Dynamic primary resources, not just wild prey availability, underpin lion depredation of livestock in a savanna ecosystem.

Because it can lead to retaliatory killing, livestock depredation by large carnivores is among the foremost threats to carnivore conservation, and it severely impacts human well-being worldwide. Ongoing climate change can amplify these human-wildlife conflicts, but such issues are largely unexplored, though are becoming increasingly recognized. Here, we assessed how the availability of primary resources and wild prey interact to shape large carnivore selection for livestock rather than wild prey (i.e., via prey switching or apparent competition). Specifically, we combined remotely sensed estimates of primary resources (i.e., water availability and primary productivity), wild prey movement, and 7 years (2015-2021) of reports for livestock depredation by African lions (Panthera leo) in the Makgadikgadi Pans ecosystem, Botswana. Although livestock depredation did not vary between wet versus dry seasons, analyses at finer temporal scales revealed higher incidences of livestock depredation when primary production, water availability, and wild prey availability were lower, though the effects of wild prey availability were mediated by water availability. Increased precipitation also amplified livestock depredation events despite having no influence on wild prey availability. Our results suggest that livestock depredation is influenced by the diverse responses of livestock, wild prey, and lions to primary resource availability, a driver that is largely overlooked or oversimplified in studies of human-carnivore conflict. Our findings provide insight into tailoring potential conflict mitigation strategies to fine-scale changes in resource conditions to efficiently reduce conflict and support human livelihoods.

Fragility Index Analysis of the 2018 Clinical Practice Guidelines on Tranexamic Acid Use in Total Joint Arthroplasty.

BACKGROUND: The 2018 American Association of Hip and Knee Surgeons clinical practice guideline (CPG) 'Tranexamic Acid Use in Total Joint Arthroplasty' evaluated the efficacy and safety of tranexamic acid in primary total joint arthroplasty. The following review assessed the statistical fragility of the randomized controlled trial (RCT) outcomes on which the CPG recommendations were based using a fragility analysis. METHODS: All dichotomous outcomes from the randomized controlled trials used to guide the CPG from its associated network and direct meta-analyses were analyzed. Fragility and reverse fragility indices (FI and rFI) and quotients (FQ and rFQ) were calculated for each outcome. Mean indices and quotients were calculated for each guideline question, outcome category, and comparison of tranexamic dose, formulation, and administration timing. RESULTS: This review evaluated 403 dichotomous outcomes on transfusion and complication rates associated with tranexamic acid (TXA) administration. The mean FI of significant outcomes of the CPG was 5.23, and the mean rFI of nonsignificant outcomes was 5.80. Outcomes assessing complication rates had a mean rFI of 6.48. Most outcomes on transfusion in categories comparing TXA to placebo administration had higher mean FIs than rFIs, and all outcomes comparing transfusion risk associated with different TXA formulations and doses had higher mean rFIs than FI or no associated significant outcomes. CONCLUSION: The rFI and FIs calculated for this CPG are comparable to or higher than mean values reported across orthopaedic literature, indicating the relative statistical stability of its included outcomes. As we learn more about fragility analyses and their potential applications, this type of statistical analysis shows promise as a useful tool to incorporate into future guidelines to assess the quality of RCTs and evaluate the strength of recommendations.

Dopamine mediates a directionally opposite correlation between empathy and the reinforcing effects of amphetamine and gambling in people with gambling disorder vs. healthy controls.

Understanding the relationship between empathy, subjective effects of addictive reinforcers and dopamine function in people with gambling disorder (PGD) vs. healthy controls (HCs) may inform GD treatment. The current investigation addressed this issue via retrospective analysis of data from three studies using amphetamine and a slot machine (SLOTS) as reinforcers in PGD and HCs. The Empathy scale of Eysenck's Impulsiveness Questionnaire assessed trait Empathy. The Gamblers Beliefs Questionnaire assessed cognitive distortions. The Eysenck Lie scale assessed socially desirable responding. PET scans quantified dopamine receptor expression and amphetamine-induced dopamine release in Study 1. Pre-treatment with the D2-receptor (D2R)-preferring antagonist, haloperidol or D1R-D2R antagonist, fluphenazine before SLOTS tested the role of D2 autoreceptors and post-synaptic D2R in Study 2. Pre-treatment with the multi-system indirect dopamine agonist, modafinil before SLOTS assessed the reliability of correlations in PGD. Striatal D2R expression predicted greater Empathy and lower amphetamine 'Liking' in HCs, and predicted greater symptom severity in PGD. Empathy predicted lower 'Exciting' effects of SLOTS under placebo in HCs; no correlation emerged under either antagonist. Relative to placebo, haloperidol decreased, whereas fluphenazine increased, the positive correlation between Empathy and Exciting effects of SLOTS in PGD. Modafinil markedly reduced the positive correlation between Empathy and Exciting effects of SLOTS seen under placebo in PGD. Empathy predicted greater cognitive distortions in PGD in all studies. Lie scale variance influenced several primary effects. Prior research linking the insula with Empathy, reactivity to interoceptive signals for risky rewards (uncertainty), and cognitive distortions, provides a parsimonious account for these results.

Effect of Age, Deboning Time of Carcass, and Different Cooking Conditions on the Woody Breast Myopathies in Chicken: A Meta-Analysis.

This meta-analysis review undertakes a comprehensive examination of various approaches for identifying myopathic fillets and meticulously evaluates the effects of bird age, deboning time, and different cooking and storage conditions on woody breast (WB) myopathic conditions in broiler deboned fillets. The data, meticulously collected from 20 articles based on predefined inclusion criteria sourced from various databases and online resources, reveal significant insights. For instance, the analysis uncovers that deboning time significantly affects Meullenet-Owens Razor Shear (MORS), Blunt Meullenet-Owens Razor Shear (BMORS), and descriptive analysis values (p < 0.001). Instrumentation techniques, such as compression force and shear force, along with different cooking conditions, strongly impact BMORS shear force values (R2 = 86.80%), with significance levels ranging from 0.01 to 0.001. Deboning time also substantially impacts MORS shear force values (R = 64.03%). In contrast, the effects of deboning time, bird age, and cooking conditions on descriptive sensory evaluation are minimal when compared to woody breast fillets (age of birds: R2 = 26.53%; cooking conditions: R2 = 32.57%; deboning time: R2 = 10.06%). The overall effect of bird age on chicken breast meat quality shows significant differences for the evaluated parameters (Hedges' g [95% CI] = -0.72 [0.17, 1.26], I2 = 93%, p < 0.01). The sous vide cooking method significantly affects shear force energies and sensory descriptive evaluation for woody breast fillets (Hedges' g [95% CI] = 5.30 [-50.30, 83.40], I2 = 98%, p < 0.01). These findings, with their significant implications, provide valuable insights for optimizing processing conditions in the poultry industry to reduce woody breast occurrences and enhance meat quality, instilling confidence in the robustness of the research.

Proactive cursorial and ambush predation risk avoidance in four African herbivore species.

Most herbivores must balance demands to meet nutritional requirements, maintain stable thermoregulation and avoid predation. Species-specific predator and prey characteristics determine the ability of prey to avoid predation and the ability of predators to maximize hunting success. Using GPS collar data from African wild dogs, lions, impala, tsessebes, wildebeest and zebra in the Okavango Delta, Botswana, we studied proactive predation risk avoidance by herbivores. We considered predator activity level in relation to prey movement, predator and prey habitat selection, and preferential use of areas by prey. We compared herbivore behaviour to lion and wild dog activity patterns and determined the effect of seasonal resource availability and prey body mass on anti-predator behaviour. Herbivore movement patterns were more strongly correlated with lion than wild dog activity. Habitat selection by predators was not activity level dependent and, while prey and predators differed to some extent in their habitat selection, there were also overlaps, probably caused by predators seeking habitats with high prey abundance. Areas favoured by lions were used by herbivores more when lions were less active, whereas wild dog activity level was not correlated with prey use. Prey body mass was not a strong predictor of the strength of proactive predation avoidance behaviour. Herbivores showed stronger anti-predator behaviours during the rainy season when resources were abundant. Reducing movement when top predators are most active and avoiding areas with a high likelihood of predator use during the same periods appear to be common strategies to minimize predation risk. Such valuable insights into predator-prey dynamics are only possible when using similar data from multiple sympatric species of predator and prey, an approach that should become more prevalent given the ongoing integration of technological methods into ecological studies.

