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Objective: The empty pelvis syndrome (EPS) is common after pelvic exenteration (PE), causing fluid collections, bowel obstruction, perineal sinuses, and fistulas. The best approach to fill the pelvis to mitigate this remains controversial, and the impact of EPS on health-related quality of life (HrQoL) is unknown. This study is the first to begin to explore lived-experiences of EPS complications., Methods: Unstructured EPS virtual focus group meetings were conducted with a convenience sample of patients who underwent PE, as an extension of a modified-Delphi study. Interpretative phenomenological analysis was conducted on verbatim transcripts to generate group experiential themes., Results: Twelve patients (eight UK, one Dutch, and three Belgian) participated in four focus groups. Eight EPS complications were reported, (two pelvic collections, five chronic perineal sinuses, and one bowel obstruction). Group experiential themes were 'Out of Options', depicting patients forced to accept complications or limited survival; 'The New Normal', with EPS potentially delaying adaptation to post-PE HrQoL; 'Information Influencing Adaptation,' emphasising the significance of patients understanding EPS to cope with its effects; and 'Symptoms,' reporting manifestations of EPS, the resultant physical limitations, and an intangible feeling that patients lost part of themselves., Conclusions: EPS may influence patient decision-making, regret, adaptation, and information-seeking. It can cause a variety of unpleasant symptoms and physical limitations, which may include phantom phenomenon. This work supports ongoing purposeful HrQoL research to better define these themes., (© 2024 The Author(s). Psycho‐Oncology published by John Wiley & Sons Ltd.)

Background: Large tissue defects following pelvic exenteration (PE) fill with fluid and small bowel, leading to the empty pelvis syndrome (EPS). EPS causes a constellation of complications including pelvic sepsis and reduced quality of life. EPS remains poorly defined and cannot be objectively measured. Pathophysiology of EPS is multifactorial, with increased pelvic dead space potentially important. This study aims to describe methodology to objectively measure volumetric changes relating to EPS., Methods: The true pelvis is defined by the pelvic inlet and outlet. Within the true pelvis there is physiological pelvic dead space (PDS) between the peritoneal reflection and the inlet. This dead space is increased following PE and is defined as the exenteration pelvic dead space (EPD). EPD may be reduced with pelvic filling and the volume of filling is defined as the pelvic filling volume (PFV). PDS, EPD, and PFV were measured intraoperatively using a bladder syringe, and Archimedes' water displacement principle., Results: A patient undergoing total infralevator PE had a PDS of 50 ml. A rectus flap rendered the pelvic outlet watertight. EPD was then measured as 540 ml. Therefore there was a 10.8-fold increase in true pelvis dead space. An omentoplasty was placed into the EPD, displacing 130 ml; therefore, PFV as a percentage of EPD was 24.1%., Conclusions: This is the first reported quantitative assessment of pathophysiological volumetric changes of pelvic dead space; these measurements may correlate to severity of EPS. PDS, EPD, and PFV should be amendable to assessment based on perioperative cross-sectional imaging, allowing for potential prediction of EPS-related outcomes., (© 2024. The Author(s).)

Introduction: Chronic cancer-related pain from locally recurrent infiltrative cancers within the bony confines of the pelvis is a devastating and hard to manage condition that can be refractory to many conventional pain management methods. Spinal cord stimulation (SCS) is an evolving and safe method of pain management and can be trialled in a quick and well-tolerated operation under local anaesthesia. To date, this has not been reported in the setting of locally recurrent inoperable pelvic cancers., Case Description: In the present study, we report two cases of patients with severe back and lower limb pain resulting from recurrent anal and rectal cancers involving the right lumbar and sacral nerve roots as well as the bony sacrum, which severely affected quality of life and daily functioning., Discussion: Following successful SCS, effective pain relief was observed., Conclusion: SCS could represent an effective supplementary or alternative technique to conventional pain management in this challenging group of patients, especially if other available methods have been exhausted., Competing Interests: The 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 © 2024 Salem, West, West, Yano, Fernandes, Vajramani and Mirnezami.)

Child growth failure, as indicated by low height-for-age z-scores (HAZ), is an important metric of health, social inequality, and food insecurity. Understanding the environmental pathways to this outcome can provide insight into how to prevent it. While other studies have examined the environmental determinants of HAZ, there is no agreed upon best-practices approach to measure the environmental context of this outcome. From this literature, we derive a large set of potential environmental predictors and specifications including temperature and precipitation levels, anomalies, and counts as well as vegetation anomalies and trends, which we include using linear, nonlinear, and interactive specifications. We compare these measures and specifications using four rounds of DHS survey data from Burkina Faso and a large set of fixed effects regression models, focusing on exposures from the time of conception through the second year of life and relying on joint hypothesis tests and goodness-of-fit measures to determine which approach best explains HAZ. Our analysis reveals that nonlinear and interactive transformations of climate anomalies, as opposed to climate levels or vegetation indices, provide the best explanation of child growth failure. These results underline the complex and nonlinear pathways through which climate change affects child health and should motivate climate-health researchers to more broadly adopt measures and specifications that capture these pathways., Competing Interests: Statements and Declarations: The authors have no financial or non-financial interests to disclose.

Introduction: Racial disparities have been well reported in the utilization and outcomes of knee arthroplasty, but it is unclear whether disparities also extend to the choice of surgical treatment. The primary objective of this study is to identify if race plays a role in the selection of unicondylar versus total knee arthroplasty (UKA, TKA) for isolated tibiofemoral osteoarthritis (OA). A secondary objective is to identify the differences in the complication rates for each procedure by racial identity., Methods: A retrospective review of the 2006-2018 American College of Surgeons National Surgical Quality Improvement Program was performed. Asian, Black, Hawaiian/Pacific Islander, Hispanic, Native American/Alaskan, and White individuals who underwent primary elective UKA or TKA were compared in terms of UKA vs. TKA utilization rates and outcomes., Results: A total of 308,715 patients were analyzed. After controlling for all baseline differences, Whites (3.5%), Asians (3.7%), and Hawaiian/Pacific Islanders (3.1%) had around twice the rate of UKA compared to Blacks (1.6%), while Hispanics (2.1%) and Native American/Alaskans (1.7%) were in between (p <0.001). TKA was associated with higher complications compared to UKA in all racial groups (p < 0.001)., Conclusion: Minority patients, especially Blacks, were less likely to receive UKA for treatment of isolated knee OA. This is significant because treatment selection in patients who are eligible for UKA can have a significant impact on postoperative recovery and complications rates., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Fundamental to the synthesis of enantioenriched chiral molecules is the ability to assign absolute configuration at each stereogenic center, and to determine the enantiomeric excess for each compound. While determination of enantiomeric excess and absolute configuration is often considered routine in many facets of asymmetric synthesis, the same determinations for enantioisotopomers remains a formidable challenge. Here, we report the first highly enantioselective metal-catalyzed synthesis of enantioisotopomers that are chiral by virtue of deuterium substitution along with the first general spectroscopic technique for assignment of the absolute configuration and quantitative determination of the enantiomeric excess of isotopically chiral molecules. Chiral tag rotational spectroscopy uses noncovalent chiral derivatization, which eliminates the possibility of racemization during derivatization, to perform the chiral analysis without the need of reference samples of the enantioisotopomer., (© 2022 The Authors. Angewandte Chemie International Edition published by Wiley-VCH GmbH.)

