Trauma craneoencefálico severo en la UCIP del Hospital de la Misericordia, 2010-2013

El Trauma Craneoencefálico (TCE) infantil constituye un motivo frecuente de consulta en Urgencias y supone la primera causa de muerte en niños, llegando a ser hasta del 50% en trauma severo. En Colombia se conocen cifras de TCE por algunos estudios descriptivos, pero no existen reportes en Bogotá ni específicamente en TCE severo. Objetivo: Caracterizar el trauma craneoencefálico severo pediátrico en la Unidad de Cuidado intensivo del Hospital de la Misericordia entre los años 2010 y 2013. Materiales y métodos: Un estudio descriptivo retrospectivo fue realizado en el Hospital de la Misericordia mediante revisión de las historias clínicas de los pacientes que ingresaron a la Unidad de Cuidado Intensivo pediátrico con diagnóstico de trauma craneoencefálico severo entre el año 2010 al 2013. Resultados: Se incluyeron 63 pacientes (71,4% hombres) con una edad mediana de 4 años (RIQ 2-8). La mayoría de los traumas fueron originados por caída o accidente de tránsito (79,4%). La principal lesión fue fractura de cráneo (79%). Casi la mitad de los pacientes sufrieron algún tipo de secuela neurológica al egreso (47,1%). La mayoría de los pacientes que murieron (19%) sufrieron choque hipovolémico (83,3%) y presentaron trauma asociado (66,7%). Conclusión: Las características y epidemiología del trauma craneoencefálico en nuestra población muestran claras similitudes con lo reportados en otras series de la literatura mundial y de Colombia, excepto por la mortalidad, que se esperaba más alta al estudiar solo pacientes con TCE severo.

Interpreting the response of a dryland river system to Late Quaternary climate change

A U-series calcrete chronology has been constructed for three Late Quaternary terrace units, termed the D1, D2 and D3 terraces in age descending order, from the Rio Aguas river system of the Sorbas basin, southeast Spain. The D1 terrace formed between 30,300 +/- 4400 year BP and 12,140 +/- 360 year BP, correlating well with the Last Glacial Maximum when rates of sediment supply would have increased greatly, because of higher rates of weathering, reduced vegetation cover and weak soil development. The D2 terrace formed between 12,800 +/- 1100 year BP and 9,600 +/- 530 year BP, correlating well with the Younger Dryas event. The D3 terrace could only be poorly constrained to the early Holocene and no unequivocal cause could be assigned to this period of aggradation. The sedimentology and geomorphology of the D2 terrace suggests, however, that the aggradation of this unit was a response to diapirism/karstic processes occurring within the underlying Messinian gypsum strata and the subsequent damming of the Aguas system. Therefore, despite its coincident occurrence with the Younger Dryas, aggradation of the D2 terrace is unrelated to climate change. The style of this response, controlled predominantly by the characteristics of the underlying bedrock, makes correlating the terrace record of the Aguas with other systems in the Mediterranean unreliable. This study, therefore, highlights the problems of correlating fluvial sequences in regions of variable tectonics, climatic history and bedrock geology and emphasises the need to properly understand the main controls on individual fluvial systems before any attempt is made to correlate their depositional histories. (C) 2004 Elsevier Ltd. All rights reserved.

A groove-ploughing theory for the production of mega-scale glacial lineations, and implications for ice-stream mechanics

Mega-scale glacial lineations (MSGLs) are longitudinally aligned corrugations (ridge-groove structures 6-100 km long) in sediment produced subglacially. They are indicators of fast flow and a common signature of ice-stream beds. We develop a qualitative theory that accounts for their formation, and use numerical modelling, and observations of ice-stream beds to provide supporting evidence. Ice in contact with a rough (scale of 10-10(3) m) bedrock surface will mimic the form of the bed. Because of flow acceleration and convergence in ice-stream onset zones, the ice-base roughness elements experience transverse strain, transforming them from irregular bumps into longitudinally aligned keels of ice protruding downwards. Where such keels slide across a soft sedimentary bed, they plough through the sediments, carving elongate grooves, and deforming material up into intervening ridges. This explains MSGLs and has important implications for ice-stream mechanics. Groove ploughing provides the means to acquire new lubricating sediment and to transport large volumes of it downstream. Keels may provide basal drag in the force budget of ice streams, thereby playing a role in flow regulation and stability We speculate that groove ploughing permits significant ice-stream widening, thus facilitating high-magnitude ice discharge.

Sources of sulphur in gypsiferous sediments and crusts and pathways of gypsum redistribution in southern Tunisia

Southern Tunisia contains one of the most extensive gypsum accumulations in Africa comprising Triassic, Cretaceous, Eocene and Mio-Pliocene marine evaporites, spring deposits, playa sediments, aeolian sands and gypsum crusts. Sulphur isotope analysis (delta(34)S) of bedrock samples, groundwater, playa brines, playa sediments, and gypsiferous crusts provides insight into the sources of gypsum in the region and sheds light on the processes that lead to gypsum crust formation. Results Suggest that recycling of marine gypsum is the most likely source of the sulphate in the groundwater, playa sediments and crusts. The low PS values found in Eocene and Mio-Pliocene samples suggest that this recycling has been going on for millions of years. Though bedrock appears to be the ultimate source of the gypsum in the crusts, transport of this sulphate to playas, concentration therein, and subsequent dispersal across the landscape by aeolian processes provides the most likely pathway for surticial gypsum crust formation. Comparison of these results with those from Australia, Chile and Namibia suggests that, although the source of the sulphur varies from region to region, the processes of surficial crust formation appear to be similar. Copyright (C) 2004 John Wiley Sons, Ltd.

The Dubawnt Lake palaeo-ice stream: evidence for dynamic ics sheet behaviour on the Canadian Shield and insights regarding the controls on ice-stream location and vigour

We report evidence for a major ice stream that operated over the northwestern Canadian Shield in the Keewatin Sector of the Laurentide Ice Sheet during the last deglaciation 9000-8200 (uncalibrated) yr BP. It is reconstructed at 450 km in length, 140 km in width, and had an estimated catchment area of 190000 km. Mapping from satellite imagery reveals a suite of bedforms ('flow-set') characterized by a highly convergent onset zone, abrupt lateral margins, and where flow was presumed to have been fastest, a remarkably coherent pattern of mega-scale glacial lineations with lengths approaching 13 km and elongation ratios in excess of 40:1. Spatial variations in bedform elongation within the flow-set match the expected velocity field of a terrestrial ice stream. The flow pattern does not appear to be steered by topography and its location on the hard bedrock of the Canadian Shield is surprising. A soft sedimentary basin may have influenced ice-stream activity by lubricating the bed over the downstream crystalline bedrock, but it is unlikely that it operated over a pervasively deforming till layer. The location of the ice stream challenges the view that they only arise in deep bedrock troughs or over thick deposits of 'soft' fine-grained sediments. We speculate that fast ice flow may have been triggered when a steep ice sheet surface gradient with high driving stresses contacted a proglacial lake. An increase in velocity through calving could have propagated fast ice flow upstream (in the vicinity of the Keewatin Ice Divide) through a series of thermomechanical feedback mechanisms. It exerted a considerable impact on the Laurentide Ice Sheet, forcing the demise of one of the last major ice centres.

Laurentide ice streaming on the Canadian Shield: A conflict with the soft-bedded ice stream paradigm?

Elucidating the controls on the location and vigor of ice streams is crucial to understanding the processes that lead to fast disintegration of ice flows and ice sheets. In the former North American Laurentide ice sheet, ice stream occurrence appears to have been governed by topographic troughs or areas of soft-sediment geology. This paper reports robust evidence of a major paleo-ice stream over the northwestern Canadian Shield, an area previously assumed to be incompatible with fast ice flow because of the low relief and relatively hard bedrock. A coherent pattern of subglacial bedforms (drumlins and megascalle glacial lineations) demarcates the ice stream flow set, which exhibits a convergent onset zone, a narrow main trunk with abrupt lateral margins, and a lobate terminus. Variations in bedform elongation ratio within the flow set match theoretical expectations of ice velocity. In the center of the ice stream, extremely parallel megascalle glacial lineations tens of kilometers long with elongation ratios in excess of 40:1 attest to a single episode of rapid ice flow. We conclude that while bed properties are likely to be influential in determining the occurrence and vigor of ice streams, contrary to established views, widespread soft-bed geology is not an essential requirement for those ice streams without topographic control. We speculate that the ice stream acted as a release valve on ice-sheet mass balance and was initiated by the presence of a proglacial lake that destabilized the ice-sheet margin and propagated fast ice flow through a series of thermomechanical feedbacks involving ice flow and temperature.

