Computed Tomography Angiography of the Upper Extremities.

Upper extremity computed tomography angiography is a powerful tool in the evaluation of acute and nonacute arterial pathology. Technical principles including patient positioning, choice of contrast injection site and rate of administration, and physiologic considerations must be optimized to achieve a high-quality angiographic study. The use of computed tomography angiography in the setting of trauma has been recognized. However, it's less well-known and varied clinical applications in the subacute setting are also important. Volume-rendered, maximum intensity projection, and multiplanar reformat images are indispensable for evaluating the data set.

Ultrasound-guided musculoskeletal interventions in American football: 18 years of experience.

OBJECTIVE: Myotendinous strains, contusions, and hematomas are common injuries in American football. Along with ligament sprains and inflammatory disorders, musculoskeletal injuries often result in lost participation time. This article summarizes 18 years of experience with 128 ultrasound-guided drainages and injections in 69 football players with 88 injuries. CONCLUSION: When performed by an operator with sufficient expertise in diagnostic and procedural skills, ultrasound-guided musculoskeletal interventions are minimally invasive, are safe, and can play an integral role in injury management.

Extreme vulnerability of smallholder farmers to agricultural risks and climate change in Madagascar.

Across the tropics, smallholder farmers already face numerous risks to agricultural production. Climate change is expected to disproportionately affect smallholder farmers and make their livelihoods even more precarious; however, there is limited information on their overall vulnerability and adaptation needs. We conducted surveys of 600 households in Madagascar to characterize the vulnerability of smallholder farmers, identify how farmers cope with risks and explore what strategies are needed to help them adapt to climate change. Malagasy farmers are particularly vulnerable to any shocks to their agricultural system owing to their high dependence on agriculture for their livelihoods, chronic food insecurity, physical isolation and lack of access to formal safety nets. Farmers are frequently exposed to pest and disease outbreaks and extreme weather events (particularly cyclones), which cause significant crop and income losses and exacerbate food insecurity. Although farmers use a variety of risk-coping strategies, these are insufficient to prevent them from remaining food insecure. Few farmers have adjusted their farming strategies in response to climate change, owing to limited resources and capacity. Urgent technical, financial and institutional support is needed to improve the agricultural production and food security of Malagasy farmers and make their livelihoods resilient to climate change.

Climate change and the cost of conserving species in Madagascar.

We examined the cost of conserving species as climate changes. We used a Maxent species distribution model to predict the ranges from 2000 to 2080 of 74 plant species endemic to the forests of Madagascar under 3 climate scenarios. We set a conservation target of achieving 10,000 ha of forest cover for each species and calculated the cost of achieving this target under each scenario. We interviewed managers of projects to restore native forests and conducted a literature review to obtain the net present cost per hectare of management actions to maintain or establish forest cover. For each species, we added hectares of land from lowest to highest cost per additional year of forest cover until the conservation target was achieved throughout the time period. Climate change was predicted to reduce the size of species' ranges, the overlap between species' ranges and existing or planned protected areas, and the overlap between species' ranges and existing forest. As a result, climate change increased the cost of achieving the conservation target by necessitating successively more costly management actions: additional management within existing protected areas (US$0-60/ha); avoidance of forest degradation (i.e., loss of biomass) in community-managed areas ($160-576/ha); avoidance of deforestation in unprotected areas ($252-1069/ha); and establishment of forest on nonforested land within protected areas ($802-2710/ha), in community-managed areas ($962-3226/ha), and in unprotected areas ($1054-3719/ha). Our results suggest that although forest restoration may be required for the conservation of some species as climate changes, it is more cost-effective to maintain existing forest wherever possible.