The importance of stakeholders in scoping risk assessments—Lessons from low-carbon transitions

Identifying the risks that could impact a low-carbon transition is a prerequisite to assessing and managing these risks. We systematically characterise risks associated with decarbonisation pathways in fifteen case studies conducted in twelve countries around the world. We find that stakeholders from business, government, NGOs, and others supplied some 40 % of these risk inputs, significantly widening the scope of risks considered by academics and experts. Overall, experts and academics consider more economic risks and assess these with quantitative methods and models, while other stakeholders consider political risks more. To avoid losing sight of risks that cannot be easily quantified and modelled, including some economic risks, impact assessment modelling should be complemented with qualitative research and active stakeholder engagement. A systematic risk elicitation facilitates communication with stakeholders, enables better risk mitigation, and increases the chance of a sustainable transition

IBRD Operational Decision Framework

The IBRD Operational Decision Framework in this document is an expansion of an emerging general risk management framework under development by an interagency working group. It provides the level of detail necessary to develop a general Consequence Management Guidance Document for biological contamination remediation and restoration. It is the intent of this document to support both wide area and individual site remediation and restoration activities. This product was initiated as a portion of the IBRD Task 1 Systems Analysis to aid in identification of wide area remediation and restoration shortcomings and gaps. The draft interagency general risk management framework was used as the basis for the analysis. The initial Task 1 analysis document expanded the draft interagency framework to a higher level of resolution, building on both the logic structure and the accompanying text explanations. It was then employed in a qualitative manner to identify responsible agencies, data requirements, tool requirements, and current capabilities for each decision and task. This resulted in identifying shortcomings and gaps needing resolution. Several meetings of a joint LLNL/SNL working group reviewed and approved the initial content of this analysis. At the conclusion of Task 1, work continued on the expanded framework to generate this Operational Decision Framework which is consistent with the existing interagency general risk management framework. A large LLNL task group met repeatedly over a three-month period to develop the expanded framework, coordinate the framework with the biological remediation checklist, and synchronize the logic with the Consequence Management Plan table of contents. The expanded framework was briefed at a large table top exercise reviewing the interagency risk management framework. This exercise had representation from major US metropolitan areas as well as national agencies. This product received positive comments from the participants. Upon completion of the Operational Decision Framework, another joint LLNL/SNL working group conducted a day-long review. Identified modifications were made to the document, resulting in the included product

Cartan subalgebras in C*-algebras of Hausdorff etale groupoids

The reduced $C^*$-algebra of the interior of the isotropy in any Hausdorff \'etale groupoid $G$ embeds as a $C^*$-subalgebra $M$ of the reduced $C^*$-algebra of $G$. We prove that the set of pure states of $M$ with unique extension is dense, and deduce that any representation of the reduced $C^*$-algebra of $G$ that is injective on $M$ is faithful. We prove that there is a conditional expectation from the reduced $C^*$-algebra of $G$ onto $M$ if and only if the interior of the isotropy in $G$ is closed. Using this, we prove that when the interior of the isotropy is abelian and closed, $M$ is a Cartan subalgebra. We prove that for a large class of groupoids $G$ with abelian isotropy---including all Deaconu--Renault groupoids associated to discrete abelian groups---$M$ is a maximal abelian subalgebra. In the specific case of $k$-graph groupoids, we deduce that $M$ is always maximal abelian, but show by example that it is not always Cartan.Comment: 14 pages. v2: Theorem 3.1 in v1 incorrect (thanks to A. Kumjain for pointing out the error); v2 shows there is a conditional expectation onto $M$ iff the interior of the isotropy is closed. v3: Material (including some theorem statements) rearranged and shortened. Lemma~3.5 of v2 removed. This version published in Integral Equations and Operator Theor

Project MOSI: rationale and pilot-study results of an initiative to help protect zoo animals from mosquito-transmitted pathogens and contribute data on mosquito spatio–temporal distribution change

Mosquito-borne pathogens pose major threats to both wildlife and human health and, largely as a result of unintentional human-aided dispersal of their vector species, their cumulative threat is on the rise. Anthropogenic climate change is expected to be an increasingly significant driver of mosquito dispersal and associated disease spread. The potential health implications of changes in the spatio-temporal distribution of mosquitoes highlight the importance of ongoing surveillance and, where necessary, vector control and other health-management measures. The World Association of Zoos and Aquariums initiative, Project MOSI, was established to help protect vulnerable wildlife species in zoological facilities from mosquito-transmitted pathogens by establishing a zoo-based network of fixed mosquito monitoring sites to assist wildlife health management and contribute data on mosquito spatio-temporal distribution changes. A pilot study for Project MOSI is described here, including project rationale and results that confirm the feasibility of conducting basic standardized year-round mosquito trapping and monitoring in a zoo environment

Long-Term Gynecological Outcomes in Women with Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency

Background. Our knowledge on long-term outcome in CAH remains incomplete. Methods. In a prospective study (33 CAH patients, 33 age-matched controls), reproductive outcomes, self-rating of genital appearance and function, and sexuality were correlated to degree of initial virilisation, genotype, and surgery. Results. Patients had larger median clitoral lengths (10.0 mm [range 2–30] versus 3.5 [2–8], P < .001), shorter vaginal length (121 mm [100–155] versus 128 [112–153], P = .12), lower uterine volumes (29.1 ml [7.5–56.7] versus 47.4 [15.9–177.5], P = .009), and higher ovarian volumes (4.4 ml [1.3–10.8] versus 2.8 [0.6–10.8], P = .09) than controls. Satisfaction with genital appearance was lower and negatively correlated to degree of initial virilisation (rs = ≤−0.39, P ≤ .05). More patients had never had intercourse (P = .001), and age at 1st intercourse was higher (18 yrs versus 16 yrs, P = .02). Conclusion. Despite overall acceptable cosmetic results, reproductive outcomes were suboptimal, supporting that multidisciplinary teams should be involved in adult follow up of CAH patients

paediatric respiratory disease past present and future

Paediatric respiratory disease has changed in the past 20 yrs; we could fill a whole issue of the journal paying tribute to our famous forebears. We are posing new challenges to our colleagues in the field of adult respiratory disease. They have to learn to deal with conditions that 20 yrs ago were rare in the adult chest clinic, such as cystic fibrosis (CF) and the long-term consequences of premature birth and congenital malformations of the respiratory tract. Furthermore, studies in childhood are challenging pathophysiological concepts throughout life. The many great prospective birth cohort studies have shed light on the different patterns of wheezing, their risk factors and their evolution through childhood. Who would have thought it was good to be born in a barn! It is becoming increasingly clear that even for "adult" diseases, such as chronic obstructive pulmonary disease (COPD), antenatal and early life events are at least as important as smoking in adulthood 1. CF has become a disease also of adults 2. Although many factors have contributed, the main reason has been the development of expert special CF centres, a model increasingly adopted by adult teams. This can serve as a model for other diseases; how a well-structured multidisciplinary approach to treatment can translate into benefits for patients. Perhaps numerically the most important achievement is in the field of public health. The benefit of the decrease in invasive bacterial infections, due to vaccination programmes for infants, is among the most important achievements of the past. Other areas of change include the survival of ever smaller preterm neonates. These children are reaching adult life with impaired lung function and abnormal computed tomography scans. What will happen to their ageing lungs? Interstitial lung disease (ILD) is becoming increasingly well understood, with new genetic entities, such as

The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3): a randomised trial to determine the efficacy of adding a complex intervention for major depressive disorder (Depression Care for People with Lung Cancer) to usual care, compared to usual care alone in patients with lung cancer

Background: Depression Care for People with Lung Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. The third Symptom Management Research Trial in Oncology (SMaRT Oncology-3 Trial) will test its efficacy when compared to usual care alone. Design: A two arm parallel group multi-centre randomised controlled trial. 200 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of lung cancer; an estimated life expectancy of three months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Lung Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is average depression severity. This will be assessed using scores on the 20-item Symptom Hopkins Checklist (SCL-20D), collected every four weeks over 32 weeks. Secondary outcomes include severity of anxiety, pain and fatigue; self-rated improvement of depression; quality of life and satisfaction with depression care

Non-classical ProIL-1beta activation during mammary gland infection is pathogen-dependent but caspase-1 independent

Infection of the mammary gland with live bacteria elicits a pathogen-specific host inflammatory response. To study these host-pathogen interactions wild type mice, NF-kappaB reporter mice as well as caspase-1 and IL-1beta knockout mice were intramammarily challenged with Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus). The murine mastitis model allowed to compare the kinetics of the induced cytokine protein profiles and their underlying pathways. In vivo and ex vivo imaging showed that E. coli rapidly induced NF-kappaB inflammatory signaling concomitant with high mammary levels of TNF-alpha, IL-1 alpha and MCP-1 as determined by multiplex analysis. In contrast, an equal number of S. aureus bacteria induced a low NF-kappaB activity concomitant with high mammary levels of the classical IL-1beta fragment. These quantitative and qualitative differences in local inflammatory mediators resulted in an earlier neutrophil influx and in a more extensive alveolar damage post-infection with E. coli compared to S. aureus. Western blot analysis revealed that the inactive proIL-1beta precursor was processed into pathogen-specific IL-1beta fragmentation patterns as confirmed with IL-1beta knockout animals. Additionally, caspase-1 knockout animals allowed to investigate whether IL-1beta maturation depended on the conventional inflammasome pathway. The lack of caspase-1 did not prevent extensive proIL-1beta fragmentation by either of S. aureus or E. coli. These non-classical IL-1beta patterns were likely caused by different proteases and suggest a sentinel function of IL-1beta during mammary gland infection. Thus, a key signaling nodule can be defined in the differential host innate immune defense upon E. coli versus S. aureus mammary gland infection, which is independent of caspase-1