Reflexive climate service infrastructure relations

Exploring existing climate knowledge infrastructures as the important backbone of service endeavours, the authors analysed how climate knowledge infrastructures are organised, how (far) they take into account the 'end user', and how processes of data infrastructure governance function. Following these themes, we first catalogued and mapped relationships of organisations involved in the climate data infrastructure value chain and conducted interviews with representatives of some of the mapped organisations in order to corroborate the literature research and obtain additional insights. We suggest viewing climate service infrastructure in the four dimensions of instrumentation, information, communication, and service infrastructures. We argue that success or failure of climate services will be determined, firstly, by the ability to view and practically embed users as integral partners in the co-construction of climate services rather than treating them as 'external factors' (cross-boundary reflexivity). Secondly, we argue that it will be crucial for the growth of the climate service market, and therefore wider societal resilience to pay more attention to communication and service infrastructures intersecting. This may take in multiple ways with instrumentation and information infrastructures (infrastructural reflexivity) in the sense of a "value network" (not simply a value chain) given all the fluidity of the service infrastructure

Comorbidity between depression and anxiety:assessing the role of bridge mental states in dynamic psychological networks

Background: Comorbidity between depressive and anxiety disorders is common. A hypothesis of the network perspective on psychopathology is that comorbidity arises due to the interplay of symptoms shared by both disorders, with overlapping symptoms acting as so-called bridges, funneling symptom activation between symptom clusters of each disorder. This study investigated this hypothesis by testing whether (i) two overlapping mental states "worrying"and "feeling irritated"functioned as bridges in dynamic mental state networks of individuals with both depression and anxiety as compared to individuals with either disorder alone, and (ii) overlapping or non-overlapping mental states functioned as stronger bridges. Methods: Data come from the Netherlands Study of Depression and Anxiety (NESDA). A total of 143 participants met criteria for comorbid depression and anxiety (65%), 40 participants for depression-only (18.2%), and 37 for anxiety-only (16.8%) during any NESDA wave. Participants completed momentary assessments of symptoms (i.e., mental states) of depression and anxiety, five times a day, for 2 weeks (14,185 assessments). First, dynamics between mental states were modeled with a multilevel vector autoregressive model, using Bayesian estimation. Summed average lagged indirect effects through the hypothesized bridge mental states were compared between groups. Second, we evaluated the role of all mental states as potential bridge mental states. Results: While the summed indirect effect for the bridge mental state "worrying"was larger in the comorbid group compared to the single disorder groups, differences between groups were not statistically significant. The difference between groups became more pronounced when only examining individuals with recent diagnoses (< 6 months). However, the credible intervals of the difference scores remained wide. In the second analysis, a non-overlapping item ("feeling down") acted as the strongest bridge mental state in both the comorbid and anxiety-only groups. Conclusions: This study empirically examined a prominent network-approach hypothesis for the first time using longitudinal data. No support was found for overlapping mental states "worrying"and "feeling irritable"functioning as bridge mental states in individuals vulnerable for comorbid depression and anxiety. Potentially, bridge mental state activity can only be observed during acute symptomatology. If so, these may present as interesting targets in treatment, but not prevention. This requires further investigation

The use of surgery in the treatment of ER+ early stage breast cancer in England: variation by time, age and patient characteristics

AIM: To assess whether the proportion of patients aged 70 and over with ER+ operable breast cancer in England who are treated with surgery has changed since 2002, and to determine whether age and individual level factors including tumour characteristics and co-morbidity influence treatment choice. METHODS: A retrospective cohort analysis of routinely collected cancer registration data from two English regions (West Midlands, Northern & Yorkshire) was carried out (n = 17,129). Trends in surgical use over time for different age groups were assessed graphically and with linear regression. Uni- and multivariable logistic regressions were used to assess the effects of age, comorbidity, deprivation and disease characteristics on treatment choice. Missing data was handled using multiple imputation. RESULTS: There is no evidence of a change in the proportion of patients treated surgically over time. The multivariable model shows that age remains an important predictor of whether or not a woman with ER+ operable breast cancer receives surgery after covariate adjustment (Odds ratio of surgery vs no surgery, 0.82 (per year over 70)). Co-morbidity, deprivation, symptomatic presentation, later stage at diagnosis and low grade are also associated with increased probability of non-surgical treatment. CONCLUSION: Contrary to current NICE guidance in England, age appears to be an important factor in the decision to treat operable ER+ breast cancer non-surgically. Further research is needed to assess the role of other age-related factors on treatment choice, and the effect that current practice has on survival and mortality from breast cancer for older women

Observing Change Over Time in Strength-Based Parenting and Subjective Wellbeing for Pre-teens and Teens

The focus of this study was on adolescent mental health. More specifically, the relationship between strength-based parenting (SBP) and subjective wellbeing (SWB) during adolescence was examined at three time points over 14 months (N = 202, Mage = 12.97, SDage = 0.91, 48% female). SBP was positively related to life satisfaction and positive affect at each of the three time points, and was negatively related to negative affect. SBP and SWB both declined significantly over time. When examining the causal relationships between SBP and SWB, two different statistical models were applied: latent growth-curve models (LGM) and random-intercept cross-lagged panel models (RI-CLPM). The LGM revealed a strong positive relationship between changes in SBP and SWB. Specifically, this model showed that SBP at one time point predicted adolescent SWB at future time points. However, when the more stringent statistical test was completed through RI-CLPMs, no cross-lagged paths reached significance. Thus, while parenting is a significant predictor of wellbeing for pre-teens and teens in real time, it is not predictive of wellbeing at future time points. Parents, thus, cannot assume that their current levels of SBP are ‘banked’ by their children to support future wellbeing. Instead, SBP needs to be an ongoing, contemporary parenting practice. Furthermore, the fact that perceptions of SBP decline in this age bracket suggest that SBP interventions may be helpful in supporting adolescent mental health

Reflexive climate service infrastructure relations

Exploring existing climate knowledge infrastructures as the important backbone of service endeavours, the authors analysed how climate knowledge infrastructures are organised, how (far) they take into account the ‘end user’, and how processes of data infrastructure governance function. Following these themes, we first catalogued and mapped relationships of organisations involved in the climate data infrastructure value chain and conducted interviews with representatives of some of the mapped organisations in order to corroborate the literature research and obtain additional insights. We suggest viewing climate service infrastructure in the four dimensions of instrumentation, information, communication, and service infrastructures. We argue that success or failure of climate services will be determined, firstly, by the ability to view and practically embed users as integral partners in the co-construction of climate services rather than treating them as ‘external factors’ (cross-boundary reflexivity). Secondly, we argue that it will be crucial for the growth of the climate service market, and therefore wider societal resilience to pay more attention to communication and service infrastructures intersecting. This may take in multiple ways with instrumentation and information infrastructures (infrastructural reflexivity) in the sense of a “value network” (not simply a value chain) given all the fluidity of the service infrastructure

Matching Supply and Demand: A Typology of Climate Services

Climate services bear the promise of becoming a new, remunerative market of knowledge-intensive services. Although several climate services have been developed, there has been little reflection on the kinds of services such a new market could encompass, and the ways in which formats can be created that match supply and demand. Using a research approach based on Constructive Technology Assessment (CTA), this article presents a typology of climate services, with types called ‘Maps & Apps’, ‘Expert Analysis’, ‘Climate-inclusive Consulting’, and ‘Sharing Practices’. This typology, which is conceptually elaborated and empirically illustrated, structures the variety in current and potential climate services. It provides a framework for the development of climate services and helps users and producers to explore and articulate alternatives for matching supply and demand. On the basis of our analysis we also point towards a more differentiated and broader conceptualization of climate services

Dietary Fiber Treatment Corrects the Composition of Gut Microbiota, Promotes SCFA Production, and Suppresses Colon Carcinogenesis

Epidemiological studies propose a protective role for dietary fiber in colon cancer (CRC). One possible mechanism of fiber is its fermentation property in the gut and ability to change microbiota composition and function. Here, we investigate the role of a dietary fiber mixture in polyposis and elucidate potential mechanisms using TS4Cre × cAPCl°x468 mice. Stool microbiota profiling was performed, while functional prediction was done using PICRUSt. Stool short-chain fatty acid (SCFA) metabolites were measured. Histone acetylation and expression of SCFA butyrate receptor were assessed. We found that SCFA-producing bacteria were lower in the polyposis mice, suggesting a decline in the fermentation product of dietary fibers with polyposis. Next, a high fiber diet was given to polyposis mice, which significantly increased SCFA-producing bacteria as well as SCFA levels. This was associated with an increase in SCFA butyrate receptor and a significant decrease in polyposis. In conclusion, we found polyposis to be associated with dysbiotic microbiota characterized by a decline in SCFA-producing bacteria, which was targetable by high fiber treatment, leading to an increase in SCFA levels and amelioration of polyposis. The prebiotic activity of fiber, promoting beneficial bacteria, could be the key mechanism for the protective effects of fiber on colon carcinogenesis. SCFA-promoting fermentable fibers are a promising dietary intervention to prevent CRC

Charting a new climate

Three years on from the publication of the Task Force on Climate-related Financial Disclosures (TCFD) recommendations, the financial sector’s attention is firmly focused on climate-related risks and opportunities. The TCFD recommendations aimed to promote forward-looking scenario-based assessments of climate change by financial institutions and corporates, and for the findings to be incorporated into their strategic decisions. Since then, the Network for Greening the Financial System (NGFS), a grouping of central banks and supervisors, has been established and its membership has grown at a fast pace. The NGFS aims to contribute to the development of environment and climate risk management in the financial sector, and to mobilize mainstream finance to support the transition toward a sustainable economy. Its members have collectively pledged support for the TCFD recommendations. In another major development, the Principles for Responsible Banking (PRB) were established by UNEP FI and member banks in 2019. Signatory banks to the PRB (more than 180 by August 2020), have committed to align their strategy and practice with the vision that society has set out for its future in the Sustainable Development Goals and the Paris Climate Agreement. UNEP FI has run pilot projects on implementing the TCFD recommendations for over 90 banks, investors, and insurers. Many other processes and organizations aim to tackle climate risk and opportunity in the financial sector. This new focus on climate-related risks and opportunities sits within a context of intensifying climate change impacts. The Intergovernmental Panel on Climate Change (IPCC) Special Report on global warming of 1.5°C estimates that human activities have already caused about 1°C of global warming above pre-industrial levels.1 If global GHG emissions continue to increase at the current rate, warming is likely to reach 1.5°C by around 2040 and up to 4°C by the end of the century. Yet the world will face severe climate impacts even with 1.5°C of warming. Physical risks – which result from climate variability, extreme events and longer-term shifts in climate patterns – are already being experienced and are set to intensify in the future. This report describes the outputs of the UN Environment Programme Finance Initiative (UNEP FI) Phase II banking pilot which lays out state-of-the-art tools and data for assessment of physical climate-related risks and opportunities by banks. The Phase II pilot, involving 39 UNEP FI member banks from six continents, focused on addressing key methodological challenges highlighted in its predecessor Phase I report, ‘Navigating a New Climate’.2 As the climate policy context evolves, banks are more focused on meeting the emerging expectations of financial industry regulators. While the emphasis at present is on assessing risks, banks have a key role to play – and an enormous business opportunity to realize – in providing finance for governments, businesses and consumers to invest in adaptation measures. This Phase II report provides rich technical guidance and information on the resources available to support forward-looking scenario-based assessments of physical risks and opportunities. The tools and data to support banks’ physical risk and opportunity assessments must be grounded in robust scientific evidence, be usable within the context of banks’ other data, tools and systems, and facilitate comparability between banks. While these needs are not yet fully met, significant advances have been made

Variation in the management of early breast cancer in rural and metropolitan centres: Implications for the organisation of rural cancer services

The study examines the management and outcomes of women with early invasive breast cancer treated in rural and metropolitan centres over a nine-year observation period. A prospective audit of the treatment and outcomes of 2081 women with early breast cancer who underwent potentially curative surgery between 1997 and 2006 in metropolitan Canberra or in the surrounding rural region was completed. Overall, there was good agreement between published guidelines and the treatment received by the women in the study. However, women treated in rural centres were less likely to receive postoperative radiotherapy after breast-conserving surgery, or to undergo axillary lymph node surgery or sentinel lymph node biopsy compared with women treated in metropolitan centres. Surgery in a rural centre was associated with increased breast cancer recurrence (HR = 1.54, p < 0.001) and increased breast cancer mortality (HR = 1.84, p < 0.001), after adjustment for age and tumour characteristics. Non-cancer related mortality was increased in women treated in rural centres compared with women travelling to a metropolitan centre for surgery (HR = 2.08; p = 0.005). There were differences in both the care provided and treatment outcomes between women treated in rural centres and women treated in metropolitan centres. However, the increased non-cancer related mortality in women treated in rural centres suggests an increased medical comorbidity in this group. Initiatives supporting rural-based surgeons to adopt new procedures such as sentinel node biopsy may help to optimise rural breast cancer treatment.Paul S. Craft, John M. Buckingham, Jane E. Dahlstrom, Kerri R. Beckmann, Yanping Zhang, Robin Stuart-Harris, George Jacob, David Roder, Noel Tai