Social capital, community-based governance and resilience in an African artisanal river fishery

This is a study of a community-based fishery on the Rovuma River that forms the border between Mozambique and Tanzania. We postulate a relationship between social capital and community-based governance over access to and the use of the fish resource. In historical times social capital was high and community-based governance regulated access to and use of the fishery as a common property resource. Transforming forces particularly colonial administration, advocating Christianity, war and an emerging market economy undermined social capital, which in turn affected community-based governance. The deconstruction of social capital has resulted in attitudes and behaviours that challenge governance processes with dire consequences for sustainable resource utilisation. Harvesting of fish stocks occurs at levels that are no longer sustainable and inappropriate practices are being adopted. While the Mozambique government policy promotes community-based fisheries management in artisanal fisheries, we argue that under current conditions of ineffective community-based governance, a strong focus on reconstruction of social capital will be required before a community-based resource management process can be effectively implemented. The findings are discussed in the context of resilience in social ecological systems. We suggest that given the historical context in which community-based natural resource management is promoted within southern Africa such a focus may have wide relevance

Balancing resource protection and development in a highly regulated river: The role of conjunctive use

The central position of water in social and economic development drives the imperative for water storage, particularly in water-stressed parts of the world. A consequence is that rivers are perceived primarily as locations for water storage as we seek to manage risks to social welfare and development. Assurance of supply becomes the dominant paradigm shaping decisions about allocation of water from impoundments. When this paradigm is deeply ingrained it constrains decision-making around flow management for other purposes, particularly for sustaining ecological systems. Ten years ago South Africa introduced progressive legislation for water resource management (the National Water Act of 1998) which enshrines the ecological Reserve. This requirement for the environment is not considered as a water use, because the environment is the resource. However, due to the very complex Reserve determination process, and perhaps a lack of political will, the ecological Reserve has proved difficult to implement and has only now started to be implemented in some river systems. In the case of the lower uMngeni River in KwaZulu-Natal, besides releases to maintain a minimum river flow (the so called ‘compensation flows’, which were never designed as environmental flows), for nearly 20 years there has been an unofficial policy to allow spates on between 1 and 4 days per year to make possible the continuation of the prestigious Dusi Canoe Marathon. The total amount of water involved is just over 1.2% of the river’s virgin MAR, although in years perceived to be dry the releases may be cut to as little as 0.3% of the virgin MAR. While these releases have been tolerated for the continuation of a high-value recreational industry, they are in fact aligned, albeit with a fraction of the necessary volume, with the environmental flows that would be required if the ecological Reserve had been determined. The releases for these events therefore have a dual or conjunctive value, serving both environmental and recreational purposes at the same time. We suggest that considerations of conjunctive use offer practical opportunities for balancing resource protection and development in regulated rivers. Keywords: resource protection, regulated rivers, assurance of supply, conjunctive use, ecological Reserve, environmental water allocation, environmental flows, recreational use, canoein

Multi-scenario modelling of learning

International audienceDesigning an educational scenario is a sensitive and challenging activity because it is the vector of learning. However, the designed scenario may not correspond to some learners’ characteristics (pace of work, cognitive styles, emotional factors, prerequisite knowledge, …). To personalize the learning task and adapt it gradually to each learner, several scenarios are needed. Adaptation and personalization are difficult because it is necessary on the one hand to know in advance the profiles and on the other hand to produce the multiple scenarios corresponding to these profiles. Our model allows to design many scenarios without knowing the learner profiles beforehand. Furthermore, it offers each learner opportunities to choose a scenario and to change it during their learning process. The model ensures that all announced objectives have enough resources for acquiring knowledge and activities for evaluation

Body composition in anorexia nervosa: Meta-analysis and meta-regression of cross-sectional and longitudinal studies

