‘Q-storming’ to identify challenges and opportunities for integrating health and climate adaptation measures in Africa

INTRODUCTION : Climate factors influence the state of human health and wellbeing. Climate-related threats are particularly being experienced by vulnerable populations in Africa. A Question (Q)-Storming session was convened at an international climate adaptation conference. It promoted dialog among a diverse spectrum of researchers, climate and medical scientists, health professionals, national government officials, civil society, business, and international governing organizations. The session identified approaches for the effective integration of health within African national climate adaptation policies. MATERIALS AND METHODS : Two organizations partnered to convene the session at the Adaptations Futures 2018 Conference in Cape Town. Q-storming (which is an inverse approach to brainstorming) was applied to extract ideas from all participants. Four topics were presented during the session: (i) adaptive capacities related to climate change and infectious diseases; (ii) adaptive capacity of African governments in relation to health and climate change; (iii) making climate science work to protect the health of vulnerable populations; and (iv) making climate-health research usable. RESULTS : Nine cross-cutting adaptation themes were generated (i.e. key definitions, adaptive capacity, health sector priorities, resources, operational capacities and procedures, contextual conditions, information pathways, and information utility). The Q-Storming approach was a valuable tool for improving the understanding of the complexities of climate-health research collaborations, and priority identification for improved adaptation and service delivery. CONCLUSION : Concerted recognition regarding difficulties in linking climate science and health vulnerability at the interface of practitioners and decision-makers is required, for better integration and use of climate-health research in climate adaptation in Africa. This can be achieved by innovations offered through Q-Storming.The World Health Organization, Clim-Health Africa, Natural Environment Research Council, the South African government via the South African Medical Research Council and an Oppenheimer Memorial Trust International Fellowship.http://www.elsevier.com/joclimam2024Geography, Geoinformatics and MeteorologySDG-03:Good heatlh and well-beingSDG-13:Climate actio

Demystifying academics to enhance university-business collaborations in environmental science

In countries globally there is intense political interest in fostering effective university-business collaborations, but there has been scant attention devoted to exactly how an individual scientist's workload (i.e. specified tasks) and incentive structures (i.e. assessment criteria) may act as a key barrier to this. To investigate this an original, empirical dataset is derived from UK job specifications and promotion criteria, which distil universities' varied drivers into requirements upon academics. This work reveals the nature of the severe challenge posed by a heavily time-constrained culture; specifically, tension exists between opportunities presented by working with business and non-optional duties (e.g. administration and teaching). Thus, to justify the time to work with business, such work must inspire curiosity and facilitate future novel science in order to mitigate its conflict with the overriding imperative for academics to publish. It must also provide evidence of real-world changes (i.e. impact), and ideally other reportable outcomes (e.g. official status as a business' advisor), to feed back into the scientist's performance appraisals. Indicatively, amid 20-50 key duties, typical full-time scientists may be able to free up to 0.5 day per week for work with business. Thus specific, pragmatic actions, including short-term and time-efficient steps, are proposed in a "user guide"to help initiate and nurture a long-term collaboration between an early- to mid-career environmental scientist and a practitioner in the insurance sector. These actions are mapped back to a tailored typology of impact and a newly created representative set of appraisal criteria to explain how they may be effective, mutually beneficial and overcome barriers. Throughout, the focus is on environmental science, with illustrative detail provided through the example of natural hazard risk modelling in the insurance sector. However, a new conceptual model of academics' behaviour is developed, fusing perspectives from literature on academics' motivations and performance assessment, which we propose is internationally applicable and transferable between sectors. Sector-specific details (e.g. list of relevant impacts and user guide) may serve as templates for how people may act differently to work more effectively together

Q-Storming’ to identify challenges and opportunities for integrating health and climate adaptation measures in Africa

Introduction Climate factors influence the state of human health and wellbeing. Climate-related threats are particularly being experienced by vulnerable populations in Africa. A Question (Q)-Storming session was convened at an international climate adaptation conference. It promoted dialog among a diverse spectrum of researchers, climate and medical scientists, health professionals, national government officials, civil society, business, and international governing organizations. The session identified approaches for the effective integration of health within African national climate adaptation policies. Materials and methods Two organizations partnered to convene the session at the Adaptations Futures 2018 Conference in Cape Town. Q-storming (which is an inverse approach to brainstorming) was applied to extract ideas from all participants. Four topics were presented during the session: (i) adaptive capacities related to climate change and infectious diseases; (ii) adaptive capacity of African governments in relation to health and climate change; (iii) making climate science work to protect the health of vulnerable populations; and (iv) making climate-health research usable. Results Nine cross-cutting adaptation themes were generated (i.e. key definitions, adaptive capacity, health sector priorities, resources, operational capacities and procedures, contextual conditions, information pathways, and information utility). The Q-Storming approach was a valuable tool for improving the understanding of the complexities of climate-health research collaborations, and priority identification for improved adaptation and service delivery. Conclusion Concerted recognition regarding difficulties in linking climate science and health vulnerability at the interface of practitioners and decision-makers is required, for better integration and use of climate-health research in climate adaptation in Africa. This can be achieved by innovations offered through Q-Storming

Beyond individualism:Is there a place for relational autonomy in clinical practice and research?

This is the author accepted manuscript. The final version is available from SAGE Publications via the DOI in this recordThe dominant, individualistic understanding of autonomy that features in clinical practice and research is underpinned by the idea that people are, in their ideal form, independent, self-interested and rational gain-maximising decision-makers. In recent decades, this paradigm has been challenged from various disciplinary and intellectual directions. Proponents of ‘relational autonomy’ in particular have argued that people’s identities, needs, interests – and indeed autonomy – are always also shaped by their relations to others. Yet, despite the pronounced and nuanced critique directed at an individualistic understanding of autonomy, this critique has had very little effect on ethical and legal instruments in clinical practice and research so far. In this article, we use four case studies to explore to what extent, if at all, relational autonomy can provide solutions to ethical and practical problems in clinical practice and research. We conclude that certain forms of relational autonomy can have a tangible and positive impact on clinical practice and research. These solutions leave the ultimate decision to the person most affected, but encourage and facilitate the consideration of this person’s care and responsibility for connected others.The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: ESD is supported by a Wellcome Senior Investigator Award ‘Confronting the Liminal Spaces of Health Research Regulation’ (Award No: WT103360MA)

Physiological responses to ocean acidification and warming synergistically reduce condition of the common cockle Cerastoderma edule

The combined effect of ocean acidification and warming on the common cockle Cerastoderma edule was investigated in a fully crossed laboratory experiment. Survival of the examined adult organisms remained high and was not affected by elevated temperature (+3 °C) or lowered pH (−0.3 units). However, the morphometric condition index of the cockles incubated under high pCO2 conditions (i.e. combined warming and acidification) was significantly reduced after six weeks of incubation. Respiration rates increased significantly under low pH, with highest rates measured under combined warm and low pH conditions. Calcification decreased significantly under low pH while clearance rates increased significantly under warm conditions and were generally lower in low pH treatments. The observed physiological responses suggest that the reduced food intake under hypercapnia is insufficient to support the higher energy requirements to compensate for the higher costs for basal maintenance and growth in future high pCO2

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes