6 research outputs found

    Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

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    Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

    Asymmetrical niche determinism across geological units shapes phylogenetic tree communities in the Colombian Amazonia

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    We evaluate the role of differences in substrate age and environmental conditions, as represented by different geological units, in determining the phylogenetic structure and distribution of tree communities in the northwest Amazon. We used 412 0.1-ha plots distributed across the three main geological units (craton, tertiary and alluvial) in the Colombian Amazon, to answer the following research questions: i) To what extent do environmental filtering and dispersal limitation determine the phylogenetic composition of tree communities across geological units in the Colombian Amazon? and ii) Are there differences between geological units in the extent to which niche conservatism shapes the phylogenetic structure of indicator species (i.e., strong habitat-specialists) in tree communities? The results of our study give support for both environmental filtering and dispersal being important drivers of the phylogenetic structure and turnover of tree communities. Nonetheless, the extent to which geology explained the phylogenetic turnover of tree communities was surpassed by the geographic distance between plots, which was used to account for effects of dispersal limitation. This finding suggests that most of the lineages have had sufficient time to migrate and establish into adjacent geological units, contradicting claims that geological conditions are the dominant factors determining the distribution of tree communities across northwestern Amazonia. However, in the craton unit, indicator species were more closely related than expected by chance, while in the alluvial and tertiary units, observed relationships were not statistically different from null expectations. These results indicate that environmental filtering is asymmetrical among geological units, with the craton environment being the most restrictive. In contrast, the alluvial unit may be relatively easy to colonize and hence ecological strategies may be more labile through evolutionary history

    Monitoring ecological change during rapid socio-economic and political transitions: Colombian ecosystems in the post-conflict era

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    After more than 50-years of armed conflict, Colombia is now transitioning to a more stable social and political climate due to a series of peace agreements between the government and different armed groups. Consequences of these socio-economic and political changes on ecosystems are largely uncertain, but there is growing concern about derived increases in environmental degradation. Here, we review the capacity of Colombia to monitor the state of its ecosystems and their rate of change over time. We found several important programs currently set in place by different institutions as well as by independent groups of scientists that address different aspects of environmental monitoring. However, most of the current initiatives could be improved in terms of data coverage, quality and access, and could be better articulated among each other. We propose a set of activities that would increase the capacity of Colombia to monitor its ecosystems, provide useful information to policy makers, and facilitate scientific research. These include: 1) the establishment of a national center for ecological synthesis that focuses on analyzing existing information; 2) the establishment of an ecological observatory system that collects new information, integrates remote sensing products, and produces near real-time products on key ecological variables; and 3) the creation of new platforms for dialog and action within existing scientific and policy groups. © 2017 The Author

    Monitoring ecological change during rapid socio-economic and political transitions: Colombian ecosystems in the post-conflict era

    Get PDF
    After more than 50-years of armed conflict, Colombia is now transitioning to a more stable social and political climate due to a series of peace agreements between the government and different armed groups. Consequences of these socio-economic and political changes on ecosystems are largely uncertain, but there is growing concern about derived increases in environmental degradation. Here, we review the capacity of Colombia to monitor the state of its ecosystems and their rate of change over time. We found several important programs currently set in place by different institutions as well as by independent groups of scientists that address different aspects of environmental monitoring. However, most of the current initiatives could be improved in terms of data coverage, quality and access, and could be better articulated among each other. We propose a set of activities that would increase the capacity of Colombia to monitor its ecosystems, provide useful information to policy makers, and facilitate scientific research. These include: 1) the establishment of a national center for ecological synthesis that focuses on analyzing existing information; 2) the establishment of an ecological observatory system that collects new information, integrates remote sensing products, and produces near real-time products on key ecological variables; and 3) the creation of new platforms for dialog and action within existing scientific and policy groups. © 2017 The Author
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