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Abstract: Translocation programmes for endangered species typically focus on a single species, but in areas where little native habitat remains, it may be necessary to translocate multiple species to the same sites. Interactions between translocated species, such as predation and competition, are among the factors that need to be considered when planning multispecies translocations. Translocation sites for aquatic species are particularly scarce in southern California, where a limited number of sites exist for historically co‐occurring endangered mountain yellow‐legged frogs Rana muscosa and unarmoured three‐spine sticklebacks Gasterosteus aculeatus williamsoni. To determine how these species would interact if translocated to the same sites, we carried out experiments ex situ with R. muscosa tadpoles and a surrogate subspecies of stickleback (G. a. microcephalus). We found that (1) adult sticklebacks preyed on hatchling tadpoles but did not consume R. muscosa eggs or large tadpoles; (2) tadpoles did not consume stickleback eggs or disturb sticklebacks nests; and (3) both species' microhabitat use shifted slightly when the other was present. Our results suggest that these species can likely be co‐managed successfully, if measures are taken to curb stickleback predation on tadpoles until the R. muscosa population is well established. Using ex situ studies to evaluate species interactions prior to translocation is an approach that could prove useful in other species recovery programmes. Multispecies translocations could make better use of available resources when habitat is limited and promote ecosystem recovery by re‐establishing interactions among native species.

This perspective reflects on conservation efforts to increase the coverage of marine protected areas in Solomon Islands. We demonstrate that the current model in which international conservation NGOs provide technical and financial support to pilot projects, from which community‐based resource management will spontaneously spread, is misguided. These site‐based projects typically require substantial financial resources, ignore external threats to coastal ecosystems, and tend to bypass existing governance structures, which makes replication in other areas highly problematic. We argue that to effectively support indigenous peoples and local communities in the management of marine resources and, thereby, achieve biodiversity conservation outcomes at scale, it is necessary to move away from site‐based conservation projects and focus instead on strengthening the capability of government agencies. [ABSTRACT FROM AUTHOR]

In this paper, drawing from our dual positionality as researchers and practitioners, we discuss the insights and learnings from our decade-long engagement with fisheries in the Lakshadweep Islands, India. Using a case study of Lakshadweep’s live-bait pole and line tuna fishery, we describe how dominant developmental thinking manifests at local scales and trickles down to highly remote regions and induces vulnerability in small-scale fisheries. We also discuss our attempts to address unsustainable transitions in this fishery through interventions aimed at instituting participatory governance regimes. Reflecting on our work in this space, we highlight the setbacks and challenges of operationalizing such frameworks on the ground, the important processual lessons that have emerged from our engagement with a fishery in constant flux, and their implications for the theory and practice of participatory governance. We also underscore the need for theorists and practitioners to work more closely and learn from each other’s experiences to develop effective knowledge-practice frameworks for small-scale fisheries. [ABSTRACT FROM AUTHOR]

ABSTRACT Aquatic protected areas and co‐management have been proposed as strategies for conserving fisheries resources in several world regions. We analyzed the effects of different levels of governance on yield of experimental fisheries in Amazonian floodplain lakes. Sampling between 2018 and 2022 used gill nets deployed for 24 h during flooding and receding water phases. Generalized linear models (GLMs) were fitted to catch per unit effort (CPUE) and covariates, river level, time, sampling sites, level of management of the collection sites, and lake fishery management type. CPUE was significantly related to governance, management type, sampling site, and water level. Our results indicated that areas of sustainable use where community‐based co‐management was implemented were more effective for promoting high fishery yield. [ABSTRACT FROM AUTHOR]

Through the years, research has described the importance of community-based approaches in the management of coastal and marine ecosystems. Coastal and marine issues are multifaceted and require place-specific approaches developed in partnership with vulnerable communities who are impacted by environmental stressors. Place-based conservation, a management approach that focuses on unique, place-specific characteristics, and other similar methods. It considers the need to integrate human dimensions and location-centered approaches, which are often lacking in typical natural resource management. Meaningful engagement with underrepresented communities can holistically account for socioeconomic factors and cultural knowledge that inform best management practices. As the health of marine and coastal ecosystems is linked with environmental quality and local livelihoods, engaging practitioners with knowledge of these systems can support science and trust in environmental management. This article discusses the importance of community-based research, local insight, various examples of successful management, and culturally relevant knowledge to advance sustainable place-based conservation. [ABSTRACT FROM AUTHOR]

Worldwide, enhancement of oyster populations is undertaken to achieve a variety of goals including support of food production, local economies, water quality, coastal habitat, biodiversity, and cultural heritage. Although numerous strategies for improving oyster stocks exist, enhancement efforts can be thwarted by long-standing conflict among community groups about which strategies to implement, where efforts should be focused, and how much funding should be allocated to each strategy. The objective of this paper is to compare two engagement approaches that resulted in recommendations for multi-benefit enhancements to oyster populations and the oyster industry in Maryland, U.S.A., using the Consensus Solutions process with collaborative simulation modeling. These recommendations were put forward by the OysterFutures Workgroup in 2018 and the Maryland Oyster Advisory Commission (OAC) in 2021. Notable similarities between the efforts were the basic principles of the Consensus Solutions process: neutral facilitation, a 75% agreement threshold, the presence of management agency leadership at the meetings, a scientific support team that created a management scenario model in collaboration with community group representatives, numerous opportunities for representatives to listen to each other, and a structured consensus building process for idea generation, rating, and approval of management options. To ensure meaningful representation by the most affected user groups, the goal for membership composition was 60% from industry and 40% from advocacy, agency, and academic groups in both processes. Important differences between the processes included the impetus for the process (a research program versus a legislatively-mandated process), the size of the groups, the structure of the meetings, and the clear and pervasive impact of the COVID-19 pandemic on the ability of OAC members to interact. Despite differences and challenges, both groups were able to agree on a package of recommendations, indicating that consensus-based processes with collaborative modeling offer viable paths toward coordinated cross-sector natural resource decisions with scientific basis and community support. In addition, collaborative modeling resulted in 'myth busting' findings that allowed participants to reassess and realign their thinking about how the coupled human-oyster system would respond to management changes. [ABSTRACT FROM AUTHOR]

