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Süs Tavuğu Bayan Üreticiler Bilgilenme Gurubu

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Landon Allen
Landon Allen

Oxford University Press Ed. Aim High Level 3: A... UPD

There is increasing interest among implementation researchers in using theories concerning the organizational level because the context of implementation is becoming more widely acknowledged as an important influence on implementation outcomes. Theories concerning organizational culture, organizational climate, leadership and organizational learning are relevant for understanding and explaining organizational influences on implementation processes [21,53,57,94-101]. Several organization-level theories might have relevance for implementation science. For instance, Estabrooks et al. [14] have proposed the use of the Situated Change Theory [102] and the Institutional Theory [103,104], whereas Plsek and Greenhalgh [105] have suggested the use of complexity science [106] for better understanding of organizations. Meanwhile, Grol et al. [22] have highlighted the relevance of economic theories and theories of innovative organizations. However, despite increased interest in organizational theories, their actual use in empirical implementation studies thus far is relatively limited.

Oxford University Press ed. Aim High Level 3: A...

Keeping active can help people stay at a healthy weight or lose weight. It can also lower the risk of heart disease, diabetes, stroke, high blood pressure, osteoporosis, and certain cancers, as well as reduce stress and boost mood. Inactive (sedentary) lifestyles do just the opposite.

The authors of two 2017 systematic reviews examining the clinical trial data concluded that nicotinic acid therapy provides little if any protection from atherosclerotic heart disease, even though the therapy raises HDL cholesterol levels and lowers total cholesterol, LDL cholesterol, and triglyceride levels. One of these reviews examined 23 randomized controlled trials of moderate to high quality in 39,195 participants aged 33-71 years (average 65 years; majority were male). Some had experienced a heart attack, and most were taking a statin. The doses used and treatment duration in these studies varied widely; the median dose of nicotinic acid was 2 g/day (range 0.5 to 4 g/day) for a median of 11.5 months (range 6 months to 6 years) [25]. Overall, use of nicotinic acid did not reduce overall mortality or cardiovascular mortality rates or the number of fatal or nonfatal myocardial infarctions or strokes. Eighteen percent of participants taking nicotinic acid discontinued treatment because of side effects. The second review examined 13 randomized controlled trials with 35,206 participants with, or at risk of, atherosclerotic cardiovascular disease [33]. Overall, the addition of nicotinic acid supplementation (dose range not specified) to statin therapy taken for a mean of 33 months (with a broad range of 6 to 60 months) did not lead to significant reductions in rates of all-cause or cardiovascular mortality, myocardial infarction, or stroke. Nicotinic acid treatment was associated with a significantly higher risk of gastrointestinal and musculoskeletal adverse events. In addition, four of the studies that examined diabetes as an outcome found that the patients taking niacin had a significantly higher risk of developing the disease.

When taken in pharmacologic doses of 1,000 to 3,000 mg/day, nicotinic acid can also cause more serious adverse effects [2,4,12,36]. Many of these effects have occurred in patients taking high-dose nicotinic acid supplements to treat hyperlipidemias. These adverse effects can include hypotension severe enough to increase the risk of falls; fatigue; impaired glucose tolerance and insulin resistance; gastrointestinal effects, such as nausea, heartburn, and abdominal pain; and ocular effects, such as blurred or impaired vision and macular edema (a buildup of fluid at the center of the retina). High doses of nicotinic acid taken over months or years can also be hepatotoxic; effects can include increased levels of liver enzymes; hepatic dysfunction resulting in fatigue, nausea, and anorexia; hepatitis; and acute liver failure [2,12,29,37]. Hepatotoxicity is more likely to occur with the use of extended-release forms of nicotinic acid [12,38,39].

Antidiabetes medicationsLarge doses of nicotinic acid can raise blood glucose levels by causing or aggravating insulin resistance and increasing hepatic production of glucose [43]. Some studies have found that nicotinic acid doses of 1.5 g/day or more are most likely to increase blood glucose levels in individuals with or without diabetes [38]. People who take any antidiabetes medications should have their blood glucose levels monitored if they take high-dose nicotinic acid supplements concomitantly because they might require dose adjustments [43].

