Use of reprocessed external fixators in orthopaedic surgery: a survey of 243 orthopaedic trauma surgeons

Abstract Background The increasing financial burden of orthopaedic implants on our health care system has prompted cost-control measures, such as implant reprocessing. The purpose of this study was to describe the current usage by orthopaedic trauma surgeons of reprocessed external fixators (EFs) for treatment of complex fractures. Methods A 16-question survey about use and perceptions of reprocessed EFs was distributed to 894 Orthopaedic Trauma Association members between August 2016 and June 2017 using a web-based survey system. Results The authors received 243 responses (27%). Thirty-seven percent of respondents reported using reprocessed EFs. Nonprofit hospitals used reprocessed EFs more commonly than did for-profit hospitals (41% vs 15%, P = .0004). Eighty-seven percent of respondents believed reprocessing could be cost-effective. The most common reason (32%) for not using reprocessed EFs was coordination/logistics of reprocessing. Concern about litigation was also reported as a main reason for not using (20%) or having recently stopped using (21%) reprocessed EFs. Conclusions Many orthopaedic traumatologists are interested in the reprocessing of EF components but few have reprocessing systems in place at their institutions. A major barrier to implementation is concern about litigation, which is likely unwarranted on the basis of Food and Drug Administration approval and a lack of previous litigation. Reprocessing by the original device manufacturers has yielded substantial savings at our institution and is an example of the cost savings that can be expected when implementing an EF reprocessing system

Distribution et prevalence de Aphelenchoides besseyi (christie) sur les semences de riz en Afrique

Le riz (Oryza sativa) est un aliment de base de la plupart des pays africains et il est également sujet à l'attaque de nombreux ravageurs parmi lesquels, les nématodes parasites des plantes qui réduisent le rendement. L'objectif de ce travail est d'étudier la distribution et la prévalence du nématode de grains Aphelenchoides besseyi dans trois écologies incluant vingt un (21) pays en Afrique. Pour caractériser le nématode, des essais suivis de collectes des accessions de riz à la récolte ont été effectués dans ces pays entre avril 2012 et septembre 2012. Un total de 105 accessions de riz a été prélevé, dont 35 par écologie. Il s’agit de trois écologies dont l’écologie de basfond, de plateau et des zones en altitude. Les échantillons ont été amenés au laboratoire de nématologie de l’Institut International d’Agriculture Tropicale (IITA) à Cotonou au Bénin. Les nématodes ont été extraits en utilisant la méthode de Baermann. Pour l'extraction des nématodes, 5 grammes de grains ont été utilisés par accession. Le résultat a montré que la distribution de A. besseyi était différente selon le pays et à l'intérieur d'un pays selon l’écologie. Ainsi, aucun A. besseyi n'a été enregistré dans l'écologie de basfond au Libéria, au Sénégal et au Tchad ni en Ouganda en haute altitude et pourrait être considéré comme un organisme de quarantaine dans ces régions. La fréquence a été déterminée et le rôle du ravageur A. besseyi dans la réduction de la qualité des semences de riz au Togo a été discuté.Mots clés: Grains de riz, Aphelenchoides besseyi, organisme de quarantaine écosystèmeEnglish Title: Distribution and prevalence of Aphelenchoides besseyi (Christie) on rice seeds in AfricaEnglish AbstractRice (Oryza sativa) is a staple food in most of African countries and it is also subject to the attack of many pests among which, plants parasitic nematodes are very important. The objective of this work is to study the distribution and the prevalence of the seed nematode Aphelenchoides besseyi in three agro-ecosystems which included twenty-one (21) countries in Africa. To characterize the nematode, a trial was carried out followed by the survey at the harvest across 21 countries in Africa between (April 2012) and (September 2012). A total of 105 rice seeds samples were collected which included 35 accession per ecology. The three ecologies were the lowland, the Upland and the High altitude. The samples were brought to the Laboratory of nematology of the International Institute of Tropical Agriculture (IITA) Cotonou in Benin. The nematodes were extracted by using the method of Baermann. For the nematode extraction, 5 grams of seeds were used by samples the result showed that the distribution of A. besseyi was different according to the country and within a country according to the ecology. Thus, no A. besseyi was recorded from the lowland ecology in Liberia, Senegal and Chad neither at Uganda in high altitude and could be considered as quarantine pest in those regions. The frequency of occurrence was determined and the role of A. besseyi in reducing rice seeds quality in Togo was discussed.Keywords: Rice seeds, Aphelenchoides besseyi, quarantinable organism, ecosyste

Moderate rate of transmitted resistance mutations to antiretrovirals and genetic diversity in newly HIV-1 patients diagnosed in Benin

ObjectiveSeventeen years after the start of the IBAARV (Beninese initiative for access to antiretrovirals), transmitted drug resistance mutations in ARV-naive patients and HIV-1 genetic diversity were investigated in Benin.ResultsDrug resistance mutations were detected in (27/248; 10.9%) according to the WHO SDRM 2009 list, with a predominance of mutations directed against NNRTIs drugs (24/248; 10%). Phylogenetic and recombination analyses showed a predominance of CRF02_AG strains (165/248; 66.5%) and a high genetic diversity with five other variants and 39 URFs (15.7%) which contained portions of strains that co-circulate in Benin. Eight recent transmission chains revealed active ongoing transmission of HIV-1 strains among ARV-naive patients. Our study showed a moderate primary drug resistance mutations rate and also provided recent data on the HIV-1 variants that circulate in Benin. Regular monitoring of primary drug resistance is required to adapt HIV-1 treatment strategies and adoption of new WHO recommendations in Benin

A mathematical model impact analysis of a real-life pre-exposure prophylaxis and treatment-as-prevention study among female sex workers in Cotonou, Benin

BACKGROUND: Daily pre-exposure prophylaxis (PrEP) and treatment-as-prevention (TasP) reduce HIV acquisition and transmission risk, respectively. A demonstration study (2015-2017) assessed TasP and PrEP feasibility among female sex workers (FSW) in Cotonou, Benin. SETTING: Cotonou, Benin METHODS:: We developed a compartmental HIV transmission model, featuring PrEP, and ART among the high-risk (FSW, clients) and low-risk populations, calibrated to historical epidemiological and demonstration study data, reflecting observed lower PrEP uptake, adherence and retention compared to TasP. We estimated the population-level impact of the two-year study and several twenty-year intervention scenarios, varying coverage and adherence independently and together. We report the percentage (median, 2.5th-97.5th percentile uncertainty interval (95%UI)) of HIV infections prevented comparing the intervention and counterfactual (2017 coverages: 0% PrEP, 49% ART) scenarios. RESULTS: The two-year study (2017 coverages: 9% PrEP, 83% ART) prevented an estimated 8% (95%UI 6-12) and 6% (3-10) infections among FSW over two and twenty years, respectively, compared to 7% (3-11) and 5% (2-9) overall. The PrEP and TasP arms prevented 0.4% (0.2-0.8) and 4.6% (2.2-8.7) infections overall over 20 years, respectively. Twenty-year PrEP and TasP scale-ups (2035 coverages: 47% PrEP, 88% ART) prevented 21% (17-26) and 17% (10-27) infections among FSW respectively, and 5% (3-10) and 17% (10-27) overall. Compared to TasP scale-up alone, PrEP and TasP combined scale-up prevented 1.9x and 1.2x more infections among FSW and overall, respectively. CONCLUSIONS: The modest demonstration study impact was modest, and mostly from TasP. Increasing PrEP adherence and coverage improves impact substantially among FSW, but little overall. We recommend TasP in prevention packages