Refining the Ecosystems Services Model: Integrating Animal Behavior into Ecotourism Management

As life on Earth has entered a sixth mass extinction driven by pervasive human impacts, there is a growing need for research that effectively identifies and resolves potential conflicts between wildlife and humans. While developing solutions on how to mitigate adverse interactions between humans and wildlife is of critical importance, there is notably less research on the impact of animal behavior shifts on the quality of ecosystem services that humans benefit from, such as those derived from ecotourism activities, that are fundamentally based on people's ability to witness natural animal behaviors. These human-wildlife interactions can lead to valuable contributions to conservation and economic opportunities for local communities. However, studies have revealed that drastic behavior changes occur when wildlife populations are subjected to high levels of anthropogenic disturbance. Building on the understanding that human and animal behaviors are strongly linked through complex social-ecological feedback systems and utilizing the existing ecosystem frameworks, this chapter highlights the need for better understanding of the current wildlife-based ecotourism models and how they might become better adapted into the future. The year-long COVID-19 pandemic provided a unique opportunity for the current practices to be adapted, and emerging questions about the on-going relationship between humans and wildlife need to be investigated to establish more effective ecosystem management interventions. © 2022 Elsevier Inc. All rights reserved

The effects of coronavirus (COVID-19) on operative and workbased assessment (WBA) activity on surgical training

Background: COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. The COVID-STAR qualitative study demonstrated a perceived negative impact of COVID-19 on numerous aspects of surgical training across all specialties and training grades. The aim of this study is to investigate how COVID-19 has affected operative case exposure and work-based assessments for surgeons in training. Methods: Anonymized data has been sought from the Intercollegiate Surgical Curriculum Programme (ISCP) database for operations and work-based assessments in each specialty, involving surgical trainees on an approved training programme at defined Pre-COVID (16/ 03/19-11/05/19) and COVID (16/03/2020-11/05/20) timepoints. Primary outcome measures are the percentage (%) difference in WBA and operative activity between time points respectively. Differences in training activity between time periods will be tested using Pearson v2 and Kruskal-Wallis tests for categorical and continuous variables respectively. Results: This study has been approved by the ISCP Data Analysis, Audit and Research Group, and data will be managed in accordance with ISCP data governance. The hypothesis of this study is that COVID-19 has caused a reduction in the operative and WBA activity of trainees across all specialties. Conclusion: This study seeks to quantify the impact of COVID-19 on operative training activity and completion of WBAs in clinical practice. This information will inform major stakeholders involved in optimising surgical training in the COVID-19 recovery phase.

COVID-19 impact on surgical training and recovery planning (COVID-STAR) survey

Background: The COVID-19 pandemic has resulted in dynamic changes to healthcare delivery. Surgery as a specialty has been significantly affected and with that the delivery of surgical training. Method: This national, collaborative, cross sectional study comprising 13 surgical trainee associations distributed a pan surgical specialty survey on the COVID-19 impact on surgical training over a 4-week period (11th May-8th June 2020). The survey was voluntary and open to medical students and surgical trainees of all specialties and training grades. All aspects of training were qualitatively assessed. This study was reported according to STROBE guidelines. Results: 810 completed responses were analysed. (M401: F 390) with representation from all deaneries and training grades. 41% of respondents (n=301) were redeployed with 74% (n=223) redeployed > 4 weeks. Complete loss of training was reported in elective operating (69.5% n=474), outpatient activity (67.3%, n=457), Elective endoscopy (69.5% n=246) with > 50% reduction in training time reported in emergency operating (48%, n=326) and completion of work-based assessments (WBA) (46%, n=309). 81% (n=551) reported course cancellations and departmental and regional teaching programmes were cancelled without rescheduling in 58% and 60% of cases respectively. A perceived lack of Elective operative exposure and completions of WBA's were the primary reported factor affecting potential training progression. Overall, > 50% of trainees (n=377) felt they would not meet the competencies required for that training period. Conclusion: This study has demonstrated a perceived negative impact on numerous aspects of surgical training affecting all training specialties and grades.

Adapting an emergency general surgery service in response to the COVID-19 pandemic.

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.

The quantitative impact of COVID-19 on surgical training in the United Kingdom.

BACKGROUND: COVID-19 has had a global impact on all aspects of healthcare including surgical training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the UK. METHODS: Anonymized operative logbook numbers were collated from electronic logbook and ARCP outcome data from the Intercollegiate Surgical Curriculum Programme database for trainees in the 10 surgical specialty training specialties.Operative logbook numbers and awarded ARCP outcomes were compared between predefined dates. Effect sizes are reported as incident rate ratios (IRR) with 95 per cent confidence intervals. RESULTS: Some 5599 surgical trainees in 2019, and 5310 in surgical specialty training in 2020 were included. The IRR was reduced across all specialties as a result of the COVID-19 pandemic (0.62; 95 per cent c.i. 0.60 to 0.64). Elective surgery (0.53; 95 per cent c.i. 0.50 to 0.56) was affected more than emergency surgery (0.85; 95 per cent c.i. 0.84 to 0.87). Regional variation indicating reduced operative activity was demonstrated across all specialties. More than 1 in 8 trainees in the final year of training have had their training extended and more than a quarter of trainees entering their final year of training are behind their expected training trajectory. CONCLUSION: The COVID-19 pandemic has had a major effect on surgical training in the UK. Urgent, coordinated action is required to minimize the impacts from the reduction in training in 2020.

Facing the Ethical Challenges: Consumer Involvement in COVID-19 Pandemic Research.

Consumer involvement in clinical research is an essential component of a comprehensive response during emergent health challenges. During the COVID-19 pandemic, the moderation of research policies and regulation to facilitate research may raise ethical issues. Meaningful, diverse consumer involvement can help to identify practical approaches to prioritize, design, and conduct rapidly developed clinical research amid current events. Consumer involvement might also elucidate the acceptability of flexible ethics review approaches that aim to protect participants whilst being sensitive to the challenging context in which research is taking place. This article describes the main ethical challenges arising from pandemic research and how involving consumers and the community could enable resolution of such issues.