How to assess cutover Peatland regeneration with combined organic matter indicators ?

International audienceWhen restored, cutover peatlands can favour biodiversity and carbon (C) sequestration. Within the EU program RECIPE, we aimed to identify combinations of site physico-chemical conditions, vegetation composition and below-ground microbiological characteristics that are beneficial to the long-term biodiversity and C sink function regeneration. To unreveal these characteristics, we assessed the bioindicator value of peat organic matter (OM) physico-chemistry from cutover peatlands at various stages of regeneration. Although OM continues to reflect disturbances in the catotelm deep peat, we show that along the chronosequence the regenerated peat tends to be biochemically and physically similar to the one from the non exploited area of the same site. The combination of several indicators provides an efficient assessment of ecological conditions and makes valuable for the management of cutover peatlands

River bed-load sediments and suspended particles: two different worlds for trace metals

International audienceAnthropogenic activities release many types of contaminants, such as trace metals, in the environment. For recent decades, numerous studies investigated their behavior, particularly in the dissolved phase. The transfer of contaminants adsorbed on the particulate phase received less attention although particulate matter also plays a key role in their propagation. One first difficulty is the variability of adsorption and releasing processes driven by both water physico-chemical conditions and contaminants properties. Secondly, there are different compartments in particulate phases, e.g. bed-load sediments and suspended particles, and the proportion of these two worlds is highly variable according to climate conditions (temperature, rainfall) and stream (hydro)geomorphological characteristics. In this context, our study investigates trace metal dynamics (Pb, Zn, Cu) in bed-load sediments and suspended particles from a small tributary of the Loire River, the Egoutier stream (Loiret, France). High spatial and temporal sampling frequency of the two fractions allowed to understand the patterns of trace metals transfer. Trends of trace metals contents observed in the particulate phase correspond to those in the dissolved one, except for Pb, the most insoluble compound. Contaminants concentrations and behaviors are driven both by trace metals order of solubility in bed-load sediments and suspended particles, and by external factors such as meteorological conditions, stream geochemistry and geomorphology. Besides, they are mostly adsorbed on iron and manganese oxides from suspended particles and on organic compounds from the bed-load sediments. Their temporal dynamics are controlled by seasons variabilities, notably rain amounts and humid periods, whereas their spatial distribution essentially reflects stream geomorphology, notably by the presence of a small pond creating a disconnection between the upstream and the downstream part of the watercourse and therefore two different patterns of transfert. Upstream, bed-load sediments contamination presents large fluctuations regulated by anthropogenic releases during dry periods and organic supplies during the humid ones, whereas homogeneous levels were observed downstream. In the suspended particles fraction, upstream higher contents are only correlated to humid periods, where more oxides are transported, while downstream transport is amplified by higher rain amounts

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

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

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