Diversity for Restoration (D4R): guiding the selection of tree species and seed sources for climate-resilient restoration of tropical forest landscapes

1. At the start of the UN Decade of Ecosystem Restoration (2021–2030), the restoration of degraded ecosystems is more than ever a global priority. Tree planting will make up a large share of the ambitious restoration commitments made by countries around the world, but careful planning is needed to select species and seed sources that are suitably adapted to present and future restoration site conditions and that meet the restoration objectives. 2. Here we present a scalable and freely available online tool, Diversity for Restoration (D4R), to identify suitable tree species and seed sources for climate-resilient tropical forest landscape restoration. 3. The D4R tool integrates (a) species habitat suitability maps under current and future climatic conditions; (b) analysis of functional trait data, local ecological knowledge and other species characteristics to score how well species match the restoration site conditions and restoration objectives; (c) optimization of species combinations and abundances considering functional trait diversity or phylogenetic diversity, to foster complementarity between species and to ensure ecosystem multifunctionality and stability; and (d) development of seed zone maps to guide sourcing of planting material adapted to present and predicted future environmental conditions. We outline the various elements behind the tool and discuss how it fits within the broader restoration planning process, including a review of other existing tools. 4. Synthesis and applications. The Diversity for Restoration tool enables non-expert users to combine species traits, environmental data and climate change models to select tree species and seed sources that best match restoration site conditions and restoration objectives. Originally developed for the tropical dry forests of Colombia, the tool has now been expanded to the tropical dry forests of northwestern Peru–southern Ecuador and the countries of Burkina Faso and Cameroon, and further expansion is underway. Acknowledging that restoration has a wide range of meanings and goals, our tool is intended to support decision making of anyone interested in tree planting and seed sourcing in tropical forest landscapes, regardless of the purpose or restoration approachISSN:0021-8901ISSN:1365-266

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Pharmacokinetics of Phenprocoumon in Emergency Situations–Results of the Prospective Observational RADOA-Registry (Reversal Agent Use in Patients Treated with Direct Oral Anticoagulants or Vitamin K Antagonists Registry)

Background: Phenprocoumon has been used as an oral anticoagulant in patients with thromboembolic disease for more than 40 years. So far its pharmacokinetics have not been analyzed in emergency situations. Methods: Phenprocoumon-treated patients with major bleeding or urgent surgery were included in a prospective, observational registry. Phenprocoumon drug concentrations were analyzed in samples, collected as part of routine care using ultraperformance liquid chromatography tandem mass spectrometry. Moreover, anticoagulant intensity and drug half-life (t1/2) were calculated. Results: 115 patients were included. Phenprocoumon levels declined over time with a half-life of 5.27 and 5.29 days in patients with major bleedings (n = 82) and with urgent surgery (n = 33). Baseline phenprocoumon levels were 2.2 times higher in the bleeding group compared to the surgery group (1.92 vs. 0.87 ng/mL, p < 0.0001). International normalized ratio (INR) values decreased rapidly during the first 24 h. In 27.6% of patients a rebound of INR (recurrent increase > 1.5) was observed which was associated with significantly increased bleeding rates (22% vs. 4.2% in patients with or without INR rebound, p = 0.012). Conclusions: In emergency situations, the long half-life of phenprocoumon may cause INR rebound and associated recurrent bleedings. Optimal management may need to include repeated vitamin K supplementation over days

Liberal transfusion strategy to prevent mortality and anaemia-associated, ischaemic events in elderly non-cardiac surgical patients – the study design of the LIBERAL-Trial

Abstract Background Perioperative anaemia leads to impaired oxygen supply with a risk of vital organ ischaemia. In healthy and fit individuals, anaemia can be compensated by several mechanisms. Elderly patients, however, have less compensatory mechanisms because of multiple co-morbidities and age-related decline of functional reserves. The purpose of the study is to evaluate whether elderly surgical patients may benefit from a liberal red blood cell (RBC) transfusion strategy compared to a restrictive transfusion strategy. Methods The LIBERAL Trial is a prospective, randomized, multicentre, controlled clinical phase IV trial randomising 2470 elderly (≥ 70 years) patients undergoing intermediate- or high-risk non-cardiac surgery. Registered patients will be randomised only if Haemoglobin (Hb) reaches ≤9 g/dl during surgery or within 3 days after surgery either to the LIBERAL group (transfusion of a single RBC unit when Hb ≤ 9 g/dl with a target range for the post-transfusion Hb level of 9–10.5 g/dl) or the RESTRICTIVE group (transfusion of a single RBC unit when Hb ≤ 7.5 g/dl with a target range for the post-transfusion Hb level of 7.5–9 g/dl). The intervention per patient will be followed until hospital discharge or up to 30 days after surgery, whichever occurs first. The primary efficacy outcome is defined as a composite of all-cause mortality, acute myocardial infarction, acute ischaemic stroke, acute kidney injury (stage III), acute mesenteric ischaemia and acute peripheral vascular ischaemia within 90 days after surgery. Infections requiring iv antibiotics with re-hospitalisation are assessed as important secondary endpoint. The primary endpoint will be analysed by logistic regression adjusting for age, cancer surgery (y/n), type of surgery (intermediate- or high-risk), and incorporating centres as random effect. Discussion The LIBERAL-Trial will evaluate whether a liberal transfusion strategy reduces the occurrence of major adverse events after non-cardiac surgery in the geriatric population compared to a restrictive strategy within 90 days after surgery. Trial registration ClinicalTrials.gov (identifier: NCT03369210)