Objective To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. Data sources Cochrane Library, Medline (1996Medline ( -2000, Embase, Current Contents, and Cancerlit databases as well as hand searching. Study selection Studies were included if a physician's temporal clinical prediction of survival (CPS) and the actual survival (AS) for terminally ill cancer patients were available for statistical analysis. Study quality was assessed by using a critical appraisal tool produced by the local health authority. Data synthesis Raw data were pooled and analysed with regression and other multivariate techniques. Results 17 published studies were identified; 12 met the inclusion criteria, and 8 were evaluable, providing 1563 individual prediction-survival dyads. CPS was generally overoptimistic (median CPS 42 days, median AS 29 days); it was correct to within one week in 25% of cases and overestimated survival by at least four weeks in 27%. The longer the CPS the greater the variability in AS. Although agreement between CPS and AS was poor (weighted 0.36), the two were highly significantly associated after log transformation (Spearman rank correlation 0.60, P < 0.001). Consideration of performance status, symptoms, and use of steroids improved the accuracy of the CPS, although the additional value was small. Heterogeneity of the studies' results precluded a comprehensive meta-analysis. Conclusions Although clinicians consistently overestimate survival, their predictions are highly correlated with actual survival; the predictions have discriminatory ability even if they are miscalibrated. Clinicians caring for patients with terminal cancer need to be aware of their tendency to overestimate survival, as it may affect patients' prospects for achieving a good death. Accurate prognostication models incorporating clinical prediction of survival are needed.

No abstract

No abstract

Microplastics are contaminants of emerging concern; they are ingested by marine biota. About a quarter of global marine fish landings is used to produce fishmeal for animal and aquaculture feed. To provide a knowledge foundation for this matrix we reviewed the existing literature for studies of microplastics in fishmeal-relevant species. 55% of studies were deemed unsuitable due to focus on large microplastics (> 1 mm), lack of, or limited contamination control and polymer testing techniques. Overall, fishmeal-relevant species exhibit 0.72 microplastics/individual, with studies generally only assessing digestive organs. We validated a density separation method for effectiveness of microplastic extraction from this medium and assessed two commercial products for microplastics. Recovery rates of a range of dosed microplastics from whitefish fishmeal samples were 71.3 ± 1.2%. Commercial samples contained 123.9 ± 16.5 microplastics per kg of fishmeal—mainly polyethylene—including 52.0 ± 14.0 microfibres—mainly rayon. Concentrations in processed fishmeal seem higher than in captured fish, suggesting potential augmentation during the production process. Based on conservative estimates, over 300 million microplastic particles (mostly < 1 mm) could be released annually to the oceans through marine aquaculture alone. Fishmeal is both a source of microplastics to the environment, and directly exposes organisms for human consumption to these particles.

Achieving food security in a ‘perfect storm’ scenario is a grand challenge for society. Climate change and an expanding global population act in concert to make global food security even more complex and demanding. As achieving food security and the millennium development goal (MDG) to eradicate hunger influences the attainment of other MDGs, it is imperative that we offer solutions which are complementary and do not oppose one another. Sustainable intensification of agriculture has been proposed as a way to address hunger while also minimizing further environmental impact. However, the desire to raise productivity and yields has historically led to a degraded environment, reduced biodiversity and a reduction in ecosystem services (ES), with the greatest impacts affecting the poor. This paper proposes that the ES framework coupled with a policy response framework, for example Driver-Pressure-State-Impact-Response (DPSIR), can allow food security to be delivered alongside healthy ecosystems, which provide many other valuable services to humankind. Too often, agro-ecosystems have been considered as separate from other natural ecosystems and insufficient attention has been paid to the way in which services can flow to and from the agro-ecosystem to surrounding ecosystems. Highlighting recent research in a large multi-disciplinary project (ASSETS), we illustrate the ES approach to food security using a case study from the Zomba district of Malawi.