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Despite three decades of political efforts and a wealth of research on the causes and catastrophic impacts of climate change, global carbon dioxide emissions have continued to rise and are 60% higher today than they were in 1990. Exploring this rise through nine thematic lenses—covering issues of climate governance, the fossil fuel industry, geopolitics, economics, mitigation modeling, energy systems, inequity, lifestyles, and social imaginaries—draws out multifaceted reasons for our collective failure to bend the global emissions curve. However, a common thread that emerges across the reviewed literature is the central role of power, manifest in many forms, from a dogmatic political-economic hegemony and influential vested interests to narrow techno-economic mindsets and ideologies of control. Synthesizing the various impediments to mitigation reveals how delivering on the commitments enshrined in the Paris Agreement now requires an urgent and unprecedented transformation away from today's carbon- and energy-intensive development paradigm.

This article discusses currently neglected distinctions between control, care, and conviviality in the politics of technology for sustainability. We conceptualize control as the ambition to maintain fictitious borders between hierarchically ordered categories such as subjects and objects. This ambition is materialized into a wide range of Modern technological innovations, including genome editing and deep sea mining. Contrasting with control, we conceptualize values of care that constitute socio-technical practices where connections are prioritized over categories and hierarchy is countered with egalitarian commitment. In caring practices, objects are thus treated as subjects, often within political contexts that are dominated by ambitions to control. Building on care, we explore hopes for conviviality as mutualistic autonomy and decolonial self-realization to orient plural socio-technical pathways for moving beyond Modernity. We argue that such pathways are crucial for democratic transformations to sustainability. We illustrate our concepts using two brief case studies of agricultural developments. The first case discusses the politics of control in agricultural biotechnologies in Belgium. The second case reports on care within rural people's coping strategies in a south Indian "green revolution" landscape laden with control. In conclusion, we emphasize the need to situate attempted materializations of control, care, and conviviality in specific historical junctures. Situated understandings of the interplay between control, care, and conviviality can help realize sustainability that does not reproduce the centralizing, control-driven logic of Modern technocratic development.

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30-90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6-12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

Starting from Marcel Mauss’ observation that “one has no right to refuse a gift”, this paper explores the politics of refusal in the context of field trials with genetically modified organisms in Flanders (Belgium). Based on a decade of activist research, and focusing on the genetically modified organism field trials of the Flemish Institute for Biotechnology, we show that the business model of this strategic research center – with its triple mission of carrying biotechnology research, technology transfer, and the promotion of biotechnology through communication and lobby activities – fosters a climate in which innovations in the technosciences have to “be accepted”. The future is laid out without including the possibility of refusal. Consternation is great when this is exactly what happens. Irrational fears and lack of understanding or lack of familiarity are invoked to explain refusal. Language of precision, innovation, safety, and control are deployed to re-assure the public. Refusal is not considered a legitimate option. Yet, if farmers and grassroots initiatives would accept the gift of genetically modified organisms, it would mean the acceptance of their dispossession and the impossibility of diverse food sovereignties. Starting from theoretical work on “the gift” and “the politics of refusal”, we argue that recognizing innovation as the intrinsically plural and divergent process it is, entails including options to refuse particular pathways as a first step to open up others. As we will argue, saying no to genetically modified organisms is part of saying yes to peasant autonomy, agrobiodiversity, and peoples’ food sovereignties.

Comment on mathematical modeling and uncertainty published in Nature. This comment has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement N0 792178 (A.P.).

Conservation science deals with crises and supports policy interventions devised to mitigate highly uncertain threats that pose irreversible harm. When conventional policy tools, such as quantitative risk assessments, are insufficient, the precautionary principle provides a practical framework and range of robust heuristics. Yet, precaution is often resisted in many policy arenas, especially those involving powerful self-interests, and this resistance is compounded by structures of privilege and competitive individualism in science. We describe key drivers and effects of such resistance in conservation science. These include a loss of rigor under uncertainty, an erosion of crisis response capabilities, and a further reinforcement of privileged interests in conservation politics. We recommend open acknowledgement of the pressures exerted by power inside science; greater recognition for the value of the precautionary principle under uncertainty; deliberate measures to resist competitive individualism; support for blind review, open science, and data sharing; and a shift from hierarchical multidisciplinarity toward more egalitarian transdisciplinarity to accelerate advances in conservation science. Article impact statement: Precautionary principle, privilege structures among disciplines, and culture of individualism link to effective conservation policy making.Fortalecimiento de las Ciencias de la Conservación como Disciplinas de Crisis Resumen Las ciencias de la conservación tratan con crisis y respaldan a muchas intervenciones políticas para mitigar las amenazas altamente inciertas que representan un daño irreversible. El principio de precaución proporciona un marco práctico y una gama de heurística sólida cuando son insuficientes las herramientas convencionales de políticas como las evaluaciones cuantitativas de riesgo. Aun así, con frecuencia se niega el uso de la precaución en muchas arenas políticas, especialmente en aquellas que involucran intereses propios de mucho poder, y esta negación se agrava con las estructuras de privilegio y el individualismo competitivo presentes en la ciencia. Describimos los factores y efectos clave de dicha resistencia en las ciencias de la conservación. Estos incluyen la pérdida del rigor bajo la incertidumbre, un desgaste de las capacidades de respuesta a la crisis y un reforzamiento más profundo de los intereses privilegiados en las políticas de conservación. Recomendamos que se realice una aceptación abierta de las presiones ejercidas por el poder dentro de la ciencia; un mayor reconocimiento del valor del principio de precaución bajo la incertidumbre; que se lleven a cabo medidas deliberadas para oponerse al individualismo competitivo; que se apoye a las revisiones a ciegas, la ciencia abierta y la difusión de datos; y que se realice un cambio de la multidisciplinariedad jerárquica a una transdisciplinariedad más igualitaria para acelerar los avances dentro de las ciencias de la conservación.保护科学是一门处理危机的学科, 该学科支持政策干预以减轻构成不可逆转损害的高度不确定的威胁。当定量风险评估等传统政策工具存在不足时, 预防性原则可以提供实践框架和一系列稳健的启发式方法。然而, 预警机制在许多政策领域却常常遭到抵制, 特别是那些涉及强大自身利益的领域, 而科学界的特权结构和竞争性个人主义更是加剧了这种阻力。本文描述了保护科学中产生这种阻力的主要驱动力和影响, 包括在存在不确定性的情况下失去严谨性, 危机应对能力减弱, 以及保护政治中特权利益的进一步强化。我们建议公开承认科学界内部权力施加的压力; 更深入地认识不确定情况下预防性原则的价值; 制定措施来抵制竞争性个人主义; 支持盲审、开放科学和数据共享; 以及从多学科层级体系转向更加平等的跨学科制度, 以加速保护科学的进步。【翻译: 胡怡思; 审校: 聂永刚】.

Highlights • The following contributions are provided: A general process for conducting systematic prospective appraisal of policy options within the field of research policy, using multicriteria mapping (MCM). • Novel methods for systematically analysing MCM data using pairwise comparison and merit orders which improve the utility of the MCM method. • Quantitative findings (derived using MCM) on the appraisal of policy options for antimicrobial resistance (AMR) by 47 experts from six European countries, providing seven stakeholder perspectives, and identifying most and least favoured policy options. • Qualitative findings (derived using MCM) addressing different modes of reasoning as to why contrasting policy options may be expected to perform well or poorly in different settings and from different perspectives. • Qualitative findings (derived using MCM) underpinning a framework for policy design that may be useful for research policy around AMR. • Quantitative findings (derived not using MCM) concerning those particular options that interviewees identified as most complementary to each other, supported by qualitative illustrations and qualifications., This article provides prospective appraisal of key policy instruments intended to stimulate innovation to combat antimicrobial resistance (AMR). AMR refers to the ability of microbes to evolve resistance to those treatments designed to kill them, and is associated with the overuse or misuse of medicines such as antibiotics. AMR is an emerging global challenge with major implications for healthcare and society as a whole. Diagnostic tests for infectious diseases can guide decision making when prescribing medicines, so reducing inappropriate drug use. In the context of growing international interest in policies to stimulate innovation in AMR diagnostics, this study uses multicriteria mapping (MCM) to appraise a range of policy instruments in order to understand their potential performance while also highlighting the uncertainties that stakeholders hold about such interventions in complex contexts. A contribution of the article is the demonstration of a novel method to analyse and visualise MCM data in order to reveal stakeholder inclinations towards particular options while exploring interviewees’ uncertainties about the effectiveness of each instrument's design or implementation. The article reports results from six European countries (Germany, Greece, Italy, the Netherlands, Spain and the UK). The findings reveal which policy instruments are deemed most likely to perform well, and why, across stakeholder groups and national settings, with areas of common ground and difference being identified. Importantly, the conclusions presented here differ from prominent policy discourse, with international implications for the design of mixes of policy instruments to combat AMR. Strategic and practical methodological implications also emerge for general appraisal of innovation policy instrument mixes., Graphical abstract Appraising research policy instrument mixes: a multicriteria mapping study in six European countries of diagnostic innovation to manage antimicrobial resistanceImage, graphical abstract

This chapter explores some underlying issues bearing on relationships between engineering and Sustainability. It aims to help point towards ways in which engineering practice might avoid some of the dangers associated with pressures and rhetorics of justification and legitimation, such as to become more robustly aligned with authentic values and interests of Sustainability. The key to this is to recognise some deep resonances around the central preoccupations of much instrumental-style engineering with attempted performances of control. For it is similar imaginations of control that characterise the presently globalising ‘infraculture’ of Modernity itself. And it is to the associated problems of failed efforts at control, that the Sustainability movement is a reaction. In order practically to resist the associated fixations, fallacies and fantasies of control both in engineering and Modernity more widely, it is suggested that a starting point lies in enacting a distinction between control and care. A number of examples are explored—for instance, around current responses to ‘climate change’ and visions of ‘the Anthropocene’—where controlling imaginations are aggravating progressive values and where more caring practices would be more supportive of Sustainability. At the end, the chapter critiques visions of transitions to Sustainability as relatively technical expert-led challenges of controlling progress in particular notionally singular, depoliticised directions. It is argued instead that a more caring approach might recognise the inherently diverse, political nature of Sustainability. Here, engineering is more about collective action than instrumental policy intervention—as just one among many ways to care for more plural, open-ended transformations.

