Spatial variation of trace elements in the peri-urban soil of Madrid

Purpose The peri-urban region to the south east of Madrid contains a mixture of housing, manufacturing industry and farming, some of which disperse metals, in particular cadmium, copper, lead, and zinc, into the soil. We have mapped the concentrations of these elements and identified the major influences on their distributions. Material and methods We sampled the topsoil at 125 sites across 1,050 km2 of peri-urban land to the south east of the city on two grids, one nested inside the other. At each site, we measured the current contents of the four trace elements in the soil. We used robust geostatistical methods to model the complex spatial distributions of the data as mixtures of fixed and random effects. The empirical best linear unbiased predictor was used to map the elements. Site descriptors (lithology, land cover, cultivation, relief, erosion, and stoniness) were then included as covariates to identify significant effects on trace element concentrations. Results and discussion The complex spatial distributions of the elements seem to arise from several sources. The concentrations generally increase from southeast to northwest, i.e.;with increasing proximity to Madrid itself, the main potential source of pollution. This pattern is clear for lead and similar for copper and zinc, though with "hot spots" at or near industrial sites. The spatial pattern of cadmium is more complex and depends on varied lithology, industry, and land use such as irrigation and cultivation. In general, the concentrations of the four elements appear to decrease with increases in stoniness and erosion, and to be largest on the valley floors. Conclusions Robust geostatistical methods enabled us to analyze and map the complex patterns of spatial variation of trace elements in a peri-urban region of Madrid. They show that distance to the city center, lithology, manufacturing industry, and cultivation all play their parts in loading the soil with lead, copper, zinc, and cadmium. In the event, none of the metals has yet exceeded the legislative thresholds, but some concentrations are already substantially greater than would arise from natural sources, especially closest to Madrid itself. © 2013 The Author(s)

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Case studies of the expansion of Acacia dealbata in the valley of the river Miño (Galicia, Spain)

<p><em>Aim of study:</em> Acacia dealbata is a naturalized tree of invasive behaviour that has expanded from small plots associated with vineyards into forest ecosystems. Our main objective is to find evidence to support the notion that disturbances, particularly forest fires, are important driving factors in the current expansion of A. dealbata.<br /><em>Area of study:</em> We mapped it current distribution using three study areas and assesses the temporal changes registered in forest cover in these areas of the valley of the river Miño. <br /><em>Material and Methods:</em> The analyses were based on visual interpretation of aerial photographs taken in 1985 and 2003 of three 1x1 km study areas and field works.<br /><em>Main result:</em> A 62.4%, 48.6% and 22.2% of the surface area was covered by A. dealbata in 2003 in pure or mixed stands. Furthermore, areas composed exclusively of A. dealbata make up 33.8%, 15.2% and 5.7% of the stands. The transition matrix analyses between the two dates support our hypothesis that the areas currently covered by A. dealbata make up a greater proportion of the forest area previously classified as unwooded or open forest than those without A. dealbata cover. Both of these surface types are the result of an important impact of fire in the region. Within each area, A. dealbata is mainly located on steeper terrain, which is more affected by fires. <br /><em>Research highlights:</em> A. dealbata is becoming the dominant tree species over large areas and the invasion of this species gives rise to monospecific stands, which may have important implications for future fire regimes.</p><p><br /><strong>Keywords:</strong> Fire regime; Mimosa; plant invasion; silver wattle.</p

Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study

Background: To date, 750 000 patients with COVID-19 worldwide have required mechanical ventilation and thus are at high risk of acute brain dysfunction (coma and delirium). We aimed to investigate the prevalence of delirium and coma, and risk factors for delirium in critically ill patients with COVID-19, to aid the development of strategies to mitigate delirium and associated sequelae. Methods: This multicentre cohort study included 69 adult intensive care units (ICUs), across 14 countries. We included all patients (aged 6518 years) admitted to participating ICUs with severe acute respiratory syndrome coronavirus 2 infection before April 28, 2020. Patients who were moribund or had life-support measures withdrawn within 24 h of ICU admission, prisoners, patients with pre-existing mental illness, neurodegenerative disorders, congenital or acquired brain damage, hepatic coma, drug overdose, suicide attempt, or those who were blind or deaf were excluded. We collected de-identified data from electronic health records on patient demographics, delirium and coma assessments, and management strategies for a 21-day period. Additional data on ventilator support, ICU length of stay, and vital status was collected for a 28-day period. The primary outcome was to determine the prevalence of delirium and coma and to investigate any associated risk factors associated with development of delirium the next day. We also investigated predictors of number of days alive without delirium or coma. These outcomes were investigated using multivariable regression. Findings: Between Jan 20 and April 28, 2020, 4530 patients with COVID-19 were admitted to 69 ICUs, of whom 2088 patients were included in the study cohort. The median age of patients was 64 years (IQR 54 to 71) with a median Simplified Acute Physiology Score (SAPS) II of 40\ub70 (30\ub70 to 53\ub70). 1397 (66\ub79%) of 2088 patients were invasively mechanically ventilated on the day of ICU admission and 1827 (87\ub75%) were invasively mechanical ventilated at some point during hospitalisation. Infusion with sedatives while on mechanical ventilation was common: 1337 (64\ub70%) of 2088 patients were given benzodiazepines for a median of 7\ub70 days (4\ub70 to 12\ub70) and 1481 (70\ub79%) were given propofol for a median of 7\ub70 days (4\ub70 to 11\ub70). Median Richmond Agitation\u2013Sedation Scale score while on invasive mechanical ventilation was \u20134 (\u20135 to \u20133). 1704 (81\ub76%) of 2088 patients were comatose for a median of 10\ub70 days (6\ub70 to 15\ub70) and 1147 (54\ub79%) were delirious for a median of 3\ub70 days (2\ub70 to 6\ub70). Mechanical ventilation, use of restraints, and benzodiazepine, opioid, and vasopressor infusions, and antipsychotics were each associated with a higher risk of delirium the next day (all p 640\ub704), whereas family visitation (in person or virtual) was associated with a lower risk of delirium (p&lt;0\ub70001). During the 21-day study period, patients were alive without delirium or coma for a median of 5\ub70 days (0\ub70 to 14\ub70). At baseline, older age, higher SAPS II scores, male sex, smoking or alcohol abuse, use of vasopressors on day 1, and invasive mechanical ventilation on day 1 were independently associated with fewer days alive and free of delirium and coma (all p&lt;0\ub701). 601 (28\ub78%) of 2088 patients died within 28 days of admission, with most of those deaths occurring in the ICU. Interpretation: Acute brain dysfunction was highly prevalent and prolonged in critically ill patients with COVID-19. Benzodiazepine use and lack of family visitation were identified as modifiable risk factors for delirium, and thus these data present an opportunity to reduce acute brain dysfunction in patients with COVID-19. Funding: None. Translations: For the French and Spanish translations of the abstract see Supplementary Materials section

Kuluttajabarometri maakunnittain 2000, 2. neljännes

Suomen virallinen tilasto (SVT

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery

This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London