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Bychkov D. Insider Threats to the Military Health System: A Systematic Background Check of TRICARE West Providers. JMIRx Med 2024; 5:e52198. [PMID: 38602314 PMCID: PMC11024397 DOI: 10.2196/52198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 04/12/2024]
Abstract
Background To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1%. In 2022, the DHA Annual Report stated that TRICARE's provider directories were only 80% accurate. Unlike Medicare, the DHA does not publicly reveal National Provider Identification (NPI) numbers. As a result, TRICARE's 9.6 million beneficiaries lack the means to verify their doctor's credentials. Since 2013, the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) has excluded 17,706 physicians and other providers from federal health programs due to billing fraud, neglect, drug-related convictions, and other offenses. These providers and their NPIs are included on the OIG's List of Excluded Individuals and Entities (LEIE). Patients who receive care from excluded providers face higher risks of hospitalization and mortality. Objective We sought to assess the extent to which TRICARE screens health care provider names on their referral website against criminal databases. Methods Between January 1-31, 2023, we used TRICARE West's provider directory to search for all providers within a 5-mile radius of 798 zip codes (38 per state, ≥10,000 residents each, randomly entered). We then copied and pasted all directory results' first and last names, business names, addresses, phone numbers, fax numbers, degree types, practice specialties, and active or closed statuses into a CSV file. We cross-referenced the search results against US and state databases for medical and criminal misconduct, including the OIG-LEIE and General Services Administration's (GSA) SAM.gov exclusion lists, the HHS Office of Civil Rights Health Insurance Portability and Accountability Act (HIPAA) breach reports, 15 available state Medicaid exclusion lists (state), the International Trade Administration's Consolidated Screening List (CSL), 3 Food and Drug Administration (FDA) debarment lists, the Federal Bureau of Investigation's (FBI) list of January 6 federal defendants, and the OIG-HHS list of fugitives (FUG). Results Our provider search yielded 111,619 raw results; 54 zip codes contained no data. After removing 72,156 (64.65%) duplicate entries, closed offices, and non-TRICARE West locations, we identified 39,463 active provider names. Within this baseline sample group, there were 2398 (6.08%) total matches against all exclusion and sanction databases, including 2197 on the OIG-LEIE, 2311 on the GSA-SAM.gov list, 2 on the HIPAA list, 54 on the state Medicaid exclusion lists, 69 on the CSL, 3 on the FDA lists, 53 on the FBI list, and 10 on the FUG. Conclusions TRICARE's civilian provider roster merits further scrutiny by law enforcement. Following the National Institute of Standards and Technology 800, the DHA can mitigate privacy, safety, and security clearance threats by implementing an insider threat management model, robust enforcement of the False Claims Act, and mandatory security risk assessments. These are the views of the author, not the Department of Defense or the US government.
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Affiliation(s)
- David Bychkov
- UC Institute for Prediction Technology, University of California, Irvine, Orange, CA, United States
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2
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Liu B, Liu H, Liu M. Aggressive local therapy for de novo metastatic breast cancer: Challenges and updates (Review). Oncol Rep 2023; 50:163. [PMID: 37449542 PMCID: PMC10394734 DOI: 10.3892/or.2023.8600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Systemic therapy has been viewed as the mainstay for de novo metastatic breast cancer (dnMBC). However, as dnMBC is highly heterogeneous both biologically and clinically, and with ever-improving systemic strategies, it has been implied that the local therapy of the primary tumor (PT) may be beneficial for certain patients with dnMBC. However, the results from retrospective studies have been questioned due to their selection bias and retrospective nature. To the best of our knowledge, there are two published randomized clinical trials addressing this issue with conflicting conclusions: i) TATA study from India indicated no overall survival (OS) superiority with early local radiotherapy (LRT); and ii) MF07-01 indicated a 5-year OS rate improvement of 17% with upfront LRT. The updated results of a randomized phase III ECOG-ACRIN E2108 trial released in the 2020 American Society of Clinical Oncology (ASCO) meeting reported a negative survival effect of early LRT treatment in patients with dnMBC responding to initial systemic treatment, despite LRT significantly reducing the locoregional failure. Thus, a number of issues, such as the exact value of LRT, the optimal means of LRT (surgery and/or RT to the PT), the ideal timing of LRT and the population most likely to benefit from LRT, warrant further investigation. Herein, the related studies focusing on these aspects were comprehensively reviewed and a decision algorithm was proposed to select suitable patients with dnMBC for reasonable LRT. Generally, upfront systemic therapy is recommended. For good respondents and a subgroup of favorable profiles (young age, good general condition, low tumor burden, hormone receptor-positive and so on), radical LRT including PT surgery followed by RT and the resection of distant metastases is recommended. LRT should also be administered if the PT is still symptomatic. LRT may benefit patients with dnMBC due to the following reasons: Control of the PT decreases tumor burden, eliminates the source of dissemination, enhances the sensitivity to therapy and exerts positive immunomodulation. Therefore, the treatment paradigm for dnMBC may change from 'palliative LRT' into 'curative LRT' in a highly selected entity with careful evaluation.
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Affiliation(s)
- Bailong Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Hui Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Min Liu
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
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Qu C, Hu Y, Tang Z, Derrington E, Dreher JC. Neurocomputational mechanisms underlying immoral decisions benefiting self or others. Soc Cogn Affect Neurosci 2020; 15:135-149. [PMID: 32163158 PMCID: PMC7304519 DOI: 10.1093/scan/nsaa029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/21/2020] [Accepted: 02/28/2020] [Indexed: 12/22/2022] Open
Abstract
Immoral behavior often consists of weighing transgression of a moral norm against maximizing personal profits. One important question is to understand why immoral behaviors vary based on who receives specific benefits and what are the neurocomputational mechanisms underlying such moral flexibility. Here, we used model-based functional magnetic resonance imaging to investigate how immoral behaviors change when benefiting oneself or someone else. Participants were presented with offers requiring a tradeoff between a moral cost (i.e. profiting a morally bad cause) and a benefit for either oneself or a charity. Participants were more willing to obtain ill-gotten profits for themselves than for a charity, driven by a devaluation of the moral cost when deciding for their own interests. The subjective value of an immoral offer, computed as a linear summation of the weighed monetary gain and moral cost, recruited the ventromedial prefrontal cortex (PFC) regardless of beneficiaries. Moreover, paralleling the behavioral findings, this region enhanced its functional coupling with mentalizing-related regions while deciding whether to gain morally tainted profits for oneself vs charity. Finally, individual differences in moral preference differentially modulated choice-specific signals in the dorsolateral PFC according to who benefited from the decisions. These findings provide insights for understanding the neurobiological basis of moral flexibility.
