Blinded Intraoperative Quantitative Indocyanine Green Metrics Associate With Intestinal Margin Acceptance in Colorectal Surgery.

BACKGROUND: Indocyanine green is a useful tool in colorectal surgery. Quantitative values may enhance and standardize its application. OBJECTIVE: To determine whether quantitative indocyanine green metrics correlate with standard subjective indocyanine green perfusion assessment in acceptance or rejection of anastomotic margins. DESIGN: Prospective single-arm, single-institution cohort study. Surgeons viewed subjective indocyanine green images but were blinded to quantitative indocyanine green metrics. SETTING: Tertiary academic center. PATIENTS: Adults undergoing planned intestinal resection. MAIN OUTCOME MEASURES: Accepted perfusion and rejected perfusion of the intestinal margin were defined by the absence or presence of ischemia by subjective indocyanine green and gross inspection. The primary outcomes included quantitative indocyanine green values, maximum fluorescence, and time-to-maximum fluorescence in accepted compared to rejected perfusion. Secondary outcomes included maximum fluorescence and time-to-maximum fluorescence values in anastomotic leak. RESULTS: There were 89 perfusion assessments comprising 156 intestinal segments. Nine segments were subjectively assessed to have poor perfusion by visual inspection and subjective indocyanine green. Maximum fluorescence (% intensity) exhibited higher intensity in accepted perfusion (accepted perfusion 161% [82%-351%] vs rejected perfusion 63% [10%-76%]; p = 0.03). Similarly, time-to-maximum fluorescence (seconds) was earlier in accepted perfusion compared to rejected perfusion (10 seconds [1-40] vs 120 seconds [90-120]; p < 0.01). Increased BMI was associated with higher maximum fluorescence. Anastomotic leak did not correlate with maximum fluorescence or time-to-maximum fluorescence. LIMITATIONS: Small cohort study, not powered to measure the association between quantitative indocyanine green metrics and anastomotic leak. CONCLUSIONS: We demonstrated that blinded quantitative values reliably correlate with subjective indocyanine green perfusion assessment. Time-to-maximum intensity is an important metric in perfusion evaluation. Quantitative indocyanine green metrics may enhance intraoperative intestinal perfusion assessment. Future studies may attempt to correlate quantitative indocyanine green values with anastomotic leak. See Video Abstract . LAS MTRICAS CUANTITATIVAS INTRAOPERATORIAS CIEGAS DEL VERDE DE INDOCIANINA SE ASOCIAN CON LA ACEPTACIN DEL MARGEN INTESTINAL EN LA CIRUGA COLORRECTAL: ANTECEDENTES:El verde de indocianina es una herramienta útil en la cirugía colorrectal. Los valores cuantitativos pueden mejorar y estandarizar su aplicación.OBJETIVO:Determinar si las métricas cuantitativas de verde de indocianina se correlacionan con la evaluación subjetiva estándar de perfusión de verde de indocianina en la aceptación o rechazo de los márgenes anastomóticos.DISEÑO:Estudio de cohorte prospectivo de un solo brazo y de una sola institución. Los cirujanos vieron imágenes subjetivas de verde de indocianina, pero no conocían las métricas cuantitativas de verde de indocianina.AJUSTE:Centro académico terciario.PACIENTES:Adultos sometidos a resección intestinal planificada.PRINCIPALES MEDIDAS DE RESULTADO:La perfusión aceptada y la perfusión rechazada del margen intestinal se definieron por la ausencia o presencia de isquemia mediante verde de indocianina subjetiva y la inspección macroscópica. Los resultados primarios fueron los valores cuantitativos de verde de indocianina, la fluorescencia máxima y el tiempo hasta la fluorescencia máxima en la perfusión aceptada en comparación con la rechazada. Los resultados secundarios incluyeron la fluorescencia máxima y el tiempo hasta alcanzar los valores máximos de fluorescencia en la fuga anastomótica.RESULTADOS:Se realizaron 89 evaluaciones de perfusión, comprendiendo 156 segmentos intestinales. Se evaluó subjetivamente que 9 segmentos tenían mala perfusión mediante inspección visual y verde de indocianina subjetiva. La fluorescencia máxima (% de intensidad) mostró una mayor intensidad en la perfusión aceptada [Perfusión aceptada 161% (82-351) vs Perfusión rechazada 63% (10-76); p = 0,03]. De manera similar, el tiempo hasta la fluorescencia máxima (segundos) fue más temprano en la perfusión aceptada en comparación con la rechazada [10 s (1-40) frente a 120 s (90-120); p < 0,01]. Aumento del índice de masa corporal asociado con una fluorescencia máxima más alta. La fuga anastomótica no se correlacionó con la fluorescencia máxima ni con el tiempo hasta la fluorescencia máxima.LIMITACIONES:Estudio de cohorte pequeño, sin poder para medir la asociación entre las mediciones cuantitativas del verde de indocianina y la fuga anastomótica.CONCLUSIÓN:Demostramos que los valores cuantitativos ciegos se correlacionan de manera confiable con la evaluación subjetiva de la perfusión de verde de indocianina. El tiempo hasta la intensidad máxima es una métrica importante en la evaluación de la perfusión. Las métricas cuantitativas de verde de indocianina pueden mejorar la evaluación de la perfusión intestinal intraoperatoria. Los estudios futuros pueden intentar correlacionar los valores cuantitativos de verde de indocianina con la fuga anastomótica. (Traducción-Dr. Yolanda Colorado).

Ensuring Indigenous co-leadership in health research: a Can-SOLVE CKD case example.

BACKGROUND: Indigenous people are insightful and informed about their own health and wellness, yet their visions, strengths and knowledge are rarely incorporated into health research. This can lead to subpar engagement or irrelevant research practices, which exacerbates the existing health inequities Indigenous people experience compared to the non-Indigenous population. Data consistently underscores the importance of Indigenous self-determination in research as a means to address health inequities. However, there are few formal methods to support this goal within the existing research context, which is dominated by Western perspectives. MAIN TEXT: Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease (Can-SOLVE CKD) is a patient-oriented research network in Canada that recognizes the need to create the space to facilitate Indigenous self-determination in research. Indigenous members of the network therefore created and evolved a unique group, called the Indigenous Peoples' Engagement and Research Council (IPERC). IPERC plays a critical role in informing Can-SOLVE CKD research priorities, as well as creating tools to support Indigenous-specific research and engagement. This approach ensures that Indigenous voices and knowledge are critical threads within the fabric of the network's operations and research projects. Here, we describe the methods taken to create a council such as IPERC, and provide examples of initiatives by the council that aim to increase Indigenous representation, participation and partnership in research. We share lessons learned on what factors contribute to the success of IPERC, which could be valuable for other organizations interested in creating Indigenous-led research councils. CONCLUSION: Indigenous self-determination in research is critical for addressing health inequities. Here, we present a unique model, led by a council of diverse Indigenous people, which could help reduce health equities and lead to a better era of research for everyone.

Mercury in Neotropical birds: a synthesis and prospectus on 13 years of exposure data.

Environmental mercury (Hg) contamination of the global tropics outpaces our understanding of its consequences for biodiversity. Knowledge gaps of pollution exposure could obscure conservation threats in the Neotropics: a region that supports over half of the world's species, but faces ongoing land-use change and Hg emission via artisanal and small-scale gold mining (ASGM). Due to their global distribution and sensitivity to pollution, birds provide a valuable opportunity as bioindicators to assess how accelerating Hg emissions impact an ecosystem's ability to support biodiversity, and ultimately, global health. We present the largest database on Neotropical bird Hg concentrations (n = 2316) and establish exposure baselines for 322 bird species spanning nine countries across Central America, South America, and the West Indies. Patterns of avian Hg exposure in the Neotropics broadly align with those in temperate regions: consistent bioaccumulation across functional groups and high spatiotemporal variation. Bird species occupying higher trophic positions and aquatic habitats exhibited elevated Hg concentrations that have been previously associated with reductions in reproductive success. Notably, bird Hg concentrations were over four times higher at sites impacted by ASGM activities and differed by season for certain trophic niches. We developed this synthesis via a collaborative research network, the Tropical Research for Avian Conservation and Ecotoxicology (TRACE) Initiative, which exemplifies inclusive, equitable, and international data-sharing. While our findings signal an urgent need to assess sampling biases, mechanisms, and consequences of Hg exposure to tropical avian communities, the TRACE Initiative provides a meaningful framework to achieve such goals. Ultimately, our collective efforts support and inform local, scientific, and government entities, including Parties of the United Nations Minamata Convention on Mercury, as we continue working together to understand how Hg pollution impacts biodiversity conservation, ecosystem function, and public health in the tropics.

RESúMEN: La contaminación ambiental por mercurio (Hg) en los trópicos supera nuestra comprensión de sus consecuencias para la biodiversidad. Los vacíos de conocimiento que existen sobre la exposición a la contaminación podrían ocultar las amenazas para la conservación en el Neotrópico: una región que alberga a más de la mitad de las especies del mundo, pero que enfrenta una continua intensificación de las emisiones de Hg y del cambio de uso del suelo por el avance de la minería de oro artesanal y de pequeña escala (MAPE). Debido a su distribución global y su sensibilidad a la contaminación, las aves brindan una oportunidad valiosa como bioindicadores para evaluar cómo las emisiones de Hg afectan la capacidad de un ecosistema para sustentar la biodiversidad y, en última instancia, la salud global. Presentamos la más grande base de datos sobre concentraciones de Hg en aves Neotropicales (n = 2,316) para establecer una línea base para los niveles de exposición a Hg en 322 especies de aves de nueve países de América Central, América del Sur, y el Caribe. Encontramos patrones de las concentraciones de Hg en aves de los trópicos que se asemejan a los de las regiones templadas: mostrando una bioacumulación consistente a través de grupos funcionales y una alta variación espaciotemporal. Las especies de aves que ocupan posiciones más altas en la cadena trófica y en hábitats acuáticos registraron concentraciones elevadas de Hg que podrían tener efectos negativos en su éxito reproductivo. Es importante resaltar que las concentraciones de Hg en las aves de los sitios afectados por la MAPE fueron cuatro veces más altas que las de los sitios control y además difirió por temporada para ciertos nichos tróficos. Desarrollamos esta síntesis a través de una red de investigación colaborativa, la Iniciativa de Investigación Tropical para la Conservación y Ecotoxicología Aviar (TRACE), que ejemplifica un intercambio de datos inclusivo, equitativo e internacional. Si bien nuestros hallazgos sugieren una necesidad urgente de evaluar los sesgos en el muestreo, los mecanismos, y las consecuencias de la exposición al Hg en las comunidades de aves tropicales, la Iniciativa TRACE proporciona un marco para abordar estos objetivos. Nuestro esfuerzo colectivo tiene como propósito respaldar y brindar información a las entidades locales, científicas, y gubernamentales, incluyendo las Partes de la Convención de Minamata de las Naciones Unidas sobre el Mercurio, mientras continuamos trabajando juntos para comprender cómo la contaminación por Hg en los trópicos puede afectar la salud pública, el funcionamiento de los ecosistemas, y la conservación de la biodiversidad. Total mercury (THg) concentrations (µg/g) and sample sizes of birds across Central America, South America, and the West Indies from 2007­2023. Point size and color are arranged in order of increasing THg concentration and hexagonal grid cells are colored in terms of increasing sample size.

