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Panarchy: opportunities and challenges for ecosystem management.

ABSTRACT: Addressing unexpected events and uncertainty represents one of the grand challenges of the Anthropocene, yet ecosystem management is constrained by existing policy and laws that were not formulated to deal with today's accelerating rates of environmental change. In many cases, managing for simple regulatory standards has resulted in adverse outcomes, necessitating innovative approaches for dealing with complex social-ecological problems. We highlight a project in the US Great Plains where panarchy - a conceptual framework that emerged from resilience - was implemented at project onset to address the continued inability to halt large-scale transition from grass-to-tree dominance in central North America. We review how panarchy was applied, the initial outcomes and evidence for policy reform, and the opportunities and challenges for which it could serve as a useful model to contrast with traditional ecosystem management approaches.

SUBMITTER: Garmestani A

PROVIDER: S-EPMC7784709 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Panarchy: opportunities and challenges for ecosystem management.

Garmestani Ahjond A Twidwell Dirac D Angeler David G DG Sundstrom Shana S Barichievy Chris C Chaffin Brian C BC Eason Tarsha T Graham Nick N Granholm Dean D Gunderson Lance L Knutson Melinda M Nash Kirsty L KL Nelson R John RJ Nystrom Magnus M Spanbauer Trisha L TL Stow Craig A CA Allen Craig R CR

Frontiers in ecology and the environment 20200101 10

Addressing unexpected events and uncertainty represents one of the grand challenges of the Anthropocene, yet ecosystem management is constrained by existing policy and laws that were not formulated to deal with today's accelerating rates of environmental change. In many cases, managing for simple regulatory standards has resulted in adverse outcomes, necessitating innovative approaches for dealing with complex social-ecological problems. We highlight a project in the US Great Plains where panarc ...[more]

PMID: 33408590

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Project description:ObjectiveThe novel coronavirus disease 2019 (COVID-19) pandemic is an unexpected universal problem that has changed health care access across the world. Telehealth is an effective solution for health care delivery during disasters and public health emergencies. This study was conducted to summarize the opportunities and challenges of using telehealth in health care delivery during the COVID-19 pandemic.MethodsA structured search was performed in the Web of Science, PubMed, Science Direct, and Scopus databases, as well as the Google Scholar search engine, for studies published until November 4, 2020. The reviewers analyzed 112 studies and identified opportunities and challenges. This review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocols. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis.ResultsA total of 112 unique opportunities of telehealth application during the pandemic were categorized into 4 key themes, such as (1) clinical, (2) organizational, (3) technical, and (4) social, which were further divided into 11 initial themes and 26 unique concepts. Furthermore, 106 unique challenges were categorized into 6 key themes, such as (1) legal, (2) clinical, (3) organizational, (40 technical, (5) socioeconomic, and (6) data quality, which were divided into 16 initial themes and 37 unique concepts altogether. The clinical opportunities and legal challenges were the most frequent opportunities and challenges, respectively.ConclusionThe COVID-19 pandemic significantly accelerated the use of telehealth. This study could offer useful information to policymakers about the opportunities and challenges of implementing telehealth for providing accessible, safe, and efficient health care delivery to the patient population during and after COVID-19. Furthermore, it can assist policymakers to make informed decisions on implementing telehealth in response to the COVID-19 pandemic by addressing the obstacles ahead.

Project description:Most patients with diffuse large B-cell lymphoma (DLBCL) are diagnosed at age 60 years or older. Challenges to effective therapy among older individuals include unfavorable biologic features of DLBCL, geriatric vulnerabilities, suboptimal treatment selection, and toxicities of cytotoxic chemotherapy. Wider application of geriatric assessments may help identify fit older patients who benefit from standard immunochemotherapy without unnecessary dose reductions. Conversely, attenuated regimens may provide a better balance of risk and benefit for selected unfit or frail patients. Supportive care with the use of corticosteroid-based prephase, prophylactic growth factors, and early institution of supportive and palliative care can help maximize treatment tolerance. Several novel or emerging therapies have demonstrated favorable toxicity profiles, thus facilitating effective treatment for elderly patients. In the relapsed or refractory setting, patients who are not candidates for stem cell transplantation can benefit from newly approved options including polatuzumab vedotin-based combinations or tafasitamab plus lenalidomide, which may have higher efficacy and/or lower toxicity than historical chemotherapy regimens. Chimeric antigen receptor T-cell therapy has been successfully applied to older patients outside of clinical trials. In the first-line setting, emerging immunotherapy options (bispecific antibodies) and targeted therapies (anti-CD20 antibodies combined with lenalidomide and/or B-cell receptor inhibitors) may provide chemotherapy-free approaches for DLBCL. Enrolling older patients in clinical trials will be paramount to fully examine potential efficacy and toxicity of these strategies. In this review, we discuss recent advances in fitness stratification and therapy that have expanded curative options for older patients, as well as future opportunities to improve outcomes in this population. IMPLICATIONS FOR PRACTICE: Management of diffuse large B-cell lymphoma in older patients poses challenges due to aggressive disease biology and geriatric vulnerability. Although R-CHOP remains standard first-line treatment, geriatric assessment may help evaluate patients' fitness for immunochemotherapy. Corticosteroid prephase, prophylactic growth factors, and early palliative care can improve tolerance of treatment. Novel salvage options (polatuzumab vedotin-based combinations, tafasitamab plus lenalidomide) or chimeric antigen receptor T-cell therapy should be considered in the relapsed or refractory setting for patients ineligible for stem cell transplantation. Emerging immunotherapies (bispecific antibodies) and targeted therapies provide potential first-line chemotherapy-free approaches, which need to be rigorously assessed in clinical trials that involve geriatric patients.

Dataset Information

Panarchy: opportunities and challenges for ecosystem management.

Publications

Panarchy: opportunities and challenges for ecosystem management.

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