Using high-resolution climate change information in water management: a decision-makers' perspective.

The UK Climate Change Act requires the Environment Agency to report the risks it faces from climate change and actions taken to address these. Derived information from projections is critical to understanding likely impacts in water management. In 2019, the UK published an ensemble of high-resolution model simulations. The UKCP Local (2.2 km) projections can resolve smaller scale physical processes that determine rainfall and other variables at subdaily time-scales with the potential to provide new insights into extreme events, storm runoff and drainage management. However, simulations also need to inform adaptation. The challenge ahead is to identify and provide derived products without the need for further analysis by decision-makers. These include a wider evaluation of uncertainty, narratives about rainfall change across the projections and bias-corrected datasets. Future flood maps, peak rainfall estimates, uplift factors and future design storm profiles also need detailed guidance to support their use. Central government support is justified in the provision of up-to-date impacts information to inform flood risk management, given the large risks and exposure of all sectors. The further development of projections would benefit from greater focus and earlier scoping with industry representatives, operational tool developers and end users. This article is part of a discussion meeting issue 'Intensification of short-duration rainfall extremes and implications for flash flood risks'.

Hartmann's procedure versus intersphincteric abdominoperineal excision (HiP Study): a multicentre prospective cohort study.

AIM: In patients with low rectal cancer it is occasionally necessary to avoid a low coloanal anastomosis due to patient frailty or poor function. In such situations there are two alternative approaches: Hartmann's procedure (HP) or intersphincteric abdominoperineal excision (IAPE). There are few data to guide surgeons as to which of these two procedures is the safest. The aim of this study was to determine the surgical complication rates associated with each procedure. METHOD: This was a multicentre, nonrandomized prospective cohort study of patients undergoing either HP or IAPE. The primary objective was to determine surgical complication rates. Secondary objectives included length of stay, time to adjuvant therapy and quality of life at 90 days. RESULTS: One hundred and seventy nine patients were recruited between April 2016 and June 2019; approximately two thirds of patients underwent HP and one third IAPE. The overall complication rate was high in both groups (54% for the HP group and 52% for the IAPE group). Surgery-specific complication rates were also high, but not significantly different: 43% for HP and 48% for IAPE. The pelvic abscess rate in HP was 11% and was significantly higher in patients with a palpable staple line (15% vs 2%). There was a higher incidence of serious medical complications following IAPE (16% vs 5%), along with a reduction in 90-day quality of life scores. CONCLUSION: This is the largest prospective study to compare HP and IAPE in patients undergoing rectal cancer surgery where primary anastomosis is not deemed appropriate. With similar complication rates, these data support the ongoing use of either HP or IAPE in this patient group.

Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage.

BACKGROUND: Anastomotic complications following colorectal surgery are associated with significant morbidity and mortality. For patients in whom systemic sepsis is absent or well controlled, minimal access techniques, such as endoscopic therapies, are being increasingly employed to reduce the morbidity of surgical re-intervention. In this review, we aim to assess the utility of endoscopic management in the acute setting of colorectal anastomotic complications, focusing on anastomotic leak. METHOD: A literature search was performed for published full text articles using the PubMed, Cochrane and Scopus databases using the search criteria string "colorectal anastomotic ("leak" OR "bleed"), "endoscopy", endoscopic management". Additional papers were detected by scanning the references of relevant papers. Data were extracted from each study by two authors onto a dedicated pro-forma. Given the nature of the data extracted, no meta-analysis was performed. RESULTS: A total of 89 papers were identified, 16 of which were included in this review; an additional 14 papers were obtained from reference searches. In patients who are not physiologically compromised, there are promising data regarding the salvage rate of stents, over-the-scope endoscopic clips, vacuum therapy and fibrin glue in the early management of colorectal anastomotic leak. There is no consensus regarding the optimal approach, and data to assist the physician in patient selection are lacking. Whilst data on salvage (i.e. healing and avoidance of surgery) are well understood, no data on functional outcomes are reported. CONCLUSION: Endoscopic therapy in the management of stable patients with colorectal anastomotic leaks appears safe and in selected patients is associated with high rates of technical success. Challenges remain in selecting the most appropriate strategy, patient selection, and understanding the functional and long-term sequelae of this approach. Further evidence from large prospective cohort studies are needed to further evaluate the role of these novel strategies.

