Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Incentives +: how can REDD improve well-being in forest communities?

REDD initiatives are more likely to succeed if they build on the interests of forest communities and indigenous people. More attention is needed to the balance of incentives, benefits, rights and political participation across levels of decision making, interest groups and administration. Incentives can include payments or other benefits for good practices, developing alternative livelihoods, formalising land tenure and local resource rights and intensifying productivity on nonforest lands. The pressure to reduce deforestation needs to be spread across many levels to reduce the burden on forest communities

Ecosystem Services: Origins, Contributions, Pitfalls, and Alternatives

The concept of ecosystem services (ES) has taken the environmental science and policy literature by storm, and has become almost the approach to thinking about and assessing the nature-society relationship. In this review, we ask whether and in what way the ES concept is a useful way of organising research on the nature-society relationship. We trace the evolution of the different versions of the concept and identify key points of convergence and divergence. The essence of the concept nevertheless is that the contribution of biotic nature to human well-being is unrecognised and undervalued, which results in destruction of ecosystems. We discuss why this formulation has attracted ecologists and summarise the resultant contributions to research, particularly to the understanding of indirect or regulating services. We then outline three sets of weaknesses in the ES framework: confusion over ecosystem functions and biodiversity, omission of dis-services, trade-offs and abiotic nature, and the use of an economic valuation framework to measure and aggregate human well-being. Underlying these weaknesses is a narrow problem frame that is unidimensional in its environmental concern and techno-economic in its explanation of environmental degradation. We argue that an alternative framing that embraces broader concerns and incorporates multiple explanations would be more useful, and outline how this approach to understanding the nature-society relationship may be implemented

Ecosystem Services: Origins, Contributions, Pitfalls, and Alternatives

The concept of ecosystem services (ES) has taken the environmental science and policy literature by storm, and has become almost the approach to thinking about and assessing the nature-society relationship. In this review, we ask whether and in what way the ES concept is a useful way of organising research on the nature-society relationship. We trace the evolution of the different versions of the concept and identify key points of convergence and divergence. The essence of the concept nevertheless is that the contribution of biotic nature to human well-being is unrecognised and undervalued, which results in destruction of ecosystems. We discuss why this formulation has attracted ecologists and summarise the resultant contributions to research, particularly to the understanding of indirect or regulating services. We then outline three sets of weaknesses in the ES framework: confusion over ecosystem functions and biodiversity, omission of dis-services, trade-offs and abiotic nature, and the use of an economic valuation framework to measure and aggregate human well-being. Underlying these weaknesses is a narrow problem frame that is unidimensional in its environmental concern and techno-economic in its explanation of environmental degradation. We argue that an alternative framing that embraces broader concerns and incorporates multiple explanations would be more useful, and outline how this approach to understanding the nature-society relationship may be implemented