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Protected areas (PAs) are a core component of conservation policy and practice. However, many species for which they are designated are highly mobile, and may move among sites within and beyond PA boundaries. Environmental impacts on sites beyond those boundaries could thus impact the PA's protected populations, with the risk of adversely affecting its conservation objectives. Conservationists therefore urgently need tools to assess impacts on PAs and their populations of developments beyond their boundaries. We present a framework for using network analysis of observations of marked individuals to assess the protection footprint of PAs in the wider landscape and the impact footprint of developments within or neighboring PAs. We illustrate the use of this framework by assessing the impact of a current airport development proposal on a partially protected wetland, the Tagus estuary in Portugal, specifically by evaluating the extent of noise disturbance on the PA's population of Black‐tailed Godwits, a protected migratory wader species. By analyzing individual movements between sites and across seasons, we find disturbance impacts on up to 68.3% of individual Black‐tailed Godwits overall, greatly exceeding the estimates of 0.46–5.5% in the airport's Environmental Impact Assessments which derived from count data. We then compared the pre‐development network with simulated networks that represented two levels of site avoidance by removing sites predicted to receive noise in excess of two thresholds, 55 or 65 dB(A). Avoidance by Godwits of the potentially‐impacted sites is predicted to have a larger effect on network structure than removing the same number of sites at random, suggesting that an airport in the proposed location would operate as a barrier to connectivity in this wetland. We also highlight the role that network analyses of locations of marked individuals can play in assessing environmental impacts on protected sites and populations. [ABSTRACT FROM AUTHOR]

This study investigated the implications of different assumptions of 3D forest stand reconstructions for the accuracy and efficiency of radiative transfer (RT) modeling based on two highly detailed 3D stand representations: 3D‐explicit and voxel‐based. The discrete anisotropic radiative transfer (DART) model was used for RT simulations. The 3D‐explicit and voxel‐based 3D forest scenes were used as structural inputs for the DART model, respectively. Using the 3D‐explicit RT simulation as the benchmark, the accuracy and efficiency of the voxel‐based RT simulation were evaluated under multiple simulation conditions. The results showed that for voxel‐based RT simulations: with voxel sizes 0.1, 1, and 10 m and in blue, green, red, and near‐infrared wavebands, the normalized deviations of simulated directional reflectance exceeded the 5% tolerance limit in 89% viewing directions; with voxel sizes 0.2, 1, and 10 m, the normalized deviations of simulated spectral albedo exceeded the 5% tolerance limit in 90.5% wavelengths; for simulated spectral albedo in blue, green, red, and near‐infrared wavebands and fraction of absorbed photosynthetically active radiation, the normalized deviations exceeded the 5% tolerance limit in 65.3% voxel sizes and spatial resolutions. The two major causes for differences in the 3D‐explicit versus voxel‐based RT simulations were: (a) the difference between light interaction in spatially explicit objects and in turbid medium, and (b) the structural difference of 3D contours between voxel‐based and 3D‐explicit models. However, voxel‐based RT simulations were substantially more computationally efficient than 3D‐explicit RT simulations in large voxel sizes (≥1 m) and coarse spatial resolutions (≥1 m). Key Points: The radiative transfer simulation bias of a voxelized versus spatially explicit canopy exceeds 5% in 81.6% of the simulationsVoxelized objects reflected and absorbed less electromagnetic radiation than explicit objects: −45.6% in visible and −6% in NIR bandsVoxel sizes 1–2 m are optimal for voxel‐based radiative transfer simulations within the temperate deciduous forest studied [ABSTRACT FROM AUTHOR]

Background: The direct effect of the coronavirus disease 2019 (COVID‐19) pandemic on patients with intestinal failure (IF) has not been described. Methods: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. Results: A total of 45 patients with IF contracted COVID‐19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)–dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community‐acquired COVID‐19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P <.01). Two HPN‐dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). Conclusion: This is the first study to describe the outcomes of COVID‐19 in a large cohort of patients requiring long‐term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial. [ABSTRACT FROM AUTHOR]

