32 research outputs found

    Methods for Quantifying Shallow-Water Habitat Availability in the Missouri River

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    As part of regulatory requirements for shallow-water habitat (SWH) restoration, the U.S. Army Corps of Engineers (USACE) completes periodic estimates of the quantity of SWH available throughout the lower 752 mi of the Missouri River. To date, these estimates have been made by various methods that consider only the water depth criterion for SWH. The USACE has completed estimates of SWH availability based on both depth and velocity criteria at four river bends (hereafter called reference bends), encompassing approximately 8 river miles within the lower 752 mi of the Missouri River. These estimates were made from the results of hydraulic modeling of water depth and velocity throughout each bend. Hydraulic modeling of additional river bends is not expected to be completed for deriving estimates of available SWH. Instead, future estimates of SWH will be based on the water depth criterion. The objective of this project, conducted by the Pacific Northwest National Laboratory for the USACE Omaha District, was to develop geographic information system methods for estimating the quantity of available SWH based on water depth only. Knowing that only a limited amount of water depth and channel geometry data would be available for all the remaining bends within the lower 752 mi of the Missouri River, the intent was to determine what information, if any, from the four reference bends could be used to develop methods for estimating SWH at the remaining bends. Specifically, we examined the relationship between cross-section channel morphology and relative differences between SWH estimates based on combined depth and velocity criteria and the depth-only criterion to determine if a correction factor could be applied to estimates of SWH based on the depth-only criterion. In developing these methods, we also explored the applicability of two commonly used geographic information system interpolation methods (TIN and ANUDEM) for estimating SWH using four different elevation data scenarios. Relative differences in SWH estimates among the four data scenarios were compared to illustrate estimation ranges

    2005 Annual Synthesis Report, Pallid Sturgeon Population Assessment Program and Associated Fish Community Monitoring for the Missouri River

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    Pallid sturgeon, Scaphirhynchus albus, have declined throughout the Missouri River since dam construction and inception of the Bank Stabilization and Navigation Project in 1912. Their decline likely is due to the loss and degradation of their natural habitat as a result of changes in the river’s structure and function, as well as the pallid sturgeon’s inability to adapt to these changes. The U. S. Army Corps of Engineers has been working with state and federal agencies to develop and conduct a Pallid Sturgeon Monitoring and Assessment Program (Program), with the goal of recovering pallid sturgeon populations. The Program has organized the monitoring and assessment efforts into distinct geographic segments, with state and federal resource management agencies possessing primary responsibility for one or more segment. To date, the results from annual monitoring have been reported for individual Program segments. However, monitoring results have not been summarized or evaluated for larger spatial scales, encompassing more than one Program segment. This report describes a summary conducted by the Pacific Northwest National Laboratory (PNNL) that synthesizes the 2005 sampling year monitoring results from individual segments

    Global economic burden of unmet surgical need for appendicitis

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    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 92492millionusingapproach1and92 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 95004millionusingapproach1and95 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

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    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

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

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    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

    Effects of Age at First Joining and Ewe Genotype on the Performance of Two-Tooth Ewes and That of Their Progeny to Slaughter

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    The effects of first-joining age (7 or 19 months) and genotype on ewe performance when joined to lamb at 2 years, and the performance of their progeny, were evaluated using 424 ewes, representing 3 genotypes: Belclare (Bel), Suffolk &times; Belclare (Suf &times; Bel) and Suffolk-type (&ge;75% Suffolk ancestry (Suf75)). Ewes were managed in a grass-based system. Ewes first joined at 7 months were lighter (p &lt; 0.01) at 19 months and immediately post lambing; otherwise, age at first joining had no effects (p &gt; 0.05) on ewes or their progeny and there were no important interactions with genotype. Bel and Suf &times; Bel had larger litters (p &lt; 0.001) and reared more lambs per ewe joined (p &lt; 0.01) than Suf75. Ewe genotype had no effect (p &gt; 0.05) on proportion failing to lamb, incidence of lambing assistance, lamb mortality, ewe survival to 31 months, or progeny performance. Increasing the body weight of ewes at 7 months of age increased the probability (p &lt; 0.02) of rearing 1 or more lambs at 2 years and there was no interaction with genotype. It is concluded that age at first joining had no negative impact on the performance of ewes or their progeny
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