Tides in the Last Interglacial: insights from notch geometry and palaeo tidal models in Bonaire, Netherland Antilles

The study of past sea levels relies largely on the interpretation of sea-level indicators. Palaeo tidal notches are considered as one of the most precise sea-level indicators as their formation is closely tied to the local tidal range. We present geometric measurements of modern and palaeo (Marine Isotope Stage (MIS) 5e) tidal notches on Bonaire (southern Caribbean Sea) and results from two tidal simulations, using the present-day bathymetry and a palaeo-bathymetry. We use these two tools to investigate changes in the tidal range since MIS 5e. Our models show that the tidal range changes most significantly in shallow areas, whereas both, notch geometry and models results, suggest that steeper continental shelves, such as the ones bordering the island of Bonaire, are less affected to changes in tidal range in conditions of MIS 5e sea levels. We use our data and results to discuss the importance of considering changes in tidal range while reconstructing MIS 5e sea level histories, and we remark that it is possible to use hydrodynamic modelling and notch geometry as first-order proxies to assess whether, in a particular area, tidal range might have been different in MIS 5e with respect to today

Distal humerus fractures in patients over 65: Complications

SummaryIntroductionFractures of the distal humerus in patients over the age of 65 remain a therapeutic challenge. Treatment options include conservative treatment, internal fixation or total elbow arthroplasty. The complications of these different treatment options were evaluated in a multicentre study.Materials and methodsFour hundred and ninety-seven medical records were evaluated. A retrospective study was performed in 410 cases: 34 received conservative treatment, 289 internal fixation and 87 underwent total elbow arthroplasty. A prospective study was performed in 87 cases: 22 received conservative treatment, 53 internal fixation, and 12 underwent total elbow arthroplasty. Patients were evaluated after at least 6 months follow-up.ResultsThe rate of complications was 30% in the retrospective study and 29% in the prospective study. The rate of complications in the conservative treatment group was 60%, and the main complication was essentially malunion. The rate of complications was 44% in the internal fixation group and included neuropathies, mechanical failure or wound dehiscence. Although complications only developed in 23% of total elbow arthroplasties, they were often more severe than those following other treatments.DiscussionComplications develop in one out of three patients over 65 with distal humerus fractures. Three main types of complications were identified. Neuropathies especially of the ulnar nerve, especially during arthroplasty, must always be identified, the nerve requiring isolation and transposition. Bone complications, due principally to mechanical failure, were found following internal fixation. Despite technical progress, care must be taken not to favor excessive utilization of this treatment option in complex fractures on fragile bone. Although there were relatively fewer complications with total elbow arthroplasty they were more difficult to treat. Ossifications were frequent whatever the surgical option and can jeopardize the functional outcome.Level of evidenceLevel IV

Tratamiento psicosocial Matrix para la adicción a cocaína: componentes de un tratamiento efectivo

España, uno de los países europeos con mayor prevalencia de consumo de cocaína entre población joven, tiene una necesidad de transferencia de modelos empíricos de tratamiento llegados de otros países. El instituto Norteamericano NIDA recomienda Matrix como un modelo efectivo de tratamiento en adicciones a estimulantes. Los objetivos de este estudio teórico-descriptivo del modelo son describir con detalle: 1) el desarrollo histórico y repercusión del modelo, 2) la fi losofía y base teórica, 3) los constructos centrales; 4) la estructura y organización, y 5) los recursos materiales, humanos e infraestructura necesarios para implementarlo. La metodología incluye una revisión bibliográfi ca exhaustiva, la formación y experiencia clínica directa con el modelo. Los resultados muestran que Matrix está basado en teorías psicológicas consideradas efi caces para el tratamiento de las adicciones y comunes a las utilizadas por los psicólogos a nivel internacional (cognitivo-conductuales, psico-educativas, motivacionales, manejo de contingencias, monitorización del consumo, apoyo social). Consiste en una intervención intensiva inicial de 62 sesiones mínimas repartidas en 4 meses, seguida de un tratamiento de continuación indefi nido. Conclusiones: el modelo en su conjunto cumple los principios de buenas prácticas de NIDA. Su estandarización y materiales lo hacen fácil de implementar a nivel internacional.Evidence-Based Models for the psychosocial treatment drug addiction are in need in Spain, currently one of the European countries with highest prevalence on cocaine use among youth. This article describes in detail the Matrix model, one of the EBM recommended by NIDA as effective treatments for stimulant drugs. The goals are to describe: 1) the history and impact of this model, 2) philosophy and basic psychosocial theories, 3) core constructs, 4) structure of the model and 5) infrastructure and needed resources. Methods include a comprehensive literature review of the model descriptive publications, collaboration with the model authors, on-site training and direct experience utilizing the model sessions. Results showed that Matrix is based on psychological theories known and used by Spanish psychologists (cognitive-behavioral therapy, motivational strategies, relapse prevention, contingency management, monitoring drug-use, social support). It consists on 62 multivariate sessions along 4 months of intensive treatment followed by continuous support group sessions. The model follows the NIDA principles of Drugaddiction Treatment. Its standardization, structure and writing materials make possible to easily transfer this model to multiple communities and countries