Around 76,000 people fracture their hip annually in the UK at a considerable personal, social and financial cost. Despite longstanding debate, the optimal mode of anaesthesia (general or spinal) remains unclear. Our aim was to assess whether there is a significant difference in mortality and morbidity between patients undergoing spinal anaesthesia compared with general anaesthesia during hip fracture surgery. A secondary analysis examined whether a difference exists in mortality for patients with pre-existing cardiovascular disease or chronic obstructive pulmonary disease. This was a clinical database analysis of patients treated for hip fracture in Nottingham, UK between 2004 and 2015. Propensity score-matching was used to generate matched pairs of patients, one of whom underwent each mode of anaesthesia. Data were analysed using conditional logistic regression, with 7164 patients successfully matched. There was no difference in 30- or 90-day mortality in patients who had spinal rather than general anaesthesia (OR [95%CI] 0.97 [0.8-1.15]; p = 0.764 and 0.93 [0.82-1.05]; p = 0.247 respectively). Patients who had a spinal anaesthetic had a lower-risk of blood transfusion (OR [95%CI] 0.84 [0.75-0.94]; p = 0.003) and urinary tract infection (OR [95%CI] 0.72 [0.61-0.84]; p < 0.001), but were more likely to develop a chest infection (OR [95%CI] 1.23 [1.07-1.42]; p = 0.004), deep vein thrombosis (OR [95%CI] 2.18 [1.07-4.45]; p = 0.032) or pulmonary embolism (OR [95%CI] 2.23 [1.16-4.29]; p = 0.016). The mode of anaesthesia for hip fracture surgery resulted in no significant difference in mortality, but there was a significant difference in several measures of postoperative morbidity. [ABSTRACT FROM AUTHOR]

Aim The primary aim of this study was to determine whether the in-hospital mortality for acute mesenteric infarction has reduced in the last decade. The secondary aim was to determine if there was a statistical difference in mortality between patients having acute primary mesenteric infarction due to different causes. Method A literature search was performed of PubMed, Ovid (Embase) and Google Scholar databases. Studies on acute mesenteric infarction of primary vascular pathology were included for pooled analyses while studies that had reported comparative mortality between arterial, venous and non-occlusive mesenteric infarction ( NOMI) were included in meta-analyses. Their quality was assessed using the National Institute for Health and Care Excellence assessment scale. Odds ratios (ORs) of mortality were calculated using a Mantel−Haenszel random effect model. Results The total number of patients was 4527 and the male/female ratio was 1912/2247. The pooled in-hospital mortality was 63%. There was no significant reduction of in-hospital mortality rate in the last decade ( P = 0.78). There was a significant difference in in-hospital mortality between acute arterial mesenteric infarction (73.9%) compared with acute venous mesenteric infarction (41.7%) [ OR 3.47, confidence interval ( CI) 2.43−4.96, P < 0.001] and NOMI (68.5%) compared with acute venous mesenteric infarction (44.2%) ( OR 3.2, CI 1.83−5.6, P < 0.001). There was no difference in mortality between acute arterial mesenteric infarction and NOMI ( OR 1.08, CI 0.57−2.03, P = 0.82). Conclusion In-hospital mortality rate has not changed in the last decade. Patients with arterial mesenteric infarction or with NOMI are over three times more likely to die during the first hospital admission compared with those with venous mesenteric infarction. [ABSTRACT FROM AUTHOR]