Two of the most widely emphasized contenders for carbon emissions reduction in the electricity sector are nuclear power and renewable energy. While scenarios regularly question the potential impacts of adoption of various technology mixes in the future, it is less clear which technology has been associated with greater historical emission reductions. Here, we use multiple regression analyses on global datasets of national carbon emissions and renewable and nuclear electricity production across 123 countries over 25 years to examine systematically patterns in how countries variously using nuclear power and renewables contrastingly show higher or lower carbon emissions. We find that larger-scale national nuclear attachments do not tend to associate with significantly lower carbon emissions while renewables do. We also find a negative association between the scales of national nuclear and renewables attachments. This suggests nuclear and renewables attachments tend to crowd each other out. Nuclear and renewable energy are considered two of the most important technologies towards decarbonization though it is not clear how their adoption relates to national emission reductions. Sovacool et al. look at data from 123 countries to examine emission reductions associated with nuclear- or renewable energy-focused strategies.

This introductory chapter asks why the idea of uncertainty is so important to politics today. To explore this, the chapter reviews the diverse contributions to the book on themes ranging from finance and banking to insurance to technology regulation, to critical infrastructures, infectious disease responses, climate change, natural disasters, migration, crime and security and spirituality and religion. Across this wide field, the chapter argues that uncertainties are constructions of knowledge, materiality, experience, embodiment and practice; and acknowledging this means challenging singular notions of modernity and progress. Given these multiple dimensions of uncertainty, there can be no singular assumptions about ‘the future’. Instead, the directions taken in pursuit of sustainability and development depend on social, and deeply political, choices. Discussing challenges to singular versions of ‘modernity’ through embracing uncertainty and ignorance and respecting difference, the chapter explores necessary shifts from ‘calculative control’ towards ‘creative care’. Examining how uncertainties are experienced and futures constructed in contexts of marginalisation and precarity, the chapter calls for a new collective, convivial politics of responsibility. The chapter concludes by showing how, in a time of crisis for democratic struggle, embracing uncertainty and challenging control raise hopes of much-needed progressive transformation.

The governance of the nexus between water, energy, and food (hereafter, 'the nexus') is permeated by complex interactions of knowledge at a science-policy-society interface. This paper starts from a literature review to find the main narratives that allow us to understand what is at stake in this interface. By thematically synthesising 19 select articles, we reached three layers of knowledge interaction: 'knowledge application', 'knowledge integration', and 'knowledge transformation'. To avoid misleading simplifications, we discussed the constraints on this debate and some pressures for what we consider as 'closing down' knowledge about the nexus. We then developed a conceptual framework based on the 'technologies of humility' proposed by Jasanoff (2003, 2007) to create opportunities to 'open up' the nexus approach. Finally, we illustrated the four pillars proposed by some studies to describe what we have termed 'nexus of humility': framing, vulnerability, distribution, and learning. These foci seek to enable a humbler appreciation on all sides of the persistent sources of uncertainty, divergence, and conditionality in sustainability governance. This framework also contributes towards necessary transformations of knowledge about nexus and its challenging implementation.

The purpose of this essay is to critically review the design of methods for ethically robust forms of technology appraisal in the regulation of research and innovation in synthetic biology. It will focus, in particular, on the extent to which cost-benefit analysis offers a basis for informing decisions about which technological pathways to pursue and which to discourage. A further goal is to consider what (if anything) the precautionary principle might offer in enabling better decisions. And this, in turn, raises questions about why mention of precaution can excite accusations of unscientific bias or irrational, "anti-innovation" extremism. What does the polarized debate tell us about the politics around synthetic biology? In seeking more rigorous, timely, and practical ways to govern these remarkable new technologies, what might we be missing? The sophistication, diversity, and scope of synthetic biology may seem to make it a rather idiosyncratic area for exploring these general issues. It may seem to be a special case, with the bewildering pace of change amplifying the difficulties. But at root, some of the trickiest issues are just specific instances of familiar and long-standing conundrums in the governance of science and technology. The basic challenge is how to weigh up, for a wide range of potential options, the various pros and cons, as viewed from divergent perspectives, and find a way to justify the best course of action on behalf of society as a whole. This is the central problem addressed by a number of techniques in CBA. On the face of it, synthetic biology seems to present just one more application of these well-established and self-confident prescriptive methods. But there do emerge several obstinate, even prohibitive, difficulties for CBA. Although they are well acknowledged by the scholarly literature on and around this topic, they are often sidelined in practice. Yet all are central to the case for applying the concept of precaution to a field like synthetic biology. This essay will briefly explore multicriteria mapping, an appraisal method for exploring contrasting perspectives on emerging technologies, as one practical way to address them. The essay focuses on MCM, not because it presents any sort of panacea for appraisal, but because it is illustrative of the concrete implications of precaution. Setting out even just one among potentially many practical alternative methods at least refutes the last-ditch argument that CBA is the only operational choice.

