Choice of estimand and analysis methods in diabetes trials with rescue medication

The analysis of clinical trials aiming to show symptomatic benefits is often complicated by the ethical requirement for rescue medication when the disease state of patients worsens. In type 2 diabetes trials, patients receive glucose‐lowering rescue medications continuously for the remaining trial duration, if one of several markers of glycemic control exceeds pre‐specified thresholds. This may mask differences in glycemic values between treatment groups, because it will occur more frequently in less effective treatment groups. Traditionally, the last pre‐rescue medication value was carried forward and analyzed as the end‐of‐trial value. The deficits of such simplistic single imputation approaches are increasingly recognized by regulatory authorities and trialists. We discuss alternative approaches and evaluate them through a simulation study. When the estimand of interest is the effect attributable to the treatments initially assigned at randomization, then our recommendation for estimation and hypothesis testing is to treat data after meeting rescue criteria as deterministically ‘missing’ at random, because initiation of rescue medication is determined by observed in‐trial values. An appropriate imputation of values after meeting rescue criteria is then possible either directly through multiple imputation or implicitly with a repeated measures model. Crucially, one needs to jointly impute or model all markers of glycemic control that can lead to the initiation of rescue medication. An alternative for hypothesis testing only are rank tests with outcomes from patients ‘requiring rescue medication’ ranked worst, and non‐rescued patients ranked according to final visit values. However, an appropriate ranking of not observed values may be controversial. Copyright © 2015 John Wiley & Sons, Ltd.     

Spiritualität im Coaching

There is only poor research and psychological orientated application of spirituality in the field of coaching in Germany. Addressing the sacred in coaching or counseling is a kind of taboo in Germany. We need to define the term of spirituality and we have to find ways how spirituality could be integrated even in coaching training and coaching practice—not in a popular way but in way that is psychological orientated and evidence based. There is a lot of research that shows clear benefits of integrating a spiritual perspective in psychotherapy and medicine. Could we assume the same benefits for coaching clients?     

Nonsuicidal Self‐Injury in a Community Sample of Adolescents: Subgroups,Stability, and Associations With Psychological Difficulties

Patterns of nonsuicidal self‐injury (NSSI) and their association with other psychological difficulties were studied in a community sample of young Swedish adolescents, by a two‐wave longitudinal design with a 1‐year interval. Hierarchical cluster analysis at T1 identified eight NSSI subgroups in each gender, of which five were clearly replicated at T2. Among these were a subgroup with generalized high‐frequency NSSI, which was associated with both internalizing and externalizing problems, and a subgroup of girls who engaged primarily in cutting and showed mainly internalizing problems. In general, NSSI clusters among girls were more stable over time and associated with more psychological problems. The results indicate that different patterns of NSSI have different developmental and clinical implications.     

Strategies for business model innovation: How firms reel in migrating value

This paper brings together firm-level research on business models and industry-level research on value migration to examine patterns of business model innovation. We draw on qualitative data from 14 cases and 68 interviews in the computer and telecommunications industries to demonstrate how business model innovation is sensitive to industry-wide forces of value migration. Based on our analysis we conclude that when value is rapidly migrating across industries and between firms, proactively substituting key elements of the primary business model provides a better fit with the new value landscape than launching secondary business models in parallel. We suggest four underlying mechanisms that link business model innovation, value migration and subsequent outcomes. Unpacking business model innovation allows us to discuss contingencies for the main business model strategies, specifically in terms of limitations to—and opportunities of—changing the primary business model and the practice of parallel business models.     

From Drama Text to Stage Text: Transitions of Text Understanding in a Student Theatre Production

Exploring how text understanding evolves through interaction in a drama-text-based student theatre production, the present study takes its theoretical point of departure in sociocultural and dialogical approaches to meaning making and creativity. Video data from a Swedish upper secondary school allowed us to follow transitions of text understanding in the artistic shaping of characters from drama text to stage text. We analyze a special kind of communicative side project: short, recurrent student-initiated role-plays, embedded in teacher-led activities. The joint text understanding that was established in these side projects proved productive in the emergent shaping of the stage text.     

