Battle and Beating, Water and Waste: Micro-Level Impact Evaluation in Developing and Emerging Economies

Die Dissertation mit dem Titel “Battle and Beating, Water and Waste: Micro-Level Impact Evaluation in Developing and Emerging Economies” beinhaltet die Ergebnisse ökonometrischer Wirkungsevaluierungen, die innerhalb zwei verschiedener Themengebieten des täglichen Lebens in Entwicklungs- und Schwellenländern durchgeführt wurden: Gewalt und Wasser. Im ersten dieser Themengebiete konzentriert sich die Analyse auf die Verhaltens-Reaktionen der Bevölkerung, die in räumlicher Nähe zu gewaltsamem Konflikt lebt. Detailliert die Wirkung solcher Exponierung auf das Auftreten häuslicher Gewalt untersuchend, trägt das erste Kapitel – gemeinsam verfasst mit Dominik Noe – dazu bei, die gesellschaftlichen Kosten kriegsähnlicher Auseinandersetzungen abzuschätzen. Insbesondere die Nachwirkungen auf zwischenmenschliche Beziehungen und soziales Verhalten gegenüber Familie und Freunden werden betrachtet. Wir formulieren die Theorie, dass das Leben in Haushalten in der Nähe zu Orten von extrem gewaltsamen Zwischenfällen die Wahrscheinlichkeit von Frauen in diesen Haushalten erhöht, Opfer häuslicher Gewalt zu werden. Diese Theorie überprüfen wir dann anhand von Daten aus Kolumbien; einem Land, in dem sowohl reichhaltige Daten zu Gefechten als auch zu häuslicher Gewalt vorliegen. Die Kernerkenntnis lautet, dass eine höhere Intensität der gewaltsamen Konflikte mutmaßlich die Wahrscheinlichkeit der Frauen, Opfer häuslicher Gewalt zu werden, deutlich erhöht. Das zweite und dritte Kapitel dieser Dissertation sind dem zweiten Themengebiet gewidmet, und hier insbesondere Aspekten des Anschlusses von Haushalten an Leitungswasser und moderne Abwasser-Entsorgung. Das zweite Kapitel – gemeinsam verfasst mit Stephan Klasen, Tobias Lechtenfeld und Kristina Meier – untersucht die Wirkung des Anschlusses von Haushalten an Leitungswasser und Abwasser-entsorgung auf Gesundheit sowie Schul- und Arbeitsplatz-Anwesenheit. Es trägt zu der derzeit noch überschaubaren Anzahl von Wirkungsevaluierungen im Wasser- und Abwasserbereich bei, und ist nach Kenntnis der Autoren die erste rigorose Wirkungsevaluierung im städtischen Umfeld. Quasi-experimentelle Methoden und Wasserqualitäts-Tests unter Berücksichtigung von ungleichmäßiger Infrastruktur-Ausbreitung erlauben es, die Wirkungen separat einerseits für Anschluss lediglich an Leitungswasser, als auch andererseits für zusätzlichen Anschluss an Abwasserentsorgung, zu schätzen. Die Kernerkenntnis lautet, dass Anschluss an Leitungswasser in jemenitischen Städten schädlich sein kann, wenn die Wasserversorgung unregelmäßig ist; und die Wirkung bei regelmäßiger Versorgung im Vergleich zu traditionellen und alternativen Wasserquellen sehr gering ist. Anschluss an Abwasserentsorgung scheint dagegen bei regelmäßiger Wasserversorgung zu gesundheitlichem Nutzen zu führen. Es ist regelmäßig zu beobachten, dass in Aufbereitungsanlagen entkeimtes Leitungswasser innerhalb des Haushaltes rekontaminiert wird. Wasserqualitäts-Tests an Testpunkten entlang der Versorgungskette innerhalb des Haushaltes erlaubt Rückschlüsse auf Ort und Quelle der Kontaminierung. Der Löwenanteil dieser Verschlechterung der Wasserqualität ist auf Verhalten im Zusammenhang mit Wasser-Handhabung und Hygiene zurückzuführen. Das in Alleinautorschaft verfasste dritte Kapitel baut auf dem zweiten auf und untersucht, welche treibenden Faktoren hinter Verhaltensaspekten stehen, die Rekontaminierung verhindern würden. Spezifisch die Determinanten von Wasserbehandlung und Hygiene werden untersucht, und vor dem Hintergrund der Erkenntnisse aus dem zweiten Kapitel interpretiert. Die Kernerkenntnis lautet, dass Hygiene-Training, Zugang zu Informations- und Kommunikations-Technologie sowie Schulbildung mutmaßlich zu den relevanten, beeinflussbaren Determinanten zählen. Anschluss an Leitungswasser und Abwasserentsorgung – welche üblicherweise bestenfalls mittelfristig ausgebaut werden können – haben scheinbar ebenfalls wünschenswerte Effekte, allerdings in geringerem Maße, und in höherem Maße bei Leitungswasser als bei zusätzlicher Abwasserentsorgung

