The irrigation efficiency paradox says that raising the efficiency of irrigation systems, thereby reducing return flows, either gives no change in water depletion or it raises depletion via increased ...evapotranspiration and irrigated area. While this paradox can occur, there are problems associated with it. It eludes precise explanation and characterisation; it can be confused with other irrigation hydrology paradoxes; it is one of several ways irrigated areas increase; it over-emphasises the role of return flows; it relies on other irrigation variables (usually unstated) being uncontrolled; it can be inverted to reduce depletion; and it may mistakenly guide the conservation of water in irrigated systems. Addressing these concerns, a comprehensive predictive model called Irrigated Systems Accounting (ISA) analyses irrigation undergoing water conservation based on accounts for soil-crop evapotranspiration, irrigation efficiency (IE), irrigation practices and infrastructure, withdrawals, depletion, crop production and water reallocation. By using more calculi than current water accounting, ISA; resolves irrigation efficiency paradoxes; predicts how an irrigated system changes its aggregate area and depletion via primary, expansion and reuse zones; and reveals how other non-IE factors drive up area but not necessarily depletion. Compiling all zonal changes reveals how reductions in aggregate depletion can be derived and reallocated to other users without cutting crop production. The paper concludes there are hazards for water policy if irrigation efficiency and depletion are exclusively tied together via imprecise characterisations that draw on water accounting models containing few terms and relationships.
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•Irrigated systems accounting (ISA) is a model to quantify aggregate water depletion for reallocation.•It applies irrigation efficiency, practices and infrastructure in primary, expansion and reuse zones.•It can cut aggregate depletion (real savings) pareto-checked against crop ET/production.•Higher irrigation efficiency, with lower withdrawals, area and duration, deliver real savings.•Often misunderstood, the irrigation efficiency paradox over-relies on recovered flows.
Many water sustainability and governance issues around the world can be viewed as wicked problems, whereby a solution, even if quite broad and comprehensive, may be contested because of high ...complexity, uncertainty, and diverging perspectives. These types of issues and their contestation thus create a complex landscape of possible solutions, which we term a water governance "solutionscape." We develop the concept of the solutionscape to identify different types of solutions that present themselves through the emphases placed upon four major dimensions: science, policy, practice, and participation. After first considering these four dimensions via a literature review, we then conceptualize the solutionscape's expressions comprising six different solution pathways. These are comprehensive solutions, where all four dimensions are equally supported and integrated; clumsy solutions, where multiple solutions are pursued separately without coordination (risking contradictions); two types of expedient solutions (high and low-cost), which involve attempts to pursue outcomes rapidly; solutionism, which refers to the over-emphasis of one dimension in an attempt to provide a quick-fix (leading to unintended consequences); and finally anti-solutions, whereby one or more dimensions are actively disputed or disregarded by policy makers. An example from South Africa is used to illustrate the framework's key components. We then discuss the allure of solutionism in solving wicked water problems, and how alternatives might be envisaged with the consideration of often-hidden institutional processes and power. Finally, we consider the value of the solutionscape as an integrative heuristic tool to discuss wicked water problems, recognizing issues such as plural perspectives and power asymmetries between stakeholders.
•Maternal and fetal survival was favorable after severe COVID-19.•Prone positioning was feasible and well tolerated.•Proning or delivery had unclear impacts on maternal ventilation and ...oxygenation.•Airway management preparation includes contingency planning for emergent delivery.
We present the care of 17 consecutive pregnant patients who required mechanical ventilation for Coronavirus Disease 2019 (COVID-19) pneumonia at a quaternary referral center in the United States. We retrospectively describe the management of these patients, maternal and fetal outcomes, as well as the feasibility of prone positioning and delivery.
Between March 2020 and June 2021, all pregnant and postpartum patients who were mechanically ventilated for COVID-19 pneumonia were identified. Details of their management including prone positioning, maternal and neonatal outcomes, and complications were noted.
Seventeen pregnant patients required mechanical ventilation for COVID-19. Thirteen patients received prone positioning, with a total of 49 prone sessions. One patient required extracorporeal membrane oxygenation. All patients in this series survived until at least discharge. Nine patients delivered while mechanically ventilated, and all neonates survived, subsequently testing negative for SARS-CoV-2. There was one spontaneous abortion. Four emergent cesarean deliveries were prompted by refractory maternal hypoxemia or non-reassuring fetal heart rate after maternal intubation.
Overall, maternal and neonatal survival were favorable even in the setting of severe COVID-19 pneumonia requiring mechanical ventilation. Prone positioning was well tolerated although the impact of prone positioning or fetal delivery on maternal oxygenation and ventilation are unclear.
Abstract Despite growing evidence to the contrary, it is still widely assumed that suicide terrorists are not actually suicidal. However, this review supports recent studies which suggest the ...opposite, and presents initial evidence that much like other suicidal individuals, many suicide terrorists appear to be driven by clinically suicidal risk factors, including: (1) the desire to escape the world they live in, (2) the desire to escape moral responsibility for their actions, (3) the inability to cope with a perceived crisis, and (4) a sense of low self-worth. By establishing the links between suicide terrorism and suicidality, scholars may be able to better understand the nature of these violent attacks and develop more effective ways to stop them.
