Tracking elusive and shifting identities of the global fishing fleet

Illegal, unreported, and unregulated (IUU) fishing costs billions of dollars per year and is enabled by vessels obfuscating their identity. Here, we combine identities of ~35,000 vessels with a decade of GPS data to provide a global assessment of fishing compliance, reflagging patterns, and fishing by foreign-owned vessels. About 17% of high seas fishing is by potentially unauthorized or internationally unregulated vessels, with hot spots of this activity in the west Indian and the southwest Atlantic Oceans. In addition, reflagging, a tactic often used to obscure oversight, occurs in just a few ports primarily by fleets with high foreign ownership. Fishing by foreign-owned vessels is concentrated in parts of high seas and certain national waters, often flying flags of convenience. These findings can address the global scope of potential IUU fishing and enable authorities to improve oversight

The living infinite: Envisioning futures for transformed human-nature relationships on the high seas

We find ourselves at a critical crossroads for the future governance of the high seas, but the perceived remoteness of the global ocean creates a psychological barrier for people to engage with it. Given challenges of overexploitation, inequitable access and other sustainability and equity concerns, current ocean governance mechanisms are not fit-for-purpose. This decade offers opportunities for direct impact on ocean governance, however, triggering a global transformation on how we use and protect the half of our planet requires a concerted effort that is guided by shared values and principles across regions and sectors. The aim of the series of workshops outlined in this paper, was to undertake a futures thinking process that could use the Nature Futures Framework as a mechanism to bring more transformative energy into how humans conceptualise the high seas and therefore how we aim to govern the ocean. We found that engaging with the future through science fiction narratives allowed a more radical appreciation of what could be and infusing science with artistic elements can inspire audiences beyond academia. Thus, creative endeavours of co-production that promote and encourage imagination to address current challenges should be considered as important tools in the science-policy interface, also as a way to elicit empathetic responses. This workshop series was a first, and hopefully promising, step towards generating a more creative praxis in how we imagine and then act for a better future for the high seas

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Incidence of cardiometabolic outcomes among people living with HIV‐1 initiated on integrase strand transfer inhibitor versus non‐integrase strand transfer inhibitor antiretroviral therapies: a retrospective analysis of insurance claims in the United States

Abstract Introduction Integrase strand transfer inhibitor (INSTI)‐containing antiretroviral therapy (ART) has been associated with weight gain, though there is limited information on associations between ART‐related weight gain and cardiometabolic outcomes among people living with HIV‐1 (PLWH). We, therefore, evaluated risks of incident cardiometabolic outcomes following INSTI versus non‐INSTI‐based ART initiation in the United States. Methods We conducted a retrospective study using IBM MarketScan Research Databases (12 August 2012−31 January 2021). Treatment‐naïve PLWH initiating ART (index date) on/after 12 August 2013 (approval date of the first second‐generation INSTI, dolutegravir) were included and censored at regimen switch/discontinuation, end of insurance eligibility or end of data availability. We used inverse probability of treatment weights constructed with baseline (12 months pre‐index) characteristics to account for differences between INSTI‐ and non‐INSTI‐initiating cohorts. Doubly robust hazard ratios (HRs) obtained from weighted multivariable Cox regression were used to compare time to incident cardiometabolic outcomes (congestive heart failure [CHF], coronary artery disease, myocardial infarction, stroke/transient ischemic attack, hypertension, type II diabetes, lipid disorders, lipodystrophy and metabolic syndrome) by INSTI‐initiation status. Results Weighted INSTI (mean age = 39 years, 23% female, 70% commercially insured, 30% Medicaid insured) and non‐INSTI (mean age = 39 years, 24% female, 71% commercially insured, 29% Medicaid insured) cohorts included 7059 and 7017 PLWH, respectively. The most common INSTI‐containing regimens were elvitegravir‐based (43.4%), dolutegravir‐based (33.3%) and bictegravir‐based (18.4%); the most common non‐INSTI‐containing regimens were darunavir‐based (31.5%), rilpivirine‐based (30.4%) and efavirenz‐based (28.3%). Mean±standard deviation follow‐up periods were 1.5±1.5 and 1.1±1.2 years in INSTI‐ and non‐INSTI‐initiating cohorts, respectively. INSTI initiators were at a clinically and significantly increased risk of experiencing incident CHF (HR = 2.12, 95% confidence interval [CI] = 1.08−4.05; p = 0.036), myocardial infarction (HR = 1.79, 95% CI = 1.03−5.65; p = 0.036) and lipid disorders (HR = 1.26, 95% CI = 1.04−1.58; p = 0.020); there was no evidence of an increased risk for other individual or composite outcomes. Conclusions Over a short average follow‐up period of <2 years, INSTI use among treatment‐naïve PLWH was associated with an increased risk of several cardiometabolic outcomes, such as CHF, myocardial infarction and lipid disorders, compared to non‐INSTI use. Further research accounting for additional potential confounders and with longer follow‐up is warranted to more accurately and precisely quantify the impact of INSTI‐containing ART on long‐term cardiometabolic outcomes