Local Options Research Articles

Who Eats, Where, What, and How? COVID-19, Food Security, and Canadian Foodscapes

Who Eats, Where, What, and How? COVID-19, Food Security, and Canadian Foodscapes

Reconstruction of Digital Defects with the Free Proximal Ulnar Artery Perforator Flap.

Background:The aim of post-traumatic digital reconstruction is to restore form and function, allowing early rehabilitation. In the absence of feasible local options, free tissue transfer can be a versatile and reliable alternative. The aim of this study was to describe our experience with the use of the free proximal ulnar artery perforator flap (PUPF).Methods:Our prospectively maintained free flap database was inquired for patients that had undergone digital reconstructions with free PUPFs.Results:Six patients that underwent digital reconstruction were eligible. The ipsilateral forearm was donor site of choice, with all flaps based on a perforator of the ulnar artery, without the need to compromise the main vessel. A superficial vein was routinely included with the flap. No flap failures were encountered. Mean hospital stay was 5.5 days, and all patients achieved a satisfactory functional result.Conclusions:The proximal ulnar perforator free flap offers an alternative for finger reconstruction, having the advantage of including thin and hairless skin from the proximal ulnar forearm. The vascular anatomy of the ulnar perforators seems to be constant. Furthermore, donor site morbidity is low, as the ulnar artery is not harvested with the flap, the donor site defect can generally be closed directly, and the scar is well concealed.

MR-guided adaptive stereotactic body radiotherapy (SBRT) of primary tumor for pain control in metastatic pancreatic ductal adenocarcinoma (mPDAC): an open randomized, multicentric, parallel group clinical trial (MASPAC)

BackgroundPain symptoms in the upper abdomen and back are prevalent in 80% of patients with metastatic pancreatic ductal adenocarcinoma (mPDAC), where the current standard treatment is a systemic therapy consisting of at least doublet-chemotherapy for fit patients. Palliative low-dose radiotherapy is a well-established local treatment option but there is some evidence for a better and longer pain response after a dose-intensified radiotherapy of the primary pancreatic cancer (pPCa). Stereotactic body radiation therapy (SBRT) can deliver high radiation doses in few fractions, therefore reducing chemotherapy-free intervals. However, prospective data on pain control after SBRT of pPCa is very limited. Therefore, we aim to investigate the impact of SBRT on pain control in patients with mPDAC in a prospective trial.MethodsThis is a prospective, double-arm, randomized controlled, international multicenter study testing the added benefit of MR-guided adaptive SBRT of the pPca embedded between standard of care-chemotherapy (SoC-CT) cycles for pain control and prevention of pain in patients with mPDAC. 92 patients with histologically proven mPDAC and at least stable disease after initial 8 weeks of SoC-CT will be eligible for the trial and 1:1 randomized in 3 centers in Germany and Switzerland to either experimental arm A, receiving MR-guided SBRT of the pPCa with 5 × 6.6 Gy at 80% isodose with continuation of SoC-CT thereafter, or control arm B, continuing SoC-CT without SBRT. Daily MR-guided plan adaptation intents to achieve good target coverage, while simultaneously minimizing dose to organs at risk. Patients will be followed up for minimum 6 and maximum of 18 months. The primary endpoint of the study is the “mean cumulative pain index” rated every 4 weeks until death or end of study using numeric rating scale.DiscussionAn adequate long-term control of pain symptoms in patients with mPDAC is an unmet clinical need. Despite improvements in systemic treatment, local complications due to pPCa remain a clinical challenge. We hypothesize that patients with mPDAC will benefit from a local treatment of the pPCa by MR-guided SBRT in terms of a durable pain control with a simultaneously favorable safe toxicity profile translating into an improvement of quality-of-life.Trial registrationGerman Registry for Clinical Trials (DRKS): DRKS00025801. Meanwhile the study is also registered at ClinicalTrials.gov with the Identifier: NCT05114213.

