Fractura de radio distal como predictor de fractura de cadera en mayores de 65 años de un hospital universitario de alta complejidad en Bogotá

La osteoporosis es una de las condiciones patológicas en mayor crecimiento a medida que la población de tercera edad aumenta, esto se traduce en fracturas por fragilidad como lo son las fracturas de radio distal y las fracturas de cadera, actualmente no se cuentas con datos de la población a estudio que correlacione este tipo de fracturas. Es un estudio retrospectivo de casos y controles donde se obtuvo un grupo de pacientes con fractura de cadera que consultaron a un hospital universitario de alta complejidad en la ciudad de Bogotá, se evaluó la presencia de antecedente de fractura de radio distal y se comparó con un grupo control de trauma en cadera. Se obtuvo un total de 325 casos (72,5%) y 123 (25%) controles. El promedio de edad fue de 81 años, el 70% de los pacientes en ambos grupos correspondió a mujeres. No hubo diferencia en cuanto a la prevalencia de tabaquismo, hipertensión arterial o diabetes en los grupos. No se encontraron diferencias significativas en cuanto a niveles de glicemia, calcio, vitamina D. La presencia de antecedente de fractura de radio distal en grupo con fractura de cadera fue del 7,1% encontrando un OR de 3,91 IC 95%(1,17– 13,10). La presencia de fractura de radio distal como antecedente es un predictor para la fractura de cadera en pacientes mayores. Se necesitan más estudios que correlacionen otras variables que pueden influir en la asociación para fractura de cadera y radio, para así identificar una población específica que se beneficie de un tratamiento temprano.

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.

Magic for the dead? The archaeology of magic in later medieval burials

THIS PAPER EXAMINES patterns in the placement of apotropaic objects and materials in high- to late-medieval burials in Britain (11th to 15th centuries). It develops an interdisciplinary classification to identify: (1) healing charms and protective amulets; (2) objects perceived to have occult natural power; (3) 'antique' items that were treated as possessing occult power; and (4) rare practices that may have been associated with the demonic magic of divination or sorcery. Making comparisons with amulets deposited in conversion-period graves of the 7th to 9th centuries it is argued that the placement of amulets with the dead was strategic to Christian belief, intended to transform or protect the corpse. The conclusion is that material traces of magic in later medieval graves have a connection to folk magic, performed by women in the care of their families, and drawing on knowledge of earlier traditions. This popular magic was integrated with Christian concerns and tolerated by local clergy, and was perhaps meant to heal or reconstitute the corpse, to ensure its reanimation on judgement day, and to protect the vulnerable dead on their journey through purgatory.

TIGGE: Comparison of the prediction of northern hemisphere extratropical cyclones by different ensemble prediction systems

The Observing System Research and Predictability Experiment (THORPEX) Interactive Grand Global Ensemble (TIGGE) is a World Weather Research Programme project. One of its main objectives is to enhance collaboration on the development of ensemble prediction between operational centers and universities by increasing the availability of ensemble prediction system (EPS) data for research. This study analyzes the prediction of Northern Hemisphere extratropical cyclones by nine different EPSs archived as part of the TIGGE project for the 6-month time period of 1 February 2008–31 July 2008, which included a sample of 774 cyclones. An objective feature tracking method has been used to identify and track the cyclones along the forecast trajectories. Forecast verification statistics have then been produced [using the European Centre for Medium-Range Weather Forecasts (ECMWF) operational analysis as the truth] for cyclone position, intensity, and propagation speed, showing large differences between the different EPSs. The results show that the ECMWF ensemble mean and control have the highest level of skill for all cyclone properties. The Japanese Meteorological Administration (JMA), the National Centers for Environmental Prediction (NCEP), the Met Office (UKMO), and the Canadian Meteorological Centre (CMC) have 1 day less skill for the position of cyclones throughout the forecast range. The relative performance of the different EPSs remains the same for cyclone intensity except for NCEP, which has larger errors than for position. NCEP, the Centro de Previsão de Tempo e Estudos Climáticos (CPTEC), and the Australian Bureau of Meteorology (BoM) all have faster intensity error growth in the earlier part of the forecast. They are also very underdispersive and significantly underpredict intensities, perhaps due to the comparatively low spatial resolutions of these EPSs not being able to accurately model the tilted structure essential to cyclone growth and decay. There is very little difference between the levels of skill of the ensemble mean and control for cyclone position, but the ensemble mean provides an advantage over the control for all EPSs except CPTEC in cyclone intensity and there is an advantage for propagation speed for all EPSs. ECMWF and JMA have an excellent spread–skill relationship for cyclone position. The EPSs are all much more underdispersive for cyclone intensity and propagation speed than for position, with ECMWF and CMC performing best for intensity and CMC performing best for propagation speed. ECMWF is the only EPS to consistently overpredict cyclone intensity, although the bias is small. BoM, NCEP, UKMO, and CPTEC significantly underpredict intensity and, interestingly, all the EPSs underpredict the propagation speed, that is, the cyclones move too slowly on average in all EPSs.

