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Effectiveness of treatments for post-traumatic stress disorder for older people:A systematic review and meta-analysis of randomized controlled trials
No full textBackground: Although effective treatments for post-traumatic stress-disorder (PTSD) in adults are well established, research reporting on the effectiveness of treatments for older people remains limited. Aims: To systematically review global evidence reporting on the effectiveness of treatments for PTSD in older adults. Method: We searched several databases for randomized controlled trials on PTSD in older people. Results: From a total of 17,987 search hits, 10 studies met our inclusion criteria; these reported on the effectiveness of narrative exposure therapy (4 trials), Cognitive Behavioural Therapy (2 trials), spiritual-focused psychotherapy (1 trial), life-review therapy (1 trial), collaborative care (1 trial), and physical activity (1 trial). We identified no trials evaluating the effectiveness of pharmacological interventions. Meta-analyses showed that trauma-based psychological treatments improved symptoms of depression (standardised mean difference (SMD) -0.48, 95 % Confidence Interval (CI) -0.74 to -0.23, 7 studies, 504 participants; moderate-certainty evidence) compared to treatment as usual at end of treatment. These interventions also reduced symptoms of PTSD post treatment but certainty of evidence for this outcome was low (SMD -0.29, 95 % CI -0.62 to 0.03, 5 studies, 261 participants). Conclusion: Trauma-based psychological treatments for older people with PTSD are better than treatment as usual in reducing symptoms of depression at post-treatment. These interventions may also reduce symptoms of PTSD, however the quality of evidence remains low. Future large-scale studies are needed to establish which interventions are more likely to be associated with the greatest benefits. Trials evaluating the effectiveness of pharmacological interventions for PTSD in older people are urgently needed
Nonparametric efficiency and artificial intelligence techniques in higher education:a systematic literature review and bibliometric analysis
No full textIn a sector that needs to work as efficient as possible, artificial intelligence (AI) can guide the efficiency improvements of higher education institutions (HEIs). This paper explores both the AI literature and the efficiency literature as applied to HEIs following the Preferred Reporting Items for Systematic Review guidelines. The goal is to identify the relevant research that uses nonparametric efficiency and AI techniques within the HEI sector by examining articles published up to March 2025. Our findings provide a powerful mix of bibliometric and systematic literature review results that identify the main trends common to these two strands of research. The analysis highlights a long-standing tradition of applying nonparametric efficiency analysis to the sector, as it is attracting the increasing attention of AI scholars. We outline the substantial evidence that reveals much room for improvement in efficiency in the HEI sector, and how the application of AI may be well-suited. This is particularly evident as AI can support efficiency evaluations, particularly in handling tasks that traditional efficiency techniques alone cannot perform. A key contribution of this work is the identification of the opportunities for further research focus within this critical intersection between the two fields, which can inform both HEI administrators and policymakers
Willingness to pay for animal welfare across labels, products, consumers, and time
No full textIn recent years, the number of labels indicating improved animal welfare conditions on meat products has increased making it difficult for consumers to understand, evaluate, and compare husbandry conditions across products. Based on a discrete choice experiment implemented in three cross-section surveys over a period of 15 months with a total of 6000 German respondents, we estimate the willingness to pay (WTP) for various levels of animal welfare associated with different meat products. We use three existing labels with overlapping animal welfare requirements mimicking the situation in the German meat market: The well-established organic label as well as a binary animal welfare label by the Animal Welfare Initiative and a multi-level animal husbandry label which were introduced in Germany in 2015 and 2019, respectively. We show that the multi-level label scheme leads to more product differentiation and, subsequently, higher WTP estimates. WTP further depends on meat type, where animal welfare improvements for beef and chicken products are valued much higher compared to those for pork. WTP for the organic and the highest level of the husbandry label increases with higher household incomes. WTP for these labels on chicken is also higher among women
Rethinking Workplace-Based Assessment:The Costly Illusion of Authenticity
No full textThe current practice of workplace-based assessment (WBA) in many health professions education contexts does not live up to the expectations regarding WBA's both formative (for learning) and summative (for decision-making) potential. In this Scholarly Perspective, the authors argue that the ambition to observe and assess so-called authentic behavior of trainees plays a role in this. According to the literature, for assessments in the workplace to be valid, direct observation of authentic behavior of trainees performing authentic clinical work is key. Guidelines, therefore, advise supervisors to observe their trainees silently from a distance, while avoiding direct eye contact with the patient. If these guidelines are followed, trainee-patient-supervisor situations that could be used for teaching in dialogue, with bidirectional observations, must be transformed into distanced, silent, unidirectional assessments. Research outcomes, however, suggest that direct observation and assessment of true authentic behavior of trainees in true authentic clinical work is an illusion; the presence of an observing supervisor, however distanced, changes the situation and, with that, the conduct of the trainee. Additionally, this illusion is costly because distancing the supervisor from the trainee comes at the expense of teaching and learning in dialogue. Although assessments in the workplace may serve summative purposes, they do not fit well with formative goals of health professions education. Therefore, WBA's current central position in health professions education, which is based on both its summative and formative promises, should be questioned. More specifically, the prominent role of assessment when supervisors are present while their trainee works with a patient should be reconsidered. The authors propose to use these trainee-patient-supervisor situations predominantly for teaching and learning, with bidirectional direct observation and dialogue, and then determine the needs for and purposes of assessment
