Collaborative stewardship in multifunctional landscapes: Toward relational, pluralistic approaches

Landscape stewardship offers a means to put social-ecological approaches to stewardship into practice. The growing interest in landscape stewardship has led to a focus on multistakeholder collaboration. Although there is a significant body of literature on collaborative management and governance of natural resources, the particular challenges posed by multifunctional landscapes, in which there are often contested interests, require closer attention. We present a case study from South Africa to investigate how collaborative stewardship can be fostered in contested multifunctional landscapes. We conducted this research through an engaged transdisciplinary research partnership in which we integrated social-ecological practitioner and academic knowledge to gain an in-depth understanding of the challenges of fostering collaboration. We identified five overarching factors that influence collaboration: contextual, institutional, social-relational, individual, and political-historical. Collaborative stewardship approaches focused on the development of formal governance institutions appear to be most successful if enabling individual and social-relational conditions are in place. Our case study, characterized by high social diversity, inequity, and contestation, suggests that consensus-driven approaches to collaboration are unlikely to result in equitable and sustainable landscape stewardship in such contexts. We therefore suggest an approach that focuses on enhancing individual and social-relational enablers. Moreover, we propose a bottom-up patchwork approach to collaborative stewardship premised on the notion of pluralism. This would focus on building new interpersonal relationships and collaborative capacity through small collective actions. Taking a relational, pluralistic approach to fostering collaborative stewardship is particularly important in contested, socially heterogeneous landscapes. Drawing on our study and the literature, we propose guiding principles for implementing relational, pluralistic approaches to collaborative stewardship and suggest future research directions for supporting such approaches

Models of everywhere revisited: a technological perspective

The concept ‘models of everywhere’ was first introduced in the mid 2000s as a means of reasoning about the environmental science of a place, changing the nature of the underlying modelling process, from one in which general model structures are used to one in which modelling becomes a learning process about specific places, in particular capturing the idiosyncrasies of that place. At one level, this is a straightforward concept, but at another it is a rich multi-dimensional conceptual framework involving the following key dimensions: models of everywhere, models of everything and models at all times, being constantly re-evaluated against the most current evidence. This is a compelling approach with the potential to deal with epistemic uncertainties and nonlinearities. However, the approach has, as yet, not been fully utilised or explored. This paper examines the concept of models of everywhere in the light of recent advances in technology. The paper argues that, when first proposed, technology was a limiting factor but now, with advances in areas such as Internet of Things, cloud computing and data analytics, many of the barriers have been alleviated. Consequently, it is timely to look again at the concept of models of everywhere in practical conditions as part of a trans-disciplinary effort to tackle the remaining research questions. The paper concludes by identifying the key elements of a research agenda that should underpin such experimentation and deployment

Interprofessional education in geriatric medicine: towards best practice. A controlled before-after study of medical and nursing students

