A 21-year record of vertically migrating subepilimnetic populations of Cryptomonas spp.

The vertical distribution and diel migration of Cryptomonas spp. were monitored continuously for 21 years in mesotrophic Cross Reservoir, northeast Kansas, USA. The movements of these motile algae were tracked on multiple dates during July–October of each year using in situ fluorometry and optical microscopy of Lugol’s iodine-preserved samples. Episodes of subepilimnetic diel vertical migration by Cryptomonas were detected and recorded on 221 different days between 1994 and 2014, with just 2 of these years (1998 and 2013) lacking any sampling events with deep peaks sufficiently large enough to track. Whenever a subepilimnetic layer of Cryptomonas was detectable, it was generally observed to ascend toward the bottom of the epilimnion beginning approximately at sunrise; to descend toward the lake bottom during the late afternoon and evening; and to remain as a deep-dwelling population until dawn of the following day. Moreover, there was high day-to-day consistency in the absolute water column depths at which the migrating algal cells would cease their ascending or descending movement. We believe this unique and remarkable dataset comprises the most detailed record of diel migratory behavior for any planktonic freshwater alga reported for a single freshwater lake

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700