Distribution and trends of mercury in aquatic and terrestrial biota of New York, USA: a synthesis of 50 years of research and monitoring.

Mercury (Hg) inputs have particularly impacted the northeastern United States due to its proximity to anthropogenic emissions sources and abundant habitats that efficiently convert inorganic Hg into methylmercury. Intensive research and monitoring efforts over the past 50 years in New York State, USA, have informed the assessment of the extent and impacts of Hg exposure on fishes and wildlife. By synthesizing Hg data statewide, this study quantified temporal trends of Hg exposure, spatiotemporal patterns of risk, the role that habitat and Hg deposition play in producing spatial patterns of Hg exposure in fish and other wildlife, and the effectiveness of current monitoring approaches in describing Hg trends. Most temporal trends were stable, but we found significant declines in Hg exposure over time in some long-sampled fish. The Adirondack Mountains and Long Island showed the greatest number of aquatic and terrestrial species with elevated Hg concentrations, reflecting an unequal distribution of exposure risk to fauna across the state. Persistent hotspots were detected for aquatic species in central New York and the Adirondack Mountains. Elevated Hg concentrations were associated with open water, forests, and rural, developed habitats for aquatic species, and open water and forested habitats for terrestrial species. Areas of consistently elevated Hg were found in areas driven by atmospheric and local Hg inputs, and habitat played a significant role in translating those inputs into biotic exposure. Continued long-term monitoring will be important in evaluating how these patterns continue to change in the face of changing land cover, climate, and Hg emissions.

Surface and subsurface oceanographic features drive forage fish distributions and aggregations: Implications for prey availability to top predators in the US Northeast Shelf ecosystem.

Forage fishes are a critical food web link in marine ecosystems, aggregating in a hierarchical patch structure over multiple spatial and temporal scales. Surface-level forage fish aggregations (FFAs) represent a concentrated source of prey available to surface- and shallow-foraging marine predators. Existing survey and analysis methods are often imperfect for studying forage fishes at scales appropriate to foraging predators, making it difficult to quantify predator-prey interactions. In many cases, general distributions of forage fish species are known; however, these may not represent surface-level prey availability to predators. Likewise, we lack an understanding of the oceanographic drivers of spatial patterns of prey aggregation and availability or forage fish community patterns. Specifically, we applied Bayesian joint species distribution models to bottom trawl survey data to assess species- and community-level forage fish distribution patterns across the US Northeast Continental Shelf (NES) ecosystem. Aerial digital surveys gathered data on surface FFAs at two project sites within the NES, which we used in a spatially explicit hierarchical Bayesian model to estimate the abundance and size of surface FFAs. We used these models to examine the oceanographic drivers of forage fish distributions and aggregations. Our results suggest that, in the NES, regions of high community species richness are spatially consistent with regions of high surface FFA abundance. Bathymetric depth drove both patterns, while subsurface features, such as mixed layer depth, primarily influenced aggregation behavior and surface features, such as sea surface temperature, sub-mesoscale eddies, and fronts influenced forage fish diversity. In combination, these models help quantify the availability of forage fishes to marine predators and represent a novel application of spatial models to aerial digital survey data.

Preoperative CT Indices Predict Nonreach Before IPAA.

BACKGROUND: IPAA aims to restore continence to patients after total proctocolectomy. However, some patients have inadequate small-bowel mesenteric length to achieve reconstruction. No preoperative risk stratification tools of native anatomy exist. OBJECTIVE: We report CT-guided measurements of anatomic landmarks to predict nonreach before IPAA. DESIGN: This is a single-institution retrospective analysis of a prospective database. SETTING: This study was conducted at Cedars-Sinai between January 2007 and December 2021. PATIENTS: Patients with IBD undergoing a 2- or 3-stage IPAA with a preoperative abdominal CT using either an enterography protocol or IV contrast sufficient to visualize mesenteric vasculature were included in the study. CT mesenteric indices were assessed, including total length (representing length required for the pouch to reach the anal canal), mesenteric length (inherent length of small-bowel mesentery), and mobilization length (the difference between total length and mesenteric length). MAIN OUTCOME MEASURES: The primary outcome was IPAA nonreach. The secondary outcomes were association of clinical variables and CT mesenteric indices. RESULTS: Six of 59 patients (10%) experienced nonreach. Mobilization length was longer in the nonreach group by 5.8 cm ( p = 0.01), and mesenteric length was shorter by 3.5 cm ( p = 0.04). Mobilization length ≥17 cm provided 100% sensitivity and 69% specificity (OR 1.46, area under the curve 0.84, p = 0.004) for nonreach. Similarly, a mesenteric length <14.6 cm demonstrated 100% sensitivity and 49% specificity for IPAA nonreach (area under the curve 0.75, p = 0.03). LIMITATIONS: The retrospective nature of the study precluded a standardized imaging protocol. External validation will be required because of the small sample size. CONCLUSIONS: CT-based measurements of length, specifically mesenteric and mobilization length, predict nonreach before IPAA. This method is noninvasive, readily available, and may be useful for preoperative patient counseling and operative planning. See Video Abstract at http://links.lww.com/DCR/C140 . LOS NDICES DE TOMOGRAFA COMPUTARIZADA PREOPERATORIA PREDICEN LA AUSENCIA DE ALCANCE ANTES DE LA ANASTOMOSIS DEL RESERVORIO ILEALANAL: ANTECEDENTES:La anastomosis del reservorio ileoanal tiene como objetivo restaurar la continencia en los pacientes después de una proctocolectomía total. Sin embargo, algunos pacientes tienen una longitud mesentérica del intestino delgado inadecuada para lograr la reconstrucción. No existen herramientas de estratificación del riesgo preoperatorio de la anatomía nativa.OBJETIVO:Informamos mediciones guiadas por tomografía computarizada de puntos de referencia anatómicos para predecir la falta de alcance antes de la anastomosis ileoanal con reservorio.DISEÑO:Este es un análisis retrospectivo de una sola institución de una base de datos prospectiva.AJUSTE:Este estudio se realizó en Cedars-Sinai entre Enero de 2007 y Diciembre de 2021.PACIENTES:Pacientes con enfermedad inflamatoria intestinal que se someten a una anastomosis anal con reservorio ileal en 2 o 3 etapas con una tomografía computarizada abdominal preoperatoria utilizando un protocolo de enterografía o contraste intravenoso suficiente para visualizar la vasculatura mesentérica. Se evaluaron los índices mesentéricos de tomografía computarizada, incluida la longitud total (que representa la longitud requerida para que la bolsa alcance el canal anal), la longitud mesentérica (longitud inherente del mesenterio del intestino delgado) y la longitud de movilización (la diferencia entre la longitud total y la longitud mesentérica).PRINCIPALES MEDIDAS DE RESULTADO:El resultado primario fue falta de alcance de la anastomosis del reservorio ileoanal. Los resultados secundarios fueron la asociación de variables clínicas y los índices mesentéricos de tomografía computarizada.RESULTADOS:Seis de 59 (10%) pacientes experimentaron falta de alcance. La longitud de movilización fue mayor en el grupo sin alcance en 5,8 cm ( p = 0,01) y la longitud mesentérica fue menor en 3,5 cm ( p = 0,04). La longitud de movilización ≥17 cm proporcionó una sensibilidad del 100% y una especificidad del 69% (OR 1,46, AUC 0,84, p = 0,004) para la falta de alcance. De manera similar, una longitud mesentérica <14,6 cm demostró una sensibilidad del 100% y una especificidad del 49% para la falta de alcance de la anastomosis del reservorio ileoanal (AUC 0,75, p = 0,03).LIMITACIONES:La naturaleza retrospectiva del estudio impidió un protocolo de imágenes estandarizado. Se requerirá una validación externa debido al pequeño tamaño de la muestra.CONCLUSIONES:Las mediciones de longitud basadas en tomografía computarizada, específicamente la longitud mesentérica y de movilización, predicen la falta de alcance antes de la anastomosis anal con bolsa ileo. Este método no es invasivo, está fácilmente disponible y puede ser útil para el asesoramiento preoperatorio del paciente y la planificación quirúrgica. Consulte el Video Resumen en https://links.lww.com/DCR/C140 . (Traducción-Dr. Yesenia Rojas-Khalil ).

Efficacy of Anal Sphincter Division During Fistulotomy in Anal Fissure-Associated Fistula.

BACKGROUND: A subset of chronic anal fissures beget focal infection, leading to concomitant fistula. The optimal management of fissure-associated fistula is unknown. OBJECTIVE: This study aimed to characterize healing rates and effects of fistulotomy in fissure-associated fistula. DESIGN: Retrospective study. SETTING: Urban tertiary center. PATIENTS: Adults who underwent fistulotomy for a fistula associated with a chronic anal fissure were included in the study. However, those with Crohn's disease, a history of lateral internal sphincterotomy, and a fistula not amenable to fistulotomy were excluded. INTERVENTIONS: Patients were managed with fistulotomy. Fissures were otherwise managed conservatively with a step-up approach. MAIN OUTCOME MEASURES: The primary end point was healing, defined as resolution of symptoms and both fistula and fissure wounds within 1 year. Subgroup analysis compared those who underwent subcutaneous fistulotomy (group A) with those who underwent fistulotomy involving anal sphincter fibers (group B). RESULTS: Twenty-four of 38 patients (63%) healed with a median overall follow-up of 6.6 months (4.2-14.1). The overall median time to healing was 4.4 months (2.2-6.0). No clinical or pathologic factors predicted healing. In subgroup analysis, overall subcutaneous fistulotomy healing rates were nonstatically lower at 46% (6/13) compared to fistulotomy involving anal sphincter fibers at 72% (18/25; p = 0.16). There was no difference in time to healing (subcutaneous fistulotomy, 6.7 mo [5.2-8.4] vs fistulotomy involving sphincter, 5.1 mo [2.1-7.0]; p = 0.36). LIMITATIONS: The limitations include treatment bias, with increased utilization of chemical sphincter-relaxing agents in those who did not heal. Findings are not applicable to complex fistulas, Crohn's disease, or atypical fissures. CONCLUSIONS: Patients presenting with chronic fissure and associated subcutaneous, intersphincteric, or low transphincteric fistula are successfully managed with fistulotomy. Patients with a subcutaneous fistula tract exhibited nonstatistically significantly lower rates of healing. See Video Abstract at http://links.lww.com/DCR/C145 . EFICACIA DE LA DIVISIN ESFINTRICA DURANTE LA FISTULOTOMA EN CASOS DE FSTULA ASOCIADA A FISURA ANAL: ANTECEDENTES: Ciertos subgrupos de fisuras anales crónicas ocasionan infección localizada, induciendo la aparición de una fístula anal concomitante. Se desconoce el manejo óptimo de la fístula concomitante a una fisura anal.OBJETIVO: Se trata de caracterizar las tasas de curación y el efecto de la fistulotomía en el tratamiento de la fístula concomitante a la fisura anal.DISEÑO: Estudio retrospectivo.EMPLAZAMIENTO: Centro terciario urbano.PACIENTES: Adultos sometidos a fistulotomía por una fístula concomitante a una fisura anal crónica. Se excluyeron la enfermedad de Crohn, el antecedente de una esfinterotomía lateral interna y las fístulas no susceptibles de fistulotomía.INTERVENCIONES: Los pacientes fueron manejados con una fistulotomía clasica. Por lo demás, las fisuras se trataron de forma conservadora con un enfoque médico escalonado.PRINCIPALES MEDIDAS DE RESULTADO: El criterio principal de valoración fué la cura definitiva, determinada como la resolución completa de los síntomas y de las heridas tanto de la fístula como de la fisura en el plazo de un año. El análisis de los subgrupos comparó los que se sometieron a una fistulotomía subcutánea (grupo A) versus una fistulotomía que involucró las fibras del esfínter anal interno (grupo B).RESULTADOS: 24/38 pacientes (63%) curaron con una mediana de seguimiento global de 6,6 meses (4,2-14,1). El tiempo medio general de curación fue de 4,4 meses (2,2-6,0). Ningún factor clínico o patológico predijo la cura. En el análisis de subgrupos, las tasas generales de cura de la fistulotomía subcutánea no fueron estadísticamente más bajas de 46 % (6/13) comparados con la fistulotomía que involucró las fibras del esfínter anal interno en 72 % (18/25; p = 0,16). No hubo diferencia en el tiempo de cicatrización [fistulotomía subcutánea 6,7 meses (5,2-8,4) conparada a la fistulotomía y esfínterotomía parcial interna a 5,1 meses (2,1-7,0); p = 0,36].LIMITACIONES: Sesgo del tratamiento, con mayor utilización de agentes químicos relajantes de la musculatura esfínteriana en aquellos pacientes que no sanaron. No aplicable a fístulas complejas, enfermedad de Crohn o fisuras atípicas.CONCLUSIÓNES: Los pacientes que presentan fisura crónica y fístula subcutánea, inter-esfintérica o trans-esfintérica baja concomitante se manejan con éxito con una fistulotomía. Los pacientes con un trayecto de fístula subcutánea exhibieron tasas de curación más bajas y no estadísticamente significativas. Consulte Video Resumen en http://links.lww.com/DCR/C145 . (Traducción-Dr. Xavier Delgadillo ).

