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Resumen Introduccion Mas de 50 millones de personas tienen epilepsia activa, de las cuales aproximadamente un 30% no responden a los farmacos anticrisis, y en algunos casos, la cirugia es una opcion terapeutica. Es fundamental no considerar lo opcion quirurgica como ultimo recurso en el tratamiento y referir en forma temprana a centros de alta complejidad especializados en un tratamiento integral de las epilepsias. Objetivos Analizar y comunicar la experiencia en cirugia de epilepsia realizada en nuestro centro en los ultimos 5 anos. Pacientes y metodos Diseno observacional descriptivo de pacientes con epilepsia resistente al tratamiento farmacologico evaluados para cirugia de epilepsia durante el periodo 2014-2019 en el Instituto de Neurociencias de la Fundacion Favaloro, con un seguimiento minimo de 12 meses. Resultados Se realizaron 57 procedimientos quirurgicos, de los cuales: 41 fueron cirugias de epilepsia (3 de ellas, reoperaciones) y 16 video-EEG profundidad. Con respecto a la cirugia de epilepsia, la edad promedio fue 38,2 anos, el 51% eran mujeres y el 97% tenia lesion visible en la resonancia de cerebro. Un 75% de los pacientes presentaron resultados de excelentes (Wieser clase i , 66%) a buenos (Wieser ii , 9%). En un 65% de los casos, se demoro mas de 10 anos entre el diagnostico de epilepsia y la cirugia (y de estos, casi la mitad demoro mas de 20 anos). Conclusiones Es fundamental considerar la opcion quirurgica en forma temprana y promover programas de educacion para identificacion de los pacientes con epilepsia resistente que se beneficiarian de un tratamiento quirurgico.

Climate change and biodiversity loss trigger policies targeting and impacting local communities worldwide. However, research and policy implementation often fail to sufficiently consider and involve them. Therefore, we present the results of a collective self-assessment exercise for eight case studies of communications regarding climate change or biodiversity loss between project teams and local communities. We develop eight indicators of good stakeholder communication, reflecting the scope of Verran (2002)'s concept of postcolonial moments as a communicative utopia. We demonstrate that applying our indicators enhances communication, although we discover a divergence between timing, complexity, and (introspective) effort. Three cases qualify for postcolonial moments , but scrutinising power relations and genuine knowledge co-production remain rare. While we verify the potency of various instruments for deconstructing science, their sophistication cannot substitute trust-building and epistemic/transdisciplinary awareness. Lastly, we consider that reforming inadequate funding policies helps improving the work in and with local communities.

Synthesizing evidence is an essential part of scientific progress, but it is often done in a slow and uncoordinated manner, sometimes producing misleading conclusions. Here, we propose the idea of an ‘open synthesis community’ to resolve this pressing issue.

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International audience; The cultural ecosystem services (CES) construct has evolved to accommodate multiple worldviews, knowledge systems and conceptualizations of nature and values, including relational and mental health values.Cultural ecosystem services research and practice has mostly focused on cognitive ways of constructing and expressing intangible values of, and relationships with, nature. But our non-material relationships with nature are not exclusively cognitive: sensory and affective processes are fundamental to how we build, enact and experience these relationships.Building on the core ideas of relational values, embodied experiences and connectedness with nature, we present a simple framework to explore the sensory, affective and cognitive dimensions of human–nature interactions, as well as the settings and activities that frame them.We demonstrate its use in a case study in the Peruvian Andes, where we applied an inductive, exploratory approach to elicit personal imageries and imaginings related to nature, place and recreation. The narratives shared were rich with symbolism and personal sensory experiences, emotions and memories, which the interviewees linked with general assertions about people, place and nature.We discuss the usefulness of such a perspective for CES research, and for human well-being, environmental justice and landscape management.

License information: This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. This research was partially funded by the German Federal Ministry of Education and Research BMBF (FoReSee, grant no. 01LA1811B, Economics of the Climate Change II programme; COMTESS, grant no. 01LL0911A-G, Sustainable Land Management programme; Carbiocial, grant no. 01LL0902F, Sustainable Land Management programme, ECAS-BALTIC, grant no. 03F0860G, Küno Küstenforschung Nordsee / Ostsee), the European Commission (DESIRE, project number 561638-EPP-1-2015-1-JO-EPP KA2-CBHE-JP, grant agreement number: 2012-3324/001-001), the Flemish Interuniversity Council – University Development Cooperation VLIR-UOS (North South South Cooperation Programme ZIUS2015VOA3106), the Belgian Directorate-General for Development Cooperation and Humanitarian Aid (CEBioS programme), the Special Research Fund of Hasselt University (BOF20TT06), the Belgian Science Policy BELSPO (EVAMAB of CEBioS programme), the Luc Hoffmann Institute, and the German Research Foundation DFG (Germany's Excellence Strategy – EXC 2037 'CLICCS - Climate, Climatic Change, and Society', project no 390683824).