Markerless 3D kinematics and force estimation in cheetahs.

The complex dynamics of animal manoeuvrability in the wild is extremely challenging to study. The cheetah (Acinonyx jubatus) is a perfect example: despite great interest in its unmatched speed and manoeuvrability, obtaining complete whole-body motion data from these animals remains an unsolved problem. This is especially difficult in wild cheetahs, where it is essential that the methods used are remote and do not constrain the animal's motion. In this work, we use data obtained from cheetahs in the wild to present a trajectory optimisation approach for estimating the 3D kinematics and joint torques of subjects remotely. We call this approach kinetic full trajectory estimation (K-FTE). We validate the method on a dataset comprising synchronised video and force plate data. We are able to reconstruct the 3D kinematics with an average reprojection error of 17.69 pixels (62.94% PCK using the nose-to-eye(s) length segment as a threshold), while the estimates produce an average root-mean-square error of 171.3N ( ≈ 17.16% of peak force during stride) for the estimated ground reaction force when compared against the force plate data. While the joint torques cannot be directly validated against ground truth data, as no such data is available for cheetahs, the estimated torques agree with previous studies of quadrupeds in controlled settings. These results will enable deeper insight into the study of animal locomotion in a more natural environment for both biologists and roboticists.

Identification and management of preoperative anaemia in adults: A British Society for Haematology Guideline update.

This updated British Society for Haematology guideline provides an up-to-date literature review and recommendations regarding the identification and management of preoperative anaemia. This includes guidance on thresholds for the diagnosis of anaemia and the diagnosis and management of iron deficiency in the preoperative context. Guidance on the appropriate use of erythropoiesis-stimulating agents and preoperative transfusion is also provided.

How territoriality and sociality influence the habitat selection and movements of a large carnivore.

While territoriality is one of the key mechanisms influencing carnivore space use, most studies quantify resource selection and movement in the absence of conspecific influence or territorial structure. Our analysis incorporated social information in a resource selection framework to investigate mechanisms of territoriality and intra-specific competition on the habitat selection of a large, social carnivore. We fit integrated step selection functions to 3-h GPS data from 12 collared African wild dog packs in the Okavango Delta and estimated selection coefficients using a conditional Poisson likelihood with random effects. Packs selected for their neighbors' 30-day boundary (defined as their 95% kernel density estimate) and for their own 90-day core (defined as their 50% kernel density estimate). Neighbors' 30-day boundary had a greater influence on resource selection than any habitat feature. Habitat selection differed when they were within versus beyond their neighbors' 30-day boundary. Pack size, pack tenure, pup presence, and seasonality all mediated how packs responded to neighbors' space use, and seasonal dynamics altered the strength of residency. While newly-formed packs and packs with pups avoided their neighbors' boundary, older packs and those without pups selected for it. Packs also selected for the boundary of larger neighboring packs more strongly than that of smaller ones. Social structure within packs has implications for how they interact with conspecifics, and therefore how they are distributed across the landscape. Future research should continue to investigate how territorial processes are mediated by social dynamics and, in turn, how territorial structure mediates resource selection and movement. These results could inform the development of a human-wildlife conflict (HWC) mitigation tool by co-opting the mechanisms of conspecific interactions to manage space use of endangered carnivores.

Indole-3-acetic acid promotes growth in bloom-forming Microcystis via an antioxidant response.

Interactions between bacteria and phytoplankton in the phycosphere facilitate and constrain biogeochemical cycling in aquatic ecosystems. Indole-3-acetic acid (IAA) is a bacterially produced chemical signal that promotes growth of phytoplankton and plants. Here, we explored the impact of IAA on bloom-forming cyanobacteria and their associated bacteria. Exposure to IAA and its precursor, tryptophan, resulted in a strong growth response in a bloom of the freshwater cyanobacterium, Microcystis. Metatranscriptome analysis revealed the induction of an antioxidant response in Microcystis upon exposure to IAA, potentially allowing populations to increase photosynthetic rate and overcome internally generated reactive oxygen. Our data reveal that co-occurring bacteria within the phycosphere microbiome exhibit a division of labor for supportive functions, such as nutrient mineralization and transport, vitamin synthesis, and reactive oxygen neutralization. These complex dynamics within the Microcystis phycosphere microbiome are an example of interactions within a microenvironment that can have ecosystem-scale consequences.

Engineered algal systems for the treatment of anaerobic digestate: A meta-analysis.

The objective of this review was to provide quantitative insights into algal growth and nutrient removal in anaerobic digestate. To synthesize the relevant literature, a meta-analysis was conducted using data from 58 articles to elucidate key factors that impact algal biomass productivity and nutrient removal from anaerobic digestate. On average, algal biomass productivity in anaerobic digestate was significantly lower than that in synthetic control media (p < 0.05) but large variation in productivity was observed. A mixed-effects multiple regression model across study revealed that biological or chemical pretreatment of digestate significantly increase productivity (p < 0.001). In contrast, the commonly used practice of digestate dilution was not a significant factor in the model. High initial total ammonia nitrogen suppressed algal growth (p = 0.036) whereas initial total phosphorus concentration, digestate sterilization, CO2 supplementation, and temperature were not statistically significant factors. Higher growth corresponded with significantly higher NH4-N and phosphorus removal with a linear relationship of 6.4 mg NH4-N and 0.73 mg P removed per 100 mg of algal biomass growth (p < 0.001). The literature suggests that suboptimal algal growth in anaerobic digestate could be due to factors such as turbidity, high free ammonia, and residual organic compounds. This analysis shows that non-dilution approaches, such as biological or chemical pretreatment, for alleviating algal inhibition are recommended for algal digestate treatment systems.

Drivers of cyanotoxin and taste-and-odor compound presence within the benthic algae of human-disturbed rivers.

Freshwater benthic algae form complex mat matrices that can confer ecosystem benefits but also produce harmful cyanotoxins and nuisance taste-and-odor (T&O) compounds. Despite intensive study of the response of pelagic systems to anthropogenic change, the environmental factors controlling toxin presence in benthic mats remain uncertain. Here, we present a unique dataset from a rapidly urbanizing community (Kansas City, USA) that spans environmental, toxicological, taxonomic, and genomic indicators to identify the prevalence of three cyanotoxins (microcystin, anatoxin-a, and saxitoxin) and two T&O compounds (geosmin and 2-methylisoborneol). Thereafter, we construct a random forest model informed by game theory to assess underlying drivers. Microcystin (11.9 ± 11.6 µg/m2), a liver toxin linked to animal fatalities, and geosmin (0.67 ± 0.67 µg/m2), a costly-to-treat malodorous compound, were the most abundant compounds and were present in 100 % of samples, irrespective of land use or environmental conditions. Anatoxin-a (8.1 ± 11.6 µg/m2) and saxitoxin (0.18 ± 0.39 µg/m2), while not always detected, showed a systematic tradeoff in their relative importance with season, an observation not previously reported in the literature. Our model indicates that microcystin concentrations were greatest where microcystin-producing genes were present, whereas geosmin concentrations were high in the absence of geosmin-producing genes. Together, these results suggest that benthic mats produce microcystin in situ but that geosmin production may occur ex situ with its presence in mats attributable to adsorption by organic matter. Our study broadens the awareness of benthic cyanobacteria as a source of harmful and nuisance metabolites and highlights the importance of benthic monitoring for sustaining water quality standards in rivers.

The fitness consequences of wildlife conservation translocations: a meta-analysis.

