Hospital and departmental level strategies for managing the impact of adverse events on surgeons.

Adverse events have a profound impact on surgeons. This impact extends to physical and mental health, psychological wellbeing, and professional performance. Surgeons are ill prepared for these consequences of adverse events and are under-supported when they inevitably occur.

GP roles in emergency medical services: a systematic mapping review and narrative synthesis.

Background: A significant proportion of emergency medical services (EMS) work is for problems that may be amenable to timely primary care management and could benefit from GP input. Utilising GPs in EMS may reduce avoidable emergency department (ED) conveyance, releasing emergency ambulances for higher-acuity care, and meeting patient needs earlier in the evolution of an emergency call.

Aim: To collate and summarise evidence on how GPs are utilised in EMS.

The current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review.

Background: 3D reconstruction technology could revolutionise medicine. Within surgery, 3D reconstruction has a growing role in operative planning and procedures, surgical education and training as well as patient engagement. Whilst virtual and 3D printed models are already used in many surgical specialities, oesophagogastric surgery has been slow in their adoption.

Current and possible future role of 3D modelling within oesophagogastric surgery: a scoping review protocol.

Introduction: Three-dimensional (3D) reconstruction describes the generation of either virtual or physically printed anatomically accurate 3D models from two-dimensional medical images. Their implementation has revolutionised medical practice. Within surgery, key applications include growing roles in operative planning and procedures, surgical education and training, as well as patient engagement and education.

Langer's arch: A rare but important consideration for axillary surgery with implications for training.

Langer's arch (LA), although rare, is an important anatomical anomaly in the axilla that may be encountered during axillary lymph node dissection (ALND). Failure to recognize this anomaly may cause disorientation during ALND, resulting in inadequate clearance, with implications for local disease recurrence and inaccurate staging. Here, we present a case that highlights the confusion LA can cause even in experienced surgeons.

Using adaptive processes and adverse outcome pathways to develop meaningful, robust, and actionable environmental monitoring programs.

The primary goals of environmental monitoring are to indicate whether unexpected changes related to development are occurring in the physical, chemical, and biological attributes of ecosystems and to inform meaningful management intervention. Although achieving these objectives is conceptually simple, varying scientific and social challenges often result in their breakdown. Conceptualizing, designing, and operating programs that better delineate monitoring, management, and risk assessment processes supported by hypothesis-driven approaches, strong inference, and adverse outcome pathways can overcome many of the challenges.

The Accuracy of Noninvasive Peripheral Pulse Oximetry After Palliative Cardiac Surgery in Patients With Cyanotic Congenital Heart Disease.

Background: Children with cyanotic congenital heart disease (CCHD) live with oxyhemoglobin saturations that are typically expressed as percentages in the range of 70s and 80s. Peripheral pulse oximetry (measurement of SpO) performs poorly in this range and yet is widely used to inform clinical decisions in these patients. The reference standard is co-oximetry of arterial samples (SaO).

Lessons Learned from an Industry, Government and University Collaboration to Restore Stream Habitats and Mitigate Effects.

Restoration ecologists conduct both basic and applied research using a diversity of funding and collaborative models. Over the last 17 years we have assessed the effectiveness of a stream compensation project in Canada's north, where an independent university-based research program was a condition of the regulatory approval process. This resulted in a non-traditional university-government-industry partnership.

Development and application of benthic algal reference condition models to assess stream condition in the South Nahanni Watershed.

Monitoring biologists continually strive to improve the effectiveness of protocols to quantify environmental and ecological effects of anthropogenic activities. We developed and applied a reference condition approach (RCA) model to assess the ability of 3 descriptors of algal community structure (algal taxonomy, diatom taxonomy, and algal pigments) to identify impairment in 2 northern rivers in the South Nahanni River Watershed, Northwest Territories, Canada. We established reference conditions by sampling 62 regional reference (i.

Accuracy of the Masimo SET® LNCS neo peripheral pulse oximeter in cyanotic congenital heart disease.

Unlabelled: Introduction Non-invasive peripheral pulse oximeters are routinely used to measure oxyhaemoglobin saturation (SpO2) in cyanotic congenital heart disease. These probes are calibrated in healthy adult volunteers between arterial saturations of ~75 and 100%, using the gold standard of co-oximetry on arterial blood samples. There are little data to attest their accuracy in cyanotic congenital heart disease.

Relations between water physico-chemistry and benthic algal communities in a northern Canadian watershed: defining reference conditions using multiple descriptors of community structure.

Defining reference conditions is central to identifying environmental effects of anthropogenic activities. Using a watershed approach, we quantified reference conditions for benthic algal communities and their relations to physico-chemical conditions in rivers in the South Nahanni River watershed, NWT, Canada, in 2008 and 2009. We also compared the ability of three descriptors that vary in terms of analytical costs to define algal community structure based on relative abundances of (i) all algal taxa, (ii) only diatom taxa, and (iii) photosynthetic pigments.

Gas induction for pyloromyotomy.

Background: Infants with pyloric stenosis are considered to be at high risk of aspiration on induction of anesthesia. Traditionally, texts have recommended classic rapid sequence induction (RSI) or awake intubation (AI). AI has generally fallen out of favor, while the components of RSI have become increasingly controversial.

Evaluating the use of algal pigments to assess the biological condition of streams.

Assessments of stream condition using benthic algal communities have traditionally relied on taxonomy-based approaches to compare community structure at sites exposed to a stressor versus reference sites. Taxonomy-based methods are often effective, but they require high levels of training and are relatively time consuming and expensive. We examined the utility of assessing stream biological condition using algal pigments.

Assessing the effectiveness of a constructed Arctic stream using multiple biological attributes.

Objective assessment of habitat compensation is a central yet challenging issue for restoration ecologists. In 1997, a 3.4-km stream channel, designed to divert water around an open pit diamond mine, was excavated in the Barrenlands region of the Canadian Arctic to create productive stream habitat.

Cumulative industrial activity alters lotic fish assemblages in two boreal forest watersheds of Alberta, Canada.

We evaluated the cumulative effects of land use disturbance resulting from forest harvesting, and exploration and extraction of oil and gas resources on the occurrence and structure of stream fish assemblages in the Kakwa and Simonette watersheds in Alberta, Canada. Logistic regression models showed that the occurrence of numerically dominant species in both watersheds was related to two metrics defining industrial activity (i.e.

Physico-chemical determinants of helminth component community structure in whitefish (Coregonus clupeaformes) from adjacent lakes in Northern Alberta, Canada.

Populations of hosts vary extensively in the types and numbers of parasites that the average individual contains. Understanding the factors that lead to this variation is an important goal for parasite ecologists. We characterized patterns of helminth component community structure in whitefish collected from a cluster of 7 lakes located on an isolated plateau in northern Alberta, Canada.

Consequences of livestock grazing on water quality and Benthic algal biomass in a Canadian natural grassland plateau.

The effects of livestock grazing on selected riparian and stream attributes, water chemistry, and algal biomass were investigated over a two-year period using livestock enclosures and by completing stream surveys in the Cypress Hills grassland plateau, Alberta, Canada. Livestock enclosure experiments, partially replicated in three streams, comprised four treatments: (1) early season livestock grazing (June-August), (2) late season livestock grazing (August-September), (3) all season grazing (June-September), and (4) livestock absent controls. Livestock grazing significantly decreased streambank stability, biomass of riparian vegetation, and the extent to which aquatic vegetation covered the stream channels compared with livestock-absent controls.

Selection of an aquatic indicator species to monitor organic contaminants in trophically simple lotic food webs.

A four-step procedure was used to identify an aquatic macroinvertebrate with which to monitor organic contaminant burdens in trophically simple lake food webs of Alberta, Canada. We identified leeches (Oligochaeta: Hirudinea) as the potential indicator assemblage (Step 1), and then documented their abundance and distribution in 16 lakes to identify a species-level bioindicator (Step 2). The latter two steps involved identifying the number and level of organic contaminants within the indicator species (Step 3) and a comparison with other taxa within the food web (Step 4).

Feeding while evading predators by a lotic mayfly: linking short-term foraging behaviours to long-term fitness consequences.

Laboratory experiments were performed to quantify the combined effects of food abundance (low, high) and predation threat, imposed using a model fish (safe, risky) on fitness correlates (i.e. growth, time to emergence, adult body mass, fecundity, egg size) of the mayfly Baetis tricaudatus.

Reduction of predation risk under the cover of darkness: Avoidance responses of mayfly larvae to a benthic fish.

Mayfly larvae of Paraleptophlebia heteronea (McDunnough) had two antipredator responses to a nocturnal fish predator (Rhinichthys cataractae (Valenciennes)): flight into the drift and retreat into interstitial crevices. Drift rates of Paraleptophlebia abruptly increased by 30 fold when fish were actively foraging in the laboratory streams but, even before fish were removed, drift began returning to control levels because larvae settled to the substrate and moved to areas of low risk beneath stones. This drifting response was used as an immediate escape behavior which likely decreases risk of capture from predators which forage actively at night.

Mechanisms of algal patch depletion: importance of consumptive and non-consumptive losses in mayfly-diatom systems.

Laboratory experiments were performed to identify the mechanisms by which three mayfly grazers, Baetis tricaudatus, Ephemerella aurivilli and Paraleptophlebia heteronea deplete algae from substrates. Field observations indicated these mayflies foraged predominantly (>70% of all individuals) within small (1-2 cm diameter), low biomass areas where algal biomass was significantly lower than the surrounding algal mat. We postulated four models of algal patch depletion based on the combined effects of a type II functional response consumptive model and four possible forms of nonconsumptive loss.

Extensive pre-operative shaving: a costly exercise.

We studied the effect of pre-operative shaving on clean operation wound infection rates. The patients of a general surgeon were used in this study. There was a clean wound infection rate of 2.

Campylobacter enteritis and Yersinia enterocolitica infection in New Zealand.

A three-month survey was undertaken to determine the incidence of Campylobacter jejuni and Yersinia enterocolitica in diarrhoeal disease and acute abdominal disease in Palmerston North. C. jejuni was isolated from five domiciliary patients and one hospitalised patient with acute diarrhoea but there were no isolations from patients suffering from acute abdominal disease.