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The Gulf of Carpentaria and Torres Strait in north‐eastern Australia support globally significant seagrass ecosystems that underpin fishing and cultural heritage of the region. Reliable data on seagrass distribution are critical to understanding how these ecosystems are changing, while managing for resilience. Spatial data on seagrass have been collected since the early 1980s, but the early data were poorly curated. Some was not publicly available, and some already lost. We validated and synthesized historical seagrass spatial data to create a publicly available database. We include a site layer of 48,612 geolocated data points including information on seagrass presence/absence, sediment, collection date, and data custodian. We include a polygon layer with 641 individual seagrass meadows. Thirteen seagrass species are identified in depths ranging from intertidal to 38 m below mean sea level. Our synthesis includes scientific survey data from 1983 to 2022 and provides an important evidence base for marine resource management. [ABSTRACT FROM AUTHOR]

The study of minor planets is motivated both by fundamental science of Solar system origins (some of these bodies contain the most pristine materials from the early ages of the planetary nebula) and by practical reasons concerning space exploration and impact frequency with Earth. Among minor bodies, near-Earth asteroids are a particularly important group: these objects are nearby the Earth's orbit and they represent both resources and hazards to humans. This is the case of 2014 JO25. The encounter of this potentially hazardous asteroid with the Earth at 0.011 75 au on 2017 April 19 was a good opportunity to study its properties through photometric and spectral analyses. The work we present here has been carried out thanks to a worldwide observational campaign that included time-series photometry and spectroscopy in the visible and near-infrared wavelengths. The optical images for photometric analysis were collected at different phase angles using small telescopes (<0.5 m) and medium telescopes (from 0.6 to 1.5 m). Spectral analysis was performed by 2–4 m telescopes. The light curve of 2014 JO25 indicates a synodic rotational period of 4.5286 ± 0.0004 h. Although rotational period had been previously obtained by other authors, this work confirms it with a better accuracy. The obtained reflectance spectrum of this asteroid indicates that it belongs to the S-complex and its surface is most likely composed of a mixture of pyroxenes and olivine. From the comparison of its spectrum to those of meteorite samples, as well as from the wavelength position of the first absorption band (close to 0.9 |$\mu$| m), we suggest that this asteroid might contain a large fraction of low-calcium pyroxene and, tentatively, some amounts of metal. [ABSTRACT FROM AUTHOR]

It has long been recognized that superior carnivores can impact on the demography and ecology of smaller members of the guild, although exact mechanisms remain unclear. Here we use original data from a unique natural experiment to study some of the mechanisms by which African lions Panthera leo impact on African wild dogs Lycaon pictus. Using a study site where wild dogs outnumbered lions for several years prior to lion population recovery, we aimed to investigate whether or not, and by which means, wild dog populations are regulated and influenced by lions. We used 38 pack-years of demographic and behavioural data across two 4-year periods where lion density differed 20-fold (pre-lion era: 1996-1999 and lion era: 2010-2013) to assess how lions may affect wild dog pack size and age structure, litter size and pup survival ( n = 329 pups), as well as den site selection ( n = 46 dens). Pack size was significantly greater during the pre-lion era. The pup to adult ratio was lower during the lion era and the change in pack composition was directly attributable to significantly greater lion-induced pup mortality. We also demonstrate a behavioural shift, with locations selected for the vulnerable denning period being in more rugged terrain and in areas with lower prey densities during the lion era, as compared with the pre-lion era. Lower adult recruitment into a population of an obligate cooperative breeder like the African wild dog can have complex consequences, including on feeding and defence of young, and mate finding. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether the Relative Age Effect (RAE) was present in different sexes and age categories in 12 elite-level international amateur boxing competitions. A total of 4813 athletes competing between 2013 and 2022 were analysed. Athletes were split into four quartiles according to their birth date and compared to the expected (equal) birth date distribution using chi-squared goodness of fit. The results revealed greater RAE prevalence in youth compared to the senior group. RAE was more prominent in males compared to females, with the female group showing an inverse RAE trend. Odds ratio (OR) showed an overrepresentation of male boxers born in Q1 compared to Q4 (OR > 1.19-1.33), while senior female boxers presented an inverse trend (OR < 0.95). Odds Ratios for medallists within the youth group were greater than 1.07 (except Q3 × Q4 = 0.93) highlighting an overrepresentation of boxers born earlier in the year. A shift in strategy to reduce the RAE in young boxers whereby coaches focus less on the short-term pursuit of sporting success is encouraged. Organisations and coaches should increase awareness and provide systematic education around RAE, whilst creating equal competitive opportunities for all young boxers to reduce the extent of RAE in boxing.

Acute respiratory failure (ARF) strikes an estimated two million people in the United States each year, with care exceeding US$50 billion. The hallmark of ARF is a heterogeneous injury, with normal tissue intermingled with a large volume of low compliance and collapsed tissue. Mechanical ventilation is necessary to oxygenate and ventilate patients with ARF, but if set inappropriately, it can cause an unintended ventilator-induced lung injury (VILI). The mechanism of VILI is believed to be overdistension of the remaining normal tissue known as the 'baby' lung, causing volutrauma, repetitive collapse and reopening of lung tissue with each breath, causing atelectrauma, and inflammation secondary to this mechanical damage, causing biotrauma. To avoid VILI, extracorporeal membrane oxygenation (ECMO) can temporally replace the pulmonary function of gas exchange without requiring high tidal volumes (V T ) or airway pressures. In theory, the lower V T and airway pressure will minimize all three VILI mechanisms, allowing the lung to 'rest' and heal in the collapsed state. The optimal method of mechanical ventilation for the patient on ECMO is unknown. The ARDSNetwork Acute Respiratory Management Approach (ARMA) is a Rest Lung Approach (RLA) that attempts to reduce the excessive stress and strain on the remaining normal lung tissue and buys time for the lung to heal in the collapsed state. Theoretically, excessive tissue stress and strain can also be avoided if the lung is fully open, as long as the alveolar re-collapse is prevented during expiration, an approach known as the Open Lung Approach (OLA). A third lung-protective strategy is the Stabilize Lung Approach (SLA), in which the lung is initially stabilized and gradually reopened over time. This review will analyze the physiologic efficacy and pathophysiologic potential of the above lung-protective approaches., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a major bacterial pathogen., Aim: The present study aimed to determine the incidence of MRSA infections among kidney dialysis patients and the antibiotic susceptibility patterns and investigate the prevalence of mecA gene among MRSA isolates., Materials and Methods: A total of 83 nasal sterile cotton swabs samples were obtained from hemodialysis patients from Al-Karak Governmental Hospital, Al-Karak, Jordan. Collected and cultured on nutrient agar and mannitol salt agar and incubating at 37°C for 24-48 hours, Staphylococcus aureus ( S. aureus ) strains were identified by gram stain, coagulase test, and catalase tests. The MRSA isolates were tested for the presence of MecA and SCCmec genes using the Xpert SA Nasal Complete assay real-time PCR. Factors such as age and gender were included in the study. The antibiotic profile tested by using the disc diffusion method tested all MRSA isolates., Results: This study showed that 10.8% of the cultures' growth was S. aureus and 9.6% of all the patients were infected with MRSA, with no relationship between the number and frequency of MRSA according to the patient's gender or age. All MRSA (100%) isolates have both genes (MecA genes and SCCmec genes), and all samples were resistant to oxacillin, ceftazidime, cefoxitin, aztreonam, and ampicillin., Conclusion: The MRSA prevalence was determined among kidney dialysis patients in the hospital. All positive samples were resistant to oxacillin, ceftazidime, cefoxitin, aztreonam, and ampicillin, which is a very rare finding, and this will give the scientists and doctors a dangerous indication about health-care centers in the Al-Karak city of Jordan., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2023 Omar Al-Dmour et al.)

