Late Ordovician brachiopods from the Selety River basin, North Central Kazakhstan

A medium−diversity fauna of late Ordovician rhynchonelliformean brachiopods occurs in the Tauken Formation (upper Caradoc–lowermost Ashgill) of north Central Kazakhstan.It demonstrates close similarity to the approximately contemporaneous faunas characteristic of shallow clastic shelves (BA 2–3) of the Chingiz and Chu−Ili ranges (both in Kazakhstan) and South China, but is characterized by a high proportion of endemic new species, including Tetraphalerella bestiubensis sp.nov., Glyptomena kaskolica sp.nov., Dinorthis taukensis sp.nov., Rhynchotrema seletensis sp.nov., and Nalivkinia (Pronalivkinia)zvontsovisp.nov.The abundance of Rhynchotrema is somewhat unusual by comparison with faunas from other Kazakhstanian terranes, where rhynchonellides of the family Ancistrorhynchidae are usually dominant in near−shore biofacies.The occurrence of the atrypides Sulcatospira and early Nalivkinia demonstrates a clear biogeographical linkage with approximately contemporaneous faunas of South China

Organisational factors and mortality after an emergency laparotomy: multilevel analysis of 39 903 National Emergency Laparotomy Audit patients

BACKGROUND: Studies across healthcare systems have demonstrated between-hospital variation in survival after an emergency laparotomy. We postulate that this variation can be explained by differences in perioperative process delivery, underpinning organisational structures, and associated hospital characteristics. METHODS: We performed this nationwide, registry-based, prospective cohort study using data from the National Emergency Laparotomy Audit organisational and patient audit data sets. Outcome measures were all-cause 30- and 90-day postoperative mortality. We estimated adjusted odds ratios (ORs) for perioperative processes and organisational structures and characteristics by fitting multilevel logistic regression models. RESULTS: The cohort comprised 39 903 patients undergoing surgery at 185 hospitals. Controlling for case mix and clustering, a substantial proportion of between-hospital mortality variation was explained by differences in processes, infrastructure, and hospital characteristics. Perioperative care pathways [OR: 0.86; 95% confidence interval (CI): 0.76–0.96; and OR: 0.89; 95% CI: 0.81–0.99] and emergency surgical units (OR: 0.89; 95% CI: 0.80–0.99; and OR: 0.89; 95% CI: 0.81–0.98) were associated with reduced 30- and 90-day mortality, respectively. In contrast, infrequent consultant-delivered intraoperative care was associated with increased 30- and 90-day mortality (OR: 1.61; 95% CI: 1.01–2.56; and OR: 1.61; 95% CI: 1.08–2.39, respectively). Postoperative geriatric medicine review was associated with substantially lower mortality in older (≥70 yr) patients (OR: 0.35; 95% CI: 0.29–0.42; and OR: 0.64; 95% CI: 0.55–0.73, respectively). CONCLUSIONS: This multicentre study identified low-technology, readily implementable structures and processes that are associated with improved survival after an emergency laparotomy. Key components of pathways, perioperative medicine input, and specialist units require further investigation