Extreme environmental variations (EV), as a phenomenon deriving from climate change (CC), led to an exacerbated uncertainty on water availability and increased the likelihood of conflicts regarding water-dependent activities such as agriculture. In this paper, we investigate the role of conflict resolution mechanisms -one of Ostrom’s acclaimed Design Principles (DPs)- when social-ecological systems (SESs) are exposed to physical external disturbances. The theoretical propositions predict that SESs with conflict-resolution-mechanisms will perform better than those without them. We tested this proposition through a framed-field-experiment that mimicked an irrigation system. In this asymmetric setting, farmers were exposed to two (2) dilemmas: (i) how much to invest in the communal irrigation system’s (CIS) maintenance and (ii) how much water to extract. The setting added a layer of complexity: water availability did not only depend on the investment but also on the environmental variability. Our findings largely confirmed the theoretical proposition: groups with stronger institutional robustness are able to cope with EV better than those with weaker robustness. However, we also found that some groups, despite lacking conflict-resolution-mechanisms, were also able to address EV. We explored potential explanatory variables to these unexpected results. We found that subjects’ and groups’ attributes might address uncertainty and avert conflict. Thus, SESs’ capacity to respond to external disturbances, such as EV, might not only be a question of DPs. Instead, it might also be strongly related to group members' attributes and group dynamics. Our results pave the way for further research, hinting that some groups might be better equipped for mitigation measures, while others might be better equipped for adaptation measures.

Comorbidities can have a cumulative effect on hospital outcomes of care, such as the length of stay (LOS), and hospital mortality. This study examines patients hospitalized with Congestive Heart Failure (CHF), a life-threatening condition, which, when it coexists with a burdened disease profile, the risk for negative hospital outcomes increases. Since coexisting conditions co-interact, with a variable effect on outcomes, clinicians should be able to recognize these joint effects. In order to study CHF comorbidities, we used medical claims data from CMS. After extracting the most frequent cluster of CHF comorbidities, we: (i) Calculated, step-by-step, the conditional probabilities for each disease combination inside this cluster (ii) Estimated the cumulative effect of each comorbidity combination on the LOS and hospital mortality (iii) Constructed (a) Bayesian, scenario-based graphs and (b) Bayes-networks to visualize results. Results show that, for CHF patients, different comorbidity constructs have variable effect on the LOS and hospital mortality. Therefore, dynamic comorbidity risk assessment methods should be implemented for informed clinical decision making in any ongoing effort for quality of care improvements.

Admission and discharge diagnoses of in-hospital patients are often in discord. Incorrect admission diagnoses are related to increased cost of care and patient safety. Additionally, due to the seasonality of many conditions, this discord may vary across the year. In this paper, we used medical claims data to develop a methodological framework that examines these differences, for Medicare beneficiaries. We provide examples for pneumonia, a condition with seasonal implications, and aneurysm, where early detection can be life-saving. Following a Bayesian approach, our work quantifies and visualizes with time series plots the degree that any clinical condition is correctly diagnosed upon admission. We examined differences in weekly intervals, during a calendar year. The mean length of stay and hospital charges were furthermore compared between matching and non-matching {admission, discharge Dx} pairs, and 95% confidence intervals of the difference of means were estimated. We applied Statistical Process Control methods and then visualized differences, for the hospital charges and the length of stay, per week, with time series plots. Our methodology and the visualizations underline the importance of a rigorous and non-delayed diagnostic process upon admission since there are significant implications in terms of hospital outcomes and cost of care.

European Protected Areas (PAs) are facing today complex and highly diverse challenges. Farm management structures have changed over time and traditional low-intensity farming systems have become unprofitable leading to either abandonment or intensification of farming practices. These changes have contributed to the environmental degradation of biodiversity rich agricultural landscapes and the loss of cultural knowledge and traditions. The interrelations developing at various levels between agricultural land use, nature and landscape conservation, and socio-economic activities influence the sustainable development and management of PAs. The development of certification and labelling schemes for high quality agri-food products with a PA logo is a rural development process that involves multiple functions which could generate environmental improvements and positive socio-economic changes. The differentiation of the agricultural products of PAs, through labelling and information, can be a proactive market-based instrument to support the local economy, promote environmentally sound practices, raise environmental awareness, and preserve farmland biodiversity in protected areas. This paper review is an attempt to gather and analyze in depth the findings of the existing studies focusing on the relationship between the European PAs, farming systems and certification/labelling schemes of agri-food products with a PA logo. Academic research on the subject is limited but provides valuable insights. The findings can serve as a starting point for discussions and reveal opportunities for further research to better understand the interrelations and additional effects emerging from the labelling/certification of PAs’ high quality agri-food products.