POSSUM and P-POSSUM overpredict mortality for carotid endarterectomy

Objectives: the aim was to test the predictive accuracy of POSSUM and P-POSSUM on patients undergoing CEA. Design: retrospective and prospective study. Materials: 499 CEAs performed by four vascular surgeons from a single unit from 1992-99. The median age was 68 (range 38-86) and 60% were men. Methods: physiological parameters, operative parameters and the 30-day mortality were collected. Predicted mortality for each patient was calculated using POSSUM and P-POSSUM equations. Patients were stratified into risk groups and observed and predicted deaths were compared. Accuracy of the prediction was assessed using chi-squared analysis. Results: the observed 30-day mortality was 1.8% (9/499). The predicted deaths using POSSUM and P-POSSUM analysis were 49 and 25 respectively compared to nine observed deaths. There was significant evidence of lack of fit of both models in predicting mortality (chi-squared analysis, p<0.05). Conclusions: POSSUM and P-POSSUM overpredict mortality and are unsuitable for comparative audit of CEA. Models developed specific for CEA might accurately predict mortality

New Equations for Predicting Postoperative Risk in Patients with Hip Fracture

Predicting the postoperative course of patients with hip fractures would be helpful for surgical planning and risk management. We therefore established equations to predict the morbidity and mortality rates in candidates for hip fracture surgery using the Estimation of Physiologic Ability and Surgical Stress (E-PASS) risk-scoring system. First we evaluated the correlation between the E-PASS scores and postoperative morbidity and mortality rates in all 722 patients surgically treated for hip fractures during the study period (Group A). Next we established equations to predict morbidity and mortality rates. We then applied these equations to all 633 patients with hip fractures treated at seven other hospitals (Group B) and compared the predicted and actual morbidity and mortality rates to assess the predictive ability of the E-PASS and Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) systems. The ratio of actual to predicted morbidity and mortality rates was closer to 1.0 with the E-PASS than the POSSUM system. Our data suggest the E-PASS scoring system is useful for defining postoperative risk and its underlying algorithm accurately predicts morbidity and mortality rates in patients with hip fractures before surgery. This information then can be used to manage their condition and potentially improve treatment outcomes

Intraspecific aggregation and soil heterogeneity: competitive interactions of two clonal plants with contrasting spatial architecture

Background and aims Intraspecific aggregation of plant individuals can promote species coexistence by delaying competitive exclusions. However, such impacts may differ among species with contrasting spatial architecture and rely on the spatial distribution of resources. Methods We grew a phalanx clonal plant Carex neurocarpa (with aggregated ramets) and a guerilla one Bolboschoenus planiculmis (with diffused ramets) in monocultures or in 1:1 mixtures with an even or a clustered distribution pattern of the two species in homogeneous or heterogeneous soils. Results After 16 months, shoot biomass and ramet number were greater in mixtures than in monocultures in C. neurocarpa, but smaller in B. planiculmis. However, the growth of neither C. neurocarpa nor B. planiculmis differed between even and clustered mixtures. Soil nutrient heterogeneity did not significantly affect the growth of either species, but increased relative yield of B. planiculmis and decreased that of C. neurocarpa. Conclusions The relative importance of intra- vs. interspecific competition depends on the spatial architecture of plants, and soil nutrient heterogeneity slows down competitive exclusion by decreasing differences in competitive ability between plants. However, our results do not support the idea that intraspecific aggregation of individuals alters competitive interactions between species

The effectiveness of a Mesoamerican 'paper park' in conserving cloud forest avifauna

Mesoamerican cloud forests are important centres of biodiversity, but are under severe pressure from anthropogenic activities. Protected areas have been established to conserve remaining areas of this habitat, but it is debatable how effective these under-resourced 'paper parks' are in preserving biodiversity. This study investigates this issue utilising species-level data, examining composition of avifaunal communities within an undermanaged cloud forest park. Research was conducted in the Parque Nacional Cusuco, North-West Honduras. Results indicate that overall avian species richness is greater in the less heavily protected buffer zone than the nominally inviolate core zone. However, core zone areas are shown to be effective in preserving threatened and range-restricted species. Results therefore demonstrate that buffer zone forest has a comparably reduced conservation value, but the overall park system appears to be effective in conserving the core zone. These findings should be taken into account when considering extensions to protected area networks in Mesoamerica