Advising From a Constructive Developmental Perspective

Advisors can enhance development by, first, identifying student\u27s meaning-making assumptions and, second, challenging those assumptions while offering support as students struggle to increase the complexity of meaning making. Constructive developmental theory is offered as a useful framework from which to encourage greater student ownership of the educational planning process. Methods of assessing and enhancing development are suggested. Two cases that depict advising from the constructive developmental perspective are offered

Multi-scale integrated evaluation of the sustainability of large-scale use of alternative feeds in salmon aquaculture

The steady increase in production volume of salmon aquaculture has sharpened concerns about its sustainability. In particular the production of salmon feed is a reason for concern given its reliance on scarce natural resources, such as wild fish captures. Multi-scale integrated analysis is put forward as a tool to anticipate the environmental and socio-economic impacts of large-scale implementation of alternative salmon feeds, considering both plant and insect sources as potential replacements of fish meal and fish oil. The proposed accounting framework, based on relational analysis across hierarchical levels, describes the patterns of required inputs using biophysical and economic variables. It also considers the inputs used by external systems for the production of imported feed, thus providing a coherent assessment of the sustainability of the production system in terms of feasibility, viability, and desirability. The analytical tool-kit is illustrated in conceptual terms and then applied to the Norwegian salmon aquaculture, both in diagnostic (describing the actual situation) and anticipatory mode (examining feed scenarios). Results are used in an exercise of quantitative story-telling to check the quality of the narratives currently shaping policy discussions on aquaculture. Quantitative story-telling is a heuristic approach aimed at checking the robustness of knowledge claims in face of uncertainty. It is concluded that rearing insects in the salmon feed production chain enlarges the option space of feed sources by opening up the possibility of using locally-produced seaweed and organic waste, but also raises the level of uncertainty with regard to the possible insurgence of negative side effects.publishedVersio

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Precision medicine and the principle of equal treatment: a conjoint analysis

Background In precision medicine biomarkers stratify patients into groups that are offered different treatments, but this may conflict with the principle of equal treatment. While some patient characteristics are seen as relevant for unequal treatment and others not, it is known that they all may influence treatment decisions. How biomarkers influence these decisions is not known, nor is their ethical relevance well discussed. Methods We distributed an email survey designed to elicit treatment preferences from Norwegian doctors working with cancer patients. In a forced-choice conjoint analysis pairs of hypothetical patients were presented, and we calculated the average marginal component effect of seven individual patient characteristics, to estimate how each of them influence doctors’ priority-setting decisions. Results A positive biomarker status increased the probability of being allocated the new drug, while older age, severe comorbidity and reduced physical function reduced the probability. Importantly, sex, education level and smoking status had no significant influence on the decision. Conclusion Biomarker status is perceived as relevant for priority setting decisions, alongside more well-known patient characteristics like age, physical function and comorbidity. Based on our results, we discuss a framework that can help clarify whether biomarker status should be seen as an ethically acceptable factor for providing unequal treatment to patients with the same disease

Multi-scale integrated evaluation of the sustainability of large-scale use of alternative feeds in salmon aquaculture

The steady increase in production volume of salmon aquaculture has sharpened concerns about its sustainability. In particular the production of salmon feed is a reason for concern given its reliance on scarce natural resources, such as wild fish captures. Multi-scale integrated analysis is put forward as a tool to anticipate the environmental and socio-economic impacts of large-scale implementation of alternative salmon feeds, considering both plant and insect sources as potential replacements of fish meal and fish oil. The proposed accounting framework, based on relational analysis across hierarchical levels, describes the patterns of required inputs using biophysical and economic variables. It also considers the inputs used by external systems for the production of imported feed, thus providing a coherent assessment of the sustainability of the production system in terms of feasibility, viability, and desirability. The analytical tool-kit is illustrated in conceptual terms and then applied to the Norwegian salmon aquaculture, both in diagnostic (describing the actual situation) and anticipatory mode (examining feed scenarios). Results are used in an exercise of quantitative story-telling to check the quality of the narratives currently shaping policy discussions on aquaculture. Quantitative story-telling is a heuristic approach aimed at checking the robustness of knowledge claims in face of uncertainty. It is concluded that rearing insects in the salmon feed production chain enlarges the option space of feed sources by opening up the possibility of using locally-produced seaweed and organic waste, but also raises the level of uncertainty with regard to the possible insurgence of negative side effects

Transmission of HIV drug resistance and the predicted effect on current first-line regimens in Europe

Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%-9.5%) in 2008-2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected