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Background In anaesthesiology, intrathecal drugs play pivotal roles in spinal anaesthesia. Despite their ability to induce a high sensory block, bupivacaine alone may not be adequate for postoperative analgesia. It often requires a substantial dose of postoperative rescue analgesia to manage pain effectively. Thus, we studied the efficacy of nalbuphine 1.5 mg injected intrathecally as an adjuvant in endoscopic urological surgery. Materials and methods Sixty patients undergoing endoscopic urological surgery were equally divided into two study groups: group B (injection 0.5% hyperbaric bupivacaine 15 mg (3 ml) plus sterile NS 0.15 ml) and group N (injection 0.5% hyperbaric bupivacaine 15 mg (3 ml)+nalbuphine 1.5 mg (0.15 ml)). The first appearance of the sensory and motor blockages and duration required to attain complete sensory and motor threshold was noted. All vitals were recorded. After surgery, it was recorded when the patient first needed rescue analgesia (injection paracetamol 1 gm IV). Any adverse effects were recorded and addressed. The statistical analysis was conducted using IBM SPSS Statistics for Windows, V. 22.0 (IBM Corp., Armonk, NY), with p<0.05 indicating significance in both groups' operations. Results Intrathecal nalbuphine as an adjuvant caused an earlier onset of sensory and motor inhibition, delayed two-segment regression, and prolonged postoperative anaesthesia. The control group experienced sensory block at 3.33±0.61 minutes, while the nalbuphine group had a mean onset of 2.66±0.92 minutes (p=0.001). The patient who received nalbuphine had a mean regression time of 119.60±14.549 minutes, whereas the bupivacaine group had a mean regression time of 88.43±17.196 minutes. Group N had a considerably longer duration of postoperative analgesia, lasting 264.97 minutes, compared to group B's 198.50 minutes (p<0.001). Intrathecal nalbuphine did not influence vital indicators such as heart rate, respiration rate, and oxygen saturation. Conclusion To conclude, endoscopic urological surgery patients who received a subarachnoid block with 1.5 mg (0.15 ml) of nalbuphine hydrochloride with 0.5% hyperbaric bupivacaine 15 mg (3 ml) had longer postoperative pain relief than those who received 3 ml of intrathecal bupivacaine (15 mg). Urinary retention and pruritus were absent. Intrathecal nalbuphine with hyperbaric 0.5% bupivacaine is deemed safe with minimal side effects in endoscopic urology surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research issued approval DMIMS(DU)/IEC/2022/93. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Raut Dessai et al.)

Anesthesiologists often use benzodiazepines (BZDs) due to their remarkable amnestic and anxiolytic capabilities. Because of this, they are perfect for use during the perioperative phase, when patients' anxiety levels are already high. Remimazolam has replaced certain commonly used intravenous (IV) anesthetics due to its excellent safety profile, rapid onset of action, and short half-life. The four classes of BZDs, 2-keto-benzodiazepines, 3-hydroxy-benzodiazepines, triazolobenzodiazepines, and 7-nitro-benzodiazepines based on chemical structure, provide various levels of drowsiness, forgetfulness, and anxiolysis. Based on their elimination half-life, short-acting BZDs typically have a half-life ranging from one to 12 hours, e.g., oxazepam; intermediate-acting BZDs have an average elimination half-life of 12 to 40 hours, e.g., alprazolam; and long-acting BZDs have an average elimination half-life of more than 40 hours, e.g., diazepam. The chloride ion channel is conformationally shifted by the benzodiazepine molecule resulting in central nervous system (CNS) inhibition and hyperpolarization. Each type of benzodiazepine has a favored use. For example, diazepam is used to treat anxiety. Midazolam is used for its anxiolytic and anterograde amnestic effects during the perioperative phase. Anxiety and epilepsy are two conditions that lorazepam effectively treats. There are now phase II and III clinical studies investigating remimazolam. It is not sensitive to alterations in its surroundings and has a brief half-life so that it may be removed rapidly, even after extensive infusion. Being a soft drug means the body easily breaks it down via metabolism, which explains many features. Remimazolam is hydrolyzed into methanol and its carboxylic acid metabolite CNS 7054 by esterase metabolism. Therefore, remimazolam has a shorter onset time and faster recovery than other BZDs. Remimazolam is metabolized independently of any particular organ. Patients with hepatic and renal problems will not see any changes in metabolism or excretion since the drug's ester moiety makes it a substrate for general tissue esterase enzymes. Like its predecessor, midazolam, it has a high potential for addiction. Some side effects that could occur during infusion include headaches and drowsiness. In clinical trials, hypotension, respiratory depression, and bradycardia were noted in participants. BZDs are helpful when used in conjunction with anesthesia. Remimazolam stands out, thanks to its unique pharmacokinetics, pharmacodynamics, safety profile, and potential medical applications. Its desirable properties make it a potential surgical premedication and sedative in the critical care unit. Anesthesiologists and other doctors could have access to more consistent and safer medication. However, additional comprehensive clinical trials are necessary to understand remimazolam's advantages and disadvantages., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Dessai et al.)

We summarise the contributions to the Topical Collection on quality of climate information for adaptation decision support. Based on these contributions, we draw some further lessons for the development of high-quality climate information and services, bridging between a "credibility-first" paradigm (exemplified by top-down information provision from systematic downscaling or impact projections) and a "salience-first" paradigm (exemplified by user-led tailored information products or storylines) by looking to identify their respective strengths and use cases. We emphasise that a more nuanced collective understanding of the dimensions of information quality in climate information and services would be beneficial to users and providers and ultimately support more confident and effective climate adaptation decisions and policy-making., Competing Interests: Competing interestsNone to declare., (© The Author(s) 2024.)

Bartter syndrome is a genetic condition characterized by autosomal recessive inheritance, resulting in impaired salt reabsorption and clinical manifestations such as low/normal blood pressure and extracellular fluid volume depletion. Multiple abnormalities of the electrolytes, including decreased potassium as well as chloride levels and, in some instances, hypomagnesemia, are its defining features. Metabolic alkalosis, hypokalaemia, hypocalcemia, and hypomagnesemia, together with adequate renal function, are all components of the Bartter-like syndrome. It is associated with certain antibiotics and antineoplastic drugs. We report a case of traumatic brain injury with pneumothorax who was on treatment on colistin and presented with metabolic disturbance., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dessai et al.)

Recent studies find that people in high-income countries now think of climate change impacts, such as flooding or periods of high temperature, as being of immediate relevance and concern. Individuals and households can take adaptation actions to help limit the severity of harm caused when climate impacts occur, for example, they could make adjustments to their homes such as installing flood gates or sun shades, or they could adapt their behavior such as staying indoors during the hottest part of the day. However, so far adaptation is not yet happening at the speed or scale needed to adequately prepare for the climate impacts already being experienced or those projected for the coming decades. Here, we propose an agenda for future social science research that would further our understanding of how best to increase engagement and action in climate change adaptation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Harcourt, Dessai, Bruine de Bruin and Taylor.)

The term "total intravenous anesthesia" refers to the preservation of an anesthetic plane with the use of an injectable anesthetic, a sedative that is often given in intermittent boluses. The tendency to have recurrent unprovoked seizures is known as epilepsy. Its prevalence ranges from 0.5% to 1%. The highest incidence rates are in those with anatomical or developmental brain abnormalities, as well as at the extremes of age. The most common triggering factors for epilepsy are stress and fear. The main advantage of total intravenous anesthesia is the patient's rapid recovery and early ambulatory. Conscious sedation is a strategy for giving patients excellent anesthesia and analgesia. In this case report, we will describe a high-risk epileptic patient who required conscious sedation to perform a medical termination., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dessai et al.)

The climate science and applications communities need a broad and demand-driven concept to assess physical climate conditions that are relevant for impacts on human and natural systems. Here, we augment the description of the "climatic impact-driver" (CID) approach adopted in the Working Group I (WGI) contribution to the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report. CIDs are broadly defined as "physical climate system conditions (e.g., means, events, and extremes) that affect an element of society or ecosystems. Depending on system tolerance, CIDs and their changes can be detrimental, beneficial, neutral, or a mixture of each across interacting system elements and regions." We give background information on the IPCC Report process that led to the development of the 7 CID types (heat and cold, wet and dry, wind, snow and ice, coastal, open ocean, and other) and 33 distinct CID categories, each of which may be evaluated using a variety of CID indices. This inventory of CIDs was co-developed with WGII to provide a useful collaboration point between physical climate scientists and impacts/risk experts to assess the specific climatic phenomena driving sectoral responses and identify relevant CID indices within each sector. The CID Framework ensures that a comprehensive set of climatic conditions informs adaptation planning and risk management and may also help prioritize improvements in modeling sectoral dynamics that depend on climatic conditions. CIDs contribute to climate services by increasing coherence and neutrality when identifying and communicating relevant findings from physical climate research to risk assessment and planning activities., (© 2022 Crown copyright and The Authors. This article is published with the permission of the Controller of HMSO and the King's Printer for Scotland. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Malawi depends on Lake Malawi outflows into the Shire River for its water, energy and food (WEF) security. We explore future WEF security risks under the combined impacts of climate change and ambitious development pathways for water use expansion. We drive a bespoke water resources model developed with stakeholder inputs, with 29 bias-corrected climate model projections, alongside stakeholder elicited development pathways, and examine impacts on stakeholder-elicited WEF sector performance metrics. Using scenario analysis, we stress-test the system, explore uncertainties, assess trade-offs between satisfying WEF metrics, and explore whether planned regulation of outflows could help satisfy metrics. While uncertainty from potential future rainfall change generates a wide range of outcomes (including no lake outflow and higher frequency of major downstream floods), we find that potential irrigation expansion in the Lake Malawi catchments could enhance the risk of very low lake levels and risk to Shire River hydropower and irrigation infrastructure performance. Improved regulation of lake outflows through the upgraded barrage does offer some risk mitigation, but trade-offs emerge between lake level management and downstream WEF sector requirements. These results highlight the need to balance Malawi's socio-economic development ambitions across sectors and within a lake-river system, alongside enhanced climate resilience. This article is part of the theme issue 'Developing resilient energy systems'.

The deglaciated lacustrine systems in Grovnes, Larsemann Hills, East Antarctica was assessed for its solute dynamics and hydrogeochemical interactions. These pristine high latitude lacustrine systems serve as a natural laboratory to understand the interaction between hydrosphere, lithosphere and atmosphere thus providing valuable insights on the functioning of major biogeochemical cycles. A total of 14 fresh water lakes were identified and the water samples were analysed for its physico-chemical characteristics. The abundance of anions and cations in the lake water samples were in the following order of Cl -  > HCO 3 -  > SO 4 2 -  > NO 3 - and Na +  > Mg 2+  > Ca 2+  > K + respectively. Moreover, the lakes exhibit slightly alkaline condition due to dissolution of alkaline earth metals and atmospheric fallout. Na + -Cl - -HCO 3 - and Na + -Cl - are the commonly noticed water type in the study area and higher concentration of Na + -Cl - were due to the effect of sea spray through marine aerosols. Reverse ion exchange is noticed in most of the lakes due to saline influence. Three major mechanisms such as rock dominance, precipitation/snow and evaporation/sea spray controls the lake water geochemistry in the study area. Silicate weathering and evaporite dissolution also contribute ionic load to the lake water. Significant positive correlations (p < .01) among major ions reveal sources from bedrock weathering along with marine aerosols. Trace element chemistry shows that rock-water interaction is the primary source for dissolved metals in the lake water followed by long range atmospheric transport in the form of aeolian dust. Mineral groups such as evaporites, sulphates, carbonates, metal oxides and hydroxides are responsible for the dissolution of metal complexes in the lake water. Furthermore, lakes falling within a micro basin have shown higher Na + -Cl - content which is due to the catchment effect where snow enriched with sea spray melts during the austral summer feeding these lakes., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Countries differ markedly in their production of climate science. While richer nations are often home to a variety of climate models, data infrastructures and climate experts, poorer sovereigns often lack these attributes. However, less is known about countries' capacity to use global climate science and customise it into products informing national adaptation. We use a unique global dataset, the UNFCCC National Communications, to perform a global documentary analysis of scientific submissions from individual countries (n = 189). Comparing countries' climate projections with their competence in publishing climate science, our research examines the existence of geographical divides. Although countries proficient in publishing climate science use more complex climate modelling techniques, key characteristics of climate projections are highly similar around the globe, including multi-model ensembles of Global Circulation Models (GCMs). This surprising result is made possible because of the use of pre-configured climate modelling software packages. One concern is that these tools restrict customisation, such as country-specific observations, modelling information, and visualisation. Such tools may therefore hide a new geographical divide where countries with higher scientific capacities are able to inform what goes into these software packages, whereas lower scientific capacity countries are dependent upon these choices - whether beneficial for them or not. Our research suggests that free-to-use modelling and training efforts may unwittingly restrict, rather than foster, countries' capacity to customise global climate science into nationally relevant and legitimate climate information., (© 2019 The Authors.)

