MARCO CONCEPTUAL PARA INVESTIGACIONES TSUNAMIGÉNICAS: CASO LITORAL PACÍFICO COLOMBIANO

A nivel histórico, la Costa Pacífica Colombiana ha presenciado seis tsunamis en los últimos 130 años, de los cuales dos han ocasionado completa destrucción de algunos municipios y provocado víctimas humanas. El presente trabajo pretende dar las bases conceptuales necesarias para abordar investigaciones focalizadas a la caracterización de la amenaza por tsunami, verificar el estado del arte y determinar las necesidades investigativas futuras. Toda adecuada realización de investigaciones en paleo-tsunamis debe ser multi-disciplinaria, y compilar, obtener y analizar información geológica, geomorfológica, biológica, antropológica, arqueológica e histórica, lo más detallada posible. Hasta el momento en Colombia, los trabajos realizados en torno a tsunamis han estado enfocados a la cuantificación de la inundación en localidades como Tumaco y Buenaventura. No obstante, a lo largo de la Costa Pacífica Colombiana aún no se ha trabajado en la identificación y caracterización de las fuentes de tsunami, búsqueda y caracterización de evidencias físicas de eventos pasados (e.g. depósitos de paleo-tsunamis), microzonificación sísmica regional, cambios en patrones de vegetación por eventos extremos o el impacto a la dinámica de comunidades indígenas antiguas por tsunamis, entre otros. Para que la gestión del riesgo sea efectiva, deben generarse mapas de amenaza por tsunami que integren todas las herramientas y disciplinas que identifiquen y caractericen dicha amenaza. Por ende, aquí se proponen los pasos a seguir para adecuadas investigaciones tsunamigénicas.Historically, the Colombian Pacific Coast has witnessed six tsunamis in the past 130 years, two of which have caused complete community destruction and human loss. The present paper aims to provide a conceptual framework needed to approach palaeo-tsunami research in the area, verifying the state of the art of tsunami hazard characterization and identifying any future investigations. Any acceptable palaeo-tsunami investigation should be multi-disciplinary, and compile, acquire and analyze in much detail, geological, geomorphological, biological, anthropological, archaeological and historical information. So far, the only research done related to tsunami hazard has been for the coastal cities of Tumaco and Buenaventura, and it has been focused on quantification of tsunami flooding. However, no research has yet been done on the identification and characterization of tsunami sources, exploration and characterization of the physical evidence of past events (e.g. palaeo-tsunami deposits), seismic micro-zonation, regional changes in vegetation patterns resulting from extreme events, or changes related to indigenous peoples’ habitational patterns or settlement abandonment, among others. For an effective risk management, tsunami hazard maps have to be emplaced, but they should integrate all the proxies and disciplines that enhance the identification and characterization of this hazard. We propose herein, the steps to follow to develop adequate tsunamigenic research

MARCO CONCEPTUAL PARA INVESTIGACIONES TSUNAMIGÉNICAS: CASO LITORAL PACÍFICO COLOMBIANO

A nivel histórico, la Costa Pacífica Colombiana ha presenciado seis tsunamis en los últimos 130 años, de los cuales dos han ocasionado completa destrucción de algunos municipios y provocado víctimas humanas. El presente trabajo pretende dar las bases conceptuales necesarias para abordar investigaciones focalizadas a la caracterización de la amenaza por tsunami, verificar el estado del arte y determinar las necesidades investigativas futuras. Toda adecuada realización de investigaciones en paleo-tsunamis debe ser multi-disciplinaria, y compilar, obtener y analizar información geológica, geomorfológica, biológica, antropológica, arqueológica e histórica, lo más detallada posible. Hasta el momento en Colombia, los trabajos realizados en torno a tsunamis han estado enfocados a la cuantificación de la inundación en localidades como Tumaco y Buenaventura. No obstante, a lo largo de la Costa Pacífica Colombiana aún no se ha trabajado en la identificación y caracterización de las fuentes de tsunami, búsqueda y caracterización de evidencias físicas de eventos pasados (e.g. depósitos de paleo-tsunamis), microzonificación sísmica regional, cambios en patrones de vegetación por eventos extremos o el impacto a la dinámica de comunidades indígenas antiguas por tsunamis, entre otros. Para que la gestión del riesgo sea efectiva, deben generarse mapas de amenaza por tsunami que integren todas las herramientas y disciplinas que identifiquen y caractericen dicha amenaza. Por ende, aquí se proponen los pasos a seguir para adecuadas investigaciones tsunamigénicas.Historically, the Colombian Pacific Coast has witnessed six tsunamis in the past 130 years, two of which have caused complete community destruction and human loss. The present paper aims to provide a conceptual framework needed to approach palaeo-tsunami research in the area, verifying the state of the art of tsunami hazard characterization and identifying any future investigations. Any acceptable palaeo-tsunami investigation should be multi-disciplinary, and compile, acquire and analyze in much detail, geological, geomorphological, biological, anthropological, archaeological and historical information. So far, the only research done related to tsunami hazard has been for the coastal cities of Tumaco and Buenaventura, and it has been focused on quantification of tsunami flooding. However, no research has yet been done on the identification and characterization of tsunami sources, exploration and characterization of the physical evidence of past events (e.g. palaeo-tsunami deposits), seismic micro-zonation, regional changes in vegetation patterns resulting from extreme events, or changes related to indigenous peoples’ habitational patterns or settlement abandonment, among others. For an effective risk management, tsunami hazard maps have to be emplaced, but they should integrate all the proxies and disciplines that enhance the identification and characterization of this hazard. We propose herein, the steps to follow to develop adequate tsunamigenic research

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effects of mesoscale structures on the distribution of cephalopod paralarvae in the Gulf of California and adjacent Pacific

13 pages, 3 tables, 9 figuresVertical distribution of the cephalopod paralarvae was investigated in relation to a system of two cyclonic and three anticyclonic eddies in the southern Gulf of California and a front in the adjacent Pacific Ocean. Results showed that the preferential habitat for the Sthenoteuthis oualaniensis – Dosidicus gigas “SD-complex” in both regions was the oxygenated surface mixed layer and the thermocline. The highest abundances occurred in of one of the anticyclonic eddies and a frontal zone, which are convergent structures. Enoploteuthid and Pyroteuthid paralarvae both displayed their highest abundances in the thermocline. Pyroteuthids dominated in the cyclonic eddy whereas Enoploteuthidae were less evident in the eddy system. Pyroteuthids were observed on the western (California Current) side of the frontal zone, and Enoploteuthids on its eastern (Gulf of California) side. The octopods and the complex of Ommastrephes-Eucleoteuthis-Hyaloteuthis paralarvae were present below the thermocline. Both groups had a scarce presence in the eddy system and high abundance near the frontal zone. The octopods abounded on the eastern side in association with the low dissolved oxygen concentrations (< 44 µmol kg−1) of Subtropical-Subsurface Water; the complex on the western front side was immersed in California Current Water. It may be concluded that the spawning and early stages of development of these cephalopod groups are associated with particular mesoscale structures of the water masses. For example, the “SD complex” inhabits the surface water masses, preferentially in convergence zones generated by mesoscale activityThis work was made possible thanks to the financial support of SEPCONACyT (contracts 2014-236864, LSV; 2011-168034-T, EB), and Fronteras de la Ciencia-CONACyT (contracts 2015-2-280, LSV).Peer reviewe

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk