The role of temperate treed swamps as a carbon sink in southwestern Nova Scotia

Accepted VersionForested wetlands may represent important ecosystems for mitigating climate change effects through carbon (C) sequestration because of their slow decomposition and C storage by trees. Despite this potential importance, few studies have acknowledged the role of temperate treed swamps in the C cycle. In southwestern Nova Scotia, Canada, we examined the role of treed swamps in the soil C cycle by determining C inputs through litterfall, assessing decomposition rates and soil C pools, and quantifying C outputs through soil greenhouse gas (GHG) emissions. The treed swamps were found to represent large supplies of C inputs through litterfall to the forest floor. The swamp soils had substantially greater C stores than the swamp–upland edge or upland soils. We found growing season C inputs via litterfall to exceed C outputs via GHG emissions in the swamps by a factor of about 2.5. Our findings indicate that temperate treed swamps can remain a C sink even if soil GHG emissions were to double, supporting conservation efforts to preserve temperate treed swamps as a measure to mitigate climate change

Comparison of multiple PM2.5 exposure products for estimating health benefits of emission controls over New York State, USA

Ambient exposure to fine particulate matter (PM2.5) is one of the top global health concerns. We estimate the PM2.5-related health benefits of emission reduction over New York State (NYS) from 2002 to 2012 using seven publicly available PM2.5 products that include information from ground-based observations, remote sensing and chemical transport models. While these PM2.5 products differ in spatial patterns, they show consistent decreases in PM2.5 by 28%–37% from 2002 to 2012. We evaluate these products using two sets of independent ground-based observations from the New York City Community Air Quality Survey (NYCCAS) Program for an urban area, and the Saint Regis Mohawk Tribe Air Quality Program for a remote area. Inclusion of satellite remote sensing improves the representativeness of surface PM2.5 in the remote area. Of the satellite-based products, only the statistical land use regression approach captures some of the spatial variability across New York City measured by NYCCAS. We estimate the PM2.5-related mortality burden by applying an integrated exposure-response function to the different PM2.5 products. The multi-product mean PM2.5-related mortality burden over NYS decreased by 5660 deaths (67%) from 8410 (95% confidence interval (CI): 4570–12 400) deaths in 2002 to 2750 (CI: 700–5790) deaths in 2012. We estimate a 28% uncertainty in the state-level PM2.5 mortality burden due to the choice of PM2.5 products, but such uncertainty is much smaller than the uncertainty (130%) associated with the exposure-response function

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

ANALISIS KUALITAS WEBSITE JADWALIBADAH TERHADAP KEPUASAN PENGGUNA MENGGUNAKAN METODE WEBQUAL 4.0

This study aims to measure the quality of the JadwalIbadah website based on usability quality, information quality, and interaction quality on user satisfaction. The method used in this research is WebQual 4.0. Based on the WebQual 4.0 method, there are three variables, namely usability, information quality, and interaction quality on user satisfaction. The results showed that the variables usability (X1), information quality (X2), and interaction quality (X3) where each independent variable had 90% effect on user satisfaction (Y) on the JadwalIbadah website. While the rest is influenced by external variables other than the webqual 4.0 variable. Based on the results of the analysis conducted, there is a positive relationship between the services provided by the JadwalIbadah website to the three variables, namely usability (X1), information quality (X2), and interaction quality (X3) so that the results are positive on user satisfaction (Y). So that the three variables have a significant effect on the quality of the Schedule of Worship website on user satisfaction (Y).kajian ini bertujuan untuk melakukan pengukuran kualitas website JadwalIbadah berdasarkan kualitas kegunaan, kualitas informasi, dan kualitas interaksi terhadap kepuasan pengguna. Metode yang digunakan pada penelitian ini yaitu WebQual 4.0. Berdasarkan metode WebQual 4.0 terdapat 3 variabel ialah kegunaan, kualitas informasi, dan kualitas interaksi pada kepuasan pengguna. Hasil penelitian menunjukkan bahwa variabel usability (X1), information quality (X2), dan interaction quality (X3) dimana setiap variabel independen terdapat 90% berpengaruh pada kepuasan Pengguna (Y) pada website JadwalIbadah. Sedangkan sisanya 10% dipengaruhi oleh variabel luar selain variabel webqual 4.0. Berdasarkan hasil analisis yang dilakukan terdapat hubungan positif pada layanan yang telah diberikan oleh website JadwalIbadah terhadap ketiga variabel yaitu usability (X1), information quality (X2), dan interaction quality (X3) sehingga hasilnya positif terhadap kepuasan Pengguna (Y). Sehingga ketiga variabel berpengaruh signifikan pada kualitas website JadwalIbadah terhadap kepuasan Pengguna (Y)

The role of temperate treed swamps as a carbon sink in southwestern Nova Scotia

Forested wetlands may represent important ecosystems for mitigating climate change effects through carbon (C) sequestration because of their slow decomposition and C storage by trees. Despite this potential importance, few studies have acknowledged the role of temperate treed swamps in the C cycle. In southwestern Nova Scotia, Canada, we examined the role of treed swamps in the soil C cycle by determining C inputs through litterfall, assessing decomposition rates and soil C pools, and quantifying C outputs through soil greenhouse gas (GHG) emissions. The treed swamps were found to represent large supplies of C inputs through litterfall to the forest floor. The swamp soils had substantially greater C stores than the swamp–upland edge or upland soils. We found growing season C inputs via litterfall to exceed C outputs via GHG emissions in the swamps by a factor of about 2.5. Our findings indicate that temperate treed swamps can remain a C sink even if soil GHG emissions were to double, supporting conservation efforts to preserve temperate treed swamps as a measure to mitigate climate change.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Interannual variations in needle and sapwood traits of Pinus edulis branches under an experimental drought

In the southwestern USA, recent large‐scale die‐offs of conifers raise the question of their resilience and mortality under droughts. To date, little is known about the interannual structural response to droughts. We hypothesized that piñon pines (Pinus edulis) respond to drought by reducing the drop of leaf water potential in branches from year to year through needle morphological adjustments. We tested our hypothesis using a 7‐year experiment in central New Mexico with three watering treatments (irrigated, normal, and rain exclusion). We analyzed how variation in “evaporative structure” (needle length, stomatal diameter, stomatal density, stomatal conductance) responded to watering treatment and interannual climate variability. We further analyzed annual functional adjustments by comparing yearly addition of needle area (LA) with yearly addition of sapwood area (SA) and distance to tip (d), defining the yearly ratios SA:LA and SA:LA/d. Needle length (l) increased with increasing winter and monsoon water supply, and showed more interannual variability when the soil was drier. Stomatal density increased with dryness, while stomatal diameter was reduced. As a result, anatomical maximal stomatal conductance was relatively invariant across treatments. SA:LA and SA:LA/d showed significant differences across treatments and contrary to our expectation were lower with reduced water input. Within average precipitation ranges, the response of these ratios to soil moisture was similar across treatments. However, when extreme soil drought was combined with high VPD, needle length, SA:LA and SA:LA/d became highly nonlinear, emphasizing the existence of a response threshold of combined high VPD and dry soil conditions. In new branch tissues, the response of annual functional ratios to water stress was immediate (same year) and does not attempt to reduce the drop of water potential. We suggest that unfavorable evaporative structural response to drought is compensated by dynamic stomatal control to maximize photosynthesis rates.ISSN:2045-775