Persistent inequalities in 90-day colon cancer mortality: an English cohort study.

BACKGROUND: Variation in colon cancer mortality occurring shortly after diagnosis is widely reported between socio-economic status (SES) groups: we investigated the role of different prognostic factors in explaining variation in 90-day mortality. METHODS: National cancer registry data were linked with national clinical audit data and Hospital Episode Statistics records for 69 769 adults diagnosed with colon cancer in England between January 2010 and March 2013. By gender, logistic regression was used to estimate the effects of SES, age and stage at diagnosis, comorbidity and surgical treatment on probability of death within 90 days from diagnosis. Multiple imputations accounted for missing stage. We predicted conditional probabilities by prognostic factor patterns and estimated the effect of SES (deprivation) from the difference between deprivation-specific average predicted probabilities. RESULTS: Ninety-day probability of death rose with increasing deprivation, even after accounting for the main prognostic factors. When setting the deprivation level to the least deprived group for all patients and keeping all other prognostic factors as observed, the differences between deprivation-specific averaged predicted probabilities of death were greatly reduced but persisted. Additional analysis suggested stage and treatment as potential contributors towards some of these inequalities. CONCLUSIONS: Further examination of delayed diagnosis, access to treatment and post-operative care by deprivation group may provide additional insights into understanding deprivation disparities in mortality.

Salmonella Knowledge, Attitudes and Practices: A Survey of Backyard Poultry Owners Residing in Seattle, Washington and the Surrounding Metropolitan Area.

Raising poultry flocks in urban backyard settings is becoming increasingly popular across the United States, but carries a risk of zoonotic infection. In the United States from 1990 to 2014, 53 outbreaks of human salmonellosis linked to live poultry have been documented resulting in 2611 known illnesses, 387 known hospitalizations and five known deaths (Centers for Disease Control and Prevention 2015a, http://www.cdc.gov/healthypets/resources/dont-play-chicken-with-your-health-poster-24x36_508.pdf). A cross-sectional descriptive study was developed to better understand knowledge, attitudes and practices of urban backyard poultry owners regarding Salmonella risk and prevention. The study included a survey of bird health, animal husbandry and hygiene practices, and knowledge, attitudes and practices relating to Salmonella risk. Participants were videotaped while caring for their birds, and the recordings were transcribed using notational analysis to determine whether reported practices differed from observed practices. The results indicated that while a large proportion of participants knew that exposure to Salmonella is an inherent risk associated with raising poultry and harvesting eggs, their reported and observed practices would not consistently reduce risk of transmission of Salmonella and other zoonotic diseases. Approximately one in four participants reported performing practices that increase risk of inoculation, such as snuggling and kissing birds or eating/drinking near them. None of the participants were observed kissing their birds on video; however, snuggling (holding birds to clothes) or touching their face during routine care was observed in approximately two-thirds of the video recordings. The video data provided a unique opportunity to compare reported practices with actions recorded during site visits. While the differences were not statistically significant, findings from our study suggest that flock owners may not accurately report the frequency with which risky practices are performed during routine animal care. Education and outreach targeting backyard flock owners should aim to improve husbandry and hygiene practices and reduce risk of zoonotic diseases associated with raising poultry in the backyard setting.

A survey of veterinary antimicrobial prescribing practices, Washington State 2015.

Antimicrobial resistance is a growing global health issue. It is also a recognised problem in veterinary medicine. Between September and December 2015 the authors administered a cross-sectional survey to licensed veterinarians in Washington State to assess factors affecting antimicrobial prescribing practices among veterinarians in Washington State. Two hundred and three veterinarians completed the survey. The majority of respondents (166, 82 per cent) were engaged in small animal or exotic animal practice. 24 per cent of respondents reported not ordering culture and sensitivity (C/S) testing in practice. Of the 76 per cent of veterinarians who reported ordering C/S tests, 36 per cent reported ordering such testing 'often' or 'always' when treating presumptive bacterial infections. Most respondents (65 per cent) mentioned cost as the most common barrier to ordering a C/S test. Only 16 (10 per cent) respondents reported having access to or utilising a clinic-specific antibiogram. This survey demonstrated that while antimicrobials are commonly used in veterinary practice, and veterinarians are concerned about antimicrobial resistance, cost is a barrier to obtaining C/S tests to guide antimicrobial therapy. Summaries of antimicrobial resistance patterns are rarely available to the practising veterinarian. Efforts to promote antimicrobial stewardship in a 'One Health' manner should address barriers to the judicious use of antimicrobials in the veterinary practice setting.

Deriving stage at diagnosis from multiple population-based sources: colorectal and lung cancer in England.

BACKGROUND: Stage at diagnosis is a strong predictor of cancer survival. Differences in stage distributions and stage-specific management help explain geographic differences in cancer outcomes. Stage information is thus essential to improve policies for cancer control. Despite recent progress, stage information is often incomplete. Data collection methods and definition of stage categories are rarely reported. These inconsistencies may result in assigning conflicting stage for single tumours and confound the interpretation of international comparisons and temporal trends of stage-specific cancer outcomes. We propose an algorithm that uses multiple routine, population-based data sources to obtain the most complete and reliable stage information possible. METHODS: Our hierarchical approach derives a single stage category per tumour prioritising information deemed of best quality from multiple data sets and various individual components of tumour stage. It incorporates rules from the Union for International Cancer Control TNM classification of malignant tumours. The algorithm is illustrated for colorectal and lung cancer in England. We linked the cancer-specific Clinical Audit data (collected from clinical multi-disciplinary teams) to national cancer registry data. We prioritise stage variables from the Clinical Audit and added information from the registry when needed. We compared stage distribution and stage-specific net survival using two sets of definitions of summary stage with contrasting levels of assumptions for dealing with missing individual TNM components. This exercise extends a previous algorithm we developed for international comparisons of stage-specific survival. RESULTS: Between 2008 and 2012, 163 915 primary colorectal cancer cases and 168 158 primary lung cancer cases were diagnosed in adults in England. Using the most restrictive definition of summary stage (valid information on all individual TNM components), colorectal cancer stage completeness was 56.6% (from 33.8% in 2008 to 85.2% in 2012). Lung cancer stage completeness was 76.6% (from 57.3% in 2008 to 91.4% in 2012). Stage distribution differed between strategies to define summary stage. Stage-specific survival was consistent with published reports. CONCLUSIONS: We offer a robust strategy to harmonise the derivation of stage that can be adapted for other cancers and data sources in different countries. The general approach of prioritising good-quality information, reporting sources of individual TNM variables, and reporting of assumptions for dealing with missing data is applicable to any population-based cancer research using stage. Moreover, our research highlights the need for further transparency in the way stage categories are defined and reported, acknowledging the limitations, and potential discrepancies of using readily available stage variables.

Emergency and out of hours care of patients with inherited bleeding disorders.

Recently, the United Kingdom Haemophilia Centre Doctors Organisation published recommendations for the standard of care for assessment and treatment of patients with bleeding disorders in the emergency department (A&E). An audit was undertaken to compare the level of care to the acceptable standards in a tertiary hospital A&E, attached to a haemophilia comprehensive care centre. A&E attendances were found by cross referencing all patients with known bleeding disorders against the EDMS attendance system. Visits from the past 3 years were identified to produce sufficient data and electronic notes from these visits were then accessed, and marked against the proforma. Data were available from 45 of a total of 54 patients, who had a total of 75 emergency visits documented. In all aspects of care, the standards were not adequately met including the average length of time between booking and clinical assessment, early initiation of specific haemostatic treatment, seeking haematology advice and arrangement of follow-up. Also no specialist clotting investigations were done with only 9/11 patients admitted having their haematological diagnosis recorded. In addition, only very few patients had the severity of bleeding disorder noted and less than half their first line treatment documented. There were significant differences in the standard of care for haemophilia patients provided by the A&E department when compared with acceptable standards. Measures have been put in place and policies have been drafted to improve this situation and provide the best possible care to persons with haemophilia.