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Affiliation(s)
- Chen Qu
- School of Psychology, Center for Studies of Psychological Application, South China Normal University, Guangzhou 510631, China
| | - Yang Hu
- Neuroeconomics Laboratory, Institut des Sciences Cognitives Marc Jeannerod, CNRS, Bron 69675, France
- School of Psychological and Cognitive Sciences, Peking University, Beijing 100871, China
| | - Zixuan Tang
- Neuroeconomics Laboratory, Institut des Sciences Cognitives Marc Jeannerod, CNRS, Bron 69675, France
- Université Claude Bernard Lyon 1, Lyon 69100, France
| | - Edmund Derrington
- Neuroeconomics Laboratory, Institut des Sciences Cognitives Marc Jeannerod, CNRS, Bron 69675, France
- Université Claude Bernard Lyon 1, Lyon 69100, France
| | - Jean-Claude Dreher
- Neuroeconomics Laboratory, Institut des Sciences Cognitives Marc Jeannerod, CNRS, Bron 69675, France
- Université Claude Bernard Lyon 1, Lyon 69100, France
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Maciejewski ML, Hammill BG, Voils CI, Ding L, Bayliss EA, Curtis LH, Wang V. Prescriber continuity and medication availability in older adults with cardiometabolic conditions. SAGE Open Med 2018; 6:2050312118757388. [PMID: 29449946 PMCID: PMC5808964 DOI: 10.1177/2050312118757388] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 01/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Many older adults have multiple conditions and see multiple providers, which may impact their use of essential medications. Objective: We examined whether the number of prescribers of these medications was associated with the availability of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia. Methods: A retrospective cohort of 383,145 older adults with diabetes, hypertension or dyslipidemia in the US Medicare program living in 10 states. The association between the number of prescribers of cardiometabolic medications in 2010 and medication availability (proportion of days with medication on hand) in 2011 was estimated via logistic regression, controlling for patient demographic characteristics and chronic conditions. Results: Medicare beneficiaries with diabetes, hypertension and/or dyslipidemia had an average of five chronic conditions overall, obtained 10–12 medications for all conditions and most often had one prescriber of cardiometabolic medications. In adjusted analyses, the number of prescribers was not significantly associated with availability of oral diabetes agents but having more prescribers is associated with increased medication availability in older Medicare beneficiaries with dyslipidemia or hypertension. Conclusion: The incremental addition of new prescribers may be clinically reasonable for complex patients but creates the potential for coordination problems and informational discontinuity over time. Health systems may want to identify complex patients with multiple prescribers to minimize care fragmentation.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Bradley G Hammill
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Corrine I Voils
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Laura Ding
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Elizabeth A Bayliss
- Institute for Health Research, Kaiser Permanente, Denver, CO, USA.,Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Virginia Wang
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Maciejewski ML, Mi X, Sussman J, Greiner M, Curtis LH, Ng J, Haffer SC, Kerr EA. Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries. J Gen Intern Med 2018; 33:34-41. [PMID: 28905179 PMCID: PMC5756160 DOI: 10.1007/s11606-017-4167-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/26/2017] [Accepted: 08/11/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Deintensification of diabetic therapy is often clinically appropriate for older adults, because the benefit of aggressive diabetes treatment declines with age, while the risks increase. OBJECTIVE We examined rates of overtreatment and deintensification of therapy for older adults with diabetes, and whether these rates differed by medical, demographic, and socioeconomic characteristics. DESIGN, SUBJECTS, AND MAIN MEASURES We analyzed Medicare claims data from 10 states, linked to outpatient laboratory values to identify patients potentially overtreated for diabetes (HbA1c < 6.5% with fills for any diabetes medications beyond metformin, 1/1/2011-6/30/2011). We examined characteristics associated with deintensification for potentially overtreated diabetic patients. We used multinomial logistic regression to examine whether patient characteristics associated with overtreatment of diabetes differed from those associated with undertreatment (i.e. HbA1c > 9.0%). KEY RESULTS Of 78,792 Medicare recipients with diabetes, 8560 (10.9%) were potentially overtreated. Overtreatment of diabetes was more common among those who were over 75 years of age and enrolled in Medicaid (p < 0.001), and was less common among Hispanics (p = 0.009). Therapy was deintensified for 14% of overtreated diabetics. Appropriate deintensification of diabetic therapy was more common for patients with six or more chronic conditions, more outpatient visits, or living in urban areas; deintensification was less common for those over age 75. Only 6.9% of Medicare recipients with diabetes were potentially undertreated. Variables associated with overtreatment of diabetes differed from those associated with undertreatment. CONCLUSIONS Medicare recipients are more frequently overtreated than undertreated for diabetes. Medicare recipients who are overtreated for diabetes rarely have their regimens deintensified.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA. .,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA.
| | - Xiaojuan Mi
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Jeremy Sussman
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.,Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Melissa Greiner
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Lesley H Curtis
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, 27705, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Judy Ng
- National Committee for Quality Assurance, Washington, DC, USA
| | - Samuel C Haffer
- Office of Minority Health, U.S. Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Eve A Kerr
- Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA.,Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA
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Maciejewski ML, Hammill BG, Qualls LG, Hastings SN, Wang V, Curtis LH. Appropriate baseline laboratory testing following ACEI or ARB initiation by Medicare FFS beneficiaries. Pharmacoepidemiol Drug Saf 2016; 25:1015-22. [PMID: 26991354 DOI: 10.1002/pds.3994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 02/01/2016] [Accepted: 02/13/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropriate testing among Medicare fee-for-service beneficiaries are unknown. PURPOSE The study's purpose was to examine baseline laboratory testing rates, identify predictors of suboptimal testing, and assess the prevalence of abnormal creatinine and potassium among beneficiaries initiating ACE inhibitors or ARBs. DESIGN AND SUBJECTS Retrospective cohort of 101 376 fee-for-service beneficiaries from 10 eastern US states in 1 July to 30 November 2011. MAIN MEASURES Appropriate monitoring for serum creatinine or serum potassium was defined as evidence of an outpatient claim within 180 days before or 14 days after the index prescription fill date. KEY RESULTS Thirty-eight percent of beneficiaries were men, 78% were White race, 26% had prevalent heart failure, and 89% had prevalent hypertension. Rates of appropriate baseline laboratory testing were 82.7% for potassium, 83.2% for creatinine, and 82.6% for both potassium and creatinine 180 days prior to initiation. In logistic regression, men (odds ratio [OR] = 1.15, 95% confidence interval [CI]: 1.11, 1.19), African-Americans (OR = 1.26, 95%CI: 1.20, 1.32), and beneficiaries with Alzheimer's disease and related disorders (OR = 1.22, 95%CI: 1.15, 1.28) or stroke (OR = 1.34, 95%CI: 1.26, 1.43) were more likely to experience suboptimal testing. At baseline, hyperkalemia was relatively uncommon (5.8%), and elevated creatinine values were rare (1.4%). CONCLUSIONS Appropriate monitoring could be improved for African-American beneficiaries and beneficiaries with a history of stroke or Alzheimer's disease and related disorders initiating ACE inhibitors or ARBs. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Matthew L Maciejewski
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Bradley G Hammill
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Laura G Qualls
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Susan N Hastings
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Geriatrics Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Ambulatory Care Service, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of Geriatrics, Department of Medicine, Duke University, Durham, NC, USA.,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Virginia Wang
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA.,Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Lesley H Curtis
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
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Guerry AD, Polasky S, Lubchenco J, Chaplin-Kramer R, Daily GC, Griffin R, Ruckelshaus M, Bateman IJ, Duraiappah A, Elmqvist T, Feldman MW, Folke C, Hoekstra J, Kareiva PM, Keeler BL, Li S, McKenzie E, Ouyang Z, Reyers B, Ricketts TH, Rockström J, Tallis H, Vira B. Natural capital and ecosystem services informing decisions: From promise to practice. Proc Natl Acad Sci U S A 2015; 112:7348-55. [PMID: 26082539 PMCID: PMC4475956 DOI: 10.1073/pnas.1503751112] [Citation(s) in RCA: 241] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The central challenge of the 21st century is to develop economic, social, and governance systems capable of ending poverty and achieving sustainable levels of population and consumption while securing the life-support systems underpinning current and future human well-being. Essential to meeting this challenge is the incorporation of natural capital and the ecosystem services it provides into decision-making. We explore progress and crucial gaps at this frontier, reflecting upon the 10 y since the Millennium Ecosystem Assessment. We focus on three key dimensions of progress and ongoing challenges: raising awareness of the interdependence of ecosystems and human well-being, advancing the fundamental interdisciplinary science of ecosystem services, and implementing this science in decisions to restore natural capital and use it sustainably. Awareness of human dependence on nature is at an all-time high, the science of ecosystem services is rapidly advancing, and talk of natural capital is now common from governments to corporate boardrooms. However, successful implementation is still in early stages. We explore why ecosystem service information has yet to fundamentally change decision-making and suggest a path forward that emphasizes: (i) developing solid evidence linking decisions to impacts on natural capital and ecosystem services, and then to human well-being; (ii) working closely with leaders in government, business, and civil society to develop the knowledge, tools, and practices necessary to integrate natural capital and ecosystem services into everyday decision-making; and (iii) reforming institutions to change policy and practices to better align private short-term goals with societal long-term goals.
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Affiliation(s)
- Anne D Guerry
- The Natural Capital Project, c/o School of Environment and Forest Sciences, University of Washington, Seattle, WA 98195; Woods Institute for the Environment, Stanford University, Stanford, CA 94305;
| | - Stephen Polasky
- Institute on the Environment, University of Minnesota, St. Paul, MN 55108; Department of Applied Economics, University of Minnesota, St. Paul, MN 55108; The Natural Capital Project, University of Minnesota, St. Paul, MN 55108
| | - Jane Lubchenco
- Department of Integrative Biology, Oregon State University, Corvallis, OR 97333
| | - Rebecca Chaplin-Kramer
- Woods Institute for the Environment, Stanford University, Stanford, CA 94305; The Natural Capital Project, Stanford University, Stanford, CA 94305
| | - Gretchen C Daily
- The Natural Capital Project, Stanford University, Stanford, CA 94305; Department of Biology, Center for Conservation Biology, Stanford University, Stanford, CA 94305; Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm SE-104 05, Sweden
| | - Robert Griffin
- Woods Institute for the Environment, Stanford University, Stanford, CA 94305
| | - Mary Ruckelshaus
- The Natural Capital Project, c/o School of Environment and Forest Sciences, University of Washington, Seattle, WA 98195; Woods Institute for the Environment, Stanford University, Stanford, CA 94305
| | - Ian J Bateman
- Centre for Social and Economic Research on the Global Environment, School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom
| | - Anantha Duraiappah
- Mahatma Gandhi Institute of Education for Peace and Sustainable Development, New Delhi 110 029, India
| | - Thomas Elmqvist
- Stockholm Resilience Centre, Stockholm University, Stockholm SE-106 91, Sweden
| | | | - Carl Folke
- Global Economic Dynamics and the Biosphere, Royal Swedish Academy of Sciences, Stockholm SE-104 05, Sweden; Stockholm Resilience Centre, Stockholm University, Stockholm SE-106 91, Sweden; Beijer Institute of Ecological Economics, Royal Swedish Academy of Sciences, Stockholm SE-104 05, Sweden
| | | | | | - Bonnie L Keeler
- Institute on the Environment, University of Minnesota, St. Paul, MN 55108; The Natural Capital Project, University of Minnesota, St. Paul, MN 55108
| | - Shuzhuo Li
- Institute of Population and Development Studies, School of Public Policy and Administration, Xian Jiaotong University, Xi'an, Shaanxi Province 710049, People's Republic of China
| | - Emily McKenzie
- World Wildlife Fund, Washington, DC 20037; World Wildlife Fund-UK, The Living Planet Centre, Surrey GU21 4LL, United Kingdom
| | - Zhiyun Ouyang
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, People's Republic of China
| | - Belinda Reyers
- Natural Resources and the Environment, Council for Scientific and Industrial Research, Stellenbosch 7599, South Africa
| | - Taylor H Ricketts
- Gund Institute of Ecological Economics, and Rubenstein School for Environment and Natural Resources, University of Vermont, Burlington, VT 05405
| | - Johan Rockström
- Stockholm Resilience Centre, Stockholm University, Stockholm SE-106 91, Sweden
| | | | - Bhaskar Vira
- Department of Geography, and Conservation Research Institute, University of Cambridge, Cambridge CB2 1TN, United Kingdom
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