Ankle-brachial index: more than a diagnostic test?

The ankle-brachial index (ABI) is the relationship between the systolic blood pressure taken at the ankle level and the brachial artery. A pathological ABI (<0.90 or >1.40) indicates the presence of peripheral artery disease (PAD). Many studies indicate the great utility of this test in the diagnosis of PAD due to its ease of use, reproducibility, low cost, and high cost-effectiveness. This evaluation can be directly correlated with cardiovascular morbidity and mortality; however, it has recently been confirmed that a low ABI can be a predictor of major cardiovascular events, as it is related to diabetes mellitus, chronic coronary disease, stroke, and more. The objective of this work was to review the current evidence on the importance of ABI in the diagnosis of PAD and its main role as a predictor of cardiovascular morbidity and mortality.El índice tobillo-brazo (ITB) es la relación entre la presión arterial sistólica tomada entre el tobillo y la arteria braquial. Un ITB patológico (<0,90 o >1,40) indica la presencia de enfermedad arterial periférica (EAP). Muchos estudios muestran la gran utilidad de esta prueba en el diagnóstico de la EAP debido a su facilidad de uso, reproducibilidad, bajo coste y alta rentabilidad. Esta evaluación puede correlacionarse directamente con la morbilidad y mortalidad cardiovascular; sin embargo, recientemente se ha confirmado que un ITB bajo puede ser un predictor de eventos cardiovasculares mayores, ya que está relacionado con la diabetes mellitus, la enfermedad coronaria crónica y el ictus, entre otros. El objetivo de este trabajo fue revisar la evidencia actual sobre la importancia del ITB en el diagnóstico de la EAP y su papel principal como predictor de morbilidad y mortalidad cardiovascular

Learning Situation for the Trigonometric Fourier Series from a Socio-epistemological Stand Point

This article aims at showing a didactic proposal that favours the signification of the Trigonometric Fourier Series through a learning situation, based on the Socio-epistemological Theory of Mathematics Education, on research where this knowledge has been problematized. The Fourier Trigonometric Series is a complex topic for learning at a higher level, where the process is usually mechanised without fully understanding its operation and characteristics. We want to verify that with activities that support the relationship between algebra and geometry, making use of GeoGebra —dynamic geometry software— as a control variable, the series and its convergence can be signified using a physical-geometric context

Modelado de la eficiencia de inversores para sistemas fotovoltaicos conectados a la red

El objetivo de este trabajo es modelar la eficiencia total de un inversor para conexionado a la red con el fin de utilizar el modelo en simulaciones y estudiar su comportamiento. El modelo utiliza veinte curvas de eficiencia de conversión correspondientes a veinte tensiones diferentes de entrada, estimando la eficiencia estática del seguimiento del punto de máxima potencia para cada punto de las diferentes curvas. Las eficiencias se calcularon en base a los ensayos realizados a un inversor SMA 3800U en LABSOL, en la Universidad Federal de Rio Grande del Sur, Brasil. Con esta información se desarrolló la función eficiencia la cual depende de la tensión y la potencia de entrada, utilizando un sistema de aprendizaje supervisado basado en Lógica Difusa. En el trabajo se realizaron ensayos mediante una fuentes programables que simula la variación de la curvas I-V en la entrada del inversor a lo largo de un día, para estudiar y validar el modelo de la eficiencia total desarrollado.Fil: Farfán, Roberto Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones en Energía no Convencional. Universidad Nacional de Salta. Facultad de Ciencias Exactas. Departamento de Física. Instituto de Investigaciones en Energía no Convencional; ArgentinaFil: Prieb, C. W. M.. Universidade Federal do Rio Grande do Sul; BrasilFil: Krenzinger, A.. Universidade Federal do Rio Grande do Sul; BrasilFil: Cadena, Carlos Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones en Energía no Convencional. Universidad Nacional de Salta. Facultad de Ciencias Exactas. Departamento de Física. Instituto de Investigaciones en Energía no Convencional; Argentin

The National Center for Radioecology (NCoRE): A Network of Excellence for Environmental and Human Radiation Risk Reduction -13365

ABSTRACT Radioecology in the United States can be traced back to the early 1950s when small research programs were established to address the fate and effects of radionuclides released in the environment from activities at nuclear facilities. These programs focused primarily on local environmental effects, but global radioactive fallout from nuclear weapons testing and the potential for larger scale local releases of radioisotopes resulted in major concerns about the threat, not only to humans, but to other species and to ecosystems that support all life. These concerns were shared by other countries and it was quickly recognized that a multi-disciplinary approach would be required to address and understand the implications of anthropogenic radioactivity in the environment. The management, clean-up and long-term monitoring of legacy wastes at Department of Energy (DOE), Department of Defense (DOD), and Nuclear Regulatory Commission (NRC)-regulated facilities continues to be of concern as long as nuclear operations continue. Research conducted through radioecology programs provides the credible scientific data needed for decision-making purposes. The current status of radioecology programs in the United States are: fragmented with little coordination to identify national strategies and direct programs; suffering from a steadily decreasing funding base; soon to be hampered by closure of key infrastructure; hampered by aging and retiring workforce (loss of technical expertise); and in need of training of young scientists to ensure continuation of the science (no formal graduate education program in radioecology remaining in the U.S.). With these concerns in mind, the Savannah River National Laboratory (SRNL) took the lead to establish the National Center for Radioecology (NCoRE) as a network of excellence of the remaining radioecology expertise in the United States. As part of the NCoRE mission, scientists at SRNL are working with six key partner universities to re-establish a graduate education training program for radioecology. Recently, NCoRE hosted a workshop to identify the immediate needs for science-driven discoveries, tool development and the generation of scientific data to support the legislative decision-making process for remediation strategies, long-term monitoring of radiologicallycontaminated sites and protection of human health and the environment. Some of the immediate strategic research needs were identified in the fields of functional genomics for determining lowdose effects, improved low-level dosimetry, and mixed (radiological and chemical) contaminant studies. Longer term strategic research and tool development areas included development of radioecology case study sites, comprehensive decision-making tools, consequence response actions, and optimized scenario based ecosystem modeling. A summary of the NCoRE workshop findings related to waste management needs and priority areas will be presented in this paper

Drought impact on forest carbon dynamics and fluxes in Amazonia

In 2005 and 2010 the Amazon basin experienced two strong droughts, driven by shifts in the tropical hydrological regime possibly associated with global climate change, as predicted by some global models. Tree mortality increased after the 2005 drought, and regional atmospheric inversion modelling showed basin-wide decreases in CO2 uptake in 2010 compared with 2011 (ref. 5). But the response of tropical forest carbon cycling to these droughts is not fully understood and there has been no detailed multi-site investigation in situ. Here we use several years of data from a network of thirteen 1-ha forest plots spread throughout South America, where each component of net primary production (NPP), autotrophic respiration and heterotrophic respiration is measured separately, to develop a better mechanistic understanding of the impact of the 2010 drought on the Amazon forest. We find that total NPP remained constant throughout the drought. However, towards the end of the drought, autotrophic respiration, especially in roots and stems, declined significantly compared with measurements in 2009 made in the absence of drought, with extended decreases in autotrophic respiration in the three driest plots. In the year after the drought, total NPP remained constant but the allocation of carbon shifted towards canopy NPP and away from fine-root NPP. Both leaf-level and plot-level measurements indicate that severe drought suppresses photosynthesis. Scaling these measurements to the entire Amazon basin with rainfall data, we estimate that drought suppressed Amazon-wide photosynthesis in 2010 by 0.38 petagrams of carbon (0.23-0.53 petagrams of carbon). Overall, we find that during this drought, instead of reducing total NPP, trees prioritized growth by reducing autotrophic respiration that was unrelated to growth. This suggests that trees decrease investment in tissue maintenance and defence, in line with eco-evolutionary theories that trees are competitively disadvantaged in the absence of growth. We propose that weakened maintenance and defence investment may, in turn, cause the increase in post-drought tree mortality observed at our plots.Gordon and Betty Moore FoundationNatural Environment Research Council (NERC)EU FP7 Amazalert (282664) projectEU FP7GEOCARBON (283080) projectNational Council for Scientific and Technological Development (CNPq, Brazil)ARC - fellowship awardERC - Advanced Investigator AwardRoyal Society - Wolfson Research Merit AwardJackson FoundationJohn Fell Fun

Total Hip Arthroplasty or Hemiarthroplasty for Hip Fracture.

BACKGROUND: Globally, hip fractures are among the top 10 causes of disability in adults. For displaced femoral neck fractures, there remains uncertainty regarding the effect of a total hip arthroplasty as compared with hemiarthroplasty. METHODS: We randomly assigned 1495 patients who were 50 years of age or older and had a displaced femoral neck fracture to undergo either total hip arthroplasty or hemiarthroplasty. All enrolled patients had been able to ambulate without the assistance of another person before the fracture occurred. The trial was conducted in 80 centers in 10 countries. The primary end point was a secondary hip procedure within 24 months of follow-up. Secondary end points included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health end points. RESULTS: The primary end point occurred in 57 of 718 patients (7.9%) who were randomly assigned to total hip arthroplasty and 60 of 723 patients (8.3%) who were randomly assigned to hemiarthroplasty (hazard ratio, 0.95; 95% confidence interval [CI], 0.64 to 1.40; P = 0.79). Hip instability or dislocation occurred in 34 patients (4.7%) assigned to total hip arthroplasty and 17 patients (2.4%) assigned to hemiarthroplasty (hazard ratio, 2.00; 99% CI, 0.97 to 4.09). Function, as measured with the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score, pain score, stiffness score, and function score, modestly favored total hip arthroplasty over hemiarthroplasty. Mortality was similar in the two treatment groups (14.3% among the patients assigned to total hip arthroplasty and 13.1% among those assigned to hemiarthroplasty, P = 0.48). Serious adverse events occurred in 300 patients (41.8%) assigned to total hip arthroplasty and in 265 patients (36.7%) assigned to hemiarthroplasty. CONCLUSIONS: Among independently ambulating patients with displaced femoral neck fractures, the incidence of secondary procedures did not differ significantly between patients who were randomly assigned to undergo total hip arthroplasty and those who were assigned to undergo hemiarthroplasty, and total hip arthroplasty provided a clinically unimportant improvement over hemiarthroplasty in function and quality of life over 24 months. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov number, NCT00556842.)

Updating known distribution models for forecasting climate change impact on endangered species

To plan endangered species conservation and to design adequate management programmes, it is necessary to predict their distributional response to climate change, especially under the current situation of rapid change. However, these predictions are customarily done by relating de novo the distribution of the species with climatic conditions with no regard of previously available knowledge about the factors affecting the species distribution. We propose to take advantage of known species distribution models, but proceeding to update them with the variables yielded by climatic models before projecting them to the future. To exemplify our proposal, the availability of suitable habitat across Spain for the endangered Bonelli’s Eagle (Aquila fasciata) was modelled by updating a pre-existing model based on current climate and topography to a combination of different general circulation models and Special Report on Emissions Scenarios. Our results suggested that the main threat for this endangered species would not be climate change, since all forecasting models show that its distribution will be maintained and increased in mainland Spain for all the XXI century. We remark on the importance of linking conservation biology with distribution modelling by updating existing models, frequently available for endangered species, considering all the known factors conditioning the species’ distribution, instead of building new models that are based on climate change variables only.Ministerio de Ciencia e Innovación and FEDER (project CGL2009-11316/BOS

Árboles del Santuario Histórico de Machu Picchu: Monitoreo de diversidad y carbono a largo plazo

Understanding how the richness, diversity, and carbon monitoring vary and are distributed through altitudinal gradients in Andean montane forests is essential to understand how these forests are adapting to global warming effects. Botanical explorations and general collections were carried out within the limits of the Historic Sanctuary of Machu Picchu in an altitude gradient of 1600 to 4200 m.a.s.l. Two permanent plots of 1.0 ha were established in the sectors of Intipunku (SHM – 01) at an altitude of 2,653 m.a.s.l and Kantupata (SHM-02) at an altitude of 3,200 m.a.s.l., with the standardized methodology of RAINFOR in 2013 and remedied in 2016. We updated the number of tree species for the Historic Sanctuary of Machu Picchu, 364 species are reported so far, this catalog includes all wild and cultivated species but also tree ferns and palm trees. In recent years, four new tree species have been described whose TYPE collections come from SHM forests: Ocotea alveatavan der Werff, Ocotea mollivillosavan der Werff (Lauraceae), Bunchosia cuscanaW.R. Anderson (Malpighiaceae), Ficus machupicchuensisC.C. Berg (Moraceae). In the two permanent plots, a total of 69 species were recorded in 1286 individuals. Individually in the SHM – 01 plot, 26 families, 36 genera and 45 species were recorded in 682 individuals; and in the SHM – 02 plot: 22 families, 28 genera and 31 species in 604 individuals. Stored aerial biomass was higher in the Intipunku sector (146 Mg ha-1) compared to Kantupata sector (101 Mg ha-1). Our research shows that the Andean forests of Machu Picchu provide important ecosystem services, and there is still much to do in terms of scientic research. The continued discovery of new tree species in the locality demonstrates the need for conservation to protect forests that support some of the highest levels of endemism in the world

The variation of productivity and its allocation along a tropical elevation gradient: a whole carbon budget perspective

Why do forest productivity and biomass decline with elevation? To address this question, research to date generally has focused on correlative approaches describing changes in woody growth and biomass with elevation. We present a novel, mechanistic approach to this question by quantifying the autotrophic carbon budget in 16 forest plots along a 3300 m elevation transect in Peru. Low growth rates at high elevations appear primarily driven by low gross primary productivity (GPP), with little shift in either carbon use efficiency (CUE) or allocation of net primary productivity (NPP) between wood, fine roots and canopy. The lack of trend in CUE implies that the proportion of photosynthate allocated to autotrophic respiration is not sensitive to temperature. Rather than a gradual linear decline in productivity, there is some limited but nonconclusive evidence of a sharp transition in NPP between submontane and montane forests, which may be caused by cloud immersion effects within the cloud forest zone. Leaf-level photosynthetic parameters do not decline with elevation, implying that nutrient limitation does not restrict photosynthesis at high elevations. Our data demonstrate the potential of whole carbon budget perspectives to provide a deeper understanding of controls on ecosystem functioning and carbon cycling

Hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty (HEALTH): protocol for a multicentre randomised trial

Introduction: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures. Methods and analysis: HEALTH is a multicentre, randomised controlled trial where 1434 patients, 50 years of age or older, with displaced femoral neck fractures from international sites are randomised to receive either THA or HA. Exclusion criteria include associated major injuries of the lower extremity, hip infection(s) and a history of frank dementia. The primary outcome is unplanned secondary procedures and the secondary outcomes include functional outcomes, patient quality of life, mortality and hiprelated complications—both within 2 years of the initial surgery. We are using minimisation to ensure balance between intervention groups for the following factors: age, prefracture living, prefracture functional status, American Society for Anesthesiologists (ASA) Class and centre number. Data analysts and the HEALTH Steering Committee are blinded to the surgical allocation throughout the trial. Outcome analysis will be performed using a χ2 test (or Fisher’s exact test) and Cox proportional hazards modelling estimate. All results will be presented with 95% CIs. Ethics and dissemination: The HEALTH trial has received local and McMaster University Research Ethics Board (REB) approval (REB#: 06-151). Results: Outcomes from the primary manuscript will be disseminated through publications in academic journals and presentations at relevant orthopaedic conferences. We will communicate trial results to all participating sites. Participating sites will communicate results with patients who have indicated an interest in knowing the results. Trial registration number: The HEALTH trial is registered with clinicaltrials.gov (NCT00556842)