Search

Introduction The aim of this study was to analyze primary flexor tendon repair results in zones I and II, comparing the rupture rate and clinical outcomes of the controlled active motion (CAM) protocol with the modified Kleinert/Duran (mKD) protocol. Materials and methods Patients who underwent surgery with traumatic flexor tendon lacerations in zones I and II were divided in three groups according to the type of rehabilitation protocol and period of management: group 1 included patients who underwent CAM rehabilitation protocol with six-strand Lim and Tsai suture after May 2014. Group 2 and 3 included patients treated by six-strand Lim Tsai suture followed by a modified Kleinert/Duran (modK/D) protocol with additional place and hold exercises between 2003 and 2005 (group 2) and between 2011 and 2013 (group 3). Results Rupture rate was 4.7% at 12 weeks in group 1 (3/63 flexor tendon repairs) compared to 2% (1/51 flexor tendon repairs) in group 2 and 8% in group 3 (7/86 flexor tendon repairs). The grip strength at 12 weeks was significantly better in group 2 compared to the group 1 (35 kg/25 kg, p = 0.006). The TAM in group 1 [113° (30–175°)] was significantly worse (p Conclusion The gut feeling that lead to change in our rehabilitation protocol could be explained by the heterogenous bias. A precise outcome analysis of group 1 could underline that in patients with complex hand trauma, nerve reconstruction, oedema or early extension deficit, an even more intensive and individual rehabilitation has to be performed to achieve better TAM at 6 or 12 weeks. Our study explicitly demonstrated a significant better outcome in the modK/D group compared to CAM group. This monocenter study is limited by its retrospective nature and the low number of patients.

Despite the acknowledged benefits of crop diversification, the transition towards more diversified cropping systems needs to be supported, mainly due to socio-technical lock-ins favoring major dominant crop species. This calls for the development of new approaches to support the design of locally tailored diversified cropping systems. This paper aims to present an original participatory and multi-actor design approach, developed to support the introduction of camelina (Camelina sativa) into the cropping systems of northern France and to provide some insights about the characteristics, the specificities, and the limits of this approach to support its use and adaptation to other contexts. For 3 years, and in connection with the development of an oilseed biorefinery, we gathered a variety of actors (farmers, advisors, engineers in agronomy, researchers, and industrialists) to locally support the introduction of camelina in the cropping systems. First, we illustrate the diversity of the modalities that have been collectively imagined to introduce and manage camelina in the local cropping systems. Then, we describe the originality and the diversity of the knowledge produced on camelina, especially during the assessment of some of these modalities within on-farm experiments. Finally, drawing on concepts and theories from design sciences, we show that (i) the pre-existence of networks of actors, (ii) the rationale involvement of the actors, (iii) the implementation of a situated design process fueled by action and distributed among actors, (iv) the sharing and the circulation of knowledge among a diversity of actors involved in the production and use of the new crop, and (v) the implementation of an effective network management contributed to foster the three key elements that we identified as crucial to support crop diversification, namely, the production of actionable knowledge, the exploration of new ideas/concepts, and the active participation of a diversity of actors of the agri-food system.

In response to the sustainability issues that agriculture faces in advanced economies, agroecology has gained increasing relevance in scientific, political, and social debates. This has promoted discussion about transitions to agroecology, which represents a significant advancement. Accordingly, it has become a growing field of research. We reviewed the literature on and in support of farm transitions to agroecology in advanced economies in order to identify key research challenges and suggest innovative research paths. Our findings can be summarized as follows: (1) Research that supports exploration and definition of desired futures, whether based on future-oriented modeling or expert-based foresight approaches, should more explicitly include the farm level. It should stimulate the creativity and design ability of farmers and other stakeholders, and also address issues of representation and power among them. (2) Research that creates awareness and assesses farms before, during or after transition requires more holistic and dynamic assessment frameworks. These frameworks need to be more flexible to adapt to the diversity of global and local challenges. Their assessment should explicitly include uncertainty due to the feedback loops and emergent properties of transitions. (3) Research that analyzes and supports farms during transition should focus more on the dynamics of change processes by valuing what happens on the farms. Research should especially give more credence to on-farm experiments conducted by farmers and develop new tools and methods (e.g., for strategic monitoring) to support these transitions. This is the first review of scientific studies of farm transitions to agroecology. Overall, the review indicates that these transitions challenge the system boundaries, temporal horizons, and sustainability dimensions that agricultural researchers usually consider. In this context, farm transitions to agroecology require changes in the current organization and funding of research in order to encourage longer term and more adaptive configurations.

While nitrogen inputs are crucial to agricultural production, excess nitrogen contributes to serious ecosystem damage and water pollution. Here, we investigate this trade-off using an integrated modelling framework. We quantify how different nitrogen mitigation options contribute to reconciling food security and compliance with regional nitrogen surplus boundaries. We find that even when respecting regional nitrogen surplus boundaries, hunger could be substantially alleviated with 590 million fewer people at risk of hunger from 2010 to 2050, if all nitrogen mitigation options were mobilized simultaneously. Our scenario experiments indicate that when introducing regional N targets, supply-side measures such as the nitrogen use efficiency improvement are more important than demand-side efforts for food security. International trade plays a key role in sustaining global food security under nitrogen boundary constraints if only a limited set of mitigation options is deployed. Policies that respect regional nitrogen surplus boundaries would yield a substantial reduction in non-CO2 GHG emissions of 2.3 GtCO2e yr−1 in 2050, which indicates a necessity for policy coordination.

Input–output estimates of nitrogen on cropland are essential for improving nitrogen management and better understanding the global nitrogen cycle. Here, we compare 13 nitrogen budget datasets covering 115 countries and regions over 1961–2015. Although most datasets showed similar spatiotemporal patterns, some annual estimates varied widely among them, resulting in large ranges and uncertainty. In 2010, global medians (in TgN yr−1) and associated minimum–maximum ranges were 73 (64–84) for global harvested crop nitrogen; 161 (139–192) for total nitrogen inputs; 86 (68–97) for nitrogen surplus; and 46% (40–53%) for nitrogen use efficiency. Some of the most uncertain nitrogen budget terms by country showed ranges as large as their medians, revealing areas for improvement. A benchmark nitrogen budget dataset, derived from central tendencies of the original datasets, can be used in model comparisons and inform sustainable nitrogen management in food systems. Existing datasets of nitrogen (N) balance in agriculture are often discrepant. Comparing 13 of them regarding five metrics (fertilizer application, manure application, biological N fixation, atmospheric deposition, and N harvested as crop products) over 1961–2015 reveals why. Recommendations for improving N quantification and an N budget benchmark dataset are also proposed.

To evaluate the validity and reliability of an innovative training model for endocrine surgical procedures. A simulator training model for endocrine procedures (SimLife) was developed at an academic center. The model consisted of a realistic operating environment with a coherent simulated patient dynamized by pulsatile vascularization with simulated blood warmed to 37 °C, and ventilation. Training sessions were designed for adrenal and thyroid surgery, as well as neck dissection. The primary outcome of interest was to evaluate learners’ performance and satisfaction. Learners’ performance was evaluated based on a scoring scale that followed the Downing method for the assessment of competency. While learners’ satisfaction was evaluated using a Likert scale of 1 to 10 on four items (ease of learning, anatomic correspondence of landmarks, realism, and overall satisfaction). Participants were engaged in 32 training sessions. These included 24 adrenalectomies (conventional and laparoscopic both transabdominal and posterior), and 4 thyroid lobectomies with concomitant functional lateral compartment neck dissection. competency scores were procedure-specific addressing specific core components of a given procedure. Learners’ performance scored above average in all procedures evaluated. Satisfaction scores for the specified four items ranged between 8.43 (SD 0.87) and 8.89 (SD 0.96). No major events were reported for the adrenalectomies, while only one jugular vein injury occurred during neck dissection. SimLife is a hyper-realistic training model that allows for satisfactory acquisition of skills and the evaluation of performance progression. It has the potential to become a cornerstone in specialized surgical training. Electronic supplementary material The online version of this article (10.1007/s13304-020-00871-x) contains supplementary material, which is available to authorized users.