We conducted a retrospective chart review of patients with neuromuscular scoliosis following spinal fusion surgery who were cared for post-operatively by either a hospitalist/orthopedics co-management team or a complex care clinic (CCC). Assignment to either treatment group was not random. To account for baseline differences between groups, we calculated propensity scores and used these as probability weights in generalized linear models. After matching, the CCC had a shorter length of stay (LOS, coefficient = −2.60; P =.04) without a significant difference in 30-day readmission rate (P =.62). For secondary outcomes, there were some significant resource utilization benefits favoring the complex care group without significant difference in complication outcomes between groups. In managing patients after spinal fusion surgery, both groups had similar LOS compared with prior studies of children after spinal fusion surgery. Management by the CCC may confer some outcome benefits for their patients. [ABSTRACT FROM AUTHOR]

Community management of natural resources faces various challenges that require the recognition of a plurality of perspectives among stakeholders. We used the Q methodology to investigate stakeholders’ perspectives on the management and conservation strategies for the Bouche du Roy Community Biodiversity Conservation Area (CBCA), an area mainly made up of mangrove ecosystems. Our results highlight three main perspectives explaining 70% of the total variance. The optimistic perspective contends that the creation and management of the CBCA are lifesaving and essential, the restrictive perspective maintains that its creation and management restrict the activities of local residents, while the alternative perspective asserts that the CBCA is well managed, but that some aspects need improvement to meet the needs of the community. Despite differences between perspectives, participants’ responses also highlighted several aspects of consensus and opportunities for a constructive debate on the management of the CBCA. Nevertheless, the management of the CBCA is confronted with complex socio-ecological interactions that adversely affect the livelihoods of certain stakeholders. The development of alternative incomes by and for these stakeholders, especially the diversification of sustainable livelihoods, can both achieve conservation goals and respond to their needs. Our findings can help provide stakeholders and decision makers with a mapping of social perspectives that can be used to promote inclusive CBCA management and conservation strategies.Highlights: Conservation of coastal ecosystems can involve communities and local knowledge. Community management requires the recognition of a plurality of discourses. Using the Q method, three social perspectives were identified. Consensus and divergence provide an opportunity to increase dialogue. [ABSTRACT FROM AUTHOR]

Abstract Understanding and addressing biodiversity declines across the globe will require interdisciplinary practices that embrace multiple worldviews and weave knowledge systems. Here, we used a Two‐Eyed Seeing approach to weave Anishinaabe ecological knowledge with peer‐reviewed Western scientific literature to provide a comprehensive understanding of the drivers of a declining moose (mooz; Alces alces) population in Ontario, Canada. We interviewed 66 participants from three Anishinabek communities on the causes of moose decline and conducted a literature review of 52 Western‐science studies that focused on factors that affect moose in Ontario. Our study revealed that there was agreement among knowledge systems on the importance of climate change and disease and parasites in explaining moose population decline in Ontario. Unique perspectives were provided on the mechanisms describing climatic impacts on calf recruitment, with an emphasis on spring onset and green‐up by Western science, and winter onset and timing of the rut by Anishinaabe knowledge. Western science also focused on the effects of habitat disturbance and predation on moose, and Anishinaabe knowledge emphasised harvest pressure. Other factors identified by both knowledge systems included the impacts of roads and railways. Distinctive information offered by Anishinaabe knowledge holders included the displacement of moose from areas in response to the range expansion of white‐tailed deer (waawaashkeshi; Odocoileus virginianus) and the negative effects of contaminants introduced into the environment by mining and forestry activity. Overall, weaving knowledge systems offered a nuanced and wholistic understanding of factors affecting moose and provided different perspectives to explain interacting and cumulative effects. Our study showcases the value in weaving knowledge systems to improve understanding of ecological problems and find wholistic strategies for conservation. Read the free Plain Language Summary for this article on the Journal blog.

Abstract This paper presents the design and development of a coastal fisheries monitoring system that harnesses artificial intelligence technologies. Application of the system across the Pacific region promises to revolutionize coastal fisheries management. The program is built on a centralized, cloud-based monitoring system to automate data extraction and analysis processes. The system leverages YoloV4, OpenCV, and ResNet101 to extract information from images of fish and invertebrates collected as part of in-country monitoring programs overseen by national fisheries authorities. As of December 2023, the system has facilitated automated identification of over six hundred nearshore finfish species, and automated length and weight measurements of more than 80,000 specimens across the Pacific. The system integrates other key fisheries monitoring data such as catch rates, fishing locations and habitats, volumes, pricing, and market characteristics. The collection of these metrics supports much needed rapid fishery assessments. The system’s co-development with national fisheries authorities and the geographic extent of its application enables capacity development and broader local inclusion of fishing communities in fisheries management. In doing so, the system empowers fishers to work with fisheries authorities to enable data-informed decision-making for more effective adaptive fisheries management. The system overcomes historically entrenched technical and financial barriers in fisheries management in many Pacific island communities.

The global shift towards sustainable waste management has led to an intensified exploration of co-digestion and co-treatment of sewage and organic waste using anaerobic reactors. This review advocates for an integrated approach where organic waste is treated along with the sewage stream, as a promising solution to collect, treat, and dispose of organic waste, thereby reducing the environmental and economic burden on municipalities. Various efforts, ranging from laboratory to full-scale studies, have been undertaken to assess the feasibility and impacts of co-digestion or co-management of sewage and organic waste, using technologies such as up-flow anaerobic sludge blankets or anaerobic membrane bioreactors. However, there has been no consensus on a standardized definition of co-digestion, nor a comprehensive understanding of its impacts. In this paper, we present a comprehensive review of the state-of-the-art in liquid anaerobic co-digestion systems, which typically operate at 1.1% total solids. The research aims to investigate how the integration of organic waste into mainstream anaerobic-based sewage treatment plants has the potential to enhance the sustainability of both sewage and organic waste management. In addition, utilizing the surplus capacity of existing anaerobic reactors leads to significant increases in methane production ranging from 190 to 388% (v/v). However, it should be noted that certain challenges may arise, such as the necessity for the development of tailored strategies and regulatory frameworks to enhance co-digestion practices and address the inherent challenges. [ABSTRACT FROM AUTHOR]

Given that terrestrial ecosystems globally are facing the loss of biodiversity from land use conversion, invasive species, and climate change, effective management requires a better understanding of the drivers and correlates of biodiversity. Increasingly, biodiversity is co‐managed with aboveground carbon storage because high biodiversity in animal species is observed to correlate with high aboveground carbon storage. Most previous investigations into the relationship of biodiversity and carbon co‐management do not focus on the biodiversity of the species rich plant kingdom, which may have tradeoffs with carbon storage. To examine the relationships of plant species richness with aboveground tree biomass carbon storage, we used a series of generalized linear models with understory plant species richness and diversity data from the USDA Forest Service Forest Inventory and Analysis dataset and high‐resolution modeled carbon maps for the Tongass National Forest. Functional trait data from the TRY database was used to understand the potential mechanisms that drive the response of understory plants. Understory species richness and community weighted mean leaf dry matter content decreased along an increasing gradient of tree biomass carbon storage, but understory diversity, community weighted mean specific leaf area, and plant height at maturity did not. Leaf dry matter content had little variance at the community level. The decline of understory plant species richness but not diversity to increases in aboveground biomass carbon storage suggests that rare species are excluded in aboveground biomass carbon dense areas. These decreases in understory species richness reflect a tradeoff between the understory plant community and aboveground carbon storage. The mechanisms that are associated with observed plant communities along a gradient of biomass carbon storage in this forest suggest that slower‐growing plant strategies are less effective in the presence of high biomass carbon dense trees in the overstory. [ABSTRACT FROM AUTHOR]

Co-management is a promising forest governance strategy that integrates local communities' traditional rights and forest dependencies while aiming to improve forest cover and ecosystem health. Bangladesh, facing high deforestation rates and limited per capita forest area, has implemented co-management initiatives since 2003 to restore forest cover and support the livelihoods of forest-dependent communities. While the socio-economic impacts of co-management are well studied, its effects on forest cover remain underexplored. This study addresses that gap by using three common spectral vegetation indices (NDVI, EVI, and MSAVI), calculated from Landsat 7 data, to analyze forest cover changes in five major protected areas under co-management. The results indicated that dense forest cover (41–71%) was initially prevalent in these areas, but a significant decline occurred between 2004 and 2015, with slope values ranging from −3.7 to −0.96. In contrast, the non-co-managed control site exhibited a much smaller decline (slope: −0.48 to −0.62) across all indices. Notable increases in agricultural land and forest–agriculture mosaics were also observed in the protected areas under co-management. Global Forest Watch data further confirmed substantial forest cover loss, particularly in CWS (158.77 ha) and SNP (0.49 ha). These findings highlight the need to reassess co-management strategies to address ongoing forest degradation. [ABSTRACT FROM AUTHOR]

Understanding and addressing biodiversity declines across the globe will require interdisciplinary practices that embrace multiple worldviews and weave knowledge systems.Here, we used a Two‐Eyed Seeing approach to weave Anishinaabe ecological knowledge with peer‐reviewed Western scientific literature to provide a comprehensive understanding of the drivers of a declining moose (mooz; Alces alces) population in Ontario, Canada.We interviewed 66 participants from three Anishinabek communities on the causes of moose decline and conducted a literature review of 52 Western‐science studies that focused on factors that affect moose in Ontario.Our study revealed that there was agreement among knowledge systems on the importance of climate change and disease and parasites in explaining moose population decline in Ontario. Unique perspectives were provided on the mechanisms describing climatic impacts on calf recruitment, with an emphasis on spring onset and green‐up by Western science, and winter onset and timing of the rut by Anishinaabe knowledge. Western science also focused on the effects of habitat disturbance and predation on moose, and Anishinaabe knowledge emphasised harvest pressure. Other factors identified by both knowledge systems included the impacts of roads and railways. Distinctive information offered by Anishinaabe knowledge holders included the displacement of moose from areas in response to the range expansion of white‐tailed deer (waawaashkeshi; Odocoileus virginianus) and the negative effects of contaminants introduced into the environment by mining and forestry activity.Overall, weaving knowledge systems offered a nuanced and wholistic understanding of factors affecting moose and provided different perspectives to explain interacting and cumulative effects. Our study showcases the value in weaving knowledge systems to improve understanding of ecological problems and find wholistic strategies for conservation. Read the free Plain Language Summary for this article on the Journal blog. Read the free Plain Language Summary for this article on the Journal blog. [ABSTRACT FROM AUTHOR]

Parks Canada, in response to commitments undertaken towards reconciliation, has signaled its readiness to reassess the participation of Indigenous peoples in the co-management of national parks, national park reserves, and national marine conservation areas (NMCAs). However, the effectiveness of co-management, as the established framework underpinning these and other longstanding partnerships between the state and Indigenous groups, has been disputed, based on an uneven track record in meeting the needs, interests, and aspirations of Indigenous communities. This paper explores the potential of co-management to facilitate reconciliation within national parks, reserves and NMCAs by developing a typology of various types of co-management agreements. Addressing a critical knowledge gap in co-management governance, we provide a comprehensive review of 23 negotiated co-management agreements involving the state and Indigenous groups in a national park context. The resulting typology categorizes these agreements according to contextual factors and governance arrangements, offering insights into the feasibility of shared governance approaches with Parks Canada. Moreover, it identifies the strengths and weaknesses of co-management agreements in fulfilling reconciliation commitments. Our findings indicate that, although Parks Canada has implemented innovative approaches to co-management and shown a willingness to support Indigenous-led conservation efforts, true shared governance with Indigenous groups, as defined by international standards, is limited by the Canadian government's evident reluctance to amend the foundational legislation to effectively share authority in national parks. [ABSTRACT FROM AUTHOR]

Moose (Alces alces; mooz [singular], moozoog [plural] in Anishinaabemowin, Ojibwe language) are an important species to many Indigenous rights‐holders and stakeholders throughout their circumpolar range. Management of moose can often lead to conflict when various perspectives of Indigenous nations are not recognized or appreciated. During the 55th North American Moose Conference and Workshop held in Grand Portage, Minnesota, USA, we held a workshop with 145 participants centered around co‐stewardship of moose among various Indigenous nations, federal, state, and provincial governments, academia, and non‐governmental agencies. Using a facilitator, the participants identified opportunities and challenges surrounding issues related to moose management. Participants then further identified priority improvements and action steps for co‐stewardship. Six core principles of Indigenous co‐stewardship were developed: 1) recognition of Indigenous Sovereignty, which specifies that co‐stewardship must begin with a recognition of the sovereignty of Indigenous nations and their inherent rights to manage, conserve, and preserve natural and cultural resources within their ancestral lands; 2) shared responsibility, where co‐stewardship is a shared responsibility between Indigenous nations, federal governments, and state governments; 3) cultural and ecological respect, which stipulates that co‐stewardship should honor the cultural significance of moose to Indigenous nations and recognize the ecological importance of moose within the broader ecosystem; 4) inclusive decision‐making, which details that co‐stewardship requires inclusive and equitable decision‐making processes that involve meaningful consultation and consent from Indigenous nations; 5) resource sharing and capacity building, where co‐stewardship involves the sharing of resources and knowledge between Indigenous and non‐Indigenous partners; and 6) adaptive management and sustainability, specifying that co‐stewardship should embrace adaptive management principles, where management strategies are continuously evaluated, adjusted, and improved based on new information and changing conditions. Some of the key takeaways from the workshop included that it will be essential to integrate Indigenous ways of knowing into an equitable and inclusive management system, there are existing models of co‐stewardship that can be built upon, it is critical to build trust among all key stakeholders and rights‐holders, and it will be important to establish formal and informal collaborative systems among all partners to support co‐stewardship at all levels. We discuss a study and synthesis on Indigenous co‐stewardship of moose and offer a synopsis and recommendations to advance restoration of moose in North America. [ABSTRACT FROM AUTHOR]

Purpose: The safety of laparoscopic inguinal–hernia repair must be carefully evaluated in elderly patients. Very little is known regarding the safety of the laparoscopic approach in elderly patients under surgical and medical co-management (SMC). Therefore, this study evaluated the safety of the laparoscopic approach in elderly patients, especially patients with multiple comorbidities under SMC. Methods: From January 2012 to December 2021, patients aged ≥ 65 years who underwent open or laparoscopic inguinal–hernia repair during hospitalization were consecutively enrolled. Postoperative outcomes included major and minor operation-related complications, and other adverse events. To reduce potential selection bias, propensity score matching was performed between open and laparoscopic groups based on patients' demographics and comorbidities. Results: A total of 447 elderly patients who underwent inguinal–hernia repair were enrolled, with 408 (91.3%) underwent open and 39 (8.7%) laparoscopic surgery. All postoperative outcomes were comparable between open and laparoscopic groups after 1:1 propensity score matching (all p > 0.05). Moreover, compared to the traditional care group (n = 360), a higher proportion of the SMC group (n = 87) was treated via the laparoscopic approach (18.4% vs. 6.4%, p = 0.00). In the laparoscopic approach subgroup (n = 39), patients in the SMC group (n = 16) were older with multiple comorbidities but were at higher risks of only minor operation-related complications, compared to those in the traditional care group. Conclusions: Laparoscopic inguinal–hernia repair surgery is safe for elderly patients, especially those with multiple comorbidities under SMC. [ABSTRACT FROM AUTHOR]

Abstract This perspective reflects on conservation efforts to increase the coverage of marine protected areas in Solomon Islands. We demonstrate that the current model in which international conservation NGOs provide technical and financial support to pilot projects, from which community‐based resource management will spontaneously spread, is misguided. These site‐based projects typically require substantial financial resources, ignore external threats to coastal ecosystems, and tend to bypass existing governance structures, which makes replication in other areas highly problematic. We argue that to effectively support indigenous peoples and local communities in the management of marine resources and, thereby, achieve biodiversity conservation outcomes at scale, it is necessary to move away from site‐based conservation projects and focus instead on strengthening the capability of government agencies.

Aspen exists as the most abundant and industrially important forest type in contemporary Minnesota. Historically, the species was seen as economically undesirable yet saw prolific increases in abundance due to pine harvest and fire. The Leech Lake Reservation exists as a unique case study of tribal-U.S. Forest Service co-management, with 90 % of reservation land within Chippewa National Forest boundaries. This large geographical intersection was created by a series of American Indian law policies and makes the relationship between the Chippewa National Forest and the Leech Lake Band of Ojibwe unique within the USDA National Forest System. Comparison of pre-reservation and more modern forest/land cover types within the modern-day boundaries of the Leech Lake Reservation were conducted alongside investigation of historical management authority documentation of Chippewa National Forest and Leech Lake Band of Ojibwe cooperation and broader historical management of aspen in Minnesota. Results suggest historical power dynamics between the Chippewa National Forest and Leech Lake Band of Ojibwe influenced decreasing pine and increasing aspen on the Leech Lake Reservation. However, the modern relationship between the Chippewa National Forest and the Leech Lake Band of Ojibwe shows the potential for successful co-management within the shared goals of aspen management.

Coastal fisheries are vital for food supply, employment, and social stability. However, overfishing is a common problem, often attributed to open access. Territorial Use Rights in Fisheries (TURFs) have gained popularity as a tool to improve the sustainability of coastal fisheries, but research on TURFs in China is limited. This paper examines the island reef fishery lease policy implemented in Shengsi County, Zhejiang Province, within the Ma'an Islands National Marine Special Reserve. The policy leases the use of island reefs to a collective, aiming to address overfishing and resource degradation by establishing fishing area boundaries and limiting the number of users and usage time. Technically, it is an application of TURFs, and it represents a shift from traditional fishing licenses to collective compliance. This experience has disrupted the existing top–down fishery governance structure and signifies a transition to a rights-based fishery management system in China. Through a comprehensive investigation and analysis of the policy's implementation, this research identifies the factors contributing to its flaws. These include the inadequate provision of national and local government policies, insufficient support for policy implementation from fishery management authorities, and the limited involvement of fishermen's organizations. To enhance coastal fishery management, we propose that the Chinese government should build upon existing foundations by clarifying fishing rights through central and local laws and policies. Additionally, there is a need to strengthen data monitoring of coastal fisheries, conduct multidisciplinary research to improve the allocation mechanism of fishing rights, adopt diverse fishery management approaches to enhance supervision capabilities, establish a collaborative governance mechanism, and foster coordination and cooperation between grassroots fishermen's organizations and government departments. [ABSTRACT FROM AUTHOR]