Why do Local Governments Externalise Public Service Delivery? An Empirical Analysis of the Drivers of Corporatisation, Public-public Collaboration and PPP in the Flemish Elderly Care Sector

Based on a study of 22 Flemish local governments and their respective delivery of elderly care, this article analyses the drivers of three local public service delivery externalisation options: corporatisation, public-public collaboration and public-private partnerships (PPP). The analysis reveals a combination of financial and economic efficiency underlying externalisation. Further, while political ideology appears to impact the choice for PPP, the findings suggest that externalisation is guided by pragmatic rather than political-ideological motivations. Overall, the results show that smaller and more financially strapped local governments are more inclined to choose for public-public collaboration and PPP. Rather than the overall financial situation of local governments being a underlying factor, the (potential) impact of the service-related costs on local finances drive externalisation. We also find that policymakers do not solely motivate their choices based on past and current situations, but also anticipate future challenges.

Passive restoration considerably improved the community structure, soil health and carbon stock in the Pine forests of Kashmir Himalaya, India

Forest restoration significantly enhances soil quality, carbon stock and improves community characteristics, but reports from temperate coniferous ecosystems are limited. The present research aimed to study the changes in vegetation characteristics, biomass, and soil health after eight years of restoration in coniferous forests of Kashmir Himalaya, India. The studied forest stands include the sites before restoration (IN), restored forests (RT) and non-restored (NR) control plots. The results exhibited similar soil texture (clay-loam) in both RT and NR, albeit soils under RT had lower acidity (6.03 ± 0.11) and bulk density (1.21 ± 0.07 Mg m−3) than NR. The average total nitrogen, soil organic carbon, and available phosphorus were 13.2, 32.7 and 19.6%, respectively, greater in RT than NR. For vegetation characteristics, the results exhibited little changes in plant species richness (S = 8 and 7 for RT and NR, respectively), while the stand density and basal area enhancement were recorded for RT. The increase in plant species population and improvement in their regeneration status in RT was observed in comparison to NR in the study area. The density-diameter distribution showed that post-restoration, number of individuals in RT increased substantially in lower (10–25 cm), medium (35–55 cm), and highest (>65 cm) diameter classes with the cumulative percentage increase of 12.2, 44.1 and 12.6, respectively in comparison to the diameter classes 25–35 cm and 55–65 cm which recorded the decrease of 9.8% and 18.3%, respectively. In the case of NR, the results exhibited an alarming trend with a substantial decrease of individuals in lower diameter classes, namely, 15–35 cm (−19.7%), and 55–65 cm (−7.6%), thereby, suggesting the higher vulnerability to degradation than RT. The results of biomass and carbon contents indicated the overall biomass (aboveground and belowground) increase of 97.67 Mg ha−1 in RT and a reduction of 17.46 Mg ha−1 in NR, indicating the restoration added enough biomass to cause measurable changes. The results are evidence of the successful passive restoration efforts via fencing on soil and community characteristics across temperate coniferous forests. Restoring the vulnerable coniferous forests in the Himalayas is recommended to regain their vitality and vigour along with safeguarding the local livelihood options.

Costal Chondrosarcoma in Childhood: Case Report

Costal chondrosarcoma is characterized by a high locoregional invasion potential. Because more chondrosarcomas are resistant to chemotherapy and radiation therapy, the main treatment is based on surgery. Radiologic evaluation of patients and confirmatory biopsy of tissue plays a great role in determining localization, spread, invasion, and treatment options. Chondrosarcomas which arise from the axial skeleton have a poor prognosis. Costal chondrosarcomas in pediatric patients are not well discussed in the literature and due to its proximity of organs in the thoracic cavity, carries great risk for complications. Clinical presentation can be unpredictable. Low cost, accessibility, quick examination time makes X-rays a preferable inspection tool to detect the disease, but the important thing here is to examine each chest radiograph precisely, otherwise, the result may be misleading. Costal Chondrosarcoma in an 8-month-old female is a rare case and is covered in this case report.

Successful management of complex scalp wounds with exposed calvarial bones by customized Negative pressure wound therapy (NPWT): Case series and review of the literature.

Scalp wounds with exposed calvarial bones continue to be a challenge especially when no local flap options are available and no microvascular flaps can be performed. Our prospective study looked at 19 patients (14 males) where customized negative pressure wound treatment was used till the complex scalp wounds, mostly from animal bites, were covered with healthy granulation and grafted. Scalp wounds ranged from 6 × 4 cm to 17 × 11 cm in size whereas the area of exposed bone ranged from 1 × 2 cm to 10 × 10 cm. No major complication was seen, and wounds were rapidly healed.

Intraoperative Fluoroscopy-Assisted Localization of Small Bowel Gastrointestinal Bleeding.

Intraoperative management of refractory small bowel gastrointestinal bleeding continues to present challenges to surgeons, specifically, in localizing the source of bleeding. The need for operative intervention has decreased significantly with improved percutaneous radiologic techniques for embolization with good success rates. When percutaneous treatment methods fail, the surgeon is left with a variety of suboptimal options for localization if the pathologic source is not obvious on external inspection of the small bowel. This report describes a novel method for localizing small bowel gastrointestinal bleeding in those patients who have had previous coil embolization attempts at controlling small bowel gastrointestinal bleeding.

Reconstruction of the large columella defect with Сchmid-Мeyer flap

Introduction. The reconstruction of columella defects is still regarded as a challenging procedure due to the very specific anatomy of the columella and limited local and regional flap options. Furthermore, the texture and color of columella tissue pose difficulties in choosing the right method of reconstruction. Case report. The report presents a patient who underwent reconstruction of a complex columella defect using a Schmid-Meyer flap. Schmid-Meyer flap represents a tubular flap with an internal supraciliary pedicle which allows the transposition of the temporal skin with the addition of ear cartilage on the tip of the nose or the ala nasi. The integration of the flap was complete. During the five-year follow-up period, the cosmetic and functional results were satisfying. Conclusion. Schmid-Meyer flap may be one of the best options for the reconstruction of complex defects of the columella.

Effects of COVID-19 on Local Small Businesses and Resiliency Options in South Wollo and Oromia Administration Zone, Ethiopia

Unemployment is rising in Africa due to inefficient economic performance; rural –urban migration as well as the speeding up poverty. Ethiopia is not exceptional in facing by such daunting unemployment and poverty and its resultant effect at both the rural and urban areas. Government envisaged and implemented national economic policies and programs, for instance, micro and small enterprise and technical and vocational training programs that boost local and small business growth in the urban areas. Micro and small enterprise particularly local and small business activities created vast job opportunities in cities in Amhara regional state, specific to South Wollo and Oromiya administration Zone, Ethiopia. However, local and small business were in fact triggered and faced by adverse factors, COVID-19 was prevalently affecting their monthly sale, saving, expenditure and overall activities. Along with this, this study pinpointed the effect of COVID-19 on the local and small businesses activities in Kemissie, Dessie, Kombolecha and Haik. In pursuit of it, this study employed a descriptive type of research design using cross sectional surveyed data. In pursuit of this, binary logistic regression model and stata software 14 version was used to determine significant effect of COVID-19 on local and small business. Along with this, this study, identified that COVID-19 was influenced the local and small business owner’s income; saving and expenditure. Moreover, lack of loan without collateral and working area were significantly affecting local and small business activities besides to the COVID-19 lockdown. This, study, therefore, suggest to whom it may concern to subsidies and deliver loan without collateral; entrepreneurial and client handling training, working areas for local and small business that will have help of resilienting from the effect of COVID-19 pandemic and the rising inflation effect in the study area and at large in Amhara region, Ethiopia.

The evolution of lower extremity reconstruction

Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century. Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection. The introduction of antibiotics improved surgical debridement and local reconstructive options, enhancing the viability of lower extremities with simple and proximal defects. With the advent of microvascular surgery, free tissue transfer techniques provided a means to reconstruct more distal and complex problems. As these surgical techniques have continued to evolve, so too have indications for reconstruction, patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function. The purpose of this article is to outline the evolution of lower extremity reconstruction, and how the standard of practice has changed over time.

Wireless Localization of Breast Lesions: An Update

Non-wire breast lesion localizations offer several advantages, including dissociation of the breast localization procedure from the operative schedule, greater flexibility to the surgeon when choosing operative approach, and a better overall patient experience. The options for non-wire localization have variable effects on patients, pathologists, surgeons, radiologists and support personnel and cost varies considerably. This review will update the reader on two newer options available for non-wire localization, point out factors to assess when considering use of a non-wire localization device, and provide a table allowing comparison of multiple features between many of the more popular devices currently available.

