Characteristics of Some Fruiting Plant Species in Northwest Arkansas, and the Avian Assemblages that Feed on Them

Fruits continue to be recognized as an important food source for birds in temperate areas, particularly during the fall migration period. More than 20 species of plants producing fleshy fruits are found in the Arkansas Ozarks. However, only a few of these appear to be important resources for birds during the fall migration period (August - October). Among those are sassafras (Sassafras albidum), gray-backed grape (Vitis cinerea), black cherry (Prunus serotina), hercules club (Araliaspinosa) and pokeweed (Phytolacca americana). Over the past 4 years, we have documented the physical and nutritional characteristics of those fruits and taken observational data on the assemblages of birds eating them. It appears that avian species assemblages feeding on fruits are partially determined by the physical and nutritional contents of those fruits. Sassafras is extremely lipid-rich and higher in caloric content than the other species of fruits. It appears to be eaten almost exclusively by larger birds, perhaps be due to the large size of its fruits, which may exceed gape width of many smaller bird species. Prunus and Vitis are also eaten by a large number of avian species. Phytolacca was eaten only by a small number of primarily resident bird species and often persisted into the winter. Reasons for this pattern are not clear, as it was relatively similar to the other fruits inmost characteristics. Aralia was seen being eaten by only a few species of birds but is less common than the other species, and its small fruits may not be as attractive as those of the other species. Compared to other places in the east, there appear to be a relatively low number of migratory frugivorous birds in northwestern Arkansas. Overall, there were very few species noted at any fruiting plants, and a large proportion of the total assemblage of birds was comprised of resident species

Individualized Risk of Surgical Complications: An Application of the Breast Reconstruction Risk Assessment Score.

BACKGROUND: Risk discussion is a central tenet of the dialogue between surgeon and patient. Risk calculators have recently offered a new way to integrate evidence-based practice into the discussion of individualized patient risk and expectation management. Focusing on the comprehensive Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, we endeavored to add plastic surgical outcomes to the previously developed Breast Reconstruction Risk Assessment (BRA) score. METHODS: The TOPS database from 2008 to 2011 was queried for patients undergoing breast reconstruction. Regression models were constructed for the following complications: seroma, dehiscence, surgical site infection (SSI), explantation, flap failure, reoperation, and overall complications. RESULTS: Of 11,992 cases, 4439 met inclusion criteria. Overall complication rate was 15.9%, with rates of 3.4% for seroma, 4.0% for SSI, 6.1% for dehiscence, 3.7% for explantation, 7.0% for flap loss, and 6.4% for reoperation. Individualized risk models were developed with acceptable goodness of fit, accuracy, and internal validity. Distribution of overall complication risk was broad and asymmetric, meaning that the average risk was often a poor estimate of the risk for any given patient. These models were added to the previously developed open-access version of the risk calculator, available at http://www.BRAscore.org. CONCLUSIONS: Population-based measures of risk may not accurately reflect risk for many individual patients. In this era of increasing emphasis on evidence-based medicine, we have developed a breast reconstruction risk assessment calculator from the robust TOPS database. The BRA Score tool can aid in individualizing-and quantifying-risk to better inform surgical decision making and better manage patient expectations

The Use of Patient Registries in Breast Surgery: a Comparison of the Tracking Operations and Outcomes for Plastic Surgeons and National Surgical Quality Improvement Program Data Sets.

BACKGROUND: The National Surgical Quality Improvement Program (NSQIP) and the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) registries gather outcomes for plastic surgery procedures. The NSQIP collects hospital data using trained nurses, and the TOPS relies on self-reported data. We endeavored to compare the TOPS and NSQIP data sets with respect to cohort characteristics and outcomes to better understand the strengths and weakness of each registry as afforded by their distinct data collection methods. STUDY DESIGN: The 2008 to 2011 TOPS and NSQIP databases were queried for breast reductions and breast reconstructions. Propensity score matching identified similar cohorts from the TOPS and NSQIP databases. Shared 30-day surgical and medical complications rates were compared across matched cohorts. RESULTS: The TOPS captured a significantly greater number of wound dehiscence occurrences (4.77%-5.47% vs 0.69%-1.17%, all P0.05). CONCLUSIONS: The TOPS and NSQIP capture significantly different patient populations, with TOPS\u27 self-reported data allowing for the inclusion of private practices. This self-reporting limits TOPS\u27 ability to identify medical complications; surgical complications and readmissions, however, were not underreported. Many surgical complications are captured by TOPS at a higher rate due to its broader definitions, and others are not captured by NSQIP at all. The TOPS and NSQIP provide complementary information with different strengths and weakness that together can guide evidence-based decision making in plastic surgery