Many of the challenges conservation professionals face can be framed as scale mismatches. The problem of scale mismatch occurs when the planning for and implementation of conservation actions is at a ...scale that does not reflect the scale of the conservation problem. The challenges in conservation planning related to scale mismatch include ecosystem or ecological process transcendence of governance boundaries; limited availability of fine-resolution data; lack of operational capacity for implementation; lack of understanding of social-ecological system components; threats to ecological diversity that operate at diverse spatial and temporal scales; mismatch between funding and the long-term nature of ecological processes; rate of action implementation that does not reflect the rate of change of the ecological system; lack of appropriate indicators for monitoring activities; and occurrence of ecological change at scales smaller or larger than the scale of implementation or monitoring. Not recognizing and accounting for these challenges when planning for conservation can result in actions that do not address the multiscale nature of conservation problems and that do not achieve conservation objectives. Social networks link organizations and individuals across space and time and determine the scale of conservation actions; thus, an understanding of the social networks associated with conservation planning will help determine the potential for implementing conservation actions at the required scales. Social-network analyses can be used to explore whether these networks constrain or enable key social processes and how multiple scales of action are linked. Results of network analyses can be used to mitigate scale mismatches in assessing, planning, implementing, and monitoring conservation projects. Muchos de los retos que enfrentan los profesionales de la conservación pueden ser catalogados como discordancia de escalas. El problema de discordancia de escalas ocurre cuando la planificación e implementación de acciones de conservación se llevan a cabo en una escala que no refleja la escala del problema de conservación. Los retos de la planificación de la conservación relacionados con la discordancia de escala incluyen el rebase de límites de gobernanza por los procesos ecológicos; la disponibilidad limitada de datos de resolución fina; la carencia de capacidad operativa para la implementación; la falta de entendimiento de los componentes socio-ecológicos del sistema; amenazas a la diversidad ecológica que operan en escalas espaciales y temporales diversas; discordancia entre el financiamiento y la naturaleza a largo plazo de los procesos ecológicos; tasa de implementación de acciones que no refleja la tasa de cambio del sistema ecológico; ausencia de indicadores apropiados de las actividades de monitoreo y ocurrencia de cambio ecológico en escalas menores o mayores que la escala de implementación o monitoreo. El no reconocimiento y consideración de estos retos al planificar la conservación puede resultar en acciones que no abordan la naturaleza multiescala de los problemas de conservación y que no se alcancen los objetivos de conservación. Las redes sociales enlazan organizaciones e individuos en el tiempo y espacio y determinan la escala de las acciones de conservación; por lo tanto, el entendimiento de las redes sociales asociadas con la planificación de la conservación ayudará a determinar el potencial para la implementación de acciones de conservación en las escalas requeridas. El análisis de redes sociales puede ser utilizado para explorar si esas redes constriñen o facilitan procesos sociales claves y como se relacionan las múltiples escalas de acción. Los resultados del análisis de redes pueden ser utilizados para mitigar la discordancia de escalas en la evaluación, planificación, implementación y monitoreo de proyectos de conservación.
Optimizing services to facilitate engagement and retention in care of people living with HIV (PLWH) on antiretroviral therapies (ARTs) is critical to decrease HIV-related morbidity and mortality and ...HIV transmission. We systematically reviewed the literature for the effectiveness of implementation strategies to reestablish and subsequently retain clinical contact, improve viral load suppression, and reduce mortality among patients who had been lost to follow-up (LTFU) from HIV services.
We searched 7 databases (PubMed, Cochrane, ERIC, PsycINFO, EMBASE, Web of Science, and the WHO regional databases) and 3 conference abstract archives (CROI, IAC, and IAS) to find randomized trials and observational studies published through 13 April 2020. Eligible studies included those involving children and adults who were diagnosed with HIV, had initiated ART, and were subsequently lost to care and that reported at least one review outcome (return to care, retention, viral suppression, or mortality). Data were extracted by 2 reviewers, with discrepancies resolved by a third. We characterized reengagement strategies according to how, where, and by whom tracing was conducted. We explored effects, first, among all categorized as LTFU from the HIV program (reengagement program effect) and second among those found to be alive and out of care (reengagement contact outcome). We used random-effect models for meta-analysis and conducted subgroup analyses to explore heterogeneity. Searches yielded 4,244 titles, resulting in 37 included studies (6 randomized trials and 31 observational studies). In low- and middle-income countries (LMICs) (N = 16), tracing most frequently involved identification of LTFU from the electronic medical record (EMR) and paper records followed by a combination of telephone calls and field tracing (including home visits), by a team of outreach workers within 3 months of becoming LTFU (N = 7), with few incorporating additional strategies to support reengagement beyond contact (N = 2). In high-income countries (HICs) (N = 21 studies), LTFU were similarly identified through EMR systems, at times matched with other public health records (N = 4), followed by telephone calls and letters sent by mail or email and conducted by outreach specialist teams. Home visits were less common (N = 7) than in LMICs, and additional reengagement support was similarly infrequent (N = 5). Overall, reengagement programs were able to return 39% (95% CI: 31% to 47%) of all patients who were characterized as LTFU (n = 29). Reengagement contact resulted in 58% (95% CI: 51% to 65%) return among those found to be alive and out of care (N = 17). In 9 studies that had a control condition, the return was higher among those in the reengagement intervention group than the standard of care group (RR: 1.20 (95% CI: 1.08 to 1.32, P < 0.001). There were insufficient data to generate pooled estimates of retention, viral suppression, or mortality after the return.
While the types of interventions are markedly heterogeneity, reengagement interventions increase return to care. HIV programs should consider investing in systems to better characterize LTFU to identify those who are alive and out of care, and further research on the optimum time to initiate reengagement efforts after missed visits and how to best support sustained reengagement could improve efficiency and effectiveness.
Global HIV treatment programs have sought to lengthen the interval between clinical encounters for people living with HIV (PLWH) who are established on antiretroviral treatment (ART) to reduce the ...burden of seeking care and to decongest health facilities. The overall effect of reduced visit frequency on HIV treatment outcomes is however unknown. We conducted a systematic review and meta-analysis to evaluate the effect of implementation strategies that reduce the frequency of clinical appointments and ART refills for PLWH established on ART.
We searched databases between 1 January 2010 and 9 November 2021 to identify randomized controlled trials (RCTs) and observational studies that compared reduced (6- to 12-monthly) clinical consultation or ART refill appointment frequency to 3- to 6-monthly appointments for patients established on ART. We assessed methodological quality and real-world relevance, and used Mantel-Haenszel methods to generate pooled risk ratios (RRs) with 95% confidence intervals for retention, viral suppression, and mortality. We evaluated heterogeneity quantitatively and qualitatively, and overall evidence certainty using GRADE. Searches yielded 3,955 records, resulting in 10 studies (6 RCTs, 3 observational studies, and 1 study contributing observational and RCT data) representing 15 intervention arms with 33,599 adults (≥16 years) in 8 sub-Saharan African countries. Reduced frequency clinical consultations occurred at health facilities, while reduced frequency ART refills were delivered through facility or community pharmacies and adherence groups. Studies were highly pragmatic, except for some study settings and resources used in RCTs. Among studies comparing reduced clinical consultation frequency (6- or 12-monthly) to 3-monthly consultations, there appeared to be no difference in retention (RR 1.01, 95% CI 0.97-1.04, p = 0.682, 8 studies, low certainty), and this finding was consistent across 6- and 12-monthly consultation intervals and delivery strategies. Viral suppression effect estimates were markedly influenced by under-ascertainment of viral load outcomes in intervention arms, resulting in inconclusive evidence. There was similarly insufficient evidence to draw conclusions on mortality (RR 1.12, 95% CI 0.75-1.66, p = 0.592, 6 studies, very low certainty). For ART refill frequency, there appeared to be little to no difference in retention (RR 1.01, 95% CI 0.98-1.06, p = 0.473, 4 RCTs, moderate certainty) or mortality (RR 1.45, 95% CI 0.63-3.35, p = 0.382, 4 RCTs, low certainty) between 6-monthly and 3-monthly visits. Similar to the analysis for clinical consultations, although viral suppression appeared to be better in 3-monthly arms, effect estimates were markedly influence by under-ascertainment of viral load outcomes in intervention arms, resulting in overall inclusive evidence. This systematic review was limited by the small number of studies available to compare 12- versus 6-monthly clinical consultations, insufficient data to compare implementation strategies, and lack of evidence for children, key populations, and low- and middle-income countries outside of sub-Saharan Africa.
Based on this synthesis, extending clinical consultation intervals to 6 or 12 months and ART dispensing intervals to 6 months appears to result in similar retention to 3-month intervals, with less robust conclusions for viral suppression and mortality. Future research should ensure complete viral load outcome ascertainment, as well as explore mechanisms of effect, outcomes in other populations, and optimum delivery and monitoring strategies to ensure widespread applicability of reduced frequency visits across settings.