Objectives. To investigate nursing and medical students’ readiness for interprofessional learning before and after implementing geriatric interprofessional education (IPE), based on problem-based learning (PBL) case scenarios. To define the optimal number of geriatric IPE sessions, the size and the ratio of participants from each profession in the learner groups, the outcomes related to the Kirkpatrick four-level typology of learning evaluation, students’ concerns about joint learning and impact of geriatric IPE on these concerns. The study looked at the perception of roles and expertise of the ‘other’ profession in interprofessional teams, and students’ choice of topics for future sessions. Students’ expectations, experience, learning points and the influence on the understanding of IP collaboration, as well as their readiness to participate in such education again were investigated. Design. A controlled before–after study (2014/2015, 2015/2016) with data collected immediately before and after the intervention period. Study includes additional comparison of the results from the intervention with a control group of students. Outcomes were determined with a validated ‘Readiness for Interprofessional Learning’ questionnaire, to which we added questions with free comments, combining quantitative and qualitative research methods. The teaching sessions were facilitated by experienced practitioners/educators, so each group had both, a clinician (either geratology consultant or registrar) and a senior nurse. Participants. 300 medical, 150 nursing students. Setting. Tertiary care university teaching hospital. Results. Analysis of the returned forms in the intervention group had shown that nursing students scored higher on teamwork and collaboration post-IPE (M=40.78, SD=4.05) than pre-IPE (M=34.59, SD=10.36)—statistically significant. On negative professional identity, they scored lower post-IPE (M=7.21, SD=4.2) than pre-IPE (M=8.46, SD=4.1)—statistically significant. The higher score on positive professional identity post-IPE (M=16.43, SD=2.76) than pre-IPE (M=14.32, SD=4.59) was also statistically significant. Likewise, the lower score on roles and responsibilities post-IPE (M=5.41, SD=1.63) than pre-IPE (M=6.84, SD=2.75). Medical students scored higher on teamwork and collaboration post-IPE (M=36.66, SD=5.1) than pre-IPE (M=32.68, SD=7.4)—statistically significant. Higher positive professional identity post-IPE (M=14.3, SD=3.2) than pre-IPE (M=13.1, SD=4.31)—statistically significant. The lower negative professional identity post-IPE (M=7.6, SD=3.17) than pre-IPE (M=8.36, SD=2.91) was not statistically significant. Nor was the post-IPE difference over roles and responsibilities (M=7.4, SD=1.85), pre-IPE (M=7.85, SD=2.1). In the control group, medical students scored higher for teamwork and collaboration post-IPE (M=36.07, SD=3.8) than pre-IPE (M=33.95, SD=3.37)—statistically significant, same for positive professional identity post-IPE (M=13.74, SD=2.64), pre-IPE (M=12.8, SD=2.29), while negative professional identity post-IPE (M=8.48, SD=2.52), pre-IPE (M=9, SD=2.07), and roles and responsibilities post-IPE (M=7.89, SD=1.69), pre-IPE (M=7.91, SD=1.51) shown no statistically significant differences. Student concerns, enhanced understanding of collaboration and readiness for future joint work were addressed, but not understanding of roles. Conclusions. Educators with nursing and medical backgrounds delivered geriatric IPE through case-based PBL. The optimal learner group size was determined. The equal numbers of participants from each profession for successful IPE are not necessary. The IPE delivered by clinicians and senior nurses had an overall positive impact on all participants, but more markedly on nursing students. Surprisingly, it had the same impact on medical students regardless if it was delivered to the mixed groups with nursing students, or to medical students alone. Teaching successfully addressed students’ concerns about joint learning and communication and ethics were most commonly suggested topics for the future

ProDiet: A Phase II Randomized Placebo-controlled Trial of Green Tea Catechins and Lycopene in Men at Increased Risk of Prostate Cancer.

Epidemiologic studies suggest that diet can alter prostate cancer risk. This study aimed to establish the feasibility and acceptability of dietary modification in men at increased risk of prostate cancer. Men were invited with a PSA level of 2.0-2.95 ng/mL or 3.0-19.95 ng/mL with negative prostate biopsies. Randomization (3 × 3 factorial design) to daily green tea and lycopene: green tea drink (3 cups, unblinded) or capsules [blinded, 600 mg flavan-3-ol ()-epigallocatechin-3-gallate (EGCG) or placebo] and lycopene-rich foods (unblinded) or capsules (blinded, 15 mg lycopene or placebo) for 6 months. Primary endpoints were randomization rates and intervention adherence (blinded assessment of metabolites) at 6 months with secondary endpoints of acceptability (from interviews), safety, weight, blood pressure, and PSA. A total of 133 of 469 (28.4%) men approached agreed to be randomized and 132 were followed-up (99.2%). Mean lycopene was 1.28 [95% confidence intervals (CI), 1.09-1.50, P = 0.003] times higher in the lycopene capsule group and 1.42 (95% CI, 1.21-1.66; P < 0.001) times higher in the lycopene-enriched diet group compared with placebo capsules. Median EGCG was 10.7 nmol/L (95% CI, 7.0-32.0) higher in in the active capsule group and 20.0 nmol/L (95% CI, 0.0-19.0) higher in the green tea drink group compared with placebo capsules (both P < 0.001). All interventions were acceptable and well tolerated although men preferred the capsules. Dietary prevention is acceptable to men at risk of prostate cancer. This intervention trial demonstrates that a chemoprevention clinical trial is feasible. Cancer Prev Res; 11(11); 687-96. ©2018 AACR

Effect of a Low-Intensity PSA-Based Screening Intervention on Prostate Cancer Mortality:The CAP Randomized Clinical Trial

Importance Prostate cancer screening remains controversial because potential mortality or quality-of-life benefits may be outweighed by harms from overdetection and overtreatment. Objective To evaluate the effect of a single prostate-specific antigen (PSA) screening intervention and standardized diagnostic pathway on prostate cancer–specific mortality. Design, Setting, and Participants The Cluster Randomized Trial of PSA Testing for Prostate Cancer (CAP) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practices across the United Kingdom. Randomization and recruitment of the practices occurred between 2001 and 2009; patient follow-up ended on March 31, 2016. Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs standard (unscreened) practice. Main Outcomes and Measures Primary outcome: prostate cancer–specific mortality at a median follow-up of 10 years. Prespecified secondary outcomes: diagnostic cancer stage and Gleason grade (range, 2-10; higher scores indicate a poorer prognosis) of prostate cancers identified, all-cause mortality, and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic. Results Among 415 357 randomized men (mean [SD] age, 59.0 [5.6] years), 189 386 in the intervention group and 219 439 in the control group were included in the analysis (n = 408 825; 98%). In the intervention group, 75 707 (40%) attended the PSA testing clinic and 67 313 (36%) underwent PSA testing. Of 64 436 with a valid PSA test result, 6857 (11%) had a PSA level between 3 ng/mL and 19.9 ng/mL, of whom 5850 (85%) had a prostate biopsy. After a median follow-up of 10 years, 549 (0.30 per 1000 person-years) died of prostate cancer in the intervention group vs 647 (0.31 per 1000 person-years) in the control group (rate difference, −0.013 per 1000 person-years [95% CI, −0.047 to 0.022]; rate ratio [RR], 0.96 [95% CI, 0.85 to 1.08]; P = .50). The number diagnosed with prostate cancer was higher in the intervention group (n = 8054; 4.3%) than in the control group (n = 7853; 3.6%) (RR, 1.19 [95% CI, 1.14 to 1.25]; P

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Time in Mixed Methods Longitudinal Research: working across written narratives and large scale panel survey data to investigate attitudesto volunteering

This chapter focuses on how mixed-methods researchers can conceptualise and analyse time and the life-course when reusing longitudinal qualitative and quantitative data sources. Specifically, it addresses the methodological and analytical challenges involved in undertaking a mixed-method, longitudinal, research project that reused qualitative and quantitative secondary data to investigate individual attitudes towards voluntarism between 1981 and 2012. Discussing the project’s research design, its mixed-method analyses, and the key learning points of this mixed-method process, the chapter poses a series of key questions. Were the longitudinal qualitative and quantitative datasets used compatible and able to be mixed? What were the roles and relationships between the qualitative and quantitative analyses, did one facilitate the other? Does a mixed-method approach work when researching time and the life-course? The chapter examines some of the challenges involved in longitudinal mixed-method research, notably in ensuring a good fit between data sources, and between analyses. However it also highlights the value of using this approach, where the respective weaknesses of each analytical methodology were offset by their joint strengths to enable a multi-dimensional, comprehensive understanding of time and the life-course in the context of understanding British voluntaris

A relational approach to landscape stewardship

Landscape stewardship is increasingly understood within the framing of complex social-ecological systems. To consider the implications of this, we focus on one of the key characteristics of complex social-ecological systems: they are relationally constituted, meaning that system characteristics emerge out of dynamic relations between system components. We focus on multi-actor collaboration as a key form of relationality in landscapes, seeking a more textured understanding of the social relations between landscape actors. We draw on a set of ‘gardening tools’ to analyse the boundary-crossing work of multi-actor collaboration. These tools comprise three key concepts: relational expertise, common knowledge, and relational agency. We apply the tools to two cases of landscape stewardship in South Africa: the Langkloof Region and the Tsitsa River catchment. These landscapes are characterised by economically, socio-culturally, and politically diverse groups of actors. Our analysis reveals that history and context strongly influence relational processes, that boundary-crossing work is indeed difficult, and that doing boundary-crossing work in smaller pockets within a landscape is helpful. The tools also helped to identify three key social-relational practices which lend a new perspective on boundary-crossing work: 1. belonging while differing, 2. growing together by interacting regularly and building common knowledge, and 3. learning and adapting together with humility and empathy