The conduct of cardiopulmonary bypass in neonatal, infant, and pediatric patients continuously evolves as new devices and innovative techniques are introduced. Since 1989, periodic pediatric perfusion surveys have been conducted to ascertain practice patterns involving demographics, equipment, and perfusion techniques. The goal of this current project is to provide an updated perspective on international pediatric and congenital perfusion practice since the last survey conducted in 2016. In July 2021, a 100-question perfusion survey was distributed to 284 pediatric cardiac surgery centers using a secure web browser-based data application. Each center was given a unique survey hyperlink to ensure one response per institution and to monitor the response rate. Centers were given 1 month to complete the survey and electronic reminders were sent weekly to nonrespondents. After the survey was closed, information from completed surveys was exported to a software program for analysis. Responses were received from 153 of 284 pediatric centers for a response rate of 54%. Sixty respondents (39%) were from North American (NA) centers while 93 respondents (61%) were from non-North American (NNA) centers. The vast majority of centers use a roller head arterial pump (93%), hollow fiber oxygenators with open reservoirs (86%), and integrated arterial line filters (73%). The use of modified ultrafiltration was reported by 76% of centers. Ninety-two percent of centers reported the use of selective antegrade cerebral perfusion for aortic arch repairs. The N + 1 staffing model was most prevalent (52%), followed by two perfusionists per case (33%). Periodic surveys continue to be a useful modality in assessing regional variation in pediatric perfusion practice. This survey marked the first time the majority of responses came from non-North American institutions. Identifying these practice patterns may aid in the development of, and adherence to, regional standards and guidelines. This would foster the reduction of variation in practice and potentially improve patient safety., (© Copyright 2022 AMSECT.)

The COVID-19 pandemic represents the most significant global challenge in a generation. Based on extant data from previous pandemics, demographic, occupational, and psychological factors have been linked to distress and for some vulnerable members of society. COVID-19 has added to the layers of grief and distress of existing trauma. Evidence-based frameworks exist to guide our individual and collective response to reduce the trauma associated with the experience of a pandemic. Pandemic and post-pandemic measures to ameliorate impacts require a multi-disciplined approach, central to which is community connectedness, resilience, and access to support. We advocate for the acceptance and broader application of Dadirri, a healing practice held by the Ngan'gikurunggurr and Ngen'giwumirri Aboriginal people of the Daly River region in the Northern Territory, Australia. This modality engages therapeutic phases that are comparable with other practiced trauma therapies. The demonstrated therapeutic outcomes from Dadirri can be attained through an individualistic or in a relational engagement context. This practice is accessible to all ages, is non-specific to gender and is suitable for people constrained in their mobility or limited by resources, pertinent in pandemic affected settings., Competing Interests: CA was employed by the company We Al-li Pty Ltd. Author Emeritus Professor JA is an advisor for the company We Al-li Pty Ltd without any financial interests in this company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Morris, Groom, Schuberg, Atkinson, Atkinson and Ungunmerr-Baumann.)

Small increases in serum creatinine postoperatively reflect an acute kidney injury (AKI) that likely occurred during cardiopulmonary bypass (CPB). Maintaining adequate oxygen delivery (DO 2 ) during CPB, known as GDP (goal-directed perfusion), improves outcomes. Whether GDP improves outcomes of patients at high risk for acute renal failure (ARF) is unknown. Forty-seven adult patients undergoing cardiac surgery with CPB utilizing GDP with Cleveland Clinic Acute Renal Failure Score of 3 or greater were compared with a matched cohort of patients operated upon using a flow-directed strategy. CPB flow in the GDP cohort was based on a DO 2 goal of 260 mL/min/m 2 . Serum creatinine values were used to determine whether postoperative AKI occurred according to AKIN (Acute Kidney Injury Network) guidelines. We examined the distribution of all variables using proportions for categorical variables and means (standard deviations) for continuous variables and compared treatment groups using t tests for categorical variables and tests for differences in distributions for continuous and count variables. We used inverse probability of treatment weighting to adjust for treatment selection bias. In adjusted models, GDP was not associated with a decrease in AKI (odds ratio [OR]: .97; confidence interval [CI]: .62, 1.52), but was associated with higher odds of ARF (OR: 3.13; CI: 1.26, 7.79), mortality (OR: 3.35; CI: 1.14, 9.89), intensive care unit readmission (OR: 2.59; CI: 1.31, 5.15), need for intraoperative red blood cell transfusion (OR: 2.02; CI: 1.26, 3.25), and postoperative platelet transfusion (OR: 1.78; CI: 1.05, 3.01) when compared with the historic cohort. In patients who are at high risk for postoperative renal failure, GDP was not associated with a decrease in AKI when compared to the historical cohort managed traditionally by determining CPB flows based on body surface area. Surprisingly, the GDP cohort performed significantly worse than the retrospective control group in terms of ARF, mortality, intensive care unit readmission, and RBC and platelet transfusions., (© Copyright 2022 AMSECT.)

Standards and guidelines for cardiopulmonary bypass have been established by various professional societies. They serve as an instrument to guide safe and effective patient care. We conducted a survey of practicing perfusionists in Kenya to learn about their background, education, current clinical practice and about their knowledge, and attitude regarding standards and guidelines. Two multiple-choice surveys were distributed to all known practicing perfusionist in Kenya using SurveyMonkey (San Mateo, CA). Multiple-choice questions related to professional background, training, annual procedure volume, staffing models, clinical practices, the use of safety devices, and the use of checklists were included in the questionnaires. The survey also inquired about familiarity with American and European perfusion practice standards and guidelines and opinions on establishing standards in Kenya. Responses were received from 12 perfusionists practicing at 10 centers. Professional backgrounds included anesthesia nursing, clinical officers, and critical care nursing. Sixty-seven percent (8/12) received formal training and 33% (4/12) trained primarily through clinical instruction. Of those that received formal training, 63% (5/8) received 1-2 years of training, 25% (2/8) <1 year but more than 6 months, and 12.5% (1/8) received 6 months of formal training. The median clinical experience was 5 years (range 1-22). The median annual case load was 54 (range 0-100). Use of safety devices was reported as follows: level sensor 75% (9/12), air bubble detector 17% (2/12), one-way vent valves 67% (8/12), continuous venous oxygen saturation monitoring 25% (3/12), and gas supply analyzers 33% (4/12). More than one-third of the respondents had no knowledge of the American and European perfusion practice standards, and nearly two-thirds were aware of or had read them. This survey provides contextual information about perfusion practice in Kenya in 2021. There was consensus among perfusionists to develop standards and practice guidelines for Kenya., (© Copyright 2022 AMSECT.)

The impacts of high ambient temperatures on mortality in humans and domestic animals are well-understood. However much less is known about how hot weather affects mortality in wild animals. High ambient temperatures have been associated with African wild dog Lycaon pictus pup mortality, suggesting that high temperatures might also be linked to high adult mortality.We analyzed mortality patterns in African wild dogs radio-collared in Kenya (0°N), Botswana (20°S), and Zimbabwe (20°S), to examine whether ambient temperature was associated with adult mortality.We found that high ambient temperatures were associated with increased adult wild dog mortality at the Kenya site, and there was some evidence for temperature associations with mortality at the Botswana and Zimbabwe sites.At the Kenya study site, which had the highest human impact, high ambient temperatures were associated with increased risks of wild dogs being killed by people, and by domestic dog diseases. In contrast, temperature was not associated with the risk of snare-related mortality at the Zimbabwe site, which had the second-highest human impact. Causes of death varied markedly between sites.Pack size was positively associated with survival at all three sites.These findings suggest that while climate change may not lead to new causes of mortality, rising temperatures may exacerbate existing anthropogenic threats to this endangered species, with implications for conservation. This evidence suggests that temperature-related mortality, including interactions between temperature and other anthropogenic threats, should be investigated in a greater number of species to understand and mitigate likely impacts of climate change. ​., Competing Interests: None declared., (© 2021 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

New cardiopulmonary bypass device techniques emerge and are reported in the scientific literature. The extent to which they are actually adopted into clinical practice is not well known. Since 1989, we have periodically surveyed pediatric cardiac centers to ascertain practice patterns. In December 2016, a 186-question perfusion survey was distributed to pediatric cardiac surgery centers all over the world using a Web-based survey tool. Responses were received from 93 North American (NA) centers (the United States and Canada) and 67 non-NA (NNA) centers, representing 19,645 cumulative annual procedures in NA and 27,776 in NNA centers on patients <18 years. Wide variation in practice was evident across geographic regions. However, the most common pediatric circuit consisted of a hard-shell (open) venous reservoir, an arterial roller pump, and a hollow-fiber membrane oxygenator with a separate or integrated arterial filter. Compared with our previous surveys, there was increased utilization of all types of safety devices. The use of an electronic perfusion record was reported by 50% of NA centers and 31% of NNA centers. There was wide regional variation in cardioplegia delivery systems and cardioplegia solutions. Seventy-nine percent of the centers reported the use of some form of modified ultrafiltration. The survey demonstrated that there remains variation in perfusion practice for pediatric patients. Future surveys will be useful to evaluate the adoption of emerging perfusion practice guidelines., (© Copyright 2021 AMSECT.)