Introduction: Haemorrhage is the major cause of early mortality following traumatic injury. Patients suffering from non-compressible torso haemorrhage are more likely to suffer early death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be effective in initial resuscitation; however, establishing swift arterial access is challenging, particularly in a severe shock. This is made more difficult by anatomical variability of the femoral vessels., Methods: The femoral vessels were characterised in 81 cadaveric lower limbs, measuring specifically the distance from the inferior border of the inguinal ligament to the distal part of the origin of the profunda femoris artery (PFA), and from the distal part of the origin of the PFA to where the femoral vein lies posterior to and is completely overlapped by the femoral artery., Results: The femoral vein lay deep to the femoral artery at a mean distance of 105 mm from the inferior border of the inguinal ligament. The PFA arose from the femoral artery at a mean distance of 51.1 mm from the inguinal ligament. From the results, it is predicted that the PFA originates from the common femoral artery approximately 24 mm from the inguinal ligament, and the femoral vein is completely overlapped by the femoral artery by 67.7 mm distal from the inguinal ligament, in 95% of subjects., Conclusions: Based on the results, proposed is an 'optimal access window' of up to 24 mm inferior to the inguinal ligament for common femoral arterial catheterisation for pre-hospital REBOA, or more simply within one finger breadth., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Declining grazing lands threaten the livelihoods of Fulɓe herders in Burkina Faso and other parts of Africa. I used GIS to spatially represent ethnographic narratives about land use and land cover changes. In a place where maps were unavailable or treated as closely held community secrets, I used participatory mapping to offer participants the opportunity to control the process and resulting maps. Our project sought to understand environmental challenges from a fine-grained emic perspective using high-resolution satellite imagery and focus groups. I reflect on challenges of conducting fieldwork in one's home country, which made it easier to build relationships and interact with officials. At the same time, however, I faced the intersecting challenges of "being an outsider and a woman" as I interacted with Fulɓe men and that of being "too educated" in interacting with women.

Introduction: The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery., Materials and Methods: Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted., Results: LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs., Conclusions: This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures., (© 2020 The Authors. Clinical Anatomy published by Wiley Periodicals LLC on behalf of American Association of Clinical Anatomists.)

In this article we present results from transect walks and participatory mapping done in Burkina Faso. Since the Sahelian drought of the 1970s, researchers have continued to depict the Sahelian region of West Africa as an environment experiencing severe degradation; a narrative that persists over time. Recently, however, analyses of satellite imagery have identified remarkable patterns of greening across the Sahel. The causes of this greening are hotly debated. Through this project we aim to inform these debates with on-the-ground perceptions of local farmers and pastoralists. The transect walk method is a community-based process that collects information on the land-use/land-cover (LULC) features across villages. Transects help triangulate data by combining high-resolution satellite imagery, firsthand observations, and local experiences of ecological processes. We describe the methodology behind transects and discuss how they contextualize an otherwise removed process of environmental analysis. We also describe the challenges that arise throughout the fieldwork process.

Competing Interests: Competing interests: None declared.

Sahelian West Africa is a region that suffers from high population densities, frequent severe droughts, and enormous pressure on natural resources. Because of these challenges, it is the place where the term "desertification" was originally coined. Recently, however, experts have identified large zones of "greening" where the amount of vegetation exceeds what one would expect based on rainfall alone. This pattern is well documented, but its mechanisms remain poorly understood. This research employs participatory mapping linked with high-resolution satellite imagery to better understand the human role behind regional vegetation trends. Through a case study of three communities in northern Burkina Faso, this paper presents a pilot methodology for explicitly mapping perceived areas of both land degradation and rehabilitation. Combining participatory mapping exercises with standard image classification techniques allows areas of land degradation and rehabilitation to be precisely located and their extents measured for individual communities and their surrounding terroirs . Results of the spatial analysis show that the relative proportion of greening and browning varies among communities. In the case of Sakou, nearly 60 percent of its terroir is degraded. While in another, Kouka, this is 48 percent. This method also elicits perspectives of Burkinabè agro-pastoralists on the local land-use practices driving these twin environmental processes. Altogether, this case study demonstrates the analytical power of integrating ethnography and high-resolution satellite imagery to provide a bottom-up perspective on social-ecological dynamics.