An interdisciplinary and critical synthesis of the relevant literature is conducted, presenting two stances that are largely considered as rival: The instrumental one that treats higher education as an ordinary investment with particular financial yields in the labour market and the more intrinsic one which sees higher education as mainly detached from the logic of economic costs and benefits. The theoretical rivalry is apparent since in the former approach higher education is an inevitable property of labour market and thus an indispensable part of the mainstream economic neoliberal regime, whereas the latter sees no logical link between higher education and labour market purposes and therefore the content and substance of learning and knowledge acquisition in education and specifically in higher education should not be market-driven or aligned to the functions of specific economic regimes. However, this article argues that educational systems, and particularly their higher levels, are amalgamated parts of contemporary societies and therefore theories and practices need to move away from rather futile binary rationales.

Stone (2013), finally sees things from a very different perspective, where inequalities exist mainly because of simply bad luck. He argues in favour of lots, when a university has to decide whether to accept an applicant or not. Even if, an argument like this seems highly controversial, it consists of something that has been implemented in many countries, several times in the past (Hyland, 2011). The argument that an individual deserves a place in university just because he/she scored higher marks in a standardised sorting examination test does not prove that he/she will perform better in his/her subsequent academic tasks. Likewise, if an individual, who failed to secure a place in university due to low marks, was given a chance to enter university through a different procedure, he/she might have performed exceptionally well. Yet, human society cannot solely depend on lotteries and computer random algorithms, but sometimes, up to a certain point and in the name of fairness and transparency, there is a strong case for also looking on the merits for using one (Stone, 2013).

Furthermore, Lowe (2000) argued that the widening of higher education participation can create a hyper-inflation of credentials, causing their serious devaluation in the labour market. This relates to the concept of diploma disease, where labour markets create a false impression that a higher degree is a prerequisite for a job and therefore, induce individuals to undertake them only for the sake of getting a job (Dore, 1976; Collins, 1979). This situation can create a highly competitive credential market, and even if there are indications of higher education expansion, individuals from lower social class do not have equal opportunities to get a degree, which can lead them to a more prestigious occupational category. This is, in turn, very similar to the Weberian theory of educational credentialism, where credentials determine social stratum (Brown, 2003; Karabel, 2006; Douthat, 2005; Waters, 2012).

Moreover, the decision for someone to undertake higher education is not solely influenced by its added value in the labour market. Since an individual is exposed to different experiences and influences, strategic decisions can easily change, especially when these are taken from adolescents or individuals in their early stages of their adulthood. Given this, perceptions and preferences do change with ageing and this is why there are some individuals who drop out from university, others who choose radical shifts in their career or others who return to education after having worked in the labour market for many years and in different types of jobs.

However, even if the two theoretical stances presented are regarded as contradictory, this article argues that, in practical terms, they can be better seen as complementing each other. From one hand, using an instrumental perspective, an increase in higher education participation, focusing particularly on the most vulnerable and deprived members of society, can alleviate problems of income and social inequalities. The instrumental view of education has a very important role to play if focused on lower-income social classes, as it can become the mechanism towards the alleviation of income inequalities. On the other hand, apart from the pecuniary, there are also other non-pecuniary benefits associated with this, such as the improvement in the fertility and mortality and general health level rates or the boost of active democracy and citizenship even within workplaces and therefore a shift of higher education towards its intrinsic purposes is also needed. (Bowles and Gintis, 2002; Council of Europe, 2004; Brennan, 2004; Brown and Lauder, 2006; Wolff and Barsamian, 2012).

RoB 2 includes optional judgements of the direction of the bias for each domain and overall. For some domains, the bias is most easily thought of as being towards or away from the null. For example, high levels of switching of participants from their assigned intervention to the other intervention may have the effect of reducing the observed difference between the groups, leading to the estimated effect of adhering to intervention (see Section 8.2.2) being biased towards the null. For other domains, the bias is likely to favour one of the interventions being compared, implying an increase or decrease in the effect estimate depending on which intervention is favoured. Examples include manipulation of the randomization process, awareness of interventions received influencing the outcome assessment and selective reporting of results. If review authors do not have a clear rationale for judging the likely direction of the bias, they should not guess it and can leave this response blank. 041b061a72


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