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We develop explicit bounds for the tail of the distribution of the all-time supremum of a random walk with negative drift, where the increments have a truncated heavy-tailed distribution. As an application, we consider a ruin problem in the presence of reinsurance.
We use the framework of multivariate regular variation to analyse the extremal behaviour of preferential attachment models. To this end, we follow a directed linear preferential attachment model for a random, heavy-tailed number of steps in time and treat the incoming edge count of all existing nodes as a random vector of random length. By combining martingale properties, moment bounds and a Breiman type theorem we show that the resulting quantity is multivariate regularly varying, both as a vector of fixed length formed by the edge counts of a finite number of oldest nodes, and also as a vector of random length viewed in sequence space. A Pólya urn representation allows us to explicitly describe the extremal dependence between the degrees with the help of Dirichlet distributions. As a by-product of our analysis we establish new results for almost sure convergence of the edge counts in sequence space as the number of nodes goes to infinity.
One-fifth of the 101 million stroke survivors worldwide experience another stroke within the following five years. Research indicates that lifestyle risk factors account for 90% of stroke (similar to recurrent stroke) risk, and improving diet quality is a promising strategy(1). Synthesised research suggests that adopting a Mediterranean-style diet(2) with reduced sodium intake(3) can enhance cardiovascular health, which may be beneficial for secondary stroke prevention. Our previous ENAbLE trial, a co-designed telehealth diet and exercise intervention, demonstrated improvements in diet quality among stroke survivors. However, post-stroke effects (such as fatigue, hemiplegia, memory issues, aphasia, and dysphasia) along with poor culinary nutrition skills, limit the full adoption of the Mediterranean-style diet. Culinary nutrition combines cooking skills and nutrition knowledge to help individuals create nutritious and fulfilling meals. A recent scoping review revealed only two culinary nutrition programs designed for stroke survivors, with none co-designed specifically for Australian survivors. This research aims to co-design a Mediterranean-style diet based culinary nutrition program to enhance post-stroke nutrition. Using an Integrated Knowledge Translation model(4), three lived experience research partners and six clinical researchers engaged in the co-design process. Preliminary interviews with stakeholders highlighted gaps in current stroke care. We conducted two focus groups with potential end-users, including six stroke survivors and seven clinicians. Data were analysed thematically, and prototypes were developed iteratively with end-users. Consumers (lived experience research partners and end-users) identified a significant gap in practice during the early post-discharge period, emphasising the need for self-paced remote culinary nutrition resources. They identified several facilitators (e.g., simple recipes, easy translation of nutrition knowledge, aphasia-friendly design) and barriers (e.g., fatigue, muscle weakness, cooking for one or for a household) in meal preparation. Consumers noted that while recipe books reduce the cognitive load of meal preparation, no stroke-specific resources are currently available. As a result, we developed a co-designed recipe book titled Cook Well After Stroke, incorporating feedback from end-users. This book features Mediterranean-style diet recipes for both single-serving and household/batch cooking. It is designed with plain English, requiring minimal ingredients, equipment, and cooking skills. Recipes are highly adaptable to common Australian ingredients, encouraging users to repeat the recipes with available resources. It includes nutrition principles to create balanced meals, increase protein and vegetable intake, and reduce sodium consumption. Each section includes hints and hacks tailored to post-stroke effects, providing strategies for one-handed cooking, softer diet textures, and energy conservation. The recipe book will be integrated into a co-designed online cooking program, which will be trialled with stroke survivors.
In this paper we discuss laboratory experiments that address the problem of self-governance in an asymmetric commons dilemma. Small-scale irrigation systems that provide food for hundreds of millions of people around the world are probably the most common example of such dilemmas. Here, we formulate an abstract dilemma in which subjects make both a decision about investment in the provision of infrastructure associated with the use of a resource and about how much to extract from the common-pool resource made available by this infrastructure. The impact of inherent asymmetry in irrigation systems on the provision of a resource and the impact of communication on the capacity of the group to solve the two-level commons dilemma of cooperation and coordination based on the analysis of the experimental data are discussed.
A rich history of theoretical models in finance shows that speculation can lead to overpricing and price bubbles. We provide evidence that, indeed, individual speculative behavior fuels overpricing in (experimental) asset markets. In a first step, we elicit individual speculative behavior in a one-shot setting with a novel speculation elicitation task (SET). In a second step, we use this measure of speculative behavior to compose dynamic, continuous double auction markets in line with Smith et al. (Econometrica 56(5):1119–1151, 1988). We find significant higher overpricing in markets with traders who exhibited more speculative behavior in the individual SET. However, we find no such differences in overpricing when we test for alternative explanations, using a market environment introduced by Lei, Noussair, and Plott (Econometrica 69(4):831–859, 2001) where speculation is impossible. Taken together, our results corroborate the notion that speculation is an important factor in overpricing and bubble formation if market environments allow for the pursuit of capital gains.
Ethical consumption and consumer choice are at the heart of public debates today, but consumer activism has a long history. At the end of the nineteenth century, groups of women activists in different countries weaponised their reputation as consumers to mount campaigns against labour exploitation. By the early twentieth century, they had built an international network of Consumers' Leagues that influenced public opinion and achieved legislative change. Analysing the campaign writing of women activists, including both well-known and recently rediscovered historical figures, Flore Janssen provides new insights into the campaigns that underpinned important developments in the rights of workers and the social position of women. Highlighting the social, economic and political influence of women as activists, this book discusses campaign strategies, but also draws attention to problematic politics within these campaigns. Through its critically contextualised analysis of this specific consumer movement, the book reveals the origins of many consumer campaign strategies that remain familiar today.
Stakeholders in the drug life cycle recognize the importance of integrating patient experience data (PED) into healthcare decision-making. PED includes patient input, patient reported outcomes (PROs), patient reported experiences, and patient preference information. However, it remains unclear if, how, and to what extent PED are used in reimbursement decisions in Belgium.
Methods
A document analysis was performed to evaluate and compare the reporting of PED in Belgian reimbursement documents for COVID-19, oncology, and cardiology. Documents of medicinal products that received a European marketing authorization between 1 January 2015 and 30 September 2023 and were reimbursed in Belgium were included. Data were analyzed descriptively and qualitatively.
Results
Preliminary results showed that PED was generally either not reported or not explicitly reported in Belgian reimbursement documents. In some documents, patient reported outcome measures (PROMs) were mentioned. Additionally, few documents stated PROs such as quality of life. PROMs, PROs, and quality of life outcomes appeared in the reimbursement dossier section describing the therapeutic value of the product. From the preliminary findings it seems that PED were more often present in oncology documents. The reimbursement dossiers did not report whether or how PED were used to inform a particular reimbursement decision.
Conclusions
Preliminary findings suggest that PED are not systematically included in Belgian reimbursement documents. To improve transparent submission and reporting of PED in reimbursement dossiers, guidance from reimbursement agencies as well as checklists and evaluation templates are needed.
Patient experience data (PED), encompassing patient preferences (PP), patient-reported outcomes (PROs), and patient input, play a pivotal role in understanding patient needs and informing healthcare decision-making, including reimbursement decisions. This study aimed to assess the current barriers hindering the integration of PED into practice and its particular challenges, opportunities, and concrete policy actions for the systematic implementation of PED.
Methods
Semistructured interviews (n=38) were conducted with industry (n=12), non-profit organizations and academia (n=4), regulatory authorities (n=6), health technology assessment (HTA) bodies and reimbursement agencies (n=6), and patient organizations (n=10) in Europe. A thematic analysis was conducted to explore stakeholders’ perspectives and to gain a comprehensive understanding of challenges and opportunities related to the systematic implementation of PED. Interview transcripts were analyzed using the thematic framework analysis to extract and elucidate the insights provided by the diverse stakeholders.
Results
HTA and reimbursement interviewees agreed on the value of including quality-of-life data, particularly when assessed using validated PRO measures. Despite acknowledging the potential of PP, there remained reluctance to integrate PP into reimbursement decision-making. Participants expressed divergent opinions regarding who should collect PED, with some regulators favoring industry, while HTA and reimbursement agencies emphasized transparency and independent PED collection. Limited experience in assessing PED also contributed to hesitancy, underscoring the need for more guidelines, especially at the national reimbursement level. Stakeholders endorsed collaboration through joint scientific consultations, expressing optimism about the impact of the Regulation (EU) 2021/2282 on health technology assessment (HTAR).