<em>Hypericum perforatum</em> and <em>Azadirachta indica</em> (Neem) oil in the management of chronic leg ulcers: An uncontrolled retrospective observational case review

Chronic nonhealing leg ulcers are debilitating with high morbidity in a vulnerable patient population and pose a frequent clinical and socioeconomic problem. Numerous local treatment options exist, but clinical trials are rare and wound management still represents a big challenge. Recently a wound dressing based on the natural remedies Hypericum perforatum and Neem oil has been proposed for chronic wound management, but trials on nonhealing leg ulcers are missing. Uncontrolled retrospective observational case review on all patients under our supervision with chronic leg ulcers who underwent treatment with a plant-derived wound dressing based on Hypericum perforatum and Azadirachta indica (Neem) oil. It could be retrieved in a total 16 cases (11 female) with a median age of 71 years. All ulcers (7 ulcers on the leg and 9 ulcers on the feed) showed a complete healing after a median healing time of 82 days (Mean 85, range 14-180 days). No side effects occurred, medication was painless or even reduced pain. Wound dressings based on Hypericum perforatum and Neem oil are well tolerated and could be a potential additional simple treatment option in the management of non-healing leg ulcers. Prospective controlled trials are needed to confirm these observations.

Recurrent Endometrial Cancer: Local and Systemic Treatment Options.

Simple SummaryIn this review, we discuss the different treatment strategies in recurrent endometrial cancer. The incidence of endometrial cancer is rising. The available treatment options increase with the development of novel radiotherapy techniques and new systemic therapies. Dependent on the site of recurrence and previous therapy, the treatment of recurrent endometrial cancer can be curative or palliative. Newly emerging medical treatments, such as immunotherapy, might be of benefit in selected patients. Moreover, combinations of different treatments can lead to a better outcome. Recent insights on oligometastatic disease lead us to expect that ablative or radical local treatment for distant metastasis will be of benefit in selected patients. Due to the complexity of the cases, it is recommended to discuss individual cases in a multidisciplinary tumor board. Shared decision-making principles are recommended to maximize treatment personalization.The treatment of recurrent endometrial cancer is a challenge. Because of earlier treatments and the site of locoregional recurrence, in the vaginal vault or pelvis, morbidity can be high. A total of about 4 to 20% of the patients with endometrial cancer develop a locoregional recurrence, mostly among patients with locally advanced disease. The treatment options are dependent on previous treatments and the site of recurrence. Local and locoregional recurrences can be treated curatively with surgery or (chemo)radiotherapy with acceptable toxicity and control rates. Distant recurrences can be treated with palliative systemic therapy, i.e., first-line chemotherapy or hormonal therapy. Based on the tumor characteristics and molecular profile, there can be a role for immunotherapy. The evidence on targeted therapy is limited, with no approved treatment in the current guidelines. In selected cases, there might be an indication for local treatment in oligometastatic disease. Because of the novel techniques in radiotherapy, disease control can often be achieved at limited toxicity. Further studies are warranted to analyze the survival outcome and toxicity of newer treatment strategies. Patient selection is very important in deciding which treatment is of most benefit, and better prediction models based on the patient- and tumor characteristics are necessary.

Invited Review: Lessons from the COVID-19 pandemic for food supply chains

PurposeSome of the biggest economic disruptions from the COVID-19 pandemic were experienced in food supply chains, particularly in the protein sector. This article examines these protein-sector supply-chain shocks, exploring the nature and causes of the market disruptions during the pandemic, evaluating the effects of these shocks from an economic perspective, and discussing potential market and policy responses that could mitigate the adverse effects of similar events in the future.SourcesA variety of sources contemporary to the pandemic were surveyed to document pandemic effects on meat and poultry supply chains. The implications of pandemic effects for supply chain participants were explored, drawing from sources in supply chain management, network reliability, and agricultural economics literature.SynthesisPandemic-related disruptions to meat supply chains and the economic hardship associated with those disruptions have generated tremendous interest in improving supply chain robustness and resilience. Much of that interest focuses on encouraging local and regional processing operations, creating shorter supply chains. At the same time, commercial interests will most likely aggressively pursue further automation to mitigate the effects of labor supply disruption—their major problem during the pandemic.Conclusions and ApplicationsLocal and regional processing operations are receiving a significant infusion of pandemic relief funds. Consumers are currently keenly interested in local and regional food options. At the same time, commercial operations will likely become even more efficient due to postpandemic adjustments. Thus, local and regional operations may face an even more challenging competitive environment than before the pandemic.

