Factores asociados a infección de fracturas abiertas de extremidades por accidentes de tránsito. Bogotá, 2012-2013

Los traumatismos por accidentes de tránsito, constituyen un problema de salud pública, a nivel mundial. Las lesiones más frecuentes son las fracturas de extremidades (84.3%). Las fracturas tienen un elevado riesgo de presentar infecciones, secuelas e incapacidades permanentes. Objetivo : Determinar si los factores asociados con la patología (lugar de fractura, clasificación de fractura, comorbilidades del paciente) y/o los factores relacionados con la atención médica (uso de profilaxis antibiótica diferente al protocolo institucional, tiempo prolongado para remisión, demoras en manejo quirúrgico) se asocian a mayor probabilidad de presentar infección de fracturas abiertas, en población mayor a 15 años, atendidos por accidente de tránsito, en una clínica de Bogotá de tercer nivel especializada en atención de SOAT, durante el período Octubre de 2012 a Octubre de 2013. Metodología: Estudio de casos y controles no apareado, relación 1:3, conformado por 43 casos (fracturas abiertas infectadas) y 129 controles (fracturas abiertas no infectadas). Resultados: La edad media de los casos fue de 39.42 +/- 16.82 años (med=36 años) y la edad media de los controles fue de 33.15 +/- 11.78 años (med=30 años). El 83.7% de los casos y el 78.3% de los controles corresponden al sexo masculino. Predominaron los accidentes en motocicleta en el 81.4% de los casos y el 86% de los controles. En el análisis bivariado se encuentra que la edad mayor a 50 años (p=0.042), una clasificación de la fractura grado IIIB o IIIC (p=0.02), cumplimiento del protocolo antibiótico institucional según el grado de fractura (p=0.014) y un tiempo mayor a 24 horas desde el momento del accidente al centro especializado en trauma (p=0.035) se asociaron significativamente con infección de la fractura abierta. En el análisis multivariado se encuentra únicamente que la clasificación de la fractura grado IIIB o IIIC se asocia con infección de la fractura OR 2.6 IC95% (1.187 – 5.781) (p=0.017). La duración de hospitalización fue mayor en los casos (32.37+/- 22.92 días, med=26 días) que en los controles (8.81 +/- 7.52 días, med=6 días) (p<0.001). El promedio de lavados quirúrgicos fue mayor en los casos (4.85±4.1, med=4.0) que en el grupo control (1.94±1.26, med=2) (p<0.001). Conclusiones: La infección posterior a una fractura abierta, implica costos elevados de atención con hospitalizaciones prolongadas y mayor frecuencia de intervenciones quirúrgicas como se evidencia en el presente estudio. Se debe fortalecer el sistema de remisión y contra remisión para acortar los tiempos de inicio de manejo especializado de los pacientes con fracturas abiertas. Se debe incentivar dentro de las instituciones, el cumplimiento de protocolos de profilaxis antibiótica según el grado de la fractura para disminuir el riesgo de complicación infecciosa.

Integração do elemento vegetal no edificado

Esta dissertação é muito mais do que um trabalho sobre ajardinamento de edifícios, pois pretende-se que seja uma ferramenta de ajuda em benefício da transformação de milhares de metros quadrados, das coberturas e das fachadas, muitas vezes negligenciados, em espaços verdes públicos beneficiando, não somente, os promotores imobiliários mas, acima de tudo os seus ocupantes e usufrutuários, que desta forma podem tirar partido de novos espaços de estar, ao ar livre. Enquanto a cidade, ao nível térreo, apresenta um aumento de tráfego rodoviário, com inegável poluição e confusão, é possível, desta forma, usufruir de um espaço aberto. Esta dissertação procura estudar os edifícios que já integram o elemento vegetal no seu conceito e que sejam um sucesso na forma como usam o elemento vegetal, de modo a divulgar as técnicas de construção, entender as decisões dos projectistas e o impacto nos utilizadores que habitam e usufruem dos espaços – Análise-Pós-Ocupação. Esta dissertação pretende demonstrar o quanto é importante que as cidades apresentem espaços verdes para uso da população. As zonas verdes existentes nas cidades são inequivocamente um importante indicador da qualidade ambiental existente nessas mesmas cidades. As coberturas e fachadas verdes arrefecem os edifícios, capturam e filtram as águas da chuva, proporcionam habitat à vida selvagem, reduzem o efeito de estufa das cidades, proporcionam uma preciosidade estética, uma experiência recreativa e por vezes comida, para os habitantes das cidades. Pretende-se assim, focar os benefícios humanos, sociais e naturais que se obtêm ao introduzir vegetação nas paredes, terraços, pátios e coberturas dos edifícios. Assim foi considerado útil usar uma metodologia para também analisar o tipo de espécies usadas nos estudos de caso, e determinar a necessidade de uma ferramenta para que a selecção vegetal respeite critérios de biodiversidade e melhor adaptabilidade aos ecossistemas locais, sabendo de antemão que não podem nem pretendem substituir os habitats naturais, que as cidades também podem e devem apresentar.

Positive schizotypy and trait dissociation as vulnerability factors for post-traumatic distress

Objective. This study investigated whether trait positive schizotypy or trait dissociation was associated with increased levels of data-driven processing and symptoms of post-traumatic distress following a road traffic accident. Methods. Forty-five survivors of road traffic accidents were recruited from a London Accident and Emergency service. Each completed measures of trait positive schizotypy, trait dissociation, data-driven processing, and post-traumatic stress. Results. Trait positive schizotypy was associated with increased levels of data-driven processing and post-traumatic symptoms during a road traffic accident, whereas trait dissociation was not. Conclusions. Previous results which report a significant relationship between trait dissociation and post-traumatic symptoms may be an artefact of the relationship between trait positive schizotypy and trait dissociation.

Remarkable dynamics of nanoparticles in the urban atmosphere

Nanoparticles emitted from road traffic are the largest source of respiratory exposure for the general public living in urban areas. It has been suggested that the adverse health effects of airborne particles may scale with the airborne particle number, which if correct, focuses attention on the nanoparticle (less than 100 nm) size range which dominates the number count in urban areas. Urban measurements of particle size distributions have tended to show a broadly similar pattern dominated by a mode centred on 20–30 nm diameter particles emitted by diesel engine exhaust. In this paper we report the results of measurements of particle number concentration and size distribution made in a major London park as well as on the BT Tower, 160 m high. These measurements taken during the REPARTEE project (Regents Park and BT Tower experiment) show a remarkable shift in particle size distributions with major losses of the smallest particle class as particles are advected away from the traffic source. In the Park, the traffic related mode at 20–30 nm diameter is much reduced with a new mode at <10 nm. Size distribution measurements also revealed higher number concentrations of sub-50 nm particles at the BT Tower during days affected by higher turbulence as determined by Doppler Lidar measurements and indicate a loss of nanoparticles from air aged during less turbulent conditions. These results suggest that nanoparticles are lost by evaporation, rather than coagulation processes. The results have major implications for understanding the impacts of traffic-generated particulate matter on human health.

How much information is lost by using global-mean climate metrics? an example using the transport sector

Metrics are often used to compare the climate impacts of emissions from various sources, sectors or nations. These are usually based on global-mean input, and so there is the potential that important information on smaller scales is lost. Assuming a non-linear dependence of the climate impact on local surface temperature change, we explore the loss of information about regional variability that results from using global-mean input in the specific case of heterogeneous changes in ozone, methane and aerosol concentrations resulting from emissions from road traffic, aviation and shipping. Results from equilibrium simulations with two general circulation models are used. An alternative metric for capturing the regional climate impacts is investigated. We find that the application of a metric that is first calculated locally and then averaged globally captures a more complete and informative signal of climate impact than one that uses global-mean input. The loss of information when heterogeneity is ignored is largest in the case of aviation. Further investigation of the spatial distribution of temperature change indicates that although the pattern of temperature response does not closely match the pattern of the forcing, the forcing pattern still influences the response pattern on a hemispheric scale. When the short-lived transport forcing is superimposed on present-day anthropogenic CO2 forcing, the heterogeneity in the temperature response to CO2 dominates. This suggests that the importance of including regional climate impacts in global metrics depends on whether small sectors are considered in isolation or as part of the overall climate change.

High-resolution (space, time) anthropogenic heat emissions: London 1970-2025

The anthropogenic heat emissions generated by human activities in London are analysed in detail for 2005–2008 and considered in context of long-term past and future trends (1970–2025). Emissions from buildings, road traffic and human metabolism are finely resolved in space (30 min) and time (200 × 200 m2). Software to compute and visualize the results is provided. The annual mean anthropogenic heat flux for Greater London is 10.9 W m−2 for 2005–2008, with the highest peaks in the central activities zone (CAZ) associated with extensive service industry activities. Towards the outskirts of the city, emissions from the domestic sector and road traffic dominate. Anthropogenic heat is mostly emitted as sensible heat, with a latent heat fraction of 7.3% and a heat-to-wastewater fraction of 12%; the implications related to the use of evaporative cooling towers are briefly addressed. Projections indicate a further increase of heat emissions within the CAZ in the next two decades related to further intensification of activities within this area.

