Climatic significance of the marginalization of Scots pine (Pinus sylvestris L.) c. 2500 BC at White Moss, south Cheshire, UK

Subfossil wood from White Moss, south Cheshire, has become the focus of palaeoenvironmental research employing not only conventional coring, pollen analysis, radiocarbon dating and dendrochronology on pine and oak, but also the exhumation of in situ peat areas and dendroecology of the pine ring-width records. Initial dendrochronological research at the site yielded five pine chronologies dating from 3520 to 2462 cal. BC. These and other data indicate three episodes of pine colonization of the mire in the period between 3643 and 1740 cal. BC. Comparison of the pollen and spore records suggest that pine became marginalized at the site c. 2500 cal. BC after successive episodes of increased wetness, and this may represent a staged response to climatic deterioration. Two oak chronologies were dated by reference to the Belfast and to English oak master chronologies to 3228-2898 BC and 2190-1891 BC, respectively, showing the possible co-existence of pine and oak on the mire for part of the time. Further dendrochronological work on subfossil pine at the site resulted in a chronology (WM4) that was cross-matched with pine from elsewhere in England, and subsequently dated absolutely to 2881-2559 BC. Detailed dendroecological information, such as fire episodes and periods of environmental stress indicated in the tree-ring records, have been assigned, precisely and accurately, to calendar years in prehistory. The detailed data show the potential for both dendroecological and wider palaeoclimatic and palaeoenvironmental information that may become available from prehistoric bog-pine chronologies, which might then permit precise correlation and comparisons of proxy-climate data between sites

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society