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Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data—in conjunction with the recent American Society of Anesthesiologists guidelines—offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon’s preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient’s fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients’ CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.

Abstract Tension pneumomediastinum is a rare complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection that has increased in incidence with the novel coronavirus disease 2019 pandemic. Although traditionally managed with conservative measures, we present the indications and methods for the first operative management of tension pneumomediastinum with concomitant SARS‐CoV‐2 infection.

OBJECTIVES:. Extracorporeal membrane oxygenator support is a powerful clinical tool that is currently enjoying a resurgence in popularity. Wider use of extracorporeal membrane oxygenator support is limited by its significant risk profile and extreme consumption of resources. This study examines the role of markers of liver dysfunction in predicting outcomes of adult patients requiring extracorporeal membrane oxygenator support. DESIGN:. Retrospective review. SETTING:. Large extracorporeal membrane oxygenator center, Chicago, IL. PATIENTS:. This study reports a single institution experience examining all adult patients for whom extracorporeal membrane oxygenator support was used over an 8-year period. Data were collected regarding patient demographics, details of extracorporeal membrane oxygenator support provided, laboratory data, and outcomes. Trends in liver function were examined for their ability to predict survival. INTERVENTION:. Extracorporeal membrane oxygenator support, critical care. MEASUREMENTS AND MAIN RESULTS:. Mean age was 50 years (range, 19–82 yr). There were 86 male patients (56.6%) and 66 female patients (43.4%). Indications for initiation of extracorporeal membrane oxygenator support included cardiac 76 patients (50.0%), respiratory 48 patients (31.6%), extracorporeal cardiopulmonary resuscitation 21 patients (13.3%), and combined cardiac/respiratory seven patients (4.6%). Mean duration of extracorporeal membrane oxygenator support was 17 days (range 1–223 d) or median 8 days (interquartile range, 4–17 d). Overall, in-hospital mortality was 56% (86/152). Forty-five percent of adult patients (68/152) surpassed at least one of the following established liver dysfunction thresholds: total bilirubin greater than 15 mg/dL, aspartate aminotransferase greater than 20× upper limit of normal, and alanine aminotransferase greater than 20× upper limit of normal. The multivariable logistic analysis yielded three significant findings associated with in-hospital mortality: highest total bilirubin greater than 15 (adjusted odds ratio = 4.40; 95% CI, 1.19–21.87; p = 0.04), age (adjusted odds ratio = 1.03; 95% CI, 1.00–1.05; p = 0.04), and highest lactate (adjusted odds ratio = 1.15; 95% CI, 1.06–1.26; p = 0.002). CONCLUSIONS:. Increases in age, highest total bilirubin, and lactate all correlated with in-hospital mortality in multivariable analysis of patients requiring extracorporeal membrane oxygenator support.

Este texto responde a la apertura de un debate en torno a la figura del espectador y los contex¬tos político-sociales en los que se fragua el modo en que lo entendemos y nos entendemos; un debate1 que ha generado tanto un proceso de pensar junt*s (diversos investigador*s de diversas áreas de conocimiento) como de pensar la forma de pensar y de presenciarnos, es¬cucharnos, entender y entendernos; es decir, que ha generado un proceso de co-creación de sentido que se concreta, más allá del objeto-texto, en la emergencia de un grupo de trabajo, en un proceso de vida que es el hacer y el hacerse de un encuentro y una experiencia colectiva que deviene experiencia común. En este sentido, es un texto performativo y político, abierto a seguir co-creándose al exponerse aquí hoy.

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Abstract Background The aim of the study was to have youth participate in the design and implementation of a research project set within a child rights framework to better understand high schoolers’ perceptions of safety in their school and community. Results Between June 2020 and March 2021, a team of East Harlem, New York high school students, participated as co-researchers to modify the United Nations Children's Fund Child Friendly Cities Initiative Survey to suit their needs. Due to the COVID-19 pandemic, the final survey was conducted through an online remote classes system during advisory school classes, accompanied by brief focused group discussions. The novel process of conducting an interactive qualitative and quantitative virtual survey during a pandemic via youth participatory action research is outlined in this paper. Conclusions Our results demonstrate that youth participatory action research can be utilized as part of a child rights framework approach to assess the views of youth regarding community safety and violence prevention.

The Maasai Mara and the wider Mau River Basin in East Africa provide fundamental ecosystem services that support people, wildlife, livestock and agriculture. The historical indigenous land use of the Mara and wider Mau basin was wildlife conservation and pastoralism with highland agriculture. However, land policy changes, the rise of community conservancies and the increase in human populations have mediated unprecedented land use shifts over time. We analyze land use and land cover change (LULCC) trends from 1990 to 2040 in the Mara and the wider Mau River Basin landscape. The study examines land use and land cover change trends, establishes factors driving the trends, and assesses the implications of these trends on biodiversity. Multi-temporal satellite images, together with physical and social economic data, were collated to generate future scenarios for transitions for forest, shrubland, grassland, cropland, wetlands and built-up areas between 1990 and 2040. Agricultural expansion is the chief driver of LULCC in the Mara and the wider Mau River Basin, particularly since 2015. There was insignificant change to the forest cover after 2015, which was in part due to government intervention on forest encroachment and boundaries. The anthropogenic choice of tilling the land in the basin caused a decline in grasslands, forests and expanded shrublands, particularly where there was clear tree cutting in the Mau forest. Land use and land cover trends have generated undesirable impacts on ecosystem services that support wildlife conservation.

Abstract Background The USA has failed to codify the protection of children from gun violence (GV) as a human right. This study employs a youth participatory action research methodology, within the framework of the United Nations Convention on the Rights of the Child (UNCRC), to investigate the relationships between GV exposure, self-identified gender and perceptions of children’s rights and safety. Methods An anonymous survey based on UNICEF USA’s Child Friendly Cities Initiative interactive survey tool targeting adolescents was modified by East Harlem, New York high school student co-researchers in collaboration with near-peer graduate students. The 61-question survey was administered at an East Harlem high school. Analysis consisted of univariate, bivariate and logistic regression using SPSS®. Results A total of 153 students completed the survey: 48.4% self-identified as male and 45.8% as female. Thirty-five percent reported witnessing GV. Most (79.1%) were aware of child rights regardless of gender or GV exposure but there were differences in perceptions of safety. Fifteen percent of females reported never feeling safe at school compared to 3% of males (p = 0.01). Females were 2.2 times as likely as males to report transportation waiting areas as never safe (p = 0.008). Almost a third of females reported never feeling safe from sexual harassment in public, compared to 10% of males (p = 0.004). In multivariable logistic regression adjusted for gender, race/ethnicity and grade level, students who witnessed GV were 4.6 times more likely to report never feeling safe from violence (95% CI 1.7–12.4). Thirty percent of students who witnessed GV reported not attending school because of safety concerns. Students who witnessed GV had 2.2 times the odds of carrying a weapon to school (95% CI 1.1–4.5). These patterns continued for other perceptions of safety. Conclusions The students in this study affirmed their rights to participate and express their views on matters that may affect them, as articulated in the UNCRC. The study revealed differences in perceptions of safety by self-identified gender and identified gun violence as a major contributor of youth’s perception of lack of safety. The study evinces the efficacy of employing YPAR methodology to identify and answer youth concerns of community safety and prioritize honoring child rights.

Development corridors are linear programmes of infrastructure and agriculture aiming to facilitate rapid socio-economic development. In Africa, they are a major development activity, with 88 underway or planned corridors. Drawing from extensive literature and insights gleaned from a 4 year research programme, this review scrutinizes the impacts of development corridors on people, wildlife and ecosystems in Kenya and Tanzania, proposing solutions to achieve better outcomes. The overarching goal was to discern the principle challenges emerging from the practical execution of the prevailing corridor model. The holistic approach taken, assessing the development corridors paradigm through an integrated ecological, social, and economic lens, provides novel insights that have not been possible using more traditional—siloed—research approaches. Eight key challenge areas are identified: impact assessments processes; coherence across international, national and local planning; governance; inclusivity; equality; impacts on biodiversity and ecosystem services; incorporation of future climate risks; and integrated water resource management. Poorly planned and implemented corridors detrimentally impact livelihoods and ecosystems. They lack a sustainable development vision, detailed social, environmental or climate risk assessments, and develop incrementally in policy and corporate spaces. There is also often a disconnect between investors and recipient governments, with some investors funding what governments request without applying internationally-recognised safeguards, and governments lacking capacity and resources to enforce regulations. We make recommendations for addressing these challenge areas. These aim to enhance impact assessment efficacy; integrate local perspectives into effective and inclusive corridor planning; overcome siloed project development and implementation; anticipate future development projections; and prioritise landscape preservation for enhanced ecosystem services and climate resilience.

