Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

A Range of Earth Observation Techniques for Assessing Plant Diversity

AbstractVegetation diversity and health is multidimensional and only partially understood due to its complexity. So far there is no single monitoring approach that can sufficiently assess and predict vegetation health and resilience. To gain a better understanding of the different remote sensing (RS) approaches that are available, this chapter reviews the range of Earth observation (EO) platforms, sensors, and techniques for assessing vegetation diversity. Platforms include close-range EO platforms, spectral laboratories, plant phenomics facilities, ecotrons, wireless sensor networks (WSNs), towers, air- and spaceborne EO platforms, and unmanned aerial systems (UAS). Sensors include spectrometers, optical imaging systems, Light Detection and Ranging (LiDAR), and radar. Applications and approaches to vegetation diversity modeling and mapping with air- and spaceborne EO data are also presented. The chapter concludes with recommendations for the future direction of monitoring vegetation diversity using RS

Real-time single-nucleotide polymorphism profiling using taqman technology for rapid recognition of campylobacter jejuni clonal complexes

The rapid identification of Campylobacter jejuni isolates to strain level would significantly inform the public health investigation of C. jejuni infection. Conceptual advances provided by multilocus sequence typing (MLST) have established the clonal complex as an important epidemiological group at the strain level, enabling accurate and phylogenetically valid strain identification for C. jejuni. The development of real-time PCR assays for allelic discrimination of strain-associated single-nucleotide polymorphisms (SNPs) based upon MLST locus alleles offers one possible approach for rapid strain detection. SNPs defining key alleles diagnostic for the most prevalent clonal complexes were identified following a detailed analysis of the available MLST data. Real-time Taqman allelic discrimination assays designed to detect the SNPs specific for six major clonal complexes, ST-21, ST-45, ST-48, ST-61, ST-206 and ST-257, were developed, allowing the rapid detection of C. jejuni isolates and preliminary strain identification. This will provide an important complementary technique to sequence typing for rapid detection and strain characterization to inform in real-time the public health management and investigation of C. jejuni infections

Synthetic Aperture Radar (SAR) image processing for operational space-based agriculture mapping

Few countries are using space-based Synthetic Aperture Radar (SAR) to operationally produce national-scale maps of their agricultural landscapes. For the past ten years, Canada has integrated C-band SAR with optical satellite data to map what crops are grown in every field, for the entire country. While the advantages of SAR are well understood, the barriers to its operational use include the lack of familiarity with SAR data by agricultural end-user agencies and the lack of a ‘blueprint’ on how to implement an operational SAR-based mapping system. This research reviewed order of operations for SAR data processing and how order choice affects processing time and classification outcomes. Additionally this research assessed the impact of speckle filtering by testing three filter types (adaptive, multi-temporal and multi-resolution) at varying window sizes for three study sites with different average field sizes. The Touzi multi-resolution filter achieved the highest overall classification accuracies for all three sites with varying window sizes, and with only a small (< 2%) difference in accuracy relative to the Gamma Maximum A Posteriori (MAP) adaptive filter which had similar window sizes across sites. As such, the assessment of order of operations for noise reduction and terrain correction was completed using the Gamma MAP adaptive filter. This research found there was no difference in classification accuracies regardless of whether noise reduction was applied before or after terrain correction. However, implementing the terrain correction as the first operation resulted in a 10 to 50% increase in processing time. This is an important consideration when designing and delivering operational systems, especially for large geographies like Canada where hundreds of SAR images are required. These findings will encourage country-wide, regional and global food monitoring initiatives to consider SAR sensors as an important source of data to operationally map agricultural production

Fossil proxies of near-shore sea surface temperatures and seasonality from the late Neogene Antarctic shelf

We evaluate the available palaeontological and geochemical proxy data from bivalves, bryozoans, silicoflagellates, diatoms and cetaceans for sea surface temperature (SST) regimes around the nearshore Antarctic coast during the late Neogene. These fossils can be found in a number of shallow marine sedimentary settings from three regions of the Antarctic continent, the northern Antarctic Peninsula, the Prydz Bay region and the western Ross Sea. Many of the proxies suggest maximum spring–summer SSTs that are warmer than present by up to 5 °C, which would result in reduced seasonal sea ice. The evidence suggests that the summers on the Antarctic shelf during the late Neogene experienced most of the warming, while winter SSTs were little changed from present. Feedbacks from changes in summer sea ice covermay have driven much of the lateNeogene ocean warming seen in stratigraphic records. Synthesized late Neogene and earliest Quaternary Antarctic shelf proxy data are compared to the multi-model SST estimates of the Pliocene Model Intercomparison Project (PlioMIP) Experiment 2. Despite the fragmentary geographical and temporal context for the SST data, comparisons between the SSTwarming in each of the three regions represented in the marine palaeontological record of theAntarctic shelf and the PlioMIP climate simulations show a good concordance