Neurosurgical Needs and Assets Assessment of Public Hospitals in Uganda: An Eevaluation of Mulago Hospital to Inform Neurosurgical Program Planning at Mbarara

Background: Since 2007, there has been an ongoing collaboration between Duke University and Mulago National Referral Hospital (NRH) in Kampala, Uganda to increase surgical capacity. This program is prepared to expand to other sites within Uganda to improve neurosurgery outside of Kampala as well. This study assessed the existing progress at Mulago NRH and the neurosurgical needs and assets at two potential sites for expansion. Methods: Three public hospitals were visited to assess needs and assets: Mulago NRH, Mbarara Regional Referral Hospital (RRH), and Gulu RRH. At each site, a surgical capacity tool was administered and healthcare workers were interviewed about perceived needs and assets. A total of 39 interviews were conducted between the three sites. Thematic analysis of the interviews was conducted to identify the reported needs and assets at each hospital. Results: Some improvements are needed to the Duke-Mulago Collaboration model prior to expansion; minor changes to the neurosurgery residency program as well as the method for supply donation and training provided during neurosurgery camps need to examined. Neurosurgery can be implemented at Mbarara RRH currently but the hospital needs a biomedical equipment technician on staff immediately. Gulu RRH is not well positioned for Neurosurgery until there is a CT Scanner somewhere in the Northern Region of Uganda or at the hospital. Conclusions: Neurosurgery is already present in Uganda on a small scale and needs rapid expansion to meet patient needs. This progression is possible with prudent allocation of resources on strategic equipment purchases, human resources including clinical staff and biomedical staff, and changes to the supply chain management system.

Putting together phylogenetic and ontogenetic perspectives on empathy.

The ontogeny of human empathy is better understood with reference to the evolutionary history of the social brain. Empathy has deep evolutionary, biochemical, and neurological underpinnings. Even the most advanced forms of empathy in humans are built on more basic forms and remain connected to core mechanisms associated with affective communication, social attachment, and parental care. In this paper, we argue that it is essential to consider empathy within a neurodevelopmental framework that recognizes both the continuities and changes in socioemotional understanding from infancy to adulthood. We bring together neuroevolutionary and developmental perspectives on the information processing and neural mechanisms underlying empathy and caring, and show that they are grounded in multiple interacting systems and processes. Moreover, empathy in humans is assisted by other abstract and domain-general high-level cognitive abilities such as executive functions, mentalizing and language, as well as the ability to differentiate another's mental states from one's own, which expand the range of behaviors that can be driven by empathy.

(Appendix) Stable carbon and oxygen isotopes, and Mg/Ca ratios of foraminifera from ODP Hole 154-925A

To better understand the links between the carbon cycle and changes in past climate over tectonic timescales we need new geochemical proxy records of secular change in silicate weathering rates. A number of proxies are under development, but some of the most promising (e.g. palaeoseawater records of Li and Nd isotope change) can only be employed on such large samples of mono-specific foraminifera that application to the deep sea sediment core archive becomes highly problematic. "Dentoglobigerina" venezuelana presents a potentially attractive target for circumventing this problem because it is a typically large (> 355 ?m diameter), abundant and cosmopolitan planktic foraminifer that ranges from the early Oligocene to early Pliocene. Yet considerable taxonomic and ecological uncertainties associated with this taxon must first be addressed. Here, we assess the taxonomy, palaeoecology, and ontogeny of "D." venezuelana using stable isotope (oxygen and carbon) and Mg/Ca data measured in tests of late Oligocene to early Miocene age from Ocean Drilling Program (ODP) Site 925, on Ceara Rise, in the western equatorial Atlantic. To help constrain the depth habitat of "D." venezuelana relative to other species we report the stable isotope composition of selected planktic foraminifera species within Globigerina, Globigerinoides, Paragloborotalia and Catapsydrax. We define three morphotypes of "D." venezuelana based on the morphology of the final chamber and aperture architecture. We determine the trace element and stable isotope composition of each morphotype for different size fractions, to test the validity of pooling these morphotypes for the purposes of generating geochemical proxy datasets and to assess any ontogenetic variations in depth habitat. Our data indicate that "D." venezuelana maintains a lower thermocline depth habitat at Ceara Rise between 24 and 21 Ma. Comparing our results to published datasets we conclude that this lower thermocline depth ecology for the Oligo-Miocene is part of an Eocene-to-Pliocene evolution of depth habitat from surface to sub-thermocline for "D." venezuelana. Our size fraction data advocate the absence of photosymbionts in "D." venezuelana and suggest that juveniles calcify higher in the water column, descending into slightly deeper water during the later stages of its life cycle. Our morphotype data show that d18O and d13C variation between morphotypes is no greater than within-morphotype variability. This finding will permit future pooling of morphotypes in the generation of the "sample hungry" palaeoceanographic records.

(Table 1) AMS 14C dates from sediment cores RC12-10 and GYRE97-6PV-20

Proxy records from two piston cores in the Gulf of Mexico (GOM) provide a detailed (50-100 year resolution) record of climate variability over the last 14,000 years. Long-term (millennial-scale) trends and changes are related to the transition from glacial to interglacial conditions and movement of the average position of the Intertropical Convergence Zone (ITCZ) related to orbital forcing. The d18O of the surface-dwelling planktic foraminifer Globigerinoides ruber show negative excursions between 14 and 10.2 ka (radiocarbon years) that reflect influx of meltwater into the western GOM during melting of the Laurentide Ice Sheet. The relative abundance of the planktic foraminifer Globigerinoides sacculifer is related to transport of Caribbean water into the GOM. Maximum transport of Caribbean surface waters and moisture into the GOM associated with a northward migration of the average position of the ITCZ occurs between about 6.5 and 4.5 ka. In addition, abundance variations of G. sacculifer show century-scale variability throughout most of the Holocene. The GOM record is consistent with records from other areas, suggesting that century-scale variability is a pervasive feature of Holocene climate. The frequency of several cycles in the climate records is similar to cycles identified in proxy records of solar variability, indicating that at least some of the century-scale climate variability during the Holocene is due to external (solar) forcing.

Condensation versus air density change as a major cause of airflow: experimental evidence, link to data files and videos

The dominant model of atmospheric circulation posits that hot air rises, creating horizontal winds. A second major driver has recently been proposed by Makarieva and Gorshkov in their biotic pump theory (BPT), which suggests that evapotranspiration from natural closed-canopy forests causes intense condensation, and hence winds from ocean to land. Critics of the BPT argue that air movement to fill the partial vacuum caused by condensation is always isotropic, and therefore causes no net air movement (Bunyard, 2015, hdl:11232/397). This paper explores the physics of water condensation under mild atmospheric conditions, within a purpose-designed square-section 4.8 m-tall closed-system structure. Two enclosed vertical columns are connected at top and bottom by two horizontal tunnels, around which 19.5 m**3 of atmospheric air can circulate freely, allowing rotary airflows in either direction. This air can be cooled and/or warmed by refrigeration pipes and a heating mat, and changes in airflow, temperature, humidity and barometric pressure measured in real time. The study investigates whether the "hot-air-rises" or an implosive condensation model can better explain the results of more than 100 experiments. The data show a highly significant correlation (R2 >0.96, p value <0.001) between observed airflows and partial pressure changes from condensation. While the kinetic energy of the refrigerated air falls short of that required in bringing about observed airflows by a factor of at least 30, less than a tenth of the potential kinetic energy from condensation is shown to be sufficient. The assumption that condensation of water vapour is always isotropic is therefore incorrect. Condensation can be anisotropic, and in the laboratory does cause sustained airflow.

Seafloor spreading magnetic anomaly isochron map compilation for the Weddell Sea and Scotia Sea

The deep sea sedimentary record is an archive of the pre-glacial to glacial development of Antarctica and changes in climate, tectonics and ocean circulation. Identification of the pre-glacial, transitional and full glacial components in the sedimentary record is necessary for ice sheet reconstruction and to build circum-Antarctic sediment thickness grids for past topography and bathymetry reconstructions, which constrain paleoclimate models. A ~3300 km long Weddell Sea to Scotia Sea transect consisting of multichannel seismic reflection data from various organisations, were used to interpret new horizons to define the initial basin-wide seismostratigraphy and to identify the pre-glacial to glacial components. We mapped seven main units of which three are in the inferred Cretaceous-Paleocene pre-glacial regime, one in the Eocene-Oligocene transitional regime and three units in the Miocene-Pleistocene full glacial climate regime. Sparse borehole data from ODP leg 113 and SHALDRIL constrain the ages of the upper three units. Compiled seafloor spreading magnetic anomalies constrain the basement ages and the hypothetical age model. In many cases, the new horizons and stratigraphy contradict the interpretations in local studies. Each seismic sedimentary unit and its associated base horizon are continuous and traceable for the entire transect length, but reflect a lateral change in age whilst representing the same deposition process. The up to 1240 m thick pre-glacial seismic units form a mound in the central Weddell Sea basin and, in conjunction with the eroded flank geometry, support the interpretation of a Cretaceous proto-Weddell Gyre. The base reflector of the transitional seismic unit, which marks the initial ice sheet advances to the outer shelf, has a lateral model age of 26.6-15.5 Ma from southeast to northwest. The Pliocene-Pleistocene glacial deposits reveals lower sedimentations rates, indicating a reduced sediment supply. Sedimentation rates for the pre-glacial, transitional and full glacial components are highest around the Antarctic Peninsula, indicating higher erosion and sediment supply of a younger basement. We interpret an Eocene East Antarctic Ice Sheet expansion, Oligocene grounding of the West Antarctic Ice Sheet and Early Miocene grounding of the Antarctic Peninsula Ice Sheet.

Susceptibility, d13C and Iron of Site 171-1051

Current models of the global carbon cycle lack natural mechanisms to explain known large, transient shifts in past records of the stable carbon-isotope ratio (delta13C) of carbon reservoirs. The injection into the atmosphere of ~1,200-2,000 gigatons of carbon, as methane from the decomposition of sedimentary methane hydrates, has been proposed to explain a delta13C anomaly associated with high-latitude warming and changes in marine and terrestrial biota near the Palaeocene-Eocene boundary, about 55 million years ago. These events may thus be considered as a natural 'experiment' on the effects of transient greenhouse warming. Here we use physical, chemical and spectral analyses of a sediment core from the western North Atlantic Ocean to show that two-thirds of the carbon-isotope anomaly occurred within no more than a few thousand years, indicating that carbon was catastrophically released into the ocean and atmosphere. Both the delta13C anomaly and biotic changes began between 54.93 and 54.98 million years ago, and are synchronous in oceans and on land. The longevity of the delta13C anomaly suggests that the residence time of carbon in the Palaeocene global carbon cycle was ~120 thousand years, which is similar to the modelled response after a massive input of methane. Our results suggest that large natural perturbations to the global carbon cycle have occurred in the past-probably by abrupt failure of sedimentary carbon reservoirs-at rates that are similar to those induced today by human activity.

Seawater carbonate chemistry and elemental composition of purple sea urchin (Strongylocentrotus purpuratus) calcite in a laboratory experiment

Ocean acidification will likely have negative impacts on invertebrates producing skeletons composed of calcium carbonate. Skeletal solubility is partly controlled by the incorporation of "foreign" ions (e.g. magnesium) into the crystal lattice of these skeletal structures, a process that is sensitive to a variety of biological and environmental factors. Here we explore effects of life stage, oceanographic region of origin, and changes in the partial pressure of carbon dioxide in seawater (pCO2) on trace elemental composition in the purple sea urchin (Strongylocentrotus purpuratus). We show that, similar to other urchin taxa, adult purple sea urchins have the ability to precipitate skeleton composed of a range of biominerals spanning low- to high-Mg calcites. Mg / Ca and Sr / Ca ratios were substantially lower in adult spines compared to adult tests. On the other hand, trace elemental composition was invariant among adults collected from four oceanographically distinct regions spanning a range of carbonate chemistry conditions (Oregon, Northern California, Central California, and Southern California). Skeletons of newly settled juvenile urchins that originated from adults from the four regions exhibited intermediate Mg / Ca and Sr / Ca between adult spine and test endmembers, indicating that skeleton precipitated during early life stages is more soluble than adult spines and less soluble than adult tests. Mean skeletal Mg / Ca or Sr / Ca of juvenile skeleton did not vary with source region when larvae were reared under present-day, global-average seawater carbonate conditions (400 µatm; pHT = 8.02 ± 0.03 1 SD; Omega calcite = 3.3 ± 0.2 1 SD). However, when reared under elevated pCO2 (900 µatm; pHT = 7.73 ± 0.03; Omega calcite = 1.8 ± 0.1), skeletal Sr / Ca in juveniles exhibited increased variance across the four regions. Although larvae from the northern populations (Oregon, Northern California, Central California) did not exhibit differences in Mg or Sr incorporation under elevated pCO2 (Sr / Ca = 2.10 ± 0.06 mmol/mol; Mg / Ca = 67.4 ± 3.9 mmol/mol), juveniles of Southern California origin partitioned ~8% more Sr into their skeletons when exposed to higher pCO2 (Sr / Ca = 2.26 ± 0.08 vs. 2.09 ± 0.005 mmol/mol 1 SD). Together these results suggest that the diversity of carbonate minerologies present across different skeletal structures and life stages in purple sea urchins does not translate into an equivalent geochemical plasticity of response associated with geographic variation or temporal shifts in seawater properties. Rather, composition of S. purpuratus skeleton precipitated during both early and adult life history stages appears relatively robust to spatial gradients and predicted future changes in carbonate chemistry. An exception to this trend may arise during early life stages, where certain populations of purple sea urchins may alter skeletal mineral precipitation rates and composition beyond a given pCO2 threshold. This potential for geochemical plasticity during early development in contrast to adult stage geochemical resilience adds to the growing body of evidence that ocean acidification can have differing effects across organismal life stages.

Prudent Budget Planning and Budgetary Process Effectiveness: The Canadian Federal Government’s Experience (Working Paper 47)

In 1994, the Liberal government introduced a structured approach to prudent budgeting to provide the fiscal discipline needed to meet its debt reduction targets in which explicit prudence factors were introduced into the fiscal framework to reduce the amount of fiscal flexibility available for allocation in each annual budget. Although that framework was successful in contributing to the elimination of persistent budgetary deficits, this paper advances three linked arguments: • that additional but undisclosed prudence factors were also introduced into the fiscal framework to attenuate the political risk of missing budget targets; • that these undisclosed prudence factors are one cause of a number of unintended budgetary outcomes that put the effectiveness of the budgetary process at risk; and • that there is nothing inherently politically partisan about the Liberal’s approach to prudent budget planning and, changes to terminology and display notwithstanding, the present Conservative government has continued to apply most elements of that framework in its budgets. Moving from a single-year budget target to one that is expressed as a cumulative total over the election cycle is discussed as one option that would help preserve the merits of prudent budgeting.

Hypoxia-induced epigenetic modifications are associated with cardiac tissue fibrosis and the development of a myofibroblast-like phenotype

Ischemia caused by coronary artery disease and myocardial infarction leads to aberrant ventricular remodeling and cardiac fibrosis. This occurs partly through accumulation of gene expression changes in resident fibroblasts, resulting in an overactive fibrotic phenotype. Long-term adaptation to a hypoxic insult is likely to require significant modification of chromatin structure in order to maintain the fibrotic phenotype. Epigenetic changes may play an important role in modulating hypoxia-induced fibrosis within the heart. Therefore, the aim of the study was to investigate the potential pro-fibrotic impact of hypoxia on cardiac fibroblasts and determine whether alterations in DNA methylation could play a role in this process. This study found that within human cardiac tissue, the degree of hypoxia was associated with increased expression of collagen 1 and alpha-smooth muscle actin (ASMA). In addition, human cardiac fibroblast cells exposed to prolonged 1% hypoxia resulted in a pro-fibrotic state. These hypoxia-induced pro-fibrotic changes were associated with global DNA hypermethylation and increased expression of the DNA methyltransferase (DNMT) enzymes DNMT1 and DNMT3B. Expression of these methylating enzymes was shown to be regulated by hypoxia-inducible factor (HIF)-1α. Using siRNA to block DNMT3B expression significantly reduced collagen 1 and ASMA expression. In addition, application of the DNMT inhibitor 5-aza-2'-deoxycytidine suppressed the pro-fibrotic effects of TGFβ. Epigenetic modifications and changes in the epigenetic machinery identified in cardiac fibroblasts during prolonged hypoxia may contribute to the pro-fibrotic nature of the ischemic milieu. Targeting up-regulated expression of DNMTs in ischemic heart disease may prove to be a valuable therapeutic approach.

Sedimentology of sites 14-141, 41-366, 47-397 and 79-544B

Along the N-S-transect of DSDP-Sites 5446, 397, 141, and 366, oxygen and carbon isotopes, flux rates of calcium carbonate, terrigenous matter, and biogenic opal, clay minerals and the size distribution of terrigenous partictes were determined in order to assess the ties between atmospheric and oceanic surface and deep-water circulation off northwest Africa during the late Neogene. During the last 9 m.y., both the paleoceanography in the eastern Atlantic and west African paleodimates were intimately correlated with the evolution of the polar ice sheets as reflected in the benthos d18O curves of the 4 DSDP-Sites. These records make it possible to distinguish six major time intervals which were charaterized by long-term persistent regimes of climatic stability or climatic change. Short-term, "Milankovitch"-type cycles superimpose the long-term climatic evolution and may reflect the chronostratigraphic control fluctuations of the solar insolation persisting back to pre-Pleistocene times. Relatively stable, warm climates prevailed during the late Tortonian/early Messinean, 9 to 6 m.y., and the early Pliocene, 4.5 to 3.5 m.y. ago. Based on d18O curves, the amplitudes of short-term climatic variation were generally low, and the ice sheets were smaller than during peak Holocene time. Oceanic circulation and resulting paleoproductivity in upwelling zones were insignificant. The strength of dust supplying meridional trade winds was low (3 to 5 m/s), interglacial-style zonal winds near the ITCZ were dominant, as indicated by the high abundance of kaolinite. Phases of fluvial sediment supply were common. Humidity was characteristic of the climate in northwest Africa for the major part of this time. Major episodes of climatic deterioration in the subtropics occurred in the latest Miocene/early Pliocene, between some 5.6 and 5.2 and between 4.9 and 4.6 m.y. ago, in the late Pliocene, between 3.2 and 2.4 m.y. ago, and again in the Quaternary, near 1 m.y. ago. The episodes were correlated with marked increases of the global ice volume, as revealed by drastic increases of d18O values. They suggest sea-level falls of up to 70 m below the present sea level in the latest Miocene and earliest Pliocene and of 145 m in the latest Pliocene and Quaternary. The climatic changes resulted in strongly enhanced meridional trade winds as suggested by coarser terrigenous grain-sizes, increased mass accumulation rates of eolian dust, and changes in clay-mineral composition from dominantly kaolinite to illite and chlorite. The meridional trade winds reached speeds of 8 to 10 m/s with a maximum near 15 m/s. The enhanced winds probably led t o intensified coastal upwelling as shown by the contemporaneous local increase i n the deposition of biogenic silica and the local depletion of 13C at Site 397. The most drastic environmental changes near 2.4 and 1 m.y. ago coincide with hiatuses which may indicate phases of general erosion due to strongly enhanced deep-water circulation in the northeast At1antic along the northwest African continental margin. The occasional occurrence of quartz grains coarser than 250 µm may suggest ice-rafted debris in sediments off Morocco. During these time intervals the climate in NW-Africa was dominantly arid. Nevertheless, fluvial runoff (and humidity) continued to be important during intermittent warm phases of the short-term climatic cycles. During the end and the beginning of (inter-) glacial times, fluvial supply of nutrients seems to be the dominant factor, controling phases of enhanced paleoproductivity observed off northwest Africa, whereas during phases of glacial maximum strenger fertility of (increased) coastal upwelling becomes more important. A long-term evolution of paleoenvironments during the last 40 m.y. is depicted in the sediments of Site 366 and is clearly controlled by the plate tectonic route of this Site. During Oligocene times, Site 366 lay in the center of the equatorial upwelling, as shown by the high content of biogenic silica contributing up to 100 % of the carbonate-free sediment fraction >6 µm. The influence of equatorial upwelling abruptly terminated near 15 m.y. ago, a change in the record exaggerated by a hiatus of about 2 m.y. Prior to 25 m.y., the terrigenous input at the paleolatitude of Site 366 was restricted t o eolian sediment supply from South Africa by southeasterly trade winds, as shown by dominantly illite and chlorite in the clay fraction and extremely fine-grained terrigenous matter. Near the Oligocene/Miocene boundary, Site 366 drifted across the equator into the belt of the northeasterly trade winds, which is inferred from the increased content of kaolinite and coarser grain sizes of the terrigenous sediment fraction. The clay-mineral and grain-size compositions of Site 366 do not reflect a noteworthy northward shift of the ITCZ during late Miocene and early Pliocene times, i.e. no marked global circulation asymmetry due to the possible absence of a major Northern Hemisphere glaciation (Flohn 1981). This lack of a more northerly position of the ITCZ may result from a bipolar glaciation already existing during late Miocene times, such as also suggested by the evidence of tillites on Iceland and in southern Alaska during those intervals (e.g., Denton & Amstrong 1969, Mudie & Helgason 1983).

Modeling long-term variability and change of soil moisture and groundwater level - from catchment to global scale

The water stored in and flowing through the subsurface is fundamental for sustaining human activities and needs, feeding water and its constituents to surface water bodies and supporting the functioning of their ecosystems. Quantifying the changes that affect the subsurface water is crucial for our understanding of its dynamics and changes driven by climate change and other changes in the landscape, such as in land-use and water-use. It is inherently difficult to directly measure soil moisture and groundwater levels over large spatial scales and long times. Models are therefore needed to capture the soil moisture and groundwater level dynamics over such large spatiotemporal scales. This thesis develops a modeling framework that allows for long-term catchment-scale screening of soil moisture and groundwater level changes. The novelty in this development resides in an explicit link drawn between catchment-scale hydroclimatic and soil hydraulics conditions, using observed runoff data as an approximation of soil water flux and accounting for the effects of snow storage-melting dynamics on that flux. Both past and future relative changes can be assessed by use of this modeling framework, with future change projections based on common climate model outputs. By direct model-observation comparison, the thesis shows that the developed modeling framework can reproduce the temporal variability of large-scale changes in soil water storage, as obtained from the GRACE satellite product, for most of 25 large study catchments around the world. Also compared with locally measured soil water content and groundwater level in 10 U.S. catchments, the modeling approach can reasonably well reproduce relative seasonal fluctuations around long-term average values. The developed modeling framework is further used to project soil moisture changes due to expected future climate change for 81 catchments around the world. The future soil moisture changes depend on the considered radiative forcing scenario (RCP) but are overall large for the occurrence frequency of dry and wet events and the inter-annual variability of seasonal soil moisture. These changes tend to be higher for the dry events and the dry season, respectively, than for the corresponding wet quantities, indicating increased drought risk for some parts of the world.

