| 1. |
- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Melo Zurita, Maria de Lourdes, et al.
(författare)
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Global Water Governance and Climate Change : Identifying Innovative Arrangements for Adaptive Transformation
- 2018
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 10:1
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Forskningsöversikt (refereegranskat)abstract
- A convoluted network of different water governance systems exists around the world. Collectively, these systems provide insight into how to build sustainable regimes of water use and management. We argue that the challenge is not to make the system less convoluted, but rather to support positive and promising trends in governance, creating a vision for future environmental outcomes. In this paper, we analyse nine water case studies from around the world to help identify potential innovative arrangements' for addressing existing dilemmas. We argue that such arrangements can be used as a catalyst for crafting new global water governance futures. The nine case studies were selected for their diversity in terms of location, scale and water dilemma, and through an examination of their contexts, structures and processes we identify key themes to consider in the milieu of adaptive transformation. These themes include the importance of acknowledging socio-ecological entanglements, understanding the political dimensions of environmental dilemmas, the recognition of different constructions of the dillema, and the importance of democratized processes.
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| 3. |
- Powell, Neil, et al.
(författare)
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Water Security in Times of Climate Change and Intractability : Reconciling Conflict by Transforming Security Concerns into Equity Concerns
- 2017
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 9:12
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Tidskriftsartikel (refereegranskat)abstract
- This paper considers how to achieve equitable water governance and the flow-on effects it has in terms of supporting sustainable development, drawing on case studies from the international climate change adaptation and governance project (CADWAGO). Water governance, like many other global issues, is becoming increasingly intractable (wicked) with climate change and is, by the international community, being linked to instances of threats to human security, the war in the Sudanese Darfur and more recently the acts of terrorism perpetuated by ISIS. In this paper, we ask the question: how can situations characterized by water controversy (exacerbated by the uncertainties posed by climate change) be reconciled? The main argument is based on a critique of the way the water security discourse appropriates expert (normal) claims about human-biophysical relationships. When water challenges become increasingly securitized by the climate change discourse it becomes permissible to enact processes that legitimately transgress normative positions through post-normal actions. In contrast, the water equity discourse offers an alternative reading of wicked and post-normal water governance situations. We contend that by infusing norm critical considerations into the process of securitization, new sub-national constellations of agents will be empowered to enact changes; thereby bypassing vicious cycles of power brokering that characterize contemporary processes intended to address controversies.
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| 4. |
- Do, Thao, 1988-, et al.
(författare)
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Report on Baltic Sea Region Learning
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- As part of the social learning process within the BONUS MIRACLE project, a Baltic Sea Region Governance Learning workshop was held on 28 November 2017 in Uppsala, Sweden. The aim of the workshop was to enable co-learning among researchers, policy-makers, and practitioners to identify desirable changes in the BSR water governance domain and generate suggestions for how to bring about those changes. The workshop built upon local insights from social learning processes in four case areas in the project - Berze (Latvia), Reda (Poland), Selke (Germany), and Helge å (Sweden), which have served as forums to support dialogue between researchers and stakeholders having strong stakes and expertise within water governance. The intention of this workshop was to provide an opportunity for participants to share, explore and challenge their knowledge and experiences in water governance, thereby creating shared understandings and revealing new insights into how existing and new regional governance configurations can be adapted and enacted to support the orchestration of local development initiatives that foster multiple benefits in local contexts. In particular, the workshop set out to address the following question: What can be done at the Baltic Sea Regional level to enable more effective water governance at the local level?
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| 5. |
- Do, Thao, 1988-, et al.
(författare)
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Report on Cross-Case Learning Workshop
- 2018
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- As part of the social learning process enacted within BONUS MIRACLE, a Cross-case Learning Workshop was held on 21-22 September 2017 in Norrköping, Sweden. By bringing together stakeholders from all the four case areas, the workshop aimed to enable co-learning across the cases, and identify to what extent governance approaches in case areas can be adapted to improve the effectiveness of policies and governance of nutrient management delivering multiple ecosystem services benefits. This report presents the objective and rationale for the process design, summarises the results from the discussions, and offers some reflections and lessons learned in terms of supporting the social learning process in this workshop.
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| 6. |
- Locke, Adam E, et al.
(författare)
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Genetic studies of body mass index yield new insights for obesity biology.
- 2015
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 518:7538, s. 197-401
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Tidskriftsartikel (refereegranskat)abstract
- Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.
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| 7. |
- Tonderski, Karin, 1958-, et al.
(författare)
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BONUS MIRACLE ‐ Mediating integrated actions for sustainable ecosystem services in a changing climate
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Water and nutrient governance in the Baltic Sea Region face several challenges. The future is highly uncertain due to climate change and on-going land-use changes, and different sectors works towards partly contradicting objectives, which makes it difficult to bring about integrated governance. In BONUS MIRACLE, a social learning process has been enacted to identify new configurations for water governance based on the hypothesis that more effective approaches to 'nutrient governance' need to bring on-board new constellations of actors with stakes in local issues that are interconnected with nutrient enrichment. A series of learning events between stakeholder groups and researchers in four case areas have been orchestrated. To support the process of reconciling stakeholder interests, researchers were asked to provide ´on-demand´ results regarding effects, cost-efficiency and benefits of suggested measures on water flow, nutrient transport (using the HYPE model) and other ecosystem services benefits under different climate change and land-use scenarios. Results were visualized in the MIRACLE Visualization Tool. Lessons learnt and results of policy analyses were used to discuss governance approaches on the BSR level that could support more integrated actions. An important project insight is that case level stakeholders, in general, are not interested in learning how different measures perform in reducing nutrient enrichment at a larger Baltic Sea basin level. Rather, they are interested in the impact measures have in terms of addressing multiple demands in the local settings. Regarding stakeholder positions, insights have emerged pertaining the important role position holders play in hindering or enabling change processes. In the ´pathways to change´, application of mineral fertilizers was one of the more cost-efficient measures suggested, along with creation of increased water retention, floodplains and wetlands. The latter also provide other ecosystem service benefits, and an approach was developed to interactively assess those, despite considerable knowledge gaps regarding effects and values. On the BSR level, the Visualization Tool provided useful learning support by visualizing E-HYPE model results regarding water flow and nutrient transport, as on this level the stakeholder´s system of interest is on governance innovations that address the nutrient issue. E-HYPE scenario modeling showed that while the mean water flow is expected to decrease in some southern BSR catchments, a substantial increase is predicted for most others. Similarly, the load of nitrogen may increase up to 25 % in some parts of the northern BSR, whereas a slight decrease is predicted for the south/southwestern parts. Governance innovations are needed that can accommodate those differences. However, current policies are insufficiently coordinated and integrated between sectors, due to imbalanced power relations and opposing agendas. This remains a constraint for the effectiveness of existing policy strategies, regulations and directives in addressing multiple ecosystem benefits. The involvement of local stakeholders needs to be strengthened and new models for cooperative and collective measures with intermediaries tested, to stimulate the use of local knowledge in improving the effectiveness and efficiency of management measures and reducing transaction costs. The synthesized BONUS MIRACLE results will be translated into a "Roadmap for improving water resource management in the Baltic Sea Region", with suggestions for adaptation of policies, institutional settings and governance arrangements.
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| 8. |
- Westberg, Lotten, et al.
(författare)
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Learning for Transformation of Water Governance: Reflections on Design from the Climate Change Adaptation and Water Governance (CADWAGO) Project
- 2016
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Ingår i: Water. - : MDPI AG. - 2073-4441. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- This paper considers how learning for transformation of water governance in the context of climate change adaptation can be designed for and supported, drawing examples from the international climate change adaptation and water governance project (CADWAGO). The project explicitly set out to design for governance learning in the sense of developing elements of social infrastructure such as workshops, performances and online media to bring stakeholders together and to facilitate co-learning of relevance to governance. CADWAGO drew on a variety of international cases from past and ongoing work of the project partners. It created a forum for dialogue among actors from different contexts working at different levels and scales. The range of opportunities and constraints encountered are discussed, including the principles and practicalities of working with distributed processes of design and leadership of events. A range of concepts, tools and techniques were used to consider and facilitate individual and collective learning processes and outcomes associated with water governance in the context of climate adaptation. Questions were addressed about how elements of past, present and future water governance thinking and practice are connected and how multi-level systemic change in governance can take place. Some reflections on the effectiveness of the design for learning process are included. The nature of the contribution that projects such as CADWAGO can make in learning for transformation of water governance practices is also critically considered.
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