Developing and evaluating cognitive remediation therapy (CRT) for adolescents with anorexia nervosa: A feasibility study

Background: Cognitive Remediation Therapy (CRT) aims at improving neuropsychological weaknesses and associated thinking styles in patients with anorexia nervosa (AN). It has only recently been developed for adolescents with AN, and evidence of its applicability for this particular patient group is limited. This study aimed to test the feasibility of individually tailored and delivered CRT for young females with AN. Methods: A sample of 20 in- and outpatients (13–18 years) with AN participated in once- or twice weekly individual CRT sessions. The CRT materials used were available in a “CRT Resource Pack.” Feasibility was assessed with regards to the recruitment process, the delivery of the intervention, the materials used and clinical experiences. Results: Overall results indicate that the intervention was feasible with regards to (a) the recruitment of both in- and outpatients, (b) individual tailoring and delivery, (c) the CRT materials adapted to suit young females with AN, and (d) the acceptability for clinicians involved in the study. There were no voluntary dropouts, with 19 of 20 patients completing the entire course of treatment. Conclusions: The findings have implications for the refinement of CRT for the youngest AN population, and strengthens our understanding of the core components in the development and evaluation of novel interventions targeting AN. This study will help inform the design of a subsequent randomized controlled trial. © The Author(s) 2013. Published by SAGE Publications

a prospective cohort study

Background The effects of target temperature management (TTM) on the heart aren’t thoroughly studied yet. Several studies showed the prolongation of various ECG parameters including Tpeak-Tend-time under TTM. Our study’s goal is to evaluate the acute and long-term outcome of these prolongations. Methods In this study we included patients with successful resuscitation after cardiac arrest who were admitted to the Charité Virchow Klinikum Berlin or the Heart and Vascular Centre of the Ruhr University Bochum between February 2006 and July 2013 (Berlin) or May 2014 to November 2015 (Bochum). For analysis, one ECG during TTM was recorded after reaching the target temperature (33–34 °C) or in the first 6 h of TTM. If possible, another ECG was taken after TTM. The patients were being followed until February 2016. Primary endpoint was ventricular arrhythmia during TTM, secondary endpoints were death and hospitalization due to cardiovascular diseases during follow-up. Results One hundred fifty-eight patients were successfully resuscitated in the study period of which 95 patients had usable data (e.g. ECGs without artifacts). During TTM significant changes for different parameters of ventricular de- and repolarization were noted: QRS (103.2 ± 23.7 vs. 95.3 ± 18.1; p = 0.003),QT (405.8 ± 76.4 vs. 373.8 ± 75.0; p = 0.01), QTc (474.9 ± 59.7 vs. 431.0 ± 56.8; p < 0.001), JT (302.8 ± 69.4 vs. 278.5 ± 75.2; p = 0.043), JTc (354.3 ± 60.2 vs. 318.7 ± 59.1; p = 0.001). 13.7% of the patients had ventricular arrhythmias during TTM, however these patients showed no difference regarding their ECG parameters in comparison to those were no ventricular arrhythmias occurred. We were able to follow 69 Patients over an average period of 35 ± 31 months. The 14 (21.5%) patients who died during the follow-up had significant prolongations of the TpTe-time in the ECGs without TTM (103.9 ± 47.2 vs. 75.8 ± 28.6; p = 0.023). Conclusion Our results show a significant prolongation of ventricular repolarization during TH. However, there was no significant difference between the ECG parameters of those who developed a ventricular arrhythmia and those who did not. The temporary prolongation of the repolarization during TTM seems to be less important for the prognosis of the patient. Whereas the prolongation of the repolarization in the basal ECG is associated with a higher mortality in our study

Adherence to medication in adults with Cystic Fibrosis: An investigation using objective adherence data and the Theoretical Domains Framework

