Lo glocal y el turismo. Nuevos paradigmas de interpretación.

El estudio del turismo se realiza desde múltiples escalas y enfoques, este libro aborda muchos temas que es necesario discutir desde diversas perspectivas; es el caso de la reflexión sobre la propia disciplina y sus conceptos, así como los asuntos específicos referidos al impacto territorial, los tipos de turismo, las cuestiones ambientales, el tema de la pobreza, la competitividad, las políticas públicas, el papel de las universidades, las áreas naturales protegidas, la sustentabilidad, la cultura, el desarrollo, la seguridad, todos temas centrales documentados y expuestos con originalidad y dominio del asunto. Lo multiescalar es básico para la comprensión del sistema turístico, sistema formado de procesos globales, regionales y locales. El eje de discusión del libro es lo glocal, esa interacción entre lo nacional y local con lo global

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Fossil Crocodilians from the High Guajira Peninsula of Colombia, and the History of Neogene Crocodilian Diversity in Tropical South America

The greatest diversity of Cenozoic crocodilians occurred during the Miocene in equatorial South America. However, the origin of this high diversity and its relationship to environmental factors are poorly understood. Most described species come from localities assigned to Laventan (13.8-11.8 Ma) and Huayquerian (9.0-6.8 Ma) South American land mammal ages (SALMAS), whereas the record is sparse in the early to middle Miocene and after the latest Miocene and Pliocene. Field research in the Castilletes (early Miocene-Pliocene) Formation in the High Guajira Peninsula of Colombia provides new fossil data on the origin of Neotropical crocodylian diversity. The Castilletes Formation crops out most extensively in the Cocinetas Basin, and represent depositional environments consisting of deltaic and shallow marine systems in the lower Castilletes and predominately fluvial environments in the upper Castilletes. Crocodilian fossils from the Castilletes Formation include gavialoids, alligatoroids and crocodyloids. Gavialoid remains have been recovered from both terrestrial and shallow marine deposits in the lower Castilletes. Remains of the specialized caimanines Purussaurus and Mourasuchus extend the temporal range of both lineages into the early middle Miocene (15-16 Ma). These records suggest that high diversity crocodilian assemblages were already established by the early Miocene or late Oligocene. Fossils from the upper Castilletes Formation include cranial elements identified as a non-tomistomine crocodyloid, some of them assigned to cf. Crocodylus. These records indicate that by the Pliocene, endemic assemblages were extinct, at least in the northern parts of the continent, allowing the establishment of Crocodylus. The pattern of crocodilian diversity in the Neogene of equatorial South America suggests that diversity was highly linked to hydrographic conditions. The development of high diversity assemblages developed in a time of greater connections among river drainages and mega-wetland systems. The isolation of river drainages and disappearance of mega-wetlands are correlated with the extinction of most crocodilian lineages. Aridity in peripheral drainages may have caused local extinctions outside Amazonia. The change from wetland to riverine conditions has been proposed as the cause of crocodilian extinctions in the western Amazon, but this remains to be tested. Advisor: Jason Hea

Miocene Freshwater Dolphins from La Venta, Huila, Colombia Suggest Independent Invasions of Riverine Environments in Tropical South America

The two extant genera of strictly freshwater dolphins Inia and Platanista are the result of convergent evolution to freshwater environments with reduced visibility. Characterized by their long snout and small melon, these extant taxa are clustered into two clades, Iniidae in South America and Platanistidae in Southern Asia. Their evolutionary history leading to freshwater environments remains mostly unknown, because many of their related fossil species have been found in marine environments. Here, we report riverine dolphin remains (two rostral fragments and a periotic) from two stratigraphic levels of the late middle Miocene (ca. 12.5 Ma) from La Venta, Colombia. The periotic has a reduced cochlear aqueduct mediodorsally oriented, the anterior process is relatively thin, and the dorsal opening of the facial canal is located lateral to the spiral cribriform tract. The rostral fragments are dorsoventrally flattened; the mandible features two longitudinal ventral grooves, and the premaxilla-maxilla suture of the rostrum is located in a deep lateral groove. These characteristics indicate that the specimens belong to Platanistidae, the lineage of the Ganges river dolphin Platanista. Platanistids had also been recorded on coeval strata from the Fitzcarrald arch, Peru. The occurrence of middle Miocene platanistids in both the La Venta and Fiztcarrald localities suggests that members of this lineage moved into freshwater environments in South America earlier than the ancestors of the modern Amazon river dolphin Inia. The subsequent collapse of the Pebas ecosystem could have played a role in the extinction of non-marine Platanistoidea in South America

New Miocene Caribbean gavialoids and patterns of longirostry in crocodylians

Gavialoidea is a clade of slender- and long-snouted crocodylomorphs with a single living species, the Indian gharial Gavialis gangeticus. Because elongated snouts (longirostry) have evolved independently in several crocodylomorph clades, this head shape has been interpreted as an ecological adaptation. How this condition affected patterns of diversification and how longirostrineassociated cranial features changed through adaptive radiations remain poorly understood. Two new small gryposuchine gavialoids, Dadagavialis gunai gen. et sp. nov. (early Miocene, Panama) and Aktiogavialis caribesi sp. nov. (late Miocene, Venezuela), evidence remarkable Miocene diversification of longirostrine forms in the Neotropics and support transmarine biogeographical relations between northern South America, the Caribbean, and southernmost North America before the Isthmus of Panama was fully established. By integrating phylogenetics and geometric morphometrics, we focus on this gavialoid diversity to investigate patterns of longirostry across the crown group of crocodylomorphs (Crocodylia). Analyses revealed that the snout shape of gavialoids has occupied a small, distinct and almost invariable morphospace since the Cretaceous, in contrast with the morphologically labile snout shape of other crocodylians (crocodyloids and alligatoroids). Our results suggest iterative environmental shift occupations throughout gavialoid evolution without major changes in snout proportions, but involving conspicuous rearrangements of the circumorbital bones. The longirostrine gavialoid morphotype is a distinct adaptation for seizing small prey and typically includes short and wide premaxillae and enlarged ‘caniniform’ teeth only at the tip of the snout. In longirostrine crocodyloids (Tomistoma, Crocodylus intermedius), the conservation of powerful bites and ‘caniniforms’ closer to the jaw joints allowed them to exploit a wider range of prey sizes, which could explain their snout shape plasticity. Therefore, the Mio–Pliocene extirpation of gryposuchine gavialoids from the Caribbean by the arrival of Crocodylus is quite unlikely. The last gryposuchine survived throughout the Pliocene in the south-eastern Pacific, where Crocodylus has never been documented

Integrated Chronology, Flora and Faunas, and Paleoecology of the Alajuela Formation, Late Miocene of Panama

<div><p>The late Miocene was an important time to understand the geological, climatic, and biotic evolution of the ancient New World tropics and the context for the Great American Biotic Interchange (GABI). Despite this importance, upper Miocene deposits containing diverse faunas and floras and their associated geological context are rare in Central America. We present an integrated study of the geological and paleontological context and age of a new locality from Lago Alajuela in northern Panama (Caribbean side) containing late Miocene marine and terrestrial fossils (plants, invertebrates, and vertebrates) from the Alajuela Formation. These taxa indicate predominantly estuarine and shallow marine paleoenvironments, along with terrestrial influences based on the occurrence of land mammals. Sr-isotope ratio analyses of <i>in situ</i> scallop shells indicate an age for the Alajuela Formation of 9.77 ± 0.22 Ma, which also equates to a latest Clarendonian (Cl3) North American Land Mammal Age. Along with the roughly contemporaneous late Miocene Gatun and Lago Bayano faunas in Panama, we now have the opportunity to reconstruct the dynamics of the Central America seaway that existed before final closure coincident with formation of the Isthmus of Panama.</p></div

List of location sites from which the fossils described in this report were collected from the upper Miocene Alajuela Formation, Lago Alajuela, Panama (UF VP general locality YPA088, lat. 9.2124°, long. -79.5936°.

<p>List of location sites from which the fossils described in this report were collected from the upper Miocene Alajuela Formation, Lago Alajuela, Panama (UF VP general locality YPA088, lat. 9.2124°, long. -79.5936°.</p