Recent observations suggest that polar bears (Ursus maritimus) are increasingly using land habitats in some parts of their range, where they have minimal access to their preferred prey, likely in ...response to loss of their sea ice habitat associated with climatic warming. We used location data from female polar bears fit with satellite radio collars to compare land use patterns in the Chukchi Sea between two periods (1986-1995 and 2008-2013) when substantial summer sea-ice loss occurred. In both time periods, polar bears predominantly occupied sea-ice, although land was used during the summer sea-ice retreat and during the winter for maternal denning. However, the proportion of bears on land for > 7 days between August and October increased between the two periods from 20.0% to 38.9%, and the average duration on land increased by 30 days. The majority of bears that used land in the summer and for denning came to Wrangel and Herald Islands (Russia), highlighting the importance of these northernmost land habitats to Chukchi Sea polar bears. Where bears summered and denned, and how long they spent there, was related to the timing and duration of sea ice retreat. Our results are consistent with other studies supporting increased land use as a common response of polar bears to sea-ice loss. Implications of increased land use for Chukchi Sea polar bears are unclear, because a recent study observed no change in body condition or reproductive indices between the two periods considered here. This result suggests that the ecology of this region may provide a degree of resilience to sea ice loss. However, projections of continued sea ice loss suggest that polar bears in the Chukchi Sea and other parts of the Arctic may increasingly use land habitats in the future, which has the potential to increase nutritional stress and human-polar bear interactions.
Reduction of summer sea ice extent has led some polar bear (Ursus maritimus) populations to increase their use of land during the summer/autumn open-water period. While terrestrial food resources are ...generally not sufficient to compensate for lost hunting opportunities on the sea ice, marine mammal carcasses, where available, could help reduce the energetic cost of longer periods of land use. Subsistence-harvested bowhead whale (Balaena mysticetus) remains are available annually near local communities along the Alaskan portion of the Beaufort Sea coast to bears that come to shore. Relatively large numbers of polar bears and some grizzly bears (U. arctos) use these resources, creating a competitive environment among species and social classes. We documented competitive interactions among polar bears and between polar and grizzly bears for bowhead whale remains adjacent to a small community in northeastern Alaska in September 2005–2007. We observed temporal partitioning of the resource by bears, with lone adult polar bears and grizzly bears primarily feeding at night, and higher use by polar bear family groups and subadults during dawn and dusk. Interspecific interactions were less frequently aggressive than intraspecific interactions, but polar bears were more likely to be displaced from the feeding site by grizzly bears than by conspecifics. Female polar bears with cubs were more likely to display aggressive behavior than other social classes during intra- and interspecific aggressive interactions. Our results indicate that grizzly bears are socially dominant during interspecific competition with polar bears for marine mammal carcasses during autumn.
Abstract Creatine chemical exchange saturation transfer (CrCEST) MRI is an emerging high resolution and noninvasive method for measuring muscle specific oxidative phosphorylation (OXPHOS). However, ...CrCEST measurements are sensitive to changes in muscle pH, which might confound the measurement and interpretation of creatine recovery time (τ Cr ). Even with the same prescribed exercise stimulus, the extent of acidification and hence its impact on τ Cr is expected to vary between individuals. To address this issue, a method to measure pH pre- and post-exercise and its impact on CrCEST MRI with high temporal resolution is needed. In this work, we integrate carnosine 1 H- magnetic resonance spectroscopy (MRS) and 3D CrCEST to establish “mild” and “moderate/intense” exercise stimuli. We then test the dependence of CrCEST recovery time on pH using different exercise stimuli. This comprehensive metabolic imaging protocol will enable personalized, muscle specific OXPHOS measurements in both healthy aging and myriad other disease states impacting muscle mitochondria.
Long distance migrations by large mammals are increasingly imperiled by human development. We studied autumn migratory patterns of caribou (Rangifer tarandus) in relation to an industrial road in ...northwestern Alaska. We built null movement models to determine the expected time to cross the road if caribou movements were not affected by the road. We then identified individuals that took longer to cross than expected (slow crossers) and those that did not differ from that expected from the null model (normal crossers). We identified eight as slow and 20 as normal crossers. Slow crossers took an average of 33.3±17.0 (±SD) days to cross the road compared to 3.1±5.5days for normal crossers. Slow crossers had an average crossing date of 8 Nov.±7.7days versus 25 Oct.±20.6days for normal crossers. Movement rates of the two classes did not differ before crossing the road, but slow crossers moved >1.5 times as fast as normal crossers after crossing the road. Movement patterns were partially explained by environmental attributes, but were most strongly affected by how far a caribou was from the road and whether it was classified as slow or normal crosser. While avoidance is an important aspect of the effects of roads on populations, our results show the importance of other factors, such as how long individuals are delayed in crossing when assessing the influence of development on wildlife.