Lovering and colleagues attempt to advance understanding of construction cost escalation risks inherent in building nuclear reactors and power plants, a laudable goal. Although we appreciate their focus on capital cost increases and overruns, we maintain in this critical appraisal that their study conceptualizes cost issues in a limiting way. Methodological choices in treating different cost categories by the authors mean that their conclusions are more narrowly applicable than they describe. We also argue that their study is factually incorrect in its criticism of the previous peer-reviewed literature. Earlier work, for instance, has compared historical construction costs for nuclear reactors with other energy sources, in many countries, and extending over several decades. Lastly, in failing to be transparent about the limitations of their own work, Lovering et al. have recourse to a selective choice of data, unbalanced analysis, and biased interpretation.

This paper focuses on the starkly differing nuclear policies of Germany and the UK. Germany has committed to discontinue nuclear power, aiming to phase the technology out by 2022. The UK has long professed the aim of a ‘nuclear renaissance’, promoting the most ambitious nuclear construction programme in Europe. The present analysis of this contrast is based around a simple yet fundamental question: which aspects contribute most to producing such divergent energy developments in these two countries? Distinguishing possible interpretive dimensions that are relatively ‘internal’ or ‘external’ to the main foci of attention in sociotechnical transitions theory, we develop a novel set of criteria spanning technical, economic, resource-based and political issues. Under each, we ask whether specific characteristics of either national setting would tend to make the phase out of nuclear power more or less likely. Our findings are that ‘internal’ aspects tend to predict discontinuity to be more likely in the UK than Germany. Only ‘external’ aspects clearly predict the actual trend. We argue on this basis that sociotechnical discontinuity is rather poorly explained by reference to the circumscribed concepts highlighted in conventional narrow versions of transitions theory. What is evidently more important, are wider political factors relating broadly to general 'qualities of democracy'.

The field of science and technology studies (STS) has introduced and developed a “sociotechnical” perspective that has been taken up by many disciplines and areas of inquiry. The aims and objectives of this study are threefold: to interrogate which sociotechnical concepts or tools from STS are useful at better understanding energy-related social science, to reflect on prominent themes and topics within those approaches, and to identify current research gaps and directions for the future. To do so, the study builds on a companion project, a systematic analysis of 262 articles published from 2009 to mid-2019 that categorized and reviewed sociotechnical perspectives in energy social science. It identifies future research directions by employing the method of “co-creation” based on the reflections of sixteen prominent researchers in the field in late 2019 and early 2020. Drawing from this co-created synthesis, this study first identifies three main areas of sociotechnical perspectives in energy research (sociotechnical systems, policy, and expertise and publics) with 15 topics and 39 subareas. The study then identifies five main themes for the future development of sociotechnical perspectives in energy research: conditions of systematic change; embedded agency; justice, power, identity and politics; imaginaries and discourses; and public engagement and governance. It also points to the recognized need for pluralism and parallax: for research to show greater attention to demographic and geographical diversity; to stronger research designs; to greater theoretical triangulation; and to more transdisciplinary approaches. © 2020 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).

The coronavirus disease 2019 (COVID-19) global pandemic has resulted in diversion of healthcare resources to the management of patients infected with SARS-CoV-2 virus. Elective interventions and surgical procedures in most countries have been postponed and operating room resources have been diverted to manage the pandemic. The Venous and Lymphatic Triage and Acuity Scale was developed to provide an international standard to rationalise and harmonise the management of patients with venous and lymphatic disorders or vascular anomalies. Triage urgency was determined based on clinical assessment of urgency with which a patient would require medical treatment or surgical intervention. Clinical conditions were classified into six categories of: (1) venous thromboembolism (VTE), (2) chronic venous disease, (3) vascular anomalies, (4) venous trauma, (5) venous compression and (6) lymphatic disease. Triage urgency was categorised into four groups and individual conditions were allocated to each class of triage. These included (1) medical emergencies (requiring immediate attendance), example massive pulmonary embolism; (2) urgent (to be seen as soon as possible), example deep vein thrombosis; (3) semi-urgent (to be attended to within 30–90 days), example highly symptomatic chronic venous disease, and (4) discretionary/non-urgent- (to be seen within 6–12 months), example chronic lymphoedema. Venous and Lymphatic Triage and Acuity Scale aims to standardise the triage of patients with venous and lymphatic disease or vascular anomalies by providing an international consensus-based classification of clinical categories and triage urgency. The scale may be used during pandemics such as the current COVID-19 crisis but may also be used as a general framework to classify urgency of the listed conditions.

