Connected by sea, disconnected by tuna? Challenges to regionalism in the Southwest Indian Ocean

Madagascar, Mauritius and Seychelles are at the center of industrial tuna extraction in the Southwest Indian Ocean (SWIO). In this paper, we show that, while a discourse of regionalism between the three islands is prominent, the possibilities of regionalism face deep challenges in relation to the tuna industry. This is due to three factors. First, local perceptions, especially amongst those working in and on the tuna industry, are in disconnection with an ‘Indianoceania’ vision. Second, the geopolitics between coastal states and distant water fishing nations create various entanglements including through fishing access revenue and foreign aid. Finally, the materiality of tuna can at times create competition as countries seek to individually maximize benefits from the industry. We argue that the active reinforcement of regional identity and collaboration around this resource is necessary to sustain local benefits into the future

¹⁸F-Fludeoxyglucose-Positron Emission Tomography/Computed Tomography and Laparoscopy for Staging of Locally Advanced Gastric Cancer:A Multicenter Prospective Dutch Cohort Study (PLASTIC)

Importance: The optimal staging for gastric cancer remains a matter of debate. Objective: To evaluate the value of 18F-fludeoxyglucose-positron emission tomography with computed tomography (FDG-PET/CT) and staging laparoscopy (SL) in addition to initial staging by means of gastroscopy and CT in patients with locally advanced gastric cancer. Design, Setting, and Participants: This multicenter prospective, observational cohort study included 394 patients with locally advanced, clinically curable gastric adenocarcinoma (≥cT3 and/or N+, M0 category based on CT) between August 1, 2017, and February 1, 2020. Exposures: All patients underwent an FDG-PET/CT and/or SL in addition to initial staging. Main Outcomes and Measures: The primary outcome was the number of patients in whom the intent of treatment changed based on the results of these 2 investigations. Secondary outcomes included diagnostic performance, number of incidental findings on FDG-PET/CT, morbidity and mortality after SL, and diagnostic delay. Results: Of the 394 patients included, 256 (65%) were men and mean (SD) age was 67.6 (10.7) years. A total of 382 patients underwent FDG-PET/CT and 357 underwent SL. Treatment intent changed from curative to palliative in 65 patients (16%) based on the additional FDG-PET/CT and SL findings. FDG-PET/CT detected distant metastases in 12 patients (3%), and SL detected peritoneal or locally nonresectable disease in 73 patients (19%), with an overlap of 7 patients (2%). FDG-PET/CT had a sensitivity of 33% (95% CI, 17%-53%) and specificity of 97% (95% CI, 94%-99%) in detecting distant metastases. Secondary findings on FDG/PET were found in 83 of 382 patients (22%), which led to additional examinations in 65 of 394 patients (16%). Staging laparoscopy resulted in a complication requiring reintervention in 3 patients (0.8%) without postoperative mortality. The mean (SD) diagnostic delay was 19 (14) days. Conclusions and Relevance: This study's findings suggest an apparently limited additional value of FDG-PET/CT; however, SL added considerably to the staging process of locally advanced gastric cancer by detection of peritoneal and nonresectable disease. Therefore, it may be useful to include SL in guidelines for staging advanced gastric cancer, but not FDG-PET/CT

Group Space Allowance Has Little Effect on Sow Health, Productivity, or Welfare in a Free-Access Stall System

Free-access stalls allow sows to choose the protection of a stall or use of a shared group space. This study investigated the effect of group space width, 0.91 (SS), 2.13 (IS), and 3.05 (LS) m, on the health, production, behavior, and welfare of gestating sows. Nine replications of 21 (N = 189) gestating sows were used. At gestational d 35.4 ± 2.3, the pregnant sows were distributed into 3 pens of 7 sows, where they remained until 104.6 ± 3.5 d. Each treatment pen had 7 free-access stalls and a group space that together provided 1.93 (SS), 2.68 (IS), or 3.24 (LS) m2/sow. Baseline measurements were obtained before mixing. Back fat depth, BW, BCS, and lameness were measured monthly, and skin lesions were scored weekly. Blood was collected monthly for hematological, immunological, and cortisol analyses. Sow behavior was video recorded continuously during the initial 4 d of treatment and 24 h every other week thereafter. Behavior was analyzed for location, posture, pen investigation, social contact, and aggression. Skin response to the mitogen concanavalin A (Con A) was tested at mean gestational d 106. Litter characteristics including size and weight were collected at birth and weaning. The data were analyzed using a mixed model. Multiple comparisons were adjusted with the Tukey-Kramer and Bejamini-Hochberg methods. Group space allowance had no effect on any measure of sow health, physiology, or production (P ≥ 0.10). Sows in the SS, IS, and LS pens spent 77.88% ± 3.88%, 66.02% ± 3.87%, and 63.64% ± 3.91%, respectively, of their time in the free-access stalls (P = 0.12). However, SS sows used the group space less than IS and LS sows (P = 0.01). Overall, pen investigatory behavior was not affected by group space allowance (P = 0.91). Sows in the LS pens spent more time in a social group than SS sows (P = 0.02), whereas sows in IS pens were intermediate to, but not different from, the other treatments (P ≥ 0.10). The size of the social groups was also affected by the group space allowance (P = 0.03), with SS sows forming smaller groups than LS sows; again, IS sows were intermediate to, but not different from, the other treatments. Although the group space allowance had no measurable impact on the health, physiology, or productivity of the sows, the lower group space use and social contact of the SS sows reduced the behavioral diversity benefits of group housing and may indicate an avoidance of social stressors or a lack of physical comfort in the smallest pens

The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)

Background: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). Methods/Design: In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and powe