The value of theoretical multiplicity for steering transitions towards sustainability

Transition management, as a theory of directing structural societal changes towards sustainable system innovations, has become a major topic in scientific research over the last years. In this paper we focus on the question how transitions towards sustainability can be steered, governed or managed, in particular by governmental actors. We suggest an approach of theoretical multiplicity, arguing that multiple theories will be needed simultaneously for dealing with the complex societal sustainability issues. Therefore, we address the steering question by theoretically comparing transition management theory to a number of related theories on societal change and intervention, such as multi-actor collaboration, network governance, configuration management, policy agenda setting, and adaptive management. We conclude that these related theories put the managerial assumptions of transition management into perspective, by adding other steering roles and leadership mechanisms to the picture. Finally we argue that new modes of steering inevitable have consequences for the actual governance institutions. New ways of governing change ask for change within governance systems itself and vice versa. Our argument for theoretical multiplicity implicates the development of multiple, potentially conflicting, governance capacitie

Thyroid Disorders in Patients Treated with Dimethyl Fumarate for Multiple Sclerosis: A Retrospective Observational Study.

Dimethyl fumarate (DMF), a drug used for the treatment of multiple sclerosis (MS) and psoriasis, has been shown to activate the Keap1/Nrf2 antioxidant response. Nrf2 exerts pleiotropic roles in the thyroid gland; among others, single nucleotide polymorphisms (SNPs) in the gene encoding Nrf2 modulate the risk of Hashimoto's thyroiditis (HT), suggesting that pharmacological activation of Nrf2 might also be protective. However, a patient with acute exacerbation of HT after starting DMF for MS was recently reported, raising questions about the thyroidal safety of Nrf2 activators. In a retrospective observational study, we investigated the prevalence and incidence of thyroid disorders (TD) among 163 patients with MS treated with DMF. Only 7/163 patients (4.3%) were diagnosed with functional TD; most (5/163, 3.0%) were diagnosed before DMF treatment. Functional TD were diagnosed under or after DMF in only 2 patients (1.2%). Under DMF, one patient developed transient mild hypothyroidism with negative thyroid autoantibodies. After DMF discontinuation, another patient developed hyperthyroidism due to Graves' disease. No patient developed thyroid structural disease under or after DMF. The very low incidence of functional TD indicates an overall very good thyroid tolerance of DMF, arguing against screening for TD in MS patients considered for or treated with DMF, and supporting the further study of Nrf2 activators for the prevention and treatment of TD

Medical Management versus PACK-CXL in Dogs with Infectious Keratitis: A Randomized Controlled Trial Protocol

Infectious keratitis is a common and painful disease, usually caused by bacteria in dogs. Brachycephalic breeds are at increased risk. Despite medical therapy, enzymatic corneal melting can lead to ulcer perforation and globe loss. Treatment alternatives are needed due to an increase in antibiotic resistance and growing popularity of brachycephalic dogs. Photoactivated Chromophore for Keratitis-Corneal Cross-linking (PACK-CXL) reduces enzymatic collagenolysis and damages multiple targets within microorganisms, resulting in corneal tissue stabilization and elimination of bacteria, irrespective of their antibiotic resistance status. A randomized controlled trial providing evidence of PACK-CXL effectiveness in dogs is lacking. We aim to determine whether PACK-CXL is a viable alternative to conventional medical therapy for canine infectious keratitis. Two hundred-and-seventy client-owned dogs with presumed infectious keratitis will be allocated to two equally sized treatment groups (PACK-CXL or medical therapy) in a masked, randomized, controlled, multicenter trial in eleven clinics. The primary outcome measure is treatment success defined as complete epithelial closure within 28 days. The sample size is based on a group sequential design with two interim analyses, which will be overseen by a Data Safety and Monitoring Board. Ethical approvals have been obtained. The study protocol is preregistered at preclinicaltrials.eu. Publishing trial protocols improves study reproducibility and reduces publication bias

Seasonal effects on the corneoconjunctival microflora in a population of Persian cats in Iran

