The links between wood traits and species demography change during tree development in a lowland tropical rainforest.

One foundational assumption of trait-based ecology is that traits can predict species demography. However, the links between traits and demographic rates are, in general, not as strong as expected. These weak associations may be due to the use of traits that are distantly related to performance, and/or the lack of consideration of size-related variations in both traits and demographic rates. Here, we examined how wood traits were related to demographic rates in 19 tree species from a lowland forest in eastern Amazonia. We measured 11 wood traits (i.e. structural, anatomical and chemical traits) in sapling, juvenile and adult wood; and related them to growth and mortality rates (MR) at different ontogenetic stages. The links between wood traits and demographic rates changed during tree development. At the sapling stage, relative growth rates (RGR) were negatively related to wood specific gravity (WSG) and total parenchyma fractions, while MR decreased with radial parenchyma fractions, but increased with vessel lumen area (VA). Juvenile RGR were unrelated to wood traits, whereas juvenile MR were negatively related to WSG and axial parenchyma fractions. At the adult stage, RGR scaled with VA and wood potassium concentrations. Adult MR were not predicted by any trait. Overall, the strength of the trait-demography associations decreased at later ontogenetic stages. Our results indicate that the associations between traits and demographic rates can change as trees age. Also, wood chemical or anatomical traits may be better predictors of growth and MR than WSG. Our findings are important to expand our knowledge on tree life-history variations and community dynamics in tropical forests, by broadening our understanding on the links between wood traits and demography during tree development.

A Novel Digital Educational Strategy Improves Treatment Adherence and Quality of Life in Patients with Multiple Myeloma.

Multiple myeloma, the second most common hematologic malignancy worldwide, is an aggressive disease with high morbidity and mortality rates. Although myeloma remains incurable, new treatments have improved patients' life expectancy and quality of life. However, as these therapies are administered for prolonged and often indefinite periods, their success depends on high treatment adherence and significant patient engagement. This study aimed to evaluate the impact of a novel digital educational strategy on treatment adherence, quality of life, and the development of complications in patients with newly diagnosed myeloma. To this end, a two-arm, randomized, prospective, double-blind study was conducted to compare the conventional educational approach alone or combined with the novel digital strategy. This strategy was based on some principles of the Persuasive Systems Design model and incorporated the educational recommendations of patients and caregivers. Compared to the control group that only received information through the conventional educational approach, patients randomized to the digital strategy showed significantly higher treatment adherence and quality of life, associated with increased functionality and rapid reincorporation into daily routines. The digital strategy empowered patients and caregivers to understand the disease and therapeutic options and helped patients recall treatment information and implement healthy lifestyle habits. These results support that patient-targeted educational strategies can positively influence treatment adherence and thus improve their quality of life.

Wood density is related to aboveground biomass and productivity along a successional gradient in upper Andean tropical forests.

Wood density (WD) is a key functional trait related to ecological strategies and ecosystem carbon dynamics. Despite its importance, there is a considerable lack of information on WD in tropical Andean forests, particularly regarding its relationship with forest succession and ecosystem carbon cycling. Here, we quantified WD in 86 upper Andean tree and shrub species in central Colombia, with the aim of determining how WD changes with forest succession and how it is related to productivity. We hypothesized that WD will increase with succession because early successional forests will be colonized by acquisitive species, which typically have low WD, while the shaded understory of older forests should favor higher WD. We measured WD in 481 individuals from 27 shrub and 59 tree species, and quantified aboveground biomass (AGB), canopy height, net primary production (NPP) and species composition and abundance in 14, 400-m2, permanent plots. Mean WD was 0.513 ± 0.114 (g/cm3), with a range between 0.068 and 0.718 (g/cm3). Shrubs had, on average, higher WD (0.552 ± 0.095 g/cm3) than trees (0.488 ± 0.104 g/cm3). Community weighted mean WD (CWMwd) decreased with succession (measured as mean canopy height, AGB, and basal area); CWMwd also decreased with aboveground NPP and stem growth. In contrast, the percentage of NPP attributed to litter and the percent of shrubs in plots increased with CWMwd. Thus, our hypothesis was not supported because early successional forests had higher CWMwd than late successional forests. This was related to a high proportion of shrubs (with high WD) early in succession, which could be a consequence of: 1) a low seed availability of trees due to intense land use in the landscape and/or 2) harsh abiotic conditions early in succession that filter out trees. Forest with high CWMwd had a high %NPP attributed to litter because they were dominated by shrubs, which gain little biomass in their trunks. Our findings highlight the links between WD, succession and carbon cycling (biomass and productivity) in this biodiversity hotspot. Thus, WD is an important trait that can be used to understand upper Andean forest recovery and improve forest restoration and management practices.

