Assessing prioritization measures for a private land conservation program in the U.S. Prairie Pothole Region

Private land conservation has become an important tool for protecting biodiversity and habitat, but methods for prioritizing and scheduling conservation on private land are still being developed. While return on investment methods have been suggested as a potential path forward, the different processes linking private landscapes to the socioeconomic systems in which they are embedded create unique challenges for scheduling conservation with this approach. We investigated a range of scheduling approaches within a return on investment framework for breeding waterfowl and broods in the Prairie Pothole Region of North Dakota, South Dakota, and Montana. Current conservation targeting for waterfowl in the region focuses mostly on the distribution and abundance of breeding waterfowl. We tested whether MaxGain approaches for waterfowl conservation differed from MinLoss approaches in terms of return on investment and which approach performed best in avoiding loss of waterfowl and broods separately. We also examined variation in results based upon the temporal scale of the abundance layers used for input and compared the region's current scheduling approach with results from our simulations. Our results suggested that MinLoss was the most efficient scheduling approach for both breeding waterfowl and broods and that using just breeding waterfowl to target areas for conservation programs might cause organizations to overlook important areas for broods, particularly over shorter timespans. The higher efficiency of MinLoss approaches in our simulations also indicated that incorporating probability of wetland drainage into decision-making improved the overall return on investment. We recommend that future conservation scheduling for easements in the region and for private land conservation in general include some form of return on investment or cost-effective analysis to make conservation more transparent

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

European development cooperation and the poor / Aidan Cox, John Healey ; with Paul Hoebink and Timo Voipio.

"In association with Overseas Development Institute."Includes bibliographical references and index.xvii, 236 p.