First evidence for Wollemi Pine-type pollen (Dilwynites: Araucariaceae) in South America

We report the first fossil pollen from South America of the lineage that includes the recently discovered, extremely rare Australian Wollemi Pine, Wollemia nobilis (Araucariaceae). The grains are from the late Paleocene to early middle Eocene Ligorio Márquez Formation of Santa Cruz, Patagonia, Argentina, and are assigned to Dilwynites, the fossil pollen type that closely resembles the pollen of modern Wollemia and some species of its Australasian sister genus, Agathis. Dilwynites was formerly known only from Australia, New Zealand, and East Antarctica. The Patagonian Dilwynites occurs with several taxa of Podocarpaceae and a diverse range of cryptogams and angiosperms, but not Nothofagus. The fossils greatly extend the known geographic range of Dilwynites and provide important new evidence for the Antarctic region as an early Paleogene portal for biotic interchange between Australasia and South America.Mike Macphail, Raymond J. Carpenter, Ari Iglesias, Peter Wil

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

The late Oligocene-early Miocene marine transgression of Patagonia

The most important Cenozoic marine transgression in Patagonia occurred during the late Oligocene–early Miocene when marine waters of Pacific and Atlantic origin flooded most of southern South America including the present Patagonian Andes between ~41° and 47° S. The age, correlation, and tectonic setting of the different marine formations deposited during this period are debated. However, recent studies based principally on U–Pb geochronology and Sr isotope stratigraphy, indicate that all of these units had accumulated during the late Oligocene–early Miocene. The marine transgression flooded a vast part of southern South America and, according to paleontological data, probably allowed for the first time in the history of this area a transient connection between the Pacific and Atlantic oceans. Marine deposition started in the late Oligocene–earliest Miocene (~26–23 Ma) and was probably caused by a regional event of extension related to major plate reorganization in the Southeast Pacific. Progressive extension and crustal thinning allowed a generalized marine flooding of Patagonia that reached its maximum extension at ~20 Ma. It was followed by a phase of compressive tectonics that started around 19–16 Ma and led to the growth of the Patagonian Andes. The youngest (~19–15 Ma) marine deposits that accumulated in the eastern Andean Cordillera and the extra-Andean regions are coeval with fluvial synorogenic deposits and probably had accumulated under a compressive regime.Fil: Encinas, Alfonso. Universidad de Concepción; ChileFil: Folguera Telichevsky, Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; ArgentinaFil: Bechis, Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio. Universidad Nacional de Río Negro. Instituto de Investigaciones en Diversidad Cultural y Procesos de Cambio; ArgentinaFil: Finger, Kennet. University of California; Estados UnidosFil: Zambrano, Patricio. Universidad Andrés Bello; ChileFil: Pérez, Andrés Felipe. Universidad de Concepción; ChileFil: Bernabé, Pablo. Universidad de Concepción; ChileFil: Tapia, Francisca. Universidad de Concepción; ChileFil: Riffo, Ricardo. Universidad de Concepción; ChileFil: Buatois, Luis Alberto. University of Saskatchewan; CanadáFil: Orts, Darío Leandro. Universidad Nacional de Río Negro. Sede Alto Valle. Instituto de Investigaciones en Paleobiología y Geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Nielsen, Sven Nikolaus. Universidad Austral de Chile. Instituto de Ciencias de la Tierra; ChileFil: Valencia, Víctor V.. Washington State University; Estados UnidosFil: Cuitiño, José Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Centro Nacional Patagónico. Instituto Patagónico de Geología y Paleontología; ArgentinaFil: Oliveros, Verónica. Universidad de Concepción; ChileFil: De Girolamo Del Mauro, Lizet. Universidad de Concepción; ChileFil: Ramos, Victor Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Estudios Andinos "Don Pablo Groeber". Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Estudios Andinos "Don Pablo Groeber"; Argentin