Science-policy processes for transboundary water governance.

In this policy perspective, we outline several conditions to support effective science-policy interaction, with a particular emphasis on improving water governance in transboundary basins. Key conditions include (1) recognizing that science is a crucial but bounded input into water resource decision-making processes; (2) establishing conditions for collaboration and shared commitment among actors; (3) understanding that social or group-learning processes linked to science-policy interaction are enhanced through greater collaboration; (4) accepting that the collaborative production of knowledge about hydrological issues and associated socioeconomic change and institutional responses is essential to build legitimate decision-making processes; and (5) engaging boundary organizations and informal networks of scientists, policy makers, and civil society. We elaborate on these conditions with a diverse set of international examples drawn from a synthesis of our collective experiences in assessing the opportunities and constraints (including the role of power relations) related to governance for water in transboundary settings.

Arm lengthening after reverse shoulder arthroplasty: a review.

PURPOSE: The purpose of this review is to provide a better understanding of biomechanical changes induced by reverse shoulder arthroplasty (RSA), discuss the different techniques of radiographic assessment of upper limb lengthening after RSA and determine the ideal soft tissue tension that provides the best functional outcome without increasing the risk of complications. METHODS: Inclusion criteria were articles in which the primary interest was the technique of measuring upper-extremity lengthening after complications related to lengthening and its role in postoperative function; those written in English, French or German; and those that provided evidence levels I-IV relevant to search terms. RESULTS: Seven articles met our inclusion criteria. Postoperatively, changes in humeral length varied from minus five to five millimetres, and changes in upper-extremity length varied from 15 mm to 27 mm. The acromiohumeral distance averaged 23 mm. Humeral and arm shortening increased the risk of dislocation and led to poor anterior active elevation. The type of surgical approach did not play a role in postoperative function. Subclinical neurological lesions were frequent. CONCLUSIONS: Studies in this systematic review indicate that deltoid tensioning by restoring humeral length and increasing the acromiohumeral distance is critical for adequate postoperative function and to prevent dislocation. Excessive arm lengthening should be avoided, with zero to two centimetres of lengthening being a reasonable goal to avoid postoperative neurological impairment.

A 10-year follow-up service evaluation of the treatment pathway outcomes for patients in nine in-patient psychiatric rehabilitation services.

AIMS AND METHOD: This study examines the treatment pathway outcomes over a 10-year period for patients in nine rehabilitation wards at the beginning of this time period. RESULTS: Data were obtained on 85 patients, of whom 59 were discharged during the 10-year period; 29 were readmitted, of whom 15 had further in-patient rehabilitation admissions. Nineteen patients remained in hospital throughout the period. Only nine patients were living independently at the time of follow-up or death, and 34 were in longer-term in-patient settings. Eighteen patients had died during the 10-year period. CLINICAL IMPLICATIONS: New planning of rehabilitation services needs to ensure an integrated whole-systems approach, across in-patient and community settings, with specialist mental health rehabilitation teams to support people moving from hospital to the community, and for the small number remaining in hospital for very long periods, development of sufficient high-quality, local in-patient provision.

The future of biomolecular simulation in the pharmaceutical industry: what we can learn from aerodynamics modelling and weather prediction. Part 1. understanding the physical and computational complexity of in silico drug design.

The predictive power of simulation has become embedded in the infrastructure of modern economies. Computer-aided design is ubiquitous throughout industry. In aeronautical engineering, built infrastructure and materials manufacturing, simulations are routinely used to compute the performance of potential designs before construction. The ability to predict the behaviour of products is a driver of innovation by reducing the cost barrier to new designs, but also because radically novel ideas can be piloted with relatively little risk. Accurate weather forecasting is essential to guide domestic and military flight paths, and therefore the underpinning simulations are critical enough to have implications for national security. However, in the pharmaceutical and biotechnological industries, the application of computer simulations remains limited by the capabilities of the technology with respect to the complexity of molecular biology and human physiology. Over the last 30 years, molecular-modelling tools have gradually gained a degree of acceptance in the pharmaceutical industry. Drug discovery has begun to benefit from physics-based simulations. While such simulations have great potential for improved molecular design, much scepticism remains about their value. The motivations for such reservations in industry and areas where simulations show promise for efficiency gains in preclinical research are discussed. In this, the first of two complementary papers, the scientific and technical progress that needs to be made to improve the predictive power of biomolecular simulations, and how this might be achieved, is firstly discussed (Part 1). In Part 2, the status of computer simulations in pharma is contrasted with aerodynamics modelling and weather forecasting, and comments are made on the cultural changes needed for equivalent computational technologies to become integrated into life-science industries.

