The geographic diversity of authorship in leading general surgery journals; A study of 24,332 authors.

BACKGROUND: Research guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide. METHODS: The six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression. RESULTS: 8274 original articles were published in the top six ranked general surgery journals over 2016-2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period. CONCLUSION: Authorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy.

Biological Assessment of Coral Reefs in Southern Puerto Rico: A Technical Approach for Coral Reef Protection Under the U.S. Clean Water Act.

States and other jurisdictions may protect coral reefs using biological water quality standards outlined by the United States Clean Water Act (CWA). Such protection will require long-term, regional monitoring of the resource using biological indicators and a probability-based sampling design. A 60-station survey targeting nearshore linear coral reef was conducted across southern Puerto Rico in December 2011 to document the status of reef inhabitants using a probabilistic, regional sampling design. The quantity, type and condition of stony corals, fish, gorgonians and sponges were documented from each station, providing a robust representation of linear reef status and composition across the region. Fish represented 106 unique taxa and stony corals 32 unique taxa. Benthic organisms (stony corals, sponges and gorgonians) averaged nearly 12 colonies per square meter, more than half of which were gorgonians. Assessment results can be used as a baseline to compare with future regional surveys to quantify change in reef condition over time (trend). Both temporal and spatial changes can be expected after large-scale disturbances like hurricanes Maria and Irma in 2017. The indicators and probabilistic sampling design support the long-term regional monitoring envisioned by the Environmental Protection Agency to implement CWA protections in Puerto Rico and elsewhere.

Regional status assessment of stony corals in the US Virgin Islands.

States may protect coral reefs using biological water quality standards outlined by the Clean Water Act. This requires biological assessments with indicators sensitive to human disturbance and regional, probability-based survey designs. Stony coral condition was characterized on a regional scale for the first time in the nearshore waters of the US Virgin Islands (USVI). Coral composition, abundance, size, and health were assessed at 66 stations in the St. Croix region in fall 2007 and at 63 stations in the St. Thomas and St. John region in winter 2009. Indicators were chosen for their sensitivity to human disturbance. Both surveys were probability-based (random) designs with station locations preselected from areas covered by hardbottom and coral reef substrate. Taxa richness was as high as 21 species but more than half the area of both regions exhibited taxa richness of <10 species in the 25 m(2) transect area. Coral density was as high as 5 colonies m(-2) but more than half the area of both regions had <2 colonies m(-2). Both regions showed similar dominant species based on frequency of occurrence and relative abundance. Because of large colony sizes, Montastrea annularis provided more total surface area and live surface area than more abundant species. The surveys establish baseline regional conditions and provide a foundation for long-term regional monitoring envisioned by the USVI Department of Planning and Natural Resources. The probabilistic sampling design assures the data can be used in Clean Water Act reporting.

Association between atrial fibrillation and hip fractures and the implications for hip fracture patients: a systematic review.

BACKGROUND: Atrial fibrillation (AF) and hip fractures are both prevalent in the elderly population. The aim of this study was to systematically review the literature regarding the association between AF and hip fractures, and the impact of AF on hip fracture prognosis. METHODS: The literature search was performed using PubMed, MEDLINE, Embase and Scopus. Inclusion was based upon the application of eligibility criteria in duplicate prior to data extraction with a standardized form. RESULTS: A total of 42 studies met the inclusion criteria. AF prevalence was found to vary between 6.5% and 35% in cohorts. Large studies with broad inclusion criteria found the prevalence of AF in hip fracture patients to be approximately 12-15%. There were conflicting results as to whether patients with AF have an increased rate of hip fractures, as compared to patients without AF. Several studies demonstrated that hip fracture patients with AF have increased rates of mortality, both as an inpatient and following discharge, and increased readmission rates. CONCLUSION: AF and hip fractures frequently coexist, and there is evidence to suggest AF is associated with increased readmission and mortality rates in hip fracture patients. Elements of the relationship between AF and hip fractures remain uncertain and further prospective studies on AF and hip fracture cohorts may clarify this relationship. Interventional studies targeting hip fracture patients with AF may be beneficial.

Evaluation of stony coral indicators for coral reef management.

Colonies of reef-building stony corals at 57 stations around St. Croix, US Virgin Islands were characterized by species, size and percentage of living tissue. Taxonomic, biological and physical indicators of coral condition were derived from these measurements and assessed for their response to gradients of human disturbance-a requirement for indicators used in regulatory assessments under authority of the Clean Water Act. At the most intensely disturbed location, five of eight primary indicators were highly correlated with distance from the source of disturbance: Coral taxa richness, average colony size, the coefficient of variation of colony size, total topographic coral surface area, and live coral surface area. An additional set of exploratory indicators related to rarity, reproductive and spawning mode and taxonomic identity were also screened. The primary indicators demonstrated sufficient precision to detect levels of change that would be applicable in a regional-scale regulatory program.

Characterizing coral condition using estimates of three-dimensional colony surface area.

Coral reefs provide shoreline protection, biological diversity, fishery harvests, and tourism, all values that stem from the physically-complex coral infrastructure. Stony corals (scleractinians) construct and maintain the reef through deposition of calcium carbonate. Therefore, assessment of coral reefs requires at least some measurement endpoints that reflect the biological and physical condition of stony corals. Most monitoring programs portray coral quantity as live coral cover, which is the two-dimensional proportion of coral surface to sea floor viewed from above (planar view). The absence of the third dimension, however, limits our ability to characterize coral reef value, physiology, health and sustainability. A three-dimensional (3D) approach more realistically characterizes coral structure available as community habitat and, when combined with estimates of live coral tissue, quantifies the amount of living coral available for photosynthesis, growth and reproduction. A rapid coral survey procedure that coupled 3D coral quantification with more traditional survey measurements was developed and tested in the field. The survey procedure relied on only three underwater observations--species identification, colony size, and proportion of live tissue--made on each colony in the transect. These observations generated a variety of metrics, including several based on 3D colony surface area, that are relevant to reef management.