Prospective review of 30-day morbidity and mortality in a paediatric neurosurgical unit

Purpose: The purpose of this study is to record the 30-day and inpatient morbidity and mortality in paediatric patients in a tertiary neuroscience centre over a 2-year period. The intentions were to establish the frequency of significant adverse events, review the current published rates of morbidity in paediatric neurosurgical patients and propose three clinical indicators for future comparison. Methods: All deaths and adverse events were prospectively recorded from 1 January 2014 to 31 December 2015. Each adverse event was categorised, allocated a clinical impact severity score and linked to a neurosurgical procedure wherever possible. Where a patient suffered several adverse events in the same admission, each event was recorded separately. If a patient had been discharged home, an adverse event was recorded if it occurred within 30 days of admission. Results: Five hundred forty-nine procedures were performed in 287 patients (aged <16 years). One hundred thirty significant adverse events were identified. The following are the three clinical indicators: significant adverse event rate: 111 (20.2%) operations were linked to at least one significant adverse event; unscheduled return to theatre rate: 81 (14.8%) operations were associated with an adverse event that resulted in an unscheduled return to theatre; and surgical site infection rate: 29 (5.3%) operations were associated with an infection. Conclusion: Complications and adverse events are common in paediatric neurosurgery. Prospective, continuous surveillance will promote both quality assurance and quality improvement in the neurosurgical care delivered to patients

Factors Affecting the Predator-Prey Relationship Between Predaceous Diving Beetle Larvae (Dytiscus fasciventris) and Two Anuran Tadpole Species (Bufo americanus and Hyla crucifer)

It has previously been demonstrated that American toad (Bufo americanus) tadpoles are more vulnerable to predation by diving beetle larvae (Dytiscus fasciventris) than are spring peeper (Hyla crucifer) tadpoles. A laboratory study was undertaken to further delineate factors that contribute to the differential vulnerability observed. Beetle larvae are more effective tadpole predators in shallow, than in deep, water and appear to prefer to adopt a sit-and-wait predator strategy while clinging to emergent vegetation. Depth preference experiments in the laboratory indicated that both tadpole species prefer deep areas to shallow areas irrespective of whether a predator was present or absent. Dytiscus preferred the shallow end (0 - 5 cm of water) of the depth choice tank when tadpoles were absent, but preferred deeper areas when tadpoles were present. Beetle larvae prefer to eat in shallow areas, or on vegetation near the water surface. Both tadpole species appear to be more vulnerable to predation on light colored substrates, indicating that vision may be a more important prey locating mechanism in beetle larvae than previously thought. Bufo tadpoles move significantly more than Hyla tadpoles, which results in a higher vulnerability for Bufo. Field experiments show a positive relationship between tadpole density and the number of tadpoles a beetle larva is able to capture. Field results also suggest that late stage Bufo tadpoles (which move the same amount Hyla tadpoles do) are not more vulnerable to beetle larvae than are Hyla tadpoles, further delineating the relationship between the amount of movement tadpoles exhibit and the level of tadpole vulnerability to beetle larvae. These results are discussed with reference to some evolutionary theories of predator-prey systems

iPads, iPods and Technology-Enabled Isolation: If We’re So Connected, Why are We so Alone?

In the past twenty-five years, we have witnessed and absorbed incredible technological advances into our lives. The new technologies in many ways have been liberating and empowering – in our age, we have become accustomed to and dependent upon the immediacy of electronic delivery. However, these technological innovations have not come without a cost. As we have become more connected and aware of our online selves, we have become less available and less connected to our offline worlds. We are in danger of not merely transforming our humanity, but forever losing what makes us human. We are more connected than ever before in history, we are more medicated than at any point in history, and we are more isolated from one another than ever before. It is important to consider and reflect upon technology’s contribution to these issues and decide whether or not the benefits brought on by the innovations are truly worth the societal, communal, familial and individual costs. We must decide if it is worth reframing our lives with a consideration of balance between what is digital and what is real