Promoting ossification of calvarial defects in craniosynostosis surgery by demineralized bone plate and bone dust in different age groups

Correction of calvarial defects after calvarial vault reconstruction (CVR) is challenging in craniosynostosis patients of advanced age and typically employs autologous bone. Demineralized bone matrix (DBM) is a potential alternative material for autologous bone, but its use has not been extended to correct calvarial defects. CVR patients operated at the Department of Plastic Surgery, Helsinki University Hospital, during 2008-2010 were retrospectively reviewed. Inclusion criteria of the study were CVR patients who received DBM plate, with or without bone dust, on calvarial defects and who had suitable uncovered defect on the contralateral side as control. This study included 17 craniosynostosis and one positional plagiocephaly patient, whose mean age was 6.9 years (range 0.9-19 years). The mean follow-up time was 5.6 years. The fusion degree of all defects was measured from 1 week to 1 year postoperatively using three-dimensional computed tomography (3D CT) images by the OsiriX (R) method. Medical records were reviewed for DBM-related complications. A total of 26 defects were covered with a DBM plate (mean area 11.1 cm(2)) and 26 control defects were identified (mean area 7.8 cm2). The mean fusion degree of the DBM defects was 74% and 54% for the controls (p 30 months) than in younger patients or when used with bone dust. (C) 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.Peer reviewe

North Carolina Cooperative Extension Professionals\u27 Climate Change Perceptions, Willingness, and Perceived Barriers to Programming: An Educational Needs Assessment

The educational needs assessment reported here measured North Carolina Cooperative Extension (NCCE) professionals\u27 perceptions of global warming and identified barriers to climate change programming. Survey results from 400 NCCE professionals show 70% are cautious, concerned, or alarmed about global warming. Liberal and female Extension professionals were more likely to be alarmed and concerned than their conservative and male counterparts. Respondents indicated willingness to engage in programming, but need in-service training to address conflicts, gather information, and emphasize relevancy. NCCE professionals perceive lack of audience interest, conflicts within available information, and lack of applied information as the greatest barriers to climate change programming

Cooperative Extension and Climate Change: Successful Program Delivery

The politically charged debate surrounding climate change poses a challenge to outreach and education. A 2011 survey revealed that NC Extension professionals have approached climate change programming cautiously, citing lack of audience interest as the primary barrier—perhaps because the Southeast region has experienced relatively mild climate change impacts, to date. We propose a tiered approach to effectively communicate climate change adaptation strategies to agriculture and natural resource Extension clients: Extension should provide climate science information to early adopters and emphasize risk management of specific threats to clients not convinced about climate change, focusing on local solutions and familiar management tools

What is a Green Economy? Review of National-Level Green Economy Policies in Cambodia and Lao PDR

A green economy that simultaneously promotes environmental sustainability, social inclusiveness, and economic growth is expected to benefit the heavily resource-dependent least developed countries. Yet, internationally, there is very little empirically based research on how the “green development” agenda translates into natural resource management policies in the least developed countries. This paper examines the implementation of green economy policies at the national level in the energy and forestry sectors in the Lao PDR and Cambodia. Both countries have adopted green growth targets; however, in terms of natural resources management, two contradictory processes have taken place during the past decade. While there have been some initiatives to decentralize natural resource management by enhancing the role of local communities role, such as community-based forest or fishery management, the far greater trend has been the opening up of the economies of the Lao PDR and Cambodia to large-scale investments by multinational enterprises. Large-scale hydropower projects and increasing deforestation pose challenges to more sustainable natural resource management efforts. This article is based on an analysis of the national green economy strategies and expert interviews with the government, academia, private sector and international and national development organizations. Focusing on the energy and forestry sectors, but also analysing the national green economy strategies as a whole, our analysis sheds light on the choices made in the national development versus green economy strategies. While green economy thinking rests on strong state regulation, the policies are often formulated within a complex dynamic of donor and investor interests. The achievement of a green economy depends on the state; thus, it should steer investments to ecologically less harmful industries and ensure social inclusiveness in land-use decisions. Our results show, however, that implementing a green economy is far more complex. Despite the quest for synergies, at the sectoral level there are still many unaddressed trade-offs between, for example, energy sources and forms of land use

What is a Green Economy? Review of National-Level Green Economy Policies in Cambodia and Lao PDR

A green economy that simultaneously promotes environmental sustainability, social inclusiveness, and economic growth is expected to benefit the heavily resource-dependent least developed countries. Yet, internationally, there is very little empirically based research on how the “green development” agenda translates into natural resource management policies in the least developed countries. This paper examines the implementation of green economy policies at the national level in the energy and forestry sectors in the Lao PDR and Cambodia. Both countries have adopted green growth targets; however, in terms of natural resources management, two contradictory processes have taken place during the past decade. While there have been some initiatives to decentralize natural resource management by enhancing the role of local communities role, such as community-based forest or fishery management, the far greater trend has been the opening up of the economies of the Lao PDR and Cambodia to large-scale investments by multinational enterprises. Large-scale hydropower projects and increasing deforestation pose challenges to more sustainable natural resource management efforts. This article is based on an analysis of the national green economy strategies and expert interviews with the government, academia, private sector and international and national development organizations. Focusing on the energy and forestry sectors, but also analysing the national green economy strategies as a whole, our analysis sheds light on the choices made in the national development versus green economy strategies. While green economy thinking rests on strong state regulation, the policies are often formulated within a complex dynamic of donor and investor interests. The achievement of a green economy depends on the state; thus, it should steer investments to ecologically less harmful industries and ensure social inclusiveness in land-use decisions. Our results show, however, that implementing a green economy is far more complex. Despite the quest for synergies, at the sectoral level there are still many unaddressed trade-offs between, for example, energy sources and forms of land use

From Extractivism to Global Extractivism : The Evolution of an Organizing Concept

All the named authors were members of the Helsinki Research Working Group on Global Extractivisms and Alternatives, who jointly constructed this article. Equal authorship by all authors is recognised.Research on extractivism has rapidly proliferated, expanding into new empirical and conceptual spaces. We examine the origins, evolution, and conceptual expansion of the concept. Extractivism is useful to analyze resource extraction practices around the world. ‘Global Extractivism’ is a new conceptual tool for assessing global phenomena. We situate extractivism within an ensemble of concepts, and explore its relation to development, the state, and value. Extractivism as an organizing concept addresses many fields of research. Extractivism forms a complex of self-reinforcing practices, mentalities, and power differentials underwriting and rationalizing socio-ecologically destructive modes of organizing life-through subjugation, depletion, and non-reciprocity.Peer reviewe

Potent CD8+ T-cell immunogenicity in humans of a novel heterosubtypic influenza A vaccine, MVA-NP+M1.

BACKGROUND: Influenza A viruses cause occasional pandemics and frequent epidemics. Licensed influenza vaccines that induce high antibody titers to the highly polymorphic viral surface antigen hemagglutinin must be re-formulated and readministered annually. A vaccine providing protective immunity to the highly conserved internal antigens could provide longer-lasting protection against multiple influenza subtypes. METHODS: We prepared a Modified Vaccinia virus Ankara (MVA) vector encoding nucleoprotein and matrix protein 1 (MVA-NP+M1) and conducted a phase I clinical trial in healthy adults. RESULTS: The vaccine was generally safe and well tolerated, with significantly fewer local side effects after intramuscular rather than intradermal administration. Systemic side effects increased at the higher dose in both frequency and severity, with 5 out of 8 volunteers experiencing severe nausea/vomiting, malaise, or rigors. Ex vivo T-cell responses to NP and M1 measured by IFN-γ ELISPOT assay were significantly increased after vaccination (prevaccination median of 123 spot-forming units/million peripheral blood mononuclear cells, postvaccination peak response median 339, 443, and 1443 in low-dose intradermal, low-dose intramuscular, and high-dose intramuscular groups, respectively), and the majority of the antigen-specific T cells were CD8(+). CONCLUSIONS: We conclude that the vaccine was both safe and remarkably immunogenic, leading to frequencies of responding T cells that appear to be much higher than those induced by any other influenza vaccination approach. Further studies will be required to find the optimum dose and to assess whether the increased T-cell response to conserved influenza proteins results in protection from influenza disease

Nanofibrillar cellulose wound dressing in skin graft donor site treatment

Peer reviewe

A Photo Score for Aesthetic Outcome in Sagittal Synostosis:An ERN CRANIO Collaboration

European Reference Network (ERN) CRANIO is focused on optimizing care for patients with rare or complex craniofacial anomalies, including craniosynostosis and/or rare ear, nose, and throat disorders. The main goal of ERN CRANIO is to collect uniform data on treatment outcomes for multicenter comparison. We aimed to develop a reproducible and reliable suture-specific photo score that can be used for cross-center comparison of phenotypical severity of sagittal synostosis and aesthetic outcome of treatment. We conducted a retrospective study among nonsyndromic sagittal synostosis patients aged &lt;19 years. We included preoperative and postoperative photo sets from 6 ERN CRANIO centers. Photo sets included bird's eye, lateral, and anterior-posterior views. The sagittal synostosis photo score was discussed in the working group, and consensus was obtained on its contents. Interrater agreement was assessed with weighted Fleiss' Kappa and intraclass correlation coefficients.The photo score consisted of frontal bossing, elongated skull, biparietal narrowness, temporal hollowing, vertex line depression, occipital bullet, and overall phenotype. Each item was scored as normal, mild, moderate, or severe. Results from 36 scaphocephaly patients scored by 20 raters showed kappa values ranging from 0.38 [95% bootstrap CI: 0.31, 0.45] for biparietal narrowness to 0.56 [95% bootstrap CI: 0.47, 0.64] for frontal bossing. Agreement was highest for the sum score of individual items [intraclass correlation coefficients agreement 0.69 [95% CI: 0.57, 0.82]. This is the first large-scale multicenter study in which experts investigated a photo score to assess the severity of sagittal synostosis phenotypical characteristics. Agreement on phenotypical characteristics was suboptimal (fair-moderate agreement) and highest for the summed score of individual photo score items (substantial agreement), indicating that although experts interpret phenotypical characteristics differently, there is consensus on overall phenotypical severity.</p