Knowledge coproduction on the impact of decisions for waterbird habitat in a changing climate.

Scientists, resource managers, and decision makers increasingly use knowledge coproduction to guide the stewardship of future landscapes under climate change. This process was applied in the California Central Valley (USA) to solve complex conservation problems, where managed wetlands and croplands are flooded between fall and spring to support some of the largest concentrations of shorebirds and waterfowl in the world. We coproduced scenario narratives, spatially explicit flooded waterbird habitat models, data products, and new knowledge about climate adaptation potential. We documented our coproduction process, and using the coproduced models, we determined when and where management actions make a difference and when climate overrides these actions. The outcomes of this process provide lessons learned on how to cocreate usable information and how to increase climate adaptive capacity in a highly managed landscape. Actions to restore wetlands and prioritize their water supply created habitat outcomes resilient to climate change impacts particularly in March, when habitat was most limited; land protection combined with management can increase the ecosystem's resilience to climate change; and uptake and use of this information was influenced by the roles of different stakeholders, rapidly changing water policies, discrepancies in decision-making time frames, and immediate crises of extreme drought. Although a broad stakeholder group contributed knowledge to scenario narratives and model development, to coproduce usable information, data products were tailored to a small set of decision contexts, leading to fewer stakeholder participants over time. A boundary organization convened stakeholders across a large landscape, and early adopters helped build legitimacy. Yet, broadscale use of climate adaptation knowledge depends on state and local policies, engagement with decision makers that have legislative and budgetary authority, and the capacity to fit data products to specific decision needs.

Coproducción de información sobre el impacto de las decisiones para el hábitat de las aves acuáticas en un clima cambiante Resumen Hay un incremento del uso que dan los científicos, gestores de recursos y los órganos decisorios a la coproducción de información para guiar la administración de los futuros paisajes bajo el cambio climático. Se aplicó este proceso para resolver problemas complejos de conservación en el Valle Central de California (EE. UU.), en donde los humedales y campos de cultivos manejados se inundan entre el otoño y la primavera para mantener una de las mayores concentraciones de aves playeras y acuáticas del mundo. Coproducimos narrativas de escenarios, modelos espacialmente explícitos de hábitats inundados de las aves acuáticas, productos de datos y conocimiento nuevo sobre el potencial de adaptación climática. Documentamos nuestro proceso de coproducción y usamos los modelos resultantes para determinar cuándo y en dónde marcan una diferencia las acciones de manejo y cuándo el clima anula estas acciones. Los resultados de este proceso proporcionan aprendizaje sobre cómo cocrear información útil y cómo incrementar la capacidad adaptativa al clima en un paisaje con mucha gestión. Las acciones de restauración de los humedales y la priorización del suministro de agua originaron un hábitat resiliente al impacto del cambio climático, particularmente en marzo, cuando el hábitat estaba más limitado; la protección del suelo combinado con el manejo puede incrementar la resiliencia del ecosistema al cambio climático; y la captación y uso de esta información estuvo influenciada por el papel de los diferentes actores, el cambio rápido de las políticas del agua, discrepancias en los marcos temporales de la toma de decisiones y las crisis inmediatas de la sequía extrema. Mientras que un grupo amplio de accionistas contribuyó conocimiento para las narrativas de escenarios y el desarrollo del modelo, para coproducir información útil, los productos de datos fueron adaptados para un conjunto pequeño de contextos decisivos, lo que con el tiempo llevó a una reducción en la participación de los actores. Una organización fronteriza convocó a los actores de todo un paisaje y los primeros adoptantes ayudaron a construir la legitimidad. A pesar de esto, el uso a gran escala de la información sobre la adaptación climática depende de las políticas locales y estatales, la participación de los órganos decisorios que tienen autoridad legislativa y presupuestaria y de la capacidad para ajustar los productos de datos a las necesidades específicas de las decisiones.

Assessment of the Conservation Measures Partnership's effort to improve conservation outcomes through adaptive management.

Conservation practice has demonstrated an increasing desire for accountability of actions, particularly with respect to effectiveness, efficiency, and impact to clearly identified objectives. This has been accompanied by increased attention to achieving adaptive management. In 2002, practitioners representing several prominent conservation nongovernmental organizations (NGOs) launched a community of practice called the Conservation Measures Partnership (CMP). The partnership CMP has worked to establish standards of conservation practice to improve accountability of conservation actions through adaptive management. The focal organizing framework for CMP has been the Open Standards for the Practice of Conservation (OS). We evaluated, through an online survey and personal interviews, the first decade of CMP and the OS. The CMP has garnered a positive reputation among agencies, NGOs, and funders and has succeeded in developing a large user base of the OS. However, CMP has not fully achieved its goal of making the OS standard operating procedure for the largest NGOs (e.g., The Nature Conservancy, World Wildlife Fund), despite it being widely used within these organizations. This lack of institutionalization is attributable to multiple causes, including an increase in the number of partially overlapping decision-support frameworks and challenges achieving full-cycle adaptive management. Users strongly believed the OS fosters better conservation practice and highly valued the OS for improving their practice. A primary objective of the OS is to assist practitioners to achieve full-cycle adaptive management to better integrate learning into improving the effectiveness and efficiency of actions. However, most practitioners had not yet achieved cycle completion for their projects. To improve the effectiveness of CMP, OS, and conservation practice in general, we recommend collaborative efforts among the proponents of multiple decision-support frameworks to foster strong institutional adoption of a common set of adaptive-management standards for conservation accountability.

Improvement in the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors.

BACKGROUND AND OBJECTIVE: Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings. MATERIALS AND METHODS: After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses. RESULTS: 130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2-9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3-20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2-8.5). CONCLUSION: The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.

Development and impact of computerised decision support systems for clinical management of depression: A systematic review.

One of the proposals for improving clinical practice is to introduce computerised decision support systems (CDSS) and integrate these with electronic medical records. Accordingly, this study sought to systematically review evidence on the effectiveness of CDSS in the management of depression. A search was performed in Medline, EMBASE and PsycInfo, in order to do this. The quality of quantitative studies was assessed using the SIGN method, and qualitative studies using the CASPe checklist. Seven studies were identified (3 randomised clinical trials, 3 non-randomised trials, and one qualitative study). The CDSS assessed incorporated content drawn from guidelines and other evidence-based products. In general, the CDSS had a positive impact on different aspects, such as the screening and diagnosis, treatment, improvement in depressive symptoms and quality of life, and referral of patients. The use of CDSS could thus serve to optimise care of depression in various scenarios by providing recommendations based on the best evidence available and facilitating decision-making in clinical practice.