Regional Approach Research Articles

Embedding a Circular Economy through Local Government in Gippsland: A Case Study, Utilising Smart Specialisation Methodology

AbstractIn 2017, the ageing Hazelwood coal-fired power station in Gippsland (Australia), finally—and abruptly, closed. The Latrobe Valley Authority (LVA), funded by the Victorian State Government was then established to assist redundant workers and develop a long-term approach to transitioning towards a more sustainable regional economy and socially cohesive community. To enable this, the LVA adopted and implemented a methodology made popular in the European Union of the ‘Smart Specialisation Strategy’ (S3), bringing together practitioners from government, business, research and education, and the wider local community (known as the ‘quadruple helix’) to co-design a shared vision for the region’s future prosperity. With Australia declaring its commitment to and the Victorian government developing policy support for a Circular Economy (CE), the LVA funded a research project in 2022 to facilitate a ‘place-based’ approach to implementing a CE business model across Gippsland. Based on interviews and workshops conducted in the period 2022–23 with key regional stakeholders, as well as on the analysis of secondary sources, this paper provides an overview of the experience utilising the S3 methodology to explore the implementation of CE in a regional setting, historically dominated by natural resource-based industries, that is now undergoing multiple economic transitions, including cessation of coal-fired power generation, oil and gas extraction and native timber harvesting. Significant barriers identified include: poor understanding of broader opportunities embedded in systemic notions of S3 and CE, siloed structure of local government authorities (both within or between councils), difficulty in promoting alignment and cooperation at all levels between a diverse range of stakeholders, lack of policy coordination and support for business innovation, together with the absence of financial incentives or regulatory mechanisms to change behaviour from a linear to CE. Despite improved intentions in policy settings around intentionality of CE practices and other initiatives being progressed simultaneously with this work, CE in Gippsland (and Victoria more broadly) and its implementation continue to be narrowly focussed on recycling and waste management, where there are clear pressures in stock-piling of waste and limitations on landfill expansion. Regional approaches to implementation of circular economy are limited in Australia, with the exception of exemplars such as Geelong, Barwon South West, and Bega. However, there are currently no examples of utilising S3 methodology to implement CE in a regional setting. Here we identify current barriers and provide recommendations on how to overcome these with the engagement of a diverse range of stakeholders across Gippsland from agribusiness, regional planning, local governments, small and medium enterprises, utilising S3 methodology, to enable systemic changes towards CE models to be implemented region-wide. This study documents the journey so far for Gippsland, where the transition from traditional extractive industry provides the opportunity to embed more sustainable practices moving forward.

Regional Approach to Boosting Local Pharmaceutical Manufacturing Capacity: A Critique of the East African Community Pharmaceutical Manufacturing Plan of Action

Abstract The East African Community (EAC) has had a chequered history, evidenced by multiple changes of names and objectives, and a hiatus lasting more than two decades following a collapse in 1977. It was resuscitated in 1999 by its founding members (Uganda, Tanzania, and Kenya). That four other partner states have since joined is a clear testament to the effectiveness of its overhaul. The community is regulated by the EAC Treaty which promotes collective actions in several areas of mutual interests. Plagued by an ongoing access-to-medicines conundrum, EAC governments have considered collective action as recommended by the Treaty. This effort began around the 2010s when policy measures aimed at exploring collective solutions were adopted with a view to replacing reliance on importation and external drug donation with a gradually developed regional pharmaceutical production capacity. EAC policies such as the Policy/Protocol on TRIPS Flexibilities, the Medicines Registration Harmonisation Initiative, the Draft Anti-Counterfeit Policy, and a Pharmaceutical Manufacturing Plan of Action (EAC PMP) have since been developed to achieve this ambitious goal. Using both doctrinal and empirical (semi-structured interviews) methods, this paper examines the EAC PMP – the ‘be all’ of the policies. The priority actions outlined under the plan’s six pillars and presented as a bankable pathway to self-sufficiency in pharmaceutical production are critiqued. The paper finds considerable implementation of the drug harmonisation theme, while the others (leveraging TRIPS flexibilities, ensuring coherence, and boosting research and development and technology transfer) remain largely unimplemented.

Seizure freedom using a regional approach to responsive neurostimulation for multifocal drug-resistant epilepsy: illustrative case.