Estimates of regional infectivity of COVID-19 in the United Kingdom following imposition of social distancing measures.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reproduction number has become an essential parameter for monitoring disease transmission across settings and guiding interventions. The UK published weekly estimates of the reproduction number in the UK starting in May 2020 which are formed from multiple independent estimates. In this paper, we describe methods used to estimate the time-varying SARS-CoV-2 reproduction number for the UK. We used multiple data sources and estimated a serial interval distribution from published studies. We describe regional variability and how estimates evolved during the early phases of the outbreak, until the relaxing of social distancing measures began to be introduced in early July. Our analysis is able to guide localized control and provides a longitudinal example of applying these methods over long timescales. This article is part of the theme issue 'Modelling that shaped the early COVID-19 pandemic response in the UK'.

Factors influencing digital review of pathology test results in an inpatient setting: a cross-sectional study.

BACKGROUND: Delay or failure to view test results in a hospital setting can lead to delayed diagnosis, risk of patient harm, and represents inefficiency. Factors influencing this were investigated to identify how timeliness and completeness of test review could be improved through an evidence-based redesign of the use of clinical test review software. METHODS: A cross-section of all abnormal hematology and biochemistry results which were published on a digital test review platform over a 3-year period were investigated. The time it took for clinicians to view these results, and the results that were not viewed within 30 days, were analyzed relative to time of the week, the detailed type of test, and an indicator of patient record data quality. RESULTS: The majority of results were viewed within 90 min, and 93.9% of these results viewed on the digital platform within 30 days. There was significant variation in results review throughout the week, shown to be due to an interplay between technical and clinical workflow factors. Routine results were less likely to be reviewed, as were those with patient record data quality issues. CONCLUSION: The evidence suggests that test result review would be improved by stream-lining access to the result platform, differentiating between urgent and routine results, improving handover of responsibility for result review, and improving search for temporary patient records. Altering the timing of phlebotomy rounds and a review of the appropriateness of routine test requests at the weekend may also improve result review rates.

Investigation of congestive heart failure in beef cattle in a feedyard at a moderate altitude in western Nebraska.

Right-sided congestive heart failure (brisket disease) commonly occurs in cattle raised at elevations >2,500-3,500 m. We investigated clinical cases resembling brisket disease at a western Nebraska feedyard at a moderate altitude (1,369 m). Over a 15-mo period (2009-2010), we examined 17 cases (16 steers and 1 heifer), all purebred Angus. All animals had clinical right-sided heart failure: brisket and ventral abdominal edema, and severe chronic passive congestion of the liver. Gross examination confirmed right ventricular hypertrophy (left ventricle plus septum: right ventricle weight ratio mean: 1.33 vs. 2.8-4.0 reference interval). Microscopically, all 17 cases had interstitial fibrosis (mean score: 2.4 ± 0.8) and 6 had replacement fibrosis of the right ventricle, whereas 14 had interstitial fibrosis (mean score: 1.2 ± 0.2) and 0 had replacement fibrosis of the left ventricle. Lesions of arteriosclerosis were seen in 9 of 16 cases in 51 of 571 (8.9%) right ventricular coronary arteries, and in 10 of 16 cases in 52 of 366 (14.2%) left ventricular coronary arteries. The probability of coronary arteriosclerosis was greater in papillary ventricular muscle (OR = 11.3; p < 0.0001), left ventricle (OR = 4.8; p < 0.0001), and larger arteries (OR = 1.01; p < 0.0001). Pulmonary arteries and arterioles had lesions compatible with hypoxia-induced pulmonary hypertension. We hypothesize that moderate hypobaric conditions significantly contributed to disease in cattle genetically predisposed to hypoxia-induced pulmonary hypertension. Adiposity, coronary arteriosclerosis, and left ventricular fibrosis may have contributed to the condition; however, the cattle died prior to development of advanced obesity.