Background Cyanoacrylates are fast-acting adhesives used in procedural medicine including closure of superficial wounds, embolization of truncal vessels pre-operatively, vascular anomalies, visceral false aneurysms, endoleaks, gastrointestinal varices and gastrointestinal bleeding. More recently, catheter-directed cyanoacrylate adhesive closure was introduced as an alternative to endovenous thermal ablation (ETA) to occlude superficial veins of the lower limbs. Objectives To formulate policies for the safe and effective delivery of cyanoacrylate adhesive closure procedures in Australasia, based on current experience and evidence. Methods A panel of phlebologists including vascular surgeons, interventional radiologists, dermatologists and research scientists systematically reviewed the available data on cyanoacrylate products used in medicine and shared personal experience with the procedure. The reviewed material included bibliographic and biomedical data, material safety data sheets and data requested and received from manufacturers. Results and recommendations: Cyanoacrylate adhesive closure appears to be an effective treatment for saphenous reflux with occlusion rates at 36 months of 90–95%. We recommend a maximum dose of 10 mL of cyanoacrylate per treatment session. Serious complications are rare, but significant. Hypersensitivity to acrylates is reported in 2.4% of the population and is an important absolute contraindication to cyanoacrylate adhesive closure. 1 Post-procedural inflammatory reactions, including hypersensitivity-type phlebitis, occur in 10–20% of patients. 2 In the long term, cyanoacrylate adhesive closure results in foreign-body granuloma formation within 2–12 months of the procedure. We recommend against the use of cyanoacrylate adhesive closure in patients with uncontrolled inflammatory, autoimmune or granulomatous disorders (e.g. sarcoidosis). Caution should be exercised in patients with significant active systemic disease or infection and alternative therapies such as thermal ablation and foam sclerotherapy should be considered. Conclusions Cyanoacrylate adhesive closure appears to be an effective endovenous procedure, with short-term closure rates comparable to ETA and therefore greater efficacy than traditional surgery for treating superficial veins of the lower limbs. Ongoing data collection is required to establish the long-term safety.

Sustainable development brings together a series of normative themes related to negotiating environmental limits, to addressing equity, needs and development, and to the process of transformation and transition. To mark the thirtieth anniversary of Our Common Future (1987), that first placed sustainable development on the global agenda, the editors have brought together a group of international scholars from a range of social science backgrounds. They have discussed these same themes - looking backwards in terms of what has been achieved, assessing the current situation with respect to sustainable development, and looking forwards to identify the key elements of the future agenda. This book presents a series of critical reflections on these enduring themes. The overriding concern is with the present and with the future as the editors seek to explore the question: What next for sustainable development?

(2016). RETRACTED ARTICLE: Nuclear energy and path dependence in Europe’s ‘Energy union’: coherence or continued divergence? Climate Policy: Vol. 16, European Energy Governance and Decarbonization Policy: Learning from the 2020 Strategy, pp. 622-641.

Key Points Question How can clinical departments implement a clinical decision support tool to predict expected resource use to prioritize elective inpatient surgical procedures? Findings In this prognostic study, predictive models for length of stay, intensive care unit length of stay, mechanical ventilator requirement, and discharge disposition to a skilled nursing facility were developed using historical case data abstracted from the electronic health records of 42 199 patients. These models were integrated into an interactive online dashboard with end-user input and iteratively tested. Meaning Predictive modeling, in conjunction with other contextualizing factors, can be used to inform how to recommence elective inpatient procedures after the coronavirus disease 2019 (COVID-19) pandemic., Importance Hospitals ceased most elective procedures during the height of coronavirus disease 2019 (COVID-19) infections. As hospitals begin to recommence elective procedures, it is necessary to have a means to assess how resource intensive a given case may be. Objective To evaluate the development and performance of a clinical decision support tool to inform resource utilization for elective procedures. Design, Setting, and Participants In this prognostic study, predictive modeling was used on retrospective electronic health records data from a large academic health system comprising 1 tertiary care hospital and 2 community hospitals of patients undergoing scheduled elective procedures from January 1, 2017, to March 1, 2020. Electronic health records data on case type, patient demographic characteristics, service utilization history, comorbidities, and medications were and abstracted and analyzed. Data were analyzed from April to June 2020. Main Outcomes and Measures Predicitons of hospital length of stay, intensive care unit length of stay, need for mechanical ventilation, and need to be discharged to a skilled nursing facility. These predictions were generated using the random forests algorithm. Predicted probabilities were turned into risk classifications designed to give assessments of resource utilization risk. Results Data from the electronic health records of 42 199 patients from 3 hospitals were abstracted for analysis. The median length of stay was 2.3 days (range, 1.3-4.2 days), 6416 patients (15.2%) were admitted to the intensive care unit, 1624 (3.8%) received mechanical ventilation, and 2843 (6.7%) were discharged to a skilled nursing facility. Predictive performance was strong with an area under the receiver operator characteristic ranging from 0.76 to 0.93. Sensitivity of the high-risk and medium-risk groupings was set at 95%. The negative predictive value of the low-risk grouping was 99%. We integrated the models into a daily refreshing Tableau dashboard to guide decision-making. Conclusions and Relevance The clinical decision support tool is currently being used by surgical leadership to inform case scheduling. This work shows the importance of a learning health care environment in surgical care, using quantitative modeling to guide decision-making., In this prognostic study, the development and performance of a clinical decision support tool to inform resource utilization for elective procedures requiring inpatient care were evaluated.

