Socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017).

OBJECTIVE: To identify socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017). METHODS: We reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance. Using multivariate regression, we tested findings from the literature drawing from a longitudinal dataset on antimicrobial resistance from 41 major private and public hospitals and a nationally representative household survey in Chile (2008-2017). We estimated resistance rates for three priority antibiotic-bacterium pairs, as defined by the Organisation for Economic Co-operation and Development; i.e., imipenem and meropenem resistant P. aeruginosa, cloxacillin resistant S. aureus, and cefotaxime and ciprofloxacin resistant E. coli. RESULTS: Evidence from the literature review suggests poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. Our analysis showed an overall antimicrobial resistance rate of 32.5%, with the highest rates for S. aureus (40.6%) and the lowest for E. coli (25.7%). We found a small but consistent negative association between socioeconomic factors (income, education, and occupation) and overall antimicrobial resistance in univariate (p < 0.01) and multivariate analyses (p < 0.01), driven by resistant P. aeruginosa and S. aureus. CONCLUSION: Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption

Biogeochemical sedimentology of the Pleistocene-Holocene transition of the TaguaTagua 3 record in central Chile (~34ºS)

Oral presentada en el XI Congreso Geológico de España, Ávila (España), 2-6 de julio de 2024Este estudio examina los cambios biogeoquímicos en el sitio geoarqueológico Tagua-Tagua durante la transición Pleistoceno-Holoceno en el centro de Chile (~34°S), mediante un análisis detallado de la secuencia TT19-3A a lo largo de los últimos 20 mil años. Se realizaron análisis de tamaño de grano, microfósiles, análisis isotópicos en carbonatos, y se estudiaron biomarcadores lipídicos como n-alcanos, n-alcanoles, ácidos grasos y esteroles para investigar los procesos sedimentarios y cambios ambientales pasados. Los resultados indican cambios significativos en el transporte y deposición de sedimentos, así como en la vegetación y temperatura hacia la transición Pleistoceno-Holoceno. Se produjeron cambios importantes en ~20.5-18, ~15-12.8, ~12,5-12, ~11,5-11 y ~10,5-10 ka cal BP caracterizados por cambios a condiciones más húmedas y temperatura. Detectamos un pulso humedo entre ~12,8 y 12,5 ka cal BP. El registro ATTL sugieren cambios importantes en la intensidad del Anticiclón del Pacífico Sur, sincronizados con cambios atmosféricos a gran escala durante la Terminación 1 y el inicio del Holoceno.[EN] This study examines the biogeochemical changes at the Tagua-Tagua geoarchaeological site during the Pleistocene-Holocene transition in central Chile (~34°S), through a detailed analysis of the TT19-3A sequence over the last 20,000 years. Analyses of grain size, microfossils, isotopic analyses on carbonates, and lipid biomarkers such as n-alkanes, n-alkanols, fatty acids, and sterols were conducted to investigate sedimentary processes and past environmental changes. The results indicate significant changes in sediment transport and deposition, as well as in vegetation and temperature towards the Pleistocene- Holocene transition. Major changes occurred at ~20.5-18, ~15-12.8, ~12.5-12, ~11.5-11, and ~10.5-10 ka cal BP, characterized by shifts to wetter conditions and temperature. We detected a wet pulse between ~12.8 and 12.5 ka cal BP. The ATTL record suggests significant changes in the intensity of the South Pacific Anticyclone, synchronized with large-scale atmospheric changes during Termination 1 and the beginning of the Holocene

Concurso Bienal 1975 - 1976

Contenido Casas entre mediaderos Simón Bolivar, Santiago - Conjunto Habitacional Siete Hermanas Viña del Mar - Industria Nacional del Cemento "Inacesa" Antofagasta - Central de Adquisiciones Automotrices Santiago - Estudio preinversional de vivienda y desarrollo urbano para Iquique "Cedur" - Planeamiento del equipo escolar "Centro Metropolitano" de Concepción - Sociedad de stablecimientos Educacionales - Nuede Arquitectura y Urbanismo de la Universidad de Chile - Vivienda popular en Santiago de Chile - Elemento estructural Feria Municipal de la Vega Santiago - Hotel Internacional Rocas de Santo Domingo

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)