Primary Joint Arthroplasty Surgery: Is the Risk of Major Bleeding Higher in Elderly Patients? A Retrospective Cohort Study

Increased risk of bleeding after major orthopedic surgery (MOS) has been widely documented in general population. However, this complication has not been studied in elderly patients. The purpose of this study is to determine whether the risk of major bleeding after MOS is higher in elderly patients, compared with those operated at a younger age. Methods: This retrospective cohort study included total hip and total knee arthroplasty patients operated during 5 consecutive years. The main outcome was the occurrence of major bleeding. Patients with other causes of bleeding were excluded. Relative risks (RRs) and confidence intervals (CIs) were calculated, anda multivariate analysis was performed. Results: A total of 1048 patients were included, 56% of patients were hip arthroplasties. At the time of surgery, 553 (53%) patients were older than 70 years. Patients aged >70 years showed an increased risk of major bleeding (RR: 2.42 [95% CI: 1.54-3.81]). For hip arthroplasty, the RR of bleeding was 2.61 (95%CI: 1.50-4.53) and 2.25 (95% CI: 1.03-4.94) for knee arthroplasty. After multivariate analysis, age was found to be independently associated with higher risk of major bleeding. Conclusion: According to European Medicines Agency criteria, patients aged 70 years are at a higher risk of major bleeding after MOS, result of a higher frequency of blood transfusions in this group of patients. Standardized protocols for blood transfusion in these patients are still required.

Régime thermique en période de maturation du raisin dans le géoclimat viticole.

Mots clés :indice de fraîcheur des nuits, amplitude thermique, Système CCM Géoviticole, zonage, qualité. Key words: cool night index, thermal amplitude, MCC System for World Viticulture, zoning, quality. RESUME Le régime thermique en période de maturation du raisin est l?une des variables déterminantes de la coloration du raisin et de la richesse en arômes, anthocyanes et polyphénols des vins. L?objectif du travail est de caractériser le régime thermique, notamment la fraîcheur des nuits et l?amplitude thermique au cours de la maturation, au niveau du climat viticole mondial, sur une base des données de 100 régions viticoles dans 30 pays, obtenue par l?intermédiaire de l?Organisation Mondiale de la Météorologie - OMM. Plusieurs indices climatiques viticoles ont été calculés: l?Indice de Fraîcheur des Nuits ?IF (ºC), l?Indice Héliothermique de Huglin ?IH (ºC) et l?Indice de Sécheresse ?IS (mm) du Système de Classification Climatique Multicritères Géoviticole, et l?amplitude thermique moyenne en août et septembre Aa-s (ºC). Egalement, sur la période véraison-récolte ?v-r(moyenne des 30 jours précédant la date de récolte, estimée sur la base d?un Indice Héliothermique de HUGLIN égal à 1.900 - approximatif pour la maturation du Cabernet-Sauvignon): la fraîcheur des nuits (FNv -r), la température moyenne de l?air (Tv-r), la température maximale de l?air (Txv-r) et l?amplitude thermique (Av-r). Les résultats montrent que IH est corrélé avec Tv-r (r=0,79**) et avec Txv-r (r=0,80**). IH représente donc bien les conditions thermiques générales de la période de maturation en ce qui concerne la température moyenne et maximale de l?air. Mais IH n?est pas corrélé ni avec Aa-s ni avec Av-r. Par contre, IF est corrélé avec Aa-s (r=-0,70**) et FNv-r est corrélé avec Av-r (r=-0,69**). Cette corrélation doit justifier, en partie, l?usage assez courant de l?amplitude thermique comme indicateur de bonnes conditions thermiques de maturation pour les régions qui présentent des valeurs élevées. Mais ce raisonnement peut amener à des caractérisations erronées. Le travail met en évidence, également, ?importance de considérer le bilan hydrique des régions (IS) dans l?analyse du régime thermique sur la qualité du raisin. On peut onclure que pour avoir une bonne caractérisation du régime thermique en période de maturation il faut considérer la fraîcheur des nuits (IF étant un bon indicateur de FNv-r moyen des régions, avec un r=0,80**), caractérisation qui peut être améliorée avec l?information des températures maximales et de sur 11l?amplitude thermique en période de maturation du raisin. Les éléments présentés peuvent servir à améliorer les indices climatiques pour estimer le potentiel qualitatif du raisin des différentes régions viticoles, notamment en complément de IF. ABSTRACT The thermal conditions during the grape ripening period are important variables related to colour of the grapes, anthocyanins, polyphenols and flavour of the wine. The main purpose of this work was to characterise the thermal conditions, especially the night coolness and the thermal amplitude during maturation, in the geoclimate of the world vine culture. A database of 100 grape-growing regions of 30 countries obtained from the World Meteorology Organisation (WMO) was used. Some climatic indexes were calculated: Cool Night Index ?IF (°C), Huglin?s Heliothermal Index ?IH (°C) and Dryness Index ?IS (mm), from the Multicriteria Climatic Classification System for World Viticulture, and the thermal amplitude in August and September Aa-s (°C). Over véraison-harvest period ?v-r(mean of the 30 days before harvesting date, estimated on the basis of HUGLIN Heliothermal Index equal to 1,900 ? approximately value to ripen Cabernet-Sauvignon) similar indexes were obtained: the cool night (FNv-r), the mean air temperature (Tv-r), the maximal air temperature (Txv-r) and the thermal amplitude (Av-r). The results showed that IH is positively correlated with Tv-r (r=0.79**), Txv-r (r=0.80)and IF (r=0.67**). Therefore, IH represents well the general thermal conditions during maturation period, specially concerning the mean and the maximal air temperature. owever, IH was correlated neither with Aa-s nor to Av-r. IF was negatively correlated with Aa-s (r= -0.70**) and FNv-r was negatively correlated with Av-r (r=-0.69**). The correlation to some extent explains the current use of the thermal amplitude to predict good ripening thermal conditions for those regions that show high values. As here we have described, this thinking may give incorrect results. This work has also showed the importance to consider the water balance of the regions (IS) in the effect of the thermal conditions in grape quality. We conclude that the characterisation of the thermal conditions during the ripening period do need the cool night index (in this case, IFis a good index to provide the mean FNv-r of the regions, r=0,80**). Factors other than cool night which influence this characterisation are both maximal air temperature and thermal amplitude data. The elements presented in this work, in addition to IF , may improve the climatic indexes to be used to predict the qualitative potential of grapes from different regions.

Effet du climat viticole sur la perception sensorielle du vin: éléments méthodologiques pour une modélisation au niveau mondial.

Summary The objective of this study was to develop a methodology capable of modeling the effect of viticultural climate on wine sensory characteristics. The climate was defined by the Géoviticulture Multicriteria Climatic Classification System (Tonietto and Carbonneau, 2004), based on the Heliothermal index (HI), Cool Night index (CI) and Dryness index (DI). The sensory wine description was made according with the methodology established by Zanus and Tonietto (2007). In this study we focused on the 5 principal wine producing regions of Brazil: Serra Gaúcha, Serra do Sudeste, Campanha (Meridional and Central), Planalto Catarinense and Vale do Submédio São Francisco. The results from Principal Component Analysis (PCA) show the HI and CI opposed to the DI. High HI values were associated to a lower perception of acidity, as well as to a lower perception of concentration (palate) and persistence by mouth. For the red wines, high HI values were positively associated with alcohol (palate), conversely to the DI index, which showed high values related to the perception of tanins and acidity. The higher the CI, the lower were the color intensity, tanins, concentration and persistence by mouth. It may be concluded that viticultural climate - expressed by the HI, CI and DI indexes ? adequately explained much of the sensory differences of the wines made in different regions. The methodology proposed and the enlargement of the database it will maybe open the possibility of modeling the part of wine sensory characteristics as dependent variables of the viticultural climate, as defined by the Géoviticulture MCC System. Keywords: viticultural climate, modeling, wine, tipicity.

ALGUNOS FACTORES QUE INCIDEN EN LA VALORACION DEL SUELO URBANO

Este ensayo tuvo como finalidad primordial señalar la importancia que encierra, para fines planificadores, el conocimiento de la distribución de los valores del suelo dentro de un área urbana determinada. Asi tomada como el area de estudio; el distrito 1 o el Carmen, y localizada en la porción noroeste de la ciudad capital de Costa Rica, toda una serie de factores o variables que presentan gran relevancia en la fijación de valores para su suelo, fuero fijados y analizados, una vez caracterizada el area bajo análisis. En búsqueda de un modelo que se adapte a tal situación, se realizo una revisión bibliográfica y los principios modelo sobre el valor del suelo fueron presentados. Con los datos e informaciones recibidos en las diferentes instituciones mencionadas a lo largo del trabajo, y con el material recopilado en el campo, se llevo a cabo una cuantificación de los mismos, principalmente mediante el uso de un sistema de clasificación del dato esencial (valor del suelo) y, posteriormente, una serie de correlaciones –regresiones, simples y múltiples-, fue realizada con el fin de comprobarlas hipótesis planteadas y  con ello llegar a un análisis de los resultados obtenidos que permitiese brindar algunas recomendaciones al respecto. Otra finalidad de este consiste en demostrar la importancia del trabajo del geógrafo en el proceso  de la fijación de los valores para el terreno, sea urbano, sea rural, y cualquiera sea el fin que persiga: valores fiscales, valores reales, comerciales y, por qué no, hasta especulativos. SUMARY The main objetive of this investigation is to demonstrate the importance of the distribution of land values in an urban area in regards to the planning process. The chosen study area is the first district (Carmen) located in the northeast section of  the capital city of San José. Once the study area had been chosen, a series of factors and variables relavant to the fixation of land values, were chosen and analyzed. In the search for a model that could be adapted to the situation, a bibliographic revision was made concerning the topic of land values, and a list of possible land values, and a list of possible land value models was presented. In was possible to quantify the data information obtained from the different institutions mentioned in the investigation as well as from the material collected in the field; principally by means of a classification system of essential data ( land values), and later, series of simple and multiple correlation regressions were applied with the primary purpose being to confirm  the main hypothesis and then, arrive at an analysis of the obtained results that permit respective recommendations. Another purpose of the investigation consisted in demonstrating the importance of the geographer in the process of determining urban and rural land values and even for speculative purposes.