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- Alakukku, Laura, et al.
(författare)
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Maatalouden ympäristötuen vaikuttavuuden seurantatutkimus (MYTVAS 3) : loppuraportti
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Since 1995, agri-environmental support partly funded by the EU has formed the core of Finland’s agri-environmental policy. This system has had a variety of impacts on the relationship between agriculture and the environment. Today’s agri-environmental support is one of the packages included in the Rural Development Programme for Mainland Finland (2007–2013/2014), which both in itself and through the underlying EU legislation requires monitoring of the impacts of the measures implemented. The study monitoring the impact of the 2nd Finnish agri-environmental scheme (MYTVAS 3), which ran from 2008 to 2013, forms part of this monitoring. The MYTVAS 3 monitoring study was also financed by the Ministry of the Environment. The monitoring study was carried out by a consortium coordinated by MTT Agrifood Research Finland and including the Finnish Environment Institute (SYKE), the University of Helsinki, the Finnish Game and Fisheries Research Institute and the University of Turku.The purpose of the MYTVAS 3 monitoring study was to find out how agri-environmental support and its various measures have affected the state of the environment in agricultural areas, how agri-environmental support has affected the potential for farming and how agri-environmental support should be developed to increase its impact. The monitoring focused on the impacts of agri-environmental support on the nutrient load from agriculture on the waterways and on biodiversity. When evaluating the findings presented, we should remember that while monitoring data shows that something happened, it does not necessarily explain what caused it. It is not always possible to show that particular developments were a specific outcome of the current agri-environmental support system and the implementation of its measures. The delay between a measure and its observed impact is often long, and the cause-and-effect relationships are complicated and partly unknown. Also, other agricultural policy and fluctuations on the market may affect the state of the agricultural environment directly or indirectly.The monitoring data show that agri-environmental support has not had a detrimental impact on the potential for farming. Despite a slight increase in the incidence of weeds, they do not cause problems of the kind that would require amendments to the content of agri-environmental measures. Carbon levels in the surface stratum of arable land seems to be continuing their slow decline, and there is still need for measures to preserve organic material in the soil.Compliance with the fertilisation limits in the agri-environmental support system would seem to have had very little impact on crop quality. Variations in the weight and protein content per hectolitre and per 1,000 seeds were of the same order between 2006 and 2012 as they were between 1995 and 2005. Crop quantities have also not been noticeably affected by compliance with the fertilisation limits. Average crop yields remained stable between 1986 and 2013, and no clearly different crop years were observed in the 2000s. It is possible, however, that the lower fertilisation levels could have lowered crop potential in the years with advantageous weather conditions in the 2000s and that protein contents have been lower in advantageous years.The monitoring data also show that the nutrient load potential of agriculture, measured by nutrient balances, has decreased continuously for nitrogen and particularly for phosphorus. The decrease in the nutrient load potential is due above all to a decrease in the use of synthetic fertilisers. The decline in nitrogen fertilisation has bottomed out in recent years, and low protein levels measured in high crop yield years show that there is no point in further reducing nitrogen fertilisation. Optimising nitrogen fertilisation according to how advantageous the growing season is and effectively using the soluble nitrogen in cattle manure are key measures in achieving reasonable nitrogen balances and good crop quality despite fluctuations in growing season conditions. New crop variants have been found to make more efficient use of nitrogen than old ones, and thus the introduction of new variants should be promoted. Despite the decrease in the nutrient balances, there are indications that nutrient loads in runoff water from domestic animal production sites are becoming an increasing problem. Indeed, the fundamental problem with the nutrient load from agriculture is the diversification of livestock farming and crop farming, which has made it more difficult to use nutrients appropriately. Therefore attention must be paid to measures that both boost the use of nutrients in manure and reduce the levels of nutrients that end up in manure. Based on nutrient load monitoring in the catchment areas of rivers, the phosphorus load per hectare of cropland has decreased in each programme period, being about 80% of the level of the first period (1995–1999) in the third period (2007–2013). Because of the increase in the area of cropland, the nitrogen load on waterways from agriculture continued to grow during the second programme period (2000–2006) but peaked in the third (2007–2013). A similar trend was found in the nitrogen load per hectare of cropland.The most important threat to biodiversity is caused by the development of landscape structure, typically involving a decrease in the number of open or half-open areas excluded from actual cultivation. The consequence of the clearing of margins and ecological islands located in crop fields, drainage measures aimed at increasing arable land and all rationalisation of cultivated areas is the diminishing of exactly those areas that are the most important from the perspective of the biodiversity of the agricultural environment. However, the measure-specific findings in the monitoring study show that biodiversity benefits have been locally achieved where measures have been implemented on a broad enough scale (biodynamic farming, traditional biotopes, wetlands, buffer zones, green fallow / nature management areas). Particular care should therefore be taken that all cultivated land continues to have a sufficient percentage of non-cultivated areas, whether they be natural meadows, nature management areas, biodiversity strips, buffer zones, filter strips, headlands, ecological islands, etc. Including the rather popular nature management areas as a new voluntary measure under basic measures was a significant contribution to biodiversity.Regarding the rural landscape, it may be noted that by visual inspection the area of cropland has remained largely unchanged, at the level of the landscape as a whole it is far more common for the landscape to become more closed than to become more open. This trend was also observed in the visual inspection of traditional biotopes, even if the openness of the meadows monitored largely remained unchanged.The only measures that directly address the reduction of gaseous emissions in the agri-environmental support system are the longterm grass cultivation on peat fields and special aid agreements for slurry injection in cropland. While other measures have indirectly affected gaseous emissions, the impact of agri-environmental support as a whole on reducing gaseous emissions from agriculture has been negligible. In general, we may conclude that the goals, content and support levels of agri-environmental support measures must be increasingly adapted and customised by region, by type of farming and by farm, because both the state of the agricultural environment and the needs of society differ greatly between different types of rural area.
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| 2. |
- Bass, Gary Alan, 1979-, et al.
(författare)
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Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study
- 2023
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 17-32
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.
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| 3. |
- Forssten, Maximilian Peter, 1996-, et al.
(författare)
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Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective
- 2023
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 57-67
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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