Monitoring Cumulative Effects of Human Activity on Alberta’s (Canada) Biodiversity

Due to its significant natural resource wealth, the province of Alberta in western Canada has experienced rapid expansion of related industrial activities (forestry, agriculture, and oil and gas exploration and development), as well as associated population growth, over recent decades. The resulting rate of conversion of natural ecosystems to support these activities led to increasing concerns regarding their cumulative effects on Alberta's biodiversity. As a result, in 2007, the Alberta Biodiversity Monitoring Institute (ABMI) was formally established to monitor the status and trends of Alberta's species, their habitats, as well as human footprint (HF). The ABMI is a not-for-profit scientific organization that operates at arm's length from government and industry. The goal of the ABMI is to provide relevant scientific information on the state of Alberta's biodiversity to support natural resource and land-use decision making in the province. To meet this goal, the ABMI employs a systematic grid of 1,656 site locations across the province, spaced 20 km apart, to collect biodiversity information on terrestrial and wetland sites. At each location, data and field samples are collected for a wide range of plant and animal species through on-the-ground measurements, and also using motion-sensitive camera traps and acoustic technology. Since 2007, over 480,000 specimens-data on over 3000 species have been collected and processed, many of which represent new scientific records for the province, sometimes new records for Canada, and even records new to science. Annually, a percentage of the total sites is surveyed, with the sites revisited approximately every 7 years to measure trend in species abundance. In addition to field surveys, Alberta's land cover and human footprint is monitored using remote sensing technology at two spatial scales. To report on patterns and trend in human footprint, the ABMI classifies human footprint into 115 feature types, which are then rolled up into the categories of energy, forestry, agriculture, residential and industrial, human-created water bodies, and transportation. The ABMI's accumulated biodiversity and HF database supports the creation of predictive species models that provide information on spatial distribution, habitat associations, responses to HF, and predicted relative abundance for over 800 species, including mammals, birds, soil mites, vascular plants, mosses (bryophytes), and lichens. The scale and depth of the ABMI's monitoring program and biodiversity data make it a unique program nationally, and a leader internationally. In addition to ongoing protocol development and data analysis, the ABMI is committed to deriving value from its data and information for a wide range of Alberta stakeholders through concerted knowledge translation and stakeholder engagement efforts.peerReviewe

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

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