A retrospective analysis of controlled active motion (CAM) versus modified Kleinert/Duran (modKD) rehabilitation protocol in flexor tendon repair (zones I and II) in a single center.

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 < 0.001) than the TAM in group 2 [141° (90-195°)] but with similar extension deficits in both groups. The assessment of range of motion by the original Strickland classification system resulted in 20% excellent and 15% good outcomes in the CAM group 1 compared with 42% and 36% in the modK/D group 2. Subanalysis demonstrated improvement of good/excellent results according to Strickland from 45% at 3 months to 63.6% after 6-month follow-up in the CAM group. 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

Measurement of reflectivity of butt-joint active-passive interfaces in integrated extended cavity lasers

A method and measurement results are presented for the determination of the reflectivity of butt-joint active-passive interfaces in a series of extended cavity Fabry-Pe´rot lasers. The method is based on the analysis of subthreshold laser spectra. The small reflections at the two intracavity active-passive interfaces modify the mode structure of the laser. By fitting the calculated subthreshold mode structure to the recorded data, values of the reflectivities are extracted. An average value of 9.10-5 has been determined. The value of the reflectivity of those interfaces is relevant for photonic integrated circuits and particularly integrated mode-locked lasers

Synthesis and Bulk Properties of poly(methylmethacrylate)-b-poly(isooctylacrylate)-b-poly(methylmethacrylate)

peer reviewe

Direct formulation of the supersonic acoustic intensity in space domain

International audienceThis paper proposes and examines a direct formulation in space domain of the so-called supersonic acoustic intensity. This quantity differs from the usual (active) intensity by excluding the circulating energy in the near-field of the source, providing a map of the acoustic energy that is radiated into the far field. To date, its calculation has been formulated in the wave number domain, filtering out the evanescent waves outside the radiation circle and reconstructing the acoustic field with only the propagating waves. In this study, the supersonic intensity is calculated directly in space domain by means of a two-dimensional convolution between the acoustic field and a spatial filter mask that corresponds to the space domain representation of the radiation circle. Therefore, the acoustic field that propagates effectively to the far field is calculated via direct filtering in space domain. This paper presents the theory, as well as a numerical example to illustrate some fundamental principles. An experimental study on planar radiators was conducted to verify the validity of the technique. The experimental results are presented, and serve to illustrate the usefulness of the analysis, its strengths and limitations

Reduction in mortality from HIV-related CNS infections in routine care in Africa (DREAMM): a before-and-after, implementation study

BACKGROUND: Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality (DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection. METHODS: DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379. FINDINGS: From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference –23%, 95% CI –33 to –13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (–13%, –24 to –3; p=0·01). INTERPRETATION: DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals. FUNDING: European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section

Feeding climate and biodiversity goals with novel plant-based meat and milk alternatives

Plant-based animal product alternatives are increasingly promoted to achieve more sustainable diets. Here, we use a global economic land use model to assess the food system-wide impacts of a global dietary shift towards these alternatives. We find a substantial reduction in the global environmental impacts by 2050 if globally 50% of the main animal products (pork, chicken, beef and milk) are substituted—net reduction of forest and natural land is almost fully halted and agriculture and land use GHG emissions decline by 31% in 2050 compared to 2020. If spared agricultural land within forest ecosystems is restored to forest, climate benefits could double, reaching 92% of the previously estimated land sector mitigation potential. Furthermore, the restored area could contribute to 13-25% of the estimated global land restoration needs under target 2 from the Kunming Montreal Global Biodiversity Framework by 2030, and future declines in ecosystem integrity by 2050 would be more than halved. The distribution of these impacts varies across regions—the main impacts on agricultural input use are in China and on environmental outcomes in Sub-Saharan Africa and South America. While beef replacement provides the largest impacts, substituting multiple products is synergistic

Hundreds of genetic barcodes of the species-rich hydroid superfamily Plumularioidea (Cnidaria, Medusozoa) provide a guide toward more reliable taxonomy

Marine hydroids are important benthic components of shallow and deep waters worldwide, but their taxonomy is controversial because diagnostic morphological characters to categorize taxa are limited. Their genetic relationships are also little investigated. We tested taxonomic hypotheses within the highly speciose superfamily Plumularioidea by integrating a classical morphological approach with DNA barcoding of the 16S and COI mitochondrial markers for 659 and 196 specimens of Plumularioidea, respectively. Adding Genbank sequences, we inferred systematic relationships among 1,114 plumularioids, corresponding to 123 nominal species and 17 novel morphospecies in five families of Plumularioidea. We found considerable inconsistencies in the systematics of nominal families, genera and species. The families Kirchenpaueriidae and Plumulariidae were polyphyletic and the Halopterididae paraphyletic. Most genera of Plumularioidea are not monophyletic. Species diversity is considerably underestimated. Within our study, at least 10% of the morphologically-distinctive morphospecies are undescribed, and about 40% of the overall species richness is represented by cryptic species. Convergent evolution and morphological plasticity therefore blur systematic relationships. Additionally, cryptic taxa occur frequently in sympatry or parapatry, complicating correspondence with type material of described species. Sometimes conspecificity of different morphotypes was found. The taxonomy of hydroids requires continued comprehensive revision.This work relied on several hydrozoan samples collected from various sites, with the aid of many people. Supplementary Table S1 refers many of the people involved in the collection and/or preservation of the samples. C.J.M. acknowledges his great buddy-divers Jaime N.-Ruiz (CIMAR, Univ. Costa Rica), Axel Calderon, Nathaniel Chu, Eleni Petrou (STRI, Smiths. Inst.), Hanae Spathias, Karen Koltes (at the Belize station, Smith. Inst.), Freya Sommer (Hopkins Marine Station), Remilson Ferreira ('Costa Norte', Sao Tome), Frederico Cardigos (DOP, Univ. Azores) and others that assisted the dives. C.J.M. also acknowledges Rita Castillo (CIMAR, Univ. Costa Rica), Plinio Gondola, Ligia Calderon, Laura Geyer, Maria Castillo (STRI, Smiths. Inst.), Gregory Ruiz (SERC, Smiths. Inst.), Paul Greenhall, William Keel (MSC, Smith. Inst.), Manuel Enes, Valentina Matos (IMAR/DOP, Univ. Azores), Filipe Porteiro, Joao Goncalves (OKEANOS/IMAR, Univ. Azores), Marina Cunha, Ascensao Ravara (CESAM, Univ. Aveiro), Shirley Pomponi (Harbor Branch, Florida Atlantic Univ.), Estrela Matilde (Fundacao Principe Trust), Monica Albuquerque, Ines Tojeira (EMEPC), Diana Carvalho (Nat. Mus. Nat. Hist., Lisbon) and many others colleagues that facilitated the morphologic classifications and deposition of the samples. Peter Schuchert (Mus. d'Hist. Nat. Geneve) kindly provided some DNA extractes. Todd Kincaid and his team of GUE divers (Project Baseline - Azores) collected valuable samples from unusual depths. Joana Boavida (CIIMAR, Univ. Algarve) facilitated some samples of the 'DeepReefs' project. Jim Drewery (Marine Scotland Science Inst.) also provided few samples. Dale Calder (Royal Ontario Museum) provided some bibliography to C.J.M. and discussed/resolved some dubios taxonomic classifications. Colleagues at the L.A.B. (NMNH, Smith. Inst.) were very supportive. The APC fees for open access publication were supported by a program of the Regional Government of the Azores ("Apoio ao funcionamento e gestao dos centros de I&D regionais: 2018 - DRCT-medida 1

African food system and biodiversity mainly affected by urbanization via dietary shifts

