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1.
Foods ; 12(9)2023 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-37174454

RESUMO

Various food safety and environmental problems in China have raised consumer awareness of food safety issues and negative environmental impacts in various supply chains. This research assessed consumer preferences and willingness to pay (WTP) for food safety and ecosystem delivery attributes associated with apples, demonstrated through the application of different traceability systems. Research participants were recruited in Beijing (N = 384) and Shanghai (N = 320). Choice experiment methodology was applied. The data were analyzed using conditional logit, random parameter logit, and latent class models; the results indicated significant consumer preferences for traceability information, including in relation to lower pesticide usage and application of organic fertilizer during primary production. The results also indicated that participants in this research had a significant willingness-to-pay premium for apple products that had production information traceability, had reduced pesticide use, and were grown with organic fertilizers. The models demonstrated heterogeneous preferences among participants such that consumers could be divided into three classes: non-price-sensitive (53.5%), pesticide-sensitive (21.7%), and price-sensitive (24.8%).

2.
Plast Reconstr Surg ; 151(3): 412e-419e, 2023 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-36730439

RESUMO

BACKGROUND: Sufficient perfusion is foundational to successful reconstructive surgery. Various technologies have been developed to help determine whether tissue is adequately perfused, or whether it will be prone to necrosis postoperatively. Indocyanine green (ICG) angiography is one such method that uses fluorescence and analyzes tissue perfusion. Multispectral reflectance imaging (MSRI) is an alternative technology that analyzes optical properties of oxygenated and deoxygenated hemoglobin to determine tissue viability. Because tissue in low-perfusion states may still survive because of sufficient oxygenation, the authors hypothesized that compared to MSRI, ICG angiography overpredicts necrosis, potentially resulting in unnecessary resection of viable tissue. This study expands on preliminary work to investigate this hypothesis. METHODS: This was a prospective cohort of patients undergoing prepectoral direct implant reconstruction at a single institution. Each patient was examined intraoperatively with both ICG angiography and MSRI. Decisions to resect tissue were made in conjunction with MSRI and ICG images collected purely for data analysis. Patients were followed postoperatively for at least 2 months for signs of postoperative necrosis. RESULTS: Fifty-three cases were included. ICG angiography accurately predicted viability in 40 of 40 patients (100%) and incorrectly predicted necrosis in 11 of 13 patients (84.6%). Simultaneously, MSRI predicted necrosis in zero patients and accurately predicted viability in 51 of 53 patients (96.2%). There was no statistically significant difference in demographic data among patients predicted to experience necrosis by means of ICG angiography versus those predicted to have entirely viable tissue. CONCLUSION: This study suggests that ICG angiography is prone to overpredicting postoperative necrosis in comparison to MSRI. CLINICAL RELEVANCE STATEMENT: This study suggests that multispectral reflectance imaging may benefit practicing plastic surgeons in determining the likelihood of postoperative necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.


Assuntos
Verde de Indocianina , Procedimentos de Cirurgia Plástica , Humanos , Estudos Prospectivos , Angiografia/métodos , Necrose , Angiofluoresceinografia
3.
Plast Reconstr Surg Glob Open ; 10(12): e4667, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36530854

RESUMO

Seroma formation is the most common complication after mastectomy. While the exact pathophysiology behind seroma development has not been entirely elucidated, seromas are associated with negative outcomes in breast reconstruction. The utilization of drains is one method to combat seroma. However, the current state of plastic surgery is divided as to whether one drain or two drains is optimal in reducing seroma formation. We hypothesized that using two drains instead of one drain would reduce the risk of seroma more so than one drain. Methods: This was a retrospective cohort study of patients who underwent prepectoral direct to implant reconstruction at a single institution by a single surgeon. Each patient underwent reconstruction with either one or two drains. Patients were followed postoperatively for rates of seroma formation. Seroma were classified as either minor or major. Secondary variables including drain duration, infection, and necrosis were also analyzed. Results: A total of 99 breasts and 71 patients experienced breast reconstruction with two drains, and 163 breasts corresponding to 135 patients received reconstruction with one drain. In the two drain cohort, 14 (14.1%) developed a seroma, with 11 (11.1%) being minor seromas and three (3.03%) being major seromas. In comparison, out of the one drain cohort, 41 (25.2%) developed a seroma, with 35 (21.5%) being a minor seroma and six (3.68%) being classified as major. Conclusion: This study suggests that two drains decreases the rate and risk of seroma formation compared to one drain in prepectoral breast reconstruction with an acellular dermal matrix.

