Reduced fire severity offers near-term buffer to climate-driven declines in conifer resilience across the western United States

Increasing fire severity and warmer, drier postfire conditions are making forests in the western United States (West) vulnerable to ecological transformation. Yet, the relative importance of and interactions between these drivers of forest change remain unresolved, particularly over upcoming decades. Here, we assess how the interactive impacts of changing climate and wildfire activity influenced conifer regeneration after 334 wildfires, using a dataset of postfire conifer regeneration from 10,230 field plots. Our findings highlight declining regeneration capacity across the West over the past four decades for the eight dominant conifer species studied. Postfire regeneration is sensitive to high-severity fire, which limits seed availability, and postfire climate, which influences seedling establishment. In the near-term, projected differences in recruitment probability between low- and high-severity fire scenarios were larger than projected climate change impacts for most species, suggesting that reductions in fire severity, and resultant impacts on seed availability, could partially offset expected climate-driven declines in postfire regeneration. Across 40 to 42% of the study area, we project postfire conifer regeneration to be likely following low-severity but not high-severity fire under future climate scenarios (2031 to 2050). However, increasingly warm, dry climate conditions are projected to eventually outweigh the influence of fire severity and seed availability. The percent of the study area considered unlikely to experience conifer regeneration, regardless of fire severity, increased from 5% in 1981 to 2000 to 26 to 31% by mid-century, highlighting a limited time window over which management actions that reduce fire severity may effectively support postfire conifer regeneration. © 2023 the Author(s)

COordination of Standards in MetabOlomicS (COSMOS): facilitating integrated metabolomics data access

Metabolomics has become a crucial phenotyping technique in a range of research fields including medicine, the life sciences, biotechnology and the environmental sciences. This necessitates the transfer of experimental information between research groups, as well as potentially to publishers and funders. After the initial efforts of the metabolomics standards initiative, minimum reporting standards were proposed which included the concepts for metabolomics databases. Built by the community, standards and infrastructure for metabolomics are still needed to allow storage, exchange, comparison and re-utilization of metabolomics data. The Framework Programme 7 EU Initiative ‘coordination of standards in metabolomics’ (COSMOS) is developing a robust data infrastructure and exchange standards for metabolomics data and metadata. This is to support workflows for a broad range of metabolomics applications within the European metabolomics community and the wider metabolomics and biomedical communities’ participation. Here we announce our concepts and efforts asking for re-engagement of the metabolomics community, academics and industry, journal publishers, software and hardware vendors, as well as those interested in standardisation worldwide (addressing missing metabolomics ontologies, complex-metadata capturing and XML based open source data exchange format), to join and work towards updating and implementing metabolomics standards

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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

State of the climate in 2018

In 2018, the dominant greenhouse gases released into Earth’s atmosphere—carbon dioxide, methane, and nitrous oxide—continued their increase. The annual global average carbon dioxide concentration at Earth’s surface was 407.4 ± 0.1 ppm, the highest in the modern instrumental record and in ice core records dating back 800 000 years. Combined, greenhouse gases and several halogenated gases contribute just over 3 W m−2 to radiative forcing and represent a nearly 43% increase since 1990. Carbon dioxide is responsible for about 65% of this radiative forcing. With a weak La Niña in early 2018 transitioning to a weak El Niño by the year’s end, the global surface (land and ocean) temperature was the fourth highest on record, with only 2015 through 2017 being warmer. Several European countries reported record high annual temperatures. There were also more high, and fewer low, temperature extremes than in nearly all of the 68-year extremes record. Madagascar recorded a record daily temperature of 40.5°C in Morondava in March, while South Korea set its record high of 41.0°C in August in Hongcheon. Nawabshah, Pakistan, recorded its highest temperature of 50.2°C, which may be a new daily world record for April. Globally, the annual lower troposphere temperature was third to seventh highest, depending on the dataset analyzed. The lower stratospheric temperature was approximately fifth lowest. The 2018 Arctic land surface temperature was 1.2°C above the 1981–2010 average, tying for third highest in the 118-year record, following 2016 and 2017. June’s Arctic snow cover extent was almost half of what it was 35 years ago. Across Greenland, however, regional summer temperatures were generally below or near average. Additionally, a satellite survey of 47 glaciers in Greenland indicated a net increase in area for the first time since records began in 1999. Increasing permafrost temperatures were reported at most observation sites in the Arctic, with the overall increase of 0.1°–0.2°C between 2017 and 2018 being comparable to the highest rate of warming ever observed in the region. On 17 March, Arctic sea ice extent marked the second smallest annual maximum in the 38-year record, larger than only 2017. The minimum extent in 2018 was reached on 19 September and again on 23 September, tying 2008 and 2010 for the sixth lowest extent on record. The 23 September date tied 1997 as the latest sea ice minimum date on record. First-year ice now dominates the ice cover, comprising 77% of the March 2018 ice pack compared to 55% during the 1980s. Because thinner, younger ice is more vulnerable to melting out in summer, this shift in sea ice age has contributed to the decreasing trend in minimum ice extent. Regionally, Bering Sea ice extent was at record lows for almost the entire 2017/18 ice season. For the Antarctic continent as a whole, 2018 was warmer than average. On the highest points of the Antarctic Plateau, the automatic weather station Relay (74°S) broke or tied six monthly temperature records throughout the year, with August breaking its record by nearly 8°C. However, cool conditions in the western Bellingshausen Sea and Amundsen Sea sector contributed to a low melt season overall for 2017/18. High SSTs contributed to low summer sea ice extent in the Ross and Weddell Seas in 2018, underpinning the second lowest Antarctic summer minimum sea ice extent on record. Despite conducive conditions for its formation, the ozone hole at its maximum extent in September was near the 2000–18 mean, likely due to an ongoing slow decline in stratospheric chlorine monoxide concentration. Across the oceans, globally averaged SST decreased slightly since the record El Niño year of 2016 but was still far above the climatological mean. On average, SST is increasing at a rate of 0.10° ± 0.01°C decade−1 since 1950. The warming appeared largest in the tropical Indian Ocean and smallest in the North Pacific. The deeper ocean continues to warm year after year. For the seventh consecutive year, global annual