Sub-Saharan Africa is facing an expected doubling of human population and tripling of food demand over the next quarter century, posing a range of severe environmental, political, and socio-economic challenges. In some cases, key Sustainable Development Goals (SDGs) are in direct conflict, raising difficult policy and funding decisions, particularly in relation to trade-offs between food production, social inequality, and ecosystem health. In this study, we used a horizon-scanning approach to identify 100 practical or research-focused questions that, if answered, would have the greatest positive impact on addressing these trade-offs and ensuring future productivity and resilience of food-production systems across sub-Saharan Africa. Through direct canvassing of opinions, we obtained 1339 questions from 331 experts based in 55 countries. We then used online voting and participatory workshops to produce a final list of 100 questions divided into 12 thematic sections spanning topics from gender inequality to technological adoption and climate change. Using data on the background of respondents, we show that perspectives and priorities can vary, but they are largely consistent across different professional and geographical contexts. We hope these questions provide a template for establishing new research directions and prioritising funding decisions in sub-Saharan Africa.

Attempts to structurally transform segments of the agri-food system inevitably involve trade-offs between the priorities of actors with different incentives, perspectives and values. Trade-offs are context-specific, reflecting different socio-economic and political realities. We investigate the potential of structured boundary objects to facilitate exposing and reconciling these trade-offs within the context of multi-stakeholder social learning processes with pastoral and mixed crop-livestock communities in Burkina Faso, Ethiopia and Tanzania. Building on boundary objects as items flexible enough to be understood by all without having one common definition, structured boundary objects visualize actors’ input in a comparable format to facilitate knowledge sharing. Stakeholders in each country used a simulation tool and board game to explore the implications of changing livestock stocking and management practices for the environment and for actors’ future socio-economic priorities. Using structured boundary objects elicited trade-offs between household food and animal feed, and between livestock for income, labour, and/ or cultural functions, reflecting the context-specific and subjective evaluations actors make when attempting to plan livelihood changes. Our findings suggest to policy and decision-makers that sustainable transition plans can be developed when stakeholders in local agri-food systems employ approaches that allow shared understandings of trade-offs inherent to sustainable agriculture to emerge.

Societal Impact Statement Large areas of tropical forest are degraded. While global tree cover is being mapped with increasing accuracy from space, much less is known about the quality of that tree cover. Here we present a field protocol for rapid assessments of forest condition. Using extensive field data from Tanzania, we show that a focus on remotely‐sensed deforestation would not detect significant reductions in forest quality. Radar‐based remote sensing of degradation had good agreement with the ground data, but the ground surveys provided more insights into the nature and drivers of degradation. We recommend the combined use of rapid field assessments and remote sensing to provide an early warning, and to allow timely and appropriately targeted conservation and policy responses. Summary Tropical forest degradation is widely recognised as a driver of biodiversity loss and a major source of carbon emissions. However, in contrast to deforestation, more gradual changes from degradation are challenging to detect, quantify and monitor. Here, we present a field protocol for rapid, area‐standardised quantifications of forest condition, which can also be implemented by non‐specialists. Using the example of threatened high‐biodiversity forests in Tanzania, we analyse and predict degradation based on this method. We also compare the field data to optical and radar remote‐sensing datasets, thereby conducting a large‐scale, independent test of the ability of these products to map degradation in East Africa from space. Our field data consist of 551 ‘degradation’ transects collected between 1996 and 2010, covering >600 ha across 86 forests in the Eastern Arc Mountains and coastal forests. Degradation was widespread, with over one‐third of the study forests—mostly protected areas—having more than 10% of their trees cut. Commonly used optical remote‐sensing maps of complete tree cover loss only detected severe impacts (≥25% of trees cut), that is, a focus on remotely‐sensed deforestation would have significantly underestimated carbon emissions and declines in forest quality. Radar‐based maps detected even low impacts (

Abstract Background Mangrove forests have gained recognition for their potential role in climate change mitigation due to carbon sequestration in live trees, and carbon storage in the sediments trapped by mangrove tree roots and pneumatophores. Africa hosts about 19% of the world’s mangroves, yet relatively few studies have examined the carbon stocks of African mangroves. The available studies report considerable differences among sites and amongst the different pools of carbon stocks. None considered the effects of seaward distance. We present details of AGC and SOC carbon stocks for Lindi in Tanzania, and focus on how these values differ with increasing seaward distance and, how our results compare to those reported elsewhere across Africa. Results AGC ranged between 11 and 55 Mg C ha−1, but was not significantly affected by seaward distance. SOC for 0–1 m depth ranged from 154 to 484, with a mean of 302 Mg C ha−1. SOC was significantly negatively correlated with seaward distance. Mangrove type (estuarine/oceanic), soil erosion, soil depth may explain these differences We note important methodological differences in previous studies on carbon stocks in mangroves in Africa. Conclusion This study indicates that seaward distance has an important effect on SOC stocks in the Lindi region of Tanzania. SOC should be fully incorporated into national climate change mitigation policies. Studies should report seaward distance and to describe the type of mangrove stand to make results easily comparable across sites and to assess the true value of Blue Carbon in Africa. We recommend focusing on trees > 10 cm diameter for AGC, and sampling soils to at least 1 m depth for SOC, which would provide a more complete assessment of the potentially considerable mangrove carbon store.