Hyperglycaemia does not modify the efficacy of endovascular therapy in the late time window (6-24 hours)
No full textIntroduction: Hyperglycemia is common in ischemic stroke. Admission glucose modifies the effect of endovascular therapy (EVT) in patients with ischemic stroke of the anterior circulation, who are treated 0 to 6 hours since onset. Whether this also applies for late-window EVT (6–24 hours since symptom onset or last known well) is unknown. In this study, we assessed whether admission glucose level and/or hyperglycemia modifies the EVT effect in patients with ischemic stroke of the anterior circulation in the late time window. Methods: We used data from the MR CLEAN LATE trial. The primary outcome measure was the modified Rankin Scale (mRS) score at 90 days. Secondary outcome measures were symptomatic intracranial hemorrhage and mortality at 90 days. Treatment effect modification of EVT by either glucose or hyperglycemia on admission was assessed by multiplicative interaction factors with logistic regression analysis and adjusted for potential confounders. Hyperglycemia was defined as glucose level >7.8 mmol/L on admission. Results: On admission, median glucose was 7.0 mmol/L (IQR 6.0–8.3 mmol/L), and 147 patients (32%) were hyperglycemic. We found no interaction of either hyperglycemia or serum glucose on admission with treatment effect on functional outcome (p = 0.76 and p = 0.79, respectively), symptomatic intracranial hemorrhage (p = 0.29 for hyperglycemia; p = 0.57 for glucose on admission), and for mortality (p = 0.52 for hyperglycemia; p = 0.69 for glucose on admission). Conclusion: We found no evidence for effect modification of EVT by admission glucose level or hyperglycemia in patients with acute ischemic stroke and large-vessel occlusion of the anterior circulation in the late treatment window.</p
Mitral valve treatment for mitral valve regurgitation:The past, the present and the future - A challenge for the surgeon and the imager
No full textHolding the EU Accountable for Environmental Law Violations: Legitimacy Assets, ‘Complete’ System of Remedies and Unexplored Pathways
No full textWithin the EU, a complex web of legal avenues exists to address breaches of environmental law. This paper critically examines the judicial and non-judicial mechanisms available for litigating such breaches, focusing on the ‘legitimacy assets’ that characterize these mechanisms: independence, accessibility, material scope, and powers. This contribution therefore delves into the action for annulment and the preliminary reference procedure before the Court of Justice of the European Union (CJEU), the internal review procedure foreseen under the Aarhus Regulation, the complaint before the European Ombudsman (EO), the review mechanism of the Aarhus Convention Compliance Committee (ACCC), and the possibility of bringing cases to the European Court of Human Rights (ECtHR). It reveals strong suits and drawbacks for each avenue, ultimately advocating for a renewed attention for the non-judicial mechanisms
The influence of School principals’ management on school efficiency:Evidence from Italian schools
No full textThis paper investigates the relationship between school principals’ managerial practices and two key dimensions of school performance: students’ cognitive outcomes and school climate. School performance is assessed using a classical Data Envelopment Analysis (DEA) framework, complemented by both unconditional robust and conditional robust models to evaluate the influence of managerial practices on school efficiency. We introduce a methodological innovation that allows for a nuanced analysis of how contextual variables – specifically, principals’ managerial practices – affect performance, both individually and through their interactions. The analysis is based on 2019 INVALSI data from a nationally representative sample of 8th grade students in Italian schools. The findings show that principals’ practices, as well as the ways in which these practices interact, play a significant role in shaping school efficiency, particularly by promoting a positive and supportive school climate
School nutrition programs in Dubai:a landscape analysis
No full textBACKGROUND: Little is known about the execution of School Nutrition Programs (SNPs) within schools across the public and private sectors in Dubai, United Arab Emirates. This highlights the importance of capturing an inside perspective about the specificities of the SNPs in order to ensure their effective, efficient, and equitable implementation across schools, irrespective of whether they are public or private. OBJECTIVE: The overall purpose of this study was to develop insight into SNPs in Dubai, and to investigate the difference in characteristics of those SNPs, between the public and private sectors. METHODS: This study relied on a quantitative tailor-made survey. The data were analyzed using SPSS; descriptive analysis consisted of computing the proportions for all the variables. In terms of inferential analysis, chi-square test of independence was selected to determine whether there are associations between the categorical variables (i.e., the various characteristics of the SNPs, and whether the corresponding schools are public or private). RESULTS: Out of 75 school representatives who were invited to participate in the current study, 60 responded, of whom 48 school representatives indicated that their respective schools had SNPs. These 48 SNPs had varying implementation scopes and program compositions (i.e., combination of initiatives) of Parents' Involvement, Lunch Box, Educational Curriculum, Hydration, Awareness Activities, School Canteen, and/ or Food Safety and Hygiene. The stakeholders involved in developing and maintaining the respective SNPs and the intended outcomes of those programs also differed across the schools. CONCLUSION: This study highlights, in alignment with Sustainable Development Goals 3, 4, 9 and 17, the importance of the proposed reformation around SNPs in Dubai to take into account the governance structure on the local and national levels, quality assurance measures, stakeholder engagement, and programs' intended outcomes and compositions. It proposes the enactment and maintenance of holistic, school-level healthy living programs that include nutrition as part of a more comprehensive approach to fostering the students' individual and collective wellbeing