mean sea level became the highest in the 26-year record, rising to 81 mm above the 1993 average. As anticipated in a warming climate, the hydrological cycle over the ocean is accelerating: dry regions are becoming drier and wet regions rainier. Closer to the equator, 95 named tropical storms were observed during 2018, well above the 1981–2010 average of 82. Eleven tropical cyclones reached Saffir–Simpson scale Category 5 intensity. North Atlantic Major Hurricane Michael’s landfall intensity of 140 kt was the fourth strongest for any continental U.S. hurricane landfall in the 168-year record. Michael caused more than 30 fatalities and $25 billion (U.S. dollars) in damages. In the western North Pacific, Super Typhoon Mangkhut led to 160 fatalities and$6 billion (U.S. dollars) in damages across the Philippines, Hong Kong, Macau, mainland China, Guam, and the Northern Mariana Islands. Tropical Storm Son-Tinh was responsible for 170 fatalities in Vietnam and Laos. Nearly all the islands of Micronesia experienced at least moderate impacts from various tropical cyclones. Across land, many areas around the globe received copious precipitation, notable at different time scales. Rodrigues and Réunion Island near southern Africa each reported their third wettest year on record. In Hawaii, 1262 mm precipitation at Waipā Gardens (Kauai) on 14–15 April set a new U.S. record for 24-h precipitation. In Brazil, the city of Belo Horizonte received nearly 75 mm of rain in just 20 minutes, nearly half its monthly average. Globally, fire activity during 2018 was the lowest since the start of the record in 1997, with a combined burned area of about 500 million hectares. This reinforced the long-term downward trend in fire emissions driven by changes in land use in frequently burning savannas. However, wildfires burned 3.5 million hectares across the United States, well above the 2000–10 average of 2.7 million hectares. Combined, U.S. wildfire damages for the 2017 and 2018 wildfire seasons exceeded $40 billion (U.S. dollars)

Free-Living Turtles Are a Reservoir for Salmonella but Not for Campylobacter

Different studies have reported the prevalence of Salmonella in turtles and its role in reptile-associated salmonellosis in humans, but there is a lack of scientific literature related with the epidemiology of Campylobacter in turtles. The aim of this study was to evaluate the prevalence of Campylobacter and Salmonella in free-living native (Emys orbicularis, n=83) and exotic (Trachemys scripta elegans, n=117) turtles from 11 natural ponds in Eastern Spain. In addition, different types of samples (cloacal swabs, intestinal content and water from Turtle containers) were compared. Regardless of the turtle species, natural ponds where individuals were captured and the type of sample taken, Campylobacter was not detected. Salmonella was isolated in similar proportions in native (8.0±3.1%) and exotic (15.0±3.3%) turtles (p=0.189). The prevalence of Salmonella positive turtles was associated with the natural ponds where animals were captured. Captured turtles from 8 of the 11 natural ponds were positive, ranged between 3.0±3.1% and 60.0±11.0%. Serotyping revealed 8 different serovars among four Salmonella enterica subspecies: S. enterica subsp. enterica (n = 21), S. enterica subsp. salamae (n = 2), S. enterica subsp. diarizonae (n = 3), and S. enterica subsp. houtenae (n = 1). Two serovars were predominant: S. Thompson (n=16) and S. typhimurium (n=3). In addition, there was an effect of sample type on Salmonella detection. The highest isolation of Salmonella was obtained from intestinal content samples (12.0±3.0%), while lower percentages were found for water from the containers and cloacal swabs (8.0±2.5% and 3.0±1.5%, respectively). Our results imply that free-living turtles are a risk factor for Salmonella transmission, but do not seem to be a reservoir for Campylobacter. We therefore rule out turtles as a risk factor for human campylobacteriosis. Nevertheless, further studies should be undertaken in other countries to confirm these results.This work was supported by the Conselleria de Infraestructura, Territorio y Medio Ambiente for their assistance and financial support (Life09-Trachemys, Resolution 28/02/12 CITMA). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Marín, C.; Ingresa-Capaccioni, S.; González Bodí, S.; Marco Jiménez, F.; Vega Garcia, S. (2013). Free-Living Turtles Are a Reservoir for Salmonella but Not for Campylobacter. PLoS ONE. 8(8):1-6. https://doi.org/10.1371/journal.pone.0072350S1688(2012). The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food‐borne Outbreaks in 2010. EFSA Journal, 10(3). doi:10.2903/j.efsa.2012.2597Kapperud, G. (2003). Factors Associated with Increased and Decreased Risk of Campylobacter Infection: A Prospective Case-Control Study in Norway. American Journal of Epidemiology, 158(3), 234-242. doi:10.1093/aje/kwg139Mermin, J., Hutwagner, L., Vugia, D., Shallow, S., Daily, P., … Bender, J. (2004). Reptiles, Amphibians, and HumanSalmonellaInfection: A Population‐Based, Case‐Control Study. Clinical Infectious Diseases, 38(s3), S253-S261. doi:10.1086/381594De Jong, B., Andersson, Y., & Ekdahl, K. (2005). Effect of Regulation and Education on Reptile-associated Salmonellosis. Emerging Infectious Diseases, 11(3), 398-403. doi:10.3201/eid1103.040694NAKADAI, A., KUROKI, T., KATO, Y., SUZUKI, R., YAMAI, S., YAGINUMA, C., … HAYASHIDANI, H. (2005). Prevalence of Salmonella spp. in Pet Reptiles in Japan. Journal of Veterinary Medical Science, 67(1), 97-101. doi:10.1292/jvms.67.97Lafuente, S., Bellido, J. B., Moraga, F. A., Herrera, S., Yagüe, A., Montalvo, T., … Caylà, J. A. (2013). Salmonella paratyphi B and Salmonella litchfield outbreaks associated with pet turtle exposure in Spain. Enfermedades Infecciosas y Microbiología Clínica, 31(1), 32-35. doi:10.1016/j.eimc.2012.05.013Van PELT, W., de WIT, M. A. S., WANNET, W. J. B., LIGTVOET, E. J. J., WIDDOWSON, M. A., & van DUYNHOVEN, Y. T. H. P. (2003). Laboratory surveillance of bacterial gastroenteric pathogens in The Netherlands, 1991–2001. Epidemiology and Infection, 130(3), 431-441. doi:10.1017/s0950268803008392Havelaar, A. H., Haagsma, J. A., Mangen, M.-J. J., Kemmeren, J. M., Verhoef, L. P. B., Vijgen, S. M. C., … van Pelt, W. (2012). Disease burden of foodborne pathogens in the Netherlands, 2009. International Journal of Food Microbiology, 156(3), 231-238. doi:10.1016/j.ijfoodmicro.2012.03.029DOORDUYN, Y., VAN PELT, W., SIEZEN, C. L. E., VAN DER HORST, F., VAN DUYNHOVEN, Y. T. H. P., HOEBEE, B., & JANSSEN, R. (2007). Novel insight in the association between salmonellosis or campylobacteriosis and chronic illness, and the role of host genetics in susceptibility to these diseases. Epidemiology and Infection, 136(9), 1225-1234. doi:10.1017/s095026880700996xHAAGSMA, J. A., SIERSEMA, P. D., DE WIT, N. J., & HAVELAAR, A. H. (2010). Disease burden of post-infectious irritable bowel syndrome in The Netherlands. Epidemiology and Infection, 138(11), 1650-1656. doi:10.1017/s0950268810000531Allos, B. M., & Blaser, M. J. (1995). Campylobacter jejuni and the Expanding Spectrum of Related Infections. Clinical Infectious Diseases, 20(5), 1092-1101. doi:10.1093/clinids/20.5.1092Friedman, C. R., Hoekstra, R. M., Samuel, M., Marcus, R., Bender, J., … Shiferaw, B. (2004). Risk Factors for SporadicCampylobacterInfection in the United States: A Case‐Control Study in FoodNet Sites. Clinical Infectious Diseases, 38(s3), S285-S296. doi:10.1086/381598STUDAHL, A., & ANDERSSON, Y. (2000). Risk factors for indigenous campylobacter infection: a Swedish case-control study. Epidemiology and Infection, 125(2), 