Conservation translocation is a common strategy to offset mounting rates of population declines through the transfer of captive- or wild-origin organisms into areas where conspecific populations are imperilled or completely extirpated. Translocations that supplement existing populations are referred to as reinforcements and can be conducted using captive-origin animals [ex situ reinforcement (ESR)] or wild-origin animals without any captive ancestry [in situ reinforcement (ISR)]. These programs have been criticized for low success rates and husbandry practices that produce individuals with genetic and performance deficits, but the post-release performance of captive-origin or wild-origin translocated groups has not been systematically reviewed to quantify success relative to wild-resident control groups. To assess the disparity in post-release performance of translocated organisms relative to wild-resident conspecifics and examine the association of performance disparity with organismal and methodological factors across studies, we conducted a systematic review and meta-analysis of 821 performance comparisons from 171 studies representing nine animal classes (101 species). We found that translocated organisms have 64% decreased odds of out-performing their wild-resident counterparts, supporting claims of systemic issues hampering conservation translocations. To help identify translocation practices that could maximize program success in the future, we further quantified the impact of broad organismal and methodological factors on the disparity between translocated and wild-resident conspecific performance. Pre-release animal enrichment significantly reduced performance disparities, whereas our results suggest no overall effects of taxonomic group, sex, captive generation time, or the type of fitness surrogate measured. This work is the most comprehensive systematic review to date of animal conservation translocations in which wild conspecifics were used as comparators, thereby facilitating an evaluation of the overall impact of this conservation strategy and identifying specific actions to increase success. Our review highlights the need for conservation managers to include both sympatric and allopatric wild-reference groups to ensure the post-release performance of translocated animals can be evaluated. Further, our analyses identify pre-release animal enrichment as a particular strategy for improving the outcomes of animal conservation translocations, and demonstrate how meta-analysis can be used to identify implementation choices that maximize translocated animal contributions to recipient population growth and viability.

Increasing ambient temperatures trigger shifts in activity patterns and temporal partitioning in a large carnivore guild.

Shifts in species' interactions are implicated as an important proximate cause underpinning climate-change-related extinction. However, there is little empirical evidence on the pathways through which climate conditions, such as ambient temperature, impact community dynamics. The timing of activities is a widespread behavioural adaptation to environmental variability, and temporal partitioning is a key mechanism that facilitates coexistence, especially within large carnivore communities. We investigated temperature impacts on community dynamics through its influence on the diel activity of, and temporal partitioning amongst, four sympatric species of African large carnivores: lions (Panthera leo), leopards (Panthera pardus), cheetahs (Acinonyx jubatus) and African wild dogs (Lycaon pictus). Activity of all species was shaped by a combination of light availability and temperature, with most species becoming more nocturnal and decreasing activity levels with increasing temperatures. A nocturnal shift was most pronounced in cheetahs, the most diurnal species during median temperatures. This shift increased temporal overlap between cheetahs and other carnivore species by up to 15.92%, highlighting the importance of considering the responses of interacting sympatric species when inferring climate impacts on ecosystems. Our study provides evidence that temperature can significantly affect temporal partitioning within a carnivore guild by generating asymmetrical behavioural responses amongst functionally similar species.

Positive and negative impacts of flue gas desulfurization (FGD) gypsum on water quality.

Flue gas desulfurization (FGD) gypsum, a by-product of carbon-based energy sources, has typically been incorporated as a component of concrete mixes and wallboard and beneficially used as an agricultural amendment to enhance terrestrial crop production and improve the quality of runoff. These various uses for the by-product aid in reducing the amount that is ultimately landfilled. Limited studies have investigated its benefits when used directly in aquatic settings, such as ponds and lakes, to increase hardness and potentially mitigate eutrophication. A 36-day field mesocosm experiment tested a larger range of FGD gypsum concentrations (500-2000 mg/L) than those previously tested in the literature to investigate its desired and potentially undesired impacts on water quality, including the algal community. High FGD gypsum concentrations, 1000 and 2000 mg/L, were found to have more undesired impacts than the 500 mg/L treatment, including an initial spike in cyanobacteria, a decrease in total zooplankton abundance, and an increase in certain trace metals in the highest treatment. Ultimately, the 500 mg/L FGD gypsum treatment was found to have fewer undesired impacts while still resulting in significant desired effects, including those on hardness and pH, as well as moderate reductions in algal abundance. This experiment provides a better understanding of the effects of FGD gypsum when directly used in an aquatic setting, determines an optimal dose for future field experiments, and helps provide the groundwork for developing an upper threshold on FGD gypsum so as to not have the negative effects outweigh the positive.

Long-term missing role of small colloids and nanoparticles on the loading and speciation of phosphorus in catfish aquaculture ponds in west Alabama.

