Characterization of floating microplastic contamination in the bay of Marseille (French Mediterranean Sea) and its impact on zooplankton and mussels.

Microplastics (MPs) were sampled in three seasons from 2016 to 2018 in the Bay of Marseille, northwestern Mediterranean Sea, adjacent to a highly urbanized area. Six sites were selected according to their different characteristics (river mouth, treatment plants, protected marine area). Surface floating MPs were characterized (number, weight, typology and polymer) as was zooplankton. In addition, mussels were submerged and used to investigate ingestion. Finally, a hydrodynamic model was used to improve understanding of dispersion mechanisms. The annual averages of floating MPs values ranged from 39,217 to 514,817 items/km2. The MPs collected were mainly fragments principally composed of polyethylene and polypropylene. The mean abundance ratio (MPs/zooplankton) was 0.09. On average 87% of mussel pools were contaminated and ingested 18.73 items/100 g of flesh. Two hydrodynamic patterns were identified: the first retaining the MPs in the harbor, and the second dispersing them outside.

Volume Fabrication of Quantum Cascade Lasers on 200 mm-CMOS pilot line.

The manufacturing cost of quantum cascade lasers is still a major bottleneck for the adoption of this technology for chemical sensing. The integration of Mid-Infrared sources on Si substrate based on CMOS technology paves the way for high-volume low-cost fabrication. Furthermore, the use of Si-based fabrication platform opens the way to the co-integration of QCL Mid-InfraRed sources with SiGe-based waveguides, enabling realization of optical sensors fully integrated on planar substrate. We report here the fabrication and the characterization of DFB-QCL sources using top metal grating approach working at 7.4 µm fully implemented on our 200 mm CMOS pilot line. These QCL featured threshold current density of 2.5 kA/cm² and a linewidth of 0.16 cm-1 with a high fabrication yield. This approach paves the way toward a Mid-InfraRed spectrometer at the silicon chip level.

A case study approach to high-containment laboratory workflows promoting sustainability, networking and innovation.

Advances in information technologies (ITs) and operational technologies (OTs) offer high-containment laboratories opportunities to evolve scientific and operational approaches, while increasing efficiency. Emerging technologies steadily introduce changes in data generation and management practices. United States (US) government agencies and partners operate high-containment laboratories that rely on ITs/OTs to provide critical scientific functions that support prevention, detection, response and recovery for catastrophic events. These unique operating environments provide an opportunity for implementation of ITs/OTs that can facilitate both efficiency and deeper or parallel study of disease and associated biological phenomena. Operational study by subject matter experts can aid in identification of requirements and challenges pertaining to emerging ITs/OTs, examination of use cases, refinement of technical specifications and optimisation of workflows. The National Bio and Agro-Defense Facility (NBAF) in the United States of America (USA), slated to be fully operational by 2023, will be a state-of-the-art research and diagnostic facility with Biosafety Level 2, 3 and 4 laboratories for the study of high-consequence transboundary animal pathogens and zoonotic diseases impacting public health. The NBAF will support the diagnosis of emerging diseases, development of countermeasures and transboundary animal disease training. Given the rapid emergence of IT/OT solutions, the authors used a case study approach to analyse and assess real-world, high-containment laboratory functions to help maximise efficiency in mission delivery for the NBAF and the broader high-containment laboratory network. The case study approach described here could be widely adapted to diverse situations characterised by a high rate of change to provide accurate, relevant workflow analyses and optimised recommendations.

Les progrès enregistrés dans les domaines des technologies de l'information (IT) et des technologies opérationnelles (OT) offrent aux laboratoires de confinement à haute sécurité la possibilité de faire évoluer leurs approches scientifiques et opérationnelles tout en gagnant en efficacité. Grâce à ces technologies émergentes, les pratiques de production et de gestion des données sont régulièrement affinées. Les organismes gouvernementaux étatsuniens et leurs partenaires exploitent des laboratoires de confinement à haute sécurité qui font appel aux IT/OT pour mettre en oeuvre des fonctionnalités scientifiques cruciales en appui de la prévention, la détection, l'intervention et le rétablissement en cas de catastrophes. Ces environnements opérationnels uniques offrent la possibilité d'introduire des applications IT/OT afin de faciliter aussi bien l'efficacité des opérations que l'étude plus approfondie ou concomitante d'une maladie et des phénomènes biologiques qui lui sont associés. Des études opérationnelles menées par des spécialistes peuvent contribuer à identifier les exigences et les défis liés aux IT/OT émergentes, à vérifier leurs utilisations concrètes, à affiner les spécifications techniques et à optimiser l'ordonnancement des opérations. Le National Bio and Agro-Defense Facility (NBAF) des états-Unis d'Amérique, qui devrait être pleinement opérationnel d'ici 2023, sera une institution de recherche et de diagnostic de pointe dotée de laboratoires de niveaux de biosécurité 2, 3 et 4 pour l'étude des agents pathogènes responsables de maladies animales transfrontalières à haut risque et des agents zoonotiques à fort impact sur la santé publique. Le NBAF contribuera au diagnostic des maladies émergentes et à l'élaboration de mesures de lutte ; il dispensera également des formations sur les maladies animales transfrontalières. Compte tenu du développement rapide des nouvelles solutions IT/OT, les auteurs ont mis au point une méthode d'études de cas pour l'analyse et l'évaluation des fonctionnalités concrètes des laboratoires de confinement à haute sécurité, destinée à maximiser l'efficacité des prestations du NBAF et du réseau plus large de laboratoires de confinement à haute sécurité. La méthode par études de cas décrite ici pourrait être largement adaptée à diverses situations caractérisées par un niveau élevé de changement, afin de fournir des analyses précises et pertinentes de l'ordonnancement des opérations et d'élaborer des recommandations optimisées.

Los adelantos de las tecnologías de la información (TI) y las tecnologías operativas (TO) ofrecen a los laboratorios de alta contención la posibilidad de transformar sus lógicas y procedimientos de trabajo científico y al mismo tiempo ganar en eficiencia. Progresivamente, a la estela de las nuevas tecnologías, los métodos empleados para generar y gestionar datos van evolucionando. Ciertos organismos públicos estadounidenses administran, junto con entidades colaboradoras, laboratorios de alta contención que dependen de las TI/TO para cumplir una serie de cometidos científicos fundamentales en apoyo de la prevención y detección de sucesos catastróficos, de la respuesta a ellos y de los subsiguientes procesos de recuperación. Estos excepcionales entornos de trabajo ofrecen la posibilidad de implantar TI/TO que a la vez aporten más eficiencia y faciliten un estudio más a fondo o en paralelo de as enfermedades y los fenómenos biológicos asociados a ellas. La realización de estudios operativos a cargo de especialistas en el tema puede ayudar a determinar las necesidades y dificultades que plantean las nuevas TI/TO, a examinar ejemplos de utilización, a afinar las especificaciones técnicas y a optimizar los procesos de trabajo. El órgano nacional de defensa biológica y agrícola (National Bio and Agro-Defense Facility, NBAF) de los Estados Unidos de América, que según las previsiones funcionará a pleno rendimiento en 2023, constituirá un avanzado dispositivo de investigación y diagnóstico al que estarán adscritos laboratorios de nivel 2, 3 y 4 de seguridad biológica para el estudio de agentes patógenos de los animales y enfermedades zoonóticas de carácter transfronterizo y de gran repercusión que afecten a la salud pública. El NBAF secundará el diagnóstico de enfermedades emergentes, la preparación de medidas de lucha y la formación sobre enfermedades animales transfronterizas. Teniendo en cuenta la velocidad a la que surgen soluciones de TI/TO, los autores recurrieron al estudio de ejemplos concretos para analizar y evaluar las funciones que cumplen en el mundo real los laboratorios de alta contención con el objetivo de ayudar al NBAF y a la red general de laboratorios de alta contención a ejercer su cometido con la máxima eficiencia. El método de trabajo aquí descrito, basado en el estudio de casos concretos, podría ser adaptado a diversas situaciones que se caractericen por un alto ritmo de transformaciones para efectuar análisis precisos y pertinentes de los procesos de trabajo y formular recomendaciones optimizadas.

Dynamic characterization of a periodic microstructured flexural system with rotational inertia.

We consider the propagation of waves in a flexural medium composed of massless beams joining a periodic array of elements, elastically supported and possessing mass and rotational inertia. The dispersion properties of the system are determined and the influence and interplay between the dynamic parameters on the structure of the pass and stop bands are analysed in detail. We highlight the existence of three special dynamic regimes corresponding to a low stiffness in the supports and/or low rotational inertia of the masses; to a high stiffness and/or high rotational inertia regime; and to a transition one where dispersion degeneracies are encountered. In the low-frequency regime, a rigorous asymptotic analysis shows that the structure approximates a continuous Rayleigh beam on an elastic foundation. This article is part of the theme issue 'Modelling of dynamic phenomena and localization in structured media (part 1)'.

Seafloor litter from the continental shelf and canyons in French Mediterranean Water: Distribution, typologies and trends.

Seafloor litter has been studied both on the continental shelves (by trawling during 24 years) and in canyons (by ROV) of the French Mediterranean sea Water (FMW). On the continental shelf, mean densities range from 49.63 to 289.01 items/km2. The most abundant categories were plastic, glass/ceramics, metals and textiles. Trend analysis shows a significant increase in plastic quantities during the study period. Plastics accumulate at all depths, with heavier items being found in deeper areas, while the continental slope-break appears as a clean area. The spatial distribution of litter revealed the influence of geomorphologic factors, anthropic activities, shipping route, river inputs. All the canyons are affected by debris but coastal canyons (Ligurian Sea and Corsica) were more impacted than offshore canyons in the Gulf of Lion. The FMW appears to be highly polluted with regard to values found in other areas, but lower than those observed in the Eastern Mediterranean.

Reducing off target viral delivery in ovarian cancer gene therapy using a protease-activated AAV2 vector platform.

Gene therapy is a promising strategy for treating metastatic epithelial ovarian cancer (EOC). However, efficient vector targeting to tumors is difficult and off-target effects can be severely detrimental. Most vector targeting approaches rely on surface receptors overexpressed on some subpopulation of cancer cells. Unfortunately, there is no universally expressed cell surface biomarker for tumor cells. As an alternative, we developed an adeno-associated virus (AAV) based "Provector" whose cellular transduction can be activated by extracellular proteases, such as matrix metalloproteinases (MMP) that are overexpressed in the tumor microenvironments of the most aggressive forms of EOC. In a non-tumor bearing mouse model, the Provector demonstrates efficient de-targeting of healthy tissues, especially the liver, where viral delivery is <1% of AAV2. In an orthotopic HeyA8 tumor model of EOC, the Provector maintains decreased off-target delivery in the liver and other tissues but with no loss in tumor delivery. Notably, approximately 10% of the injected Provector is still detected in the blood at 24 h while >99% of injected AAV2 has been cleared from the blood by 1 h. Furthermore, mouse serum raised against the Provector is 16-fold less able to neutralize Provector transduction compared to AAV2 serum neutralizing AAV2 transduction (1:200 vs 1:3200 serum dilution, respectively). Thus, the Provector appears to generate less neutralizing antibodies than AAV2. Importantly, serum against AAV2 does not neutralize the Provector as well as AAV2, suggesting that pre-existing antibodies against AAV2 would not negate the clinical application of Provectors. Taken together, we present an EOC gene delivery vector platform based on AAV with decreased off-target delivery without loss of on-target specificity, and greater immunological stealth over the traditional AAV2 gene delivery vector.

Meshes in a mess: Mesenchymal stem cell-based therapies for soft tissue reinforcement.

Surgical meshes are frequently used for the treatment of abdominal hernias, pelvic organ prolapse, and stress urinary incontinence. Though these meshes are designed for tissue reinforcement, many complications have been reported. Both differentiated cell- and mesenchymal stem cell-based therapies have become attractive tools to improve their biocompatibility and tissue integration, minimizing adverse inflammatory reactions. However, current studies are highly heterogeneous, making it difficult to establish comparisons between cell types or cell coating methodologies. Moreover, only a few studies have been performed in clinically relevant animal models, leading to contradictory results. Finally, a thorough understanding of the biological mechanisms of mesenchymal stem cells in the context of foreign body reaction is lacking. This review aims to summarize in vitro and in vivo studies involving the use of differentiated and mesenchymal stem cells in combination with surgical meshes. According to preclinical and clinical studies and considering the therapeutic potential of mesenchymal stem cells, it is expected that these cells will become valuable tools in the treatment of pathologies requiring tissue reinforcement. STATEMENT OF SIGNIFICANCE: The implantation of surgical meshes is the standard procedure to reinforce tissue defects such as hernias. However, an adverse inflammatory response secondary to this implantation is frequently observed, leading to a strong discomfort and chronic pain in the patients. In many cases, an additional surgical intervention is needed to remove the mesh. Both differentiated cell- and stem cell-based therapies have become attractive tools to improve biocompatibility and tissue integration, minimizing adverse inflammatory reactions. However, current studies are incredibly heterogeneous and it is difficult to establish a comparison between cell types or cell coating methodologies. This review aims to summarize in vitro and in vivo studies where differentiated and stem cells have been combined with surgical meshes.

Refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia convencional ou videoassistida / Gastroesophageal reflux in dogs undergoing convencional or video-assisted ovariohysterectomy

A doença do refluxo gastroesofágico decorre do fluxo de conteúdo gastroduodenal para o esôfago e/ou órgãos adjacentes, o que leva à ampla gama de sinais e implicações clínicas. A incidência de refluxo gastroesofágico transoperatório em caninos é desconhecida. O objetivo deste trabalho foi, por meio da endoscopia flexível, avaliar a presença e quantificar o refluxo gastroesofágico em cadelas submetidas à ovário-histerectomia por duas abordagens cirúrgicas (convencional e videoassistida com dois portais), pré-medicadas com morfina. Cem por cento das cadelas submetidas à ovário-histerectomia videoassistida e 30% das cadelas submetidas à ovário-histerectomia convencional apresentaram algum grau de refluxo. A intensidade dos refluxos foi maior nas cadelas submetidas ao procedimento minimamente invasivo, visto que elas (10 entre 10 animais) apresentaram, no mínimo, um refluxo classificado em R4, enquanto as outras (três entre 10) apresentaram, no máximo, refluxos em grau R3, de acordo com a escala planejada para esta pesquisa. Concluiu-se que os procedimentos laparoscópicos sob o protocolo anestésico utilizado promovem mais refluxo gastroesofágico que os convencionais.(AU)

Gastroesophageal reflux disease occurs when gastric or duodenal contents flow back into the esophagus by retroperistalsis, which leads to several signs and clinical implications. The incidence of intraoperative gastroesophageal reflux in canines is unknown. The aim of this study was, using flexible endoscopy, to assess the presence and quantify gastroesophageal reflux in bitches undergoing ovariohysterectomy by two surgical approaches (conventional and video-assisted by two portals-access), pre-medicated with morphine. 100% of dogs submitted to video-assisted and 30% of dogs submitted to conventional ovariohysterectomy presented some reflux degree. Reflux intensity was higher in dogs submitted to the minimally invasive procedure, since they (10 out of 10 animals) had at least one reflux classified in R4 while the others (three out of 10) had a maximum reflux in degree R3 according to the planned scale for this research. The laparoscopic procedures under the used anesthetic protocol promote more gastroesophageal reflux than the conventional ones.(AU)

Ensaio biomecânico para determinação do diâmetro de barra conectora de polimetilmetacrilato em fixador esquelético externo tipo Ia no úmero de suínos / Biomechanical test to determination the diameter of the polymethylmethacrylate bar in external skeletal fixator type Ia in swine humerusi

Fraturas ósseas podem ser corrigidas com a utilização de fixadores esqueléticos externos (FEE), método de estabilização bastante comum. Para tanto, têm-se utilizado barras conectoras de polimetilmetacrilato (PMMA) sem critério de diâmetro, as quais podem quebrar, se ficarem muito delgadas, ou ocasionar incômodo, quando muito pesadas e volumosas. O objetivo deste trabalho foi testar, por meio de ensaio biomecânico de compressão axial e flexão, qual é o diâmetro ideal da barra conectora de PMMA, correlacionado com o diâmetro ósseo para utilização em FEE tipo Ia. Utilizaram-se 24 úmeros para se realizarem medidas de comprimento, diâmetro, circunferência e ensaios biomecânicos. Após, foram confeccionadas barras de 1,5 vezes a média do diâmetro ósseo (grupo I), do mesmo diâmetro ósseo (grupo II) e de 0,5 vezes o diâmetro (grupo III). Com os resultados obtidos ao se compararem os valores dos ossos com os dos grupos II e III, verificou-se que as barras conectoras do grupo II mostraram-se mais resistentes do que o tecido ósseo no ensaio de compressão. No ensaio de flexão, os ossos resistiram mais quando comparados aos grupos II e III, sendo 4,3 vezes mais resistentes do que o grupo III nesse mesmo ensaio mecânico. Os resultados permitem um direcionamento para confecção de barras considerando-se o diâmetro ósseo como referência.(AU)

Bone fractures can be corrected from external skeletal fixators (ESF) in a fairly common internal stabilization method, in which connector bars polymethylmethacrylate (PMMA) is used. PMMA is used without criterion of diameter, and it can break if it is too thin or too heavy. It can be uncomfortable when bulky. The aim of this study was to test, through biomechanical axial compression and bending which is the ideal connector bar diameter PMMA, correlated to bone diameter for use in type Ia ESF. Twenty-four humerus were used to make measurements of length, diameter, circumference, and biomechanical testing. After the bars confected with 1.5 times the average diameter of the bone (group I), the same diameter (group II) and 0.5 times the diameter of the bone (group III). With the obtained results, using GII and GIII results, it was observed that the connector bars in group II were more resistant than the bones in the compression test. In the bending test, the bones resisted flexion strength when compared to group III and the group II was 4.3 times more resistant than group III in the same mechanical test. The results allow a direction for making bars considering bone diameter as a reference.(AU)

Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders' experiences.

PLAIN ENGLISH SUMMARY: It is important for health care workers to know the needs and expectations of their patients. Therefore, service users have to be involved in research. To achieve a meaningful dialogue between service users, healthcare workers and researchers, participatory methods are needed. This paper describes how the application of a specific participatory methodology, Participatory Learning and Action (PLA) can lead to such a meaningful dialogue. In PLA all stakeholders are regarded as equal partners and collaborators in research.During 2011-2015, a European project called RESTORE used PLA in Austria, Greece, Ireland, The Netherlands and the UK to investigate how communication between primary health care workers and their migrant patients could be improved.Seventy eight migrants, interpreters, doctors, nurses and other key stakeholders (see Table 2) participated in 62 PLA sessions. These dialogues (involving discussions, activities, PLA techniques and evaluations) were generally 2-3 h long and were recorded and analysed by the researchers.Participants reported many positive experiences about their dialogues with other stakeholders. There was a positive, trusting atmosphere in which all stakeholders could express their views despite differences in social power. This made for better understanding within and across stakeholder groups. For instance a doctor changed her view on the use of interpreters after a migrant explained why this was important. Negative experiences were rare: some doctors and healthcare workers thought the PLA sessions took a lot of time; and despite the good dialogue, there was disappointment that very few migrants used the new interpreting service. ABSTRACT: Background In order to be effective, primary healthcare must understand the health needs, values and expectations of the population it serves. Recent research has shown that the involvement of service users and other stakeholders and gathering information on their perspectives can contribute positively to many aspects of primary healthcare. Participatory methodologies have the potential to support engagement and dialogue between stakeholders from academic, migrant community and health service settings. This paper focuses on a specific participatory research methodology, Participatory Learning and Action (PLA) in which all stakeholders are regarded as equal partners and collaborators in research.Our research question for this paper was: "Does the application of PLA lead to meaningful engagement of all stakeholders, and if so, what elements contribute to a positive and productive inter-stakeholder dialogue?". Methods We explored the use of PLA in RESTORE, a European FP7-funded project, during 2011-2015 in 5 countries: Austria, Greece, Ireland, the Netherlands and the UK. The objective of RESTORE was to investigate and support the implementation of guidelines and training initiatives (G/TIs) to enhance communication in cross-cultural primary care consultations with migrants.Seventy eight stakeholders (migrants, interpreters, doctors, nurses and others - see Table 2) participated in a total of 62 PLA sessions (discussions, activities, evaluations) of approximately 2-3 h' duration across the five sites. During the fieldwork, qualitative data were generated about stakeholders' experiences of engagement in this dialogue, by means of various methods including participatory evaluations, researchers' fieldwork reports and researcher interviews. These were analysed following the principles of thematic analysis. Results Stakeholders involved in PLA inter-stakeholder dialogues reported a wide range of positive experiences of engagement, and very few negative experiences. A positive atmosphere during early research sessions helped to create a sense of safety and trust. This enabled stakeholders from very different backgrounds, with different social status and power, to offer their perspectives in a way that led to enhanced learning in the group - they learned with and from each other. This fostered shifts in understanding - for example, a doctor changed her view on interpreted consultations because of the input of the migrant service-users. Conclusion PLA successfully promoted stakeholder involvement in meaningful and productive inter-stakeholder dialogues. This makes it an attractive approach to enhance the further development of health research partnerships to advance primary healthcare.

