Evaluation of the clinical and economic value of sofosbuvir/velpatasvir (SOF/VEL) in patients with chronic hepatitis C in Spain during the last 5 years.

OBJECTIVE: Direct-acting antivirals for the treatment of hepatitis C virus (HCV) represented a paradigm shift. In 2017, sofosbuvir/velpatasvir (SOF/VEL-Epclusa®) was approved, which showed a high cure rate in all patient, contributing to HCV elimination. The analysis aimed to quantify the clinical and economic value of SOF/VEL in HCV chronic patients since its approval in Spain. METHODS: An economic evaluation was elaborated adapting a Markov model that simulated the lifetime disease progression in of all HCV chronic patients treated with SOF/VEL (30,488 patients) since its launch (5-years), compared to previous therapies. Patients entered the model and were distributed between the fibrosis states (F0-to-F4) in treated and untreated. All patients (100%) were treated with SOF/VEL regardless of their fibrosis, and 49% with previous therapies in ≥F2. The average sustained viral response (SVR) rates 98.9% SOF/VEL versus 61.0% previous therapies. All parameters for the analysis were obtained from real-life data and literature. Only direct healthcare costs associated with disease management were included. The SOF/VEL value was measured as the number of hepatic complications avoided and their associated cost, and hepatic mortality compared to previous therapies. National Health System perspective and a 3% discount rate was applied. RESULTS: SOF/VEL decreased the number of liver complications, avoiding 92% decompensated cirrhosis, 80% hepatocellular carcinomas, and 87% liver transplants, as well as 85% liver-related mortality. Their cost associated was reduced, amounting to savings of 197M€. CONCLUSION: SOF/VEL adds relevant value to the HCV treatment, reducing the clinical and economic disease burden and contributing to HCV elimination in Spain.

Aligning the logics of inquiry and action to address the biodiversity crisis.

Despite an abundance of research reaffirming biodiversity's importance to the health of the planet and society, species continue to go extinct at an alarming rate. Why has continued research on the value of biodiversity not had the intended effect and what can be done about it? We considered biodiversity loss as a public value failure and the result of a misalignment between the logic of inquiry (which guides scientists) and the logic of action (which guides practitioners). We drew lessons from our own research to propose the creation of a national biodiversity strategy designed to link the logic of inquiry with the logic of action and coordinate the production of actionable conservation science and informed conservation action.

Alineación de la lógica de la investigación y de la acción para abordar la crisis de la biodiversidad Resumen Aunque abundan los estudios que reafirman la importancia de la biodiversidad para la salud del planeta y la sociedad, la tasa de extinción de las especies es alarmante. ¿Por qué no han tenido el efecto previsto los estudios continuos sobre el valor de la biodiversidad y qué se puede hacer al respecto? Consideramos la pérdida de la biodiversidad como un fracaso del valor público y como el resultado del desajuste entre la lógica de la investigación (que guía a los científicos) y la lógica de la acción (que guía a los practicantes). Sacamos lecciones de nuestros propios estudios para proponer la creación de una estrategia nacional de biodiversidad diseñada para conectar ambas lógicas y coordinar la producción de ciencia práctica para la conservación y de acciones de conservación informadas.

[Multicomponent treatment of tobacco in primary care: Follow-up over 5years]. / Tratamiento multicomponente del tabaquismo en Atención Primaria: seguimiento transcurridos más de 5 años.

OBJECTIVES: To analyze the effectiveness of a multicomponent treatment for smoking cessation carried out in primary care and to evaluate the evolution of the consumption of tobacco that the people who participated had, more than 5 years after the end of the treatment. DESIGN: Longitudinal study of 307 participants in a multicomponent program in group format of tobacco cessation. EMPLACEMENT: Santander (Spain) Primary Care Health Center. PARTICIPANTS: Smokers from the basic health zone who wanted to quit smoking between 2006 and 2012 and requested help. INTERVENTIONS: Multicomponent treatment of 5face-to-face sessions and follow-up for up to 12 months. PRIMARY MEASUREMENTS: The activity was evaluated in 263 participants more than 5years after the end of treatment. The results of continuous and punctual withdrawal were obtained by self-declaration and the data recorded in the medical record. The punctual was also validated with co-oximetry. RESULTS: After a year 42.7% of participants declared continuous abstinence. From 5 to 12 years later, the continuous declared abstinence further than 12 months was 40.7%. They did not smoke again since the end of the treatment 66 people; 68.0% of those who relapsed made new attempts and 45.5% of them requested help to quit smoking. CONCLUSIONS: The proposed multi-component treatment is effective. Abstinence at 12 months predicts long-term maintenance and participating in disabling groups favors further attempts in case of relapse and the request for help to quit smoking.

[Why is it increasingly difficult to "do the right thing" and to "stop doing the wrong thing"? Strategies for reversing low-value practices]. / ¿Por qué resulta cada vez más complicado "hacer lo que hay que hacer" y "dejar de hacer lo que no hay que hacer"? Estrategias para revertir las prácticas de bajo valor.

This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with "do not do" recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to "do not do" recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients' healthcare, and because most of the citizens' healthcare demands are managed and resolved at the first level of care.

[The new program of the Family and Community Medicine specialty: An opportunity not to be missed]. / El nuevo programa de la especialidad de medicina familiar y comunitaria: una oportunidad que no se debe perder.

The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development. To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible. It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.

Using historical spy satellite photographs and recent remote sensing data to identify high-conservation-value forests.

High-conservation-value forests (HCVFs) are critically important for biodiversity and ecosystem service provisioning, but they face many threats. Where systematic HCVF inventories are missing, such as in parts of Eastern Europe, these forests remain largely unacknowledged and therefore often unprotected. We devised a novel, transferable approach for detecting HCVFs based on integrating historical spy satellite images, contemporary remote sensing data (Landsat), and information on current potential anthropogenic pressures (e.g., road infrastructure, population density, demand for fire wood, terrain). We applied the method to the Romanian Carpathians, for which we mapped forest continuity (1955-2019), canopy structural complexity, and anthropogenic pressures. We identified 738,000 ha of HCVF. More than half of this area was identified as susceptible to current anthropogenic pressures and lacked formal protection. By providing a framework for broad-scale HCVF monitoring, our approach facilitates integration of HCVF into forest conservation and management. This is urgently needed to achieve the goals of the European Union's Biodiversity Strategy to maintain valuable forest ecosystems.

Uso de Fotografías Históricas de Satélites Espía y Datos Recientes de Telemetría para Identificar Bosques de Alto Valor para la Conservación Resumen Los bosques de alto valor para la conservación (BAVC) tienen una importancia crítica para el suministro de servicios ambientales y biodiversidad pero enfrentan muchas amenazas. En donde hacen falta inventarios sistemáticos de los BAVC, como en partes del este de Europa, estos bosques siguen siendo ignorados y por lo tanto carecen de protección. Diseñamos una estrategia novedosa y transferible para la detección de BAVC con base en la integración de imágenes de satélites espía, datos contemporáneos de telemetría (Landsat) e información sobre las presiones antropogénicas actuales (p. ej.: infraestructura vial, densidad poblacional, demanda de leña, terreno). Aplicamos el método en los Cárpatos rumanos, para los cuales mapeamos la continuidad forestal (1955 - 2019), la complejidad estructural del dosel y las presiones antropogénicas. Identificamos 738,000 ha de BAVC. Más de la mitad de esta área fue identificada como susceptible a las actuales presiones antropogénicas y además carecía de protección formal. Mediante la aportación de un marco de trabajo para el monitoreo a escala amplia de los BAVC, nuestra estrategia facilita la integración de los BAVC dentro de la gestión y conservación de los bosques. Lo último es una necesidad urgente para alcanzar las metas de la Estrategia de Biodiversidad de la Unión Europea para mantener los ecosistemas boscosos valiosos.

Impact of COVID-19 prevention measures on health service quality, perceived value and user satisfaction. A structural equation modelling (SEM) approach.

OBJECTIVE: To explain using a structural equation model to patient satisfaction by analysing confidence in preventive measures against COVID-19 as an antecedent of this satisfaction and the effect that these measures have on the antecedents of service quality and perceived value. DESIGN: An observational cross-sectional study. SITE: Online survey was sent via social networks for recruiting citizens resident in Spain. PARTICIPANTS: The final sample consisted of 149 women and 122 men. The mean age of the participants was 36.73 years, all of whom were health service users. INTERVENTIONS: No interventions were conducted in the study. MAIN MEASUREMENTS: The study variables for the development of the structural equation model were: confidence in COVID-19 safety protocol, perceived value, quality and user satisfaction. RESULTS: The results showed a direct and positive effect of confidence in COVID-19 safety protocol on the quality of services provided, perceived value and user satisfaction. CONCLUSIONS: The study is expected to be of interest to those in charge of designing protective measures against the spread of diseases, health centre managers and marketing professionals interested in the improvement user satisfaction, affected as a result of the current pandemic.

Conservation lessons from taboos and trolley problems.

Governments pass conservation laws, adopt policies, and make plans yet frequently fail to implement them. Implementation of conservation, however, often requires costly sacrifice: people foregoing benefit for the benefit of biodiversity. Decisions involve trade-offs with outcomes that depend on the values at stake and people's perceptions of those values. Psychology, ethics, and behavioral science have each addressed the challenge of making difficult, often tragic, trade-off decisions. Based on these literatures, values can be classified as secular or sacred, where sacred values are those for which compensation may be unthinkable (e.g., freedom). Taboo trade-offs emerge when secular values are pitted against sacred ones. These are difficult to discuss, much less negotiate. Confronting taboo trade-offs in conservation may require discursive approaches to better understand particular attributes of decisions that place sacred human values at risk. Tragic trade-offs emerge when sacred values are pitted against one another. The trolley problem-a forced choice between 2 unthinkable outcomes-is a simple heuristic illustrating ethical challenges of tragic trade-offs. Behavior studies illustrate that people have a strong aversion to losses where an active choice was made, resulting in a bias toward status quo decisions. Faced with tragic, trolley-problem-like choices, people tend to avoid taking responsibility for action, defer decisions, evade opinions on painful choices, and regret unfortunate outcomes of actions. To help close the implementation gap, conservation actors may need to directly address the psychological, ethical, and behavioral barriers created by the remorse, regret, and moral residue of implementing conservation choices that have tragic outcomes. Recognition of these predictable features of the human psyche may foster better administrative structures to support action with durable outcomes as well as new research directions.

Lecciones sobre Conservación a Partir de los Tabúes y el Dilema del Tranvía Resumen Los gobiernos aprueban leyes, adoptan políticas y elaboran planes para la conservación, pero con frecuencia fallan en implementar todo lo anterior. La implementación de la conservación, sin embargo, requiere con frecuencia un sacrificio muy costoso: que la gente renuncie a un beneficio para beneficiar a la biodiversidad. Las decisiones involucran compensaciones con resultados que dependen de los valores que están en juego y la percepción que tiene la gente de esos valores. La Psicología, la Ética y las Ciencias del Comportamiento han abordado el reto de la toma de decisiones difíciles, con frecuencia trágicas, relacionadas con las compensaciones. Con base en la literatura de estas disciplinas, podemos clasificar los valores como seculares o sagrados, donde los últimos son aquellos para los cuales una compensación puede ser inimaginable (p. ej.: la libertad). Las compensaciones tabúes emergen cuando se confrontan los valores seculares contra los sagrados y es difícil discutirlas y mucho menos negociarlas. La confrontación de las compensaciones tabú dentro del esquema de la conservación puede requerir de estrategias discursivas para entender de mejor manera los atributos particulares de las decisiones que colocan los valores humanos sagrados que están en riesgo. Las compensaciones trágicas surgen cuando se confrontan entre sí los valores sagrados. El dilema del tranvía - una elección forzada entre dos resultados impensables - es un heurístico simple que ilustra los retos éticos que representan las compensaciones trágicas. Los estudios sobre el comportamiento demuestran que las personas tienen una fuerte aversión hacia las pérdidas en las que se realizó una elección activa, lo que resultó en un sesgo hacia las decisiones del orden establecido. Cuando las personas se enfrentan a elecciones trágicas del estilo del dilema del tranvía tienden a evitar responsabilizarse por la acción, aplazar las decisiones, evadir opiniones sobre elecciones dolorosas y arrepentirse por los resultados desafortunados de las acciones. Para ayudar a reducir la brecha de la implementación, los actores de la conservación podrían necesitar abordar directamente las barreras psicológicas, éticas y de comportamiento creadas por el remordimiento, el arrepentimiento y el residuo moral de la implementación de las elecciones de conservación que tienen resultados trágicos. El reconocimiento de estos rasgos predecibles de la psique humana puede promover de mejor manera las estructuras administrativas para respaldar las acciones con resultados duraderos, así como nuevas directrices para la investigación.

Ethics and biodiversity offsetting.

Biodiversity offsetting is an increasingly applied tool aiming to compensate for environmental damage caused by exploitation projects. Critics, however, raise concerns over the purported effectiveness of offsetting and question the ethical underpinnings and implications of offsetting. These ethical dimensions have largely been overlooked in research, which may lead to offsetting systems that fail to respect the values intended to be safeguarded. To address these dimensions, 5 ethical objections in the scientific literature were identified: offsetting violates nature's intrinsic value; losses of nature cannot be compensated for by human interventions; too little is known to make adequate trades; offsetting impedes virtuous dispositions toward nature; and offsetting has negative justice implications. We examined these objections and arguments against them based on the ethical concepts of intrinsic and instrumental values, anthropocentrism, nonanthropocentrism, and deontological, consequentialist, and virtue-ethical paradigms. Both nonanthropocentric and anthropocentric concerns were expressed in deontological, consequential, and virtue-ethical framings. Objections mostly had a deontological or virtue-ethical basis, whereas counterarguments were based on consequential reasoning, but common ground in practice is often conceivable. Based on our findings, we formulated 10 recommendations for policy makers and 5 questions for practitioners to consider. We propose, for example, that policy makers clarify aims, legislate on no-go areas, and govern the use of multipliers. We suggest that practitioners consider, for instance, how to improve case-specific knowledge and promote learning and stakeholder engagement. We hope these recommendations and questions will encourage further discussion of the ethics of biodiversity offsets and ultimately strengthen the respect for biodiversity and human-welfare values at stake in offsetting projects.

Ética y Compensación de Biodiversidad Resumen La compensación de la biodiversidad es una herramienta que cada vez se aplica más a la búsqueda de la remuneración por el daño ambiental causado por proyectos de explotación. Sin embargo, hay quienes la critican basándose en la presunta efectividad de las compensaciones y cuestionan los sustentos éticos y las implicaciones de las compensaciones. Estas dimensiones éticas han sido ignoradas en la investigación, lo cual puede resultar en sistemas que no respetan los valores que se pretende salvaguardar. Para resolver estas dimensiones identificamos cinco objeciones éticas en la literatura: las compensaciones violan el valor intrínseco de la naturaleza; las pérdidas de la naturaleza no pueden compensarse mediante intervenciones humanas; se conoce muy poco para realizar intercambios adecuados; las compensaciones impiden las disposiciones virtuosas hacia la naturaleza; y las compensaciones tienen implicaciones de justicia negativa. Analizamos estas objeciones y los argumentos en su contra basados en los conceptos éticos de los valores intrínsecos e instrumentales, el antropocentrismo, el no antropocentrismo y los paradigmas deontológico, consecuencialista y de virtud ética. Tanto las preocupaciones antropocéntricas como las no antropocéntricas se expresaron mediante encuadres deontológicos, consecuencialistas y de virtud ética. Las objeciones principalmente tuvieron una base deontológica o de virtud ética, mientras que los contraargumentos estuvieron basados en el razonamiento consecuencial pero los puntos de coincidencia en la práctica con frecuencia son concebibles. Con base en nuestros hallazgos formulamos diez recomendaciones para los formuladores de políticas y cinco preguntas para los practicantes de la conservación para que las tomen a consideración. Por ejemplo, proponemos que los formuladores de políticas clarifiquen los objetivos, legislen las áreas prohibidas y determinen el uso de multiplicadores. Sugerimos que los practicantes consideren cómo mejorar el conocimiento específico por caso y promover el aprendizaje y la participación de los actores sociales. Esperamos que estas recomendaciones y preguntas fomenten una mayor discusión sobre la ética de las compensaciones de biodiversidad y, finalmente, fortalezcan el respeto por la biodiversidad y los valores de bienestar humano en juego en los proyectos de compensaciones.

Evaluation of the use of psychometric scales in human-wildlife interaction research to determine attitudes and tolerance toward wildlife.

Studies evaluating human-wildlife interactions (HWIs) in a conservation context often include psychometric scales to measure attitudes and tolerance toward wildlife. However, data quality is at risk when such scales are used without appropriate validation or reliability testing, potentially leading to erroneous interpretation or application of findings. We used 2 online databases (ProQuest Psych Info and Web of Science) to identify published HWI studies that included attitude and tolerance. We analyzed these studies to determine the methods used to measure attitudes or tolerance toward predators and other wildlife; determine the proportion of these methods applying psychometric scales; and evaluate the rigor with which the scales were used by examining whether the psychometric properties of validity and reliability were reported. From 2007 to 2017, 114 published studies were identified. Ninety-four (82%) used questionnaires and many of these (53 [56%]) utilized a psychometric scale. Most scales (39 [74%]) had at least 1 test of reliability reported, but reliance on a single test was notable, contrary to recommended practice. Fewer studies (35 [66%]) reported a test of validity, but this was primarily restricted to structural validity rather than more comprehensive testing. Encouragingly, HWI investigators increasingly utilized the necessary psychometric tools for designing and analyzing questionnaire data, but failure to assess the validity or reliability of psychometric scales used in over one-third of published HWI attitude research warrants attention. We advocate incorporation of more robust application of psychometric scales to advance understanding of stakeholder attitudes as they relate to HWI.

Análisis del Uso de Escalas Psicométricas en la Investigación sobre la Interacción Humano-Fauna para Determinar Actitudes y Tolerancia hacia la Fauna Resumen Los estudios que analizan las interacciones humano-fauna (IHF) dentro de un contexto de conservación con frecuencia incluyen escalas psicométricas para medir las actitudes y la tolerancia hacia la fauna. Sin embargo, la calidad de los datos se encuentra en riesgo cuando dichas escalas se usan sin una validación apropiada o una prueba de confiabilidad, lo que potencialmente puede llevar a interpretaciones o aplicaciones erróneas de los resultados. Usamos dos bases de datos virtuales (ProQuest Psych Info y Web of Science) para identificar estudios publicados sobre las IHF que incluyeran actitud y tolerancia. Analizamos estos estudios para determinar los métodos utilizados para medir las actitudes o la tolerancia hacia los depredadores y otros tipos de fauna; determinar la proporción de estos métodos aplicando escalas psicométricas; y evaluar el rigor con el cual se usaron las escalas al examinar si las propiedades psicométricas de validez y confiabilidad estuvieron reportadas en el estudio. Identificamos 114 estudios publicados entre 2007 y 2017. De estos estudios, 94 (82%) usaron cuestionarios y muchos de estos cuestionarios (53 [56%]) usaron una escala psicométrica. La mayoría de las escalas (39 [74%]) tuvieron al menos una prueba de confiabilidad reportada, pero la dependencia de una sola prueba fue notable, contrario a la práctica recomendada. Fueron menos los estudios (35 [66%]) que reportaron una prueba de validez, pero esto estuvo restringido primordialmente a una validez estructurada en lugar de un análisis más integral. De manera alentadora, los investigadores de las IHF cada vez usaron más las herramientas psicométricas necesarias para diseñar y analizar los datos de los cuestionarios, aunque la falta de análisis de la validez o confiabilidad de las escalas psicométricas utilizadas en más de un tercio de los estudios publicados sobre las actitudes hacia las IHF requiere de atención. Promovemos la incorporación de una aplicación más sólida de las escalas psicométricas para propiciar el entendimiento de las actitudes de los actores sociales conforme se relacionan con las IHF.

Fundamental insights on when social network data are most critical for conservation planning.

As declines in biodiversity accelerate, there is an urgent imperative to ensure that every dollar spent on conservation counts toward species protection. Systematic conservation planning is a widely used approach to achieve this, but there is growing concern that it must better integrate the human social dimensions of conservation to be effective. Yet, fundamental insights about when social data are most critical to inform conservation planning decisions are lacking. To address this problem, we derived novel principles to guide strategic investment in social network information for systematic conservation planning. We considered the common conservation problem of identifying which social actors, in a social network, to engage with to incentivize conservation behavior that maximizes the number of species protected. We used simulations of social networks and species distributed across network nodes to identify the optimal state-dependent strategies and the value of social network information. We did this for a range of motif network structures and species distributions and applied the approach to a small-scale fishery in Kenya. The value of social network information depended strongly on both the distribution of species and social network structure. When species distributions were highly nested (i.e., when species-poor sites are subsets of species-rich sites), the value of social network information was almost always low. This suggests that information on how species are distributed across a network is critical for determining whether to invest in collecting social network data. In contrast, the value of social network information was greatest when social networks were highly centralized. Results for the small-scale fishery were consistent with the simulations. Our results suggest that strategic collection of social network data should be prioritized when species distributions are un-nested and when social networks are likely to be centralized.

Ideas Fundamentales sobre Cuándo Son Más Importantes los Datos de las Redes Sociales para la Planeación de la Conservación Resumen Conforme se aceleran las declinaciones de la biodiversidad, existe una exigencia urgente para asegurar que cada dólar que se gasta en conservación contribuya a la protección de las especies. La planeación sistemática de la conservación es una estrategia usada extensivamente para lograr esto, aunque cada vez existe una mayor preocupación por que integre las dimensiones sociales humanas de la conservación para que sea una estrategia efectiva. Aun así, es insuficiente el conocimiento fundamental sobre cuándo son más importantes los datos sociales para orientar a las decisiones de planeación de la conservación. Para tratar con este problema identificamos los principios novedosos que sirven como guía para la inversión estratégica en la información de las redes sociales para la planeación sistemática de la conservación. Consideramos un problema común para la conservación; identificar con cuáles actores sociales, dentro de una red social, interactuar para incentivar el comportamiento de conservación que maximice el número de especies protegidas. Usamos simuladores de redes sociales y de especies distribuidas a lo largo de nodos de redes para identificar las estrategias dependientes del estado más convenientes y el valor de la información provenientes de las redes sociales. Hicimos lo anterior para una gama de estructuras de redes de motivos y distribución de especies y aplicamos la estrategia a una pesquería a pequeña escala en Kenia. El valor de la información proveniente de las redes sociales depende firmemente tanto de la distribución de las especies como de la estructura de la red social. Cuando las distribuciones de las especies se encontraban extremadamente anidadas (es decir, cuando los sitios pobres en cuanto a cantidad de especies son subconjuntos de sitios ricos en cantidad de especies), el valor de la información proveniente de las redes sociales casi siempre fue bajo. Esto sugiere que la información sobre cómo se distribuyen las especies en una comunidad es crítica para determinar si invertir o no en la recolección de datos provenientes de las redes sociales. Como contraste, el valor de este tipo de información fue mucho mayor cuando las redes sociales estaban sumamente centralizadas. Los resultados de la pesquería a pequeña escala fueron compatibles con las simulaciones. Nuestros resultados sugieren que la recolección estratégica de datos a partir de las redes sociales debería ser prioridad cuando las distribuciones de las especies no se encuentran anidadas y cuando sea probable que las redes sociales estén centralizadas.

Myths and assumptions about human-wildlife conflict and coexistence.

Recent extinctions often resulted from humans retaliating against wildlife that threatened people's interests or were perceived to threaten current or future interests. Today's subfield of human-wildlife conflict and coexistence (HWCC) grew out of an original anthropocentric concern with such real or perceived threats and then, starting in the mid-1990s, with protecting valued species from people. Recent work in ethics and law has shifted priorities toward coexistence between people and wild animals. To spur scientific progress and more effective practice, we examined 4 widespread assumptions about HWCC that need to be tested rigorously: scientists are neutral and objective about HWCC; current participatory, consensus-based decisions provide just and fair means to overcome challenges in HWCC; wildlife threats to human interests are getting worse; and wildlife damage to human interests is additive to other sources of damage. The first 2 assumptions are clearly testable, but if they are entangled can become a wicked problem and may need debunking as myths if they cannot be disentangled. Some assumptions have seldom or never been tested and those that have been tested appear dubious, yet the use of the assumptions continues in the practice and scholarship of HWCC. We call for tests of assumptions and debunking of myths in the scholarship of HWCC. Adherence to the principles of scientific integrity and application of standards of evidence can help advance our call. We also call for practitioners and interest groups to improve the constitutive process prior to decision making about wildlife. We predict these steps will hasten scientific progress toward evidence-based interventions and improve the fairness, ethics, and legality of coexistence strategies.

Mitos y Suposiciones sobre el Conflicto y la Coexistencia entre el Humano y la Fauna Resumen Casi todas las extinciones recientes han resultado de las represalias que los humanos han realizado en contra de la fauna que amenaza o que ha sido percibida como una amenaza para intereses humanos actuales o futuros. Hoy en día, la disciplina de conflicto y coexistencia humano - fauna (HWCC, en inglés), surgió de la original preocupación antropocéntrica por las amenazas reales o percibidas y después, a partir de mediados de la década de 1990, por la preocupación de proteger a las especies valoradas por el los humanos. Trabajos recientes de ética y leyes han modificado sus prioridades hacia la coexistencia entre las personas y la fauna silvestre. Para estimular el progreso científico y una práctica más efectiva, examinamos cuatro suposiciones generalizadas sobre el HWCC que necesitan ser evaluadas rigurosamente: los científicos son neutrales y objetivos con el HWCC; las decisiones participativas actuales basadas en consensos proporcionan medios justos y razonables para sobreponerse a los retos del HWCC; las amenazas de la fauna hacia los intereses humanos cada vez son peores; y el daño causado por la fauna a los intereses humanos es aditivo a otras fuentes de daño. Las primeras dos suposiciones son claramente evaluables, pero si se entrelazan, pueden convertirse en un serio problema y necesitarían ser desacreditadas como mitos si no se pueden desenlazar. Algunas suposiciones nunca o rara vez han sido evaluadas y aquellas que sí lo han sido parecen ser dudosas. A pesar de esto, el uso de las suposiciones continua en la práctica y en la academia del HWCC. La adhesión a los principios de integridad científica y la aplicación de estándares de evidencia pueden ayudar a promover nuestra petición. También hacemos un llamado a los practicantes y a los grupos de interés para que mejoren el proceso constitutivo previo a la toma de decisiones sobre la fauna. Pronosticamos que estos pasos a seguir apresurarán el progreso científico hacia intervenciones basadas en evidencia y mejorarán la imparcialidad, ética y legalidad de las estrategias de coexistencia.

