Summary1. The impact of climate change on the distribution, abundance, phenology and ecophysiology of species is already well documented, whereas the influence of climate change on habitat choice and utilization has received little attention. Here we report the changing habitat associations of a thermally constrained grassland butterfly, Hesperia comma , over 20 years. 2. Between 1982 and 2001-2, the optimum percentage of bare ground within habitat used for egg-laying shifted from 41% to 21%. 3. Egg-laying rates are temperature-dependent and females actively adjust microhabitat usage in response to temperature variations; relatively warmer host plants are chosen or oviposition at low ambient temperatures, and cooler host plants at high ambient temperatures. 4. Climate warming has increased the availability of thermally suitable habitat for H. comma at the cool, northern edge of the species' distribution, therefore increasing: (a) egg-laying rate and potentially the realized rate of population increase; (b) effective area of habitat patches as more microhabitats within a given vegetation fragment are now suitable for egg-laying; (c) buffering of populations against environmental variation as eggs are laid within a wider range of microhabitats; and (d) the number of habitat patches in the landscape that are currently available for colonization (including the use of more northerly facing aspects; Thomas et al ., Nature , 2001, 411 , 577-581). 5. Conservationists often assume the habitat requirements of a species to be constant, and manage habitats to maintain these conditions. For many species, these requirements are likely to change in response to climate warming, and care must be taken not to manage habitats based on outdated prescriptions.

Although resection of lesions in s7 is technically demanding, a laparoscopic approach can be performed safely and effectively in experienced hands.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to improve metabolic comorbidities as well as quality of life (QoL) in the obese population. The vast majority of previous studies have investigated the metabolic effects of bariatric surgery and there is a dearth of studies examining long-term QoL outcomes post bariatric surgery. The outcomes of 43 patients who underwent bariatric surgery were prospectively assessed, using BAROS questionnaires to quantify QoL and metabolic status pre-operatively, at 1 year and at 8 years. Total weight loss and comorbidity resolution were similar between RYGB and SG. The RYGB cohort experienced greater QoL improvement from baseline and had higher BAROS scores at 8 years. RYGB may provide more substantial and durable long-term benefits as compared to SG.

BackgroundAn unexplained scalp swelling in under 1 year children are rare and particularly in nonmobile infants raises suspicion of non-accidental injury. We describe a case which presented with an unexplained scalp swelling in an 18 weeks baby.Case reportA 4 month old boy presented to ED with a swelling on the back of head. An 8 × 11 cm swelling on the vertex crossing the suture lines was noted. A CT scan of head showed a subaponeurotic fluid collection(SAFC). As no possible explanation of mechanism of injury was given in a non-mobile infant, it was felt that a non-accidental cause needed to be investigated, so Children social services were involved and the child was removed from the family and kept in a place of safety. On further enquiry from the neighbouring hospital, it was found that fetal scalp electrodes and kielland’s forceps were used before progressing to caesarian section. After reviewing literature it was felt, sub-aponeurotic fluid collection can have a delayed presentation following a birth trauma and the child protection order was retrieved.DiscussionSubgaleal or sub-aponeurotic haemorrhage can occur in immediate post-delivery period due to instrumental delivery or difficult delivery. SAFC is a very rare cause of scalp swelling which can have delayed presentation. Aisling1 have reported 11 cases (7–11 weeks) and Wang2 reported 9 cases of spontaneous SAFC (5 weeks to 9 months) who all had either successful vacuum assisted delivery or attempted vacuum deliver. In a series of 4 cases reported by schoberer3 the aspirated fluid from 3 cases was serosanguinous and interestingly re-accumulated in all 3 cases. SAFC resolves spontaneously without any treatment1,2.Learning pointsSub-aponeurotic fluid collection is a rare cause of scalp swelling in infants which is fluctuant, ill-defined and not limited by sutures. It can have delayed presentation and resolves spontaneously.SAFC usually associated with vacuum or instrumental delivery or use of electrodesSAFC should be considered as differential diagnosis in safeguarding and information should be added to COREINFO

Aim To assess our compliance to the trust and national guidelines for antibiotic usage and prescription in elective laparoscopic cholecystectomy and to assess whether prophylactic antibiotics are prescribed appropriately and identify areas of improvement. Method Medical records for patients who underwent laparoscopic cholecystectomy over 3 months were collected (May – July 2019). Urgent laparoscopic cholecystectomies were excluded, and medical records were reviewed retrospectively for operative note details, patient risk factors, antibiotic prescribed, concomitant procedure, and complications. Results Appropriate antibiotic prescription represented 50% (Patient had at least one risk factor and prescribed antibiotic or no risk factors and wasn't prescribed antibiotics) and inappropriate prescription 50% (Patient had no risk factors and prescribed antibiotic or had risk factors and wasn't prescribed antibiotics). In the group with risk factors and wasn't prescribed antibiotics, Age was a risk factor in 17 patients, BMI in 25, Bile spillage in 10, and Diabetes in 3. Conclusion We are not compliant with the current guidelines for antibiotic prophylaxis in elective laparoscopic cholecystectomy, some patient with no risk factors received antibiotics while other with risk factors did not. We plan to disseminate this information in the governance meeting and print guidelines posters in theatres and then re-audit in 3 months’ time to assess progress.