The first documentation of the Nearctic-Paleotropical migratory route of the Arctic Warbler.

The Arctic Warbler (Phylloscopus borealis) is a cryptically plumed songbird with an uncommon Nearctic-Paleotropical migratory strategy. Using light-level geolocators, we provide the first documentation of the migratory routes and wintering locations of two territorial adult male Arctic Warblers from Denali National Park and Preserve, Alaska. After accounting for position estimation uncertainties and biases, we found that both individuals departed their breeding grounds in early September, stopped over in southeastern Russia and China during autumn migration, then wintered in the Philippines and the island of Palau. Our documentation of Arctic Warbler wintering on Palau suggests that additional study is needed to document their wintering range. Our study provides hitherto unknown information on stopover and wintering locations for Arctic Warblers and indicates that this species may migrate further overwater than previously thought.

Quantitative meta-analysis reveals no association between mercury contamination and body condition in birds.

Mercury contamination is a major threat to the global environment, and is still increasing in some regions despite international regulations. The methylated form of mercury is hazardous to biota, yet its sublethal effects are difficult to detect in wildlife. Body condition can vary in response to stressors, but previous studies have shown mixed effects of mercury on body condition in wildlife. Using birds as study organisms, we provide the first quantitative synthesis of the effect of mercury on body condition in animals. In addition, we explored the influence of intrinsic, extrinsic and methodological factors potentially explaining cross-study heterogeneity in results. We considered experimental and correlative studies carried out in adult birds and chicks, and mercury exposure inferred from blood and feathers. Most experimental investigations (90%) showed a significant relationship between mercury concentrations and body condition. Experimental exposure to mercury disrupted nutrient (fat) metabolism, metabolic rates, and food intake, resulting in either positive or negative associations with body condition. Correlative studies also showed either positive or negative associations, of which only 14% were statistically significant. Therefore, the overall effect of mercury concentrations on body condition was null in both experimental (estimate ± SE = 0.262 ± 0.309, 20 effect sizes, five species) and correlative studies (-0.011 ± 0.020, 315 effect sizes, 145 species). The single and interactive effects of age class and tissue type were accounted for in meta-analytic models of the correlative data set, since chicks and adults, as well as blood and feathers, are known to behave differently in terms of mercury accumulation and health effects. Of the 15 moderators tested, only wintering status explained cross-study heterogeneity in the correlative data set: free-ranging wintering birds were more likely to show a negative association between mercury and body condition. However, wintering effect sizes were limited to passerines, further studies should thus confirm this trend in other taxa. Collectively, our results suggest that (i) effects of mercury on body condition are weak and mostly detectable under controlled conditions, and (ii) body condition indices are unreliable indicators of mercury sublethal effects in the wild. Food availability, feeding rates and other sources of variation that are challenging to quantify likely confound the association between mercury and body condition in natura. Future studies could explore the metabolic effects of mercury further using designs that allow for the estimation and/or manipulation of food intake in both wild and captive birds, especially in under-represented life-history stages such as migration and overwintering.

Long-term Oncological Outcome of Segmental Versus Extended Colectomy for Colorectal Cancer in Crohn's Disease: Results from an International Multicentre Study.

BACKGROUND AND AIMS: Crohn's disease increases colorectal cancer risk, with high prevalence of synchronous and metachronous cancers. Current guidelines for colorectal cancer in Crohn's disease recommend pan-proctocolectomy. The aim of this study was to evaluate oncological outcomes of a less invasive surgical approach. METHODS: This was a retrospective database analysis of Crohn's disease patients with colorectal cancer undergoing surgery at selected European and US tertiary centres. Outcomes of segmental colectomy were compared with those of extended colectomy, total colectomy, and pan-proctocolectomy. Primary outcome was progression-free survival. Secondary outcomes included overall survival, synchronous and metachronous colorectal cancer, and major postoperative complications. RESULTS: Ninety-nine patients were included: 66 patients underwent segmental colectomy and 33 extended colectomy. Segmental colectomy patients were older [p = 0.0429], had less extensive colitis [p = 0.0002] and no preoperatively identified synchronous lesions [p = 0.0109].Median follow-up was 43 [31-62] months. There was no difference in unadjusted progression-free survival [p = 0.2570] or in overall survival [p = 0.4191] between segmental and extended colectomy. Multivariate analysis adjusting for age, sex, ASA score, and AJCC staging, confirmed no difference for progression-free survival (hazard ratio [HR] 1.00, p = 0.9993) or overall survival [HR 0.77, p = 0.6654]. Synchronous and metachronous cancers incidence was 9% and 1.5%, respectively. Perioperative mortality was nil and major complications were comparable [7.58% vs 6.06%, p = 0.9998]. CONCLUSIONS: Segmental colectomy seems to offer similar long-term outcomes to more extensive surgery. Incidence of synchronous and metachronous cancers appears much lower than previously described. Further prospective studies are warranted to confirm these results.

A review of the effectiveness of operational curtailment for reducing bat fatalities at terrestrial wind farms in North America.

Curtailment of turbine operations during low wind conditions has become an operational minimization tactic to reduce bat mortality at terrestrial wind energy facilities. Site-specific studies have demonstrated that bat activity is higher during lower wind speeds and that operational curtailment can effectively reduce fatalities. However, the exact nature of the relationship between curtailment cut-in speed and bat fatality reduction remains unclear. To evaluate the efficacy of differing curtailment regimes in reducing bat fatalities, we examined data from turbine curtailment experiments in the United States and Canada in a meta-analysis framework. We used multiple statistical models to explore possible linear and non-linear relationships between turbine cut-in speed and bat fatality. Because the overall sample size for this meta-analysis was small (n = 36 control-treatment studies from 17 wind farms), we conducted a power analysis to assess the number of control-treatment curtailment studies needed to understand the relationship between fatality reduction and change in cut-in speed. We also identified the characteristics of individual curtailment field studies that may influence their power to detect fatality reductions, and in turn, contribute to future meta-analyses. We found strong evidence that implementing turbine curtailment reduces fatality rates of bats at wind farms; the estimated fatality ratio across all studies was 0.37 (p < 0.001), or a 63% decrease in fatalities. However, the nature of the relationship between the magnitude of treatment and reduction in fatalities was more difficult to assess. Models that represented the response ratio as a continuous variable (e.g., with a linear relationship between the change in cut-in speed and fatalities) and a categorical variable (to allow for possible non-linearity in this relationship) both had substantial support when compared using AICc. The linear model represented the best fit, likely due to model simplicity, but the non-linear model was the most likely without accounting for parsimony and suggested fatality rates decreased when the difference in curtailment cut-in speeds was 2m/s or larger. The power analyses showed that the power to detect effects in the meta-analysis was low if fatality reductions were less than 50%, which suggests that smaller increases in cut-in speed (i.e., between different treatment categories) may not be easily detectable with the current dataset. While curtailment is an effective operational mitigation measure overall, additional well-designed curtailment studies are needed to determine precisely whether higher cut-in speeds can further reduce bat fatalities.

Can scientists and knowledge keepers sit comfortably together? An Indigenous physician's reflections on a decade of participatory research into First Nations nutrition, environment and health.

The author, an Indigenous physician, offers his reflections on the history of scientific research with Indigenous People and its past role in ethical breaches and excesses of colonialism, as a backdrop to the relatively recent advances in collaborative, community-based participatory research involving First Nations and Inuit in Canada. The First Nations Food, Nutrition and Environment Study (2008-2018), introduced in this Special Issue, is presented as an example of an ethical space that was sustained for a decade to collaboratively develop new knowledge by First Nations and scientists working together, respectfully and inspired by shared interest. A short overview of twelve articles of the Special Issue is provided and characterized as creating a previously inaccessible picture of the modern diets of First Nations, along with the suite of environmental factors that are present in food and water in and around communities. Ultimately, the author hopes that Canadian society can set the table with Indigenous Peoples and respectfully set opinions onto each other and do this over and over again. With Canada already being a multicultural and pluralistic society, adding Indigenous realities into the mix only respects and honours the Indigenous roots of this country.

RéSUMé: L'auteur, médecin autochtone, nous livre ses réflexions sur l'histoire de la recherche scientifique avec les peuples autochtones et le rôle que celle-ci a pu avoir dans les violations éthiques et les excès du colonialisme, comme toile de fond aux avancées relativement récentes de la recherche participative collaborative et communautaire avec les Premières Nations et les Inuits au Canada. L'Étude sur l'alimentation, la nutrition et l'environnement des Premières Nations (2008­2018) qui est présentée dans ce numéro spécial, est citée comme un exemple d'un espace éthique maintenu pendant une décennie pour développer de nouvelles connaissances, de manière collaborative, conjointement par les Premières Nations et les scientifiques qui, mus par un intérêt commun, travaillent ensemble dans le respect. L'auteur nous fournit un bref aperçu des douze articles du numéro spécial qui est considéré comme dressant un tableau, jusqu'alors inexistant, des régimes alimentaires modernes des Premières Nations, ainsi que de la suite des facteurs environnementaux présents dans les aliments et l'eau dans et autour des communautés. L'auteur espère que la société canadienne pourra s'asseoir à la table avec les peuples autochtones et faire se confronter, avec respect, les opinions des uns et des autres, et ce, à répétition. Le Canada étant déjà une société multiculturelle et pluraliste, l'ajout des réalités autochtones ne fait que respecter et honorer les racines autochtones de ce pays.

