Biodiversity gains from efficient use of private sponsorship for flagship species conservation

To address the global extinction crisis, both efficient use of existing conservation funding and new sources of funding are vital. Private sponsorship of charismatic ‘flagship’ species conservation represents an important source of new funding, but has been criticized as being inefficient. However, the ancillary benefits of privately sponsored flagship species conservation via actions benefiting other species have not been quantified, nor have the benefits of incorporating such sponsorship into objective prioritization protocols. Here, we use a comprehensive dataset of conservation actions for the 700 most threatened species in New Zealand to examine the potential biodiversity gains from national private flagship species sponsorship programmes. We find that private funding for flagship species can clearly result in additional species and phylogenetic diversity conserved, via conservation actions shared with other species. When private flagship species funding is incorporated into a prioritization protocol to preferentially sponsor shared actions, expected gains can be more than doubled. However, these gains are consistently smaller than expected gains in a hypothetical scenario where private funding could be optimally allocated among all threatened species. We recommend integrating private sponsorship of flagship species into objective prioritization protocols to sponsor efficient actions that maximize biodiversity gains, or wherever possible, encouraging private donations for broader biodiversity goals.     

Assessment of conservations actions for the critically endangered spotted handfish (Brachionichthyidae), following curation of data collected by multiple investigators into a long-term time-series

Multi-decadal datasets for endangered species that track both populations and performance of management interventions are rare. One such dataset is for the critically endangered Spotted handfish, a species which has been used as a conservation model for the most endangered of the marine bony fish families the Brachionichthyidae. We assessed a 23-year, multi-site, time-series of population density surveys for the spotted handfish as well as a conservation intervention, the planting of ∼ 14,000 artificial spawning habitats (ASH). Data ownership spanned multiple Principal Investigators (PIs) and key data and covariates, such as monitoring and interventions, were often documented within personal files and difficult to access grey literature. We consolidated and curated these data, identifying gaps in the time-series and their causes and isolating confounding factors before we assessed population trends and the effectiveness of ASH planting. Both funding gaps and the 2020 Covid-19 lockdown produced breaks in the time-series. Breeding season observations mostly occurred in the early part of the dataset and there was also a change in method that needed to be considered when interpretating the time-series. There was an overall decline in fish observed between 1997 and 2019 but, at least since 2014, there has been stabilisation of the population. Local populations of spotted handfish can either be highly dynamic or relatively stable but population increases were linked to the long-running, conservation intervention of planting ASH. As local populations can be dynamic, the functional life span of the ASH is limited and threats to the species - chronic, stochastic and climate - are ongoing, spotted handfish may be a ‘conservation reliant’ species that require annual site-specific monitoring, insitu interventions and existu captive husbandry.     

Are current management recommendations for saproxylic invertebrates effective? A systematic review

Conservation management recommendations for saproxylic invertebrates advocate the continuous provision of the dead and decaying wood microhabitats that they require for survival. Accepted site-based management practices include leaving fallen dead and decaying wood in situ, providing supplementary coarse woody material (CWM), inducing decay in mature trees and strategic planting in order to maintain a balanced age structure of trees in both space and time. Here we examine the empirical evidence regarding the effectiveness of such interventions using rigorous systematic review methodology. Systematic searching yielded 27 studies containing pertinent information. The evidence presently available is insufficient to critically appraise the utility of any specific intervention for conserving saproxylic species, or assemblages, in the long-term. However, there are a range of studies, conducted over relatively short periods of time, which do describe changes in saproxylic fauna in response to management practices. In the absence of robust, high quality evidence, recommendations relating to the use of specific site-based conservation interventions should only be regarded as speculative. Nonetheless, general proposals for the maintenance of suitable microhabitats, such as the protection of veteran trees within the landscape, are based on sound ecological principles and should be encouraged even though experimentally controlled and replicated evidence is lacking. Further primary research and long-term monitoring are required to fill the gaps in our ecological knowledge that potentially weaken the case for the effectiveness of current saproxylic invertebrate conservation action and would enable practitioners to make better informed decisions with regard to dead wood protection and provision.     

Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non‐domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision‐making on whether and to what extent to allocate resources to non‐domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny.     

Collaborative Interventions for Circulation and Depression (COINCIDE): study protocol for a cluster randomized controlled trial of collaborative care for depression in people with diabetes and/or coronary heart disease

ABSTRACT: BACKGROUND: Depression is up to two to three times as common in people with long-term conditions. It negatively affects medical management of disease and self-care behaviors, and leads to poorer quality of life and high costs in primary care. Screening and treatment of depression is increasingly prioritized, but despite initiatives to improve access and quality of care, depression remains under-detected and under-treated, especially in people with long-term conditions. Collaborative care is known to positively affect the process and outcome of care for people with depression and long-term conditions, but its effectiveness outside the USA is still relatively unknown. Furthermore, collaborative care has yet to be tested in settings that resemble more naturalistic settings that include patient choice and the usual care providers. The aim of this study was to test the effectiveness of a collaborative-care intervention, for people with depression and diabetes/coronary heart disease in National Health Service (NHS) primary care, in which low-intensity psychological treatment services are delivered by the usual care provider - Increasing Access to Psychological Therapies (IAPT) services.s. The study also aimed to evaluate the cost-effectiveness of the intervention over 6 months of collaborative care, and to assess qualitatively the extent to which collaborative care was implemented in the intervention general practices. METHODS: This is a cluster randomized controlled trial of 30 general practices allocated to either collaborative care or usual care. Fifteen patients per practice will be recruited after a screening exercise to detect patients with recognized depression (greater than or equal to 10 on the nine-symptom Patient Health Questionnaire; PHQ-9). Patients in the collaborative-care arm with recognized depression will be offered a choice of evidence-based low-intensity psychological treatments based on cognitive and behavioral approaches. Patients will be case managed by psychological well-being practitioners employed by IAPT in partnership with a practice nurse and/or general practitioner. The primary outcome will be change in depressive symptoms at 6 months on the 90-item Symptoms Checklist (SCL-90). Secondary outcomes include change in health status, self-care behaviors, and self-efficacy. A qualitative process evaluation will be undertaken with patients and health practitioners to gauge the extent to which the collaborative-care model is implemented, and to explore sustainability beyond the clinical trial. DISCUSSION: COINCIDE will assess whether collaborative care can improve patient-centered outcomes, and evaluate access to and quality of care of co-morbid depression of varying intensity in people with diabetes/coronary heart disease. Additionally, by working with usual care providers such as IAPT, and by identifying and evaluating interventions that are effective and appropriate for routine use in the NHS, the COINCIDE trial offers opportunities to address translational gaps between research and implementation.Trial Registration NumberISRCTN80309252Trial StatusOpen.     

Conservation successes at micro-, meso- and macroscales

Although large-scale biodiversity declines are ongoing, certain conservation actions have made a positive difference. Rates of extinction and endangerment of vertebrate species, for instance, have probably been reduced via conservation interventions. Such conservation actions operate at different spatial scales. Habitat preservation and endangered species recovery are examples of conservation successes at microscales. Mesoscale conservation includes regional cooperation among neighboring countries that has arrested population declines of endangered species, such as mountain gorillas. At macroscales, public pressure on multinational corporations has sometimes resulted in their abandoning environmentally damaging practices or suppliers with poor environmental records. Overall, conservation projects such as these need more long-term funding and greater political and popular support, and must also include provisions to evaluate and document their outcomes. As we discuss here, a focus on conservation successes achieved at different scales can help to promote these aims and guide future conservation victories.     

Measuring the difference made by conservation initiatives: protected areas and their environmental and social impacts

Success in conservation depends on our ability to reduce human pressures in areas that harbour biological diversity and ecosystem services. Legally protecting some of these areas through the creation of protected areas is a key component of conservation efforts globally. To develop effective protected area networks, practitioners need credible, scientific evidence about the degree to which protected areas affect environmental and social outcomes, and how these effects vary with context. Such evidence has been lacking, but the situation is changing as conservation scientists adopt more sophisticated research designs for evaluating protected areas'' past impacts and for predicting their future impacts. Complementing these scientific advances, conservation funders and practitioners are paying increasing attention to evaluating their investments with more scientifically rigorous evaluation designs. This theme issue highlights recent advances in the science of protected area evaluations and explores the challenges to developing a more credible evidence base that can help societies achieve their goals of protecting nature while enhancing human welfare.     

European Non-Communicable Respiratory Disease Research, 2002-13: Bibliometric Study of Outputs and Funding

This study was conducted in order to map European research in chronic respiratory diseases (CRDs). It was intended to assist the European Commission and other research funders to identify gaps and overlaps in their portfolios, and to suggest ways in which they could improve the effectiveness of their support and increase the impact of the research on patient care and on the reduction of the incidence of the CRDs. Articles and reviews were identified in the Web of Science on research in six non-communicable respiratory diseases that were published in 2002–13 from 31 European countries. They represented only 0.8% of biomedical research output but these diseases accounted for 4.7% of the European disease burden, as measured by Disability-Adjusted Life Years (DALYs), so the sub-field is seriously under-researched. Europe is prominent in the sub-field and published 56% of the world total, with the UK the most productive and publishing more than France and Italy, the next two countries, combined. Asthma and Chronic Obstructive Pulmonary Disease (COPD) were the diseases with the most publications and the highest citation rates. They also received the most funding, with around two acknowledgments per paper (in 2009–13), whereas cystic fibrosis and emphysema averaged only one. Just over 37% of papers had no specific funding and depended on institutional support from universities and hospitals.     

Research needs for incorporating the ecosystem service approach into EU biodiversity conservation policy

Using a range of different methods including extensive reviews, workshops and an electronic conference, 70 key research recommendations and 12 priority research needs to integrate the ecosystem services approach into biodiversity conservation policy and funding were identified by a cross-disciplinary group of over 100 scientists and 50 stakeholders, including research funders and policy-makers. These recommendations focus on the ecological underpinning of ecosystem services, drivers that affect ecosystems and their services, biological traits and ecosystem services, the valuation of ecosystem services, spatial and temporal scales in ecosystem service assessment, indicators of ecosystem services, and habitat management, conservation policy and ecosystem services. The recommendations in this paper help steer the research agenda on ecosystem services into policy-relevant areas, agreed upon by funders, researchers and policy-makers. This research agenda will only succeed with increased collaboration between researchers across disciplines, thereby providing a challenge to the research community and research funders to work in new, interdisciplinary ways.     

Conservation needs ethologv

With the number of species and near-to-natural habitats rapidly dwindling, conservation has become an undebatable necessity. There have been some laudable, successful species conservation projects but there have also been many deplorable failures. The failures are exacerbated by limited funding. Conservationists depend on funding by national government organizations (NG0s) and by private sponsors, more than other practitioners of organismic biology do. To maximize their success, conservationists would be well advised to heed the messages resulting from animal behaviour study (i.e. ethology) and/or to involve ethologists in their projects. Here, I illustrate how ethology can benefit both in situ and ex situ conservation measures; the need for conservation-oriented behaviour research is paramount.     

基于水鸟保护的长江流域湿地优先保护格局模拟

基于系统保护规划的理论和方法,以长江流域湿地为研究区,构建了基于气候、地貌分异的湿地生态地理综合分类单元,并将其作为宏观尺度湿地生态系统保护目标,同时考虑以湿地鸟类为代表的物种保目标,依托Marxan系统保护规划工具,确定了长江流域湿地保护具有不可替代性的优先保护格局。该格局能以最小的社会经济和土地资源代价最大程度的保护湿地生物多样性,对比现有湿地保护格局,最终确定了游离于现有保护体系外的湿地保护空缺。研究结果表明:长江流域源区和长江三角洲地区的湿地保护体系完善,无需新建保护区;金沙江流域湿地保护空缺主要分布在现有保护区周围,可以适当扩充保护区外围或调整边界;嘉陵江流域和长江上游干流流域的保护空缺严重,大面积集中在重庆西北部,乌江流域的贵州省习水县北部湖泊湿地存在保护空缺,这些区域建议适当新建保护区或者保护小区;长江中下游湿地保护空缺主要分布在湖北、湖南、江西与安徽境内的沿江湖泊湿地,建议建立湿地公园及合理进行河流岸坡修复。研究结果可为长江流域湿地保护体系调整、保护规划制定提供参考依据,从宏观层面上为长江流域湿地统筹保护及合理开发利用提供科学依据。     

Prioritizing Land and Sea Conservation Investments to Protect Coral Reefs

Background

Coral reefs have exceptional biodiversity, support the livelihoods of millions of people, and are threatened by multiple human activities on land (e.g. farming) and in the sea (e.g. overfishing). Most conservation efforts occur at local scales and, when effective, can increase the resilience of coral reefs to global threats such as climate change (e.g. warming water and ocean acidification). Limited resources for conservation require that we efficiently prioritize where and how to best sustain coral reef ecosystems.

Methodology/Principal Findings

Here we develop the first prioritization approach that can guide regional-scale conservation investments in land- and sea-based conservation actions that cost-effectively mitigate threats to coral reefs, and apply it to the Coral Triangle, an area of significant global attention and funding. Using information on threats to marine ecosystems, effectiveness of management actions at abating threats, and the management and opportunity costs of actions, we calculate the rate of return on investment in two conservation actions in sixteen ecoregions. We discover that marine conservation almost always trumps terrestrial conservation within any ecoregion, but terrestrial conservation in one ecoregion can be a better investment than marine conservation in another. We show how these results could be used to allocate a limited budget for conservation and compare them to priorities based on individual criteria.

Conclusions/Significance

Previous prioritization approaches do not consider both land and sea-based threats or the socioeconomic costs of conserving coral reefs. A simple and transparent approach like ours is essential to support effective coral reef conservation decisions in a large and diverse region like the Coral Triangle, but can be applied at any scale and to other marine ecosystems.     

A common‐sense approach to tropical peat swamp forest restoration in Southeast Asia

Tropical peat swamp forests (TPSFs) are found mainly in Southeast Asia and especially Indonesia. A total of 61% were lost between 1990 and 2015 and 6% remained in a pristine condition by 2015. Tropical peat swamps store vast amounts of carbon in their peat, but peat degradation, through drainage and fire, leads to high greenhouse gas emissions. This is gaining much international attention and, with it, policy initiatives and funding for restoration from local to landscape scales are being promoted. Unfortunately, although there is a now strong desire and need for TPSF restoration, methods are lacking. Ecological understanding is still at an early stage, and, even more so, in its applied use. There is an imbalance between the activities of TPSF restoration and sound ecological application. Furthermore, while many activities are underway and knowledge is being gained, these techniques are yet to be published. This article has been written to provide a common‐sense, practical guide to tropical peatland forest restoration which summarizes what we know to date, while acknowledging the gaps in our understanding. Topics covered include species selection, land assessment, land selection, and appropriate nursery, transplanting, and monitoring methods. The authors make no apologies that in places this reads like a manual as, given the importance of tropical peatland recovery and the recent attention and funding opportunities available, it is essential we now provide techniques to restoration practitioners working on the ground, and a basic common‐sense approach must be the starting point.     

HIV Testing Implementation in Two Urban Cities: Practice,Policy, and Perceived Barriers

Background

Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

Methods

We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.

Results

In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC.

Conclusions

Given unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.     

Who will develop new antibacterial agents?

The golden age of antimicrobial drug development is a distant memory, and the likelihood of there being another seems slim. In part, this is because the pharmaceutical industry, which has now adopted an unsustainable business model, abandoned the anti-infective sector, and the pipeline is almost empty. The contribution to this crisis of national governments, health agencies and funders also merits discussion. Much of the basis for drug discovery is funded by the public sector, thereby generating intellectual property and leads for drug development that are often not pursued owing to funding gaps. In particular, the cost of testing drug efficacy in clinical trials is beyond the means of most companies and organizations. Lack of a concerted international effort to develop new antimicrobials is particularly alarming at a time when multidrug-resistant bacteria threaten all areas of human medicine globally. Here, the steps that led to this situation are retraced, and some possible solutions to the dilemma are proposed.     

No Effect of Insecticide Treated Curtain Deployment on Aedes Infestation in a Cluster Randomized Trial in a Setting of Low Dengue Transmission in Guantanamo,Cuba

Objective & Methodology

The current study evaluated the effectiveness and cost-effectiveness of Insecticide Treated Curtain (ITC) deployment for reducing dengue vector infestation levels in the Cuban context with intensive routine control activities. A cluster randomized controlled trial took place in Guantanamo city, east Cuba. Twelve neighborhoods (about 500 households each) were selected among the ones with the highest Aedes infestation levels in the previous two years, and were randomly allocated to the intervention and control arms. Long lasting ITC (PermaNet) were distributed in the intervention clusters in March 2009. Routine control activities were continued in the whole study area. In both study arms, we monitored monthly pre- and post-intervention House Index (HI, number of houses with at least 1 container with Aedes immature stages/100 houses inspected), during 12 and 18 months respectively. We evaluated the effect of ITC deployment on HI by fitting a generalized linear regression model with a negative binomial link function to these data.

Principal Findings

At distribution, the ITC coverage (% of households using ≥1 ITC) reached 98.4%, with a median of 3 ITC distributed/household. After 18 months, the coverage remained 97.4%. The local Aedes species was susceptible to deltamethrin (mosquito mortality rate of 99.7%) and the residual deltamethrin activity in the ITC was within acceptable levels (mosquito mortality rate of 73.1%) after one year of curtain use. Over the 18 month observation period after ITC distribution, the adjusted HI rate ratio, intervention versus control clusters, was 1.15 (95% CI 0.57 to 2.34). The annualized cost per household of ITC implementation was 3.8 USD, against 16.8 USD for all routine ACP activities.

