Characterisation framework of key policy, regulatory and governance dynamics and impacts upon European food value chains: Fairer trading practices, food integrity, and sustainability collaborations. : VALUMICS project “Understanding Food Value Chains and Network Dynamics” funded by EU Horizon 2020 G.A. No 727243. Deliverable D3.3

The report provides a framework that categorises the different European Union (EU) policies, laws and governance actions identified as impacting upon food value chains in the defined areas of: fairer trading practices, food integrity (food safety and authenticity), and sustainability collaborations along food value chains. A four-stage framework is presented and illustrated with examples. The evidence shows that European Union policy activity impacting upon food value chain dynamics is increasing, both in terms of the impacts of policies upon the chains, and, in terms of addressing some of the more contentious outcomes of these dynamics. A number of policy priorities are at play in addressing the outcomes of food value chain dynamics. unevenness of the distribution of profit within food value chains, notably to farmers. Regulation of food safety and aspects of authenticity has been a key focus for two decades to ensure a functioning single market while ensuring consumer health and wellbeing. A food chain length perspective has been attempted, notably through regulations such as the General Food Law, and the rationalisation of the Official Controls on food and feed safety. However, there are still gaps in the effective monitoring and transparency of food safety and of food integrity along value chains, as exemplified by misleading claims and criminal fraud. This has led to renewed policy actions over food fraud, in particular. EU regulations, policies and related governance initiatives provide an important framework for national-level actions for EU member states and for EEA members. The more tightly EU-regulated areas, such as food safety, see fewer extra initiatives, but where there is a more general strategic policy and governance push, such as food waste reduction or food fraud, there is greater independent state-level activity. Likewise, there is much more variation in the application of both national and European (Competition) law to govern unfair trading practices impacting upon food value chains. This report presents the findings of a survey of members from the VALUMICS stakeholder platform, that were policy facing food value chain stakeholders across selected European countries, including both EU and EEA Member States. The survey was conducted to check the significance of the main policies identified in the mapping exercise at EU and national levels and so to incorporate the views of stakeholders in the research. The responses suggest the policy concerns identified in EU and national-level research resonate with food value chain stakeholders in participating nations. The report concludes by exploring in more detail how the themes of fairness and of transparency are being handled in the policy activities presented. Highlighted are the ways that both fairness and transparency can be extended within the existing frameworks of EU policy activity. The findings in this report provide an important context for further and detailed research analysis of the workings and dynamics of European food value chains under the VALUMICS project

Allostery and GroEL: Exploring the Tenets of Nested Cooperativity

Despite a wealth of structural and biochemical studies on the functional cycle of the <i>E. coli</i> chaperonins GroEL and GroES, no model proposed to date accounts for all the effects seen experimentally by the various allosteric ligands: ATP, ADP, SP, GroES, and K+. The work in this dissertation explores the various allosteric transitions in the GroEL reaction cycle and offers a refined model for nested cooperativity that successfully accounts for the effects of these ligands. Initial studies take advantage of a single ring variant, termed SR1, to examine the allosteric properties of GroEL in the absence of complicating interactions arising from negative cooperativity. Initial rates of ATP hydrolysis by GroEL and SR1 as a function of ATP concentration were fit to an equation that makes no arbitrary assumptions. A novel role for K+ and SP is proposed, which suggests they help regulate the negative cooperativity and control the timing of the chaperonin cycle. The kinetics of association of GroES to the trans ring of the asymmetric complex were also studied, using stopped flow fluorescence energy transfer (FRET), revealing that conditions which accelerate dissociation of the cis ligands also accelerate association to the trans ring. This, along with previous work obtained by our lab, suggests that the allosteric signal transmitted between the rings for cis ligand release is the binding of ATP to the T state of the trans ring. A mechanism for the formation of symmetrical particles, termed "footballs," is suggested

