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

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COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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

Connaraceae

ilustraciones, fotografías, mapasEsta monografía elaborada por el Profesor Titular ENRIQUE FORERO, junto con varios alumnos del programa de posgrado en Sistemática de la Universidad Nacional, cumple uno de los objetivos, quizá el más importante de dicho programa, como es el de facilitar la formación de personal científico en el campo taxonómico, bajo la dirección de personas con mayor experiencia investigativa y académica. Por otra parte en esta revisión se integra y coordina el trabajo de la comunidad botánica del país, al participar en él profesionales con responsabilidades en herbarios regionales, tales como el de la Universidad Tecnológica dd Magdalena (UTMC) en Santa Marta; el del Departamento de Biología, Universidad Industrial de Santander (UIS) en Bucaramanga; el del Departa- mento de Biología Uni11ersidad del Valle (CUVC) en Cali; el del Departa- mento de Biología, UniVersidad del Tolima (TOLI) en Ibagué; el de la Facultad de Ciencias Agrícolas, Uni11ersidad de Naríño (PSO) en Pasto, bajo la acertada dirección del Profesor Enrique Forero del Herbario Nacional Colombiano (COL). (texto tomado de la fuente)Nota-- Monografía No. 2 - Connaraceae -- Descripción de la familia -- Clave de los géneros -- Cnestidium -- Connarus -- Pseudoconnarus -- Rourea -- Agradecimientos -- Literatura citada -- Lista numérica de los taxa -- Lista de ejemplares estudiados -- Índice de nombres locales -- Índice de nombres científico

Arsénico edáfico y su distribución en el distrito de riego 017: uso métodos de interpolación

Los constituyentes del suelo (arcillas, carbonatos, materia orgánica y óxidos e hidróxidos), intervienen en la movilidad del arsénico (As) y determinan su variación espacial; por lo cual, su cartografía puede contribuir al entendimiento de la presencia de este metaloide en el suelo. Los objetivos de esta investigación fueron determinar la concentración de As en los suelos del Distrito de Riego 017 (DR017) de México y establecer su distribución espacial, utilizando dos métodos de interpolación. Cuatro etapas fueron realizadas; la primera consistió en trabajo de gabinete y campo, en la que 33 sitios de muestreo fueron localizados en un polígono del DR017, posteriormente en cada sitio, muestras simples de suelo (0-30 cm de profundidad) fueron colectadas. La segunda y tercera se llevaron a cabo en laboratorio, en las cuales, a cada muestra se determinó la concentración de As disponible, contenidos de arcilla, carbonatos de calcio y fósforo disponible y su regresión. La cuarta etapa tuvo dos partes, la elaboración de dos mapas con dos métodos de interpolación (Interpolador Ponderación Inversa de la Distancia, IDW en sus siglas en inglés y Kriging ordinario, KO), así como la verificación de la precisión de cada mapa. Los resultados mostraron que, la distribución del As en el DR017 no es uniforme y está asociada con el contenido de arcilla y CaCO3. De tal manera que, las concentraciones de As fluctuaron de 0.07 a 1.89 mg kg-1, donde las mayores concentraciones de este metaloide (1.39-1.89 mg kg‑1) se relacionaron positivamente (R2 = 0.9058) con altos contenidos de arcilla (39.44 a 43.44%). El mapa de distribución espacial de As obtenido con KO, tuvo la mayor precisión (75.7%), en el cual se muestra que la concentración aumenta en un sentido sur-norte, donde el área de mayor concentración está en la parte norte del distrito

The Sonozotz project: Assembling an echolocation call library for bats in a megadiverse country

Bat acoustic libraries are important tools that assemble echolocation calls to allow the comparison and discrimination to confirm species identifications. The Sonozotz project represents the first nation-wide library of bat echolocation calls for a megadiverse country. It was assembled following a standardized recording protocol that aimed to cover different recording habitats, recording techniques, and call variation inherent to individuals. The Sonozotz project included 69 species of echolocating bats, a high species richness that represents 50% of bat species found in the country. We include recommendations on how the database can be used and how the sampling methods can be potentially replicated in countries with similar environmental and geographic conditions. To our knowledge, this represents the most exhaustive effort to date to document and compile the diversity of bat echolocation calls for a megadiverse country. This database will be useful to address a range of ecological questions including the effects of anthropogenic activities on bat communities through the analysis of bat sound.</p