Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Students’ perceptions of Education for Sustainable Development (ESD) to Achieve SDG 4 in Indonesia: a case study of Universitas Islam Riau

Sustainable development at higher education level plays an important role in achieving the Sustainable Development Goals (SDGs). Higher education holds a great responsibility to increase the awareness and knowledge of students who will manage and develop resources. For the purpose of the sustainability of resources, awareness and knowledge of sustainable development are needed. This knowledge can be conveyed through Education for Sustainable Development (ESD) to achieve high education quality and equal access to education for women and men. Perception ofESDmust be studied to gather information about the facts, problems and challenges faced by Universitas Islam Riau (UIR) to achieve SDGs, especially SDG 4 (Quality Education). This study aims to identify the perception students of both genders at Universitas Islam Riau (UIR) hold about Education for Sustainable Development (ESD). This research is a descriptive survey research conducted using a quantitative approach. There were 99 respondents in this study, Consisting of 43 men and 56 women. Data was collected by distributing questionnaires containing 70 statements, while processing of questionnaire data was done through the frequency analysis formula. Generally, the results of social, environmental and economic aspects in the ‘Good’ category are between 71.08 and 78.75%. Based on gender, both female and male students scored a higher percentage in economic aspect than other aspects, whereby female students scored 77.76%, whereas it was 76.50% for male students. Based on this study, it can be concluded that the students of Universitas Islam Riau have a good perception of Education for Sustainable Development. Therefore, the University must begin to apply the concept of sustainable development in every aspect in order to contribute to achieving SDG 4

Theoretical and Methodological Pluralism in Sustainability Science

Sustainability science is an integrative scientific field embracing not only complementary but also contradictory approaches and perspectives for dealing with an array of sustainability challenges.In this chapter we distinguish between pluralism and unification as two main and distinctly different approaches to knowledge integration in sustainability science. To avoid environmental determinism, functionalism, or overly firm reliance on rational choice theory, we have reason to promote pluralism as a way to better tackle sustainability challenges. In particular we emphasise two main benefits of taking a pluralist approach in research: it opens up for collaboration, and ensures a more theoretically informed understanding of society.After a brief introduction to how we interpret the field of sustainability science, we discuss ontology, epistemology and ways of understanding society based on social science theory. We make three contributions. First, we identify important reasons for the incommensurability between the social and natural sciences, and propose remedies for how to overcome some of the difficulties in integrative research. Second, by suggesting a frame that we call ‘social fields and natural systems’ we show how sustainability science will benefit from drawing more profoundly on – and thus more adequately incorporate – a social science understanding of society. As such, the frame is a foundation for pluralism. Third, by suggesting a new theoretical typology, we show how sustainability visions and pathways are associated with particular theoretical and methodological perspectives in geography, political science, and sociology; and how that matters for research and politics addressing sustainability challenges. The typology can be used as a thinking tool to frame and reframe research