Non-stationarity in Southern Hemisphere climate variability associated with the seasonal breakdown of the stratospheric polar vortex

Statistical models of climate generally regard climate variability as anomalies about a climatological seasonal cycle, which are treated as a stationary stochastic process plus a long-term seasonally dependent trend. However, the climate system has deterministic aspects apart from the climatological seasonal cycle and long-term trends, and the assumption of stationary statistics is only an approximation. The variability of the Southern Hemisphere zonal-mean circulation in the period encompassing late spring and summer is an important climate phenomenon and has been the subject of numerous studies. It is shown here, using re-analysis data, that this variability is rendered highly non-stationary by the organizing influence of the seasonal breakdown of the stratospheric polar vortex, which breaks time symmetry. It is argued that the zonal-mean tropospheric circulation variability during this period is best viewed as interannual variability in the transition between the springtime and summertime regimes induced by variability in the vortex breakdown. In particular, the apparent long-term poleward jet shift during the early-summer season can be more simply understood as a delay in the equatorward shift associated with this regime transition. The implications of such a perspective for various open questions are discussed

Development of guidelines to reduce, handle and report missing data in palliative care trials: A multi-stakeholder modified nominal group technique

Background: Missing data can introduce bias and reduce the power, precision and generalisability of study findings. Guidelines on how to address missing data are limited in scope and detail, and poorly implemented. Aim: To develop guidelines on how best to (i) reduce, (ii) handle and (iii) report missing data in palliative care clinical trials. Design: Modified nominal group technique. Setting/participants: Patient and public research partners, palliative care clinicians, trialists, methodologists and statisticians attended a 1-day workshop, following which a multi-stakeholder development group drafted the guidelines. Results: Seven main recommendations for reducing missing data, nine for handling missing data and twelve for reporting missing data were developed. The top five recommendations were: (i) train all research staff on missing data, (ii) prepare for missing data at the trial design stage, (iii) address missing data in the statistical analysis plan, (iv) collect the reasons for missing data and (v) report descriptive statistics comparing the baseline characteristics of those with missing and observed data. Reducing missing data, preparing for missing data and understanding the reasons for missing data were greater priorities for stakeholders than how to deal with missing data once they had occurred. Conclusion: Comprehensive guidelines on how to address missing data were developed by stakeholders involved in palliative care trials. Implementation of the guidelines will require endorsement of research funders and research journals

A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care

BACKGROUND: Antimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals. METHODS: Semi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework. RESULTS: A total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals' roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation). CONCLUSION: This study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change

How do self‐advocates use community development to change attitudes to disability?

Background Negative attitudes remain a major barrier to the equality of people with disability, especially when coupled with the lack of autonomy imposed on many people. This paper analyses how disability self‐advocacy groups seek to change community attitudes and work towards systemic change by mobilising knowledge from their lived experience. Methods The paper applies a cycle of praxis community development approach (a cycle of experience, learning and reflection, synthesis and planning, and implementation and review) to conceptualise and analyse their activities. The methods were a desktop document search, focus groups and reflective analysis with members of two self‐advocacy groups. Findings A synthesised data analysis found that applying the four‐part community development framework was useful to understand the practice and the purpose of work by self‐advocacy groups to change attitudes. The analysis also demonstrates the benefits for advocates and codesigned activities to intentionally apply the cycle of praxis model to guide their future efforts to change attitudes. Conclusions The research provides evidence that self‐advocacy groups achieve sustained impacts on attitudes in the community, beyond the direct benefit to their members. Government investment in self‐advocacy has potential to leverage wider system change in attitudes to achieve policy goals for the rights of people with disability. Methodologically, the research also has implications for the benefit of inclusive roles in reflective analysis to understand the lived experience of how practices contribute to system change. The design is an opportunity for inclusive researchers to intentionally incorporate reflective analysis into research processes

From traits to typologies: Piloting new approaches to profiling trait preferences along the cassava value chain in Nigeria

Breeding programs are increasing efforts towards demand-led breeding approaches to ensure that cultivars released meet the needs of end users including processors, traders, and consumers, and that they are adopted by farmers. To effectively deploy these approaches, new tools are required to better understand and quantify the degree of preference differences among alternative trait changes competing for measurement and selection effort. The purpose of this study was to present a method of quantifying preferences and developing typologies according to breeding priorities by applying an online trait preference survey approach to cassava (Manihot esculenta Crantz). This paper presents a conjoint analysis based on Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) to help guide breeding programs in understanding trait preferences across value chain roles and social contexts and set breeding priorities that represent diverse interests. Trait preferences were assessed using a comprehensive survey and analysis package incorporating a core adaptive conjoint method (1000minds, 2020). Trait selection was based on a trade-off of 11 cassava traits carried out with 792 cassava value chain actors in four geopolitical regions in Nigeria. Principal component and cluster analyses revealed three clusters (typologies) of respondents according to their trait preferences. The results demonstrate the usefulness of this methodology that innovates on previous trait preference approaches to address the expanding needs of plant breeding programs within smallholder contexts. © 2021 The Authors. Crop Science © 2021 Crop Science Society of Americ

Science-based intensive agriculture: Sustainability, food security, and the role of technology

Sustainable agriculture describes crop management approaches that address the interdependent goals of increasing or at least maintaining yield while protecting the environment, conserving natural resources, and slowing climate change. Numerous authors have espoused limiting synthetic fertilizer and pesticides and promoting organic agriculture (Lechenet et al., 2014; Martinez-Alcantara et al., 2016; Muller at al. 2017), less meat consumption (West et al., 2014; Poore and Nemecek, 2018; Springmann et al., 2018), or combinations of these strategies as viable solutions to achieve those goals, thereby improving agricultural sustainability

Tumour infiltrating lymphocytes correlate with improved survival in patients with oesophageal adenocarcinoma

BACKGROUND: Oesophageal adenocarcinoma (OAC) is increasingly common in the west, and survival remains poor at 10-15 % at 5 years. Immune responses are increasingly implicated as a determining factor of tumour progression. The ability of lymphocytes to recognise tumour antigens provides a mechanism for a host immune attack against cancer providing a potential treatment strategy.MATERIALS AND METHODS: Tumour infiltrating lymphocytes (TILs: CD3+, CD4+, CD8+ and FOXp3+) were assessed by immunohistochemistry using tissue microarrays in a contemporary and homogeneous cohort of OAC patients (n = 128) undergoing curative treatment.RESULTS: Multivariate analysis identified three independent prognostic factors for improved cancer-specific survival (CSS): increased CD8+ TILs (p = 0.003), completeness of resection (p < 0.0001) and lower pathological N stage (p < 0.0001). Independent prognostic factors for favourable disease-free survival included surgery-only treatment (p = 0.015), completeness of resection (p = 0.001), increased CD8+ TILs (p < 0.0001) and reduced pathological N stage (p < 0.0001). Higher levels of TILs in the pathological specimen were associated with significant pathological response to neoadjuvant chemotherapy (NAC). On multivariate analysis increased levels of CD4+ (p = 0.017) and CD8+ TILs (p = 0.005) were associated with significant local tumour regression and lymph node downstaging, respectively.DISCUSSION: Our results establish an association of TILs and survival in OAC, as seen in other solid tumours, and identify particular TIL subsets that are present at higher levels in patients who responded to NAC compared to non-responders. These findings highlight potential therapeutic strategies in EAC based on utilising the host immunological response and highlight the immune responses biomarker potential