Summary1. There is increasing concern about the world's animal migrations. With many land-use and climatological changes occurring simultaneously, pinning down the causes of large-scale conservation problems requires sophisticated and data-intensive approaches. 2. Declining shorebird numbers along the East Asian-Australasian Flyway, in combination with data on habitat loss along the Yellow Sea (where these birds refuel during long-distance migrations), indicate a flyway under threat. 3. If habitat loss at staging areas indeed leads to flyway-wide bird losses, we would predict that: (i) decreases in survival only occur during the season that birds use the Yellow Sea, and (ii) decreases in survival occur in migrants that share a reliance on the vanishing intertidal flats along the Yellow Sea, even if ecologically distinct and using different breeding grounds. 4. Monitored from 2006-2013, we analysed seasonal apparent survival patterns of three shorebird species with non-overlapping Arctic breeding areas and considerable differences in foraging ecology, but a shared use of both north-west Australian non-breeding grounds and the Yellow Sea coasts to refuel during northward and southward migrations (red knot Calidris canutus piersmai, great knot Calidris tenuirostris, bar-tailed godwit Limosa lapponica menzbieri). Distinguishing two three-month non-breeding periods and a six-month migration and breeding period, and analysing survival of the three species and the three seasons in a single model, we statistically evaluated differences at both the species and season levels. 5. Whereas apparent survival remained high in north-west Australia, during the time away from the non-breeding grounds survival in all three species began to decline in 2011, having lost 20 percentage points by 2012. By 2012 annual apparent survival had become as low as 0Á71 in bar-tailed godwits, 0Á68 in great knots and 0Á67 in red knots. In a separate analysis for red knots, no mortality occurred during the migration from Australia to China. In the summers of low summer survival, weather conditions were benign in the Arctic breeding areas. 6. We argue that rapid seashore habitat loss in the Yellow Sea is the most likely explanation of reduced summer survival, with dire (but uncertain) forecasts for the future of these flyway populations. This interpretation is consistent with recent findings of declining shorebird numbers at seemingly intact southern non-breeding sites. 2016, 53, 479-490 doi: 10.1111/1365-2664.12582 7. Policy implications. Due to established economic interests, governments are usually reluctant to act for conservation, unless unambiguous evidence for particular cause-effect chains is apparent. This study adds to an increasing body of evidence that habitat loss along the Yellow Sea shores explains the widespread declines in shorebird numbers along the East Asian-Australasian Flyway and threatens the long-term prospects of several long-distance migrating species. To halt further losses, the clearance of coastal intertidal habita...

This paper summarises the consequences of emergency department crowding. It provides a comparison of the scales used to measure emergency department crowding. We discuss the multiple causes of crowding and present an up-to-date literature review of the interventions that reduce the adverse consequences of crowding. We consider interventions at the level of an individual hospital and a policy level.

Background Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0•9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0•9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.

Psychological interventions to support the recovery of this highly vulnerable population are urgently needed.