Evidence-based management of bullous pemphigoid

Bullous pemphigoid (BP) is the most common autoimmune subepidermal bullous disease typically affecting the elderly. Although different therapeutic regimens have been proposed, a review of the evidence is needed to aid clinicians in their decision making and management. Systemic therapies such as corticosteroids and adjuvants are effective in BP but are plagued with adverse effects, and potent topical steroids are an alternative treatment. This article reviews the evidence supporting different therapeutic options in the management of BP.

Rapid diagnostic tests for the home-based management of malaria, in a high-transmission area

Rapid diagnostic tests (RDT) are sometimes recommended to improve the home-based management of malaria. The accuracy of an RDT for the detection of clinical malaria and the presence of malarial parasites has recently been evaluated in a high-transmission area of southern Mali. During the same study, the cost-effectiveness of a 'test-and-treat' strategy for the home-based management of malaria (based on an artemisinin-combination therapy) was compared with that of a 'treat-all' strategy. Overall, 301 patients, of all ages, each of whom had been considered a presumptive case of uncomplicated malaria by a village healthworker, were checked with a commercial RDT (Paracheck-Pf). The sensitivity, specificity, and positive and negative predictive values of this test, compared with the results of microscopy and two different definitions of clinical malaria, were then determined. The RDT was found to be 82.9% sensitive (with a 95% confidence interval of 78.0%-87.1%) and 78.9% (63.9%-89.7%) specific compared with the detection of parasites by microscopy. In the detection of clinical malaria, it was 95.2% (91.3%-97.6%) sensitive and 57.4% (48.2%-66.2%) specific compared with a general practitioner's diagnosis of the disease, and 100.0% (94.5%-100.0%) sensitive but only 30.2% (24.8%-36.2%) specific when compared against the fulfillment of the World Health Organization's (2003) research criteria for uncomplicated malaria. Among children aged 0-5 years, the cost of the 'test-and-treat' strategy, per episode, was about twice that of the 'treat-all' (U.S.$1.0. v. U.S.$0.5). In older subjects, however, the two strategies were equally costly (approximately U.S.$2/episode). In conclusion, for children aged 0-5 years in a high-transmission area of sub-Saharan Africa, use of the RDT was not cost-effective compared with the presumptive treatment of malaria with an ACT. In older patients, use of the RDT did not reduce costs. The question remains whether either of the strategies investigated can be made affordable for the affected population.

Discontinuity in the responses of ecosystem processes and multifunctionality to altered soil community composition

Ecosystem management policies increasingly emphasize provision of multiple, as opposed to single, ecosystem services. Management for such "multifunctionality" has stimulated research into the role that biodiversity plays in providing desired rates of multiple ecosystem processes. Positive effects of biodiversity on indices of multifunctionality are consistently found, primarily because species that are redundant for one ecosystem process under a given set of environmental conditions play a distinct role under different conditions or in the provision of another ecosystem process. Here we show that the positive effects of diversity (specifically community composition) on multifunctionality indices can also arise from a statistical fallacy analogous to Simpson's paradox (where aggregating data obscures causal relationships). We manipulated soil faunal community composition in combination with nitrogen fertilization of model grassland ecosystems and repeatedly measured five ecosystem processes related to plant productivity, carbon storage, and nutrient turnover. We calculated three common multifunctionality indices based on these processes and found that the functional complexity of the soil communities had a consistent positive effect on the indices. However, only two of the five ecosystem processes also responded positively to increasing complexity, whereas the other three responded neutrally or negatively. Furthermore, none of the individual processes responded to both the complexity and the nitrogen manipulations in a manner consistent with the indices. Our data show that multifunctionality indices can obscure relationships that exist between communities and key ecosystem processes, leading us to question their use in advancing theoretical understanding-and in management decisions-about how biodiversity is related to the provision of multiple ecosystem services.

Multiyear predictability of tropical marine productivity

With the emergence of decadal predictability simulations, research toward forecasting variations of the climate system now covers a large range of timescales. However, assessment of the capacity to predict natural variations of relevant biogeochemical variables like carbon fluxes, pH, or marine primary productivity remains unexplored. Among these, the net primary productivity (NPP) is of particular relevance in a forecasting perspective. Indeed, in regions like the tropical Pacific (30°N–30°S), NPP exhibits natural fluctuations at interannual to decadal timescales that have large impacts on marine ecosystems and fisheries. Here, we investigate predictions of NPP variations over the last decades (i.e., from 1997 to 2011) with an Earth system model within the tropical Pacific. Results suggest a predictive skill for NPP of 3 y, which is higher than that of sea surface temperature (1 y). We attribute the higher predictability of NPP to the poleward advection of nutrient anomalies (nitrate and iron), which sustain fluctuations in phytoplankton productivity over several years. These results open previously unidentified perspectives to the development of science-based management approaches to marine resources relying on integrated physical-biogeochemical forecasting systems.

Professionalisation of sport federations. A multi-level framework for analysing forms, causes and consequences

Research question: International and national sport federations as well as their member organisations (usually sport clubs) are key actors within the sport system and have a wide range of relationships outside the sport system (e.g. with the state, sponsors, and the media). They are currently facing major challenges such as growing competition in top-level sports, democratisation of sports with “sports for all” and sports as the answer to social problems (integration, education, health, unemployment, etc.). In this context, professionalising sport organisations seems to be an appropriate strategy to face these challenges and solve current problems. We define the professionalisation of sport organisations as an organisational process of transformation leading towards organisational rationalisation, efficiency and business-like management. This has led to a profound organisational change, particularly within sport federations, characterised by the strengthening of institutional management (managerialism) and the implementation of efficiency-based management instruments and paid staff. Research methods: The goal of this article is to review the international literature and establish a global understanding of and theoretical framework for how sport organisations professionalise and what consequences this may have. Results and Findings: Our multi-level approach based on the social theory of action integrates the current concepts for analysing professionalisation in sport federations. We specify the framework for the following research perspectives: (1) forms, (2) causes and (3) consequences, and discuss the reciprocal relations between sport federations and their member organisations in this context. Implications: Finally, we derive general methodological consequences for the investigation of professionalisation processes in sport organisations.

A systematic review and meta-analysis of factors associated with anthelmintic resistance in sheep.

BACKGROUND Anthelmintic drugs have been widely used in sheep as a cost-effective means for gastro-intestinal nematode (GIN) control. However, growing anthelmintic resistance (AHR) has created a compelling need to identify evidence-based management recommendations that reduce the risk of further development and impact of AHR. OBJECTIVE To identify, critically assess, and synthesize available data from primary research on factors associated with AHR in sheep. METHODS Publications reporting original observational or experimental research on selected factors associated with AHR in sheep GINs and published after 1974, were identified through two processes. Three electronic databases (PubMed, Agricola, CAB) and Web of Science (a collection of databases) were searched for potentially relevant publications. Additional publications were identified through consultation with experts, manual search of references of included publications and conference proceedings, and information solicited from small ruminant practitioner list-serves. Two independent investigators screened abstracts for relevance. Relevant publications were assessed for risk of systematic bias. Where sufficient data were available, random-effects Meta-Analyses (MAs) were performed to estimate the pooled Odds Ratio (OR) and 95% Confidence Intervals (CIs) of AHR for factors reported in ≥2 publications. RESULTS Of the 1712 abstracts screened for eligibility, 131 were deemed relevant for full publication review. Thirty publications describing 25 individual studies (15 observational studies, 7 challenge trials, and 3 controlled trials) were included in the qualitative synthesis and assessed for systematic bias. Unclear (i.e. not reported, or unable to assess) or high risk of selection bias and confounding bias was found in 93% (14/15) and 60% (9/15) of the observational studies, respectively, while unclear risk of selection bias was identified in all of the trials. Ten independent studies were included in the quantitative synthesis, and MAs were performed for five factors. Only high frequency of treatment was a significant risk factor (OR=4.39; 95% CI=1.59, 12.14), while the remaining 4 variables were marginally significant: mixed-species grazing (OR=1.63; 95% CI=0.66, 4.07); flock size (OR=1.02; 95% CI=0.97, 1.07); use of long-acting drug formulations (OR=2.85; 95% CI=0.79, 10.24); and drench-and-shift pasture management (OR=4.08; 95% CI=0.75, 22.16). CONCLUSIONS While there is abundant literature on the topic of AHR in sheep GINs, few studies have explicitly investigated the association between putative risk or protective factors and AHR. Consequently, several of the current recommendations on parasite management are not evidence-based. Moreover, many of the studies included in this review had a high or unclear risk of systematic bias, highlighting the need to improve study design and/or reporting of future research carried out in this field.

Professionalisation of sport federations – A multi-level framework for analysing forms, causes and consequences

Research question: International and national sport federations as well as their member organisations are key actors within the sport system and have a wide range of relationships outside the sport system (e.g. with the state, sponsors, and the media). They are currently facing major challenges such as growing competition in top-level sports, democratisation of sports with ‘sports for all’ and sports as the answer to social problems. In this context, professionalising sport organisations seems to be an appropriate strategy to face these challenges and current problems. We define the professionalisation of sport organisations as an organisational process of transformation leading towards organisational rationalisation, efficiency and business-like management. This has led to a profound organisational change, particularly within sport federations, characterised by the strengthening of institutional management (managerialism) and the implementation of efficiency-based management instruments and paid staff. Research methods: The goal of this article is to review the current international literature and establish a global understanding of and theoretical framework for analysing why and how sport organisations professionalise and what consequences this may have. Results and findings: Our multi-level approach based on the social theory of action integrates the current concepts for analysing professionalisation in sport federations. We specify the framework for the following research perspectives: (1) forms, (2) causes and (3) consequences, and discuss the reciprocal relations between sport federations and their member organisations in this context. Implications: Finally, we work out a research agenda and derive general methodological consequences for the investigation of professionalisation processes in sport organisations.

Professionalisation of sports federations – A multi-level framework for analysing forms, causes and consequences

Introduction: International and national sports federations as well as their member organisations (usually sports clubs) are key actors within the sports system and have a wide range of relationships outside the sports system (e.g. with the state, sponsors, and the media). They are currently facing major challenges such as growing competition in top-­‐level sports, democratisation of sports with “sports for all” and sports as the answer to social problems (integration, education, health, unemployment, etc.). In this context, professionalising sports organisations seems to be an appropriate strategy to face these challenges and solve current problems. This has led to a profound organisational change, particularly within sports federations, characterised by the strengthening of institutional management (managerialism) and the implementation of efficiency-­‐based management instruments and paid staff. In this context the questions arise how sports organisations professionalise and what consequences this may have. Theoretical framework: The goal of our presentation is to review the international literature and develop an appropriate concept of professionalisation in sport federations. Our multi-­‐level approach based on social theory of action integrates the current concepts and perspectives for analysing professionalisation in sports federations. We specify the framework for the following research perspectives: (1) forms, (2) causes and mechanisms, (3) consequences and (4) dynamics, and discuss the reciprocal relations between sports federations and their member organisations in this context. When analysing these different research perspectives, it is important to select or elaborate appropriate theoretical concepts to match the general multi-­‐level framework Discussion: The elaborated multi-­‐level framework for analysing professionalisation in sports federations is able to integrate most of the existing theoretical concepts and therefore, the broad range of endogenous as well as exogenous factors that might influence the professionalisation of sports organisations. Based on the theoretical framework, we can identify several consequences for the methodological design of studies intending to analyse the different perspectives of professionalisation in sports organisations: Data have to be collected on the different levels. Not only the forms of professionalisation and relevant structures of the organisations should be taken into account but also important characteristics of the environment (macro level) as well as members or member organisations, particularly key actors who might play a crucial role in gaining an understanding of professionalisation processes in sports organisations. In order to carry out a complex organisational research design, it seems necessary to focus on case studies – an approach that has become increasingly important in organisational research. Different strategies and methods of data collection have to be used within the case studies (e.g. interviews with experts within the organisations, questionnaire for selected people in the organisation, document analysis). Therefore, qualitative and quantitative research strategies have to be combined.

Desertification mitigation and water harvesting based on sustainable land management

Traditionally, desertification research has focused on degradation assessments, whereas prevention and mitigation strategies have not sufficiently been emphasised, although the concept of sustainable land management (SLM) is increasingly being acknowledged. SLM strategies are interventions at the local to regional scale aiming at increasing productivity, protecting the natural resource base, and improving livelihoods. The global WOCAT initiative and its partners have developed harmonized frameworks to compile, evaluate and analyse the impact of SLM practices around the globe. Recent studies within the EU research project DESIRE developed a methodological framework that combines a collective learning and decision-making approach with use of best practices from the WOCAT database. In-depth assessment of 30 technologies and 8 approaches from 17 desertification sites enabled an evaluation of how SLM addresses prevalent dryland threats such as water scarcity, soil and vegetation degradation, low production, climate change, resource use conflicts and migration. Among the impacts attributed to the documented technologies, those mentioned most were diversified and enhanced production and better management of water and soil degradation, whether through water harvesting, improving soil moisture, or reducing runoff. Water harvesting offers under-exploited opportunities for the drylands and the predominantly rainfed farming systems of the developing world. Recently compiled guidelines introduce the concepts behind water harvesting and propose a harmonised classification system, followed by an assessment of suitability, adoption and up-scaling of practices. Case studies go from large-scale floodwater spreading that make alluvial plains cultivable, to systems that boost cereal production in small farms, as well as practices that collect and store water from household compounds. Once contextualized and set in appropriate institutional frameworks, they can form part of an overall adaptation strategy for land users. More field research is needed to reinforce expert assessments of SLM impacts and provide the necessary evidence-based rationale for investing in SLM. This includes developing methods to quantify and value ecosystem services, both on-site and off-site, and assess the resilience of SLM practices, as currently aimed at within the new EU CASCADE project.

Current approach to the haemodynamic management of septic shock patients in European intensive care units: a cross-sectional, self-reported questionnaire-based survey

The aim of this survey was to investigate clinicians' current approach to the haemodynamic management and resuscitation endpoints in septic shock.