Objectives Adherence to nebulizer treatment in adults with Cystic Fibrosis (CF) is poor, and interventions are needed. This research aimed to identify the factors affecting nebulizer adherence using the Theoretical Domains Framework (TDF) and to compare these for participants with different levels of adherence. Design Data‐prompted interviews using the TDF. Methods Eighteen semi‐structured interviews were conducted with adults with CF during which objectively measured adherence data were discussed. Framework analysis was used to code the data into TDF domains, and inductive qualitative content analysis was used to code different beliefs and experiences. Aspects of the TDF that differed between participants with different adherence levels were explored. Results Factors influencing adherence to treatment included all 14 domains of the TDF, 10 of which appeared to vary by adherence level: Skills; Memory and decision‐making; and Behavioural regulation; Environmental context and resources; Social influences; Beliefs about consequences; Beliefs about capability; Reinforcement; Social role and identify; Intentions; Optimism; and Emotions. Conclusions This study is the first to use objectively measured adherence data in a data‐prompted interview using the TDF framework to systematically assess the full range of factors potentially influencing adherence. The results highlighted that interventions need to consider issues of capability, opportunity, and motivation. Interventions that challenge dysfunctional beliefs about adherence and which support the development of routines or habits and problem‐solving may be particularly useful for adults with CF

Managed-health care in Kenya

http://deepblue.lib.umich.edu/bitstream/2027.42/96907/1/MBA_Lask_W_1998_final.pd

Life cycle assessment of perennial cultivation systems : advancing applicability and comprehensiveness

