Fractures in Children and Adolescents

Fractures of the growing bone require fixation techniques, which preclude any injury to the growth plate regions. This requirement is met by Elastic Stable Intramedullary Nails (ESIN) which are positioned between both metaphyseal regions. Pronounced malposition and/or shortening, open fractures and fractures with impending skin perforation are indications for clavicle nailing in adolescents. Retrograde nailing with two elastic nails, inserted from lateral, is the method of choice for stabilization of humerus fractures. In radial neck fractures with severe tilting of the radial head, a retrograde nail may reduce and fix the head. In Monteggia lesions, the ulna fracture is reduced and fixed with an antegrade nail. Forearm fractures with unacceptable axial deviation are reduced and fixed with one antegrade nail in the ulna and a retrograde nail in the radius. Ascending elastic nailing is done for femur shaft and proximal femur fractures. The medial and lateral entry sites are located above the distal physis. End caps are used to prevent shortening in spiral and multiple segment fractures. Fractures of the distal third of the femur are nailed in a descending technique. The entry sites of two nails are located on the lateral cortex below the greater trochanter. Combined tibia and fibula fractures, open fractures and unstable fracture types such as spiral and multifragmental tibia fractures are good indications for ESIN. Descending nailing is the method of choice. The nail entry points are medially and laterally distal to the apophysis of the proximal tibia. Thorough knowledge of each fracture type, fracture location and age specific healing pattern is necessary for safe and effective treatment of pediatric fractures

Scaling the Costs of 404 Testing to Fit the Needs of Small Public Companies

In July of 2002, the Sarbanes-Oxley Act was passed by Congress, including section 404 which requires the auditors to test and opine on the company's internal controls. Since that time there has been much debate about whether the intended benefits of increased investor confidence and financial statement transparency trump the unexpectedly high compliance costs, especially for public companies with market-caps less than $75 million. Before these companies begin complying in the upcoming year, interest groups are calling for the requirements to be 'scaled' to better fit the needs of these companies. While auditors already are expected to scale their audit approach to each individual client, more must be done to significantly decrease the costs in order to reverse the trend of small companies foregoing listing on U.S. capital markets. Increased guidance from the PCAOB, SEC, and other related parties could help the small-cap companies and their auditors be aware of best practices. Also, exempting industries that already follow similar guidelines or are significantly injured by the compliance requirements could help. Lastly, the controversial proposal of rotational audits could be put in place if the affected parties cooperate to remove the undue burden on these small-cap companies. Without some form of significant action, the investors could soon lose the ability to buy small-cap companies in U.S. markets.

Monetary Policy Under a Currency Board

The consensus view is that central banks under currency boards do not have tools for active monetary policy. In this paper, we analyze the foreign exchange fee as a monetary policy instrument that can be used by a central bank under a currency board. We develop a general equilibrium model showing that changes in this fee may have the same effects as a change in the monetary policy stance. Thus central banks under the currency board are shown to have an avenue to implement active monetary policy.

The Texas driver responsibility program: A preliminary analysis of the impact on impaired driving and trauma system funding

Objective. In 2003, the State of Texas instituted the Driver Responsibility Program (TDRP), a program consisting of a driving infraction point system coupled with a series of graded fines and annual surcharges for specific traffic violations such as driving while intoxicated (DWI). Approximately half of the revenues generated are earmarked to be disbursed to the state's trauma system to cover uncompensated trauma care costs. This study examined initial program implementation, the impact of trauma system funding, and initial impact on impaired driving knowledge, attitudes and behaviors. A model for targeted media campaigns to improve the program's deterrence effects was developed. ^ Methods. Data from two independent driver survey samples (conducted in 1999 and 2005), department of public safety records, state health department data and a state auditor's report were used to evaluate the program's initial implementation, impact and outcome with respect to drivers' impaired driving knowledge, attitudes and behavior (based on constructs of social cognitive theory) and hospital uncompensated trauma care funding. Survey results were used to develop a regression model of high risk drivers who should be targeted to improve program outcome with respect to deterring impaired driving. ^ Results. Low driver compliance with fee payment (28%) and program implementation problems were associated with lower surcharge revenues in the first two years ($59.5 million versus $525 million predicted). Program revenue distribution to trauma hospitals was associated with a 16% increase in designated trauma centers. Survey data demonstrated that only 28% of drivers are aware of the TDRP and that there has been no initial impact on impaired driving behavior. Logistical regression modeling suggested that target media campaigns highlighting the likelihood of DWI detection by law enforcement and the increased surcharges associated with the TDRP are required to deter impaired driving. ^ Conclusions. Although the TDRP raised nearly $60 million in surcharge revenue for the Texas trauma system over the first two years, this study did not find evidence of a change in impaired driving knowledge, attitudes or behaviors from 1999 to 2005. Further research is required to measure whether the program is associated with decreased alcohol-related traffic fatalities. ^