4.
J Plant Dis Prot (2006) ; 129(5): 1249-1261, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36119355

RESUMO

Innovation in environmental fields such as plant health is complex because of unbounded challenges and lack of certainty of commercial uptake. In this paper we present a Technology Readiness Level (TRL) framework, specifically to assist with assessment of technologies to support detection of tree pests and pathogens, but also for wider potential adaptation. Biosecurity can be enhanced by improved early detection of pests and pathogens, but development and deployment of new technologies requires robust scrutiny. We critically analyse the concept, practice and applicability of TRLs. Interviews revealed scientist perspectives during the development process of five novel early plant pest and pathogen detection technologies. A retrospective, collective narrative of one technology from concept to commercial deployment was undertaken. We then developed a calculator tool for assessment of biosecurity TRLs. Our findings illustrate the iterative process of technology development, the challenges in final TRLs of acquiring funding to move from proven success to viable product, inefficiencies created through the need for multiple projects for each technology and the imperative to consider the wider socio-ecological technical landscape, including policy context. End user engagement was particularly valuable at beginning and end of the TRL scale. We conclude that the TRL framework comprises a robust approach to assess technologies in that it facilitates progress tracking, evaluation of success likelihood and identification of opportunities for investment. However, its potential will only be realised for environmental management if it is integrated into the socio-ecological technical landscape and wider discussions regarding knowledge co-production and valuing nature. Supplementary Information: The online version contains supplementary material available at 10.1007/s41348-022-00599-3.

5.
J Appl Volcanol ; 11(1): 5, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35535045

RESUMO

The Mount Meager Volcanic Complex (Mount Meager) is a glacier-clad stratovolcanic system in southwestern British Columbia which last erupted over 2400 years ago (VEI 4). While this is Canada's most recent major explosive eruption, most past research on Mount Meager has focused on its numerous and large volume landslides and thus the volcanic hazard characteristics remain understudied. Here we present a suite of scenario-based hazard maps and an assessment addressing a range of potential future explosive eruptions and associated hazards. In order to overcome limited knowledge of the eruptive history, numerical models have been used to simulate the primary syneruptive hazards of concern (dome-collapse pyroclastic density currents, lahars and tephra fallout) largely utilizing eruption parameters from analogous volcanoes, i.e., glacier-clad stratovolcanoes in a subduction zone setting. This study provides a framework for similar volcanic hazard studies where geologic data is limited, funds are minimal, and access is difficult. Furthermore, this sets the stage for recognizing volcanic hazards in the Canadian landscape, providing a resource to prepare for and mitigate potential impacts well in advance of a crisis situation.

6.
Nat Commun ; 13(1): 2832, 2022 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-35595774

RESUMO

During explosive eruption of low viscosity magmas, pyroclasts are cooled predominantly by forced convection. Depending on the cooling efficiency relative to other timescales, a spectrum of deposits can be formed. Deposition of hot clasts, above their glass transition temperature, can form spatter mounds, ramparts and clastogenic lava flows. Clasts may also be deposited cold, producing tephra cones and blankets. Thus, the deposit and pyroclast type can provide information about eruption dynamics and magma properties. Here we examine pyroclasts from Tseax volcano, British Columbia, Canada. These newly identified inflated pyroclasts, are fluidal in form, have undergone post-depositional expansion, and are found juxtaposed with scoria. Detailed field, chemical and textural observations, coupled with high temperature rheometry and thermal modelling, reveal that abrupt transitions in eruptive behaviour - from lava fountaining to low-energy bubble bursts - created these pyroclastic deposits. These findings should help identify transitions in eruptive behaviour at other mafic volcanoes worldwide.


Assuntos
Desastres , Colúmbia Britânica , Temperatura Baixa
7.
Agric Food Secur ; 11(1): 21, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35310134

RESUMO

Background: Research into public risk perceptions associated with emerging risks in agriculture and supply chains has focused on technological risks, zoonotic diseases, and food integrity, but infrequently on naturally occurring diseases in plants. Plant virus infections account for global economic losses estimated at $30 billion annually and are responsible for nearly 50% of plant diseases worldwide, threatening global food security. This research aimed to understand public perceptions of emerging risks and benefits associated with plant viruses in agriculture in Belgium, Slovenia, Spain, and the UK. Methods: Online qualitative semi-structured interviews with 80 European consumers were conducted, including 20 participants in each of Belgium, Slovenia, the UK, and Spain. Microsoft Streams was used to transcribe the interview data, and NVivo was utilized to code the transcripts and analyze the data. Results: The results indicate that, while study participants were relatively unfamiliar with the plant viruses and their potential impacts, plant viruses evoked perceived risks in a similar way to other emerging risks in the agri-food sector. These included risks to environment and human health, and the economic functioning of the relevant supply chain. Some participants perceived both risks and benefits to be associated with plant viruses. Benefits were perceived to be associated with improved plant resistance to viruses. Conclusions: The results provide the basis for risk regulation, policy, and communication developments. Risk communication needs to take account of both risk and benefit perceptions, as well as the observation that plant viruses are perceived as an emerging, rather than an established, understood, and controlled risk. Some participants indicated the need for risk-benefit communication strategies to be developed, including information about the impacts of the risks, and associated mitigation strategies. Participants perceived that responsibility for control of plant viruses should be conferred on actors within the supply chain, in particular primary producers, although policy support (for example, financial incentivization) should be provided to improve their motivation to instigate risk mitigation activities.

8.
J Environ Manage ; 302(Pt B): 114082, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34775335

RESUMO

Apple is one of the most important cash crops in China. However, negative economic, environmental and social impacts are associated with its production. This study aims to apply a holistic systems perspective to understand existing problems associated with apple production in China and use this information to improve its sustainability. A structured survey was administered to farmers (n = 245) in Shandong and Shanxi provinces, combined with semi-structured interviews with apple supply chain stakeholders (n = 25). Themes, dimensions and relationships were identified based on an inductive thematic analysis of interview data, and then triangulated against the survey data. Interpretive Structural Modelling and Cross-Impact Matrix Multiplication Applied to Classification methods were applied to investigate interrelationships and effects of the elicited elements within the system. The results indicated that various environmental, economic and social problems are associated with apple production in China, including environmental and health risks associated with synthetic input applications, yield instability, deterioration of apple quality, farmers' uncertainty about accessing routes to market, and the ageing farming workforce. The interaction of socio-economic and supply chain issues has contributed to the system "lock-in" to unsustainable practices within the apple production system. Existing agricultural policies were ineffective as they did not include policy leverage to mitigate the multiple factors driving lock-in to unsustainable practices within the system. The research has provided evidence to enable policymakers to develop effective and targeted strategies to facilitate sustainable production within the apple production system. In particular, the future policy mix should consider the entirety of the food system including perspectives and requirements of different stakeholders. The three-stage approach applied has demonstrated its feasibility of investigating sustainability issues facing a particular industry within a specific cultural and policy context.


