Identifying low risk climate change adaptation in catchment management while avoiding unintended consequences

Inherent in every adaptation measure are risks, costs and benefits. A challenge for decision-makers is how to choose adaptations that reduce risks from climate change impacts and provide overwhelmingly beneficial outcomes. This project focused on three catchments in the Murray-Darling Basin to test a method for more integrative climate change adaptation that increased resilience and avoided maladaptation. Water management under the highly variable Murray-Darling Basin climate has lessons and broad implications for climate policies, especially as some of the proposed climate change adaptation measures for ecosystems and water resources are overly narrow or maladaptive, and have a high risk of institutional failure. We brought together a range of experts and Catchment Management Authority (CMA) representatives from the Goulburn-Broken, Lachlan and NSW Murray catchments to synthesise and integrate the risks, costs and benefits of climate change adaptation measures and assess the extent to which they may represent maladaptation or contribute to adaptation and resilience. Specific methods included a literature review; a three-day technical workshop with representatives from the three CMAs as well as technical experts from academic institutions and government departments; three stakeholder workshops with the CMAs; and semi-structured interviews with 20 key stakeholder representatives in each case study. Limitations of this approach, mainly due to timing and financial constraints, included small sample sizes for the interviews, a CMA-only focus, reliance on expert opinion and limited opportunity to further test the results. By working with the CMAs, we: • showed how systemic climate change adaptation planning can better consider risks, costs and benefits to inform choice of measures • produced research data on climate change adaptation options in specific catchments in southern Australia • identified current stakeholder understanding of the complex issue of climate change adaptation at a catchment level • confirmed the usefulness of an ‘ecosystem-based approach’ for climate change adaptation • developed a ‘CCA Catchment Assessment Framework’ as a tool for regional management bodies in southern Australia to assess climate change adaptation. The key lessons that emerged from this research are presented below. First, there are many activities underway that, if extended and linked, would comprise a substantial ecosystem-based approach to adaptation. It is notable that many of these activities had not previously been considered in an adaptation context. Second, the research confirmed the need to look at a suite of complementary actions that spread risk rather than investing in one or two perceived best actions. Third, the adoption of an ecosystem-based approach is constrained by institutional complexity and socioeconomic considerations that should be included in assessments of climate change adaptation. Finally, adaptive management provides a basis for the implementation of an ecosystem-based approach to climate change adaptationInherent in every adaptation measure are risks, costs and benefits. A challenge for decision-makers is how to choose adaptations that reduce risks from climate change impacts and provide overwhelmingly beneficial outcomes. This project focused on three catchments in the Murray-Darling Basin to test a method for more integrative climate change adaptation that increased resilience and avoided maladaptation. Water management under the highly variable Murray-Darling Basin climate has lessons and broad implications for climate policies, especially as some of the proposed climate change adaptation measures for ecosystems and water resources are overly narrow or maladaptive, and have a high risk of institutional failure. We brought together a range of experts and Catchment Management Authority (CMA) representatives from the Goulburn-Broken, Lachlan and NSW Murray catchments to synthesise and integrate the risks, costs and benefits of climate change adaptation measures and assess the extent to which they may represent maladaptation or contribute to adaptation and resilience. Specific methods included a literature review; a three-day technical workshop with representatives from the three CMAs as well as technical experts from academic institutions and government departments; three stakeholder workshops with the CMAs; and semi-structured interviews with 20 key stakeholder representatives in each case study. Limitations of this approach, mainly due to timing and financial constraints, included small sample sizes for the interviews, a CMA-only focus, reliance on expert opinion and limited opportunity to further test the results. By working with the CMAs, we: • showed how systemic climate change adaptation planning can better consider risks, costs and benefits to inform choice of measures • produced research data on climate change adaptation options in specific catchments in southern Australia • identified current stakeholder understanding of the complex issue of climate change adaptation at a catchment level • confirmed the usefulness of an ‘ecosystem-based approach’ for climate change adaptation • developed a ‘CCA Catchment Assessment Framework’ as a tool for regional management bodies in southern Australia to assess climate change adaptation. The key lessons that emerged from this research are presented below. First, there are many activities underway that, if extended and linked, would comprise a substantial ecosystem-based approach to adaptation. It is notable that many of these activities had not previously been considered in an adaptation context. Second, the research confirmed the need to look at a suite of complementary actions that spread risk rather than investing in one or two perceived best actions. Third, the adoption of an ecosystem-based approach is constrained by institutional complexity and socioeconomic considerations that should be included in assessments of climate change adaptation. Finally, adaptive management provides a basis for the implementation of an ecosystem-based approach to climate change adaptatio

IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel

Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that selectively affects optic nerves and spinal cord. It is considered a severe variant of multiple sclerosis (MS), and frequently is misdiagnosed as MS, but prognosis and optimal treatments differ. A serum immunoglobulin G autoantibody (NMO-IgG) serves as a specific marker for NMO. Here we show that NMO-IgG binds selectively to the aquaporin-4 water channel, a component of the dystroglycan protein complex located in astrocytic foot processes at the blood-brain barrier. NMO may represent the first example of a novel class of autoimmune channelopathy

Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study

Introduction: This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined. Methods: Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports. Results: Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management. Conclusion: MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist. Implications for practice: This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers

Transforming failing smallholder irrigation schemes in Africa: a theory of change

Drawing on the results of the Transforming Irrigation in Southern Africa project, we assess positive transitions in smallholder irrigation schemes. The project’s theory of change is evaluated. Soil monitoring tools and agricultural innovation platforms were introduced in five irrigation schemes in Mozambique, Tanzania and Zimbabwe. The synergies between these interventions increased both crop yields and profitability. This empowered farmers, improved equity, and accelerated social learning and innovation. The resulting, iterative cycles of change improved governance, sustainability and socio-economic outcomes. The challenges of scaling these interventions up and out are outlined

Global impacts of energy demand on the freshwater resources of nations

The growing geographic disconnect between consumption of goods, the extraction and processing of resources, and the environmental impacts associated with production activities makes it crucial to factor global trade into sustainability assessments. Using an empirically validated environmentally extended global trade model, we examine the relationship between two key resources underpinning economies and human well-being—energy and freshwater. A comparison of three energy sectors (petroleum, gas, and electricity) reveals that freshwater consumption associated with gas and electricity production is largely confined within the territorial boundaries where demand originates. This finding contrasts with petroleum, which exhibits a varying ratio of territorial to international freshwater consumption, depending on the origin of demand. For example, although the United States and China have similar demand associated with the petroleum sector, international freshwater consumption is three times higher for the former than the latter. Based on mapping patterns of freshwater consumption associated with energy sectors at subnational scales, our analysis also reveals concordance between pressure on freshwater resources associated with energy production and freshwater scarcity in a number of river basins globally. These energy-driven pressures on freshwater resources in areas distant from the origin of energy demand complicate the design of policy to ensure security of fresh water and energy supply. Although much of the debate around energy is focused on greenhouse gas emissions, our findings highlight the need to consider the full range of consequences of energy production when designing policy

Agricultural innovation platforms for scaling innovations – insights from the Transforming Irrigation in Southern Africa project

A major challenge in agricultural research for development is understanding how agricultural innovation platforms (AIPs) scale innovations to maximize environmental and socioeconomic benefits. Multilevel perspective and anchoring frameworks were used to assess the effectiveness of AIPs in anchoring innovations to go to scale under the Transforming Irrigation in Southern Africa project. Resultant scaling approaches, and whether and how scaling impacts were sustained are assessed at the sociotechnical regime. AIP collective capabilities ensured anchoring strategies and scaling approaches utilized by AIPs led to the embedding of innovations within the agricultural sociotechnical system. This resulted in changes in policy, behaviour and practices

Communal irrigation systems in South-Eastern Africa: findings on productivity and profitability

Significant expansion of irrigated agriculture is planned in Africa, though existing smallholder schemes perform poorly. Research at six schemes in Mozambique, Tanzania and Zimbabwe shows that a range of problems are exacerbated by poor management, with limited market linkages leading to underutilization and a lack of profit. Improving sustainability of these complex systems will require: multiple interventions at different scales; investing in people and institutions as much as hardware; clarity in governments’ objectives for their smallholder irrigation schemes; appropriate business models to enable farmers; and better market linkages

