This paper proposes a novel framework for the development of interventions in vulnerable populations. The framework combines a complex systems lens with syndemic theory. Whereas funding bodies,... Show moreThis paper proposes a novel framework for the development of interventions in vulnerable populations. The framework combines a complex systems lens with syndemic theory. Whereas funding bodies, research organizations and reporting guidelines tend to encourage intervention research that (i) focuses on singular and predefined health outcomes, (ii) searches for generalizable cause-effect relationships, and (iii) aims to identify universally effective interventions, the paper suggests that a different direction is needed for addressing health inequities: We need to (i) start with exploratory analysis of population-level data, and (ii) invest in contextualized in-depth knowledge of the complex dynamics that produce health inequities in specific populations and settings, while we (iii) work with stakeholders at multiple levels to create change within systems. Show less
Background: Prospective data on nonvitamin-K-antagonist oral anticoagulant (NOAC) management during cardiovascular interventions are limited. We therefore evaluated the safety and effectiveness of... Show moreBackground: Prospective data on nonvitamin-K-antagonist oral anticoagulant (NOAC) management during cardiovascular interventions are limited. We therefore evaluated the safety and effectiveness of uninterrupted dabigatran therapy as well as dabigatran management during atrial fibrillation (AF)-cardioversions, AFablations, pacemaker implantations and coronary angiography and/or stenting procedures. Method: GLORIA-AF is an international registry programme involving patients with newly diagnosed AF. Dabigatran users were followed for <2 years. The primary outcome was occurrence of stroke/systemic embolism and major bleeding <8 weeks after a cardiovascular intervention during uninterrupted dabigatran therapy. Results: During the 2-year follow-up, 599 cardiovascular interventions were identified in 479 eligible patients. 412/599 (69%) interventions were performed with uninterrupted dabigatran therapy: 299/354 (84%) AFcardioversions, 38/89 (43%) AF-ablations, 25/58 (43%) pacemaker implantations, and 50/98 (51%) coronary angiography and/or stenting procedures. During an average follow-up of 8.4 weeks after intervention, one major bleed and one systemic embolic event occurred (risk 0.25% for both outcomes; 95% confidence interval, 0.01%1.36%). Conclusions: More than two thirds of the interventions were performed with uninterrupted dabigatran therapy, of which most were AF-cardioversions. Uninterrupted dabigatran therapy was associated with low major bleeding and stroke/systemic embolism risk, supporting the favourable safety and effectiveness profile of dabigatran in clinical practice-based settings. Show less
Zand, E. van 't; Matthijsse, S.; Fischer, T.; Wagen, W. van der 2021
A circular economy is an industrial system that is restorative or regenerative by intention or design. During the last decade, the circular economy became an attractive paradigm to increase global... Show moreA circular economy is an industrial system that is restorative or regenerative by intention or design. During the last decade, the circular economy became an attractive paradigm to increase global welfare while minimizing the environmental impacts of economic activities. Although several studies concerning the potential benefits and drawbacks of policies that implement the new paradigm have been performed, there is currently no standardized theoretical model or software to execute such assessment. In order to fill this gap, in the present paper we show how to perform these analyses using Environmentally Extended Input-Output Analysis. We also describe a python package (pycirk) for modeling Circular Economy scenarios in the context of the Environmentally Extended Multi-Regional Input-Output database EXIOBASE V3.3, for the year 2011. We exemplify the methods and software through a what-if zero-cost case study on two circular economy strategies (Resource Efficiency and Product Lifetime Extension), four environmental pressures and two socio-economic factors. Show less
Seijmonsbergen-Schermers, A.E.; Zondag, D.C.; Nieuwenhuijze, M.; Akker, T. van den; Verhoeven, C.J.; Geerts, C.; ... ; Jonge, A. de 2018
