Comparison of the Heel Enthesitis MRI Scoring System (HEMRIS) with clinical enthesitis and local metabolic activity on PET-CT

OBJECTIVE: To compare the Heel Enthesitis MRI Scoring model (HEMRIS) with clinical and PET/CT outcomes in patients with cutaneous psoriasis (Pso), psoriatic arthritis (PsA) or ankylosing spondylitis (AS). METHODS: This prospective, observational study included 38 patients with Pso, PsA and AS. Patients were included regardless of presence or absence of clinical heel enthesitis. MRI-scans of both ankles and a whole-body 18F-FDG PET/CT were acquired. MRIs were assessed for enthesitis by two independent and blinded observers according to the HEMRIS. A physician, blinded for imaging results, performed clinical evaluations of enthesitis at the Achilles tendon and plantar fascia. RESULTS: In total, 146 entheses were scored according to the HEMRIS and clinically assessed for enthesitis (6 entheses were clinically affected). In Achilles tendons with clinical enthesitis, the HEMRIS structural damage score was significantly higher, compared to Achilles tendons without clinical enthesitis (respective median scores 1.0 and 0.5; p=0.04). In clinically unaffected entheses, HEMRIS abnormalities occurred in 44/70 (63%) of Achilles tendons and in 23/70 (33%) of plantar fascia. At the Achilles tendon, local metabolic activity measured on PET/CT was weakly associated with the structural (rs=0.25, p=0.03) and total HEMRIS (rs=0.26, p=0.03). CONCLUSION: This study revealed a high prevalence of subclinical HEMRIS abnormalities and discrepancy between HEMRIS and clinical and PET/CT findings. This may suggest that the HEMRIS is a sensitive method for detection of inflammatory and structural disease of enthesitis at the Achilles tendon and plantar fascia, although the clinical significance of these MRI findings remains to be determined in longitudinal studies

Assessing the effectiveness of zero-deforestation commitments

Forests are indispensable assets for mitigating climate change, protecting biodiversity and reducing poverty. While this has been widely recognized, vast swathes of forests are cleared each year, predominantly to make space for agricultural land. Since the 1980s, agricultural expansion into forest areas has been increasingly linked to international supply chains, especially of agricultural commodities such as beef, palm oil, soy, and timber. In response to the ongoing rates of forest loss, a large number of companies involved in the production, processing or distribution of deforestation-risk commodities publicly pledged to eliminate deforestation from their supply chains in the early 2010s. Although these so-called Zero-Deforestation Commitments (ZDCs) have received ample scholarly attention, there are still large uncertainties as to how effective they have been up until now and how effective they could be if their uptake was increased. The overarching objective of this thesis is therefore to investigate what insights can be gained from applying different approaches to assess the effectiveness of ZDCs and the degree of complementarity between these different approaches. In doing so, special attention will be paid to three distinct methodological approaches that hold great promise for advancing assessments of ZDC effectiveness: geospatial analysis, quasi-experimental designs for causal inference, and simulation modelling. Chapter 2 takes stock of the different definitions and criteria articulated in ZDCs and maps the potential coverage of ZDCs through geospatial analysis. In the absence of a clear methodology for delineating forests protected by ZDCs, Chapter 2 tries to fill this gap by putting forward a methodology for doing this at the global scale. Overall, the chapter demonstrates the importance of geospatial analysis in any type of empirical research on ZDCs. Chapter 3 builds on Chapter 2 by zeroing in on the local spillover effects (positive or negative) that may have occurred in the wake of a specific anti-deforestation policy: the Indonesian forest moratorium, enacted in 2011. Capitalizing on recent methodological developments in quasi-experimental research, the chapter provides a first-of-its-kind analysis and finds strong evidence that the enactment of the moratorium caused an uptick in deforestation near the official moratorium boundaries. Chapter 4 takes a deep dive into the role that sourcing patterns of individual traders in Brazil’s soy supply chain may play in the adoption and implementation of ZDCs. The results show that although stickier traders are more likely to adopt ZDCs, they also appear to have less effective ZDCs than other traders (as indicated by the level of soy and territorial deforestation in their sourcing regions). Chapter 5 builds on the previous chapters by providing an ex-ante hypothetical modelling experiment on how the worldwide implementation ZDCs could potentially affect the expansion of oil palm and other crops up until 2030, thereby accounting for potential spillover effects. The results suggest that under a scenario where ZDCs are strictly enforced across industries and regions, they are likely to bring about significant land sparing effects and reduce deforestation rates by a significant degree, even in areas that fall beyond the scope of ZDCs. Taken together, the chapters show that none of the methodological approaches applied in the thesis are by themselves sufficiently flexible to assess all aspects of ZDCs effectiveness. However, when combined, they constitute a rigorous portfolio of approaches that enables researchers to assess both the actual and potential effectiveness of ZDCs under a wide range of conditions. It is hoped that this will help policy makers, companies, and civil society to make more informed decisions as to how targets regarding deforestation and other societal targets can be reconciled, thereby paving the way towards a more sustainable future

Which forests could be protected by corporate zero deforestation commitments? A spatial assessment

The production of palm oil, soy, beef and timber are key drivers of global forest loss. For this reason, over 470 companies involved in the production, processing or distribution of these commodities have issued commitments to eliminate or reduce deforestation from their supply chains. However, the effectiveness of these commitments is uncertain since there is considerable variation in ambition and scope and there are no globally agreed definitions of what constitutes a forest. Many commitments identify high conservation value forests (HCVFs), high carbon stock forests (HCSFs) and forests on tropical peatland as priority areas for conservation. This allows for mapping of the global extent of forest areas classified as such, to achieve an assessment of the area that may be at reduced risk of development if companies comply with their zero deforestation commitments. Depending on the criteria used, the results indicate that between 34% and 74% of global forests qualify as either HCVF, HCSF or forests on tropical peatland. However, we found that the total extent of these forest areas varies widely depending on the choice of forest map. Within forests which were not designated as HCVF, HCSF or forests on tropical peatland, there is substantial overlap with areas that are highly suitable for agricultural development. Since these areas are unlikely to be protected by zero-deforestation commitments, they may be subject to increased pressure resulting from leakage of areas designated as HCVF, HCSF and tropical peatland forests. Considerable uncertainties around future outcomes remain, since only a proportion of the global market is currently covered by corporate commitments. Further work is needed to map the synergies between corporate commitments and government policies on land use. In addition, standardized criteria for delineating forests covered by the commitments are recommended

The influence of company sourcing patterns on the adoption and effectiveness of zero-deforestation commitments in Brazil’s soy supply chain

Many companies sourcing agricultural commodities with high deforestation risk have committed to zero deforestation, meaning they intend to eliminate deforestation from their supply chains. While previous research has attempted to assess progress against such initiatives, little is known about how the characteristics of sourcing patterns may influence the adoption and potential effectiveness of zero-deforestation commitments. Supply chain stickiness – here defined as the geographic persistence in trade relationships between traders and sourcing regions over time – may reflect lock-in effects and the level of trust between the parties involved. Here, we use a metric of supply chain stickiness, calculated from temporal network analyses on the Brazilian soy export supply chain, as a proxy for these underlying dynamics to explore their effect on the adoption and effectiveness of zero deforestation commitments (ZDCs). Using data for 2004–2017, we find that although stickier traders are more likely to adopt ZDCs, they also appear to have less effective ZDCs than other traders (as indicated by the level of soy and territorial deforestation in their sourcing regions). This finding suggests that additional strategies are needed to increase the effectiveness of ZDCs

Electrocorticographic dissociation of alpha and beta rhythmic activity in the human sensorimotor system