Displacement of a landslide retaining wall and application of an enhanced failure forecasting approach.

The 10-mile Slide is contained within an ancient earthflow located in British Columbia, Canada. The landslide has been moving slowly for over 40 years, requiring regular maintenance work along where a highway and a railway track cross the sliding mass. Since 2013, the landslide has shown signs of retrogression. Monitoring prisms were installed on a retaining wall immediately downslope from the railway alignment to monitor the evolution of the retrogression. As of September 2016, cumulative displacements in the horizontal direction approached 4.5 m in the central section of the railway retaining wall. After an initial phase of acceleration, horizontal velocities showed a steadier trend between 3 and 9 mm/day, which was then followed by a second acceleration phase. This paper presents an analysis of the characteristics of the surface displacement vectors measured at the monitoring prisms. Critical insight on the behavior and kinematics of the 10-mile Slide retrogression was gained. An advanced analysis of the trends of inverse velocity plots was also performed to assess the potential for a slope collapse at the 10-mile Slide and to obtain further knowledge on the nature of the sliding surface.

Diversity of endemic rhizobia on Christmas Island: Implications for agriculture following phosphate mining.

Given that phosphate supplies may diminish and become uneconomic to mine after 2020, there is a compelling need to develop alternative industries to support the population on Christmas Island. Former mine sites could be turned into productive agricultural land, however, large-scale commercial agriculture has never been attempted, and, given the uniqueness of the island, the diversity of rhizobia prior to introducing legumes needed evaluation. Therefore, 84 rhizobia isolates were obtained from nine different hosts, both crop and introduced legumes, located at seven sites across the island. Based on 16S rRNA and recA gene sequence analysis, the isolates grouped into 13 clades clustering within the genus Bradyrhizobium, Ensifer, Cupriavidus and Rhizobium. According to the sequences of their symbiosis genes nodC and nifH, the isolates were classified into 12 and 11 clades, respectively, and clustered closest to tropical or crop legume isolates. Moreover, the symbiosis gene phylogeny and Multi Locus Sequence Analysis gene phylogeny suggested vertical transmission in the Alpha-rhizobia but horizontal transmission within the Beta-rhizobia. Furthermore, this study provides evidence of a large diversity of endemic rhizobia associated with both crop and introduced legumes, and highlights the necessity of inoculation for common bean, chickpea and soybean on the Island.

Prescribing pattern of clozapine and other antipsychotics for patients with first-episode psychosis: a cross-sectional survey of early intervention teams.

OBJECTIVE: To describe the pattern of antipsychotic drug prescribing in patients with first episode psychosis, with more emphasis in the use of clozapine in this group of patients. METHOD: A cross-sectional survey involving six early intervention service (EIS) teams in the West Midlands was conducted. Data was extracted from case notes and electronic records by clinicians working in each participating team. The pattern of antipsychotic prescribing and the changes that took place after being accepted in EIS, including the use of clozapine, was established. Clinicians involved in the treatment of patients in each team rated the overall clinical response to treatment based on the presence or absence of positive psychotic symptoms. RESULT: 431 patients with FEP were included in the final analysis. Low antipsychotic discontinuation rate was observed, with the majority (88.2%) still being prescribed antipsychotics. Most (77.3%) were prescribed second-generation antipsychotic drugs, with olanzapine (21.8%) and aripiprazole (19.7%) being the most frequently prescribed antipsychotics. There was low rate use of antipsychotic combinations (7.4%), high dose antipsychotic regime (3.9%), low depot antipsychotic prescribing (9.3%), and clozapine use was low (9.7%). On average, three antipsychotics were tried before clozapine was initiated and it took on average 19.5 months from being accepted into EIS to clozapine being initiated. CONCLUSION: The majority of patients were prescribed antipsychotics within the guidelines. EIS was associated with an overall low antipsychotic discontinuation. There was also a short waiting time before clozapine was initiated following patients being accepted into EIS.

