Caractérisation des unités de soins aigus chirurgicaux au sein des départements de chirurgie générale au Canada

Introduction : The acute care surgery (ACS) units are dedicated to the prompt management of surgical emergencies. It is a systemic way of organizing on-call services to diminish conflict between urgent care and elective obligations. The aim of this study was to define the characteristics of an ACS unit and to find common criteria in units with reported good functioning. Methods : As of July 1st 2014, 22 Canadian hospitals reported having an ACS unit. A survey with questions about the organization of the ACS units, the population it serves, the number of emergencies and trauma cases treated per year, and the satisfaction about the implementation of this ACS unit was sent to those hospitals. Results : The survey’s response rate was 73%. The majority of hospitals were tertiary or quaternary centers, served a population of more than 200 000 and had their ACS unit for more than three years. The median number of surgeons participating in an ACS unit was 8.5 and the majority were doing seven day rotations. The median number of operating room days was 2.5 per week. Most ACS units (85%) had an estimated annual volume of more than 2500 emergency consultations (including both trauma and non-trauma) and 80% operated over 1000 cases per year. Nearly all the respondents (94%) were satisfied with the implementation of the ACS unit in their hospital. Conclusion : Most surgeons felt that the implementation of an ACS unit resulted in positive outcomes. However, there should be a sizeable catchment population and number of surgical emergencies to justify the resulting financial and human resources.

Twin peak distribution of electron emission profile and impact ionization of ambient molecules during laser ablation of silver target

Laser-induced plasma generated from a silver target under partial vacuum conditions using the fundamental output of nanosecond duration from a pulsed Nd:yttrium aluminum garnet laser is studied using a Langmuir probe. The time of flight measurements show a clear twin peak distribution in the temporal profile of electron emission. The first peak has almost the same duration as the laser pulse while the second lasts for several microseconds. The prompt electrons are energetic enough ('60 eV) to ionize the ambient gas molecules or atoms. The use of prompt electron pulses as sources for electron impact excitation is demonstrated by taking nitrogen, carbon dioxide, and argon as ambient gases.

Investigations on the Structural, Spectral and Magnetic Interactions of Transition Metal Complexes of Multidentate Ligands from Di-2-pyridyl ketone and N(4)-substituted Thiosemicarbazides

The present work deals with the investigations on sthe structural spectral and magnetic interactions of transition metal complexes of multidentate ligands from D1-2-pyridyl ketone and N(4)-Substituted thiosemicarbazides.Thiosemicarbazones are thiourea derivatives with the general formula R2N— C(S)—NH—N=CR2. In the solution state, the thiosemicarbazones exhibit the thionethiol tautomerism similar to the keto-enol tautomerism, and in solution state the thiol form predominates and a deprotonation at the thiolate group in alcoholic medium enhances the coordination abilities ofthe thiosemicarbazones.The magnetochemistry of metal complexes of di-2-pyridyl ketone is a current hot subject of research, which mainly owes to the excellent structural diversity of the complexes ranging from cubanes to clusters, with promising ferromagnetic outputs.Only few efforts were aimed at the magnetochemistry of metal complexes of thiosemicarbazones, and that too were concerned with the complexes of bisttltioscinicarbazones). However, as far as the monothiosemicarbazones are concerned, the magnetochemistry of transition metal complexes of di-2-pyridyl ketone thiosemicarbazones turned up quite unexplored. Consequently, an investigation into it appeared novel and promising to us and that prompted this study, which can be regarded as the initial step towards exploring the magnetochemistry of thiosemicarbazone complexes, especially of di-2-pyridyl ketone derivatives.We could successfully isolate single crystals suitable for X-ray diffraction for the first three ligands. To conclude, we have synthesized some new thiosemicarbazones and their transition metal complexes and studied their structural, spectral and magnetic attributes. Some ofthe complexes revealed interesting stereochemistries and possible bridging characteristics with spectroscopic evidences. Unfortunately, single crystal Xray diffraction studies could not be carried out for many of these interesting compounds due to the lack of availability of suitable quality single crystals. However, the magnetic studies provided support for the proposed stereochemistry giving evidences for their magnetically concentrated nature. The magnetic susceptibilities measured at six different temperatures in the 80-298 K range are fitted into different magnetic equations, which provided an idea about the magnetic behavior of the compounds under study. Some of the copper, oxovanadium, nickel and cobalt complexes are found to possess anomalous magnetic moments, i.e., they revealed no regular gradation with temperature. However, some other copper complexes are observed to be antiferromagnetic, due to super-exchange pathways. The manganese complexes and one of the cobalt complexes are also observed to be antiferromagnetic in nature. However, some nickel complexes have turned up to be ferromagnetic. Accordingly, the versatile stereoehemistry and magnetic behavior of the complexes studied, prompt us to conclude that the transition metal complexes of di-2-pyridyl ketone thiosemicarbazones are promising systems for potential magnetic applications.

Auger spectroscopy of foil-excited beryllium ions

We have measured prompt and delayed emission spectra of electrons from foilexcited Be, B^+, and Be^2+ ions at 300 keV. On the basis of recently calculated eigenvalues we identified two lines in the prompt Be^+ spectrum as transitions from 2s^22p and 2s2p^2. The delayed Be spectrum indicates that transitions from highly excited quintet states occur. We propose radiationless deexcitation with one excited spectator electron not involved in the transition.

Equilibrium K-shell excitation of highly ionized neon

Augerelectron emission from foil-excited Ne-ions (6 to 10 MeV beam energy) has been measured. The beam-foil time-of-flight technique has been applied to study electronic transitions of metastable states (delayed spectra) and to determine their lifetimes. To achieve a line identification for the complex structure observed in the prompt spectrum, the spectrum is separated into its isoelectronic parts by an Augerelectron-ion coincidence correlating the emitted electrons and the emitting projectiles of well defined final charge states q_f. Well resolved spectra were obtained and the lines could be identified using intermediate coupling Dirac-Fock multiconfiguration calculations. From the total KLL-Augerelectron transition probabilities observed in the electronion coincidence experiment for Ne (10 MeV) the amount of projectiles with one K-hole just behind a C-target can be estimated. For foil-excited Ne-projectiles in contrast to single collision results the comparison of transition intensities for individual lines with calculated transition probabilities yields a statistical population of Li- and Be-like configurations.

Femtosecond dynamics of molecules and clusters

The real-time dynamics of multiphoton ionization and fragmentation of molecules - Na_2 , Na_3 - and clusters - Na_n, Hg_n - has been studied in molecular beam experiments employing ion and electron spectroscopy together with femtosecond pump-probe techniques. Experiments with Na_2 and Na_3 reveal unexpected features of the dynamics of the absorption of several photons as seen in the one- and three dimensional vibrational wave packet motion in different potential surfaces and in high laser fields. Cluster size dependent studies of physical properties such as absorption resonances, lifetimes and decay channels have been performed using tunable femtosecond light pulses in resonance enhanced multiphoton ionization (REMPI) of the cluster size under investigation. This method failed in ns-laser experiments due to the ultrafast decay of the studied cluster. For Na_n, cluster we find that for cluster sizes n \le 21 molecular excitations and properties prevail over collective excitations of plasmon-like resonances. In the case of Hg_n cluster prompt formation of singly and doubly charged cluster are observed up to n \approx 60. The transient multiphoton ionization spectra show a 'short' time wave packet dynamics, which is identical for singly and doubly charged mercury clusters while the 'long' time fragmentation dynamics is different.

Caracterización de cardiopatías congénitas en pacientes con Síndrome de Down en una institución especializada de Bogotá

Las cardiopatías son el principal defecto congénito asociado al Síndrome de Down (SD), y su detección e intervención oportuna contribuye a reducir la morbimortalidad. El objetivo del presente estudio fue caracterizar las malformaciones cardiacas congénitas de la población pediátrica con SD que asiste a un centro de atención especializado en la ciudad de Bogotá (Colombia). Materiales y métodos: Se realizó un estudio descriptivo transversal con registros clínicos de pacientes con diagnostico cariotípico de SD, evaluando las cardiopatías congénitas documentadas en las valoraciones pediátricas institucionales; se estudió su posible relación con determinados factores como la edad de los padres y el género del hijo. Resultados: Se revisaron 157 historias clínicas que cumplieron con los criterios de calidad para estudio. El 57,2% eran hombres y el 42,8% mujeres. El cariotipo del 91,7% fue trisomía libre, 3.8% mosaicismos y un caso de translocación. El diagnóstico prenatal se realizó en el 12,1% de los evaluados. Se observó algún defecto cardiaco congénito en el 65,8% de los pacientes (n=103). Se identificaron defectos aislados en 53 pacientes (33,7%), siendo el ductus arterioso persistente el más frecuente con un 26,2%. El defecto múltiple más recurrente fue la comunicación interauricular asociada a comunicación interventricular con un 18,4%. No se identificó relación entre los factores de riesgo estudiados y algún tipo de cardiopatía. Conclusiones: Se identificó una prevalencia de cardiopatías congénitas similar a la reportada por la literatura, sin embargo se documentaron diferencias en cuanto a la frecuencia y tipos de defectos únicos y múltiples descritos en otros estudios. Palabras Clave: Síndrome Down, Cardiopatías congénitas, Colombia.

Resistencia bacteriana en infección urinaria adquirida en comunidad en niños, según urocultivos, 2013

Método: En el Complejo Calle 100 en Bogotá, en el periodo de Julio a Diciembre de 2013 se revisaron los Urocultivos positivos, de pacientes menores de 16 años con diagnóstico clínico de IVU, procedentes de la comunidad. Consultamos las historias clínicas para documentar antibiótico empírico dado y episodios previos de infección. Se describieron los gérmenes aislados y las resistencias antibióticas. Discusión: Las cefalosporinas de primera generación tienen tasas de resistencias superiores al 37%, similar a lo reportado en la literatura, y son usadas como primera línea; ésta conducta debe ser reevaluada. Los aminoglucósidos, la nitrofurantoína y la cefuroxima son alternativas terapéuticas recomendables. La prevalencia de E coli BLEE de origen comunitario genera preocupación, debe incitar a realizar manejo antibiótico dirigido y concienzudo.

Relación de exposición a polvos de carbón, sílice cristalina y neumoconiosis, en trabajadores de minas de socavón, Cundinamarca, 2014.

Objetivo: Determinar el nivel de riesgo de la exposición por fracción respirable a polvo de carbón y sílice cristalina y la prevalencia de neumoconiosis en trabajadores de minas de socavón del departamento de Cundinamarca. Métodos: estudio de corte transversal, en grupos de exposición similar (GES) en las minas seleccionadas, el tamaño muestral fue constituido por 11 empresas y 215 trabajadores en donde se realizó un muestreo ambiental para medir los niveles de polvo de carbón y sílice cristalina. Resultados: La edad promedio del grupo fue de 46±9,5 años y género masculino (97,2%), se encontró una asociación significativa entre polvo de carbón y neumoconiosis (p =0,050) y no fue significativa con exposición a sílice cristalina (p = 0,537). El modelo de regresión logística mostró asociación significativa con la escala de nivel de riesgo de carbón medio (OR=10.4, IC 95%:1.50, 71.41, p=0,02), ajustando con variables significativas como: tamaño de la empresa mediana (OR = 2,67, IC 95%:1.07, 6.66, p=0,04), antigüedad mayor o igual a 30 años (OR = 7,186, IC 95%:2.98, 17.29, p=0,001) y habito tabáquico por más de un año (OR = 4,437, IC 95%:2.06, 9.55, p=0,001) para sílice cristalina no hubo asociación en el modelo multivariado. Conclusión: El riesgo de exposición a carbón de nivel medio está relacionado con la prevalencia de neumoconiosis y otros factores adicionales como tamaño de la empresa mediana, antigüedad mayor o igual a 30 años y habito tabáquico por más de un año para los trabajadores de minería de socavón en Cundinamarca. Para los niveles de sílice cristalina no se encontró asociación significativa.

Perfil de mercado de China

El presente estudio analiza las importaciones desde China hacia Colombia y abarca temas estadísticos, análisis regionales, políticas de comercio exterior y revisiones geopolíticas del papel comercial de China en el mundo, dentro de otros aspectos. Es importante hacer el análisis sobre los contextos del comercio exterior colombiano reciente y vincularlo con el papel de China.

Paradojas e incertidumbres de las economías andinas (Coyuntura)

El artículo parte de señalar la contradicción entre un desempeño macroeconómico, generalmente calificado como favorable, de las economías andinas en lo que va del presente siglo, sustentado en mayores tasas de crecimiento del PIB Y en la reducción del ritmo inflacionario, con el significativo agravamiento de la inestabilidad política en la región, que se ha constituido en la zona más conflictiva del continente. Posteriormente, se examina detenidamente el comportamiento de las economías andinas, estableciendo sus limitaciones y sobre todo los elevados niveles de desempleo en todos los países andinos, como factores estructurales que unidos a la crisis de sus instituciones políticas configuran una situación paradójica y muy frágil. En este contexto, la apuesta al TLC que realizan tres de sus miembros, con diversos grados de decisión, significa una seria amenaza para la integración andina y abre serias dudas sobre el balance de costos y beneficios.