Conclusion

Deployment of ITC in a setting with already intensive routine Aedes control actions does not lead to reductions in Aedes infestation levels.     

Total HIV/AIDS Expenditures in Dehong Prefecture,Yunnan Province in 2010: The First Systematic Evaluation of Both Health and Non-Health Related HIV/AIDS Expenditures in China

Objective

We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations.

Methods

2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS’ National AIDS Spending Assessment methodology.

Results

Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4%) prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs), sex workers, and men who have sex with men (MSM), with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%.

Conclusions

Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation.     

Insights into plant biodiversity conservation in large river valleys in China: A spatial analysis of species and phylogenetic diversity

Large river valleys (LRVs) are heterogeneous in habitat and rich in biodiversity, but they are largely overlooked in policies that prioritize conservation. Here, we aimed to identify plant diversity hotspots along LRVs based on species richness and spatial phylogenetics, evaluate current conservation effectiveness, determine gaps in the conservation networks, and offer suggestions for prioritizing conservation. We divided the study region into 50 km × 50 km grid cells and determined the distribution patterns of seed plants by studying 124,927 occurrence points belonging to 14,481 species, using different algorithms. We generated phylogenies for the plants using the “V. PhyloMaker” R package, determined spatial phylogenetics, and conducted correlation analyses between different distribution patterns and spatial phylogenetics. We evaluated the effectiveness of current conservation practices and discovered gaps of hotspots within the conservation networks. In the process, we identified 36 grid cells as hotspots (covering 10% of the total area) that contained 83.4% of the species. Fifty‐eight percent of the hotspot area falls under the protection of national nature reserves (NNRs) and 83% falls under national and provincial nature reserves (NRs), with 42% of the area identified as conservation gaps of NNRs and 17% of the area as gaps of NRs. The hotspots contained high proportions of endemic and threatened species, as did conservation gaps. Therefore, it is necessary to optimize the layout of current conservation networks, establish micro‐nature reserves, conduct targeted conservation priority planning focused on specific plant groups, and promote conservation awareness. Our results show that the conservation of three hotspots in Southwest China, in particular, is likely to positively affect the protection of biodiversity in the LRVs, especially with the participation of the neighboring countries, India, Myanmar, and Laos.     

Measuring conservation priorities: A simple tool for conservation planning in poorly sampled areas

Global conservation resources are limited and as a result donors and funders are forced to make difficult decisions as to which areas are in most urgent need of support. Biodiversity can play a key role in these choices, but many other factors must be considered. In order to assist with such decisions we present a simple index that can be employed by non-scientists in poorly sampled countries, using the reptile fauna of 55 protected and two unprotected areas of Paraguay as a case study. This index can be applied at multiple taxonomic and geographic levels to minimize biases generated by uneven sampling. We offer words of caution on unsupported claims of high biodiversity, and highlight how the use of inaccurate terminology, although well-intentioned, can be detrimental to national or local conservation efforts. Results show that the top two areas of conservation priority in Paraguay are currently unprotected, and current investment of resources is ineffective and insufficient for long term protection of Paraguay’s globally and nationally threatened reptiles.     

Trends in publications regarding evidence-practice gaps: A literature review

Background

Well-designed trials of strategies to improve adherence to clinical practice guidelines are needed to close persistent evidence-practice gaps. We studied how the number of these trials is changing with time, and to what extent physicians are participating in such trials.

Methods

This is a literature-based study of trends in evidence-practice gap publications over 10 years and participation of clinicians in intervention trials to narrow evidence-practice gaps. We chose nine evidence-based guidelines and identified relevant publications in the PubMed database from January 1998 to December 2007. We coded these publications by study type (intervention versus non-intervention studies). We further subdivided intervention studies into those for clinicians and those for patients. Data were analyzed to determine if observed trends were statistically significant.

Results

We identified 1,151 publications that discussed evidence-practice gaps in nine topic areas. There were 169 intervention studies that were designed to improve adherence to well-established clinical guidelines, averaging 1.9 studies per year per topic area. Twenty-eight publications (34%; 95% CI: 24% - 45%) reported interventions intended for clinicians or health systems that met Effective Practice and Organization of Care (EPOC) criteria for adequate design. The median consent rate of physicians asked to participate in these well-designed studies was 60% (95% CI, 25% to 69%).

Conclusions

We evaluated research publications for nine evidence-practice gaps, and identified small numbers of well-designed intervention trials and low rates of physician participation in these trials.