Resource-efficient perennial cultivation systems are considered promising sources of sustainably produced biomass to meet the growing demand of a future European bioeconomy. They require fewer agricultural procedures than annual systems, contribute to an increase in soil carbon sequestration and can be productive on marginal land. In Europe, the C4 grass miscanthus is the most prominent and best researched perennial crop for lignocellulosic biomass production. Recently, wild plant mixtures (WPM) have been suggested as a more diverse alternative system. Perennial cultivation systems have already been the subject of multiple sustainability assessments, with life cycle assessment (LCA) being the method most commonly used. This method aims to provide a holistic depiction of the environmental performance of a system. However, two challenges are usually encountered. First, results of agricultural LCAs very much depend on site- and management-specific characteristics. Parameters such as biomass yield, quantity of fertiliser applied and carbon sequestered can vary considerably, impairing the applicability of the method. Second, most of these studies focus on greenhouse gas emissions only. Land use impacts on biodiversity are commonly neglected, casting doubt on the comprehensiveness that LCA is trying to achieve. This thesis aims to advance the applicability and comprehensiveness of LCA of perennial cultivation systems. For this purpose, it focuses on three aspects relevant to the assessment of such systems, each of which was addressed by a dedicated research question: 1) How can the conducting and application of LCAs of perennial cultivations systems be simplified? 2) Which methodological approaches are best suited for the consideration of carbon sequestration and storage in LCAs of perennial cultivation systems? 3) How can land use impacts of perennial cultivation systems on biodiversity best be incorporated into the LCA framework? These questions were answered by applying the LCA method to perennial cultivation systems in three case studies, using specific approaches for the inclusion of sensitivity analysis and the evaluation of carbon sequestration and storage. In addition, information on the biodiversity impacts of perennial crop cultivation was collated by means of a meta-analysis which compared species richness and abundance in annual and perennial crop cultivation systems. Due to the variability of agricultural systems, the life cycle inventory phase can be quite intricate. Thus, the conducting of an LCA can be substantially simplified by focusing on a few relevant inputs and outputs only. In this thesis a global sensitivity analysis was used to identify the most important inventory parameters in the greenhouse gas assessment of miscanthus cultivation: carbon sequestration, biomass yield, length of the cultivation period, nitrogen and potassium fertiliser application, and the distance over which the harvested biomass is transported. Focusing on these inventory parameters, a simplified model was developed. It allows farmers and SME active in miscanthus-based value chains easy access to customised LCA results. This thesis includes a detailed analysis of the relevance of carbon sequestration and storage in the sustainability assessment of perennial cultivation systems. It was found that the quantity and in particular the permanence of carbon sequestered through the cultivation of perennial crops are critical for their favourability in terms of global warming impacts. Two alternative methodological approaches for the quantification of carbon sequestered were tested within two of the case studies a simple carbon model and an allometric approach. In addition, the handling of the uncertain permanence of the carbon storage was reflected upon. The approaches were compared with regard to their suitability for use by typical LCA practitioners. It was concluded that allometric models should be used for the quantification of carbon sequestered and the corresponding amount accounted for as delayed emissions. This combination provides a manageable approach for the accounting of benefits from carbon sequestration and storage, and also prevents their overestimation. Established impact assessment methods such as ReCiPe2016 suggest characterisation factors for the incorporation of land use impacts on biodiversity into LCA. These factors use relative species richness as an indicator and assume a higher species richness in perennial than annual cultivation systems. This thesis includes a critical review of these characterisation factors, drawing on the results of the meta-analysis comparison of species richness in annual arable crops and perennial rhizomatous grasses. The meta-study did not confirm a higher number of species in perennial rhizomatous grasses than in annual arable crops. It was concluded that LCA studies on perennial cultivation systems need to be cautious in their application of the land use characterisation factors suggested in present-day impact assessment methods. Criticisms of the approach include the application of one single characterisation factor for diverse perennial cultivation systems such as WPM and miscanthus and the sole focus on species richness. In future, LCA research should focus on context-specific adjustment options for land use characterisation factors to ensure an adequate representation of biodiversity impacts in agricultural LCAs. Finally, the current focus on species richness in biodiversity impact assessment needs to be reassessed.Mehrjährige Anbausysteme werden als