Global relationships in tree functional traits.

Due to massive energetic investments in woody support structures, trees are subject to unique physiological, mechanical, and ecological pressures not experienced by herbaceous plants. Despite a wealth of studies exploring trait relationships across the entire plant kingdom, the dominant traits underpinning these unique aspects of tree form and function remain unclear. Here, by considering 18 functional traits, encompassing leaf, seed, bark, wood, crown, and root characteristics, we quantify the multidimensional relationships in tree trait expression. We find that nearly half of trait variation is captured by two axes: one reflecting leaf economics, the other reflecting tree size and competition for light. Yet these orthogonal axes reveal strong environmental convergence, exhibiting correlated responses to temperature, moisture, and elevation. By subsequently exploring multidimensional trait relationships, we show that the full dimensionality of trait space is captured by eight distinct clusters, each reflecting a unique aspect of tree form and function. Collectively, this work identifies a core set of traits needed to quantify global patterns in functional biodiversity, and it contributes to our fundamental understanding of the functioning of forests worldwide.

Climatic and soil factors explain the two-dimensional spectrum of global plant trait variation.

Plant functional traits can predict community assembly and ecosystem functioning and are thus widely used in global models of vegetation dynamics and land-climate feedbacks. Still, we lack a global understanding of how land and climate affect plant traits. A previous global analysis of six traits observed two main axes of variation: (1) size variation at the organ and plant level and (2) leaf economics balancing leaf persistence against plant growth potential. The orthogonality of these two axes suggests they are differently influenced by environmental drivers. We find that these axes persist in a global dataset of 17 traits across more than 20,000 species. We find a dominant joint effect of climate and soil on trait variation. Additional independent climate effects are also observed across most traits, whereas independent soil effects are almost exclusively observed for economics traits. Variation in size traits correlates well with a latitudinal gradient related to water or energy limitation. In contrast, variation in economics traits is better explained by interactions of climate with soil fertility. These findings have the potential to improve our understanding of biodiversity patterns and our predictions of climate change impacts on biogeochemical cycles.

Artritis séptica. Revisión descriptiva / Septic Arthritis. Descriptive Review / Artrite séptica. Revisão descritiva

Introducción: La artritis séptica es considerada una emergencia en ortopedia. Se define como el proceso inflamatorio desproporcionado, desencadenado por la colonización de algún microorganismo en el espacio articular que con los cambios fisiopatológicos ocasionados degradan el cartílago y aumentan la morbimortalidad, la prolongación de la estancia hospitalaria, las secuelas irreversibles, así como los costos para el sistema de salud. Por tal razón, es vital que el médico general, quien tiene el primer contacto con el paciente, sea capaz de reconocer las manifesta-ciones, e instaure un tratamiento para evitar complicaciones y secuelas del paciente. Objetivo: Identificar los aspectos importantes de la artritis séptica y proporcionar al lector información relevante de forma práctica y concreta para su actuar médico diario. Método: Búsqueda de artículos originales en bases de datos, empleando términos MeSH y DeCS, consulta de textos guía, en el periodo 2010-2022. Resultados: Con mayor frecuencia se ven afectados pacientes en extremos de edad, como los mayores de 60 años y los menores de 20 años, y la rodilla es la principal articulación afectada. La fiebre no es un criterio necesario para el diagnóstico de artritis séptica y el principal factor de riesgo es la enfermedad articular previa. Conclusiones: El análisis del líquido sinovial y la tinción de Gram, junto con el cultivo, permiten hacer el diagnóstico. El tratamiento antibiótico empírico es guiado por los factores de riesgo del paciente y, posteriormente, por los resultados del cultivo

