Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

On the transferability of concepts and its significance for landscape ecology.

peer reviewe

Relation entre la composition floristique et des indicateurs de la fragmentation du paysage dans une région de transition forêt-savane ivoirienne.

Relation between floristic composition and landscape fragmentation indicators in a transition forest-savanna area of Côte d'Ivoire. Forest landscape fragmentation is known to be a significant factor of forest degradation. In this article, we analyze the case of forest-savanna contact of East Côte d'Ivoire, where savannas progress quickly to the detriment of forests. Using forest inventories and the spectral and spatial properties of a Landsat ETM+ image, we established the existence of two independent floristic gradients within forests, which were correlated to various aspects of forest fragmentation. The main floristic gradient was correlated with the degree of opening of forest stands and with the abundance of heliophilics. Spectrally, this gradient clearly correlates with a variation in the red and near infra-red bands. In terms of landscape structure, it is significantly related on the size and the isolation of small forest patches. A second floristic gradient is correlated to the perimeter of forest fragments, and may thus reflect an edge effect. These results make it possible to consider an operational approach based on multispectral data of average resolution and pattern metrics for operational assessment and monitoring of forest degradations on regional scales

Dynamique paysagère en milieu de transition forêt-savane ivoirienne.

peer reviewe

Inventory and availability of non-timber forest products used by local residents of the classified Forest of Haut Sassandra after the armed conflict period in Ivory Coast

This study aims at identifying and assessing the plant species, apart from timbers, that can be found inside the Classified Forest of Haut-Sassandra (CFHS) and around after, the civil war in Ivory Coast. Investigations were carried out in 45 riverside resident households by individual and focus group interviews regardless the gender. One hundred and thirty-four plant species and 3 fungal species belonging to 56 families have been listed. Seven categories of uses of NTFP have been identified, among which medicinal use is the most important. Ten preferential plant species for rural population have been identified. The population stated that 45% of the NTFP have become rare in the area. The harvested NTFP are mainly for self-consumption. Farmers preserve and domesticate some plant species in their field. Faced with the scarcity of NTFPs, the use of manufactured goods is increasingly recurrent in the villages