Services for people with complex psychosis: towards a new understanding.

This paper describes the need for commissioners and service providers to consider the development of a whole-system approach to providing rehabilitation services for patients with complex psychosis, in the context of the current economic pressures and emergence of a competitive market in this area of mental health. The practical and organisational arrangements for the management of risk with such services are described, taking into account the varying provision of rehabilitation services across the UK and considering how these can be developed against the care clustering system and interfaces with other mental health services.

Patient engagement and problematic behaviours in nurse-staffed residential rehabilitation units.

Aims and method To build on previous research findings by examining engagement and problematic behaviours of patients in 10 residential rehabilitation units. Two measures were completed on patients in community rehabilitation, longer-term complex care and high-dependency units (109 patients in total). Data were analysed and categorised into higher-engagement ratings across the domains of engagement and behaviour over the past 6 months and lifetime in terms of presence of the behaviour and likelihood of resulting harm. Results Data were available for 73% of patients. All aspects of engagement were consistently low for all units, with highest levels in community rehabilitation units. Levels of problematic behaviours were similar across all units. Socially inappropriate behaviours and failure to complete everyday activities were evident for over half of all patients and higher for lifetime prevalence. Verbal aggression was at significantly lower levels in community units. Lifetime behaviours likely to lead to harm were much more evident in high-dependency units. Clinical implications Despite some benefits of this type of care, patients continue to present challenges in engagement and problematic behaviours that require new approaches and a change in focus.

Microscale vapour diffusion for protein crystallization.

The development of new crystallization platforms via the application of high-throughput technologies has delivered a plethora of crystallization plates suitable for robot-driven and manual setups. However, practically all these plates (except for microfluidic channel chips) are based on a very similar design and well (precipitant):drop (protein) volume ratios. A new type of crystallization plate (microplate) has therefore been developed and tested that still employs the classical vapour-diffusion technique but minimizes the precipitant well volume to 1.2 microl for a 150 nl protein drop setup. This enables a very significant saving on the total bulk of the crystallization screen, hence allowing the application of new, rare and expensive solutions in automated crystallization-screening procedures. Additionally, owing to the very low drop:well volume ratio, the new microplate can significantly accelerate the equilibrium time necessary for crystal nucleation and growth, in many cases shortening the high-throughput crystallization screening process to a few hours.

A prospective analysis of the diagnostic yield resulting from the attendance of 4020 patients at a protocol-driven haematuria clinic.

OBJECTIVE: To clarify the prevalence of disease as determined by age, sex and the degree of haematuria at presentation, and to ascertain the merits of using ultrasonography (US), i.v. urography (IVU) or both when imaging the upper urinary tract, in a prospective cohort of patients attending a protocol-based haematuria clinic. PATIENTS AND METHODS: In a two-tier protocol, as a part of first-line investigation, all 4020 patients attending the clinic between October 1998 and August 2003 had US and flexible cystoscopy. Subsequently, IVU was used where indicated following abnormal first-line tests and in patients with persistent haematuria where no abnormality had been detected. RESULTS: In all, 2627 men and 1393 women presented with microscopic (53.2%) or macroscopic haematuria (46.8%). The overall prevalence of malignant disease was 12.1%, but for macroscopic haematuria it was 18.9% and for microscopic haematuria 4.8%. Age and sex also influenced the observed rates of disease. Of the upper tract tumours, 70 were identified after abnormal US, with three cases of transitional cell carcinoma identified on IVU after a normal US. CONCLUSIONS: The study provides a rationale for the appropriate investigation of all patients, moderated by the age, sex and degree of haematuria, and the ubiquitous use of US with selective IVU based on age, sex and degree of (and persistence of) haematuria.