International Overview Research Articles

Local Living and Travel Time based Urbanism

ABSTRACT The concept of local living, whether in the form of 10-, 15-, 20- or 30-minute cities or walkable and healthy neighbourhoods, has become a central theme of Australian planning strategies. It is used to achieve a number of important objectives ranging from sustainability, public health, community and economic development. Despite the common use of this catch-all phrase, there are inconsistencies in its definition, underlying assumptions and objectives, its shaping of planning policy and the instruments used to measure its successful implementation. This paper provides a comparative international overview of the ways in which these more broadly-framed local living policies have been framed, and how they have been incorporated into strategic metropolitan plans for Australia’s capital cities. It is evident that approaches differ greatly, in terms of policy aims, objectives, their relationships to planning practice and other sectors and measures used to assess the success of implementation. The paper examines the salient differences and commonalities in these methodologies with a discussion of their implications for policy and research within varying socio-cultural and spatial contexts. It concludes with a discussion of the need for more specific and target-oriented strategies to overcome the implementation challenges in countries with car-dominated cities such as Australia.

Indigenous-Led Nature-Based Solutions for the Climate Crisis: Insights from Canada

This article provides an international and national overview of climate change and biodiversity frameworks and is focused on emerging evidence of Indigenous leadership and collaborations in Canada. After introducing the international context and describing the national policy landscape, we provide preliminary evidence documenting emerging national, regional, and local examples of Indigenous-led collaborative conservation projects and nature-based climate change solutions for the climate crisis. Based on our preliminary data, we suggest that Indigenous peoples and communities are well-positioned and currently have and will continue to play important roles in the protection, conservation management, and restoration of lands and waters in Canada and globally. These efforts are critical to the global mitigation, sequestration, and storage of greenhouse gases (GHGs) precipitating the climate crisis while also building adaptive resiliency to reduce impacts. Emerging Canadian evidence suggests that there are a diversity of co-benefits that Indigenous-led nature-based solutions to climate change and biodiversity protection bring, enabled by creating ethical space for reconciliation and conservation collaborations.

Tanning Bed Legislation for Minors: A Comprehensive International Comparison.

Tanning beds have been classified as carcinogenic to humans. As a result, many countries have enacted laws regulating the use of commercial tanning beds, including bans for minors. However, there is no international overview of the current legal status of access restrictions for minors that provides details on their specific design regarding age limits and possible exceptions to the statutory regulation. Therefore, we performed a comprehensive web search of current tanning bed legislation for minors on the three continents North America, Australia, and Europe. Our findings regarding the existence and concrete design of access restrictions are presented graphically, using maps. We found a wide variety of different legislations. In Australia, a total ban on tanning beds exists, while in New Zealand, tanning bed use is banned for minors. In Europe, about half of the countries have implemented a strict ban for minors. In North America, we found differences in the age limit for access restrictions between the states, provinces, and territories for those regions that implemented a ban for minors. In the United States, some states have rather “soft bans” that allow use by minors with different types of parental consent. The patchwork in legislation calls for harmonization. Therefore, our comparison is an important starting point for institutions such as the World Health Organization or the European Commission to advance their goals toward a harmonization of tanning bed legislation in general and for minors in particular.

The Rise of the Cultural Treaty: Diplomatic Agreements and the International Politics of Culture in the Age of Three Worlds

Beginning in the late 1950s, observers noted that states around the world were entering into cultural treaties—bilateral agreements promoting exchange and cooperation in a range of ‘cultural’ fields—at an accelerating rate. This article combines qualitative and quantitative approaches to offer an international overview of the growth in cultural treaty-making as a means of exploring the role of ‘culture’ in the conduct of interstate relations during the age of the Cold War and decolonization. The article first reconstructs the international history of how ‘cultural agreements’ were defined, and on that basis proposes a historically accurate way of categorizing them. Applying this categorization to data from the electronic World Treaty Index, it then presents a descriptive statistical analysis of how often, when, and by which states cultural agreements were signed between 1935 and 1980, identifying six major trends. The article concludes with a discussion of how to account, at the level of the international system, for these trends, suggesting that the mid-century rise of the cultural treaty reflected a distinctive historical conjuncture in which the statist and cultural-nationalist implications of such agreements made them seem a valuable diplomatic tool for certain states—to a degree not seen before or since.

Prevention of Surgical Site Infections in Spine Surgery: An International Survey of Clinical Practices Among Expert Spine Surgeons.

Questionnaire-based survey. Surgical site infection (SSI) is a common complication in spine surgery but universal guidelines for SSI prevention are lacking. The objectives of this study are to depict a global status quo on implemented prevention strategies in spine surgery, common themes of practice and determine key areas for future research. An 80-item survey was distributed among spine surgeons worldwide via email. The questionnaire was designed and approved by an International Consensus Group on spine SSI. Consensus was defined as more than 60% of participants agreeing to a specific prevention strategy. Four hundred seventy-two surgeons participated in the survey. Screening for Staphylococcus aureus (SA) is not common, whereas preoperative decolonization is performed in almost half of all hospitals. Body mass index (BMI) was not important for surgery planning. In contrast, elevated HbA1c level and hypoalbuminemia were often considered as reasons to postpone surgery. Cefazoline is the common drug for antimicrobial prophylaxis. Alcohol-based chlorhexidine is mainly used for skin disinfection. Double-gloving, wound irrigation, and tissue-conserving surgical techniques are routine in the operating room (OR). Local antibiotic administration is not common. Wound closure techniques and postoperative wound dressing routines vary greatly between the participating institutions. With this study we provide an international overview on the heterogeneity of SSI prevention strategies in spine surgery. We demonstrated a large heterogeneity for pre-, peri- and postoperative measures to prevent SSI. Our data illustrated the need for developing universal guidelines and for testing areas of controversy in prospective clinical trials.

Cannabis-related allergies: An international overview and consensus recommendations.

Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue.

HTA Training for Healthcare Professionals: International Overview of Initiatives Provided by HTA Agencies and Organizations.

BackgroundHealth Technology Assessment (HTA) is a multidisciplinary process that synthesizes, with a systematic, transparent, impartial and robust methodological approach, the main information on the medical, economic, ethical and social implications of the use and dissemination of a health technology. Its aim is to support decision-makers in identifying safe, effective, patient-centered and best-value health policies, in order to promote an equitable, efficient, and high-quality health system. Given the continued application of innovative technologies into clinical practice, healthcare professionals need to be able to adequately evaluate these technologies using evidence-based approaches such as HTA. Therefore, the implementation of training in HTA is crucial. The aim of this study was to investigate existing HTA training initiatives for healthcare professionals provided by international HTA agencies and organizations around the world.MethodsFrom March to November 2020, the websites of HTA agencies and organizations belonging to the European network for HTA (EUnetHTA) and to the International Network of Agencies for HTA (INAHTA), and the website of the HTA International (HTAi), were explored for identifying the HTA training initiatives directed to healthcare professionals. In addition, we screened the training initiatives proposed at European level by EUnetHTA as part of its Joint Actions and conducted in collaboration with its public-private partners. Specific keywords were searched in English and adapted to French, Portuguese, Spanish, Italian and German. Data extraction of the retrieved training initiatives was conducted from November 2020 to February 2021 and considered the following information: agency, country, website, coordinator, type of initiative, target, topic, main contents, and language.ResultsOut of 124 agencies/organizations/EUnetHTA public-private partners screened, only 21 provided training initiatives for healthcare professionals. A total of 55 training initiatives were analyzed, 85.5% of which were delivered at the European level and 14.5% at the international level. The countries with a greater number of courses were: Austria, Argentina, Spain, Portugal, and the United Kingdom. Twenty-one training initiatives focused on HTA application and methodology while 34 on specific HTA domains, particularly on the economic one. The technologies covered were mainly drugs.ConclusionsOur study revealed a limited number of HTA training programs targeting healthcare professionals. HTA supports the decision-making processes concerning the use and application of health technologies with scientific evidence. Indeed, training of healthcare professionals in this field should be a key driver in implementing evidence-based healthcare choices and through rigorous methodological approaches such as HTA, in order to ensure proper health governance and value-based application of technological innovations in clinical practice. Therefore, capacity building of healthcare professionals in this area should be enhanced by using appropriate and effective training initiatives and educational strategies.

Dance Therapy Today: An Overview of the Profession and Its Practice Around the World

Creative Arts Educ Ther (2021) 7(2):158–186 DOI: 10.15212/CAET/2021/7/13 Dance Therapy Today: An Overview of the Profession and Its Practice Around the World Abstract Humans have used dance as a healing art since the beginning of human history, but dance therapy has only begun to be recognized as a formal profession since the mid-1940s. At that time, dancers living in the USA began using dance as a therapeutic medium in health-care settings. Since then, the field has expanded across the world, with dance therapists now practicing in most countries. Professional associations have been established, training courses set up, and processes for registering therapists with government authorities implemented. This article provides an international overview of these developments. Detailed information about progress and challenges in the advancement of the dance therapy profession is offered across six world regions. Progress includes expansion of geographic range to countries where no formal training or networks exist, including many developing nations. Barriers to progress include lack of university-based accredited training and low numbers of professionals, making the establishment of a critical mass of practitioners difficult. Suggestions for future development of the profession internationally are made. Keywords: dance therapy, dance movement therapy (DMT), professional practice, training, registration 摘要 自人类历史开始以来, 人类就将舞蹈作为一种疗愈的艺术。但自 1940 年代中期以来, 舞蹈治疗才开始被认为是一种正式的职业。当时, 在美国的舞者开始在临床医疗环境中 使用舞蹈作为治疗媒介。从那时起, 该领域已经扩展到世界各地, 现在大多数国家都有 舞蹈治疗师在执业, 成立了专业协会, 开设了培训课程, 并实施了向政府当局注册治疗 师的程序。本文提供了这些发展的全球概述, 特别是在世界六个地区有关舞蹈治疗行业 发展和挑战的详情, 以及如何将地理范围扩大到没有正式专业培训或资源的国家, 包括 许多发展中国家。文章指出行业进步的主要障碍包括缺乏以大学为基础的学历教育和专 业人员数量限制, 使得难以建立足够的从业人员数量。对该行业在国际上的未来发展文 章提出了相关建议。 关键词： 舞蹈治疗, 舞蹈动作治疗, 专业实践, 培训, 注册

Non-medical cannabis use: international policies and outcomes overview. An outline for Portugal.

Introduction Cannabis is probably the most commonly used illicit drug. It is often regarded as a relatively nonharmful experience, even though evidence indicates otherwise. Legalization of non-medical cannabis, which has already taken place in several countries, is currently a controversial issue.Objective To provide an up-to-date overview of current models and policies and their outcomes that can inform future political decisions regarding non-medical cannabis use.Methods PubMed/MEDLINE and Google Scholar scientific databases were searched for articles written in English, Spanish, and Portuguese published between 1990 and December 2020. The reference lists of these articles were similarly used as bibliography sources. Gray literature was also included.Results While non-medical cannabis has been decriminalized in many countries, it has only been legalized in Uruguay, Canada, and some U.S. states. Several benefits of legalization were identified: decreases in cannabis-related crimes, law-enforcement and judicial costs; reduction in synthetic cannabis supply; decline in black economies and possible diminution of other illegal drug buying; and tax revenue increases. Reported legalization problems included: increases in cannabis use; cannabis-related disorders; and cannabis-related accidents and hospitalizations. Harm-reduction strategies are available in the scientific literature.Conclusion Growing, although incomplete, evidence exists to guide policy makers, minimize cannabis-related harm, and positively contribute to public health, if the legalization path is to be followed. Dialogue between legislators and science should be encouraged. There are more than a few legalization pathways, with diverse economic, social and health wellbeing effects. Public health-driven, instead of profit-driven models, seem to offer the most benefits regarding non-medical cannabis legalization. Most of the true public health effects of cannabis legalization are still unknown, for we are still in the early stages of these policies and their implications. Future studies should address the medium-to-long-term social, economic, and health consequences of legalization policies.