Responsive neurostimulation (RNS) has emerged as an effective neuromodulatory intervention for patients with medically refractory epilepsy who are not candidates for resective or ablative surgery. However, in patients with multifocal seizures arising from a widely distributed network, optimizing lead placement can be challenging. Here, the authors present the case of a patient with drug-resistant multifocal, nonlateralizing seizures and multiple developmental brain lesions who underwent phase II monitoring with stereoelectroencephalography electrodes targeting the lesion and surrounding cortex as well as the centromedian thalamus. Neurophysiological signals observed during recorded events implicated a seizure network within the left perisylvian polymicrogyria, involving the left parietal operculum, insula, and centromedian thalamic regions rather than a single focus. Using a regional RNS approach to modulate this network, the patient improved from 5 seizures a day to freedom from disabling seizures shortly after lead implantation despite low stimulation parameters. This has implications for understanding the timescale of adaptive mechanisms that occur in response to stimulation and supports the use of RNS as a surgical treatment for drug-resistant epilepsy. https://thejns.org/doi/10.3171/CASE24369.

Climate change impacts on hydrology and water resources in East Africa considering CMIP3, CMIP5, and CMIP6

Climate change impacts on the hydrology and water resources in East Africa require proper planning of regional adaptation measures. Past studies on the subject matter tended to focus on catchment instead of regional scale. To support actionable policy regarding regional planning of water resources management, this paper reviewed studies conducted in East Africa based on CMIP3, CMIP5, and CMIP6. Compared to the historical condition, temperature of East Africa over the mid- to late 21st century will increase by varying extents over the range 0.17–7°C with about 2.6°C on average. Future precipitation over East Africa will increase by 8.5% on average. Changes in discharge based on CMIP3, CMIP5, and CMIP6 will vary from −25.3 to +60.5%, −42.5 to 129%, and −23.4 to 69%, respectively. Ensemble means of the changes in discharge across the study area based on CMIP3, CMIP5, and CMIP6 will be by 25.2, 19.2, and 19.1%, respectively. Future peak river discharge across East Africa will increase by 8% on average. These results are important for planning regional climate change adaptation across East Africa. To support local or catchment adaptation, results of climate change impacts of temperature, precipitation and discharge of about 50 catchments across East Africa can be found summarized in this review paper. It is recommended that both regional and local policies or approaches should be considered for climate change adaptation to ensure a balanced, effective and sustainable framework for climate resilience in support of measures for tackling broad and specific needs cohesively.

Comparative Analysis Of Ai Governance In Africa Relative To Global Standards And Practices

Africa as a continent recognizes the need for Artificial Intelligence (AI) governance frameworks. However, despite initiatives like the African Union's Continental AI Strategy, African nations grappled with challenges in formulating comprehensive AI policies, while established global frameworks provided advanced benchmarks for comparison. To address this disparity, this study conducted a comparative analysis of AI governance in Africa relative to global standards and practices. Employing a comprehensive document analysis methodology, the research examined key policy documents, strategic frameworks, and regulatory guidelines across African, European, American, and Asian contexts. The findings revealed that while the African Union demonstrated commitment to coordinated AI governance, African approaches generally lagged behind global benchmarks in comprehensiveness, formalization, and ethical integration. The study identified a notable fragmentation in AI governance across African nations, contrasting with more unified approaches in other regions. African frameworks emphasized leveraging AI for socio-economic development, diverging from the risk mitigation focus seen in EU regulations. The integration of indigenous African ethical perspectives in AI governance frameworks was limited, presenting both challenges and opportunities. Significant disparities in digital infrastructure and AI capacity between Africa and other regions were found to affect governance implementation. The study concluded that despite these challenges, there was potential for Africa to develop innovative, context-specific AI governance models that could contribute valuable insights to the global discourse on responsible AI development. Recommendations included accelerating the implementation of the Continental AI Strategy, prioritizing investment in digital infrastructure, developing Africa-centric AI ethics frameworks, establishing mechanisms for regular benchmarking against global standards, fostering increased collaboration, and implementing AI literacy programs across the continent.

Regional BDE-209 emission, environmental fate and risks: Methods establishment, data filling and feature analysis

BDE-209 is an emerging environmental contaminant that poses a significant threat to human health. Despite its inclusion in the Stockholm Convention, the current regional emission levels, environmental fate, and corresponding risks remain unclear, especially with the ongoing release of BDE-209 during the disposal of waste electrical and electronic equipment. The significant gaps in BDE-209 emission data highlight the need for a regional approach to better understand these issues. Therefore, we established a method to identify regional BDE-209 emissions, environmental fate, and risks in the Guangdong–Hong Kong–Macao Greater Bay Area (GBA) using a substance flow analysis framework, fugacity model, and risk model. Our results showed: (1) Despite the increasing pressure of electronic waste, emissions have decreased with gradual strengthening of restrictions. The stage with the highest contribution to emissions is flame-retardant plastic production, which accounts for 41 % of emissions, followed by informal treatment (36 %). (2) The largest BDE-209 emissions are into air and soil, at 7.23 t and 4.56 t, respectively, and the highest reserves are in soil and sediment. (3) Infants and young children have the highest levels of exposure and cancer risk. This research helps fill the multi-regional data gap for BDE-209 and clarify the complex regional emission situation in the GBA.

Variability of thermal subthreshold retinal laser treatment plans

To investigate the variability in subthreshold laser treatment plans for patients with diabetic macular edema or central serous chorioretinopathy. Diagnostic images from 20 patients were utilized, and 25 retina specialists generated subthreshold treatment plans along with a self-rated experience level. Evaluation comprised of i) Area Variability (AV): quantifies the consensus regarding the covered area and is the difference between the areas planned by 75% and 25% of the participants ii) mean Centroid Distance (CD): level of agreement on the localization of a treatment. Subgroup analysis investigated the impact of participants’ experience levels, utilizing the Mann-Whitney-Wilcoxon test. The predominant plan style is a targeted treatment approach (92%) and avoidance of subfoveal region (89%). Mean CD is 71.0 ± 37.5 pixels (≈half disc diameter) and mean AV is 9.8%±8.9%. A slight difference is observed between the 50-75% areas, but a notable distinction exists between the 25-50% areas. Subgroup analysis revealed CD and AV value of 75.9 pixels and 24% in the lower experience level group as opposed to 55.9 pixels and 8.6% in the higher experience level group. There is significant variability in treatment planning which reduces with increased experience of retina specialists. While consensus is observed around focal points, differences in the surrounding extents persist.

Shrimp Larvae Counting Based on Improved YOLOv5 Model with Regional Segmentation

Counting shrimp larvae is an essential part of shrimp farming. Due to their tiny size and high density, this task is exceedingly difficult. Thus, we introduce an algorithm for counting densely packed shrimp larvae utilizing an enhanced You Only Look Once version 5 (YOLOv5) model through a regional segmentation approach. First, the C2f and convolutional block attention modules are used to improve the capabilities of YOLOv5 in recognizing the small shrimp. Moreover, employing a regional segmentation technique can decrease the receptive field area, thereby enhancing the shrimp counter’s detection performance. Finally, a strategy for stitching and deduplication is implemented to tackle the problem of double counting across various segments. The findings from the experiments indicate that the suggested algorithm surpasses several other shrimp counting techniques in terms of accuracy. Notably, for high-density shrimp larvae in large quantities, this algorithm attained an accuracy exceeding 98%.

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial

BackgroundObesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block.MethodsWe propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups—group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient’s overall postoperative recovery.DiscussionRegional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery.Trial registrationThis trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

A Multivariate Approach to Quantifying Risk Factors Impacting Stereotactic Robotic-Guided Stereoelectroencephalography.

Stereoelectroencephalography (SEEG) is an important method for invasive monitoring to establish surgical candidacy in approximately half of refractory epilepsy patients. Identifying factors affecting lead placement can mitigate potential surgical risks. This study applies multivariate analyses to identify perioperative factors affecting stereotactic electrode placement. We collected registration and accuracy data for consecutive patients undergoing SEEG implantation between May 2022 and November 2023. Stereotactic robotic guidance, using intraoperative imaging and a novel frame-based fiducial, was used for planning and SEEG implantation. Entry-point (EE), target-point (TE), and angular errors were measured, and statistical univariate and multivariate linear regression analyses were performed. Twenty-seven refractory epilepsy patients (aged 15-57 years) undergoing SEEG were reviewed. Sixteen patients had unilateral implantation (10 left-sided, 6 right-sided); 11 patients underwent bilateral implantation. The mean number of electrodes per patient was 18 (SD = 3) with an average registration mean error of 0.768 mm (SD = 0.108). Overall, 486 electrodes were reviewed. Univariate analysis showed significant correlations of lead error with skull thickness (EE: P = .003; TE: P = .012); entry angle (EE: P < .001; TE: P < .001; angular error: P = .030); lead length (TE: P = .020); and order of electrode implantation (EE: P = .003; TE: P = .001). Three multiple linear regression models were used. All models featured predictors of implantation region (157 temporal, 241 frontal, 79 parietal, 9 occipital); skull thickness (mean = 5.80 mm, SD = 2.97 mm); order (range: 1-23); and entry angle in degrees (mean = 75.47, SD = 11.66). EE and TE error models additionally incorporated lead length (mean = 44.08 mm, SD = 13.90 mm) as a predictor. Implantation region and entry angle were significant predictors of error (P ≤ .05). Our study identified 2 primary predictors of SEEG lead error, region of implantation and entry angle, with nonsignificant contributions from lead length or order of electrode placement. Future considerations for SEEG may consider varying regional approaches and angles for more optimal accuracy in lead placement.

