Managed groundwater development for water-supply security in Sub-Saharan Africa: Investment priorities

In numerous countries of Sub-Saharan Africa the strategic agenda of the water-sector is undergoing substantial change because of demographic pressure, climate change and economic transformation. Two new policy questions are arising from the need to make better use of available groundwater storage to improve water-supply security:• What is the scope for promoting much increased groundwater use for irrigated agriculture, and how might the investment risks be reduced and sustainable outcomes ensured?• How can the demand to expand urban groundwater use, for both further supplementing municipal water-supply systems and for direct in situ water supply, be best channelled to maximise the benefits whilst minimising the risks?This ‘new agenda’ poses very different challenges from the long-standing requirement to provide rural water supplies of adequate coverage, reliability and quality (which, while still not yet fully addressed, is outside the scope of this paper). Balanced answers to these new questions are needed to provide a sound basis for appropriate investment policies on managed groundwater development and adequate institutional provisions for their implementation. They are discussed here from the standpoint of the GW-MATE experience in some World Bank-supported projects in eastern Africa during 2001-2010, together with a review of some developments in western Africa and insights from parts of Asia and Latin America

Zonder marge geen centrum: Een pleidooi voor rechtvaardige transities

How can processes of social in- and exclusion be understood from a perspective of radical systems change? This question is addressed by exploring the dialectics of in- and exclusion both theoretically and empirically. A study of historical and current innovation processes focused on ‘poverty care’, ‘homeless youth’ and ‘deprived neighborhoods’ shows that while such processes strive for just transitions, at the same time reproduce existing inequalities

Quality of group decisions by board members:A hidden-profile experiment

Purpose Reaching decisions in a deliberative manner is of utmost importance for boards, as their decision-making impacts entire organisations. The current study aims to investigate (1) the quality of group decisions made by board members, (2) their confidence in, satisfaction with, and reflection on the decision-making, and (3) the effect of two discussion procedures on objective decision quality and subjective evaluations of the decision-making. Design/methodology/approach Board members of various Dutch non-profit organisations (N = 141) participated in a group decision-making task and a brief questionnaire. According to the hidden-profile paradigm, information was asymmetrically distributed among group members and should have been pooled to reach the objectively best decision. Half of the groups received one of two discussion procedures (i.e. advocacy decision or decisional balance sheet), while the other half received none. Findings Only a fifth of the groups successfully chose the best decision alternative. The initial majority preference strongly influenced the decision, which indicates that discussion was irrelevant to the outcome. Nevertheless, board members were satisfied with their decision-making. Using a discussion procedure enhanced participants' perception that they adequately weighed the pros and cons, but did not improve objective decision quality or other aspects of the subjective evaluation. These findings suggest that board members are unaware of their biased decision-making, which might hinder improvement. Originality/value Rather than using student samples, this study was the first to have board members participating in a hidden-profile task

Effectiveness and tolerability of pegylated interferon alfa-2b in combination with ribavirin for treatment of chronic hepatitis C: the PegIntrust Study

Background and study aims : Large international clinical trials conducted in the past 5 years rapidly improved the treatment of chronic hepatitis C; however, it is unclear whether the advances seen in clinical trials are being paralleled by similar improvements in routine clinical practice. PegIntrust is a Belgian community-based trial evaluating the sustained virological response. Patients and Methods : Observational study of 219 patients receiving pegylated interferon alfa-2b (1.5 mu g/kg/wk) and weight. based ribavirin (800-1200 mg/day) for 48 weeks. Primary study end point was sustained virological response (SVR), defined as undetectable HCV RNA 6 months after the completion of treatment. Results : In total, 108 patients (49.3 %) had undetectable HCV RNA at the end of therapy, 91(41.6%) attaining SVR. Of the 111 patients without an end-of-treatment response, 28 were non-responders, and 21 had virological breakthrough. In total, 134 patients attained early virological response (EVR); 88 (65.7%) of those patients attained SVR. In contrast, 82 (96.5 %) of the 85 patients who did not attain EVR also did not attain SVR. Age, fibrosis score and baseline viral load were identified as important predictors of treatment outcome. The most frequently reported serious adverse events resulting in treatment discontinuation were anemia (n = 10), fatigue/asthenia/malaise (n = 6) and fever (n = 3). Conclusion : Our data indicate that treatment of chronic hepatitis C with PEG-IFN alfa-2b plus weight-based ribavirin results in favourable treatment outcomes in a Belgian cohort of patients treated in community-based clinical practice. (Ada gastroenterol. belg., 2010, 73, 5-11)

Linking transitions to sustainability: A study of the societal effects of transition management

Sustainability transitions as processes of fundamental change in societal systems are open-ended, nonlinear and uncertain. Respective research and governance approaches, e.g., transition management, propose a reflexive way of governing, aiming for a number of societal effects to help facilitating a transition. Effects include empowerment, social learning and social capital development. Jointly mentioned effects shall allow for reflexivity and innovation in developing socially robust and contextualized solutions to sustainability challenges that work in practice. But, understanding the mentioned societal effects and their interplay in more depth is necessary to design and assess transition management processes. While such understanding and related assessment framework is under development in the transition management literature, transdisciplinary sustainability research can provide a rich body of tools and experiences. Building on a review of the literature, this article develops an evaluation framework focusing on social learning, empowerment and social capital as important and hitherto under-conceptualised aspects of the sustainability transition literature. This framework is used to empirically investigate the effects of two specific transition management processes at the local scale. In doing so, the article provides a conceptual and empirical understanding of how social learning, empowerment and social capital contribute to a transition towards sustainability. The three effects are shown to be interrelated, mutually supportive and bridging different scale levels from individuals to groups, niches and beyond. Results highlight possibilities to facilitate and assess societal effects, addressing sustainability as their inherent quality

Socioeconomic inequalities in patient-reported outcome measures of Dutch primary hip and knee arthroplasty patients for osteoarthritis

Objective:To study socio-economic inequalities in patient-reported outcomes in primary hip and knee arthroplasty (THA/TKA) patients for osteoarthritis, using two analytical techniques. Methods: We obtained data from 44,732 THA and 30,756 TKA patients with preoperative and 12-month follow-up PROMs between 2014 and 2020 from the Dutch Arthroplasty Registry. A deprivation indicator based on neighborhood income, unemployment rate, and education level was linked and categorized into quintiles. The primary outcome measures were the EQ-5D-3L index and Oxford Hip/Knee Score (OHS/OKS) preoperative, at 12-month follow-up, and the calculated change score between these measurements. We contrasted the most and least deprived quintiles using multivariable linear regression, adjusting for patient characteristics. Concurrently, we calculated concentration indices as a non-arbitrary tool to quantify inequalities. Results: Compared to the least deprived, the most deprived THA patients had poorer preoperative (EQ-5D −0.03 (95%CI −0.02, -0.04), OHS −1.26 (−0.99, −1.52)) and 12-month follow-up health (EQ-5D −0.02 (−0.01, −0.02), OHS −0.42 (−0.19, −0.65)), yet higher mean change (EQ-5D 0.02 (0.01, 0.03), OHS 0.84 (0.52, 1.16)). The most deprived TKA patients had similar results. The higher mean change among the deprived resulted from lower preoperative health in this group (confounding). After accounting for this, the most deprived patients had a lower mean change. The concentration indices showed similar inequality effects and provided information on the magnitude of inequalities over the entire socio-economic range. Conclusion: The most deprived THA and TKA patients have worse preoperative health, which persisted after surgery. The concentration indices allow comparison of inequalities across different outcomes (e.g., revision risk).</p