Glocal

The term GLOCAL that appeared only thirty years ago and was taken by us as the theme of this issue, is internally contradictory. The global, relating to the globe as a whole, looks like the opposite to the local, partial. Our paradoxical time, however, fills the term with actual meaning. Humanity is united in a common information space, and none of the corners of the Earth can ignore universal human processes and trends anymore. Globality threatens to erase all local differences, unify and average everything and everyone. Against this background, there is an escalating struggle for vivid and unique local national, cultural and ethnic identities, which can be compared with a tree breaking through the asphalt... The pandemic, which has gripped the world, divides people strictly and sets up many borders and walls. But it also unites them, demonstrating the widest range of local options for responding to a deadly threat.The articles from the theoretical section of this issue are devoted to the analysis of the concept of "glocality".

Benefits of radiotherapy for patients with solitary plasmacytoma or multiple myeloma

Treatment options for patients with solitary plasmacytoma (SP) or multiple myeloma (MM) should be discussed in an interdisciplinary context. This systematic review focuses on the importance of radiotherapy in MM and SP. Summary of local radio-oncological treatment options for patients with SP and MM. Based on asystematic literature search, the current evidence on the topic was analyzed and summarized. Patients with SP should be primarily treated with radiotherapy with or without surgery. Irradiation concepts may vary depending on risk factors and manifestation (solitary bone plasmacytoma vs. solitary extramedullary plasmacytoma). Although local control rates are high after radiotherapy, progression to multiple myeloma frequently occurs. In patients with MM, radiation is mainly used in palliative settings for pain relief, prevention of fractures or in patients who suffer from neurological symptoms due to spinal cord compression. Irradiation dose and fractionation should be selected based on treatment indication and general condition of the patient. Although most patients receive systemic treatment at initial diagnosis, approximately 40% of patients with MM will require radiation during the course of their disease. While radiation is mainly used for palliation in patients with MM, it represents the primary and curative treatment option in patients with SP.

Differences in Time Burden across Local Therapy Strategies for Early-stage Breast Cancer.

Background:“Time burden” (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon).Methods:Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates.Results:Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon (P < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon (P < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days.Conclusions:Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.

Devising spatio-temporal adaptation from land suitability inputs: Measures and options for sub-alpine agricultural systems

The paper introduces a decision-making approach with the intention to guide agricultural adaptation to climate change during the 21st century. Using two orographically dissimilar sub-alpine systems located in the Australian Alps and Chilean Dry Andes, the rational selection of adaptation measures and local options is framed into a spatio-temporal adaptation model. Decision-making here is supported by the interpretation of adaptation pathway analogues following key adaptation typologies (like flexibility and deepness) and representative landscape functionalities found in specific rural spaces. The model is based on estimating multi-scale land suitability gaps and feasible biophysical and irrigation-potential combination of adjustments seen as necessary to propose specific adaptation strategies for a baseline, mid-century and end-century periods. Decision-making insights resulting from this exercise could improve the evaluation when corroborating and generalising regional-type adaptation pathways in the light of adaptation opportunities and limits.

Clinical Effectiveness of Hypofractionated Proton Beam Therapy for Liver Metastasis From Breast Cancer.

BackgroundFew studies of proton beam therapy (PBT) for patients with liver metastasis from breast cancer (LMBC) are available to date. The aim of the present study was to evaluate the clinical effectiveness of PBT for patients with LMBC.Material and MethodsSeventeen patients with LMBC treated with PBT were included in this study. The median prescribed dose of PBT was 66 GyE (range, 60–80) in 10 fractions, 5 times a week. In patients with LMBC receiving PBT, freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) rates were assessed.ResultsThe median follow-up time was 34.2 months (range, 11.5–56.1). The median FFLP time was not yet reached, and the 3-year FFLP rates were 94.1% (95% confidence interval [CI], 82.9–105.3). The median times of PFS and OS were 7.9 months (95% CI, 5.3–10.5) and 39.3 months (95% CI, 33.2–51.9), respectively, and the 3-year PFS and OS rates were 19.6% (95% CI, -1.8–41.0) and 71.7% (95% CI, 46.8–96.6), respectively. Grade 3 or higher adverse events were not observed.ConclusionPBT for patients with LMBC showed promising FFLP and OS with safe toxicity profiles. These findings suggest that PBT can be considered a local treatment option in patients with LMBC.