Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse or other critical incidents: Guidelines from the Association of Anaesthetists and the Intensive Care Society.

The need to evacuate an ICU or operating theatre complex during a fire or other emergency is a rare event but one potentially fraught with difficulty: Not only is there a risk that patients may come to harm but also that staff may be injured and unable to work. Designing newly-built or refurbished ICUs and operating theatre suites is an opportunity to incorporate mandatory fire safety features and improve the management and outcomes of such emergencies: These include well-marked manual fire call points and oxygen shut off valves (area valve service units); the ability to isolate individual zones; multiple clear exit routes; small bays or side rooms; preference for ground floor ICU location and interconnecting routes with operating theatres; separate clinical and non-clinical areas. ICUs and operating theatre suites should have a bespoke emergency evacuation plan and route map that is readily available. Staff should receive practical fire and evacuation training in their clinical area of work on induction and annually as part of mandatory training, including 'walk-through practice' or simulation training and location of manual fire call points and fire extinguishers, evacuation routes and location and operation of area valve service units. The staff member in charge of each shift should be able to select and operate fire extinguishers and lead an evacuation. Following an emergency evacuation, a network-wide response should be activated, including retrieval and transport of patients to other ICUs if needed. A full investigation should take place and ongoing support and follow-up of staff provided.

Multiple soil map comparison highlights challenges for predicting topsoil organic carbon concentration at national scale.

Soil organic carbon (SOC) concentration is the fundamental indicator of soil health, underpinning food production and climate change mitigation. SOC storage is highly sensitive to several dynamic environmental drivers, with approximately one third of soils degraded and losing carbon worldwide. Digital soil mapping illuminates where hotspots of SOC storage occur and where losses to the atmosphere are most likely. Yet, attempts to map SOC often disagree. Here we compare national scale SOC concentration map products to reveal agreement of data in mineral soils, with progressively poorer agreement in organo-mineral and organic soils. Divergences in map predictions from each other and survey data widen in the high SOC content land types we stratified. Given the disparities are highest in carbon rich soils, efforts are required to reduce these uncertainties to increase confidence in mapping SOC storage and predicting where change may be important at national to global scales. Our map comparison results could be used to identify SOC risk where concentrations are high and should be conserved, and where uncertainty is high and further monitoring should be targeted. Reducing inter-map uncertainty will rely on addressing statistical limitations and including covariates that capture convergence of physical factors that produce high SOC contents.

Indices of stress in three-spined sticklebacks Gasterosteus aculeatus in relation to extreme weather events and exposure to wastewater effluent.

Whole-body concentrations of cortisol and glucose were measured in three-spined sticklebacks Gasterosteus aculeatus from two rivers (Rivers Ray and Ock) in southern England during a 30 month period in order to assess effects on the stress axis of (1) remediation of a wastewater treatment works (WWTW) effluent (River Ray) and (2) episodic changes in flow rate arising from periods of high rainfall (Rivers Ray and Ock). The postcapture concentrations of cortisol and glucose in fish from both rivers did not exhibit a seasonal periodicity but did show significant between-sample, between-site and between-river variation, superimposed upon a consistent downward trend for each analyte during the monitoring period. Corticosteroid and glucose concentrations following capture were inversely linked with a progressive increase in condition of the fish during this period. Site-dependent trends possibly related to exposure to the WWTW effluent were detected for both analytes in fish from the River Ray. For fish in the River Ray, a significant proportion of variation in both corticosteroid and glucose concentrations, additional to the downward trend with time, was accounted for by temporal proximity of the sample to exceptional flow events arising from episodes of high rainfall and high turbidity. This relationship was not statistically significant for fish from the River Ock. These data suggest that the responsiveness of the stress axis in free-living G. aculeatus may be altered by exposure to WWTW effluent and by exposure to physical changes in the aquatic environment such as those arising from extreme weather events. The magnitude of these effects may be increased by exposure to both stressors concurrently.

Patterns and trends of topsoil carbon in the UK: Complex interactions of land use change, climate and pollution.

The UK Countryside Survey (CS) is a national long-term survey of soils and vegetation that spans three decades (1978-2007). Past studies using CS data have identified clear contrasting trends in topsoil organic carbon (tSOC) concentrations (0-15 cm) related to differences between habitat types. Here we firstly examine changes in tSOC resulting from land use change, and secondly construct mixed models to describe the impact of indirect drivers where land use has been constant. Where it occurs, land use change is a strong driver of SOC change, with largest changes in tSOC for transitions involving SOC-rich soils in upland and bog systems. Afforestation did not always increase tSOC, and the effect of transitions involving woodland was dependent on the other vegetation type. The overall national spatial pattern of tSOC concentration where land use has been constant is most strongly related to vegetation type and topsoil pH, with contributions from climate variables, deposition and geology. Comparisons of models for tSOC across time periods suggest that declining SO4 deposition has allowed recovery of topsoils from acidification, but that this has not resulted in the increased decomposition rates and loss of tSOC which might be expected. As a result, the relationship between pH and tSOC in UK topsoils has changed significantly between 1978 and 2007. The contributions of other indirect drivers in the models suggest negative relationships to seasonal temperature metrics and positive relationships to seasonal precipitation at the dry end of the scale. The results suggest that the CS approach of long-term collection of co-located vegetation and soil biophysical data provides essential tools both for identifying trends in tSOC at national and habitat levels, and for identifying areas of risk or areas with opportunities for managing topsoil SOC and vegetation change.

Inference for clustered inhomogeneous spatial point processes.

SUMMARY: We propose a method to test for significant differences in the levels of clustering between two spatial point processes (cases and controls) while taking into account differences in their first-order intensities. The key advance on earlier methods is that the controls are not assumed to be a Poisson process. Inference and diagnostics are based around the inhomogeneous K-function with confidence envelopes obtained from either resampling events in a nonparametric bootstrap approach, or simulating new events as in a parametric bootstrap. Methods developed are demonstrated using the locations of adult and juvenile trees in a tropical forest. A simulation study briefly examines the accuracy and power of the inferential procedures.

Livestock host composition rather than land use or climate explains spatial patterns in bluetongue disease in South India.

Culicoides-borne arboviruses of livestock impair animal health, livestock production and livelihoods worldwide. As these arboviruses are multi-host, multi-vector systems, predictions to improve targeting of disease control measures require frameworks that quantify the relative impacts of multiple abiotic and biotic factors on disease patterns. We develop such a framework to predict long term (1992-2009) average patterns in bluetongue (BT), caused by bluetongue virus (BTV), in sheep in southern India, where annual BT outbreaks constrain the livelihoods and production of small-holder farmers. In Bayesian spatial general linear mixed models, host factors outperformed landscape and climate factors as predictors of disease patterns, with more BT outbreaks occurring on average in districts with higher densities of susceptible sheep breeds and buffalo. Since buffalo are resistant to clinical signs of BT, this finding suggests they are a source of infection for sympatric susceptible sheep populations. Sero-monitoring is required to understand the role of buffalo in maintaining BTV transmission and whether they must be included in vaccination programs to protect sheep adequately. Landscape factors, namely the coverage of post-flooding, irrigated and rain-fed croplands, had weak positive effects on outbreaks. The intimate links between livestock host, vector composition and agricultural practices in India require further investigation at the landscape scale.

Long-term increases in soil carbon due to ecosystem fertilization by atmospheric nitrogen deposition demonstrated by regional-scale modelling and observations.