International Overview of Somatic Dysfunction Assessment and Treatment in Osteopathic Research: A Scoping Review.

Background: Osteopathic manipulative treatment (OMT) is a patient-centred, whole-body intervention aimed at enhance the person’s self-regulation. OMT interventions are focused on somatic dysfunctions (SD) that can be defined as an altered regulative function associated with inflammatory signs palpable in the body framework in different body regions. The conceptual model that sustains SD, as well as its usefulness for the osteopathic profession, is still being discussed by the osteopathic community. Understanding the role and the application of SD is the aim of this scoping review. Methods: A literature search was carried out through the main biomedical databases: Pubmed (Medline), Cochrane, Central (Cochrane), Embase, PEDro and Scopus. Grey literature was considered via Google Scholar and the Osteopathic Research Web. The review was prepared by referring to the “Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews” (PRISMA-ScR). Results: A total of 37,279 records were identified through database searching and other sources. After the duplicates were removed, 27,023 titles and abstracts were screened. A total of 1495 full-text articles were assessed for eligibility. The qualitative synthesis included 280 studies. Conclusions: Treating SD is an important part of osteopathic practice that varies from country to country. SD should be considered as a clinical value that assists in the clinical assessment and guides the decision-making process of osteopathic practitioners. Further studies should be designed to better understand why and how to choose the different assessment and intervention modalities to approach SD and to evaluate new osteopathic models.

Clinical reporting following the quantification of cerebrospinal fluid biomarkers in Alzheimer's disease: An international overview.

The current practice of quantifying cerebrospinal fluid (CSF) biomarkers as an aid in the diagnosis of Alzheimer's disease (AD) varies from center to center. For a same biochemical profile, interpretation and reporting of results may differ, which can lead to misunderstandings and raises questions about the commutability of tests. We obtained a description of (pre-)analytical protocols and sample reports from 40 centers worldwide. A consensus approach allowed us to propose harmonized comments corresponding to the different CSF biomarker profiles observed in patients. The (pre-)analytical procedures were similar between centers. There was considerable heterogeneity in cutoff definitions and report comments. We therefore identified and selected by consensus the most accurate and informative comments regarding the interpretation of CSF biomarkers in the context of AD diagnosis. This is the first time that harmonized reports are proposed across worldwide specialized laboratories involved in the biochemical diagnosis of AD.

Clinical reporting following the quantification of cerebrospinal fluid biomarkers in Alzheimer's disease: An international overview

AbstractBackgroundThe quantification of cerebrospinal fluid (CSF) biomarkers (Amyloid beta peptides [Aß1‐40 and Aß1‐42], t‐tau and p‐tau(181)) is progressively implemented in specialized laboratories as an aid for the multidisciplinary diagnosis of Alzheimer’s disease (AD). There is however a diversity of practices between centers related to pre‐analytical and analytical conditions, the calculation of ratios between analytes, the applied cut‐off, or the use of interpretation scales. Finally, for the same biochemical profile, the interpretation and reporting of results may differ from one center to another, which may raise questions about the commutability of the tests. So far, no consensus has been reached between the different laboratories involved to define the most appropriate conclusions/comments based on the profile of the quantified biomarkers.This work is an essential step towards a consensual harmonization of clinical reporting after CSF analysis in the context of AD diagnosis, as advocated by the "Biofluid Based Biomarkers PIA" working group of the Alzheimer's Association.MethodWe obtained, by means of a questionnaire, a description of the pre‐analytical and analytical protocols and examples of reporting from 40 centers located in 15 countries, i.e. in the majority of countries that have implemented clinical CSF tests for the diagnosis of AD. We then adopted a consensus approach to propose harmonized comments corresponding to different AD CSF biomarker profiles observed in patients.ResultPre‐analytical procedures were very similar, among the centers. Regarding the analytical part, more than 88% of the laboratories use automatized immunoassays and more than 83% measure Aß1‐40 and compute the Aß1‐42/Aß1‐40 ratio, in addition to the three core biomarkers (Aß1‐42, t‐tau and p‐tau(181)). The cut‐off values of biomarkers used by the different laboratories are widely dispersed. Delay before sending back the results is lower than 1 week in more than 34% of the laboratories.ConclusionOur results highlight the state of the art in terms of clinical CSF analysis in the context of AD. Harmonization of clinical reporting between different centers could benefit AD care, prevention and treatment strategies, as a common terminology will allow a better assessment of the prevalence of AD and the contribution of biochemical biomarkers to its diagnosis.

Guidance and Practice in Planning Cycling Facilities in Europe—An Overview

The provision of convenient, safe and seamless facilities for cyclists is one core success factor in promoting cycling as a mode of transport. Cycling infrastructures and planning philosophies differ greatly between countries, but there is no systematic overview or comparison of similarities and dissimilarities. The aim of this study is to provide an in-depth international overview of guidance material for cycling facilities in European countries and to develop recommendations for advancing provisions for cyclists. International guidance materials for cycling facilities along street sections are collated, systemised and compared. For researchers, the findings provide background information to better understand cycling behaviour and safety. For planners, the findings support their efforts to support cycling and to improve guidance materials. The results show that, in general, countries that are just beginning to promote cycling tend to offer a greater variety of cycling infrastructures in their guidance materials than more mature cycling countries. Countries differ in whether they prefer to put cyclists on the street level or on the sidewalk and whether they mix cyclists with other user groups in the same space. There was even greater variability among countries in the criteria for selecting types of cycling facilities than in the design characteristics (width, buffer zones, etc.).

International overview of phallometric testing for sexual offending behaviour and sexual risk.

Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.

Colored bicycle lanes and intersection treatments: International overview and best practices

The use of colored pavements for bicycle facilities represents an interesting strategy for supporting the implementation of a high-quality cycling network. The distinctive coloration of dedicated lanes, tracks or shared paths provides a clearly delineated route, making the infrastructure more attractive as well as legible and intuitive, especially through intersections and junctions. The additional emphasis resulting from the coloring enhances a change in the road users' behavior, but its safety effectiveness seems to be particularly related to several site-specific contextual features. Although some of these benefits are well established and multiple applications of colored pavements are widespread around the world, most of cycling design standards and guides, which are usually written only in the language of the country that drafted them and are often difficult to find, completely lack in technical recommendations and concepts regarding the use of color for cycling provisions. Thus, based on an extensive worldwide literature search from more than 80 official design guidelines, manuals and standards and 50 scientific articles, the authors have structured a guided overview of the state of the art/practice concerning the use of color for bike facilities at the international level, including the latest innovative and experimental schemes. The review is not intended to be a summary of manuals, but is conceived as a decision-makers’ and designers’ tool for a rational planning, construction, maintenance and management of colored cycling infrastructures, able to favor a cultural and technical interchange. After a first section in which the main locations where to use colored surfaces were highlighted (corridor or spot treatments), the commonly used colors (red, green and blue) have been identified, explaining the hierarchical and/or combined reasons (regulatory and legal limitations, visual-perceptual aspects and application/maintenance requirements) behind this choice. Finally, the different coloring techniques associated with the pavement materials have been described. • Color may be applied along dedicated bike lanes/tracks or only on potential conflict zones. • Different shades of red, green and blue are adopted worldwide for bicycle facilities. • Standards for color in cycling infrastructures are rarely established at a national level. • The choice of color depends on regulatory limitations, visual-perceptual aspects and application/maintenance requirements. • Colored pavements require a fully-fledged design and maintenance planning.

The law enforcement neurobiology of the „bika” (bull) drug

Recently, a new drug, called „bika” (bull) in Hungarian, received considerable media attention. The drug is notorious for driving its consumers into a deep state of delirium and even killing some of them. Law enforcement seizures revealed that the „bika” was in fact the synthetic cannabinoid called 4F-MDMB-BICA, which was identified for the first time in Hungary at the end of May 2020. Here we describe the effects and mechanism of action of the „bika”, identify its very close „relatives”, and provide a domestic and international overview of the specifics of its use. The main aim is to draw attention on the presence of this drug on the illegal market. The article is for police professionals who are not necessarily familiar with the neurobiology of drugs; therefore, we start with the basics and reveal neurobiological details gradually to provide means for understanding of this new drug.

