Evidence of deep circulation in two perennially ice-covered Antarctic lakes

The perennial ice covers found on many of the lakes in the McMurdo Dry Valley region of the Antarctic have been postulated to severely limit mixing and convective turnover of these unique lakes. In this work, we utilize chlorofluorocarbon (CFC) concentration profiles from Lakes Hoare and Fryxell in the McMurdo Dry Valley to determine the extent of deep vertical mixing occurring over the last 50 years. Near the ice-water interface, CFC concentrations in both lakes were well above saturation, in accordance with atmospheric gas supersaturations resulting from freezing under the perennial ice covers. Evidence of mixing throughout the water column at Lake Hoare was confirmed by the presence of CFCs throughout the water column and suggests vertical mixing times of 20-30 years. In Lake Fryxell, CFC-11, CFC-12, and CFC-113 were found in the upper water column; however, degradation of CFC-11 and CFC-12 in the anoxic bottom waters appears to be occurring with CFC-113 only present in these bottom waters. The presence of CFC-113 in the bottom waters, in conjunction with previous work detecting tritium in these waters, strongly argues for the presence of convective mixing in Lake Fryxell. The evidence for deep mixing in these lakes may be an important, yet overlooked, phenomenon in the limnology of perennially ice-covered lakes

Perceptions of wood in rivers and challenges for stream restoration in the United States

This article reports a study of the public perception of large wood in rivers and streams in the United States. Large wood is an element of freshwater aquatic ecosystems that has attracted much scientific interest in recent years because of its value in biological and geomorphological processes. At the heart of the issue is the nature of the relationship between scientific recognition of the ecological and geomorphological benefits of wood in rivers, management practices utilizing wood for river remediation progress, and public perceptions of in-channel wood. Surveys of students' perceptions of riverscapes with and without large wood in the states of Colorado, Connecticut, Georgia, Illinois, Iowa, Missouri, Oregon, and Texas suggest that many individuals in the United States adhere to traditionally negative views of wood. Except for students in Oregon, most respondents considered photographs of riverscapes with wood to be less aesthetically pleasing and needing more improvement than rivers without wood. Analysis of reasons given for improvement needs suggest that Oregon students are concerned with improving channels without wood for fauna habitat, whereas respondents elsewhere focused on the need for cleaning wood-rich channels for flood risk management. These results underscore the importance of public education to increase awareness of the geomorphological and ecological significance of wood in stream systems. This awareness should foster more positive attitudes toward wood. An integrated program of research, education, and policy is advocated to bridge the gap between scientific knowledge and public perception for effective management and restoration of river systems with wood

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research