269-275. doi:10.1017/s0950268899004562NEIMANN, J., ENGBERG, J., MØLBAK, K., & WEGENER, H. C. (2003). A case–control study of risk factors for sporadic campylobacter infections in Denmark. Epidemiology and Infection, 130(3), 353-366. doi:10.1017/s0950268803008355DOORDUYN, Y., VAN DEN BRANDHOF, W. E., VAN DUYNHOVEN, Y. T. H. P., BREUKINK, B. J., WAGENAAR, J. A., & VAN PELT, W. (2010). Risk factors for indigenous Campylobacter jejuni and Campylobacter coli infections in The Netherlands: a case-control study. Epidemiology and Infection, 138(10), 1391-1404. doi:10.1017/s095026881000052xSchroter, M., Roggentin, P., Hofmann, J., Speicher, A., Laufs, R., & Mack, D. (2004). Pet Snakes as a Reservoir for Salmonella enterica subsp. diarizonae (Serogroup IIIb): a Prospective Study. Applied and Environmental Microbiology, 70(1), 613-615. doi:10.1128/aem.70.1.613-615.2004Van Meervenne, E., Botteldoorn, N., Lokietek, S., Vatlet, M., Cupa, A., Naranjo, M., … Bertrand, S. (2009). Turtle-associated Salmonella septicaemia and meningitis in a 2-month-old baby. Journal of Medical Microbiology, 58(10), 1379-1381. doi:10.1099/jmm.0.012146-0Williams, L. P. (1965). Pet Turtles as a Cause of Human Salmonellosis. JAMA: The Journal of the American Medical Association, 192(5), 347. doi:10.1001/jama.1965.03080180005001Feeley, J. C., & Treger, M. D. (1969). Penetration of Turtle Eggs by Salmonella braenderup. Public Health Reports (1896-1970), 84(2), 156. doi:10.2307/4593527Mermin, J., Hoar, B., & Angulo, F. J. (1997). Iguanas and Salmonella Marina Infection in Children: A Reflection of the Increasing Incidence of Reptile-associated Salmonellosis in the United States. PEDIATRICS, 99(3), 399-402. doi:10.1542/peds.99.3.399Rodgers, G. L., Long, S. S., Smergel, E., & Dampier, C. (2002). Salmonella Infection Associated With a Pet Lizard in Siblings With Sickle Cell Anemia: An Avoidable Risk. Journal of Pediatric Hematology/Oncology, 24(1), 75-76. doi:10.1097/00043426-200201000-00020Tu, Z.-C., Zeitlin, G., Gagner, J.-P., Keo, T., Hanna, B. A., & Blaser, M. J. (2004). Campylobacter fetus of Reptile Origin as a Human Pathogen. Journal of Clinical Microbiology, 42(9), 4405-4407. doi:10.1128/jcm.42.9.4405-4407.2004Hidalgo-Vila, J., Díaz-Paniagua, C., Pérez-Santigosa, N., de Frutos-Escobar, C., & Herrero-Herrero, A. (2008). Salmonella in free-living exotic and native turtles and in pet exotic turtles from SW Spain. Research in Veterinary Science, 85(3), 449-452. doi:10.1016/j.rvsc.2008.01.011Harris, J. R., Neil, K. P., Behravesh, C. B., Sotir, M. J., & Angulo, F. J. (2010). Recent Multistate Outbreaks of HumanSalmonellaInfections Acquired from Turtles: A Continuing Public Health Challenge. Clinical Infectious Diseases, 50(4), 554-559. doi:10.1086/649932Geue, L., & Löschner, U. (2002). Salmonella enterica in reptiles of German and Austrian origin. Veterinary Microbiology, 84(1-2), 79-91. doi:10.1016/s0378-1135(01)00437-0Sánchez-Jiménez, M. M., Rincón-Ruiz, P. A., Duque, S., Giraldo, M. A., Ramírez-Monroy, D. M., Jaramillo, G., & Cardona-Castro, N. (2011). Salmonella enterica in semi-aquatic turtles in Colombia. The Journal of Infection in Developing Countries, 5(05), 361-364. doi:10.3855/jidc.1126HEALTH SURVEY OF WILD AND CAPTIVE BOG TURTLES (CLEMMYS MUHLENBERGII) IN NORTH CAROLINA AND VIRGINIA. (2002). Journal of Zoo and Wildlife Medicine, 33(4), 311-316. doi:10.1638/1042-7260(2002)033[0311:hsowac]2.0.co;2Richards, J. M., Brown, J. D., Kelly, T. R., Fountain, A. L., & Sleeman, J. M. (2004). ABSENCE OF DETECTABLE SALMONELLA CLOACAL SHEDDING IN FREE-LIVING REPTILES ON ADMISSION TO THE WILDLIFE CENTER OF VIRGINIA. Journal of Zoo and Wildlife Medicine, 35(4), 562-563. doi:10.1638/03-070Hidalgo-Vila, J., Díaz-Paniagua, C., de Frutos-Escobar, C., Jiménez-Martínez, C., & Pérez-Santigosa, N. (2007). Salmonella in free living