Towards a pragmatic approach for dealing with uncertainties in water management practice

Management of water resources is afflicted with uncertainties. Nowadays it is facing more and new uncertainties since pace and dimension of changes (e.g. climatic, demographic) are accelerating and are likely to increase even more in the future. Hence it is crucial to find pragmatic ways to deal with these uncertainties in water management. So far, decision-making under uncertainty in water management is based on either intuition, heuristics and experience of water managers or on expert assessments all of which are only of limited use for water managers in practice. We argue for an analytical yet pragmatic approach to enable practitioners to deal with uncertainties in a more explicit and systematic way and allow for better informed decisions. Our approach is based on the concept of framing, referring to the different ways in which people make sense of the world and of the uncertainties. We applied and tested recently developed parameters that aim to shed light on the framing of uncertainty in two sub-basins of the Rhine. We present and discuss the results of a series of stakeholder interactions in the two basins aimed at developing strategies for improving dealing with uncertainties. The strategies are synthesized in a cross-checking list based on the uncertainty framing parameters as a hands-on tool for systematically identifying improvement options when dealing with uncertainty in water management practice. We conclude with suggestions for testing the developed check-list as a tool for decision aid in water management practice. Key words: water management, future uncertainties, framing of uncertainties, hands-on decision aid, tools for practice, robust strategies, social learnin

Assessing framing of uncertainties in water management practice

The importance of problem framing in relation with environmental problems has been stated in various scientific contributions. In this paper we intend to relate it to the issue of uncertainties in water management. Dealing with uncertainties in water management is an important issue and will increase to be so in light of global changes, in particular climate change. To know how uncertainties are framed in water management practice then is important in order to evaluate strategies for dealing with these uncertainties. With the aim of identifying what are important parameters for the framing of uncertainties in water management practice, in this paper we analyze uncertainty situations described by decision-makers in water management. The analysis builds on a series of ¿Uncertainty Dialogues¿ carried out within the NeWater project with water managers in the Rhine, Elbe and Guadiana basins in 2006. During these dialogues, representatives of these river basins were asked what uncertainties they en2 N. Isendahl, A. Dewulf, M. Brugnach, G. François, S. Möllenkamp, C. Pahl-Wostl countered in their professional work life and how they confronted them. Analysing these dialogues we identified several important parameters of how uncertainties get framed. Our assumption is that making framing of uncertainty explicit will allow for better dealing with the respective uncertainty situations. In order to get a broader picture of the framing of an uncertainty we therefore suggest to add a third axis to the uncertainty matrix developed earlier by Brugnach et al. (2007) detailing on the relation of actors towards an uncertainty situation. This axis is assembled from the parameters identified in this paper

Should first-line empiric treatment strategies cover coagulase-negative staphylococcal infections in severely malnourished or HIV-infected children in Kenya?

BACKGROUND: Bloodstream infection is a common cause of morbidity in children aged andlt;5 years in developing countries. In studies reporting bacteremia in Africa, coagulase-negative Staphylococci (CoNS) are commonly isolated. However, it is currently unclear whether children who are highly susceptible to infection because of severe acute malnutrition (SAM) or HIV should be treated with antimicrobials specifically to cover CoNS. We aimed to determine the clinical significance of CoNS amongst children admitted to a rural hospital in Kenya in relation to nutritional and HIV status. METHODS: Systematically collected clinical and microbiological surveillance data from children aged 6-59 months admitted to Kilifi County Hospital (2007-2013) were analysed. Multivariable regression was used to test associations between CoNS isolation from blood cultures and SAM (MUAC andlt;11.5cm or nutritional oedema (kwashiorkor)), and HIV serostatus; and among children with SAM or HIV, associations between CoNS isolation and mortality, duration of hospitalization and clinical features. RESULTS: CoNS were isolated from blood culture in 906/13,315 (6.8%) children, of whom 135/906 (14.9%) had SAM and 54/906 (6.0%) were HIV antibody positive. CoNS isolation was not associated with SAM (MUACandlt;11.5cm (aOR 1.11, 95% CI 0.88-1.40) or kwashiorkor (aOR 0.84, 95% CI 0.48-1.49)), or a positive HIV antibody test (aOR 1.25, 95% CI 0.92-1.71). Among children with SAM or a positive HIV antibody test, CoNS isolation was not associated with mortality or prolonged hospitalization. CONCLUSION: In a large, systematic study, there was no evidence that antimicrobial therapy should specifically target CoNS amongst children with SAM or HIV-infection or exposure

Genetic diversity and risk factors for the transmission of antimicrobial resistance across human, animals and environmental compartments in East Africa: a review.

