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1. Fragmentation of tropical forests is one of the greatest threats to global biodiversity. Understanding how biological and functional attributes of communities respond to fragmentation and, in turn, whether ecosystem functioning is impacted upon are critical steps for assessing the long-term effects and conservation values of forest fragments. Ecosystem functioning can be inferred through functional diversity metrics, including functional richness, evenness and divergence, which collectively quantify the range, distribution and uniqueness of functional traits within a community. 2. Our study was carried out in forest remnants of the Brazilian Atlantic rain forest, which is a global hotspot of threatened biodiversity that has undergone massive deforestation and fragmentation. We focus on trees, which play critical functional roles in forest structure, food provisioning and carbon storage, to examine community organization and functional diversity across a gradient of fragmentation, from small to large fragments and at edge versus interior habitats. 3. The interiors of small fragments have marginally higher species richness, but similar community structures, to the interiors of bigger fragments. In contrast, fragment edges suffered significant losses of species and changes in community structure, relative to fragment interiors. 4. Despite shifts in community organization, functional richness was not impacted by fragmentation, with the same number of functions provided independent of fragment size or proximity to edge. However, functional evenness and functional divergence both increased with decreasing fragment size, while fragment edges had lower functional evenness than interiors did, indicating that the abundance and dominance of functional traits has changed, with negative implications for functional redundancy and ecosystem resilience. At fragment edges, large-fruited trees, critical as resources for fauna, were replaced by early successional, small-seeded species. The influence of fragment size was smaller, with a reduction in very large-fruited trees in small fragments counterbalanced by increased numbers of fleshy- and medium-fruited trees. Wood density was not impacted by fragmentation. 5. Synthesis. These results suggest that the interiors of even small fragments can contain important biodiversity, ecosystem functions and carbon stores, offering potential opportunities for cobenefits under existing carbon markets. Retaining forest fragments is an important conservation strategy within the highly threatened Brazilian Atlantic forest biome.

PurposeThe Acute Disease Quality Initiative (ADQI) Workgroup recently released a consensus definition of sepsis-associated acute kidney injury (SA-AKI), combining Sepsis-3 and Kidney Disease Improving Global Outcomes (KDIGO) AKI criteria. This study aims to describe the epidemiology of SA-AKI.MethodsThis is a retrospective cohort study carried out in 12 intensive care units (ICUs) from 2015 to 2021. We studied the incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes of SA-AKI based on the ADQI definition.ResultsOut of 84,528 admissions, 13,451 met the SA-AKI criteria with its incidence peaking at 18% in 2021. SA-AKI patients were typically admitted from home via the emergency department (ED) with a median time to SA-AKI diagnosis of 1 day (interquartile range (IQR) 1–1) from ICU admission. At diagnosis, most SA-AKI patients (54%) had a stage 1 AKI, mostly due to the low urinary output (UO) criterion only (65%). Compared to diagnosis by creatinine alone, or by both UO and creatinine criteria, patients diagnosed by UO alone had lower renal replacement therapy (RRT) requirements (2.8% vs 18% vs 50%; p < 0.001), which was consistent across all stages of AKI. SA-AKI hospital mortality was 18% and SA-AKI was independently associated with increased mortality. In SA-AKI, diagnosis by low UO only, compared to creatinine alone or to both UO and creatinine criteria, carried an odds ratio of 0.34 (95% confidence interval (CI) 0.32–0.36) for mortality.ConclusionSA-AKI occurs in 1 in 6 ICU patients, is diagnosed on day 1 and carries significant morbidity and mortality risk with patients mostly admitted from home via the ED. However, most SA-AKI is stage 1 and mostly due to low UO, which carries much lower risk than diagnosis by other criteria.

