Fish and Wildlife Benefits of the Wildlife Habitat Incentives Program

Th e Wildlife Habitat Incentives Program (WHIP) is a voluntary program that encourages the establishment and enhancement of a wide variety of fish and wildlife habitats of national, state, tribal, or local significance. Through voluntary agreements, the Natural Resources Conservation Service (NRCS) provides financial and technical assistance to participants who installed habitat restoration and management practices. Since 1998, nearly $150 million has been dedicated to the program and over 2.8 million acres involving over 18,000 contracts have been enrolled. A wide range of habitat-enhancement actions are cost-shared through the program, affecting hundreds of target and non-target species. While few quantitative data exist describing how fish and wildlife have responded to terrestrial and aquatic habitats enrolled in the program, the popularity of WHIP among participants and funding partners and anecdotal evidence imply that tangible benefits to target species are being realized. Additional studies are needed to better understand how WHIP projects affect local habitat use by and population response of target and non-target species

Early chronic kidney disease: diagnosis, management and models of care

Chronic kidney disease (CKD) is prevalent in many countries, and the costs associated with the care of patients with end-stage renal disease (ESRD) are estimated to exceed US$1 trillion globally. The clinical and economic rationale for the design of timely and appropriate health system responses to limit the progression of CKD to ESRD is clear. Clinical care might improve if early-stage CKD with risk of progression to ESRD is differentiated from early-stage CKD that is unlikely to advance. The diagnostic tests that are currently used for CKD exhibit key limitations; therefore, additional research is required to increase awareness of the risk factors for CKD progression. Systems modelling can be used to evaluate the impact of different care models on CKD outcomes and costs. The US Indian Health Service has demonstrated that an integrated, system-wide approach can produce notable benefits on cardiovascular and renal health outcomes. Economic and clinical improvements might, therefore, be possible if CKD is reconceptualized as a part of primary care. This Review discusses which early CKD interventions are appropriate, the optimum time to provide clinical care, and the most suitable model of care to adopt

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Fish and Wildlife Benefits Associated with Wetland Establishment Practices

Efforts to establish wetlands through restoration and creation actions have increased in recent decades in response to regulatory and voluntary incentive programs. This paper summarizes the findings of studies conducted to document fish and wildlife response to these practices. The majority of published studies describe bird response to wetland restoration, with most reporting bird communities in restored wetlands to be similar to those of natural reference wetlands. Studies also indicate that invertebrates and amphibians generally respond quickly to and colonize newly established wetland habitats. Key factors reported as correlated with wildlife species richness include wetland size, availability of nearby wetlands habitats, diversity of water depths and vegetation, wetland age, and maintenance and management activity. Key knowledge gaps in our understanding of fish and wildlife response to wetland establishment practices are identified, including the need for studies on biota other than birds and long-term monitoring of wetland condition and wildlife response over time

Wildlife Benefi ts of the Wetlands Reserve Program

Since its initial authorization in 1990, more than 1.6 million acres of primarily drained or degraded wetlands on agricultural lands have been enrolled in the U.S. Department of Agriculture’s (USDA) Wetlands Reserve Program (WRP). The Natural Resources Conservation Service (NRCS) and its partners are working with landowners to restore these lands to ecologically productive wetland and upland buffer habitats. Numerous studies have documented the value of restored and created wetlands to fish and wildlife resources. However, few objective studies have been completed that document fish and wildlife response to wetlands enrolled in and restored through WRP. Preliminary results of some studies underway indicate that wildlife use of WRP sites is comparable to or exceeds that of non-program restored wetland habitats. In addition, anecdotal reports on some WRP restored wetland complexes indicate that wildlife response has been greater than expected. Additional studies are needed to enable WRP program managers and participants to better understand how lands enrolled in the program affect local fish and wildlife use and the landscape factors that affect wildlife community dynamics and population trends influenced by the lands enrolled. Elements of USDA’s Conservation Effects Assessment Project are intended to begin addressing this need

Environmental Quality Incentives Program Contributions to Fish and Wildlife Conservation

The Environmental Quality Incentives Program (EQIP) is a voluntary program whereby the U.S. Department of Agriculture provides technical and financial assistance to active farmers and ranchers to address natural resource concerns such as soil conservation, water quality and quantity, nutrient management, and fish and wildlife habitat. The Natural Resources Conservation Service (NRCS) is working with these landowners to maximize the environmental benefits gained for the expenditures made in the program. Funding has expanded significantly under the 2002 Farm Bill, with the amount of annual funding authorized reaching $1.3 billion by fiscal year 2007. The EQIP has been used to implement a wide variety of practices that are considered beneficial to many species of fish and wildlife. The NRCS is also beginning to use EQIP to address the needs of declining and other at-risk fish and wildlife species. Few data are available that document fish and wildlife response to EQIP. Program implementation to date is summarized, and recent information on planning of practices with the potential to benefit fish and wildlife resources is examined

The first five years of the Conservation Effects Assessment Project

The Conservation Effects Assessment Project (CEAP) was initiated by the USDA Natural Resources Conservation Service (NRCS), Agricultural Research Service (ARS), and Cooperative State Research, Education, and Extension Service (CSREES) in response to a general call for better accountability of how society would benefit from the 2002 farm bill’s substantial increase in conservation program funding (Mausbach and Dedrick 2004). The original goals of CEAP were to establish the scientific understanding of the effects of conservation practices at the watershed scale and to estimate conservation impacts and benefits for reporting at the national and regional levels. Other federal agencies and nongovernmental organizations with conservation and natural resource interests are currently partners in various CEAP activities, often through jointly funded research projects