Assuntos
Malus , Agricultura , Produtos Agrícolas , Fazendeiros , Fazendas , Humanos
9.
Funct Plant Biol ; 48(7): 732-742, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34099101

RESUMO

The distributions of CAM and C3 epiphytic bromeliads across an altitudinal gradient in western Panama were identified from carbon isotope (δ13C) signals, and epiphyte water balance was investigated via oxygen isotopes (δ18O) across wet and dry seasons. There were significant seasonal differences in leaf water (δ18Olw), precipitation, stored 'tank' water and water vapour. Values of δ18Olw were evaporatively enriched at low altitude in the dry season for the C3 epiphytes, associated with low relative humidity (RH) during the day. Crassulacean acid metabolism (CAM) δ18Olw values were relatively depleted, consistent with water vapour uptake during gas exchange under high RH at night. At high altitude, cloudforest locations, C3 δ18Olw also reflected water vapour uptake by day. A mesocosm experiment with Tillandsia fasciculata (CAM) and Werauhia sanguinolenta (C3) was combined with simulations using a non-steady-state oxygen isotope leaf water model. For both C3 and CAM bromeliads, δ18Olw became progressively depleted under saturating water vapour by day and night, although evaporative enrichment was restored in the C3 W. sanguinolenta under low humidity by day. Source water in the overlapping leaf base 'tank' was also modified by evaporative δ18O exchanges. The results demonstrate how stable isotopes in leaf water provide insights for atmospheric water vapour exchanges for both C3 and CAM systems.


Assuntos
Vapor , Água , Isótopos de Oxigênio , Panamá , Folhas de Planta
10.
Emerg Top Life Sci ; 4(5): 473-483, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33313752

RESUMO

Plant health is relatively poorly funded compared with animal and human health issues. However, we contend it is at least as complex and likely more so given the number of pests and hosts and that outbreaks occur in poorly monitored open systems. Modelling is often suggested as a method to better consider the threats to plant health to aid resource and time poor decision makers in their prioritisation of responses. However, like other areas of science, the modelling community has not always provided accessible and relevant solutions. We describe some potential solutions to developing plant health models in conjunction with decision makers based upon a recent example and illustrate how an increased emphasis on plant health is slowly expanding the potential role of modelling in decision making. We place the research in the Credibility, Relevance and Legitimacy (CRELE) framework and discuss the implications for future developments in co-construction of policy-linked models.


Assuntos
Política de Saúde , Formulação de Políticas , Animais , Surtos de Doenças , Humanos , Plantas , Projetos de Pesquisa
11.
Plast Reconstr Surg Glob Open ; 8(11): e3245, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33299709

RESUMO

Perforator selection is of paramount importance when performing a Deep Inferior Epigastric Perforator flap. Technological advancements within imaging modalities have proved invaluable in preoperative planning and intraoperative assessment. Computed tomographic angiography remains the gold standard for preoperative perforator mapping, while color ultrasound Doppler is considered more reliable for determining vessel caliber. Intraoperatively, an imaging modality that provides sequential, real-time assessment of various perforators' supply to the flap would provide helpful insight to determine which perforator will optimize flap viability, especially of the most distal, lateral margins. Multispectral imaging, a variant of near infrared imaging, has emerged as an alternative method to assess tissue viability in the operating room as well as postoperatively. Unlike Spy technology, which is invasive and cost ineffective, the SnapshotNIR (KD203) is a handheld multispectral imaging device utilizing NIR to measure the oxygenation of the hemoglobin in the area to calculate the tissue oxygen content (StO2) displayed in a color image. The following case of a 46-year-old woman undergoing tertiary breast reconstruction for treatment of progressive grade 2 capsular contracture illustrates the utility and ease of KD203 application to intra-operative perforator determination in deep inferior epigastric perforator flap assessment.

12.
Phytopathology ; 110(11): 1740-1750, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32954988

RESUMO

In order to prevent and control the emergence of biosecurity threats such as vector-borne diseases of plants, it is vital to understand drivers of entry, establishment, and spatiotemporal spread, as well as the form, timing, and effectiveness of disease management strategies. An inherent challenge for policy in combatting emerging disease is the uncertainty associated with intervention planning in areas not yet affected, based on models and data from current outbreaks. Following the recent high-profile emergence of the bacterium Xylella fastidiosa in a number of European countries, we review the most pertinent epidemiological uncertainties concerning the dynamics of this bacterium in novel environments. To reduce the considerable ecological and socio-economic impacts of these outbreaks, eco-epidemiological research in a broader range of environmental conditions needs to be conducted and used to inform policy to enhance disease risk assessment, and support successful policy-making decisions. By characterizing infection pathways, we can highlight the uncertainties that surround our knowledge of this disease, drawing attention to how these are amplified when trying to predict and manage outbreaks in currently unaffected locations. To help guide future research and decision-making processes, we invited experts in different fields of plant pathology to identify data to prioritize when developing pest risk assessments. Our analysis revealed that epidemiological uncertainty is mainly driven by the large variety of hosts, vectors, and bacterial strains, leading to a range of different epidemiological characteristics further magnified by novel environmental conditions. These results offer new insights on how eco-epidemiological analyses can enhance understanding of plant disease spread and support management recommendations.[Formula: see text] Copyright © 2020 The Author(s). This is an open access article distributed under the CC BY 4.0 International license.


Assuntos
Xylella , Europa (Continente) , Doenças das Plantas , Incerteza
13.
Emerg Top Life Sci ; 4(5): 453-462, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-32756868

RESUMO

Invasive alien species (IAS) are one of the most severe threats to biodiversity and are the subject of varying degrees of surveillance activity. Predictive early warning systems (EWS), incorporating automated surveillance of relevant dataflows, warning generation and dissemination to decision makers are a key target for developing effective management around IAS, alongside more conventional early detection and horizon scanning technologies. Sophisticated modelling frameworks including the definition of the 'risky' species pool, and pathway analysis at the macro and micro-scale are increasingly available to support decision making and to help prioritise risks from different regions and/or taxa. The main challenges in constructing such frameworks, to be applied to border inspections, are (i) the lack of standardisation and integration of the associated complex digital data environments and (ii) effective integration into the decision making process, ensuring that risk information is disseminated in an actionable way to frontline surveillance staff and other decision makers. To truly achieve early warning in biosecurity requires close collaboration between developers and end-users to ensure that generated warnings are duly considered by decision makers, reflect best practice, scientific understanding and the working environment facing frontline actors. Progress towards this goal will rely on openness and mutual understanding of the role of EWS in IAS risk management, as much as on developments in the underlying technologies for surveillance and modelling procedures.


Assuntos
Biodiversidade , Espécies Introduzidas , Humanos , Gestão de Riscos
14.
Sci Rep ; 10(1): 9034, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32494034

RESUMO

Olivine-hosted melt inclusions (MIs) provide samples of magmatic liquids and their dissolved volatiles from deep within the plumbing system. Inevitable post-entrapment modifications can lead to significant compositional changes in the glass and/or any contained bubbles. Re-heating is a common technique to reverse MI crystallisation; however, its effect on volatile contents has been assumed to be minor. We test this assumption using crystallised and glassy basaltic MIs, combined with Raman spectroscopy and 3D imaging, to investigate the changes in fluid and solid phases in the bubbles before and after re-heating. Before re-heating, the bubble contains CO2 gas and anhydrite (CaSO4) crystallites. The rapid diffusion of major and volatile elements from the melt during re-heating creates new phases within the bubble: SO2, gypsum, Fe-sulphides. Vapour bubbles hosted in naturally glassy MIs similarly contain a plethora of solid phases (carbonates, sulphates, and sulphides) that account for up to 84% of the total MI sulphur, 80% of CO2, and 14% of FeO. In both re-heated and naturally glassy MIs, bubbles sequester major and volatile elements that are components of the total magmatic budget and represent a "loss" from the glass. Analyses of the glass alone significantly underestimates the original magma composition and storage parameters.