vielversprechende Quellen für nachhaltig produzierte Biomasse für eine europäische Bioökonomie betrachtet. Diese Systeme nutzen Ressourcen effizient und benötigen weniger Kulturmaßnahmen als einjährige Anbausysteme. Sie können zu einer verstärkten Kohlenstoffsequestrierung im Boden beitragen und auf marginalem Land angebaut werden. Miscanthus ist das meist untersuchte mehrjährige Anbausystem für die Bereitstellung lignocellulose-haltiger Biomasse in Europa. In den letzten Jahren wurden zunehmend auch mehrjährige Wildpflanzenmischungen (WPM) als alternative Systeme vorgeschlagen. Mehrjährige Anbausysteme wurden im Rahmen zahlreicher Studien bereits Nachhaltigkeitsbewertungen unterzogen. Meist wird hierfür die Methode der Ökobilanzierung (LCA) verwendet. Diese zielt auf eine ganzheitliche Darstellung der Umweltauswirkungen eines Systems ab. Dabei treten oftmals zwei Schwierigkeiten auf: Einerseits hängen die Resultate von agrarischen LCAs stark von Standort- und Management-spezifischen Charakteristika ab. Parameter wie der Biomasseertrag, die Menge der eingesetzten Düngemittel sowie des sequestrierten Kohlenstoffs variieren beträchtlich. Dies erschwert die Anwendbarkeit der LCA sowie der Nutzung der Resultate. Anderseits beschränken sich die Studien zumeist auf die Untersuchung der Treibhausgasemissionen. Durch Landnutzung bedingte Biodiversitätsauswirkungen werden oftmals vernachlässigt, wodurch die Ganzheitlichkeit des Ansatzes in Frage gestellt wird. Ziel dieser Arbeit ist es, die Anwendbarkeit und Ganzheitlichkeit von LCAs mehrjähriger Anbausysteme zu fördern. Hierzu wurde das Augenmerk auf drei relevante Aspekte der Bewertung dieser Systeme gelegt: 1) Wie kann die Durchführung und Anwendung von LCA mehrjähriger Anbausystemen vereinfacht werden? 2) Welche methodischen Herangehensweisen eignen sich für die Betrachtung von Kohlenstoffsequestrierung und speicherung in LCAs mehrjähriger Anbausysteme? 3) Welche Herangehensweisen eignen sich für die Abbildung landnutzungsbedingter Biodiversitätsauswirkungen in LCAs mehrjähriger Anbausysteme? Um diese Fragen zu beantworten, wurde die LCA-Methode im Rahmen dreier Fallstudien auf mehrjährige Anbausysteme angewandt. Dabei wurden verschiedene Herangehensweisen zur Durchführung von Sensitivitätsanalysen und der Bewertung der Kohlenstoffsequestrierung genutzt. Zusätzlich wurden Informationen über Biodiversitätsauswirkungen mehrjähriger Anbausysteme zusammengefasst. Hierzu wurde eine Meta-Analyse durchgeführt, in welcher der Artenreichtum in ein- und mehrjährigen Anbausystemen verglichen wurde. Bedingt durch die Variabilität von Agrarsystemen kann die Erstellung einer Sachbilanz (LCI) aufwendig sein. Durch die Fokussierung auf wenige wesentliche Parameter kann die Durchführung einer LCA stark vereinfacht werden. In dieser Arbeit wurden mithilfe einer globalen Sensitivitätsanalyse die wichtigsten Parameter für die Erstellung eines Treibhausgas-Assessments des Miscanthusanbaus identifiziert: Kohlenstoffsequestrierung, Biomasseertrag, Dauer der Anbauperiode, Stickstoff- und Kaliumgabe und die Transportdistanz des Ernteguts. Basierend auf diesen Parametern wurde ein vereinfachtes Modell entwickelt. Landwirte sowie Unternehmen, die Teil von Miscanthus-basierten Wertschöpfungsketten sind, bekommen somit einen einfachen Zugang zu individuell anpassbaren LCA Resultaten. Die Bedeutung der Kohlenstoffsequestrierung für die Nachhaltigkeitsbewertung von mehrjährigen Anbausystemen wurde in dieser Arbeit detailliert analysiert. Quantität und vor allem Dauerhaftigkeit der Kohlenstoffspeicherung während des Anbaus mehrjähriger Pflanzen sind zentrale Faktoren für die Vorzüglichkeit dieser Systeme in Bezug auf die Auswirkungen auf die globale Erwärmung. Zwei Herangehensweisen zur Quantifizierung der Kohlenstoffspeicherung wurden im Rahmen zweier Fallstudien getestet ein einfaches Kohlenstoffmodell sowie eine allometrische Abschätzung. Ergänzend wurde der Umgang mit einer fraglichen Dauerhaftigkeit der Kohlenstoffspeicherung kritisch reflektiert. Die Herangehensweisen wurden im Hinblick auf ihre Eignung für die Nutzung durch LCA-Anwender verglichen. Es wurde empfohlen, allometrische Modelle für die Quantifizierung der Kohlenstoffspeicherung heranzuziehen und die resultierende Kohlenstoffmenge als zeitlich verzögerte Emission zu erfassen. Diese Kombination stellt ein handhabbares Vorgehen für die Betrachtung von Vorteilen aus der Kohlenstoffsequestrierung dar und verhindert deren Überbewertung. Etablierte Wirkungsabschätzungsmethoden (LCIA-Methoden) wie ReCiPe2016 beinhalten Charakterisierungsfaktoren (CF) für die Berücksichtigung landnutzungsbedingter Biodiversitätsauswirkungen. Diese nutzen den relativen Artenreichtum einer Landnutzung als Indikator und gehen von einem höheren Maß an Artenreichtum in mehrjährigen als in einjährigen Anbausystemen aus. In der Meta-Studie konnten für die mehrjährigen Anbausysteme keine signifikant höheren Artenzahlen nachgewiesen werden. Daher wird empfohlen, die in den etablierten LCIA-Methoden vorgeschlagenen CF für die Bewertung mehrjähriger Anbausysteme nur vorsichtig zu nutzen. Die Nutzung eines einzigen CF für diverse mehrjährige Anbausysteme wie Miscanthus und WPM sowie der starke Fokus auf den Indikator Artenreichtum stellen Defizite dar. Zukünftig sollte auf eine kontext-abhängige Anpassung der CF hingewirkt werden, um eine adäquate Darstellung der Biodiversitätsauswirkungen in agrarischen LCAs zu ermöglichen. Abgesehen hiervon sollte der Fokus auf die Verwendung des Artenreichtums als Biodiversitätsindikator überdacht werden