Conclusions
This study emphasizes the high potential of PED in informing reimbursement decision-making, fostering a more patient-centered approach. Stakeholder disparities highlight the complexity, necessitating more guidance, scientific robustness, transparency, and collaboration. In light of these stakeholder considerations, the upcoming HTAR holds promise to enhance the systematic implementation of PED, aligning healthcare decision-making with patients’ needs and preferences.
When a response to a multiple-choice item consists of selecting a single-best answer, it is not possible for examiners to differentiate between a response that is a product of knowledge and one that is largely a product of uncertainty. Certainty-based marking (CBM) is one testing format that requires examinees to express their degree of certainty on the response option they have selected, leading to an item score that depends both on the correctness of an answer and the certainty expressed. The expected score is maximized if examinees truthfully report their level of certainty. However, prospect theory states that people do not always make rational choices of the optimal outcome due to varying risk attitudes. By integrating a psychometric model and a decision-making perspective, the present study looks into the response behaviors of 334 first-year students of physiotherapy on six multiple-choice examinations with CBM in a case study. We used item response theory to model the objective probability of students giving a correct response to an item, and cumulative prospect theory to estimate their risk attitudes when students choose to report their certainty. The results showed that with the given CBM scoring matrix, students’ choices of a certainty level were affected by their risk attitudes. Students were generally risk averse and loss averse when they had a high success probability on an item, leading to an under-reporting of their certainty. Meanwhile, they were risk seeking in case of small success probabilities on the items, resulting in the over-reporting of certainty.
In the course of the medical program at the University of Limburg, students complete a total of 24 progress tests, consisting of items drawn from a constant itembank. A model is presented for the growth of knowledge reflected by these results. The Rasch model is used as a starting point, but both ability and difficulty parameters are taken to be random, and moreover the logistic distribution is replaced by the normal. Both individual and group abilities are estimated and explained through simple linear regression. Application to real data shows that the model fits very well.
Smartphones and social media have considerably transformed adolescents’ media engagement. Adolescents consume, create, and share media content anywhere, anytime, and with anyone, often beyond parents’ oversight. Parents try to keep track of their adolescents’ media use by employing control, surveillance, and solicitation. This chapter explores the prevalence and predictors of such monitoring strategies, and their effectiveness in managing adolescents’ media use and shaping the potential consequences of adolescents’ media use for their mental health. In addition, the chapter discusses parents’ use of digital media for monitoring adolescents’ nonmedia activities, such as the use of location-tracking applications. Overall, evidence regarding the prevalence, predictors, and effectiveness of parental media monitoring is limited and inconclusive. The chapter underscores the need for refining conceptualizations of media monitoring. Moreover, it highlights the importance of understanding the effectiveness of media monitoring within an ever-evolving digital world.
Open data promises various benefits, including stimulating innovation, improving transparency and public decision-making, and enhancing the reproducibility of scientific research. Nevertheless, numerous studies have highlighted myriad challenges related to preparing, disseminating, processing, and reusing open data, with newer studies revealing similar issues to those identified a decade prior. Several researchers have proposed the open data ecosystem (ODE) as a lens for studying and devising interventions to address these issues. Since actors in the ecosystem are individually and collectively impacted by the sustainability of the ecosystem, all have a role in tackling the challenges in the ODE. This paper asks what the contributions of open data intermediaries may be in addressing these challenges. Open data intermediaries are third-party actors providing specialized resources and capabilities to (i) enhance the supply, flow, and/or use of open data and/or (ii) strengthen the relationships among various open data stakeholders. They are critical in ensuring the flow of resources within the ODE. Through semi-structured interviews and a validation exercise in the European Union context, this study explores the potential contribution of open data intermediaries and the specific ODE challenges they may address. This study identified 20 potential contributions, addressing 27 challenges. The findings of this study pave the way for further inquiry into the internal incentives (viable business models) and external incentives (policies and regulations) to direct the contributions of open data intermediaries toward addressing challenges in the ODE.