An Interprofessional Approach to Teaching Evidence-based Practice

Purpose: The purpose of this mixed methods study was to identify students’ engagement and implementation of EBP competencies after exposure to EBP content in an interprofessional online research course. In this research, a diverse, convenience sample of nursing, respiratory care, and social work students were selected. The results aim to assist educators in preparing the next generation for their first professional role in providing care using the best evidence. The research questions that guided the study were: (1) What are the levels of practice, attitude, knowledge and skill regarding EBP among the sample? (2) What are the barriers and facilitators to acquiring EBP competency? (3) What are the differences in EBP attitudes, knowledge, and skills between the diverse disciplines in the sample? Methods: This descriptive mixed methods study employed a cross sectional design that allowed comparisons of programs and the different levels within the program. Quantitative data was collected using the S-EBPQ survey, allowing participants’ the opportunity to self-report on the practice, attitude, and knowledge/skills. Qualitative data was collected through two focus groups of approximately six to ten students from the three programs. Results: Data showed that students within the three selected disciplines had a positive attitude towards EBP. Theme analysis supported this view as participants noted EBP impacts patient safety and quality care. Barriers identified included, “lack of resources, use of research language interchangeably with EBP, quick exposure to EBP and confusion among EBP practices in the clinical setting.” Participants had an awareness of EBP and recognized the value of EBP. However, there may be ways to improve the implementation of EBP throughout the learning process while students are in undergraduate studies. Conclusion: Using an interprofessional online research course to introduce students to EBP was successful. Providing an interprofessional approach to teaching EBP will provide support the implementation of EBP competencies. Further development of additional interprofessional EBP courses or activities should be considered. This study found that if interprofessional care teams’ work together and use the EBP process in their courses it will improve student perceived value of EBP

Genetic Insights into Aging and Age-Related Diseases among Varied Pedigree Structures.

Older age is associated with decline in many physiological functions that eventually lead to increased susceptibility to diseases. The rate of aging varies among individuals and may be influenced by genes. This dissertation has three aims: 1) define a measure of aging using physiologic traits and determine its heritability among various pedigree structures, 2) investigate genetic associations with the age trait using genome-wide association study analyses, and 3) focus on decline in kidney function by examining its association with known kidney loci and clinical risk factors within the SardiNIA Study on Aging. Using data from five genetic cohorts (30,000+ individuals) with varying pedigree structure (SardiNIA Study on Aging – large pedigrees, Framingham Heart Study offspring – small pedigrees, Atherosclerotic Risk in Communities Study – unrelated, and two twins studies: Twingene and TwinsUK), two aging traits were developed. Both traits employ three physiologic health measures (kidney function, systolic blood pressure, and waist circumference) to estimate an individual’s biologic age and contrast it with actual age. Linear mixed modeling was employed to estimate a predicted age, while Cox models were used to estimate a risk age equivalent to the age of the census population with the same mortality risk. Using Merlin software (Abecasis, 2002), both age traits were found to be heritable in all cohorts with h2 estimates of 0.25 to 0.68, depending on pedigree structure. Meta-analysis revealed a genome-wide significant association (p < 5 x 10-8) within the LRP1B gene on chromosome 2. LRP1B produces low density lipoprotein receptor-related protein 1B and has been previously associated with tumor suppression, metabolic traits, and successful aging. Association analyses were also conducted using a genetic risk score for CKD, adjusting for clinical factors, with CKD prevalence and change in kidney function. One additional allele in the genetic risk score for CKD was significantly associated with CKD prevalence (OR=1.07, p=0.001), decline in eGFR (β=-0.23, p=0.004), and eGFR decline > 1 SD (OR=1.05, p=0.04). These findings further our understanding of the genetics of aging and the CKD risk score results suggest a possible clinical utility. Putting the findings into clinical use should be evaluated.PHDEpidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/97920/1/jennb_1.pd

A principal component meta-analysis on multiple anthropometric traits identifies novel loci for body shape

Large consortia have revealed hundreds of genetic loci associated with anthropometric traits, one trait at a time. We examined whether genetic variants affect body shape as a composite phenotype that is represented by a combination of anthropometric traits. We developed an approach that calculates averaged PCs (AvPCs) representing body shape derived from six anthropometric traits (body mass index, height, weight, waist and hip circumference, waist-to-hip ratio). The first four AvPCs explain \u3e99% of the variability, are heritable, and associate with cardiometabolic outcomes. We performed genome-wide association analyses for each body shape composite phenotype across 65 studies and meta-analysed summary statistics. We identify six novel loci: LEMD2 and CD47 for AvPC1, RPS6KA5/C14orf159 and GANAB for AvPC3, and ARL15 and ANP32 for AvPC4. Our findings highlight the value of using multiple traits to define complex phenotypes for discovery, which are not captured by single-trait analyses, and may shed light onto new pathways

