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

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 remain 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 (1) fires occurred from 96 bc to recent times and induced significant vegetation change, (2) persistent ecological legacies from pre-contact and post-colonial fire and deforestation practices were mainly within 1 km of the archaeological site, and (3) palm enrichment of Attalea, Oenocarpus and Astrocaryum occurred within 0, 1, 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 are dependent on their 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.

Phytolith assemblages reflect variability in human land use and the modern environment.

Phytoliths preserved in soils and sediments can be used to provide unique insights into past vegetation dynamics in response to human and climate change. Phytoliths can reconstruct local vegetation in terrestrial soils where pollen grains typically decay, providing a range of markers (or lack thereof) that document past human activities. The ca. 6 million km2 of Amazonian forests have relatively few baseline datasets documenting changes in phytolith representation across gradients of human disturbances. Here we show that phytolith assemblages vary on local scales across a gradient of (modern) human disturbance in tropical rainforests of Suriname. Detrended correspondence analysis showed that the phytolith assemblages found in managed landscapes (shifting cultivation and a garden), unmanaged forests, and abandoned reforesting sites were clearly distinguishable from intact forests and from each other. Our results highlight the sensitivity and potential of phytoliths to be used in reconstructing successional trajectories after site usage and abandonment. Percentages of specific phytolith morphotypes were also positively correlated with local palm abundances derived from UAV data, and with biomass estimated from MODIS satellite imagery. This baseline dataset provides an index of likely changes that can be observed at other sites that indicate past human activities and long-term forest recovery in Amazonia. Supplementary Information: The online version contains supplementary material available at 10.1007/s00334-023-00932-2.

Fourteen quick tips for crowdsourcing geographically linked data for public health advocacy.

This article presents 14 quick tips to build a team to crowdsource data for public health advocacy. It includes tips around team building and logistics, infrastructure setup, media and industry outreach, and project wrap-up and archival for posterity.

Mobilizing the Community to Implement Mass Coronavirus Disease-2019 Vaccination Clinics: The Power of Free and Charitable Clinics.

A free and charitable clinic successfully designed and implemented mass COVID-19 vaccination clinics in a semirural area in Central Pennsylvania. A total of 172 clinics were offered, approximately 500 volunteers were mobilized, and approximately 45,000 vaccine doses were administered. Partnering with local schools, universities, and recreation centers to offer mass vaccination clinics made it possible to expand the clinic's reach beyond its own patients. Findings provide evidence for the capacity of small community clinics to respond to major public health emergencies, such as a pandemic.

Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study.

Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early" (within 14 d of intubation) or "late" (more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

Effects of bolus rheology on aspiration in patients with Dysphagia.

Bolus manipulation is a primary treatment strategy in the management of oral-pharyngeal dysphagia. The use of thickening agents to alter bolus rheology is particularly commonplace; however, the precise effects of these alterations on swallowing remain uncertain. The purpose of our study, a prospective, double-blind clinical trial (Level 1b), was to investigate the effects of viscosity on aspiration. One hundred patients with dysphagia were prospectively evaluated with fluoroscopic swallow studies performed across three standardized and randomized conditions: thin liquid barium (THIN), liquid barium thickened with a starch-based agent (STARCH), and liquid barium thickened with a gum-based agent (GUM). Outcome measures included the prevalence of aspiration and score on the Penetration-Aspiration Scale. A total of 23 out of 100 patients exhibited 56 episodes of aspiration. Twenty patients aspirated on THIN, 15 on STARCH, and 11 on GUM bolus conditions (P<0.05, thin vs gum). There were 28 instances of aspiration on THIN, 16 on STARCH, and 12 on GUM. Mean Penetration-Aspiration Scale score ± standard deviation was 2.11 ± 2.22 for THIN, 1.76 ± 1.88 for STARCH, and 1.42 ± 1.47 for GUM conditions, respectively (P<0.001, THIN vs GUM). A clinically significant reduction in the incidence of penetration and aspiration was observed for gum-thickened barium compared with thin liquid barium.

Comparison of esophageal screen findings on videofluoroscopy with full esophagram results.

BACKGROUND: Videofluoroscopic swallowing studies do not routinely obtain images of the esophagus. We incorporated a single esophageal screening swallow into our videofluoroscopic swallowing study protocol. The purpose of this study was to compare findings from "esophageal screening" with the results of full esophagram. METHODS: Patients undergoing videofluoroscopic swallowing studies with an esophageal screen followed by full esophagram between January 1, 2009, and October 1, 2009, were retrospectively reviewed. Comparison of esophageal screening and esophagram results were undertaken, with esophagram used as the gold standard. RESULTS: Seventy-four patients underwent esophageal screening and esophagram. Sensitivity of esophageal screening is 63% (CI 50%-73%); specificity is 100% (CI 39%-100%). Positive and negative predictive values of esophageal screening were 100% and 13%, respectively. CONCLUSIONS: Esophageal screening identified 44/70 (63%) patients with esophageal disease. Esophageal screening is a simple tool that may guide further esophageal investigation. The sensitivity of esophageal screening is limited (63%). If clinical suspicion is high, formal esophagram should be considered.