Based on a new cored succession at Winterswijk, evidence is uncovered of the end-Triassic mass-extinction (ETME) event in a subsurface sedimentary succession of the Netherlands. The ETME was one of the most devastating events for the biosphere during the Phanerozoic era. Massive volcanism from the Central Atlantic Magmatic Province initiated the breakup of the supercontinent Pangea and resulted in terrestrial and marine extinction pulses, which drastically altered the course of life on Earth. The newly cored material reveals a sedimentary succession representing a shallow marine setting dominated by laminated black shale and claystone deposits. A high-resolution palynostratigraphic dataset provides evidence for a late Rhaetian vegetation assemblage that displays a stepwise decline of arborescent tree vegetation that is transiently replaced by a community of ferns and fern allies. Geochemical records link this major disturbance in palynofloral biodiversity to a pulse of volcanic activity as evidenced by a negative excursion in stable organic carbon isotopes. Shifts towards drier climate conditions, as inferred from sedimentary elemental composition, suggest continental aridification strongly influenced the terrestrial realm following volcanic pulses. Presence of reworked material suggests unstable soils that were affected by increased erosion rates, inhibiting the re-establishment of conifer tree vegetation. Comparison of our findings with other contemporaneous European Triassic-Jurassic boundary sections confirms the progression of the end-Triassic extinction, which exhibits a two-phased structure. The presence of the ETME in the subsurface of the Netherlands provides further evidence towards our understanding of terrestrial extinction with emphasis on the decline of vegetation.
The application of AI in judicial decision-making has the potential for both courts and people seeking justice in consumer law contexts. This is especially true for AI assistant systems that help judges by pre-evaluating individual cases. Currently, the application of a human-out-of-the-loop robojudge is unrealistic in Europe as its use would not only be in conflict of fundamental rights enshrined in the ECHR
This research explores the dynamic nature of family involvement in remote patient management for cardiovascular disease and its impact on lifestyle behaviour changes. Through an interview study with patients and family members, we categorise family involvement into three types: Inform, Integrate, and Influence, highlighting the dynamic and heterogeneous nature of family involvement across different phases and activities. Overall, we emphasise the need for personalised and adaptable interventions to cater to the diversity of families and propose a modular approach to remote monitoring design.
We examine financial literacy in Germany and its relevance for financial wellbeing. Using data from the Panel on Household Finances collected in 2021, we show that about 62% of German households answer the Big Three financial literacy questions correctly. Those with lower education, who are out of the labor force, women, and those living in East Germany have lower levels of financial literacy. Identifying groups with lower financial literacy and developing strategies to reach them and enhance their abilities should therefore be an integral part of the German national financial literacy strategy. Financial literacy is linked to financial wellbeing: we document that those with higher financial literacy have a higher stock market participation rate and are less likely to report financial difficulties.
In recent years, the illegal wildlife trade has received increasing attention. In the political debate, the focus is mainly on iconic species such as elephants, rhinoceroses, and tigers, but reptile populations are also seriously harmed by the illegal reptile trade. For example, reptiles are an easy target for criminal groups because they can often survive for a long time under poor transport conditions, reptiles are quiet, and they can easily be transported in suitcases or postal parcels (Altherr 2014). It has been determined that between 2010 and 2014, approximately 64,000 live wild vertebrates with protected status were seized; 95 per cent of these seized animals were reptiles (D’Cruze and Macdonald 2016).
Even though the illegal trade in reptiles is often associated with Asian origin countries, Europe is one of the biggest markets for illegal reptiles. This has been illustrated by research showing that the majority of all live animal seizures in the European Union (EU) over a ten-year period were reptiles (van Uhm 2016a). Sometimes the seizures concern reptile species from Europe, but many reptile species do not occur naturally within the EU. In fact, the majority of the illegal reptiles is first being imported from outside the EU and then the reptiles are freely traded within the EU borders (Gussow 2009; Sollund and Maher 2016; Mărginean et al 2018; van Uhm et al 2019; Sollund, this volume).
The Netherlands is an important player in the illegal reptile trade, both as a transit country and a destination country (van der Grijp 2016; van Uhm 2016b; Janssen and Leupen 2019). For example, the Netherlands is in the top ten of EU countries that import endangered reptile species, but a substantial part of the legal trade actually has an illegal origin (Janssen and Leupen 2019). In addition to many live reptiles for the pet market, reptile products are on the market as belts, boots, bags, meat, medication, shields, skulls, skeletons, teeth and taxidermy (Auliya et al 2016; Harvey 2017). The more scarce, attractive and expensive some rare endangered reptiles become, the more interesting they are on the reptile black market (van der Grijp 2016).