Climate services seek the timely production and delivery of useful climate information to decision-makers, yet there continues to be a reported 'usability gap'. To address this, many have advocated the coproduction of climate services between knowledge producers, providers and users, with a tendency to focus on tailoring information products to user needs, with less attention towards the service environment itself. In service management and service marketing fields, this is referred to as the 'servicescape' and is shown to influence behavioural intention, value creation and perceived service quality. In an effort to facilitate cross-disciplinary learning, this research asks whether climate services can learn from other service-based research in public administration/management, service management and service marketing. Performing a semi-deductive literature review, this perspective article examines themes of coproduction and servicescapes, and identifies relevant topics for future climate services research around the added value of service-dominant logic, the subjective experience of users' interaction with servicescapes, and empowerment of users as co-producers of value. This is an important first step in promoting further cross-disciplinary learning to advance both scholarship and operational delivery of climate services., (© The Author(s) 2019.)

The UK is already experiencing the impacts of climate change and these are expected to increase in scale and severity in the coming decades. Preparing for impacts by undertaking adaptive actions can potentially reduce the level of harm. In the UK, the government's adaptation program aims to develop a "climate-ready society." However, achieving broad public engagement in adaptation presents a significant communications challenge. Here, we aimed to understand how UK residents use and interpret the terms "climate change impacts" and "climate change adaptation." We conducted a secondary analysis of 22 interviews with UK residents, who were recruited for their diverse climate change views. The interviewees expressed a lack of clarity around expected climate change impacts, which did not prevent them from saying that they were already experiencing the effects of a changing climate. Further, threats to cultural norms and values were perceived as serious and emotionally charged. Adaptation was often conflated with mitigation, and responsibility for adaptation was contested. We discuss the implications of our findings for developing more useful public communication about climate change adaptation.

Decision-Making Under Uncertainty (DMUU) approaches have been less utilized in developing countries than developed countries for water resources contexts. High climate vulnerability and rapid socioeconomic change often characterize developing country contexts, making DMUU approaches relevant. We develop an iterative multi-method DMUU approach, including scenario generation, coproduction with stakeholders and water resources modeling. We apply this approach to explore the robustness of adaptation options and pathways against future climate and socioeconomic uncertainties in the Cauvery River Basin in Karnataka, India. A water resources model is calibrated and validated satisfactorily using observed streamflow. Plausible future changes in Indian Summer Monsoon (ISM) precipitation and water demand are used to drive simulations of water resources from 2021 to 2055. Two stakeholder-identified decision-critical metrics are examined: a basin-wide metric comprising legal instream flow requirements for the downstream state of Tamil Nadu, and a local metric comprising water supply reliability to Bangalore city. In model simulations, the ability to satisfy these performance metrics without adaptation is reduced under almost all scenarios. Implementing adaptation options can partially offset the negative impacts of change. Sequencing of options according to stakeholder priorities into Adaptation Pathways affects metric satisfaction. Early focus on agricultural demand management improves the robustness of pathways but trade-offs emerge between intrabasin and basin-wide water availability. We demonstrate that the fine balance between water availability and demand is vulnerable to future changes and uncertainty. Despite current and long-term planning challenges, stakeholders in developing countries may engage meaningfully in coproduction approaches for adaptation decision-making under deep uncertainty.

Context: This study was designed to translate and validate the National Comprehensive Cancer Network (NCCN) distress thermometer (DT) in regional language " Malayalam" and to see the feasibility of using it in our patients., Aims: (1) To translate and validate the NCCN DT. (2) To study the feasibility of using validated Malayalam translated DT in Malabar Cancer center., Settings and Design: This is a single-arm prospective observational study. The study was conducted at author's institution between December 8, 2015, and January 20, 2016 in the Department of Cancer Palliative Medicine., Materials and Methods: This was a prospective observational study carried out in two phases. In Phase 1, the linguistic validation of the NCCN DT was done. In Phase 2, the feasibility, face validity, and utility of the translated of NCCN DT in accordance with QQ-10 too was done., Statistical Analysis Used: SPSS version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.) was used for analysis., Results: Ten patients were enrolled in Phase 2. The median age was 51.5 years and 40% of patients were male. All patients had completed at least basic education up to the primary level. The primary site of cancer was heterogeneous. The NCCN DT completion rate was 100%. The face validity, utility, reliability, and feasibility were 100%, 100%, 100%, and 90%, respectively., Conclusion: It can be concluded that the Malayalam validated DT has high face validity, utility, and it is feasible for its use., Competing Interests: There are no conflicts of interest.

As climate change research becomes increasingly applied, the need for actionable information is growing rapidly. A key aspect of this requirement is the representation of uncertainties. The conventional approach to representing uncertainty in physical aspects of climate change is probabilistic, based on ensembles of climate model simulations. In the face of deep uncertainties, the known limitations of this approach are becoming increasingly apparent. An alternative is thus emerging which may be called a 'storyline' approach. We define a storyline as a physically self-consistent unfolding of past events, or of plausible future events or pathways. No a priori probability of the storyline is assessed; emphasis is placed instead on understanding the driving factors involved, and the plausibility of those factors. We introduce a typology of four reasons for using storylines to represent uncertainty in physical aspects of climate change: (i) improving risk awareness by framing risk in an event-oriented rather than a probabilistic manner, which corresponds more directly to how people perceive and respond to risk; (ii) strengthening decision-making by allowing one to work backward from a particular vulnerability or decision point, combining climate change information with other relevant factors to address compound risk and develop appropriate stress tests; (iii) providing a physical basis for partitioning uncertainty, thereby allowing the use of more credible regional models in a conditioned manner and (iv) exploring the boundaries of plausibility, thereby guarding against false precision and surprise. Storylines also offer a powerful way of linking physical with human aspects of climate change., Competing Interests: Compliance with ethical standardsThe authors declare that they have no conflict of interest.

Bluetongue, an economically important animal disease, can be spread over long distances by carriage of insect vectors (Culicoides biting midges) on the wind. The weather conditions which influence the midge's flight are controlled by synoptic scale atmospheric circulations. A method is proposed that links wind-borne dispersion of the insects to synoptic circulation through the use of a dispersion model in combination with principal component analysis (PCA) and cluster analysis. We illustrate how to identify the main synoptic situations present during times of midge incursions into the UK from the European continent. A PCA was conducted on high-pass-filtered mean sea-level pressure data for a domain centred over north-west Europe from 2005 to 2007. A clustering algorithm applied to the PCA scores indicated the data should be divided into five classes for which averages were calculated, providing a classification of the main synoptic types present. Midge incursion events were found to mainly occur in two synoptic categories; 64.8% were associated with a pattern displaying a pressure gradient over the North Atlantic leading to moderate south-westerly flow over the UK and 17.9% of the events occurred when high pressure dominated the region leading to south-easterly or easterly winds. The winds indicated by the pressure maps generally compared well against observations from a surface station and analysis charts. This technique could be used to assess frequency and timings of incursions of virus into new areas on seasonal and decadal timescales, currently not possible with other dispersion or biological modelling methods.

This paper seeks to understand why climate information is produced differently from country to country. To do this, we critically examined and compared the social and scientific values that shaped the production of three national climate scenarios in the Netherlands, Switzerland and the UK. A comparative analysis of documentary materials and expert interviews linked to the climate scenarios was performed. Our findings reveal a new typology of use-inspired research in climate science for decision-making: (i) innovators, where the advancement of science is the main objective; (ii) consolidators, where knowledge exchanges and networks are prioritised; and (iii) collaborators, where the needs of users are put first and foremost. These different values over what constitutes 'good' science for decision-making are mirrored in the way users were involved in the production process: (i) elicitation, where scientists have privileged decision-making power; (ii) representation, where multiple organisations mediate on behalf of individual users; and (iii) participation, where a multitude of users interact with scientists in an equal partnership. These differences help explain why climate knowledge gains its credibility and legitimacy differently even when the information itself might not be judged as salient and usable. If the push to deliberately co-produce climate knowledge is not sensitive to the national civic epistemology at play in each country, scientist-user interactions may fail to deliver more 'usable' climate information., (© The Author(s) 2017.)

Planning for adaptation to climate change is often regarded to be a local imperative and considered to be more effective if grounded on a solid evidence base and recognisant of relevant climate projections. Research has already documented some of the challenges of making climate information usable in decision-making but has not yet sufficiently reflected on the role of the wider institutional and regulatory context. This article examines the impact of the external institutional context on the use and usability of climate projections in local government through an analysis of 44 planning and climate change (adaptation) documents and 54 semi-structured interviews with planners in England and Germany conducted between July 2013 and May 2014. We show that there is little demand for climate projections in local adaptation planning in either country due to existing policy, legal and regulatory frameworks. Local government in England has not only experienced a decline in use of climate projections, but also the waning of the climate change adaptation agenda more widely, amidst changes in the planning and regulatory framework and severe budget cuts. In Germany, spatial planning makes substantial use of past and present climate data, but the strictly regulated nature of planning prevents the use of climate projections, due to their inherent uncertainties. Findings from the two countries highlight that if we are to better understand the usability of climate projections, we need to be more aware of the institutional context within which planning decisions are made. Otherwise we run the risk of continuing to provide tools and information that are of limited use within their intended context., Competing Interests: Conflict of interestThe authors declare no conflicts of interests., (© The Author(s) 2016.)

The widely recognized increase in greenhouse gas emissions is necessitating adaptation to a changing climate, and policies are being developed and implemented worldwide, across sectors, and between government scales globally. The aim of this article is to reflect on one of the major challenges: facilitating and sharing information on the next adaptation practices. Web portals (i.e., web sites) for disseminating information are important tools in meeting this challenge, and therefore, we assessed the characteristics of select major portals across multiple scales. We found that there is a rather limited number of case studies available in the portals-between 900 and 1000 in total-with 95 that include cost information and 195 that include the participation of stakeholders globally. Portals are rarely cited by researchers, suggesting a suboptimal connection between the practical, policy-related, and scientific development of adaptation. The government portals often lack links on search results between US and European Union (EU) web sites, for example. With significant investments and policy development emerging in both the United States and the European Union, there is great potential to share information via portals. Moreover, there is the possibility of better connecting the practical adaptation experience from bottom-up projects to the science of adaptation. Integr Environ Assess Manag 2016;12:627-631. © 2016 SETAC., (© 2016 SETAC.)

Heat waves can cause death, illness, and discomfort, and are expected to become more frequent as a result of climate change. Yet, United Kingdom residents have positive feelings about hot summers that may undermine their willingness to protect themselves against heat. We randomly assigned United Kingdom participants to 1 of 3 intervention strategies intended to promote heat protection, or to a control group. The first strategy aimed to build on the availability heuristic by asking participants to remember high summer temperatures, but it elicited thoughts of pleasantly hot summer weather. The second strategy aimed to build on the affect heuristic by evoking negative affect about summer temperatures, but it evoked thoughts of unpleasantly cold summer weather. The third strategy combined these 2 approaches and succeeded in evoking thoughts of unpleasantly hot summer weather. Across 2 experiments, the third (combined) strategy increased participants' expressed intentions to protect against heat compared with the control group, while performing at least as well as the 2 component strategies. We discuss implications for developing interventions about other "pleasant hazards." (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

Purpose: An audit was planned to study the demographics, staging, treatment details, and outcomes of operable endometrial cancers., Methodology: All operable endometrial cancers treated between January 2009 and October 2014 were included in the study. The details regarding demographics, staging, surgical procedure, pathological staging, adjuvant treatment, and outcomes were extracted from the case records. Descriptive statistics was performed. The time-to-event analysis was done by Kaplan-Meier method. Univariate and multivariate analyses were done for disease-free survival (DFS) and overall survival (OS)., Results: There were 55 patients with a median age of 59 years (35-73 years). The Eastern Cooperative Oncology Group performance status was 1 in 52 patients (94.5%) and 2 in 3 patients (5.5%). Forty-nine patients (89.1%) had disease restricted to endometrium while 6 patients (10.9%) had cervical involvement. The surgery done was Type I hysterectomy in 49 patients (89.1%), Type II in 5 patients (9.1%), and Type III in 1 patient (1.8%). Pelvic lymph node dissection was done in all patients while para-aortic (infrahilar) dissection was done in 48 patients (87.3%). The pathological stages were Stage IA in 19 patients, Stage IB in 15 patients, Stage II in 4 patients, Stage IIIA in 3 patients, Stage IIIB in 2 patients, Stage IIIC1 in 5 patients, Stage IIIC2 in 4 patients, and Stage IV in 3 patients. Grade 1 tumors were seen in 23 patients, Grade 2 in 13 patients, and Grade 3 in 19 patients. The histology was endometrioid in 44 patients, serous in 6 patients, clear cell in 3 patients, and others in 2 patients. Adjuvant treatment was received by 40 patients. With a median follow-up of 2.5 years, the 3-year DFS and OS were 78% and 82%, respectively. Age >59 years, Stage III or greater, and Grade 3 tumors were independent prognostic factors adversely affecting both DFS and OS., Conclusion: The outcomes in our study are comparable to that seen in Western literature. Elderly status, higher stage, and a poorly differentiated tumor are associated with poor outcomes.

Objective: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to study the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients., Methods: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m2) and carboplatin AUC-2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (CTCAE version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented., Result: Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy-related mortality. Grade 3-4 life-threatening complications were seen in two patients. The post NACT response rate was 100%., Conclusion: Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.

Objective: The objective was to design and validate the questionnaire for capturing palliative chemotherapy-related preferences and expectations., Design: Single arm, unicentric, prospective observational study., Methods: EXPECT questionnaire was designed to capture preferences and expectations of patients undergoing palliative chemotherapy. This questionnaire underwent a linguistic validation and then was tested in patients. Ten patients are undergoing chemotherapy for solid tumors who fulfilled the inclusion and exclusion criteria self-administered the EXPECT questionnaire in regional language. After filling this questionnaire, they self-administered quick questionnaire-10 (QQ-10). SPSS version 16 (IBM New York) was used for analysis. Completion rate of EXPECT questionnaire was calculated. The feasibility, face validity, utility and time taken for completion of EXPECT questionnaire was also assessed., Results: The completion rate of this questionnaire was 100%. All patients completed questionnaire within 5 min. The QQ-10 tool confirmed the feasibility, face validity and utility of the questionnaire., Conclusion: EXPECT questionnaire was validated in the regional language, and it's an effective tool for capturing patient's preferences and expectation from chemotherapy.

Objective: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to examine the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients., Methods: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m(2)) and carboplatin AUC-2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (Common Terminology Criteria for Adverse Events version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented., Results: Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy-related mortality. Grade 3-4 life-threatening complications were seen in two patients. The post NACT response rate was 100%., Conclusions: Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.

Background and Objective: Ovarian cancers are frequently seen at an advanced stage in our center. This audit was planned to see the morbidity and efficacy of different types of cytoreductive surgeries (radical vs. ultra-radical) done in such patients., Methods: This was a retrospective analysis of all ovarian cancer patients who underwent cytoreductive surgery at our center from January 2009 to August 2013. The case records of these patients were reviewed and the demographic, disease-related and treatment-related data were extracted., Results: Fifty-fivepatients were identified. Ten (18.2%) patients underwent primary cytoreduction while 45 patients had (81.8%) interval cytoreduction. The resections achieved were optimal in 50 patients (90.9%) and suboptimal in five patients (9.1%). The postoperative median blood loss was 400 (350-600) mL. The median time interval for surgery was 4.0 h (3-5 h). The type of resection achieved (optimal vs. suboptimal) was the only factor affecting the progression free survival (PFS) (Hazard ratio = 0.08 95% confidence interval 0.02-0.3). There was no significant difference in postoperative morbidity in patients undergoing the ultra-radical surgery as compared to those who underwent radical surgery., Conclusion: Optimal cytoreduction may improve PFS in advanced ovarian cancer patients and needs to be done even if it mandates an ultra-radical surgery.