Posterior cricoid region fluoroscopic findings: the posterior cricoid plication.

The region posterior to the cricoid cartilage is challenging to assess fluoroscopically. The purpose of this investigation is to critically evaluate the posterior cricoid (PC) region on fluoroscopy and describe patterns of common findings. This was a case control study. All fluoroscopic swallowing studies performed between June 16, 2009, and February 9, 2010, were reviewed for features seen in the PC region. These findings were categorized into distinct patterns and compared to fluoroscopic studies performed in a cohort of normal volunteers. Two hundred patient studies and 149 healthy volunteer studies were reviewed. The mean age of the referred patient cohort and the volunteer cohort was 57 years (±19) and 61 years (±16), respectively (p > 0.05). The patient cohort was 53% male and the control cohort was 56% female (p > 0.05). Four groups were identified. Pharyngoesophageal webs were seen in 7% (10/149) of controls and 14% (28/200) of patients (p = 0.03). A PC arch impression was seen in 16% of patients (32/200) and controls (24/149) (p = 1). A PC plication was demonstrated in 23% (34/149) of controls and 30% (60/200) of patients (p = 0.13). No distinctive PC region findings were seen in 54% (81/149) of controls and 42% (84/200) of referred patients (p = 0.02). Four patients (2%) had both a web and a PC plication. Four categories of PC region findings were identified (unremarkable PC region, web, PC arch impression, and PC plication). Both patients referred for swallowing studies and healthy volunteers demonstrated esophageal webs, PC arch impressions, and PC plications. Only webs were more common in patients than in control subjects (p = 0.03). The PC impression and PC plication are likely to represent normal variants that may be identified on fluoroscopic swallow studies.

Effect of cricopharyngeus muscle surgery on the pharynx.

OBJECTIVES/HYPOTHESIS: Cricopharyngeus muscle dysfunction (CPD) ranges from asymptomatic cricopharyngeal bar (CPB) to Zenker's diverticulum. Previous work suggests that CPD can result in dilation and weakening of the pharynx above the obstruction. The purpose of this investigation was to evaluate the ability of surgery on the cricopharyngeus muscle to improve pharyngeal area and strength. STUDY DESIGN: Retrospective case study. METHODS: Videofluoroscopic swallowing studies of all persons with CPD who underwent cricopharyngeus (CP) intervention followed by routine postoperative fluoroscopic study, between October 1, 1999 and January 1, 2010 were reviewed. Objective measures of pharyngeal area and constriction were obtained from pretreatment and post-treatment studies. Paired t tests and repeated measures analysis of variance were employed to compare results. RESULTS: Fifty-four patients were included. Pharyngeal constriction and pharyngoesophageal segment (PES) opening improved significantly after intervention (P < .05).Pharyngeal dilation was unchanged (P > .05). PES opening improved more with CP myotomy than with dilation and botulinum toxin. CONCLUSIONS: Relief of CP obstruction by surgery or dilation improves pharyngeal constriction and PES opening. Dilation of the pharynx possibly related to prolonged outlet obstruction does not improve. CP myotomy appears more effective than dilation or botulinum toxin in relieving obstruction.

Prevalence of penetration and aspiration on videofluoroscopy in normal individuals without dysphagia.

OBJECTIVE: To determine the prevalence of penetration and aspiration on videofluoroscopic swallow studies (VFSS) in normal individuals without dysphagia. STUDY DESIGN: Case series with planned data collection. SETTING: A tertiary urban university hospital. SUBJECTS AND METHODS: Normal adult volunteers without dysphagia, neurological disease, or previous surgery underwent VFSS. Studies were recorded and then reviewed for evidence of penetration or aspiration. The degree of penetration was assessed with the penetration-aspiration scale (PAS). The effect of age, bolus size, and consistency was evaluated. RESULTS: A total of 149 VFSS (596 swallows) were reviewed. The mean age of the cohort was 57 years (+/-19 years); 56 percent were female. Only one (0.6%) individual aspirated on VFSS. Seventeen (11.4%) individuals demonstrated penetration. The mean PAS for the entire cohort was 1.17 (+/-0.66). Prevalence of penetration by swallow was 2.85 percent (17/596). Prevalence of penetration was 9.3 percent in elderly individuals aged >65 years and 14.3 percent in adults aged <65 years (P = 0.49). Prevalence of penetration on a liquid bolus was 3.4 percent (15/447) and on paste was 1.3 percent (2/149) (P > 0.05). Prevalence of penetration for a bolus <30 cc was 2.34 percent (7/298) and for a bolus >30 cc was 5.4 percent (8/149) (P > 0.05). CONCLUSION: Aspiration on VFSS is not a normal finding. Penetration is present in 11.4 percent of normal adults and is more common with a liquid bolus.