A healable supramolecular polymer blend based on aromatic π-π stacking and hydrogen bonding interactions

An elastomeric, supramolecular healable polymer blend, comprising a chain-folding polyimide and a telechelic polyurethane with pyrenyl endgroups, is compatibilised by aromatic π−π stacking between the π-electron-deficient diimide groups and the π-electron-rich pyrenyl units. This inter-polymer interaction is key to forming a tough, healable, elastomeric material. Variable temperature FTIR analysis of the bulk material also conclusively demonstrates the presence of hydrogen bonding, which complements the π–π stacking interactions. Variable temperature SAXS analysis shows that the healable polymeric blend has a nanophase-separated morphology, and that the X-ray contrast between the two types of domain increases with increasing temperature, a feature that is repeatable over several heating and cooling cycles. A fractured sample of this material reproducibly regains more than 95% of the tensile modulus, 91% of the elongation to break, and 77% of the modulus of toughness of the pristine material.

An integrated assessment of carbon dioxide capture and storage in the UK

Geological carbon dioxide storage (CCS) has the potential to make a significant contribution to the decarbonisation of the UK. Amid concerns over maintaining security, and hence diversity, of supply, CCS could allow the continued use of coal, oil and gas whilst avoiding the CO2 emissions currently associated with fossil fuel use. This project has explored some of the geological, environmental, technical, economic and social implications of this technology. The UK is well placed to exploit CCS with a large offshore storage capacity, both in disused oil and gas fields and saline aquifers. This capacity should be sufficient to store CO2 from the power sector (at current levels) for a least one century, using well understood and therefore likely to be lower-risk, depleted hydrocarbon fields and contained parts of aquifers. It is very difficult to produce reliable estimates of the (potentially much larger) storage capacity of the less well understood geological reservoirs such as non-confined parts of aquifers. With the majority of its large coal fired power stations due to be retired during the next 15 to 20 years, the UK is at a natural decision point with respect to the future of power generation from coal; the existence of both national reserves and the infrastructure for receiving imported coal makes clean coal technology a realistic option. The notion of CCS as a ‘bridging’ or ‘stop-gap’ technology (i.e. whilst we develop ‘genuinely’ sustainable renewable energy technologies) needs to be examined somewhat critically, especially given the scale of global coal reserves. If CCS plant is built, then it is likely that technological innovation will bring down the costs of CO2 capture, such that it could become increasingly attractive. As with any capitalintensive option, there is a danger of becoming ‘locked-in’ to a CCS system. The costs of CCS in our model for UK power stations in the East Midlands and Yorkshire to reservoirs in the North Sea are between £25 and £60 per tonne of CO2 captured, transported and stored. This is between about 2 and 4 times the current traded price of a tonne of CO2 in the EU Emissions Trading Scheme. In addition to the technical and economic requirements of the CCS technology, it should also be socially and environmentally acceptable. Our research has shown that, given an acceptance of the severity and urgency of addressing climate change, CCS is viewed favourably by members of the public, provided it is adopted within a portfolio of other measures. The most commonly voiced concern from the public is that of leakage and this remains perhaps the greatest uncertainty with CCS. It is not possible to make general statements concerning storage security; assessments must be site specific. The impacts of any potential leakage are also somewhat uncertain but should be balanced against the deleterious effects of increased acidification in the oceans due to uptake of elevated atmospheric CO2 that have already been observed. Provided adequate long term monitoring can be ensured, any leakage of CO2 from a storage site is likely to have minimal localised impacts as long as leaks are rapidly repaired. A regulatory framework for CCS will need to include risk assessment of potential environmental and health and safety impacts, accounting and monitoring and liability for the long term. In summary, although there remain uncertainties to be resolved through research and demonstration projects, our assessment demonstrates that CCS holds great potential for significant cuts in CO2 emissions as we develop long term alternatives to fossil fuel use. CCS can contribute to reducing emissions of CO2 into the atmosphere in the near term (i.e. peak-shaving the future atmospheric concentration of CO2), with the potential to continue to deliver significant CO2 reductions over the long term.

Self-assembled healable materials through a combination of pi-pi stacking and hydrogen bonding

The discovery of polymers with stimuli responsive physical properties is a rapidly expanding area of research. At the forefront of the field are self-healing polymers, which, when fractured can regain the mechanical properties of the material either autonomically, or in response to a stimulus. It has long been known that it is possible to promote healing in conventional thermoplastics by heating the fracture zone above the Tg of the polymer under pressure. This process requires reptation and subsequent re-entanglement of macromolecules across the fracture void, which serves to bridge, and ‘heal’ the crack. The timescale for this mechanism is highly dependent on the molecular weight of the polymer being studied. This process is in contrast to that required to affect healing in supramolecular polymers such as the plasticised, hydrogen bonded elastomer reported by Leibler et al. The disparity in bond energies between the non-covalent and covalent bonds within supramolecular polymers results in fractures propagating through scission of the comparatively weak supramolecular interactions, rather than through breaking the stronger, covalent bonds. Thus, during the healing process the macromolecules surrounding the fracture site only need sufficient energy to re-engage their supramolecular interactions in order to regenerate the strength of the pristine material. Herein we describe the design, synthesis and optimization of a new class of supramolecular polymer blends that harness the reversible nature of pi-pi stacking and hydrogen bonding interactions to produce self-supporting films with facile healable characteristics.

A supramolecular polymer based on tweezer-type pi-pi stacking interactions: molecular design for healability and enhanced toughness

An elastomeric, healable, supramolecular polymer blend comprising a chain-folding polyimide and a telechelic polyurethane with pyrenyl end groups is compatibilized by aromatic pi-pi stacking between the pi-electron-deficient diimide groups and the pi-electron-rich pyrenyl units. This interpolymer interaction is the key to forming a tough, healable, elastomeric material. Variable-temperature FTIR analysis of the bulk material also conclusively demonstrates the presence of hydrogen bonding, which complements the pi-pi stacking interactions. Variable-temperature SAXS analysis shows that the healable polymeric blend has a nanophase-separated morphology and that the X-ray contrast between the two types of domain increases with increasing temperature, a feature that is repeatable over several heating and cooling cycles. A fractured sample of this material reproducibly regains more than 95% of the tensile modulus, 91% of the elongation to break, and 77% of the modulus of toughness of the pristine material.

Nutritional status and clinical outcome in elderly female surgical orthopaedic patients

The possible relationship between nutritional status and clinical outcome following orthopaedic hip surgery was investigated. The nutritional status of 60 elderly female patients admitted for elective total hip replacement (THR) and emergency fractured neck of femur surgery (FNF) was measured over time. Specific measures of clinical outcome, including well-being and functional status, were monitored during hospital stay and at 4, 8 and 26 weeks following discharge. Patients were allocated to a high nutritional risk group where any three of the following were less than the 5th percentile value: serum albumin, haemoglobin, triceps skinfold thickness, mid-upper arm muscle circumference and body weight. Using this definition, malnutrition was present in 4% of THR patients and 41% of FNF patients. It was found that the high risk patients had significantly longer convalescence periods, (median stay27.5 days compared with 0 days, P < 0.0009), and a greater proportion were dependent upon walking frames at 6 months (46% compared with 11%, P < 0.01). Fifty percent of the high risk patients had been living independently prior to admission, in contrast only 29% had returned to their homes at 6 months after discharge. The results indicate an apparent link between clinical outcome and nutritional status based upon the allocation procedure employed, which has the potential for ensuring cost-effective nutritional intervention.

Integration of remote sensing and GIS for modelling flash floods in Wadi Hudain catchment, Egypt

This paper presents a new approach to modelling flash floods in dryland catchments by integrating remote sensing and digital elevation model (DEM) data in a geographical information system (GIS). The spectral reflectance of channels affected by recent flash floods exhibit a marked increase, due to the deposition of fine sediments in these channels as the flood recedes. This allows the parts of a catchment that have been affected by a recent flood event to be discriminated from unaffected parts, using a time series of Landsat images. Using images of the Wadi Hudain catchment in southern Egypt, the hillslope areas contributing flow were inferred for different flood events. The SRTM3 DEM was used to derive flow direction, flow length, active channel cross-sectional areas and slope. The Manning Equation was used to estimate the channel flow velocities, and hence the time-area zones of the catchment. A channel reach that was active during a 1985 runoff event, that does not receive any tributary flow, was used to estimate a transmission loss rate of 7·5 mm h−1, given the maximum peak discharge estimate. Runoff patterns resulting from different flood events are quite variable; however the southern part of the catchment appears to have experienced more floods during the period of study (1984–2000), perhaps because the bedrock hillslopes in this area are more effective at runoff production than other parts of the catchment which are underlain by unconsolidated Quaternary sands and gravels. Due to high transmission loss, runoff generated within the upper reaches is rarely delivered to the alluvial fan and Shalateen city situated at the catchment outlet. The synthetic GIS-based time area zones, on their own, cannot be relied on to model the hydrographs reliably; physical parameters, such as rainfall intensity, distribution, and transmission loss, must also be considered.

