Threats to conservation from national security interests.

There is a growing trend of nation states invoking national security and emergency declarations to build state-sponsored infrastructure projects for border defense, energy production, and transportation. Established laws, regulations, and agreements for the protection of nature and cultural heritage within and between countries are becoming secondary to national security, compromising the function of protected areas, such as national parks, wilderness areas, and biosphere reserves that safeguard biodiversity, climate, and human health. We considered cases where decades-long multinational cross-border endangered species recovery programs have been jeopardized by waivers of environmental protection laws to facilitate rapid construction of border barriers that impede the movement and migration of animals, such as at the US-Mexico and Poland-Belarus borders. Renewable energy megaprojects, such as the Pinacate solar plant in Mexico, coupled with power transmission lines and road networks likewise cast a large footprint on the land and are being carried out with minimal to no environmental compliance under the guise of national security. National sovereignty likewise has been used as justification for bypassing laws to proceed with similar projects, such as Mexico's Dos Bocas refinery and Poland's Vistula Spit canal. Emphasis on security is also apparent in increasing military expenditure by the world's largest economies, which has created a mismatch with improvement in environmental policy stringency. Decisions to prioritize security can undermine democratic principles and environmental review protocols, trivialize humanity's dependence on functioning ecosystems, and contradict the United Nation's resolution on the human right to a healthy environment. Framing infrastructure projects as matters of national security also foments civil and political unrest by the labeling and casting of dissenters, including conservation scientists and environmental defenders, as antinational. World leaders must refrain from misusing extraordinary powers, adhere to laws and international agreements, and consult experts and local people before taking unilateral action on projects that affect ecological and human communities.

Amenazas para la conservación a partir de los intereses nacionales de seguridad Resumen En los países existe una tendencia creciente por invocar la seguridad nacional y las declaraciones de emergencia para construir infraestructuras financiadas por el estado para la defensa de las fronteras, producción de energía y transporte. Las leyes, regulaciones y acuerdos establecidos para la protección de la naturaleza y el patrimonio cultural dentro y entre los países se están relegando por la seguridad nacional, lo que compromete la función de las áreas protegidas (parques nacionales, áreas silvestres y reservas de la biósfera) que resguardan la biodiversidad, el clima y la salud humana. Consideramos los casos en donde se han puesto en peligro los programas longevos y multinacionales de recuperación de especies en peligro por las exenciones a las leyes de protección ambiental para facilitar la construcción rápida de barreras fronterizas que impiden el movimiento y la migración de animales, como es el caso de las fronteras entre EU y México y Polonia y Bielorrusia. Los megaproyectos de energía renovable, como la planta solar del Pinacate en México, en conjunto con las líneas de transmisión eléctrica y las redes de carreteras también dejan una gran huella sobre la tierra y se realizan con el mínimo o ningún cumplimiento bajo el aspecto de la seguridad nacional. La soberanía nacional también se ha usado para justificar la omisión de las leyes para proceder con proyectos similares, como la refinería de Dos Bocas en México y el canal Vistula Spit en Polonia. El énfasis sobre la seguridad también es evidente con el incremento del gasto militar de las mayores economías mundiales, lo que ha creado una desigualdad con las mejoras en la exigencia de la política ambiental. Las decisiones para priorizar la seguridad pueden debilitar los principios democráticos y los protocolos de revisión ambiental, banalizar la dependencia de la humanidad por los ecosistemas funcionales y contradecir la resolución de las Naciones Unidas sobre el derecho humano a un ambiente saludable. Cuando se denominan los proyectos de infraestructura como asuntos de seguridad nacional, también se fomenta el malestar civil y político al etiquetar como antinacionales a los disidentes, incluidos los defensores ambientales y los científicos de la conservación. Los líderes mundiales deben abstenerse de usar indebidamente los poderes extraordinarios, adherirse a las leyes y acuerdos internacionales y consultar con expertos y personas locales antes de actuar de forma unilateral en cuanto a proyectos que afectan las comunidades humanas y ecológicas.

The perpetual state of emergency that sacrifices protected areas in a changing climate.