Increasing loading of phosphorus (P) into freshwater systems is deemed as one of the key drivers triggering harmful algal blooms (HABs). However, conventional water quality monitoring of P normally uses the operational cutoff (e.g., 450-nm filter membrane) to separate particulate and dissolved phases (entities passing through the 450-nm membrane are regarded as dissolved phase), which completely neglects the roles of small colloids (450-100 nm) and nanoparticles (100-1 nm). Herein, a new particle size separation approach was used to separate water samples collected from catfish aquaculture ponds in west Alabama into six size fractions: large particles (>1000 nm), large colloids (1000-450 nm), small colloids (450-100 nm), large nanoparticles (100-50 nm), small nanoparticles (50-1 nm), and the truly dissolved phase (<1 nm). The speciation and concentration of P in these six size fractions were then investigated using Hedley's sequential extraction method. The new particle size separation results showed that particle loading (mass) followed the order: >1000 nm, 450-100 nm, 1000-450 nm, 100-50 nm, and 50-1 nm. This is mainly due to the abundance of large-sized (>1000 nm) zooplankton and phytoplankton such as algae and cyanobacteria in the catfish aquaculture ponds. Importantly, the small colloid (450-100 nm) and nanoparticle (100-1 nm) size fractions, which were previously regarded as the dissolved phase using the 450-nm membrane filtration operation, accounted for ∼41.8% of the total particle mass. The Hedley's sequential extraction results showed that sodium hydroxide (NaOH)-extracted P represented the largest P pool, followed by water (H2O)- and sodium bicarbonate (NaHCO3)-extracted P pools. Smaller particles exhibited a higher loading of P due to their large surface areas. These new findings suggest that the new particle size separation approach needs to be adopted for future water quality monitoring and mitigation of HABs in freshwater ecosystems.

Most treatments to control freshwater algal blooms are not effective: Meta-analysis of field experiments.

Harmful algal blooms negatively impact freshwater, estuarine, and marine systems worldwide, including those used for drinking water, recreation, and aquaculture, through the production of toxic and nontoxic secondary metabolites as well as hypoxic events that occur when algal blooms degrade. Consequently, water resource managers often utilize chemical, bacterial, physical, and/or plant-based treatments to control algal blooms and improve water quality. However, awareness of available treatments may be limited, and there is ambiguity among the effects of algal bloom treatments across studies. Such variation within the literature and lack of knowledge of other tested treatments leave uncertainty for water resource managers when deciding what treatments are best to control algal blooms and improve water quality. Our primary objective was to synthesize data from 39 published and unpublished studies that used one of 28 chemical, bacterial, physical, and/or plant-based treatments in field experiments on various water quality measurements, including phytoplankton pigments and cell density, cyanobacterial toxins (microcystin), and common off-flavors (i.e., taste and odor compounds; geosmin and 2-methylisoborneol). We hypothesized that treatments would improve water quality. Across all studies and treatment types (227 effect sizes), water quality improvements were observed when measured at the time of greatest decline following treatment or at the end of the experiment. However, these findings were primarily mediated by only four chemicals, namely copper sulfate, hydrogen peroxide, peracetic acid, and simazine. None of the bacterial, physical, or plant-based treatments were shown to significantly improve water quality by themselves. Results from this synthesis quantitatively showed that most treatments fail to improve water quality in the field and highlight the need for more research on existing and alternative treatments.

The Microbiome as a Maternal Effect: A Systematic Review on Vertical Transmission of Microbiota.

The microbiome is an interactive and fluctuating community of microbes that colonize and develop across surfaces, including those associated with organismal hosts. A growing number of studies exploring how microbiomes vary in ecologically relevant contexts have recognized the importance of microbiomes in affecting organismal evolution. Thus, identifying the source and mechanism for microbial colonization in a host will provide insight into adaptation and other evolutionary processes. Vertical transmission of microbiota is hypothesized to be a source of variation in offspring phenotypes with important ecological and evolutionary implications. However, the life-history traits that govern vertical transmission are largely unexplored in the ecological literature. To increase research attention to this knowledge gap, we conducted a systematic review to address the following questions: (1) How often is vertical transmission assessed as a contributor to offspring microbiome colonization and development? (2) Do studies have the capacity to address how maternal transmission of microbes affects the offspring phenotype? (3) How do studies vary based on taxonomy and life history of the study organism, as well as the experimental, molecular, and statistical methods employed? Extensive literature searches reveal that many studies examining vertical transmission of microbiomes fail to collect whole microbiome samples from both maternal and offspring sources, particularly for oviparous vertebrates. Additionally, studies should sample functional diversity of microbes to provide a better understanding of mechanisms that influence host phenotypes rather than solely taxonomic variation. An ideal microbiome study incorporates host factors, microbe-microbe interactions, and environmental factors. As evolutionary biologists continue to merge microbiome science and ecology, examining vertical transmission of microbes across taxa can provide inferences on causal links between microbiome variation and phenotypic evolution.

