Outcomes analysis of microsurgical physiologic lymphatic procedures for the upper extremity from the United States National Surgical Quality Improvement Program

INTRODUCTION: Physiologic microsurgical procedures to treat lymphedema include vascularized lymph node transfer (VLNT) and lymphovenous bypass (LVB). The purpose of this study was to assess 30-day outcomes of VLNT and LVB using the National Surgical Quality Improvement Program (NSQIP) database. METHODS: NSQIP was queried (2012-2018) for lymphatic procedures for upper extremity lymphedema after mastectomy. Prophylactic lymphatic procedures and those for lower extremity lymphedema were excluded. Outcomes were assessed for three groups: LVB, VLNT, and patients who had procedures simultaneously (VLNA+LVB). Primary outcomes measured were operative time, 30-day morbidities, and hospital length of stay. RESULTS: The study included 199 patients who had LVB (n = 43), VLNT (n = 145), or VLNT+LVB (n = 11). There was no difference in co-morbidities between the groups (p = 0.26). 30-day complication rates including unplanned reoperation (6.9% VLNT vs. 2.3% LVB) and readmission (0.69% VLNT vs. none in LVB) were not statistically significant (p = 0.54). Surgical site infection, wound complications, deep vein thromboembolism, and cardiac arrest was also similar among the three groups. Postoperative length of stay for VLNT (2.5 days± 2.3), LVB (1.9 days± 1.9), and VLNT+LVB (2.8 days± 0.3) did not differ significantly (p = 0.20). Operative time for LVB (305.4 min ± 186.7), VLNT (254 min ± 164.4), and VLNT+LVB (295.3 min ± 43.2) was not significantly different (p = 0.21). CONCLUSIONS: Our analysis of the NSQIP data revealed that VLNT and LVB are procedures with no significant difference in perioperative morbidity. Our results support that choice of VLNT versus LVB can be justifiably made per the surgeon's preference and experience as the operations have similar complication rates

Contrasting nitrogen fluxes in African tropical forests of the Congo Basin

The observation of high losses of bioavailable nitrogen (N) and N richness in tropical forests is paradoxical with an apparent lack of N input. Hence, the current concept asserts that biological nitrogen fixation (BNF) must be a major N input for tropical forests. However, well-characterized N cycles are rare and geographically biased; organic N compounds are often neglected and soil gross N cycling is not well quantified. We conducted comprehensive N input and output measurements in four tropical forest types of the Congo Basin with contrasting biotic (mycorrhizal association) and abiotic (lowland-highland) environments. In 12 standardized setups, we monitored N deposition, throughfall, litterfall, leaching, and export during one hydrological year and completed this empirical N budget with nitrous oxide (N2O) flux measurement campaigns in both wet and dry season and in situ gross soil N transformations using N-15-tracing and numerical modeling. We found that all forests showed a very tight soil N cycle, with gross mineralization to immobilization ratios (M/I) close to 1 and relatively low gross nitrification to mineralization ratios (N/M). This was in line with the observation of dissolved organic nitrogen (DON) dominating N losses for the most abundant, arbuscular mycorrhizal associated, lowland forest type, but in contrast with high losses of dissolved inorganic nitrogen (DIN) in all other forest types. Altogether, our observations show that different forest types in central Africa exhibit N fluxes of contrasting magnitudes and N-species composition. In contrast to many Neotropical forests, our estimated N budgets of central African forests are imbalanced by a higher N input than output, with organic N contributing significantly to the input-output balance. This suggests that important other losses that are unaccounted for (e.g., NOx and N-2 as well as particulate N) might play a major role in the N cycle of mature African tropical forests

Parental Burnout Assessment (PBA) in Different Hispanic Countries: An Exploratory Structural Equation Modeling Approach

Parental burnout is a unique and context-specific syndrome resulting from a chronic imbalance of risks over resources in the parenting domain. The current research aims to evaluate the psychometric properties of the Spanish version of the Parental Burnout Assessment (PBA) across Spanish-speaking countries with two consecutive studies. In Study 1, we analyzed the data through a bifactor model within an Exploratory Structural Equation Modeling (ESEM) on the pooled sample of participants (N = 1,979) obtaining good fit indices. We then attained measurement invariance across both gender and countries in a set of nested models with gradually increasing parameter constraints. Latent means comparisons across countries showed that among the participants' countries, Chile had the highest parental burnout score, likewise, comparisons across gender evidenced that mothers displayed higher scores than fathers, as shown in previous studies. Reliability coefficients were high. In Study 2 (N = 1,171), we tested the relations between parental burnout and three specific consequences, i.e., escape and suicidal ideations, parental neglect, and parental violence toward one's children. The medium to large associations found provided support for the PBA's predictive validity. Overall, we concluded that the Spanish version of the PBA has good psychometric properties. The results support its relevance for the assessment of parental burnout among Spanish-speaking parents, offering new opportunities for cross-cultural research in the parenting domain

Organic matter cycling along geochemical, geomorphic and disturbance gradients in forests and cropland of the African Tropics – Project TropSOC Database Version 1.0