Climate change and biodiversity loss trigger policies worldwide, many of which target or impact local communities. Although research, international development, and policy implementation (and, thus, success in fighting both threats) require thoughtful consideration and communication of the underlying concepts, field work encounters a cascade of tangible barriers. Technoscientific representations of quantifiable causes and effects often remain alien to local perspectives, and failure to involve communities constantly and genuinely creates gaps that may ultimately prevent research and policy success. Therefore, in this article, we present the results of a collective self-assessment exercise for a panel of eight case studies (covering four continents) of communications between project teams and local communities within the context of climate change or biodiversity loss. Our analysis develops eight indicators of good stakeholder communication, which we construct from the literature, in addition to Verran (2002) 's concept of postcolonial moments as a communicative utopia. Our study contributes to the (analytical) understanding of such communications, while also providing tangible insights for field work and policy recommendations. We demonstrate that applying our indicators can foster a more successful communication, although we find an apparent divergence between timing, complexity, and (introspective) effort of the project teams. While three case studies qualify for postcolonial moments, our findings show that especially the scrutiny of power relations and genuine knowledge co-production are still rare. We verify the potency of various instruments for deconstructing science; however, we also show that their sophistication cannot substitute other crucial factors. Instead, simple deconstruction efforts may suffice, while trust-building, proper time management, and an advanced awareness of the scientists are crucial. Lastly, we consider that reforming rigid and inadequate funding policies will help overcome significant barriers and improve the work in and with local communities.

Protected areas face many threats, including the observed and projected impacts of climate change, yet there is little evidence that adaptation strategies are providing comprehensive solutions to deal with ecological transformation due to changing climates. In this article we explore whether, how and to what extent the governance of knowledge helps or hinders managerial change towards more proactive climate adaptation. We applied a knowledge governance framework that addresses social and cultural dimensions of environmental decision-making, alongside the institutional arrangements that support particular knowledge-based relationships, to document the knowledge-based processes in place for managing protected areas under uncertain climate change in Colombia. We found that the results of scientific experimentation and modelling (mainly in the natural sciences) are often stated as the preferred source of knowledge to inform decision making, forming a dominant narrative that climate adaptation can and should be driven by scientific and technical information. However, institutional arrangements in practice were typically more diverse in the knowledge sources that contribute to protected area policy and practice. This indicates a significant mis-match between the desired knowledge base for climate adaptation governance, and the actual knowledge processes that underpin effective planning. We propose that understanding institutional arrangements that shape adaptation decision contexts can help to address barriers for using climate information effectively, including understanding its limitations. It can also help managers identify opportunities to draw on existing diverse and rich knowledge systems to support the institutional transformations needed to enable strategic planning and management for effective climate adaptation.

Management of protected areas must adapt to climate impacts, and prepare for ongoing ecological transformation. Future-Proofing Conservation is a dialogue-based, multi-stakeholder learning process that supports conservation managers to consider the implications of climate change for governance and management. It takes participants through a series of conceptual transitions to identify new management options that are robust to a range of possible biophysical futures, and steps that they can take now to prepare for ecological transformation. We outline the Future-Proofing Conservation process, and demonstrate its application in a pilot programme in Colombia. This process can be applied and adapted to a wide range of climate adaptation contexts, to support practitioners in developing positive ways forward for management and decision-making. By acknowledging scientific uncertainty, considering social values, and rethinking the rules that shape conservation governance, participants can identify new strategies towards “future-oriented conservation” over the long term.

Human actions have driven earth systems close to irreversible and profound change. The need to shift towards intentional transformative adaptation (ITA) is clear. Using case studies from the Transformative Adaptation Research Alliance (TARA), we explore ITA as a way of thinking and acting that is transformative in concept and objectives, but achieved through a mix of incremental and transformative co-production processes that ultimately lead to the social-ecological system being transformed. Central to ITA are social and political issues of how individuals and collectives address environmental and social change and deal with power imbalances. ITA approaches are claimed to help overcome adaptation challenges, including: 1) re-framing human-nature relationships; 2) dealing with uncertainty; 3) engendering empowerment and agency and 4) addressing conflicting values and interests. However, it is unclear if these approaches work in practice. We examined six adaptation case studies in which participants used processes of: 1) co-producing visions of the future; 2) re-framing values, rules and knowledge to shift decision contexts for adaptation and 3) implementing actions using theories of change and adaptation pathways. We assessed the extent to which participants could use these processes to address their adaptation challenges. We found evidence of many positive achievements towards the implementation of ITA, but also examples where processes were not working, such as communities having difficulties in finding ways to work co-operatively. Different processes will be needed to address these issues, such as promoting pluralism, knowledge contestation, and deliberative re-politicisation of the adaptation agenda to shift power imbalances and enable change.

The promise of co-production to address complex sustainability challenges is compelling. Yet, co-production, the collaborative weaving of research and practice, encompasses diverse aims, terminologies and practices, with poor clarity over their implications. To explore this diversity, we systematically mapped differences in how 32 initiatives from 6 continents co-produce diverse outcomes for the sustainable development of ecosystems at local to global scales. We found variation in their purpose for utilizing co-production, understanding of power, approach to politics and pathways to impact. A cluster analysis identified six modes of co-production: (1) researching solutions; (2) empowering voices; (3) brokering power; (4) reframing power; (5) navigating differences and (6) reframing agency. No mode is ideal; each holds unique potential to achieve particular outcomes, but also poses unique challenges and risks. Our analysis provides a heuristic tool for researchers and societal actors to critically explore this diversity and effectively navigate trade-offs when co-producing sustainability. Co-production includes diverse aims, terminologies and practices. This study explores such diversity by mapping differences in how 32 initiatives from 6 continents co-produce diverse outcomes for the sustainable development of ecosystems at local to global scales.