Participatory scenario development for environmental management: a methodological framework illustrated with experience from the UK uplands.

A methodological framework is proposed for participatory scenario development on the basis of evidence from the literature, and is tested and refined through the development of scenarios for the future of UK uplands. The paper uses a review of previous work to justify a framework based around the following steps: i) define context and establish whether there is a basis for stakeholder engagement in scenario development; ii) systematically identify and represent relevant stakeholders in the process; iii) define clear objectives for scenario development with stakeholders including spatial and temporal boundaries; iv) select relevant participatory methods for scenario development, during initial scenario construction, evaluation and to support decision-making based on scenarios; and v) integrate local and scientific knowledge throughout the process. The application of this framework in case study research suggests that participatory scenario development has the potential to: i) make scenarios more relevant to stakeholder needs and priorities; ii) extend the range of scenarios developed; iii) develop more detailed and precise scenarios through the integration of local and scientific knowledge; and iv) move beyond scenario development to facilitate adaptation to future change. It is argued that participatory scenario development can empower stakeholders and lead to more consistent and robust scenarios that can help people prepare more effectively for future change.

Shoulder function following early mobilization of the shoulder after mastectomy and axillary dissection.

A prospective clinical trial was conducted to determine the effect of axillary node dissection for breast carcinoma on shoulder function and seroma production. 59 Operations were carried out in 57 patients. The patients were divided into two groups. In group A, shoulder exercises were started, under the guidance of a physiotherapist, immediately following surgery, and in group B the exercises were begun on the seventh postoperative day. A full range of motion within six months was achieved in 25 patients of group A (81%) and in 22 of group B (79%). There was no significant difference in wound drainage between the two groups. Restricted shoulder movement was often seen after local wound complications following axillary radiotherapy or after seriously disturbed wound healing.

Long-term follow-up of Lord's procedure for haemorrhoids.

86 Patients treated for first or second degree haemorrhoids by Lord's manual dilatation of the anus were followed up for a mean period of 7.2 years. The outcome in the 76 patients traced was satisfactory or good in 76.3%. In only 14.5% was the result unsatisfactory. Lord's anal dilatation is a relatively simple procedure; the results of this study show that it gives good long-lasting results.

Results of primary surgical treatment of gastric carcinoma.

During the period 1958 to 1968 inclusive, 238 patients were subjected to primary surgical treatment for gastric carcinoma. On the basis of Hoerr's classification, this material has been subdivided into a group operated on with palliative intention and a group operated on with curative intention. The latter group accounted for only 31.5% of the entire series. The postoperative mortality rate in the series as a whole amounted to 18.5%, and the rate of five-year survival to 16.2%. The proportion of resectability was 53.8%. Sixty-four patients were subjected to total gastrectomy, and in 50% of them this was done with palliative intention. During the period 1964 to 1968 inclusive, postoperative mortality was 5.9% for subtotal and 8.8% for total gastrectomy. The rates of five-year survival during the entire period for the groups operated on with curative intention amounted to 46.5% and 40.6% respectively, postoperative mortality included. At the time of writing, 25 patients are still alive, with periods of survival of longer than 15 years.