Young adults and the 5 a day campaign: perceived benefits and barriers of eating more fruits and vegetables

Although consuming adequate amounts of fruits and vegetables reduces the risk of developing chronic diseases, it is widely recognized that young adults’ intakes are currently well below the Department of Health’s recommended five portions a day, with men consuming even less than women. One approach in the UK has been to introduce health campaigns such as the 5 A DAY programme; however, little is currently known about how well their messages are understood amongst young adults. This study examined current knowledge of the 5 A DAY message in young adults, as well as the perceived benefits and remaining barriers towards consuming more fruits and vegetables. In total, four focus groups were conducted using male (n = 22) and female (n = 18) students at the University of Reading. Content analysis revealed that while participants were aware of the 5 A DAY recommendation, there was widespread confusion regarding the detail. In addition, men were less accepting of the message than women, reporting greater disbelief and a lack of motivation to increase intake. Finally, a range of barriers was reported by participants of both genders, despite the perceived beneficial effects for health and appearance. The results illustrate a considerable gap between awareness and knowledge of the 5 A DAY message, and underscore the challenge that changing behaviour in young adults represents. As well as stepping up education- and skill-based health campaigns, more targeted gender specific interventions will be needed to achieve sustained increases in fruit and vegetable intake.

Domestication of plants revisited - Darwin to the present day

Darwin studied domesticated plants and animals to try to understand the causes of variability. He observed that variation is greatest in the part of the plant most used by humans, but explanations of the causes of this variation had to await the discovery of Mendelian genetics and subsequent advances in the understanding of the structure and mode of action of genes, from the one gene, one enzyme hypothesis to the role of transcriptional regulators. Darwin credited his studies on domesticated plants and animals with demonstrating to him the power of selection. He recognized two forms of human-mediated selection, methodical and unconscious, in addition to natural selection. Selection leaves a signature in the form of reduced diversity in genes that have been the targets of selection and in 'hitch-hiking' genomic regions linked to the target genes. These so-called selective sweeps may serve now to identify genes targeted by selection in early stages of domestication and thus provide a possible guide to crop improvement in future. (C) 2009 The Linnean Society of London, Botanical Journal of the Linnean Society, 2009, 161, 203-212.

Support and information needs of older and disabled older people in the UK

The aim of this study was to determine the support and information needs of older and disabled older people in the UK. Following an initial literature survey, an examination of data on enquiries made by older people to information providers, and a series of focus groups, a questionnaire was developed for a nationwide survey. Over 1630 questionnaires were completed by disabled older clients of Day Care Centres and less frail older members of social clubs. Findings showed that there is a serious shortfall in the number of older people getting the practical support that they need, and the information that enables access to this support, compared to the number that actually need help. Substantial percentages of the survey respondents experienced difficulty with everyday tasks and with accessing the information they needed. Implications for formal sources of support and information are discussed.

