Enhancing restoration success of rare plants in an arid-tropical climate through water-saving technologies: a case study of Scalesia affinis ssp. brachyloba in the Galapagos Islands

Arid tropical archipelagos, such as the Galapagos Islands, host a high concentration of endemic plant species, many of which require restoration intervention to recover from past environmental degradation. Water-saving technologies (WSTs) have potential for hastening restoration by providing plants with additional water during the early stages of growth. However, it remains unclear whether such technologies provide an advantage for plant species of arid-tropical regions. This study examined the effect of the water-saving technology Groasis Waterboxx® (Groasis) on the rare endemic plant species Scalesia affinis ssp. brachyloba during early stages of restoration. Survival was monitored for 374 individuals planted across six sites on Santa Cruz Island, Galapagos (326 with technology and 48 as controls). Kaplan-Meier survival analysis showed that the use of Groasis reduced mortality during the first two years of the seedling survival. A mixed-effect logistic regression that modelled plant survival as a function of total precipitation, maximum temperature, and WST treatment (Groasis and no-technology control) found that despite low overall survival rates, plants grown with Groasis exhibited a three-fold higher predicted survival by the end of the 3.7 year duration of the study. Finally, through a resampling method, we demonstrate that the effect of the WST treatment is not dependent on the unbalanced design typical of a restoration project framework. We conclude that water-saving technologies such as the Groasis Waterboxx® can enhance survival of rare plant species such as S. affinis ssp. brachyloba in restoration programs in arid-tropical regions.

Suicide in anaesthetists: a systematic review

Evidence suggests that healthcare professionals are at an increased risk of dying by suicide, with anaesthetists at particularly high risk. However, much of the data on which this is based are historical. With a focus on the epidemiology and methods used, we conducted a systematic review of evidence regarding suicide and suicidal behaviour among anaesthetists to provide a more contemporary summary. The systematic review process was adapted from a previous similar study in veterinary surgeons and was consistent with recommended guidance. We identified 54 articles published in or after 1990 that had anaesthetist-specific data and met the inclusion criteria. Seven of these reported epidemiological data, of which four were published after 2000. Although none of the more recent studies reported standardised mortality rates specific to suicide in anaesthetists, the proportion of anaesthetists dying by suicide was increased with respect to comparator groups, which is consistent with previous findings. Eleven studies that included information on suicidal behaviour reported suicidal ideation in 3.2-25% of individuals (six studies) and suicide attempts in 0.5-2% (four studies). Studies reporting methods of suicide highlighted the use of anaesthetic drugs, particularly propofol, supporting the suggestion that the increased risk of suicide in anaesthetists may be related to the availability of the means. We discuss our findings in relation to other recently published data and guidance concerning mental health problems in anaesthetists.

A national survey of out-of-hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland

The tragic death of an anaesthetic trainee driving home after a series of night shifts prompted a national survey of fatigue in trainee anaesthetists. This indicated that fatigue was widespread, with significant impact on trainees' health and well-being. Consultants deliver an increasing proportion of patient care resulting in long periods of continuous daytime duty and overnight on-call work, so we wished to investigate their experience of out-of-hours working and the causes and impact of work-related fatigue. We conducted a national survey of consultant anaesthetists and paediatric intensivists in the UK and Ireland between 25 June and 6 August 2018. The response rate was 46% (94% of hospitals were represented): 84% of respondents (95%CI 83.1-84.9%) contribute to a night on-call rota with 32% (30.9-33.1%) working 1:8 or more frequently. Sleep disturbance on-call is common: 47% (45.6-48.4%) typically receive two to three phone calls overnight, and 48% (46.6-49.4%) take 30 min or more to fall back to sleep. Only 15% (14.0-16.0%) reported always achieving 11 h of rest between their on-call and their next clinical duty, as stipulated by the European Working Time Directive. Moreover, 24% (22.8-25.2%) stated that there is no departmental arrangement for covering scheduled clinical duties following a night on-call if they have been in the hospital overnight. Overall, 91% (90.3-91.7%) reported work-related fatigue with over half reporting a moderate or significantly negative impact on health, well-being and home life. We discuss potential explanations for these results and ways to mitigate the effects of fatigue among consultants.

