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The article focuses on the study regarding the history of water governance in Ghana. The net-map was used for the data collection, wherein interviews were conducted among fishermen, traditional village authorities, and some employees of the Ministry of Fisheries (MoFi). It reveals that the water governance in Northern Ghana showed the gap between theory and practice of community-based, participatory management. Moreover, water users failed to realize the idea of participatory decision making.

• Informing the post-2020 development agenda requires better models and data. • Approaches do not capture interactions of economy, society and environment. • Economy-wide models linked with ecosystem services (ES) modeling fills the gap. • GTAP linked with ES modeling can inform international discourse and advocacy. • The IEEM Platform linked with ES modeling can inform national policy. The year 2020 is a critical year for sustainable development policy and practice with the review and renewal of various international commitments including the Sustainable Development Goals, the Convention on Biological Diversity and the Paris Agreement. The post-2020 agenda needs to be informed by more robust analytical approaches that capture the interactions between the economy, society and the environment. In this paper, we review the state of the art in available models and datasets that lay the groundwork for future analytical work to inform this agenda. Based on this review, we propose an integrated modeling approach for global analysis to underpin international policy discourse and advocacy, and; a sub-global approach focusing on evaluating specific strategies and policy portfolios to make progress toward sustainability commitments considering detailed local country context. Both approaches rely on integrating whole of economy computable general equilibrium models with spatial land use land cover and ecosystem services models. Endogenizing feedbacks between modeling system components ensures that evidence is based on interactions between all system components. Recent advances in methods, data and available tools discussed herein reduce barriers to entry for this type of complex systems analysis and increases the timeliness of policy advice. [ABSTRACT FROM AUTHOR]

Study Objective: The lag in creatinine-mediated diagnosis of cardiac surgery-associated acute kidney injury (AKI) may be impeding the development of renoprotection therapies. Postoperative renal resistive index (RRI) measured by transabdominal Doppler ultrasound is a promising early AKI biomarker. RRI measured intraoperatively by transesophageal echocardiography (TEE) is available even earlier but is less evaluated. Therefore, we conducted an assessment of intraoperative RRI as an AKI biomarker using previously reported post-renal insult thresholds.Design: Retrospective convenience sample.Setting: Intraoperative.Patients: 180 adult cardiac surgical patients between July 2013 and July 2014.Intervention: None.Measurements: Pre- and post-cardiopulmonary bypass (CPB) RRI thresholds, measured using intraoperative TEE, exceeding 0.74 or 0.79 were used to evaluate for an association with KDIGO AKI risk using the Chi-square test. Other consensus AKI criteria (AKIN, RIFLE) were similarly evaluated. Additional t-test analyses examined the relationship of pre- and pre-to-post (delta) CPB RRI with AKI.Main Results: Post-CPB RRI for 99 patients included 36 and 23 with values exceeding 0.74 and 0.79, respectively. Analyses confirmed associations of both RRI thresholds with all consensus AKI definitions (0.74; KDIGO: p = 0.05, AKIN: p = 0.03, RIFLE: p = 0.03, 0.79; KDIGO: p = 0.002, AKIN: p = 0.001, RIFLE: p = 0.004). In contrast, pre-CPB and pre-to post-CPB RRI were not associated with AKI.Conclusions: RRI obtained intraoperatively in cardiac surgery patients, assessed using previously reported thresholds, is highly associated with AKI and warrants further evaluation as a promising "earliest" AKI biomarker. These significant findings suggest that RRI assessment should be included in the standard intraoperative TEE exam. [ABSTRACT FROM AUTHOR]

The number of collaborative initiatives between scientists and volunteers (i.e., citizen science) is increasing across many research fields. The promise of societal transformation together with scientific breakthroughs contributes to the current popularity of citizen science (CS) in the policy domain. We examined the transformative capacity of citizen science in particular learning through environmental CS as conservation tool. We reviewed the CS and social-learning literature and examined 14 conservation projects across Europe that involved collaborative CS. We also developed a template that can be used to explore learning arrangements (i.e., learning events and materials) in CS projects and to explain how the desired outcomes can be achieved through CS learning. We found that recent studies aiming to define CS for analytical purposes often fail to improve the conceptual clarity of CS; CS programs may have transformative potential, especially for the development of individual skills, but such transformation is not necessarily occurring at the organizational and institutional levels; empirical evidence on simple learning outcomes, but the assertion of transformative effects of CS learning is often based on assumptions rather than empirical observation; and it is unanimous that learning in CS is considered important, but in practice it often goes unreported or unevaluated. In conclusion, we point to the need for reliable and transparent measurement of transformative effects for democratization of knowledge production. [ABSTRACT FROM AUTHOR]

The deployment of onshore wind power involves spatial sustainability trade-offs, e.g., between the minimization of energy system costs, the mitigation of impacts on humans and biodiversity, and interregional equity concerns. We analyze challenges arising for decision-making if wind power generation capacity has to be allocated spatially in the presence of such trade-offs. The analysis is based on a participatory multi-criteria analysis that involved stakeholders in Germany. Stakeholders were asked to play a serious game during which they had to allocate wind power generation capacity to German states. The results of the serious game illustrate that there is no unanimously agreed ranking of sustainability criteria among the participating stakeholders. They disagreed not only on the weights of different criteria but also their definition and measurement. Group discussions further revealed that interregional equity concerns mattered when generation capacity was allocated to states. Yet, stakeholders used quite different concepts of interregional equity, including approaches of both distributional and commutative justice. The results support the importance of transparent, multi-level and participatory approaches to take decisions on the spatial allocation of wind power generation capacity. • The spatial allocation of wind power deployment involves sustainability trade-offs. • A serious game is used to analyze how stakeholders weigh allocation criteria. • Results show significant disagreement regarding the weights of different criteria. • Stakeholders consider interregional equity an important criterion for allocation. [ABSTRACT FROM AUTHOR]

