CARACTERIZACIÓN GEOLÓGICO–ESTRUCTURAL DE ALGUNAS ZONAS DE CIZALLA EN EL COMPLEJO QUEBRADAGRANDE EN LOS ALREDEDORES DE MANIZALES Y VILLAMARÍA

The Quebradagrande Complex (Located in the vicinity of Manizales and Villamaria in the Department of Caldas, Colombia) exhibit three zones of low-grade mylonites. These were identified and named, from West to East as: Los Túneles-Río Olivares, El Arroyo-Corinto, and Gallinazo-Río Blanco. An analysis of the deformation mechanisms allow for the identification of areas where these mylonites show foliation with strikes ranging from N/S to NE/SW, and moderate to high angle dips to the SE. In places dip angles are nearly vertical. Likewise, kinematic indicators such as type σ porphyroclast, S-C structures and S-C’ structures allowed to determine displacements right lateral, right lateral-reverse to reverse, with several vergence angles of the stretching lineation to the SW. It is suggested that the system of shear zones is related to the lateral accretion of the Caribbean plate in the Upper Cretaceous.  En el Complejo Quebradagrande (en los alrededores de Manizales y Villamaría, Caldas) se identificaron tres zonas de rocas miloníticas de bajo grado que de oeste a este se denominaron: Los Túneles-Río Olivares, El Arroyo-Corinto y Gallinazo-Río Blanco. Los análisis micro- y macroscópicos permitieron identificar zonas de rocas miloníticas con una foliación que varía de N-S a NNE-SSW en rumbo, con buzamientos de intermedios a altos hacia el E, eventualmente con disposición subvertical. Indicadores cinemáticos tales como porfiroclastos tipo σ, estructuras S-C, estructuras S-C’, permitieron determinar movimientos dextrales subhorizontales, dextrales-inversos hasta inversos, con varios ángulos de orientación de la lineación que muestran vergencia al SW. Se sugiere que el sistema de zonas de cizalla está relacionado con la acreción lateral de la Placa Caribe en el Cretácico Superior. &nbsp

CARACTERIZACIÓN GEOLÓGICO–ESTRUCTURAL DE ALGUNAS ZONAS DE CIZALLA EN EL COMPLEJO QUEBRADAGRANDE EN LOS ALREDEDORES DE MANIZALES Y VILLAMARÍA

The Quebradagrande Complex (Located in the vicinity of Manizales and Villamaria in the Department of Caldas, Colombia) exhibit three zones of low-grade mylonites. These were identified and named, from West to East as: Los Túneles-Río Olivares, El Arroyo-Corinto, and Gallinazo-Río Blanco. An analysis of the deformation mechanisms allow for the identification of areas where these mylonites show foliation with strikes ranging from N/S to NE/SW, and moderate to high angle dips to the SE. In places dip angles are nearly vertical. Likewise, kinematic indicators such as type σ porphyroclast, S-C structures and S-C’ structures allowed to determine displacements right lateral, right lateral-reverse to reverse, with several vergence angles of the stretching lineation to the SW. It is suggested that the system of shear zones is related to the lateral accretion of the Caribbean plate in the Upper Cretaceous.  En el Complejo Quebradagrande (en los alrededores de Manizales y Villamaría, Caldas) se identificaron tres zonas de rocas miloníticas de bajo grado que de oeste a este se denominaron: Los Túneles-Río Olivares, El Arroyo-Corinto y Gallinazo-Río Blanco. Los análisis micro- y macroscópicos permitieron identificar zonas de rocas miloníticas con una foliación que varía de N-S a NNE-SSW en rumbo, con buzamientos de intermedios a altos hacia el E, eventualmente con disposición subvertical. Indicadores cinemáticos tales como porfiroclastos tipo σ, estructuras S-C, estructuras S-C’, permitieron determinar movimientos dextrales subhorizontales, dextrales-inversos hasta inversos, con varios ángulos de orientación de la lineación que muestran vergencia al SW. Se sugiere que el sistema de zonas de cizalla está relacionado con la acreción lateral de la Placa Caribe en el Cretácico Superior. &nbsp

A methodology to downscale water demand data with application to the Andean region (Ecuador, Peru, Bolivia, Chile)

Mountainous regions are a hotspot for water scarcity and anthropogenic pressure on water resources. Substantial uncertainty surrounds projections of future climate and water availability. Furthermore, quantitative and distributed data on water demand are generally scarce, dispersed, and highly heterogeneous. This forms a major bottleneck to studying water resources issues and developing strategies to improve water resource management. Here we present a methodology to produce and evaluate high-resolution gridded maps of anthropogenic surface water demand with application to the Andean region. These data are disaggregated according to the major types of water demand: domestic users, irrigated area, and hydropower. This dataset was built by homogenizing, integrating, and interpolating data obtained from various national institutions in charge of water resource management as well as relevant global datasets. The maps can be used to research anthropogenic impacts on water resources, and to guide regional decision-making in regions such as the Andes

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background: Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods: The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings: We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation: Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding: Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Economic analysis of wider benefits to facilitate SuDS uptake in London, UK

Urban water management via Sustainable Urban Drainage Systems (SuDS) has been successfully applied in cities worldwide. This infrastructure has proven to be a cost efficient solution to manage flood risks whilst also delivering wider benefits. Despite their technical performance, large-scale SuDS uptake in many places has been slow, mostly due to reasons beyond the engineering realm. This is the case of England and Wales, where the implementation of SuDS has not reached its full potential. This paper investigates the strategic role of SuDS retrofit in managing environmental risks to urban infrastructure at a catchment level, through an economic appraisal of all benefits (i.e. flood reduction and wider benefits). The Decoy Brook catchment in London, UK, was used as a case study. Average Annual Benefits were used to monetise the value of SuDS in reducing surface flood risk, whilst a Value Transfer approach was used to appraise wider benefits. It was found that by including the latter, their economic feasibility improves considerably. This paper also shows how to split the investment amongst multiple stakeholders, by highlighting the benefits each one derives. Finally, recommendations regarding incentives and policies to enhance the uptake of SuDS are given. The proposed methodology for SuDS mapping and economic appraisal in the planning phase can be used in cities worldwide, as long as general principles are adapted to local contexts

Economic analysis of wider benefits to facilitate SuDS uptake in London, UK

Urban water management via Sustainable Urban Drainage Systems (SuDS) has been successfully applied in cities worldwide. This infrastructure has proven to be a cost efficient solution to manage flood risks whilst also delivering wider benefits. Despite their technical performance, large-scale SuDS uptake in many places has been slow, mostly due to reasons beyond the engineering realm. This is the case of England and Wales, where the implementation of SuDS has not reached its full potential. This paper investigates the strategic role of SuDS retrofit in managing environmental risks to urban infrastructure at a catchment level, through an economic appraisal of all benefits (i.e. flood reduction and wider benefits). The Decoy Brook catchment in London, UK, was used as a case study. Average Annual Benefits were used to monetise the value of SuDS in reducing surface flood risk, whilst a Value Transfer approach was used to appraise wider benefits. It was found that by including the latter, their economic feasibility improves considerably. This paper also shows how to split the investment amongst multiple stakeholders, by highlighting the benefits each one derives. Finally, recommendations regarding incentives and policies to enhance the uptake of SuDS are given. The proposed methodology for SuDS mapping and economic appraisal in the planning phase can be used in cities worldwide, as long as general principles are adapted to local contexts