Fertilization of nitrogen (N)-limited ecosystems by anthropogenic atmospheric nitrogen deposition (Ndep) may promote CO2 removal from the atmosphere, thereby buffering human effects on global radiative forcing. We used the biogeochemical ecosystem model N14CP, which considers interactions among C (carbon), N and P (phosphorus), driven by a new reconstruction of historical Ndep, to assess the responses of soil organic carbon (SOC) stocks in British semi-natural landscapes to anthropogenic change. We calculate that increased net primary production due to Ndep has enhanced detrital inputs of C to soils, causing an average increase of 1.2 kgCm-2 (c. 10%) in soil SOC over the period 1750-2010. The simulation results are consistent with observed changes in topsoil SOC concentration in the late 20th Century, derived from sample-resample measurements at nearly 2000 field sites. More than half (57%) of the additional topsoil SOC is predicted to have a short turnover time (c. 20 years), and will therefore be sensitive to future changes in Ndep. The results are the first to validate model predictions of Ndep effects against observations of SOC at a regional field scale. They demonstrate the importance of long-term macronutrient interactions and the transitory nature of soil responses in the terrestrial C cycle.

Country-specific effects of neonicotinoid pesticides on honey bees and wild bees.

Neonicotinoid seed dressings have caused concern world-wide. We use large field experiments to assess the effects of neonicotinoid-treated crops on three bee species across three countries (Hungary, Germany, and the United Kingdom). Winter-sown oilseed rape was grown commercially with either seed coatings containing neonicotinoids (clothianidin or thiamethoxam) or no seed treatment (control). For honey bees, we found both negative (Hungary and United Kingdom) and positive (Germany) effects during crop flowering. In Hungary, negative effects on honey bees (associated with clothianidin) persisted over winter and resulted in smaller colonies in the following spring (24% declines). In wild bees (Bombus terrestris and Osmia bicornis), reproduction was negatively correlated with neonicotinoid residues. These findings point to neonicotinoids causing a reduced capacity of bee species to establish new populations in the year following exposure.

Nitrogen deposition effects on plant species diversity; threshold loads from field data.

National-scale plant species richness data for Great Britain in 1998 were related to modelled contemporary N deposition (N(dep)) using a broken stick median regression, to estimate thresholds above which N(dep) definitely has had an effect. The thresholds (kg N ha⁻¹ a⁻¹) are 7.9 for acid grassland 14.9 for bogs, 23.6 for calcareous grassland, 7.8 for deciduous woodland and 8.8 for heath. The woodland and heath thresholds are not significantly greater than the lowest N(dep), which implies that species loss may occur over the whole range of contemporary N(dep). This also applies to acid grassland if it is assumed that N(dep) has substituted for previous N fixation. The thresholds for bog and calcareous grassland are both significantly above the lowest N(dep). The thresholds are lower than the mid-range empirical Critical Loads for acid grassland, deciduous woodland and heath, higher for bogs, and approximately equal for calcareous grassland.

Line transect methods for plant surveys.

Interest in surveys for monitoring plant abundance is increasing, due in part to the need to quantify the rate of loss of biodiversity. Line transect sampling offers an efficient way to monitor many species. However, the method does not work well in some circumstances, for example on small survey plots, when the plant species has a strongly aggregated distribution, or when plants that are on the line are not easily detected. We develop a crossed design, together with methods that exploit the additional information from such a design, to address these problems. The methods are illustrated using data on a colony of cowslips.

Clinical review of cervical spine injuries in children.

Clinical presentation is made of 18 cervical fractures occurring in children age 15 and under. Seven of 18 patients sustained neurological complications. The incidence of childhood cervical spine injury increases with age. Sixteen of 18 lesions were found in the C1 through C4 area in contrast to a greater involvement in adults in levels of C4 through C7. Although normal variations and anomalies are frequent in cervical spines in children, over treatment, at least initially, is recommended in all cases in which the diagnosis is in doubt.

Nitric oxide: description of a pipeline delivery system.

We describe a pipeline system suitable for the delivery of nitric oxide gas to an 18-bed intensive care unit. The pipeline was developed and installed according to the current UK regulations HTM 2022, which relates to the supply of piped medical gases. Where HTM 2022 did not specify the appropriate standard, we consulted widely to achieve a safe solution. We continue to monitor all aspects of the performance of the pipeline to ensure safe operating practices and recommend changes to the standards.