Seasonal climate forecasts (SCF) provide information about future climate variability that has the potential to benefit organisations and their decision-making. However, the production and availability of SCF does not guarantee its use in decision-making per se as a range of factors and conditions influence its use in different decision-making contexts. The aim of this paper is to identify the barriers and enablers to the use of SCF across organisations in Europe. To achieve that, we conducted 75 in-depth interviews with organisations working across eight sectors (including energy, transport, water and agriculture) and 16 countries. The majority of the organisations interviewed do not currently use SCF. This was due to the low reliability and skill of SCF in Europe but also with other non-technical aspects such as the lack of relevance and awareness of SCF in the organisations. Conversely, the main enabler to the use of SCF was the interactions with the providers of SCF. In addition, the level of organisational resources, capacity and expertise were also significant enablers to the use of SCF in organisations. This paper provides the first empirical assessment of the use of SCF in Europe. Such insights provide not only an overview of the existing barriers and enablers to the use of SCF in Europe and how these can be overcome and negotiated to enhance the usability of SCF, but can also help inform the broader and emerging context of climate services development in Europe., (© The Author(s) 2016.)

Visualizations are widely used in the communication of climate projections. However, their effectiveness has rarely been assessed among their target audience. Given recent calls to increase the usability of climate information through the tailoring of climate projections, it is imperative to assess the effectiveness of different visualizations. This paper explores the complexities of tailoring through an online survey conducted with 162 local adaptation practitioners in Germany and the UK. The survey examined respondents' assessed and perceived comprehension (PC) of visual representations of climate projections as well as preferences for using different visualizations in communicating and planning for a changing climate. Comprehension and use are tested using four different graph formats, which are split into two pairs. Within each pair the information content is the same but is visualized differently. We show that even within a fairly homogeneous user group, such as local adaptation practitioners, there are clear differences in respondents' comprehension of and preference for visualizations. We do not find a consistent association between assessed comprehension and PC or use within the two pairs of visualizations that we analysed. There is, however, a clear link between PC and use of graph format. This suggests that respondents use what they think they understand the best, rather than what they actually understand the best. These findings highlight that audience-specific targeted communication may be more complex and challenging than previously recognized., (© 2015 The Authors.)

Across Europe, organizations in different sectors are sensitive to climate variability and change, at a range of temporal scales from the seasonal to the interannual to the multi-decadal. Climate forecast providers face the challenge of communicating the uncertainty inherent in these forecasts to these decision-makers in a way that is transparent, understandable and does not lead to a false sense of certainty. This article reports the findings of a user-needs survey, conducted with 50 representatives of organizations in Europe from a variety of sectors (e.g. water management, forestry, energy, tourism, health) interested in seasonal and interannual climate forecasts. We find that while many participating organizations perform their own 'in house' risk analysis most require some form of processing and interpretation by forecast providers. However, we also find that while users tend to perceive seasonal and interannual forecasts to be useful, they often find them difficult to understand, highlighting the need for communication formats suitable for both expert and non-expert users. In addition, our results show that people tend to prefer familiar formats for receiving information about uncertainty. The implications of these findings for both the providers and users of climate information are discussed., (© 2015 The Authors.)

Background: The Heatwave Plan for England provides guidance for personal and home protection measures during heatwaves. Although studies in the USA, Australia and Europe have surveyed heat-related behaviours during heatwaves, few have been conducted in the UK. This study assesses personal and housing (at-home) behaviour and housing characteristics of the UK population during the 2013 heatwave., Methods: This paper analyses data from 1497 respondents of an online survey on heat protection measures and behaviour. Participants were asked questions about their behaviour during the 2013 heatwave, the characteristics of their current housing as well as about any negative health outcomes experienced due to the hot weather. We used multinomial logit regression to analyse personal and home heat protection behaviour and logistic regression to analyse characteristics of participants' current home (installed air conditioner, curtains etc.). We stratified the outcomes by age, sex, ethnicity, income, education and regional location., Results: In 2013, for all heat-related illness (except tiredness), a higher proportion of those in the younger age groups reported symptoms compared with those in the older age groups. Women, higher income groups and those with higher education levels were found to be more likely to report always/often taking personal heat protective measures. The elderly were less likely to take some personal and home protective measures but were more likely to live in insulated homes and open windows at night to keep their home cool., Conclusion: Our study has found a high level of awareness of the actions to take during heatwaves in the UK, and has identified important demographic indicators of sections of the UK population that might benefit from additional or more targeted information. The health agencies should attempt to provide better information about heatwaves to those vulnerable (elderly, those at risk living in London, low income earners) or identify any barriers that might be preventing them from undertaking protective behaviour.

Purpose: The American Society of Clinical Oncology and the Oncology Nursing Society have proposed a set of standards for safe chemotherapy administration. The state of implementation of these standards in oncologic practices in India is not understood properly., Methods: An anonymized survey was designed that consisted of items from all 37 standards that were described in the 2013 update of the standards. The survey was distributed via e-mail as well as in paper format among oncologists working in various oncology practices in the country. A standard was considered as fully implemented if more than 90% of the items beneath it had the most positive response (Yes/Always)., Results: Responses were obtained from 75 of 114 (65.8%) of the institutions surveyed. Only one institution had fully implemented the standards, whereas only six (8.0%) institutions had implemented more than 90% of the standards fully. The general chemotherapy administration-related domain was implemented fully by the least number of institutions. Although characteristics such as location, funding, and type of institution (teaching or not) failed to influence implementation rates, institutions of respondents who were aware of chemotherapy practice-related standards reported full implementation of a larger number of standards. Lack of national-level guidelines/policies was identified as the most common difficulty in implementing standards., Conclusion: This survey indicates that there is an urgent need to formulate national-level guidelines for safe chemotherapy administration., (Copyright © 2015 by American Society of Clinical Oncology.)

This research investigated how an individual's endorsements of mitigation and adaptation relate to each other, and how well each of these can be accounted for by relevant social psychological factors. Based on survey data from two European convenience samples (N = 616 / 309) we found that public endorsements of mitigation and adaptation are strongly associated: Someone who is willing to reduce greenhouse gas emissions (mitigation) is also willing to prepare for climate change impacts (adaptation). Moreover, people endorsed the two response strategies for similar reasons: People who believe that climate change is real and dangerous, who have positive attitudes about protecting the environment and the climate, and who perceive climate change as a risk, are willing to respond to climate change. Furthermore, distinguishing between (spatially) proximal and distant risk perceptions suggested that the idea of portraying climate change as a proximal (i.e., local) threat might indeed be effective in promoting personal actions. However, to gain endorsement of broader societal initiatives such as policy support, it seems advisable to turn to the distant risks of climate change. The notion that "localising" climate change might not be the panacea for engaging people in this domain is discussed in regard to previous theory and research.