The state and use of municipal tree inventories in Swedish municipalities – results from a national survey

Urban trees are an essential component of urban ecosystems, and management of this resource constitutes an essential element of urban open space management. However, municipal tree inventories in Sweden and elsewhere have received limited attention. It is unknown how common municipal tree inventories are in Sweden, factors governing whether a municipality has an inventory and what the inventories are used for. This study therefore sought to: Create an overview of the state of Swedish municipal tree inventories and determine how municipality size, green space budget and management organisation affect the presence and scope of municipal tree inventories. The research questions examined were: What is the current state of Swedish municipal tree inventories? and what affects the status of these municipal tree inventories? A survey with questions related to strategic and operational perspectives of municipal tree inventories, e.g. how they are conducted and used, together with questions relating to budget and potential use of consultants, was sent to all 290 Swedish municipalities. The response rate was 55.5%. The main findings were that municipality size affects whether a municipality has an urban tree inventory and that the municipal organisation form affects how inventories are used. The existence of an inventory also increased the probability of the municipality having a tree management plan. Based on these results we recommend further research related to strategic management perspectives of tree inventories.     

Spatial configurations of urban forest in different landscape and socio-political contexts: identifying patterns for green infrastructure planning

Rapid urbanisation and climate change have motivated the development of urban green infrastructure (UGI) as a planning strategy to support the wellbeing of urban people and ecosystems while parallel adapting cities to climate change. Forest (tree-covered areas >0.5 ha) is a key UGI component that afford a wider range of ecosystem services and mitigate urban heat islands more effectively than non-wooded green spaces. However, understanding of spatial configurations (variation in patch size and frequency) of forests across the gradient of urbanisation and between cities is limited to case studies. This represents a considerable knowledge gap for identification of general patterns that can inform integration of forest resources in UGI planning that have value beyond the individual city level. In this study we used Geographic Information Systems to explore the spatial configuration of forests across cities located within landscapes characterised by different levels of anthropogenic modification (degree of forest cover) and socio-political contexts, i.e. all Danish and Swedish cities >10,000 inhabitants (n = 176). We applied general linear modelling to investigate the relationship between forest cover, patch size and frequency with 1) regional landscape type, 2) demographic trends 1960–2010, and 3) the gradient of urbanisation (measured in three zones: urban core (0.2 km from city boundary), urban fringe (0.2–2 km), and urban periphery (2–5 km)). Regardless of demographic trends, forest cover was lowest in cities settled in large-scale agricultural regions, higher in regions with mosaics of forest and farming, and highest in forest-dominated regions. However, in all cities forest cover was lowest in the urban zone and peaked on the urban fringe rather than on the urban periphery. Furthermore, pocket woods (0.5–2 ha) accounted for over 50 % of patches in all three urban zones, irrespective of regional landscape type. We conclude by discussing how these general patterns could inform strategies for integration of urban forests in UGI planning.     

Accumulation of Welfare Problems in a Longitudinal Perspective

In this article we study the bias caused by the conventional retrospective measurement of parental high cultural activities in the effects of parental high cultural activities and educational attainment on son’s or daughter’s high cultural activities. Multi-informant data show that there is both random measurement error and correlated error in the respondent’s report of parental high cultural activities. Correlated measurement error is the consequence of the fact that adult children who have higher rates of high cultural activities, report higher levels of parental cultural activities than the parents themselves do. When controls for both types of measurement error are included in structural models, the total intergenerational effect of parental high cultural activities appears to be larger than in a model without controls for measurement error, but the direct intergenerational effect is not biased if educational attainment is controlled for. The effect of educational attainment on high cultural activities is larger in models that correct for measurement error. In addition, the effect of educational attainment is stronger than the effect of parental high cultural activities, both with and without correction for measurement error.