Towards adaptive water governance in dryland social-ecological systems: the case of the Rio del Carmen watershed

Drylands are ecologically restricted by water scarcity, limiting the water ecosystem services that can contribute to human well-being. At the same time, the 2.5 billion people living in drylands are considered the poorest and most marginalized people in the world. Given this challenging context, drylands, as coupled social-ecological systems, are prone to suffer harm from non-linear stressors such as droughts, climate change, as well as the mismanagement of water ecosystem services, with important implications for livelihoods. Adaptive water governance has the potential to increase dryland resilience in the face of uncertainty, through institutional arrangements that enable flexibility, iteration, subsidiarity, and collaboration. However, when advancing adaptation efforts, water governance assessments and reforms tend to fail because of a lack of a comprehensive analysis of the social-ecological context and its complexities. To provide important insights to strengthen dryland resilience, this thesis analyses water governance in the Rio del Carmen watershed in the Chihuahuan Desert, Mexico. Based on primary data from semi-structured interviews and survey research, this thesis explores how stakeholders perceive water ecosystem services and how water governance regulates their access; the governance vulnerabilities that undermine dryland adaptation; and the potential that stakeholders have to overcome them and enable adaptive water governance. Results show that formal institutions that do not consider informal institutions (including stakeholder perceptions, farming practices, religious beliefs, and corruption) when addressing local needs, undermine the effectiveness of governance. In the Rio del Carmen watershed, this has led to impacts on both the environment and society in the form of water overexploitation, grassland loss, water mismanagement, legal breaches, and social clashes. Findings suggest that developing a common awareness about water ecosystem services among stakeholders has the potential to engage them and ultimately help establish a formal network guided by adaptive governance approaches. Accordingly, this thesis derives three principles for moving towards adaptive water governance, highlighting the need to recognise the exposure and sensitivity to societal and climate stressors, and to adjust the institutional setting to these context-specific issues. The principles aim to enhance the implications of resilience theory for scholars and practitioners working on dryland resilience and adaptation, so the expansion and degradation of drylands can be better addressed

Lessons learned from a constitutional controversy on the Mexican water management

Between March and May 2020, fourteen municipalities in Chihuahua, Mexico, initiated a jurisdictional process called ‘constitutional controversy’ at Mexico's Supreme Court of Justice, against the Congress, the President, the Commander of the National Guard, and the National Water Commission. These municipalities sued for the unconstitutionality of the Federal Government's actions regarding the water extraction in the "La Boquilla" dam, in the light of water legislation unsuitable to foster public participation in water management. Moreover, the lack of public participation in the 'La Boquilla' dam water management have resulted in several clashes between water users and the National Guard. Amid the current drafting process of the General Water Law for Mexico, it is important to understand how the Mexican water legal framework has failed as an institutional tool to achieve sustainable water management. This report discusses the “La Boquilla” dam case to highlight the inability of the current Mexican water legal framework to address water-related problems. In doing so, some of the main problems in Mexican water laws’ structure are analysed to show why those laws are hardly complied with and weakly enforced, which has resulted in conflicts and water mismanagement. Finally, it discusses the potential of stakeholder engagement and local water policies for strengthening the rule of law with respect to water for the upcoming General Water Law for Mexico

Public Participation and the Escazú Agreement: Implementation Challenges for Vulnerable Groups Amid a Global Pandemic

While the adoption of the Escazú Agreement is of importance, there are many obstacles in the Latin America and the Caribbean to the implementation of this treaty, especially in terms of public participation. Those obstacles are social and institutional challenges, such as culture of privilege, killing of environmental activists, and COVID-19. This article discusses to what extent the Escazú Agreement can potentially overcome the existing challenges and ensuring public participation for persons or groups in vulnerable situations

Guiding Environmental Law’s Transformation into Earth System Law Through the Telecoupling Framework

Insights from Earth system science show us that we are crossing over into a new geological epoch, the Anthropocene. Yet, environmental law has failed to integrate these insights and adopt an Earth system perspective, with the result that environmental law has arguably become incapable of responding to the numerous complex, interconnected, and non-linear challenges of an erratic Earth system in the Anthropocene. Earth system law is proposed as a response and is intended to ‘translate’ Earth system science insights into the legal domain, thereby transforming Holocene nvironmental law and making it more fit for purpose in the Anthropocene. In order to practically explore how this transformation could take place, reliance is placed on the telecoupling framework, which analyses interconnected or coupled human and natural systems over distances. With reference to the mining activities conducted by Canadian companies in Mexico, the telecoupling framework is revealed as a valuable tool for thinking about environmental law in Earth system terms and enabling one to see a range of deeply intertwined telecoupled issues and considerations that must be taken account of by the law. In turn, this enables one to begin to imagine the types of considerations that should be incorporated into legal responses in order to adequately respond to the socio-ecological challenges of the Anthropocene

Unpacking stakeholder perceptions of the benefits and challenges associated with urban greenspaces in Sub-Saharan Africa

Urban greenspaces underpin ecosystem service provision in cities and are therefore indispensable for human well-being. Nevertheless, they are increasingly disappearing from cities in Sub-Saharan Africa. Understanding how the stakeholders influencing urban greenspace management perceive the benefits provided by urban greenspaces and the challenges to its conservation and management is critical for reversing this trend. Using Malawi’s capital city, Lilongwe, as a case study, we conducted 44 semi-structured interviews to explore the profiles and perceptions of stakeholders who currently hold influence over greenspace planning, conservation and management. Stakeholders with influence over urban greenspace management described the main focus of their organisation as relating to urban planning, natural resources protection and management, development work, or the hospitality business sector. Critically, only a third of all stakeholders focused on natural resources protection and management. Stakeholders had nuanced and varied appreciations of the benefits that greenspaces provide. Regulation and maintenance ecosystem services, as well as cultural services were frequently mentioned. However, provisioning services were mostly mentioned by those in development work. Stakeholders also identified an additional suite of societal benefits that do not directly map onto ecosystem service frameworks, such as the generation of financial income and the provision of employment opportunities. Challenges identified as hampering the planning, conservation and management of greenspaces included inappropriate urbanisation, lack of coordination and participation, and population growth. Lack of coordination was however not widely acknowledged among those focusing on natural resources protection, who conversely identified population growth more often than any other groups. Highlighting how stakeholders with varying priorities perceive ecosystem services a first step towards improving greenspaces management both for their better acceptation and for improving their potential for biodiversity conservation. Specifically, we bring attention to need for stakeholders working with natural resources protection to recognise more the need for collaborations and engagement. Additional research is also necessary to understand how those different perspectives might be integrated into ongoing processes and procedures to manage greenspaces in Sub-Saharan Africa

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030