Comparing advice to decrease both dietary fat and sucrose, or dietary fat only, on weight loss, weight maintenance and perceived quality of life.

This study compared two types of dietary advice on weight loss, weight maintenance and quality of life in Scottish women. One hundred and twenty-six overweight/obese sedentary women were randomly assigned to either: Group 1, reduced energy, fat and sucrose; Group 2, reduced energy and fat only; or Group 3, control. Subjects were followed up at 3 months and for a further 6 months weight maintenance. Groups 1 and 2 reported a decrease in energy intake, percentage energy fat, and increase in percentage energy total carbohydrate and protein (P < 0.001). Group 1 reduced percentage energy sucrose at 3 months (P < 0.001) but not at 9 months. Groups 1 and 2 lost body weight (2.81 kg [standard error of the mean, 0.406] and 2.6 kg [standard error of the mean, 0.506], respectively), body fat (P < 0.01) and reported increased quality of life (P < 0.05). Group 2 reported more positive changes. Both interventions were successful for weight reduction, and were maintained medium term. The associated increase in quality of life may be indicative of longer term compliance, predicting successful weight maintenance.

Male to male sex is associated with a high prevalence of exposure to GB virus C.

Co-infection with GB virus C (GBV-C) and human immunodeficiency virus (HIV) appears to reduce mortality for HIV/AIDS. Epidemiological and demographic factors for GBV-C were examined prospectively in 167 subjects at risk for co-infection. We attempted to establish a hierarchical exposure risk for GBV-C. Overall exposure to GBV-C was 45.5%. In univariate analysis, GBV-C was associated with male to male sex (P<0.0001), HIV infection (P=0.0005) and hepatitis B infection (P=0.006). Injecting drug use approached statistical significance (P=0.08) while being a female sex worker was not associated with GBV-C exposure/infection (P=0.85). Exposure to GBV-C in 192 healthy blood donors was found to be 9.4%. In conclusion, the data suggest that male to male sex is a more effective mode of transmission of GBV-C and that GBV-C is associated with HIV co-infection. As male to male sex is also a risk factor for HIV transmission our data suggest that many may benefit from the potential protective effect GBV-C exerts on HIV-infected persons.

Simplifying the vertical reduction mammaplasty.

The vertical reduction mammaplasty is an evolving technique. Its proponents report significantly decreased scarring, better breast shape, and more stable results compared with the standard inverted-T method, but the learning curve is long and cosmetic outcomes can be inconsistent. Many surgeons have experimented with the vertical closure before returning to methods more familiar to them. The authors present their modifications to the vertical reduction mammaplasty. Their changes simplify the preoperative markings and the intraoperative technique to shorten the learning curve while maintaining reliable aesthetic results. With the patient standing, only four preoperative marks are made: (1) the inframammary fold; (2) the breast axis; (3) the apex of the new nipple-areola complex; and (4) the medial and lateral limbs of the vertical incision. In the operating room, a medial or a superomedial pedicle is developed. Excess breast skin is resected with the inferior and lateral parenchyma as a C-shaped wedge. The lateral skin-adipose flap is redraped inferomedially and sutured to the chest wall. The inferior aspect of the breast is aggressively debulked and a gathering subcuticular stitch is started 2 cm below the nadir of the nipple-areola complex. Finally, a 38-mm to 42-mm nipple-areola complex marker is used to create a circular defect that is offset 0.5 cm medial to the vertical axis of the breast. In their series, 56 patients were treated and no major complications were noted. The median follow-up period was 17 months. The average reduction was 554.5 g per breast; however, the reduction was greater than 1000 g per breast in eight patients. The authors found that (1) chest wall anchoring improves lateral contour and minimizes axillary fullness; (2) aggressive debulking inferiorly avoids the persistent inferior bulge; and (3) starting the subcuticular gathering suture 2 cm below the nipple-areola complex followed by placement of a nipple-areola complex marker at the conclusion of the case prevents lateral deviation and corrects the nipple-areola complex teardrop deformity. These innovations accelerate the learning curve by simplifying the preoperative markings and lead to more consistent postoperative results and an improved cosmetic outcome. In conclusion, these modifications yield a simple, easily learned vertical reduction mammaplasty with aesthetically reliable results.