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

Effects of varying food and density on reproduction in Diaptomus clavipes Schacht

Experiments were conducted to determine the effects of varying food and density on the egg production of the calanoid copepod, Diaptomus clavipes Schacht. These experiments were performed at both the population and organismic level. An attempt was also made to evaluate the feasibility of using a flow-through system to study the effects of various environmental factors on egg production in copepods. It was found that food supply was an important factor determining rate of clutch production, number of eggs per clutch, and size of individual eggs. As food supply decreased, both the rate of clutch production and the number of eggs per clutch decreased, but the size of individual eggs increased. During periods of extreme food shortage, not only did egg production cease, but also the production of spermatophores by males. When starved females were placed under optimum feeding conditions, they produced eggs within a few days and were producing maximally within two weeks. Egg production in the flow-through system was reduced, due primarily to food shortage. The trout chow solution which was used as food was inadequate because it was not directly utilized by the copepods

Fire and land Cover Change in the Palouse Prairie–Forest Ecotone, Washington and Idaho, USA

Background: Prairie–forest ecotones are ecologically important for biodiversity and ecological processes. While these ecotones cover small areas, their sharp gradients in land cover promote rich ecological interaction and high conservation value. Our objective was to understand how historical and current fire occurrences and human development influenced the Palouse Prairie–forest ecotone. We used General Land Office survey field notes about the occurrence of bearing trees to locate historical (1870s to 1880s) prairie, pine savanna, and forest at the eastern edge of the bioregion. We combined LANDFIRE Existing Vegetation classes to contrast historical land cover with current land cover. We reconstructed historical fire occurrence (1650 to 1900) from fire-scarred trees. We used fire and lightning records from 1992 to 2015 to interpret the role of people and lightning. Results: Historically, the ecotone was a matrix of prairie with extensive savanna and some forest. More than half of the ecotone area was prairie, which is now dominated by agriculture, with some residential development. The 16% of the landscape that was pine savanna is now forest or shrubs, agriculture, perennial vegetation under the Conservation Reserve Program, or developed; no savanna now exists. Forests covered 12% of the ecotone and these are still mostly forest. Fires were historically frequent, occurring on average every 5 to 8 years at most sites. Lightning was not frequent but could likely have been sufficient to ignite fires that could spread readily given the rolling terrain and long fire season. Conclusions: Fire was far more frequent historically than currently. Conservation, restoration, and other ongoing land-use changes will likely result in more continuous vegetation and hence fuel for fires. Lightning and people may ignite fires that therefore spread readily in the future. Understanding the past and potential future of fire in the Palouse Prairie bioregion may help us live with fire while conserving ecological values here and in similar prairie–forest ecotones