Life cycle assessment of perennial cultivation systems : advancing applicability and comprehensiveness

Resource-efficient perennial cultivation systems are considered promising sources of sustainably produced biomass to meet the growing demand of a future European bioeconomy. They require fewer agricultural procedures than annual systems, contribute to an increase in soil carbon sequestration and can be productive on marginal land. In Europe, the C4 grass miscanthus is the most prominent and best researched perennial crop for lignocellulosic biomass production. Recently, wild plant mixtures (WPM) have been suggested as a more diverse alternative system. Perennial cultivation systems have already been the subject of multiple sustainability assessments, with life cycle assessment (LCA) being the method most commonly used. This method aims to provide a holistic depiction of the environmental performance of a system. However, two challenges are usually encountered. First, results of agricultural LCAs very much depend on site- and management-specific characteristics. Parameters such as biomass yield, quantity of fertiliser applied and carbon sequestered can vary considerably, impairing the applicability of the method. Second, most of these studies focus on greenhouse gas emissions only. Land use impacts on biodiversity are commonly neglected, casting doubt on the comprehensiveness that LCA is trying to achieve. This thesis aims to advance the applicability and comprehensiveness of LCA of perennial cultivation systems. For this purpose, it focuses on three aspects relevant to the assessment of such systems, each of which was addressed by a dedicated research question: 1) How can the conducting and application of LCAs of perennial cultivations systems be simplified? 2) Which methodological approaches are best suited for the consideration of carbon sequestration and storage in LCAs of perennial cultivation systems? 3) How can land use impacts of perennial cultivation systems on biodiversity best be incorporated into the LCA framework? These questions were answered by applying the LCA method to perennial cultivation systems in three case studies, using specific approaches for the inclusion of sensitivity analysis and the evaluation of carbon sequestration and storage. In addition, information on the biodiversity impacts of perennial crop cultivation was collated by means of a meta-analysis which compared species richness and abundance in annual and perennial crop cultivation systems. Due to the variability of agricultural systems, the life cycle inventory phase can be quite intricate. Thus, the conducting of an LCA can be substantially simplified by focusing on a few relevant inputs and outputs only. In this thesis a global sensitivity analysis was used to identify the most important inventory parameters in the greenhouse gas assessment of miscanthus cultivation: carbon sequestration, biomass yield, length of the cultivation period, nitrogen and potassium fertiliser application, and the distance over which the harvested biomass is transported. Focusing on these inventory parameters, a simplified model was developed. It allows farmers and SME active in miscanthus-based value chains easy access to customised LCA results. This thesis includes a detailed analysis of the relevance of carbon sequestration and storage in the sustainability assessment of perennial cultivation systems. It was found that the quantity and in particular the permanence of carbon sequestered through the cultivation of perennial crops are critical for their favourability in terms of global warming impacts. Two alternative methodological approaches for the quantification of carbon sequestered were tested within two of the case studies