Differences in performance for quality of care indicators for acute myocardial infarction (AMI) across various hospital categories in Texas

The study analyzed Hospital Compare data for Medicare Fee-for-service patients at least 65 years of age to determine whether hospital performance for AMI outcome and processes of care measures differ amongst Texas hospitals with respect to ownership status (for profit vs. not-for-profit), academic status (teaching vs. non-teaching) and geographical setting (rural vs. urban). ^ The study found a statistically significant difference between for-profit and not-for-profit hospitals in four process-of-care measures (aspirin at discharge, P=0.028; ACE or ARB inhibitor for LSVD, P=0.048; Smoking cessation advice: P=0.034; outpatients who got aspirin with 24 hours of arrival in the ED, P=0.044). No significant difference in performance was found between COTH-member teaching and non-teaching hospitals for any of the eight process-of-care measures or the two outcome measures for AMI. The study was unable to compare performance based on geographic setting of hospitals due to lack of sufficient data for rural hospitals. ^ The results of the study suggest that for-profit Texas hospitals might be slightly better than not-for –profit hospitals at providing possible heart attack patients with certain processes of care.^

Sexualidad y Ciencias Sociales: aportes al campo de la salud. 16H287

1) Profundizar el marco teórico: revisión bibliográfica, reuniones de discusión y reflexión, informes de texto. Elaboración de documentos internos para trabajar con los becarios y auxiliares según los ejes temáticos seleccionados: GENERO Y SEXUALIDAD. 2) Revisión y análisis de los documentos técnicos de planes y programas seleccionados: Plan Mamá, Plan Nacer y Programa de Salud Sexual y Reproductiva. 3) Desarrollo del trabajo de campo en Posadas: finalización de las actividades en los CAPS y continuidad con el grupo de promotoras Progen (barrios San Jorge y Santa Ceciia). 4) Elaboración de una serie de documentos de trabajo individuales según rol desempeñado y tiempo abocado al proyecto (adscriptos, becarios auxiliares y de iniciación, de postgrado, integrantes docentes). 5) Participación en reuniones y congresos científicos. 6) Redacción de artículos para publicar y/o publicados. 7) Apoyo en la presentación de los integrantes a convocatorias de becas de investigación, nacionales y provinciales. 8) Participación en diversas actividades de extensión y transferencia.

(Table 1) Boron-isotope measurements of shallow-dwelling planktonic foraminifera of ODP Holes 144-817A, 144-872C and 143-865C

Knowledge of the evolution of atmospheric carbon dioxide concentrations throughout the Earth's history is important for a reconstruction of the links between climate and radiative forcing of the Earth's surface temperatures. Although atmospheric carbon dioxide concentrations in the early Cenozoic era (about 60 Myr ago) are widely believed to have been higher than at present, there is disagreement regarding the exact carbon dioxide levels, the timing of the decline and the mechanisms that are most important for the control of CO2 concentrations over geological timescales. Here we use the boron-isotope ratios of ancient planktonic foraminifer shells to estimate the pH of surface-layer sea water throughout the past 60 million years, which can be used to reconstruct atmospheric CO2 concentrations. We estimate CO2 concentrations of more than 2,000 p.p.m. for the late Palaeocene and earliest Eocene periods (from about 60 to 52 Myr ago), and find an erratic decline between 55 and 40 Myr ago that may have been caused by reduced CO2 outgassing from ocean ridges, volcanoes and metamorphic belts and increased carbon burial. Since the early Miocene (about 24 Myr ago), atmospheric CO2 concentrations appear to have remained below 500 p.p.m. and were more stable than before, although transient intervals of CO2 reduction may have occurred during periods of rapid cooling approximately 15 and 3 Myr ago.

Ice loss in the Canadian Arctic Archipelago

Though much attention has been focused in recent years on the melting of ice from Greenland and Antarctica, nearly half of the ice volume currently being lost to the ocean is actually coming from other mountain glaciers and ice caps. Ice loss from a group of islands in northern Canada accounts for much of that volume. In a study published in April 2011 in the journal Nature, a team of researchers led by Alex Gardner of the University of Michigan found that land ice in both the northern and southern Canadian Arctic Archipelago has declined sharply. The maps above show ice loss from surface melting for the northern portion of the archipelago from 2004-2006 (left) and 2007-2009 (right). Blue indicates ice gain, and red indicates ice loss. In the six years studied, the Canadian Arctic Archipelago lost an average of approximately 61 gigatons of ice per year. (A gigaton is a billion tons of ice.) The research team also found the rate of ice loss was accelerating. From 2004 to 2006, the average mass loss was roughly 31 gigatons per year; from 2007 to 2009, the loss increased to 92 gigatons per year. Gardner and colleagues used three independent methods to assess ice mass, all of which showed the same trends. The team used a model to estimate the surface mass balance of ice and the amount of ice discharged. They also compiled and analyzed measurements from NASA's Ice, Cloud and Land Elevation Satellite (ICESat) to assess changes in the surface height of ice. Finally, they gathered observations from NASA's Gravity Recovery and Climate Experiment (GRACE) to determine changes in the gravity field in the region, an indicator of the amount of ice gained or lost. The Canadian Arctic Archipelago generally receives little precipitation, and the amount of snowfall changes little from year to year. But the rate of snow and ice melting varies considerably, so changes in ice mass come largely from changes in summertime melt. During the 2004 to 2009 study period, the Canadian Arctic Archipelago experienced four of its five warmest years since 1960, likely fueling the melting. Gardner notes that from 2001 to 2004, the sum of melting from all mountain glaciers and ice caps around the world (but not the Greenland and Antarctic ice sheets) contributed an estimated 1 millimeter per year to global sea level rise. Recent estimates suggest the Greenland and Antarctic ice sheets add another 1.3 millimeters per year to sea level. "This means 1 percent of the land ice volume-mountain glaciers and ice caps-account for about half of all ice loss to the world's oceans," Gardner said. "Most of the ice loss is coming from the Canadian Arctic Archipelago, Alaska, Patagonia, the Himalayas, and the smaller ice masses surrounding the main Greenland and Antarctic ice sheets."

Saber sobre el Virus del Papiloma Humano en la atención de jóvenes : Estudio en Centros de Atención Primaria de Salud del municipio de La Plata

En nuestro país, en 2011 se incorpora al calendario la vacuna del HPV (virus del papiloma humano) para las niñas de 11 años. Este evento acompaña la preocupación -a nivel mundial- vinculada a la incidencia del cáncer de cuello de útero, el que ocupa el segundo lugar como causa de muerte por cáncer en mujeres. La prevención pone en foco a niñas que aún no han iniciado las relaciones sexuales, cuestión que además de 'instalar' problemas relativos a la sexualidad en ese grupo etario, intersecta las especialidades médicas. En este trabajo interesa indagar el modo en que los profesionales de la salud (principalmente ginecólogos y obstétricas) de los Centros de Atención Primaria de la Salud (CAPS) abordan esta problemática en la consulta de jóvenes mayoritariamente no cubiertas por la vacuna. Considerando las limitaciones -ampliamente reconocidas- presentes en la atención de la salud sexual y reproductiva de jóvenes por parte de los equipos de salud, interesa indagar el lugar que ocupa el HPV en la atención de esta población y el modo en que los profesionales de los CAPS plantean el diagnóstico, tratamiento y prevención. Asimismo, plantea una aproximación cualitativa entrevistando a aquellos profesionales del equipo de salud que se consideran competentes en el tema, por medio de un cuestionario semiestructurado

O rural depois do êxodo : As implicações do despovoamento dos campos no distrito de Arroio do Só, município de Santa Maria/RS, Brasil

This study aims to understand the sociospatial transformations resulting from the depopulation of the fields and their effects on the rural landscape of Arroio do Só in Santa Maria - RS. To this end, we attempted to identify changes in the way of life of rural people, their activities and relationships and understand how this process has occurred, its causes and its impact on quality of life and social structure of the population that remained in place. The discussion on the modernization of agriculture is key to understanding this process. This district was chosen as a research site because it is a town that, in the past, had a very big socioeconomic dynamism, and now, according to the bankruptcy of several companies and the consequent emigration of much of the population, the sociospatial dynamic has changed. It was collected data from a secondary source of FIBGE and FEE in order to periodize population dynamics of the district, county and state. The qualitative research was conducted through interviews with the subjects in the field and their representatives, with the help of the Field Diary

Hacer las reglas del hacer : Concepciones y rutinas bibliotecarias en los reglamentos de las bibliotecas populares en la Argentina (1870-1875)

El artículo aborda los vínculos sostenidos por la Comisión Protectora de las Bibliotecas Populares y las bibliotecas populares con relación a la elaboración de reglas adecuadas para ordenar el funcionamiento de estas instituciones. A partir de un análisis del Boletín de las Bibliotecas Populares, se estudia la manera en que la Comisión insistió en la difusión de dos servicios: la lectura gratuita en la sala y el préstamo domiciliario de libros a cambio de una cuota accesible. Se observa cómo las bibliotecas incorporaron progresivamente esas pautas y, al hacerlo, colaboraron con sus propios reglamentos con la estrategia pedagógica del Boletín. Se examinan, asimismo, las indicaciones técnicas presentes en la revista para contribuir con el desarrollo de los procesos bibliotecarios necesarios para sustentar dichos servicios. Se concluye que entre 1870 y 1875 estas acciones renovaron la tradición bibliotecaria en la Argentina, aun cuando es posible detectar diversas deficiencias y contrasentidos en la transmisión de esta nueva concepción bibliotecológica. Finalmente, se evalúa la pertinencia de los reglamentos y otros documentos institucionales para desenvolver los estudios históricos sobre los contextos de la lectura

O rural depois do êxodo : As implicações do despovoamento dos campos no distrito de Arroio do Só, município de Santa Maria/RS, Brasil

This study aims to understand the sociospatial transformations resulting from the depopulation of the fields and their effects on the rural landscape of Arroio do Só in Santa Maria - RS. To this end, we attempted to identify changes in the way of life of rural people, their activities and relationships and understand how this process has occurred, its causes and its impact on quality of life and social structure of the population that remained in place. The discussion on the modernization of agriculture is key to understanding this process. This district was chosen as a research site because it is a town that, in the past, had a very big socioeconomic dynamism, and now, according to the bankruptcy of several companies and the consequent emigration of much of the population, the sociospatial dynamic has changed. It was collected data from a secondary source of FIBGE and FEE in order to periodize population dynamics of the district, county and state. The qualitative research was conducted through interviews with the subjects in the field and their representatives, with the help of the Field Diary

Hacer las reglas del hacer : Concepciones y rutinas bibliotecarias en los reglamentos de las bibliotecas populares en la Argentina (1870-1875)

El artículo aborda los vínculos sostenidos por la Comisión Protectora de las Bibliotecas Populares y las bibliotecas populares con relación a la elaboración de reglas adecuadas para ordenar el funcionamiento de estas instituciones. A partir de un análisis del Boletín de las Bibliotecas Populares, se estudia la manera en que la Comisión insistió en la difusión de dos servicios: la lectura gratuita en la sala y el préstamo domiciliario de libros a cambio de una cuota accesible. Se observa cómo las bibliotecas incorporaron progresivamente esas pautas y, al hacerlo, colaboraron con sus propios reglamentos con la estrategia pedagógica del Boletín. Se examinan, asimismo, las indicaciones técnicas presentes en la revista para contribuir con el desarrollo de los procesos bibliotecarios necesarios para sustentar dichos servicios. Se concluye que entre 1870 y 1875 estas acciones renovaron la tradición bibliotecaria en la Argentina, aun cuando es posible detectar diversas deficiencias y contrasentidos en la transmisión de esta nueva concepción bibliotecológica. Finalmente, se evalúa la pertinencia de los reglamentos y otros documentos institucionales para desenvolver los estudios históricos sobre los contextos de la lectura

Saber sobre el Virus del Papiloma Humano en la atención de jóvenes : Estudio en Centros de Atención Primaria de Salud del municipio de La Plata

En nuestro país, en 2011 se incorpora al calendario la vacuna del HPV (virus del papiloma humano) para las niñas de 11 años. Este evento acompaña la preocupación -a nivel mundial- vinculada a la incidencia del cáncer de cuello de útero, el que ocupa el segundo lugar como causa de muerte por cáncer en mujeres. La prevención pone en foco a niñas que aún no han iniciado las relaciones sexuales, cuestión que además de 'instalar' problemas relativos a la sexualidad en ese grupo etario, intersecta las especialidades médicas. En este trabajo interesa indagar el modo en que los profesionales de la salud (principalmente ginecólogos y obstétricas) de los Centros de Atención Primaria de la Salud (CAPS) abordan esta problemática en la consulta de jóvenes mayoritariamente no cubiertas por la vacuna. Considerando las limitaciones -ampliamente reconocidas- presentes en la atención de la salud sexual y reproductiva de jóvenes por parte de los equipos de salud, interesa indagar el lugar que ocupa el HPV en la atención de esta población y el modo en que los profesionales de los CAPS plantean el diagnóstico, tratamiento y prevención. Asimismo, plantea una aproximación cualitativa entrevistando a aquellos profesionales del equipo de salud que se consideran competentes en el tema, por medio de un cuestionario semiestructurado