Spectrophotometry of HII Regions, Diffuse Ionized Gas and Supernova Remnants in M31: The Transition from Photo- to Shock-Ionization

We present results of KPNO 4-m optical spectroscopy of discrete emission-line nebulae and regions of diffuse ionized gas (DIG) in M31. Long-slit spectra of 16 positions in the NE half of M31 were obtained over a 5-15 kpc range in radial distance from the center of the galaxy. The spectra have been used to confirm 16 supernova remnant candidates from the Braun & Walterbos (1993) catalog. The slits also covered 46 HII regions which show significant differences among the various morphological types (center-brightened, diffuse, rings). Radial gradients in emission-line ratios such as [OIII]/H$\beta$ and [OII]/[OIII] are observed most prominently in the center-brightened HII regions. These line ratio trends are either much weaker or completely absent in the diffuse and ring nebulae. The line ratio gradients previously seen in M31 SNRs (Blair, Kirshner, & Chevalier 1981; 1982) are well reproduced by our new data. The spectra of center-brightened HII regions and SNRs confirm previous determinations of the radial abundance gradient in M31. We use diagnostic diagrams which separate photoionized gas from shock-ionized gas to compare the spectral properties of HII regions, SNRs and DIG. This analysis strengthens earlier claims (Greenawalt, Walterbos, & Braun 1997) that the DIG in the disk of M31 is photoionized by a dilute radiation field.Comment: 45 pages, 9 figures, 7 tables, to appear in the Astronomical Journal (December 1999

The He II Emitting Nebula N44C in the LMC: Optical/UV Spectroscopy of the Nebula and its Ionizing Star

We present HST spectroscopy and imaging, along with new ground-based spectroscopy and ROSAT HRI imaging, of the He II emitting nebula N44C and its ionizing star. A GHRS spectrogram of the ionizing star yields a spectral type of about O7 for the star. The lack of P Cygni profiles for Si IV and C IV indicates that the star is not a supergiant. The nebular abundances in the ionized gas are consistent with average abundances for LMC H II regions, with the possible exception that nitrogen may be enhanced. Enrichment by a former evolved companion star is not evident. A long-slit echelle spectrogram in H-alpha + [N II] shows no evidence for high-velocity gas in N44C. This rules out high-velocity shocks as the source of the nebular He II emission. A 108 ks ROSAT HRI image of N44C shows no X-ray point source to a 3-sigma upper limit L(X) < 10^34 erg s^-1 in the 0.1-2.0 keV band. Based on new measurements of the electron density in the He II emitting region, we derive recombination timescales of approximately 20 yrs for He^+2 and approximately 4 yrs for Ne^+4. If N44C is a fossil X-ray ionized nebula, this places severe constraints on when the putative X-ray source could have turned off. The presence of strong [Ne IV] emission in the nebula is puzzling if the ionizing source has turned off. It is possible the system is related to the Be X-ray binaries, although the O star in N44C does not show Be characteristics at the present time. Monitoring of X-rays and He II emission from the nebula, as well as a radial velocity study of the ionizing star, are needed to fully understand the emission line spectrum of N44C.Comment: 37 pages, 7 figures (1 color .gif image); accepted for publication in the 10 Dec 2000 Astrophysical Journal. Complete PostScript and PDF versions can also be obtained at http://ocotillo.as.arizona.edu/~dgarnet

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas

Evaluation of distal radial artery cross-sectional internal diameter in neonates and infants by ultrasound and adequate selection of an intra-arterial catheter size

Background Radial artery catheterization in neonates, infants, and young children is a common and useful invasive procedure that brings technical placement challenges and potential complications due to the small diameter size of the radial artery in these patients. The aim of this study is to determine appropriate catheter sizes in infants up to 6 months of age. Materials and Methods A total of fifty infants undergoing general anesthesia or hospitalized in the neonatal intensive care unit were included. Images of the radial artery diameter were obtained from the infant's wrist using Philips EPIQ Diagnostic Ultrasound System CVX Release 4.0. All images obtained were distal in the forearm, medial to the border of the styloid process of the radius, at the point of maximal impulse of the radial artery, and with the wrist at a 45-degree angle position. We recorded postmenstrual age, chronological age, gender, weight, location, comorbidities, medications, weight, and vital signs of each individual. Results In this single cohort study of 50 children whose ages ranged from 0 to 6 months chronological age, their radial artery diameters were averaged proportionally to their weight and age. Use of a 22G catheter would result in 100% occlusion of the diameter of the artery in most study subjects. Use of a 24G catheter would result in a range of 75%-99% occlusion depending on weight, postmenstrual age, and chronological age of the infants. Conclusions In view of these findings, we recommend using US to measure the diameter of the radial artery and choose the most appropriate catheter size before proceeding with US-guidance for radial artery cannulation in infants. This will prevent inappropriate sizing of the catheter and the thrombotic complications this can incur

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave : the global UNITE-COVID study

Purpose To accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients. Methods Multicenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020. Results 4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%-50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors. Conclusions ICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients.Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method.Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO.Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care