Remarkable dynamics of nanoparticles in the urban atmosphere

Nanoparticles emitted from road traffic are the largest source of respiratory exposure for the general public living in urban areas. It has been suggested that adverse health effects of airborne particles may scale with airborne particle number, which if correct, focuses attention on the nanoparticle (less than 100 nm) size range which dominates the number count in urban areas. Urban measurements of particle size distributions have tended to show a broadly similar pattern dominated by a mode centred on 20–30 nm diameter emitted by diesel engine exhaust. In this paper we report the results of measurements of particle number concentration and size distribution made in a major London park as well as on the BT Tower, 160 m aloft. These measurements taken during the REPARTEE project (Regents Park and BT Tower experiment) show a remarkable shift in particle size distributions with major losses of the smallest particle class as particles are advected away from the traffic source. In the Park, the traffic related mode at 20–30 nm diameter is much reduced with a new mode at <10 nm. Size distribution measurements also revealed higher number concentrations of sub-50 nm particles at the BT Tower during days affected by higher turbulence as determined by Doppler Lidar measurements and are indicative of loss of nanoparticles from air aged during less turbulent conditions. These results are suggestive of nanoparticle loss by evaporation, rather than coagulation processes. The results have major implications for understanding the impacts of traffic-generated particulate matter on human health.

Review of the effectiveness of vehicle activated signs

This paper reviews the effectiveness of vehicle activated signs. Vehicle activated signs are being reportedly used in recent years to display dynamic information to road users on an individual basis in order to give a warning or inform about a specific event. Vehicle activated signs are triggered individually by vehicles when a certain criteria is met. An example of such criteria is to trigger a speed limit sign when the driver exceeds a pre-set threshold speed. The preset threshold is usually set to a constant value which is often equal, or relative, to the speed limit on a particular road segment. This review examines in detail the basis for the configuration of the existing sign types in previous studies and explores the relation between the configuration of the sign and their impact on driver behavior and sign efficiency. Most of previous studies showed that these signs have significant impact on driver behavior, traffic safety and traffic efficiency. In most cases the signs deployed have yielded reductions in mean speeds, in speed variation and in longer headways. However most experiments reported within the area were performed with the signs set to a certain static configuration within applicable conditions. Since some of the aforementioned factors are dynamic in nature, it is felt that the configurations of these signs were thus not carefully considered by previous researchers and there is no clear statement in the previous studies describing the relationship between the trigger value and its consequences under different conditions. Bearing in mind that different designs of vehicle activated signs can give a different impact under certain conditions of road, traffic and weather conditions the current work suggests that variable speed thresholds should be considered instead.

Estimated Number and Location of Future Moose-Vehicle Collisions (MVC) in Maine

Moose (Alces alces) are a keystone herbivore in Maine. Because of the large number of rural roads in Maine, there is a high rate of moose-vehicle collisions (MVCs), which is increasing. On-road encounters with animals resulted in 231 fatalities in the United States in 1999. Because of the fatality of MVCs, it is important to know where they are most likely to occur. I used GIS analysis to estimate where future MVCs would occur, factoring in the variables of land cover suitability for moose, distance from water bodies, locations of past MVCs, and speed limits on the roads. I ran four different analyses, each one weighting the variables equally. I also ran a regression to determine if increasing road speed was associated with the increase in the number of MVCs per length of road. There was not a strong positive relationship between the number of MVCs per length of road and the speed limit, but it was interesting to note that there were more MVCs per length of road on 35mph and 40mph roads than on 45, 50, 55 or 65mph roads. Future research on MVCs would benefit from the inclusion of include moose population density and road traffic data.

