A new approach to scoring systems to improve identification of acute medical admissions that will require critical care

Removal of the intensive care unit (ICU) at the Vale of Leven Hospital mandated the identification and transfer out of those acute medical admissions with a high risk of requiring ICU. The aim of the study was to develop triaging tools that identified such patients and compare them with other scoring systems. The methodology included a retrospective analysis of physiological and arterial gas measurements from 1976 acute medical admissions produced PREEMPT-1 (PRE-critical Emergency Medical Patient Triage). A simpler one for ambulance use (PREAMBLE-1 [PRE-Admission Medical Blue-Light Emergency]) was produced by the addition of peripheral oxygen saturation to a modification of MEWS (Modified Early Warning Score). Prospective application of these tools produced a larger database of 4447 acute admissions from which logistic regression models produced PREEMPT-2 and PREAMBLE-2, which were then compared with the original systems and seven other early warning scoring systems. Results showed that in patients with arterial gases, the area under the receiver operator characteristic curve was significantly higher in PREEMPT-2 (89·1%) and PREAMBLE-2 (84.4%) than all other scoring systems. Similarly, in all patients, it was higher in PREAMBLE-2 (92·4%) than PREAMBLE-1 (88·1%) and the other scoring systems. In conclusion, risk of requiring ICU can be more accurately predicted using PREEMPT-2 and PREAMBLE-2, as described here, than by other early warning scoring systems developed over recent years

Hydroclimate variability was the main control on fire activity in northern Africa over the last 50,000 years

North Africa features some of the most frequently burnt biomes on Earth, including the semi-arid grasslands of the Sahel and wetter savannas immediately to the south. Natural fires are fuelled by rapid biomass production during the wet season, its desiccation during the dry season and ignition by frequent dry lightning strikes. Today, fire activity decreases markedly both to the north of the Sahel, where rainfall is extremely low, almost eliminating biomass over the Sahara, and to the south where forest biomes are too wet to burn. Over the last glacial cycle, rainfall and vegetation cover over northern Africa varied dramatically in response to gradual astronomically-forced insolation change, changes in atmospheric carbon dioxide levels, and abrupt cooling events over the North Atlantic Ocean associated with the reorganisation of Meridional Overturning Circulation (MOC). Here we report the results of a study into the impact of these climate changes on fire activity in northern African over the last 50,000 years (50 kyr). Our reconstructions come from marine sediments with strong age control that provide an uninterrupted record of charcoal particles exported from the African continent. We studied three sites on a latitudinal transect along the northwest African margin between 21 and 9°N. Our sites exhibit a distinct latitudinal relationship between past changes in rainfall and fire activity. At the southernmost site (GeoB9528-3, 9°N), fire activity decreased during intervals of increasing humidity, while our northernmost site (ODP Site 658, 21°N) clearly demonstrates the opposite relationship. The site in the middle of our transect, offshore of the present day southern Sahel today (GeoB9508-5, 15°N), exhibits a “Goldilocks” relationship between fire activity and hydroclimate, wherein charcoal fluxes peak under intermediate rainfall climate conditions and are supressed by transition to more arid or more humid conditions. Our results are remarkably consistent with the predictions of the intermediate fire-productivity hypothesis developed in conceptual macroecological models and supported by empirical evidence of modern day fire activity. Feedback processes operating between fire, climate and vegetation are undoubtedly complex but temperature is suggested to be the main driver of temporal change in fire activity globally, with the precipitation-evaporation balance perhaps a secondary influence in the Holocene tropics. However, there is only sparse coverage of Africa in the composite records upon which those interpretations are based. We conclude that hydroclimate (not temperature) exerted the dominant control on burning in the tropics of northern Africa well before the Holocene (from at least 50 ka)

Biological and geophysical feedbacks with fire in the Earth system

Roughly 3% of the Earth's land surface burns annually, representing a critical exchange of energy and matter between the land and atmosphere via combustion. Fires range from slow smouldering peat fires, to low-intensity surface fires, to intense crown fires, depending on vegetation structure, fuel moisture, prevailing climate, and weather conditions. While the links between biogeochemistry, climate and fire are widely studied within Earth system science, these relationships are also mediated by fuels—namely plants and their litter—that are the product of evolutionary and ecological processes. Fire is a powerful selective force and, over their evolutionary history, plants have evolved traits that both tolerate and promote fire numerous times and across diverse clades. Here we outline a conceptual framework of how plant traits determine the flammability of ecosystems and interact with climate and weather to influence fire regimes. We explore how these evolutionary and ecological processes scale to impact biogeochemical and Earth system processes. Finally, we outline several research challenges that, when resolved, will improve our understanding of the role of plant evolution in mediating the fire feedbacks driving Earth system processes. Understanding current patterns of fire and vegetation, as well as patterns of fire over geological time, requires research that incorporates evolutionary biology, ecology, biogeography, and the biogeosciences

A 350‐million‐year legacy of fire adaptation among conifers

1. Current phylogenetic evidence shows that fire began shaping the evolution of land plants 125 Ma, although the fossil charcoal record indicates that fire has a much longer history (>350 Ma). Serotiny (on-plant seed storage) is generally accepted as an adaptation to fire among woody plants. 2. We developed a conceptual model of the requirements for the evolution of serotiny, and propose that serotiny is only expressed in the presence of a woody rachis as supporting structure, compact scales covering seeds as protective structure, seed wing as dispersal structure, and crown fire as the agent of selection and mechanism for seed release. This model is strongly supported by empirical data for modern ecosystems. 3. We reconstructed the evolutionary history of intrinsic structural states required for the expression of serotiny in conifers, and show that these were diagnostic for early (‘transitional’) conifers from 332 Ma (late-Carboniferous). 4. We assessed the likely flammable characteristics of early conifers and found that scale-leaved conifers burn rapidly and with high intensity, supporting the idea that crown fire regimes may have dominated early conifer ecosystems. 5. Synthesis. Coupled with strong evidence for frequent fire throughout the Permian-Carboniferous and fossil evidence for other fire-related traits, we conclude that many early conifers were serotinous in response to intense crown fires, indicating that fire may have had a major impact on the evolution of plant traits as far back as 350 Ma