Background: The management of perioperative bleeding and the optimization of the available therapies are subjects of significant clinical interest. Clinical guidelines recommend the use of whole blood viscoelastic testing devices to target the utilization of blood products during major surgical procedures. The Quantra QPlus System is a new cartridge-based viscoelastic testing device based on an innovative ultrasound technology. The aim of this study was to evaluate this new system in a surgical population., Methods: Two hundred seventy-seven adult subjects were enrolled in a multicenter, prospective observational study consisting primarily of patients undergoing cardiac and major orthopedic surgeries. Samples were obtained at multiple time points for testing on the Quantra QPlus System, the rotational thromboelastometry (ROTEM) delta, and standard coagulation tests. Quantra measurements included Clot Time (CT), Heparinase Clot Time (CTH), Clot Time Ratio (CTR), Clot Stiffness (CS), Fibrinogen (FCS), and Platelet (PCS) Contributions to CS. Data analyses included assessment of the concordance of Quantra parameters with a series of clinical composite indexes formed on the basis of standard coagulation tests in 3 domains representing increased, decreased, and normal/subclinical coagulation function. Linear regression and receiver operator characteristic (ROC) analyses of Quantra parameters with corresponding parameters from ROTEM assays were also performed., Results: The accuracy (overall percent agreement or ratio of true positives and true negatives over the entire population) between the Quantra and the composite indexes was between 72% and 98% depending on the specific parameter. Linear regression analysis indicated that the correlation between ROTEM delta and Quantra was very strong with r values ranging between 0.84 and 0.89. Results from ROC analysis demonstrated sensitivities and specificities in the 80%-90% range when QPlus parameters were used to discriminate ROTEM threshold values currently used in goal-directed treatment algorithms., Conclusions: This study demonstrated that the Quantra QPlus System is strongly correlated with a well-established viscoelastic testing device and its parameters effectively represent the results from multiple standard laboratory assays. The Quantra has been designed to operate at the point of care with the potential to provide rapid and comprehensive results to aid in the management of coagulopathic patients.

The role of the anesthesiologist in the perioperative environment requires facility in leadership; however, leadership education is not part of the traditional curriculum for anesthesiology trainees. To address this educational gap, we developed a leadership program for anesthesiology residents at an academic medical center to build competency in the areas of teamwork, emotional intelligence, integrity, selfless service, critical thinking, and patient-centeredness, constructs that correlate with the Accreditation Council for Graduate Medical Education competencies of interpersonal and communication skills and professionalism. This report describes the design and implementation of the program, including the curriculum, and offers recommendations for implementation at other institutions.

Objective: Intraoperative Doppler-determined renal resistive index (RRI) is a promising early acute kidney injury (AKI) biomarker. As RRI continues to be studied, its clinical usefulness and robustness in research settings will be linked to the ease, efficiency, and precision with which it can be interpreted. Therefore, the authors assessed the usefulness of computer vision technology as an approach to developing an automated RRI-estimating algorithm with equivalent reliability and reproducibility to human experts., Design: Retrospective., Setting: Single-center, university hospital., Participants: Adult cardiac surgery patients from 7/1/2013 to 7/10/2014 with intraoperative transesophageal echocardiography-determined renal blood flow measurements., Interventions: None., Measurements and Main Results: Renal Doppler waveforms were obtained retrospectively and assessed by blinded human expert raters. Images (430) were divided evenly into development and validation cohorts. An algorithm for automated RRI analysis was built using computer vision techniques and tuned for alignment with experts using bootstrap resampling in the development cohort. This algorithm then was applied to the validation cohort for an unbiased assessment of agreement with human experts. Waveform analysis time per image averaged 0.144 seconds. Agreement was excellent by intraclass correlation coefficient (0.939; 95% confidence interval [CI] 0.921 to 0.953) and in Bland-Altman analysis (mean difference [human-algorithm] -0.0015; 95% CI -0.0054 to 0.0024), without evidence of systematic bias., Conclusion: The authors confirmed the value of computer vision technology to develop an algorithm for RRI estimation from automatically processed intraoperative renal Doppler waveforms. This simple-to-use and efficient tool further adds to the clinical and research value of RRI, already the "earliest" among several early AKI biomarkers being assessed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Europe is a region of relatively high population density and productive agriculture subject to substantial government intervention under the Common Agricultural Policy (CAP). Many habitats and species of high conservation interest have been created by the maintenance of agricultural practices over long periods. These practices are often no longer profitable, and nature conservation initiatives require government support to cover the cost for them to be continued. The CAP has been reformed both to reduce production of agricultural commodities at costs in excess of world prices and to establish incentives for landholders to adopt voluntary conservation measures. A separate nature conservation policy has established an extensive series of protected sites (Natura 2000) that has, as yet, failed to halt the loss of biodiversity. Additional broader scale approaches have been advocated for conservation in the wider landscape matrix, including the alignment of agricultural and nature conservation policies, which remains a challenge. Possibilities for alignment include further shifting of funds from general support for farmers toward targeted payments for biodiversity goals at larger scales and adoption of an ecosystem approach. The European response to the competing demands for land resources may offer lessons globally as demands on rural land increase., (© 2015 Society for Conservation Biology.)