‘More than scaling-up’: Sustainability contexts, competencies, and consequences - a critical inquiry

To identify and problematise the key issues characterising the relationship between global sustainability contexts and the limited response of HE to date - with the purpose of unlocking the potential for innovative, replicable efforts to develop sustainability competencies through innovation in curriculum policy and practice, through addressing these sub-aims: How far does HE policy accommodate and reflect the need for sustainability competencies? How can capacity for teaching for competency be built and supported through new policies? How can curricula and pedagogy be better aligned to facilitate the building of sustainability competency in learners and teachers? What effect and influence does education for sustainability competency have in terms of facilitating transformative social learning, supporting systems structure change, and cultivating informed responsibility (in terms of policy and everyday decision making)?PedRI

EFNS guideline on treatment of multiple sclerosis relapses: report of an EFNS task force on treatment of multiple sclerosis relapses

Relapses, exacerbations or attacks of multiple sclerosis are the dominating feature of relapsing‐remitting multiple sclerosis (MS), but are also observed in patients with secondary progressive MS. High‐dose methylprednisolone is the routine therapy for relapses at present, but other treatments are also in current use. The objective of the task force was to review the literature on treatment of MS relapses to provide evidence‐based treatment recommendations. Review was carried out on the literature with classification of evidence according to the EFNS guidelines for scientific task forces. Short‐term, high‐dose methylprednisolone treatment should be considered for the treatment of relapses of MS (level A recommendation). The optimal glucocorticoid treatment regimen, in terms of clinical efficacy and adverse events, remains to be established. A more intense, interdisciplinary rehabilitation programme should be considered as this probably further improves recovery after treatment with methylprednisolone (level B recommendation). Plasma exchange is probably efficacious in a subgroup of patients with severe relapses not responding to methylprednisolone therapy, and should be considered in this patient subgroup (level B recommendation). There is a need for further randomized, controlled trials in order to establish the optimal treatment regimen for relapses of MS

Long-term management of multiple sclerosis patients treated with cladribine tablets beyond year 4

Introduction Oral cladribine is a highly effective pulsed selective immune reconstitution therapy licensed for relapsing multiple sclerosis (RMS) since 2017. A full treatment course comprises two treatment cycles given 1 year apart, followed by two treatment-free years. The management of cladribine-treated patients beyond year 4 needs to be addressed as patients have now passed the initial 4 years since European Medical Agency approval. Areas covered A panel of neurologists and a neuroradiologist experienced in MS treatment/monitoring evaluated clinical trial data and real-world evidence and proposed recommendations for the management of cladribine-treated patients beyond year 4. Expert opinion Continuous monitoring of disease activity during the treatment-free period is important. Subsequent management depends on the presence or absence of inflammatory disease activity, determined in the absence of consistent guidelines via practice-driven neurological decision criteria. Persisting or newly occurring inflammatory disease activity is an indication for further treatment, i.e. either re-initiation of cladribine or switching to another highly effective disease-modifying therapy. The decision to retreat or switch should be based on clinical and radiological evaluation considering disease course, treatment history, and safety aspects. In the absence of disease activity, either retreatment can be offered, or the treatment-free period can be extended under structured monitoring

Interferon β-1a in relapsing multiple sclerosis: four-year extension of the European IFNβ-1a Dose-C omparison Study