Análise das emissões gasosas de um veículo flex funcionando com diferentes combustíveis

Efforts in research and development of new technologies to reduce emission levels of pollutant gases in the atmosphere has intensified in the last decades. In this context, it can be highlighted the modern systems of electronic engine management, new automotive catalysts and the use of renewable fuels which contributes to reduce the environmental impact. The purpose of this study was a comparative analysis of gas emissions from a automotive vehicle, operating with different fuels: natural gas, AEHC or gasoline. To execute the experimental tests, a flex vehicle was installed on a chassis dynamometer equipped with a gas analyzer and other complementary accessories according to the standard guidelines of emission and security procedures. Tests were performed according to NBR 6601 and NBR 7024, which define the urban and road driving cycle, respectively. Besides the analysis of exhaust gases in the discharge tube, before and after the catalyst, using the suction probe of the gas analyzer to simulate the vehicle in urban and road traffic, were performed tests of fuel characterization. Final results were conclusive in indicating leaded gasoline as the fuel which most contributed with pollutant emissions in atmosphere and the usual gasoline being the fuel which less contributed with pollutant emissions in atmosphere

Alcoolemia em vítimas fatais de acidentes de trânsito no Rio Grande do Norte empregando cromatografia em fase gasosa - head space

Alcohol is one of the few psychotropic drugs that their consumption has admitted legally and sometimes encouraged by the society. Studies show alcohol as the highest consumption of drugs among young people and society in general, probably because of its availability and easy access. The abuse causes public health problems, which was closely related to the violence, socioeconomic problems and the high number of automobile accidents. Transit is one of the main sectors affected by the effects of alcohol, observing a high incidence in the studies. About half of automobile accidents occurs after the consumption of alcoholic beverage, and the vast majority of cases related to high concentrations of alcohol in the bloodstream. The relationship of drunk with traffic accidents is in fact evident everywhere in the world, including Brazil, where studies have shown a high relationship between alcohol consumption and traffic accidents. This study determined the alcohol in fatal victims of traffic accidents in the state of Rio Grande do Norte and established the profile of this population compared with those found in Brazil and other countries. Samples of blood of ethanol added to fulfillment of the standardization of chromatographic conditions and procedures for the analysis, being employed in the determination of alcohol in blood samples of 277 victims of traffic accidents, collected at the Institute of Scientific Technical Police of Rio Grande do North (ITEP) in the year 2007. The blood alcohol level was determined in these samples correlated with the sex, age and marital status of the victim and the location, day of week and month when the accident occurred, is doing a statistical analysis and outlining a profile of the victims of an accident at transit in the state of Rio Grande do Norte. The parameters of standardization studied ensured the quality of the analytical method and, consequently, to obtain reliable laboratory results. Being given the best temperature for injector (150 ºC), detector (250 ºC) and column (50 ºC) with a flow of gas in the column of 2mL/minutos and analysis of time of 12 minutes. The method was linear in the range of 0.01 to 3.2 g / L (r2 = 0.9989) with average recovery of 100.2% and precision with coefficient of variation less than 15%. The analysis carried out on victims of fatal road traffic accidents, ethanol detected in the blood in 66.43% of the victims and these, 96% showed concentration ≥ 0.2 g / L, 87.73% of victims were male, while 12.27% female. The younger age group (1535 years) was the most involved (52,35%) and most single (55.60%). The accidents occurred with greater prevalence in the day on Monday (27%) followed by Sunday (24,19%) and Saturday (15,52%) and it was found that the prevalence of injuries varied between the different months of the year, and in February (14.4%) and April (10.47%) the months that had a higher number of accidents, however this oscillation showed no statistically significant difference. Also no significant difference was observed between the tracks of concentration found in men and women. The standardized method showed to be efficient, given satisfactorily to the goals of this work, and the high levels of alcohol found in victims of fatal road traffic accidents are consistent with several studies of literature, and the profile of the victim also supported by presenting in its most young adults, male and single