The intensive utilization of tropical inland water bodies for multiple and sometimes competing activities underlines the necessity for their integrated and holistic co-management. This paper presents our synthesis on lake and reservoir fisheries in South and Southeast Asia as social–ecological systems, based on a synopsis of our research findings from a previous EU-funded research programme in Sri Lanka, Thailand and the Philippines (FISHSTRAT project). The paper attempts to merge our results with recent developments in research, policy and practice. We explore the effects of the main external and internal control mechanisms of the trophic state and pinpoint to the high production potential of traditionally unexploited small indigenous fish species. The limitations of conventional centralized management systems highlight the importance of introducing transdisciplinary approaches which integrate limnology, fish ecology and fisheries with the interests of other resource using stakeholders and decision makers in order to develop locally appropriate co-management strategies for sustainable aquatic resource use. [ABSTRACT FROM AUTHOR]

Background: Australia's ageing population is challenging for surgical units and there is a paucity of evidence for geriatric co‐management in acute general surgery. We aimed to assess if initiating a Geriatric Medicine in‐reach service improved outcomes for older adults in our Acute Surgical Unit (ASU). Methods: The Older Adult Surgical Inpatient Service (OASIS) was integrated into ASU in 2021. We retrospectively reviewed all patients over age 65 admitted to ASU over a 12‐month period before and after service integration with a length of stay (LOS) greater than 24 h. There was no subsequent truncation or selection. Primary outcomes were 30‐day mortality, LOS, and 28‐day readmissions. Secondary outcomes were discharge disposition, in‐hospital mortality, and hospital‐acquired complications (HACs). Results: 1339 consecutive patients were included in each group, with no differences in baseline characteristics. There was a significant decrease in 28‐day readmissions from 20.2% to 16.0% (P < 0.05), greatest in patients undergoing non‐EL operative procedures (21.9% pre‐OASIS vs. 12.6% post‐OASIS; P < 0.05). Trends towards reduced 30‐day mortality (7.17% vs. 5.90%; P = 0.211), in‐hospital mortality (3.88% vs. 2.91%; P = 0.201), permanent care placement (7.77% vs. 7.09%; P = 0.843) and HACs (8.14% vs. 7.62%; P = 0.667) were seen, although statistical significance was not demonstrated. LOS remained unchanged at 4 days (P = 0.653). Conclusion: The addition of a geriatric in‐reach service to a tertiary ASU led to a significant reduction in 28‐day readmissions. Downtrends were seen in mortality, permanent care placement, and HAC rates, while LOS remained unchanged. We aimed to assess if initiating a geriatric medicine in‐reach service (OASIS) improved outcomes for older adults in a tertiary acute surgical unit (ASU). We retrospectively reviewed all patients over age 65 admitted to ASU over a 12‐month‐period before and after service integration with primary outcomes being 30‐day mortality, length of stay (LOS), and 28‐day hospital readmissions and secondary outcomes being discharge disposition, in‐hospital mortality, and hospital‐acquired complications (HACs). The addition of OASIS led to a significant reduction in 28‐day readmissions, with downtrends seen in mortality and HAC rates, and an unchanged LOS. [ABSTRACT FROM AUTHOR]

Natural resource governance challenges are often highly complex, particularly in Indigenous contexts. These challenges involve numerous landscape-level interactions, spanning jurisdictional, disciplinary, social, and ecological boundaries. In Eeyou Istchee, the James Bay Cree Territory of northern Quebec, Canada, traditional livelihoods depend on wild food species like moose. However, these species are increasingly being impacted by forestry and other resource development projects. The complex relationships between moose, resource development, and Cree livelihoods can limit shared understandings and the ability of diverse actors to respond to these pressures. Contributing to this complexity are the different knowledge systems held by governance actors who, while not always aligned, have broadly shared species conservation and sustainable development goals. This paper presents fuzzy cognitive mapping (FCM) as a methodological approach used to help elicit and interpret the knowledge of land-users concerning the impacts of forest management on moose habitat in Eeyou Istchee. We explore the difficulties of weaving this knowledge together with the results of moose GPS collar analysis and the knowledges of scientists and government agencies. The ways in which participatory, relational mapping approaches can be applied in practice, and what they offer to pluralistic natural resource governance research more widely, are then addressed. [ABSTRACT FROM AUTHOR]

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Employing the social aspect into the blue economy is crucial to ensure equity for communities whose livelihoods are intertwined with the ocean. One way to achieve this is by integrating local knowledge into management practices. Unfortunately, information regarding the mechanisms that influence the effectiveness of this integration remains underexplored, particularly in terms of empirical field-based evidence.. This research adopts a qualitative approach that emphasizes the exploration of case studies on the integration of local knowledge through institutional bricolage. Papadak/Hoholok is one example of this practice. We argue that institutional bricolage practices emerging from external parties are determined by the functioning of change enablers and the appropriate implementation of co-management. The research findings indicate that local knowledge struggles to function effectively due to a lack of resources and commitment from the involved parties. External parties seem more interested in the initiation process rather than collaborating over the long term to ensure the successful integration of local knowledge into management practices. Hence, the long-term commitment of involved parties should be a focal point for similar practices in the upcoming times. [ABSTRACT FROM AUTHOR]

Community-based co-management strategy has been implemented in coastal and marine protected areas to reconcile resource use with biodiversity conservation, and to foster governance through the participation of multiple actors like governments, social civil organizations, and traditional resource users. How actors engage in collaboration will determine specific network structures that can facilitate or hinder different processes. The analysis of network structures can evidence the presence of social capital and leadership, both necessary to achieve collective action and contribute to build resilience and increase adaptability. Through the statement of collective action problems related to (1) biodiversity, (2) governance, and (3) socioeconomic issues we study the potential for collaboration between institutions in the Deliberative Council of Canavieiras Extractive Reserve. We identify network structures that can promote the presence of social capital and leadership necessary to address the collective action problems that may arise. The federal environmental agency was the most sought institution for solving almost all problems. This central institution can act as a coordinator and fosters collective action. Regardless, the high dependency on this federal environmental agency can affect the system's resilience because of its complex and bureaucratic structure, which can delay and hinder the collective action process. Traditional communities and their leadership institution have high social capital for collective action. Several institutions seem to share the bridging position in the networks, revealing the decentralization of this role that may provide resilience to changes in the governance of the system. [ABSTRACT FROM AUTHOR]

The relatively rapid expansion of protected areas (PAs) has outpaced their effective governance, monitoring, and evaluation processes, resulting in a knowledge gap, particularly in relation to the impact and efficacy of co-managed protected areas in conserving biodiversity globally. Bangladesh, like numerous other nations, is expanding its existing co-management model to incorporate additional PAs while simultaneously making only limited modifications to the management of these protected areas. Evaluations, however, are relatively rare throughout the world, including Bangladesh, despite their potential to improve PA quality and effectiveness. The purpose of this article is to examine current co-management practices at two sites in Bangladesh's Sundarbans to identify significant challenges and the efficacy of co-management initiatives through the establishment of a novel evaluative framework. The primary empirical data collection methods included key informant interviews, stakeholder consultation in focus group discussions, and uncontrolled personal observation. Despite significant progress in terms of policy and legislative reforms, many issues remained unattended, such as a goal of balancing conservation and development, increasing locals' say in decision making, access to resources, and establishing strong institutions. This addition is believed to aid in reconciling the local community and the government. We also need to give more weight to such things as accounting and transparency, income diversification, and showing respect for preexisting social norms. The problems raised in this article are thought to be significant in bridging the gap between management plans and actual management of PAs, not just in Bangladesh but also in other regions of the world that use co-management to achieve sustainability. [ABSTRACT FROM AUTHOR]

Protected areas (PAs) guard critical biodiversity and provide ecosystem services, serving as a pillar of the Kunming‐Montreal Global Biodiversity Framework that aims to protect 30% of the planet by 2030. But most PAs are understaffed. This study documents external workforce contributions to PA staffing in Madagascar, a biodiversity‐rich country that tripled its PA network in 2015. Taking a novel multi‐level approach, we use online surveys of 44 PAs and 13 institutions (managing 81% of PA surface area in Madagascar). Results reveal severe understaffing, reaching only a third of the global recommendation at just one staff member per 37.3 km2. Longer‐established PAs enjoy higher staffing ratios. Local community members comprise 94% of the PA external workforce, contributing up to 52% of labor in category V and VI PAs. Evolving human resource policies to deliberately better engage local communities will build PA resilience, addressing staffing gaps in a cost‐effective and sustainable manner to achieve the 30 by 30 target. [ABSTRACT FROM AUTHOR]

Background: Co-management encompasses the dyadic process between two healthcare providers. The Provider Co-Management Index (PCMI) was initially developed as a 20-item instrument across three theory-informed subscales. Objective: This study aimed to establish construct validity of the PCMI with a sample of primary care providers through exploratory and confirmatory factor analyses. Methods: We conducted a cross-sectional survey of primary care physicians, nurse practitioners, and physician assistants randomly selected from the IQVIA database across New York State. Mail surveys were used to acquire a minimum of 300 responses for split sample factor analyses. The first subsample (derivation sample) was used to explore factorial structure by conducting an exploratory factor analysis. A second (validation) sample was used to confirm the emerged factorial structure using confirmatory factor analysis. We performed iterative analysis and calculated good fit indices to determine the best-fit model. Results: There were 333 responses included in the analysis. Cronbach's alpha was high for a three-item per dimension scale within a one-factor model. The instrument was named PCMI-9 to indicate the shorter version length. Discussion: This study established the construct validity of an instrument that scales the co-management of patients by two providers. The final instrument includes nine items on a single factor using a 4-point, Likert-type scale. Additional research is needed to establish discriminant validity. [ABSTRACT FROM AUTHOR]

Market-based approaches to seafood sustainability have gained popularity in the last decade. Market-based tools, such as certification and ratings systems, enable seafood companies along supply chains to engage in sustainability initiatives while reducing business risks. Yet, these approaches are predominantly utilized in Global North markets and often evaluate performance against standards that build upon resource-intensive, mainstream fisheriesmanagement models. These management models have yielded successful outcomes in industrial fisheries, mainly in the Global North, where science, management, and compliance authorities are well-resourced. In contrast, artisanal and small-scale fisheries in the Global South have seen limited success in applying mainstream management approaches. Co-management approaches based on secure tenure rights, which emphasize effective partnerships betweenmanagement authorities and resource users with specific rights over the resources, have shown better outcomes in these contexts. Despite this, market-based tools have largely overlooked co-management principles and tenure rights in their standards. To address this gap, this paper introduces two step-wise evaluative methods designed for the ratings system FishSource, aiming to score whether fishers enjoy secure tenure rights and effectively participate in decision making. The proposed methods use available secondary data to evaluate these crucial aspects of well-managed and equitable small-scale fisheries, while aligning with international policy instruments like the Food and Agriculture Organization Voluntary Guidelines for Securing Sustainable Small-Scale Fisheries and the United Nations Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Worldwide, enhancement of oyster populations is undertaken to achieve a variety of goals including support of food production, local economies, water quality, coastal habitat, biodiversity, and cultural heritage. Although numerous strategies for improving oyster stocks exist, enhancement efforts can be thwarted by long-standing conflict among community groups about which strategies to implement, where efforts should be focused, and how much funding should be allocated to each strategy. The objective of this paper is to compare two engagement approaches that resulted in recommendations for multi-benefit enhancements to oyster populations and the oyster industry in Maryland, U.S.A., using the Consensus Solutions process with collaborative simulation modeling. These recommendations were put forward by the OysterFutures Workgroup in 2018 and the Maryland Oyster Advisory Commission (OAC) in 2021. Notable similarities between the efforts were the basic principles of the Consensus Solutions process: neutral facilitation, a 75% agreement threshold, the presence of management agency leadership at the meetings, a scientific support team that created a management scenario model in collaboration with community group representatives, numerous opportunities for representatives to listen to each other, and a structured consensus building process for idea generation, rating, and approval of management options. To ensure meaningful representation by the most affected user groups, the goal for membership composition was 60% from industry and 40% from advocacy, agency, and academic groups in both processes. Important differences between the processes included the impetus for the process (a research program versus a legislatively-mandated process), the size of the groups, the structure of the meetings, and the clear and pervasive impact of the COVID-19 pandemic on the ability of OAC members to interact. Despite differences and challenges, both groups were able to agree on a package of recommendations, indicating that consensus-based processes with collaborative modeling offer viable paths toward coordinated cross-sector natural resource decisions with scientific basis and community support. In addition, collaborative modeling resulted in ‘myth busting’ findings that allowed participants to reassess and realign their thinking about how the coupled human-oyster system would respond to management changes.

