Ecological legacies of drought, fire, and insect disturbance in western North American forests, The

Includes bibliographical references.2015 Fall.Temperate forest ecosystems are subject to various disturbances including insect agents, drought and fire, which can have profound effects on the structure of the ecosystem for many years after the event. Impacts of disturbance can vary widely, therefore an understanding of the legacies of an event are critical in the interpretation of contemporary forest patterns and those of the near future. The primary objective of this dissertation was to investigate the ecological legacies of drought, beetle outbreak and ensuing wildfire in two different ecosystems. A secondary objective of my research, data development, was motivated by a lack of available data which precluded ecological investigation of each disturbance. I studied the effects of drought on deciduous and coniferous forest along a forest-shrubland ecotone in the southern portion of the Wyoming Basin Ecoregion. The results show that forests in the region have experienced high levels of cumulative drought related mortality over the last decade. Negative trends were not consistent across forest type or distributed randomly across the study area. The patterns of long-term trends highlight areas of forest that are resistant, persistent or vulnerable to severe drought. In the second thread of my dissertation, I used multiple lines of evidence to retrospectively characterize a landscape scale mountain pine beetle disturbance from the 1970s in Glacier National Park. The lack of spatially explicit data on this disturbance was a major data gap since wildfire had removed some of the evidence from the landscape. I used this information to assess the influence of beetle severity on the burn severity of subsequent wildfires in the decades after the outbreak. Although many factors contribute to burn severity, my results indicate that beetle severity can positively influence burn severity of wildfire. This is likely due to the change in forest structure in the decades after the outbreak and not as a direct result of tree mortality from the outbreak. The long-term perspective of this study suggests that ecological legacies of high severity disturbance may continue to influence subsequent disturbance for many years after the initial event. This work also provides insight on future disturbance interactions associated with the recent mountain pine beetle outbreak that has impacted tens of millions of hectares in western North America over the last two decades

Persistence and quality of vegetation cover in expired Conservation Reserve Program fields

For nearly 40 years, the Conservation Reserve Program (CRP) has implemented practices to reduce soil erosion, improve water quality, and provide habitat for wildlife and pollinators on highly erodible cropland in the United States. However, an approximately 40,470 ha (10 million acres) decline in enrolled CRP land over the last decade has greatly reduced the program\u27s environmental benefits. We sought to assess the program\u27s enduring benefits in the central and western United States by (1) determining the proportion of fields that persist in CRP cover after contracts expired, (2) identifying the type of agricultural production that CRP fields shift to after contract expiration, (3) comparing the vegetation characteristics of expired CRP fields that are persisting in CRP-type cover with enrolled CRP fields, and (4) identifying differences in management activities (e.g., haying, grazing) between expired and enrolled CRP fields. We conducted edge-of-field vegetation cover surveys in 1092 CRP fields with contracts that expired ≥3 years prior and 1786 currently enrolled CRP fields in 14 states. We found that 41% of expired CRP fields retained at least half of their area in CRP-type cover, with significant variation in persistence among regions ranging from 19% to 84%. When expired fields retained CRP vegetation, bare ground was low in all regions and grass cover was somewhat greater than in fields with current CRP contracts, but at the expense of forb cover in some regions. Evidence of more frequent management in expired CRP fields may explain differences between active and expired CRP fields. Overall, there is clear evidence that CRP-type cover frequently persists and provides benefits for more than three years after contract expiration. Retaining CRP-type cover, post-contract, is an under-recognized program benefit that persists across the central and western United States long after the initial retirement from cropland

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

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

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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

The ecological legacies of drought, fire, and insect disturbance in western North American forests

Temperate forest ecosystems are subject to various disturbances including insect agents, drought and fire, which can have profound effects on the structure of the ecosystem for many years after the event. Impacts of disturbance can vary widely, therefore an understanding of the legacies of an event are critical in the interpretation of contemporary forest patterns and those of the near future. The primary objective of this dissertation was to investigate the ecological legacies of drought, beetle outbreak and ensuing wildfire in two different ecosystems. A secondary objective of my research, data development, was motivated by a lack of available data which precluded ecological investigation of each disturbance. I studied the effects of drought on deciduous and coniferous forest along a forest-shrubland ecotone in the southern portion of the Wyoming Basin Ecoregion. The results show that forests in the region have experienced high levels of cumulative drought related mortality over the last decade. Negative trends were not consistent across forest type or distributed randomly across the study area. The patterns of long-term trends highlight areas of forest that are resistant, persistent or vulnerable to severe drought. In the second thread of my dissertation, I used multiple lines of evidence to retrospectively characterize a landscape scale mountain pine beetle disturbance from the 1970s in Glacier National Park. The lack of spatially explicit data on this disturbance was a major data gap since wildfire had removed some of the evidence from the landscape. I used this information to assess the influence of beetle severity on the burn severity of subsequent wildfires in the decades after the outbreak. Although many factors contribute to burn severity, my results indicate that beetle severity can positively influence burn severity of wildfire. This is likely due to the change in forest structure in the decades after the outbreak and not as a direct result of tree mortality from the outbreak. The long-term perspective of this study suggests that ecological legacies of high severity disturbance may continue to influence subsequent disturbance for many years after the initial event. This work also provides insight on future disturbance interactions associated with the recent mountain pine beetle outbreak that has impacted tens of millions of hectares in western North America over the last two decades

Quaking Aspen: The Iconic and Dynamic Deciduous Tree of the Rocky Mountains

Perhaps no other species of tree jumps to mind as quickly as Quaking aspen (Populus tremuloides Michx.) when one waxes poetically about the iconic vistas of the Rocky Mountain West. Quaking aspen, so called for its trembling leaves, have been the focus of countless paintings and photographs, from Ansel Adams to John Fielder to scores of amateur photographers whose hashtags identify the species on Instagram. The ecological setting of many upland aspen settings provides a sharp contrast against exposed rock, snow and the dark green blanket of conifer forests that many of us seek out in the autumn. Such scenes drive tourism revenue and are used in many recreational activity advertisements by western resorts. Beyond their aesthetic value, aspen communities are valued for the biological diversity and habitat they provide in western landscapes. Furthermore, aspen face a number of ecological and management challenges that likely go unnoticed by the tourist or casual recreator. Above all, aspen communities are dynamic, so there is a good chance your favorite aspen grove might look different at some point in your lifetime. The goal of this essay is to provide a broad overview of the unique niche of aspen ecosystems in the interior Rocky Mountain West, highlight its dynamic nature, and shed light on the challenges associated with stewardship of this iconic species

Retrospective Approaches to Evaluate Resilience of Aspen, Mountain Mahogany, and Sagebrush Communities to Drought

The Wyoming Landscape Conservation Initiative (WLCI) is a multiagency science-based effort that supports conservation on 19 million acres in southwest WY. WLCI local teams, which are responsible for identifying conservation needs and implementing conservation actions, have posed numerous restoration questions about the resilience of aspen, mountain mahogany, and sagebrush to recent droughts. We present several retrospective approaches in combination with field measurements that we used to evaluate trends in aspen and sagebrush condition, productivity, and mortality prior and after recent droughts. Retrospective analysis included the exploration of the relationship between remotely sensed vegetation indices, drought indices (e.g. Palmer drought severity index), precipitation data, and landscape position. We present select trend observations reflecting resilience of aspen and sagebrush and highlight how this information supports WLCI conservation planning. Future efforts using dendrological methods to evaluate relationships between drought and annual radial growth, establishment dates, and mortality in aspen, mountain mahogany, and sagebrush systems are discussed