Care pathways and designing the healthcare built environment: an explanatory framework

The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.

Enabling older people to stay at home: The costs of substituting and supplementing care with assistive technology

A wide-ranging multiprofessional research project explored issues relating to the introduction of assistive technology into the existing homes of older people in order to provide them with the opportunity to remain at home. The financial relationship between assistive technology and packages of formal care was also explored. The costs of residential care and those of a number of packages containing differing quantities of assistive technology, formal care and informal care were compared. The analyses provide a strong financial case for substituting and/or supplementing formal care with assistive technology, even for individuals with quite disabling conditions. Although needs and hence the cost of provision rise with an increasing level of disability, the savings in care costs accrue quickly. The consideration of a variety of users with different needs and informal care provision, and occupying a very wide range of housing, leads to the conclusion that in comparison with traditional care packages, at worst, incorporating significant amounts of assistive technology into care packages is cost neutral, but that with careful specification of assistive technology major savings are feasible.

Don't we care?: the ethics and emotional labour of early years professionalism

This paper argues that early childhood education and care (ECEC) has a legitimate aspiration to be a 'caring profession' like others such as nursing or social work, defined by a moral purpose. For example, practitioners often draw on an ethic of care as evidence of their professionalism. However, the discourse of professionalism in England completely excludes the ethical vocabulary of care. Nevertheless, it necessarily depends on gendered dispositions towards emotional labour, often promoted by training programmes as 'professional' demeanours. Taking control of the professionalisation agenda therefore requires practitioners to demonstrate a critical understanding of their practice as 'emotion work'. At the same time, reconceptualising practice within a political ethic of care may allow the workforce, and new trainees in particular, to champion 'caring' as a sustainable element of professional work, expressed not only in maternal, dyadic key-working but in advocacy for care as a social principle.

Statistical–dynamical downscaling of present day and future precipitation regimes in the Aksu river catchment in Central Asia

A statistical–dynamical downscaling (SDD) approach is applied to determine present day and future high-resolution rainfall distributions in the catchment of the river Aksu at the southern slopes of the Tienshan Mountains, Central Asia. First, a circulation weather type (CWT) classification is employed to define typical lower atmospheric flow regimes from ERA-40 reanalysis data. Selected representatives of each CWT are dynamically downscaled with the regional climate model COSMO-CLM 4.8 at a horizontal grid resolution of 0.0625°, using the ERA-40 reanalysis data as boundary conditions. Finally, the simulated representatives are recombined to obtain a high-resolution rainfall climatology for present day climate. The methodology is also applied to ensemble simulations of three different scenarios of the global climate model ECHAM5/MPI-OM1 to derive projections of rainfall changes until 2100. Comparisons of downscaled seasonal and annual rainfall with observational data suggest that the statistical–dynamical approach is appropriate to capture the observed present-day precipitation climatology over the low lands and the first elevations of the Tienshan Mountains. On the other hand, a strong bias is found at higher altitudes, where precipitation is clearly underestimated by SDD. The application of SDD to the ECHAM5/MPI-OM1 ensemble reveals that precipitation changes by the end of the 21st century depend on the season. While for autumn an increase of seasonal precipitation is found for all simulations, a decrease in precipitation is obtained during winter for most parts of the Aksu catchment. The spread between different ECHAM5/MPI-OM1 ensemble members is strongest in spring, where trends of opposite sign are found. The largest changes in rainfall are simulated for the summer season, which also shows the most pronounced spatial heterogeneity. Most ECHAM5/MPI-OM1 realizations indicate a decrease of annual precipitation over large parts of the Tienshan, and an increase restricted to the southeast of the study area. These results provide a good basis for downscaling present-day and future rainfall distributions for hydrological purposes.