Objective: Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. Method: In accordance with PRISMA guidelines, we conducted 94 meta-analyses on 62 samples published during 1996–2019, comparing up to 2,319 pretreatment, posttreatment, and weight-recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat-free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta-regressions examined relationships among those measures and moderators. Results: Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: −8.80 kg, 95% CI: −9.81, −7.79, Q = 1.01 × 10−63) and 4.98 kg (95% CI: −5.85, −4.12, Q = 1.99 × 10−28) lower fat-free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: −2.1, −6.2, Q = 2.30 × 10−4). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat-free mass (MD: −1.27 kg, 95% CI: −1.79, −0.75, Q = 5.49 × 10−6) and bone mineral density (MD: −0.10 kg, 95% CI: −0.18, −0.03, Q = 0.01) remained significantly altered. Discussion: Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long-term altered levels of fat-free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers

Intra-subject repeatability of in vivo intervertebral motion parameters using quantitative fluoroscopy.

Purpose: In vivo quantification of intervertebral motion through imaging has progressed to a point where biomarkers for low back pain are emerging. This makes possible deeper study of the condition’s biometrics. However, the measurement of change over time involves error. The purpose of this prospective investigation is to determine the intra-subject repeatability of six in vivo intervertebral motion parameters using quantitative fluoroscopy. Methods: Intra-subject reliability (ICC) and minimal detectable change (MDC) of baseline to 6-week follow-up measurements were calculated for 6 lumbar spine intervertebral motion parameters in 109 healthy volunteers. A standardised quantitative fluoroscopy (QF) protocol was used to provide measurements in the coronal and sagittal planes using both passive recumbent and active weight bearing motion. Parameters were: intervertebral range of motion (IV-RoM), laxity, motion sharing inequality (MSI), motion sharing variability (MSV), flexion translation, and anterior disc height change during flexion. Results: The best overall intra subject reliability (ICC) and agreement (MDT) were for disc height (ICC 0.89, MDC 43%) and IV-RoM (ICC 0.96, MDC 60%) and the worst for MSV (ICC 0.04, MCD 408%). Laxity, MSI and translation had acceptable reliability (most ICCs >0.60), but not agreement (MDC >85%). Conclusion: Disc height and IV-RoM measurement using QF could be considered for randomised trials while laxity, MSI and translation could be considered for moderators, correlates or mediators of patient reported outcomes. MSV had both poor reliability and agreement over 6 weeks

Lack of Support for the Genes by Early Environment Interaction Hypothesis in the Pathogenesis of Schizophrenia

Ursini et al reported recently that the liability of schizophrenia explained by a polygenic risk score (PRS) derived from the variants most associated with schizophrenia was increased 5-fold in individuals who experienced complications during pregnancy or birth. Follow-up gene expression analysis showed that the genes mapping to the most associated genetic variants are highly expressed in placental tissues. If confirmed, these findings will have major implications in our understanding of the joint effect of genes and environment in the pathogenesis of schizophrenia. We examined the interplay between PRS and obstetric complications (OCs) in 5 independent samples (effective N = 2110). OCs were assessed with the full or modified Lewis-Murray scale, or with birth weight < 2.5 kg as a proxy. In a large cohort we tested whether the pathways from placenta-relevant variants in the original report were associated with case-control status. Unlike in the original study, we did not find significant effect of PRS on the presence of OCs in cases, nor a substantial difference in the association of PRS with case-control status in samples stratified by the presence of OCs. Furthermore, none of the PRS by OCs interactions were significant, nor were any of the biological pathways, examined in the Swedish cohort. Our study could not support the hypothesis of a mediating effect of placenta biology in the pathway from genes to schizophrenia. Methodology differences, in particular the different scales measuring OCs, as well as power constraints for interaction analyses in both studies, may explain this discrepancy

Genetic and environmental risk factors for rheumatoid arthritis in a UK African ancestry population: the GENRA case-control study

