Using Environmental DNA to Detect Whales and Dolphins in the New York Bight

Determining how cetaceans and other threatened marine animals use coastal habitats is critical to the effective conservation of these species. Environmental DNA (eDNA) is an emerging tool that can potentially be used to detect cetaceans over broad spatial and temporal scales. In particular, eDNA may present a useful complementary method for monitoring their presence during visual surveys in nearshore areas, and for co-detecting prey. In conjunction with ongoing visual surveys, we tested the ability of eDNA metabarcoding to detect the presence and identity of cetaceans in the New York Bight (NYB), and to identify fish species (potential prey) present in the area. In almost all cases in which humpback whales and dolphins were visually observed, DNA from these species was also detected in water samples. To assess eDNA degradation over time, we took samples in the same location 15 and 30min after a sighting in seven instances, and found that eDNA often, but not always, dropped to low levels after 30min. Atlantic menhaden were detected in all samples and comprised the majority of fish sequences in most samples, in agreement with observations of large aggregations of this important prey species in the NYB. While additional data are needed to better understand how factors such as behavior and oceanographic conditions contribute to the longevity of eDNA signals, these results add to a growing body of work indicating that eDNA is a promising tool to complement visual and acoustic surveys of marine megafauna

Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences

Non peer reviewe

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Denial of long-term issues with agriculture on tropical peatlands will have devastating consequences

The first International Peat Congress (IPC) held in the tropics - in Kuching (Malaysia) - brought together over 1000 international peatland scientists and industrial partners from across the world (“International Peat Congress with over 1000 participants!,” 2016). The congress covered all aspects of peatland ecosystems and their management, with a strong focus on the environmental, societal and economic challenges associated with contemporary large-scale agricultural conversion of tropical peat. However, recent encouraging developments towards better management of tropical peatlands have been undermined by misleading newspaper headlines and statements first published during the conference. Articles in leading regional newspapers (“Oil palm planting on peat soil handled well, says Uggah,” 2016; Cheng & Sibon, 2016; Nurbianto, 2016a, 2016b; Wong, 2016) widely read across the region, portrayed a general consensus, in summary of the conference, that current agricultural practices in peatland areas, such as oil palm plantations, do not have a negative impact on the environment. This view is not shared by many scientists, or supported by the weight of evidence that business-as-usual management is not sustainable for tropical peatland agriculture. Peer-reviewed scientific studies published over the last 19 years, as reflected in the Intergovernmental Panel on Climate Change (IPCC) Wetland Supplement on greenhouse gas inventories, affirms that drained tropical peatlands lose considerable amounts of carbon at high rates (Drösler et al., 2014). Tropical peat swamp forests have sequestered carbon for millennia, storing a globally significant reservoir below ground in the peat (Page et al., 2011; Dommain et al., 2014). However, contemporary agriculture techniques on peatlands heavily impact this system through land clearance, drainage and fertilization, a process that too often involves fire. Along with biodiversity losses driven by deforestation (Koh et al., 2011; Posa et al., 2011; Giam et al., 2012), the carbon stored in drained peatlands is rapidly lost through oxidation, dissolution and fire (Couwenberg et al., 2009; Hirano et al., 2012; Ramdani & Hino, 2013; Schrier-Uijl et al., 2013; Carlson et al., 2015; Warren et al., 2016). Tropical peat fires are a major contributor to global greenhouse gas emissions and produce transboundary haze causing significant impacts on human health, regional economies and ecosystems (Page et al., 2002; Marlier et al., 2012; Jaafar & Loh, 2014; Chisholm et al., 2016; Huijnen et al., 2016; Stockwell et al., 2016). With future El-Niño events predicted to increase in frequency and severity (Cai et al., 2014) and with fire prevalence now decoupled from drought years (Gaveau et al., 2014), future large scale fire and haze events are imminent given the extensive areas of now drained fire prone drained peatlands (Kettridge et al., 2015; Turetsky et al., 2015; Page & Hooijer, 2016). In reality, just how much of the estimated 69 gigatonnes of carbon (Page et al., 2011) stored in Southeast Asian tropical peatlands is being lost due to agricultural operations under the current management regime is still uncertain. Of great concern is that none of the agricultural management methods applied to date have been shown to prevent the loss of peat and the associated subsidence of the peatland surface following drainage (Wösten et al., 1997; Melling et al., 2008; Hooijer et al., 2012; Evers et al., 2016). Recent projections suggest that large areas of currently drained coastal peatlands will become un-drainable, and progressively be subjected to longer periods of inundation by river and ultimately sea water (Hooijer et al., 2015a, 2015b; Sumarga et al., 2016). With growing risk of saltwater intrusion, agriculture in these coastal lands will become increasingly untenable, calling into question the very notion of “long-term sustainability of tropical peatland agriculture”. A more accurate view of drained peatland agriculture is that of an extractive industry, in which a finite resource (the peat) is ‘mined’ to produce food, fibre and fuel, driven by global demand. In developing countries with growing populations, there are strong socio-economic arguments for exploiting this resource to support local livelihoods and broader economic development (Mizuno et al., 2016). However, an acceptance that on-going peat loss is inevitable under this scenario. Science-based measures towards improved management, including limitations on the extent of plantation development, can be used to minimise the rate of this peat loss (President of Indonesia, 2011). Such an evidence-based position, supported with data and necessary legal instruments are needed for sustainable futures. The scientifically unfounded belief that drained peatland agriculture can be made ‘sustainable’, and peat loss can be halted, via unproven methods such as peat compaction debilitates the effort to find sustainable possibilities. To a large extent, the issues surrounding unsustainable peatland management have now been recognized by sections of industry (Wilmar, 2013; APP, 2014; Cargill Inc., 2014; Mondelēz International, 2014; Sime Darby Plantation, 2014; APRIL, 2015; Olam International, 2015), government (President of Indonesia, 2014, 2016; Mongabay, 2015; Mongabay Haze Beat, 2015; Hermansyah, 2016) and consumers (Wijedasa et al., 2015). In recognition of the constraints and risks of peatland development, many large and experienced oil palm and pulpwood companies have halted further development on peat and introduced rigorous management requirements for existing peatland plantations(Lim et al., 2012). However, the denial of the empirical basis calling for improved peatland management remains persistent in influential policy spaces, as illustrated by the articles reporting on the conference (“Oil palm planting on peat soil handled well, says Uggah,” 2016; Cheng & Sibon, 2016; Nurbianto, 2016a, 2016b). The search for more responsible tropical peatland agriculture techniques includes promising recent initiatives to develop methods to cultivate crops on peat under wet conditions (Giesen, 2015; Dommain et al., 2016; Mizuno et al., 2016). While a truly sustainable peatland agriculture method does not yet exist, the scientific community and industry are collaborating in the search for solutions(International Peat Society, 2016), and for interim measures to mitigate ongoing rates of peat loss under existing plantations. Failing to recognize the devastating consequences of the current land use practices on peat soils and failing to work together to address them could mean that the next generation will have to deal with an irreversibly altered, dysfunctional landscape where neither environment nor society, globally or locally, will be winners.JRC.D.1-Bio-econom

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien\u2013Dindo Grades III\u2013V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49\u20132.96, P &lt; 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46\u20130.75, P &lt; 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease

Body mass index and complications following major gastrointestinal surgery: a prospective, international cohort study and meta-analysis.

AIM: Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a meta-analysis of all available prospective data. METHODS: This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien-Dindo Grades III-V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. RESULTS: This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery for malignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49-2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46-0.75, P < 0.001) compared to normal weight patients. CONCLUSIONS: In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease