The safety of flexible fibre-optic bronchoscopy and proceduralist-administered sedation: a tertiary referral centre experience.

BACKGROUND: Flexible fibre-optic bronchoscopy has become an essential investigation and is widely regarded as safe, but wider published prospective data regarding delayed complications are limited. There is continuing debate concerning the safety of proceduralist-administered sedation. We evaluated complication rates of bronchoscopy and proceduralist-administered sedation at our tertiary institution, and their clinical significance. METHODS: Prospective evaluation of all patients undergoing bronchoscopy over a 12-month period at a tertiary referral centre. Immediate minor and major complications were documented within 4 h of bronchoscopy, delayed complications at 48 h, case notes and bronchoscopy records were reviewed 1 month later. RESULTS: Five hundred and fifty-eight flexible fibre-optic bronchoscopies were performed, 216 with transbronchial biopsy or nodal aspiration, 19 had therapeutic airways intervention. The minor complication rate at 4 h was 4.12% (23), rising to 26% (145) at 48 h. All 2.2% (12) major complications occurred exclusively within 4 h of bronchoscopy. No complications could be attributed to proceduralist-administered sedation. DISCUSSION: Complication rates at 4 h were comparable with previously reported data. Delayed minor complications were greater than expected, and did not require additional medical input. There were no complications from proceduralist-administered sedation. Flexible fibre-optic bronchoscopy and proceduralist-administered sedation within our institution's guidelines are safe.

Social interactions do not drive territory aggregation in a grassland songbird.

Understanding the drivers of animal distributions is a fundamental goal of ecology and informs habitat management. The costs and benefits of colonial aggregations in animals are well established, but the factors leading to aggregation in territorial animals remain unclear. Territorial animals might aggregate to facilitate social behavior such as (1) group defense from predators and/or parasites, (2) cooperative care of offspring, (3) extra-pair mating, and/or (4) mitigating costs of extra-pair mating through kin selection. Using experimental and observational methods, we tested predictions of all four hypotheses in a tallgrass prairie in northeast Kansas, United States. Grasshopper Sparrow (Ammodramus savannarum) males formed clumps of territories in some parts of the site while leaving other apparently suitable areas unoccupied. Despite substantial sampling effort (653 territories and 223 nests), we found no support for any hypothesized social driver of aggregation, nor evidence that aggregation increases nest success. Our results run counter to previous evidence that conspecific interactions shape territory distributions. These results suggest one of the following alternatives: (1) the benefits of aggregation accrue to different life-history stages, or (2) the benefits of territory aggregation may be too small to detect in short-term studies and/or the consequences of aggregation are sufficiently temporally and spatially variable that they do not always appear to be locally adaptive, perhaps exacerbated by changing landscape contexts and declining population sizes.