The African Tropics are hotspots of modern-day land-use change and are, at the same time, of great relevance for the cycling of carbon (C) and nutrients between plants, soils and the atmosphere. However, the consequences of land conversion on biogeochemical cycles are still largely unknown as they are not studied in a landscape context that defines the geomorphic, geochemically and pedological framework in which biological processes take place. Thus, the response of tropical soils to disturbance by erosion and land conversion is one of the great uncertainties in assessing the carrying capacity of tropical landscapes to grow food for future generations and in predicting greenhouse gas fluxes (GHG) from soils to the atmosphere and, hence, future earth system dynamics. Here, we describe version 1.0 of an open access database created as part of the project &ldquo;Tropical soil organic carbon dynamics along erosional disturbance gradients in relation to variability in soil geochemistry and land use&rdquo; (TropSOC). TropSOC v1.0 contains spatial and temporal explicit data on soil, vegetation, environmental properties and land management collected from 136 pristine tropical forest and cropland plots between 2017 and 2020 as part of several monitoring and sampling campaigns in the Eastern Congo Basin and the East African Rift Valley System. The results of several laboratory experiments focusing on soil microbial activity, C cycling and C stabilization in soils complement the dataset to deliver one of the first landscape scale datasets to study the linkages and feedbacks between geology, geomorphology and pedogenesis as controls on biogeochemical cycles in a variety of natural and managed systems in the African Tropics. The hierarchical and interdisciplinary structure of the TropSOC database allows for linking a wide range of parameters and observations on soil and vegetation dynamics along with other supporting information that may also be measured at one or more levels of the hierarchy. TropSOC&rsquo;s data marks a significant contribution to improve our understanding of the fate of biogeochemical cycles in dynamic and diverse tropical African (agro-)ecosystems. TropSOC v1.0 can be accessed through the supplementary material provided as part of this manuscript or as a separate download via the websites of the Congo Biogeochemistry observatory and the GFZ data repository where version updates to the database will be provided as the project develops.</p

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security

Organic matter cycling along geochemical, geomorphic, and disturbance gradients in forest and cropland of the African Tropics – project TropSOC database version 1.0

The African Tropics are hotspots of modern-day land use change and are, at the same time, of great relevance for the cycling of carbon (C) and nutrients between plants, soils, and the atmosphere. However, the consequences of land conversion on biogeochemical cycles are still largely unknown as they are not studied in a landscape context that defines the geomorphic, geochemical, and pedological framework in which biological processes take place. Thus, the response of tropical soils to disturbance by erosion and land conversion is one of the great uncertainties in assessing the carrying capacity of tropical landscapes to grow food for future generations and in predicting greenhouse gas fluxes from soils to the atmosphere and, hence, future earth system dynamics. Here we describe version 1.0 of an open-access database created as part of the project “Tropical soil organic carbon dynamics along erosional disturbance gradients in relation to variability in soil geochemistry and land use” (TropSOC). TropSOC v1.0 (Doetterl et al., 2021, https://doi.org/10.5880/fidgeo.2021.009) contains spatially and temporally explicit data on soil, vegetation, environmental properties, and land management collected from 136 pristine tropical forest and cropland plots between 2017 and 2020 as part of monitoring and sampling campaigns in the eastern Congo Basin and the East African Rift Valley system. The results of several laboratory experiments focusing on soil microbial activity, C cycling, and C stabilization in soils complement the dataset to deliver one of the first landscape-scale datasets to study the linkages and feedbacks between geology, geomorphology, and pedogenesis as controls on biogeochemical cycles in a variety of natural and managed systems in the African Tropics. The hierarchical and interdisciplinary structure of the TropSOC database allows linking of a wide range of parameters and observations on soil and vegetation dynamics along with other supporting information that may also be measured at one or more levels of the hierarchy. TropSOC's data mark a significant contribution to improve our understanding of the fate of biogeochemical cycles in dynamic and diverse tropical African (agro-)ecosystems. TropSOC v1.0 can be accessed through the Supplement provided as part of this paper or as a separate download via the websites of the Congo Biogeochemistry Observatory and GFZ Data Services where version updates to the database will be provided as the project develops.ISSN:1866-3516ISSN:1866-350

Toward a holistic approach for diagnosing sepsis in the emergency department

Sepsis is an important healthcare issue worldwide due to the unfavorable clinical outcome and the increasing risk of antimicrobial resistance caused by inappropriate usage of antimicrobials. According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is currently defined as a life-threatening organ dysfunction caused by deregulated host response to an infection. This updated definition has contributed to revolutionizing our current understanding of sepsis, emphasizing the central pathogenetic role of the non-homeostatic host response to microorganisms rather than the infection per se. As a result, \u201cbloodstream infection\u201d is no longer being used synonymously to sepsis. Although blood culture has been considered the gold standard for diagnosing sepsis for decades, the accuracy of this technique remains limited due to the low diagnostic sensitivity with high false negative rates in patients undergoing antimicrobial therapy, and in patients with severe localized infections or in noninfectious cause of sepsis. Also, preanalytical factors and possible contamination further limit the reliability of blood cultures. Recent evidence suggests that an increased concentration of some innovative sepsis biomarkers, especially procalcitonin and presepsin, more reliably reflects the systemic host response to infection. Recent evidence suggests that the measurement of such sepsis biomarkers in addition to blood culture or molecular biology further improves the diagnostic management of patients with possible sepsis. The current article aims to propose a \u201cholistic\u201d approach to sepsis diagnostics, encompassing a reasonable combination of clinical signs and symptoms, sepsis biomarkers and microbiological tests