The role of different types of actors in the future of sustainable agriculture in a Dutch Peri-urban area

Peri-urban areas support a broad range of multifunctional demands for public goods. In northwest Europe, peri-urban areas tend to overlap with intensive agricultural land, resulting in conflicts between agricultural use and the public good demands of residents. Sustainable intensification (SI) of agriculture might help reconcile agricultural and well-being goals, but it is unclear how the mix of actors in a peri-urban setting can trigger or restrain SI. In a Dutch case study, we explored how SI of agriculture can contribute to making peri-urban areas more sustainable, and which actors are key enabling factors for implementing SI. We used interviews, surveys, workshops, and empirical analysis to obtain insight into the stakeholder's vision of a sustainable future for the case study area, the farming system and actor network. We integrated these insights in a Bayesian Belief Network, where we linked the actor network to implementation of three SI measures (farm-level efficiency measures, small landscape elements, and direct sales), and used sensitivity analysis to model effects of support for implementation by different groups of actors. The case study has a dense stakeholder network, where, dependent on the SI measure, farmers are triggered by all actors to implement SI, or have a stronger role in uptake themselves. The sensitivity analysis suggested that the future preferred by the stakeholders requires broad support of all actors involved, with local actors without a formal role being essential for uptake. Overall, trade-offs among public goods are almost inevitable when taking up SI measures.Industrial Ecolog

Combinations of QT-prolonging drugs: towards disentangling pharmacokinetic and pharmaco-dynamic effects in their potentially additive nature.

Background: Whether arrhythmia risks will increase if drugs with electrocardiographic (ECG) QT-prolonging properties are combined is generally supposed but not well studied. Based on available evidence, the Arizona Center for Education and Research on Therapeutics (AZCERT) classification defines the risk of QT prolongation for exposure to single drugs. We aimed to investigate how combining AZCERT drug categories impacts QT duration and how relative drug exposure affects the extent of pharmacodynamic drug–drug interactions. Methods: In a cohort of 2558 psychiatric inpatients and outpatients, we modeled whether AZCERT class and number of coprescribed QT-prolonging drugs correlates with observed rate-corrected QT duration (QTc) while also considering age, sex, inpatient status, and other QTc-prolonging risk factors. We concurrently considered administered drug doses and pharmacokinetic interactions modulating drug clearance to calculate individual weights of relative exposure with AZCERT drugs. Because QTc duration is concentration-dependent, we estimated individual drug exposure with these drugs and included this information as weights in weighted regression analyses. Results: Drugs attributing a ‘known’ risk for clinical consequences were associated with the largest QTc prolongations. However, the presence of at least two versus one QTc-prolonging drug yielded nonsignificant prolongations [exposure-weighted parameter estimates with 95% confidence intervals for ‘known’ risk drugs + 0.93 ms (–8.88;10.75)]. Estimates for the ‘conditional’ risk class increased upon refinement with relative drug exposure and coadministration of a ‘known’ risk drug as a further risk factor. Conclusions: These observations indicate that indiscriminate combinations of QTc-prolonging drugs do not necessarily result in additive QTc prolongation and suggest that QT prolongation caused by drug combinations strongly depends on the nature of the combination partners and individual drug exposure. Concurrently, it stresses the value of the AZCERT classification also for the risk prediction of combination therapies with QT-prolonging drugs

Off–label long acting injectable antipsychotics in real–world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction: Information on the off–label use of Long–Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on– vs off–label LAIs and predictors of off–label First– or Second–Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method: In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off– or on–label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off–label group. Results: SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on– and off–label use. Approximately 1 in 4 patients received an off–label prescription. In the off–label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion: Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off–label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co–morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

Comparing Long-Acting Antipsychotic Discontinuation Rates Under Ordinary Clinical Circumstances: A Survival Analysis from an Observational, Pragmatic Study

Background: Recent guidelines suggested a wider use of long-acting injectable antipsychotics (LAI) than previously, but naturalistic data on the consequences of LAI use in terms of discontinuation rates and associated factors are still sparse, making it hard for clinicians to be informed on plausible treatment courses. Objective: Our objective was to assess, under real-world clinical circumstances, LAI discontinuation rates over a period of 12 months after a first prescription, reasons for discontinuation, and associated factors. Methods: The STAR Network ‘Depot Study’ was a naturalistic, multicentre, observational prospective study that enrolled subjects initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centres were assessed at baseline and at 6 and 12 months of follow-up. Psychopathology, drug attitude and treatment adherence were measured using the Brief Psychiatric Rating Scale, the Drug Attitude Inventory and the Kemp scale, respectively. Results: The study followed 394 participants for 12 months. The overall discontinuation rate at 12 months was 39.3% (95% confidence interval [CI] 34.4–44.3), with paliperidone LAI being the least discontinued LAI (33.9%; 95% CI 25.3–43.5) and olanzapine LAI the most discontinued (62.5%; 95% CI 35.4–84.8). The most frequent reason for discontinuation was onset of adverse events (32.9%; 95% CI 25.6–40.9) followed by participant refusal of the medication (20.6%; 95% CI 14.6–27.9). Medication adherence at baseline was negatively associated with discontinuation risk (hazard ratio [HR] 0.853; 95% CI 0.742–0.981; p = 0.026), whereas being prescribed olanzapine LAI was associated with increased discontinuation risk compared with being prescribed paliperidone LAI (HR 2.156; 95% CI 1.003–4.634; p = 0.049). Conclusions: Clinicians should be aware that LAI discontinuation is a frequent occurrence. LAI choice should be carefully discussed with the patient, taking into account individual characteristics and possible obstacles related to the practicalities of each formulation

Intensification, periurbanization and specialization of agriculture as significant short-term land system dynamics in the Mediterranean basin

Mediterranean land systems are undergoing significant changes in terms of agricultural land use and practices. In the literature these changes are highlighted by a number of local or regional studies, however, an overview of the land system changes at the Mediterranean basin level is lacking. This paper identifies the main land system dynamics over a short time period (2005-2015) and their location, in order to highlight the trajectories that are also taking place in other parts of the world. We identified four significant types of change: (1) from mixed agriculture to specialized fruit groves; (2) from agricultural areas to urban and/or periurban areas; (3) from agroforestry to arable systems, and (4) from predominantly bare soils to agricultural areas. These ongoing dynamics can be characterized as intensification, periurbanization and specialization of agriculture

Characterisation of agri-landscape systems at a regional level. A case study in Northern Tuscany (Italy).

Preserving our landscape in sustainable development processes is now widely considered as fundamental. It is a complex and evolving issue that can be tackled from several perspectives. Agronomy can contribute to analyzing the relationships between agricultural production systems (cropping, farming and agricultural systems) at different levels (field, farm, and region) and the agricultural landscape (in terms of patches, matrixes, dynamics, etc). This is of particular interest where the relationships between “what and how” are produced by agricultural activities and the landscape are changing. In this case their own reciprocity may represent an opportunity to analyze complex systems, such as the characterization of agri-landscapes at a regional level. We propose a case study developed as an up-scaling analytical process from a farm to a regional level. The result was the identification of six main agri-landscape systems highlighting the landscape drivers that are changing the traditional landscape of a rural region in Northern Tuscany (Lunigiana)