The resettlement of herders in pastoral zones is often criticized for hindering pastoral mobility, which is essential to survival. We integrate narratives of conflict and environmental change with maps to demonstrate the complementarity between pastoral mobility - porous borders- and border demarcation - rigid borders. We use evidence from the Sondré-Est Pastoral Zone in southern Burkina Faso, where herders were voluntarily resettled near agricultural villages following the droughts of the 1970s. Over time, however, farmers encroached on the borders of the pastoral zone and surrounding grazing areas declined. This increased land-use disputes. Tensions were exacerbated by the fact that these communities kept maps as community secrets. We re-created the administrative boundaries of the pastoral zone to map land-use/land-cover changes and conflict hot spots. The maps show that conflicts happened along porous borders where agricultural fields encroached. Herders called for a clear demarcation of the border of the pastoral zone to preserve exclusive access to resources within it. Simultaneously, they also wanted to maintain shared access to other resources outside the pastoral zone. The herders' desire for both border clarity and some form of flexibility underlines the complementary between both processes, especially in times of resource scarcity and land-use conflict. The mystery around the maps helps sustain ambiguity that is key for pursuing both goals.

Background: Little is known about the strains at the glenoid near the bone-implant interface in reverse shoulder arthroplasty. The purpose of the current study was to evaluate the strains on the glenoid bone under a compressive load after implantation of three different sizes of metal-backed baseplates in either inferior or superior position in combination with three different sizes of glenospheres and three different glenosphere designs., Methods: Three sizes of baseplates (small, medium, large) were implanted in thirty-six paired human cadaveric scapulae either inferior, flush with the glenoid neck, or with a 5 mm superior offset. Glenospheres were available in three sizes (36 mm, 39 mm, 42 mm) and designs (standard, 4 mm lateralized, 2.5 mm inferiorized). Specimens were mounted in a servo-hydraulic testing apparatus at a 60° angle between the glenoid and actuator holding the humeral component. Four strain-gauge rosettes were placed around the glenoid rim to measure strains transferred to the scapular bone under a compressive load (750 N) relative to the various baseplate-glenosphere combinations. Following repeated compression, a load-to-failure test was performed., Results: Mean overall registered strains were 161με (range: - 1165 to 2347) at the inferior sensor, -2με (range: - 213 to 90) at the superior sensor, -95με (range: - 381 to 254) at the anterior sensor, and 13με (range: - 298 to 128) at the posterior sensor. Measured bone strains did not show any significant differences across tested baseplate and glenosphere design, size, or positioning combinations (p > 0.05 for all sensors). Furthermore, linear regression analysis did not identify any of the evaluated parameters as an independent influential factor for strains (p > 0.05 for all sensors). Mean load-at-failure was significantly higher in the group of inferior (3347.0 N ± 704.4 N) compared to superior (2763.8 N ± 927.8 N) positioned baseplates (p = 0.046)., Conclusion: Different baseplate positions, baseplate sizes, glenosphere sizes, and glenosphere design or various combinations of these parameters did not significantly influence the measured bone strains at the glenoid near the bone-implant interface in a contemporary reverse shoulder arthroplasty system., Level of Evidence: Basic Science Study, Biomechanical Study.

Competing Interests: Competing interests: None declared.

Background: The carotid sinus (CS) is a dilatation in the carotid bifurcation usually at the origin of proximal internal carotid artery (ICA). It contains baroreceptors which influence blood pressure. Variations in the location of the CS are of importance as atheromatous plaque commonly forms in this area and procedures such as carotid endarterectomy are performed to reduce the risk of stroke. Inadvertent stimulation of the CS baroreceptors during interventions can have profound effects on the patient's haemodynamic status both intra- and postoperatively, causing serious complications. The aim of this study is to determine the inter- and intra-individual variations in the location of the CS., Materials and Methods: Eighty-two carotid arteries were dissected bilaterally from 41 cadavers. The locations of the CS were noted and divided into four potential sites., Results: The commonest site is the origin of the ICA (74.3%), but the CS can also be found in the distal part of the common carotid artery (CCA) inferior to the bifurcation (17.1%); at the bifurcation involving the distal CCA and origins of both the external carotid artery (ECA) and ICA (7.32%); and at the origin of the ECA (1.22%). In individual cadavers, the CS was located at the origin of the ICA in 97.6% on at least one side. The sites of the CS were asymmetrical in 34.1%., Conclusions: Clinicians performing carotid interventions should be aware of these anatomical variations to avoid inadvertent stimulation of the CS which can cause profound bradycardia and hypotension.