This study was performed to determine the normal seasonal aerobic and an-aerobic corneoconjunctival bacterial flora in cats. Thirty eyes of 15 clinically normal client-owned Persian cats were evaluated. All cats lived in a similar indoor/outdoor home environment being fed the same diet for the entire year. The cats did not receive any medications and were found to be clinically healthy 1 week prior to each microbial sampling. The cats were not exposed to other cats during the study period. Microbial samples were collected at the same time of day on the first day of the second month of each of the four seasons. During sample collection, a sterile swab was rolled over the corneoconjunctival surface avoiding contact with surrounding skin or hair. Immediately after sample collection, microbiologic aerobic and anaerobic cultures were initiated. Gram-positive bacteria were the most prevalent isolates. The most commonly isolated bacterial organisms across all seasons were Staphylococcus epidermidis (41/95; 43.2%), β-hemolytic streptococcus (18/95; 18.9%), Staphylococcus aureus (17/95; 17.9%), and Escherichia coli (11/95; 11.5%). Twenty-five cultures of a total of 120 (20.8%) were negative. One negative culture was collected in the summer, while 21 cultures were negative in fall and winter. Gram-positive bacteria were the predominant micro-organisms of the normal ocular surface of healthy cats in all seasons in this study. This result is in agreement with previous publications

PERFORMANCE OF TIMBER BOARD MODELS FOR PREDICTION OF LOCAL BENDING STIFFNESS AND STRENGTH – WITH APPLICATION ON DOUGLAS FIR SAWN TIMBER

Efficient utilization of structural timber requires accurate methods for machine strength grading. One of the most accurate methods presented this far is based on data of local fiber orientation on board surfaces, obtained from laser scanning. In this paper, two potential improvements of this method are examined. The first one consists of replacing a model based on simple integration over cross sections of boards for calculation of local bending stiffness by a 3D solid finite element (FE) model from which local bending stiffness is derived. The second improvement concerns replacement of a simple model for the fiber orientation in the interior of board by a more advanced one taking location of pith and growth direction of knots into account. Application of the alternative models on a sample of more than 200 Douglas fir boards, size 40 mm X 100 mm X 3000 mm, cut from large logs, show that each of the evaluated model improvements contributes to improved grading accuracy. When local bending stiffness is calculated utilizing the herein suggested FE model in combination with the improved model of fiber orientation in the interior of boards, a coefficient of determination to bending strength as high as 0.76 is obtained. For comparison, a coefficient of determination of 0.71 is obtain using the simpler original models

Systematically Developing a Web-Based Tailored Intervention Promoting HPV-Vaccination Acceptability Among Mothers of Invited Girls Using Intervention Mapping.

Background: Currently, the eHealth field calls for detailed descriptions of theory-based interventions in order to support improved design of such interventions. This article aims to provide a systematic description of the design rationale behind an interactive web-based tailored intervention promoting HPV-vaccination acceptability. Methods: The 6-step Intervention Mapping (IM) protocol was used to describe the design rationale. After the needs assessment in Step 1, intervention objectives were formulated in Step 2. In Step 3, we translated theoretical methods into practical applications, which were integrated into a coherent intervention in Step 4. In Step 5, we anticipated future implementation and adoption, and finally, an evaluation plan was generated in Step 6. Results: Walking through the various steps of IM resulted in a detailed description of the intervention. The needs assessment indicated HPV-vaccination uptake remaining lower than expected. Mothers play the most important role in decision-making about their daughter's immunization. However, they generally feel ambivalent after they made their decisions, and their decisions are based on rather unstable grounds. Therefore, intervention objectives were to improve HPV-vaccination uptake and informed decision-making, and to decrease decisional conflict among mothers of invited girls. Computer-tailoring was chosen as the main method; virtual assistants were chosen as a practical application to deliver interactive tailored feedback. To maximize compatibility with the needs of the target group, a user-centered design strategy by means of focus groups and online experiments was applied. In these, prototypes were tested and sequentially refined. Finally, efficacy, effectiveness, and acceptability of the intervention were tested in a randomized controlled trial. Results showed a significant positive effect of the intervention on informed decision-making, decisional conflict, and nearly all determinants of HPV-vaccination uptake (P < 0.001). Mothers evaluated the intervention as highly positive. Discussion: Using IM led to an innovative effective intervention for promoting HPV-vaccination acceptability. The intervention maps will aid in interpreting the results of our evaluation studies. Moreover, it will ease the comparison of design rationales across interventions, and may provide leads for the development of other eHealth interventions. This paper adds to the plea for systematic reporting of design rationales constituting the process of developing interventions

Regulation of long-term care for older persons:a scoping review of empirical research

