Explore the vast range of titles available.

Predicted global figures for plastic debris accumulation in the ocean surface layer range on the order of hundreds of thousands of metric tons, representing only a few percent of estimated annual emissions into the marine environment. The current accepted explanation for this difference is that positively buoyant macroplastic objects do not persist on the ocean surface. Subject to degradation into microplastics, the major part of the mass is predicted to have settled below the surface. However, we argue that such a simple emission-degradation model cannot explain the occurrence of decades-old objects collected by oceanic expeditions. We show that debris circulation dynamics in coastal environments may be a better explanation for this difference. The results presented here suggest that there is a significant time interval, on the order of several years to decades, between terrestrial emissions and representative accumulation in offshore waters. Importantly, our results also indicate that the current generation of secondary microplastics in the global ocean is mostly a result of the degradation of objects produced in the 1990s and earlier. Finally, we propose a series of future emission scenarios until 2050, discussing the necessity to rapidly reduce emissions and actively remove waste accumulated in the environment to mitigate further microplastic contamination in the global ocean.

Key Points A large volume of epidemiological evidence points to an association between body mass index (BMI) and increased risk of several cancer types. Proposed mechanisms for the adiposity–cancer link need to account for the observed specificities of associations by gender, site, histological subtype and molecular phenotype. Underlying the above associations, three mainly 'hormonal' mechanisms have been proposed: altered sex hormone metabolism; increased insulin levels and bioavailability of insulin-like growth factor I (IGF1); and adipokine pathophysiology. Additionally, newer hypotheses have been suggested, including as systemic inflammation and microbiome effects. These hypotheses generally fail to capture the specificity of associations. Intentional weight loss might lead to changes of obesity-associated intermediary biomarkers, which in turn might indicate causal pathways to the development of obesity-associated cancer. However, there are many inconsistencies, particularly for changes in inflammatory markers and circulating IGF measurements. Ectopic fat deposition is of two main types: systemic (such as visceral adipose tissue) and local (such as breast fat and hepatic steatosis). The concept of local ectopic fat is relatively new in the field of cancer, but it has been implicated in the development of cardiovascular disease. This concept confers specificity of association for cancer risk and could pave the way to more-targeted preventive interventions in the future. Obesity is associated with increased (and occasionally decreased) risk of developing several types of cancer. This Review discusses the epidemiological evidence available for, and the possible mechanisms that might lead to, this altered risk. Excess body adiposity, commonly expressed as body mass index (BMI), is a risk factor for many common adult cancers. Over the past decade, epidemiological data have shown that adiposity–cancer risk associations are specific for gender, site, geographical population, histological subtype and molecular phenotype. The biological mechanisms underpinning these associations are incompletely understood but need to take account of the specificities observed in epidemiology to better inform future prevention strategies.

The infamous garbage patches on the surface of subtropical oceanic gyres are proof that plastic is polluting the ocean on an unprecedented scale. The fate of floating plastic debris ‘trapped’ in these gyres, however, remains largely unknown. Here, we provide the first evidence for the vertical transfer of plastic debris from the North Pacific Garbage Patch (NPGP) into the underlying deep sea. The numerical and mass concentrations of plastic fragments (500 µm to 5 cm in size) suspended in the water column below the NPGP follow a power law decline with water depth, reaching values <0.001 pieces/m 3 and <0.1 µg/m 3 in the deep sea. The plastic particles in the NPGP water column are mostly in the size range of particles that are apparently missing from the ocean surface and the polymer composition of plastic in the NPGP water column is similar to that of floating debris circulating in its surface waters (i.e. dominated by polyethylene and polypropylene). Our results further reveal a positive correlation between the amount of plastic debris at the sea surface and the depth-integrated concentrations of plastic fragments in the water column. We therefore conclude that the presence of plastics in the water column below the NPGP is the result of ‘fallout’ of small plastic fragments from its surface waters.

The Journal Impact Factor is often used as a proxy measure for journal quality, but the empirical evidence is scarce. In particular, it is unclear how peer review characteristics for a journal relate to its impact factor. We analysed 10,000 peer review reports submitted to 1,644 biomedical journals with impact factors ranging from 0.21 to 74.7. Two researchers hand-coded sentences using categories of content related to the thoroughness of the review ( Materials and Methods , Presentation and Reporting , Results and Discussion , Importance and Relevance ) and helpfulness ( Suggestion and Solution , Examples , Praise , Criticism ). We fine-tuned and validated transformer machine learning language models to classify sentences. We then examined the association between the number and percentage of sentences addressing different content categories and 10 groups defined by the Journal Impact Factor . The median length of reviews increased with higher impact factor, from 185 words (group 1) to 387 words (group 10). The percentage of sentences addressing Materials and Methods was greater in the highest Journal Impact Factor journals than in the lowest Journal Impact Factor group. The results for Presentation and Reporting went in the opposite direction, with the highest Journal Impact Factor journals giving less emphasis to such content. For helpfulness, reviews for higher impact factor journals devoted relatively less attention to Suggestion and Solution than lower impact factor journals. In conclusion, peer review in journals with higher impact factors tends to be more thorough, particularly in addressing study methods while giving relatively less emphasis to presentation or suggesting solutions. Differences were modest and variability high, indicating that the Journal Impact Factor is a bad predictor of the quality of peer review of an individual manuscript.

Surgical site infections (SSIs) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations of national guidelines have been identified. Given the burden of SSIs worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evidence-based recommendations for the prevention of SSIs. The guidelines take into account the balance between benefits and harms, the evidence quality, cost and resource use implications, and patient values and preferences. On the basis of systematic literature reviews and expert consensus, we present 13 recommendations on preoperative preventive measures.

Predatory journals are spurious scientific outlets that charge fees for editorial and publishing services that they do not provide. Their lack of quality assurance of published articles increases the risk that unreliable research is published and thus jeopardizes the integrity and credibility of research as a whole. There is increasing awareness of the risks associated with predatory publishing, but efforts to address this situation are hampered by the lack of a clear definition of predatory outlets. Blacklists of predatory journals and whitelists of legitimate journals have been developed but not comprehensively examined. By systematically analyzing these lists, this study provides insights into their utility and delineates the different notions of quality and legitimacy in scholarly publishing used. This study contributes to a better understanding of the relevant concepts and provides a starting point for the development of a robust definition of predatory journals. We aimed to develop an in-depth understanding of quality criteria for scholarly journals by analyzing journals and publishers indexed in blacklists of predatory journals and whitelists of legitimate journals and the lists’ inclusion criteria. To quantify content overlaps between blacklists and whitelists, we employed the Jaro-Winkler string metric. To identify topics addressed by the lists’ inclusion criteria and to derive their concepts, we conducted qualitative coding. We included two blacklists (Beall’s and Cabells Scholarly Analytics’) and two whitelists (the Directory of Open Access Journals’ and Cabells Scholarly Analytics’). The number of journals per list ranged from 1,404 to 12,357, and the number of publishers ranged from 473 to 5,638. Seventy-two journals and 42 publishers were included in both a blacklist and a whitelist. Seven themes were identified in the inclusion criteria: (i) peer review; (ii) editorial services; (iii) policy; (iv) business practices; (v) publishing, archiving, and access; (vi) website; and (vii) indexing and metrics. Business practices accounted for almost half of the blacklists’ criteria, whereas whitelists gave more emphasis to criteria related to policy. Criteria could be allocated to four concepts: (i) transparency, (ii) ethics, (iii) professional standards, and (iv) peer review and other services. Whitelists gave most weight to transparency. Blacklists focused on ethics and professional standards. Whitelist criteria were easier to verify than those used in blacklists. Both types gave little emphasis to quality of peer review. Overall, the results show that there is overlap of journals and publishers between blacklists and whitelists. Lists differ in their criteria for quality and the weight given to different dimensions of quality. Aspects that are central but difficult to verify receive little attention. IMPORTANCE Predatory journals are spurious scientific outlets that charge fees for editorial and publishing services that they do not provide. Their lack of quality assurance of published articles increases the risk that unreliable research is published and thus jeopardizes the integrity and credibility of research as a whole. There is increasing awareness of the risks associated with predatory publishing, but efforts to address this situation are hampered by the lack of a clear definition of predatory outlets. Blacklists of predatory journals and whitelists of legitimate journals have been developed but not comprehensively examined. By systematically analyzing these lists, this study provides insights into their utility and delineates the different notions of quality and legitimacy in scholarly publishing used. This study contributes to a better understanding of the relevant concepts and provides a starting point for the development of a robust definition of predatory journals.

The role of the operating room's ventilation system in the prevention of surgical site infections (SSIs) is widely discussed, and existing guidelines do not reflect current evidence. In this context, laminar airflow ventilation was compared with conventional ventilation to assess their effectiveness in reducing the risk of SSIs. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and WHO regional medical databases from Jan 1, 1990, to Jan 31, 2014. We updated the search for MEDLINE for the period between Feb 1, 2014, and May 25, 2016. We included studies most relevant to our predefined question: is the use of laminar airflow in the operating room associated with the reduction of overall or deep SSI as outcomes in patients of any age undergoing surgical operations? We excluded studies not relevant to the study question, studies not in the selected languages, studies published before Jan 1, 1990, or after May 25, 2016, meeting or conference abstracts, and studies of which the full text was not available. Data were extracted by two independent investigators, with disagreements resolved through further discussion. Authors were contacted if the full-text article was not available, or if important data or information on the paper's content was absent. Studies were assessed for publication bias. Grading of recommendations assessment, development, and evaluation was used to assess the quality of the identified evidence. Meta-analyses were done with RevMan (version 5.3). We identified 1947 records of which 12 observational studies were comparing laminar airflow ventilation with conventional turbulent ventilation in orthopaedic, abdominal, and vascular surgery. The meta-analysis of eight cohort studies showed no difference in risk for deep SSIs following total hip arthroplasty (330 146 procedures, odds ratio [OR] 1·29, 95% CI 0·98–1·71; p=0·07, I2=83%). For total knee arthroplasty, the meta-analysis of six cohort studies showed no difference in risk for deep SSIs (134 368 procedures, OR 1·08, 95% CI 0·77–1·52; p=0·65, I2=71%). For abdominal and open vascular surgery, the meta-analysis of three cohort studies found no difference in risk for overall SSIs (63 472 procedures, OR 0·75, 95% CI 0·43–1·33; p=0·33, I2=95%). The available evidence shows no benefit for laminar airflow compared with conventional turbulent ventilation of the operating room in reducing the risk of SSIs in total hip and knee arthroplasties, and abdominal surgery. Decision makers, medical and administrative, should not regard laminar airflow as a preventive measure to reduce the risk of SSIs. Consequently, this equipment should not be installed in new operating rooms. None.

The Global Plastics Treaty presents an opportunity to “end plastic pollution”. Legacy plastics will continue to fragment to secondary microplastics for decades, without additional mitigation measures. We identify this flux as a “fragmentation gap”, currently overlooked in global policy targets.

Surgical site infections (SSIs) are the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.

The epidemiology of invasive fungal infections is changing, with new populations at risk and the emergence of resistance caused by the selective pressure from increased usage of antifungal agents in prophylaxis, empiric therapy, and agriculture. Limited antifungal therapeutic options are further challenged by drug–drug interactions, toxicity, and constraints in administration routes. Despite the need for more antifungal drug options, no new classes of antifungal drugs have become available over the last 2 decades, and only one single new agent from a known antifungal class has been approved in the last decade. Nevertheless, there is hope on the horizon, with a number of new antifungal classes in late-stage clinical development. In this review, we describe the mechanisms of drug resistance employed by fungi and extensively discuss the most promising drugs in development, including fosmanogepix (a novel Gwt1 enzyme inhibitor), ibrexafungerp (a first-in-class triterpenoid), olorofim (a novel dihyroorotate dehydrogenase enzyme inhibitor), opelconazole (a novel triazole optimized for inhalation), and rezafungin (an echinocandin designed to be dosed once weekly). We focus on the mechanism of action and pharmacokinetics, as well as the spectrum of activity and stages of clinical development. We also highlight the potential future role of these drugs and unmet needs.