Heat waves pose serious health risks, and are expected to become more frequent, longer lasting, and more intense in the future under a changing climate. Yet, people in the UK seem to feel positive when thinking about hot weather. According to research on the affect heuristic, any positive or negative emotions evoked by potentially risky experiences may be used as cues to inform concerns about risk protection. If so, then their positive feelings toward hot weather might lead UK residents to lower intentions to adopt heat protection behaviors. Here, we examine the relationships between heat protection behaviors during the July 2013 UK heat wave and self-reports of having heard heat protection recommendations, feeling positive affect about heat, seeing heat protection measures as effective, and trusting the organizations making those recommendations. Responses to a national survey revealed that 55.1% of participants had heard heat protection recommendations during the 2013 UK heat wave. Those who reported having heard recommendations also indicated having implemented more heat protection behaviors, perceiving heat protection behaviors as more effective, feeling more positive about heat, and intending to implement more protection behaviors in future hot summers. Mediation analyses suggested that heat protection recommendations may motivate heat protection behaviors by increasing their perceived effectiveness, but undermine their implementation by evoking positive affect about hot weather. We discuss our findings in the context of the affect heuristic and its implications for heat protection communications., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Many European countries have developed National Adaptation Strategies (NAS) to guide adaptation to the expected impacts of climate change. There is a need for more structured communication of the uncertainties related to future climate and its impacts so that adaptation actions can be planned and implemented effectively and efficiently. We develop a novel uncertainty assessment framework for comparing approaches to the inclusion and communication of physical science uncertainty, and use it to analyse ten European NAS. The framework is based on but modifies and integrates the notion of the "cascade of uncertainties" and the NUSAP (Numeral Unit Spread Assessment Pedigree) methodology to include the overarching assessment categories of Numerical Value, Spread, Depth and Substantiation. Our assessment indicates that there are marked differences between the NAS in terms of inclusion and communication of physical science uncertainty. We find that there is a bias towards the communication of quantitative uncertainties as opposed to qualitative uncertainties. Through the examination of the English and German NAS, we find that similar stages of development in adaptation policy planning can nevertheless result in differences in handling physical science uncertainty. We propose that the degree of transparency and openness on physical science uncertainty is linked to the wider socio-political context within which the NAS are framed. Our methodology can help raise awareness among NAS users about the explicit and embedded information on physical science uncertainty within the existing NAS and would help to design more structured uncertainty communication in new or revised NAS.

Background: There is deficit of data from India on elderly patients with cancer. Comprehensive geriatric assessment may lead to a better decision making capacity in this population. However, routine implementation of such assessment is resource consuming., Aim: The aim of this study was to determine the patterns of care in elderly patients treated at a tertiary rural cancer center in India., Materials and Methods: All patients with age 70 or above with solid tumors without any definitive treatment prior to the registration at our center and registered between 01/01/2010 and 31/12/2011 were selected for this study. The baseline demographic pattern and the pattern of care of treatment were analyzed. SPSS version 16 (IBM Inc, Armonk, New York, U.S.) was used for analysis. Descriptive data are provided., Results: A total of 761 patients were evaluable subject to the aforementioned inclusion criteria. The median age of this cohort was 75 years (70-95 years). The most frequent primary sites of malignancies in 451 males were head neck (32.4%), lung (23.3%) and gastrointestinal (23.3%). In 310 females, the most common sites were head neck (31.6%), gynecological (18.4%) and gastrointestinal (24.5%). 228 (30%) of the patients had localized disease, 376 (49.4%) had loco-regionally advanced disease and 145 (19.1%) had distant metastases at presentation. 334 (46.32%) of patients were treated with curative intent. On logistic regression analysis the factors that predicted use of curative intent treatment were age <75 years, performance status 0-1, primary site and clinical extent of disease., Conclusion: Routine comprehensive geriatric assessment needs to be implemented in our setting as almost 50% of our geriatric patients undergo curative intent treatment.

Purpose: Elderly patients (65 or older) with cervical cancer often receive suboptimal radio-chemotherapy. Intensity-modulated radiotherapy (IMRT) may improve tolerance to treatment in this setting. This study was designed to compare the treatment-related toxicities and compliance with treatment in patients of cervical cancer treated definitively with RapidArc IMRT in our institute., Methods and Materials: The treatment records of all patients treated with RapidArc IMRT between April 2012 and April 2014 were reviewed, retrospectively. Prospectively collected data regarding treatment toxicity (CTCAE 4.0), treatment outcomes and parameters related to treatment compliance were compared amongst two age groups (< 65 and ≥ 65 years). The results of 66 patients were identified, of whom 23 were found to be ≥ 65 years age. All patients completed planned external beam radiotherapy. However, significantly fewer patients in the elderly group received concurrent chemoradiation (98% versus 65%, p < 0.001). Old age (median 75 years, IQR: 74-78 years) was the commonest cause for non-receipt of chemotherapy. Incidence of grade 3 haematological toxicities (26.7% versus 16.7%) and gastrointestinal toxicity (16.7% versus 13.3%) were not significantly different between the two groups. Other treatment-related toxicities, breaks, treatment duration and early outcomes were also not significantly different between the two age groups., Conclusions: The use of IMRT did not result in excess toxicities in the elderly population and was associated with equivalent compliance to treatment. Concurrent chemoradiation can be safely combined in elderly patients with perfect organ function and performance status.

