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

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

Degraded forests are more susceptible to forest fires: Some possible ecological explanations

There is a strong belief that degraded forests are more susceptible to forest fires than non-degraded ones, but this is more intuitive than scientifically proven. The present study was conducted to investigate how fuel loading and moisture content of combustible materials; two variables that influence ignition and fire impact and therefore forests' susceptibility to fire, differ in forests with different levels of degradation. The study was done in Tain II Forest, situated in the northwest part of the forest zone and adjacent to the Savanna woodland. Three forest sites compared in this experiment were categorized as slightly degraded, moderately degraded and heavily degraded. Fuel loading was determined using the planar transect method (Brown 1974). Sampling was done on forty 200m long line transects laid in each forest site. To determine fuel and soil moisture content, wood particles and soil were monitored for changes in moisture content from November to February in the main dry season using the oven dry method. The overall pattern showed significant increases in fuel loading in more degraded forest sites. The fuel moisture content decreased from less degraded sites to heavily degraded sites for all types of fuel. The moisture content of soil sampled from the first 5cm depth was significantly lower in more degraded sites. Below 5cm depth, however the differences were not significant. These observations may explain why degraded forests have a higher likelihood of ignition and severer levels of fire damage once there is fire

Wildfire incidence and management in the forest transition zone of Ghana: Farmer’s perspectives

Forests in Ghana are increasingly being influenced by man-caused fires. Most of these fires have been blamed on farmers practicing slash and burn agriculture. In addition, many critics have assumed that farmers have very limited knowledge of fire management and therefore do not manage farming-related fires. A survey was conducted in eight communities in the forest transition zone to assess the perceptions of farmers on farming-related wildfire incidences, specific activities in farming associated with incidence of wildfires and coping measures being used by farmers to manage wildfires. Farmers in the studied settlements hold the view that there are presently certain cropping practices that are closely associated with wildfire incidence. These include early vegetable and yam cultivation whereby the burning of slash takes place between December and February when fire risk is high. The study also found that farmers have useful knowledge in wildfire management and are applying it to cope with the impacts of wildfires. Some of the important coping strategies are farm maintenance practices, fire prevention education and precautionary measures during land preparation. Adopted measures by farmers need to be supported by research and agriculture extension to remove weaknesses in farmers’ efforts.Keywords: Wildfires, slash and burn agriculture, cropping practices, fire management strategies, farmers’ perception

Species differences in seedling growth and leaf water response to light quality

For the majority of forest species slight canopy opening reduces light limitations suggesting that light quality often measured as red:far red ratio (R:FR) plays a significant role in the development of seedlings. The effect of different levels of R:FR was studied on seedlings of four Ghanaian timber species of different ecological guilds to assess their growth and leaf water response to changes in R:FR. The experiment was conducted in shade houses of varying light qualities (0.30, 0.46 and 0.76 R:FR) achieved with the use of bamboo slats, green filter and white cotton cloth. Relative height growth of all species declined in high R:FR with Guarea cedrata and Celtis mildbraedii, shade bearers, having a slower decline of height growth with increasing R:FR than Terminalia ivorensis, pioneer, and Albizia zygia non-pioneer light demander. Relative diameter growth on the other hand increased in higher R:FR treatments except for G. cedreta. Relative biomass growth was not significantly affected by R:FR. Leaf area ratio did not vary in different R:FRs for G. odorata but for the other species it was lower in higher R:FRs. Specific leaf area was also not affected by R:FR except in G. cedreta where it dropped with increase in R:FR. The diurnal pattern of change in stomatal conductance and leaf water potential of T. ivorensis and G. cedrata were similar in lower R:FR ratio but opposite in higher R:FR. This results show that the response of seedlings to changes in R:FR is different for different species and is more of morphological change rather than growth (biomass accumulation). Pioneers are more sensitive to these changes than non-pioneers.Keywords: Red:far-red ratio, light quality, seedlings growth response, leaf water status, morphological chang

Influence Of Phytolyma lata (Homoptera: Psyllidae) On Seedling Growth Of Milicia excelsa

Milicia excelsa (Iroko) is a valuable timber species occurring naturally in the humid forests of Africa. The high quality and great demand of wood obtained from M. excelsa has resulted in its overexploitation. Attempts at establishing large scale plantations to ensure sustained production have been hampered by the gall forming psyllid Phytolyma lata. In spite of the economic importance of P. lata little research has been conducted on the impact of the psyllid on the establishment of M. excelsa plantations. The effect of P. lata on growth, dry matter accumulation and allocation of M. excelsa seedlings is assessed in this study. Seedling growth in infested plots was significantly reduced. Plants infested had lower height, stem diameter and biomass growth. Mean yield losses of stem, branches, and leaves of infested plants were 68.9%, 48.3% and 64% respectively of matched uninfested plants. Infested plants also had smaller, fewer and highly chlorotic leaves. There were no significant differences (P > 0.05) in yield, specific leaf area, leaf area ratio and leaf weight ratio of plants growing in the open screen house and open plot without screening (infested plots) even though irradiance incident in the open screen house was 70% of that in the open plot without screening. It is concluded that P. lata infestation has significant effect on growth and biomass accumulation in the early development of Iroko and that such information would improve integrated pest management (IPM) programme for P. lata. Secondly, biomass allocation of M. excelsa seedlings is not significantly different probably at irradiances greater than 70% ambient full sun.Keywords: Milicia excelsa, Phytolyma lata, seedling growth, pest infestation, biomas

A comparison of tree seedling growth in artificial gaps of different sizes in two contrasting forest types.

One of the major concerns in forestry in the tropics is the lack of information on the impact of canopy disturbance through logging. The degree of canopy opening that should be allowed during logging to enhance natural regeneration of timber tree species is not known. Information on the seedling ecology of individual species and ecological species groups on which to base management decisions are also lacking. Experiments to determine the ecophysiological responses of seedlings of timber tree species to different irradiances in two forest sites were carried out. The two forest reserves are Nkrabia and Tinte Bepo in the Moist Evergreen and Moist Semi-Deciduous Forest Types, respectively. Eight species, representing three Shade Bearers, four Non-Pioneer Light Demanders and one Pioneer species, were grown in a series of artificially-created gaps in two forest sites differing in annual rainfall. The forest shade received 1-2% irradiance, while the artificial gaps received 5, 10, 15, 30 and 65% irradiance. Seedling growth was greater at Nkrabia Forest Reserve (Moist Evergreen Forest Type) than at Tinte Bepo Forest Reserve (Moist Semi-Deciduous Forest Type). This is probably due to the lower soilmoisture stress at Nkrabia as a result of more rainfall. Lower moisture stress at Nkrabia may also explain the greater leaf area and specific leaf area ratios, lower leaf turnover and lower number of small leaves on plants than those at Tinte Bepo. Response of height growth to irradiance of Shade Bearers and Non-Pioneer Light Demanders was similar but different from that of Pioneer species.Keywords: Forest types; Canopy disturbance; Irradiance; Seedling growth; Ecological species group