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The Fossil Lake deposits of the Green River Formation of Wyoming, a remarkable early Eocene Lagerstätte (51.98 ±0.35 Ma), have produced nearly 30 bat fossils over the last 50 years. However, diversity has thus far been limited to only two bat species. Here, we describe a new species of Icaronycteris based on two articulated skeletons discovered in the American Fossil Quarry northwest of Kemmerer, Wyoming. The relative stratigraphic position of these fossils indicates that they are the oldest bat skeletons recovered to date anywhere in the world. Phylogenetic analysis of Eocene fossil bats and living taxa places the new species within the family Icaronycteridae as sister to Icaronycteris index , and additionally indicates that the two Green River archaic bat families (Icaronycteridae and Onychonycteridae) form a clade distinct from known Old World lineages of archaic bats. Our analyses found no evidence that Icaronycteris ? menui (France) nor I . sigei (India) belong to this clade; accordingly, we therefore remove them from Icaronycteridae. Taken in sum, our results indicate that Green River bats represent a separate chiropteran radiation of basal bats, and provide additional support for the hypothesis of a rapid radiation of bats on multiple continents during the early Eocene.

We examine the implications for intercontinental dispersal of the extinct ant genus, Titanomyrma Archibald et al. (Hymenoptera: Formicidae: Formiciinae), following the discovery of its first fossil in Eocene temperate upland Canada. Modern Holarctic distributions of plants and animals were in part formed by dispersals across Late Cretaceous through early Eocene Arctic land bridges. Mild winters in a microthermal Arctic would allow taxa today restricted to the tropics by cold intolerance to cross, with episodic hyperthermal events allowing tropical taxa requiring hot climates to cross. Modern ants with the largest queens inhabit low latitudes of high temperature and mild coldest months, whereas those with smaller queens inhabit a wide variety of latitudes and climates. Gigantic and smaller formiciine ants (Titanomyrma and Formicium Westwood) are known from Europe and North America in the Eocene. The new Canadian Titanomyrma inhabited a cooler upland. It is incomplete, indistinctly preserved, and distorted in fossilisation, and so we do not assign it to a species or erect a new one for it. The true size of this fossil is unclear by this distortion: small size would support gigantism in Titanomyrma requiring hot climates and dispersal during hyperthermals; if it was large, it may have been cold-winter intolerant and able to have crossed during any time when the land bridge was present.

Paleoxyela nearctica gen. et sp. nov., is described from the upper Eocene of Florissant Formation in Colorado. We placed Paleoxyela gen. nov. in the subfamily Macroxyelinae and the tribe Macroxyelini based on the numerous wing venation characters visible on the specimen. Proxyelia pankowskii gen. et sp. nov. is described from the lower Eocene Fossil Lake deposits of the Green River Formation in Wyoming. We placed Proxyelia gen. nov. in the subfamily Macroxyelinae and the tribe Xyeleciini based on the numerous wing venation characters visible on the specimen. These new records of the family Xyelidae are of particular importance to better understand the past diversity of the clade and propose hypotheses about their diversification. Extant Xyelidae inhabit temperate Northern Hemisphere forests, and most of their larvae feed on conifers, which may explain why they are relatively poorly diversified compared to the other symphytan families. We suggest that the global decline in conifers and the reduced diversity of extant host trees partly explain the diversity of extant Xyelidae. We correlate the biome repartition during the Eocene to that of the extant xyelid.

Background How hospital health care personnel perceive safety climate has been assessed in several countries by using the Hospital Survey on Patient Safety (HSOPS). Few studies have examined safety climate factors in surgical departments per se. This study examined the psychometric properties of a Norwegian translation of the HSOPS and also compared safety climate factors from a surgical setting to hospitals in the United States, the Netherlands and Norway. Methods This survey included 575 surgical personnel in Haukeland University Hospital in Bergen, an 1100-bed tertiary hospital in western Norway: surgeons, operating theatre nurses, anaesthesiologists, nurse anaesthetists and ancillary personnel. Of these, 358 returned the HSOPS, resulting in a 62% response rate. We used factor analysis to examine the applicability of the HSOPS factor structure in operating theatre settings. We also performed psychometric analysis for internal consistency and construct validity. In addition, we compared the percent of average positive responds of the patient safety climate factors with results of the US HSOPS 2010 comparative data base report. Results The professions differed in their perception of patient safety climate, with anaesthesia personnel having the highest mean scores. Factor analysis using the original 12-factor model of the HSOPS resulted in low reliability scores (r = 0.6) for two factors: \"adequate staffing\" and \"organizational learning and continuous improvement\". For the remaining factors, reliability was ≥ 0.7. Reliability scores improved to r = 0.8 by combining the factors \"organizational learning and continuous improvement\" and \"feedback and communication about error\" into one six-item factor, supporting an 11-factor model. The inter-item correlations were found satisfactory. Conclusions The psychometric properties of the questionnaire need further investigations to be regarded as reliable in surgical environments. The operating theatre personnel perceived their hospital's patient safety climate far more negatively than the health care personnel in hospitals in the United States and with perceptions more comparable to those of health care personnel in hospitals in the Netherlands. In fact, the surgical personnel in our hospital may perceive that patient safety climate is less focused in our hospital, at least compared with the results from hospitals in the United States.

