¿Hospitalizaciones inadecuadas?

En la revista de la Sociedad Peruana de Medicina Interna, en su volumen 24 y numero 1 de los médicos Carlos Contreras y Carlos Galarza titulado ‘Hospitalizaciones inadecuadas en emergencias médicas’ se concluyó que el porcentaje de pacientes hospitalizados inadecuadamente poremergencia en el Hospital Nacional ‘Dos de Mayo’ fue de 10,22%, cifras mayores a las óptimas (< 5%)

Multiple late-Pleistocene colonisation events of the Antarctic pearlwort Colobanthus quitensis (Caryophyllaceae) reveal the recent arrival of native Antarctic vascular flora

Aim: Antarctica's remote and extreme terrestrial environments are inhabited by only two species of native vascular plants. We assessed genetic connectivity amongst Antarctic and South American populations of one of these species, Colobanthus quitensis, to determine its origin and age in Antarctica. Location: Maritime Antarctic, sub‐Antarctic islands, South America. Taxon: Antarctic pearlwort Colobanthus quitensis (Caryophyllaceae). Methods: Four chloroplast markers and one nuclear marker were sequenced from 270 samples from a latitudinal transect spanning 21–68° S. Phylogeographic, population genetic and molecular dating analyses were used to assess the demographic history of C. quitensis and the age of the species in Antarctica. Results: Maritime Antarctic populations consisted of two different haplotype clusters, occupying the northern and southern Maritime Antarctic. Molecular dating analyses suggested C. quitensis to be a young (<1 Ma) species, with contemporary population structure derived since the late‐Pleistocene. Main conclusions: The Maritime Antarctic populations likely derived from two independent, late‐Pleistocene dispersal events. Both clusters shared haplotypes with sub‐Antarctic South Georgia, suggesting higher connectivity across the Southern Ocean than previously thought. The overall findings of multiple colonization events by a vascular plant species to Antarctica, and the recent timing of these events, are of significance with respect to future colonizations of the Antarctic Peninsula by vascular plants, particularly with predicted increases in ice‐free land in this area. This study fills a significant gap in our knowledge of the age of the contemporary Antarctic terrestrial biota. Adding to previous inferences on the other Antarctic vascular plant species (the grass Deschampsia antarctica), we suggest that both angiosperm species are likely to have arrived on a recent (late‐Pleistocene) time‐scale. While most major groups of Antarctic terrestrial biota include examples of much longer‐term Antarctic persistence, the vascular flora stands out as the first identified terrestrial group that appears to be of recent origin

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

Meeting abstrac

Global hotspots for soil nature conservation

19 páginas.- 5 figuras.- 98 referencias.- Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s41586-022-05292-xSoils are the foundation of all terrestrial ecosystems1. However, unlike for plants and animals, a global assessment of hotspots for soil nature conservation is still lacking2. This hampers our ability to establish nature conservation priorities for the multiple dimensions that support the soil system: from soil biodiversity to ecosystem services. Here, to identify global hotspots for soil nature conservation, we performed a global field survey that includes observations of biodiversity (archaea, bacteria, fungi, protists and invertebrates) and functions (critical for six ecosystem services) in 615 composite samples of topsoil from a standardized survey in all continents. We found that each of the different ecological dimensions of soils—that is, species richness (alpha diversity, measured as amplicon sequence variants), community dissimilarity and ecosystem services—peaked in contrasting regions of the planet, and were associated with different environmental factors. Temperate ecosystems showed the highest species richness, whereas community dissimilarity peaked in the tropics, and colder high-latitudinal ecosystems were identified as hotspots of ecosystem services. These findings highlight the complexities that are involved in simultaneously protecting multiple ecological dimensions of soil. We further show that most of these hotspots are not adequately covered by protected areas (more than 70%), and are vulnerable in the context of several scenarios of global change. Our global estimation of priorities for soil nature conservation highlights the importance of accounting for the multidimensionality of soil biodiversity and ecosystem services to conserve soils for future generations.This project received funding from the British Ecological Society (agreement LRA17\1193; MUSGONET). C.A.G. and N.E. were funded by DFG–FZT 118, 202548816; C.A.G. was supported by FCT-PTDC/BIA-CBI/2340/2020; M.D.-B. was supported by RYC2018-025483-I, PID2020-115813RA-I00\MCIN/AEI/10.13039/501100011033 and P20_00879. M.A.M.-M. and S.A. were funded by FONDECYT 1181034 and ANID-PIA-Anillo INACH ACT192057. J.D. and A.R. acknowledge support from IF/00950/2014, 2020.03670.CEECIND, SFRH/BDP/108913/2015 and UIDB/04004/2020. Y.-R.L. was supported by 2662019PY010 from the FRFCU. L.T. was supported by the ESF grant PRG632. F.B. and J.L.M. were supported by i-LINK+2018 (LINKA20069) funded by CSIC. C.T.-D. was supported by the Grupo de Biodibersidad & Cambio Global UBB–GI 170509/EF. C.P. was supported by the EU H2020 grant agreement 101000224. H.C. was supported by NSFC32101335, FRFCU2412021QD014 and CPSF2021M690589. J.P.V. was supported by DST (DST/INT/SL/P-31/2021) SERB (EEQ/2021/001083) and BHU-IoE (6031).Peer reviewe

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

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Diminishing benefits of urban living for children and adolescents’ growth and development

AbstractOptimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.</jats:p