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The World Health Organization (WHO), the leading global authority in public health, routinely attracts loud calls for reform. Although Member States negotiate reform internally, academic debate is more public, and can generate ideas and provide independent accountability. We investigate why authors advocate for WHO reform so commonly. We wondered if this literature had potentially useful themes for WHO, what methods and evidence were used, and we wanted to analyze the geography of participation. We conducted a systematic review using four databases to identify 139 articles assessing WHO or advocating for reform. We discuss these using categories we derived from the management literature on organizational performance. We also analyzed evidence, country of origin, and topic. The literature we reviewed contained 998 claims about WHO's performance or reform, although there were no standard methods for assessing WHO. We developed a framework to analyze WHO's performance and structure a synthesis of the claims, which find WHO imperiled. Its legitimacy and governance are weakened by disagreements about purpose, unequal Member State influence, and inadequate accountability. Contestation of goals and strategies constrain planning. Structure and workforce deficiencies limit coordination, agility, and competence. WHO has technical and normative authority, but insufficient independence and legal power to influence uncooperative states. WHO's identity claims transparency, independence, and courage, but these aspirations are betrayed in times of need. Most articles (88%) were commentaries without specified methods. More than three-quarters (76%) originated from the US, the UK, or Switzerland. A quarter of papers (25%) focused on international infectious disease outbreaks, and another 25% advocated for WHO reform generally. Many criticisms cite wide-ranging performance problems, some of which may relate to obstructive behavior by Member States. This literature is incomplete in the geographic representation of authors, evidence, methods, and topics. We offer ideas for developing more rigorous and inclusive academic debate on WHO., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.) more...

Freshwater biodiversity loss is a major concern, and global warming is already playing a significant role in species extinctions. Our main goal was to predict climate change impacts on aquatic insect species distribution and richness in Swiss running waters according to two climate change scenarios (RCP2.6 and RCP8.5), using different modeling approaches, that is, species distribution models (SDMs), stacked-SDMs (S-SDMs) and a macroecological model (MEM). We analyzed 10,808 reaches, used as spatial units for model predictions, for a total river network length of 20,610 km. Results were assessed at both the countrywide and the biogeographic regional scales. We used incidence data of 41 species of Ephemeroptera, Plecoptera and Trichoptera (EPT) from 259 sites distributed across Switzerland. We integrated a coupled model for hydrology and glacier retreat to simulate monthly time-step discharge from which we derived hydrological variables. These, along with thermal, land-cover, topographic and spatially explicit data, served as predictors for our ecological models. Predictions of occurrence probabilities and EPT richness were compared among the different regions, periods and scenarios. A Shiny web application was developed to interactively explore all the models' details, to ensure transparency and promote the sharing of information. MEM and S-SDMs approaches consistently showed that overall, climate change is likely to reduce EPT richness. Decrease could be around 10% in the least conservative scenario, depending on the region. Global warming was shown to represent a threat to species from high elevation, but in terms of species richness, running waters from lowlands and medium elevation seemed more vulnerable. Finally, our results suggested that the effects of anthropogenic activities could overweight natural factors in shaping the future of river biodiversity., (© 2021 The Authors. Global Change Biology published by John Wiley & Sons Ltd.) more...

We initiated a prospective study with a group of practitioners to assess the etiology, clinical presentation, and outcome of community-acquired pneumonia in patients diagnosed in the outpatient setting. All patients with signs and symptoms suggestive of pneumonia and an infiltrate on chest X-ray underwent an extensive standard workup and were followed over 4 weeks. Over a 4-year period, 184 patients were eligible, of whom 170 (age range, 15-96 yr; median, 43 yr) were included and analyzed. In 78 (46%), no etiologic agent could be demonstrated. In the remaining 92 patients, 107 etiologic agents were implicated: 43 were due to "pyogenic" bacteria (39 Streptococcus pneumoniae, 3 Haemophilus spp., 1 Streptococcus spp.), 39 were due to "atypical" bacteria (24 Mycoplasma pneumoniae, 9 Chlamydia pneumoniae, 4 Coxiella burnetii, 2 Legionella spp.), and 25 were due to viruses (20 influenza viruses and 5 other respiratory viruses). There were only a few statistically significant clinical differences between the different etiologic categories (higher age and comorbidities in viral or in episodes of undetermined etiology, higher neutrophil counts in "pyogenic" episodes, more frequent bilateral and interstitial infiltrates in viral episodes). There were 2 deaths, both in patients with advanced age (83 and 86 years old), and several comorbidities. Only 14 patients (8.2%) required hospitalization. In 6 patients (3.4%), the pneumonia episode uncovered a local neoplasia. This study shows that most cases of community-acquired pneumonia have a favorable outcome and can be successfully managed in an outpatient setting. Moreover, in the absence of rapid and reliable clinical or laboratory tests to establish a definite etiologic diagnosis at presentation, the spectrum of the etiologic agents suggest that initial antibiotic therapy should cover both S. pneumoniae and atypical bacteria, as well as possible influenza viruses during the epidemic season. more...