What are the priorities for prevention and control of non-communicable diseases and injuries in sub-Saharan Africa and South East Asia?

Last year’s UN high level meeting sought to galvanise the international community into scaling up its response to the escalating global burden of non-communicable diseases. With resources tight, D Chisholm and colleagues examine which interventions should be given priority for action and investment

¿La presencia de estudiantes de pregrado en la atención de pacientes obstétricas cambia los indicadores de calidad?

Se midieron indicadores de calidad con y sin la presencia de estudiantes de pregrado en el servicio de Obstetricia del Hospital Universitario Clínica San Rafael, con el fin de determinar diferencias en su comportamiento y se evaluó la opinión de los docentes acerca de su presencia.

Manejo de las crisis familiares ante la hospitalización de uno de sus miembros en una unidad de cuidado intensivo

En las Unidades de Cuidado Intensivo se proporcionan cuidados altamente especializados al paciente. Sin embargo en la práctica, en la mayoría de los casos se olvida y no se tiene en cuenta, la posibilidad de afrontamiento de crisis

Stable Isotope Analysis Reveals That Agricultural Habitat Provides an Important Dietary Component for Nonbreeding Dunlin

Although shorebirds spending the winter in temperate areas frequently use estuarine and supratidal (upland) feeding habitats, the relative contribution of each habitat to individual diets has not been directly quantified. We quantified the proportional use that Calidris alpina pacifica (Dunlin) made of estuarine vs. terrestrial farmland resources on the Fraser River Delta, British Columbia, using stable isotope analysis (δ13C, δ15N) of blood from 268 Dunlin over four winters, 1997 through 2000. We tested for individual, age, sex, morphological, seasonal, and weather-related differences in dietary sources. Based on single- (δ13C) and dual-isotope mixing models, the agricultural habitat contributed approximately 38% of Dunlin diet averaged over four winters, with the balance from intertidal flats. However, there was a wide variation among individuals in the extent of agricultural feeding, ranging from about 1% to 95% of diet. Younger birds had a significantly higher terrestrial contribution to diet (43%) than did adults (35%). We estimated that 6% of adults and 13% of juveniles were obtaining at least 75% of their diet from terrestrial sources. The isotope data provided no evidence for sex or overall body size effects on the proportion of diet that is terrestrial in origin. The use of agricultural habitat by Dunlin peaked in early January. Adult Dunlin obtained a greater proportion of their diet terrestrially during periods of lower temperatures and high precipitation, whereas no such relationship existed for juveniles. Seasonal variation in the use of agricultural habitat suggests that it is used more during energetically stressful periods. The terrestrial farmland zone appears to be consistently important as a habitat for juveniles, but for adults it may provide an alternative feeding site used as a buffer against starvation during periods of extreme weather. Loss or reduction of agricultural habitat adjacent to estuaries may negatively impact shorebird fitness, with juveniles disproportionately affected.

Patch Scale Nest-Site Selection by Marbled Murrelets (Brachyramphus marmoratus)

The Marbled Murrelet (Brachyramphus marmoratus) is a threatened alcid that nests almost exclusively in old-growth forests along the Pacific coast of North America. Nesting habitat has significant economic importance. Murrelet nests are extremely difficult and costly to find, which adds uncertainty to management and conservation planning. Models based on air photo interpretation of forest cover maps or assessments by low-level helicopter flights are currently used to rank presumed Marbled Murrelet nesting habitat quality in British Columbia. These rankings are assumed to correlate with nest usage and murrelet breeding productivity. Our goal was to find the models that best predict Marbled Murrelet nesting habitat in the ground-accessible portion of the two regions studied. We generated Resource Selection Functions (RSF) using logistic regression models of ground-based forest stand variables gathered at plots around 64 nests, located using radio-telemetry, versus 82 random habitat plots. The RSF scores are proportional to the probability of nests occurring in a forest patch. The best models differed somewhat between the two regions, but include both ground variables at the patch scale (0.2-2.0 ha), such as platform tree density, height and trunk diameter of canopy trees and canopy complexity, and landscape scale variables such as elevation, aspect, and slope. Collecting ground-based habitat selection data would not be cost-effective for widespread use in forestry management; air photo interpretation and low-level aerial surveys are much more efficient methods for ranking habitat suitability on a landscape scale. This study provides one method for ground-truthing the remote methods, an essential step made possible using the numerical RSF scores generated herein.

Stratospheric Memory and Skill of Extended-Range Weather Forecasts

We use an empirical statistical model to demonstrate significant skill in making extended-range forecasts of the monthly-mean Arctic Oscillation (AO). Forecast skill derives from persistent circulation anomalies in the lowermost stratosphere and is greatest during boreal winter. A comparison to the Southern Hemisphere provides evidence that both the time scale and predictability of the AO depend on the presence of persistent circulation anomalies just above the tropopause. These circulation anomalies most likely affect the troposphere through changes to waves in the upper troposphere, which induce surface pressure changes that correspond to the AO.

Empirical Orthogonal Functions: The Medium is the Message

Empirical orthogonal function (EOF) analysis is a powerful tool for data compression and dimensionality reduction used broadly in meteorology and oceanography. Often in the literature, EOF modes are interpreted individually, independent of other modes. In fact, it can be shown that no such attribution can generally be made. This review demonstrates that in general individual EOF modes (i) will not correspond to individual dynamical modes, (ii) will not correspond to individual kinematic degrees of freedom, (iii) will not be statistically independent of other EOF modes, and (iv) will be strongly influenced by the nonlocal requirement that modes maximize variance over the entire domain. The goal of this review is not to argue against the use of EOF analysis in meteorology and oceanography; rather, it is to demonstrate the care that must be taken in the interpretation of individual modes in order to distinguish the medium from the message.

Arctic oscillation or North Atlantic oscillation?

The definition and interpretation of the Arctic oscillation (AO) are examined and compared with those of the North Atlantic oscillation (NAO). It is shown that the NAO reflects the correlations between the surface pressure variability at its centers of action, whereas this is not the case for the AO. The NAO pattern can be identified in a physically consistent way in principal component analysis applied to various fields in the Euro-Atlantic region. A similar identification is found in the Pacific region for the Pacific–North American (PNA) pattern, but no such identification is found here for the AO. The AO does reflect the tendency for the zonal winds at 35° and 55°N to anticorrelate in both the Atlantic and Pacific regions associated with the NAO and PNA. Because climatological features in the two ocean basins are at different latitudes, the zonally symmetric nature of the AO does not mean that it represents a simple modulation of the circumpolar flow. An increase in the AO or NAO implies strong, separated tropospheric jets in the Atlantic but a weakened Pacific jet. The PNA has strong related variability in the Pacific jet exit, but elsewhere the zonal wind is similar to that related to the NAO. The NAO-related zonal winds link strongly through to the stratosphere in the Atlantic sector. The PNA-related winds do so in the Pacific, but to a lesser extent. The results suggest that the NAO paradigm may be more physically relevant and robust for Northern Hemisphere variability than is the AO paradigm. However, this does not disqualify many of the physical mechanisms associated with annular modes for explaining the existence of the NAO.