Refluxo gastroesofágico em cadelas durante ovário-histerectomia convencional submetidas a diferentes medicações pré-anestésicas / Gastroesophageal reflux in dogs undergoing conventional ovariohysterectomy using different premedications

A doença do refluxo gastroesofágico decorre do fluxo de conteúdo gastroduodenal para o esôfago e/ou para os órgãos adjacentes, o que leva à ampla gama de sinais e implicações clínicas. É desconhecida a incidência de refluxo gastroesofágico transoperatório em caninos. O objetivo deste trabalho foi, por meio da endoscopia flexível, avaliar a presença do refluxo gastroesofágico em cadelas submetidas a ovário-histerectomia com base nos fármacos analgésicos utilizados na medicação pré-anestésica (morfina, tramadol ou metadona). Concluiu-se que não houve diferença na incidência de refluxo gastroesofágico transoperatório, não tendo os fármacos testados influenciado de forma diferente esse comportamento; porém, alguns animais do grupo morfina apresentaram êmese pré-operatória. A gravidade dos refluxos foi maior nas cadelas submetidas ao uso da metadona, de acordo com o método de avaliação utilizado para esta pesquisa.(AU)

Gastroesophageal reflux disease arises from the gastroduodenal content flow to the esophagus and/or associated organs, which leads to the wide range of signs and clinical implications. Incidence of intraoperative gastroesophageal reflux disease in dogs is unknown. The objective was, through flexible endoscopy, to assess the presence of gastroesophageal reflux in dogs undergoing ovariohysterectomy based on analgesic drugs used in premedication (morphine, tramadol or methadone). It was concluded that there was no difference in the incidence of intraoperative gastroesophageal reflux, these drugs don't influence this behavior; however, in the morphine group some animals showed preoperative vomiting. The severity of the reflux was higher, but not significantly, in bitches undergoing the methadone according to the evaluator method used for this research.(AU)

Herniorrafia diafragmática videoassistida em gato: relato de caso / Videoassisted diaphragmatic hernia repair in a cat: case report

Relata-se um caso de um felino com sinais de dificuldade respiratória havia cerca de 30 dias e emagrecimento progressivo. Ao exame radiográfico torácico e de abdômen, ficou evidenciada perda de definição da linha diafragmática, sendo compatível com hérnia diafragmática. Na laparoscopia, foi observado grande defeito diafragmático, além de estruturas herniadas. Em razão de as vísceras abdominais direcionarem-se ao tórax, dificultando a oclusão do defeito com suturas intracorpóreas, optou-se pela realização de incisão paracostal, procedendo-se à herniorrafia por celiotomia reduzida. A videolaparoscopia permitiu localizar o local herniado e promover a redução dos órgãos envolvidos com mínimo trauma operatório. Logo, mostrou-se como eficaz ferramenta diagnóstica e auxiliar no tratamento de hérnias diafragmáticas crônicas de grande dimensão em gato.(AU)