$\textbf{Objectives}$.: To evaluate whether genetic and environmental factors associated with RA in European and Asian ancestry populations are also associated with RA in African ancestry individuals. $\textbf{Methods}$.: A case-control study was undertaken in 197 RA cases and 868 controls of African ancestry (Black African, Black Caribbean or Black British ethnicity) from South London. Smoking and alcohol consumption data at RA diagnosis was captured. Genotyping was undertaken (Multi-Ethnic Genotyping Array) and human leukocyte antigen (HLA) alleles imputed. The following European/Asian RA susceptibility factors were tested: 99 genome-wide loci combined into a genetic risk score; HLA region [20 haplotypes; shared epitope (SE)]; smoking; and alcohol consumption. The SE was tested for its association with radiological erosions. Logistic regression models were used, including ancestry-informative principal components, to control for admixture. $\textbf{Results}$.: European/Asian susceptibility loci were associated with RA in African ancestry individuals. The genetic risk score provided an odds ratio (OR) for RA of 1.53 (95% CI: 1.31, 1.79; P = 1.3 × 10$^{-7}$). HLA haplotype ORs in European and African ancestry individuals were highly correlated ( r = 0.83, 95% CI: 0.56, 0.94; P = 1.1 × 10$^{-4}$). Ever-smoking increased (OR = 2.36, 95% CI: 1.46, 3.82; P = 4.6 × 10$^{-4}$) and drinking alcohol reduced (OR = 0.34, 95% CI: 0.20, 0.56; P = 2.7 × 10$^{-5}$) RA risk in African ancestry individuals. The SE was associated with erosions (OR = 2.61, 95% CI: 1.36, 5.01; P = 3.9 × 10$^{-3}$). $\textbf{Conclusion}$.: Gene-environment RA risk factors identified in European/Asian ancestry populations are relevant in African ancestry individuals. As modern statistical methods facilitate analysing ancestrally diverse populations, future genetic studies should incorporate African ancestry individuals to ensure their implications for precision medicine are universally applicable.This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funders had no role in the study design, data collection and analysis, data interpretation, the writing of the manuscript or the decision to submit the manuscript for publication. This study also represents independent research part-funded by the NIHR Biomedical Research Centre (NIHR BRC) at South London and Maudsley NHS Foundation Trust and King’s College London, and the NIHR BRC at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London

An empirical approach to selecting community-based alcohol interventions:combining research evidence, rural community views and professional opinion

<p>Abstract</p> <p>Background</p> <p>Given limited research evidence for community-based alcohol interventions, this study examines the intervention preferences of rural communities and alcohol professionals, and factors that influence their choices.</p> <p>Method</p> <p>Community preferences were identified by a survey of randomly selected individuals across 20 regional Australian communities. The preferences of alcohol professionals were identified by a survey of randomly selected members of the Australasian Professional Society on Alcohol and Other Drugs. To identify preferred interventions and the extent of support for them, a budget allocation exercise was embedded in both surveys, asking respondents to allocate a given budget to different interventions. Tobit regression models were estimated to identify the characteristics that explain differences in intervention preferences.</p> <p>Results</p> <p>Community respondents selected school programs most often (88.0%) and allocated it the largest proportion of funds, followed by promotion of safer drinking (71.3%), community programs (61.4%) and police enforcement of alcohol laws (60.4%). Professionals selected GP training most often (61.0%) and allocated it the largest proportion of funds, followed by school programs (36.6%), community programs (33.8%) and promotion of safer drinking (31.7%). Community views were susceptible to response bias. There were no significant predictors of professionals' preferences.</p> <p>Conclusions</p> <p>In the absence of sufficient research evidence for effective community-based alcohol interventions, rural communities and professionals both strongly support school programs, promotion of safer drinking and community programs. Rural communities also supported police enforcement of alcohol laws and professionals supported GP training. The impact of a combination of these strategies needs to be rigorously evaluated.</p

Duration of temporary catheter use for hemodialysis: an observational, prospective evaluation of renal units in Brazil

<p>Abstract</p> <p>Background</p> <p>For chronic hemodialysis, the ideal permanent vascular access is the arteriovenous fistula (AVF). Temporary catheters should be reserved for acute dialysis needs. The AVF is associated with lower infection rates, better clinical results, and a higher quality of life and survival when compared to temporary catheters. In Brazil, the proportion of patients with temporary catheters for more than 3 months from the beginning of therapy is used as an evaluation of the quality of renal units. The aim of this study is to evaluate factors associated with the time between the beginning of hemodialysis with temporary catheters and the placement of the first arteriovenous fistula in Brazil.</p> <p>Methods</p> <p>This is an observational, prospective non-concurrent study using national administrative registries of all patients financed by the public health system who began renal replacement therapy (RRT) between 2000 and 2004 in Brazil. Incident patients were eligible who had hemodialysis for the first time. Patients were excluded who: had hemodialysis reportedly started after the date of death (inconsistent database); were younger than 18 years old; had HIV; had no record of the first dialysis unit; and were dialyzed in units with less than twenty patients. To evaluate individual and renal unit factors associated with the event of interest, the frailty model was used (N = 55,589).</p> <p>Results</p> <p>Among the 23,824 patients (42.9%) who underwent fistula placement in the period of the study, 18.2% maintained the temporary catheter for more than three months until the fistula creation. The analysis identified five statistically significant factors associated with longer time until first fistula: higher age (Hazard-risk - HR 0.99, 95% CI 0.99-1.00); having hypertension and cardiovascular diseases (HR 0.94, 95% CI 0.9-0.98) as the cause of chronic renal disease; residing in capitals cities (HR 0.92, 95% CI 0.9-0.95) and certain regions in Brazil - South (HR 0.83, 95% CI 0.8-0.87), Midwest (HR 0.88, 95% CI 0.83-0.94), Northeast (HR 0.91, 95% CI 0.88-0.94), or North (HR 0.88, 95% CI 0.83-0.94) and the type of renal unit (public or private).</p> <p>Conclusion</p> <p>Monitoring the provision of arteriovenous fistulas in renal units could improve the care given to patients with end stage renal disease.</p

Spectrum, risk factors and outcomes of neurological and psychiatric complications of COVID-19: a UK-wide cross-sectional surveillance study

SARS-CoV-2 is associated with new-onset neurological and psychiatric conditions. Detailed clinical data, including factors associated with recovery, are lacking, hampering prediction modelling and targeted therapeutic interventions. In a UK-wide cross-sectional surveillance study of adult hospitalized patients during the first COVID-19 wave, with multi-professional input from general and sub-specialty neurologists, psychiatrists, stroke physicians, and intensivists, we captured detailed data on demographics, risk factors, pre-COVID-19 Rockwood frailty score, comorbidities, neurological presentation and outcome. A priori clinical case definitions were used, with cross-specialty independent adjudication for discrepant cases. Multivariable logistic regression was performed using demographic and clinical variables, to determine the factors associated with outcome. A total of 267 cases were included. Cerebrovascular events were most frequently reported (131, 49%), followed by other central disorders (95, 36%) including delirium (28, 11%), central inflammatory (25, 9%), psychiatric (25, 9%), and other encephalopathies (17, 7%), including a severe encephalopathy (n = 13) not meeting delirium criteria; and peripheral nerve disorders (41, 15%). Those with the severe encephalopathy, in comparison to delirium, were younger, had higher rates of admission to intensive care and a longer duration of ventilation. Compared to normative data during the equivalent time period prior to the pandemic, cases of stroke in association with COVID-19 were younger and had a greater number of conventional, modifiable cerebrovascular risk factors. Twenty-seven per cent of strokes occurred in patients 60 years old, the younger stroke patients presented with delayed onset from respiratory symptoms, higher rates of multi-vessel occlusion (31%) and systemic thrombotic events. Clinical outcomes varied between disease groups, with cerebrovascular disease conferring the worst prognosis, but this effect was less marked than the pre-morbid factors of older age and a higher pre-COVID-19 frailty score, and a high admission white cell count, which were independently associated with a poor outcome. In summary, this study describes the spectrum of neurological and psychiatric conditions associated with COVID-19. In addition, we identify a severe COVID-19 encephalopathy atypical for delirium, and a phenotype of COVID-19 associated stroke in younger adults with a tendency for multiple infarcts and systemic thromboses. These clinical data will be useful to inform mechanistic studies and stratification of patients in clinical trials