Factores asociados a infección de fracturas abiertas de extremidades por accidentes de tránsito. Bogotá, 2012-2013

Los traumatismos por accidentes de tránsito, constituyen un problema de salud pública, a nivel mundial. Las lesiones más frecuentes son las fracturas de extremidades (84.3%). Las fracturas tienen un elevado riesgo de presentar infecciones, secuelas e incapacidades permanentes. Objetivo : Determinar si los factores asociados con la patología (lugar de fractura, clasificación de fractura, comorbilidades del paciente) y/o los factores relacionados con la atención médica (uso de profilaxis antibiótica diferente al protocolo institucional, tiempo prolongado para remisión, demoras en manejo quirúrgico) se asocian a mayor probabilidad de presentar infección de fracturas abiertas, en población mayor a 15 años, atendidos por accidente de tránsito, en una clínica de Bogotá de tercer nivel especializada en atención de SOAT, durante el período Octubre de 2012 a Octubre de 2013. Metodología: Estudio de casos y controles no apareado, relación 1:3, conformado por 43 casos (fracturas abiertas infectadas) y 129 controles (fracturas abiertas no infectadas). Resultados: La edad media de los casos fue de 39.42 +/- 16.82 años (med=36 años) y la edad media de los controles fue de 33.15 +/- 11.78 años (med=30 años). El 83.7% de los casos y el 78.3% de los controles corresponden al sexo masculino. Predominaron los accidentes en motocicleta en el 81.4% de los casos y el 86% de los controles. En el análisis bivariado se encuentra que la edad mayor a 50 años (p=0.042), una clasificación de la fractura grado IIIB o IIIC (p=0.02), cumplimiento del protocolo antibiótico institucional según el grado de fractura (p=0.014) y un tiempo mayor a 24 horas desde el momento del accidente al centro especializado en trauma (p=0.035) se asociaron significativamente con infección de la fractura abierta. En el análisis multivariado se encuentra únicamente que la clasificación de la fractura grado IIIB o IIIC se asocia con infección de la fractura OR 2.6 IC95% (1.187 – 5.781) (p=0.017). La duración de hospitalización fue mayor en los casos (32.37+/- 22.92 días, med=26 días) que en los controles (8.81 +/- 7.52 días, med=6 días) (p<0.001). El promedio de lavados quirúrgicos fue mayor en los casos (4.85±4.1, med=4.0) que en el grupo control (1.94±1.26, med=2) (p<0.001). Conclusiones: La infección posterior a una fractura abierta, implica costos elevados de atención con hospitalizaciones prolongadas y mayor frecuencia de intervenciones quirúrgicas como se evidencia en el presente estudio. Se debe fortalecer el sistema de remisión y contra remisión para acortar los tiempos de inicio de manejo especializado de los pacientes con fracturas abiertas. Se debe incentivar dentro de las instituciones, el cumplimiento de protocolos de profilaxis antibiótica según el grado de la fractura para disminuir el riesgo de complicación infecciosa.

Productivity, demand and the home market effect

The causality between international trade and industrialization is still ambiguous. We consider a model of international trade with the Home Market Effect - with differences in income and productivity between sectors and between countries - in order to identify additional channels for determining the effects of international trade on industrialization. Introducing non-homothetic preferences and differences in productivity aids in the interpretation of any apparent paradoxes within international trade, such as the commercial relations between more populated countries like China and India and large economies such as the U.S. Population size, demand composition and productivity levels constitute the three main channels for determining the effects of international trade. Interactions among these channels define the results obtained in terms of industrialization, while welfare levels are always higher in relation to autarky.

Estimation of age- and stage-specific Catalan breast cancer survival functions using US and Catalan survival data

