Critical Reflections on Building a Community of Conversation about Water Governance in Australia

Water governance has emerged as a field of research endeavour in response to failures of current and historical management approaches to adequately address persistent decline in ecological health of many river catchments and pressures on associated communities. Attention to situational framing is a key aspect of emerging approaches to water governance research, including innovations that build capacity and confidence to experiment with approaches capable of transforming situations usefully framed as ‘wicked’. Despite international investment in water governance research, a national research agenda on water governance was lacking in Australia in the late 2000s as were mechanisms to build the capacity of interdisciplinary and transdisciplinary research and collaborative policy practice. Through a two-year Water Governance Research Initiative (WGRI), we designed and facilitated the development of a community of conversation between researchers concerned with the dynamics of human-ecological systems from the natural sciences, humanities, social sciences, policy, economics, law and philosophy. The WGRI was designed as a learning system, with the intention that it would provide opportunities for conversations, learning and reflection to emerge. In this paper we outline the starting conditions and design of the WGRI, critically reflect on new narratives that arose from this initiative, and evaluate its effectiveness as a boundary organisation that contributed to knowledge co-production in water governance. Our findings point to the importance of investment in institutions that can act as integrative and facilitative governance mechanisms, to build capacity to work with and between research, policy, local stakeholders and practitioners

Governing irrigation renewal in rural Australia

Irrigation renewal schemes are taking place globally for water conservation and gains in agricultural productivity, as competition for water resources increases. The publically-funded renewal of irrigation infrastructure is a key platform of water reform in Australia’s Murray-Darling Basin; it is considered by some to be a policy that contradicts market-based approaches. In this Australian study, we examine an irrigation renewal scheme in northern Victoria resulting from a large investment by the State and Federal Governments. The long historical development of infrastructure and institutions for irrigation in the region led to technological lock-in and exposure to international terms of trade and climate change. From interviews with water professionals involved in the region, three key themes were identified through an adapted grounded theory approach: (1) a lack of an appropriate platform for fostering community involvement in what was a large-scale investment of public money; (2) issues in the way that water losses and savings were calculated; and (3) contradictions in policies for water buyback and irrigation renewal that lead to some irrigators being disadvantaged. To better understand the situation, we also applied a theoretical lens based on social learning. We conclude that the framing of a water ‘crisis’ was used to the benefit of some irrigators in attracting large-scale investment of public funds for irrigation renewal. The proposed solution, a technologically-driven irrigation renewal scheme, was implemented at a pace that didn’t match the planning horizons for many, leading many to exit from irrigated agriculture. Systemic insights for the design and implementation of irrigation renewal schemes internationally are highlighted

Editorial: water governance in a climate change world: appraising systemic and adaptive effectiveness

and other research outputs Editorial: water governance in a climate change world: appraising systemic and adaptive effectivenes

A Systemic approach to scoping of factors influencing more sustainable land use in Herefordshire

Defining and putting into practice sustainable land use is a complex, systemic problem. Systems models and techniques were used in a study of Herefordshire to clarify the situation and identify the potential for a more locally focused, learning-based approach to land use. Issues included: (i) uncertainty about the boundary of a 'system of sustainable Herefordshire land use'; (ii) the complexity of economic flows in the county and the absence of some critical data; (iii) the importance of the Herefordshire landscape to tourism and the role of agriculture as a determinant of the state of that landscape; (iv) weakness of the institutional linkage between tourism and agriculture; (v) the current lack of inclusion of many relevant stakeholders in concerted action. Factors favouring a learning approach included a strong local identity, local food-related developments, and educational initiatives. Barriers to such an approach included questions of power and landholding, government policies, and attitudes and skills within organizations. These findings are considered in relation to the wider debate over approaches to sustainability

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

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

Teaching threatens sustainable agriculture.

Over recent years the term sustainability has begun to mean all things to all people. There are now, for example, more than 60 definitions of sustainable development (Winpenny, 1990). But a central flaw is that sustainability is too often seen as an outcome - as something that exists, such as a sustainable farming system - rather than a process of change. Such a process should involve the building of sustainable relationships between people and people, and between people and their environment. And to do this requires the development of learning societies, in which learning becomes an active verb, not an adjective. The problem is that a pre-occupation with teaching has left us largely ignorant of learning. Yet society puts little premium on learning. It does not necessarily result from teaching, which is, of course, pervasive in all institutions associated with agriculture. It is the normal mode in many formal curricula; it underpins the transfer of technology model of agricultural research and development; and is central to many organisational structures. To my mind the teaching paradigm so differs from learning paradigms that it constrains our attempts to engage in a sustainable agriculture. Indeed, teaching appears to threaten sustainable agriculture

Experience, tradition and service? Institutionalised R&D in the rangelands

This chapter is based on two distinct but related pieces of research. The first is a series of semi-structured interviews conducted with staff from the service organisations with a R&D presence in the Western Division of NSW (NSW Agriculture, the Soil Conservation Service (SCS) and the Western Lands Commission (WLC)). Both field staff (referred to as advisory or extension officers) and managers were interviewed. The second research project involved working with a group of rangeland R&D staff in an attempt to develop a second-order, or co-researching approach to their own work. Chronologically the latter research was initiated after our co-researching project with pastoralists (Chapters 6, 7 and 8) and is not discussed in detail here (see CARR, 1993). However, aspects of it are drawn upon where it illuminates themes which emerged from the interviews