Application of Topographical Anatomy of the Trochlear Nerve in Transtentorial Approaches: An Anatomic Study.

BACKGROUND AND OBJECTIVES: Transection of the free edge of tentorium (FET) might be necessary when approaching cavernous sinus lesions, clip placement in certain posterior communicating artery aneurysms, or during transpetrosal and retrosigmoid transtentorial approaches. No anatomic study has investigated the relationship of the trochlear and oculomotor nerve and FET in an attempt to identify a safe zone for such maneuver. METHODS: Ten embalmed specimens (20 sides) were studied and the following morphometric measurements were taken using digital microcalipers: trochlear (TP) to oculomotor porus (OP), length of the intratentorial segment of cranial nerve (CN) IV, nerve free FET, and distance along the oculomotor (CN III) from its OP to CN III/trochlear (CN IV) crossing and angle between the long-axis petrous ridge and TP (petrotrochlear angle). RESULTS: The CN IV pierced the deep layer of the FET in all cases at a mean distance 8.11 mm (4.43-11.33) posterior to the OP, measured along the FET. CN IV continued within the tentorial edge for a mean of 6.17 mm (3.18-11.33) before entering the cavernous sinus at a mean distance of 1.9 mm (0-5.46 mm) from the posterior-most aspect of the OP. A nerve-free portion of FET was 1.93 mm (mean) (0-5.46). No nerve-free FET segment (<1 mm) was observed in 4 sides (20%), and a nerve-free FET segment <2.00 mm was seen in 55% of cases. The mean distance from OP to the CN III/IV crossing was 10.17 mm (1.00-15.57). The mean petrotrochlear angle was 164.49° (140.01-183.85), and >175° in 4 specimens (20%). CONCLUSION: Our data confirm presence of the intratentorial segment of CN IV. Transection of the FET carries the lowest risk of CN IV injury if performed < 2 mm or >10 mm posterior to the OP, or posterior to intersection of the FET and a virtual extension of a petrous ridge.

Influence of Preoperative Motor Score and Patient Comorbidities on Transcranial Motor-Evoked Potential Acquisition in Intracranial Surgery: A Retrospective Cohort Study.

BACKGROUND AND OBJECTIVES: Intraoperative neurophysiological monitoring plays a pivotal role in modern neurosurgery, aiding in real-time assessment of eloquent neural structures to mitigate iatrogenic neural injury. This study represents the largest retrospective series to date in monitoring corticospinal tract integrity during intracranial surgery with transcranial motor-evoked potentials (TCMEPs), focusing on the influence of demographic factors, comorbidities, and preoperative motor deficits on the reliability of intraoperative neurophysiological monitoring. While the impact of patient-specific factors affecting TCMEP monitoring in spine surgery is well-documented, similar insights for intracranial surgery are lacking. METHODS: A total of 420 craniotomy patients were retrospectively analyzed from electronic medical records from December 2017 to February 2023, excluding patients without preoperative Medical Research Council scores or medical histories. Using intrinsic hand muscles as a robust data set, 840 hand TCMEPs acquired during intracranial surgery were assessed. Demographic and clinical factors, including preoperative motor scores, were analyzed to identify associations with TCMEP acquisition and amplitude. Nonparametric statistics and multivariate regression analysis were employed. RESULTS: TCMEPs were successfully acquired in 734 (87.7%) patient hands, even in the presence of preoperative motor deficits in 13.9% of total patient hands. Preoperative motor scores did not predict the ability to acquire baseline TCMEPs ( P = .6). Notably, older age ( P < .001) and hypertension ( P = .01) were independent predictors of lower TCMEP acquisition rates. Preoperative motor scores significantly influenced TCMEP amplitudes, with higher scores correlating with higher amplitudes (1771 [SD = 1550] eve vs 882 [SD = 856] µV, P < .0001). Older age ( P < .001) and chronic kidney disease ( P = .04) were also associated with reduced TCMEP amplitudes. CONCLUSION: Our investigation into TCMEPs during intracranial surgery demonstrated a notably high acquisition rate in hand muscles, irrespective of preoperative motor deficits. Preoperative motor scores reliably correlated with TCMEP amplitudes in a linear fashion while advanced age and renal disease emerged as independent predictors of lower TCMEP amplitudes.

Nature's contribution to poverty alleviation, human wellbeing and the SDGs.

Millions of households globally rely on uncultivated ecosystems for their livelihoods. However, much of the understanding about the broader contribution of uncultivated ecosystems to human wellbeing is still based on a series of small-scale studies due to limited availability of large-scale datasets. We pooled together 11 comparable datasets comprising 232 settlements and 10,971 households in ten low-and middle-income countries, representing forest, savanna and coastal ecosystems to analyse how uncultivated nature contributes to multi-dimensional wellbeing and how benefits from nature are distributed between households. The resulting dataset integrates secondary data on rural livelihoods, multidimensional human wellbeing, household demographics, resource tenure and social-ecological context, primarily drawing on nine existing household surveys and their associated contextual information together with selected variables, such as travel time to cities, population density, local area GDP and land use and land cover from existing global datasets. This integrated dataset has been archived with ReShare (UK Data Service) and will be useful for further analyses on nature-wellbeing relationships on its own or in combination with similar datasets.

Soil moisture and temperature drive emergence delays associated with fire seasonality in eucalypt forests.

Many ecosystems are well adapted to fire, although the impacts of fire seasonality and its effect on post-fire recruitment are less well understood. Late summer or autumn fires within eucalypt forests with a Mediterranean-type climate allow for seedling emergence during the cooler and wetter seasons. The emergence and survival after spring fires may be impacted by higher soil temperatures and water stress, delaying recruitment until the subsequent winter period. During this delay, seeds may be exposed to predation and decay, which reduce the viable seed bank. This study examines post-fire recruitment dynamics in a eucalypt forest ecosystem (Northern Jarrah Forest (NJF) of southwestern Western Australia) and whether it may be vulnerable to human-induced changes to fire season. Here, we compare in situ post-fire seedling emergence patterns between autumn and spring burns and account for a potential ecological mechanism driving seasonal differences in emergence by determining the thermal germination requirements of seeds for 15 common species from the NJF. Our results demonstrate that 93% of species had thermal optima between 10°C and 20°C, analogous with soil temperatures measured during the germination window (late April to October). Concurrent in situ post-fire emergence was highest 144 days after an autumn (seasonal) fire, followed by a 10-72% decline. In contrast, there was no emergence within the first 200 days following a spring (aseasonal) fire. We conclude that aseasonal fire in the NJF can lead to a complete delay in recruitment in the first season post-fire, resulting in a lower inter-fire growth period and increasing the potential for further reductions in recruitment through seed predation and decay. The study suggests that aseasonal fire has an immediate and significant impact on initial recruitment in the NJF, but further research is required to determine any longer-term effects of this delay and its implications for fire management in southwestern Western Australia.

The COVID-19 Applicant: The Rise of Twitter Among Matched Neurosurgery Applicants.

INTRODUCTION: Social media is becoming increasingly ubiquitous in the professional realm. The coronavirus disease 2019 (COVID-19) pandemic accelerated the shift towards utilizing social media to network and disseminate information, especially via Twitter. Neurosurgery programs have also leveraged Twitter to inform and attract applicants. OBJECTIVE: The purpose of this study is to identify factors influencing the adoption of Twitter by matched neurosurgery applicants before and during the COVID-19 pandemic. METHODS: A list of matched U.S. neurosurgery residents from just before the start of the pandemic (2019-2020) to after the peak of the pandemic (2021-2022), was collated. Twitter was searched to evaluate the presence of a professional account at the time of Electronic Residency Application Service (ERAS) submission. The following demographic variables were collected: gender, medical school, and matched residency institution. RESULTS: Over four application cycles (2019-2022), 897 matched residents were evaluated in the study. Overall, 31.1% had a Twitter account during the time of their residency application. In particular, international medical school graduates were more likely to have a Twitter platform compared to U.S. applicants (50.0% vs. 29.7%; p=.001). The percentage of matched neurosurgery applicants with a Twitter profile significantly increased during the pandemic (21.0% vs. 41.1%; p<.001) with a two-fold increase from 20.0% to 39.7% (p<.001) in U.S. applicants. CONCLUSION: Over the past four years, an increasing number of matched neurosurgery applicants have adopted a Twitter presence during application. Driven by the increasing use of social media and accelerated by the COVID-19 pandemic, Twitter has become an important tool leveraged by during the application process.

Confronting deep uncertainty in the forest carbon industry.

Resilience-based and service-focused approaches could reduce contentions and injustices.

Awake craniotomies in the pediatric population: a systematic review.

