Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte I: Deglución

At the time of writing this article, more than a million people have been affected by the SARS-CoV-2 virus in Chile, displaying different degrees of COVID-19 disease. Severe infections generate a condition that requires invasive ventilatory support and treatment in intensive care units, which, when extended in time, makes necessary conducting a tracheostomy. Despite its benefits for the recovery of patients with respiratory difficulties, it is linked to swallowing disorders that add to the problems generated by COVID-19. This represents a challenge for speech pathologists, who are potentially exposed to the virus because they work on structures of the aerodigestive tract and becuase they conduct procedures that may be aerosol-generating. The aim of this article is to provide guidance and clinical tools for swallowing-intervention in people with tracheostomies and COVID-19. Thees tools spring from a pragmatic analysis of the currently available evidence , interpreted based on our experience of caring more than 561 infected patients. We hope to contribute to the rehabilitation of swallowing of patients with COVID-19 and a tracheostomy. The characteristics of swallowing in this population, its treatment, considerations for the use of specific techniques, and guidelines for improving the quality of life through the maintenance and/or recovery of swallowing functionality are discussed, focused caring and protecting hospitalized patients and the health team.A la fecha de redacción de este artículo, más de 500 mil personas han sido afectadas por el virus SARS-CoV-2 en Chile, manifestando diferentes grados de la enfermedad COVID-19. Aquellas que sobrellevan condiciones más severas generan una condición que requiere soporte ventilatorio invasivo y tratamiento en unidades de cuidados intensivos, que de prolongarse en el tiempo deriva en la necesidad de una traqueostomía. A pesar de los beneficios que posee esta en la recuperación de personas con dificultades respiratorias, su implementación se asocia a alteraciones deglutorias que se suman a las generadas por COVID-19. Condición que supone un desafío para los/as fonoaudiólogos/as, quienes están expuestos/as al virus debido a su proceder en estructuras del tracto aerodigestivo y la realización de procedimientos potencialmente generadores de aerosol. El objetivo de este artículo es entregar orientaciones y herramientas clínicas para la intervención en la deglución de personas con traqueostomía y COVID-19. Estas emanan de un análisis pragmático de la evidencia disponible a la fecha, interpretadas bajo nuestra experiencia de atender a más de 561 personas con dicha condición. Se espera contribuir a la rehabilitación de la deglución en personas con COVID-19 y traqueostomía. Para ello se expone sobre las características de la deglución en esta población, su tratamiento, consideraciones para el uso de técnicas específicas, y orientaciones para la mejora de la calidad de vida mediante la mantención y/o recuperación de la funcionalidad deglutoria. Siempre bajo un esquema centrado en el cuidado y protección de las personas hospitalizadas y el equipo de salud

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación

The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients’ communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país

Environmental costs of water transfers

Millennium Science Initiative from Chile's Ministry of Economy, Development, and Tourism, through the Millennium Nucleus MUSELS NC120086 Millennium Science Initiative from Chile's Ministry of Economy, Development, and Tourism, through the Millennium Institute of Oceanography (IMO) IC120019 Water Research Center for Agriculture and Mining (CRHIAM) Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT) CONICYT FONDAP 15130015 Comision Nacional de Investigacion Cientifica y Tecnologica (CONICYT) CONICYT FONDECYT 1170065 119080

A Secondary precious and base metal mineralization in chromitites linked to the development of a Paleozoic accretionary complex in Central Chile

Platinum-group element (PGE) and gold inclusions are usually present in peridotites and chromitite deposits associated with ophiolites. Here, we present the first detailed study of the mineralogy of precious metals in ultramafic rocks hosted in the Paleozoic Coastal Accretionary Complex of Central Chile. In these ultramafic rocks the mineralization of precious metals is associated with small meter-size pods and veins of massive chromitite hosted in serpentinite-filled shear zones. Crystallographic orientation maps of single chromite grains, obtained using the Electron-Backscattered Secondary Diffraction technique, allow us to identify two types of chromite in the precious-metal bearing chromitites: (1) Type A chromite, characterized by an average misorientation per grain of ≤2° and chemically homogeneous cores surrounded by a porous rim with abundant inclusions of chlorite, and (2) Type B chromite, which exhibits higher degrees of misorientation (2-8°) and porosity, and abundant silicate inclusions, but a relatively homogeneous chemical composition. In situ analyses using EMPA and LA-ICP-MS for major, minor and trace elements indicate that composition of the magmatic chromite is only preserved in the cores of Type A chromite grains. Core to rim chemical trends in these Type A chromites are characterized by a progressive increase of the Cr# with a decrease of the Mg#, loss of Al and addition of Fe²⁺ in the porous rim. The observed changes in the microstructure and chemistry of chromite are associated with the infiltration of external fluids through shear zones filled with antigorite (± talc) developed in partly serpentinized peridotites (i.e., olivine-lizardite dunites). Thermodynamic calculations using the phase equilibria relations in the system Cr₂O₃–MgO–FeO–Al₂O₃–SiO₂–H₂O (CrMFASH) indicate that Fe²⁺-rich porous chromite + chlorite replaced the original assemblage chromite + olivine in the chromitite while prograde antigorite was formed. According to our results this transformation occurred at ~510–560 ℃ when external fluids penetrated the ultramafic/chromitite bodies through shear zones. These temperatures are slightly higher than estimated for the metamorphic peak in the host metapelitic rocks (i.e., ~420 ℃ at 9.3 kbar), suggesting that a hotter ultramafic body was captured by the metasediments of the accretionary prism during their exhumation through subduction channel. Chlorite geothermometry yielded a wide range of lower temperature from 430 to 188 ℃, for chlorite present in the porous chromite rims. These results are in agreement with the retrograde overprint under greenchist-facies metamorphism conditions recorded by metapelitic host rocks and minor volcanogenic massive sulphide deposits in the area (300-400 ℃, ~3-4 kbar). We suggest that although initially decoupled, the chromitite-bearing ultramafic rocks and their metasedimentary host undergone a common metamorphic PT pathway of exhumation during the formation and evolution of the subduction-related accretionary complex. The chromitites contain appreciable amounts of the platinum-group elements (up to 347 ppb total) and gold (up to 24 ppb), present as inclusions of platinum-group minerals (PGM) and alloys as well as native gold. The PGM identified include native osmium, laurite (RuS₂), irarsite (IrAsS), osarsite (OsAsS), omeiite (OsAs₂), Pt-Fe alloy (possibly isoferroplatinum) and a suite of inadequately identified phases such as PtSb (possibly stumpflite), PdHg (possibly potarite), RhS, Ir-Ni and Ir-Ni-Ru compounds. Only a few grains of osmium and laurite were identified in unaltered cores of chromite and therefore considered as magmatic in origin formed during the high-T event of chomite crystallisation in the upper mantle. The other PGM were located in the porous chromite associated with chlorite or base-metal minerals (BMM) that often fill the pores of this altered chromite or are intergrowth with antigorite in the host serpentinized ultramafic rock. The assemblage of BMM identified in the studied rocks include sulphides [millerite (NiS), polydymite (Ni₃S₄), violarite (FeNi₂S₄), galena (PbS), sphalerite (ZnS), chalcocite (CuS)], arsenides [(orcelite (Ni₅ − xAs₂) and maucherite (Ni₁₁As₈)], the sulpharsenide gersdorfitte (NiAsS), and native bismuth. The irregular shape of several PGM grains observed in porous chromite suggest disequilibrium, whereas others exhibit perfectly developed crystal faces with the associated secondary silicate or base-metal mineral suggesting neoformation of PGMs in situ from metamorphic fluids. We suggest that the origin of these PGM inclusions is magmatic, but some grains were reworked in situ when metalloid (i.e., As, Sb, Pb, Zn and Hg)-rich fluids released from metasediments penetrated the ultramafic rocks through active shear zones, once the ultramafic bodies became tectonically mixed with the host metasedimentary host rocks. During this event, gold sourced from the (meta)sediments was also precipitated within chromitites and serpentinites.27 page(s

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación

The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients’ communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país