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Methods for reviewing epidemiological signals are necessary to building and maintaining data-driven public health capabilities. We have developed a novel approach for assessing the plausibility of infectious disease forecasts and surveillance data. The PLANES ( PL ausibility AN alysis of E pidemiological S ignals) methodology is designed to be multi-dimensional and flexible, yielding an overall score based on individual component assessments that can be applied at various temporal and spatial granularities. Here we describe PLANES, provide a demonstration analysis, and discuss how to use the open-source rplanes R package. PLANES aims to enable modelers and public health end-users to evaluate forecast plausibility and surveillance data integrity, ultimately improving early warning systems and informing evidence-based decision-making.

Spatial optimization approaches that were originally developed to help conservation organizations determine protection decisions over small spatial scales are now used to inform global or continental scale priority setting. However, the different decision contexts involved in large‐scale resource allocation need to be considered. We present a continuous optimization approach in which a decision‐maker allocates funding to regional offices. Local decision‐makers then use these funds to implement habitat protection efforts with varying effectiveness when evaluated in terms of the funder's goals. We illustrate this continuous formulation by examining the relative priority that should be given to different counties in the coterminous United States when acquiring land to establish new protected areas. If weighting all species equally, counties in the southwest United States, where large areas can be bought cheaply, are priorities for protection. If focusing only on species of conservation concern, priorities shift to locations rich in such species, particularly near expanding exurban areas facing high rates of future habitat conversion (e.g., south‐central Texas). Priorities for protection are sensitive to what is assumed about local ecological and decision‐making processes. For example, decision‐makers who doubt the efficacy of local land protection efforts should focus on a few key areas, while optimistic decision‐makers should disperse funding more widely. Efforts to inform large‐scale conservation priorities should reflect better the types of choice that decision‐makers actually face when working over these scales. They also need to report the sensitivity of recommended priorities to what are often unstated assumptions about local processes affecting conservation outcomes.

Protected area systems include sites preserved by various institutions and mechanisms, but the benefits to biodiversity provided by different types of sites are poorly understood. Protected areas established by local communities for various reasons may provide complementary benefits to those established by large-scale agencies and organizations. Local communities are geographically constrained, however, and it remains unclear how effectively they protect biodiversity. We explored this issue by focusing on protected areas established through direct democracy via local ballot initiatives whereby communities vote to tax themselves for open space preservation. We compared the effectiveness of local ballot-protected areas to areas protected by a large-scale conservation actor, The Nature Conservancy (TNC). We evaluated how well the two protected area types correspond with amphibians, reptiles, birds, mammals and special status elements of natural diversity. Local ballot-protected areas differed from those of TNC in terms of size, location, proximity to urban areas and habitat diversity. In terms of potential habitat coverage, local ballot-protected areas outperformed TNC sites for all species groups with the exception of special status elements of natural diversity. While not necessarily targeting wildlife and habitats, we conclude that locally established protected areas can make an important contribution to biodiversity conservation.

Spatial optimization approaches that were originally developed to help conservation organizations determine protection decisions over small spatial scales are now used to inform global or continental scale priority setting. However, the different decision contexts involved in large-scale resource allocation need to be considered.We present a continuous optimization approach in which a decision-maker allocates funding to regional offices. Local decision-makers then use these funds to implement habitat protection efforts with varying effectiveness when evaluated in terms of the funder's goals.We illustrate this continuous formulation by examining the relative priority that should be given to different counties in the coterminous United States when acquiring land to establish new protected areas. If weighting all species equally, counties in the southwest United States, where large areas can be bought cheaply, are priorities for protection. If focusing only on species of conservation concern, priorities shift to locations rich in such species, particularly near expanding exurban areas facing high rates of future habitat conversion (e.g., south-central Texas). Priorities for protection are sensitive to what is assumed about local ecological and decision-making processes. For example, decision-makers who doubt the efficacy of local land protection efforts should focus on a few key areas, while optimistic decision-makers should disperse funding more widely. Efforts to inform large-scale conservation priorities should reflect better the types of choice that decision-makers actually face when working over these scales. They also need to report the sensitivity of recommended priorities to what are often unstated assumptions about local processes affecting conservation outcomes.

Multidrug-resistant (MDR) gram-negative infections are a substantial threat to patients and public health. Imipenem-cilastatin-relebactam (IMI/REL) is a β-lactam/β-lactamase inhibitor with expanded activity against MDR and carbapenem-resistant Enterobacterales. This study aims to describe the patient characteristics, prescribing patterns, and clinical outcomes associated with IMI/REL. This was a retrospective, multicenter, observational study of patients ≥18 years old who received IMI/REL for ≥48 hours for a suspected or confirmed gram-negative infection. The primary outcome was clinical success, defined as improvement or resolution of infection-related signs or symptoms while receiving IMI/REL and the absence of 30-day microbiologic failure. Multivariable logistic regression analysis was performed to identify independent predictors of clinical success. The study included 151 patients from 24 US medical centers. IMI/REL was predominantly prescribed for lower respiratory tract infections, accounting for 52.3% of cases. Most patients were infected with a carbapenem-nonsusceptible pathogen (85.4%); was frequently targeted (72.2%). Clinical success was achieved in 70.2% of patients. Heart failure, receipt of antibiotics within the past 90 days, intensive care unit admission at time of index culture collection, and isolation of difficult-to-treat resistant were independently associated with a reduced odds of clinical success. Adverse events were reported in 6.0% of patients, leading to discontinuation of IMI/REL in 3 instances. This study provides a comprehensive analysis of the real-world effectiveness and safety of IMI/REL. Comparative studies and investigations of specific subgroups will further enhance our understanding of IMI/REL in treating MDR infections.