OBJECTIVE: Awake craniotomy (AC) is employed to maximize tumor resection while preserving neurological function in eloquent brain tissue. This technique is used frequently in adults but remains poorly established in children. Its use has been limited due to concern for children's neuropsychological differences compared with adults and how these differences may interfere with the safety and feasibility of the procedure. Among studies that have reported pediatric ACs, complication rates and anesthetic management vary. This systematic review was performed to comprehensively analyze outcomes and synthesize anesthetic protocols of pediatric ACs. METHODS: The authors followed PRISMA guidelines to extract studies that reported AC in children with intracranial pathologies. The Medline/PubMed, Ovid, and Embase databases were searched from database inception to 2021, using the terms ("awake") AND ("Pediatric*" OR "child*") AND (("brain" AND "surgery") OR "craniotomy"). Data extracted included patient age, pathology, and anesthetic protocol. Primary outcomes assessed were premature conversion to general anesthesia, intraoperative seizures, completion of monitoring tasks, and postoperative complications. RESULTS: Thirty eligible studies published from 1997 to 2020 were included that described a total of 130 children ranging in age from 7 to 17 years who had undergone AC. Of all patients reported, 59% were male and 70% had left-sided lesions. Procedure indications included the following etiologies: tumors (77.6%), epilepsy (20%), and vascular disorders (2.4%). Four (4.1%) of 98 patients required conversion to general anesthesia due to complications or discomfort during AC. In addition, 8 (7.8%) of 103 patients experienced intraoperative seizures. Furthermore, 19 (20.6%) of 92 patients had difficulty completing monitoring tasks. Postoperative complications occurred in 19 (19.4%) of 98 patients and included aphasia (n = 4), hemiparesis (n = 2), sensory deficit (n = 3), motor deficit (n = 4), or others (n = 6). The most commonly reported anesthetic techniques were asleep-awake-asleep protocols using propofol, remifentanil or fentanyl, a local scalp nerve block, and with or without dexmedetomidine. CONCLUSIONS: The findings of this systematic review suggest the tolerability and safety of ACs in the pediatric population. Although pediatric intracranial pathologies pose etiologies that certainly may benefit from AC, there is a need for surgeons and anesthesiologists to perform individualized risk-benefit analyses due to the risks associated with awake procedures in children. Age-specific, standardized guidelines for preoperative planning, intraoperative mapping, monitoring tasks, and anesthesia protocols will help to continue minimizing complications, while improving tolerability, and streamlining workflow in the treatment of this patient population.

Understanding livelihood changes in the charcoal and baobab value chains during Covid-19 in rural Mozambique: The role of power, risk and civic-based stakeholder conventions.

Non-pharmaceutical interventions (NPIs) to reduce the transmission of Covid-19 had different repercussions for domestic, regional and global value chains, but empirical data are sparse on specific dynamics, particularly on their implications for value-chain stakeholders' local livelihoods. Through research including weekly phone interviews (n = 273 from May to July 2020) with panellists in six Mozambican communities, our research traced firstly how the baobab and charcoal value chains were affected by Covid NPIs, particularly in terms of producers' livelihoods. Secondly, we ask how our findings advance our understanding of the role of civic-based stakeholder conventions and different types of power in building viable local livelihoods. Our conceptual lens is based on a synthesis of value-chain and production-network analysis, convention theory and livelihood resilience focusing on power and risk. We found that Covid trading and transport restrictions considerably re-shaped value chains, albeit in different ways in each value chain. The global baobab value chain continued to provide earnings particularly to women, when other income sources were eliminated, with socially oriented stakeholders altering their operations to accommodate pandemic restrictions. By contrast, producers involved in the domestic, solely market-oriented charcoal value chain saw their selling opportunities and incomes reduced, with hunger rising in charcoal-dependent communities. Our paper argues that local livelihoods were more resilient under Covid NPIs if civic-based conventions and collective, social power were present.

How Social Considerations Improve the Equity and Effectiveness of Ecosystem Restoration.

Ecosystem restoration is an important means to address global sustainability challenges. However, scientific and policy discourse often overlooks the social processes that influence the equity and effectiveness of restoration interventions. In the present article, we outline how social processes that are critical to restoration equity and effectiveness can be better incorporated in restoration science and policy. Drawing from existing case studies, we show how projects that align with local people's preferences and are implemented through inclusive governance are more likely to lead to improved social, ecological, and environmental outcomes. To underscore the importance of social considerations in restoration, we overlay existing global restoration priority maps, population, and the Human Development Index (HDI) to show that approximately 1.4 billion people, disproportionately belonging to groups with low HDI, live in areas identified by previous studies as being of high restoration priority. We conclude with five action points for science and policy to promote equity-centered restoration.