Isotopic nitrogen in fecal fiber as an indicator of winter diet in caribou and muskoxen.

RATIONALE: The ratios of stable nitrogen isotopes (δ(15)N values) in excreta have been used to examine aspects of trophic and nutritional ecology across taxa. Nitrogen fractions in feces of herbivores include endogenous (e.g., sloughed intestinal cells, unresorbed digestive secretions, and microbial debris) and dietary sources. For animals such as large herbivores, that have diets and feces with high concentrations of indigestible fiber, endogenous (15)N may constrain the use of fecal δ(15)N values to estimate dietary δ(15)N values and reconstruct diets. METHODS: We compared two techniques (detergent and detergent-free) to isolate fractions of plant fibers in the forages of caribou (Rangifer tarandus) and muskoxen (Ovibos moschatus); estimated the discrimination factors between the δ(15)N values of fecal fiber residues and of the diets of captive animals; and used the more effective isotopic tracer of dietary δ(15)N values to examine the relationships between the δ(15)N values of fecal residues and diet composition in several populations of wild caribou and muskoxen throughout North America in winter. RESULTS: The detergent-based approach contaminated the fractions of plant fibers in forages and feces with (14)N, whereas the detergent-free method was a good proxy to estimate δ(15)N values of plant fibers (r(2) = 0.92) and provided a better estimate of the fecal-fiber to diet discrimination factor for both species (caribou = 3.6‰; muskoxen = 2.8‰). In wild populations, the δ(15)N values of fecal fibers reflected diet composition in muskoxen (adjusted R(2) = 0.43) but not caribou (adjusted R(2) = 0.06). CONCLUSIONS: Contamination from detergent residues prohibited the use of detergent extraction in isolating forage (15)N from endogenous (15)N in the feces of herbivores. Although δ(15)N values in fecal fibers can be used to track dietary δ(15)N values in wild herbivores, discrimination between fecal extracts and diet may vary with the contribution of endogenous nitrogen (N), and, therefore, residual endogenous (15)N in feces may limit dietary reconstructions from fecal δ(15)N values for some large herbivores.

A pragmatic multi-centre randomised controlled trial of fluid loading in high-risk surgical patients undergoing major elective surgery--the FOCCUS study.

INTRODUCTION: Fluid strategies may impact on patient outcomes in major elective surgery. We aimed to study the effectiveness and cost-effectiveness of pre-operative fluid loading in high-risk surgical patients undergoing major elective surgery. METHODS: This was a pragmatic, non-blinded, multi-centre, randomised, controlled trial. We sought to recruit 128 consecutive high-risk surgical patients undergoing major abdominal surgery. The patients underwent pre-operative fluid loading with 25 ml/kg of Ringer's solution in the six hours before surgery. The control group had no pre-operative fluid loading. The primary outcome was the number of hospital days after surgery with cost-effectiveness as a secondary outcome. RESULTS: A total of 111 patients were recruited within the study time frame in agreement with the funder. The median pre-operative fluid loading volume was 1,875 ml (IQR 1,375 to 2,025) in the fluid group compared to 0 (IQR 0 to 0) in controls with days in hospital after surgery 12.2 (SD 11.5) days compared to 17.4 (SD 20.0) and an adjusted mean difference of 5.5 days (median 2.2 days; 95% CI -0.44 to 11.44; P = 0.07). There was a reduction in adverse events in the fluid intervention group (P = 0.048) and no increase in fluid based complications. The intervention was less costly and more effective (adjusted average cost saving: £2,047; adjusted average gain in benefit: 0.0431 quality adjusted life year (QALY)) and has a high probability of being cost-effective. CONCLUSIONS: Pre-operative intravenous fluid loading leads to a non-significant reduction in hospital length of stay after high-risk major surgery and is likely to be cost-effective. Confirmatory work is required to determine whether these effects are reproducible, and to confirm whether this simple intervention could allow more cost-effective delivery of care. TRIAL REGISTRATION: Prospective Clinical Trials, ISRCTN32188676.