Wildlife trade is a multibillion-dollar industry 1 targeting a hyperdiversity of species 2 and can contribute to major declines in abundance 3 . A key question is understanding the global hotspots of wildlife trade for phylogenetic (PD) and functional (FD) diversity, which underpin the conservation of evolutionary history 4 , ecological functions 5 and ecosystem services benefiting humankind 6 . Using a global dataset of traded bird and mammal species, we identify that the highest levels of traded PD and FD are from tropical regions, where high numbers of evolutionary distinct and globally endangered species in trade occur. The standardized effect size (ses) of traded PD and FD also shows strong tropical epicentres, with additional hotspots of mammalian ses.PD in the eastern United States and ses.FD in Europe. Large-bodied, frugivorous and canopy-dwelling birds and large-bodied mammals are more likely to be traded whereas insectivorous birds and diurnally foraging mammals are less likely. Where trade drives localized extinctions 3 , our results suggest substantial losses of unique evolutionary lineages and functional traits, with possible cascading effects for communities and ecosystems 5 , 7 . Avoiding unsustainable exploitation and lost community integrity requires targeted conservation efforts, especially in hotspots of traded phylogenetic and functional diversity. Using a global dataset of traded species, it is found that the highest levels of traded phylogenetic and functional diversity are from tropical regions, where high numbers of evolutionary distinct and globally endangered species occur.

Tropical agriculture is expanding rapidly at the expense of forest, driving a global extinction crisis. How to create agricultural landscapes that minimise the clearance of forest and maximise sustainability is thus a key issue. One possibility is protecting natural forest within or adjacent to crop monocultures to harness important ecosystem services provided by biodiversity spill-over that may facilitate production. Yet this contrasts with the conflicting potential that the retention of forest exports dis-services, such as agricultural pests. We focus on oil palm and obtained yields from 499 plantation parcels spanning a total of ≈23,000 ha of oil palm plantation in Sabah, Malaysian Borneo. We investigate the relationship between the extent and proximity of both contiguous and fragmented dipterocarp forest cover and oil palm yield, controlling for variation in oil palm age and for environmental heterogeneity by incorporating proximity to non-native forestry plantations, other oil palm plantations, and large rivers, elevation and soil type in our models. The extent of forest cover and proximity to dipterocarp forest were not significant predictors of oil palm yield. Similarly, proximity to large rivers and other oil palm plantations, as well as soil type had no significant effect. Instead, lower elevation and closer proximity to forestry plantations had significant positive impacts on oil palm yield. These findings suggest that if dipterocarp forests are exporting ecosystem service benefits or ecosystem dis-services, that the net effect on yield is neutral. There is thus no evidence to support arguments that forest should be retained within or adjacent to oil palm monocultures for the provision of ecosystem services that benefit yield. We urge for more nuanced assessments of the impacts of forest and biodiversity on yields in crop monocultures to better understand their role in sustainable agriculture.

Selecting economically viable forest management strategies that deliver carbon storage and biodiversity benefits can be a difficult task. Now, research in the western Andes of Colombia shows that naturally regenerating forests can quickly accumulate carbon and support diverse ecological communities at minimal cost. Climate change and biodiversity loss can be addressed simultaneously by well-planned conservation policies, but this requires information on the alignment of co-benefits under different management actions 1 , 2 , 3 . One option is to allow forests to naturally regenerate on marginal agricultural land: a key question is whether this approach will deliver environmental co-benefits in an economically viable manner 4 , 5 , 6 , 7 . Here we report on a survey of carbon stocks, biodiversity and economic values from one of the world’s most endemic-rich and threatened ecosystems: the western Andes of Colombia. We show that naturally regenerating secondary forests accumulate significant carbon stocks within 30 years, and support biodiverse communities including many species at risk of extinction. Cattle farming, the principal land use in the region, provides minimal economic returns to local communities, making forest regeneration a viable option despite weak global carbon markets. Efforts to promote natural forest regeneration in the tropical Andes could therefore provide globally significant carbon and biodiversity co-benefits at minimal cost.