A modern challenge for conservation biology is to assess the consequences of policies that adhere to assumptions of stationarity (e.g., historic norms) in an era of global environmental change. Such policies may result in unexpected and surprising levels of mitigation given future climate-change trajectories, especially as agriculture looks to protected areas to buffer against production losses during periods of environmental extremes. We assessed the potential impact of climate-change scenarios on the rates at which grasslands enrolled in the Conservation Reserve Program (CRP) are authorized for emergency harvesting (i.e., biomass removal) for agricultural use, which can occur when precipitation for the previous 4 months is below 40% of the normal or historical mean precipitation for that 4-month period. We developed and analyzed scenarios under the condition that policy will continue to operate under assumptions of stationarity, thereby authorizing emergency biomass harvesting solely as a function of precipitation departure from historic norms. Model projections showed the historical likelihood of authorizing emergency biomass harvesting in any given year in the northern Great Plains was 33.28% based on long-term weather records. Emergency biomass harvesting became the norm (>50% of years) in the scenario that reflected continued increases in emissions and a decrease in growing-season precipitation, and areas in the Great Plains with higher historical mean annual rainfall were disproportionately affected and were subject to a greater increase in emergency biomass removal. Emergency biomass harvesting decreased only in the scenario with rapid reductions in emissions. Our scenario-impact analysis indicated that biomass from lands enrolled in the CRP would be used primarily as a buffer for agriculture in an era of climatic change unless policy guidelines are adapted or climate-change projections significantly depart from the current consensus.

Acute poisonings during pregnancy and in other non-pregnant women in emergency departments of four government hospitals, Addis Ababa, Ethiopia: 2010-2015.

OBJECTIVE: To characterise acute poisonings in pregnant and non-pregnant women treated at emergency departments of government hospitals in Addis Ababa, Ethiopia, between 2010 and 2015. METHODS: All data for acutely poisoned women were retrospectively collected from patient medical charts at the emergency departments of Saint Paul's Hospital Millennium Medical College, Ras Desta Memorial Hospital, Yekatit 12 Hospital Medical College and Zewditu Memorial Hospital. Data were collected by extraction questionnaire and analysed using SPSSv. 20 statistical software. RESULTS: During the study period, 998 cases of acutely poisoned women were listed in the hospital registries. Of these, complete data for inclusion in the study were available for 592. 36.3% of the study participants were in the age group of 20-24, with a mean (±SD) age of 23.03 (±6.3) years. 80.9% were from Addis Ababa; 4.6% were pregnant. The mean arrival time of all cases was 4.14 h. 85.5% of all study cases were due to intentional self-poisoning, of whom 42.1% were discharged without complications. The most common poisons were bleach and organophosphates; 25.9% of pregnant cases and 32.6% of non-pregnant cases were poisoned by bleach; and 18.5% of pregnant cases and 18.9% of non-pregnant cases had organophosphate poisoning. 0.7% had a history of poisoning; all were non-pregnant women. The common route of poison exposure was oral, and the case fatality rate of organophosphate poisoning in pregnant and non-pregnant women was 20 and 1.87%, respectively. The pre-hospital intervention for the majority of the women was milk, in 12.0% of cases. CONCLUSION: Acute poisoning remains a public health problem in our community. Bleach is the most common poisons. Our present findings indicate the necessity of educational programmes on preventable reasons of acute poisonings and their outcomes on pregnant and non-pregnant women.

Why women bypass front-line health facility services in pursuit of obstetric care provided elsewhere: a case study in three rural districts of Tanzania.

OBJECTIVES: In the Tanzanian health system, women are expected to first visit their nearest front-line health facility (FLF) for delivery. However, women frequently bypass these FLF. Our study estimates the extent of bypassing for childbirth and assesses factors associated with this behaviour. METHODS: Data describing the experiences of 597 women who recently delivered at a facility and the EmONC service capability at 107 health facilities were collected in 2011. Women who did not deliver at their nearest FLF were considered 'bypassers'. Factors associated with bypassing were assessed using multivariate logistic regression models. Three sets of analyses were conducted: among 597 women who delivered at the first facility they visited, among 521 women with no previous complications, and among 407 women not primigravida and without previous complications. RESULTS: More than 75.4% of women bypassed. In the fully adjusted model of all 597 women those who had experienced complications were more likely to bypass for delivery [OR = 6.31 (2.36, 16.86)]. In the fully adjusted model excluding women with previous complications, primigravida women were more likely to bypass [OR = 3.70 (1.71, 8.01)]. Fully adjusted models for each set of analysis found that, for each additional emergency obstetric and newborn care signal function (EmONC SF) available at the nearest FLF, women's odds of bypassing almost halved. CONCLUSIONS: Bypassing is highly associated with EmONC SF score at nearest FLF, controlling for individual and community-level factors.