Despite high uncertainties, strongly diverging values, and often-perverse effects of powerful vested interests, large and complex projects require clear decisions to be made from the outset. Coburn and Stirling introduce multicriteria mapping (MCM) as a problem structuring method for addressing these challenges in project appraisal by engaging with key stakeholders, broadening out the scope of the project, and opening up alternative possible interpretations concerning how to proceed. From defining project goals through to analysing results, two case studies illustrate the MCM process. The resulting interlinked quantitative and qualitative information provides a broader and deeper picture than is usual. Clearly highlighting how different conditions hold contrasting practical implications for action, MCM offers a more robust basis for making decisions under circumstances of uncertainty and complexity.

This paper examines a variety of theories bearing on ‘socio-material incumbency’ and explores methodological implications. The aim is to develop a systematic general approach, which builds on strengths and mitigates weaknesses in prevailing analytical frameworks. Defining power as ‘asymmetrically structuring agency’, incumbency is visible in a diversity of power gradients constituted by multiple economic, political and social processes. But existing representations of these incumbency-reinforcing dynamics often neglect their own exposures to effects of incumbency. The result can be a self-acknowledged tendency to “reify” focal categories and assumptions. Under an ostensibly detached ‘eagle-eye view’ (as if from a lofty governance ‘cock-pit’), ‘fallacies of misplaced concreteness’ emphasise unduly simplified notions like ‘the regime’. These can serve to exaggerate the confined, congruent, discrete and singular properties of incumbency in any setting. This picture may in turn overstate the tractability of incumbency to conventional policy instruments. Resulting actions that aim to challenge incumbency, but neglect its wider and deeper forms, may inadvertently help reinforce it. An alternative is argued to lie in addressing incumbency as a ‘multiplexity’ of overlapping ‘configuring fields’. Pervading an entire ‘milieu’ of imaginably viable socio-material configurations, these gradients in structuring agency display both ‘scalar intensity’ (in concentrating power) and ‘vector intensity’ (in orienting particular associated pathways for change). For purposes of interrogating empirical evidence, this allows a heuristic distinction between different ‘topologies of incumbency’. With a conventional ‘eagle-eye view’ of a ‘closed topology’ forming one ideal-type, the paper systematically contrasts an alternative ‘worm-eye view’ of an ‘open topology’ of incumbency. This recognises that patterns in configuring fields that constitute incumbency are often more pervasive, polycongruent, entangled and plural (so less tractable) than envisaged in an ‘eagleeye’ view. This more nuanced, less instrumentalised, picture suggests other kinds of methodological responses in which some potentially empirically testable questions are explored. Possible practical implications extend beyond narrow policy interventions, to embrace broader and deeper kinds of political collective action, culture change and democratic struggle. The findings will be tested in a second empirical paper in this two-part series.

Noting the increasingly unfavourable economic and operational position of nuclear power around the world, this paper reviews evidence for a hitherto neglected connection between international commitments to civil and military nuclear infrastructures. Reviewing well established understandings of interlinkages associated with fissile materials and other nuclear weapons related substances, the paper surveys a distinct – and currently potentially more important – kind of interdependency that has up to now received virtually no policy attention. This relates to the national industrial supply chains necessary for the manufacture and operation of nuclear propelled submarines, that are deemed central to strategic military doctrine in a few states – and to burgeoning ambitions in a number of others. One of the most striking features of these interdependencies, is that evidence is so strong in strategic military literatures, but that the issue is typically so neglected in energy policy analysis. So the repercussions extend beyond specific domains of civil and military nuclear policy making in themselves – significant as these may be. Across a range of countries, arguably the most important implications arise for the rigour and transparency of mainstream academic and energy policy analysis and the quality and accountability of wider democratic processes – that are failing to give due attention to the evident force of these connections. With civil nuclear power now increasingly recognised to be growing obsolescent as a low carbon energy source, but key military capabilities evidently depending so strongly on its maintenance, a potentially important new window of opportunity may be opening up for robust measures to reduce global military nuclear threats.

The United Kingdom was not the first country to consider regulations for TV white spaces (TVWS). However, following its detailed and painstaking implementation the UK regulatory model has been influential as other regulators around the world seek a solution that fits their needs.

In this interview, Andy Stirling talks to Michael Kattirtzi about what initially drew him to Science and Technology Studies, his account of the impact of the Science Wars on the field, and why it matters that STS researchers do not shy away from challenging incumbents. Through a series of thoughtful reflections on his encounters with STS researchers, Stirling arrives at the conclusion that we should not expect the field to reconcile tensions that are more deeply rooted in society. Nonetheless, he hopes that in the future STS researchers will be more open and admitting of a plurality of epistemic perspectives within the field and avoid overly constraining it––all the while as he continues to demonstrate the value of appreciating such epistemic pluralism to policy-makers and stakeholders. A reflection by Michael Kattirtzi follows the interview.