Ultraviolet-assisted oiling assessment improves detection of oiled birds experiencing clinical signs of hemolytic anemia after exposure to the Deepwater Horizon oil spill.

While large-scale oil spills can cause acute mortality events in birds, there is increasing evidence that sublethal oil exposure can trigger physiological changes that have implications for individual performance and survival. Therefore, improved methods for identifying small amounts of oil on birds are needed. Because ultraviolet (UV) light can be used to identify thin crude oil films in water and on substrate that are not visually apparent under normal lighting conditions, we hypothesized that UV light could be useful for detecting small amounts of oil present on the plumage of birds. We evaluated black skimmers (Rynchops niger), brown pelicans (Pelecanus occidentalis), clapper rails (Rallus crepitans), great egrets (Ardea alba), and seaside sparrows (Ammodramus maritimus) exposed to areas affected by the Deepwater Horizon oil spill in the Gulf of Mexico as well as from reference areas from 20 June, 2010 to 23 February, 2011. When visually assessed without UV light, 19.6% of birds evaluated from areas affected by the spill were determined to be oiled (previously published data), whereas when examined under UV light, 56.3% of the same birds were determined to have oil exposure. Of 705 individuals examined in areas potentially impacted by the spill, we found that fluorescence under UV light assessment identified 259 oiled birds that appeared to be oil-free on visual exam, supporting its utility as a simple tool for improving detection of modestly oiled birds in the field. Further, UV assessment revealed an increase in qualitative severity of oiling (approximate % of body surface oiled) in 40% of birds compared to what was determined on visual exam. Additionally, black skimmers, brown pelicans, and great egrets exposed to oil as determined using UV light experienced oxidative injury to erythrocytes, had decreased numbers of circulating erythrocytes, and showed evidence of a regenerative hematological response in the form of increased reticulocytes. This evidence of adverse effects was similar to changes identified in birds with oil exposure as determined by visual examination without UV light, and is consistent with hemolytic anemia likely caused by oil exposure. Thus, UV assessment proved useful for enhancing detection of birds exposed to oil, but did not increase detection of birds experiencing clinical signs of anemia compared to standard visual oiling assessment. We conclude that UV light evaluation can help identify oil exposure in many birds that would otherwise be identified visually as unexposed during oil spill events.

Mercury exposure in songbird communities along an elevational gradient on Whiteface Mountain, Adirondack Park (New York, USA).

Mercury (Hg) is a potent neurotoxin that biomagnifies within food webs. Adverse effects have been documented for avian species related to exposure of elevated Hg levels. High elevation, boreal forests generally receive higher atmospheric Hg deposition and regional studies have subsequently identified elevated blood Hg concentrations in songbird species inhabiting these montane habitats. The overall goal of this study was to investigate spatial and seasonal Hg exposure patterns in songbird species along an elevational gradient on Whiteface Mountain in the Adirondack Park of New York State. Songbird blood samples were collected from June-July in 2009 and 2010 along an elevational gradient at 13 study plots (450-1400 m) with a focus on Catharus thrushes, including the hermit thrush, Swainson's thrush, and Bicknell's thrush. The main results of this study documented: (1) an overall linear pattern of increasing blood Hg concentrations with increasing elevation, with additional analysis suggesting a nonlinear elevational pattern of increasing blood Hg concentrations to 1075 m, followed by decreasing concentrations thereafter, for all Catharus thrush species across the elevational gradient; and (2) an overall nonlinear seasonal pattern of increasing, followed by decreasing blood Hg concentrations across target species. Avian exposure patterns appear driven by elevated atmospheric Hg deposition and increased methylmercury bioavailability within high elevation habitats as compared with low elevation forests. Seasonal patterns are likely influenced by a combination of complex and dynamic variables related to dietary selection and annual molting cycles. Considering that few high elevation analyses have been conducted within the context of regional songbird research, this project complements the results from similar studies and highlights the need for further monitoring efforts to investigate environmental Hg contamination within avian communities.

Long-term monitoring of mercury in adult saltmarsh sparrows breeding in Maine, Massachusetts and New York, USA 2000-2017.

Here we report on the results of a long-term study of mercury exposure in a songbird species, the saltmarsh sparrow (Ammodramus caudacutus). We measured total mercury concentrations in blood (n = 840) and feathers (n = 560) of adult saltmarsh sparrows at six locations between 2000 and 2017: Rachel Carson National Wildlife Refuge (RCNWR) in Wells, Maine; Scarborough Marsh State Wildlife Management Area in Scarborough, Maine; Parker River National Wildlife Refuge on Plum Island, Massachusetts; Pine Neck Preserve in Southampton, Long Island, New York; and North Cinder and North Green Sedge Islands off the coast of Long Island, New York. During the 12-17 year sampling periods, we found that mercury exposure differed by site and year but there was no consistent temporal trend across sites. Blood mercury concentrations declined only at RCNWR in Maine. We also found seasonal variation in blood mercury concentrations and a positive relationship between mercury concentrations of blood and innermost primary feather, but not between blood and tail feather.

Mercury exposure in migrating songbirds: correlations with physical condition.

