Tools for adaptive governance for complex social-ecological systems: A review of role-playing-games as serious games at the community-policy interface

The management of natural resources—from forests to fisheries to freshwater—is becoming increasingly complex and requires new tools and processes for engaging with individuals, communities, and decision-makers. Policy makers and practitioners have begun using serious games (SGs) (those used for purposes other than entertainment) to overcome some of the complex challenges of governing resources in social-ecological systems. This paper uses a systematic literature review methodology to assess role-playing SGs for natural resource management. Fifty-two articles from the role-playing game (RPG) subset of SGs are identified, synthesised and analysed using a multi-criteria evaluation framework. First, we explore three theoretical and conceptual elements of games: principles of RPGs, functions of games, and (practical) game characteristics. We evaluate game elements, including game design, adherence to reality and the degree to which games integrate elements of participatory—and action research. These dimensions of RPGs are then analysed and discussed. Particular attention is paid to the value and application of RPGs to address complex problems with interacting environmental, social, cultural and economic challenges, and the extent to which they can inform adaptive governance solutions. Results show that RPGs can be a valuable tool at different levels; however, we also identify important gaps in the current state of knowledge, in particular, related to bridging community—and higher-level decision-making scales through RPGs

Follistatin-like 3 (FSTL3) mediated silencing of transforming growth factor (TGF ) signaling is essential for testicular aging and regulating testis size

Follistatin-like 3 (FSTL3) is a glycoprotein that binds and inhibits the action of TGFβ ligands such as activin. The roles played by FSTL3 and activin signaling in organ development and homeostasis are not fully understood. The authors show mice deficient in FSTL3 develop markedly enlarged testes that are also delayed in their age-related regression. These FSTL3 knockout mice exhibit increased Sertoli cell numbers, allowing for increased spermatogenesis but otherwise showing normal testicular function. The data show that FSTL3 deletion leads to increased AKT signaling and SIRT1 expression in the testis. This demonstrates a cross-talk between TGFβ ligand and AKT signaling and leads to a potential mechanism for increased cellular survival and antiaging. The findings identify crucial roles for FSTL3 in limiting testis organ size and promoting age-related testicular regression

Use of cffDNA to avoid administration of anti-D to pregnant women when the fetus is RhDnegative: Implementation in the NHS. BJOG doi

Objective To determine whether a policy of offering cffDNA testing to all RhD-negative women at about 16 weeks' gestation to avoid anti-D administration when the fetus is RhD-negative could be implemented successfully in the NHS without additional funding. Design Prospectively planned observational service implementation pilot and notes audit. Setting Three maternity services in the South West of England. Population All RhD-negative women in a 6-month period. Methods Prospective, intervention, cross-sectional observational study, using pre-intervention data as controls. Main outcome measures Proportion of suitable women who offered and accepted the test. Accuracy of the cffDNA result as assessed by cord blood group result. Fall in anti-D doses administered. Results 529 samples were received; three were unsuitable. The results were reported as RhD-positive (n = 278), RhD-negative (n = 185) or inconclusive, treat as positive (n = 63). Cord blood results were available in 502 (95%) and the only incorrect result was one case of a false positive (cffDNA reported as positive, cord blood negative -and so given anti-D unnecessarily). The notes audit showed that women who declined this service were correctly managed and that anti-D was not given when the fetus was predicted to be RhD-negative. The total use of anti-D doses fell by about 29% which equated to about 35% of RhD-negative women not receiving anti-D in their pregnancy unnecessarily. Conclusions We recommend this service is extended to all UK NHS services

Economic Evaluation of Transperineal versus Transrectal Devices for Local Anaesthetic Prostate Biopsies

Abstract: Background: Biopsy of the prostate for suspected cancer is usually performed transrectally under local anaesthesia in the outpatient clinic setting. As this involves piercing the bowel wall, the procedure is associated with a risk of infection. Recently, devices that facilitate transperineal biopsy approaches have been developed that avoid piercing the bowel and so should reduce the risk of infection. Objective: The aim of this study was to estimate the cost effectiveness of transperineal versus transrectal ultrasound-guided local anaesthesia procedures for prostate biopsy from the perspective of the UK NHS and to estimate the value of further research in the area. Methods: a) Decision tree and Markov model synthesising all relevant evidence estimating the life-time costs and QALYs accrued from each biopsy mode. b) Value of information analysis to predict the return from further research and thus guide future research efforts. Results: Transperineal biopsy yields an ICER below £20,000 per QALY gained at a per-procedure device acquisition cost below £81, or £41 for cost-neutrality. These results are driven by differences in consumables cost, reduced cost of treating infections, and QALY gains associated with reduced infections. There is value in future research on the diagnostic accuracy of transperineal versus transrectal biopsies and the incidence of iatrogenic infection and sepsis; consideration should be given to enriching the patient population with men with intermediate-risk disease. Conclusions: Transperineal biopsy devices may be cost effective compared with transrectal biopsy at per-procedure acquisition costs below £81 and cost-neutral if under £41. Future research is required to confirm or refute these findings, particularly randomised comparisons of the diagnostic accuracy and infection risks between the methods

Principles and process for developing participatory adaptation pathways in the primary industries

Adaptation pathways is an approach to identify, assess, and sequence climate change adaptation options over time, linking decisions to critical signals and triggers derived from scenarios of future conditions. However, conceptual differences in their development can hinder methodological advance and create a disconnect between those applying pathways approaches and the wider community of practitioners undertaking vulnerability, impacts, and adaptation assessments. Here, we contribute to close these gaps, advancing principles, and processes that may be used to guide the trajectory for adaptation pathways, without having to rely on data-rich or resource-intensive methods. To achieve this, concepts and practices from the broad pathways literature is combined with our own experience in developing adaptation pathways for primary industries facing the combined impacts of climate change and other, nonclimatic stressors. Each stage is guided by a goal and tools to facilitate discussions and produce feasible pathways. We illustrate the process with a case study from Hawke’s Bay, New Zealand, involving multiple data sources and methods in two catchments. Resulting guidelines and empirical examples are consistent with principles of adaptive management and planning and can provide a template for developing local-, regional- or issue-specific pathways elsewhere and enrich the diversity of vulnerability, impacts, and adaptation assessment practice

Spermatogenesis and sertoli cell activity in mice lacking Sertoli cell receptors for follicle stimulating hormone and androgen

Spermatogenesis in the adult male depends on the action of FSH and androgen. Ablation of either hormone has deleterious effects on Sertoli cell function and the progression of germ cells through spermatogenesis. In this study we generated mice lacking both FSH receptors (FSHRKO) and androgen receptors on the Sertoli cell (SCARKO) to examine how FSH and androgen combine to regulate Sertoli cell function and spermatogenesis. Sertoli cell number in FSHRKO-SCARKO mice was reduced by about 50% but was not significantly different from FSHRKO mice. In contrast, total germ cell number in FSHRKO-SCARKO mice was reduced to 2% of control mice (and 20% of SCARKO mice) due to a failure to progress beyond early meiosis. Measurement of Sertoli cell-specific transcript levels showed that about a third were independent of hormonal action on the Sertoli cell, whereas others were predominantly androgen dependent or showed redundant control by FSH and androgen. Results show that FSH and androgen act through redundant, additive, and synergistic regulation of spermatogenesis and Sertoli cell activity. In addition, the Sertoli cell retains a significant capacity for activity, which is independent of direct hormonal regulation

Integrating Traditional Healers into the Health Care System:Challenges and Opportunities in Rural Northern Ghana

Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health care. Moving beyond literature, it stresses the importance of trust-relationships between healers and biomedical staff. Insights are based on qualitative research conducted in Ghana’s Northern Region (2013–2014). Five challenges to integration emerged out of the data: a lack of understanding of traditional medicine, discrimination, high turnover of biomedical staff, declining interest in healing as a profession, and equipment scarcity. Besides challenges, opportunities for integration exist, including the extensive infrastructure of traditional medicine, openness to collaboration, and grassroots initiatives. Contemplating challenges and opportunities this paper provides recommendations for integration, including: identify/select healers, promote best practices, institute appropriate forms of appreciation/recognition of healers, provide aid and equipment, use communication campaigns to promote integration and steer attitudinal change towards healers among biomedical staff. Most crucial, we argue successful implementation of these recommendations depends on a concerted investment in relationships between healers and biomedical staff

Direct action through the Sertoli cells is essential for androgen stimulation of spermatogenesis

Androgens act to stimulate spermatogenesis through androgen receptors (AR) on the Sertoli cells and peritubular myoid cells (PTM). Specific ablation of the AR in either cell type will cause a severe disruption of spermatogenesis. To determine whether androgens can stimulate spermatogenesis through direct action on the PTM alone or whether action on the Sertoli cells is essential we have crossed hypogonadal (hpg) mice which lack gonadotrophins and intratesticular androgen with mice lacking androgen receptors (AR) either ubiquitously (ARKO) or specifically on the Sertoli cells (SCARKO). These hpg.ARKO and hpg.SCARKO mice were treated with testosterone (T) or dihydrotestosterone (DHT) for 7 days and testicular morphology and cell numbers assessed. Androgen treatment did not affect Sertoli cell numbers in any animal group. Both T and DHT increased numbers of spermatogonia and spermatocytes in hpg mice but DHT has no effect on germ cell numbers in hpg.SCARKO and hpg.ARKO mice. T increased germ cell numbers in hpg.SCARKO and hpg.ARKO mice but this was associated with stimulation of FSH release. Results show that androgen stimulation of spermatogenesis requires direct androgen action on the Sertoli cells

Synergies, tensions and challenges in HIV prevention, treatment and cure research: exploratory conversations with HIV experts in South Africa

Background: The ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary data from South African HIV clinicians, researchers and activists. Methods: In-depth interviews were conducted on a purposive sample of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three authors independently. Results: The rapid evolution of HIV cure research agendas was prominent with participants expressing some concern that the global North was driving the cure agenda. Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging. Managing expectations and avoiding curative misconception will have implications for consent processes. Unique strategies in cure research could include treatment interruption, which has the potential to create therapeutic and ethical conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed consent and community engagement. Conclusions: It was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cur

Climate change adaptation through an integrative lens in Aotearoa New Zealand

Climate change is being felt across all human and natural systems in Aotearoa New Zealand and is projected to worsen this decade as impacts compound and cascade through natural system and sectoral dependencies. The effectiveness of adaptation is constrained by how fast greenhouse gas emissions are reduced globally, the pace of change, the frequency and progression of impacts, and the capacity of our natural, societal and political systems to respond. We explore how these systems and sectors interact with existing and projected climate change stressors by categorising climate change impacts (Trends and Events) and consequential thresholds (Thresholds), and by grouping systems and sectors by types (Typologies). This approach has identified commonalities and differences between the typologies which are illustrated with examples. Critical constraints and opportunities for adaptation have been identified to guide sector adaptation decision-making and for ongoing adaptation progress and effectiveness monitoring. Constraints are found across all sectors, and opportunities exist to address them through modelling and projections, monitoring frameworks, decision tools and measures, governance coordination and integration of the Māori worldview of the relationship between humans and nature. However, limits to adaptation exist and will increase over time unless all sectors and all nations urgently reduce their emissions