The notion of a ‘policy mix’ can describe interactions across a wide range of innovation policies, including ‘motors for creation’ as well as for ‘destruction’. This paper focuses on the United Kingdom’s (UK) ‘new policy direction’ that has weakened support for renewables and energy efficiency schemes while strengthening promotion of nuclear power and hydraulic fracturing for natural gas (‘fracking’). The paper argues that a ‘policy apparatus for incumbency’ is emerging which strengthens key regime-based technologies while arguably damaging emerging niche innovations. Basing the discussion around the three technology-based cases of renewable energy and efficiency, fracking, and nuclear power, this paper refers to this process as “destructive recreation”. Our study raises questions over the extent to which policymaking in the energy field is not so much driven by stated aims around sustainability transitions, as by other policy drivers. It investigates different ‘strategies of incumbency’ including ‘securitization’, ‘masking’, ‘reinvention’, and ‘capture.’ It suggests that analytical frameworks should extend beyond the particular sectors in focus, with notions of what counts as a relevant ‘policy maker’ correspondingly also expanded, in order to explore a wider range of nodes and critical junctures as entry points for understanding how relations of incumbency are forged and reproduced.

The paper critically reviews the work of David Collingridge in the light of contemporary concerns about responsibility and accountability in innovation, public engagement with science and technology, and the role of scientific expertise in technology policy. Given continued interest in his thoughts on the ‘social control of technology’, and the ‘dilemma of control’, this attention is both timely and overdue. The paper illuminates a mismatch between the prevalence of citations to Collingridge’s work on the dilemma of control in the literature on responsible innovation, and the depth of engagement with his arguments. By considering neglected aspects of Collingridge’s substantive, methodological and philosophical analysis, important implications can be drawn for theory and practice relating to the governance of innovation and co-evolution between technology and society. The paper helps to improve understandings of wider political contexts for responsible innovation, especially in relation to anticipatory, participatory and institutional aspects of governance.

This chapter engages with three important themes of the larger report: the meaning of progress, its uneven nature, and obstacles to future progress. It also considers a number of political and economic alternatives aimed to overcome these obstacles, emphasizing the need for diverse strategies, open-minded experimentation, and scientific assessment. While it may be impossible to ever reach agreement, the effort to calibrate different interpretations of progress remains an important exercise for political deliberation about how to make the world a better place. The very hope of moving forward implies some agreement on a destination. All of us must take responsibility for the future. Our discussion emphasizes the complexity and multidimensionality of the interpretive debate, but also calls attention to its ideological character. Social actors-individuals, groups, and even academic disciplines-tend to define progress in ways that serve their own interests. In a way, distributional conflict undermines our very efforts to better understand and mediate such conflict. The uneven character of progress is manifest in many different domains. Increases in the global reach of formally democratic institutions have been accompanied by growing concerns about their stability, efficacy, and consistency with democratic ideals.

This paper examines a variety of theories bearing on ‘socio-material incumbency’ and explores methodological implications. The aim is to develop a systematic general approach, which builds on strengths and mitigates weaknesses in prevailing analytical frameworks. A particular priority lies in avoidance of self-acknowledged tendencies in existing theory to ‘reify’ central notions like ‘the regime’. Such pictures may overstate the tractability of incumbency to conventional policy instruments and so inadvertently help reinforce it. Based on detailed analysis of ways in which longstanding concepts of structuration apply to socio-material change, a novel ‘configuring fields’ approach is proposed. Contrasting ‘eagle-eye’ and ‘worm-eye’ views are each shown to yield distinctive possible ‘topologies of incumbency’. This results in testable hypotheses with potentially important practical implications. Attention can thus extend beyond narrow policy instruments and mixes, to fully embrace broader and deeper kinds of political collective action, culture change and democratic struggle.

Civil society is a critical arena both for exploring Sustainability itself and for sustaining trajectories towards it through innovation, experimentation and debate. Innovations can be mould breaking and can challenge local institutions. Concurrently, initiatives may be fragile due to the development of new working relationships, reliance on voluntary labour and goodwill, and dependence on grant funding. Here we examine different aspects of what it takes to sustain grassroots trajectories for ‘communal growing’, given the pressures that groups and intermediary organisations practicing and supporting this activity experience, and the consequential need to build qualities like ‘resilience’. Attending carefully to the definition of this otherwise slippery concept, a particular focus is given to how contrasting aspects of temporality and agency lead to divergent constructions of ‘resilience’ and strategies for sustaining growing. We draw on fieldwork that explores the practice and support of communal growing in East Sussex, England, and directly associated activities at a national level. We find important interdependencies between communal growing projects and the intermediary organisations supporting them. Additionally there is huge diversity within and between both projects and the organisations that support them, including with respect to the ends to which growing is seen as a means. These ends link growing initiatives – both antagonistically and synergistically – to food, education and health systems. This diversity can be seen positively as: a source of innovation; facilitating the open and bottom up nature of growing; and, enabling the securing of greater financial support for the endeavour. What is less clear is how this plays into framing and configuring communal growing specifically in relation to achieving a more Sustainable and localised food system. We discuss the conceptual and methodological implications of these empirically derived observations with regards future research on grassroots innovations.