Dalihan na tolu as a marketing strategy in attracting customer interest:Case study of PT Sipirok Nauli Medan branch

&lt;p&gt;This research aims to explore and gain a deeper understanding of the marketing strategies employed by PT. Sipirok Nauli Express in attracting customer interest. This research method used is descriptive qualitative, with data collection techniques involving in-depth interviews, observations, and documentation studies. The research informants consist of the Head of the PT Sipirok Nauli Express Medan Representative Office, ticketing staff, agents, warehouse staff, and 8 loyal customers of PT Sipirok Nauli Express Medan. Informants were selected using the snowball sampling technique. Based on the research findings, to increase the number of customers, the promotion strategy applied by the PT Sipirok Nauli Express Medan Representative Office focuses on three stages of marketing communication strategies. These strategies include the implementation of marketing communication objectives utilizing both conventional and digital promotional media; the implementation of segmentation and targeting through direct marketing strategies using local approaches such as local greetings (e.x., &lt;em&gt;ipar&lt;/em&gt;, lae, &lt;em&gt;oppung&lt;/em&gt;, &lt;em&gt;bapak uda&lt;/em&gt;, &lt;em&gt;amangoru&lt;/em&gt;, and &lt;em&gt;anggi&lt;/em&gt;) to create familiarity, build familial and emotional relationships through regional approaches; and the implementation of differentiation and positioning. Amidst technological innovations and service improvements aimed at attracting customer interest, PT Sipirok Nauli Express adopts a unique approach by leveraging regional approaches to attract and retain customers.&lt;/p&gt;

Sustainable and inclusive development in left-behind places

AbstractScholarly work in economic geography and regional science has recently seen a renewed interest in spatial inequalities, driven significantly by the debate on left-behind places and the resulting geographies of discontent. The plight of left-behind places calls for new place-based policy responses that address the specific challenges of these regions but that at the same time address grand societal challenges such as climate change, biodiversity loss, or pollution with synthetic chemicals. Despite growing attention among economic geographers and regional scientists to either green or inclusive regional development approaches, how to reconcile environmental sustainability and social inclusiveness in highly challenged left-behind places remains poorly understood. This editorial reflects on and critically discusses the literature on left-behind places and distils unifying conceptual characteristics of left-behindness. We argue that left-behindness is a temporal, relational, multidimensional, discursive, but not deterministic concept. The non-determinism of left-behindness opens up different choices for actors to shape regional futures. Imagining and negotiating these futures involves dealing with difficult potential trade-offs between environmental sustainability and social inclusiveness, some of which are explored by the articles in this special issue.

Improving Reproductive Efficiency in Dairy Cows through Hormonal Interventions: A Regional Approach

Improving Reproductive Efficiency in Dairy Cows through Hormonal Interventions: A Regional Approach

Towards a unified carbon accounting landscape.

The overarching purpose of carbon accounting is to reduce carbon emissions to meet net-zero targets and minimize the impact of climate change. However, the plethora of methods and approaches used means that products and systems sometimes cannot easily be compared. The mix of regional and life cycle-based systems can mean that we lack global oversight of our emissions and impact. In some situations where a regional approach is used, industry/business/regions are incentivized to reduce their own/territorial emissions, which can mean that an optimal global solution is not adopted. Countries where grid emissions are higher can be selected for production because it reduces regional (not global) carbon levels. Furthermore, these can be areas where the climate impact may be felt the most: not the just transition we aspire to. Our work provides an analysis of the current system together with its challenges and limitations, paving the way towards a more unified framework to create climate justice together with transparent and comparable accounting methodology for industry and regions alike. This article is part of the discussion meeting issue 'Green carbon for the chemical industry of the future'.

Shaping the curve from the microscopic transsphenoidal to the endoscopic endonasal approach for the sellar region

Shaping the curve from the microscopic transsphenoidal to the endoscopic endonasal approach for the sellar region

The genomics and physiology of abiotic stressors associated with global elevational gradients in Arabidopsis thaliana

Summary Phenotypic and genomic diversity in Arabidopsis thaliana may be associated with adaptation along its wide elevational range, but it is unclear whether elevational clines are consistent among different mountain ranges. We took a multi‐regional view of selection associated with elevation. In a diverse panel of ecotypes, we measured plant traits under alpine stressors (low CO2 partial pressure, high light, and night freezing) and conducted genome‐wide association studies. We found evidence of contrasting locally adaptive regional clines. Western Mediterranean ecotypes showed low water use efficiency (WUE)/early flowering at low elevations to high WUE/late flowering at high elevations. Central Asian ecotypes showed the opposite pattern. We mapped different candidate genes for each region, and some quantitative trait loci (QTL) showed elevational and climatic clines likely maintained by selection. Consistent with regional heterogeneity, trait and QTL clines were evident at regional scales (c. 2000 km) but disappeared globally. Antioxidants and pigmentation rarely showed elevational clines. High elevation east African ecotypes might have higher antioxidant activity under night freezing. Physiological and genomic elevational clines in different regions can be unique, underlining the complexity of local adaptation in widely distributed species, while hindering global trait–environment or genome–environment associations. To tackle the mechanisms of range‐wide local adaptation, regional approaches are thus warranted.

Review and analysis of mangrove litter production in Mexico: A contrasting regions approach

Review and analysis of mangrove litter production in Mexico: A contrasting regions approach

Cybercrime in Association of Southeast Asian Nations: Regional Effort and Its Effectiveness

Abstract The world has already observed how digitalization is reshaping countries in the Association of Southeast Asian Nations (ASEAN). ASEAN has experienced a positive gross domestic product (GDP) trend of over US$3.6 trillion by 2022, becoming the fifth largest economy in the world. However, ASEAN countries have become a prime target for cybercrimes, such as online scam hubs where people are forced to work in scam centers, data breaches, and cyberattack launchpads. This study analyzes the effectiveness of ASEAN’s regional approach in dealing with cybercrime issues while considering ASEAN’s substantial challenges in enhancing its cooperation against cybercrime. The conclusions will provide policy recommendations for strengthening ASEAN’s cybercrime framework.

Analysis of Neoadjuvant Chemotherapy Utilization, Pathologic Response, and Overall Survival in Upper Tract Urothelial Carcinoma

IntroductionUpper tract urothelial carcinoma (UTUC) is a rare malignancy with poor prognosis. Radical nephroureterectomy (RNU) remains the standard treatment for high-risk UTUC. Considering the decline in renal function with RNU and results from prospective trials, NAC has emerged as a favored perioperative treatment for chemo-eligible patients with UTUC. However, strong evidence of the efficacy of NAC and predictors for its use are scarce. We aimed to assess trends in NAC utilization and pathologic outcomes and survival with NAC use. MethodsThe National Cancer Database was queried for patients with high-grade cTanyNanyM0 UTUC treated with RNU from 2004 to 2019. Outcomes included overall survival (OS), pathologic response (pR) and pathologic complete response (pCR), defined as ≤pT1pN0/X and pT0pN0/X, respectively. ResultsOf 6,645 patients treated with RNU, 209 received RNU NAC. Greater distance from treatment facility decreased the likelihood of receiving NAC. Higher cT stages (OR 1.72, P = .028), cN+ status (OR 7.40, P < .001) and treatment at an academic facility (OR 2.02, P < .001) predicted NAC treatment. NAC was associated with 34.0% pR and 5.3% pCR. In multivariable analysis, patients with pR and pCR had improved OS (HR = 0.176, P < .014). ConclusionWe report significant response rates with NAC and improved OS in patients who experienced pR or pCR. Over a 15-year study period, NAC was underutilized, especially in nonacademic settings and among patients living farther from care facilities, underscoring the need for improved regionalization and multidisciplinary approaches in UTUC management.

Moving beyond simplistic representations of land use in conservation

AbstractLand use is both a major cause of the biodiversity crises and a potential solution to it. Decisions about land use are made in complex social–ecological systems, yet conservation research, policy, and practice often neglect the diverse and dynamic nature of land use. A deeper integration of land system science and conservation science provides major opportunities in this context, through a transfer of concepts, data, and methodologies. Specifically, a closer exchange between land‐use data developers and users will enable common terminology and better data use, allowing to move beyond coarse land‐cover representations of land use. Similarly, archetyping and regionalization approaches can help to embrace, rather than oversimplify, the diversity of land‐use actors and practices. Finally, systematically linking land‐use actors to portfolios of pressures on biodiversity, beyond their direct impact on habitat, can better represent and map co‐occurring and interacting threats. Together, this will enable conservation policymakers and planners to recognize the often‐complex and wicked nature of conservation challenges related to land, allowing for more context‐specific conservation policymaking and planning, and more targeted conservation interventions.