a simple carbon model and an allometric approach. In addition, the handling of the uncertain permanence of the carbon storage was reflected upon. The approaches were compared with regard to their suitability for use by typical LCA practitioners. It was concluded that allometric models should be used for the quantification of carbon sequestered and the corresponding amount accounted for as delayed emissions. This combination provides a manageable approach for the accounting of benefits from carbon sequestration and storage, and also prevents their overestimation. Established impact assessment methods such as ReCiPe2016 suggest characterisation factors for the incorporation of land use impacts on biodiversity into LCA. These factors use relative species richness as an indicator and assume a higher species richness in perennial than annual cultivation systems. This thesis includes a critical review of these characterisation factors, drawing on the results of the meta-analysis comparison of species richness in annual arable crops and perennial rhizomatous grasses. The meta-study did not confirm a higher number of species in perennial rhizomatous grasses than in annual arable crops. It was concluded that LCA studies on perennial cultivation systems need to be cautious in their application of the land use characterisation factors suggested in present-day impact assessment methods. Criticisms of the approach include the application of one single characterisation factor for diverse perennial cultivation systems such as WPM and miscanthus and the sole focus on species richness. In future, LCA research should focus on context-specific adjustment options for land use characterisation factors to ensure an adequate representation of biodiversity impacts in agricultural LCAs. Finally, the current focus on species richness in biodiversity impact assessment needs to be reassessed.Mehrjährige Anbausysteme werden als vielversprechende Quellen für nachhaltig produzierte Biomasse für eine europäische Bioökonomie betrachtet. Diese Systeme nutzen Ressourcen effizient und benötigen weniger Kulturmaßnahmen als einjährige Anbausysteme. Sie können zu einer verstärkten Kohlenstoffsequestrierung im Boden beitragen und auf marginalem Land angebaut werden. Miscanthus ist das meist untersuchte mehrjährige Anbausystem für die Bereitstellung lignocellulose-haltiger Biomasse in Europa. In den letzten Jahren wurden zunehmend auch mehrjährige Wildpflanzenmischungen (WPM) als alternative Systeme vorgeschlagen. Mehrjährige Anbausysteme wurden im Rahmen zahlreicher Studien bereits Nachhaltigkeitsbewertungen unterzogen. Meist wird hierfür die Methode der Ökobilanzierung (LCA) verwendet. Diese zielt auf eine ganzheitliche Darstellung der Umweltauswirkungen eines Systems ab. Dabei treten oftmals zwei Schwierigkeiten auf: Einerseits hängen die Resultate von agrarischen LCAs stark von Standort- und Management-spezifischen Charakteristika ab. Parameter wie der Biomasseertrag, die Menge der eingesetzten Düngemittel sowie des sequestrierten Kohlenstoffs variieren beträchtlich. Dies erschwert die Anwendbarkeit der LCA sowie der Nutzung der Resultate. Anderseits beschränken sich die Studien zumeist auf die Untersuchung der Treibhausgasemissionen. Durch Landnutzung bedingte Biodiversitätsauswirkungen werden oftmals vernachlässigt, wodurch die Ganzheitlichkeit des Ansatzes in Frage gestellt wird. Ziel dieser Arbeit ist es, die Anwendbarkeit und Ganzheitlichkeit von LCAs mehrjähriger Anbausysteme zu fördern. Hierzu wurde das Augenmerk auf drei relevante Aspekte der Bewertung dieser Systeme gelegt: 1) Wie kann die Durchführung und Anwendung von LCA mehrjähriger Anbausystemen vereinfacht werden? 