Globally, over 85% of oyster reefs have been lost, and the combined effects of climate change, ocean acidification, and environmental degradation, including pollution and mangrove overharvesting, could further reduce global oyster fisheries in the coming decades. To understand the level of impact of climate change on the oyster fishery in West Africa, an expert-based vulnerability assessment to climate change was conducted for the West African mangrove oyster (Crassostrea tulipa, Lamarck 1819). Using a combination of the exposure of the oyster to climatic stressors (estuarine temperature, salinity, river flow, surface run-off, sea level rise, and estuarine circulation) together with an assessment of sensitivity to these stressors, we estimate the overall vulnerability of C. tulipa to climate change. A very high overall climate vulnerability score of 12 on a scale of 16 was calculated for C. tulipa. While the overall climate exposure score in the West African coastal region remained high, the high sensitivity of C. tulipa to hydrographic conditions of its habitat, in particular salinity, coupled with its sessile and habitat-specific nature, pushed the overall vulnerability to very high. Early life history settlement requirements, adult mobility, and sensitivity to salinity were the three most important biological and sensitivity attributes that determined the vulnerability score. By leaving each of these three sensitivity attributes out of the analysis, the overall vulnerability score was reduced to 9 (i.e., from very high to high). A negative directional effect of climate change, coupled with a low potential for change in distribution, threatens the C. tulipa fishery in a long-term adverse climate scenario. We recommend management efforts that incorporate climate resilience and adaptation practices to prioritize recruitment success, as well as the development of breeding lines with climate-resilient traits.

Mountainous regions are globally important, in part because they support large populations and are biodiverse. They are also characterized by enhanced vulnerability to anthropogenic pressures and sensitivity to climate change. This importance necessitates the development of a global reference network of long-term environmental and socioeconomic monitoring—mountain observatories. At present, monitoring is limited and unevenly distributed across mountain regions globally. Existing thematic networks do not fully support the generation of multidisciplinary knowledge required to inform decisions, enact drivers of sustainable development, and safeguard against losses. In this paper, the Mountain Observatories Working Group, established by the Mountain Research Initiative (MRI) Science Leadership Council, identifies geographical and thematic gaps as well as recent advances in monitoring of relevant biophysical and socioeconomic variables in the mountains. We propose principles and ways of connecting existing initiatives, supporting emerging areas, and developing new mountain observatory networks regionally and, eventually, globally. Particularly in the data-poor regions, we aspire to build a community of researchers and practitioners in collaboration with the Global Network on Observations and Information in Mountain Environments, Group on Earth Observations (GEO) Mountains, a GEO Work Programme Initiative.

Transportation infrastructure, such as railways, roads and power lines, contribute to national and regional economic, social and cultural growth and integration. Kenya, with support from the Chinese government, is currently constructing a standard gauge railway (SGR) to support the country's Vision 2030 development agenda. Although the actual land area affected by the SGR covers only a small proportion along the SGR corridor, a significant proportion of the area supports a wide range of ecologically fragile and important ecosystems in the country, with potential wider impacts. This study used a qualitative content analysis approach to gain an understanding and perceptions of stakeholders on the potential ecological impacts of the interactions between the SGR and the traversed ecological systems in Kenya. Three dominant themes emerged: 1) ecosystem degradation; 2) ecosystem fragmentation; and 3) ecosystem destruction. Ecosystem degradation was the most commonly cited impact at while ecosystem destruction was of the least concern and largely restricted to the physical SGR construction whereas the degradation and fragmentation have a much wider footprint. The construction and operation of the SGR degraded, fragmented and destroyed key ecosystems in the country including water towers, protected areas, community conservancies and wildlife dispersal areas. Therefore, we recommend that project proponents develop sustainable and ecologically sensitive measures to mitigate the key ecosystem impacts.