Public perception research in different countries has suggested that real and perceived periods of high temperature strengthen people's climate change beliefs. Such findings raise questions about the climate change beliefs of people in regions with moderate climates. Relatively little is known about whether public concerns about climate change may also be associated with perceived changes in other weather-related events, such as precipitation or flooding. We examine the relationship between perceived changes in weather-related events and climate change beliefs among U.K. residents at a time of below-average winter temperatures and recent flooding. National survey data (n = 1,848) revealed that heat waves and hot summers were perceived to have become less common during respondents' lifetimes, while flooding, periods of heavy rainfall, coastal erosions, and mild winters were perceived to have increased in frequency and cold winters were perceived to be unchanged. Although perceived changes in hot-weather-related events were positively associated with climate change beliefs, perceived changes in wet-weather-related events were found to be an even stronger predictor. Self-reported experience of "flooding in own area" and "heat-wave discomfort" also significantly contributed to climate change beliefs. These findings highlight the importance of salient weather-related events and experiences in the formation of beliefs about climate change. We link our findings to research in judgment and decision making, and propose that those wishing to engage with the public on the issue of climate change should not limit their focus to heat., (© 2014 Society for Risk Analysis.)

Climate services involve the generation, provision, and contextualization of information and knowledge derived from climate research for decision making at all levels of society. These services are mainly targeted at informing adaptation to climate variability and change, widely recognized as an important challenge for sustainable development. This paper reviews the development of climate services, beginning with a historical overview, a short summary of improvements in climate information, and a description of the recent surge of interest in climate service development including, for example, the Global Framework for Climate Services, implemented by the World Meteorological Organization in October 2012. It also reviews institutional arrangements of selected emerging climate services across local, national, regional, and international scales. By synthesizing existing literature, the paper proposes four design elements of a climate services evaluation framework. These design elements include: problem identification and the decision-making context; the characteristics, tailoring, and dissemination of the climate information; the governance and structure of the service, including the process by which it is developed; and the socioeconomic value of the service. The design elements are intended to serve as a guide to organize future work regarding the evaluation of when and whether climate services are more or less successful. The paper concludes by identifying future research questions regarding the institutional arrangements that support climate services and nascent efforts to evaluate them.

The UK Government's first National Adaptation Programme seeks to create a 'climate-ready society' capable of making well-informed and far-sighted decisions to address risks and opportunities posed by a changing climate, where individual households are expected to adapt when it is in their interest to do so. How, and to what extent, households are able to do this remains unclear. Like other developed countries, research on UK adaptation has focused predominately on public and private organisations. To fill that gap, a systematic literature review was conducted to understand what actions UK households have taken in response to, or in anticipation of, a changing climate; what drives or impedes these actions; and whether households will act autonomously. We found that UK households struggle to build long-term adaptive capacity and are reliant upon traditional reactive coping responses. Of concern is that these coping responses are less effective for some climate risks (e.g. flooding); cost more over the long-term; and fail to create household capacity to adapt to other stresses. While low-cost, low-skill coping responses were already being implemented, the adoption of more permanent physical measures, behavioural changes, and acceptance of new responsibilities are unlikely to happen autonomously without further financial or government support. If public policy on household adaptation to climate change is to be better informed than more high-quality empirical research is urgently needed.

Climate change impacts and adaptation assessments have traditionally adopted a scenario-based approach, which precludes an assessment of the relative risks of particular adaptation options. Probabilistic impact assessments, especially if based on a thorough analysis of the uncertainty in an impact forecast system, enable adoption of a risk-based assessment framework. However, probabilistic impacts information is conditional and will change over time. We explore the implications of a probabilistic end-to-end risk-based framework for climate impacts assessment, using the example of water resources in the Thames River, UK. We show that a probabilistic approach provides more informative results that enable the potential risk of impacts to be quantified, but that details of the risks are dependent on the approach used in the analysis.

This paper presents the results of a preliminary study of climate vulnerability in East Timor. It shows the results of projections of climate change in East Timor. The country's climate may become hotter, drier, and increasingly variable. Sea levels are likely to rise. The paper then considers the implications of these changes on three natural resources--water, soils, and the coastal zone--and finds all to be sensitive to changes in climate and sea level. Changes in the abundance and distribution of these resources is likely to cause a reduction in agricultural production and food security, and sea-level rise is likely to damage coastal areas, including Dili, the capital city.

Global environmental change, in particular climate change, will have adverse effects on public health. The increased frequency/intensity of heat waves is expected to increase heat-related mortality and illness. To quantify the climatic risks of heat-related mortality in Lisbon an empirical-statistical model was developed in Part I, based on the climate-mortality relationship of the summer months of 1980-1998. In Part II, scenarios of climate and population change are applied to the model to assess the potential impacts on public health in the 2020s and 2050s, in terms of crude heat-related mortality rates. Two regional climate models (RCMs) were used and different assumptions about seasonality, acclimatisation and the estimation of excess deaths were made in order to represent uncertainty explicitly. An exploratory Bayesian analysis was used to investigate the sensitivity of the result to input assumptions. Annual heat-related death rates are estimated to increase from between 5.4 and 6 (per 100,000) for 1980-1998 to between 5.8 and 15.1 for the 2020s. By the 2050s, the potential increase ranges from 7.3 to 35.6. The burden of deaths is decreased if acclimatisation is factored in. Through a Bayesian analysis it is shown that, for the tested variables, future heat-related mortality is most sensitive to the choice of RCM and least to the method of calculating the excess deaths.

Global climate change will have direct impacts on human health, including increased mortality due to heat stress and heat waves. An empirical-statistical model for heat stress is constructed for the city of Lisbon using the June-August months of the observational period 1980-1998. The model uses the regression of an aggregate dose-response relationship between maximum temperature and excess heat-related deaths, based on the difference between observed and expected deaths. The model is validated by correlation and residual analysis. The mean annual heat-related mortality for the period 1980-1998 was between 5.4 and 6 deaths per 100,000 depending on the method used to calculate expected deaths. Both validation methods show that the model has a moderate to high accuracy in modelling heat-related deaths compared to the observed record.