terrestrial and aquatic turtles. Veterinary Microbiology, 119(2-4), 311-315. doi:10.1016/j.vetmic.2006.08.012Acheson, D., & Allos, B. M. (2001). Campylobacter jejuni Infections: Update on Emerging Issues and Trends. Clinical Infectious Diseases, 32(8), 1201-1206. doi:10.1086/319760Briones, V., Tellez, S., Goyache, J., Ballesteros, C., del Pilar Lanzarot, M., Dominguez, L., & Fernandez-Garayzabal, J. F. (2004). Salmonella diversity associated with wild reptiles and amphibians in Spain. Environmental Microbiology, 6(8), 868-871. doi:10.1111/j.1462-2920.2004.00631.xMan, S. M. (2011). The clinical importance of emerging Campylobacter species. Nature Reviews Gastroenterology & Hepatology, 8(12), 669-685. doi:10.1038/nrgastro.2011.191Ugarte-Ruiz, M., Gómez-Barrero, S., Porrero, M. C., Álvarez, J., García, M., Comerón, M. C., … Domínguez, L. (2012). Evaluation of four protocols for the detection and isolation of thermophilic Campylobacter from different matrices. Journal of Applied Microbiology, 113(1), 200-208. doi:10.1111/j.1365-2672.2012.05323.xJeffrey, J. S., Tonooka, K. H., & Lozanot, J. (2001). Prevalence of Campylobacter spp. from Skin, Crop, and Intestine of Commercial Broiler Chicken Carcasses at Processing. Poultry Science, 80(9), 1390-1392. doi:10.1093/ps/80.9.1390Perko-Mäkelä, P., Isohanni, P., Katzav, M., Lund, M., Hänninen, M.-L., & Lyhs, U. (2009). A longitudinal study of Campylobacter distribution in a turkey production chain. Acta Veterinaria Scandinavica, 51(1). doi:10.1186/1751-0147-51-18Saelinger, C. A., Lewbart, G. A., Christian, L. S., & Lemons, C. L. (2006). Prevalence ofSalmonellaspp in cloacal, fecal, and gastrointestinal mucosal samples from wild North American turtles. Journal of the American Veterinary Medical Association, 229(2), 266-268. doi:10.2460/javma.229.2.266Chambers, D. L., & Hulse, A. C. (2006). Salmonella Serovars in the Herpetofauna of Indiana County, Pennsylvania. Applied and Environmental Microbiology, 72(5), 3771-3773. doi:10.1128/aem.72.5.3771-3773.2006Gaertner, J. P., Hahn, D., Jackson, J., Forstner, M. R. J., & Rose, F. L. (2008). Detection of Salmonellae in Captive and Free-Ranging Turtles Using Enrichment Culture and Polymerase Chain Reaction. Journal of Herpetology, 42(2), 223-231. doi:10.1670/07-1731.1Magnino, S., Colin, P., Dei-Cas, E., Madsen, M., McLauchlin, J., Nöckler, K., … Van Peteghem, C. (2009). Biological risks associated with consumption of reptile products. International Journal of Food Microbiology, 134(3), 163-175. doi:10.1016/j.ijfoodmicro.2009.07.001XIA, X., ZHAO, S., SMITH, A., MCEVOY, J., MENG, J., & BHAGWAT, A. (2009). Characterization of Salmonella isolates from retail foods based on serotyping, pulse field gel electrophoresis, antibiotic resistance and other phenotypic properties. International Journal of Food Microbiology, 129(1), 93-98. doi:10.1016/j.ijfoodmicro.2008.11.007Franco, A., Hendriksen, R. S., Lorenzetti, S., Onorati, R., Gentile, G., Dell’Omo, G., … Battisti, A. (2011). Characterization of Salmonella Occurring at High Prevalence in a Population of the Land Iguana Conolophus subcristatus in Galápagos Islands, Ecuador. PLoS ONE, 6(8), e23147. doi:10.1371/journal.pone.0023147Scheelings, T. F., Lightfoot, D., & Holz, P. (2011). PREVALENCE OF SALMONELLA IN AUSTRALIAN REPTILES. Journal of Wildlife Diseases, 47(1), 1-11. doi:10.7589/0090-3558-47.1.1Pasmans, F., Blahak, S., Martel, A., & Pantchev, N. (2008). Introducing reptiles into a captive collection: The role of the veterinarian. The Veterinary Journal, 175(1), 53-68. doi:10.1016/j.tvjl.2006.12.009Strohl, P., Tilly, B., Fremy, S., Brisabois, A., & Guerin-Faublee, V. (2004). Prevalence of Salmonella shedding in faeces by captive chelonians. Veterinary Record, 154(2), 56-58. doi:10.1136/vr.154.2.5

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)