Epifisiolisis de cabeza de radio asociadas a luxación de codo y reducción espontánea

Realizamos un estudio retrospectivo de 10 casos de la epifisiolisis de cabeza de radio ocurridas durante el periodo 1992 a 1997, con un desplazamiento mayor de 60º que según los criterios de O'Brien corresponderían a un grado III. De todas las revisadas seleccionamos 6 casos en los que había una angulación mayor de 90º, creemos ocurren después de luxación o reducción espontánea de luxación de codo; por ser las más frecuentes, las que más problemas presentan en el tratamiento y las que producen más secuelas. Nuestro objetivo es valorar los resultados obtenidos con nuestros tratamientos y realizar una revisión bibliográfica.We have done a retrospective study of ten cases of radial head epiphysiolysis occurred between 1992 and 1997, displaced more than 60º. (O'Brien's grade III). Amongst them we have selected those which were displaced more than 90º (six cases) probably occurred after an elbow luxation or after the spontaneous reduction of an elbow luxation; because the are more infrequent, more troublesome and they give more secuelae. Our aim is to evaluate the results obtained with the treatment and to review the literature

Palliative care needs and integration of palliative care support in chronic obstructive pulmonary disease (COPD): a qualitative study

Background The provision of palliative care for severe chronic obstructive pulmonary disease (COPD) remains low resulting in unmet needs in patients and carers. Research Question This study aimed to 1) explore palliative care needs of patients living with severe COPD and their caregivers, 2) understand views of accessing and providing palliative care and factors influencing these experiences, and 3) explore to what extent palliative care and COPD services have been integrated. Study Design and Methods A multicentre qualitative study was undertaken in COPD services and specialist palliative care in the UK, involving patients with severe COPD, their carers and health professionals. Data were collected using semi-structured interviews and analysed using framework analysis. Themes were integrated using the constant comparison process, enabling systematic data synthesis. Results Four themes were generated from interviews with 20 patients, six carers and 25 health professionals: management of exacerbations, palliative care needs, access to palliative care and pathways, and integration of palliative care support. Uncertainty and fear were common in patients and carers, with identified needs for reassurance, rapid medical access, home care and finance advice. Timely palliative care was perceived as important by health professionals. Palliative care was integrated into COPD services although models of working varied across regions. Reliable screening tools and needs assessment, embedded psychological care and enhanced training in palliative care and communication skills were perceived important by health professionals for timely palliative care referrals and optimised management. Interpretation Palliative care is increasingly being implemented for non malignant diseases including COPD throughout the UK although models of working vary. A theoretical model is developed to illustrate the concept and pathway of the integration of palliative care support. A standardised screening and needs assessment tool is required to improve timely palliative care and address the significant needs of this population

Substrate Entrainment, Depositional Relief, and Sediment Capture: Impact of a Submarine Landslide on Flow Process and Sediment Supply

From Frontiers via Jisc Publications RouterHistory: collection 2021, received 2021-08-12, accepted 2021-10-27, epub 2021-11-16Publication status: PublishedSubmarine landslides can generate complicated patterns of seafloor relief that influence subsequent flow behaviour and sediment dispersal patterns. In subsurface studies, the term mass transport deposits (MTDs) is commonly used and covers a range of processes and resultant deposits. While the large-scale morphology of submarine landslide deposits can be resolved in seismic reflection data, the nature of their upper surface and its impact on both facies distributions and stratal architecture of overlying deposits is rarely resolvable. However, field-based studies often allow a more detailed characterisation of the deposit. The early post-rift Middle Jurassic deep-water succession of the Los Molles Formation is exceptionally well-exposed along a dip-orientated WSW-ENE outcrop belt in the Chacay Melehue depocentre, Neuquén Basin, Argentina. We correlate 27 sedimentary logs constrained by marker beds to document the sedimentology and architecture of a >47 m thick and at least 9.6 km long debrite, which contains two different types of megaclasts. The debrite overlies ramps and steps, indicating erosion and substrate entrainment. Two distinct sandstone-dominated units overlie the debrite. The lower sandstone unit is characterised by: 1) abrupt thickness changes, wedging and progressive rotation of laminae in sandstone beds associated with growth strata; and 2) detached sandstone load balls within the underlying debrite. The combination of these features suggests syn-sedimentary foundering processes due to density instabilities at the top of the fluid-saturated mud-rich debrite. The debrite relief controlled the spatial distribution of foundered sandstones. The upper sandstone unit is characterised by thin-bedded deposits, locally overlain by medium-to thick-bedded lobe axis/off-axis deposits. The thin-beds show local thinning and onlapping onto the debrite, where it develops its highest relief. Facies distributions and stacking patterns record the progradation of submarine lobes and their complex interaction with long-lived debrite-related topography. The emplacement of a kilometre-scale debrite in an otherwise mud-rich basinal setting and accumulation of overlying sand-rich deposits suggests a genetic link between the mass-wasting event and transient coarse clastic sediment supply to an otherwise sand-starved part of the basin. Therefore, submarine landslides demonstrably impact the routing and behaviour of subsequent sediment gravity flows, which must be considered when predicting facies distributions and palaeoenvironments above MTDs in subsurface datasets

Adaptation and Refinement of Validated Risk Screening Tools in the Spanish Healthcare System

AbstractThe aim of this study is to develop a tool to screen elders at risk of hospital readmissions adapted to Spanish target population. The development of this new tool is based on the validated instrument The Community Assessment Risk Screen – CARS –, which is being applied in a sample of 1.000 older patients. The adaptation and refinement of CARS is being carried out through the compilation of new potential variables from primary care clinicians to predict patients at risk of readmissions. The introduction of this new instrument adapted to Spanish target population will provide a potential tool to identify prematurel y patients at risk of hospital readmissions

Meta-evaluación del programa DOCENTIA de la UCM

En este proyecto nos hemos planteado el análisis de las propiedades psicométricas de los instrumentos del Programa DOCENTIA aplicado por la UCM para determinar si es adecuado para conseguir los objetivos que se pretenden con su aplicació

Luxación glenohumeral bilateral. A propósito de un caso

La luxación posterior glenohumeral es una lesión poco frecuente que representa entre el 1,5% y el 4,3% de las luxaciones glenohumerales

Exceptional preservation of three-dimensional dunes on an ancient deep-marine seafloor: implications for sedimentary processes and depositional environments

Depositional and erosional bedforms can be used to reconstruct sedimentary processes and aid palaeoenvironmental interpretations. Using exhumed deep-marine strata in the Eocene Aínsa Basin, Spain, we document a 3-dimensional package of dunes, a rarely identified bedform in deep-marine environments. Our analysis shows that the dunes have curvilinear crests in planform, with smaller superimposed oblique dunes and ripples across the stoss sides. Beds containing these dunes have two main internal divisions: a lower inversely-graded (fine-to-coarse sandstone) and predominantly structureless division, and an upper coarse-grained sandstone division with well-developed cross-stratification, which is scoured and mantled with mudclasts and coarse-grains on the stoss-side. The rugose remnant relief of the bedforms controls the location of subsequent bedforms. Following recently reported direct measurements of natural turbidity currents, we interpret the basal division as recording deposition from the dense basal head of a high-velocity turbidity current, followed by the development of dunes beneath the more sustained but relatively high-velocity and unsteady flow body that reworked the initial sandy deposit into downstream migrating dunes and scours. These dune-forming beds have been identified in different deep-water environments in the Aínsa Basin stratigraphy, including channel overbank and channel mouth settings and scour-fills. These locations suggest that the dunes were intimately tied to high-velocity flows that bypassed through channel axes before expanding and depositing in less confined channel overbank or channel mouth settings. Preservation of these dunes in the Aínsa Basin was likely enhanced by tectonically-forced lateral migration of channels, which prevented cannibalisation of bypass-dominated zones, in combination with high aggradation rates due to confinement. Where identified these dune-like bedforms are considered diagnostic of substantial sediment bypass downslope to deep-water basins

Using Sr isotopes and Rare Earth Elements to correlate sequences in regions with complex facies distributions: Example from the Late Cretaceous of the South-Central Pyrenees

Bathurst Meeting, 16th International Meeting of Carbonate Sedimentologists, 2019Understanding the distribution of carbonate facies in areas with complex structural histories can be challenging. The Upper Cretaceous deposits of the Sant Corneli and Boixols anticlines in the Pyrenees are controlled by extensional inherited structures and subsequent inversion. The aim of the present study is to understand the timing of the structures and correlate the facies across the anticlines. The dating of the Coniacian-Santonian postrift and Campanian- Maastrichtian syn-growth sequences is based on numerical ages derived from 87Sr/86Sr ratios. Additionally, elemental analysis and rare earth elements have been used to characterise seawater signatures, environments and diagenetic overprints. A total amount of 162 samples were collected across the two anticlines. Geochemical analysis by using ICP-MS permitted an evaluation of the elemental concentrations of the samples in order to discriminate the suitable ones for strontium isotopes. Numerical ages derived from strontium isotopes show that the Santonian carbonate systems were coetaneous across the Sant Corneli anticline. Rudist-rich facies in the northern flank of the Sant Corneli anticline correlate with the carbonate platforms in the southern flank. The uppermost Santonian shallow marine carbonates sampled in the southern flank in Collades de Basturs might correlate with the silty clays and marls of l’Aubagueta Member in the northern flank. The obtained numerical ages derived from strontium isotopes together with magnetostratigraphic, and biostratigraphic data have been used to constrain the timing of growth of the anticlines. The syn-growth succession shows ages ranging from middle Campanian in the uppermost Herbasavina Formation to early Maastrichtian in the Castell d’Orcau Unit. Those results point to older ages than previously published works. The analysis of rare earth elements and Yttrium (REEY) has shown flat shaped REEY profiles that are typical for the Late Cretaceous; and may indicate low diagenetic alteration. Preliminary results based on the Y/Ho ratio has revealed changes on paleobathymetries and environments. Therefore, the use of rare earth elements could be used as a proxy to support sedimentological observations