The interconnected dynamics of social practices and their implications for transformative change: A review

This review article analyses the interconnectedness of different fields of social practice. Our aim is to understand if and how the literature using social practice theory addresses these interrelations and how this is linked to questions of sustainability transformations. Based on our review, we suggest a framework that conceives everyday-life practices of working, dwelling, mobility, eating, and recreation as closely intertwined and not changing independently of each other. As our analysis demonstrates, such a framing also contributes to better understanding the dynamics of (un)sustainable transformative change. Greater sustainability cannot be achieved by technological fixes or changes in individual behaviour alone but requires comprehensive interventions that address the interactions between practices, as these often co-evolve and co-locate, and changes need to be aligned between different practice fields. This has high relevance for understanding the development of public policy interventions that aim to increase the sustainability of everyday life. Our review shows a significant value of social practice research on the interconnectedness of different practice fields, although certain areas still appear to be somewhat neglected, such as the interconnectedness of work-related practices with other practices of everyday life. It furthermore points to the potential contribution of studies of interconnected practices to the literature on sustainability transitions, a perspective otherwise neglected in transition studies focusing on organisational actors and institutional dimensions of socio-technical change

The interconnected dynamics of social practices and their implications for transformative change : A review

This review article analyses the interconnectedness of different fields of social practice. Our aim is to understand if and how the literature using social practice theory addresses these interrelations and how this is linked to questions of sustainability transformations. Based on our review, we suggest a framework that conceives everyday life practices of working, dwelling, mobility, eating, and recreation as closely intertwined and not changing independently of each other. As our analysis demonstrates, such a framing also contributes to better understanding the dynamics of (un)sustainable transformative change. Greater sustainability cannot be achieved by technological fixes or changes in individual behaviour alone but requires comprehensive interventions that address the interactions between practices, as these often co-evolve and co-locate, and changes need to be aligned between different practice fields. This has high relevance for understanding the development of public policy interventions that aim to increase the sustainability of everyday life. Our review shows a significant value of social practice research on the interconnectedness of different practice fields, although certain areas still appear to be somewhat neglected, such as the interconnectedness of work-related practices with other practices of everyday life. It furthermore points to the potential contribution of studies of interconnected practices to the literature on sustain ability transitions, a perspective otherwise neglected in transition studies focusing on organisational actors and institutional dimensions of socio-technical change.Funding: NIFU Nordic Institute for Studies in Innovation, Research and EducationLicensing: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).</p

An evaluation of the effectiveness of perampanel in people with epilepsy who have previously undergone resective surgery and/or implantation of a vagal nerve stimulator.

About 30% of people with epilepsy (PWE) are drug-resistant. Those with focal seizures may be suitable for epilepsy surgery. Those not amenable to resective surgery can be considered for vagus nerve stimulation (VNS). However, after operative procedures, around 50% of patients continue to experience seizures. A multi-center retrospective study assessing perampanel effectiveness and tolerability for PWE who have undergone surgical resection and/or VNS implantation was performed. The primary outcome was ≥50% reduction in seizure frequency while secondary outcomes included side effects (SEs), dose-related effectiveness, and toxicity. The median perampanel dose was 6 mg. Only one PWE became seizure free. A ≥50% decrease in seizure frequency was observed in 52.8% of the post-resection group and 16.9% of the VNS group (p < 0.001), while SEs were seen in 44.8% and 41.1%, respectively. Perampanel doses greater than 8 mg led to better response in both groups, especially in the post-VNS cohort. SEs were not dose-related and the safety profile was similar to previous observational studies. Perampanel can be beneficial in these two super-refractory epilepsy groups, particularly in PWE with seizures after surgical resection. Doses of more than 8 mg appear to be well tolerated and may be more effective than lower doses in PWE after surgical interventions

Perampanel in routine clinical use across Europe: Pooled, multicenter, observational data

OBJECTIVE: To pool observational data on the routine use of perampanel to obtain information on real-world outcomes and data in populations typically underrepresented in clinical trials. METHODS: Individual-level data of people with epilepsy treated with perampanel at 45 European centers were merged into a single dataset. Prespecified outcomes were: 1-year retention rate, 1-year seizure freedom rate (duration ≥6 months), and incidence of treatment-emergent adverse events (TEAEs). In addition, relationships were explored with logistic regression analyses. RESULTS: The full analysis set comprised 2396 people: 95% had focal seizures; median epilepsy duration was 27 years; median number of concomitant antiepileptic drugs (AEDs) was 2; and median prior AEDs was 6. One-year retention rate was 48% (1117/2332; 95% confidence interval [CI] 46-50%), and 1-year seizure-free rate (≥6-month duration) was 9.2% (74/803; 95% CI 7-11%). Median treatment duration was 11.3 months (1832 patient-years); median dose was 8 mg. In 388 individuals with available data at 3, 6, and 12 months, responder rates were 42%, 46%, and 39%, respectively. During the first year, TEAEs were reported in 68% of participants (1317/1497; 95% CI 66-70%). Logistic regression found higher age at perampanel initiation was associated with higher seizure-free rate, and higher number of prior AEDs with lower seizure-free rate and lower rates of somatic TEAEs. In 135 individuals aged ≥65 years, 1-year retention rate was 48% and seizure-free rate was 28%. SIGNIFICANCE: Across a large, treatment-resistant population, add-on perampanel was retained for ≥1 year by 48% of individuals, and 9% were seizure-free for ≥6 months. TEAEs were in line with previous reports in routine clinical use, and less frequent than in the clinical trial setting. No new or unexpected TEAEs were seen. Despite the limitations of observational studies, our data indicate that some individuals may derive a marked benefit from the use of perampanel