Summary Introduction: Protein C (PC) Asn2Ile is a rare pro-thrombotic variant in which loss of anticoagulant function in vivo is likely to result from defective PC binding to the endothelial PC receptor and phospholipid. Methods: To characterize the consequences of this functional defect on the diagnostic performance of commercial PC activity assays, we performed one antigen, three chromogenic and three coagulometric assays on plasma from a subject who was heterozygous for the PC Asn2Ile substitution. Results: As anticipated, the PC antigen (96.2 IU/dl) and chromogenic PC activity assays (98.4 IU/dl) were insensitive to PC Asn2Ile, which has intact enzymatic activity and is secreted normally. There was a marked reduction in apparent PC activity by STACLOT coagulometric assay (50.4 IU/dl). However, there was only a small reduction in apparent PC activity by CRYOcheck Clot C assay (69.5 IU/dl) and by HemosIL ProClot assay, the PC activity was within the laboratory reference range (91 IU/dl). This discrepancy between coagulometric assays could not be explained by lupus anticoagulant, activated PC resistance or elevated plasma factor VIII activity. Conclusion: We demonstrate that coagulometric assays are not equally sensitive to clinically important functional defects of PC and that multiple assays may be required to identify all variants. [ABSTRACT FROM AUTHOR]

Patients with a high-output stoma (HOS) (> 2000 ml/day) suffer from dehydration, hypomagnesaemia and under-nutrition. This study aimed to determine the incidence, aetiology and outcome of HOS. The number of stomas fashioned between 2002 and 2006 was determined. An early HOS was defined as occurring in hospital within 3 weeks of stoma formation and a late HOS was defined as occurring after discharge. Six-hundred and eighty seven stomas were fashioned (456 ileostomy/jejunostomy and 231 colostomy). An early HOS occurred in 75 (16%) ileostomies/jejunostomies. Formation of a jejunostomy (defined as having less than 200 cm remaining of proximal small bowel; n = 20) and intra-abdominal sepsis? obstruction (n = 14) were the commonest causes identified for early HOS. It was possible to stop parenteral infusions in 53 (71%) patients treated with oral hypotonic fluid restriction, glucose-saline solution and anti diarrhoeal medication. In 46 (61%) patients, the HOS resolved and no drug treatment was needed, 20 (27%) patients continued treatment, six (8%) of whom went home and continued to receive parenteral or subcutaneous saline, and nine died. Twenty-six patients had late HOS. Eleven were admitted with renal impairment and four had intermittent small-bowel obstruction. Eight patients were given long-term subcutaneous or parenteral saline and two also received parenteral nutrition. All had hypomagnesaemia. Early high output from an ileostomy is common and although 49% resolved spontaneously, 51% needed ongoing medical treatment, usually because of a short small-bowel remnant. [ABSTRACT FROM AUTHOR]

Comments on the apparent and real levels of concentrations in the Australian manufacturing industry. Effect of buyer concentration on the market structure; Challenges faced by multi-industry firms; Significance of seller concentration ratios in the market structure.

The article presents a survey on clinicians' usage of epidural analgesia in patients with sepsis who are undergoing laparotomy in Great Britain. The result shows that some clinicians would not use epidural analgesia due to the risk of epidural abscess, hemodynamic instability, and coagulopathy. It also notes that majority of the clinicians consider the usage of epidural analgesia for patients with peritonitis who do not manifest signs of systemic sepsis at the time of surgery.

Background: The main aims of intestinal failure (IF) surgery are to reduce the severity of IF in patients by repairing fistulae and restoring continuity in those with short gut, and to restore body image. We report on the surgical management of IF patients at a major tertiary referral institution, in order to evaluate current management practises and outcomes. Methods: Retrospective review of outcomes between July 2005 and December 2007. Results: 60 patients (36 male; median age 47 yrs) underwent 78 operations. On presentation 42 (70%) required parenteral nutrition (PN) and 34 (57%) had stomas. IF was secondary to short gut in 19 (30%) or enterocutaneous fistulae in 42 (70%). Median number of procedures before referral was 4 (1–14). Median time from last operation to our intervention was 365 days (25–3534). Median length of stay postoperatively was 16 days, and at a median follow-up of 268 days, 54 (90%) had been discharged from surgical care. 7 (12%) required ICU care postoperatively but 30 day/inpatient mortality rates were 0%. Re-fistulation occurred in 5 patients. 23 (56%) became independent of PN. Residual small bowel length was the only significant contributing factor identified (p = 0.007). Conclusion: Surgical management of IF is safe when performed in a dedicated unit and when time is allowed for patient optimisation. [ABSTRACT FROM AUTHOR]

A letter to the editor about a delayed diagnosis of an epidural hematoma with a working epidural in situ is presented.