This is a case report of a cat with signs of respiratory distress for about 30 days and progressive weight loss. The thoracic radiograph and abdomen examination evidencing loss of definition of the diaphragmatic line is compatible with diaphragmatic hernia. In laparoscopy, a large diaphragmatic defect and herniated structures were observed. Since abdominal viscera point towards the chest making occlusion of defective intracorporeal sutures difficult, paracostal incision proceeding to hernia repair by short celiotomy was chosen. Laparoscopy allows for location of herniated place and promotes the reduction of organs involved with minimal surgical trauma. Therefore, it was shown to be an effective diagnostic tool and an aid in the treatment of chronic diaphragmatic hernias of large size in a cat.(AU)

Traumatic avulsion of the flexor digitorum profundus tendon. Jersey finger, a 29 cases report.

Traumatic avulsion of flexor digitorum profundus (jersey finger) is an uncommon injury. Our study aimed to describe functional outcomes of jersey fingers after surgical treatment. From January 2004 to 2014, we performed surgery on 32 patients who had jersey finger. Twenty-six of these patients were male and 6 were female with a mean age of 37.2years (range 16-68). Of the 32 cases, 11 were sports injuries, 16 presented on the ring finger and 13 on the little finger. Using the Leddy and Packer and Smith classifications, 16 of the injuries were type I, 4 were type II, 5 were type III, 7 were type IV. The mean time between injury and surgery was 6.8days (range: 0-32). The surgical techniques used were anchor, pull-out, or an association of both these techniques. Prior to the patient discharge, functional outcomes were evaluated. Twenty-nine patients were evaluated in total and three patients were lost. Of the 29, the average time between surgery and discharge was 36.6months ranging from 4.5 to 118months. According to the Buck-Gramcko classification, six patients had an excellent result, six had a good result, seven had a satisfactory result and ten a poor result. The mean Quick DASH score immediately to prior discharge was 5.66 (range: 0-56.82). Twelve complications were reported on nine patients. No infections were reported. Rapid diagnosis and rapid surgical treatment led to restoration of full range motion.

Wavelength conversion of complex modulation formats in a compact SiGe waveguide.

We report a nonlinear signal processing system based on a SiGe waveguide suitable for high spectral efficiency data signals. Four-wave-mixing (FWM)-based wavelength conversion of 10-Gbaud 16-Quadrature amplitude modulated (QAM) and 64-QAM signals is demonstrated with less than -10-dB conversion efficiency (CE), 36-dB idler optical signal-to-noise ratio (OSNR), negligible bit error ratio (BER) penalty and a 3-dB conversion bandwidth exceeding 30nm. The SiGe device was CW-pumped and operated in a passive scheme without giving rise to any two-photon absorption (TPA) effects.

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study.

BACKGROUND: Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. METHODS: We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT. RESULTS: In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP's diagnoses and GPs reported a clearer understanding of migrants' symptoms. CONCLUSIONS: Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

Relationship between level of forage intake, blood flow and oxygen consumption by splanchnic tissues of sheep fed a tropical grass forage.

Four Polwarth castrated male sheep (42 ± 4.4 kg live weight (LW) surgically implanted with chronic indwelling catheters into the mesenteric, portal and hepatic veins, housed in metabolism cages and offered Cynodon sp. hay at rates (g of dry matter (DM)/kg LW) of 7, 14, 21 or ad libitum, were used in a 4 × 4 Latin square experiment to evaluate the effect of the level of forage intake on blood flow and oxygen consumption by the portal-drained viscera (PDV), liver and total splanchnic tissues (ST). The portal blood flow and the oxygen consumption by PDV linearly increased at increased organic matter (OM) intake. No effect of level of OM intake was obtained for the hepatic artery blood flow and oxygen consumption by liver. As a consequence, the level of OM intake only tended to directly affect hepatic blood flow and oxygen consumption by total ST. Oxygen consumption was linearly and positively related to blood flow across PDV, liver and total ST. The heat production by PDV and total ST, as proportion of metabolizable energy (ME) intake, decreased curvilinearly at increased ME intake. In conclusion, the oxygen consumption by PDV, but not by liver, was directly related to the level of forage intake by sheep. Moreover, when ingested at levels below maintenance, most of ME was spent as heat produced by ST.