44 research outputs found
Comparative needs in child abuse education and resources: perceptions from three medical specialties
The impact of an educational program on recognition, treatment and report of child abuse
Remote detection of invasive alien species
The spread of invasive alien species (IAS) is recognized as the most severe threat to biodiversity outside of climate change and anthropogenic habitat destruction. IAS negatively impact ecosystems, local economies, and residents. They are especially problematic because once established, they give rise to positive feedbacks, increasing the likelihood of further invasions and spread. The integration of remote sensing (RS) to the study of invasion, in addition to contributing to our understanding of invasion processes and impacts to biodiversity, has enabled managers to monitor invasions and predict the spread of IAS, thus supporting biodiversity conservation and management action. This chapter focuses on RS capabilities to detect and monitor invasive plant species across terrestrial, riparian, aquatic, and human-modified ecosystems. All of these environments have unique species assemblages and their own optimal methodology for effective detection and mapping, which we discuss in detail
Prediction of diabetic retinopathy: role of oxidative stress and relevance of apoptotic biomarkers
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 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
Uncertainties in projections of sandy beach loss due to sea level rise: an analysis at the European scale
Sea level rise (SLR) will cause shoreline retreat of sandy coasts in the absence of sand supply mechanisms. These coasts have high touristic and ecological value and provide protection of valuable infrastructures and buildings to storm impacts. So far, large-scale assessments of shoreline retreat use specific datasets or assumptions for the geophysical representation of the coastal system, without any quantification of the effect that these choices might have on the assessment. Here we quantify SLR driven potential shoreline retreat and consequent coastal land loss in Europe during the twenty-first century using different combinations of geophysical datasets for (a) the location and spatial extent of sandy beaches and (b) their nearshore slopes. Using data-based spatially-varying nearshore slope data, a European averaged SLR driven median shoreline retreat of 97 m (54 m) is projected under RCP 8.5 (4.5) by year 2100, relative to the baseline year 2010. This retreat would translate to 2,500 km2 (1,400 km2) of coastal land loss (in the absence of ambient shoreline changes). A variance-based global sensitivity analysis indicates that the uncertainty associated with the choice of geophysical datasets can contribute up to 45% (26%) of the variance in coastal land loss projections for Europe by 2050 (2100). This contribution can be as high as that associated with future mitigation scenarios and SLR projections.JRC.E.1-Disaster Risk Managemen
Global distribution of nearshore slopes with implications for coastal retreat
Nearshore slope, defined as the cross-shore gradient of the subaqueous profile, is an important input parameter which affects hydrodynamic and morphological coastal processes. It is used in both local and large-scale coastal investigations. However, due to unavailability of data, most studies, especially those that focus on continental or global scales, have historically adopted a uniform nearshore slope. This simplifying assumption could however have far-reaching implications for predictions/projections thus obtained. Here, we present the first global dataset of nearshore slopes with a resolution of 1 km at almost 620 000 points along the global coastline. To this end, coastal profiles were constructed using global topo-bathymetric datasets. The results show that the nearshore slopes vary substantially around the world. An assessment of coastline recession driven by sea level rise (SLR) (for an arbitrary 0.5 m SLR) with a globally uniform coastal slope of 1 : 100, as carried out in previous studies, and with the spatially variable coastal slopes computed herein shows that, on average, the former approach would underestimate coastline recession by about 40 %, albeit with significant spatial variation. The final dataset has been made publicly available at https://doi.org/10.4121/uuid:a8297dcd-c34e-4e6d-bf66-9fb8913d983d (Athanasiou, 2019)
Estimating dune erosion at the regional scale using a meta-model based on neural networks
Sandy beaches and dune systems have high recreational and ecological value, and they offer protection against flooding during storms. At the same time, these systems are very vulnerable to storm impacts. Process-based numerical models are presently used to assess the morphological changes of dune and beach systems during storms. However, such models come with high computational costs, hindering their use in real-life applications which demand many simulations and/or involve a large spatial-temporal domain. Here we design a novel meta-model to predict dune erosion volume (DEV) at the Dutch coast, based on artificial neural networks (ANNs), trained with cases from process-based modeling. First, we reduce an initial database of 1/41400 observed sandy profiles along the Dutch coastline to 100 representative typological coastal profiles (TCPs). Next, we synthesize a set of plausible extreme storm events, which reproduces the probability distributions and statistical dependencies of offshore wave and water level records. We choose 100 of these events to simulate the dune response of the 100 TCPs using the process-based model XBeach, resulting in 10 000 cases. Using these cases as training data, we design a two-phase meta-model, comprised of a classifying ANN (which predicts the occurrence (or not) of erosion) and a regression ANN (which gives a DEV prediction). Validation against a benchmark dataset created with XBeach and a sparse set of available dune erosion observations shows high prediction skill with a skill score of 0.82. The meta-model can predict post-storm DEV 103-104 times faster (depending on the duration of the storm) than running XBeach. Hence, this model may be integrated in early warning systems or allow coastal engineers and managers to upscale storm forcing to dune response investigations to large coastal areas with relative ease
Uncertainties in projections of sandy beach erosion due to sea level rise: an analysis at the European scale
Sea level rise (SLR) will cause shoreline retreat of sandy coasts in the absence of sand supply mechanisms. These coasts have high touristic and ecological value and provide protection of valuable infrastructures and buildings to storm impacts. So far, large-scale assessments of shoreline retreat use specific datasets or assumptions for the geophysical representation of the coastal system, without any quantification of the effect that these choices might have on the assessment. Here we quantify SLR driven potential shoreline retreat and consequent coastal land loss in Europe during the twenty-first century using different combinations of geophysical datasets for (a) the location and spatial extent of sandy beaches and (b) their nearshore slopes. Using data-based spatially-varying nearshore slope data, a European averaged SLR driven median shoreline retreat of 97 m (54 m) is projected under RCP 8.5 (4.5) by year 2100, relative to the baseline year 2010. This retreat would translate to 2,500 km2 (1,400 km2) of coastal land loss (in the absence of ambient shoreline changes). A variance-based global sensitivity analysis indicates that the uncertainty associated with the choice of geophysical datasets can contribute up to 45% (26%) of the variance in coastal land loss projections for Europe by 2050 (2100). This contribution can be as high as that associated with future mitigation scenarios and SLR projections