Validity of thoracic ultrasonography to rule out iatrogenic pneumothorax performed by pulmonologists without experience in this procedure. / Validez de la ecografía torácica para descartar neumotórax iatrogénico realizada por neumólogos sin experiencia en este procedimiento.

INTRODUCTION: Ultrasonography has been shown to be a useful tool for diagnosing pneumothorax in the hands of experts. After performing bronchopleural procedures, the recommendation is to perform chest radiography to rule out complications. Our objective was to determine the validity of thoracic ultrasonography to rule out pneumothorax after invasive procedures, conducted by pulmonologists without experience in this procedure. MATERIAL AND METHODS: Our observational prospective study consecutively included patients who underwent transbronchial biopsy (TBB), evacuating thoracentesis (ECT) and/or transparietal pleural biopsies (TPB) who were indicated subsequent chest radiography to rule out complications. In all cases, the same pulmonologist who performed the technique performed an ultrasound immediately after the procedure. A diagnosis of pneumothorax was considered the presence of a lung point or the combination of the following signs: absence of pleural sliding, absence of B-lines and presence of the «barcode¼ sign. RESULTS: We included 275 procedures (149 TBBs, 36 TPBs, 90 ECTs), which resulted in 14 (5.1%) iatrogenic pneumothoraxes. Ultrasonography presented a sensitivity of 78.5%, a specificity of 85% and a positive and negative predictive value of 22% and 98.6%, respectively. Ultrasonography did not help detect the presence of 3 pneumothoraxes, one of which required chest drainage, but adequately diagnosed 2 pneumothoraxes that were not identified in the initial radiography. CONCLUSIONS: Thoracic ultrasonography performed by pulmonologists at the start of their training helps rule out pneumothorax with a negative predictive value of 98.6%, thereby avoiding unnecessary radiographic control studies in a considerable number of cases.

Using individual-based movement information to identify spatial conservation priorities for mobile species.

The optimal design of reserve networks and fisheries closures depends on species occurrence information and knowledge of how anthropogenic impacts interact with the species concerned. However, challenges in surveying mobile and cryptic species over adequate spatial and temporal scales can mask the importance of particular habitats, leading to uncertainty about which areas to protect to optimize conservation efforts. We investigated how telemetry-derived locations can help guide the scale and timing of fisheries closures with the aim of reducing threatened species bycatch. Forty juvenile speartooth sharks (Glyphis glyphis) were monitored over 22 months with implanted acoustic transmitters and an array of hydrophone receivers. Using the decision-support tool Marxan, we formulated a permanent fisheries closure that prioritized areas used more frequently by tagged sharks and considered areas perceived as having high value to fisheries. To explore how the size of the permanent closure compared with an alternative set of time-area closures (i.e., where different areas were closed to fishing at different times of year), we used a cluster analysis to group months that had similar arrangements of selected planning units (informed by shark movements during that month) into 2 time-area closures. Sharks were consistent in their timing and direction of migratory movements, but the number of tagged sharks made a big difference in the placement of the permanent closure; 30 individuals were needed to capture behavioral heterogeneity. The dry-season (May-January) and wet-season (February-April) time-area closures opened 20% and 25% more planning units to fishing, respectively, compared with the permanent closure with boundaries fixed in space and time. Our results show that telemetry has the potential to inform and improve spatial management of mobile species and that the temporal component of tracking data can be incorporated into prioritizations to reduce possible impacts of spatial closures on established fisheries.

Uso de Información de Movimiento Basada en Individuos para Identificar las Prioridades de Conservación Espacial para las Especies Móviles Resumen El diseño óptimo de redes de reservas y los cierres de pesquerías depende de la información sobre la presencia de especies y del conocimiento sobre cómo los impactos antropogénicos interactúan con las especies afectadas. Sin embargo, las dificultades que existen al monitorear especies móviles y crípticas en escalas espaciales y temporales adecuadas pueden enmascarar la importancia de los hábitats particulares, lo que resulta en incertidumbre con respecto a cuáles áreas proteger para optimizar los esfuerzos de conservación. Investigamos cómo las ubicaciones derivadas de la telemetría pueden ayudar a guiar la escala y el momento justo del cierre de las pesquerías con el objetivo de reducir la captura accesoria de especies amenazadas. Se monitorearon 40 tiburones lanza juveniles (Glyphis glyphis) durante 22 meses con transmisores acústicos implantados y una selección de receptores hidrofónicos. Con la herramienta de apoyo para la toma de decisiones Marxan, formulamos un cierre de pesquerías permanente que priorizó las áreas usadas con frecuencia por los tiburones marcados y que consideraba a las áreas percibidas como altamente valiosas para las pesquerías. Para explorar cómo el tamaño del cierre permanente se comparaba con un conjunto de cierres con áreas y tiempos alternativos (es decir, donde las áreas se cerraron a la pesca en diferentes momentos del año) usamos un análisis de clúster para agrupar los meses que tuvieron arreglos similares a las unidades de planeación seleccionadas (informadas por el movimiento de los tiburones durante ese mes) en dos cierres de tiempo-área. Los tiburones fueron consistentes en el tiempo y dirección de sus movimientos migratorios, pero el número de tiburones marcados generó una gran diferencia en la ubicación del cierre permanente; se necesitaron 30 individuos para capturar la heterogeneidad del comportamiento. Los cierres de tiempo-área de la temporada de secas (mayo - enero) y la de lluvias (febrero - abril) abrieron a la pesca un 20% y 25% más de unidades de planeación, respectivamente, en comparación con el cierre permanente con barreras fijas en el tiempo y el espacio. Nuestros resultados muestran que la telemetría tiene el potencial para informar y mejorar el manejo espacial de las especies móviles y que el componente temporal de los datos de rastreo puede ser incorporado a las priorizaciones para reducir los posibles impactos del manejo sobre las pesquerías establecidas.

Genetically informed captive breeding of hybrids of an extinct species of Galapagos tortoise.

Hybridization poses a major challenge for species conservation because it threatens both genetic integrity and adaptive potential. Yet, hybridization can occasionally offer unprecedented opportunity for species recovery if the genome of an extinct taxon is present among living hybrids such that selective breeding could recapture it. We explored the design elements for establishing a captive-breeding program for Galapagos tortoises (Chelonoidis spp.) built around individuals with admixed ancestry involving an extinct species. The target individuals were hybrids between the extinct species from Floreana Island, C. niger, and an extant species, C. becki, which were recently found in the endemic range of C. becki, from Wolf Volcano on Isabela Island. We combined genotypic data from 35 tortoises with high ancestry from C. niger with forward-in-time simulations to explore captive breeding strategies that maximized overall genetic diversity and ancestry from C. niger while accommodating resource constraints, species biology, and the urgency to return tortoises to Floreana Island for facilitating ecosystem restoration. Overall genetic diversity was maximized when in the simulation tortoises were organized in relatively small breeding groups. Substantial amounts of the C. niger genome were captured despite limited resources available for selectively breeding tortoises in captivity. Genetic diversity was maximized when captive-bred offspring were released to the wild rather than being used as additional breeders. Our results provide genetic-based and practical guidance on the inclusion of hybrids with genomic representation from extinct taxa into species restoration programs and informs the ongoing debate on the value of hybrids in biodiversity conservation.

Reproducción en Cautiverio Informada Genéticamente de Híbridos de una Especie Extinta de Tortuga de las Galápagos Resumen La hibridación representa un obstáculo importante para la conservación de especies ya que amenaza tanto a la integridad genética como al potencial adaptativo. Aun así, la hibridación ocasionalmente puede ofrecer una oportunidad sin precedentes para la recuperación de una especie si el genoma de un taxón extinto está presente entre los híbridos vivientes de tal manera que la reproducción selectiva pudiera recuperarlo. Exploramos los elementos de diseño para el establecimiento de un programa de reproducción en cautiverio de la tortuga de las Galápagos (Chelonoidis spp.) construido en torno a los individuos con linajes mixtos que incluyeran una especie extinta. Los individuos fueron los híbridos de la especie extinta en la Isla Floreana, C. niger, y la especie viviente C. becki, encontrados recientemente en la distribución geográfica endémica de la segunda especie en el Volcán Wolf (Isla Isabela). Combinamos los datos genotípicos de 35 tortugas con un linaje cargado de C. niger usando simulaciones futuras de la descendencia generada por el programa para explorar las estrategias de reproducción en cautiverio que maximizaran en general la diversidad genética y el linaje de C. niger a la vez que se ajustaba a las restricciones de recursos, la biología de la especie y la urgencia por regresar las tortugas a la Isla Floreana para facilitar la restauración del ecosistema. En general, la diversidad genética se maximizó cuando en la simulación las tortugas estuvieron organizadas en grupos de reproducción relativamente pequeños y cuando cantidades sustanciales del genoma de C. niger fueron capturados con base en los recursos disponibles para reproducir selectivamente a las tortugas en cautiverio. La diversidad genética se vio especialmente maximizada cuando las crías reproducidas en cautiverio fueron liberadas en lugar de ser utilizadas como reproductoras adicionales. Nuestros resultados proporcionan una guía práctica y basada en la genética para la inclusión de híbridos con representación genómica de un taxón extinto en los programas de restauración de especies. Cuando incorporamos a los híbridos con diversidad genética que previamente se creía perdida en los programas con el propósito de la reintroducción de especies, nuestro estudio informa al debate continuo sobre el valor de los híbridos para la conservación de la biodiversidad.

Exceptional responders in conservation.

Conservation operates within complex systems with incomplete knowledge of the system and the interventions utilized. This frequently results in the inability to find generally applicable methods to alleviate threats to Earth's vanishing wildlife. One approach used in medicine and the social sciences has been to develop a deeper understanding of positive outliers. Where such outliers share similar characteristics, they may be considered exceptional responders. We devised a 4-step framework for identifying exceptional responders in conservation: identification of the study system, identification of the response structure, identification of the threshold for exceptionalism, and identification of commonalities among outliers. Evaluation of exceptional responders provides additional information that is often ignored in randomized controlled trials and before-after control-intervention experiments. Interrogating the contextual factors that contribute to an exceptional outcome allow exceptional responders to become valuable pieces of information leading to unexpected discoveries and novel hypotheses.

Summoning compassion to address the challenges of conservation.

