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

Tectonic Reconstructions of the Southernmost Andes and the Scotia Sea During the Opening of the Drake Passage

Study of the tectonic development of the Scotia Sea region started with basic lithological and structural studies of outcrop geology in Tierra del Fuego and the Antarctic Peninsula. To nineteenth- and early twentieth-century geologists, the results of these studies suggested the presence of a submerged orocline running around the margins of the Scotia Sea. Subsequent increases in detailed knowledge about the fragmentary outcrop geology from islands distributed around the margins of the Scotia Sea, and later their interpretation in the light of the plate tectonic paradigm led to large modifications in the hypothesis such that by the present day the concept of oroclinal bending in the region persists only in vestigial form. Of the early comparative lithostratigraphic work in the region, only the likenesses between Jurassic–Cretaceous basin floor and fill sequences in South Georgia and Tierra del Fuego are regarded as strong enough to be useful in plate kinematic reconstruction by permitting the interpretation of those regions’ contiguity in mid-Mesozoic times. Marine and satellite geophysical data sets reveal features of the remaining, submerged, 98 % of the Scotia Sea region between the outcrops. These data enable a more detailed and quantitative approach to the region’s plate kinematics. In contrast to long-used interpretations of the outcrop geology, these data do not prescribe the proximity of South Georgia to Tierra del Fuego in any past period. It is, however, possible to reinterpret the geology of those two regions in terms of the plate kinematic history that the seafloor has preserved

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

Angiosperm fossils in supposed Jurassic volcanogenic shales, Antarctica

During palaeobotanical studies in the Antarctic Peninsula in February 1979, late Cretaceous or younger fossil angiosperm leaves were found within volcaniclastic rocks widely believed to be of late Jurassic age1. Although poorly preserved, these fossils are of great stratigraphical importance. They occur at Cape Alexandra, Adelaide Island (Fig. 1), in rocks correlated with the lowest part of the exposed succession (Sloman Glacier succession1). The fossils were found less than 10 km from the type locality for this succession at the head of Sloman Glacier (Fig. 1). However, towards the northern end of the island at Mount Bouvier (Fig. 1), ammonites and bivalves indicate that supposedly equivalent rocks1 are of Upper Jurassic age2. This intensive study of a very small part of the succession indicates that the volcanic history of Adelaide Island is much more complicated than was previously suggested by reconnaissance mapping

Geographic isolation and physiological mechanisms underpinning species distributions at the range limit hotspot of South Georgia

In order to allocate quotas for sustainable harvests, that account for climate warming, it is important to incorporate species vulnerabilities that will underlie likely changes in population dynamics. Hotspots, regions with rapidly changing climate, are important locations for rapid advances in mechanistic understanding of the factors driving these changes, particularly if they coincide with regions with a high incidence of range limits, such as the sub-Antarctic Island of South Georgia. This archipelago is at the Northern limit of the Southern Ocean and therefore the northern distribution limit for many Southern Ocean shallow water marine species, which are amongst the most sensitive fauna to increasing temperature. At range limits species may either be living close to their physiological limits, or they may have more resistant phenotypes. In case studies, the northern range limit population of the gastropod limpet, Nacella concinna, has greater physiological plasticity at South Georgia than those from further south, allowing them to cope better with the warmer and more variable seasonal temperatures. Bivalve species, however, alter their depth distributions at South Georgia, to avoid the warmer water masses, indicating that they may not be able to cope with the warmer temperatures. Mackerel icefish, Champsocephalus gunnari, has a unique Antarctic trait, the loss of haemoglobin. A combination of temperature driven change in food web structure, and this extreme physiological cold adaptation, may explain why rapid warming at its northern range limit of South Georgia, has prevented stocks fully recovering from over fishing in the 1980s, despite highly conservative management strategies

Biodiversity of an unknown Antarctic Sea: assessing isopod richness and abundance in the first benthic survey of the Amundsen continental shelf

Concerted efforts are being made to understand the current and past processes that have shaped Antarctic biodiversity. However, high rates of new species discoveries, sampling patchiness and bias make estimation of biodiversity there difficult. Antarctic continental shelf benthos is better studied in the Ross, Weddell and Scotia seas, whilst the Amundsen Sea has remained biologically unexplored largely because of severe ice conditions year-round. Here we report results from examination of the first benthic biological samples taken from the Amundsen Sea. We compare relative abundance, taxonomic richness and faunal composition of isopod families, and genera and species within two example families (i.e. Desmosomatidae and Nannoniscidae) from the Amundsen Sea with complementary sampling from the Scotia Sea. Benthic samples were taken from inner and outer Pine Island Bay (eastern Amundsen Sea) sites using an epibenthic sledge at 500 m. Similar samples were also collected from 15 Scotia arc sites at 160- to 500-m depths. The relative abundance of isopods in the Amundsen Sea samples was high and surprisingly less variable than across samples in the Scotia Sea. The abundance structure of isopods at family level was compared across different Antarctic seas. We found that in the Amundsen, Scotia and Ross Seas two families dominated abundance. In contrast, isopod abundance reported in the literature from Weddell Sea samples was much more evenly distributed across families. The Amundsen continental shelf isopod fauna appears to be rich, with 96% of individuals belonging to currently undescribed species. Most of the genera have either been described or found elsewhere, but for many of these genera it is the first time they have been recorded away from the Antarctic continental slope or deep sea. The Amundsen Sea assemblages differed greatly from the Scotia Sea sites in terms of both composition and (species and generic) richness. This was largely due to high consistency between samples compared with the highly variable Scotia Sea samples. Thorough biological analyses implementing well-structured geographic sampling regimes and the application of phylogeographic analyses on a variety of taxa are required to further explore the geographic structure of biodiversity and the evolutionary history of the Amundsen Sea

Macrofossil floras of the Latady Basin, Antarctic Peninsula

New collections of plant material from the Merrick and Sweeney Mountains provide further evidence of Jurassic floral diversity in the Antarctic Peninsula. Eighteen taxa are recognised, including sphenophytes (Equisetum), ferns (Cladophlebis, Sphenopteris, Coniopteris), Bennettitales (Otozamites, Zamites, Ptilophyllum, Dicytozamites, Williamsonia), conifers (Pagiophyllum, Brachyphyllum, Elatocladus), and other seed plants (Taeniopteris, Archangelskya, Pachypteris). Many of these species occur in floras from the Botany Bay Group (Early–Middle Jurassic), and other Late Jurassic to Early Cretaceous sites across the Antarctic Peninsula. The plant material from the Latady Basin occurs in two main associations with distinct floristic compositions that reflect local environmental and taphonomic conditions. The richest localities occur in the deltaic settings, where paleosoil and leaf litter layers are preserved. In contrast, relatively little plant material is found in the wholly marine units such as those from the Hauberg Mountains