Reconceptualising adaptation to climate change as part of pathways of change and response

The need to adapt to climate change is now widely recognised as evidence of its impacts on social and natural systems grows and greenhouse gas emissions continue unabated. Yet efforts to adapt to climate change, as reported in the literature over the last decade and in selected case studies, have not led to substantial rates of implementation of adaptation actions despite substantial investments in adaptation science. Moreover, implemented actions have been mostly incremental and focused on proximate causes; there are far fewer reports of more systemic or transformative actions. We found that the nature and effectiveness of responses was strongly influenced by framing. Recent decision-oriented approaches that aim to overcome this situation are framed within a "pathways" metaphor to emphasise the need for robust decision making within adaptive processes in the face of uncertainty and inter-temporal complexity. However, to date, such "adaptation pathways" approaches have mostly focused on contexts with clearly identified decision-makers and unambiguous goals; as a result, they generally assume prevailing governance regimes are conducive for adaptation and hence constrain responses to proximate causes of vulnerability. In this paper, we explore a broader conceptualisation of "adaptation pathways" that draws on 'pathways thinking' in the sustainable development domain to consider the implications of path dependency, interactions between adaptation plans, vested interests and global change, and situations where values, interests, or institutions constrain societal responses to change. This re-conceptualisation of adaptation pathways aims to inform decision makers about integrating incremental actions on proximate causes with the transformative aspects of societal change. Case studies illustrate what this might entail. The paper ends with a call for further exploration of theory, methods and procedures to operationalise this broader conceptualisation of adaptation

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Comparing equivalent thermal, high pressure and pulsed electric field processes for mild pasteurization of orange juice. Part I: Impact on overall quality attributes

Mild heat pasteurization, high pressure processing (HP) and pulsed electric field (PEF) processing of freshly squeezed orange juice were comparatively evaluated examining their impact on microbial load and quality parameters immediately after processing and during two months of storage. Microbial counts for treated juices were reduced beyond detectable levels immediately after processing and up to 2 months of refrigerated storage. Quality parameters such as pH, dry matter content and brix were not significantly different when comparing juices immediately after treatment and were, for all treatments, constant during storage time. Quality parameters related to pectinmethylesterase (PME) inactivation, like cloud stability and viscosity, were dependent on the specific treatments that were applied. Mild heat pasteurization was found to result in the most stable orange juice. Results for HP are nearly comparable to PEF except on cloud degradation, where a lower degradation rate was found for HP. For PEF, residual enzyme activity was clearly responsible for changes in viscosity and cloud stability during storage

Comparing equivalent thermal, high pressure and pulsed electric field processes for mild pasteurization of orange juice: Part II: Impact on specific chemical and biochemical quality parameters

The impact of thermal, high pressure (HP) and pulsed electric field (PEF) processing for mild pasteurization of orange juice was compared on a fair basis, using processing conditions leading to an equivalent degree of microbial inactivation. Examining the effect on specific chemical and biochemical quality parameters directly after treatment and during storage at 4 °C revealed only significant differences in residual enzyme activities. For pectin methylesterase inactivation, none of the treatments was able to cause a complete inactivation, although heat and HP pasteurization were the most effective in limiting the residual activity. Peroxidase was completely inactivated by heat pasteurization and was much less susceptible to HP and PEF. All other quality parameters investigated, including the sugar profile, the organic acid profile, bitter compounds, vitamin C (ascorbic acid and dehydroascorbic acid), the carotenoid profile, furfural and 5-hydroxymethylfurfural, experienced no significantly different impact from the three pasteurization techniques

Comparing equivalent thermal, high pressure and pulsed electric field processes for mild pasteurization of orange juice: Part II: Impact on specific chemical and biochemical quality parameters

The impact of thermal, high pressure (HP) and pulsed electric field (PEF) processing for mild pasteurization of orange juice was compared on a fair basis, using processing conditions leading to an equivalent degree of microbial inactivation. Examining the effect on specific chemical and biochemical quality parameters directly after treatment and during storage at 4 °C revealed only significant differences in residual enzyme activities. For pectin methylesterase inactivation, none of the treatments was able to cause a complete inactivation, although heat and HP pasteurization were the most effective in limiting the residual activity. Peroxidase was completely inactivated by heat pasteurization and was much less susceptible to HP and PEF. All other quality parameters investigated, including the sugar profile, the organic acid profile, bitter compounds, vitamin C (ascorbic acid and dehydroascorbic acid), the carotenoid profile, furfural and 5-hydroxymethylfurfural, experienced no significantly different impact from the three pasteurization techniques