Age and growth rate estimations of the commercially fished gastropod Buccinum undatum

Calculating age and growth rate for the commercially important whelk, Buccinum undatum in the aid of fishery management has historically been undertaken using growth rings on the organic operculum. This is difficult due to their poor readability and confusion between two different sets of growth lines present. Recent work presented the calcium carbonate statolith as an alternative for age determination of B. undatum. Here we compare the use of statoliths and opercula, comparing their readability and creating growth curves for three distinct populations across the United Kingdom. Using these data, we also test the most appropriate growth equation to model this species. Lastly, we use oxygen isotope analysis of the shells to assign accurate ages to several individuals from each site. These data were used to test the accuracy of statolith and operculum ages. Statoliths, whilst more time consuming to process have improved clarity and accuracy compared with the opercula. This improved readability has highlighted that a Gompertz growth function should be used for populations of this species, when in past studies, von Bertalanffy is often used. Statoliths are a viable improvement to opercula when assessing B. undatum in the context of fishery monitoring and management

Age and growth rate estimations of the commercially fished gastropod Buccinum undatum

Calculating age and growth rate for the commercially important whelk, Buccinum undatum in the aid of fishery management has historically been undertaken using growth rings on the organic operculum. This is difficult due to their poor readability and confusion between two different sets of growth lines present. Recent work presented the calcium carbonate statolith as an alternative for age determination of B. undatum. Here we compare the use of statoliths and opercula, comparing their readability and creating growth curves for three distinct populations across the United Kingdom. Using these data, we also test the most appropriate growth equation to model this species. Lastly, we use oxygen isotope analysis of the shells to assign accurate ages to several individuals from each site. These data were used to test the accuracy of statolith and operculum ages. Statoliths, whilst more time consuming to process have improved clarity and accuracy compared with the opercula. This improved readability has highlighted that a Gompertz growth function should be used for populations of this species, when in past studies, von Bertalanffy is often used. Statoliths are a viable improvement to opercula when assessing B. undatum in the context of fishery monitoring and management

Importance of liver biopsy findings in immunosuppression management: Biopsy monitoring and working criteria for patients with operational tolerance (OT)

Obstacles to morbidity free long-term survival after liver transplantation (LT) include complications of immunosuppression (IS), recurrence of original disease and malignancies and unexplained chronic hepatitis and graft fibrosis. Many programs attempt to minimize chronic exposure to IS by reducing dosages and stopping steroids. A few programs have successfully weaned all IS without apparent adverse consequences in a highly selected group of recipients, but long-term follow-up is limited. Patients subjected to adjustments of IS are usually followed by serial liver chemistry tests, which are a relatively insensitive method of detecting allograft damage. Protocol biopsies have largely been abandoned for HCV-negative recipients, at least in part, because of an inability to integrate routine histopathologic findings into a rational clinical management algorithm. Recognizing a need to more precisely categorize and determine the clinical significance of findings in long-term biopsies, the Banff Working Group on Liver Allograft Pathology have reviewed literature, pooled experience, and are proposing working definitions for biopsy changes that would: 1) be conducive to lowering IS and compatible with operational tolerance (OT); and 2) raise concern for closer follow-up and perhaps increased IS during or after weaning of IS. Establishment of guidelines should help standardize analyses of the effects of various treatment and/or weaning protocols and more rigorously categorize patients that are assumed to show OT. Long term follow-up using standardized criteria will help to determine the consequences of lowering IS and define and determine the incidence and robustness of OT in liver allografts. Liver Transpl, 2012. © 2012 AASLD

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London