Warming temperatures drive at least half of the magnitude of long-term trait changes in European birds.

SignificanceClimate change is impacting wild populations, but its relative importance compared to other causes of change is still unclear. Many studies assume that changes in traits primarily reflect effects of climate change, but this assumption is rarely tested. We show that in European birds global warming was likely the single most important contributor to temporal trends in laying date, body condition, and offspring number. However, nontemperature factors were also important and acted in the same direction, implying that attributing temporal trends solely to rising temperatures overestimates the impact of climate warming. Differences among species in the amount of trait change were predominantly determined by these nontemperature effects, suggesting that species differences are not due to variation in sensitivity to temperature.

Refining mass casualty plans with simulation-based iterative learning.

BACKGROUND: Preparatory, written plans for mass casualty incidents are designed to help hospitals deliver an effective response. However, addressing the frequently observed mismatch between planning and delivery of effective responses to mass casualty incidents is a key challenge. We aimed to use simulation-based iterative learning to bridge this gap. METHODS: We used Normalisation Process Theory as the framework for iterative learning from mass casualty incident simulations. Five small-scale 'focused response' simulations generated learning points that were fed into two large-scale whole-hospital response simulations. Debrief notes were used to improve the written plans iteratively. Anonymised individual online staff surveys tracked learning. The primary outcome was system safety and latent errors identified from group debriefs. The secondary outcomes were the proportion of completed surveys, confirmation of reporting location, and respective roles for mass casualty incidents. RESULTS: Seven simulation exercises involving more than 700 staff and multidisciplinary responses were completed with debriefs. Usual emergency care was not affected by simulations. Each simulation identified latent errors and system safety issues, including overly complex processes, utilisation of space, and the need for clarifying roles. After the second whole hospital simulation, participants were more likely to return completed surveys (odds ratio=2.7; 95% confidence interval [CI], 1.7-4.3). Repeated exercises resulted in respondents being more likely to know where to report (odds ratio=4.3; 95% CI, 2.5-7.3) and their respective roles (odds ratio=3.7; 95% CI, 2.2-6.1) after a simulated mass casualty incident was declared. CONCLUSION: Simulation exercises are a useful tool to improve mass casualty incident plans iteratively and continuously through hospital-wide engagement of staff.

Predicting when climate-driven phenotypic change affects population dynamics.

Species' responses to climate change are variable and diverse, yet our understanding of how different responses (e.g. physiological, behavioural, demographic) relate and how they affect the parameters most relevant for conservation (e.g. population persistence) is lacking. Despite this, studies that observe changes in one type of response typically assume that effects on population dynamics will occur, perhaps fallaciously. We use a hierarchical framework to explain and test when impacts of climate on traits (e.g. phenology) affect demographic rates (e.g. reproduction) and in turn population dynamics. Using this conceptual framework, we distinguish four mechanisms that can prevent lower-level responses from impacting population dynamics. Testable hypotheses were identified from the literature that suggest life-history and ecological characteristics which could predict when these mechanisms are likely to be important. A quantitative example on birds illustrates how, even with limited data and without fully-parameterized population models, new insights can be gained; differences among species in the impacts of climate-driven phenological changes on population growth were not explained by the number of broods or density dependence. Our approach helps to predict the types of species in which climate sensitivities of phenotypic traits have strong demographic and population consequences, which is crucial for conservation prioritization of data-deficient species.

Paediatric major incident simulation and the number of discharges achieved using a major incident rapid discharge protocol in a major trauma centre: a retrospective study.

OBJECTIVES: Hospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions. METHOD AND SETTING: A simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days. RESULTS: Twenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed. CONCLUSION: We increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged.

High intra-specific variation in avian body condition responses to climate limits generalisation across species.

It is generally assumed that populations of a species will have similar responses to climate change, and thereby that a single value of sensitivity will reflect species-specific responses. However, this assumption is rarely systematically tested. High intraspecific variation will have consequences for identifying species- or population-level traits that can predict differences in sensitivity, which in turn can affect the reliability of projections of future climate change impacts. We investigate avian body condition responses to changes in six climatic variables and how consistent and generalisable these responses are both across and within species, using 21 years of data from 46 common passerines across 80 Dutch sites. We show that body condition decreases with warmer spring/early summer temperatures and increases with higher humidity, but other climate variables do not show consistent trends across species. In the future, body condition is projected to decrease by 2050, mainly driven by temperature effects. Strikingly, populations of the same species generally responded just as differently as populations of different species implying that a single species signal is not meaningful. Consequently, species-level traits did not explain interspecific differences in sensitivities, rather population-level traits were more important. The absence of a clear species signal in body condition responses implies that generalisation and identifying species for conservation prioritisation is problematic, which sharply contrasts conclusions of previous studies on the climate sensitivity of phenology.