2) Welche methodischen Herangehensweisen eignen sich für die Betrachtung von Kohlenstoffsequestrierung und speicherung in LCAs mehrjähriger Anbausysteme? 3) Welche Herangehensweisen eignen sich für die Abbildung landnutzungsbedingter Biodiversitätsauswirkungen in LCAs mehrjähriger Anbausysteme? Um diese Fragen zu beantworten, wurde die LCA-Methode im Rahmen dreier Fallstudien auf mehrjährige Anbausysteme angewandt. Dabei wurden verschiedene Herangehensweisen zur Durchführung von Sensitivitätsanalysen und der Bewertung der Kohlenstoffsequestrierung genutzt. Zusätzlich wurden Informationen über Biodiversitätsauswirkungen mehrjähriger Anbausysteme zusammengefasst. Hierzu wurde eine Meta-Analyse durchgeführt, in welcher der Artenreichtum in ein- und mehrjährigen Anbausystemen verglichen wurde. Bedingt durch die Variabilität von Agrarsystemen kann die Erstellung einer Sachbilanz (LCI) aufwendig sein. Durch die Fokussierung auf wenige wesentliche Parameter kann die Durchführung einer LCA stark vereinfacht werden. In dieser Arbeit wurden mithilfe einer globalen Sensitivitätsanalyse die wichtigsten Parameter für die Erstellung eines Treibhausgas-Assessments des Miscanthusanbaus identifiziert: Kohlenstoffsequestrierung, Biomasseertrag, Dauer der Anbauperiode, Stickstoff- und Kaliumgabe und die Transportdistanz des Ernteguts. Basierend auf diesen Parametern wurde ein vereinfachtes Modell entwickelt. Landwirte sowie Unternehmen, die Teil von Miscanthus-basierten Wertschöpfungsketten sind, bekommen somit einen einfachen Zugang zu individuell anpassbaren LCA Resultaten. Die Bedeutung der Kohlenstoffsequestrierung für die Nachhaltigkeitsbewertung von mehrjährigen Anbausystemen wurde in dieser Arbeit detailliert analysiert. Quantität und vor allem Dauerhaftigkeit der Kohlenstoffspeicherung während des Anbaus mehrjähriger Pflanzen sind zentrale Faktoren für die Vorzüglichkeit dieser Systeme in Bezug auf die Auswirkungen auf die globale Erwärmung. Zwei Herangehensweisen zur Quantifizierung der Kohlenstoffspeicherung wurden im Rahmen zweier Fallstudien getestet ein einfaches Kohlenstoffmodell sowie eine allometrische Abschätzung. Ergänzend wurde der Umgang mit einer fraglichen Dauerhaftigkeit der Kohlenstoffspeicherung kritisch reflektiert. Die Herangehensweisen wurden im Hinblick auf ihre Eignung für die Nutzung durch LCA-Anwender verglichen. Es wurde empfohlen, allometrische Modelle für die Quantifizierung der Kohlenstoffspeicherung heranzuziehen und die resultierende Kohlenstoffmenge als zeitlich verzögerte Emission zu erfassen. Diese Kombination stellt ein handhabbares Vorgehen für die Betrachtung von Vorteilen aus der Kohlenstoffsequestrierung dar und verhindert deren Überbewertung. Etablierte Wirkungsabschätzungsmethoden (LCIA-Methoden) wie ReCiPe2016 beinhalten Charakterisierungsfaktoren (CF) für die Berücksichtigung landnutzungsbedingter Biodiversitätsauswirkungen. Diese nutzen den relativen Artenreichtum einer Landnutzung als Indikator und gehen von einem höheren Maß an Artenreichtum in mehrjährigen als in einjährigen Anbausystemen aus. In der Meta-Studie konnten für die mehrjährigen Anbausysteme keine signifikant höheren Artenzahlen nachgewiesen werden. Daher wird empfohlen, die in den etablierten LCIA-Methoden vorgeschlagenen CF für die Bewertung mehrjähriger Anbausysteme nur vorsichtig zu nutzen. Die Nutzung eines einzigen CF für diverse mehrjährige Anbausysteme wie Miscanthus und WPM sowie der starke Fokus auf den Indikator Artenreichtum stellen Defizite dar. Zukünftig sollte auf eine kontext-abhängige Anpassung der CF hingewirkt werden, um eine adäquate Darstellung der Biodiversitätsauswirkungen in agrarischen LCAs zu ermöglichen. Abgesehen hiervon sollte der Fokus auf die Verwendung des Artenreichtums als Biodiversitätsindikator überdacht werden

