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- Ademuyiwa, Adesoji O., et al.
(författare)
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Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries
- 2016
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Ingår i: BMJ Global Health. - : BMJ Publishing Group Ltd. - 2059-7908. ; 1:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Child health is a key priority on the global health agenda, yet the provision of essential and emergency surgery in children is patchy in resource-poor regions. This study was aimed to determine the mortality risk for emergency abdominal paediatric surgery in low-income countries globally.Methods: Multicentre, international, prospective, cohort study. Self-selected surgical units performing emergency abdominal surgery submitted prespecified data for consecutive children aged <16 years during a 2-week period between July and December 2014. The United Nation's Human Development Index (HDI) was used to stratify countries. The main outcome measure was 30-day postoperative mortality, analysed by multilevel logistic regression.Results: This study included 1409 patients from 253 centres in 43 countries; 282 children were under 2 years of age. Among them, 265 (18.8%) were from low-HDI, 450 (31.9%) from middle-HDI and 694 (49.3%) from high-HDI countries. The most common operations performed were appendectomy, small bowel resection, pyloromyotomy and correction of intussusception. After adjustment for patient and hospital risk factors, child mortality at 30 days was significantly higher in low-HDI (adjusted OR 7.14 (95% CI 2.52 to 20.23), p<0.001) and middle-HDI (4.42 (1.44 to 13.56), p=0.009) countries compared with high-HDI countries, translating to 40 excess deaths per 1000 procedures performed.Conclusions: Adjusted mortality in children following emergency abdominal surgery may be as high as 7 times greater in low-HDI and middle-HDI countries compared with high-HDI countries. Effective provision of emergency essential surgery should be a key priority for global child health agendas.
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| 2. |
- Stuart-Smith, Rick D., et al.
(författare)
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Integrating abundance and functional traits reveals new global hotspots of fish diversity
- 2013
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 501:7468, s. 539-
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Tidskriftsartikel (refereegranskat)abstract
- Species richness has dominated our view of global biodiversity patterns for centuries(1,2). The dominance of this paradigm is reflected in the focus by ecologists and conservation managers on richness and associated occurrence-based measures for understanding drivers of broad-scale diversity patterns and as a biological basis for management(3,4). However, this is changing rapidly, as it is now recognized that not only the number of species but the species present, their phenotypes and the number of individuals of each species are critical in determining the nature and strength of the relationships between species diversity and a range of ecological functions (such as biomass production and nutrient cycling)(5). Integrating these measures should provide a more relevant representation of global biodiversity patterns in terms of ecological functions than that provided by simple species counts. Here we provide comparisons of a traditional global biodiversity distribution measure based on richness with metrics that incorporate species abundances and functional traits. We use data from standardized quantitative surveys of 2,473 marine reef fish species at 1,844 sites, spanning 133 degrees of latitude from all ocean basins, to identify new diversity hotspots in some temperate regions and the tropical eastern Pacific Ocean. These relate to high diversity of functional traits amongst individuals in the community (calculated using Rao's Q(6)), and differ from previously reported patterns in functional diversity and richness for terrestrial animals, which emphasize species-rich tropical regions only(7,8). There is a global trend for greater evenness in the number of individuals of each species, across the reef fish species observed at sites ('community evenness'), at higher latitudes. This contributes to the distribution of functional diversity hotspots and contrasts with well-known latitudinal gradients in richness(2,4). Our findings suggest that the contribution of species diversity to a range of ecosystem functions varies over large scales, and imply that in tropical regions, which have higher numbers of species, each species contributes proportionally less to community-level ecological processes on average than species in temperate regions. Metrics of ecological function usefully complement metrics of species diversity in conservation management, including when identifying planning priorities and when tracking changes to biodiversity values.
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| 3. |
- Stuart-Smith, Rick D., et al.
(författare)
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The potential of trait-based approaches to contribute to marine conservation
- 2015
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Ingår i: Marine Policy. - : Elsevier BV. - 0308-597X .- 1872-9460. ; 51, s. 148-150
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Tidskriftsartikel (refereegranskat)abstract
- The value of diversity metrics to represent ecological communities and inform broad-scale conservation objectives and policy has often been subject to debate and uncertainty [1,2]. In practice, diversity metrics are important in setting management and conservation priorities, just as economic indices contribute to global monetary and financial policies. Thus, key challenges for ecologists are to identify new ways to view and summarise patterns in biodiversity and improve on the metrics available for management purposes. In a recent paper on functional diversity patterns in reef fishes [3], we highlighted the potential of new insights gained from functional trait-based approaches to inform marine management, stressing the need to develop and refine biodiversity measures that are linked to ecology (rather than taxonomy). We used a unique, fisheries-independent reef fish identity and abundance dataset, collected using standardised methods from equatorial to high latitude regions all over the world, to provide the first global view of the distribution of individuals amongst species (including a measure of evenness) and functional traits amongst marine communities. A recent paper by Robinson et al. [4] published in Marine Policy criticised the use of our evenness index as a measure of biodiversity, and questioned the use of functional trait-based metrics derived from surveys of standardised areas for decisions relating to broad-scale management of marine systems. In this paper we respond to Robinson et al. and rebut their claims related to sampling bias and broad-scale applicability of trait-based approaches.
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