Ecosystem services from smallholder forestry and agroforestry in the tropics

Smallholder forestry and agroforestry systems in the tropics provide essential products and services for millions of producers, their surrounding communities, national and international consumers, and global society. The diversity of products provided by these systems meet the needs of smallholder producers for fuelwood, food, animal fodder, and other household and farm needs; they provide additional income to supplement major commodity crops; and they offer flexibility in production and income to buffer against falling commodity prices, crop failure, or other sources of financial or economic difficulty. The sustainability of these systems is increasingly dependent upon sources of income beyond the sale of conventional products, such as price premiums from sustainability certification and agro- and ecotourism. Payments for ecosystem services (PES) programs have been developed at multiple levels to provide incentives for smallholders to conserve and enhance tree cover and management practices to provide ecosystem services such as watershed protection and carbon sequestration. Ecotourism provides an enterprise-based strategy to engage producers in conservation and enhancement of these services. This review evaluates the ability of smallholder systems to support the provision of ecosystem services (ES) and the capacity of smallholders to participate in support programs and take advantage of other emerging opportunities to support smallholder enterprises

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)