Process, paper policy and practice : a case study of the introduction of a formal extension policy in Queensland, Australia 1987 - 1994

This study explores the policy element of public sector agricultural extension. It was contended that this policy element lacked an adequate framework. Without such a framework, there was a risk that major policy - or operational - issues would be neglected in policy formulation. The study was designed to propose an improved framework for thinking about, and acting upon, the policy element of agricultural extension.The notion of extension policy was presented as lacking clarity due to a number of surrounding issues. Differences in definitions of extension were considered to be a major cause of the confusion about extension policy. These definitions or paradigms ranged from a persuasive, technology transfer focus, to a facilitative, human development model. If individuals viewed extension from such different perspectives, then, meaningful discourse about extension policy would be extremely difficult to achieve. Other issues presented as confusing the notion of extension policy included the on-going debate about the legitimate role of public sector extension, the meaning of formal policy itself, and the disagreement about what should comprise the content of such formal policy. Finally, the process of developing a formal extension policy, its implementation, and its impact, was also considered to add confusion to the development of an extension policy framework.Despite this confusion, however, the term extension policy was being used in practice, and extension policy was being developed. It was in this social construction of the meaning of extension policy that the development of an improved theoretical framework was sought.It was contended that an understanding of the meaning and role of formal policy could best be explored by looking at a situation where such policy was in the process of being developed, formulated, and implemented. For this reason, the development of a formal extension policy in Queensland, Australia, provided a very useful case-study. For the first time in its 100 year history, the Queensland Department of Primary Industries had initiated a comprehensive Extension Policy Review . As a result of this review, a formal Extension Strategy Statement was written, endorsed by government, and is currently being implemented. It was the discourse and action surrounding this process that provided the research environment.A grounded theory approach was used to enter this 'messy' world of appreciated knowledge. Pre- determined categories which provided an initial basis for collating and analysing the data were the Hierarchy of Extension Objectives , an Agricultural Knowledge and Information System perspective, and the dimension of Power .The initial phase of the study focused on the 1990 QDPI Extension Policy Review. Research centred around the triggers for such a review, its process, content, and the reaction to its outcome. Because of the link between the events in Queensland and what was happening in other states and countries in the area of extension policy, the surrounding 'paper' debate was also examined. Interviews and textual analysis provided the basis of data collection during this phase.The second phase explored the development, and early implementation, of the Extension Strategy Statement. In this phase, data was collected through participant observation, as well as through the record of institutional history found in office or internal memoranda.The analysis suggested that the initiation of a formal extension policy in Queensland was primarily a means of pre-empting an anticipated imposition of 'inappropriate' changes to the extension function, which included an expected reduction in public resources for extension. The discourse surrounding extension policy firmly centred on this issue of resources, and also on other conditions required for extension to fulfil an overt public function. It was the strategic renegotiation of this public function that underpinned the claim on these resources. A formal policy appeared to provide the sought after public sector commitment to the extension function, and hence the provision of resources to permit extension to operate and develop. It also provided a mechanism to realign extension with changing societal trends and expectations. The formal policy, however, was found wanting in achieving commitment and substantive change at the interface between extension officers and their clients. Prescriptive elements of policy, in particular, were suggested as being inappropriate at this formal level.An extension policy triangle was therefore proposed as a framework for thinking about the content of extension policy. This triangle comprised the elements of the reason for extension , the enabling conditions , and the constraining conditions . The societal reason for maintaining a public extension function was contrasted with the alternative, flawed rationale for extension in achieving predetermined, physically measurable objectives. Enabling conditions were described as providing the resources, structures, and processes to permit extension to develop and fulfil its negotiated reason. Constraining conditions were those that provided limitations on the extension function. These included resourcing issues as well as political and societal imperatives.The study concluded, however, that the content and implementation of extension policy could not be divorced from the process of policy development. It appeared that extension policy was being negotiated at two levels - the strategic and the collective . At the strategic level, senior managers were manoeuvring to ensure the continued legitimacy of the public sector extension function and hence ensure its continued role, support and resources. At the collective level, however, extension officers, their managers, and stakeholders were attempting to work through the problem situation that they were confronted with - the challenge to their traditional relationships. Commitment to a direction or change at this level was considered to be essential if a strategic change was to be enacted. It was in the discontinuities evident between the strategic and collective levels where problemes with content and its implementation appeared to result. These discontinuities centred around the lack of continuing and effective feedback loops between the two levels.It was therefore proposed that formal extension policy should be viewed within the context of the negotiation of change at the collective level. Formal policy could provide an impetus and focus for that change, and introduce strategic issues into the collective discourse. It could also capture resources to enable new steps to be taken. However, formal policy should be seen as an integral step in the total extension policy process rather than the dominating component, or end result, of an extension policy development process.Extension is being increasingly asked to become involved in complex community issues that demand collective action. It was argued that if extension is to have the capacity to impact in these areas, it must first demonstrate that its own guiding policy is grounded in a collective process

Early above- and below-ground responses of subboreal conifer seedlings to various levels of deciduous canopy removal

We examined the growth of understory conifers, following partial or complete deciduous canopy removal, in a field study established in two regions in Canada. In central British Columbia, we studied the responses of three species (Pseudotsuga menziesii var. glauca (Beissn.) Franco, Picea glauca (Moench) Voss x Picea engelmannii Parry ex Engelm., and Abies lasiocarpa (Hook.) Nutt.), and in northwestern Quebec, we studied one species (Abies balsamea (L.) Mill.). Stem and root diameter and height growth were measured 5 years before and 3 years after harvesting. Both root and stem diameter growth increased sharply following release but seedlings showed greater root growth, suggesting that in the short term, improvement in soil resource capture and transport, and presumably stability, may be more important than an increase in stem diameter and height growth. Response was strongly size dependent, which appears to reflect greater demand for soil resources as well as higher light levels and greater tree vigour before release for taller individuals. Growth ratios could not explain the faster response generally attributed to true fir species or the unusual swift response of spruces. Good prerelease vigour of spruces, presumably favoured by deciduous canopies, could explain their rapid response to release

Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

Background: Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability. Methods: We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367. Findings: Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications. Interpretation: Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management. Funding: The UK National Institute for Health Research Health Technology Assessment Programme

Cost-effectiveness of replacing versus discarding the nail in children with nail bed injury

Every year in the UK, around 10 000 children need to have operations to mend injuries to the bed of their fingernails. Currently, most children have their fingernail placed back on the injured nail bed after the operation. The NINJA trial found that children were slightly less likely to have an infection if the nail was thrown away rather than being put back, but the difference between groups was small and could have be due to chance. This study looked at whether replacing the nail is cost-effective compared with throwing it away. Using data from the NINJA trial, we compared costs, healthcare use, and quality of life and assessed the cost-effectiveness of replacing the nail. It was found that throwing the nail away after surgery would save the National Health Service (NHS) £75 (€85) per operation compared with placing the nail back on the nail bed. Changing clinical practice could save the NHS in England £720 000 (€819 000) per year

Para-infectious brain injury in COVID-19 persists at follow-up despite attenuated cytokine and autoantibody responses

To understand neurological complications of COVID-19 better both acutely and for recovery, we measured markers of brain injury, inflammatory mediators, and autoantibodies in 203 hospitalised participants; 111 with acute sera (1–11 days post-admission) and 92 convalescent sera (56 with COVID-19-associated neurological diagnoses). Here we show that compared to 60 uninfected controls, tTau, GFAP, NfL, and UCH-L1 are increased with COVID-19 infection at acute timepoints and NfL and GFAP are significantly higher in participants with neurological complications. Inflammatory mediators (IL-6, IL-12p40, HGF, M-CSF, CCL2, and IL-1RA) are associated with both altered consciousness and markers of brain injury. Autoantibodies are more common in COVID-19 than controls and some (including against MYL7, UCH-L1, and GRIN3B) are more frequent with altered consciousness. Additionally, convalescent participants with neurological complications show elevated GFAP and NfL, unrelated to attenuated systemic inflammatory mediators and to autoantibody responses. Overall, neurological complications of COVID-19 are associated with evidence of neuroglial injury in both acute and late disease and these correlate with dysregulated innate and adaptive immune responses acutely

SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination

BACKGROUND: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. METHODS: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. FINDINGS: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. INTERPRETATION: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. FUNDING: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript

Large-scale phenotyping of patients with long COVID post-hospitalization reveals mechanistic subtypes of disease

One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood1. Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered. Elevated markers of myeloid inflammation and complement activation were associated with long COVID. IL-1R2, MATN2 and COLEC12 were associated with cardiorespiratory symptoms, fatigue and anxiety/depression; MATN2, CSF3 and C1QA were elevated in gastrointestinal symptoms and C1QA was elevated in cognitive impairment. Additional markers of alterations in nerve tissue repair (SPON-1 and NFASC) were elevated in those with cognitive impairment and SCG3, suggestive of brain–gut axis disturbance, was elevated in gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G (IgG) was persistently elevated in some individuals with long COVID, but virus was not detected in sputum. Analysis of inflammatory markers in nasal fluids showed no association with symptoms. Our study aimed to understand inflammatory processes that underlie long COVID and was not designed for biomarker discovery. Our findings suggest that specific inflammatory pathways related to tissue damage are implicated in subtypes of long COVID, which might be targeted in future therapeutic trials