Growing up urban: Hyena foraging groups and social structure at a city waste dump

Urban spotted hyenas (Crocuta crocuta) in Ethiopia are a prime example of large carnivores coexisting with little to no conflict with people in a human-dominated landscape, providing a valuable waste-removal service. To gain insight in how this urban lifestyle persists across generations, we studied hyena group composition at the city waste dump of Mekelle, a regional capital in northern Ethiopia. We found that hyena cubs and sub-adults foraged with adults in groups of highly variable composition. Young urban hyenas already take part in a fission-fusion dynamic that is also characteristic of hyenas in non-urban environments. They do not seem to learn from only one or few close reference adults. Social network analysis revealed no clusters among these dump-visiting hyenas. The number of counted hyenas is furthermore larger than any hyena clan in non-urban areas. All individuals were more or less equally connected to each other, and each hyena had a few connections, but to different individuals. All cubs and sub-adults were connected to each other, over a maximum of four links. Hyenas shared the abundance of food at the waste dump without overt aggression. A much larger number of urban hyenas shares this waste dump at night than would fit into a single forest fragment, such as those associated with orthodox churches where small groups of hyenas have often been observed to rest at daytime. Hyenas appear to commute from different dens and resting sites located around the city, but we have no information on their behavior and group composition away from the dump. We observed no defense of any part of the dump area by any of the foraging groups. In absence of territorial behavior at this city site, the clan concept does not seem to apply to these urban hyenas. Similar to what has been observed in other urban carnivores, individuals at the waste dump behaved as members of conflict-free foraging groups ostensibly sharing food without aggression. Perhaps this is what most strikingly defines their urbanity

Proposal of a Standardized Questionnaire to Structure Clinical Peer Reviews of Mortality and Failure of Rescue in Pancreatic Surgery

Background: Quality management tools such as clinical peer reviews facilitate root cause analysis and may, ultimately, help to reduce surgery-related morbidity and mortality. This study aimed to evaluate the reliability of a standardized questionnaire for clinical peer reviews in pancreatic surgery. Methods: All cases of in-hospital-mortality following pancreatic surgery at two high-volume centers (n = 86) were reviewed by two pancreatic surgeons. A standardized mortality review questionnaire was developed and applied to all cases. In a second step, 20 cases were randomly assigned to an online re-review that was completed by seven pancreatic surgeons. The overall consistency of the results between the peer review and online re-review was determined by Cohen’s kappa (κ). The inter-rater reliability of the online re-review was assessed by Fleiss’ kappa (κ). Results: The clinical peer review showed that 80% of the patient mortality was related to surgery. Post-operative pancreatic fistula (POPF) (36%) followed by post-pancreatectomy hemorrhage (PPH) (22%) were the most common surgical underlying (index) complications leading to in-hospital mortality. Most of the index complications yielded in abdominal sepsis (62%); 60% of the cases exhibited potential of improvement, especially through timely diagnosis and therapy (42%). There was a moderate to substantial strength of agreement between the peer review and the online re-review in regard to the category of death (surgical vs. non-surgical; κ = 0.886), type of surgical index complication (κ = 0.714) as well as surgical and non-surgical index complications (κ = 0.492 and κ = 0.793). Fleiss’ kappa showed a moderate to substantial inter-rater agreement of the online re-review in terms of category of death (κ = 0.724), category of common surgical index complications (κ = 0.455) and surgical index complication (κ = 0.424). Conclusion: The proposed questionnaire to structure clinical peer reviews is a reliable tool for root cause analyses of in-hospital mortality and may help to identify specific options to improve outcomes in pancreatic surgery. However, the reliability of the peer feedback decreases with an increasing specificity of the review questions

A survey among physicians in surgery and anesthesiology departments after the first surge of SARS-CoV-2 infections in Germany : Preparing for further challenges ahead

BACKGROUND: The SARS-CoV‑2 pandemic has extensively challenged healthcare systems all over the world. Many elective operations were postponed or cancelled, changing priorities and workflows in surgery departments. AIMS: The primary aim of this cross-sectional study was to assess the workload and psychosocial burden of surgeons and anesthesiologists, working in German hospitals during the first wave of SARS-CoV‑2 infections in 2020. METHODS: Quantitative online survey on the workplace situation including psychosocial and work-related stress factors among resident and board-certified surgeons and anesthesiologists. Physicians in German hospitals across all levels of healthcare were contacted via departments, professional associations and social media posts. RESULTS: Among 154 total study participants, 54% of respondents stated a lack of personal protective equipment in their own wards and 56% reported increased staff shortages since the onset of the pandemic. While routine practice was reported as fully resumed in 71% of surgery departments at the time of the survey, work-related dissatisfaction among responding surgeons and anesthesiologists increased from 24% before the pandemic to 36% after the first wave of infections. As a countermeasure, 94% of participants deemed the establishment of action plans to increase pandemic preparedness and strengthening German public health systems a useful measure to respond to current challenges. CONCLUSION: The aftermath of the first wave of SARS-CoV‑2 infections in Germany has left the surgical staff strained, despite temporarily decreased workloads. Overall, a critical review of the altered conditions is indispensable to identify and promote effective solutions and prudent action plans required to address imminent challenges.Not heldaccepted version (12 month embargo