During the last part of the 1990s the chance of surviving breast cancer increased. Changes in survival functions reflect a mixture of effects. Both, the introduction of adjuvant treatments and early screening with mammography played a role in the decline in mortality. Evaluating the contribution of these interventions using mathematical models requires survival functions before and after their introduction. Furthermore, required survival functions may be different by age groups and are related to disease stage at diagnosis. Sometimes detailed information is not available, as was the case for the region of Catalonia (Spain). Then one may derive the functions using information from other geographical areas. This work presents the methodology used to estimate age- and stage-specific Catalan breast cancer survival functions from scarce Catalan survival data by adapting the age- and stage-specific US functions. Methods: Cubic splines were used to smooth data and obtain continuous hazard rate functions. After, we fitted a Poisson model to derive hazard ratios. The model included time as a covariate. Then the hazard ratios were applied to US survival functions detailed by age and stage to obtain Catalan estimations. Results: We started estimating the hazard ratios for Catalonia versus the USA before and after the introduction of screening. The hazard ratios were then multiplied by the age- and stage-specific breast cancer hazard rates from the USA to obtain the Catalan hazard rates. We also compared breast cancer survival in Catalonia and the USA in two time periods, before cancer control interventions (USA 1975–79, Catalonia 1980–89) and after (USA and Catalonia 1990–2001). Survival in Catalonia in the 1980–89 period was worse than in the USA during 1975–79, but the differences disappeared in 1990–2001. Conclusion: Our results suggest that access to better treatments and quality of care contributed to large improvements in survival in Catalonia. On the other hand, we obtained detailed breast cancer survival functions that will be used for modeling the effect of screening and adjuvant treatments in Catalonia

Contributions of Weather and Predation to Reduced Breeding Success in a Threatened Northern Loggerhead Shrike Population

Populations on the periphery of a species' range may experience more severe environmental conditions relative to populations closer to the core of the range. As a consequence, peripheral populations may have lower reproductive success or survival, which may affect their persistence. In this study, we examined the influence of environmental conditions on breeding biology and nest survival in a threatened population of Loggerhead Shrikes (Lanius ludovicianus) at the northern limit of the range in southeastern Alberta, Canada, and compared our estimates with those from shrike populations elsewhere in the range. Over the 2-year study in 1992–1993, clutch sizes averaged 6.4 eggs, and most nests were initiated between mid-May and mid-June. Rate of renesting following initial nest failure was 19%, and there were no known cases of double-brooding. Compared with southern populations, rate of renesting was lower and clutch sizes tended to be larger, whereas the length of the nestling and hatchling periods appeared to be similar. Most nest failures were directly associated with nest predators, but weather had a greater direct effect in 1993. Nest survival models indicated higher daily nest survival during warmer temperatures and lower precipitation, which may include direct effects of weather on nestlings as well as indirect effects on predator behavior or food abundance. Daily nest survival varied over the nesting cycle in a curvilinear pattern, with a slight increase through laying, approximately constant survival through incubation, and a decline through the nestling period. Partial brood loss during the nestling stage was high, particularly in 1993, when conditions were cool and wet. Overall, the lower likelihood of renesting, lower nest survival, and higher partial brood loss appeared to depress reproductive output in this population relative to those elsewhere in the range, and may have increased susceptibility to population declines.

Sediment magnetic properties of glacial till deposited since the Little Ice Age maximum for selected glaciers at Svartisen and Okstindan, northern Norway

Samples of glacial till deposited since the Little Ice Age (LIA) maximum by two glaciers, North Bogbre at Svartisen and Corneliussen-breen at Okstindan, northern Norway, were obtained from transects running from the current glacier snout to the LIA (c. AD 1750) limit. The samples were analysed to determine their sediment magnetic properties, which display considerable variability. Significant trends in some magnetic parameters are evident with distance from the glacier margin and hence length of subaerial exposure. Magnetic susceptibility (X) decreases away from the contemporary snout, perhaps due to the weathering of ferrimagnetic minerals into antiferromagnetic forms, although this trend is generally not statistically significant. Trends in the ratios of soft IRM/hard IRM which are statistically significant support this hypothesis, suggesting that antiferromagnetic minerals are increasing relative to ferrimagnetic minerals towards the LIA maximum. Backfield ratios (IRM -100 mT/SIRM) also display a significant and strong trend towards magnetically harder behaviour with proximity to the LIA maximum. Thus, by employing a chronosequence approach, it may be possible to use sediment magnetics data as a tool for reconstructing glacier retreat in areas where more traditional techniques, such as lichenometry, are not applicable.

Marine04 marine radiocarbon age calibration, 0-26 cal kyr BP

New radiocarbon calibration curves, IntCal04 and Marine04, have been constructed and internationally ratified to replace the terrestrial and marine components of IntCal98. The new calibration data sets extend an additional 2000 yr, from 0-26 cal kyr BP (Before Present, 0 cal. BP = AD 1950), and provide much higher resolution, greater precision, and more detailed structure than IntCal98. For the Marine04 curve, dendrochronologically-dated tree-ring samples, converted with a box diffusion model to marine mixed-layer ages, cover the period from 0-10.5 call kyr BR Beyond 10.5 cal kyr BP, high-resolution marine data become available from foraminifera in varved sediments and U/Th-dated corals. The marine records are corrected with site-specific C-14 reservoir age information to provide a single global marine mixed-layer calibration from 10.5-26.0 cal kyr BR A substantial enhancement relative to IntCal98 is the introduction of a random walk model, which takes into account the uncertainty in both the calendar age and the C-14 age to calculate the underlying calibration curve (Buck and Blackwell, this issue). The marine data sets and calibration curve for marine samples from the surface mixed layer (Marine04) are discussed here. The tree-ring data sets, sources of uncertainty, and regional offsets are presented in detail in a companion paper by Reimer et al. (this issue).

Assessment of the effect of time and temperature on the availability of residual phosphate in a glasshouse study of four soils using the Olsen method

The Olsen method is an indicator of plant-available phosphorus (P). The effect of time and temperature on residual phosphate in soils was measured using the Olsen method in a pot experiment. Four soils were investigated: two from Pakistan and one each from England (calcareous) and Colombia (acidic). Two levels of residual phosphate were developed in each soil after addition of phosphate by incubation at either 10degreesC or 45degreesC. The amount of phosphate added was based on the P maximum of each soil, calculated using the Langmuir equation. Rvegrass was used as the test crop. The pooled data for the four soils incubated at 10degreesC showed good correlation between Olsen P and dry matter yield or P uptake (r(2) = 0.85 and 0.77, respectively), whereas at 45 degreesC, each soil had its own relationship and pooled data did not show correlation of Olsen P with dry matter yield or P uptake. When the data at both temperatures were pooled, Olsen P was a good indicator of yield and uptake for the English soil. For the Pakistani soils, Olsen P after 45 degreesC treatment was an underestimate relative to the 10 degreesC data and for the Colombian soil it was an overestimate. The reasons for these differences need to be explored further before high temperature incubation can be used to simulate long-term changes in the field.

IntCal04 terrestrial radiocarbon age calibration, 0-26 cal kyr BP

A new calibration curve for the conversion of radiocarbon ages to calibrated (cal) ages has been constructed and internationally ratified to replace ImCal98, which extended from 0-24 cal kyr BP (Before Present, 0 cal BP = AD 1950). The new calibration data set for terrestrial samples extends from 0-26 cal kyr BP, but with much higher resolution beyond 11.4 cal kyr BP than ImCal98. Dendrochronologically-dated tree-ring samples cover the period from 0-12.4 cal kyr BP. Beyond the end of the tree rings, data from marine records (corals and foraminifera) are converted to the atmospheric equivalent with a site-specific marine reservoir correction to provide terrestrial calibration from 12.4-26.0 cal kyr BP. A substantial enhancement relative to ImCal98 is the introduction of a coherent statistical approach based on a random walk model, which takes into account the uncertainty in both the calendar age and the C-14 age to calculate the underlying calibration curve (Buck and Blackwell, this issue). The tree-ring data sets, sources of uncertainty, and regional offsets are discussed here. The marine data sets and calibration curve for marine samples from the surface mixed layer (Marine 04) are discussed in brief, but details are presented in Hughen et al. (this issue a). We do not make a recommendation for calibration beyond 26 cal kyr BP at this time; however, potential calibration data sets are compared in another paper (van der Plicht et al., this issue).

Effect of acyl chain length on transfection efficiency and toxicity of polyethylenimine

Polyethylenimine (PEI) is an efficient nonviral gene delivery vector because of its high buffering capacity and DNA condensation ability. In our study, the amino groups on the polymeric backbone were acylated using acetic or propionic anhydride to alter the protonation behaviour and the hydrophilic/hydrophobic balance of the polymer. The concentration of acylated primary amines was determined using trinitrobenzene sulphonic acid assay. Results showed that our modified polymers had lower buffering capacities in solutions compared to PEI. The polymers were complexed with plasmid encoding enhanced green fluorescent protein at three different ratios (1:1, 1:2 and 1:10 w/w DNA to polymer) to form polyplexes and their toxicities and transfection efficiencies were evaluated in HEK 293 cells. Acylation reduced the number of primary amines on the polymer and the surface charge, improving haemocompatibility and reducing cytotoxicity. The reduction in the concentration of amino groups helped to optimise DNA compaction and facilitated polyplex dissociation in the cell, which increased transfection efficiency of the modified polymers compared to the parent polymer. Polymers with buffering capacities greater than 50% and less than 80% relative to PEI, showed higher transfection efficiencies than PEI. The propionic anhydride modified polymers had appropriate interactions with DNA which provided both DNA compaction and polyplex dissociation. These systems interacted better with the cell membrane because of their slightly higher lipophilicity and formed polyplexes which were less cytotoxic than polyplexes of acetic anhydride modified polymers. Among the vectors tested, 1:0.3 mol/mol PEI:propionic anhydride in a 1:2 w/w DNA:polymer composition provided the best transfection system with improved transfection efficiency and reduced cytotoxicity.

Sex-dependent age modulation of frontostriatal and temporo-parietal activation during cognitive control

Developmental functional imaging studies of cognitive control show progressive age-related increase in task-relevant fronto-striatal activation in male development from childhood to adulthood. Little is known, however, about how gender affects this functional development. In this study, we used event related functional magnetic resonance imaging to examine effects of sex, age, and their interaction on brain activation during attentional switching and interference inhibition, in 63 male and female adolescents and adults, aged 13 to 38. Linear age correlations were observed across all subjects in task-specific frontal, striatal and temporo-parietal activation. Gender analysis revealed increased activation in females relative to males in fronto-striatal areas during the Switch task, and laterality effects in the Simon task, with females showing increased left inferior prefrontal and temporal activation, and males showing increased right inferior prefrontal and parietal activation. Increased prefrontal activation clusters in females and increased parietal activation clusters in males furthermore overlapped with clusters that were age-correlated across the whole group, potentially reflecting more mature prefrontal brain activation patterns for females, and more mature parietal activation patterns for males. Gender by age interactions further supported this dissociation, revealing exclusive female-specific age correlations in inferior and medial prefrontal brain regions during both tasks, and exclusive male-specific age correlations in superior parietal (Switch task) and temporal regions (Simon task). These findings show increased recruitment of age-correlated prefrontal activation in females, and of age-correlated parietal activation in males, during tasks of cognitive control. Gender differences in frontal and parietal recruitment may thus be related to gender differences in the neurofunctional maturation of these brain regions.

Krakatoa lives: The effect of volcanic eruptions on ocean heat content and thermal expansion

A suite of climate model experiments indicates that 20th Century increases in ocean heat content and sea-level ( via thermal expansion) were substantially reduced by the 1883 eruption of Krakatoa. The volcanically-induced cooling of the ocean surface is subducted into deeper ocean layers, where it persists for decades. Temporary reductions in ocean heat content associated with the comparable eruptions of El Chichon ( 1982) and Pinatubo ( 1991) were much shorter lived because they occurred relative to a non-stationary background of large, anthropogenically-forced ocean warming. Our results suggest that inclusion of the effects of Krakatoa ( and perhaps even earlier eruptions) is important for reliable simulation of 20th century ocean heat uptake and thermal expansion. Inter-model differences in the oceanic thermal response to Krakatoa are large and arise from differences in external forcing, model physics, and experimental design. Systematic experimentation is required to quantify the relative importance of these factors. The next generation of historical forcing experiments may require more careful treatment of pre-industrial volcanic aerosol loadings.

Architectural effect on the surface tension of an ABA triblock copolymer melt

The excess surface energy of lamellae formed by an ABA triblock copolymer melt oriented parallel to a neutral surface is evaluated using self-consistent field theory (SCFT). Consistent with experiments and previous SCFT calculations, we find a preference for the A-rich domains at the surface, which can only be attributed to the architectural asymmetry between the A and B blocks. The behavior was previously attributed to a loss of bridging configurations that occurs when the B-domain resides at the surface. Here we demonstrate that it is actually the presence of chain ends that reduces the excess surface energy of an A-rich domain relative that of a B-rich domain.

Decadal-scale rainfall variability in Ethiopia recorded in an annually laminated, Holocene-age, stalagmite

An annually laminated, uranium-series dated, Holocene stalagmite from southeast Ethiopia has been analysed for growth rate and δ13C and δ18O variations at annual to biennial resolution, in order to provide the first long duration proxy record of decadal-scale rainfall variability in this climatically sensitive region. Our study site (10°N) is climatically influenced by both summer (June—August) and spring (March—May) rainfall caused by the annual movement of the Inter-Tropical Convergence Zone (ITCZ) and modulated by large-scale anomalies in the atmospheric circulation and in ocean temperatures. Here we show that stalagmite growth, episodic throughout the last 7800 years, demonstrates decadal-scale (8—25 yr) variability in both growth rate and δ 18O. A hydrological model was employed and indicates that this decadal variability is due to variations in the relative amounts of rainfall in the two rain seasons. Our record, unique in its combination of length (a total of ~1000 years), annual chronology and high resolution δ18O, shows for the first time that such decadal-scale variability in rainfall in this region has occurred through the Holocene, which implies persistent decadal-scale variability for the large-scale atmospheric and oceanic driving factors.

The effect of consumption volume on profile and liking of oral nutritional supplements of varied sweetness: sequential profiling and boredom tests

Oral nutrition supplements (ONS) are routinely prescribed to those with, or at risk of, malnutrition. Previous research identified poor compliance due to taste and sweetness. This paper investigates taste and hedonic liking of ONS, of varying sweetness and metallic levels, over consumption volume; an important consideration as patients are prescribed large volumes of ONS daily. A sequential descriptive profile was developed to determine the perception of sensory attributes over repeat consumption of ONS. Changes in liking of ONS following repeat consumption were characterised by a boredom test. Certain flavour (metallic taste, soya milk flavour) and mouthfeel (mouthdrying, mouthcoating) attributes built up over increased consumption volume (p 0.002). Hedonic liking data from two cohorts, healthy older volunteers (n = 32, median age 73) and patients (n = 28, median age 85), suggested such build-up was disliked. Efforts made to improve the palatability of ONS must take account of the build up of taste and mouthfeel characteristics over increased consumption volume.

Enhancement of the aerosol direct radiative effect by semi-volatile aerosol components: airborne measurements in North-Western Europe

A case study of atmospheric aerosol measurements exploring the impact of the vertical distribution of aerosol chemical composition upon the radiative budget in North-Western Europe is presented. Sub-micron aerosol chemical composition was measured by an Aerodyne Aerosol Mass Spectrometer (AMS) on both an airborne platform and a ground-based site at Cabauw in the Netherlands. The examined period in May 2008 was characterised by enhanced pollution loadings in North-Western Europe and was dominated by ammonium nitrate and Organic Matter (OM). Both ammonium nitrate and OM were observed to increase with altitude in the atmospheric boundary layer. This is primarily attributed to partitioning of semi-volatile gas phase species to the particle phase at reduced temperature and enhanced relative humidity. Increased ammonium nitrate concentrations in particular were found to strongly increase the ambient scattering potential of the aerosol burden, which was a consequence of the large amount of associated water as well as the enhanced mass. During particularly polluted conditions, increases in aerosol optical depth of 50–100% were estimated to occur due to the observed increase in secondary aerosol mass and associated water uptake. Furthermore, the single scattering albedo was also shown to increase with height in the boundary layer. These enhancements combined to increase the negative direct aerosol radiative forcing by close to a factor of two at the median percentile level. Such increases have major ramifications for regional climate predictions as semi-volatile components are often not included in aerosol models. The results presented here provide an ideal opportunity to test regional and global representations of both the aerosol vertical distribution and subsequent impacts in North-Western Europe. North-Western Europe can be viewed as an analogue for the possible future air quality over other polluted regions of the Northern Hemisphere, where substantial reductions in sulphur dioxide emissions have yet to occur. Anticipated reductions in sulphur dioxide in polluted regions will result in an increase in the availability of ammonia to form ammonium nitrate as opposed to ammonium sulphate. This will be most important where intensive agricultural practises occur. Our observations over North-Western Europe, a region where sulphur dioxide emissions have already been reduced, indicate that failure to include the semi-volatile behaviour of ammonium nitrate will result in significant errors in predicted aerosol direct radiative forcing. Such errors will be particularly significant on regional scales.