This study uses electrocorticography in humans to assess how alpha- and beta-band rhythms modulate excitability of the sensorimotor cortex during psychophysically-controlled movement imagery. Both rhythms displayed effector-specific modulations, tracked spectral markers of action potentials in the local neuronal population, and showed spatially systematic phase relationships (traveling waves). Yet, alpha- and beta-band rhythms differed in their anatomical and functional properties, were weakly correlated, and traveled along opposite directions across the sensorimotor cortex. Increased alpha-band power in the somatosensory cortex ipsilateral to the selected arm was associated with spatially-unspecific inhibition. Decreased beta-band power over contralateral motor cortex was associated with a focal shift from relative inhibition to excitation. These observations indicate the relevance of both inhibition and disinhibition mechanisms for precise spatiotemporal coordination of movement-related neuronal populations, and illustrate how those mechanisms are implemented through the substantially different neurophysiological properties of sensorimotor alpha- and beta-band rhythms

Electrocorticographic dissociation of alpha and beta rhythmic activity in the human sensorimotor system

This study uses electrocorticography in humans to assess how alpha- and beta-band rhythms modulate excitability of the sensorimotor cortex during psychophysically-controlled movement imagery. Both rhythms displayed effector-specific modulations, tracked spectral markers of action potentials in the local neuronal population, and showed spatially systematic phase relationships (traveling waves). Yet, alpha- and beta-band rhythms differed in their anatomical and functional properties, were weakly correlated, and traveled along opposite directions across the sensorimotor cortex. Increased alpha-band power in the somatosensory cortex ipsilateral to the selected arm was associated with spatially-unspecific inhibition. Decreased beta-band power over contralateral motor cortex was associated with a focal shift from relative inhibition to excitation. These observations indicate the relevance of both inhibition and disinhibition mechanisms for precise spatiotemporal coordination of movement-related neuronal populations, and illustrate how those mechanisms are implemented through the substantially different neurophysiological properties of sensorimotor alpha- and beta-band rhythms

Electrocorticographic dissociation of alpha and beta rhythmic activity in the human sensorimotor system

This study uses electrocorticography in humans to assess how alpha- and beta-band rhythms modulate excitability of the sensorimotor cortex during psychophysically-controlled movement imagery. Both rhythms displayed effector-specific modulations, tracked spectral markers of action potentials in the local neuronal population, and showed spatially systematic phase relationships (traveling waves). Yet, alpha- and beta-band rhythms differed in their anatomical and functional properties, were weakly correlated, and traveled along opposite directions across the sensorimotor cortex. Increased alpha-band power in the somatosensory cortex ipsilateral to the selected arm was associated with spatially-unspecific inhibition. Decreased beta-band power over contralateral motor cortex was associated with a focal shift from relative inhibition to excitation. These observations indicate the relevance of both inhibition and disinhibition mechanisms for precise spatiotemporal coordination of movement-related neuronal populations, and illustrate how those mechanisms are implemented through the substantially different neurophysiological properties of sensorimotor alpha- and beta-band rhythms

Functional articular cartilage repair: here, near, or is the best approach not yet clear?

In this Review we describe three approaches for cartilage tissue repair at the rheumatology–orthopaedics interface: disease-modifying osteoarthritis (OA) drug (DMOAD) treatment; cell-based therapies, and intrinsic cartilage repair by joint distraction. DMOADs can slow the progression of joint damage. Cell-based therapies have evolved to do the same, through selection of the most potent cell types (and combinations thereof), as well as identification of permissive boundary conditions for indications. Joint distraction techniques, meanwhile, have now demonstrated the capacity to stimulate actual intrinsic tissue repair. Although this progress is promising, true biological joint reconstruction remains distant on the developmental pathway of 'regenerative medicine'. Prolonged functional repair—that is, cure of diseases such as OA—remains an unmet medical need and scientific challenge, for which comparative and constructive interaction between these physical, chemical and cellular approaches will be required. Careful selections of patients and combinations of approaches will need to be made and tested to demonstrate their cost-effectiveness. Only with such rational and integrated assessment of outcomes will the promising results of these approaches be consolidated in clinical practice