Proventriculus of Cephalotes ants: a structural and comparative analysis.

The use of optic microscopy and scanning electron microscopy propitiated the comparative examination of the structure of the proventriculus bulb of Cephalotes atratus, Cephalotes clypeatus and Cephalotes pusillus. This portion of the digestive tract possesses highly sclerotized projections which act in the selection of victuals. This structure is of importance to phylogeny studies and thus was compared with others known species of ants in a dendrogram adapted from Eisner (1957). We did not detect differences among the three studied species in the nature of histochemistry and ultra morphology.

Development of agro-environmental scenarios to support pesticide risk assessment in Europe.

This paper describes work carried out within the EU-funded FOOTPRINT project to characterize the diversity of European agricultural and environmental conditions with respect to parameters which most influence the environmental fate of pesticides. Pan-European datasets for soils, climate, land cover and cropping were intersected, using GIS, to identify the full range of unique combinations of climate, soil and crop types which characterize European agriculture. The resulting FOOTPRINT European agro-environmental dataset constitutes a large number of polygons (approximately 1,700,000) with attribute data files for i) area fractions of annual crops related to each arable-type polygon (as an indicator of its probability of occurrence); and, ii) area fractions of each soil type in each polygon (as an indicator of its probability of occurrence). A total of 25,044 unique combinations of climate zones, agricultural land cover classes, administrative units and soil map units were identified. The same soil/crop combinations occur in many polygons which have the same climate while the fractions of the soils and arable crops are different. The number of unique combinations of climate, soil and agricultural land cover class is therefore only 7961. 26-year daily meteorological data, soil profile characteristics and crop management features were associated with each unique combination. The agro-environmental scenarios developed can be used to underpin the parameterization of environmental fate models for pesticides and should also have relevance for other agricultural pollutants. The implications for the improvement and further development of risk assessment procedures for pesticides are discussed.

Questioning the implementation of habitat corridors: a case study in interior São Paulo using ants as bioindicators.

In this paper we operated ant collections in three inland Atlantic forest fragments and in the neighboring Edmundo Navarro de Andrade State Forest (FEENA), an Eucalyptus plantation located in Rio Claro, interior of São Paulo State. We show that the ant communities of the native forest fragments are more similar among themselves than to the ant community of FEENA. Thus we evidence that, in addition to the clear difference in vegetation segment, other components of the biota (like ants) can be different between FEENA and the native forest fragments. Our results conveniently served as a basis to discuss the proposal of connecting FEENA to the three native forest fragments by a habitat corridor. These fragments are important to conservation purposes since they represent the biggest areas of native vegetation in the region.

Questioning the implementation of habitat corridors: a case study in interior São Paulo using ants as bioindicators

In this paper we operated ant collections in three inland Atlantic forest fragments and in the neighboring Edmundo Navarro de Andrade State Forest (FEENA), an Eucalyptus plantation located in Rio Claro, interior of São Paulo State. We show that the ant communities of the native forest fragments are more similar among themselves than to the ant community of FEENA. Thus we evidence that, in addition to the clear difference in vegetation segment, other components of the biota (like ants) can be different between FEENA and the native forest fragments. Our results conveniently served as a basis to discuss the proposal of connecting FEENA to the three native forest fragments by a habitat corridor. These fragments are important to conservation purposes since they represent the biggest areas of native vegetation in the region.

Neste trabalho operamos coletas de formigas em três fragmentos de Mata Atlântica e na vizinha Floresta Estadual Edmundo Navarro de Andrade (FEENA), um reflorestamento de eucaliptos em Rio Claro, interior de São Paulo. Demonstramos que as comunidades de formigas dos fragmentos de floresta nativa são mais parecidas entre si do que com a da FEENA. Desse modo evidenciamos que além da clara diferença no segmento vegetacional, outros componentes da biota (como as formigas) podem ser diferentes entre a FEENA e os fragmentos de floresta nativa. Nossos resultados oportunamente serviram como base para discussão sobre a proposta de se unir através de um corredor ecológico a FEENA a esses fragmentos de floresta nativa. Tais fragmentos são importantes para fins de conservação uma vez que representam as maiores áreas de vegetação nativa da região.