The Mountain Research Initiative (MRI) promotes basic and applied research to understand how drivers and processes of global change present challenges and opportunities in mountain social-ecological systems. It convenes a global network that collectively generates and synthesizes knowledge on global change in mountains that also supports decisions and actions to enable sustainable development. Building on the considerable social and intellectual wealth fostered by the MRI over its past 20-plus years of existence, we outline future directions aimed at supporting and further developing the network as well as our flagship and community-led activities aimed at linking and scaling interdisciplinary and transdisciplinary research efforts within and across mountain regions worldwide.

Lianas are woody vines, rooted in the soil, and supported physically by trees. Lianas contribute to forest ecosystem functioning globally, but especially in the tropics and subtropics. However, prolific liana growth following heavy disturbance frequently affects subsequent recovery of forest tree diversity, biomass, structure, and function. Understanding this forest liana dynamic, and its sensitivity to climate and anthropogenic forces, is essential for worldwide forest restoration and climate change mitigation. Here, we synthesise the evidence for both positive and negative effects of lianas on forests and propose a framework that outlines the expected global response of forests to disturbance-induced liana proliferation. Emerging evidence suggests that lianas play a major role in both facilitating and delaying forest recovery following disturbance. At low levels of disturbance and/or where environmental conditions favour tree growth, lianas can facilitate forest recovery by protecting trees from extreme weather, fire, weed invasion and herbivory. However, under conditions where lianas proliferate beyond critical thresholds, positive feedbacks are expected to induce and sustain liana-dominated forest states that can endure for decades or even longer. We conceptualise alternative classes of forest recovery response to disturbance and describe measurement and modelling of liana thresholds. We identify four essential challenges for global change science relating to lianas: (1) incorporation of lianas and sapling stems into forest monitoring and tree stand measurements worldwide; (2) long-term experiments to determine variation in liana-tree competition, and potential drivers across forest successional gradients; (3) identification and prediction of liana thresholds and other alternative forest recovery response classes; and (4) dynamic mechanistic modelling of forest recovery to determine regional and global variation within and among different recovery response classes, in relation to variation in potential drivers, liana feedbacks and their interactions. Addressing these challenges will determine the importance of lianas in shaping regional and global forest composition, recovery and dynamics.

A detailed analysis of distribution shifts in Pinus hartwegii Lindl. is provided across time for Izta-Popo National Park (México). Combining satellite images, species distribution models, and connectivity analysis we disentangled the effect of climate change and anthropogenic land use on the habitat availability. Twenty-four Maxent habitat suitability models with varying complexity were combined with insights on vegetation and land cover change derived from two Landsat satellite images at 30-m resolution from 1993 and 2013. To evaluate effects of climate change on Izta-Popo’s P. hartwegii forest, projections for future climatic conditions (averaged for 2050 and 2070) were derived using two General Circulation Models under three Representative CO2 concentration pathways (RCPs). Calculated fragmentation and connectivity indexes (Equivalent Connected Area and Probability of Connectivity metrics) showed significant habitat loss and habitat fragmentation that weakens P. hartwegii dispersion flux and the strength of connections. Projections of future climate conditions showed a reduction of P. hartwegii habitat suitability as populations would have to migrate to higher altitudes. However, the impact of anthropogenic land use change documented over the 20 years masks the predicted impact of climate change in Izta-Popo National Park.

Production processes are nowadays increasingly global, implying interdependent structures linking goods, processes and countries. Traditional economic blocks and sectoral intra-country linkages coexist with increasing worldwide dependencies. Recent literature supports the hypothesis of a new globalization process taking place in the late 1990s and the 21st century, centred on the consolidation of increasingly competitive macro-regions at a global level, with a growing specialization of countries within them. We propose a multiregional input-output (MRIO) model of the European Union (EU) to analyse whether the generation of employment and income in Europe in recent decades can be defined as a process that is mainly regional or global (involving countries within the region versus countries outside Europe). Our results show that intra-EU trade is an important factor contributing to income and employment growth, more oriented to intermediate inputs in the same way as extra-EU trade, despite the fact that some European countries are more specialized in final goods, mainly driven by high-income EU countries.

Archaeologists are under pressure to demonstrate that their work has impact beyond the discipline. This has prompted some archaeologists — and in particular environmental archaeologists and palaeoecologists — to argue that an understanding of past environmental changes is essential to model future outcomes in areas such as climate change, land cover change, soil health and food security. However, few archaeological studies have explored how to put research results into practice, and most archaeologists seem unaware of a substantial literature on research-led policy design produced primarily within the social sciences and development studies. We briefly summarise this literature, report on our attempts to engage directly with policy makers and NGOs working on sustainable agriculture, and ultimately recommend that future projects should be co-designed with potential end-users from the outset.