A noninvasive postoperative clinical score to identify patients at risk for postoperative pulmonary complications: the Air-Test Score.

BACKGROUND: Postoperative pulmonary complications (PPCs) negatively affect morbidity, healthcare costs and postsurgical survival. Preoperative and intraoperative peripheral oxyhemoglobin saturation (SpO2) levels are independent risk factors for postoperative pulmonary complications (PPCs). The air-test assesses the value of SpO2 while breathing room-air. We aimed at building a clinical score that includes the air-test for predicting the risk for PPCs. METHODS: This is a development and validation study in patients -randomly divided into two cohorts- from a large randomized clinical trial (iPROVE) that enrolled 964 intermediate-to-high risk patients scheduled for abdominal surgery. Arterial oxygenation was assessed on room-air in the preoperative period (preoperative air-test) and 3h after admission to the postoperative care unit (postoperative air-test). The air-test was defined as positive or negative if SpO2 was ≤96% or >96%, respectively. Positive air-tests were stratified into weak (93-96%) or strong (<93%). The primary outcome was a composite of moderate-to-severe PPCs during the first seven postoperative days. RESULTS: A total of 902 patients were included in the final analysis (542 in the development cohort and 360 in the validation cohort). Regression analysis identified five independent risk factors for PPC: age, type of surgery, pre- and postoperative air-test, and atelectasis. The area under the receiver operating characteristic curve (AUC) was 0.79 (95% CI: 0.75-0.82) when including these five independent predictors. We built a simplified score termed "air-test score" by using only the pre- and postoperative SpO2, resulting in an AUC of 0.72 (95% CI: 0.67-0.76) for the derivation and 0.72 (95% CI: 0.66-0.78) for the validation cohort, respectively. The air-test score stratified patients into four levels of risk, with PPCs ranging from <15% to >75%. CONCLUSIONS: The simple, non-invasive and inexpensive bedside air-test score, evaluating pre- and postoperatively SpO2 measured on room-air, helps to predict the risk for PPCs.

Chicks of the great spotted cuckoo may turn brood parasitism into mutualism by producing a foul-smelling secretion that repels predators.

The great spotted cuckoo (Clamator glandarius) is an important brood parasite of carrion crows (Corvus corone corone) in northern Spain. We recently found that, unlike what is commonly known for cuckoo-host interactions, the great spotted cuckoo has no negative impact on average crow fitness in this region. The explanation for this surprising effect is a repulsive secretion that the cuckoo chicks produce when they are harassed and that may protect the brood against predation. Here, we provide details on the chemical composition of the cuckoo secretion, as well as conclusive evidence that the dominating volatile chemicals in the secretion are highly repellent to model species representative of common predators of the crows. These results support the notion that, in this particular system, the production of a repulsive secretion by the cuckoo chicks has turned a normally parasitic interaction into a mutualistic one.

From parasitism to mutualism: unexpected interactions between a cuckoo and its host.

Avian brood parasites lay eggs in the nests of other birds, which raise the unrelated chicks and typically suffer partial or complete loss of their own brood. However, carrion crows Corvus corone corone can benefit from parasitism by the great spotted cuckoo Clamator glandarius. Parasitized nests have lower rates of predation-induced failure due to production of a repellent secretion by cuckoo chicks, but among nests that are successful, those with cuckoo chicks fledge fewer crows. The outcome of these counterbalancing effects fluctuates between parasitism and mutualism each season, depending on the intensity of predation pressure.

Lazy group members are substitute helpers in carrion crows.

In many cooperatively breeding societies, helping effort varies greatly among group members, raising the question of why dominant individuals tolerate lazy subordinates. In groups of carrion crows Corvus corone corone, helpers at the nest increase breeders' reproductive success, but chick provisioning is unevenly distributed among non-breeders, with a gradient that ranges from individuals that work as much as the breeders to others that completely refrain from visiting the nest. Here we show that lazy non-breeders represent an insurance workforce that fully compensates for a reduction in the provisioning effort of another group member, avoiding a decrease in reproductive success. When we temporarily impaired a carer, decreasing its nest attendance, the laziest non-breeders increased their provisioning rate and individuals that initially refrained from visiting the nest started helping. Breeders, in contrast, did not increase chick provisioning. This shows that lazy non-breeders can buffer a sudden unfavourable circumstance and suggests that group stability relies on the potential contribution of group members in addition to their current effort.

Experimentally increased food resources in the natal territory promote offspring philopatry and helping in cooperatively breeding carrion crows.

Kin-based societies, where families represent the basic social unit, occur in a relatively small number of vertebrate species. In the majority of avian kin societies, families form when offspring prolong their association with the parents on the natal territory. Therefore, the key to understanding the evolution of families in birds is to understand natal philopatry (i.e. the tendency to remain on the natal territory). It has been shown that, within populations, the strength of the association between parents and offspring (i.e. family stability) increases when offspring dispersal is constrained by external environmental factors, but it is unclear whether and how family wealth influences juvenile dispersal decisions. Here, we show that young carrion crows (Corvus corone corone) from territories that were food-supplemented year-round were more philopatric and more likely to help at their family's nest than the unfed ones. The results suggest that offspring philopatry and helping behaviour are influenced by the quality of 'home' and that the availability of food resources positively affects the cohesion of the family.

Kin selection in cooperative alliances of carrion crows.

In most cooperative vertebrates, delayed natal dispersal is the mechanism that leads to the formation of kin societies. Under this condition, the possibility that kin-based cooperative breeding is an unselected consequence of dispersal patterns can never be ruled out because helpers can only help their relatives. Here we show that a population of carrion crows (Corvus corone corone) fully fits the central prediction of kin selection theory that cooperative breeding should arise among relatives. On their territory, resident breeders are aided not only by nonbreeding retained offspring but also by immigrants (mainly males), with whom they share matings. Philopatry cannot account, however, for the high degree of genetic relatedness found between breeders and immigrants of the same sex that cooperate at a nest, indicating that crows actively choose to breed cooperatively with their relatives.

History, environment and social behaviour: experimentally induced cooperative breeding in the carrion crow.

Kin-based cooperative breeding, where grown offspring delay natal dispersal and help their parents to rear new young, has a long history in some avian lineages. Family formation and helping behaviour in extant populations may therefore simply represent the retention of ancestral features, tolerated under current conditions, rather than a current adaptive process driven by environmental factors. Separating these two possibilities challenges evolutionary biologists because of the tight coupling that normally exists between phylogeny and the environmental distribution of species and populations. The carrion crow Corvus corone corone, which exhibits extreme interpopulational variation in the extent of cooperative breeding, with populations showing no delayed dispersal and helping at all, provides a unique opportunity for an experimental approach. Here we show that offspring of non-cooperative carrion crows from Switzerland will remain on the natal territory and express helping behaviour when raised in a cooperative population in Spain. When we transferred carrion crow eggs from Switzerland to Spain, five out of six transplanted juveniles delayed dispersal, and two of those became helpers in the following breeding season. Our results provide compelling experimental evidence of the causal relationship between current environmental conditions and expression of cooperative behaviour.