0.013). Average extraction fraction indirectly estimated from Tc-99m-DTPA blood clearance and Qb was 0.54 (0.019). These two measurements of extraction fraction correlated with each other under conditions of varying Qb and Qd (r = 0.74) (N = 27) (P < 0.001). Changes in α resulting from changes in Qb and Qd were similar to changes predicted from computerized modeling. The ratio of mass transfer coefficients of urea and Tc-99m-DTPA with respect to the dialyzer, calculated as if they were permeability-surface area products, was 3.3, similar to the ratio, obtained from the literature, in continuous capillary endothelium.ConclusionTc-99m-DTPA is a useful agent for continuously monitoring dialyzer function in vivo and provides a platform for the use of other radio-pharmaceuticals of different molecular sizes that could be used in an analogous fashion

Effects of Argon Laser Trabeculoplasty in the Early Manifest Glaucoma Trial.

PURPOSE: To analyze reduction of intraocular pressure (IOP) by argon laser trabeculoplasty (ALT) in the Early Manifest Glaucoma Trial and factors influencing the effect of such treatment. DESIGN: Cohort study based on 127 patients from the treatment group of the Early Manifest Glaucoma Trial, a randomized clinical trial. METHODS: Patients randomized to the treatment arm of the Early Manifest Glaucoma Trial received a standard treatment protocol (topical betaxolol hydrochloride followed by 360-degree ALT) and then were followed up prospectively at 3-month intervals for up to 8 years. One eye per patient was included in the analyses. We investigated the relationship between IOP before ALT and subsequent IOP reduction and other factors that might have influenced the effect of ALT, including stage of the disease, trabecular pigmentation, presence of exfoliation syndrome, and treating surgeon. RESULTS: The mean ± standard deviation IOP before ALT and after betaxolol treatment was 18.1 ± 3.9 mm Hg, and the mean ± standard deviation short-term IOP reduction 3 months after ALT was 2.8 ± 3.9 mm Hg (12.6 ± 20.5%). The IOP before ALT strongly affected IOP reduction (P < .001); each 3-mm Hg higher IOP before ALT value was associated with an additional mean IOP reduction of approximately 2 mm Hg. The treating surgeons also had a significant impact on IOP reduction (P = 0.001), with mean values ranging from 5.8 to -1.3 mm Hg. CONCLUSIONS: In this cohort, which included many patients with low IOP levels, IOP before ALT markedly influenced the IOP reduction induced by ALT, seen as a much larger decrease in eyes with higher IOP before ALT. The treating surgeon also had a significant impact on ALT outcome