Patterns of animal movement associated with foraging lie at the heart of many ecological studies and often animals face decisions of staying in an environment they know versus relocating to new sites. The lack of knowledge of new foraging sites means there is risk associated with a decision to relocate (e.g. poor foraging) as well as a potential benefit (e.g. improved foraging). Using a unique long-term satellite tracking dataset for several sea turtle species, combined with capture-mark-recapture data extending over 50 years, we show how, across species, individuals generally maintain tight fidelity to specific foraging sites after extended (up to almost 10,000 km) migration to and from distant breeding sites as well as across many decades. Migrating individuals often travelled through suitable foraging areas en route to their 'home' site and so extended their journeys to maintain foraging site fidelity. We explore the likely mechanistic underpinnings of this trait, which is also seen in some migrating birds, and suggest that individuals will forgo areas of suitable forage encountered en route during migration when they have poor knowledge of the long-term suitability of those sites, making relocation to those sites risky., (© 2019 British Ecological Society.)

The current study aimed to identify the differences in technical performance between players from clubs of Bundesliga (Germany), La Liga (Spain), Ligue 1 (France), Premier League (England) and Serie A (Italy) when competing in the matches of the UEFA Champions League. Technical performance-related match data of 1,291 players from 1,125 matches (9,799 observations) of the UEFA Champions League (seasons 2009/2010-2017/2018) were collected and analysed. The generalised mixed linear modelling was employed taking the names of the league as the independent variable to predict the count number of 20 technical performance-related match actions and events performed by players belonging to different leagues. The non-clinical magnitude-based inference was used to evaluate the uncertainty in the true effects of the predictor. Results showed that differences in the technical performances between players from La Liga, Premier League and Ligue 1 were all trivial. Bundesliga players made higher numbers of shots than players from La Liga, Premier League and Serie A and achieved more long balls than players from Ligue 1. Serie A players achieved lower numbers of ball touches, passes and lower pass accuracy per match than players from any of the other four leagues. In addition, players from Serie A performed a higher number of long balls per match than Ligue 1 players and lower number of dribbles per match than Premier League players. Non-significant differences in other variables related to passing and organising and all variables related to defending were identified in players between the five leagues. The identified differences in technical performance among leagues could provide a more thorough understanding for practitioners working within the fields of talent identification, player development, player recruitment, coaching and match preparation., (Copyright © 2019 Yi, Groom, Dai, Liu and Gómez Ruano.)

Effective conservation management is underpinned by science. Yet, there are often barriers against the incorporation of up-to-date scientific research into decision-making and policy. Here, we draw on experience from a multi-nation approach to conserve cheetah and African wild dogs across Africa, using relationships between scientists and managers established over more than a decade, to better understand scientific information needs of managers. While our analysis focuses on Africa, many of our findings are likely to be relevant to other regions. Managers view science as critical to their decision-making processes and strongly support scientific research, particularly when research directly addresses their information needs. However, managers reported problems in accessing final results and highlighted the need to access raw ecological data from research undertaken within protected areas. Fundamental to improving the management relevance of scientific research is the need for scientists to engage with managers through all steps of the research process, from project design and implementation through to scientific publication and end-of-project agreements. Effective engagement requires open and clear communication; including agreed processes for access to biodiversity data and submission of final results. In order to foster future scientific endeavours and collaborations, systems should be established to better facilitate information exchange, while also safeguarding the rights of scientists to publish their data and protect their academic freedom. Our analysis also calls for a greater awareness of the geo-political context under which science is undertaken, and for increased scientific participation through an inclusive approach that recognizes, and gives credit to, a wider diversity of scientific contributions and expertise. This article is part of the theme issue 'Linking behaviour to dynamics of populations and communities: application of novel approaches in behavioural ecology to conservation'.

Within the "compartmentalised smart factory" approach of the ONE-FLOW project the implementation of different catalysts in "compartments" provided by Pickering emulsions and their application in continuous flow is targeted. We present here the development of heterogeneous Pd catalysts that are ready to be used in combination with biocatalysts for catalytic cascade synthesis of active pharmaceutical ingredients (APIs). In particular, we focus on the application of the catalytic systems for Suzuki-Miyaura cross-coupling reactions, which is the key step in the synthesis of the targeted APIs valsartan and sacubitril. An immobilised enzyme will accomplish the final product formation via hydrolysis. In order to create a large interfacial area for the catalytic reactions and to keep the reagents separated until required, the catalyst particles are used to stabilise Pickering emulsions of oil and water. A set of Ce-Sn-Pd oxides with the molecular formula Ce 0.99- x Sn x Pd 0.01 O 2-δ ( x = 0-0.99) has been prepared utilising a simple single-step solution combustion method. The high applicability of the catalysts for different functional groups and their minimal leaching behaviour is demonstrated with various Suzuki-Miyaura cross-coupling reactions in batch as well as in continuous flow employing the so-called "plug & play reactor". Finally, we demonstrate the use of these particles as the sole emulsifier of oil-water emulsions for a range of oils.

Climate change imposes an urgent need to recognise and conserve the species likely to be worst affected. However, while ecologists have mostly explored indirect effects of rising ambient temperatures on temperate and polar species, physiologists have predicted direct impacts on tropical species. The African wild dog (Lycaon pictus), a tropical species, exhibits few of the traits typically used to predict climate change vulnerability. Nevertheless, we predicted that wild dog populations might be sensitive to weather conditions, because the species shows strongly seasonal reproduction across most of its geographical range. We explored associations between weather conditions, reproductive costs, and reproductive success, drawing on long-term wild dog monitoring data from sites in Botswana (20°S, 24 years), Kenya (0°N, 12 years), and Zimbabwe (20°S, 6 years). High ambient temperatures were associated with reduced foraging time, especially during the energetically costly pup-rearing period. Across all three sites, packs which reared pups at high ambient temperatures produced fewer recruits than did those rearing pups in cooler weather; at the non-seasonal Kenya site such packs also had longer inter-birth intervals. Over time, rising ambient temperatures at the (longest-monitored) Botswana site coincided with falling wild dog recruitment. Our findings suggest a direct impact of high ambient temperatures on African wild dog demography, indicating that this species, which is already globally endangered, may be highly vulnerable to climate change. This vulnerability would have been missed by simplistic trait-based assessments, highlighting the limitations of such assessments. Seasonal reproduction, which is less common at low latitudes than at higher latitudes, might be a useful indicator of climate change vulnerability among tropical species., (© 2017 The Authors. Journal of Animal Ecology © 2017 British Ecological Society.)

Establishing and maintaining protected areas (PAs) are key tools for biodiversity conservation. However, this approach is insufficient for many species, particularly those that are wide-ranging and sparse. The cheetah Acinonyx jubatus exemplifies such a species and faces extreme challenges to its survival. Here, we show that the global population is estimated at ∼7,100 individuals and confined to 9% of its historical distributional range. However, the majority of current range (77%) occurs outside of PAs, where the species faces multiple threats. Scenario modeling shows that, where growth rates are suppressed outside PAs, extinction rates increase rapidly as the proportion of population protected declines. Sensitivity analysis shows that growth rates within PAs have to be high if they are to compensate for declines outside. Susceptibility of cheetah to rapid decline is evidenced by recent rapid contraction in range, supporting an uplisting of the International Union for the Conservation of Nature (IUCN) Red List threat assessment to endangered. Our results are applicable to other protection-reliant species, which may be subject to systematic underestimation of threat when there is insufficient information outside PAs. Ultimately, conserving many of these species necessitates a paradigm shift in conservation toward a holistic approach that incentivizes protection and promotes sustainable human-wildlife coexistence across large multiple-use landscapes., Competing Interests: The authors declare no conflict of interest.

Cardiac surgeons traveling to East Africa on humanitarian surgical missions treat a large number of people of all ages with rheumatic heart disease. A patient with severe mitral stenosis with pulmonary edema in the second trimester of pregnancy was treated successfully with closed mitral commissurotomy in a hospital in rural Kenya. An operation from the late 1940s may regain prominence more than 70 years later in areas of the world with a high incidence of rheumatic heart disease and limited cardiology and cardiac surgery resources., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)