International trade enables us to exploit regional differences in climate change impacts and is increasingly regarded as a potential adaptation mechanism. Here, we focus on hunger reduction through international trade under alternative trade scenarios for a wide range of climate futures. Under the current level of trade integration, climate change would lead to up to 55 million people who are undernourished in 2050. Without adaptation through trade, the impacts of global climate change would increase to 73 million people who are undernourished (+33%). Reduction in tariffs as well as institutional and infrastructural barriers would decrease the negative impact to 20 million (-64%) people. We assess the adaptation effect of trade and climate-induced specialization patterns. The adaptation effect is strongest for hunger-affected import-dependent regions. However, in hunger-affected export-oriented regions, partial trade integration can lead to increased exports at the expense of domestic food availability. Although trade integration is a key component of adaptation, it needs sensitive implementation to benefit all regions. ispartof: Nature Climate Change vol:2020 issue:10 pages:829-835 ispartof: location:England status: Published online

INTRODUCTION Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction. MATERIALS AND METHODS Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25-50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor. RESULTS Mean follow-up period was 4.0 years (range 1.2-7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor. CONCLUSION In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.

INTRODUCTION In Switzerland, collagenase Clostridium histolyticum therapy (CCH) for Dupuytren's disease was introduced in 2011. This study analyzes possible differences between CCH and limited fasciectomy (LF) in terms of range of motion, patient satisfaction and postoperative rehabilitation. MATERIALS AND METHODS This retrospective study included 52 patients with Dupuytren's disease stage 1-3 according to Tubiana, treated with CCH or LF between January 2012 and December 2013. Complications were analyzed for each patient. The contracture of each treated joint measured on average at the 3 months and up to 2 years follow-up was compared with the preoperative values. The Michigan Hand score was evaluated at 2 years and the patients were asked to subjectively evaluate the outcome of the treatment and whether they would repeat it if necessary. Postoperative rehabilitation was also precisely quantified. RESULTS 11 minor complications were reported for a complication rate of 29% in the CCH group. No major complications were reported in both groups. In the CCH group, mean MCP joint contracture was, respectively, 44° ± 20°, 9° ± 2° (gain of mobility compared to the preoperative situation 35°, P

BACKGROUND Perilunate dislocations and fracture-dislocations are a subcategory of the carpal instability complex. Herein, we report our university hospital experience with this complex injury. The goal of our study was to find predictive factors and quantify the development of arthritis and lunate necrosis. We tried to measure the impact of arthritis on hand function. METHODS Between January 2000 and December 2014, 21 patients underwent surgery for perilunate dislocations and perilunate fracture-dislocations of the wrist in our tertiary university center. Mean patient age was 29.3 ± 10.0 years (range 18-49 years). All displacements were posterior. They were reviewed both clinically and radiologically. RESULTS Complications included misdiagnosed Essex-Lopresti-like lesion in one case, insufficient reposition of the carpus in two cases (LT in one case, SL in one case), and iatrogenic injury to the radial artery immediately sutured in one case. All 3 cases underwent a second procedure with satisfactory outcome. After a mean follow-up of 112 ± 60 months (range 12-210 months), the average Cooney score was 80 ± 19 (range 50-125). The mean PRWE score was 10 ± 8 (range 0-25). The mean DASH score was 40 ± 13 (range 30-75 months). Mean pain on load, measured with VAS was 1.1 ± 1.6; Clinical examination assessed a mean wrist extension/flexion of 42.4° ± 17.2°/48.4° ± 15.2°. Mean wrist ulnar/radial deviation was, respectively, 22.9° ± 11.3°/15.3° ± 7.0°. Mean pro/supination was, respectively, 75.2° ± 11.5°/76.3° ± 8.1°. Mean pinch strength was 9.4 ± 2.2 kg (87.4 ± 17.7% of the contralateral side). Mean power strength was 41.9 ± 9.9 kg (76.2 ± 19.2% of the contralateral side). Two patients had a scaphoid non-union identified on their most recent imaging. The mean carpal height ratio was 0.53 ± 0.05 (range 0.44-0.65). All except one patient developed arthritis: Grade 1 in 11 patients, Grade 2 in 3 patients, and Grade 3 in the remaining 6 patients. Age, length of follow-up, and loss of reduction were significantly associated with wrist arthritis (p