ObjectiveSurgical site infections are known postoperative complications, yet the most preventable of healthcare-associated infections. Correct provision of surgical antibiotic prophylaxis (SAP) is crucial. Use of the WHO Safe Surgical Checklist (SSC) has been reported to improve provision of SAP, and reduce infections postoperatively. To understand possible mechanisms and interactions generating such effects, we explored the underlying work processes of SAP provision and SSC performance at the intersection of perioperative procedures and actual team working.DesignAn ethnographic study including observations and in-depth interviews. A combination of deductive and inductive content analysis of the data was conducted.SettingOperating theatres with different surgical specialities, in three Norwegian hospitals.ParticipantsObservations of perioperative team working (40 hours) and in-depth interviews of 19 experienced perioperative team members were conducted. Interview participants followed a maximum variation purposive sampling strategy.ResultsAnalysis identified provision of SAP as a process of linked activities; sequenced, yet disconnected in time and space throughout the perioperative phase. Provision of SAP was handled in relation to several interactive factors: preparation and administration, prescription accuracy, diversity of prescription order systems, patient-specific conditions and changes in operating theatre schedules. However, prescription checks were performed either as formal SSC reviews of SAP items or as informal checks of relevant documents. In addition, use of cognitive reminders and clinical experiences were identified as mechanisms used to enable administration of SAP within the 60 min timeframe described in the SSC.ConclusionProvision of SAP was identified as a complex process. Yet, a key element in provision of SAP was the given 60 min. timeframe of administration before incision, provided in the SSC. Thus, the SSC seems beneficial in supporting timely SAP administration practice by either being a cognitive tool and/or as a cognitive intervention.

Based on current weaknesses in the understanding of the mechanisms, factors and positive effects involved in checklist usage, as well as a scarcity of qualitative approaches, the aim of this study was to explore surgical personnel experiences with the World Health Organization’s Surgical Safety Checklist, 2 years after implementation. Three focus group interviews were conducted with surgical personnel. An interview guide was designed to assist the interview process, comprised of broad, open-ended questions. Notes and audio recordings were fully transcribed verbatim and subsequently analysed using qualitative content analysis in order to identify emergent meaning units, categories and themes. The checklist improves confidence, team communication and sharing of critical information in the surgical team. However, informants described the occurrence of wrong-site surgery not prevented by the checklist due to preoperative wrong-site marking combined with automated checklist use in the operating room. Using the checklist as a ‘tic box exercise’ was recognized as a safety challenge by all professions, especially during routine surgery. The surgical team balances safety and effectiveness constantly in the operating room. Challenges that need to be addressed include making the Sign-in part a team effort and taking the accompanying pause in performance during the Time-out and the Sign-out, with cross-check of items, in order to avoid automated checklist use. We suggest surgical team training that includes checklist performance, in order to enhance the quality of checklist use.

To investigate the recovery of iodinated water-soluble contrast medium from small bowel with small morphological alterations, iohexol or iodixanol was instilled through an orogastric tube in rats 14 days after surgery that established a self-filling blind loop in the jejunum. This rat model induced small bowel bacterial overgrowth with only minor abnormalities observed on histology and scanning electron microscopy. Animals with end-to-end anastomosis of the jejunum or unoperated rats served as controls. Compared with unoperated animals, urinary recovery of iohexol and iodixanol was significantly higher in both groups that underwent surgery. Moreover, the contrast medium recovery was numerically higher in the self-filling blind loop group given iodixanol than in the end-to-end anastomosis group, although not statistically significant, P = 0.09. Our results indicate that iohexol and iodixanol may detect small barrier impairments in the intestines. Iodixanol, the largest of the two, may seem to differentiate better between normal and minimally impaired intestinal barrier.