Response of a Lake Michigan coastal lake to anthropogenic catchment disturbance

A paleolimnological investigation of post-European sediments in a Lake Michigan coastal lake was used to examine the response of Lower Herring Lake to anthropogenic impacts and its role as a processor of watershed inputs. We also compare the timing of this response with that of Lake Michigan to examine the role of marginal lakes as ‘early warning’ indicators of potential changes in the larger connected system and their role in buffering Lake Michigan against anthropogenic changes through biotic interactions and material trapping. Sediment geochemistry, siliceous microfossils and nutrient-related morphological changes in diatoms, identified three major trophic periods in the recent history of the lake. During deforestation and early settlement (pre-1845–1920), lake response to catchment disturbances results in localized increases in diatom abundances with minor changes in existing communities. In this early phase of disturbance, Lower Herring Lake acts as a sediment sink and a biological processor of nutrient inputs. During low-lake levels of the 1930s, the lake goes through a transitional period characterized by increased primary productivity and a major shift in diatom communities. Post-World War II (late 1940s–1989) anthropogenic disturbances push Lower Herring Lake to a new state and a permanent change in diatom community structure dominated by Cyclotella comensis . The dominance of planktonic summer diatom species associated with the deep chlorophyll maximum (DCM) is attributed to epilimnetic nutrient depletion. Declining Si:P ratios are inferred from increased sediment storage of biogenic silica and morphological changes in the silica content of Aulacoseira ambigua and Stephanodiscus niagarae . Beginning in the late 1940s, Lower Herring Lake functions as a biogeochemical processor of catchment inputs and a carbon, nutrient and silica sink. Microfossil response to increased nutrients and increased storage of biogenic silica in Lower Herring Lake and other regional embayments occur approximately 20–25 years earlier than in a nearby Lake Michigan site. Results from this study provide evidence for the role of marginal lakes and bays as nutrient buffering systems, delaying the impact of anthropogenic activities on the larger Lake Michigan system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43091/1/10933_2004_Article_1688.pd

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy