Spatial closure regimes such as marine protected areas (MPAs) have emerged as a prominent tool in the effort to balance ecosystem health and fishery productivity. As MPAs have proliferated, the conservation community has begun to supplement traditional biological metrics with social and community considerations in the way it seeks to manage and evaluate such tools. To assess management outcomes and opportunities for a network of community-based, marine no-take zones (NTZs) in the Mexican Caribbean, semi-structured interviews were carried out with fishers and key management stakeholders. Findings indicate that the community-based management strategy has inherent tradeoffs between community engagement and conservation potential. Managers have succeeded in fostering high levels of community support for the initiative, but significant challenges remain, most notably the high presence of illegal fishing within NTZs. Successes and challenges of the community-based management strategy are documented and evaluated within a fisheries resource management framework. As the NTZ network undergoes legal renovation following the completion of its initial five-year term, this work serves as an important resource for both reflection on, and adaptation of, the community-based NTZ management regime.
Background: Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. Methods: We searched the published literature through 14 June 2020 and our inclusion criteria included decision model-based cost-effectiveness analyses that addressed diagnosis, treatment, or prevention of hearing loss. Two investigators screened articles for inclusion at the title, abstract, and full-text levels. Data were abstracted and the studies were assessed for the qualities of model structure, data assumptions, and reporting using a previously published quality scale. Findings: Of 1437 articles identified by our search, 117 unique studies met the inclusion criteria. Most of these model-based analyses were set in high-income countries (n = 96, 82%). The evaluated interventions were hearing screening (n = 35, 30%), cochlear implantation (n = 34, 29%), hearing aid use (n = 28, 24%), vaccination (n = 22, 19%), and other interventions (n = 29, 25%); some studies included multiple interventions. Eighty-six studies reported the main outcome in quality-adjusted or disability-adjusted life-years, 24 of which derived their own utility values. The majority of the studies used decision tree (n = 72, 62%) or Markov (n = 41, 35%) models. Forty-one studies (35%) incorporated indirect economic effects. The median quality rating was 92/ 100 (IQR:72À100). Interpretation: The review identified a large body of literature exploring the economic efficiency of hearing healthcare interventions. However, gaps in evidence remain in evaluation of hearing healthcare in low-and middle-income countries, as well as in investigating interventions across the lifespan. Additionally, considerable uncertainty remains around productivity benefits of hearing healthcare interventions as well as utility values for hearing-assisted health states. Future economic evaluations could address these limitations.
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