What do you mean, ‘megafire’?

BACKGROUND : ‘Megafire’ is an emerging concept commonly used to describe fires that are extreme in terms of size, behaviour, and/or impacts, but the term’s meaning remains ambiguous. APPROACH : We sought to resolve ambiguity surrounding the meaning of ‘megafire’ by conducting a structured review of the use and definition of the term in several languages in the peer-reviewed scientific literature. We collated definitions and descriptions of megafire and identified criteria frequently invoked to define megafire. We recorded the size and location of megafires and mapped them to reveal global variation in the size of fires described as megafires. RESULTS : We identified 109 studies that define the term ‘megafire’ or identify a megafire, with the term first appearing in the peer-reviewed literature in 2005. Seventy-one (~65%) of these studies attempted to describe or define the term. There was considerable variability in the criteria used to define megafire, although definitions of megafire based on fire size were most common. Megafire size thresholds varied geographically from > 100–100,000 ha, with fires > 10,000 ha the most common size threshold (41%, 18/44 studies). Definitions of megafire were most common from studies led by authors from North America (52%, 37/71). We recorded 137 instances from 84 studies where fires were reported as megafires, the vast majority (94%, 129/137) of which exceed 10,000 ha in size. Megafires occurred in a range of biomes, but were most frequently described in forested biomes (112/137, 82%), and usually described single ignition fires (59% 81/137). CONCLUSION : As Earth’s climate and ecosystems change, it is important that scientists can communicate trends in the occurrence of larger and more extreme fires with clarity. To overcome ambiguity, we suggest a definition of megafire as fires > 10,000 ha arising from single or multiple related ignition events. We introduce two additional terms – gigafire (> 100,000 ha) and terafire (> 1,000,000 ha) – for fires of an even larger scale than megafires.DATA AVAILABILITY STATEMENT: A list of the references from which the data were extracted can be found in the Appendix A: Data sources. The data used in this study are openly available at zenodo.org: https://doi.org/10.5281/zenodo.6252145.Threatened Species Recovery Hub; NSW Bushfire Risk Management Research Hub; Australian Wildlife Society; World Wildlife Fund.http://wileyonlinelibrary.com/journal/gebZoology and Entomolog

The astrobiology primer: An outline of general knowledge - Version 1, 2006

Peer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Platelet versus fresh frozen plasma transfusion for coagulopathy in cardiac surgery patients.

BackgroundPlatelets (PLTS) and fresh frozen plasma (FFP) are often transfused in cardiac surgery patients for perioperative bleeding. Their relative effectiveness is unknown.MethodsWe conducted an entropy-weighted retrospective cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database. All adults undergoing cardiac surgery between 2005-2021 across 58 sites were included. The primary outcome was operative mortality.ResultsOf 174,796 eligible patients, 15,360 (8.79%) received PLTS in the absence of FFP and 6,189 (3.54%) patients received FFP in the absence of PLTS. The median cumulative dose was 1 unit of pooled platelets (IQR 1 to 3) and 2 units of FFP (IQR 0 to 4) respectively. After entropy weighting to achieve balanced cohorts, FFP was associated with increased perioperative (Risk Ratio [RR], 1.63; 95% Confidence Interval [CI], 1.40 to 1.91; PConclusionIn perioperative bleeding in cardiac surgery patient, platelets are associated with a relative mortality benefit over FFP. This information can be used by clinicians in their choice of procoagulant therapy in this setting