Theme Park Fraud and How to Catch It

One of the most significant, if not the most important financial difficulty facing theme parks today is credit card fraud and the use of counterfeit money by individuals to improperly obtain theme park tickets. The tickets are then used by the fraudsters themselves, or sold or otherwise distributed to guests of the parks. The improper use of the tickets significantly impacts the income of the parks. In order to continue to appropriately manage the parks after the losses, ticket prices need to be raised, which generally leads to a reduction in the valid revenue of the parks as they become costlier. The goal of this paper is to discuss how cyber-fraud, the use of counterfeit money, credit card fraud, and employee theft occurs, along with what can be done to limit the extent of the fraud losses, and how this will benefit both the owners of the parks and the public at large. While the theme park entertainment industry constantly seeks more effective internal and external controls and additional fraud prevention tools, this is balanced by the necessity to not anger potential customers through the fraud prevention efforts. At the same time, the parks must provide the necessary cyber-security to both protect themselves, and insure that customers’ data is protected. The proposals and area of concentration of the paper will focus on theme park fraud prevention, credit card fraud, and counterfeit money, as well as the causes of these acts, such as false identity, ticket scams, and employee theft in the entertainment industry. Theme park owners explore the rising issues of fraud threats within their business structure, and the number of issues of fraudsters in theme parks. Most theme parks are vulnerable to fraud because of the business processes of the industry, as well as the fact that they do not provide the level of tools that are needed. The problem with criminals committing fraud in theme parks is very extensive because theme parks do not generally provide an appropriate control framework to prevent fraud from occurring in the first place, which bring fraudsters in contact with park locations. Theme parks are losing money from experiencing counterfeit transactions, such as fake currency, phony credit cards and counterfeit checks (personal, cashier’s, gift or travelers) and false identity. These fraudulent events can add up to dangerous levels of financial loss each year. Weak internal and external controls result in fraudsters committing more crimes in theme park business structures and creating an unending cycle of regularly losing a portion of profits to fraud with higher economic and social costs. Instead of not spending money on prevention tools, theme parks should provide low cost, easy to use solutions without impacting the customer experience. In the long run, prevention tools will decrease the economic costs of responding to the problem of theme park fraud

Impact of offering a financial incentive to mothers opting for an early discharge

The purposes of this this study were to (a) determine the willingness of maternity patients to participate in an early discharge program, (b) determine why patients would or would not participate and (c) determine if a financial incentive would have any impact on their decision. The subjects of the study were pregnant women currently enrolled in prenatal and LaMaze classes at Rockford Memorial Hospital in Rockford, Illinois who were planning to deliver at Rockford Memorial Hospital

Early host response and immune signaling to 2009 pandemic influenza A (H1N1) viruses in primary cell culture models.

Influenza A virus (IAV) subtypes and even genotypes within subtypes can show differences in tropism (host, cell type), magnitude of infection, immune response and progression of illness. My dissertation focused on the development and use of two in vitro physiologically-relevant human cell culture models, well-differentiated normal human bronchial epithelial (wdNHBE) cells and human monocyte-derived macrophages (MDM) for the study of early IAV-host interactions. These models have given new insight into early host responses to seasonal H1N1 (BN59) and two pandemic A(H1N1)2009 viruses or H1N1pdm herein. The H1N1pdm are clinical isolates from a fatal (A/KY/180/10) and nonfatal (A/KY/136/09) case. In the wdNHBE model, KY180 showed a significantly higher titer as compared to the other two viruses at 24 hpi (hours post-infection). Interestingly, by microarray analysis, there were no significant differences in the host genome-wide expression intensity profiles of each virus following infection. Soluble cytokine measurements revealed increased apical and basal pro-inflammatory cytokine secretion overtime. A key finding from our data was greater basolateral secretion of cytokines (IL6, CCL5, CCL4 and CCL2) by KY180-infected wdNHBE cells. This finding suggests that the basolateral signals from infected epithelial cells may differ in their potential for recruitment and responses elicited by recruited monocytes/macrophages. In the second model, I used an in vitro model of recruited “resting” MDMs to study virus-host interactions of the clinical H1N1pdm isolates. These viruses replicated in MDM albeit inefficiently. While titers were similar and remained relatively low for all isolates, pro- and anti-inflammatory expression levels differed markedly between KY180 as compared to KY136 and BN59. KY180 had delayed expression at 8 hpi of pro-inflammatory genes (CCL5, TNF, IFN, CXCL10). This apparent delay in response to KY180 depended on the mode of viral entry. For KY180, this occurred primarily through macropinocytosis, mapping to the HA1 gene. In summary, my studies reveal subtle, yet important differences in IAV-host interactions that result in alterations of immune signaling in epithelial and macrophage cell culture models. Continued advancement of the in vitro human cell culture models for the study of IAV is important as they will allow mechanistic insight into the intricate biology of these viruses

The campus: A fortress of democracy

https://stars.library.ucf.edu/prism/1127/thumbnail.jp