A flight of fancy in the Chorister Robin-Chat (Cossypha dichroa) : an isotopic standpoint

Forested areas have been cited for their highly diverse floral and faunal assemblages, which are currently under threat from anthropogenic activities that restrict their range and deplete the resources produced within these naturally fragmented patches. Historically, up to 67 percent of avifaunal species associated with well-treed areas have undergone localised extinctions, consequentially affecting biodiversity as a measure of species richness and ecosystem functionality. To date, more than 900 of the bird species affiliated with forests are under threat and despite the theory surrounding functional redundancy, the mass extinction that is currently underway poses considerable limitations on the ecological integrity of these biomes. In South Africa, indigenous forest (one of the rarest biomes), occurs predominantly in small isolated patches along the eastern escarpment. With mountainous terrain emphasised as ‘prominent hotspots of extinction’, the limited dispersal and habitat sensitivity of montane forest fauna renders these species more prone to localised extinctions. BirdLife International, the IUCN and SABAP2 all indicate reductions in the range and abundance of the Chorister Robin-Chat (Cossypha dichroa) - an endemic forest specialist that is reported to move seasonally between high-altitude forest patches where they breed in summer, and lowland coastal forests where they overwinter. Beyond diet, body morphology and vocalisations, much of the information available on the altitudinal movements of C. dichroa is based on secondary sources and the assumptions therein. This study aimed to investigate the potential utilisation of δ13C and δ15N stable isotopes in determining the dietary niche width and altitudinal movements of C. dichroa. Feathers obtained in forested patches of the Limpopo, KwaZulu-Natal and Eastern Cape provinces exhibited a wide trophic niche width and generalised diet. Strong regional separation is apparent in the isotopic signatures suggesting little movement between provinces. A comparison of 13C-isotopes showed minimal variation that point to a uniformity in the carbon-base utilised by C. dichroa across their range. The 15N-signatures obtained in Limpopo, however, revealed a distinct trophic segregation between the northern-most Chorister populations and their southern counterparts. No altitudinal movements were detected in the isotopic signatures of recaptured Choristers, but more research is needed to investigate the long-term accuracy of these results and the breeding potential of resident Choristers in lowland coastal forests; especially when considering the reduced range and abundance reported for this endemic species

The ADIPS pilot national diabetes in pregnancy benchmarking programme

Background: To test the feasibility of benchmarking the care of women with pregnancies complicated by hyperglycaemia. Methods: A retrospective audit of volunteer diabetes services in Australia and New Zealand involving singleton pregnancies resulting in live births between 2014 and 2020. Ranges are shown and compared across services. Results: The audit included 10,144 pregnancies (gestational diabetes mellitus (GDM) = 8696; type 1 diabetes (T1D) = 435; type 2 diabetes (T2D) = 1013) from 11 diabetes services. Among women with GDM, diet alone was used in 39.4% (ranging among centres from 28.8-57.3%), metformin alone in 18.8% (0.4-43.7%), and metformin and insulin in 10.1% (1.5-23.4%); when compared between sites, all p 6.5% (48 mmol/mol)), 78.4% and 54.6%, respectively (p < 0.001). Conclusion: Management of maternal hyperglycaemia and pregnancy outcomes varied significantly. The maintenance and extension of this benchmarking service provides opportunities to identify policy and clinical approaches to improve pregnancy outcomes among women with hyperglycaemia in pregnancy

Soil type influences crop mineral composition in Malawi

Food supply and composition data can be combined to estimate micronutrient intakes and deficiency risks among populations. These estimates can be improved by using local crop composition data that can capture environmental influences including soil type. This study aimed to provide spatially resolved crop composition data for Malawi, where information is currently limited. Six hundred and fifty-two plant samples, representing 97 edible food items, were sampled from N150 sites in Malawi between 2011 and 2013. Samples were analysed by ICP-MS for up to 58 elements, including the essential minerals calcium (Ca), copper (Cu), iron (Fe), magnesium (Mg), selenium (Se) and zinc (Zn). Maize grain Ca, Cu, Fe, Mg, Se and Zn concentrations were greater from plants grown on calcareous soils than those from the more widespread low-pH soils. Leafy vegetables from calcareous soils had elevated leaf Ca, Cu, Fe and Se concentrations, but lower Zn concentrations. Several foods were found to accumulate high levels of Se, including the leaves of Moringa, a crop not previously been reported in East African food composition data sets. New estimates of national dietary mineral supplies were obtained for non-calcareous and calcareous soils. High risks of Ca (100%), Se (100%) and Zn (57%) dietary deficiencies are likely on non-calcareous soils. Deficiency risks on calcareous soils are high for Ca (97%), but lower for Se (34%) and Zn (31%). Risks of Cu, Fe and Mg deficiencies appear to be low on the basis of dietary supply levels

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Comparison of pregnancy outcomes using different gestational diabetes diagnostic criteria and treatment thresholds in multiethnic communities between two tertiary centres in Australian and New Zealand : do they make a difference?