[Epidemiological update of hydatid disease in hospitals in the public health system of Extremadura (2003-2012)]. / Situación epidemiológica de la hidatidosis en los centros hospitalarios del sistema público de salud de Extremadura (2003-2012).

INTRODUCTION: Echinococcosis is a zoonotic infection with a worldwide distribution, and is still an important health problem in many areas of the world, including the Mediterranean basin. At present the epidemiological situation is unclear in certain regions of Spain. The aim of this study was to update the epidemiological situation in Extremadura through an analysis of hospitalised patients in the public health system diagnosed with hydatid disease. METHODS: A longitudinal retrospective study was conducted between 2003 and 2012 on hospitalised patients with a diagnosis of hydatidosis (ICD 122.0-122.9) in hospitals of the public health service of Extremadura. RESULTS: During the period of study, 876 patients were diagnosed with hydatid disease. Of these 536 (61%) of cases were male, with a mean age of 65.53±17.8 years. More importantly, 19 (2.2%) of patients were 19 years old, with 17 cases between 2003-2007 versus 2 cases between 2008-2012 (OR=7.83; 95%CI: 1.79-34.11; P=.001). A total of 141 (16.0%) were younger than 45 years. The primary diagnosis was most frequently reported in the younger population <45 years, whereas the secondary diagnosis was usually found in the elderly population >70 years (P<.05). The incidence rate of hydatid disease obtained from Hospital Discharge Records (HDRs) was significantly higher compared to the incidence that was declared in the Notifiable Disease System of Extremadura (8.02 cases per 10(5) person-years vs. 1.88 cases per 10(5) person-years [P<.05]). CONCLUSION: In Extremadura hydatid disease is still frequent. With a clear decrease in the number of paediatric cases. The number of cases obtained from HDRs regarding Notification System Diseases Extremadura suggests the need for modifications to improve surveillance and control of hydatid disease.

Hypertensive emergency secondary to atropine.

Atropine, a competitive antagonist of acetylcholine muscarinic receptors, is commonly used to treat severe bradycardia by blocking parasympathetic activity. We present a rare case of hypertensive emergency following atropine administration, with only one previous report in the literature. A 78-year-old woman with essential hypertension and hypercholesterolemia was admitted to the cardiac intensive care unit for non-ST segment elevation myocardial infarction. During coronary angiography, an occlusion of the right coronary artery was identified. While removing the diagnostic catheter through the right radial artery, the patient experienced intense pain and discomfort, accompanied by a vasovagal reflex characterized by bradycardia and hypotension. Intravenous atropine (0.5mg) was administered, leading to a rapid rise in heart rate with frequent ventricular ectopy. Subsequently, a progressive and exaggerated elevation in arterial blood pressure occurred, peaking at 294/121mmHg approximately 10min after atropine administration. The patient developed hypertensive acute pulmonary edema, successfully treated with intravenous nitroglycerine (10mg) and furosemide (60mg). Blood pressure normalized after approximately 14min. The exact mechanism of atropine-induced hypertensive emergency remains unknown. While hypertensive emergencies with atropine are exceedingly rare, healthcare professionals should be aware of this potential effect and be prepared for prompt intervention.

Prevalence and associated factors of secondary traumatic stress in emergency nurses: a systematic review and meta-analysis.