Two strategies are often promoted to mitigate the effects of agricultural expansion on biodiversity: one integrates wildlife‐friendly habitats within farmland (land sharing), and the other intensifies farming to allow the offset of natural reserves (land sparing). Their relative merits for biodiversity protection have been subject to much debate, but no previous study has examined whether trade‐offs between the two strategies depend on the proximity of farmed areas to large tracts of natural habitat. We sampled birds and dung beetles across contiguous forests and agricultural landscapes (low‐intensity cattle farming) in a threatened hotspot of endemism: the Colombian Chocó‐Andes. We test the hypothesis that the relative biodiversity benefits of either strategy depend partially on the degree to which farmlands are isolated from large contiguous blocks of forest. We show that distance from forest mediates the occurrence of many species within farmland. For the majority of species, occurrence on farmland depends on both isolation from forest and the proportionate cover of small‐scale wildlife‐friendly habitats within the farm landscape, with both variables having a similar overall magnitude of effect on occurrence probabilities. Simulations suggest that the biodiversity benefits of land sharing decline significantly with increasing distance from forest, but land sparing benefits remain consistent. In farm management units situated close to large contiguous forest (<500 m), land sharing is predicted to provide equal benefits to land sparing, but land sparing becomes increasingly superior in management units situated further from forest (1500 m). The predicted biodiversity benefits of land sparing are similar across all distances, provided that sparing mechanisms genuinely deliver protection for contiguous forest tracts. Synthesis and applications. The persistence of bird and dung beetle communities in low‐intensity pastoral agriculture is strongly linked to the proximity of surrounding contiguous forests. Land‐sharing policies that promote the integration of small‐scale wildlife‐friendly habitats might be of limited benefit without simultaneous measures to protect larger blocks of natural habitat, which could be achieved via land‐sparing practices. Policymakers should carefully consider the extent and distribution of remaining contiguous natural habitats when designing agri‐environment schemes in the tropics.

Strong global demand for tropical timber and agricultural products has driven large-scale logging and subsequent conversion of tropical forests. Given that the majority of tropical landscapes have been or will likely be logged, the protection of biodiversity within tropical forests thus depends on whether species can persist in these economically exploited lands, and if species cannot persist, whether we can protect enough primary forest from logging and conversion. However, our knowledge of the impact of logging and conversion on biodiversity is limited to a few taxa, often sampled in different locations with complex land-use histories, hampering attempts to plan cost-effective conservation strategies and to draw conclusions across taxa. Spanning a land-use gradient of primary forest, once- and twice-logged forests, and oil palm plantations, we used traditional sampling and DNA metabarcoding to compile an extensive data set in Sabah, Malaysian Borneo for nine vertebrate and invertebrate taxa to quantify the biological impacts of logging and oil palm, develop cost-effective methods of protecting biodiversity, and examine whether there is congruence in response among taxa. Logged forests retained high species richness, including, on average, 70% of species found in primary forest. In contrast, conversion to oil palm dramatically reduces species richness, with significantly fewer primary-forest species than found on logged forest transects for seven taxa. Using a systematic conservation planning analysis, we show that efficient protection of primary-forest species is achieved with land portfolios that include a large proportion of logged-forest plots. Protecting logged forests is thus a cost-effective method of protecting an ecologically and taxonomically diverse range of species, particularly when conservation budgets are limited. Six indicator groups (birds, leaf-litter ants, beetles, aerial hymenopterans, flies, and true bugs) proved to be consistently good predictors of the response of the other taxa to logging and oil palm. Our results confidently establish the high conservation value of logged forests and the low value of oil palm. Cross-taxon congruence in responses to disturbance also suggests that the practice of focusing on key indicator taxa yields important information of general biodiversity in studies of logging and oil palm.

