Trapezius fasciocutaneous flap for burn reconstruction

This case involves a 30-year-old female who suffered extensive facial burns as an outcome of a horrific assault. The patient subsequently underwent 2 surgeries with the ultimate goal of reducing the cosmetic, physical, and thus mental burden the assault caused. The technique of choice was the novel trapezius fasciocutaneous flap for burn reconstruction of the neck. It is discussed that while this technique is still deemed a novel procedure, its unique characteristics make it an excellent choice for cases similar to this one. While this approach has not been widely popularized in the treatment of patients with burn contracture requiring reconstruction, the donor site characteristics and ideal functionality make the trapezius fasciocutaneous flap such an excellent choice. This particular type of graft yields a hidden donor site, contains rich vascularity with physical qualities similar to those of facial skin, specifically in regard to thickness, color, and texture, and ultimately produces the most ideal cometic outcome. Further, the wide arc of rotation unique to this flap allows for better manipulation and mobility at the transplanted location. While the anatomic implications are very relevant to head and neck surgery, this method also produces exemplary cosmetic outcomes when compared to other graft procedures.

Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic

Objectives People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. Methods The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17–April 25; T2: April 26–May 23; T3: May 24–June 25). Results The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06–0.75) during T2 and 0.14 times lower (95% CI: 0.04–0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. Conclusion During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks, and/or individual site characteristics.

Responses of paediatric emergency departments to the first wave of the COVID-19 pandemic in Europe: a cross-sectional survey study

ObjectiveUnderstanding how paediatric emergency departments (PEDs) across Europe adapted their healthcare pathways in response to COVID-19 will help guide responses to ongoing waves of COVID-19 and potential future pandemics. This study aimed to evaluate service reconfiguration across European PEDs during the initial COVID-19 wave.DesignThis cross-sectional survey included 39 PEDs in 17 countries. The online questionnaire captured (1) study site characteristics, (2) departmental changes and (3) pathways for children with acute illness pre and during the first wave of COVID-19 pandemic (January–May 2020). Number of changes to health services, as a percentage of total possible changes encompassed by the survey, was compared with peak national SARS-CoV-2 incidence rates, and for both mixed and standalone paediatric centres.ResultsOverall, 97% (n=38) of centres remained open as usual during the pandemic. The capacity of 18 out of 28 (68%) short-stay units decreased; in contrast, 2 units (7%) increased their capacity. In 12 (31%) PEDs, they reported acting as receiving centres for diverted children during the pandemic.There was minimal change to the availability of paediatric consultant telephone advice services, consultant supervision of juniors or presence of responsible specialists within the PEDs.There was no relationship between percentage of possible change at each site and the peak national SARS-CoV-2 incidence rate. Mixed paediatric and adult hospitals made 8% of possible changes and standalone paediatric centres made 6% of possible changes (p=0.086).ConclusionOverall, there was limited change to the organisation or delivery of services across surveyed PEDs during the first wave of the COVID-19 pandemic.

Spatial Panel Models of Crop Yield Response to Weather: Econometric Specification Strategies and Prediction Performance

This study scrutinizes spatial econometric models and specifications of crop yield response functions to provide a robust evaluation of empirical alternatives available to researchers. We specify 14 competing panel regression models of crop yield response to weather and site characteristics. Using county corn yields in the US, this study implements in-sample, out-of-sample, and bootstrapped out-of-sample prediction performance comparisons. Descriptive propositions and empirical results demonstrate the importance of spatial correlation and empirically support the fixed effects model with spatially dependent error structures. This study also emphasizes the importance of extensive model specification testing and evaluation of selection criteria for prediction.

The Slope Association Type as a Comparative Index for the Evaluation of Environmental Risks

The topography is one of the determining site characteristics, of which the slope inclination is significant for natural science aspects, including the estimation of water erosion risk and as a criterion for agricultural subsidies. The slopes within an area vary greatly and occupy very different proportions of the area. Algorithms that take this heterogeneity into account were developed in the 1970s with the medium-scale agricultural site mapping (MMK). It also contains the slope association types (SAT, in German: “Hangneigungsflächentyp”), which classifies different slopes and summarizes them as one value per reference area. The SAT can be used across various scales and different targets. Applicability is given to soil and water conservation tasks, administrative tasks as field selection or agricultural subsidies, and over a wide range of scales from small catchments areas to whole landscape analyses. Thus, one value on an area basis characterizes an important topographic factor.

Phytomanagement of a Trace Element-Contaminated Site to Produce a Natural Dye: First Screening of an Emerging Biomass Valorization Chain

The study of different possible biomass valorization routes is crucial in order to diversify phytomanagement options, allowing the landowner/stakeholder to choose the best option based on site characteristics and the benefits of local value chains. In the current study, field and laboratory experiments were conducted to assess the suitabilitity of Malva sylvestris L. for the phytoattenuation of a dredged sediment disposal site contaminated with trace elements (trace element (Cd, Cu, Pb, and Zn). The selected crop was Malva sylvestris, a flowering plant from which a colourant can be extracted to be used in dying of textiles as a way to valorize the produced biomass grown on this contaminated land. Under the conditions of the investigated site, the analysis of TE in the sediment and the biomass matrix showed no effect of M. sylvestris on the sediment TE contamination mobility with an excluder phenotype (Bioconcentration factor < 1). Metal concentrations were found to be the highest in the leaves followed by in the stem and flower. The dye extract obtained from the flower part of M. sylvestris permitted the silk alum-pretreated fabric to be dyed yellow, and the TE concentration in the dyed textile fabrics respected the threshold values set by OEKO-Tex standard 100.

Strategies for rehabilitation of Tuk Anjar springshed in Mount Merbabu National Park

Spring is one of the freshwater sources for human life and as a groundwater potential indicator. The springs’ quality and the quantity depend on the springshed condition. However, anthropogenic activities such as forest burning, forest encroachment, illegal logging, and land-use change have caused springshed degradation. Therefore, a proper and efficient springshed rehabilitation strategy is urgently needed. This research was carried out during September-December 2020 to formulate Tuk Anjar springshed rehabilitation strategies at Mount Merbabu National Park, Indonesia. The strategies cover methods to delineate the springshed, identify site characteristics and design rehabilitation plots. Springshed delineation was done using spatial analysis. Site characteristics were obtained by field surveys and laboratory analysis through data collection in a 10x10 m sample plot (spring protection) and 20x20 m (springshed protection). The spatial analysis result showed that Tuk Anjar springshed area was 35.06 ha, with zone I: 0.01 ha, zone II: 2.54 ha, and zone III: 32.5 ha. The priority area to rehabilitate is zone II with a low tree density. Tree species selection is based on on-site species matching, optimal rainwater storage, and having fruits as an animal feed source. Species from the genus of Ficus like wilodo, kebeg and beringin should be used since it has great potential in water storage.