Detecting management gaps for biodiversity conservation: An integrated assessment

The latest report on the state of nature in Europe (2013-2018) shows that biodiversity is declining at an alarming rate, with most protected species and habitats in poor condition. Despite an increasing volume of collected biodiversity information, urgent action is needed to integrate biodiversity data and knowledge to improve conservation efforts. We conducted a study in Catalonia (NE Spain), where we collected management measures implemented between 2013 and 2018, including allocation, budget, pressures aimed, and habitats/species potentially benefiting. We integrated information on pressures and habitats/species with the measures to identify non-spatial management gaps. Then, we integrated the spatially explicit information to determine the spatial management gap, identifying geographical areas where species/habitats are under pressure without registered measures. We demonstrated the importance of integrating existing information. Our findings revealed that resources were often not distributed adequately across species/habitats, with biases towards certain taxa being a common issue. The non-spatial management gap analysis identified taxonomic groups, especially plants and mollusks with the wider management gaps. We also identified threatened areas, especially in the northeast of the region with the larger spatial management gaps. These results could guide priority objectives to optimize conservation efforts. Integrating different information sources provided a broader view of the challenges that conservation science is facing nowadays. Our study offers a path toward bending the curve of biodiversity loss by providing an integrative framework that could optimize the use of the available information and help narrow the knowing-doing gap. In the context of the EU, this example demonstrates how information can be used to promote some environmental policy instruments, such as the Prioritized Action Frameworks (PAFs). Additionally, our findings highlight the importance of supporting decision-making with systematic assessments to identify deficiencies in the conservation process, reduce the loss of critical ecosystems and species, and avoid biases among taxa.

Implementing a Rapid Response System in a tertiary-care hospital. A cost-effectiveness study

PURPOSE

The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital.

METHODS

We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon.

RESULTS

42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR - 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year.

CONCLUSIONS

The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.

[Management of elective surgical activity in a tertiary hospital during the SARS-CoV-2 pandemic]

Introducción

Durante la pandemia por SARS-CoV-2 la actividad quirúrgica electiva se redujo a su mínima expresión. A medida que disminuyeron tanto el número de casos, como las necesidades de hospitalización para esta patología creímos oportuno proceder a recuperar progresivamente la actividad quirúrgica programada. El presente trabajo describe como, aún con el estado de alarma vigente, pudimos prácticamente normalizar dicha actividad en pocas semanas.

Metodología

Dos semanas antes de la intervención quirúrgica, se contactó telefónicamente con los pacientes incluidos en las listas de espera. Tras comprobar su estado de salud y manifestar su deseo de ser intervenidos quirúrgicamente se les proporcionaron recomendaciones para disminuir el riesgo de infección por coronavirus. Asimismo, se estableció un circuito exclusivo para llevar a cabo, 48 horas antes de la intervención, la detección de SARS-CoV-2 mediante reacción en cadena de la polimerasa (PCR) de exudado nasofaríngeo. Los resultados fueron valorados por cada servicio quirúrgico y el de anestesiología. Además, los profesionales del Área Quirúrgica asintomáticos podían someterse a un cribado semanal para la detección de coronavirus, según las recomendaciones de Salud Laboral.

Resultados

En plena pandemia, la actividad quirúrgica electiva se redujo un 85%. A partir de la semana del 13 de abril, se fueron recuperando los quirófanos disponibles, lo que permitió recobrar la práctica total de la actividad quirúrgica la semana del 25 de mayo.

Conclusiones

La creación de circuitos y procedimientos para agilizar la actividad quirúrgica, aún en plena vigencia del estado de alarma, nos ha permitido, en pocas semanas, recuperar la práctica total de la misma.

[Comparison of the post-surgical analgesic effectiveness of tibial (at internal malleolus level) and common peroneal nerve block with infiltration of the surgical wound in Outpatient Surgery of the hallux valgus]

INTRODUCTION

To compare the post-operative analgesic effectiveness of blocking the posterior tibial and the common peroneal nerves against that of wound infiltration using local anaesthesia, in ambulatory surgery of hallux valgus.

MATERIAL AND METHODS

A randomised clinical study was conducted on ambulatory patients subjected to Hallux valgus surgery, assigned into two groups: BNP: peripheral nerve blockage: posterior tibial and the common peroneal with 80mg of lidocaine, 100mg of mepivacaine and 25mg of levobupivacaine. INF: surgical wound infiltration with 50mg of levobupivacaine. The following aspects were evaluated during the first 24h after surgery: pain level using a visual analogue scale (VAS), the need to use rescue analgesia, and the incidence of secondary effects and readmissions due to pain.

RESULTS

A total of 111 Patients were included (55 BNP, 56 INF), 93 per cent were women and the average age was 59 (SD10) years. The average VAS score in the first 24h was 2.9 (SD1.7) for the BNP group and 2.7 (SD1.6) for the INF group (P=.62). Less than half (42%) of patients needed rescue anaesthetic with tramadol, with no significant differences between the groups (P=.28). A 33 per cent had secondary postoperative effects were observed in 33% of cases, with a significant difference between INF and BNP (P=.01). One patient from INF group, had to be admitted for pain.

CONCLUSIONS

The peripheral nerve block and wound infiltration are valid techniques for controlling pain at home after ambulatory surgery of hallux valgus, therefore both methods appear to be safe in an outpatient setting.

Influence of the procedure used to prepare the calibration sample set on the performance of near infrared spectroscopy in quantitative pharmaceutical analyses

Calibrating near infrared diffuse reflectance spectroscopy (NIRS) methods usually involves preparing a set of samples with a view to expanding the analyte concentration range spanned by production samples. In this work, the performances of the two procedures most frequently used for this purpose in near infrared pharmaceutical analysis, viz., synthetic samples obtained by weighing of the pure constituents of the pharmaceutical and doped samples made by under- or overdosing previously powdered production samples, were compared. Both procedures were found to provide similar results in the quantification of the active compound in the pharmaceutical, which was determined with a relative standard error of prediction (RSEP) of < 1.6%. However, the two types of sample preparation provide different spectra, which precludes the accurate quantification of synthetic samples from calibrations obtained with doped samples and vice versa. None of the mathematical pre-treatments tested with a view to reducing this different scattering (viz., second derivative, standard normal variate and orthogonal signal correction) could effectively solve this problem. This hinders accurate validation of the linearity of the procedure and makes it advisable to use doped samples which are markedly less different to production samples.

Development and validation of a near infrared method for the analytical control of a pharmaceutical preparation in three steps of the manufacturing process

A near infrared diffuse reflectance spectroscopy (NIRS) procedure for the quantitative control analysis of the active compound (otilonium bromide) in a pharmaceutical preparation in three steps of the production process (blended product, cores and coated tablets) and a methodology for its validation are proposed. The analytical procedure is composed by two consecutive steps. First, the sample is identified by comparing its spectrum with a second derivative spectral library. If the sample is positively identified, the active compound is quantified by using a previously established partial least squares (PLS) calibration model. The procedure was validated by studying repeatability, intermediate precision, accuracy and linearity. To this end, an adaptation of ICH (International Conference on Harmonisation) validation methodology to an NIR multivariate calibration procedure is proposed. The relative standard error of prediction (RSEP) was < or = 1% and the suitability of the procedure for control analysis was confirmed by the results obtained analysing new production samples produced over a three-month period.