When cash cropping leads to agricultural and livelihood changes in the Global South, concern about food security is common among policy makers. This is indeed the case in the Sikasso region of Mali, where many have suggested that the ubiquitous cash crop cotton is a cause of the unexpectedly high rates of malnutrition in the region. Using household and forest surveys, we found little evidence that cotton cultivation is associated with malnutrition or decreased food security at a household level, but we did find evidence of a coassociation between cotton cultivation, loss of natural capital, and malnutrition at the village level.

Historically, the Sahel of West Africa has been considered synonymous with desertification. In recent decades, however, satellite images reveal patterns of enhanced vegetation termed the "greening of the Sahel." This greening is well-documented but its mechanisms remain poorly understood. The Sahel is also a region emerging from a thirty-year period of reduced rainfall in which several severe droughts occurred. As a response to droughts and land degradation, farmers have rehabilitated thousands of hectares of degraded soils by constructing low barriers of rock through widespread soil and water conservation (SWC) development projects. Remote sensing analyses suggest that these extensive soil conservation projects may explain greening in northern Burkina Faso. This study combines ethnographic fieldwork with the analysis of Geographic Information System (GIS) and remote sensing (RS) data to test whether SWC investments contribute to greening. Ethnographic data reveals a tension between the perceptions of rural producers who feel that their SWC efforts contribute to greening and those of state officials who contend that SWC has only local impacts and that the regional landscape continues to degrade. Our analysis of GIS and RS data suggest that both perspectives are valid but contingent on particular spatial and temporal scale used for analysis., Competing Interests: Conflict of Interest The authors declare they have no conflict of interest.

Background: In this study, 82 forearms from 41 cadavers were dissected to establish the incidence of variant additional radial wrist extensors. Three variants have been described in the literature: extensor carpi radialis intermedius (ECRI), extensor carpi radialis accessorius (ECRA) and extensor carpi radialis tertius (ECRT)., Materials and Methods: Of the 41 cadavers studied, 5/41 (12%) had an additional radial wrist extensor. Of these 5 individuals, 2 had bilateral additional muscles and 3 were unilateral. Of the 82 forearms, 7/82 (9%) had additional radial wrist extensors., Results: We found 4 examples of ECRI and 3 examples of ECRA. We did not find any examples of ECRT. One specimen of ECRA had an atypical, previously undescribed, course., Conclusions: These accessory muscles are of clinical relevance, as they may be a contributing factor in tennis elbow and nerve entrapment, or cause diagnostic confusion, especially in ultrasound scans. However, they may also be used for tendon transfer. Of the 7 muscles found in the current study, 3 would have been suitable for such procedures.

Integrating information from existing research, qualitative ethnographic interviews, and participant observation, we designed a field experiment that introduces idiosyncratic environmental risk and a voluntary sharing decision into a standard public goods game. Conducted with subsistence resource users in rural villages on the Kamchatka Peninsula in Northeast Siberia, we find evidence consistent with a model of indirect reciprocity and local social norms of helping the needy. When participants are allowed to develop reputations in the experiments, as is the case in most small-scale societies, we find that sharing is increasingly directed toward individuals experiencing hardship, good reputations increase aid, and the pooling of resources through voluntary sharing becomes more effective. We also find high levels of voluntary sharing without a strong commitment device; however, this form of cooperation does not increase contributions to the public good. Our results are consistent with previous experiments and theoretical models, suggesting strategic risks tied to rewards, punishments, and reputations are important. However, unlike studies that focus solely on strategic risks, we find the effects of rewards, punishments, and reputations are altered by the presence of environmental factors. Unexpected changes in resource abundance increase interdependence and may alter the costs and benefits of cooperation, relative to defection. We suggest environmental factors that increase interdependence are critically important to consider when developing and testing theories of cooperation.

Sub-Saharan Africa is often portrayed as a region of chronic hunger, conflict, and poverty. The country of Burkina Faso is a bright spot on the continent where government agencies, NGOs, and development organizations have progressively improved food security to the point where citizens often state, "famines of the past could never happen again." This study evaluates such claims by looking at food security trends over the last 18 years using ethnographic participatory fieldwork and grain price data. Community members have invested in numerous soil and water conservation (SWC) measures that buffer their crops from droughts and agro-climatic variability. There is also a national famine early warning system in place and improved infrastructure that helps the government and NGOs efficiently provide food assistance in times of need. Thus, fewer households are affected when droughts occur due to these adaptations and food insecurity is not as severe or widespread as in the past. Local grain prices are, however, rising and becoming more closely linked to world food markets. Just as most households are becoming more food secure, those who are dependent on grain purchases are becoming more food insecure.

We study a new class of chaotic systems with dynamical localization, where gain or loss mechanisms break the Hermiticity, while allowing for parity-time (PT) symmetry. For a value gamma{PT} of the gain or loss parameter the spectrum undergoes a spontaneous phase transition from real (exact phase) to complex values (broken phase). We develop a one parameter scaling theory for gamma{PT}, and show that chaos assists the exact PT phase. Our results have applications to the design of optical elements with PT symmetry.

We study the Loschmidt echo F(t) for a class of dynamical systems showing critical chaos. Using a kicked rotor with singular potential as a prototype model, we found that the classical echo shows a gap (initial drop) 1-F_{g} , where F_{g} scales as F_{g}(alpha,,eta)=f_{cl}(chi_{cl} identical witheta;{3-alpha}/) ; alpha is the order of singularity of the potential, eta is the spread of the initial phase-space density, and is the perturbation strength. Instead, the quantum echo gap is insensitive to alpha , described by a scaling law F_{g}=f_{q}(chi_{q}=eta;{2}/) which can be captured by a random matrix theory modeling of critical systems. We trace this quantum-classical discrepancy to strong diffraction effects that dominate the dynamics.

The results of this study indicate that the experience of sexual harassment among nursing professionals may be more widespread than previously reported. With only one percent of respondents reporting ¿quid pro quo¿ harassment, the vast majority of harassment fell into the ¿hostile environment¿ category where the victim's perceptions are all important. Health care administrators should be cautioned that harassment and discrimination are evolving and expanding areas of the law, necessitating current knowledge of the standards for actionable conduct. To lower the risk of liability from claims of both victims and the accused, harassment and discrimination policies should be aggressive, proactive, fair, and thorough.

Daphnia pulicaria from three different populations were observed to express within-population variation in habitat-choice behavior in field assays. Individuals from different habitats (i.e., lake depths) were isolated and cultured as clonal lines under standard conditions. Habitat choices by clonal descendants were then estimated in the field, using replicate experimental columns. There was significant heritable and ontogenetic variation in habitat choice, but the heritable effect was small relative to the phenotypic variation of the original isolates. In a second set of experiments, D. pulicaria that were acclimatized to different habitats showed a strong tendency to choose the habitat to which they had been acclimatized. These data suggest that a given genotype can use a wide range of habitats, given appropriate acclimatization. Although genetic variation is significant, we hypothesize that natural selection on correlated ecological traits is more likely to maintain patterns of genotypic segregation among habitats in Daphnia., (© 1994 The Society for the Study of Evolution.)