People, systems and safety: resilience and excellence in healthcare practice

This article outlines recent developments in safety science. It describes the progression of three ‘ages’ of safety, namely the ‘age of technology’, the ‘age of human factors’ and the ‘age of safety management’. Safety science outside healthcare is moving from an approach focused on the analysis and management of error (‘Safety‐1’) to one which also aims to understand the inherent properties of safety systems that usually prevent accidents from occurring (‘Safety‐2’). A key factor in the understanding of safety within organisations relates to the distinction between ‘work as imagined’ and ‘work as done’. ‘Work as imagined’ assumes that if the correct standard procedures are followed, safety will follow as a matter of course. However, staff at the ‘sharp end’ of organisations know that to create safety in their work, variability is not only desirable but essential. This positive adaptability within systems that allows good outcomes in the presence of both favourable and adverse conditions is termed resilience. We argue that clinical and organisational work can be made safer, not only by addressing negative outcomes, but also by fostering excellence and promoting resilience. We outline conceptual and investigative approaches for achieving this that include ‘appreciative inquiry’, ‘positive deviance’ and excellence reporting.

A national survey of the effects of fatigue on trainees in anaesthesia in the UK

Long daytime and overnight shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. The Working Time Regulations (1998) implemented the European Working Time Directive into UK law, and in August 2009 it was applied to junior doctors, reducing the maximum hours worked from an average of 56 per week to 48. Despite this, there is evidence that problems with inadequate rest and fatigue persist. There is no official guidance regarding provision of a minimum standard of rest facilities for doctors in the National Health Service, and the way in which rest is achieved by trainee anaesthetists during their on-call shift depends on rota staffing and workload. We conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK. We achieved a response rate of 59% (2231/3772 responses), with data from 100% of NHS trusts. Fatigue remains prevalent among junior anaesthetists, with reports that it has effects on physical health (73.6% [95%CI 71.8-75.5]), psychological wellbeing (71.2% [69.2-73.1]) and personal relationships (67.9% [65.9-70.0]). The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% (55.0-59.1) stating they had experienced an accident or near-miss when travelling home from night shifts. We discuss potential explanations for the results, and present a plan to address the issues raised by this survey, aiming to change the culture around fatigue for the better.

AAGBI: Consent for anaesthesia 2017: Association of Anaesthetists of Great Britain and Ireland

Previous guidelines on consent for anaesthesia were issued by the Association of Anaesthetists of Great Britain and Ireland in 1999 and revised in 2006. The following guidelines have been produced in response to the changing ethical and legal background against which anaesthetists, and also intensivists and pain specialists, currently work, while retaining the key principles of respect for patients' autonomy and the need to provide adequate information. The main points of difference between the relevant legal frameworks in England and Wales and Scotland, Northern Ireland and the Republic of Ireland are also highlighted.

Morphological apsects of the coronary artery in the neonates

Knowledge of the morphometric quantities of the coronary arteries in neonates is an increasingly vital component in the management of congenital and acquired heart disease. Because of the considerable heterogeneity of coronary vasculature, what is considered atypical and aberrant or insignificant anatomy is often unclear. The purpose of our present study is to define the normal anatomy of neonates. This was done by focusing on segment analysis of the coronary arteries, which was used to obtain accurate definitions of the length and diameter of the coronary network. The lengths, widths and numbers of collateral branches of the coronary arteries of neonates were measured. The coronary vessels of 50 neonate hearts were visualised post mortem by injection of the coronary arteries with opaque X-ray dye for the imaging study. Black ink cast and silver impregnation specimens were also studied. The longest segment of the circumflex branches of the left coronary arteries was the first, the lengths measuring 7188.5 +/- 839.6 microm and the diameters 850 +/- 90.8 mum. The lengths of segments II, III and IV were 5780 +/- 1182.7 microm, 5397.5 +/- 2070.2 microm and 6932.8 +/- 2236.5 microm and the diameters were 680 +/- 90.8 microm, 510 +/- 90.8 microm and 408 +/- 77.58 microm respectively. The longest segment of the anterior interventricular branches of the left coronary arteries was the first, with lengths of 10151.4 +/- 1298.6 microm and diameters of 1141.9 +/- 82.1 microm. The lengths of segments II, III and IV were 8208.5 +/- 1222.3 microm, 3278.5 +/- 602.4 microm and 5370 +/- 1657.6 mum and the diameters were 971 +/- 82.1 microm, 801.42 +/- 82.1 microm and 631.4 +/- 82.1 microm respectively. The lateral branches were increased in number in the fourth segment. Its diameters ranged from 157.8 +/- 31.7 microm to 655.7 +/- 99.7 microm. The main branch of the right coronary artery was short at the base of the heart. In the newborn the lateral branches of the right coronary artery were short, scattered and curved. Analysis of the data suggests a new anatomical system for classifying the vasculature of the coronary arteries in neonates.