Analysis of the bacterial communities present in lungs of patients with cystic fibrosis from American and British centers

The aim of this study was to determine whether geographical differences impact the composition of bacterial communities present in the airways of cystic fibrosis (CF) patients attending CF centers in the United States or United Kingdom. Thirty-eight patients were matched on the basis of clinical parameters into 19 pairs comprised of one U.S. and one United Kingdom patient. Analysis was performed to determine what, if any, bacterial correlates could be identified. Two culture-independent strategies were used: terminal restriction fragment length polymorphism (T-RFLP) profiling and 16S rRNA clone sequencing. Overall, 73 different terminal restriction fragment lengths were detected, ranging from 2 to 10 for U.S. and 2 to 15 for United Kingdom patients. The statistical analysis of T-RFLP data indicated that patient pairing was successful and revealed substantial transatlantic similarities in the bacterial communities. A small number of bands was present in the vast majority of patients in both locations, indicating that these are species common to the CF lung. Clone sequence analysis also revealed that a number of species not traditionally associated with the CF lung were present in both sample groups. The species number per sample was similar, but differences in species presence were observed between sample groups. Cluster analysis revealed geographical differences in bacterial presence and relative species abundance. Overall, the U.S. samples showed tighter clustering with each other compared to that of United Kingdom samples, which may reflect the lower diversity detected in the U.S. sample group. The impact of cross-infection and biogeography is considered, and the implications for treating CF lung infections also are discussed.

Social citizenship, housing wealth and the cost of social care: is the Care Act 2014 'Fair'?

This article assesses the extent to which it is ‘fair’ for the government to require owner-occupiers to draw on the equity accumulated in their home to fund their social care costs. The question is stimulated by the report of the Commission on Funding of Care and Support, Fairer Care Funding (the Dilnot Commission) and the subsequent Care Act 2014. The enquiry is located within the framework of social citizenship and the new social contract. It argues that the individualistic, contractarian approach, exemplified by the Dilnot Commission and reflected in the Act, raises questions when considered from the perspective of intergenerational fairness. We argue that our concerns with the Act could be addressed by inculcating an expectation of drawing on housing wealth to fund older age: a policy of asset-based welfare.

Barriers to interventions aimed at promoting the health of health care workers in Brazil

Objective. To search the literature for circumstances that impede injury and disease prevention and other activities intended to improve the health of the health care worker. Methods. The SciELO database was searched for articles published in 1967-2008. This was supplemented by a PubMed search for the period 1950-2008. The following key words were used to identify articles in English, Portuguese, and Spanish: work, health personnel, occupational, risks, diseases, ergonomics, work ability, quality of life, organization, accidents, work conditions, intervention, and administration. Articles on injury and disease prevention and occupational health in a health care setting in Latin America were selected, along with articles focused on health promotion in the health sector. Results. The following shortcomings were identified: activities lacked a sound theoretical foundation and were not integrated with the health services management; a failure to evaluate the effectiveness of the activity; health surveillance focused solely on a specific disease or injury; management not committed to the proposed activity; miscommunication; inability of workers to participate, or control the work environment; and, programs or efforts that were limited to changing the workers` behaviors. Conclusions. The literature shows that all the barriers identified by this study affect both the health care workers` health as well as their productivity.

Outcomes of newborns admitted in the intensive care unit at a public hospital

Background: We evaluated the outcome of newborns admitted in the neonatal Intensive Care Unit (ICU) in Diadema, Brazil. Methods: We evaluated 72 newborns, data were extracted from research forms, newborns` hospital records, mothers interviews, domiciliary inquiry made with the responsible for the newborn care, and paediatric accompaniment cards. Results: 48.93% presented low birth weight, 48% were considered to have normal birth weight and 2% had a birth weight higher than 4000g. Concerning gestational age, 57.44% were younger than 37 weeks old. During hospitalisation, newborn had appointments with doctors from other specialties (inter-appointments), around 40% were cardiologists. After hospital discharge 82.98% were referred to local primary health care units, and the main specialities were cardiology and neurology. Among the newborns evaluated 85.11% were accompanied by paediatric health care units. Conclusion: The implementation of a specialised newborn health accompaniment program in Brazil after ICU discharge is important for positive outcomes regarding newborns growth and development.