Willow short-rotation production systems in Canada and Northern United States: A review

Willow short rotation coppice (SRC) systems are becoming an attractive practice because they are a sustainable system fulfilling multiple ecological objectives with significant environmental benefits. A sustainable supply of bioenergy feedstock can be produced by willow on marginal land using well-adapted or tolerant cultivars. Across Canada and northern U.S.A., there are millions of hectares of available degraded land that have the potential for willow SRC biomass production, with a C sequestration potential capable of offsetting appreciable amount of anthropogenic green-house gas emissions. A fundamental question concerning 1 sustainable SRC willow yields was whether long-term soil productivity is maintained within a multi-rotation SRC system, given the rapid growth rate and associated nutrient exports offsite when harvesting the willow biomass after repeated short rotations. Based on early results from the first willow SRC rotation, it was found willow systems are relatively low nutrient-demanding, with minimal nutrient output other than in harvested biomass. The overall aim of this manuscript is to summarize the literature and present findings and data from ongoing research trials across Canada and northern U.S.A. examining willow SRC system establishment and viability. The research areas of interest presented here are the crop production of willow SRC systems, above- and below-ground biomass dynamics and the C budget, comprehensive soil-willow system nutrient budget, and soil nutrient amendments (via fertilization) in willow SRC systems. Areas of existing research gaps were also identified for the Canadian context

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised