Practical and Theoretical Underpinnings of INFFER (Investment Framework For Environmental Resources)

INFFER (Investment Framework for Environmental Resources) was developed to help investors of public funds to improve the delivery of outcomes from environmental programs. It assists environmental managers to design projects, to select delivery mechanisms, and to rank competing projects on the basis of benefits and costs. The design of INFFER and the activities of the INFFER projects are based on extensive experience of working with environmental managers and policy makers. This experience has highlighted a number of important practical lessons, that have strongly influenced the design and implementation of INFFER. These lessons include the need for simplicity, training and support of users, trusting relationships with users, transparency, flexibility, compatibility with the needs and contexts of users, and supportive institutional arrangements. In additions, the developers have paid close attention to the need for processes that are theoretically rigorous, resulting in a tool that deals appropriately and consistently with projects for different assets types, of different scales and durations, consistent with Benefit: Cost Analysis. The paper outlines theoretical considerations underpinning the way that INFFER deals with asset valuation, time lags, uncertainty, and the design of the metric used to rank projects.Environmental Economics and Policy,

Lessons from implementing INFFER with regional catchment management organisations

Investment in natural resource management (NRM) by regional organisations in Australia has been widely criticised for failing to achieve substantial environmental outcomes. The Investment Framework for Environmental Resources (INFFER) is a tool for developing and prioritising projects to address environmental issues such as water quality and biodiversity decline, environmental pest impacts and land degradation. It aims to achieve the most valuable environmental outcomes with the available resources. During 2008 and 2009 INFFER has been implemented with a number of catchment management organisations (CMOs) throughout Australia. In this paper, we report on lessons from and implications of this experience. Data on implementation were collected in formal and informal ways from staff of organisations that were using INFFER and state agencies, including: an on-line survey, benchmarking questions at training workshops, a formal on-going monitoring and evaluation process tracking the use of INFFER by CMOs, and comments made in correspondence and informal feedback to the INFFER team. In this paper we describe issues that arise when implementing INFFER with regions and organisations, and how the INFFER team has attempted to address these. Key issues include a desire to consider the community as an asset and emphasise capacity building, a rejection of the need for targeted investment, and various difficulties associated with specific aspects of the Framework. Existing institutional arrangements, and the legacy of past institutional arrangements, remain serious barriers to the adoption of methods to improve environmental outcomes from NRM investment. A lack of rigour in investment planning has become accepted as the norm, and resistance to processes to improve rigour is common. However, many CMOs want to achieve better environmental outcomes with their limited funds, and we report on our efforts to work with them to achieve this by using INFFER.Research and Development/Tech Change/Emerging Technologies,

Changing the direction of environmental investment in Australia: Learnings from implementing INFFER

Investment in natural resource management (NRM) by regional organisations in Australia has been widely criticised for failing to achieve substantial environmental outcomes. The Investment Framework for Environmental Resources (INFFER) is a tool for developing and prioritising projects to address environmental issues such as water quality, biodiversity decline, environmental pest impacts and land degradation. INFFER is an asset-based, targeted, and outcome-focussed approach to environmental investment, and as such is a very different and more rigorous approach to prioritising possible environmental projects than used previously by most catchment management organisations (CMOs) in Australia. From 2008 to 2010 INFFER has been trialled with CMOs. Evaluation and benchmarking data obtained at 2-day INFFER training sessions with seven CMOs in three eastern Australia states are reported. Before commencing to use INFFER, CMO staff are generally confident about the current decision-making processes for environmental investment used within their organisation. In some cases, this initial perception challenges their acceptance of a new approach to investment decisionmaking. Key issues when implementing INFFER include concerns about changing the direction of CMO investment, concerns about compatibility with funder requirements, and various issues associated with specific aspects of the Framework. Perceived complexity of INFFER, existing institutional arrangements, and the legacy of past institutional arrangements remain serious barriers to the adoption of methods to improve environmental outcomes from NRM investment. Despite these difficulties INFFER is being used by a number of CMOs. However, it is likely that widespread adoption of INFFER, or indeed any other transparent and robust process, will only occur with greater requirement from governments for environmental decision making by regional NRM bodies that is more focused on outcomes and cost-effectiveness.NRM investment planning, NRM investment prioritisation, regional catchment management organisations, NRM policy, environmental planning, environmental prioritisation, environmental policy, Environmental Economics and Policy, Research and Development/Tech Change/Emerging Technologies, Q50, Q58,

Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection

Background Local anaesthetic blocks of the greater occipital nerve (GON) are frequently performed in different types of headache, but no selective approaches exist. Our cadaver study compares the sonographic visibility of the nerve and the accuracy and specificity of ultrasound-guided injections at two different sites. Methods After sonographic measurements in 10 embalmed cadavers, 20 ultrasound-guided injections of the GON were performed with 0.1 ml of dye at the classical site (superior nuchal line) followed by 20 at a newly described site more proximal (C2, superficial to the obliquus capitis inferior muscle). The spread of dye and coloration of nerve were evaluated by dissection. Results The median sonographic diameter of the GON was 4.2×1.4 mm at the classical and 4.0×1.8 mm at the new site. The nerves were found at a median depth of 8 and 17.5 mm, respectively. In 16 of 20 in the classical approach and 20 of 20 in the new approach, the nerve was successfully coloured with the dye. This corresponds to a block success rate of 80% (95% confidence interval: 58-93%) vs 100% (95% confidence interval: 86-100%), which is statistically significant (McNemar's test, P=0.002). Conclusions Our findings confirm that the GON can be visualized using ultrasound both at the level of the superior nuchal line and C2. This newly described approach superficial to the obliquus capitis inferior muscle has a higher success rate and should allow a more precise blockade of the nerv

Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection

Background. Ilioinguinal and iliohypogastric nerve blocks may be used in the diagnosis of chronic groin pain or for analgesia for hernia repair. This study describes a new ultrasound-guided approach to these nerves and determines its accuracy using anatomical dissection control. Methods. After having tested the new method in a pilot cadaver, 10 additional embalmed cadavers were used to perform 37 ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve. After injection of 0.1 ml of dye the cadavers were dissected to evaluate needle position and colouring of the nerves. Results. Thirty-three of the thirty-seven needle tips were located at the exact target point, in or directly at the ilioinguinal or iliohypogastric nerve. In all these cases the targeted nerve was coloured entirely. In two of the remaining four cases parts of the nerves were coloured. This corresponds to a simulated block success rate of 95%. In contrast to the standard ‘blind' techniques of inguinal nerve blocks we visualized and targeted the nerves 5 cm cranial and posterior to the anterior superior iliac spine. The median diameters of the nerves measured by ultrasound were: ilioinguinal 3.0×1.6 mm, and iliohypogastric 2.9×1.6 mm. The median distance of the ilioinguinal nerve to the iliac bone was 6.0 mm and the distance between the two nerves was 10.4 mm. Conclusions. The anatomical dissections confirmed that our new ultrasound-guided approach to the ilioinguinal and iliohypogastric nerve is accurate. Ultrasound could become an attractive alternative to the ‘blind' standard techniques of ilioinguinal and iliohypogastric nerve block in pain medicine and anaesthetic practic

Circumferential buckling of a hydrogel tube emptying upon dehydration

A cylindrical hydrogel tube, completely submerged in water, hydrates by swelling and filling its internal cavity. When it comes back into contact with air, it dehydrates: the tube thus expels the solvent through the walls, shrinking. This dehydration process causes a depression in the tube cavity, which can lead to circumferential buckling. Here we study the occurrence of such buckling using a continuous model that combines nonlinear elasticity with Flory-Rehner theory, to take into account both the large deformations and the active behaviour of the hydrogel. In quasi-static approximation, we use the incremental deformation formalism, extended to the chemo-mechanical equations, to determine the threshold value of the enclosed volume at which buckling is triggered. This critical value is found to depend on the shell thickness, chemical potential and constitutive features. The results obtained are in good agreement with the results of the finite element simulations of the complete dynamic problem

Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery

Background. Thoracoscopic surgery can be associated with considerable postoperative pain. While the benefits of paravertebral block on pain after thoracotomy have been demonstrated, no investigations on the effects of paravertebral block on pain after thoracoscopy have been conducted. We tested the hypothesis that a single-injection thoracic paravertebral block, performed preoperatively, reduces pain scores after thoracoscopic surgery. Methods. Of 45 patients recruited, 40 completed the study. They were randomly allocated to two groups: the paravertebral group received i.v. patient-controlled analgesia (PCA) with morphine plus single-injection thoracic paravertebral block with bupivacaine 0.375% and adrenaline 1:200 000 0.4 ml kg−1 (n=20). The control group was treated with a back puncture without injection and morphine PCA (n=20). Results. The main outcomes recorded during 48 h after surgery were pain scores using the visual analogue scale (VAS, 0-100). Secondary outcomes were cumulative morphine consumption and peak expiratory flow rate (PEFR). Half an hour and 24 h after surgery, median (25th-75th percentiles) VAS on coughing in the paravertebral group was 31.0 (20.0-55.0) and 30.5 (17.5-40.0) respectively and in the control group it was 70.0 (30.0-100.0) and 50.0 (25.0-75.0) respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four and 48 h after surgery, median (25th-75th percentiles) cumulative morphine consumption (mg) was 49.0 (38.3-87.0) and 69.3 (38.8-118.5) respectively in the paravertebral group and 51.2 (36.0-84.1) and 78.1 (38.4-93.1) in the control group (statistically not significant). No differences were found in PEFR or the incidence of any side-effects between groups. Conclusion. We conclude that single-shot preoperative paravertebral block improves post-operative pain treatment after thoracoscopic surgery in a clinically significant fashio

Ilioinguinal and iliohypogastric nerves cannot be selectively blocked by using ultrasound guidance: a volunteer study

Background Ilioinguinal (IL) and iliohypogastric (IH) nerve blocks are used in patients with chronic postherniorrhaphy pain. The present study tested the hypothesis that our method, previously developed in cadavers, blocks the nerves separately and selectively in human volunteers. Methods We blocked the IL and the IH nerves in 16 volunteers in a single-blinded randomized cross-over setting under direct ultrasound visualization, by injecting two times the ED95 volume of 1% mepivacaine needed to block a peripheral nerve. The anaesthetized skin areas were tested by pinprick and marked on the skin. A digital photo was taken. For further analysis, the parameterized picture data were transformed into a standardized and unified coordinate system to compare and calculate the overlap of the anaesthetized skin areas of the two nerves on each side. An overlap <25% was defined as selective block. Results Fifty nerve blocks could be analysed. The mean volume injected to block a single nerve was 0.9 ml. Using ultrasound, we observed spread from one nerve to the other in 12% of cases. The overlap of the anaesthetized skin areas of the nerves was 60.3% and did not differ after exclusion of the cases with visible spread of local anaesthetic from one nerve to the other. Conclusions The IL and IH nerves cannot be selectively blocked even if volumes below 1 ml are used. The most likely explanation is the spread of local anaesthetic from one nerve to the other, although this could not be directly observed in most case

Local treatment with electrochemotherapy of superficial angiosarcomas: Efficacy and safety results from a multi-institutional retrospective study

Background: Angiosarcoma is an aggressive vascular neoplasm with a high propensity for local recurrence. Electrochemotherapy is an emerging skin-directed therapy, exerting prominent cytotoxic activity, and antivascular effects. Its efficacy in angiosarcoma has not been investigated. Methods: This multicenter retrospective analysis reviewed patients who underwent electrochemotherapy from 2007 to 2014 for superficial advanced angiosarcomas. Bleomycin was administered intravenously and delivered within tumors by means of percutaneously applied electric pulses, according to the European Standard Operating Procedures for Electrochemotherapy. Tumor assessment was performed using RECIST (version 1.1). Toxicity (CTCAE, v4.0) and local progression-free survival (LPFS) were also evaluated. Results: Nineteen patients (13 with locally advanced and 6 with metastatic angiosarcomas) were treated. Tumor sites were: scalp (n¼5), breast(n¼8), other skin sites (n¼3), and soft tissue (n¼3). Target lesions (n¼54) ranged in size from 1.5 to 2.5 cm (median, 2 cm). Treatment was well tolerated. After 2 months, an objective response was observed in 12/19 (63%) patients, complete in 8 (42%). One-year LPFS within treatment field was 68%. Local symptom improvement included palliation of bleeding (5/19 patients) and pain relief (6/19 patients). Conclusions: Electrochemotherapy may represent a new locoregional treatment for selected patients with superficial angiosarcomas