Assessing the impact of preventative measures to limit the spread of Toxoplasma gondii in wild carnivores of Madagascar.

Novel multihost pathogens can threaten endangered wildlife species, as well as humans and domestic animals. The zoonotic protozoan parasite Toxoplasma gondii is transmitted by members of Felidae and can infect a large number of animal species, including humans. This parasite can have significant health consequences for infected intermediate hosts and could further endanger wild carnivore populations of Madagascar. Building on an empirical characterization of the prevalence of the pathogen in local mammals, we used mathematical models of pathogen transmission in a multihost community to compare preventative measures that aim to limit the spread of this parasite in wild carnivores. Specifically, we examined the effect of hypothetical cat vaccination and population control campaigns on reducing the risk of infection by T. gondii in wild Eupleridae. Our model predicted that the prevalence of exposure to T. gondii in cats would be around 72% and that seroprevalence would reach 2% and 43% in rodents and wild carnivores, respectively. Reducing the rodent population in the landscape by half may only decrease the prevalence of T. gondii in carnivores by 10%. Similarly, cat vaccination and reducing the population of definitive hosts had limited impact on the prevalence of T. gondii in wild carnivorans of Madagascar. A significant reduction in prevalence would require extremely high vaccination, low turnover, or both in the cat population. Other potential control methods of T. gondii in endangered Eupleridae include targeted vaccination of wild animals but would require further investigation. Eliminating the threat entirely will be difficult because of the ubiquity of cats and the persistence of the parasite in the environment.

Evaluación del impacto de las medidas preventivas para limitar el contagio de Toxoplasma gondii en los carnívoros silvestres de Madagascar Resumen Los patógenos novedosos con múltiples hospederos pueden amenazar tanto a las especies silvestres como a los humanos y a los animales domésticos. Los miembros de la familia Felidae transmiten el protozoario parásito Toxoplasma gondii, el cual puede infectar a un gran número de especies animales, incluyendo al humano. Este parásito puede generar consecuencias importantes para la salud en los hospederos intermediarios infectados y podría poner más en peligro a las poblaciones de carnívoros silvestres de Madagascar. Usamos modelos matemáticos de la transmisión de patógenos en una comunidad con múltiples hospederos a partir de una caracterización empírica de la prevalencia del patógeno en los mamíferos locales para comparar las medidas preventivas que buscan limitar la transmisión de este parásito en los carnívoros silvestres. En específico, examinamos el efecto de la vacunación hipotética de felinos y las campañas de control poblacional sobre la reducción del riesgo de infección de T. gondii en los Eupleridae silvestres. Nuestro modelo predijo que la prevalencia de la exposición a T. gondii en los felinos sería de un 72% y que la seroprevalencia llegaría al 2% y al 43% en los roedores y carnívoros silvestres, respectivamente. La reducción a la mitad de la población de roedores en el paisaje podría disminuir sólo en un 10% la prevalencia del protozoario en los carnívoros. De forma similar, la vacunación y la reducción de la población de hospederos definitivos tuvieron un impacto limitado sobre la prevalencia de T. gondii en los carnívoros silvestres de Madagascar. Una reducción significativa en la prevalencia requeriría que la población de felinos tuviera una vacunación extremadamente elevada, baja rotación, o ambas. Otros métodos potenciales de control de T. gondii en los Eupleridae incluyen la vacunación de animales silvestres, pero requieren de mayor investigación. La eliminación completa de la amenaza será difícil por la ubicuidad de los felinos y la persistencia del parásito en el ambiente.

Global drivers of mangrove loss in protected areas.

Despite increasing efforts and investment in mangrove conservation, mangrove cover continues to decline globally. The extent to which protected area (PA) management effectively prevents mangrove loss globally across differing management objectives and governance types is not well understood. We combined remote sensing data with PA information to identify the extent and the drivers of mangrove loss across PAs with distinct governance types and protection levels based on categories developed by the International Union for Conservation of Nature (IUCN). Mangrove loss due to storms and erosion was prevalent across all governance types and most IUCN categories. However, the extent of human-driven loss differed across governance types and IUCN categories. Loss was highest in national government PAs. Private, local, shared arrangement, and subnational government agencies had low human-driven mangrove loss. Human-driven loss was highest in PAs with the highest level of restrictions on human activities (IUCN category I) due to mangrove conversion to areas for commodity production (e.g., aquaculture), whereas PAs that allowed sustainable resource use (e.g., category VI) experienced low levels of human-driven mangrove loss. Because category I PAs with high human-driven loss were primarily governed by national government agencies, conservation outcomes in highly PAs might depend not only on the level of restrictions, but also on the governance type. Mangrove loss across different governance types and IUCN categories varied regionally. Specific governance types and IUCN categories thus seemed more effective in preventing mangrove loss in certain regions. Overall, we found that natural drivers contributed to global mangrove loss across all PAs, whereas human-driven mangrove loss was lowest in PAs with subnational- to local-level governance and PAs with few restrictions on human activities.

Factores globales en la pérdida de manglares en las áreas protegidas Resumen A pesar del incremento en los esfuerzos e inversión de la conservación de los manglares, su cobertura sigue disminuyendo en todo el mundo. No se conoce muy bien el grado al que el manejo de las áreas protegidas (AP) previene eficientemente la pérdida mundial de los manglares en los diferentes objetivos de manejo y tipos de gestión. Combinamos los datos de teledetección con información de las AP para identificar el grado y los factores de la pérdida de manglares en las AP con tipos de gestión claros y niveles de protección basados en las categorías desarrolladas por la Unión Internacional para la Conservación de la Naturaleza (UICN). La pérdida por tormentas y erosión fue común en todos los tipos de gestión y en la mayoría de las categorías de la UICN. Sin embargo, el grado de pérdida antropogénica difirió entre los tipos de gestión y las categorías de la UICN. La pérdida fue mayor en las AP de gobiernos nacionales. Las agencias privadas, locales, de acuerdo compartido y las gubernamentales subnacionales tuvieron una pérdida antropogénica baja. La pérdida antropogénica fue mayor en la AP con el nivel más alto de restricción para las actividades humanas (categoría I de la UICN) debido a la conversión del manglar en áreas de producción de mercancía (p. ej.: acuacultura), mientras que las AP que permiten el uso sostenible de los recursos (p. ej.: categoría VI) tuvieron niveles bajos de pérdida antropogénica. Ya que las AP de categoría I con mayor pérdida antropogénica están gestionadas principalmente por agencias gubernamentales, puede que los resultados de conservación en las AP con mayor pérdida dependan no sólo del nivel de restricciones sino también del tipo de gestión. La pérdida del manglar en los diferentes tipos de gestión y en las categorías de la UICN varió en cada región. Por lo tanto, los tipos específicos de gestión y las categorías de la UICN parecen ser más eficientes en la prevención de la pérdida de manglares en ciertas regiones. En general, encontramos que los factores naturales contribuyen a la pérdida mundial del manglar en todas las AP, mientras que la pérdida antropogénica fue más baja en las AP con un nivel de subnacional a local de gestión y en las AP con pocas restricciones para la actividad humana.

Relationships between hope, optimism, and conservation engagement.

The loss and degradation of nature can lead to hopelessness and despair, which may undermine engagement in conservation actions. Emerging movements, such as that behind the organization Conservation Optimism, aim to avert potential despair of those involved in conservation. Some argue that fostering positive states, such as hope or optimism, can motivate engagement and action; however, others question whether fostering hope or optimism may inadvertently undermine perceived gravity of conservation challenges. We examined this issue by quantifying dispositional hope and optimism with a representative sample of Australians (n = 4285) and assessing their relationship with indicators of conservation engagement. We used the Great Barrier Reef (GBR) in Australia as a case study. We asked participants what they could do to help the GBR, then classified their responses into 2 outcome variables: identifying climate actions (i.e., actions that tackle the main threat to the reef) and identifying plastic actions (i.e., actions that are popular among community members). We also quantified likelihood of performing these actions and appraisals of both threats and actions. One dimension of hope, hope pathways (defined by Snyder's hope theory as knowing different ways to act), was associated with greater capacity to identify climate-related behaviors (odds ratio [OR] = 1.44) and plastic reduction behaviors (OR = 1.22) and greater likelihood of adopting climate-related actions (ß = 0.20). Optimism was associated with recognition of plastic reduction behaviors only (OR = 1.22). Neither hope nor optimism undermined appraisal of conservation threats. The effects of optimism were mediated by reduced action futility, and effects of hope pathways were mediated by stronger perceptions of threats to the reef (threat appraisal) and confidence in performing useful actions (coping appraisal). Our findings suggest that dispositional hope can strengthen, rather than undermine, appraisal of conservation challenges and solutions and thereby increase conservation engagement.

La pérdida y la degradación de la naturaleza pueden derivar en desesperanza y desesperación, las cuales pueden disminuir la participación en las actividades de conservación. Los movimientos, como aquél detrás de la organización Conservation Optimism, buscan evitar la potencial desesperación de aquellos involucrados en la conservación. Hay quienes argumentan que promover estados positivos, como la esperanza y el optimismo, puede debilitar inadvertidamente la gravedad percibida de los retos para la conservación. Analizamos este tema mediante la cuantificación de la disposición a la esperanza y el optimismo en una muestra representativa de australianos (n = 4285) y la valoración de sus relaciones con los indicadores de participación en la conservación. Usamos la Gran Barrera de Arrecife como un estudio de caso. Preguntamos a los participantes qué podrían hacer para ayudar a este ecosistema y después clasificamos sus respuestas en dos variables de resultado: identificar acciones climáticas (acciones que combaten la amenaza principal del arrecife) e identificar acciones plásticas (acciones que son populares entre los miembros de la comunidad). También cuantificamos la probabilidad de realizar estas acciones y las valoraciones tanto de las amenazas como de las acciones. Una dimensión de la esperanza, los caminos de la esperanza (definidas por la Teoría de la Esperanza de Snyder como saber actuar de diferentes maneras), estuvo asociada con una mayor capacidad para identificar los comportamientos relacionados con el clima (razón de oportunidades [OR]=1.44) y aquellos de reducción del plástico (OR = 1.22) y también con una mayor probabilidad de actuar en relación con el clima (ß = 0.20). El optimismo solamente estuvo asociado con el reconocimiento de los comportamientos de reducción del plástico (OR = 1.22). Ni el optimismo ni la esperanza debilitaron la valoración de las amenazas a la conservación. Los efectos del optimismo estuvieron mediados por la reducción de la futilidad de las acciones, mientras que los efectos de los caminos de la esperanza lo estuvieron por percepciones más firmes de las amenazas para el arrecife (valoración de amenazas) y la confianza en realizar acciones útiles (valoración del afrontamiento). Nuestros resultados sugieren que la disposición a la esperanza puede fortalecer, en lugar de debilitar, la valoración de la conservación y, por lo tanto, incrementar su participación.

Defining practical and robust study designs for interventions targeted at terrestrial mammalian predators.

Conflicts between humans and mammalian predators are globally widespread and increasing, creating a long-lasting challenge for conservation and local livelihoods. Protection interventions, which are essential to conflict mitigation, should be based on solid evidence of effectiveness produced by robust study designs. Yet, it is unclear what study designs have been used in predator-targeted interventions and how they can be improved to provide best practices for replications. I examined how applications of five study designs (before-after, before-after-control-impact, control-impact, crossover [i.e., the same randomly assigned study units acting as treatments and controls during alternating trials], and randomized controlled trial) have changed over time and how these changes are related to authors, predator species, countries, and intervention types (aversion, husbandry, mixed interventions, invasive management, lethal control, and noninvasive management). I applied multinomial regression modeling to 434 cases (28 predator species and 45 countries) from 244 studies published from 1955 to 2020. Study design was related only to intervention type. Less reliable before-after and control-impact studies were the most common (47.7% and 38.2% of cases, respectively), and their use increased over years as did all interventions. The contribution of the most robust before-after-control-impact (7.4%), randomized controlled trial (5.3%), and crossover designs (1.4%) remained minor over time. Crossover is suitable for aversion, most husbandry techniques, and a few other interventions, but crossover interventions also have the most limitations in terms of applicability. Randomized controlled trial is generally applicable, but impractical or inappropriate for some interventions, and before-after-control-impact appears to be the most widely applicable study design for predator-targeted interventions.

Definición de los Diseños Prácticos y Robustos para las Intervenciones Enfocadas en los Mamíferos Depredadores Terrestres Resumen Los conflictos entre los humanos y los mamíferos depredadores se ubican en todo el mundo y están en aumento, creando un desafío prolongado para la conservación y el sustento local. Las intervenciones de protección, que son esenciales para la mitigación de conflictos, deberían basarse en evidencias sólidas de la efectividad producidas por los diseños de estudios robustos. Aun así, no está claro cuáles diseños de estudio han sido utilizados para las intervenciones enfocadas en depredadores y cómo pueden mejorarse para proporcionar mejores prácticas para sus replicaciones. Examiné como las aplicaciones de cinco diseños de estudio (antes-después, control-impacto-antes-después, control-impacto, intervención cruzado [es decir, las mismas unidades de estudio asignadas al azar actúan como tratamiento y control durante pruebas alternantes] y prueba de control aleatorio) han cambiado con el tiempo y cómo estos cambios están relacionados con los autores, las especies depredadoras, los países y los tipos de intervención (aversión, crianza, intervenciones mixtas, manejo invasivo, control letal y manejo no invasivo). Apliqué un modelo de regresión multinomial a 434 casos (28 especies de depredadores y 45 países) de 244 estudios publicados entre 1955 y 2020. El diseño del estudio sólo estuvo relacionado con el tipo de intervención. Los estudios más comunes fueron los menos confiables: antes-después y control-impacto (47.7% y 38.2% de los casos, respectivamente). La contribución de los diseños más robustos de antes-después-control-impacto (7.4%), prueba de control aleatorio (5.3%) e intervenciones cruzadas (1.4%) permaneció escasa con el tiempo. Las intervenciones cruzadas son adecuadas para la aversión, la mayoría de las técnicas de crianza y unas cuantas intervenciones más, pero también tienen las mayores limitaciones en lo que se refiere a la aplicabilidad. La prueba de control aleatorio tiene una aplicabilidad generalizada, pero es impráctica o inapropiada para algunas intervenciones, mientras que el estudio antes-después-control-impacto parece ser el diseño de estudio con la aplicación más amplia para las intervenciones enfocadas en depredadores.

Efficacy-based and normative interventions for facilitating the diffusion of conservation behavior through social networks.

Research suggests that encouraging motivated residents to reach out to others in their social network is an effective strategy for increasing the scale and speed of conservation action adoption. However, little is known about how to effectively encourage large numbers of residents to reach out to others about conservation causes. We examined the influence of normative and efficacy-based messaging at motivating residents to engage in and to encourage others to participate in native plant gardening in their community. To do so, we conducted a field experiment with messages on mailings and tracked native plant vouchers used. Efficacy messages tended to be more effective than normative messages at increasing residents' willingness to reach out to others to encourage conservation action, as indicated by a several percentage point increase in native plant voucher use by residents' friends and neighbors. Messages sometimes had different impacts on residents based on past behaviors and perceptions related to native plant gardening. Among these subgroups, efficacy and combined efficacy and norm messages most effectively encouraged individual and collective actions, as indicated by increased voucher usage. Our findings suggest that interventions that build residents' efficacy for engaging in a conservation behavior and for reaching out to others may be a promising path forward for outreach. However, given our results were significant at a false discovery rate cutoff of 0.25 but not 0.05, more experimental trials are needed to determine the robustness of these trends.

Intervenciones Normativas y Basadas en la Eficiencia para Facilitar la Difusión del Comportamiento de Conservación por Medio de las Redes Sociales Resumen Las investigaciones sugieren que alentar a los residentes motivados para que se comuniquen con otros en sus redes sociales es una estrategia efectiva para incrementar la escala y velocidad de la adopción de las acciones de conservación. Sin embargo, se sabe poco sobre cómo alentar de manera efectiva a un gran número de residentes para que hablen con otros sobre las causas de la conservación. Examinamos la influencia de la mensajería normativa y basada en la eficiencia sobre la motivación de los residentes para ellos mismos participar y alentar a otros a participar en la jardinería de plantas nativas dentro de su comunidad. Para lograr esto, realizamos un experimento de campo con mensajes en los envíos y rastreo de los vales usados para plantas nativas. Los mensajes de eficiencia tendieron a ser más efectivos que los mensajes normativos para incrementar la voluntad de los residentes para alentar a otros a tomar acciones de conservación, como lo indicó el incremento de varios puntos porcentuales en el uso de vales para plantas nativas de los amigos y vecinos de los residentes. Los mensajes a veces tuvieron un impacto diferente sobre los residentes con base en los comportamientos pasados y las percepciones relacionadas con la jardinería de plantas nativas. Entre estos subgrupos, la eficiencia, la eficiencia combinada y los mensajes normativos fueron los factores que alentaron de manera más efectiva las acciones individuales y colectivas, como lo indicó el incremento en el uso de vales. Nuestros hallazgos sugieren que las intervenciones que construyen la eficiencia de los residentes para participar en el comportamiento de conservación y para comunicarse con otros sobre éstas puede ser un camino prometedor para la divulgación. Sin embargo, ya que nuestros resultados fueron significativos a una tasa límite de descubrimientos falsos de 0.25 y no 0.05, se requieren más pruebas experimentales para determinar la fortaleza de estas tendencias.

[Primary care organization in pandemic times]. / Organización de la Atención Primaria en tiempos de pandemia.

The COVID-19 pandemic has forced the adoption of drastic changes in primary care, modifying the organization and work dynamics previously established. From one day to the next, professionals had to adapt to the new situation to be able to attend cases and contacts tracing, to avoid contagion and to maintain attention to other health problems. At the beginning of the pandemic, professionals had to establish new practices and care circuits in primary care in an improvised way, due to lack of updated guidelines, without adequate means of protection, evaluating their risks and benefits on the fly. We present the main organizational changes in the first level of care and describe, from the point of view of patient safety and the consequences for patients and professionals of the priority care for COVID-19. Finally, we consider how to incorporate the knowledge acquired during the pandemic, analyzing the advantages and disadvantages of the adopted measures to maintain as much as possible a safe, accessible and quality primary care.

Rethinking assessment of success of mitigation strategies for elephant-induced crop damage.

Crop damage is the most common impact of negative interactions between people and elephants and poses a significant threat to rural livelihoods and conservation efforts. Numerous approaches to mitigate and prevent crop damage have been implemented throughout Africa and Asia. Despite the documented high efficacy of many approaches, losses remain common, and in many areas, damage is intensifying. We examined the literature on effectiveness of crop-damage-mitigation strategies and identified key gaps in evaluations. We determined there is a need to better understand existing solutions within affected communities and to extend evaluations of effectiveness beyond measurement of efficacy to include rates of and barriers to adoption. We devised a conceptual framework for evaluating effectiveness that incorporates the need for increased emphasis on adoption and can be used to inform the design of future crop-damage mitigation assessments for elephants and conflict species more widely. The ability to prevent crop loss in practice is affected by both the efficacy of a given approach and rates of uptake among target users. We identified the primary factors that influence uptake as local attitudes, sustainability, and scalability and examined each of these factors in detail. We argue that even moderately efficacious interventions may make significant progress in preventing damage if widely employed and recommend that wherever possible scientists and practitioners engage with communities to build on and strengthen existing solutions and expertise. When new approaches are required, they should align with local attitudes and fit within limitations on labor, financial requirements, and technical capacity.

Replanteamiento de la Evaluación del Éxito de las Estrategias de Mitigación del Daño a Cultivos Causado por Elefantes Resumen El daño a los cultivos es el impacto más común generado por las interacciones negativas entre las personas y los elefantes. Actualmente representa una amenaza significativa para el sustento rural y los esfuerzos de conservación. Se han implementado numerosas estrategias para mitigar y prevenir el daño a los cultivos en toda África y Asia. A pesar de la documentación de la eficiencia de las estrategias, las pérdidas todavía son comunes y, en muchas áreas, el daño se está intensificando. Examinamos la literatura sobre la efectividad de las estrategias de mitigación del daño a cultivos e identificamos vacíos importantes en su evaluación. Determinamos que existe una necesidad por entender de mejor manera las soluciones existentes en las comunidades afectadas y por extender las evaluaciones de eficiencia más allá de las medidas de eficacia para que incluyan las tasas y barreras de la adopción. Diseñamos un marco de trabajo conceptual para la evaluación de la eficiencia, el cual incorpora la necesidad de un incremento en el énfasis de la adopción y puede usarse para informar a los diseñadores de las futuras evaluaciones de la mitigación de daños a cultivos causados por elefantes u otras especies conflictivas de manera más amplia. La capacidad de poder prevenir la pérdida de cultivos en práctica está afectada tanto por la eficiencia de una estrategia dada como por las tasas de aceptación entre los usuarios diana. Identificamos como los factores primarios que influyen sobre la aceptación a las actitudes locales, la sustentabilidad y la adaptabilidad, y examinamos cada uno de estos factores a detalle. Argumentamos que incluso las intervenciones moderadamente eficientes pueden llevar a cabo un progreso significativo en la prevención del daño si se emplean ampliamente. También recomendamos que, en donde sea posible, los científicos y los practicantes de la conservación participen con las comunidades para construir y fortalecer las soluciones y el conocimiento existentes. Cuando se requieran nuevas estrategias, éstas deberán alinearse con las actitudes locales y deberán encajar dentro de las limitaciones de la labor, los requisitos financieros y la capacidad técnica.

Introducing SYPRENE: An International Practice Research Network for Strategic and Systemic Therapists and Researchers.

SYPRENE, a new international Systemic Practice Research Network (PRN), has been established to fill the gap in practice-based research on the effectiveness and efficiency of strategic therapies. This article presents the rationale for the creation of SYPRENE and describes data collection methods, and the encoding system implemented within this PRN. More developments are expected in the recruitment of practitioners, the types of data collected, findings, and the implementation of SYPRENE in supervision, trainings, and professional schools.

SYPRENE, una nueva red internacional sistémica de investigación basada en la práctica (PRN), se ha establecido para llenar vacíos en la investigación basada en la práctica sobre la eficacia y la eficiencia de las terapias estratégicas. Este artículo presenta las razones de la creación de SYPRENE y describe los métodos de recopilación de datos y el sistema de codificación implementado dentro de esta red de investigación basada en la práctica. Se esperan más novedades en la contratación de profesionales, los tipos de datos recogidos, los hallazgos y la implementación de SYPRENE en supervisión, capacitaciones y escuelas profesionales.

Update on the management of uncomplicated acute diverticulitis at our centre. Equally effective, more efficient. / Actualización del manejo de la diverticulitis aguda no complicada en nuestro centro. Igualmente efectivo, más eficiente.

GOALS: The current trend in the treatment of non-complicated diverticulitis is the outpatient management with antibiotic or even anti-inflammatory regimens in selected cases. We present a comparison of the results in our hospital with different protocols applied in 2016 and 2017. MATERIAL AND METHODS: All patients selected for this study were diagnosed with diverticulitis grade Ia of Hinchey's classification according to radiological findings on abdominal CT. We have analyzed two retrospective cohorts: 100 patients treated in 2016 according to the old protocol and 104 patients treated in 2017 with a new protocol. In 2016, the candidates for ambulatory treatment remained under observation for 24 hours before being discharged. The treatment consisted of 14 days of ciprofloxacin and metronidazole. In 2017, only patients with more acute symptoms were observed 24 hours and amoxicillin-clavulanic acid was prescribed for only 5 days. RESULTS: The persistence of the disease in 2016 was 6% and in 2017 was only 5.77% (p = 0.944). Recurrence during the first year was 13% in the first group, while in the second it was 5.7%, although this difference was not statistically significant. Likewise, a significant reduction in health costs was achieved. CONCLUSIONS: Outpatient treatment of acute uncomplicated diverticulitis with oral treatment seems to be a safe and effective therapeutic strategy in selected patients with low comorbidity.

[Therapeutic positioning reports: Experience in Spain during the period 2013-2019]. / Informes de posicionamiento terapéutico: experiencia en España en el periodo 2013-2019.

OBJECTIVE: Describe the characteristics of the therapeutic positioning reports (TPRs) published in Spain in the period 2013-2019. DESIGN AND DATA SOURCE: Systematic review of all TPRs published in the website of the Spanish Agency of Medicines and Health Products (AEMPS). SELECTION OF STUDIES: All TPRs published since May 2013, until March 2019 DATA EXTRACTION: The main variables collected were the therapeutic groups assessed, the number of TPRs, the time of elaboration, the existence of restrictions versus the authorized indications and the information on the efficiency of medicines. RESULTS: During the period under review, 214 TPRs were carried out, with an average production time of 8.8 months, almost three times the objective of 3-month initially set. 57% of the TPRs established restrictions of use with respect to the approved indications. 26% of TPRs referred to the existence of economic data, although none included details on the efficiency. 10% of TPRs were updated. CONCLUSIONS: For TPRs to meet their objective of improving the efficiency of the assessment process and the consistency in the decisions on price, reimbursement and financing of medicines by the SNS, the deadlines established for publication must be met, incorporating systematically information on the efficiency of the drugs and including periodic updates with the new information generated.

Predicting the time needed for environmental systematic reviews and systematic maps.

Systematic reviews (SRs) and systematic mapping aim to maximize transparency and comprehensiveness while minimizing subjectivity and bias. These are time-consuming and complex tasks, so SRs are considered resource intensive, but published estimates of systematic-review resource requirements are largely anecdotal. We analyzed all Collaboration for Environmental Evidence (CEE) SRs (n = 66) and maps (n = 20) published from 2012 to 2017 to estimate the average number of articles retained at each review stage. We also surveyed 33 experienced systematic reviewers to collate information on the rate at which those stages could be completed. In combination, these data showed that the average CEE SR takes an estimated 164 d (full-time equivalent) (SD 23), and the average CEE systematic map (SM) (excluding critical appraisal) takes 211 d (SD 53). While screening titles and abstracts is widely considered time-consuming, metadata extraction and critical appraisal took as long or longer to complete, especially for SMs. Given information about the planned methods and evidence base, we created a software tool that predicts time requirements of a SR or map with evidence-based defaults as a starting point. Our results shed light on the most time-consuming stages of the SR and mapping processes, will inform review planning, and can direct innovation to streamline processes. Future predictions of effort required to complete SRs and maps could be improved if authors provide more details on methods and results.

Pronóstico del Tiempo Necesario para las Revisiones Ambientales Sistemáticas y los Mapas Sistemáticos Resumen El mapeo sistemático y las revisiones sistemáticas buscan maximizar la transparencia y la exhaustividad mientras minimizan la subjetividad y la parcialidad. Estas son labores complejas que consumen tiempo, por lo que las revisiones sistemáticas se consideran como intensivas en recursos, pero en el caso de los requerimientos de los recursos para las revisiones sistemáticas las estimaciones publicadas son en su mayoría anecdóticas. Analizamos todas las revisiones sistemáticas (n = 66) y todos los mapas (n = 20) de la Colaboración para la Evidencia Ambiental (CEE, en inglés) publicados entre 2012 y 2017 para estimar el número promedio de artículos retenidos en cada etapa de revisión. También encuestamos a 33 revisores sistemáticos experimentado para cotejar la información sobre la tasa a la cual se podrían completar esas etapas. La combinación de estos datos mostró que la revisión sistemática promedio del CEE tarda un estimado de 164 días (equivalente de tiempo completo) (SD 23), y que el mapa sistemático promedio del CEE (excluyendo la evaluación crítica) tarda 211 días (SD 53). Se considera ampliamente que el proceso de selección de títulos y resúmenes consume mucho tiempo, pero la extracción de meta-datos y la evaluación crítica tarda la misma cantidad de tiempo, o más, para completarse, especialmente en el caso de los mapas sistemáticos. Con la información sobre los métodos planeados y la base de evidencias creamos una herramienta de software que predice los requerimientos de tiempo para un mapa sistemático o una revisión sistemática con defaults basados en evidencias como puntos de partida. Nuestros resultados traen a la luz las etapas de la revisión sistemática o del mapeo sistemático que más tiempo consumen, informarán sobre la planeación de revisiones, y pueden dirigir la innovación en los procesos simplificados. Los pronósticos futuros del esfuerzo requerido para completar los mapas y las revisiones sistémicos podría mejorarse si los autores proporcionar más detalles sobre los métodos y los resultados.

Assessment of the Conservation Measures Partnership's effort to improve conservation outcomes through adaptive management.