The ability of innovation—both technical and social—to stretch and redefine ‘limits to growth’ was recognised at Stockholm in 1972, and has been a key feature in debates through to Rio+20 in 2012. Compared with previous major moments of global reflection about human and planetary futures—Stockholm, Rio in 1992, Johannesburg in 2002—we now have a better understanding of how innovation interacts with social, technological, and ecological systems to contribute to transitions at multiple levels. What can this improved understanding offer in terms of governance approaches that might enhance the interaction between local initiatives and global sustainability objectives post-Rio+20? The global political agenda over the last two decades has largely focused on creating economic and regulatory incentives to drive more sustainable industrial development patterns within and between nation-states—resulting most notably in the Convention on Biological Diversity and the United Nations Framework Convention on Climate Change. At the other end of the spectrum, ‘Local Agenda 21’, launched at the first Rio summit, envisaged a community-led response to sustainable development challenges locally. This paper discusses the successes and challenges of globally linked local action through a number of illustrative examples, reflecting on how these have contributed to Rio 1992’s original objectives. In doing so, we will draw upon innovation studies and development studies to highlight three key issues in a hybrid politics of innovation for sustainability that links global and local: first, the direction in which innovation and development proceed; second, the distribution of the costs, benefits, and risks associated with such changes; third, the diversity of approaches and forms of innovation that contribute to global transitions to sustainability. Drawing on this analysis, we will also reflect on Rio+20, including the extent to which hybrid innovation politics is already emerging, whether this was reflected in the formal Rio+20 outcomes, and what this suggests for the future of international sustainable development summits. Keywords: Rio Earth Summit, Rio+20, sustainable development, pathways, grassroots innovation

In their Policy Forum “China-U.S. cooperation to advance nuclear power” (5 August, p. [547][1]), J. Cao et al. make the case for low-carbon energy trajectories that use “next-generation” nuclear reactors. However, they fail to address the challenges inherent in the reactors they advocate.

Equally at national and the highest international levels, few issues in technology governance are more vexed than those around the precautionary principle. Often using colourful rhetoric – and frequently paying scant attention to the substantive form taken by precaution in any given setting, even ostensibly academic analyses accuse precautionary approaches of being ‘dangerous’, ‘arbitrary’, ‘capricious’ and ‘irrational’ – somehow serving indiscriminately to ‘stifle discovery’, ‘suppress innovation’ and foster an 'anti-technology’ climate. The widely advocated alternative is ‘science based’ risk assessment – under which single aggregated probabilities are assigned to supposedly definitively-characterised possibilities and asserted to offer sufficient representations of the many intractable dimensions of uncertainty, ambiguity and ignorance. The high economic and political stakes combine with their expediency to entrenched institutional and technological interests, to intensify these arguments. Amidst all the noise, it is easy to miss the more balanced, reasonable realities of precaution. \ud \ud By reference to a large literature on all sides of these debates, this paper shows how these pressures are not only misleading, but themselves seriously unscientific – leading to potentially grave vulnerabilities. Experience over more than a century in technology governance, shows that the dominant issues are not about calculation of probabilities, but about the effects of power in innovation and regulatory systems, the need for balanced consideration of alternative options, scrutinising claimed benefits as much as alleged risks and always being vigilant for the ever-present possibility of surprise. In this light, it is not rational to assert that incertitudes of many difficult kinds must always take the convenient forms susceptible to risk assessment. To invoke the name of science as a whole, in seeking to force such practices, is gravely undermining of science itself. And these pressures also seriously misrepresent the nature of innovation processes, in which the 2 branching evolutionary dynamic means that concerns over particular trajectories simply help to favour alternative innovation pathways. \ud \ud Precaution is about steering innovation, not blocking it. It is not necessarily about ‘banning’ anything, but simply taking the time and effort to gather deeper and more relevant information and consider wider options. Under conditions of incertitude to which risk assessment is – even under its own definition – quite simply inapplicable, precaution offers a means to build more robust understandings of the implications of divergent views of the world and more diverse possibilities for action. Of course, like risk assessment, precaution is sometimes implemented in mistaken or exaggerated ways. But the reason such a sensible, measured approach is the object of such intense general criticism, has more to do with the pervasive imprints of power in and around conventional regulatory processes, than it does with any intrinsic features of precaution itself. Whilst partisan lobbying is legitimate in a democracy as a way to advance narrow sectoral interests, it is unfortunate when such rhetorics seek spuriously to don the clothing of disinterested science and reason in the public interest. \ud \ud Taking the best of all approaches, this paper ends by outlining a general framework under which more rigorous and comprehensive precautionary forms of appraisal, can be reconciled with riskbased approaches under conditions where these remain applicable. A number of practical implications arise for innovation and regulatory policy alike, spanning many different sectors of emerging technologies. In the end, precaution is identified to be about escaping from technocratic capture under which sectoral interests use narrow risk assessment to force particular views of the world. What precaution offers to enable instead is more democratic choice under ever-present uncertainties, over the best directions to be taken by innovation in any given field.

This article attempts to illuminate the story behind the African push to allow mobile broadband into the 700 MHz band, which caught European policy-makers off-guard, at the World Radio Conference. It aims to show why African policy-makers have more to gain and less to restrain them, than their European counterparts have.