Body mass index change and estimated glomerular filtration rate decline in a middle-aged population: health check-based cohort in Japan

Background: Obesity is a growing public health problem worldwide. We evaluated the mediators and association between changes in obesity metrics and renal outcomes in the general population. Methods: Using the Japanese nationwide health check-based cohort from April 2011 to March 2019, we selected individuals aged 40–74 years, with a baseline estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m2, whose body mass index (BMI) change was assessed. The primary outcome was combined 30% decline in eGFR, eGFR 4%) mediated by three risk factors (blood pressure, haemoglobin A1c and total cholesterol), was 13.3%. Conclusion: In the middle-aged Japanese population, both, increase and decrease in BMI were associated with subsequent eGFR decline. Changes in risk factors mediated a small proportion of the association between BMI increase and eGFR decline. Our findings support the clinical significance of monitoring BMI as a renal risk factor

The cost of procuring deceased donor kidneys: Evidence from OPO cost reports 2013-2017

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154616/1/ajt15669_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154616/2/ajt15669.pd

Changes in anemia management and hemoglobin levels following revision of a bundling policy to incorporate recombinant human erythropoietin

In April 2006, Japan's health insurance system instituted a bundling policy that included recombinant human erythropoietin (rHuEPO) in outpatient hemodialysis therapy. To evaluate outcomes of this, we analyzed a prospective cohort of hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study, in 53 facilities using prevalent cross-sections of 1584 patients before and 1622 patients after the rHuEPO reimbursement change. Patient data included hemoglobin levels, iron management profiles, and anemia treatment with rHuEPO and intravenous iron. No significant differences were found in pre- or post-policy cross-sections for hemoglobin distributions or the percentage of patients prescribed rHuEPO. Among patients receiving rHuEPO, the mean dose significantly decreased by 11.8 percent. The percentage of patients prescribed intravenous iron over 4months significantly increased; however, the mean dose of iron did not significantly change. Thus, this bundling policy was associated with reduced rHuEPO doses, increased intravenous iron use, and stable hemoglobin levels in Japanese patients receiving hemodialysis

Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: The DOPPS

Patterns of hepatitis B prevalence and seroconversion in hemodialysis units from three continents: The DOPPS.BackgroundHepatitis B (HBV) historically has been a public health issue within hemodialysis units. This study estimates HBV prevalence and seroconversion rates across seven countries and investigates associations with facility level practice patterns.MethodsThe study sample was from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a cross-sectional, prospective, observational study of adult hemodialysis patients randomly selected from 308 dialysis facilities in France, Germany, Italy, Spain, the United Kingdom, Japan, and the United States. Logistic regression was used to model the odds ratio (OR) of HBV prevalence, and Cox regression was used to model time from entry into the study to HBV seroconversion.ResultsIn this sample, mean HBV facility prevalence was 3.0% with a median of 1.9%. The percentage of facilities with an HBV prevalence 0% to 5% was 78.5%. Adjusted HBV prevalence was higher in France, Germany, and Italy and lower in Japan and the United Kingdom. The majority of facilities (78.1%) had a seroconversion rate of 0 conversions per 100 patient-years. Presence of a protocol for HBV-infected patients was significantly associated with HBV seroconversion in the separate practice pattern model [risk ratio (RR) = 0.52, P = 0.03] and in the combined practice pattern model (RR = 0.44, P = 0.01).ConclusionThere are differences in HBV prevalence and rate of seroconversion both at the country and the hemodialysis facility level. Presence of a protocol for HBV-infected patients was strongly and significantly associated with decreased risk for seroconversion. The observed variation suggests opportunities for improved HBV outcomes with further definition of optimal practice patterns at the facility level