Developing climatic scenarios for pesticide fate modelling in Europe.

A climatic classification for Europe suitable for pesticide fate modelling was constructed using a 3-stage process involving the identification of key climatic variables, the extraction of the dominant modes of spatial variability in those variables and the use of k-means clustering to identify regions with similar climates. The procedure identified 16 coherent zones that reflect the variability of climate across Europe whilst maintaining a manageable number of zones for subsequent modelling studies. An analysis of basic climatic parameters for each zone demonstrates the success of the scheme in identifying distinct climatic regions. Objective criteria were used to identify one representative 26-year daily meteorological series from a European dataset for each zone. The representativeness of each series was then verified against the zonal classifications. These new FOOTPRINT climate zones provide a state-of-the-art objective classification of European climate complete with representative daily data that are suitable for use in pesticide fate modelling.

Future climate scenarios and rainfall--runoff modelling in the Upper Gallego catchment (Spain).

Global climate change may have large impacts on water supplies, drought or flood frequencies and magnitudes in local and regional hydrologic systems. Water authorities therefore rely on computer models for quantitative impact prediction. In this study we present kernel-based learning machine river flow models for the Upper Gallego catchment of the Ebro basin. Different learning machines were calibrated using daily gauge data. The models posed two major challenges: (1) estimation of the rainfall-runoff transfer function from the available time series is complicated by anthropogenic regulation and mountainous terrain and (2) the river flow model is weak when only climate data are used, but additional antecedent flow data seemed to lead to delayed peak flow estimation. These types of models, together with the presented downscaled climate scenarios, can be used for climate change impact assessment in the Gallego, which is important for the future management of the system.

The integrated project AquaTerra of the EU sixth framework lays foundations for better understanding of river-sediment-soil-groundwater systems.

The integrated project "AquaTerra" with the full title "integrated modeling of the river-sediment-soil-groundwater system; advanced tools for the management of catchment areas and river basins in the context of global change" is among the first environmental projects within the sixth Framework Program of the European Union. Commencing in June 2004, it brought together a multidisciplinary team of 45 partner organizations from 12 EU countries, Romania, Switzerland, Serbia and Montenegro. AquaTerra is an ambitious project with the primary objective of laying the foundations for a better understanding of the behavior of environmental pollutants and their fluxes in the soil-sediment-water system with respect to climate and land use changes. The project performs research as well as modeling on river-sediment-soil-groundwater systems through quantification of deposition, sorption and turnover rates and the development of numerical models to reveal fluxes and trends in soil and sediment functioning. Scales ranging from the laboratory to river basins are addressed with the potential to provide improved river basin management, enhanced soil and groundwater monitoring as well as the early identification and forecasting of impacts on water quantity and quality. Study areas are the catchments of the Ebro, Meuse, Elbe and Danube Rivers and the Brévilles Spring. Here we outline the general structure of the project and the activities conducted within eleven existing sub-projects of AquaTerra.

A cross-sectional study to investigate long-term cognitive function in people with treated pituitary Cushing's disease.

INTRODUCTION: It has been proposed that exposure to high levels of endogenous steroids in untreated pituitary Cushing's disease damages hippocampal structures leading to impairment in learning and memory processes. We hypothesised that patients with treated pituitary Cushing's disease would perform significantly worse on tests of cognitive ability than those with nonfunctioning pituitary adenomas. DESIGN: Sixteen adults with pituitary Cushing's disease (PCD) and 16 adults with non-functioning pituitary adenomas (NFA) undertook the following comprehensive neuropsychological assessments: National Adult Reading Test (NART: premorbid abilities), California Verbal Learning Test (CVLT 2 UK: learning and recall), Stroop (executive functioning), Trail-Making Test (TMT: executive functioning and attention), Adult Memory and Information Processing Battery (AMIPB: Information Processing Speed and Story Recall subtests). RESULTS: There was no significant difference in premorbid IQ scores (NFA mean=101 SD=13; PCD mean=102, SD=13), in verbal learning nor any significant difference in the percentage of verbal material retained in story recall (AMIPB). Performance on higher executive tasks Stroop and TMT and on measures of information processing was similar. However, there were significant decrements between some mean scores for both groups and published normative data with a clear association between higher HADS depression scores and impaired objective memory and attention which was not specific to PCD. CONCLUSIONS: We found no difference in cognitive function between patients with PCD and NFA. The results suggest a discrepancy between patients' subjective perception of functional cognitive impairments and objective findings on psychometric testing and point to the influence of affective symptoms on cognitive performance, particularly in Cushing's disease.