Introduction: Australia, but not New Zealand (NZ), has adopted the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria to diagnose gestational diabetes (GDM). We compared pregnancy outcomes using these different diagnostic approaches. Method: Prospective data of women with GDM were collected from one NZ (NZ) and one Australian (Aus) hospital between 2007–2018. Aus screening criteria with 2-step risk-based 50 g Glucose Challenge Testing (GCT) followed by 75 g-oral glucose tolerance testing (OGTT): fasting ≥ 5.5, 2-h ≥ 8.0 mmol/L (ADIPS98) changed to a universal OGTT and fasting ≥5.1, 1-h ≥ 10, 2-h ≥ 8.5 mmol/L (IADPSG). NZ used GCT followed by OGTT with fasting ≥ 5.5, 2-h ≥ 9.0 mmol/L (NZSSD); in 2015 adopted a booking HbA1c (NZMOH). Primary outcome was a composite of macrosomia, perinatal death, preterm delivery, neonatal hypoglycaemia, and phototherapy. An Aus subset positive using NZSSD was also defined. RESULTS: The composite outcome odds ratio compared to IADPSG (1788 pregnancies) was higher for NZMOH (934 pregnancies) 2.227 (95%CI: 1.84–2.68), NZSSD (1344 pregnancies) 2.19 (1.83–2.61), and ADIPS98 (3452 pregnancies) 1.91 (1.66–2.20). Composite outcomes were similar between the Aus subset and NZ. Conclusions: The IADPSG diagnostic criteria were associated with the lowest rate of composite outcomes. Earlier NZ screening with HbA1c was not associated with a change in adverse pregnancy outcomes

The ADIPS pilot National Diabetes in Pregnancy Audit Project

Background: Limited resources are available to compare outcomes of pregnancies complicated by diabetes across different centres. Aims: To compare the use of paper, stand alone and networked electronic processes for a sustainable, systematic international audit of diabetes in pregnancy care. Methods: Development of diabetes in pregnancy minimum dataset using nominal group technique, email user survey of difficulties with audit tools and collation of audit data from nine pilot sites across Australia and New Zealand. Results: Seventy-nine defined data items were collected: 33 were for all women, nine for those with gestational diabetes (GDM) and 37 for women with pregestational diabetes. After the pilot, four new fields were requested and 18 fields had queries regarding utility or definition. A range of obstacles hampered the implementation of the audit including Medical Records Committee processes, other medical/non-medical staff not initially involved, temporary staff, multiple clinical records used by different parts of the health service, difficulty obtaining the postnatal test results and time constraints. Implementation of electronic audits in both the networked and the stand-alone settings had additional problems relating to the need to nest within pre-existing systems. Among the 496 women (45 type 1; 43 type 2, 399 GDM) across the nine centres, there were substantial differences in key quality and outcome indicators between sites. Conclusions: We conclude that an international, multicentre audit and benchmarking program is feasible and sustainable, but can be hampered by pre-existing processes, particularly in the initial introduction of electronic methods

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%–74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Standardizing nomenclature in regional anesthesia : an ASRA-ESRA Delphi consensus study of upper and lower limb nerve blocks

Abstract: BackgroundInconsistent nomenclature and anatomical descriptions of regional anesthetic techniques hinder scientific communication and engender confusion; this in turn has implications for research, education and clinical implementation of regional anesthesia. Having produced standardized nomenclature for abdominal wall, paraspinal and chest wall regional anesthetic techniques, we aimed to similarly do so for upper and lower limb peripheral nerve blocks.MethodsWe performed a three-round Delphi international consensus study to generate standardized names and anatomical descriptions of upper and lower limb regional anesthetic techniques. A long list of names and anatomical description of blocks of upper and lower extremities was produced by the members of the steering committee. Subsequently, two rounds of anonymized voting and commenting were followed by a third virtual round table to secure consensus for items that remained outstanding after the first and second rounds. As with previous methodology, strong consensus was defined as >= 75% agreement and weak consensus as 50%-74% agreement.ResultsA total of 94, 91 and 65 collaborators participated in the first, second and third rounds, respectively. We achieved strong consensus for 38 names and 33 anatomical descriptions, and weak consensus for five anatomical descriptions. We agreed on a template for naming peripheral nerve blocks based on the name of the nerve and the anatomical location of the blockade and identified several areas for future research.ConclusionsWe achieved consensus on nomenclature and anatomical descriptions of regional anesthetic techniques for upper and lower limb nerve blocks, and recommend using this framework in clinical and academic practice. This should improve research, teaching and learning of regional anesthesia to eventually improve patient care