Resultados tratamiento de las fracturas intertrocantéricas en el Hospital Universitario Mayor MEREDÍ

Las fracturas intertrocantericas son una importante causa de la morbimortalidad en los adultos mayores. Requieren la mayoria manejo quirurgico. No se ha logrado definir si es mejor el tratamiento con osteosintesis o artoplastia de cadera. Por esta razon decidimos realizar un estudio identificando los resultados en cada uno de los tratamientos con poblacion colombiana en el Hospital Universitario Mayor Mederi. Metodos: Estudio de serie de casos. Se analizó una cohorte retrospectiva de pacientes mayores de 59 años con fractura intertrocantérica en el Hospital Universitario Mayor Méderi. Resultados: Se reportaron un total de 179 pacientes con diagnóstico de fractura intertrocantérica. De los cuales se realizaron 100 osteosíntesis , 20 reemplazos totales de cadera y 59 hemiartroplastias. La mortalidad fueron 11 pacientes que corresponde al 6.1%, 3 fueron hombres y 8 mujeres, en cuanto al procedimiento realizado a 7 pacientes se les realizo osteosíntesis y a los 4 restantes se les realizo hemiartroplastia. En total 7 infecciones las cuales se presentaron respectivamente en 6 osteosíntesis y 1 hemiartroplastia. Discusión: La mortalidad fue mayor en la osteosíntesis con 7 pacientes que equivale al 63,6 % de la mortalidad total del estudio. Los porcentajes de infección postoperatoria fueron mayores en la osteosíntesis , encontrándose que del total de pacientes intervenidos 3,9% se infectaron y de estos el 85,7 % corresponden a osteosíntesis versus 14,3% de hemiartroplastia. El sangrado postoperatorio fue mayor a 500 cc en un 39% de las osteosíntesis y en un 44% en las hemiartroplastias. Conclusión: el tratamiento de las fracturas intertrocantéricas tuvo menor mortalidad y menor porcentaje de infección cuando los pacientes fueron tratados con hemiartroplastia y reemplazo total de cadera.

Mercados laborales en entornos de conflictos armados: un análisis empírico para Colombia

Históricamente se ha reconocido que los conflictos internos afectan de manera directa variables a nivel individual como la salud de las personas, los niveles de escolaridad y el desplazamiento forzoso de los afectados. Sin embargo, solo hasta la última década las investigaciones académicas se han inclinado en documentar y cuantificar rigurosamente los efectos colaterales de la violencia sobre las condiciones de vida de los individuos. La presente investigación estudia cómo la exposición al conflicto en Colombia ha afectado las decisiones en términos de mercado laboral de las personas. La estrategia de identificación internaliza los reconocidos problemas de endogeneidad del conflicto con variables de actividad y desarrollo económico y presenta resultados robustos a fenómenos de migración interna y desplazamiento. En términos de participación laboral y desempleo, se encuentran efectos heterogéneos a nivel de género como respuestas a la violencia experimentada. En particular, la probabilidad de participación laboral de las mujeres se incremente como consecuencia de la exposición al conflicto, mientras que la de desempleo disminuye. Para los hombres, los resultados muestran una menor probabilidad de participación, efecto contrario al de las mujeres, y un efecto análogo en términos de desempleo. La investigación no encuentra efectos diferenciales en términos de informalidad laboral.

Entendiendo un programa de reparación: reconstrucción del proceso de creación e implementación de familias en su tierra – FEST– El caso del municipio de La Palma, Cundinamarca

A partir de la reconstrucción del proceso de creación e implementación del programa presidencial para la reparación a población desplazada Familias En Su Tierra, se exploran las dificultades y retos que enfrenta la Ley de Víctimas y Restitución de Tierras.

La protección de los flujos masivos en el ordenamiento jurídico internacional y en el Derecho venezolano

En caso de desplazamiento masivo, resulta imposible determinar inmediatamente de manera individual los temores de persecución de las personas que integran el grupo. Precisamente, ante la realidad desconsoladora de la promoción de una protección internacional exclusivamente aplicable a un tipo de refugiados casi inexistente, la cada vez menos frecuente determinación en grupo y prima facie de refugiados, la proliferación de estatutos subsidiarios, el aumento del desplazamiento interno y las restricciones que imponen los Estados por motivo de seguridad nacional u orden público, se consideró que un estudio sobre la protección de los flujos masivos podría facilitar la obtención de una visión general del estado actual de la protección temporal y de las obligaciones que se han desarrollado para hacer frente a tales contingencias. A partir del planteamiento inicial de los retos y obstáculos legales que este fenómeno ha planteado para los Estados receptores y para la evolución del Derecho internacional de los refugiados y de la inexistencia de un régimen jurídico internacional universal que regule la protección de los flujos masivos, se ha elaborado una construcción doctrinal y práctica sobre la protección de esta situación en el Derecho internacional, sistematizando los distintos elementos que se han ido incorporando a esta protección colectiva. Se ha analizado la protección de los flujos masivos con el ánimo de dotar de rasgos positivos a un concepto que ha sido considerado como un avance negativo en el ámbito de la protección internacional. Y es que la protección temporal no tiene por qué reducir estándares de protección ni tampoco sustituir a la protección internacional clásica, que es la de los refugiados.

The dialectic of silence and remembrance in Lily Brett’s ''Things could be worse''

The dynamics of silence and remembrance in Australian writer Lily Brett’s autobiographic fiction Things Could Be Worse reflects the crisis of memory and understanding experienced by both first and second-generation Holocaust survivors within the diasporic space of contemporary Australia. It leads to issues of handling traumatic and transgenerational memory, the latter also known as postmemory (M. Hirsch), in the long aftermath of atrocities, and problematises the role of forgetting in shielding displaced identities against total dissolution of the self. This paper explores the mechanisms of remembrance and forgetting in L. Brett’s narrative by mainly focusing on two female characters, mother and daughter, whose coming to terms with (the necessary) silence, on the one hand, and articulated memories, on the other, reflects different modes of comprehending and eventually coping with individual trauma. By differentiating between several types of silence encountered in Brett’s prose (that of the voiceless victims, of survivors and their offspring, respectively), I argue that silence can equally voice and hush traumatic experience, that it is never empty, but invested with individual and collective meaning. Essentially, I contend that beside the (self-)damaging effects of silence, there are also beneficial consequences of it, in that it plays a crucial role in emplacing the displaced, rebuilding their shattered self, and contributing to their reintegration, survival and even partial healing.

La seguridad en las relaciones Ecuador-Colombia (Tema Central)

El artículo se ocupa del tema de política exterior ecuatoriana más urgente y sobresaliente en la actualidad, esto es la existencia de un conflicto violento transfronterizo. El autor examina críticamente los supuestos éticos y conceptuales de la actual política exterior ecuatoriana desde la perspectiva de los estudios de paz. Se argumenta que el conflicto colombiano puede ser entendido como una guerra contemporánea en la cual el Estado ecuatoriano estaría implicado por el imperativo ético de proteger la seguridad humana de los ecuatorianos, y de las poblaciones colombianas forzadas a desplazarse.

The prediction of extratropical storm tracks by the ECMWF and NCEP ensemble prediction systems

The prediction of extratropical cyclones by the European Centre for Medium Range Weather Forecasts (ECMWF) and the National Centers for Environmental Prediction (NCEP) Ensemble Prediction Systems (EPS) has been investigated using an objective feature tracking methodology to identify and track the cyclones along the forecast trajectories. Overall the results show that the ECMWF EPS has a slightly higher level of skill than the NCEP EPS in the northern hemisphere (NH). However in the southern hemisphere (SH), NCEP has higher predictive skill than ECMWF for the intensity of the cyclones. The results from both EPS indicate a higher level of predictive skill for the position of extratropical cyclones than their intensity and show that there is a larger spread in intensity than position. Further analysis shows that the predicted propagation speed of cyclones is generally too slow for the ECMWF EPS and show a slight bias for the intensity of the cyclones to be overpredicted. This is also true for the NCEP EPS in the SH. For the NCEP EPS in the NH the intensity of the cyclones is underpredicted. There is small bias in both the EPS for the cyclones to be displaced towards the poles. For each ensemble forecast of each cyclone, the predictive skill of the ensemble member that best predicts the cyclones position and intensity was computed. The results are very encouraging showing that the predictive skill of the best ensemble member is significantly higher than that of the control forecast in terms of both the position and intensity of the cyclones. The prediction of cyclones before they are identified as 850 hPa vorticity centers in the analysis cycle was also considered. It is shown that an indication of extratropical cyclones can be given by at least 1 ensemble member 7 days before they are identified in the analysis. Further analysis of the ECMWF EPS shows that the ensemble mean has a higher level of skill than the control forecast, particularly for the intensity of the cyclones, 2 from day 3 of the forecast. There is a higher level of skill in the NH than the SH and the spread in the SH is correspondingly larger. The difference between the ensemble mean and spread is very small for the position of the cyclones, but the spread of the ensemble is smaller than the ensemble mean error for the intensity of the cyclones in both hemispheres. Results also show that the ECMWF control forecast has ½ to 1 day more skill than the perturbed members, for both the position and intensity of the cyclones, throughout the forecast.

Stratospheric circulation in seasonal forecasting models: implications for seasonal prediction

Accurate seasonal forecasts rely on the presence of low frequency, predictable signals in the climate system which have a sufficiently well understood and significant impact on the atmospheric circulation. In the Northern European region, signals associated with seasonal scale variability such as ENSO, North Atlantic SST anomalies and the North Atlantic Oscillation have not yet proven sufficient to enable satisfactorily skilful dynamical seasonal forecasts. The winter-time circulations of the stratosphere and troposphere are highly coupled. It is therefore possible that additional seasonal forecasting skill may be gained by including a realistic stratosphere in models. In this study we assess the ability of five seasonal forecasting models to simulate the Northern Hemisphere extra-tropical winter-time stratospheric circulation. Our results show that all of the models have a polar night jet which is too weak and displaced southward compared to re-analysis data. It is shown that the models underestimate the number, magnitude and duration of periods of anomalous stratospheric circulation. Despite the poor representation of the general circulation of the stratosphere, the results indicate that there may be a detectable tropospheric response following anomalous circulation events in the stratosphere. However, the models fail to exhibit any predictability in their forecasts. These results highlight some of the deficiencies of current seasonal forecasting models with a poorly resolved stratosphere. The combination of these results with other recent studies which show a tropospheric response to stratospheric variability, demonstrates a real prospect for improving the skill of seasonal forecasts.

Displacement of Zn through acidic light-textured soils

In order to gain understanding of the movement of pollutant metals in soil. the chemical mechanisms involved in the transport of zinc were studied. The displacement of zinc through mixtures of sand and cation exchange resin was measured to validate the methods used for soil. With cation exchange capacities of 2.5 and 5.0 cmol(c) kg(-1). 5.6 and 8.4 pore volumes of 10 mM CaCl2, respectively, were required to displace a pulse of ZnCl2. A simple Burns-type model (Wineglass) using an adsorption coefficient (K-d) determined by fitting a straight line relationship to an adsorption isotherm gave a good fit to the data (K-d=0.73 and 1.29 ml g(-1), respectively). Surface and subsurface samples of an acidic sandy loam (organic matter 4.7 and 1.0%. cation exchange capacity (CEC) 11.8 and 6.1 cmol(c) kg(-1) respectively) were leached with 10 mM calcium chloride. nitrate and perchlorate. With chloride. the zinc pulse was displaced after 25 and 5 pore volumes, respectively. The Kd values were 6.1 and 2.0 ml g(-1). but are based on linear relationships fitted to isotherms which are both curved and show hysteresis. Thus. a simple model has limited value although it does give a general indication of rate of displacement. Leaching with chloride and perchlorate gave similar displacement and Kd values, but slower movement occurred with nitrate in both soil samples (35 and 7 pore volumes, respectively) which reflected higher Kd values when the isotherms were measured using this anion (7.7 and 2.8 ml g(-1) respectively). Although pH values were a little hi-her with nitrate in the leachates, the differences were insufficient to suggest that this increased the CEC enough to cause the delay. No increases in pH occurred with nitrate in the isotherm experiments. Geochem was used to calculate the proportions of Zn complexed with the three anions and with fulvic acid determined from measurements of dissolved organic matter. In all cases, more than 91% of the Zn was present as Zn2+ and there were only minor differences between the anions. Thus, there is an unexplained factor associated with the greater adsorption of Zn in the presence of nitrate. Because as little as five pore volumes of solution displaced Zn through the subsurface soil, contamination of ground waters may be a hazard where Zn is entering a light-textured soil, particularly where soil salinity is increased. Reductions in organic matter content due to cultivation will increase the hazard. (C) 2004 Elsevier B.V. All rights reserved.

The role of calcite and gypsum in the leaching of potassium in a sandy soil

Pulses of potassium (K+) applied to columns of repacked calcium (Ca2+) saturated soil were leached with distilled water or calcium chloride (CaCl2) solutions of various concentrations at a rate of 12 mm h(-1). With increased Ca2+ concentration, the rate of movement of K+ increased, as did the concentration of K+ in the displaced pulse, which was less dispersed. The movement of K+ in calcite-amended soil leached with water was at a similar rate to that of the untreated soil leached with 1 mM CaCl2, and in soil containing gypsum, movement was similar to that leached with 15 mM CaCl2. The Ca2+ concentrations in the leachates were about 0.4 and 15 mM respectively the expected values for the dissolution of the two amendments. Soil containing native K+ was leached with distilled water or CaCl2 solutions. The amount of K+ leached increased as Ca2+ concentration increased, with up to 34% of the exchangeable K+ being removed in five pore volumes of 15 mM CaCl2. Soil amended with calcite and leached with water lost K+ at a rate between that for leaching the unamended soil with 1 mM CaCl2 and that with water. Soil containing gypsum and leached with water lost K+ at a similar rate to unamended soil leached with 15 mM CaCl2. The presence of Ca2+ in irrigation water and of soil minerals able to release Ca2+ are of importance in determining the amounts of K+ leached from soils. The LEACHM model predicted approximately the displacement of K+, and was more accurate with higher concentrations of displacing solution. The shortcomings of this model are its inability to account for rate-controlled processes and the assumption that K+:Ca2+ exchange during leaching can be described using a constant adsorption coefficient. As a result, the pulse is predicted to appear a little earlier and the following edge has less of a tail than chat measured. In practical agriculture, the model will be more useful in soils containing gypsum or leached with saline water than in either calcareous or non-calcareous soils leached with rainwater.

Potassium leaching in undisturbed soil cores following surface applications of gypsum

Displacement studies on leaching of potassium (K+) were conducted under unsaturated steady state flow conditions in nine undisturbed soil columns (15.5 cm in diameter and 25 cm long). Pulses of K+ applied to columns of undisturbed soil were leached with distilled water or calcium chloride (CaCl2) at a rate of 18 mm h(-1). The movement of K+ in gypsum treated soil leached with distilled water was at a similar rate to that of the untreated soil leached with 15 mM CaCl2. The Ca2+ concentrations in the leachates were about 15 mM, the expected values for the dissolution of the gypsum. When applied K+ was displaced with the distilled water, K+ was retained in the top 10-12.5 cm depth of soil. In the undisturbed soil cores there is possibility of preferential flow and lack of K+ sorption. The application of gypsum and CaCl2 in the reclamation of sodic soils would be expected to leach K+ from soils. It can also be concluded that the use of sources of water for irrigation which have a high Ca2+ concentration can also lead to leaching of K+ from soil. Average effluent concentration of K+ during leaching period was 30.2 and 28.6 mg l(-1) for the gypsum and CaCl2 treated soils, respectively. These concentrations are greater than the recommended guideline of the World Health Organisation (12 mg K+ l(-1)).

Acid-base reactions between an acidic soil and plant residues

The elemental composition of residues of maize (Zea mays), sorghum (S. bicolor), groundnuts (Arachis hypogea), soya beans (Glycine max), leucaena (L. leucocephala), gliricidia (G. sepium), and sesbania (S. sesban) was determined as a basis for examining their alkalinity when incorporated into an acidic Zambian Ferralsol. Potential (ash) alkalinity, available alkalinity by titration to pH 4 and soluble alkalinity (16 It water extract titrated to pH 4) were measured. Potential alkalinity ranged from 3 73 (maize) to 1336 (groundnuts) mmol kg(-1) and was equivalent to the excess of their cation charge over inorganic anion charge. Available alkalinity was about half the potential alkalinity. Cations associated with organic anions are the source of alkalinity. About two thirds of the available alkalinity is soluble. Residue buffer curves were determined by titration with H2SO4 to pH 4. Soil buffer capacity measured by addition of NaOH was 12.9 mmol kg(-1) pH(-1). Soil and residue (10 g:0.25 g) were shaken in solution for 24 h and suspension pH values measured. Soil pH increased from 4.3 to between 4.6 (maize) and 5.2 (soyabean) and the amounts of acidity neutralized (calculated from the rise in pH and the soil buffer capacity) were between 3.9 and 11.5 mmol kg(-1), respectively. The apparent base contributions by the residues (calculated from the buffer curves and the fall in pH) ranged between 105 and 350 mmol kg(-1) of residue, equivalent to 2.6 and 8.8 mmol kg(-1) of soil, respectively. Therefore, in contact with soil acidity, more alkalinity becomes available than when in contact with H2SO4 solution. Available alkalinity (to pH 4) would be more than adequate to supply that which reacts with soil but soluble alkalinity would not. It was concluded that soil Al is able to displace cations associated with organic anions in the residues which are not displaced by H+, or that residue decomposition may have begun in the soil suspension releasing some of the non-available alkalinity. Soil and four of the residues were incubated for 100 days and changes in pH, NH4+ and NO3- concentrations measured. An acidity budget equated neutralized soil acidity with residue alkalinity and base or acid produced by N transformations. Most of the potential alkalinity of soyabean and leucaena had reacted after 14 days, but this only occurred after 100 days for gliricidia, and for maize only the available alkalinity reacted. For gliricidia and leucaena, residue alkalinity was primarily used to react with acidity produced by nitrification. Thus, the ability of residues to ameliorate acidity depends not only on their available and potential alkalinity but also on their potential to release mineral N. (C) 2004 Elsevier B.V. All rights reserved.

A continuum of sudden stratospheric warmings

The k-means cluster technique is used to examine 43 yr of daily winter Northern Hemisphere (NH) polar stratospheric data from the 40-yr ECMWF Re-Analysis (ERA-40). The results show that the NH winter stratosphere exists in two natural well-separated states. In total, 10% of the analyzed days exhibit a warm disturbed state that is typical of sudden stratospheric warming events. The remaining 90% of the days are in a state typical of a colder undisturbed vortex. These states are determined objectively, with no preconceived notion of the groups. The two stratospheric states are described and compared with alternative indicators of the polar winter flow, such as the northern annular mode. It is shown that the zonally averaged zonal winds in the polar upper stratosphere at 7 hPa can best distinguish between the two states, using a threshold value of 4 m s−1, which is remarkably close to the standard WMO criterion for major warming events. The analysis also determines that there are no further divisions within the warm state, indicating that there is no well-designated threshold between major and minor warmings, nor between split and displaced vortex events. These different manifestations are simply members of a continuum of warming events.

The effect of a large freshwater perturbation on the glacial north Atlantic Ocean using a coupled general circulation model

The commonly held view of the conditions in the North Atlantic at the last glacial maximum, based on the interpretation of proxy records, is of large-scale cooling compared to today, limited deep convection, and extensive sea ice, all associated with a southward displaced and weakened overturning thermohaline circulation (THC) in the North Atlantic. Not all studies support that view; in particular, the "strength of the overturning circulation" is contentious and is a quantity that is difficult to determine even for the present day. Quasi-equilibrium simulations with coupled climate models forced by glacial boundary conditions have produced differing results, as have inferences made from proxy records. Most studies suggest the weaker circulation, some suggest little or no change, and a few suggest a stronger circulation. Here results are presented from a three-dimensional climate model, the Hadley Centre Coupled Model version 3 (HadCM3), of the coupled atmosphere - ocean - sea ice system suggesting, in a qualitative sense, that these diverging views could all have occurred at different times during the last glacial period, with different modes existing at different times. One mode might have been characterized by an active THC associated with moderate temperatures in the North Atlantic and a modest expanse of sea ice. The other mode, perhaps forced by large inputs of meltwater from the continental ice sheets into the northern North Atlantic, might have been characterized by a sluggish THC associated with very cold conditions around the North Atlantic and a large areal cover of sea ice. The authors' model simulation of such a mode, forced by a large input of freshwater, bears several of the characteristics of the Climate: Long-range Investigation, Mapping, and Prediction (CLIMAP) Project's reconstruction of glacial sea surface temperature and sea ice extent.

Housing and property restitution and IDP return in Kosovo

The establishment of the Housing and Property Directorate (HPD) and Claims Commission (HPCC) in Kosovo has reflected an increasing focus internationally on the post-conflict restitution of housing and property rights. In approximately three years of full-scale operation, the institutions have managed to make a property rights determination on almost all of the approximate 30,000 contested residential properties. As such, HPD and HPCC are being looked to by many in other post-conflict areas as an example of how to proceed. While the efficiency of the organizations is commendable, one of the key original goals - the return of displaced persons to their homes of origin - has to a large degree been left aside. The paper focuses on two distinct failures of the international community with respect to the functioning of HPD/HPCC and its possible effect on returns: a failure of coordination between HPD/HPCC and other organizations working on returns, and the isolation of residential property rights determinations from other aspects of building a property rights-respecting culture in Kosovo.