Traumatic subdural hygromas: Proposed pathogenesis based classification

Background: Traumatic subdural hygroma (TSHy) is an accumulation of cerebrospinal fluid (CSF) in the subdural space after head injury. It appears to be relatively common, but its onset time and natural history are not well defined. Considered a benign epiphenomenon of trauma, the pathogenesis of TSHy is still unclear and many questions remain unanswered. This study adds to the information on TSHy, and proposes a classification based on pathogenesis.Methods: Thirty-four consecutive adult patients with TSHy were analyzed for clinical evolution and serial CT scan, during a period of several months. TSHy diagnosis was based on published CT scan criteria of hypodense subdural collection after trauma, without enhancement and neomembrane, with a minimum distance of 3 mm between the skull and brain. Ventricle size was analyzed by calculating the bicaudate index (BCI). For comparison, the BCI was measured from CT scan at three moments: admission, at time of TSHy diagnosis, and from last CT scan.Results: There were 34 patients, aged between 16 and 85 years (mean 40), half of them were below 40 years. Road traffic crashes were the main cause of head injury. The mean time for hygroma diagnosis was 9 days. Twenty-one patients (61.8%) underwent conservative treatment for TSHy and 13 (38.2%), surgical treatment. TSHy are early lesions and can be detected in the first 24 hours after trauma, usually as small subdural effusion (SSEff). Based on clinical and CT scan findings, we divided the 34 patients into 3 groups, (Ia and Ib) without evident mass effect and (II) with evident mass effect. Group Ia includes patients without ventricle dilation; Ib, patients with associated ventricle dilations.Conclusions: SSEff detected in the first 24 hours posttrauma in our series evolved into TSHy suggesting that this is an early lesion; all THSy were divided in three groups according to the pathophysiologic mechanism. These three groups probably represent a continuum of CSF absorption impairment. Group la represents what most authors consider a simple hygroma, with no impairment on CSF absorption. Group Ib represent the external hydrocephalus form with various degrees of CSF imbalance, and group II were the cases presenting marked mass effect.

Influência do ruído de tráfego em edifícios e proposta de solução desenvolvida com auxílio de modelos numéricos

No Brasil, é grande o número de casas e apartamentos que sofrem a influência da poluição sonora. Atualmente, esta questão ganhou importante destaque no cenário local, uma vez que Belém-PA foi eleita a “Capital Nacional do Ruído” por vários anos, segundo dados obtidos pelo IBGE. Dentre os tipos mais comuns de poluição sonora, percebe-se que há uma maior queixa por parte da sociedade em relação ao c, o qual é inerente ao cotidiano de qualquer grande cidade. À medida que os problemas de ruído de tráfego aumentam, cresce a preocupação com o grau de incômodo gerado na população, justificando o desenvolvimento de meios para quantificar e reduzir tal desconforto, além da busca por uma regulamentação desta situação, através de normas brasileiras. Portanto, a condição do ruído de tráfego, enquanto principal agente de incômodo da população, no que se refere à poluição sonora, vem justificar a necessidade de realização de um estudo que vise o desenvolvimento de elementos de edificações, de novas geometrias e de composição de materiais existentes, tais que se minimize a penetração do ruído de tráfego aos ambientes internos dessas edificações. Assim, este trabalho apresenta os resultados de estudos do comportamento acústico em edificações situadas frontalmente às vias de grande fluxo de veículos e que sofrem interferências ocasionadas pelo ruído de tráfego gerado em excesso, por essas fontes veiculares. Para tanto, foram realizadas medições em campo numa edificação de 25 andares, em fase avançada de construção e escolhida como piloto para o presente estudo, o qual apresenta uma modelagem numérica da edificação modelo, com o auxílio do software ODEON.

Implant-retained finger prosthesis with modified retention system

Background: Amputations affect both the physical and the psychological aspects of an individual, causing significant impact on self-esteem. The main causes of finger amputations are work-related accidents with dangerous machinery, road traffic accidents, and animal bites, as well as systemic diseases such as diabetes. This report aims to describe a simple technique for fabrication of implant-retained finger prosthesis with a modified base of the retention system.Case Description and Methods: The O-Ring retention system was used with a modified hexagon-shaped base and a metallic capsule adapted to the acrylic resin to attach the prosthesis to the implant.Findings and Outcomes: The prosthesis was made with silicone, and after osseointegration, it was installed without complications, leading to a patient satisfied with the end result and encouraged to return to social life.

Mapeamento geológico-geotécnico na rodovia Amparo - Morungaba (SP - 360)

The work depicts the study of geological and geotechnical characteristics presents, together with an analysis of the physical environment components and evaluation of its units, along a marginal stretch at Rodovia Amparo-Morungaba (SP-360) in order to present a geological and geotechnical map, 1:25.000 scale (one of the objectives of the work). There was also a geotechnical assessment of the present geological processes and the development of corrective measures necessary to establish safe conditions for road traffic. The method for the characterization of geological and geotechnical analysis was integrated the physical components associated with photo interpretation (another objective of this work) based on Google Earth´s air images along the referred highway. In addition, field studies were made that helped in the distribution and compartmentalization of the six geological and geotechnical units and profiles of each specific alteration were also made. The finals results present the above mentioned map, a detailed description of each of the six units and a a geotechnical assessment of the present geological processes and the development of corrective measures necessary to establish safe conditions for road traffic. Also, had success at photo interpretation based on Google Earth´s air images, obtaining stereoscopy