Improved Clinical and Financial Outcomes in Proximal Gastric Bypass Surgery Following the Transition from a Conventional Circular Stapling to an Augmented Linear Stapling Protocol

UNLABELLED Bariatric techniques for bypass surgery evolve constantly. Switching from one well-established protocol to another in a running surgical teaching program is challenging. We analyzed clinical and financial outcomes at a single bariatric center transitioning from circular to an augmented linear bypass protocol. MATERIALS AND METHODS Between 2011 and 2018, 454 patients were included in this retrospective study. The circular bypass protocol (CIRC; n = 177) was used between 2011 and 2012. Between 2013 and 2015 the transition occurred. Thereafter, the augmented linear protocol (aLIN; n = 277) was primarily utilized. RESULTS Overall, the mean preoperative BMI dropped from 42.2 to 29.6 kg/m$^{2}$ after 5 years with no difference between groups. Operation times were significantly shorter in the aLIN vs. CIRC group at 108 (± 32) vs. 120 (± 34) min (P < 0.001), respectively. The reoperation rate was significantly higher in the CIRC vs. aLIN group at n = 65 (36%) vs. n = 35 (13%; P < 0.001), respectively. Specifically, revision due to internal hernia occurred much more frequently in the CIRC-group, n = 36 (20%) vs. n = 12 (4%; P < 0.001). Moreover, reoperation rates for gastrojejunostomy leakage and endoscopic dilatations for anastomotic stenosis were higher in the CIRC vs. aLIN group (P < 0.001). Adjusted overall mean cost per case was lower in aLIN-patients at 15,403 (± 7848) vs. CIRC-patients at 18,525 (± 7850) Swiss francs (P < 0.001). Overall profit was 2555 ± 4768 vs. 1455 ± 5638 Swiss francs in the aLIN vs. CIRC-group, respectively (P = 0.026). CONCLUSION This study shows improved clinical and financial outcomes after a gradual transition from a circular stapling protocol to an augmented linear stapling protocol in proximal gastric bypass surgery

Pre-contact and post-colonial ecological legacies shape Surinamese rainforests

This dataset belongs to the Ecology manuscript (ECY23-0681) "Pre-contact and post-colonial ecological legacies shape Surinamese rainforests". Table S1 contains radiocarbon dating results (uncalibrated and calibrated age ranges and 1 sigma errors). Table S2 contains the phytolith morphotypes used that were used in the data analyses and fig.2-3, their corresponding plant taxa and literature Table S3 contains CROSS 1 sizes, the count of CROSS and bilobate morphotypes and its ratio. In bold are extended countsTable S4 shows the data used to create fig. 2, showing phytoliths in abundances (%) or as "present" and charcoal in volume (cm3/mm3)Table S5 shows the data used to create fig. 3, showing burned phytoliths (%), total arboreal phytoliths (%), the openess index, total palm abundances (%) and modern AGB estimates for surface samples (Avitabile et al., 2016; Hijmans et al., 2013).Table S6 contains the raw phytolith data in abundances (%) or as noted as "present", when observed during an extended scan. Abstract of the manuscript:Disturbances in tropical forests can have long-lasting ecological impacts, but their manifestations (ecological legacies) in modern forests are uncertain. Many Amazonian forests bear the mark of past soil modifications, species enrichments and fire events, but the trajectories of ecological legacies from the pre-contact or post-colonial period remains relatively unexplored. We assessed the fire and vegetation history from 15 soil cores ranging from 0 to 10 km from a post-colonial Surinamese archaeological site. We show that: i) fires occurred from 96 BC to recent times and induced significant vegetation change, ii) persistent ecological legacies from pre-contact and post-colonial fire and deforestation practices were mainly within 1 km of the archaeological site, and iii) palm enrichment of Attalea, Oenocarpus and Astrocaryum occurrewithin 0 km, 1 km, and 8 km of the archaeological site, respectively. Our results challenge the notion of spatially extensive and persistent ecological legacies. Instead, our data indicate that the persistence and extent of ecological legacies is dependent on its timing, frequency, type, and intensity. Examining the mechanisms and manifestations of ecological legacies is crucial in assessing forest resilience and Indigenous and local land rights in the highly threatened Amazonian forests.</p

Intolerance of uncertainty, fear of anxiety, and adolescent worry

Item does not contain fulltextA 5 year, ten wave longitudinal study of 338 adolescents assessed the association between two forms of cognitive vulnerability (intolerance of uncertainty and fear of anxiety) and worry. Multilevel mediational analyses revealed a bidirectional and reciprocal relation between intolerance of uncertainty and worry in which change in one variable partially explained change in the other. Fear of anxiety and worry also showed evidence of a bidirectional relation, although change in fear of anxiety had a much weaker mediational effect on change in worry than vice versa. The findings show that relative to fear of anxiety, intolerance of uncertainty may play a greater role in the etiology of worry in adolescents.8 p

Make EU trade with Brazil sustainable

Brazil, home to one of the planet's last great forests, is currently in trade negotiations with its second largest trading partner, the European Union (EU). We urge the EU to seize this critical opportunity to ensure that Brazil protects human rights and the environment