Conservation practice is informed by science, but it also reflects ethical beliefs about how humanity ought to value and interact with Earth's biota. As human activities continue to drive extinctions and diminish critical life-sustaining ecosystem processes, achieving conservation goals becomes increasingly urgent. However, the determination to react decisively can drive conservationists to handle complex challenges without due deliberation, particularly when wildlife individuals are sacrificed for the so-called greater good of wildlife collectives (populations, species, ecosystems). With growing recognition of the widespread sentience and sapience of many nonhuman animals, standard conservation practices that categorically prioritize collectives without due consideration for the well-being of individuals are ethically untenable. Here we highlight 3 overarching ethical orientations characterizing current and historical practices in conservation that suppress compassion: instrumentalism, collectivism, and nativism. We examine how establishing a commitment to compassion could reorient conservation in more ethically expansive directions that incorporate recognition of the intrinsic value of wildlife, the sentience of nonhuman animals, and the values of novel ecosystems, introduced species, and their members. A compassionate conservation approach allays practices that intentionally and unnecessarily harm wildlife individuals, while aligning with critical conservation goals. Although the urgency of achieving effective outcomes for solving major conservation problems may enhance the appeal of quick and harsh measures, the costs are too high. Continuing to justify moral indifference when causing the suffering of wildlife individuals, particularly those who possess sophisticated capacities for emotion, consciousness, and sociality, risks estranging conservation practice from prevailing, and appropriate, social values. As conservationists and compassionate beings, we must demonstrate concern for both the long-term persistence of collectives and the well-being of individuals by prioritizing strategies that do both.

On nonepistemic values in conservation biology.

Conservation biology is a uniquely interdisciplinary science with strong roots in ecology, but it also embraces a value-laden and mission-oriented framework. This combination of science and values causes conservation biology to be at the center of critique regarding the discipline's scientific credibility-especially the division between the realms of theory and practice. We identify this dichotomy between seemingly objective (fact-based) and subjective (value-laden) practices as the measure-value dichotomy, whereby measure refers to methods and analyses used in conservation biology (i.e., measuring biodiversity) and value refers to nonepistemic values. We reviewed and evaluated several landmark articles central to the foundation of conservation biology and concepts of biodiversity with respect to their attempts to separate measures and values. We argue that the measure-value dichotomy is false and that conservation biology can make progress in ways unavailable to other disciplines because its practitioners are tasked with engaging in both the realm of theory and the realm of practice. The entanglement of measures and values is by no means a weakness of conservation biology. Because central concepts such as biodiversity contain both factual and evaluative aspects, conservation biologists can make theoretical progress by examining, reviewing, and forming the values that are an integral part of those concepts. We suggest that values should be included and analyzed with respect to the methods, results, and conclusions of scientific work in conservation biology.

Expert judgment and uncertainty regarding the protection of imperiled species.

Decisions concerning the appropriate listing status of species under the U.S. Endangered Species Act (ESA) can be controversial even among conservationists. These decisions may determine whether a species persists in the near term and have long-lasting social and political ramifications. Given the ESA's mandate that such decisions be based on the best available science, it is important to examine what factors contribute to experts' judgments concerning the listing of species. We examined how a variety of factors (such as risk perception, value orientations, and norms) influenced experts' judgments concerning the appropriate listing status of the grizzly bear (Ursus arctos horribilis) population in the Greater Yellowstone Ecosystem. Experts were invited to complete an online survey examining their perceptions of the threats grizzly bears face and their listing recommendation. Although experts' assessments of the threats to this species were strongly correlated with their recommendations for listing status, this relationship did not exist when other cognitive factors were included in the model. Specifically, values related to human use of wildlife and norms (i.e., a respondent's expectation of peers' assessments) were most influential in listing status recommendations. These results suggest that experts' decisions about listing, like all human decisions, are subject to the use of heuristics (i.e., decision shortcuts). An understanding of how heuristics and related biases affect decisions under uncertainty can help inform decision making about threatened and endangered species and may be useful in designing effective processes for protection of imperiled species.

Alignment between values of dryland pastoralists and conservation needs for small mammals.

Policies for conservation outside protected areas, such as those designed to address the decline in Australian mammals, will not result in net improvements unless they address barriers to proenvironmental behavior. We used a mixed-methods approach to explore potential value-action gaps (disconnects between values and subsequent action) for small mammal conservation behaviors among pastoralists in dryland Australia. Using semistructured surveys and open-ended interviews (n = 43), we explored values toward small mammals; uptake of a range of current and intended actions that may provide benefit to small mammals; and potential perceived barriers to their uptake. Pastoralists assigned great conservation value to small mammals; over 80% (n = 36) agreed to strongly agreed that small mammals on their property were important. These values did not translate into stated willingness to engage in voluntary cessation of wild-dog control (r2 = 0.187, p = 0.142, n = 43). However, assigning great conservation value to small mammals was strongly related to stated voluntary willingness to engage in the proenvironmental behavior most likely to result in benefits to small mammals: cat and fox control (r2 = 0.558, p = 0.000, n = 43). There was no significant difference between stated voluntarily and incentivized willingness to engage in cat and fox control (p = 0.862, n = 43). The high levels of willingness to engage in voluntary cat and fox control highlight a potential entry point for addressing Australia's mammal declines because the engagement of pastoralists in conservation programs targeting cat and fox control is unlikely to be prevented by attitudinal constraints. Qualitative data suggest there is likely a subpopulation of pastoralists who value small mammals but do not wish to engage in formal conservation programs due to relational barriers with potential implementers. A long-term commitment to engagement with pastoralists by implementers will thus be necessary for conservation success. On-property cat and fox control programs that build and leverage trust, shared goals, collaboration, and shared learning experiences between stakeholders and that explicitly recognize the complexity of small mammal dynamics and the property-level ecological knowledge of pastoralists are more likely to gain traction.