Architect and user interaction: The spoken representation of form and functional meaning

The paper is an investigation of the exchange of ideas and information between an architect and building users in the early stages of the building design process before the design brief or any drawings have been produced. The purpose of the research is to gain insight into the type of information users exchange with architects in early design conversations and to better understand the influence the format of design interactions and interactional behaviours have on the exchange of information. We report an empirical study of pre-briefing conversations in which the overwhelming majority of the exchanges were about the functional or structural attributes of space, discussion that touched on the phenomenological, perceptual and the symbolic meanings of space were rare. We explore the contextual features of meetings and the conversational strategies taken by the architect to prompt the users for information and the influence these had on the information provided. Recommendations are made on the format and structure of pre-briefing conversations and on designers' strategies for raising the level of information provided by the user beyond the functional or structural attributes of space.

Proposing a way forward: a review of standardisation in the use of age categories and ageing techniques in osteological analysis (2004 to 2009)

This study assesses the current state of adult skeletal age-at-death estimation in biological anthropology through analysis of data published in recent research articles from three major anthropological and archaeological journals (2004–2009). The most commonly used adult ageing methods, age of ‘adulthood’, age ranges and the maximum age reported for ‘mature’ adults were compared. The results showed a wide range of variability in the age at which individuals were determined to be adult (from 14 to 25 years), uneven age ranges, a lack of standardisation in the use of descriptive age categories and the inappropriate application of some ageing methods for the sample being examined. Such discrepancies make comparisons between skeletal samples difficult, while the inappropriate use of some techniques make the resultant age estimations unreliable. At a time when national and even global comparisons of past health are becoming prominent, standardisation in the terminology and age categories used to define adults within each sample is fundamental. It is hoped that this research will prompt discussions in the osteological community (both nationally and internationally) about what defines an ‘adult’, how to standardise the age ranges that we use and how individuals should be assigned to each age category. Skeletal markers have been proposed to help physically identify ‘adult’ individuals.

The AVOID programme’s new simulations of the global benefits of stringent climate change mitigation

Quantitative simulations of the global-scale benefits of climate change mitigation are presented, using a harmonised, self-consistent approach based on a single set of climate change scenarios. The approach draws on a synthesis of output from both physically-based and economics-based models, and incorporates uncertainty analyses. Previous studies have projected global and regional climate change and its impacts over the 21st century but have generally focused on analysis of business-as-usual scenarios, with no explicit mitigation policy included. This study finds that both the economics-based and physically-based models indicate that early, stringent mitigation would avoid a large proportion of the impacts of climate change projected for the 2080s. However, it also shows that not all the impacts can now be avoided, so that adaptation would also therefore be needed to avoid some of the potential damage. Delay in mitigation substantially reduces the percentage of impacts that can be avoided, providing strong new quantitative evidence for the need for stringent and prompt global mitigation action on greenhouse gas emissions, combined with effective adaptation, if large, widespread climate change impacts are to be avoided. Energy technology models suggest that such stringent and prompt mitigation action is technologically feasible, although the estimated costs vary depending on the specific modelling approach and assumptions.

Dissociating between object affordances and spatial compatibility effects using early response components

Perception and action are tightly linked: objects may be perceived not only in terms of visual features, but also in terms of possibilities for action. Previous studies showed that when a centrally located object has a salient graspable feature (e.g., a handle), it facilitates motor responses corresponding with the feature's position. However, such so-called affordance effects have been criticized as resulting from spatial compatibility effects, due to the visual asymmetry created by the graspable feature, irrespective of any affordances. In order to dissociate between affordance and spatial compatibility effects, we asked participants to perform a simple reaction-time task to typically graspable and non-graspable objects with similar visual features (e.g., lollipop and stop sign). Responses were measured using either electromyography (EMG) on proximal arm muscles during reaching-like movements, or with finger key-presses. In both EMG and button press measurements, participants responded faster when the object was either presented in the same location as the responding hand, or was affordable, resulting in significant and independent spatial compatibility and affordance effects, but no interaction. Furthermore, while the spatial compatibility effect was present from the earliest stages of movement preparation and throughout the different stages of movement execution, the affordance effect was restricted to the early stages of movement execution. Finally, we tested a small group of unilateral arm amputees using EMG, and found residual spatial compatibility but no affordance, suggesting that spatial compatibility effects do not necessarily rely on individuals’ available affordances. Our results show dissociation between affordance and spatial compatibility effects, and suggest that rather than evoking the specific motor action most suitable for interaction with the viewed object, graspable objects prompt the motor system in a general, body-part independent fashion