Many migratory songbirds are at high risk of methylmercury (MeHg) exposure due to their trophic position and foraging in and around wetland habitats. Methylmercury has the potential to alter migratory behaviors and physiology via neurological impairment or reduced flight performance and can be remobilized from songbird muscle tissue during migration, increasing the risk of acute MeHg exposure. To document MeHg exposure and its relationship with physical condition in migratory songbirds, we sampled passerine blood and feathers at a migration stopover site on Key Biscayne, FL during fall and spring from 2009 to 2012. We found evidence that spring blood total mercury (THg) concentrations decreased throughout the day and that fall feather THg concentrations changed over the migratory season. Total mercury exposure was marginally correlated with migratory fat stores and related to changes in pectoral muscle thickness by time of day. These patterns suggest that environmentally relevant levels of THg are related to, and may be influencing, the physical condition of free-living migrating songbirds. Further research and monitoring during the migratory period will be important to elucidate exposure risk across multiple species and assess the potential for effects during this complex period of the annual cycle.

Mercury exposure in songbird communities within Sphagnum bog and upland forest ecosystems in the Adirondack Park (New York, USA).

Mercury (Hg) is a potent neurotoxin that biomagnifies within both aquatic and terrestrial food webs resulting in adverse physiological and reproductive effects on impacted wildlife populations, including songbird communities. Due to reducing conditions, wetland ecosystems promote the formation of methylmercury. Regional studies have documented elevated blood mercury concentrations in songbird species within these habitat types. The overall goal of this research was to examine spatial and seasonal patterns of Hg exposure for targeted songbird species within Sphagnum bog wetland systems and compare these patterns with adjacent upland forests in the Adirondack Park of New York State. Project sampling was conducted at study plots within four Sphagnum bog and associated upland forest sites from May - August during the 2008, 2009, and 2011 field seasons. The overall results documented: (1) blood Hg concentrations were elevated in songbird species inhabiting Sphagnum bog habitats as compared to nearby upland forest species; (2) target species within each habitat type exhibited consistent species-level patterns in blood Hg concentrations at each study site; and (3) no seasonal change in blood Hg concentrations within Sphagnum bog habitats was documented, but an increasing, followed by a decreasing seasonal pattern in mercury exposure was detected for upland forest species. Habitat type was demonstrated to influence avian Hg exposure levels. Moreover, Sphagnum bog ecosystems may be contributing to elevated Hg concentrations in biota within the surrounding environment. Seasonal patterns for blood Hg concentrations were found to vary between habitat type and are likely related to a combination of variables including habitat-driven Hg concentrations in prey items, seasonal dietary shifts, and annual molting cycles. This project emphasizes the importance of prioritizing future research efforts within identified high Hg habitat types, specifically wetland systems, to better characterize associated avian exposure levels, estimate the spatial extent of wetland systems on the surrounding environment, and identify locations of potential biological hotspots across the Adirondack Park.

Historical patterns in mercury exposure for North American songbirds.

Methylmercury (MeHg) is a global environmental contaminant that poses significant risks to the health of humans, wildlife, and ecosystems. Assessing MeHg exposure in biota across the landscape and over time is vital for monitoring MeHg pollution and gauging the effectiveness of regulations intended to reduce new mercury (Hg) releases. We used MeHg concentrations measured in museum specimen feathers (collected between 1869 and 2014) and total Hg concentrations (as a proxy for MeHg) of feathers sampled from wild birds (collected between 2008 and 2017) to investigate temporal patterns in exposure over approximately 150 years for North American songbirds. For individual species, we found greater concentrations for samples collected post-2000 compared to those collected during historic times (pre-1900) for six of seven songbird species. Mean feather concentrations measured in samples collected post-2000 ranged between 1.9 and 17 times (mean 6.6) greater than historic specimens. The proportion of individual songbirds with feather concentrations that exceeded modeled toxicity benchmarks increased in samples collected after 1940. Only 2% of individual songbirds collected prior to 1940 had feather concentrations greater than 2.4 µg/g (a toxicity benchmark related to a 10% decrease in nest success) compared to 35% of individuals collected post-1940. Many species included in this study have a vulnerable or near-threatened conservation status, suggesting recovery actions are needed to address mercury pollution.

The effects of climate, habitat, and trophic position on methylmercury bioavailability for breeding New York songbirds.

Mercury (Hg) is a global pollutant that affects songbird populations across a variety of ecosystems following conversion to methylmercury (MeHg)-a form of Hg with high potential for bioaccumulation and bioavailability. The amount of bioavailable MeHg in an ecosystem is a function of the amount of total Hg present as well as Hg methylation rates, which vary across the landscape in space and time, and trophic transfer. Using songbirds as an indicator of MeHg bioavailability in terrestrial ecosystems, we evaluated the role of habitat, climate, and trophic level in dictating MeHg exposure risk across a variety of ecosystems. To achieve this objective, 2243 blood Hg samples were collected from 81 passerine and near-passerine species in New York State, USA, spanning 10 different sampling regions from Long Island to western New York. Using a general linear mixed modeling framework that accounted for regional variation in sampling species composition, we found that wetland habitat area within 100 m of capture location, 50-year average of summer maximum temperatures, and trophic position inferred using stable isotope analysis were all correlated with songbird blood Hg concentrations statewide. Moreover, these patterns had a large degree of spatial variability suggesting that the drivers of MeHg bioavailability differed significantly across the state. Mercury deposition, land cover, and climate are all expected to change throughout the northeastern United States in the coming decades. Terrestrial MeHg bioavailability will likely respond to these changes. Focused research and monitoring efforts will be critical to understand how exposure risk responds to global environmental change across the landscape.