Background: Multiple sclerosis (MS) is a chronic disease requiring long-term monitoring of treatment. Objective: To assess the four-year clinical efficacy of intramuscular (IM) IFNb-1a in patients with relapsing MS from the European IFNb-1a Dose-C omparison Study. Methods: Patients who completed 36 months of treatment (Part 1) of the European IFNb-1a Dose-C omparison Study were given the option to continue double-blind treatment with IFNb-1a 30 mcg or 60 mcg IM once weekly (Part 2). Analyses of 48-month data were performed on sustained disability progression, relapses, and neutralizing antibody (NA b) formation. Results: O f 608/802 subjects who completed 36 months of treatment, 493 subjects continued treatment and 446 completed 48 months of treatment and follow-up. IFNb-1a 30 mcg and 60 mcg IM once weekly were equally effective for up to 48 months. There were no significant differences between doses over 48 months on any of the clinical endpoints, including rate of disability progression, cumulative percentage of patients who progressed (48 and 43, respectively), and annual relapse rates; relapses tended to decrease over 48 months. The incidence of patients who were positive for NAbs at any time during the study was low in both treatment groups. Conclusion: C ompared with 60-mcg IM IFNb-1a once weekly, a dose of 30 mcg IM IFNb-1a once weekly maintains the same clinical efficacy over four years

Cellular and humoral immune responses and protection against schistosomes induced by a radiation-attenuated vaccine in chimpanzees

The radiation-attenuated Schistosoma mansoni vaccine is highly effective in rodents and primates but has never been tested in humans, primarily for safety reasons. To strengthen its status as a paradigm for a human recombinant antigen vaccine, we have undertaken a small-scale vaccination and challenge experiment in chimpanzees (Pan troglodytes). Immunological, clinical, and parasitological parameters were measured in three animals after multiple vaccinations, together with three controls, during the acute and chronic stages of challenge infection up to chemotherapeutic cure. Vaccination induced a strong in vitro proliferative response and early gamma interferon production, but type 2 cytokines were dominant by the time of challenge. The controls showed little response to challenge infection before the acute stage of the disease, initiated by egg deposition. In contrast, the responses of vaccinated animals were muted throughout the challenge period. Vaccination also induced parasite-specific immunoglobulin M (IgM) and IgG, which reached high levels at the time of challenge, while in control animals levels did not rise markedly before egg deposition. The protective effects of vaccination were manifested as an amelioration of acute disease and overall morbidity, revealed by differences in gamma-glutamyl transferase level, leukocytosis, eosinophilia, and hematocrit. Moreover, vaccinated chimpanzees had a 46% lower level of circulating cathodic antigen and a 38% reduction in fecal egg output, compared to controls, during the chronic phase of infection

Dihydroartemisinin-Piperaquine Versus Chloroquine in the Treatment of Plasmodium vivax Malaria in Thailand: A Randomized Controlled Trial

The efficacy of chloroquine in the treatment of Plasmodium vivax malaria is declining on the Northwestern border of Thailand. This randomized controlled trial in 500 adults and children shows that dihydroartemisinin-piperaquine is a safe and effective alternative treatment

Investigation of sex-specific effects of apolipoprotein E on severity of EAE and MS

Background Despite pleiotropic immunomodulatory effects of apolipoprotein E (apoE) in vitro, its effects on the clinical course of experimental autoimmune encephalomyelitis (EAE) and multiple sclerosis (MS) are still controversial. As sex hormones modify immunomodulatory apoE functions, they may explain contentious findings. This study aimed to investigate sex-specific effects of apoE on disease course of EAE and MS. Methods MOG35-55 induced EAE in female and male apoE-deficient mice was assessed clinically and histopathologically. apoE expression was investigated by qPCR. The association of the MS severity score (MSSS) and APOE rs429358 and rs7412 was assessed across 3237 MS patients using linear regression analyses. Results EAE disease course was slightly attenuated in male apoE-deficient (apoE −/− ) mice compared to wildtype mice (cumulative median score: apoE −/−  = 2 [IQR 0.0–4.5]; wildtype = 4 [IQR 1.0–5.0]; n = 10 each group, p = 0.0002). In contrast, EAE was more severe in female apoE −/− mice compared to wildtype mice (cumulative median score: apoE −/−  = 3 [IQR 2.0–4.5]; wildtype = 3 [IQR 0.0–4.0]; n = 10, p = 0.003). In wildtype animals, apoE expression during the chronic EAE phase was increased in both females and males (in comparison to naïve animals; p < 0.001). However, in MS, we did not observe a significant association between MSSS and rs429358 or rs7412, neither in the overall analyses nor upon stratification for sex. Conclusions apoE exerts moderate sex-specific effects on EAE severity. However, the results in the apoE knock-out model are not comparable to effects of polymorphic variants in the human APOE gene, thus pinpointing the challenge of translating findings from the EAE model to the human disease