Riverine macrosystems ecology: sensitivity, resistance, and resilience of whole river basins with human alterations

Riverine macrosystems are described here as watershed-scale networks of connected and interacting riverine and upland habitat patches. Such systems are driven by variable responses of nutrients and organisms to a suite of global and regional factors (eg climate, human social systems) interacting with finer-scale variations in geology, topography, and human modifications. We hypothesize that spatial heterogeneity, connectivity, and asynchrony among these patches regulate ecological dynamics of whole networks, altering system sensitivity, resistance, and resilience. Long-distance connections between patches may be particularly important in riverine macrosystems, shaping fundamental system properties. Furthermore, the type, extent, intensity, and spatial configuration of human activities (eg land-use change, dam construction) influence watershed-wide ecological properties through effects on habitat heterogeneity and connectivity at multiple scales. Thus, riverine macrosystems are coupled social–ecological systems with feedbacks that influence system responses to environmental change and the sustainable delivery of ecosystem services

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Fuels treatment and wildfire effects on runoff from Sierra Nevada mixed-conifer forests

We applied an eco-hydrologic model (Regional Hydro-Ecologic Simulation System [RHESSys]), constrained with spatially distributed field measurements, to assess the impacts of forest-fuel treatments and wildfire on hydrologic fluxes in two Sierra Nevada firesheds. Strategically placed fuels treatments were implemented during 2011–2012 in the upper American River in the central Sierra Nevada (43 km2) and in the upper Fresno River in the southern Sierra Nevada (24 km2). This study used the measured vegetation changes from mechanical treatments and modelled vegetation change from wildfire to determine impacts on the water balance. The well-constrained headwater model was transferred to larger catchments based on geologic and hydrologic similarities. Fuels treatments covered 18% of the American and 29% of the Lewis catchment. Averaged over the entire catchment, treatments in the wetter central Sierra Nevada resulted in a relatively light vegetation decrease (8%), leading to a 12% runoff increase, averaged over wet and dry years. Wildfire with and without forest treatments reduced vegetation by 38% and 50% and increased runoff by 55% and 67%, respectively. Treatments in the drier southern Sierra Nevada also reduced the spatially averaged vegetation by 8%, but the runoff response was limited to an increase of less than 3% compared with no treatment. Wildfire following treatments reduced vegetation by 40%, increasing runoff by 13%. Changes to catchment-scale water-balance simulations were more sensitive to canopy cover than to leaf area index, indicating that the pattern as well as amount of vegetation treatment is important to hydrologic response