Geotectonic evolution of the Zungeru region, Nigeria

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A global assessment of actors and their roles in climate change adaptation

An assessment of the global progress in climate change adaptation is urgently needed. Despite a rising awareness that adaptation should involve diverse societal actors and a shared sense of responsibility, little is known about the types of actors, such as state and non-state, and their roles in different types of adaptation responses as well as in different regions. Based on a large n-structured analysis of case studies, we show that, although individuals or households are the most prominent actors implementing adaptation, they are the least involved in institutional responses, particularly in the global south. Governments are most often involved in planning and civil society in coordinating responses. Adaptation of individuals or households is documented especially in rural areas, and governments in urban areas. Overall, understanding of institutional, multi-actor and transformational adaptation is still limited. These findings contribute to debates around ‘social contracts’ for adaptation, that is, an agreement on the distribution of roles and responsibilities, and inform future adaptation governance

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: A WSES observational study

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age > 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure < 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) < 90% in air, platelet count < 50,000 cells/mm3, and lactate > 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality. © 2019 The Author(s)