Defining complexity in terms of the misalignment between patient needs and services offers new insights in how to research and develop solutions to patient care needs.

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SummarySpecially trained dogs are used to locate many threatened bird species in New Zealand during conservation management and research projects. Systematic searches were made in four forest patches in Northland where many Brown Kiwi Apteryx mantelli had been fitted with bands, wing tags, transponders or radio-transmitters over a 12-year period of experimental management. The percentage of subadult birds found by dogs increased in line with predictions from population models of the changing age structure of the population. The dogs independently found radio-tagged adults and subadults in close proportion to their known abundance. Dogs proved to be an excellent tool to determine the age structure of a kiwi population. With knowledge of the life history of the species involved, this information was used to make an accurate assessment of the conservation status of the study population of Brown Kiwi in Northland. Our results also support the recent downgrading of Little Spotted Kiwi Apteryx owenii from 'Vulnerable' to 'Near Threatened', which was based partly on healthy age ratios found during dog searches on Kapiti Island, rather than on results from a study of their breeding biology on the island which showed unsustainably low chick recruitment.

Objective: To compare the long-term risks of reintervention following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in a large surgical cohort. Background: The use of SG has increased dramatically relative to RYGB for the treatment of obesity. However, long-term risks following SG compared with RYGB have not been adequately defined in a large population-based study. Methods: A retrospective longitudinal cohort study of all adult health-plan members undergoing SG or RYGB for obesity in a multistate integrated health care system from January 2005 through September 2015. The risks of nutritional, endoscopic, radiologic, and surgical reintervention as well as the overall risk of any reinterventions at 1, 3, and 5 years were identified using diagnosis and procedure codes from comprehensive electronic medical records. Results: The study included 15,319 patients who underwent SG and 19,954 patients who underwent RYGB with a follow-up of 79.2%. The overall risk of any reintervention at 5 years was 21.3% for SG and 28.3% for RYGB (P < 0.0001). After adjustment, SG was associated with fewer reinterventions through 5 years than RYGB (hazard ratio, 0.78; 95% confidence interval, 0.74–0.84). When comparing subcategories, SG also had a lower risk of nutritional, endoscopic, radiologic, and surgical reinterventions when examined versus RYGB. The findings for risks of reinterventions were consistent across clinical subgroups. Conclusion: SG has significantly lower risk of reintervention in all categories studied when compared with RYGB at 5-year follow-up. The long-term safety profile of LSG compared with RYGB should be an essential part of the discussion in patient-centered decision making when choosing between bariatric procedure options.

Adopting the one-step approach was associated with a 41% increase in the diagnosis of GDM without improved maternal or neonatal outcomes.