Background Although formal participation in research is an integral and often mandatory component of clinical training programs, resulting productivity is highly variable. The objective of this review was to identify determinants of successful research performance among graduate medical education trainees. Methods A structured review of the published literature was performed by searching PubMed, CINAHL, and EMBASE from inception through to 7 April, 2021. Articles examining graduate medical education trainee research productivity evidenced by publications in peer-reviewed journals were included. Results Eighty-five articles were included of which most (66; 78%) were reported from the USA or Canada (10; 12%). A wide range of disciplines were represented with the most common being general surgery, internal medicine, orthopedic surgery, and pediatrics. Themes (number of reports) included trainee characteristics ( n  = 24), project characteristics ( n  = 8), mentoring/supervision ( n  = 11), and programmatic aspects ( n  = 57). Although variable results were observed, research productivity tended to be higher with prior research experience, later years of training, male gender, and pursuit of a postgraduate degree. Few project related aspects of success were identified. Trainee publication was associated with mentors with higher rank, publication productivity, and supportive academic environments. Training programs with organised programs/curricula including protection of time for research were associated with increased productivity as were provision of incentives or rewards but not mandatory requirements. Conclusion This review identifies several trainee characteristics, project and mentor aspects, and programmatic aspects associated with increased productivity that may serve as a useful resource for trainees and graduate medical education training programs.

Although critical illness is usually of high acuity and short duration, some patients require prolonged management in intensive care units (ICU) and suffer long-term morbidity and mortality. To describe the long-term survival and examine determinants of death among patients with prolonged ICU admission. A retrospective cohort of adult Queensland residents admitted to ICUs for 14 days or longer in North Brisbane, Australia was assembled. Comorbid illnesses were classified using the Charlson definitions and all cause case fatality established using statewide vital statistics. During the study a total of 28,742 adult Queensland residents had first admissions to participating ICUs of which 1,157 (4.0%) had prolonged admissions for two weeks or longer. Patients with prolonged admissions included 645 (55.8%), 243 (21.0%), and 269 (23.3%) with ICU lengths of stay lasting 14-20, 21-27, and ≥28 days, respectively. Although the severity of illness at admission did not vary, pre-existing comorbid illnesses including myocardial infarction, congestive heart failure, kidney disease, and peptic ulcer disease were more frequent whereas cancer, cerebrovascular accidents, and plegia were less frequently observed among patients with increasing ICU lengths of stay lasting 14-20, 21-27, and ≥28 days. The ICU, hospital, 90-day, and one-year all cause case-fatality rates were 12.7%, 18.5%, 20.2%, and 24.9%, respectively, and were not different according to duration of ICU stay. The median duration of observation was 1,037 (interquartile range, 214-1888) days. Although comorbidity, age, and admitting diagnosis were significant, neither ICU duration of stay nor severity of illness at admission were associated with overall survival outcome in a multivariable Cox regression model. Most patients with prolonged stays in our ICUs are alive at one year post-admission. Older age and previous comorbidities, but not severity of illness or duration of ICU stay, are associated with adverse long-term mortality outcome.

Habitat conversion is a major driver of tropical biodiversity loss, but its effects are poorly understood in montane environments. While community-level responses to habitat loss display strong elevational dependencies, it is unclear whether these arise via elevational turnover in community composition and interspecific differences in sensitivity or elevational variation in environmental conditions and proximity to thermal thresholds. Here we assess the relative importance of inter- and intraspecific variation across the elevational gradient by quantifying how 243 forest-dependent bird species vary in sensitivity to landscape-scale forest loss across a 3000-m elevational gradient in the Colombian Andes. We find that species that live at lower elevations are strongly affected by loss of forest in the nearby landscape, while those at higher elevations appear relatively unperturbed, an effect that is independent of phylogeny. Conversely, we find limited evidence of intraspecific elevational gradients in sensitivity, with populations displaying similar sensitivities to forest loss, regardless of where they exist in a species’ elevational range. Gradients in biodiversity response to habitat loss thus appear to arise via interspecific gradients in sensitivity rather than proximity to climatically limiting conditions.