Abstract Given that terrestrial ecosystems globally are facing the loss of biodiversity from land use conversion, invasive species, and climate change, effective management requires a better understanding of the drivers and correlates of biodiversity. Increasingly, biodiversity is co‐managed with aboveground carbon storage because high biodiversity in animal species is observed to correlate with high aboveground carbon storage. Most previous investigations into the relationship of biodiversity and carbon co‐management do not focus on the biodiversity of the species rich plant kingdom, which may have tradeoffs with carbon storage. To examine the relationships of plant species richness with aboveground tree biomass carbon storage, we used a series of generalized linear models with understory plant species richness and diversity data from the USDA Forest Service Forest Inventory and Analysis dataset and high‐resolution modeled carbon maps for the Tongass National Forest. Functional trait data from the TRY database was used to understand the potential mechanisms that drive the response of understory plants. Understory species richness and community weighted mean leaf dry matter content decreased along an increasing gradient of tree biomass carbon storage, but understory diversity, community weighted mean specific leaf area, and plant height at maturity did not. Leaf dry matter content had little variance at the community level. The decline of understory plant species richness but not diversity to increases in aboveground biomass carbon storage suggests that rare species are excluded in aboveground biomass carbon dense areas. These decreases in understory species richness reflect a tradeoff between the understory plant community and aboveground carbon storage. The mechanisms that are associated with observed plant communities along a gradient of biomass carbon storage in this forest suggest that slower‐growing plant strategies are less effective in the presence of high biomass carbon dense trees in the overstory.

Fisheries, particularly small-scale fisheries, is recognized as a source of dietary diversity, food security, and poverty alleviation. Fish is widely regarded as a significant source of protein. Despite the significance of fisheries, it is faced with several challenges such as constant change in climate. This study was conducted to examine the perception of fisher folks on climate change and the relationship between socio-economic characteristics and adoption of climate smart fisheries using semi-structured questionnaire. Perception towards climate change and adoption of climate-smart fisheries were analyzed using statistical inferential statistics. The predictor of co-management as a mitigative measure for climate change in fisheries was also analyzed with an ordered logistic regression technique. The result showed that 92.5 % of the fishers have formal education. Majority of the fishers (98.3 %) have no access to storage facilities whilst 96.66 % have access to market. In addition, 31.66 % of the fishers have access to information on climatic and weather conditions. On the perception of climate change, 47.5 % of fishers perceived decrease in amount of rainfall as evidence of climate change whilst 66.6 % perceived decrease in sea level as evidence of climate change. A few fishers perceived an increase in humidity, change in temperature and wind-storm or sea breeze as evidence of climate change. Again, 48.33 % of the fishers agree to reduction of fleet's carbon emission whilst 33.33 % fishers disagreed to diversifying sources of household income as an adoption to climate-smart fisheries. Additional cost in the beginning of adoption of climate smart fisheries as a constraint was agreed upon by 50.00 % of fishers. The results of the ordered logistic regression show that age, education, having a second source of income and an increase of fuel subsidy are statistically significant to fishers perception of the extent to which co-management could contribute to address climate change was detected.

Abstract Background Vascular surgery patients admitted to the hospital are often multimorbid. In case of questions regarding chronic medical problems different specialties are consulted, which leads to a high number of treating physicians and possibly contradicting recommendations. The General Practitioner´s (GP) view could minimize this problem. However, it is unknown for which medical problems a GP would be consulted and if regular GP-involvement during rounds would be considered helpful by the specialists. The aim of this study was to establish and describe a General Practice rounding service (GP-RS), to evaluate if the GP-RS is doable in a tertiary care hospital and beneficial to the specialists and to explore GP-consult indications. Methods The GP-RS was established as a pilot project. Between June-December 2020, a board-certified GP from the Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE) joined the vascular surgery team (UKE) once-weekly on rounds. The project was evaluated using a multi-methods approach: semi-structured qualitative interviews were conducted with vascular surgery physicians that had either participated in the GP-RS (G1), had not participated (G2), other specialists usually conducting consults on the vascular surgery floor (G3) and with the involved GP (G4). Interviews were analyzed using Kuckartz’ qualitative content analysis. In addition, two sets of quantitative data were descriptively analyzed focusing on the reasons for a GP-consult: one set from the GP-RS and one from an established, conventional “as needed” GP-consult service. Results 15 interviews were conducted. Physicians perceived the GP-RS as beneficial, especially for surgical patients (G1-3). Optimizing medication, avoiding unnecessary consults and a learning effect for physicians in training (G1-4) were named as other benefits. Critical voices saw an increased workload through the GP-RS (G1, G3) and some consult requests as too specific for a GP (G1-3). Based on data from 367 vascular surgery patients and 80 conventional GP-consults, the most common reasons for a GP-consult were cardiovascular diseases including hypertension and diabetes. Conclusions A GP-RS is doable in a tertiary care hospital. Studies of GP co-management model with closer follow ups would be needed to objectively improve patient care and reduce the overall number of consults. Trial registration Not applicable.

Abstract Introduction Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC). Methods A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022. Results A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services. Conclusions This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening.