Introduction: Septic arthritis is considered an emergency in orthopedics, it is defined as the dispro-portionate inflammatory process triggered by the colonization of some microorganism in the joint space, causing pathophysiological changes that degrade the cartilage causing increased morbidity and mortality, prolongation of hospital stay, irreversible sequelae, as well as increased costs for the health system, for this reason it is of vital importance that the general practitioner who has the first contact with the patient can recognize the manifestations, and establish treatment to avoid compli-cations and sequelae of the patient.Objective: To identify the important aspects of septic arthritis and provide the reader with relevant information in a practical and concrete way for his daily medical practice.Method: We searched for original articles in databases using MeSH and DeCS terms, consulting guide texts, with a search period from 2010 to 2022. Results: Patients in extremes of age are more frequently affected, such as patients older than 60 years and younger than 20 years, being the knee the main affected joint. Fever is not a necessary criterion for the diagnosis of septic arthritis and the main risk factor is previous joint disease. Conclusions: Synovial fluid analysis and Gram stain together with culture allow making diagnosis. Empirical antibiotic treatment is guided by the patient's risk factors, then by the culture results.

Introdução: a artrite séptica é considerada uma emergência na ortopedia. É definida como um processo inflamatório desproporcional, desencadeado pela colonização de um microrganismo no espaço arti-cular que, com as mudanças fisiopatológicas causadas, degrada a cartilagem e aumenta a morbidade e a mortalidade, a permanência hospitalar prolongada, sequelas irreversíveis, assim como os custos para o sistema de saúde. Por esta razão, é vital que o clínico geral, que tem o primeiro contato com o paciente, seja capaz de reconhecer as manifestações, e instituir tratamento para evitar complicações e sequelas para o paciente. Objetivo: Identificar os aspetos importantes da artrite séptica e fornecer ao leitor informações relevan-tes de uma forma prática e concreta para a prática médica diária. Método: Pesquisa de artigos originais em bancos de dados, usando termos MeSH e DeCS, consulta de textos guias, no período de 2010-2022. Resultados: Os mais frequentemente afetados são os pacientes em extremos de idade, como aqueles com mais de 60 anos e menos de 20 anos, e o joelho é a principal articulação afetada. A febre não é um critério necessário para o diagnóstico de artrite séptica e o principal fator de risco é a doença articular prévia. Conclusões: A análise do líquido sinovial e a coloração de Gram, junto com a cultura em meios espe-cíficos, permitem que o diagnóstico seja feito. O tratamento antibiótico empírico é orientado pelos fatores de risco do paciente e, posteriormente, pelos resultados da cultura

Anatomies, vascular architectures, and mechanics underlying the leaf size-stem size spectrum in 42 Neotropical tree species.

The leaf size-stem size spectrum is one of the main dimensions of plant ecological strategies. Yet the anatomical, mechanical, and hydraulic implications of small versus large shoots are still poorly understood. We investigated 42 tropical rainforest tree species in French Guiana, with a wide range of leaf areas at the shoot level. We quantified the scaling of hydraulic and mechanical constraints with shoot size, estimated as the water potential difference (ΔΨ) and the bending angle (ΔΦ), respectively. We investigated how anatomical tissue area, flexural stiffness and xylem vascular architecture affect such scaling by deviating (or not) from theoretical isometry with shoot size variation. Vessel diameter and conductive path length were found to be allometrically related to shoot size, thereby explaining the independence between ΔΨ and shoot size. Leaf mass per area, stem length, and the modulus of elasticity were allometrically related to shoot size, explaining the independence between ΔΦ and shoot size. Our study also shows that the maintenance of both water supply and mechanical stability across the shoot size range are not in conflict.

Assessing the reliability of predicted plant trait distributions at the global scale.

AIM: Predictions of plant traits over space and time are increasingly used to improve our understanding of plant community responses to global environmental change. A necessary step forward is to assess the reliability of global trait predictions. In this study, we predict community mean plant traits at the global scale and present a systematic evaluation of their reliability in terms of the accuracy of the models, ecological realism and various sources of uncertainty. LOCATION: Global. TIME PERIOD: Present. MAJOR TAXA STUDIED: Vascular plants. METHODS: We predicted global distributions of community mean specific leaf area, leaf nitrogen concentration, plant height and wood density with an ensemble modelling approach based on georeferenced, locally measured trait data representative of the plant community. We assessed the predictive performance of the models, the plausibility of predicted trait combinations, the influence of data quality, and the uncertainty across geographical space attributed to spatial extrapolation and diverging model predictions. RESULTS: Ensemble predictions of community mean plant height, specific leaf area and wood density resulted in ecologically plausible trait-environment relationships and trait-trait combinations. Leaf nitrogen concentration, however, could not be predicted reliably. The ensemble approach was better at predicting community trait means than any of the individual modelling techniques, which varied greatly in predictive performance and led to divergent predictions, mostly in African deserts and the Arctic, where predictions were also extrapolated. High data quality (i.e., including intraspecific variability and a representative species sample) increased model performance by 28%. MAIN CONCLUSIONS: Plant community traits can be predicted reliably at the global scale when using an ensemble approach and high-quality data for traits that mostly respond to large-scale environmental factors. We recommend applying ensemble forecasting to account for model uncertainty, using representative trait data, and more routinely assessing the reliability of trait predictions.

Epidemiología de la fractura de cadera en el adulto atendido en un hospital de tercer nivel / Epidemiology of hip fracture in adults treated at a tertiary level hospital / Epidemiologia de fratura do quadril em adultos tratados em um hospital (nível III)

Introducción: las fracturas del fémur proximal, también llamadas fracturas de cadera, se encuentran entre las prin-cipales causas de morbilidad en el mundo, donde la población más afectada son los adultos. Esto produce serias repercusiones en la salud pública, debido a su alto costo socioeconómico y la incapacidad laboral que genera. Objetivo: determinar la epidemiología de la fractura de cadera en el adulto atendido en un hospital de tercer nivel de Cúcuta (Norte de Santander, Colombia). Materiales y métodos: estudio descriptivo, transversal, de análisis retrospectivo, con enfoque cuantitativo. Se tomaron 175 pacientes con fractura de cadera que cumplían con los criterios de inclusión, con una población diana de mayores de 50 años de edad. Adicionalmente se registraron: edad, género, causa, comorbilidad, clasifi-cación, intervalo de cirugía y tipo de intervención quirúrgica. Resultados: de los 175 pacientes, se encontró una edad media general de 75,35 años. El 60 % fueron mujeres y la causa más común de la fractura correspondió a factores extrínsecos. La mayoría de los pacientes no padecía ninguna enfermedad, y en mayor proporción, acudieron por una fractura intertrocantérica. El 50 % de los pacien-tes fueron intervenidos quirúrgicamente en un periodo superior a los 4 días. Conclusiones: a partir de los hallazgos encontrados, se acepta que la frecuencia de la fractura de cadera está asociada con diversas variables, analizadas en este estudio, que obtuvo resultados novedosos y que quedan a dis-posición de la academia en bienestar de la salud, a fin de que se impulsen nuevos estudios.

