A mixed methodology for evaluating use of evidence in conservation planning.

Conservation practitioners widely recognize the importance of making decisions based on the best available evidence. However, the effectiveness of evidence use in conservation planning is rarely assessed, which limits opportunities to improve evidence-based practice. We devised a mixed methodology for empirically evaluating use of evidence that applies social science tools to systematically appraise what kinds of evidence are used in conservation planning, to what effect, and under what limitations. We applied our approach in a case study of the Nature Conservancy of Canada (NCC), a leading land conservation organization. We conducted qualitative and quantitative analyses of 65 NCC planning documents (n = 13 in-depth) to identify patterns in evidence use, and surveyed 35 conservation planners to examine experiences of and barriers to using evidence. Although claims in plans contained a wide range of evidence types, 26% of claims were not referenced or associated with an identifiable source. Lack of evidence use was particularly apparent in claims associated with direct threats, particularly those identified as low (71% coded as insufficient or lacking evidence) or medium (45%) threats. Survey participants described relying heavily on practitioner experience and highlighted capacity limitations and disciplinary gaps in expertise among planning teams as barriers to using evidence effectively. We found that although time-intensive, this approach yielded actionable recommendations for improving evidence use in NCC conservation plans. Similar mixed-method assessments may streamline the process by including interviews and refining the document analysis frames to target issues or sections of concern. We suggest our method provides an accessible and robust point of departure for conservation practitioners to evaluate whether the use of conservation planning reflects in-house standards and more broadly recognized best practices.

RESUMEN: Los practicantes de la conservación reconocen ampliamente la importancia de tomar decisiones con base en la mejor evidencia disponible. Sin embargo, pocas veces se evalúa la efectividad del uso de evidencias en la planeación de la conservación, lo que limita las oportunidades para mejorar la práctica basada en evidencias. Diseñamos una metodología mixta para evaluar empíricamente el uso de evidencias que aplica herramientas de las ciencias sociales para estimar cuáles son los tipos de evidencia que se usan en la planeación de la conservación, con cuál efecto y con cuáles limitaciones. Aplicamos nuestra estrategia a un estudio de caso de la Nature Conservancy of Canada (NCC), una organización puntera en la conservación del suelo. Realizamos el análisis cualitativo y cuantitativo de 65 documentos de planeación de NCC (n = 13 a fondo) para identificar patrones en el uso de evidencias y encuestamos a 35 planeadores de la conservación para examinar las barreras y las experiencias del uso de evidencias. Aunque las afirmaciones en los planes contenían una amplia gama de tipos de evidencia, el 26% de éstas no estuvo referenciado o asociado con una fuente identificable. La falta del uso de evidencias fue particularmente evidente en las afirmaciones asociadas con amenazas directas, particularmente aquellas identificadas como amenaza menor (71% codificado como insuficiente o falto de evidencias) o media (45%). Los participantes de la encuesta describieron una fuerte dependencia de la experiencia de los practicantes y resaltaron las limitaciones de capacidades y brechas disciplinarias en la experiencia entre los equipos de planeación como barreras para el uso efectivo de las evidencias. Descubrimos que, aunque lleva tiempo, esta estrategia produjo recomendaciones viables para mejorar el uso de evidencias en los planes de conservación de la NCC. Las evaluaciones similares de métodos mixtos pueden simplificar el proceso al incluir entrevistas y refinar los marcos de análisis documental para enfocarse en temas o secciones de interés. Sugerimos que nuestro método proporciona un punto de partida accesible y sólido para que los practicantes de la conservación evalúen si el uso de la planeación de la conservación refleja los estándares internos y las mejores prácticas reconocidas más ampliamente. Una Metodología Mixta para la Evaluación del Uso de Evidencias en la Planeación de la Conservación.

Describing the spine surgery learning curve during the first two years of independent practice.

ABSTRACT: Retrospective cohort studyTo characterize the learning curve of a spine surgeon during the first 2 years of independent practice by comparing to an experienced colleague. To stratify learning curves based on procedure to evaluate the effect of experience on surgical complexity.The learning curve for spine surgery is difficult to quantify, but is useful information for hospital administrators/surgical programs/new graduates, so appropriate expectations and accommodations are considered.Data from a retrospective cohort (2014-2016) were analyzed at a quaternary academic institution servicing a geographically-isolated, mostly rural area. Procedures included anterior cervical discectomy and fusion, posterior cervical decompression and stabilization, single and 2-level posterior lumbar interbody fusion, lumbar discectomy, and laminectomy. Data related to patient demographics, after-hours surgery, and revision surgery were collected. Operative time was the primary outcome measure, with secondary measures including cerebrospinal fluid leak and early re-operation. Time periods were stratified into 6 month quarters (quarter [Q] 1-Q4), with STATA software used for statistical analysis.There were 626 patients meeting inclusion criteria. The senior surgeon had similar operative times throughout the study. The new surgeon demonstrated a decrease in operative time from Q1 to Q4 (158 minutes-119 minutes, P < .05); however, the mean operative time was shorter for the senior surgeon at 2 years (91 minutes, P < .05). The senior surgeon performed more revision surgeries (odds ratio [OR] 2.5 [95% confidence interval [CI] 1.7-3.6]; P < .001). Posterior interbody fusion times remained longer for the new surgeon, while laminectomy surgery was similar to the senior surgeon by 2 years. There were no differences in rates of cerebrospinal fluid leak (OR 1.2 [95% CI 0.6-2.5]; P > .05), nor reoperation (OR 1.16 [95% CI 0.7-1.9]; P > .05) between surgeons.A significant learning curve exists starting spine practice and likely extends beyond the first 2 years for elective operations.

High intensity VNS disrupts VNS-mediated plasticity in motor cortex.

Vagus nerve stimulation (VNS) paired with motor rehabilitation enhances recovery of function after neurological injury in rats and humans. This effect is ascribed to VNS-dependent facilitation of plasticity in motor networks. Previous studies document an inverted-U relationship between VNS intensity and cortical plasticity, such that moderate intensities increase plasticity, while low or high intensity VNS does not. We tested the interaction of moderate and high intensity VNS trains to probe the mechanisms that may underlie VNS-dependent plasticity. Rats performed a behavioral task where VNS was paired with jaw movement during chewing. For five days, subjects received 100 pairings of moderate intensity VNS (Standard VNS), 100 pairings alternating between moderate and high intensity VNS (Interleaved VNS), or 50 pairings of moderate intensity VNS (Short VNS) approximately every 8 s. After the final behavioral session, intracortical microstimulation (ICMS) was used to evaluate movement representations in motor cortex. 100 pairings of moderate intensity VNS enhanced motor cortex plasticity. Replacing half of moderate intensity stimulation with high intensity VNS blocked this enhancement of plasticity. Removing high intensity stimulation, leaving only 50 pairings of moderate intensity VNS, reinstated plasticity. These results demonstrate that there is a period for at least 8 s after high intensity stimulation in which moderate intensity VNS is not able to engage mechanisms required for synaptic reorganization. More importantly, this study demonstrates that changes in stimulation parameters are a critical determinant of the magnitude of plasticity and likely the efficacy of VNS-enhanced recovery.