Impact of Regional Climate Change on the Infrastructure and Operability of Railway Transport

Abstract This article considers various aspects of the impact of climate change on the railway infrastructure and operations. A brief international overview and the importance of this issue for Russia are given. Temperature effects, permafrost thawing, strong winds, floods and sea level rise, long-term effects, and adaptation measures are discussed. In conclusion, the authors give several recommendations on further research in this area, and highlight that special attention should be given to the areas in the Russian Federation which already face or might soon experience damage from storm events or flooding and sea level rise, namely Kaliningrad Region on the Baltic Sea, the area between Tuapse and Adler in Krasnodar Region on the Black Sea, and on Sakhalin Island from the side of the Sea of Japan.

The present and the future of academic libraries in the perception and opinions of its leaders. A brief international overview

This synthetic overview starts with a recent book: Conversations with Leading Academic and Research Library Directors: International Perspectives on Library Management, eds. Patrick Lo et al. (Cambridge, MA; Kidlington, UK: Chandos Publishing, 2019). The book collects thirty interviews with leaders of libraries belonging to institutions of high prestige in the international field. Important informative and narrative elements emerge from the conversations. Specifically, they concern the profiles of respondents, the challenges faced, the changes taking place (change management, digital innovation, new services, new ways of relating to researchers and students). In its second part, the article compares the results of this research project to other similar studies of the same period. The final part presents a few words about the future perspectives of academic libraries in the world.

Flattening the Curve of COVID-19 Vaccine Rejection-An International Overview.

Background: If globally implemented, a safe coronavirus disease 2019 (COVID-19) vaccination program will have broad clinical and socioeconomic benefits. However, individuals who anticipate that the coronavirus vaccine will bring life back to normality may be disappointed, due to the emerging antivaccination attitude within the general population. Methods: We surveyed a sample of adult Polish citizens (n = 1066), and compared it with the data on international COVID-19 vaccine reluctance. Results: In 20 national surveys, the vaccine averseness for the anticipated COVID-19 vaccine varied from meager (2–6% China) to very high (43%, Czech Republic, and 44%, Turkey) and in most countries was much higher than regular vaccination reluctance, which varies between 3% (Egypt) and 55% (Russia). Conclusions: These results suggest that a 67% herd immunity may be possible only if mandatory preventive vaccination programs start early and are combined with coordinated education efforts supported by legislative power and social campaigns.

Management of complex ventral hernias: results of an international survey.

BackgroundThe surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice.MethodsA survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Geographical location of practice, experience and annual volumes of the surgeons were compared.ResultsOf 408 surgeons, 234 (57.4 per cent) were practising in the USA, 116 (28.4 per cent) in Europe, and 58 (14.2 per cent) in other countries. Some 412 of 418 surgeons (98.6 per cent) performed open repair and 322 of 416 (77.4 per cent) performed laparoscopic repair. Most recommended preoperative work-up/lifestyle changes such as smoking cessation (319 of 398, 80.2 per cent) and weight loss (254 of 399, 63.7 per cent), but the consequences of these strategies varied. American surgeons and less experienced surgeons were stricter. Antibiotics were given at least 1 h before surgery by 295 of 414 respondents (71.3 per cent). Synthetic and biological meshes were used equally in contaminated primary hernia repair, whereas for recurrent hernia repair synthetic mesh was used in a clean environment and biological or no mesh in a contaminated environment. American surgeons and surgeons with less experience preferred biological mesh in contaminated environments significantly more often. Percutaneous drainage and antibiotics were the first steps recommended in treating mesh infection. In the presence of sepsis, most surgeons favoured synthetic mesh explantation and further repair with biological mesh.ConclusionThere remains a paucity of good-quality evidence in dealing with these hernias, leading to variations in management. Patient optimization and issues related to mesh choice and infections require well designed prospective studies.