Neuronal intermediate filament IgGs in CSF: Autoimmune Axonopathy Biomarkers

Objectives: To describe CSF-defined neuronal intermediate filament (NIF) autoimmunity. Methods: NIF-IgG CSF-positive patients (41, 0.03% of 118599 tested, 1996-2019) were included (serum was neither sensitive nor specific). Criteria-based patient NIF-IgG staining of brain and myenteric NIFs was detected by indirect immunofluorescence assay (IFA); NIF-specificity was confirmed by cell-based assays (CBAs, alpha internexin, neurofilament light [NF-L]), heavy-[NF-H] chain). Results: Sixty-one percent of 41 patients were men, median age, 61 years (range, 21-88). Syndromes were encephalopathy predominant (23), cerebellar ataxia predominant (11), or myeloradiculoneuropathies (7). MRI abnormalities (T2 hyperintensities of brain, spinal cord white matter tracts. and peripheral nerve axons) and neurophysiologic testing (EEG, EMG, evoked potentials) co-localized with clinical neurological phenotypes (multifocal in 29%). Thirty patients (73%) had 65 1 immunological perturbation: cancer (paraneoplastic), 22; systemic infection (parainfectious [including ehrlichosis, 3] or HIV), 7; checkpoint-inhibitor cancer immunotherapy, 4; other, 5. Cancers were as follows: neuroendocrine-lineage carcinomas, 12 (small cell, 6; Merkel cell, 5; pancreatic, 1 [11/12 had NF-L-IgG detected, versus 8/29 others, P = 0.0005]) and other, 11. Onset was predominantly subacute (92%) and accompanied by inflammatory CSF (75%), and immunotherapy response (77%). In contrast, CSF controls (15684 total) demonstrated NIF-IgG negativity (100% of test validation controls), and low frequencies of autoimmune diagnoses (20% of consecutively referred clinical specimens) and neuroendocrine-lineage carcinoma diagnosis (3.1% vs. 30% of NIF cases), P &lt; 0.0001. Median NF-L protein concentration was higher in 8 NF-L-IgG-positive patients (median, 6718 ng/L) than 16 controls. Interpretation: Neurological autoimmunity, defined by CSF-detected NIF-IgGs, represents a continuum of treatable axonopathies, sometimes paraneoplastic or parainfectious

Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management

Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is the most recently defined inflammatory demyelinating disease of the central nervous system (CNS). Over the last decade, several studies have helped delineate the characteristic clinical-MRI phenotypes of the disease, allowing distinction from aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD) and multiple sclerosis (MS). The clinical manifestations of MOGAD are heterogeneous, ranging from isolated optic neuritis or myelitis to multifocal CNS demyelination often in the form of acute disseminated encephalomyelitis (ADEM), or cortical encephalitis. A relapsing course is observed in approximately 50% of patients. Characteristic MRI features have been described that increase the diagnostic suspicion (e.g., perineural optic nerve enhancement, spinal cord H-sign, T2-lesion resolution over time) and help discriminate from MS and AQP4+NMOSD, despite some overlap. The detection of MOG-IgG in the serum (and sometimes CSF) confirms the diagnosis in patients with compatible clinical-MRI phenotypes, but false positive results are occasionally encountered, especially with indiscriminate testing of large unselected populations. The type of cell-based assay used to evaluate for MOG-IgG (fixed vs. live) and antibody end-titer (low vs. high) can influence the likelihood of MOGAD diagnosis. International consensus diagnostic criteria for MOGAD are currently being compiled and will assist in clinical diagnosis and be useful for enrolment in clinical trials. Although randomized controlled trials are lacking, MOGAD acute attacks appear to be very responsive to high dose steroids and plasma exchange may be considered in refractory cases. Attack-prevention treatments also lack class-I data and empiric maintenance treatment is generally reserved for relapsing cases or patients with severe residual disability after the presenting attack. A variety of empiric steroid-sparing immunosuppressants can be considered and may be efficacious based on retrospective or prospective observational studies but prospective randomized placebo-controlled trials are needed to better guide treatment. In summary, this article will review our rapidly evolving understanding of MOGAD diagnosis and management