Factors and mechanisms controlling soil organic carbon turnover in subsoils of agricultural sites

Two-third of the terrestrial C is stored in soils, and more than 50% of soil organic C (SOC) is stored in subsoils from 30 – 100 cm. Hence, subsoil is important as a source or sink for CO2 in the global carbon cycle. Especially the stable organic carbon (OC) is stored in subsoil, as several studies have shown that subsoil OC is of a higher average age than topsoil OC. However, there is still a lack of knowledge regarding the mechanisms of C sequestration and C turnover in subsoil. Three main factors are discussed, which possibly reduce carbon turnover rates in subsoil: Resource limitation, changes in the microbial community, and changes in gas conditions. The experiments conducted in this study, which aimed to elucidate the importance of the mentioned factors, focused on two neighbouring arable sites, with depth profiles differing in SOC stocks: One Colluvic Cambisol (Cam) with high SOC contents (8-12 g kg-1) throughout the profile and one Haplic Luvisol (Luv) with low SOC contents (3-4 g kg-1) below 30 cm depth. The first experiment was designed to gain more knowledge regarding the microbial community and its influence on carbon sequestration in subsoil. Soil samples were taken at four different depths on the two sites. Microbial biomass C (MBC) was determined to identify depth gradients in relation to the natural C availability. Bacterial and fungal residues as well as ergosterol were determined to quantify changes in the in the microbial community composition. Multi-substrate-induced-respiration (MSIR) was used to identify shifts in functional diversity of the microbial community. The MSIR revealed that substrate use in subsoil differed significantly from that in topsoil and also differed highly between the two subsoils, indicating a strong influence of resource limitations on microbial substrate use. Amino sugar analysis and the ratio of ergosterol to microbial biomass C showed that fungal dominance decreased with depth. The results clearly demonstrated that microbial parameters changed with depth according to substrate availability. The second experiment was an incubation experiment using subsoil gas conditions with and without the addition of C4 plant residues. Soil samples were taken from topsoil and subsoil of the two sites. SOC losses during the incubation, were not influenced by the subsoil gas conditions. Plant-derived C losses were generally stronger in the Cam (7.5 mg g-1), especially at subsoil gas conditions, than in the Luv (7.0 mg g-1). Subsoil gas conditions had no general effects on microbial measures with and without plant residue addition. However, the contribution of plant-derived MBC to total MBC was significantly reduced at subsoil gas conditions. This lead to the conclusion that subsoil gas conditions alter the metabolism of microorganisms but not the degradation of added plant residues is general. The third experiment was a field experiment carried out for two years. Mesh bags containing original soil material and maize root residues (C4 plant) were buried at three different depths at the two sites. The recovery of the soilbags took place 12, 18, and 24 months after burial. We determined the effects of these treatments on SOC, density fractions, and MBC. The mean residence time for maize-derived C was similar at all depths and both sites (403 d). MBC increased to a similar extent (2.5 fold) from the initial value to maximum value. This increase relied largely on the added maize root residues. However, there were clear differences visible in terms of the substrate use efficiency, which decreased with depth and was lower in the Luv than in the Cam. Hence freshly added plant material is highly accessible to microorganisms in subsoil and therefore equally degraded at both sites and depths, but its metabolic use was determined by the legacy of soil properties. These findings provide strong evidence that resource availability from autochthonous SOM as well as from added plant residues have a strong influence on the microbial community and its use of different substrates. However, under all of the applied conditions there was no evidence that complex substrates, i.e. plant residues, were less degraded in subsoil than in topsoil.

Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital

Background: Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Methods: Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. Results: One hundred twenty‑four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty‑one percent were male. Motorized vehicles caused 51% of injuries in males. Forty‑one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty‑seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long‑term follow‑up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work. Conclusion: Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.