Petrografía, geocronología y geoquímica de las ignimbritas de la Formación Popayán, en el contexto del vulcanismo del suroccidente de Colombia

Desde 1.932 se está discutiendo acerca de la estratigrafía y la composición de los depósitos y rocas que constituyen la Formación Popayán, surgiendo varias propuestas estratigráficas que se han venido actualizando de acuerdo a la evolución de los conceptos que, con el transcurrir del tiempo, ha tenido la vulcanología -- A partir de la caracterización de los depósitos de la Formación Popayán se plantea que está constituida primordialmente por depósitos de flujos de ignimbritas y por espesos depósitos de flujos de ceniza y bloques de hasta 200 m de espesor que rellenaron un paleorelieve, construido sobre rocas del Paleozoico al Paleoceno, conformando la Meseta de Popayán -- Se propone que la sección estratigráfica tipo de la Formación Popayán sea la levantada en la quebrada Sombrerillo, localizada al norte de la Meseta de Popayán en el Municipio de Morales, de muy fácil acceso, y donde está perfectamente representada ésta formación -- Las columnas estratigráficas levantadas en la Chorrera del Club Campestre del municipio de Popayán y en la quebrada La Chorrera- río Hondo, al sur de la meseta, en el municipio de El Tambo, se consideran secciones estratigráficas de referencia. En la sección estratigráfica de la quebrada Sombrerillo se observa la base de la Formación Popayán conformada por depósitos de flujos de ignimbritas con un espesor máximo observado de 100 m; estas ignimbritas están suprayacidas por una serie de depósitos de flujos piroclásticos y depósitos vulcano sedimentarios, con un espesor máximo observado de 100 m, sobre los que se desarrolló un paleosuelo de color rojo que se propone constituye el techo de la Formación de Popayán -- Los análisis geoquímicos ubican las ignimbritas de la Formación Popayán en las series magmáticas calcoalcalinas, siendo su composición riolítica alta en potasio -- Estas características las comparten con las ignimbritas de la Formación Guacacallo ubicadas en el valle geográfico del río Magdalena en el departamento del Huila; las dos formaciones tienen, igualmente, características cartográficas, geomorfológicas y estratigráficas comparables y esto permite su correlación -- De acuerdo con los estudios petrográficos realizados, los depósitos de flujos de ceniza y bloques estratigráficamente localizados hacia el techo de las ignimbritas son de composición andesitica -- Los volúmenes estimados para las ignimbritas de las formaciones de Popayán y Guacacallo son de aproximadamente 250 Km3, sin considerar los volúmenes de las cenizas acompañantes o co-ignimbritícas, cuyos cálculos pueden ser iguales a los de las ignimbritas propiamente dichas -- Estos volúmenes son indicadores de la gran significancia que tiene el vulcanismo riolítico en el segmento volcánico central de la Cordillera Central de Colombia -- Así mismo, su volumen y el alto contenido en potasio permite suponer que la génesis de los magmas que generaron los mantos ignimbríticos de las Formaciones de Popayán y Guacacallo está relacionada con la corteza continental -- Las ignimbritas denominadas en este trabajo de Pisojé Alto, ubicadas en el piedemonte occidental de la Cordillera Central y que bordean la Meseta de Popayán, de acuerdo con su información geoquímica, son de composición traquiandesitíca-andesitica, altas en potasio y hacen parte de las series calcoalcalinas -- Estas ignimbritas, de composición andesitica, no son correlacionables con las de la Formación Popayán y se propone que hacen parte de la Formación Coconuco -- De acuerdo a las dataciones de las ignimbritas del suroccidente de Colombia existentes en la literatura, y a las dataciones de 40Ar/Ar39 realizadas en esta investigación, consideradas referentes estratigráficos debido al alto contenido de argón atmosférico, el vulcanismo riolítico alto en potasio, del suroccidente de Colombia, se extiende desde hace 7.1±0.3 M.a hasta 2.1±0.4 M.a y sobre él se está construyendo el vulcanismo recient

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Recomendaciones generales apra mejorar la calidad de la atención obstétrica

INTRODUCTION. Maternal care means roughly a half of medical interventions, hospital discharges and surgery realized in Mexico. Obstetrics reached the second place (14.5%) in malpractice complaints in National Commission of Medical Arbitration (CONAMED). OBJECTIVE: To analize the CONAMED�s experience about obstetric care claims, and profit recommendations for medical practice. METHOD: The authors revised 1431 complaints ob/gin-related, placed in CONAMED between june 1996 to june 2001, and selected a sampling of 121 cases of ruling reports. We describe sociodemographic, institutional, clinical, communication and lawattach indicators. RESULTS. Complaints were originated in third quarter of pregnancy (82.8%), in social-security services (72.1%), in second level hospitals (62.3%). Fifty seven percent were high risk pregnancies, with previous cesarean section as frequent medical historial (21.5%). The complications were predictable in almost half of cases. First medical error was a deficient labor surveillance (22.3%). Malpractice was identified in 54.5%, ethical mistakes in 30%, institutional insufficiencies in 40.5%, inaccurate medical records in 45% and inadequate communication in 76%. CONCLUSIONS. An accurate obstetric care is composed by proffesional sense of duty and ethics, conscientious patient care, identify high risk pregnancies, recognize personal and institutional skill restrictions, to know health laws, and effective physician - patient communication. We declare 9 recommendations for medical and paramedical who care obstetric patients.ANTECEDENTES. La atención materna representa aproximadamente la mitad de las intervenciones médicas, egresos hospitalarios y las cirugías que se realizan en México. Las demandas por mala práctica relacionadas con atención obstétrica alcanzaron el segundo lugar (14.5%) de los asuntos atendidos por CONAMED. OBJETIVO. Analizar la experiencia de CONAMED sobre conflictos por atención obstétrica y expresar recomendaciones para la atención de estas pacientes. METODOLOGÍA. Se revisaron 1431 inconformidades relacionadas con atención ginecoobstétrica, radicadas en CONAMED entre junio de 1996 hasta junio de 2001. Se seleccionó una muestra dirigida de 121 casos concluidos por dictamen pericial. Se describen indicadores sociodemográficos, institucionales, clínicos, de comunicación y apego a reglamentación vigente. RESULTADOS. Las inconformidades se originaron en el tercer trimestre de gestación (82.8%), en la seguridad social en 72.1%, en hospitales de 2º nivel (62.3%). La calificación de riesgo fue elevado en 57%, con cesárea previa como antecedente más frecuente (21.5%). Las complicaciones eran previsibles en casi la mitad de los casos. La principal desviación fue vigilancia deficiente del trabajo de parto (22.3%). Se identificó mala práctica en 54.5%, desviaciones éticas en 30%, deficiencias institucionales en 40.5%, expedientes mal integrados en 45% y mala comunicación en 76%. CONCLUSIONES. Una atención obstétrica adecuada requiere: compromiso y ética profesional, atención minuciosa, identificar los casos de riesgo, reconocer limitaciones personales e institucionales, conocer la normatividad y una comunicación médico-paciente efectiva. Se presentan 9 recomendaciones, dirigidas al personal médico y paramédico que atiende pacientes obstétricas