BACKGROUND The emergence and spread of antimicrobial resistance (AMR) present a challenge to disease control in East Africa. Resistance to beta-lactams, which are by far the most used antibiotics worldwide and include the penicillins, cephalosporins, monobactams and carbapenems, is reducing options for effective control of both Gram-positive and Gram-negative bacteria. The World Health Organization, Food and Agricultural Organization and the World Organization for Animal Health have all advocated surveillance of AMR using an integrated One Health approach. Regional consortia also have strengthened collaboration to address the AMR problem through surveillance, training and research in a holistic and multisectoral approach. This review paper contains collective information on risk factors for transmission, clinical relevance and diversity of resistance genes relating to extended-spectrum beta-lactamase-producing (ESBL) and carbapenemase-producing Enterobacteriaceae, and Methicillin-resistant Staphylococcus aureus (MRSA) across the human, animal and environmental compartments in East Africa. MAIN BODY The review of the AMR literature (years 2001 to 2019) was performed using search engines such as PubMed, Scopus, Science Direct, Google and Web of Science. The search terms included 'antimicrobial resistance and human-animal-environment', 'antimicrobial resistance, risk factors, genetic diversity, and human-animal-environment' combined with respective countries of East Africa. In general, the risk factors identified were associated with the transmission of AMR. The marked genetic diversity due to multiple sequence types among drug-resistant bacteria and their replicon plasmid types sourced from the animal, human and environment were reported. The main ESBL, MRSA and carbapenem related genes/plasmids were the CTX-Ms (45.7%), SCCmec type III (27.3%) and IMP types (23.8%), respectively. CONCLUSION The high diversity of the AMR genes suggests there may be multiple sources of resistance bacteria, or the possible exchange of strains or a flow of genes amongst different strains due to transfer by mobile genetic elements. Therefore, there should be harmonized One Health guidelines for the use of antibiotics, as well as regulations governing their importation and sale. Moreover, the trend of ESBLs, MRSA and carbapenem resistant (CAR) carriage rates is dynamic and are on rise over time period, posing a public health concern in East Africa. Collaborative surveillance of AMR in partnership with regional and external institutions using an integrated One Health approach is required for expert knowledge and technology transfer to facilitate information sharing for informed decision-making

Mechanisms for inclusive governance

How mechanisms for inclusive governance are understood is built on the framing choices that are made about governance and that which is being governed. This chapter unpacks how governance can be understood and considers different historical and contemporary framings of water governance. A framing of “governance as praxis” is developed as a central element in the chapter. What makes governance inclusive is explored, drawing on theoretical, practical and institutional aspects before elucidating some of the different mechanisms currently used or proposed for creating inclusive water governance (though we argue against praxis based on simple mechanism). Finally, the factors that either constrain or enable inclusive water governance are explored with a focus on systemic concepts of learning and feedback

Using framing parameters to improve handling of uncertainties in water management practice

Management of water resources is afflicted with uncertainties. Nowadays it is facing more and new uncertainties since the pace and dimension of changes (e.g. climatic, demographic) are accelerating and are likely to increase even more in the future. Hence it is crucial to find pragmatic ways to deal with these uncertainties in water management. We argue for an analytical yet pragmatic approach to enable decision-makers to deal with uncertainties in a more explicit and systematic way and allow for better informed decisions. Our approach is based on the concept of framing, referring to the different ways in which people make sense of the world and of the uncertainties. We apply recently developed parameters of the framing of uncertainty in two sub-basins of the Rhine, the Dutch Kromme Rijn and the German Wupper. We present and discuss the results of a series of stakeholder interactions in the two basins aimed at developing strategies for improving dealing with uncertainties. The strategies are amended and synthesized in a check-list based on the uncertainty framing parameters as a hands-on tool for systematically identifying improvement options when dealing with uncertainty in water management practice. We conclude with suggestions for testing the developed check-list as a tool for decision aid in water management practic

Making framing of uncertainty in water management practice explicit by using a participant-structured approach

By now, the need for addressing uncertainty in the management of water resources is widely recognized, yet there is little expertise and experience how to effectively deal with uncertainty in practice. Uncertainties in water management practice so far are mostly dealt with intuitively or based on experience. That way decisions can be quickly taken but analytic processes of deliberate reasoning are bypassed. To meet the desire of practitioners for better guidance and tools how to deal with uncertainty more practice-oriented systematic approaches are needed. For that purpose we consider it important to understand how practitioners frame uncertainties. In this paper we present an approach where water managers developed criteria of relevance to understand and address uncertainties. The empirical research took place in the Don˜ana region of the Guadalquivir estuary in southern Spain making use of the method of card sorting. Through the card sorting exercise a broad range of criteria to make sense of and describe uncertainties was produced by different subgroups, which were then merged into a shared list of criteria. That way framing differences were made explicit and communication on uncertainty and on framing differences was enhanced. In that, the present approach constitutes a first step to enabling reframing and overcoming framing differences, which are important features on the way to robust decision-making. Moreover, the elaborated criteria build a basis for the development of more structured approaches to deal with uncertainties in water management practic