Introduction: Proximal femur fractures, also called hip fractures, are among the main causes of mor-bidity in the world where the most affected population is adults. This greatly affects public health due to its high socio-economic cost and the incapacity for work it generates. Objective: To determine the epidemiology of hip fracture in adults treated in a tertiary hospital in Cúcuta (Norte de Santander, Colombia). Materials and methods: A descriptive, cross-sectional study, of retrospective analysis, with a quan-titative approach. 175 patients with hip fracture, who met the inclusion criteria, were taken with a target population over 50 years of age. In addition to the variables that were recorded: age, gender, cause, comorbidity, classification, surgery interval, type of surgical intervention. Results: Of the 175 patients, a general mean age of 75.35 years was found, 60% corresponds to female patients, the most common cause is extrinsic factors, most of the patients did not suffer from any disease, in greater relevance they came for a intertrochanteric fracture. 50% of patients undergo surgery in a period of time greater than 4 days. Conclusions: Based on the findings, it is accepted that the frequency of hip fracture is associated with various variables which were analyzed in this study, obtaining novel results that are available to the academy in health wellness, promoting new studies.

Introdução: as fraturas do fêmur proximal, chamada também de fraturas de quadril, estão entre as principais causas de morbidade no mundo, onde a população mais acometida são os adultos. Isso pro-duz sérias repercussões na saúde pública, devido ao seu alto custo socioeconômico e à incapaci-dade para o trabalho que gera. Objetivo: determinar a epidemiologia da fratura do quadril em adultos aten-didos em um hospital (nível III) em Cúcuta (Norte de Santander, Colômbia). Materiais e métodos: estudo descritivo, transversal, análise retrospectiva, com abordagem quantita-tiva. Foram tomados 175 pacientes com fratura do quadril que preencheram os critérios de inclusão, com uma população-alvo com mais de 50 anos de idade. Além disso, foram registrados: idade, sexo, causa, comorbidade, clas-sificação, intervalo cirúrgico e tipo de intervenção cirúrgica. Resultados: dos 175 pacientes, encon-trou-se uma média geral de idade de 75,35 anos. 60% eram mulheres e a causa mais comum da fratura correspondeu a fatores extrínsecos. A maioria dos pacien-tes não tinha nenhuma doença e, em maior proporção, vieram por causa de uma fratura intertrocan-térica. 50% dos pacientes foram operados em período superior a 4 dias. Conclusões: com base nos achados, aceita-se que a frequência de fratura de quadril está associada a diversas variáveis, analisadas neste estudo, que obtiveram resultados inéditos e que se encontram à disposição da academia em bem-estar da saúde, para que novos estudos sejam promovidos.

Scientific Productivity and Cancer-Related Mortality: A Case Study of a Positive Association in Colombia.

PURPOSE: Cancer morbidity represents an increasing public health issue; this worldwide phenomenon also is true for emerging upper-middle-income countries, such as Colombia. The main purpose of this study was to uncover the relationship between scientific productivity and cancer-related mortality in our setting. METHODS: We conducted a temporal-trend ecologic study by means of bibliometric analysis from records of publications from SCOPUS database with Colombian institutional affiliations between 2000 and 2015. Productivity and overall mortality were estimated and compared using econometric modeling to identify potential correlations. Additional exploratory analyses per six most frequent cancer sites were performed. RESULTS: Of 2,645 publication records retrieved, 1,464 (55.3%) met selection criteria to be classified as Colombian scientific production (interobserver agreement, 92.96%; κ = 0.859; 95% CI, 0.800 to 0.918). Overall, 79.6% of the records corresponded to original or in-press articles; furthermore, almost half (49.7%) embodied descriptive study designs. Selected records reported a median of five authors and three different affiliations per publication; 66% had been cited at least once up to September 2017. The most-studied cancer-specific locations were cervix (16.1%), breast (11.5%), and stomach (9.8%), but nonspecific locations had the largest combined participation (23.4%). An increasing trend in scientific productivity was correlated to decreasing trend in overall cancer mortality, which was reported as an inverse proportional relationship in the linear regression modeling (r = -0.958; P < .001). Graphic analyses per cancer-specific sites revealed heterogeneous behaviors of this relationship. CONCLUSION: Colombian cancer-specific scientific productivity demonstrated a steady growth as opposed to a decreasing mortality trend in the recent years. The research output is predominantly descriptive with relatively low interinstitutional partnership and low impact in the international scientific community.