Small-scale fisheries contribute nearly half the world’s seafood supply, yet the majority suffer from a lack of effective management, resulting in a threat to food security and ecosystem health. Co-management has been proposed as a solution to many of the problems these fisheries face (i.e., reduced catches, threats to food security, climate change, lack of effective monitoring and management, etc.), resulting in a large body of literature dedicated to its role in small-scale fisheries and the attributes linked to success. However, there is still little understanding of the role of enforcement, deterrence, and the attributes needed for compliance to occur in local settings. Using a modified framework borrowed from law and criminology science, we performed a systematic literature review to explore mechanisms associated with detection, detention, and deterrence in small-scale, co-managed fisheries. This review sheds light on the diverse approaches being used for enforcement and deterrence worldwide, the context surrounding these fisheries, compliance with management rules, and the attributes of co-management that align with successful compliance, enforcement, and deterrence. We found that 83% of the reviewed case studies included at least one mechanism used for detection, detention, and deterrence, and most cases with high compliance featured multiple types of mechanisms. Furthermore, the use of informal community-based mechanisms was more extensive than the use of formal mechanisms. Our study suggests that a combination of formal and informal enforcement and deterrence mechanisms enhances compliance with regulations. Although attributes such as the presence of leaders, strong social capital, and the presence of protected areas are important components of co-managed fisheries, further empirical research is needed to determine whether these attributes lead to enhanced compliance when different enforcement (i.e. detection and detainment) and deterrence mechanisms are present. This review is the first step toward understanding enforcement and deterrence, and their relationship with compliance from a holistic perspective. It is an attempt to motivate the scientific community to comprehensively document compliance, enforcement, and deterrence mechanisms in co-managed fisheries moving forward.

Compliance mediates how policies affect fisheries and the people who depend upon them for work, food, and well-being. Many of the world’s small-scale fisheries lack clear, legal rules to prevent overfishing, or are subject to conflicting rules. Where clear rules do exist, noncompliance is widespread. Binary assessments of compliance, which frequently lead to calls for increased enforcement when compliance is low, tend to overlook the insights that can be gained from understanding how and why people comply or not. An emerging two-dimensional model that distinguishes between four ideal-types of compliance offers the opportunity to understand the motivations behind problems of illegality in natural resource management. We qualitatively operationalized this two-dimensional model of compliance using interview and survey data from four cases of small-scale fisheries regulation in Costa Rica, Mexico, Honduras, and Puerto Rico. The two-dimensional model explained social-ecological outcomes like fishery sustainability and marginalization of fishers, particularly where apparent compliance disguised corruption and disengagement. The two-dimensional model also accommodated incongruence between rules and the broader aims that they serve. Ultimately, the two-dimensional diagnostic was practical and useful for identifying diverse policy levers to address illegal fishing in addition to enforcement. This work advances our understanding of links among compliance, self-governance, justice, and sustainability of the commons.

BackgroundDespite the effectiveness of innovations to improve the care of persons with dementia, there has been limited diffusion of these into widespread clinical practice. We aimed to identify common barriers and address them directly in the initial phase of dissemination of a successful dementia care program.MethodsDescription of and early experience with a dissemination strategy of the UCLA Alzheimer's and Dementia Care Program to health care systems nationwide. We measured site-identified goals for the program and indicators of success, number of adopting sites, and participants in their programs.ResultsFrom January 2019 to December 2021, 80 sites expressed interest in adopting the program, 14 (18%) sites adopted it, and 10 of these sites have begun caring for patients. Another 4 sites have implemented the program as part of a randomized clinical trial. To date, over 1690 persons living with dementia and their caregivers have received Alzheimer's and Dementia Care (ADC) care at 14 adopting sites. Key lessons from the early dissemination efforts include the importance of identifying a strong product champion at the adopting site, creating a business case for adoption, training of clinical staff and adapting the model to fit local cultures and workflow, as well as recognizing the likely long length of time needed for the decision to adopt and implementation process.ConclusionsDespite many obstacles to dissemination, with local champions and technical assistance, successful innovations in dementia care can be implemented in diverse health systems. The ability to adopt sites to bring the program to full scale and achieve comparable outcomes to the original program remains to be determined.

Co-production is now an established part of public service delivery. Despite its popularity, there is only a limited understanding about how co-production works in practice, particularly with marginalised groups. This paper identifies and explores insights from three case studies of a successful co-productive approach in Glasgow, Scotland. Operation Modulus is a criminal justice initiative involving public and third sector partners in the co-production of services with marginalised young people to reduce their involvement in crime and antisocial behaviour. The data highlighted the importance of leadership, the role of public service professionals and the process of working with marginalised young people; these are explored, all within the context of the authorising environment created at the level of a collaborative governance body. The findings underscore, first, the importance of distributed leadership and process in developing trust amongst partners and in turn in the relationships of partners with young people. Second, the essential role of effective co-management amongst service providers in creating the requisite conditions for meaningful co-production with marginalised citizens. Third, the potential for and importance of shared management to facilitate changes in professional relationships and ways of working, even if these do not lead to organisational systems change. Fourth, the significance of public service professionals having the authority and agency to explore collaborative ways of working. [ABSTRACT FROM AUTHOR]

The Sikunga Fish Protected Area (Sikunga FPA) was established as a management tool to manage and conserve the aquatic biodiversity of the Zambezi River of northeastern Namibia. Monitoring and evaluation are necessary for adaptive management to determine whether such protected areas are effectively meeting their objectives. Thus, this study aimed to assess communities' knowledge about the role and impacts of the Sikunga FPA on their livelihood assets. Furthermore, the study provides insights into communities' attitudes towards its management and views on managing the reserve. A cross-sectional survey was conducted among the riparian community members residing in households within a 15 km radius of the Sikunga FPA in the Zambezi Region. A total of 200 respondents out of a population of 2000 were subjected to semi-structured questionnaires. Descriptive and Inferential statistics were used to assess communities' perceptions and attitudes towards the Sikunga FPA. The results showed that 80% of the respondents knew about the Sikunga FPA but perceived it to negatively impact their livelihoods, probably due to low community participation in establishing the reserve (33%) and management meetings (47%) where decisions concerning the reserve were made. Hence, they felt excluded from an initiative that would significantly impact their well-being and likely to inflict conflicts that would erode the reserve's success. As a result, most respondents (80.7%) prefer that local community members take the lead and initiate future management plans tailored to govern the Sikunga FPA. Finally, Sikunga FPA authorities should consider affected communities as key conservation allies in the future development and management of the Sikunga FPA. This goal may be achieved through an interdisciplinary approach to empower local communities and ensure the successful implementation of the Sikunga FPA. [ABSTRACT FROM AUTHOR]

Introduction: Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC). Methods: A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022. Results: A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services. Conclusions: This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening. [ABSTRACT FROM AUTHOR]

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