Red de reservas marinas para la Región de las Grandes Islas, Golfo de California: protocolo del proyecto de planeación y reporte de los talleres del equipo de planeación [Marine reserves network for the Midriff Islands Region, Gulf of California, Mexico: planning protocol and progress report to the WWF Mexico & Carlos Slim Foundation Alliance]

La Región de las Grandes Islas (RGI), localizada en el acuario del mundo, el Golfo de California, es reconocida a nivel mundial por su espectacular belleza, diversidad y productividad; en ocasiones se le ha denominada como "las Galápagos del Hemisferio Norte" (Figura 1). En sus 45 islas, incluyendo las dos más grandes de México, Tiburón e Isla Ángel de la Guarda, se han registrado más de 400 especies de plantas, anfibios, reptiles y mamíferos terrestres, algunas de ellas endémicas a una o varias de las islas. En algunas de estas islas, como Rasa y San Pedro Mártir, llegan a anidar cientos de miles de aves marinas. Alrededor de este gran archipiélago, se pueden observar hasta 23 especies de mamíferos marinos, incluyendo la súper agregación de cachalotes en la cuenca San Pedro Mártir. Así como también es un sitio usado por cinco especies de tortugas marinas para hibernar y alimentarse. [English] In collaboration with researchers, agencies and NGOs, we aim to guide the design and implementation of a network of marine reserves for Midriff Islands, Gulf of California, a marine conservation hotspot. The area is one of the most important fishing regions in Mexico and livelihoods of coastal communities are threatened by depletion of fish stocks and climate change. The project aims to develop a practical approach to design networks of marine reserves that consider ecological connectivity and the effects of climate change. The project is an example of interdisciplinary and collaborative applied research, including over 25 researchers and managers from NGOs (COBI, Pronatura), universities (James Cook University, The University of Queensland, Arizona State University, SCRIPPS, The University of Arizona), and national (Mexico’s Commissions for Protected Areas and Biodiversity) and international agencies (NOAA)

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

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

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)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Epiflora and epifauna of natural and artificially stabilized maerl beds

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Spatial and biogeographic characterization of macroalgal assemblages from Bahía del Rincón, Baja California Sur, Mexico.

Se caracterizó la flora marina de la zona de Bahía del Rincón - La Rivera por medio de prospecciones intensivas en diferentes localidades a varias profundidades. Además, se realizó un análisis intenso de la literatura y por este mismo medio la determinación de las afinidades geográficas de las especies. En total se encontraron 72 especies,donde la mayor proporción (62%) correspondió a las algas rojas. En el caso de las afinidades biogeográficas se observó que la mayor proporción varió en función de la división, donde para algas cafés las predominantes fueron de naturaleza tropical/endémica y para las algas rojas fueron las templadas/cosmopolitas. Espacialmente se encontró una alta similitud entre las zonas someras estudiadas más no así entre las someras y profundas donde existen diferencias significativas. En el caso de la zona intermareal se determinaron diferencias significativas con áreas submareales y entre sitios de la zona somera y profunda basados en las abundancias de los principales taxa. Con base en los resultados se sugiere que existen diferencias verticales en reclutamiento y desarrollo de las poblaciones en relación a su distribución.Macroalgal studies in Baja California Sur have dealt mainly with occurrence and seasonality, but some areas are poorly known even for these basic data. Bahía del Rincón-La Rivera is an important high-productivity fisheries area where coastal infrastructure development is under way. A spatial characterization of the marine flora from Bahía del Rincón-La Rivera was done by intensive sampling at different depths and localities with skin and SCUBA diving. At least 500m2 were surveyed in each site. Additionally, quantitative sampling was done in ten random 25 cm2 quadrates per site. In the intertidal section, density and cover estimates were used. We also investigated the historical records and geographical affinities. A total of 72 species were identified (most were red algae: 62%). We found no general trend in the biogeographical affinities, which varied with each taxonomic group. Most brown algae species were tropical-endemic; red algae temperatecosmopolite and green algae tropical-cosmopolite. In the spatial assemblage structure we found a high similarity between the intertidal areas, but a low similarity in shallow or deeper areas (3-5 m). This pattern was the same when we compared the abundance of the main species. We suggest that there are significant spatial differences in recruitment and development of the assemblages in relation to vertical distribution (depth) and position along the shore. There is a clear-cut Gelidium-Jania belt in the intertidal zone and a Padina-Dictyota belt below the low tide. Sporadic and year-round species occur in the intertidal zone, annual and perennial species below the low tide line. Sites differ in recruitment and this affects the abundance of other species (such as coraline and Caulerpa species). Temperature and sedimentation affect seasonality, but community structure is relatively constant throughout the year