Evolución clínica y funcional de los pacientes que ingresan en residencias tras una fractura de cadera. Implementación de un programa de intervención multinivel

Background and objectiveThe aim of this study was to determine the clinical and functional outcomes of patients discharged to nursing homes after a hip fracture.MethodsThe study included all patients admitted to a group of nursing homes after a hip fracture in 2016. A geriatric assessment protocol was applied, and patients were treated with a specific protocol for 90 days. They were assessed for nutritional status (Mini-Nutritional Assessment and Body Mass Index), pain (Visual Analogue Scale, and the PAINAD Scale), the presence of pressure ulcers, blood test (D vitamin, haemoglobin, proteins), and functional status (Barthel index and Functional Assessment Categories).ResultsOut of a total of 175 patients, 116 (75%) met the inclusion criteria. The mean age was 84.9 years old (±6.7 SD), and 91 (78.4%) were women. At admission, 73.8% of 65 residents had anaemia, 76.7% hypovitaminosis D, 88% malnutrition or «at risk of malnutrition», and 15.3% had pressure ulcers. After 90 days, the moderate-severe functional status (Barthel index < 60) was reduced from 90.4 to 39.6%, dependence due to gait from 97.3 to 36.1%, and moderate-severe pain from 88.9 to 14.4%. Most of the pressure ulcers healed (94.4%).ConclusionsPatients admitted to nursing homes after a hip fracture had poor clinical and functional status. This study shows that after 90 days from admission these patients had positive outcomes in terms of functionality, gait, pain control, and pressure ulcers healing.     

Computational analysis of pediatric ventricular assist device implantation to decrease cerebral particulate embolization

Stroke is the most devastating complication after ventricular assist device (VAD) implantation with a 19% incidence and 65% mortality in the pediatric population. Current pediatric VAD technology and anticoagulation strategies alone are suboptimal. VAD implantation assisted by computational methods (CFD) may contribute reducing the risk of cerebral embolization. Representative three-dimensional aortic arch models of an infant and a child were generated. An 8 mm VAD outflow-graft (VAD-OG) anastomosed to the aorta was rendered and CFD was applied to study blood flow patterns. Particle tracks, originating in the VAD, were computed with a Lagrangian phase model and the percentage of particles entering the cerebral vessels was calculated. Eight implantation configurations (infant = 5 and child = 3) and 5 particle sizes (0.5, 1, 2, 3, and 4 mm) were considered. For the infant model, percentage of particles entering the cerebral vessels ranged from 15% for a VAD-OG anastomosed at 90° to the aorta, to 31% for 30° VAD-OG anastomosis (overall percentages: X² = 10,852, p < 0.0001). For the child model, cerebral embolization ranged from 9% for the 30° VAD-OG anastomosis to 15% for the 60° anastomosis (overall percentages: χ² = 10,323, p < 0.0001). Using detailed CFD calculations, we demonstrate that the risk of stroke depends significantly on the VAD implantation geometry. In turn, the risk probably depends on patient-specific anatomy. CFD can be used to optimize VAD implantation geometry to minimize stroke risk.     

Optical Feedback Loop Involving Dinoflagellate Symbiont and Scleractinian Host Drives Colorful Coral Bleaching

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Reindeer habitat use in relation to two small wind farms,during preconstruction,construction, and operation

Worldwide there is a rush toward wind power development and its associated infrastructure. In Fennoscandia, large‐scale wind farms comprising several hundred windmills are currently built in important grazing ranges used for Sámi reindeer husbandry. In this study, reindeer habitat use was assessed using reindeer fecal pellet group counts in relation to two relatively small wind farms, with 8 and 10 turbines, respectively. In 2009, 1,315 15‐m² plots were established and pellet groups were counted and cleaned from the plots. This was repeated once a year in May, during preconstruction, construction, and operation of the wind farms, covering 6 years (2009–2014) of reindeer habitat use in the area. We modeled the presence/absence of any pellets in a plot at both the local (wind farm site) and regional (reindeer calving to autumn range) scale with a hierarchical logistic regression, where spatial correlation was accounted for via random effects, using vegetation type, and the interaction between distance to wind turbine and time period as predictor variables. Our results revealed an absolute reduction in pellet groups by 66% and 86% around each wind farm, respectively, at local scale and by 61% at regional scale during the operation phase compared to the preconstruction phase. At the regional, scale habitat use declined close to the turbines in the same comparison. However, at the local scale, we observed increased habitat use close to the wind turbines at one of the wind farms during the operation phase. This may be explained by continued use of an important migration route close to the wind farm. The reduced use at the regional scale nevertheless suggests that there may be an overall avoidance of both wind farms during operation, but further studies of reindeer movement and behavior are needed to gain a better understanding of the mechanisms behind this suggested avoidance.     

Genetic diversity and restoration of a recalcitrant clonal sedge (Tetraria capillaris Cyperaceae)

The genetic diversity of a clonal sedge (Tertraria capillaris) was assessed using isozyme analysis of 11 loci. Of 29 enzyme systems tested, eight were selected which gave interpretable bands with consistently good resolution. Though seedlings of the species are rarely observed in nature, isozyme analysis showed that for the study transects containing 100 sample plants, the majority of plants at the site were sexually rather than clonally derived. Young plants generated from embryos grown in vitro from excised seeds showed a high level of genetic diversity which could account for the genetic diversity measured in the parent population. In terms of restoration of the species, 85% of the assessed genetic diversity at the study site could be retained if 25 T. capillaris plants were taken at random. The study illustrates how genetic assessment coupled with tissue culture methods provides a feasible model for the recovery of most of the assessed local genetic diversity of a clonal species.     

鼻窦内镜术治疗鼻窦炎合并鼻息肉的疗效及对鼻腔通气和嗅觉功能的影响

目的:探讨鼻窦内镜术治疗鼻窦炎合并鼻息肉的临床疗效及对鼻腔通气和嗅觉功能的影响。方法:选取2014年1月至2016年6月我院收治的鼻窦炎合并鼻息肉患者80例。根据随机数字表法分为观察组和对照组,各40例。对照组给予传统摘除术治疗,观察组则行鼻窦内镜术治疗。比较两组临床疗效以及治疗前、治疗后3个月症状评分、鼻气道总阻力、嗅觉功能评分。结果:观察组治疗总有效率为95.00%,显著高于对照组的77.50%(P0.05)。治疗前两组患者鼻塞、脓涕、嗅觉障碍、疼痛及总症状评分比较无统计学差异(P0.05),治疗后3个月两组患者鼻塞、脓涕、嗅觉障碍、疼痛及总症状评分均低于治疗前,且观察组患者鼻塞、脓涕、嗅觉障碍、疼痛及总症状评分低于对照组(P0.05)。治疗前两组患者鼻气道总阻力、嗅觉功能评分比较无统计学差异(P0.05),治疗后3个月两组患者鼻气道总阻力、嗅觉功能评分均低于治疗前,且观察组低于对照组(均P0.05)。结论:鼻窦内镜术治疗鼻窦炎合并鼻息肉有利于改善患者临床症状,促进患者嗅觉功能以及鼻腔通气的恢复,是治疗鼻窦炎合并鼻息肉的有效方法。     

Saldanha Bay,South Africa: recovery of Gracilaria verrucosa (Gracilariales,Rhodophyta)

Since World War II the greater Saldanha Bay lagoon system, South Africa, has been an important Gracilaria producer. Two agar factories, built in the 1960's, used Gracilaria from Saldanha Bay as their raw material. In the early 1970's the industry was destroyed as a result of dredging and marine construction operations to establish a harbor in the bay for loading ore. These environmental changes destroyed stocks and prevented the previously significant beachings of the seaweed from occurring. After a few years of no or very low commercial production, the resource slowly started to recover. The size of Gracilaria drifts increased over the following eight years to approximately one-third of the original output. This trend seems to continue. Although the stocks and resultant drifts are unlikely to recover fully to their original quantity, current production is already sufficient to ensure re-establishment of a seaweed industry in Saldanha Bay. This could have considerable socio-economic impact on the area.     

Threshold response of Madagascar's littoral forest to sea-level rise

Aim Coastal biodiversity hotspots are globally threatened by sea‐level rise. As such it is important to understand how ecosystems resist, respond and adapt to sea‐level rise. Using pollen, geochemistry, charcoal and diatom records in conjunction with previously published palaeoclimatic records, we investigated the mechanism, interactions and ecosystem response and resilience of Madagascar's littoral forest to late Holocene sea‐level rise. Location Sediment sequences were collected along the south‐east coast of Madagascar in two adjacent habitats in Mandena; the highly diverse littoral forest fragment and species‐poor Erica‐matrix. Methods We used a multi‐proxy approach to investigate the relative influence of environmental changes on the littoral ecosystem. We reconstructed past vegetation and fire dynamics over the past 6500 years at two sites in the littoral forest using fossil pollen and macrofossil charcoal contained in sedimentary sequences. Alongside these records we reconstructed past marine transgressions from the same sedimentary sequences using geochemical analyses, and a salinity and drought index through the analysis of fossil diatoms. Results Our findings indicated that it was the synergistic effect of sea‐level rise coupled with rainfall deficits that triggered a threshold event with a switch from two types of littoral forest (an open Uapaca forest and a closed littoral forest fragment) to an Erica–Myrica heath/grassland occurring in approximately less than 100 years. Resilience to sea‐level rise differed in the two adjacent habitats, suggesting that the littoral forest fragment was more resilient to the impacts of sea‐level change and aridity than the open Uapaca woodland. Conclusions We demonstrated that the littoral ecosystem was influenced by late Holocene sea‐level rise and climatic desiccation. While climate change‐integrated conservation strategies address the effects of climate change on species distribution and dispersal, our work suggests that more attention should be paid to the impacts of interactive climatic variables that affect ecosystem thresholds.     

Binge Eating and Eating‐Related Cognitions and Behavior in Ethnically Diverse Obese Women

Objective: To examine binge eating and eating‐related cognitions and behavior in a sample of ethnically diverse women who are severely obese and seeking bariatric surgery. Research Methods and Procedures: Female bariatric surgery candidates (62 African Americans, 18 Latinas, 130 whites) completed questionnaires on binge eating and eating‐related cognitions and behavior and completed a structured clinical interview to confirm binge‐eating disorder diagnosis. Results: Ethnic minorities and whites did not differ in rates of binge‐eating disorder (26.3%), binges per week (M = 0.95), or dietary restraint. Ethnic minorities reported less disinhibition, and there was a trend to report less hunger awareness than whites. After controlling for BMI and education, ethnicity accounted for significant variance in disinhibition (4%; p < 0.01). Ethnic minorities were younger, became overweight at a later age, and were overweight for fewer years than whites. Discussion: Results suggest that ethnicity exerts an important influence on disinhibition and that ethnic differences are not caused by BMI or education. Findings point to the need to continue to investigate the role of ethnicity, binge eating, and disinhibition in severely obese women, so that culturally appropriate services can be provided.