•Quantitative assessment of blood loss (QBL) systems are available.•Introduction of a QBL system suggested differences compared with simple estimation of blood loss.•Differences were in the timing ...and volume of peripartum blood loss.•Recognition of postpartum haemorrhage was enhanced but blood loss lower.•Differences in outcomes associated with QBL varied according to mode of delivery.
Imprecise visual estimates of blood loss contribute to morbidity from postpartum hemorrhage. We examined the impact of quantitative assessment of postpartum blood loss on clinical practice and outcomes.
An observational study comparing blood loss, management and outcomes between two historical cohorts (August 2016 to January 2017 and August 2017 to January 2018) at an academic tertiary care center. Patients in the intervention group (second period) had blood loss quantified compared with visual estimation for controls.
We included 7618 deliveries (intervention group n=3807; control group n=3811). There was an increase in the incidence of hemorrhage (blood loss >1 L) in the intervention group for both vaginal (2.2% vs 0.5%, P <0.001) and cesarean delivery (12.6% vs 6.4%, P <0.001). There was also a difference in median blood loss for vaginal (258 mL 151–384 vs 300 mL 300–350, P <0.001); and for cesarean delivery (702 mL 501–857 vs 800 mL 800–900, P <0.001). The median red blood cell units transfused was different in the intervention group having cesarean delivery (2 units 1–2 vs 2 units 2–2, P=0.043). Secondary uterotonic usage was greater in the intervention group for vaginal (22% vs 17.3%, P <0.001) but not cesarean delivery (7.0% vs 6.0%, P=0.177). Laboratory costs were different, but not the re-admission rate or length of stay.
Quantifying blood loss may result in increased vigilance for vaginal and cesarean delivery. We identified an association between quantifying blood loss and improved identification of postpartum hemorrhage, patient management steps and cost savings.
Two of Tony Allan's phrases - big water and accountants will save the world - invite me to argue that irrigation is poorly served when its hydrology is seen solely as big or via accounts. While big ...applies because irrigated areas deplete considerable volumes of water, irrigation systems contain many more water relations, behaviours and puzzles. In this problematic, environmental, social and governance (ESG) and water accountants and accounts will become a dominant force. This is worrying for the degree to which individual irrigation systems are rendered into catchment-level accounting abstractions, removing us from a more vital, multidisciplinary, cross-scale and action-oriented approach.
•A paracommons is a commons of water redistribution following irrigation water conservation.•Four paracommoners vie for these gains; the proprietor, neighbour, nature and society.•We demonstrate how ...changes in water management redistribute water to paracommoners.•Water gains usually accrue to the proprietor and neighbour, less to nature and society.•The paracommons provides insights on governing water conservation and its effects.
Based on understandings of a natural resource commons, we examine the competition for redistributed irrigation water following water conservation. A ‘paracommons’ is characterised by an interconnected hydrology whereby changes to a proprietor's water management alters its distribution into different fractions/dispositions thereby adjusting water allocations to the four paracommoners; including the proprietor conserving water, an immediate neighbour, society and nature. The topic is important given the volumes potentially involved in irrigation savings; for example, a 15% reduction in the annual water depletion of an irrigation area of 30,000 hectares can notionally meet the domestic demands of one million people at 150 l/day/pp. However, this illustration, seeming to indicate that water conservation results in sizeable predictable outcomes, hides how water savings are captured by, or flow to, a paracommoner within the interlinked system. Using data from Mendoza, Argentina, we employ a model to examine 12 scenarios of conservation-driven water reallocation among paracommoners, and conclude with generalizable lessons.
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Initiated by a research project examining agricultural and water resilience in South Africa and tested in workshops on a range of topics, we reflect on our application of a half-to-one day “games ...designing” format for constructing dynamic metaphors for complex systems and related concepts (e.g., the resilience or sustainability of a catchment/agricultural marketing system). While this short format gives rich and detailed games that potentially could be played in an extended version of the workshop, we did not go ahead with this step. Instead, we devoted the limited time available to supporting participants in designing, comparing and discussing their games and to exploring the concepts and meanings of a given complex system, even if the latter was initially deemed by participants to be abstract and “academic”. Our abridged term for short-format games designing is “rapid games designing” (RGD). Key benefits to participating individuals, the whole group and workshop organizers include (a) the highly productive and creative use of limited time; (b) an inclusive group exercise that draws everyone into the process; (c) rich discussion of pluralist viewpoints through the comparison of the remarkable variety of games generated, including their differences in purpose, players and rules; and (d) observations on how the games construct a dynamic metaphor for the system and its properties, leading to deeper insights and knowledge building regarding system concepts and components. Here, we use two case studies in South Africa to explore what value RGD provides and how it does so, and then we briefly compare it to other similar methods. We also provide practical guidance for facilitating RGD workshops. In conclusion, we argue this format offers an option for the ongoing evolution of games about complex human, natural and socio-ecological systems and that it generates considerable creativity, learning, discussion and insights amongst all participants.
We propose the concept of 'agri-vector water' (AVW) to refer to water allocated to towns to maintain urban-based agricultural services that support rainfed farming in surrounding areas. AVW captures ...the idea that highly scarce 'blue water' can be productively used in this way to support rainfed 'green water' rather than be applied as consumptive irrigation, especially when the latter exacerbates water shortages during drought and dry seasons in arid and semi-arid regions. To illustrate, we present two case studies from Ethiopia.
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