Global trends in research on the effects of climate change on Aedes aegypti: international collaboration has increased, but some critical countries lag behind

Background: Mosquito‑borne diseases (e.g., transmitted by Aedes aegypti) affect almost 700 million people each year and result in the deaths of more than 1 million people annually. Methods: We examined research undertaken during the period 1951–2020 on the effects of temperature and climate change on Ae. aegypti, and also considered research location and between‑country collaborations. Results: The frequency of publications on the effects of climate change on Ae. aegypti increased over the period examined, and this topic received more attention than the effects of temperature alone on this species. The USA, UK, Australia, Brazil, and Argentina were the dominant research hubs, while other countries fell behind with respect to number of scientific publications and/or collaborations. The occurrence of Ae. aegypti and number of related dengue cases in the latter are very high, and climate change scenarios predict changes in the range expansion and/or occurrence of this species in these countries. Conclusions: We conclude that some of the countries at risk of expanding Ae. aegypti populations have poor research networks that need to be strengthened. A number of mechanisms can be considered for the improvement of international collaboration, representativity and diversity, such as research networks, internationalization programs, and programs that enhance representativity. These types of collaboration are considered important to expand the relevant knowledge of these countries and for the development of management strategies in response to climate change scenarios

Seasonal variation and host sex affect bat–bat fly interaction networks in the Amazonian savannahs

Bats are the second-most diverse group of mammals in the world, and bat flies are their main parasites. However, significant knowledge gaps remain regarding these antagonistic interactions, especially since diverse factors such as seasonality and host sex can affect their network structures. Here, we explore the influence of such factors by comparing species richness and composition of bat flies on host bats, as well as specialization and modularity of bat–bat fly interaction networks between seasons and adult host sexes. We captured bats and collected their ectoparasitic flies at 10 sampling sites in the savannahs of Amapá State, northeastern region of the Brazilian Amazon. Despite female bats being more parasitized and recording greater bat fly species richness in the wet season, neither relationship was statistically significant. The pooled network could be divided into 15 compartments with 54 links, and all subnetworks comprised >12 compartments. The total number of links ranged from 27 to 48 (for the dry and wet seasons, respectively), and female and male subnetworks had 44 and 41 links, respectively. Connectance values were very low for the pooled network and for all subnetworks. Our results revealed higher bat fly species richness and abundance in the wet season, whereas specialization and modularity were higher in the dry season. Moreover, the subnetwork for female bats displayed higher specialization and modularity than the male subnetwork. Therefore, both seasonality and host sex contribute in different ways to bat–bat fly network structure. Future studies should consider these factors when evaluating bat–bat fly interaction networksP.M. was supported by a master’s scholarship and currently, is supported by doctoral scholarships from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil (process number 88887.662021/2022- 00). B.S.X. was supported by doctoral scholarships from CAPES, Brazil. W.D.C. was supported by post-doctoral funding (PNPD/CAPES) until early 2020. Currently, W.D.C. is supported by “Ayudas Maria Zambrano” (CA3/ RSUE/2021-00197), funded by the Spanish Ministry of Universities. G.L.U. was supported by Paraiba State Research Foundation (FAPESQ) under a doctoral scholarship from Grant No. 518/18 and by PDPG-Amazônia Legal (process number 88887.834037/2023-00). G.G. was supported by CNPq (process number 306216/2018) and Universidade Federal de Mato Grosso do Sul. J.J.T. received a research productivity scholarship from CNPq (process number 316281/2021-22

Research networks should improve connectivity for halting freshwater insect extinctions

1. Avoiding freshwater insect extinctions requires studies assessing causal links between a human pressure and biodiversity measures (threats), the state of biodiversity through time (status), and solutions to manage species loss. However, an imbalance between these different approaches on declines of freshwater insects and the distribution of the studies between countries may have implications for implementing conservation knowledge into practical conservation actions. 2. Here, we evaluate country co-authorship relationships through quantitative bibliometric analysis to identify networks of research collaboration on freshwater insects extinction, and how this overall network is modified by the type of studies (status, threats, and solutions). 3. We detected that authors from developed countries dominated the networks, and most studies assessed threats to freshwater insects, knowledge which is part of a research network involving multiple countries. The status network of research collaboration was clearly more disconnected in comparison with the network of all studies, whereas the solution network showed the greatest connectivity. 4. These results reveal that an increase in research collaboration is required for all approaches assessed here, because many megadiverse countries are not present in the networks. This is especially required for status and solution studies. Expansion of research collaboration should decrease inequalities between developed and developing countries, achieved by funding conservation studies in developing countries. Studies should also decrease classical inequalities, including those related to sexual orientation, gender identity, and ethnic minorities. These recommendations would benefit freshwater insect conservation science and practice

Additional file 1 of Global trends in research on the effects of climate change on Aedes aegypti: international collaboration has increased, but some critical countries lag behind

Additional file 1: Figure S1. PRISMA flow diagram. SM2. Similar terms merged in bibliometric analysis methods using VOSviewer version 1.6.15

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research

Delaying surgery for patients with a previous SARS-CoV-2 infection

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