15.
Plast Reconstr Surg ; 145(1): 85e-93e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881615

RESUMO

BACKGROUND: Objective assessment of tissue viability is critical to improve outcomes of cosmetic and reconstructive procedures. A widely used method to predict tissue viability is indocyanine green angiography. The authors present an alternative method that determines the relative proportions of oxyhemoglobin to deoxyhemoglobin through multispectral reflectance imaging. This affordable, hand-held device is noninvasive and may be used in clinic settings. The authors hypothesize that multispectral reflectance imaging is not inferior to indocyanine green angiography in predicting flap necrosis in the murine model. METHODS: Reverse McFarlane skin flaps measuring 10 × 3 cm were raised on 300- to 400-g male Sprague-Dawley rats. Indocyanine green angiography and multispectral reflectance imaging was performed before surgery, immediately after surgery, and 30 minutes after surgery. Clinical outcome images acquired 72 hours after surgery were evaluated by three independent plastic surgeons. Objective data obtained immediately after surgery were compared to postsurgical clinical outcomes to determine which method more accurately predicted flap necrosis. RESULTS: Nine reverse McFarlane skin flaps were evaluated 72 hours after flap elevation. Data analysis demonstrated that the 95 percent confidence intervals for the sensitivity of postoperative multispectral reflectance imaging and indocyanine green angiography imaging to predict 72-hour tissue viability at a fixed specificity of 90 percent for predicting tissue necrosis were 86.3 to 91.0 and 79.1 to 86.9, respectively. CONCLUSIONS: In this experimental animal model, multispectral reflectance imaging does not appear to be inferior to indocyanine green angiography in detecting compromised tissue viability. With the advantages of noninvasiveness, portability, affordability, and lack of disposables, multispectral reflectance imaging has an exciting potential for widespread use in cosmetic and reconstructive procedures.


Assuntos
Angiografia/métodos , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Pele/patologia , Retalhos Cirúrgicos , Animais , Corantes/administração & dosagem , Modelos Animais de Doenças , Fluorescência , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Necrose/diagnóstico por imagem , Necrose/etiologia , Necrose/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Ratos , Ratos Sprague-Dawley , Procedimentos de Cirurgia Plástica/métodos , Pele/irrigação sanguínea , Sobrevivência de Tecidos
16.
Semin Plast Surg ; 33(4): 258-263, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31632209

RESUMO

Outcomes after mastectomy and prosthetic-based breast reconstruction have improved immensely since the development of the first tissue expander and breast implant in the 1960s. One major factor contributing to our improved outcomes over the past two decades is the increasing availability and improvement of perfusion assessment technology. Instrumental methods now exist which allow surgeons to assess tissue viability intraoperatively, and provide actionable, objective data that augments clinical assessment. In this article, the authors detail two commercially available, state-of-the-art technologies that surgeons may use to assist in mastectomy flap assessment and facilitate the reconstructive process.

17.
Curr Biol ; 29(9): R315-R316, 2019 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-31063720

RESUMO

Invasive tree pests and diseases present some of the greatest global threats to forests, and the recent global acceleration in invasions has caused massive ecological damage [1,2]. Calls to improve biosecurity have, however, often lost out to economic arguments in favour of trade [3]. Human activities, such as trade, move organisms between continents, and interventions to reduce risk of introductions inevitably incur financial costs. No previous studies have attempted to estimate the full economic cost of a tree disease, and the economic imperative to improve biosecurity may have been underappreciated. We set out to estimate the cost of the dieback of ash, Fraxinus excelsior, caused by Hymenoscyphus fraxineus, in Great Britain, and investigate whether this may be the case [4].