Increasing Quality and Frequency of Goals-of-Care Documentation in the Highest-Risk Surgical Candidates: One-Year Results of the Surgical Pause Program.

Patient values may be obscured when decisions are made under the circumstances of constrained time and limited counseling. The objective of this study was to determine if a multidisciplinary review aimed at ensuring goal-concordant treatment and perioperative risk assessment in high-risk orthopaedic trauma patients would increase the quality and frequency of goals-of-care documentation without increasing the rate of adverse events. Methods: We prospectively analyzed a longitudinal cohort of adult patients treated for traumatic orthopaedic injuries that were neither life- nor limb-threatening between January 1, 2020, and July 1, 2021. A rapid multidisciplinary review termed a "surgical pause" (SP) was available to those who were ≥80 years old, were nonambulatory or had minimal ambulation at baseline, and/or resided in a skilled nursing facility, as well as upon clinician request. Metrics analyzed include the proportion and quality of goals-of-care documentation, rate of return to the hospital, complications, length of stay, and mortality. Statistical analysis utilized the Kruskal-Wallis rank and Wilcoxon rank-sum tests for continuous variables and the likelihood-ratio chi-square test for categorical variables. Results: A total of 133 patients were either eligible for the SP or referred by a clinician. Compared with SP-eligible patients who did not undergo an SP, patients who underwent an SP more frequently had goals-of-care notes identified (92.4% versus 75.0%, p = 0.014) and recorded in the appropriate location (71.2% versus 27.5%, p < 0.001), and the notes were more often of high quality (77.3% versus 45.0%, p < 0.001). Mortality rates were nominally higher among SP patients, but these differences were not significant (10.6% versus 5.0%, 5.1% versus 0.0%, and 14.3% versus 7.9% for in-hospital, 30-day, and 90-day mortality, respectively; p > 0.08 for all). Conclusions: The pilot program indicated that an SP is a feasible and effective means of increasing the quality and frequency of goals-of-care documentation in high-risk operative candidates whose traumatic orthopaedic injuries are neither life- nor limb-threatening. This multidisciplinary program aims for goal-concordant treatment plans that minimize modifiable perioperative risks. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Sorptive removal of phosphorus by flue gas desulfurization gypsum in batch and column systems.

Phosphorus (P) over-loading is often a central topic due to its linkage to harmful algal blooms (HABs) and its importance in wastewater treatment that has fueled immediate remediation attempts to reduce P loading from point (e.g., wastewater) and nonpoint sources (e.g., fertilizers). Conventional remediation techniques (e.g., filtration) are often expensive, ineffective, and difficult to implement at large scales. The flue gas desulfurization (FGD) gypsum produced as an energy plant waste byproduct has recently been advocated as a physiochemical remediation strategy for P through sorptive removal. However, limited research is available on the practical applications of FGD gypsum for P removal from water. Herein, batch sorption experiments were performed to investigate the sorptive removal efficiency of P by FGD gypsum under environmentally relevant P concentrations (0.01-0.25 mM). In parallel, fixed-bed column experiments packed with FGD gypsum were performed using elevated P concentrations (0.1-1.0 mM) to understand the scalability of FGD gypsum for large-scale practical applications. During batch experiments, P sorption equilibrium was reached within 24 h that includes an initially fast step (via boundary layer diffusion), followed by a slow rate-determining step (via intraparticle diffusion). P sorption kinetics followed the pseudo second-order kinetics, indicating chemisorption. P sorption at equilibrium can be simulated by both the Freundlich and Langmuir sorption isotherms. The Langmuir sorption isotherm yielded a maximum sorption capacity (Qmax) of 36.1 mM kg-1. The fixed-bed column experimental results showed that sorption rate depends on the applied flow rate, irrespective of the tested P concentrations. Our findings can be extrapolated to evaluate the feasibility and scalability of FGD gypsum in removing P to counteract P runoff and mitigate HABs and P-loaded wastewater.