Background Access to an Emergency Medical Communication Centre is essential for the population in emergency situations. Handling inbound calls without delay requires managing activity, process and outcome measures of the Emergency Medical Communication Centre to improve the workforce management and the level of service. France is facing political decisions on the evolution of the organisation of Emergency Medical Communication Centres to improve accessibility for the population. First, we aim to describe the variation in activity between Emergency Medical Communication Centres, and second, to explore the correlation between process measures and outcome measures. Methods Using telephone activity data extraction, we conducted an observational multicentre study of six French Emergency Medical Communication Centres from 1 July 2016 to 30 June 2017. We described the activity (number of incoming calls, call rate per 1000 inhabitants), process measure (agent occupation rate), and outcome measure (number of calls answered within 20 s) by hourly range and estimated the correlation between them according to the structural equation methods. Results A total of 52,542 h of activity were analysed, during which 2,544,254 calls were received. The annual Emergency Medical Communication Centre call rate was 285.5 [95% CI: 285.2–285.8] per 1000 inhabitants. The average hourly number of calls ranged from 29 to 61 and the call-handled rate from 75 to 98%. There are variations in activity between Emergency Medical Communication Centres. The mean agent occupation rate was correlated with the quality of service at 20 s (coefficient at − 0.54). The number of incoming calls per agent was correlated with the mean occupation rate (coefficient at 0.67). Correlation coefficients varied according to the centres and existed between different process measures. Conclusions The activity dynamics of the six Emergency Medical Communication Centres are not identical. This variability, illustrating the particularity of each centre, must be accurately assessed and should be taken into account in managerial considerations. The call taker occupation rate is the leverage in the workforce management to improve the population accessibility.

The interdependencies among land use systems at national and global levels motivate the development of advanced systems analysis approaches for integration of land use models operating at different weights. The paper develops novel general approaches based on cross entropy principle for downscaling aggregate data and projections, which are robust with respect to feasible priors. Robust downscaling methods account for so-called non-Bayesian uncertainties, i.e., incomplete, unobservable, or erroneous information or data. In numerous case studies in China, African countries, Brazil, and Ukraine, the approaches allowed deriving local development projections of land use and land use change consistently with existing trends and expectations.

Innovations in novel enzyme discoveries impact upon a wide range of industries for which biocatalysis and biotransformations represent a great challenge, i.e., food industry, polymers and chemical industry. Key tools and technologies, such as bioinformatics tools to guide mutant library design, molecular biology tools to create mutants library, microfluidics/microplates, parallel miniscale bioreactors and mass spectrometry technologies to create high-throughput screening methods and experimental design tools for screening and optimization, allow to evolve the discovery, development and implementation of enzymes and whole cells in (bio)processes. These technological innovations are also accompanied by the development and implementation of clean and sustainable integrated processes to meet the growing needs of chemical, pharmaceutical, environmental and biorefinery industries. This review gives an overview of the benefits of high-throughput screening approach from the discovery and engineering of biocatalysts to cell culture for optimizing their production in integrated processes and their extraction/purification.

To evaluate whether deep pelvic endometriosis or endometriomas diagnosed at pelvic MRI are associated with extrapelvic bowel endometriosis (EPBE) (ileal, appendicular, or cecal involvement) in order to suggest criteria for performing an additional imaging examination dedicated to the assessment of EPBE. Ninety-six patients operated on for deep pelvic endometriosis were retrospectively included. They were classified in two groups according to the presence of surgically and histologically proven EPBE. According to pelvic endometriotic lesions described on the preoperative pelvic MRI, a logistic regression analysis was performed to evaluate a possible association between EPBE and pelvic endometriosis. Eleven patients had EPBE (5 appendicular, 2 cecal, and 4 ileocecal lesions) at surgery. In adjusted models, involvement of the right ureter, rectosigmoid, and sigmoid localizations were statistically associated with EPBE with adjusted OR of 9.13 (95% CI 1.98–42.19), 5.8 (95% CI 1.12–30.07), and 6.74 (95% CI 1.23–36.77), respectively. Further imaging evaluation to assess ileal, appendicular, or cecal endometriosis should be proposed in case of sigmoid or rectosigmoid endometriosis diagnosed at pelvic MRI. A right ureteral lesion diagnosed preoperatively should be considered carefully as its association with EPBE is not described so far.

The aim of this Letter to the Editor was to report a strategy to reduce time waiting for emergency calls in a dispatch center, in line with a recently published article that reviewed evidence for medical dispatching systems to accurately dispatch Emergency medical Services. Here, we tested the effect of a connected distribution of calls, where a call is allocated to the first available resource among a pooled group of telecommunicators from several dispatch centers. We found that connect dispatch centers improve dispatch center performance, especially during an overloaded period. It could be leveraged to handle emergency calls without delay and to appropriately dispatch Emergency Medical Services.