Background: Nurses in emergency departments are at a high risk of experiencing secondary traumatic stress because of their frequent exposure to trauma patients and high-stress environments.Objective: This systematic review and meta-analysis aimed to determine the overall prevalence of secondary traumatic stress among emergency nurses and to identify the contributing factors.Method: We conducted a systematic search for cross-sectional studies in databases such as PubMed, Web of Science, Embase, CINAHL, Wanfang Database, and China National Knowledge Internet up to October 21, 2023. The Joanna Briggs Institute's appraisal checklists for prevalence and analytical cross-sectional studies were used for quality assessment. Heterogeneity among studies was assessed using Cochrane's Q test and the I2 statistic. A random effects model was applied to estimate the pooled prevalence of secondary traumatic stress, and subgroup analyses were performed to explore sources of heterogeneity. Descriptive analysis summarized the associated factors.Results: Out of 345 articles retrieved, 14 met the inclusion criteria, with 11 reporting secondary traumatic stress prevalence. The pooled prevalence of secondary traumatic stress among emergency nurses was 65% (95% CI: 58%-73%). Subgroup analyses indicated the highest prevalence in Asia (74%, 95% CI: 72%-77%), followed by North America (59%, 95% CI: 49%-72%) and Europe (53%, 95% CI: 29%-95%). Nine studies identified associated factors, including personal, work-related, and social factors. In the subgroup of divided by recruitment period, emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%-78%).Conclusions: Secondary traumatic stress prevalence is notably high among emergency department nurses, with significant regional variations and period differences. The factors affecting secondary traumatic stress also varied across studies. Future research should focus on improving research designs and sample sizes to pinpoint risk factors and develop prevention strategies.Registration: PROSPERO CRD42022301167.

Secondary traumatic stress is considered an occupational hazard for nurses. Emergency department nurses, in particular, face a greater risk of secondary traumatic stress compared to other professions.While various studies have investigated the prevalence of secondary traumatic stress among these nurses, findings have been inconsistent.The pooled prevalence of secondary traumatic stress among emergency nurses is 65%. Subgroup analysis by region shows that Asia experiences the highest combined prevalence at 74%, with North America at 59% and Europe at 53%. Emergency department nurses in the COVID-19 outbreak period had a higher prevalence of secondary traumatic stress (70%, 95% CI: 62%­78%).

Improvement in intubation success during COVID-19 pandemic with a simple and low-cost intervention: A quasi-experimental study.

OBJECTIVES: primary objective: to improve the FPS rates after an educational intervention. SECONDARY OBJECTIVE: to describe variables related to FPS in an ED and determine which ones were related to the highest number of attempts. DESIGN: it was a prospective quasi-experimental study. SETTING: done in an ED in a public Hospital in Argentina. PATIENTS: there were patients of all ages with intubation in ED. INTERVENTIONS: in the middle of the study, an educational intervention was done to improve FPS. Cognitive aids and pre- intubation Checklists were implemented. MAIN VARIABLES OF INTEREST: the operator experience, the number of intubation attempts, intubation judgment, predictors of a difficult airway, Cormack score, assist devices, complications, blood pressure, heart rate, and pulse oximetry before and after intubation All the intubations were done by direct laryngoscopy (DL). RESULTS: data from 266 patients were included of which 123 belonged to the basal period and 143 belonged to the post-intervention period. FPS percentage of the pre-intervention group was 69.9% (IC95%: 60.89-77.68) whereas the post-intervention group was 85.3% (IC95%: 78.20-90.48). The difference between these groups was statistically significant (p=0.002). Factors related to the highest number of attempts were low operator experience, Cormack-Lehane 3 score and no training. CONCLUSIONS: a low-cost and simple educational intervention in airway management was significantly associated with improvement in FPS, reaching the same rate of FPS than in high income countries.

Consequences of the COVID-19 pandemic on the mental health of nurses in the Spanish out-of-hospital Emergency Service.

