Response of Cocoa Trees (Theobroma cacao) to a 13-month Dessication Period in Sulawesi, Indonesia

In South-east Asia, ENSO-related droughts represent irregularly occuring hazards for agroforestry systems containing cocoa which are predicted to increase in severity with expected climate warming. To characterize the drought response of mature cocoa tree, we conducted the Sulawesi Throughfall Displacement Experiment in a shaded (Gliricidia sepium) cocoa agroforestry system in Central Sulawesi, Indonesia. Three large sub-canopy roofs were installed to reduce throughfall by about 80% over a 13-month period to test the hypotheses that (i) cocoa trees are sensitive to drought due to their shallow fine root system, and (ii)bean yield is more sensitive to drought than leaf or stem growth. As 83% of fine root (diameter 2mm) was located in the upper 40 cm of the soil, the cocoa tree examined had a very shallow root system. Cocoa and Gliricidia differed in their vertical rooting patterns, thereby reducing competition for water. Despite being exposed for several mnths to soil water contents close to the conventional wilting point, cocoa trees showed no significant decreases in leaf biomass, stem and branch wood production or fine root biomass. Possible causes are active osmotic adjusment in roots, mitigation of drought stress by shading from Gliricidia or other factors. By contrast, production of cocoa bean

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