Conservation practice has demonstrated an increasing desire for accountability of actions, particularly with respect to effectiveness, efficiency, and impact to clearly identified objectives. This has been accompanied by increased attention to achieving adaptive management. In 2002, practitioners representing several prominent conservation nongovernmental organizations (NGOs) launched a community of practice called the Conservation Measures Partnership (CMP). The partnership CMP has worked to establish standards of conservation practice to improve accountability of conservation actions through adaptive management. The focal organizing framework for CMP has been the Open Standards for the Practice of Conservation (OS). We evaluated, through an online survey and personal interviews, the first decade of CMP and the OS. The CMP has garnered a positive reputation among agencies, NGOs, and funders and has succeeded in developing a large user base of the OS. However, CMP has not fully achieved its goal of making the OS standard operating procedure for the largest NGOs (e.g., The Nature Conservancy, World Wildlife Fund), despite it being widely used within these organizations. This lack of institutionalization is attributable to multiple causes, including an increase in the number of partially overlapping decision-support frameworks and challenges achieving full-cycle adaptive management. Users strongly believed the OS fosters better conservation practice and highly valued the OS for improving their practice. A primary objective of the OS is to assist practitioners to achieve full-cycle adaptive management to better integrate learning into improving the effectiveness and efficiency of actions. However, most practitioners had not yet achieved cycle completion for their projects. To improve the effectiveness of CMP, OS, and conservation practice in general, we recommend collaborative efforts among the proponents of multiple decision-support frameworks to foster strong institutional adoption of a common set of adaptive-management standards for conservation accountability.

Eficiencia en la prescripción enfermera en Andalucía. Un paso atrás en el sistema sanitario tras anulación por Real Decreto.

OBJECTIVES: To analyse the efficiency of nurse prescription of the health products inherent to their care work, in Andalusia, Spain, between the years 2009-2015. To also analyse the discussions by the Medical Colleges Organisation and the Ministry of Health, Social Services and Equality, before the draft bill on nurse prescription and their outcome. DESIGN: Scoping review. DATA SOURCE: Main bibliographic databases of Latin-American, Spanish, and foreign languages were reviewed, including, Fundación Index, Doyma, and Medline Library. Google Scholar was also used with the same search terms, adding to limit the search the term "Andalusia": "prescription nurse" AND "efficiency" OR "Andalusia". Another search was conducted in the grey literature using the same criteria in the Andalusian Health Service (SAS) web site. It was complemented with an interview with the care director of the SAS. DATA EXTRACTION: A total of 617 articles were found, of which 20 were selected. In the grey literature, 52 documents were found, of which 4 were used. RESULTS: Few studies were found on the efficiency in nurse prescription in Andalusia, although they are as strong as the data provided by the Andalusian Health Care Directorate on the health products inherent in their profession. After modification of Royal Decree 954/2015, and under pressure from the Medical Colleges Organisation, it leaves the competence of prescription nurse exclusively to the medical indication, who diagnoses and prescribes and eliminates it without argument scientifically endorsed. CONCLUSIONS: We corroborate the incorporation of efficiency in the Health System through the nurse prescription, and the rupture with the Royal Decree 954/2015. The allegations of the Medical Colleges Organisation are without argument.

Generating spatially optimized habitat in a trade-off between social optimality and budget efficiency.

Auctions have been proposed as alternatives to payments for environmental services when spatial interactions and costs are better known to landowners than to the conservation agency (asymmetric information). Recently, an auction scheme was proposed that delivers optimal conservation in the sense that social welfare is maximized. I examined the social welfare and the budget efficiency delivered by this scheme, where social welfare represents the difference between the monetized ecological benefit and the conservation cost incurred to the landowners and budget efficiency is defined as maximizing the ecological benefit for a given conservation budget. For the analysis, I considered a stylized landscape with land patches that can be used for agriculture or conservation. The ecological benefit was measured by an objective function that increases with increasing number and spatial aggregation of conserved land patches. I compared the social welfare and the budget efficiency of the auction scheme with an agglomeration payment, a policy scheme that considers spatial interactions and that was proposed recently. The auction delivered a higher level of social welfare than the agglomeration payment. However, the agglomeration payment was more efficient budgetarily than the auction, so the comparative performances of the 2 schemes depended on the chosen policy criterion-social welfare or budget efficiency. Both policy criteria are relevant for conservation. Which one should be chosen depends on the problem at hand, for example, whether social preferences should be taken into account in the decision of how much money to invest in conservation or whether the available conservation budget is strictly limited.

Costs and cost-efficacy analysis of the 2016 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

INTRODUCTION: GESIDA and the AIDS National Plan panel of experts suggest preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens. METHODS: Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48 in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2016. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable, and least favourable. RESULTS: In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively. CONCLUSION: Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV.

Evaluation on the efficiencies of county-level Centers for Disease Control and Prevention in China: results from a national survey.

OBJECTIVES: The Chinese government has greatly increased funding for disease control and prevention since the 2003 Severe Acute Respiration Syndrome crisis, but it is also concerned whether these increased resources have been used efficiently to improve public health services. We aimed to assess the efficiency of county-level Centers for Disease Control and Prevention (CDCs) of China and to identify strategies for optimising their performance. METHODS: A total of 446 county-level CDCs were selected based on systematic sampling throughout China. The data envelopment analysis framework was used to calculate the efficiency score of sampled CDCs in 2010. The Charnes, Cooper and Rhodes (CCR) model was applied to calculate the overall and scale efficiency, and the Banker, Charnes and Cooper (BCC) model was used to assess technical efficiency. Models included three inputs and seven outputs. A projection analysis was conducted to identify the difference between projection value and actual value for inputs and outputs. RESULTS: The average overall efficiency score of CDCs was 0.317, and the average technical efficiency score was 0.442 and 88.3% with decreasing returns to scale. Projection analysis indicated that all seven categories of outputs were underproduced. CDCs in the eastern region tended to perform better than CDCs in the middle and the western region. CONCLUSIONS: Most county-level CDCs in China were operated inefficiently. Emphasis should be put on increasing staff and general operating expenses through current governmental funding, upgrading healthcare providers' competencies and enhancing the standardisation of operational management, so that CDCs could utilise their resources more efficiently.

Cost-effective conservation of an endangered frog under uncertainty.

How should managers choose among conservation options when resources are scarce and there is uncertainty regarding the effectiveness of actions? Well-developed tools exist for prioritizing areas for one-time and binary actions (e.g., protect vs. not protect), but methods for prioritizing incremental or ongoing actions (such as habitat creation and maintenance) remain uncommon. We devised an approach that combines metapopulation viability and cost-effectiveness analyses to select among alternative conservation actions while accounting for uncertainty. In our study, cost-effectiveness is the ratio between the benefit of an action and its economic cost, where benefit is the change in metapopulation viability. We applied the approach to the case of the endangered growling grass frog (Litoria raniformis), which is threatened by urban development. We extended a Bayesian model to predict metapopulation viability under 9 urbanization and management scenarios and incorporated the full probability distribution of possible outcomes for each scenario into the cost-effectiveness analysis. This allowed us to discern between cost-effective alternatives that were robust to uncertainty and those with a relatively high risk of failure. We found a relatively high risk of extinction following urbanization if the only action was reservation of core habitat; habitat creation actions performed better than enhancement actions; and cost-effectiveness ranking changed depending on the consideration of uncertainty. Our results suggest that creation and maintenance of wetlands dedicated to L. raniformis is the only cost-effective action likely to result in a sufficiently low risk of extinction. To our knowledge we are the first study to use Bayesian metapopulation viability analysis to explicitly incorporate parametric and demographic uncertainty into a cost-effective evaluation of conservation actions. The approach offers guidance to decision makers aiming to achieve cost-effective conservation under uncertainty.

Costs and cost-effectiveness analysis of 2015 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults.

INTRODUCTION: GESIDA and the AIDS National Plan panel of experts suggest a preferred (PR), alternative (AR) and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2015. The objective of this study is to evaluate the costs and the effectiveness of initiating treatment with these regimens. METHODS: Economic assessment of costs and effectiveness (cost/effectiveness) based on decision tree analyses. Effectiveness was defined as the probability of reporting a viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2015. A deterministic sensitivity analysis was conducted, building three scenarios for each regimen: base case, most favourable and least favourable. RESULTS: In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,902 Euros for TDF/FTC+RAL (PR). The effectiveness varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/effectiveness, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR) and RAL+DRV/r (OR), respectively. CONCLUSION: The most efficient regimen was 3TC+LPV/r (OR). Among the PR and AR, the most efficient regimen was TDF/FTC/RPV (AR). Among the PR regimes, the most efficient was ABC/3TC+DTG.

Cost/efficacy analysis of preferred Spanish AIDS study group regimens and the dual therapy with lopinavir/ritonavir plus lamivudine for initial ART in HIV infected adults.

INTRODUCTION: The National AIDS Plan and the Spanish AIDS study group (GESIDA) proposes "preferred regimens" (PR) of antiretroviral treatment (ART) as initial therapy in HIV-infected patients. In 2013, the recommended regimens were all triple therapy regimens. The Gardel Study assessed the efficacy of a dual therapy (DT) combination of lopinavir/ritonavir (LPV/r) plus lamivudine (3TC). Our objective is to evaluate the GESIDA PR and the DT regimen LPV/r+3TC cost/efficacy ratios. METHODS: Decision tree models were built. EFFICACY: probability of having viral load <50 copies/mL at week 48. ART regime cost: costs of ART, adverse effects, and drug resistance tests during the first 48 weeks. RESULTS: Cost/efficacy ratios varied between 5,817 and 13,930 euros per responder at 48 weeks, for the DT of LPV/r+3TC and tenofovir DF/emtricitabine+raltegravir, respectively. CONCLUSIONS: Taking into account the official Spanish prices of ART, the most efficient regimen was DT of LPV/r+3TC, followed by the triple therapy with non-nucleoside containing regimens.