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Soil improvement measures need to be ecologically credible, socially acceptable and economically affordable if they are to enter widespread use. However, in real world decision contexts not all measures can sufficiently meet these criteria. As such, developing, selecting and using appropriate tools to support more systematic appraisal of soil improvement measures in different decision-making contexts represents an important challenge. Tools differ in their aims, ranging from those focused on appraising issues of cost-effectiveness, wider ecosystem services impacts and adoption barriers/opportunities, to those seeking to foster participatory engagement and social learning. Despite the growing complexity of the decision-support tool landscape, comprehensive guidance for selecting tools that are best suited to appraise soil improvement measures, as well as those well-adapted to enable participatory deployment, has generally been lacking. We address this gap using the experience and survey data from an EU-funded project (RECARE: Preventing and REmediating degradation of soils in Europe through land CARE). RECARE applied different socio-cultural, biophysical and monetary appraisal tools to assess the costs, benefits and adoption of soil improvement measures across Europe. We focused on these appraisal tools and evaluated their performance against three broad attributes that gauge their differences and suitability for widespread deployment to aid stakeholder decision making in soil management. Data were collected using an online questionnaire administered to RECARE researchers. Although some tools worked better than others across case studies, the information collated was used to provide guiding strategies for choosing appropriate tools, considering resources and data availability, characterisation of uncertainty, and the purpose for which a specific soil improvement measure is being developed or promoted. This paper provides insights to others working in practical soil improvement contexts as to why getting the tools right matters. It demonstrates how use of the right tools can add value to decision-making in ameliorating soil threats, supporting the sustainable management of the services that our soil ecosystems provide., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Perioperative antibiotic prophylaxis (PAP) is an integral part of kidney transplantation to prevent surgical site infections (SSI). In July 2015, we changed our standard from a multiple-dose to a single-dose (SD) prophylaxis. Here, we report on results with both regimens and a related survey among Eurotransplant renal transplantation centers., Methods: From July 2015, all kidney graft recipients of our center were scheduled to receive SD i.v. cefazolin (group SD, n = 107). They were compared to patients, transplanted since January 2014, receiving our previous standard (i.v. piperacillin/flucloxacillin) until postoperative day (POD) 7, plus oral sultamicillin until POD 10 (group MD, n = 105). The primary endpoint was the number of SSIs during a 3-month observational period., Results: The frequency of SSI episodes was generally low (group SD vs. MD: 2 vs. 4, p = 0.40). Of note, urinary tract infections occurred in 40 SD vs. 36 MD patients, respectively (p = 0.60). Urinary tract infections were caused by Escherichia coli in 36.8%. Female gender was the only independent risk factor on multivariate analysis (p = 0.002). In addition, 12 episodes of urosepsis in both groups occurred. All-cause infection with multi-resistant bacteria occurred less frequently in SD vs. MD patients (3.7% vs. 8.6%, p = 0.16). A majority of Eurotransplant centers used i.v. single-dose cephalosporins (36.9%), although substances and duration varied remarkably., Conclusion: Single-dose cefazolin was equally effective and less expensive compared to our previous MD regimen. Based on these findings, we conclude that future prospective studies should be designed to confirm the non-inferiority of single-dose antibiotic regimens.

Oral anticoagulants are a mainstay of cardiovascular therapy, and for over 60 years vitamin K antagonists (VKAs) were the only available agents for long-term use. VKAs interfere with the cyclic inter-conversion of vitamin K and its 2,3 epoxide, thus inhibiting γ-carboxylation of glutamate residues at the amino-termini of vitamin K-dependent proteins, including the coagulation factors (F) II (prothrombin), VII, IX and X, as well as of the anticoagulant proteins C, S and Z. The overall effect of such interference is a dose-dependent anticoagulant effect, which has been therapeutically exploited in heart disease since the early 1950s. In this position paper, we review the mechanisms of action, pharmacological properties and side effects of VKAs, which are used in the management of cardiovascular diseases, including coronary heart disease (where their use is limited), stroke prevention in atrial fibrillation, heart valves and/or chronic heart failure. Using an evidence-based approach, we describe the results of completed clinical trials, highlight areas of uncertainty, and recommend therapeutic options for specific disorders. Although VKAs are being increasingly replaced in most patients with non-valvular atrial fibrillation by the new oral anticoagulants, which target either thrombin or FXa, the VKAs remain the agents of choice for patients with atrial fibrillation in the setting of rheumatic valvular disease and for those with mechanical heart valves.