Recently, we demonstrated that tropical birds have an 18% lower BMR, 34% lower PMR C and 39% lower PMR E compared with temperate species (Wiersma et al., 2007a;Wiersma et al., 2007b). Along with a reduced metabolism, tropical birds tend to have a smaller clutch size than their temperate counterparts (Cardillo, 2002;Kulesza, 1990) Accepted 25 January 2012 SUMMARY Attributes of an animalʼs life history, such as reproductive rate or longevity, typically fall along a ʻslow-fastʼ continuum. Animals at the fast end of this continuum, such as temperate birds, are thought to experience high rates of mortality and invest more resources in reproduction, whereas animals at the slow end, such as tropical birds, live longer, have fewer offspring and invest more resources in self-maintenance. We have previously shown that tropical birds, compared with temperate species, have a reduced basal (BMR) and peak metabolic rate (PMR), patterns consistent with a slow pace of life. Here, we elucidate a fundamental linkage between the smaller mass of central organs of tropical species and their reduced BMR, and between their smaller flight muscles and reduced PMR. Analyses of up to 408 species from the literature showed that the heart, flight muscles, liver, pancreas and kidneys were smaller in tropical species. Direct measurements on 49 species showed smaller heart, lungs, flight muscles, liver, kidneys, ovaries and testes in tropical species, as well as lower feather mass. In combination, our results indicate that the benign tropical environment imposes a relaxed selection pressure on high levels of sustained metabolic performance, permitting species to reduce the mass of organs that are energetically costly to maintain. Brain, gizzard and intestine were exceptions, even though energy turnover of brain and intestine are high. Feather mass was 37% lower in tropical species compared with similarsized temperate birds, supporting the idea that temperate birds require more insulation for thermoregulation. Supplementary material available online at

BACKGROUND:The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) is controversial. We hypothesize that REBOA outcomes are improved in centers with high REBOA utilization. METHODS:We examined the Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry over a 5-year period (2014)(2015)(2016)(2017)(2018).Resuscitative endovascular balloon occlusion of the aorta outcomes were analyzed by stratifying institutions into low-volume (<10), average-volume (11-30), and high-volume (>30) deployment centers. A multivariable model adjusting for volume group, mechanism of injury, signs of life, systolic blood pressure at initiation, operator level, device type, zone of placement, and hemodynamic response to aortic occlusion was created to analyze REBOA mortality and REBOA-related complications. RESULTS:Four hundred ninety-five REBOA placements were included. High-volume centers accounted for 63%, while low accounted for 13%. High-volume institutions were more likely to place a REBOA in the emergency department (81% vs. 63% low volume, p = 0.003), had a lower mean systolic blood pressure at insertion (53 ± 38 vs. 64 ± 40, p = 0.001), and more Zone I deployments (64% vs. 55%, p = 0.002). Median time from admission to REBOA placement was significantly less in patients treated at high-volume centers (15 [7-30] minutes vs. 35 [20-65] minutes, p = 0.001). Resuscitative endovascular balloon occlusion of the aorta mortality was significantly higher at low-volume centers (67% vs. 57%; adjusted odds ratio, 1.29; adj p = 0.040), while average-and high-volume centers were similar. Resuscitative endovascular balloon occlusion of the aorta complications were less frequent at high-/average-volume centers, but did not reach statistical significance (adj p = 0.784). CONCLUSION:Resuscitative endovascular balloon occlusion of the aorta survival is increased at high versus low utilization centers. Increased experience with REBOA may be associated with earlier deployment and subsequently improved patient outcomes.

Background Laparoscopic adjustable gastric banding (LAGB) continues to be a valid surgical treatment option to address severe obesity. However, outcomes are varied and can be difficult to predict. Early prediction of suboptimal weight loss following LAGB may enable adjustments to postoperative care and consequently improve surgical outcomes. Therefore, our aim is to investigate the prognostic utility of using early weight loss following LAGB to predict long‐term weight outcomes. Methods Clinical data from patients undergoing LAGB between 2001 and 2007 at a single institution were retrospectively collected and analysed. The data was used to inform a model for predicting long‐term weight loss after LAGB surgery. Percent total weight loss (%TWL) greater than 20% 1 year after surgery was considered a measurement of success since it has been associated with the improvement of comorbidities and increased patient satisfaction. Results The average %TWL 1 year after LAGB surgery was 23.73% (n = 1524, SD = 8.68%). Weight loss of less than 10% in 1 year was a negative predictor of weight loss >20% in 8–12 years (OR = 0.449; p = 0.002; 95% CI = 0.272–0.742). Moreover, weight loss >20% in 1 year was a strong predictor of weight loss >20% in 8–12 years (OR = 5.33; p < 0.001; 95% CI = 3.17–8.97). Conclusion Total body weight reduction of less than 10% 1 year after LAGB surgery suggests a lesser weight loss at 8–12 years. For these patients, targeted interventions would be appropriate to increase the chances of long‐term success.

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