Decline in an Atlantic Puffin population : evaluation of magnitude and mechanisms

Funding: This study was funded annually by Fair Isle Bird Observatory Trust (www.fairislebirdobs.co.uk) with contributions from the Joint Nature Conservation Committee (jncc.defra.gov.uk). Funding was received from these two sources by Fair Isle Bird Observatory from 1986 to 2013. The Joint Nature Conservation Committee and Fair Isle Bird Observatory Trust supplied guidance on study design, data collection, analyses, preparation of the manuscript and the decision to publish.Peer reviewedPublisher PD

Quantifying full phenological event distributions reveals simultaneous advances, temporal stability and delays in spring and autumn migration timing in long-distance migratory birds

Acknowledgements We thank all Fair Isle Bird Observatory staff and volunteers for help with data collection and acknowledge the foresight of George Waterston and Ken Williamson in instigating the observatory and census methodology. We thank all current and previous directors of Fair Isle Bird Observatory Trust for their contributions, particularly Dave Okill and Mike Wood for their stalwart support for the long-term data collection and for the current analyses. Dawn Balmer and Ian Newton provided helpful guidance on manuscript drafts. We thank Ally Phillimore and two anonymous referees for helpful comments. This study would have been impossible without the Fair Isle community's invaluable support and patience over many decades, which is very gratefully acknowledged. WTSM and JMR designed and undertook analyses, wrote the paper and contributed to data collection and compilation, MB contributed to analysis and editing, all other authors oversaw and undertook data collection and compilation and contributed to editing.Peer reviewedPostprin

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Assessing the economic impact of wind farms on tourism in Scotland: GIS, surveys and policy outcomes

The impact of wind farms on the environment and subsequently on tourism is the subject of much heated debate. The research was concerned with making a robust quantitative assessment of the economic impact, to help resolve the debate and inform government policy on planning for renewable energy. In addition to a broad description of the intercept surveys and the advanced local economic models used to ascertain impact, the research details two novel elements; a Geographic Information Systems (GIS) model for the analysis of the number of tourists and bed spaces exposed to wind farms and a large internet-based survey of the willingness to pay for landscape. The research found a very small but significant negative economic impact and, on the basis of the survey information, suggests ways of minimising this impact. Both GIS modelling and internet surveying were found to be extremely useful and, it is suggested, both should become standard tools for the tourism researcher

Stakeholder views and attitudes towards prenatal and postnatal transplantation of fetal mesenchymal stem cells to treat Osteogenesis Imperfecta

The Boost Brittle Bones Before Birth (BOOSTB4) clinical trial is investigating the safety and efficacy of transplanting fetal derived mesenchymal stromal cells (MSCs) prenatally and/or in early postnatal life to treat severe Osteogenesis Imperfecta (OI). This study aimed to explore stakeholder views to understand perceived benefits or concerns, identify ethical issues and establish protocols for support and counselling. Semi-structured qualitative interviews were conducted with three groups; 1. Adults affected with OI, with and without children, and parents of children affected with OI; 2. Health professionals who work with patients with OI; 3. Patient advocates from relevant patient support groups. Interviews were digitally recorded, transcribed verbatim and analysed using thematic analysis. Interviews with 56 participants revealed generally positive views towards using fetal MSC transplantation to treat OI. Early treatment was considered advantageous for preventing fractures and reducing severity and could bring psychological benefits for parents. Common concerns were procedure safety, short/long-term side effects and whether transplantation would be effective. Difficulties inherent in decision-making were frequently discussed, as treatment efficacy is unknown and, by necessity, parents will make decisions at a time when they are vulnerable. Support needs may differ where there is a family history of OI compared to an unexpected diagnosis of OI. Explaining fetal MSC transplantation in a way that all parents can understand, clear expectation setting, psychological support and time for reflection during the decision-making process will be crucial to allow parents to make informed decisions about participation in the BOOSTB4 clinical trial

Population size estimates for Atlantic Puffin and Great Skua.

<p>A. The maximum count of individual adult Atlantic Puffins on Fair Isle in census years between 1986 and 2013 and B. the total number of Great Skua nesting pairs (apparently occupied territories) on Fair Isle in 1987 to 2013.</p

Diet composition of Great Skua pairs in 2011 and 2012.

<p>Diet composition of Great Skua pairs in 2011 and 2012.</p

Atlantic Puffin survival and resighting probability estimates.

<p>A. Mean estimated adult Atlantic Puffin apparent survival probability (φ) and B. resighting probability (p) during 1987 to 2012. Estimates of φ and p are from models with random year effects on φ and p (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131527#pone.0131527.t001" target="_blank">Table 1</a> and see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131527#sec002" target="_blank">Methods</a>). Dashed lines represent ± 95% confidence intervals.</p

Candidate CMR models for adult Atlantic Puffin apparent annual survival (φ) and resighting probabilities (p) during 1987 to 2013.

<p>^a Notation ‘RYE’ codes for random year effects models.</p><p>^b No par = total number of parameters estimated in each model.</p><p>^c ΔQAICc values are relative to the top ranked model.</p><p>Candidate CMR models for adult Atlantic Puffin apparent annual survival (φ) and resighting probabilities (p) during 1987 to 2013.</p