This study aimed to develop the conversation tool “I-HARP for COPD” for timely identification of palliative care needs in Dutch patients with chronic obstructive pulmonary disease (COPD).
Methods
An iterative and participatory research design was used to develop “I-HARP for COPD”. There were 2 phases to the development of “I-HARP for COPD”: content development and testing. A review of current literature, parallel focus groups, and a questionnaire among experts were used to develop the content of “I-HARP for COPD”. “I-HARP for COPD” was then assessed by health-care professionals (HCPs) in clinical practice for understanding, difficulty, and relevance.
Results
A total of 46 HCPs, 6 patients, 1 informal caregiver, and 1 bereaved informal caregiver participated in this study. “I-HARP for COPD” included 14 screening questions, additional in-depth questions, and recommendations to address identified needs. The content of “I-HARP for COPD” was accepted by 86.2% of the HCPs.
Significance of results
“I-HARP for COPD” was successfully developed for providing guidance in the palliative care of Dutch patients with COPD and their informal caregivers. By supporting HCPs with “I-HARP for COPD”, they are better able to timely identify and direct palliative care needs.
The main cause of mortality in great apes in zoological settings is cardiovascular disease (CVD), affecting all four taxa: chimpanzee (Pan troglodytes), bonobo (Pan paniscus), gorilla (Gorilla spp.) and orangutan (Pongo spp.). Myocardial fibrosis, the most typical histological characterisation of CVD in great apes, is non-specific, making it challenging to understand the aetiopathogenesis. A multifactorial origin of disease is assumed whereby many potential causative factors are directly or indirectly related to the diet, which in wild-living great apes mainly consists of high-fibre, low-carbohydrate and very low-sodium components. Diets of great apes housed in zoological settings are often different compared with the situation in the wild. Moreover, low circulating vitamin D levels have recently been recognised in great apes housed in more northern regions. Evaluation of current supplementation guidelines shows that, despite implementation of different dietary strategies, animals stay vitamin D insufficient. Therefore, recent hypotheses designate vitamin D deficiency as a potential underlying factor in the pathogenesis of myocardial fibrosis. The aim of this literature review is to: (i) examine important differences in nutritional factors between zoological and wild great ape populations; (ii) explain the potential detrimental effects of the highlighted dietary discrepancies on cardiovascular function in great apes; and (iii) elucidate specific nutrition-related pathophysiological mechanisms that may underlie the development of myocardial fibrosis. This information may contribute to understanding the aetiopathogenesis of myocardial fibrosis in great apes and pave the way for future clinical studies and a more preventive approach to great ape CVD management.
Collective learning is a widespread aim in long-term care. When professionals share detailed information on their perspective regarding quality of care, they can enter each other’s perspective and create a new joint perspective which may generate a broader meaning together. Reflective spaces are helpful in learning processes as tacit and explicit knowledge is bridged when people come together to reflect on concrete care practices. This study aimed to evaluate the use of the narrative quality instrument ‘The story as a quality instrument’ as a means for collective learning to realize quality improvement.
Methods:
A qualitative evaluation was performed in 2021-2022 on six field sites of four large care organizations providing long-term care to older adults in the Netherlands. On every field site. The story as a quality instrument was applied: an action plan was formulated based on narrative portraits of older adults in a quality meeting and 8-12 weeks later the progress was evaluated. The data collection concerned the transcripts of both meetings and the observation reports of the researchers. Data were analyzed using thematic analysis.
Results:
Four mechanisms became visible that stimulate learning among participants to reach quality improvement: in-depth discussion, exchange of perspectives, abstraction, and concretization. The participants reported on several outcomes regarding individual learning such as change of attitude, looking to older adults more holistically and the realization that possibilities to work on quality improvement could be small and part of everyday work. Participants learned from each other, as they gained insight into each other’s perspectives. The added value concerned getting insight into the individual perceptions of clients, the concrete areas for improvement as outcome, and the diverse people and functions represented. Time was found to be the main challenge for the application of the instrument. Furthermore, the anonymity and quality of the portraits, structural embedding of the instrument and communication were four main conditions for future execution.
Conclusion:
The story as a quality instrument is deemed promising for practice, as it allows care professionals to learn in a structured way from narratives of older adults in order to improve the quality of care.