Body size and flight distance in stingless bees (Hymenoptera: Meliponini): inference of flight range and possible ecological implications.

We examined the spatial implications of maximum flight distance for several species of stingless bees. Data suggested that maximum flight distance in Meliponini is a function of body size, especially generalized wing size, which can be estimated through principal component analysis. For six species of stingless bees, flight distances and generalized wing sizes were highly correlated (r = 0.938). This indicates that species of Meliponini occupy an effectively larger area as body size increases, which has important implications in the spatial dynamics of local populations restricted to forest fragments. We also used the fitted linear regression model to estimate the maximum flight distance for 12 other species of Meliponini. The results of this research may provide insights for future studies of biological conservation.

Body size and flight distance in stingless bees (Hymenoptera: Meliponini): inference of flight range and possible ecological implications

Neste trabalho analisamos as implicações espaciais da distância máxima de vôo para algumas espécies de meliponíneos. Os dados sugerem que a distância máxima de vôo em meliponíneos está relacionada ao tamanho do corpo, especialmente ao tamanho generalizado das asas, que pode ser estimado utilizando análises de componentes principais. Uma análise utilizando seis espécies de meliponíneos evidenciou que o tamanho generalizado das asas está fortemente correlacionado à distância de vôo (r = 0,938). Isso sugere que espécies de meliponíneos ocupam área efetivamente maior quanto maior for o tamanho do corpo, trazendo importantes implicações para a dinâmica espacial de populações locais restritas a áreas fragmentadas. Neste trabalho, também utilizamos um modelo de regressão linear a fim de estimar as distâncias máximas de vôo para 12 outras espécies de meliponíneos. Esta pesquisa fornece subsídios para futuros estudos relacionados à conservação da biodiversidade.

Body size and flight distance in stingless bees (Hymenoptera: Meliponini): inference of flight range and possible ecological implications

We examined the spatial implications of maximum flight distance for several species of stingless bees. Data suggested that maximum flight distance in Meliponini is a function of body size, especially generalized wing size, which can be estimated through principal component analysis. For six species of stingless bees, flight distances and generalized wing sizes were highly correlated (r = 0.938). This indicates that species of Meliponini occupy an effectively larger area as body size increases, which has important implications in the spatial dynamics of local populations restricted to forest fragments. We also used the fitted linear regression model to estimate the maximum flight distance for 12 other species of Meliponini. The results of this research may provide insights for future studies of biological conservation.

Neste trabalho analisamos as implicações espaciais da distância máxima de vôo para algumas espécies de meliponíneos. Os dados sugerem que a distância máxima de vôo em meliponíneos está relacionada ao tamanho do corpo, especialmente ao tamanho generalizado das asas, que pode ser estimado utilizando análises de componentes principais. Uma análise utilizando seis espécies de meliponíneos evidenciou que o tamanho generalizado das asas está fortemente correlacionado à distância de vôo (r = 0,938). Isso sugere que espécies de meliponíneos ocupam área efetivamente maior quanto maior for o tamanho do corpo, trazendo importantes implicações para a dinâmica espacial de populações locais restritas a áreas fragmentadas. Neste trabalho, também utilizamos um modelo de regressão linear a fim de estimar as distâncias máximas de vôo para 12 outras espécies de meliponíneos. Esta pesquisa fornece subsídios para futuros estudos relacionados à conservação da biodiversidade.