Significant benefits can arise from collaborative forms of governance that foster self-organization and flexibility. Likewise, governance systems that fit with the extent and complexity of the system ...under management are considered essential to our ability to solve environmental problems. However, from an empirical perspective the fundamental question of whether self-organized (bottom-up) collaborative forms of governance are able to accomplish adequate fit is unresolved. We used new theory and methodological approaches underpinned by interdisciplinary network analysis to address this gap by investigating three governance challenges that relate to the problem of fit: shared management of ecological resources, management of interconnected ecological resources, and cross-scale management. We first identified a set of social-ecological network configurations that represent the hypothesized ways in which collaborative arrangements can contribute to addressing these challenges. Using social and ecological data from a large-scale biodiversity conservation initiative in Australia, we empirically determined how well the observed patterns of stakeholder interactions reflect these network configurations. We found that stakeholders collaborate to manage individual parcels of native vegetation, but not for the management of interconnected parcels. In addition, our data show that the collaborative arrangements enable management across different scales (local, regional, supraregional). Our study provides empirical support for the ability of collaborative forms of governance to address the problem of fit, but also suggests that in some cases the establishment of bottom-up collaborative arrangements would likely benefit from specific guidance to facilitate the establishment of collaborations that better align with the ways ecological resources are interconnected across the landscape. In our case study region, this would improve the capacity of stakeholders to detect both the intended and unintended off-site impacts of management actions. Our approach offers an avenue for empirical evaluations of collaborative governance so that preconditions for effectiveness of environmental programs can be enhanced.
Large-scale industrial activities can have negative effects on wildlife populations. Some of these effects, however, could be reduced with effective planning prior to development. The Coastal Plain ...of the Arctic National Wildlife Refuge, in northeastern Alaska, USA, is an important maternal denning area for polar bears (Ursus maritimus). Recent legislation has opened the area for potential oil and gas development. As a result, there is interest in conducting winter seismic surveys across the area that could disturb denning female polar bears and lead to decreased cub survival. We sought to demonstrate how different seismic survey designs, with and without aerial den detection surveys, could affect the level of potential effect on denning polar bears during spring (Feb–Apr). We developed 5 hypothetical seismic survey designs for a portion of the Coastal Plain ranging from no spatial or temporal restrictions on activities to explicit consideration of when and where operations can occur. We evaluated how many dens might be disturbed by seismic surveys and the average distance activity came within simulated polar bear dens. Survey design had a large effect on the estimated number of dens that could be disturbed; the scenario with the highest spatial and temporal specificity reduced the number of dens disturbed by >90% compared to the scenario with no restrictions on when and where activity could occur. The use of an aerial den detection survey prior to seismic activity further reduced the number of dens disturbed by 68% across all scenarios. The scenario with the highest spatial and temporal specificity always had the lowest level of disturbance for all scenarios with and without the aerial survey included. Our study suggests that large reductions in the probability of disturbance can occur through careful planning on the timing and distribution of proposed activities even when surveys are planned in areas with a high density of polar bear dens.
Polar bears are of international conservation concern due to climate change but are difficult to study because of low densities and an expansive, circumpolar distribution. In a collaborative ...U.S.-Russian effort in spring of 2016, we used aerial surveys to detect and estimate the abundance of polar bears on sea ice in the Chukchi Sea. Our surveys used a combination of thermal imagery, digital photography, and human observations. Using spatio-temporal statistical models that related bear and track densities to physiographic and biological covariates (e.g., sea ice extent, resource selection functions derived from satellite tags), we predicted abundance and spatial distribution throughout our study area. Estimates of 2016 abundance (Formula: see text) ranged from 3,435 (95% CI: 2,300-5,131) to 5,444 (95% CI: 3,636-8,152) depending on the proportion of bears assumed to be missed on the transect line during Russian surveys (g(0)). Our point estimates are larger than, but of similar magnitude to, a recent estimate for the period 2008-2016 (Formula: see text; 95% CI 1,522-5,944) derived from an integrated population model applied to a slightly smaller area. Although a number of factors (e.g., equipment issues, differing platforms, low sample sizes, size of the study area relative to sampling effort) required us to make a number of assumptions to generate estimates, it establishes a useful lower bound for abundance, and suggests high spring polar bear densities on sea ice in Russian waters south of Wrangell Island. With future improvements, we suggest that springtime aerial surveys may represent a plausible avenue for studying abundance and distribution of polar bears and their prey over large, remote areas.
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