Mapping local and global variability in plant trait distributions.

Our ability to understand and predict the response of ecosystems to a changing environment depends on quantifying vegetation functional diversity. However, representing this diversity at the global scale is challenging. Typically, in Earth system models, characterization of plant diversity has been limited to grouping related species into plant functional types (PFTs), with all trait variation in a PFT collapsed into a single mean value that is applied globally. Using the largest global plant trait database and state of the art Bayesian modeling, we created fine-grained global maps of plant trait distributions that can be applied to Earth system models. Focusing on a set of plant traits closely coupled to photosynthesis and foliar respiration-specific leaf area (SLA) and dry mass-based concentrations of leaf nitrogen ([Formula: see text]) and phosphorus ([Formula: see text]), we characterize how traits vary within and among over 50,000 [Formula: see text]-km cells across the entire vegetated land surface. We do this in several ways-without defining the PFT of each grid cell and using 4 or 14 PFTs; each model's predictions are evaluated against out-of-sample data. This endeavor advances prior trait mapping by generating global maps that preserve variability across scales by using modern Bayesian spatial statistical modeling in combination with a database over three times larger than that in previous analyses. Our maps reveal that the most diverse grid cells possess trait variability close to the range of global PFT means.

Estado actual de la formación de residentes de cirugía general en Colombia / Current state of general surgical training programs in Colombia

Introducción: La formación y certificación de Cirujanos es una preocupación creciente en los programas de Cirugía en Colombia, sin embargo no existe un diagnostico de la situación actual que permita un ajuste a los cambios constantes. Describimos en términos de carga académica y laboral el estado actual de los programas de residencia de Cirugía General inicialmente en la ciudad de Bogotá y en una segunda fase extenderlo al resto del país, desde la perspectiva de los residentes. Materiales y métodos: Se aplicó una encuesta a los residentes activos de Cirugía General en Bogotá y se tabularon los resultados en una base de datos Excel. Resultados: Se obtuvo información completa del 97.6 porciento de la población de residentes de Cirugía General en Bogotá, Clasificándola en cuatro variables: Datos sociodemográficos, información asistencial y académica, satisfacción y expectativa laboral. Conclusiones: El análisis de los datos muestra que los residentes de cirugía General se encuentran satisfechos con el programa donde realizan su especialización, sin embargo, no disponen de facilidades para que la investigación clínica termine en publicaciones, y el bienestar de los residentes no es una prioridad.

Encuesta sero-epidemiológica de anticuerpos anti-Toxoplasma gondii en 125 mujeres enbarazadas del oriente del estado de Tabasco / Sero-epidemiological survey of anti-Toxoplasma gondii antibodies in 125 pregnant women from the west of Tabasco-Mexico

Se presenta el resultado de la encuesta sero-epidemiológica de 125 mujeres embarazadas en el oriente del Estado de Tabasco, de acuerdo a un programa diseñado por la dirección del Hospital del Niño "Dr. Rodolfo Nieto Padrón", en el cual se utiliza la técnica de inmunofluorescencia indirecta; el 60% de los sueros analizados fueron positivos para anticuerpos anti-Toxoplasma gondii lo cual revela un alto grado de infección con respecto a lo reportado en nuestro país. Se comenta con respecto a los resultados, la literatura nacional e internacional