A letter to the editor is presented to report on a case where the tracheal tube used with the Intubating Laryngeal Mask Airway was found to be damaged.

Objectives: To explore clients' experiences of formulation in cognitive behaviour therapy for depression and/or anxiety, as reported after the end of therapy., Design: A qualitative study using inductive thematic analysis., Method: Ten clients who had completed a course of cognitive behaviour therapy for depression and/or anxiety participated in semi-structured interviews within a month of finishing therapy., Results: Four overarching themes were identified: Formulation helps me to understand my problems; formulation leads to feeling understood and accepted; formulation leads to an emotional shift and formulation enables me to move forward., Conclusions: Formulation is a powerful therapeutic tool that can be highly beneficial to clients, leading to an increased understanding of their difficulties, feeling understood and accepted and a sense of relief. The process of formulation can also result in distress, however, when associated with an increased awareness of the nature of one's difficulties, the implications of the formulation for one's sense of identity and being presented with a formulation that is perceived to be inaccurate. In some cases, this distress decreased during therapy, while for others, distress lasted beyond the end of therapy. Formulation enabled many participants to move forwards from their difficulties, leading them to feel empowered, helping them to cope, enabling them to talk more openly, in contrast to previous therapy which had not focused on formulation. Clinical implications indicate that formulation should be undertaken in a sensitive and collaborative way to maximize its benefits and minimize any possible negative effects., Practitioner Points: Formulation can be highly beneficial for clients enabling them to move forwards from their difficulties. It is important to be mindful of clients' possible adverse reactions to the formulation, so that these can be resolved during therapy. Formulation should be undertaken attentively sensitively and collaboratively to maximize its benefits and minimize negative effects., (© 2015 The British Psychological Society.)

Objectives: To test hypotheses derived from a suggestion of Williams (1989) that negative attitudes towards emotional expression act as a predisposing or maintaining factor for post-traumatic stress reactions following a traumatic event., Design: The study employed a prospective design in which attitudes to emotional expression, the 'Big Five' personality factors (Costa & McCrae, 1992a) and initial symptoms and injury severity within 1 week of a road traffic accident were used to predict the development of post-traumatic stress disorder 6 weeks post-accident., Method: Sixty victims of road traffic accidents randomly selected from attenders at a large A&E department were assessed by questionnaire and interview. Measures comprised a 4-item scale relating to emotional expression, standardized scales for intrusion and avoidance features of traumatic experiences, and for anxiety and depression and the NEO-FFI Five Factor Personality Inventory. Forty-five of these participants responded to a postal questionnaire follow-up. In this survey the battery was repeated and also included a self-report diagnostic measure of post-traumatic stress disorder (PTSD)., Results: The percentage of the sample meeting DSM-IV diagnostic criteria for PTSD at 6 weeks post-trauma was 30.8%. A small but significant relationship was found for negative attitudes to emotional expression at 1 week to predict intrusive symptoms and diagnosis at 6 weeks, over and above the independent relationships of initial symptoms, initial injury severity, personality and coping. The emotional expression measure was largely stable between the two points of measurement. More negative attitudes to emotional expression were related to less openness, extraversion and agreeableness personality domains., Conclusions: Some support for the hypotheses was found in relation to the development of PTSD and for the status of attitudes to emotion as a stable trait related to personality factors. The potential importance of attitudes to emotional expression in therapy and other work is discussed.