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Introduction Brachial plexus injuries are severe life-altering injuries. The surgical method to restore shoulder abduction in adult upper brachial plexus injuries involves the usage of nerve grafts and nerve transfers targeting the suprascapular and/or the axillary nerve. When the primary nerve surgery has been unsuccessful or recovery has been incomplete or with a late presentation, muscle transfer procedures are needed to provide or improve shoulder abduction. Levator scapulae to supraspinatus is a transfer to improve shoulder abduction in posttraumatic brachial plexus injuries. Material and Methods The study included 13 patients with the age ranging from 17 to 47 years with a mean age of 30 years. All these patients had preop shoulder abduction of Medical Research Council (MRC) grade ≤3. All had a minimum of MRC grade 4 of active elbow flexion. Eleven patients had primary surgery. Only patients with a minimum of 1 year postoperative follow-up were included. All 13 patients underwent levator scapulae transfer only. Results All patients had a stable shoulder postoperatively. The average increase in active shoulder abduction was from 6.15°(median 0°) preoperatively to 61.92°(median 60°), with an average gain in shoulder abduction of 49.61°(median 50°). Conclusions Transfer of levator scapulae tendon to the supraspinatus is an option to improve shoulder abduction in posttraumatic brachial plexus. In conditions where supraspinatus alone is not functioning, levator scapulae is the best available transfer, considering its strength and maintaining the form of the shoulder unlike trapezius transfer. In patients with previous surgery where supraspinatus has recovered partially but not functionally significant, this tendon transfer can be considered for the augmentation of the existing shoulder abduction.Background Total brachial plexus palsy (TBPP) accounts for nearly 50% of all brachial plexus injuries. Since achieving a good functional hand was almost impossible, the aim was settled to get a good shoulder and elbow function. It was Gu, who popularized the concept of utilizing contralateral C7 (CC7) with vascularized ulnar nerve graft (VUNG) to get some hand function. We have modified it to suit our patients by conducting it as a single-stage procedure, thereby trying to get a functional upper limb. Methods From 2009 to 2014, we had 20 TBPP patients. We feel nerve reconstruction is always better than any other salvage procedure, including free muscle transfer. We modified Gu's concept and present our concept of total nerve reconstruction as "ALL IN ONE OR (W)HOLE IN ONE REPAIR." Results All patients able to move their reconstructed limbs independently or with the help of contralateral limbs. Three patients developed hook grip and one patient was able to incorporate limbs to do bimanual jobs. One important observation is that all the reconstructed limbs regain the bulk, and to a certain extent, the attitude and appearance looks normal, as patients no longer hide it or hang it in a sling. Conclusion Adult brachial plexus injury itself is a devastating injury affecting young males. By doing this procedure, the affected limb is not dissociated from the rest of the body and rehabilitation can be aimed to get a supportive limb.Introduction and Methods Diabetic rocker bottom foot with secondary infection exacts the expertise of a reconstructive surgeon to salvage the foot. The author selected 28 diabetic patients with secondarily infected Charcot's degenerated rocker bottom feet and reconstructed their feet using distally based pedicled fibula flap. Reconstruction was done in a staged manner. EX527 Stage 1 surgery involved external fixation following debridement. In stage 2, struts were activated for distraction and arthroereisis. In stage 3, the distally based pedicled fibula was used for reconstruction and beaming of the arches. Results In this retrospective study, the author analyzed the outcome of all 28 patients using the Musculoskeletal Tumor Society Rating (MSTSR) score. The average MSTSR score was 27.536 in an average follow-up of 30.5 months. The limb salvage rate with the author's procedure was 96.4% ( p = 0.045). Conclusion Author's protocol for the staged reconstruction and salvage of the infected diabetic rocker bottom foot, using the pedicled fibula flap, will be a new addendum in the reconstructive armamentarium of the orthoplastic approach.This paper presents a review of social distancing measures deployed by transit agencies in the United States and Canada during the COVID-19 pandemic and discusses how specific operators across the two countries have implemented changes. Challenges and impacts on their operations are also provided. Social distancing is one of the community mitigation measures traditionally implemented during influenza pandemics and the novel coronavirus pandemic. Research has shown that social distancing is effective in containing the spread of disease. This is applicable to the current situation with the novel coronavirus, given the lack of effective vaccines and treatments in the United States and Canada in the first eight months of the pandemic. Moreover, social distancing is particularly useful in settings where community transmission is substantial. Directives for social distancing were issued in several states and public transit operators were charged with how to provide for physical distance of six feet between passengers on their property including physical infrastructure such as station buildings and rolling infrastructure (rolling stock) including trains, subway cars and buses. Operational changes were also required due to physical distancing, e.g. adding train cars to provide for opportunities to physically distance on the train. Examples of some measures discussed in this research includes taping off every other seat on buses, increasing the total length of trains by adding cars, separating bus drivers from passengers with plastic sheeting, rear door boarding, etc. This research also analyzes long-term impacts for transit operators and challenges to encourage passengers to return to public transit after lockdown requirements ordered by government officials are lifted. A section on the policies that are being explored by government to continue to sustain public transportation is also included.One of the most pronounced effects of climate change on the world's oceans is the (generally) poleward movement of species and fishery stocks in response to increasing water temperatures. In some regions, such redistributions are already causing dramatic shifts in marine socioecological systems, profoundly altering ecosystem structure and function, challenging domestic and international fisheries, and impacting on human communities. Such effects are expected to become increasingly widespread as waters continue to warm and species ranges continue to shift. Actions taken over the coming decade (2021-2030) can help us adapt to species redistributions and minimise negative impacts on ecosystems and human communities, achieving a more sustainable future in the face of ecosystem change. We describe key drivers related to climate-driven species redistributions that are likely to have a high impact and influence on whether a sustainable future is achievable by 2030. We posit two different futures-a 'business as usual' future and a technically achievable and more sustainable future, aligned with the Sustainable Development Goals. We then identify concrete actions that provide a pathway towards the more sustainable 2030 and that acknowledge and include Indigenous perspectives. Achieving this sustainable future will depend on improved monitoring and detection, and on adaptive, cooperative management to proactively respond to the challenge of species redistribution. We synthesise examples of such actions as the basis of a strategic approach to tackle this global-scale challenge for the benefit of humanity and ecosystems.
The online version contains supplementary material available at 10.1007/s11160-021-09641-3.
The online version contains supplementary material available at 10.1007/s11160-021-09641-3.In this paper, the uncertainty quantification and sensitivity analysis of a mathematical model of the SARS-CoV-2 virus transmission dynamics with mass vaccination strategy has been carried out. More specifically, a compartmental epidemic model has been considered, in which vaccination, social distance measures, and testing of susceptible individuals have been included. Since the application of these mitigation measures entails a degree of uncertainty, the effects of the uncertainty about the application of social distance actions and testing of susceptible individuals on the disease transmission have been quantified, under the assumption of a mass vaccination program deployment. A spectral approach has been employed, which allows the uncertainty propagation through the epidemic model to be represented by means of the polynomial chaos expansion of the output random variables. In particular, a statistical moment-based polynomial chaos expansion has been implemented, which provides a surrogate model for the compartments of the epidemic model, and allows the statistics, the probability distributions of the interesting output variables of the model at a given time instant to be estimated and the sensitivity analysis to be conducted. The purpose of the sensitivity analysis is to understand which uncertain parameters have most influence on a given output random variable of the model at a given time instant. Several numerical experiments have been conducted whose results show that the proposed spectral approach to uncertainty quantification and sensitivity analysis of epidemic models provides a useful tool to control and mitigate the effects of the COVID-19 pandemic, when it comes to healthcare resource planning.The maritime sector is a key asset for the world economy, but its environmental impact represents a major concern. The sector is primarily supplied with Heavy Fuel Oil, which results in high pollutant emissions. The sector has set targets for deacrbonisation, and alternative fuels have been identified as a short-to medium-term option. The paper addresses the complexity related to the activities of the maritime industry, and discusses the possible contribution of alternative fuels. A sector segmentation is proposed to define the consumption of each sub-segment, so to compare it with the current alternative fuel availability at European level. The paper shows that costs and GHG savings are fundamental enablers for the uptake of alternative fuels, but other aspects are also crucial technical maturity, safety regulation, expertise needed, etc. The demand for alternative fuels has to be supported by an existing, reliable infrastructure, and this is not yet the case for many solutions (i.e. electricity, hydrogen or methanol). Various options are already available for maritime sector, but the future mix of fuels used will depend on technology improvements, availability, costs and the real potential for GHG emissions reduction.This research proposes a new type of Grey Wolf optimizer named Gradient-based Grey Wolf Optimizer (GGWO). Using gradient information, we accelerated the convergence of the algorithm that enables us to solve well-known complex benchmark functions optimally for the first time in this field. We also used the Gaussian walk and Lévy flight to improve the exploration and exploitation capabilities of the GGWO to avoid trapping in local optima. We apply the suggested method to several benchmark functions to show its efficiency. The outcomes reveal that our algorithm performs superior to most existing algorithms in the literature in most benchmarks. Moreover, we apply our algorithm for predicting the COVID-19 pandemic in the US. Since the prediction of the epidemic is a complicated task due to its stochastic nature, presenting efficient methods to solve the problem is vital. Since the healthcare system has a limited capacity, it is essential to predict the pandemic's future trend to avoid overload. Our results predict that the US will have almost 16 million cases by the end of November.
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