Nitrogen processes in aquatic ecosystems

Executive summary Nature of the problem (science/management/policy) • Freshwater ecosystems play a key role in the European nitrogen (N) cycle, both as a reactive agent that transfers, stores and processes N loadings from the atmosphere and terrestrial ecosystems, and as a natural environment severely impacted by the increase of these loadings. Approaches • This chapter is a review of major processes and factors controlling N transport and transformations for running waters, standing waters, groundwaters and riparian wetlands. Key findings/state of knowledge • The major factor controlling N processes in freshwater ecosystems is the residence time of water, which varies widely both in space and in time, and which is sensitive to changes in climate, land use and management. • The effects of increased N loadings to European freshwaters include acidification in semi-natural environments, and eutrophication in more disturbed ecosystems, with associated loss of biodiversity in both cases. • An important part of the nitrogen transferred by surface waters is in the form of organic N, as dissolved organic N (DON) and particulate organic N (PON). This part is dominant in semi-natural catchments throughout Europe and remains a significant component of the total N load even in nitrate enriched rivers. • In eutrophicated standing freshwaters N can be a factor limiting or co-limiting biological production, and control of both N and phosphorus (P) loading is oft en needed in impacted areas, if ecological quality is to be restored. Major uncertainties/challenges • The importance of storage and denitrifi cation in aquifers is a major uncertainty in the global N cycle, and controls in part the response of catchments to land use or management changes. In some aquifers, the increase of N concentrations will continue for decades even if efficient mitigation measures are implemented now. • Nitrate retention by riparian wetlands has oft en been highlighted. However, their use for mitigation must be treated with caution, since their effectiveness is difficult to predict, and side effects include increased DON emissions to adjacent open waters, N2O emissions to the atmosphere, and loss of biodiversity. • In fact, the character and specific spatial origins of DON are not fully understood, and similarly the quantitative importance of indirect N2O emissions from freshwater ecosystems as a result of N leaching losses from agricultural soils is still poorly known at the regional scale. • These major uncertainties remain due to the lack of adequate monitoring (all forms of N at a relevant frequency), especially – but not only – in the southern and eastern EU countries. Recommendations (research/policy) • The great variability of transfer pathways, buffering capacity and sensitivity of the catchments and of the freshwater ecosystems calls for site specific mitigation measures rather than standard ones applied at regional to national scale. • The spatial and temporal variations of the N forms, the processes controlling the transport and transformation of N within freshwaters, require further investigation if the role of N in influencing freshwater ecosystem health is to be better understood, underpinning the implementation of the EU Water Framework Directive for European freshwaters.

The DigiBog model of peatland development 1: rationale, conceptual model, and hydrological basis

Using a literature review, we argue that new models of peatland development are needed. Many existing models do not account for potentially important ecohydrological feedbacks, and/or ignore spatial structure and heterogeneity. Existing models, including those that simulate a near total loss of the northern peatland carbon store under a warming climate, may produce misleading results because they rely upon oversimplified representations of ecological and hydrological processes. In this, the first of a pair of papers, we present the conceptual framework for a model of peatland development, DigiBog, which considers peatlands as complex adaptive systems. DigiBog accounts for the interactions between the processes which govern litter production and peat decay, peat soil hydraulic properties, and peatland water-table behaviour, in a novel and genuinely ecohydrological manner. DigiBog consists of a number of interacting submodels, each representing a different aspect of peatland ecohydrology. Here we present in detail the mathematical and computational basis, as well as the implementation and testing, of the hydrological submodel. Remaining submodels are described and analysed in the accompanying paper. Tests of the hydrological submodel against analytical solutions for simple aquifers were highly successful: the greatest deviation between DigiBog and the analytical solutions was 2·83%. We also applied the hydrological submodel to irregularly shaped aquifers with heterogeneous hydraulic properties—situations for which no analytical solutions exist—and found the model's outputs to be plausible.