OBJECTIVE: Not only care professionals are responsible for the quality of care but other stakeholders including regulators also play a role. Over the last decades, countries have increasingly invested in regulation of Long-Term Care (LTC) for older persons, raising the question of how regulation should be put into practice to guarantee or improve the quality of care. This scoping review aims to summarize the evidence on regulatory practices in LTC for older persons. It identifies empirical studies, documents the aims and findings, and describes research gaps to foster this field.DESIGN: A literature search (in PubMed, Embase, Cinahl, APA PsycInfo and Scopus) was performed from inception up to December 12 th, 2022. Thirty-one studies were included. RESULTS: All included studies were from high-income countries, in particular Australia, the US and Northwestern Europe, and almost all focused on care provided in LTC facilities. The studies focused on different aspects of regulatory practice, including care users' experiences in collecting intelligence, impact of standards, regulatory systems and strategies, inspection activities and policies, perception and style of inspectors, perception and attitudes of inspectees and validity and reliability of inspection outcomes.CONCLUSION: With increasingly fragmented and networked care providers, and an increasing call for person-centred care, more flexible forms of regulatory practice in LTC are needed, organized closer to daily practice, bottom-up. We hope that this scoping review will raise awareness of the importance of regulatory practice and foster research in this field, to improve the quality of LTC for older persons, and optimize their functional ability and well-being.</p

Growth factors and mechano-regulated reciprocal crosstalk with extracellular matrix tune the keratocyte–fibroblast/myofibroblast transition

Improper healing of the cornea after injury, infections or surgery can lead to corneal scar formation, which is associated with the transition of resident corneal keratocytes into activated fibroblasts and myofibroblasts (K–F/M). Myofibroblasts can create an extracellular matrix (ECM) niche in which fibrosis is promoted and perpetuated, resulting in progressive tissue opacification and vision loss. As a reversion back to quiescent keratocytes is essential to restore corneal transparency after injury, we characterized how growth factors with demonstrated profibrotic effects (PDGF, FGF, FBS, TGFβ1) induce the K–F/M transition, and whether their withdrawal can revert it. Indeed, the upregulated expression of αSMA and the associated changes in cytoskeletal architecture correlated with increases in cell contractility, fibronectin (Fn) and collagen matrix density and Fn fiber strain, as revealed by 2D cell culture, nanopillar cellular force mapping and a FRET-labeled Fn tension probe. Substrate mechanosensing drove a more complete K–F/M transition reversal following growth factor withdrawal on nanopillar arrays than on planar glass substrates. Using decellularized ECM scaffolds, we demonstrated that the K–F/M transition was inhibited in keratocytes reseeded onto myofibroblast-assembled, and/or collagen-1-rich ECM. This supports the presence of a myofibroblast-derived ECM niche that contains cues favoring tissue homeostasis rather than fibrosis

Determinants of a dietary pattern linked with greater metabolic risk and its tracking during adolescence

Background: Although growing evidence suggests that dietary patterns associated with noncommunicable diseases in adulthood may develop early in life, when these are established, as well as their determinants, remains unclear. Methods: We examined determinants and tracking of a dietary pattern (DP) associated with metabolic risk and its key food groups among 860 adolescents in the Western Australian Pregnancy (Raine) Cohort study. Food intake was reported using a food frequency questionnaire (FFQ) at 14 and 17 years. Z-scores for an 'energy-dense, high-fat, low-fibre' DP were estimated by applying reduced rank regression at both ages. Tracking was based on the predictive value (PV) of remaining in the DPZ-score or food intake quartile at 14 and 17 years. Early-life exposures included: maternal age; maternal pre-pregnancy body mass index; parent smoking status during pregnancy; and parent socio-economic position (SEP) at 14 and 17 years. Associations between the DPZ-scores, early-life factors and SEP were analysed using regression analysis. Results: Dietary tracking was strongest among boys with high DPZ-scores, high intakes of processed meat, low-fibre bread, crisps and savoury snacks (PV > 1) and the lowest intakes of vegetables, fruit and legumes. Lower maternal education (β = 0.09, P = 0.002 at 14 years; β = 0.14, P < 0.001 at 17 years) and lower maternal age at birth (β = 0.09, P = 0.003 at 14 years; β = 0.11, P = 0.004 at 17 years) were positively associated with higher DPZ-scores. Conclusions: An energy-dense, high-fat, low-fibre dietary pattern tracks more strongly among adolescent boys who have high scores for this pattern at 14 years of age. These findings highlight target foods and population subgroups for early interventions aiming to improve dietary behaviours

Student Showcase Concert

Ida GotkovskyRobert PlanelEdith Piaf & Louis GuglielmiJohnny MandelKen ThomsonBob Becke