Assuntos
Ascomicetos/fisiologia , Agricultura Florestal/economia , Fraxinus/microbiologia , Doenças das Plantas/economia , Doenças das Plantas/microbiologia , Reino Unido
18.
Gland Surg ; 8(1): 53-60, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30842928

RESUMO

BACKGROUND: Given the current trends in skin preservation during mastectomy, improved biofilm reduction algorithms, and advancements in tissue bioengineering and perfusion assessment, acellular dermal matrix (ADM)-reinforced single stage, direct to implant insertion in the pre-pectoral space has become a viable alternative to two-stage expander-based, sub-pectoral reconstruction. METHODS: The authors performed a retrospective review of their pre-pectoral cases evaluating outcomes for all single stage, direct to implant procedures. Outcomes reviewed included hematoma, seroma, infection, device loss or change, animation deformity and revisional procedures such as fat grafting. The anterior tenting surgical technique is also reviewed. RESULTS: The authors have carried out 305 direct to implant pre-pectoral breast reconstructions using an anterior tenting technique with low complication rates and superior clinical and functional outcomes. The benefits of this technique include less patient discomfort, no need for postoperative expansion, virtually no subjective negative impact on upper extremity function and elimination of animation deformity. Longer-term follow-up demonstrates maintenance of the integrity and quality of the reconstructions over time. CONCLUSIONS: The authors consider single stage, pre-pectoral direct to implant breast reconstruction to be a state-of-the-art breast reconstruction technique and have found it to be safe and reproducible. This technique is their primary choice for immediate implant-based reconstruction following mastectomy.

19.
Plast Reconstr Surg Glob Open ; 7(7): e2301, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31942337

RESUMO

A signifcant disadvantage of subpectoral breast reconstruction procedures is animation deformity during pectoralis major contraction. In this study, we discuss one surgeon's experience with elective subpectoral to prepectoral implant site conversion as a definitive solution to animation deformity.. METHODS: Authors performed a retrospective review of pre-pectoral and sub-pectoral breast reconstructions performed by a single surgeon. Implants placed in the prepectoral plane were supported with total anterior AlloDerm coverage. RESULTS: One hundred forty-two breasts in 90 patients who had underwent elective subpectoral to prepectoral implant site conversion. Postoperative resolution of animation deformity was 100%. Overall, complications are minimal with rates at 4.2% for infection, 2.1% for seroma, and 0.7% for hematoma, dehiscence, partial thickness necrosis, and explantation. One patient requested reoperation for reduction in implant volume. Baker grades II-IV capsular contractures are 0% at 43 months. CONCLUSION: Breast implant site conversion from the subpectoral to the prepectoral plane is a safe and definitive solution for animation deformity.

20.
Ecohealth ; 15(2): 302-316, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29435773

RESUMO

The maintenance of livestock health depends on the combined actions of many different actors, both within and across different regulatory frameworks. Prior work recognised that private risk management choices have the ability to reduce the spread of infection to trading partners. We evaluate the efficiency of farmers' alternative biosecurity choices in terms of their own-benefits from unilateral strategies and quantify the impact they may have in filtering the disease externality of trade. We use bovine viral diarrhoea (BVD) in England and Scotland as a case study, since this provides an example of a situation where contrasting strategies for BVD management occur between selling and purchasing farms. We use an agent-based bioeconomic model to assess the payoff dependence of farmers connected by trade but using different BVD management strategies. We compare three disease management actions: test-cull, test-cull with vaccination and vaccination alone. For a two-farm trading situation, all actions carried out by the selling farm provide substantial benefits to the purchasing farm in terms of disease avoided, with the greatest benefit resulting from test-culling with vaccination on the selling farm. Likewise, unilateral disease strategies by purchasers can be effective in reducing disease risks created through trade. We conclude that regulation needs to balance the trade-off between private gains from those bearing the disease management costs and the positive spillover effects on others.


Assuntos
Criação de Animais Domésticos/métodos , Doença das Mucosas por Vírus da Diarreia Viral Bovina/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Fazendeiros , Gestão de Riscos/métodos , Abate de Animais/economia , Abate de Animais/métodos , Criação de Animais Domésticos/economia , Animais , Doença das Mucosas por Vírus da Diarreia Viral Bovina/transmissão , Bovinos , Controle de Doenças Transmissíveis/economia , Efeitos Psicossociais da Doença , Humanos , Gado , Modelos Econômicos , Gestão de Riscos/economia , Índice de Gravidade de Doença , Reino Unido , Vacinação
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