The rapid urbanization in Africa profoundly affects local food and ecological systems. According to earlier research, urbanization may cause food production and biodiversity losses as agricultural or natural lands are absorbed by expanding cities. Land-use displacement effects may buffer agricultural production losses or may lead to additional biodiversity losses but are often overlooked. Moreover, impacts of dietary changes associated with urbanization are rarely considered. To address this, we combined spatially explicit projections of African urban area expansion with observed rice consumption shifts to inform a partial equilibrium model (the Global Biosphere Management Model). We demonstrate the importance of displacement effects to identify potential food production or biodiversity issues until 2050 and argue for their integration in land-use planning and policymaking across spatial scales. We identify that because of agricultural displacement, the impact of urban area expansion on food production losses is probably limited (<1%)—at the cost of additional losses of natural lands by 2050 (up to 2 Mt). We also show that considering dietary shifts associated with urbanization increases rice consumption, production (+8.0%), trade (up to +2 Mt of required import) and agricultural methane emissions (up to +12 MtCO2-equivalent yr–1), thereby underscoring the need for a systems approach in future sustainability studies

Global priority areas for ecosystem restoration

Extensive ecosystem restoration is increasingly seen as being central to conserving biodiversity1 and stabilizing the climate of the Earth2. Although ambitious national and global targets have been set, global priority areas that account for spatial variation in benefits and costs have yet to be identified. Here we develop and apply a multicriteria optimization approach that identifies priority areas for restoration across all terrestrial biomes, and estimates their benefits and costs. We find that restoring 15% of converted lands in priority areas could avoid 60% of expected extinctions while sequestering 299 gigatonnes of CO2—30% of the total CO2 increase in the atmosphere since the Industrial Revolution. The inclusion of several biomes is key to achieving multiple benefits. Cost effectiveness can increase up to 13-fold when spatial allocation is optimized using our multicriteria approach, which highlights the importance of spatial planning. Our results confirm the vast potential contributions of restoration to addressing global challenges, while underscoring the necessity of pursuing these goals synergistically.Fil: Strassburg, Bernardo B. N.. Pontifícia Universidade Católica do Rio de Janeiro; Brasil. Universidade Federal do Rio de Janeiro; BrasilFil: Iribarrem, Alvaro. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Beyer, Hawthorne L.. The University of Queensland; Australia. University of Queensland; AustraliaFil: Cordeiro, Carlos Leandro. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Crouzeilles, Renato. Universidade Federal do Rio de Janeiro; Brasil. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Jakovac, Catarina C.. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Braga Junqueira, André. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Lacerda, Eduardo. Pontifícia Universidade Católica do Rio de Janeiro; Brasil. Universidade Federal Fluminense; BrasilFil: Latawiec, Agnieszka E.. University of East Anglia; Reino Unido. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Balmford, Andrew. University of Cambridge; Estados UnidosFil: Brooks, Thomas M.. University Of The Philippines Los Banos; Filipinas. Institute For Marine And Antarctic Studies; Australia. International Union For Conservation Of Nature And Natural Resources; SuizaFil: Butchart, Stuart H. M.. University of Cambridge; Estados UnidosFil: Chazdon, Robin L.. University Of The Sunshine Coast; Australia. University of Connecticut; Estados UnidosFil: Erb, Karl-Heinz. Universitat Fur Bodenkultur Wien; AustriaFil: Brancalion, Pedro. Universidade de Sao Paulo; BrasilFil: Buchanan, Graeme. Royal Society For The Protection Of Birds; Reino UnidoFil: Cooper, David. Secretariat Of The Convention On Biological Diversity; CanadáFil: Díaz, Sandra Myrna. Universidad Nacional de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Donald, Paul F.. University of Cambridge; Estados UnidosFil: Kapos, Valerie. United Nations Environment Programme World Conservation Monitoring Centre; Reino UnidoFil: Leclère, David. International Institute For Applied Systems Analysis, Laxenburg; AustriaFil: Miles, Lera. United Nations Environment Programme World Conservation Monitoring Centre; Reino UnidoFil: Obersteiner, Michael. Oxford Social Sciences Division; Reino Unido. International Institute For Applied Systems Analysis, Laxenburg; AustriaFil: Plutzar, Christoph. Universitat Fur Bodenkultur Wien; Austria. Universidad de Viena; AustriaFil: de M. Scaramuzza, Carlos Alberto. International Institute For Sustainability; BrasilFil: Scarano, Fabio R.. Universidade Federal do Rio de Janeiro; BrasilFil: Visconti, Piero. International Institute For Applied Systems Analysis, Laxenburg; Austri