174 research outputs found
Copenhagen Diabetes Consensus (CODIAC) 2021: user involvement in diabetes care, prevention and research
No full textAimsUser involvement is pivotal for health development, but there are significant gaps in our understanding of the concept. The Copenhagen Diabetes Consensus on User Involvement in Diabetes Care, Prevention and Research (CODIAC) was established to address these gaps, share knowledge and develop best practices.MethodsA literature review of user involvement was undertaken in diabetes care, prevention and research. Moreover, a Group Concept Mapping (GCM) survey synthesized the knowledge and opinions of researchers, healthcare professionals and people with diabetes and their carers to identify gaps between what is important for user involvement and what is being done in practice. Finally, a consensus conference discussed the main gaps in knowledge and practice while developing plans to address the shortcomings.ResultsThe literature review demonstrated that user involvement is an effective strategy for diabetes care, prevention and research, given the right support and conditions, but gaps and key challenges regarding the value and impact of user involvement approaches were found. The GCM process identified 11 major gaps, where important issues were not being sufficiently practised. The conference considered these gaps and opportunities to develop new collaborative initiatives under eight overall themes.ConclusionsUser involvement is effective and adds value to diabetes care, prevention and research when used under the right circumstances. CODIAC developed new learning about the way in which academic and research knowledge can be transferred to more practice-oriented knowledge and concrete collaborative initiatives. This approach may be a potential new framework for initiatives in which coherence of process can lead to coherent outputs
Learning from biophysical heterogeneity: inductive use of case studies for maize cropping systems in Central America
No full textGlobal society has become conscious that efforts towards securing food production will only be successful if agricultural production increases are obtained through mechanisms that ensure active regeneration of the natural resource base. Production options should be targeted in the sense of that their suitability to improve agricultural production and maintain natural resources is evaluated prior to their introduction. Biophysical targeting evaluates production options as a function of the spatial and temporal variability of climate conditions, in interaction with soil, crop characteristics and agronomic management strategies. This thesis contributes to the development of a system-based methodology for biophysical targeting. Cropping system simulation and weather generator tools are interfaced to geographical information systems. Inductive use of two case studies - a green manure cover crop and reduced tillage with residue management - helped to develop the methodology. Insight is gained into the regional potential for and the soil and climate conditions under which successful introduction of these production options may be achieved. The resulting information supports regional stakeholders involved in agriculture in their analysis and discussion, negotiation and decision-making concerning where to implement production systems. This process can improve the supply of appropriate agricultural production practices that enhance production and conserve soil and water resources
Exploring sustainable technical alternatives for Dutch dairy systems by integrating agro-economic modelling and public preferences assessment
No full textTheoretical discussions on the joint consideration of multiple (economic, social and environmental) functions when assessing the sustainability of human actions are increasing. However few studies exist that integrate the social demand for multifunctional agriculture in the evaluation of the sustainability and the global welfare of society. This paper presents a methodology to answer to these questions: Which are the social demands for the multiple functions of agriculture and how can they be quantified?; Which are the feasible technical alternatives of land management to satisfy these demands?; What is the value of the land use alternatives according to social preferences and which alternatives optimally satisfy the social preferences?. The net utility of alternatives for society, and therefore their sustainability, will be measured as the sum of market and non-market net changes compared to the current situation. The proposed methodology combines economic valuation, integrated modelling, stakeholder analysis, and multi-criteria evaluation. In particular, different multi-criteria methods (QFD/ANP) and agro-economic modelling and optimizing tools (Landscape IMAGES) were used. The methodology will be fully illustrated through the case study of dairy farming landscapes in the Northern Friesian Woodlands, The Netherlands. Results show that for the case study it is possible to change current farming techniques and achieve more sustainable farming systems. The more sustainable alternatives are beneficial for farmers, obtaining higher gross margin, and for government, decreasing the current levels of subsidies in agri-environmental programs. Even current environmental restrictions can be slightly relaxed without compromising social demands to the analysed Dutch dairy farming systems.Land-use planning, public preferences, agro-economic models, Environmental Economics and Policy, Livestock Production/Industries,
Aortic Pulsatility Index: A New Haemodynamic Measure with Prognostic Value in Advanced Heart Failure
No full textAim: To test if the newly described haemodynamic variable, aortic pulsatility index (API), predicts long-term prognosis in advanced heart failure (HF). Methods: A single-centre study on 453 HF patients (median age: 51 years; left ventricular ejection fraction [LVEF]: 19% ± 9%) referred for right heart catheterisation. API was calculated as pulse pressure/pulmonary capillary wedge pressure. Results: Log(API) correlated significantly with central venous pressure (CVP; p<0.001) and cardiac index (p<0.001) in univariable regression analysis. CVP remained associated with log(API) in a multivariable analysis including cardiac index, heart rate, log(NT-proBNP [N-terminal proB-type natriuretic peptide]), LVEF, New York Heart Association (NYHA) class III or IV and sex (p=0.01). In univariable Cox models, log(API) was a significant predictor of freedom from the combined endpoint of death, left ventricular assist device implantation, total artificial heart implantation or heart transplantation (HR 0.33; (95% CI [0.22–0.49]); p<0.001) and all-cause mortality (HR 0.56 (95% CI [0.35–0.90]); p=0.015). After adjusting for age, sex, NYHA class III or IV and estimated glomerular filtration rate in multivariable Cox models, log(API) remained a significant predictor for the combined endpoint (HR 0.33; 95% CI [0.20–0.56]; p<0.001) and all-cause mortality (HR 0.49; 95% CI [0.26–0.96]; p=0.034). Conclusion: API was strongly associated with right-sided filling pressure and independently predicted freedom from the combined endpoint and all-cause mortality
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