We examined the principal effects of different information network topologies for local adaptive management of natural resources. We used computerized agents with adaptive decision algorithms with the following three fundamental constraints: (1) Complete understanding of the processes maintaining the natural resource can never be achieved, (2) agents can only learn by experimentation and information sharing, and (3) memory is limited. The agents were given the task to manage a system that had two states: one that provided high utility returns (desired) and one that provided low returns (undesired). In addition, the threshold between the states was close to the optimal return of the desired state. We found that networks of low to moderate link densities significantly increased the resilience of the utility returns. Networks of high link densities contributed to highly synchronized behavior among the agents, which caused occasional large-scale ecological crises between periods of stable and high utility returns. A constructed network involving a small set of experimenting agents was capable of combining high utility returns with high resilience, conforming to theories underlying the concept of adaptive comanagement. We conclude that (1) the ability to manage for resilience (i.e., to stay clear of the threshold leading to the undesired state as well as the ability to re-enter the desired state following a collapse) resides in the network structure and (2) in a coupled social-ecological system, the system-wide state transition occurs not because the ecological system flips into the undesired state, but because managers lose their capacity to reorganize back to the desired state.
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http://dx.doi.org/10.1007/s00267-004-0036-7 | DOI Listing |
BMJ Open Gastroenterol
December 2024
Florence Nightingale Faculty of Nursing Midwifery & Palliative Care, King's College London, London, UK
Objective: Many people with inflammatory bowel disease (IBD) experience fatigue, pain and faecal incontinence that some feel are inadequately addressed. It is unknown how many have potentially reversible medical issues underlying these symptoms.
Methods: We conducted a study testing the feasibility of a patient-reported symptom checklist and nurse-administered management algorithm ('Optimise') to manage common medical causes of IBD-related fatigue, pain and faecal incontinence.
BMJ Open Gastroenterol
December 2024
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Objective: Preventing return to alcohol is of critical importance for patients with alcohol-related cirrhosis and/or alcohol-associated hepatitis. Acamprosate is a widely used treatment for alcohol use disorder (AUD). We assessed the impact of acamprosate prescription in patients with advanced liver disease on abstinence rates and clinical outcomes.
View Article and Find Full Text PDFJ Rural Health
January 2025
Melissa Latcham and School of Public Health, Brown University School of Public Health, Providence, Rhode Island, USA.
Purpose: US nonprofit hospitals must provide community benefits including financial assistance to be tax-exempt. Rural residents particularly benefit from financial assistance because they have higher medical debt on average. The Internal Revenue Service allows nonprofit hospitals that are members of health systems to report expenditures for their entire system (group returns) rather than for individual hospitals.
View Article and Find Full Text PDFJ Clin Med
January 2025
Department of Plastic Surgery, University of Nevada Las Vegas School of Medicine, Las Vegas, NV 89102, USA.
The adoption of robotic surgery has been widespread and increasing amongst gynecologic surgeons given the ability to decrease morbidity. It is important that plastic surgeons adjust their reconstructive algorithm to ascertain the benefits of robotic-assisted surgery. Herein we report our outcomes of robotic-assisted rectus abdominis muscle reconstruction of the posterior vaginal wall along with a current literature review on robotic-assisted reconstructive pelvic surgery.
View Article and Find Full Text PDFJ Clin Med
January 2025
Jackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between ileus and mechanical obstruction but expose patients to radiation, add cost, and may lead to unnecessary work up. The aim of this study was to determine how often KUBs led to a change in treatment after PSF in patients with NMS.
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