OBJECTIVE: To analyse the impact of the COVID-19 pandemic on the mental health of nurses in Spanish out-of-hospital Emergency Services, identifying predictor factors of greater severity. METHOD: A multicentre cross-sectional descriptive study was designed, including all nurses working in any Spanish out-of-hospital Emergency Services between 01/02/2021 and 30/04/2021. The main outcomes were the level of depression, anxiety and stress assessed through the DASS-21 scale. Sociodemographic, clinical, and occupational information was also collected. Univariate and multivariate analyses were conducted to determine possible associations between variables. RESULTS: The sample included 474 nurses. 32.91%, 32.70% and 26.33% of the participants had severe or extremely severe levels of depression, anxiety and stress, respectively. Professionals with fewer competencies to handle stressful situations, those who had used psychotropic drugs and/or psychotherapy on some occasion before the pandemic onset, or those who had changed their working conditions presented more likelihood of developing more severe levels of depression, anxiety and/or stress. CONCLUSION: Nurses in Spanish out-of-hospital Emergency Services have presented medium levels of depression, anxiety and stress during the pandemic. Clinical and occupational factors have been associated with a higher degree of psychological distress. It is necessary to adopt strategies that promote professionals' self-efficacy and mitigate the triggers of negative emotional states.

Masks and Faces in the Setting at the Time of Coronavirus.

The "health emergency" forced analysts to seek new ways of continuing with analysis. The article focuses, in particular, on the changes brought about in the setting by the presence of the sanitary mask, following a line that begins with the theme of the "mask" in the collective uses of human cultures, and develops through the Jungian concept of persona, as opposed to the "face" that may convey an authentic image of oneself. A clinical vignette illustrates the issues that the mask raises in the setting by obstructing the communication of emotions. When there is no transformative processing of concrete data, "unmasking" can also lead to an uncanny encounter and to moments of darkness and confusion in analysis, when the analyst experiences the kind of "unconscious identity" between therapist and patient that Jung defined as nigredo. The article is intended as a contribution to the analytic community's current reflections on the new and unforeseen challenges encountered in analysis at the time of the Coronavirus. It is possible to learn from these experiences with a view to integrating new elements and thus modify one's own internal setting, the compass with which each analyst orientates himself.

'L'urgence sanitaire' a forcé les analystes à rechercher de nouvelles manières de poursuivre le travail analytique. Cet article met l'accent en particulier sur les changements survenus dans le cadre du fait du port du masque sanitaire; l'article suit un fil conducteur qui commence avec le thème du 'masque' dans les usages collectifs des cultures humaines et se poursuit avec le concept Jungien de persona, en opposition avec le 'visage' qui peut communiquer une image authentique de soi. Une vignette clinique illustre les problèmes que le masque soulève dans la situation analytique en entravant la communication d'émotions. Quand il n'y a pas de processus de transformation des données concrètes, 'démasquer' peut également mener à une rencontre étrange et à des moments de ténèbres et de confusion dans l'analyse, quand l'analyste fait l'expérience du type 'd'identité inconsciente' entre le thérapeute et le patient que Jung a défini comme nigredo. Cet article a pour but de contribuer aux réflexions actuelles de la communauté analytique en ce qui concerne les défis nouveaux et inattendus rencontrés dans l'analyse dans la période du Coronavirus. Il est possible de tirer des leçons de ces expériences afin d'intégrer de nouveaux éléments et ainsi de modifier notre propre cadre interne, la boussole avec laquelle chaque analyste s'oriente.

La "emergencia sanitaria" obligó a los analistas a buscar nuevas formas de continuar con el análisis. El artículo se centra, en particular, en los cambios provocados en el encuadre analítico por la presencia de la mascarilla sanitaria. Presenta un desarrollo a partir del tema de la "máscara" en los usos colectivos de las culturas humanas, y continúa a través del concepto junguiano de persona, en contraposición al de "rostro", el cual puede transmitir una imagen auténtica de uno mismo. Una viñeta clínica ilustra los problemas que plantea la máscara en el entorno al obstruir la comunicación de las emociones. Cuando no hay un procesamiento transformador de los datos concretos, el "desenmascaramiento" también puede conducir a un encuentro misterioso y a momentos de oscuridad y confusión en el análisis, cuando el analista experimenta una forma de "identidad inconsciente" entre terapeuta y paciente que Jung definió como nigredo. El artículo pretende ser una contribución a las reflexiones actuales de la comunidad analítica sobre los nuevos e imprevistos desafíos encontrados en el análisis en la época del Coronavirus. Es posible aprender de estas experiencias con vistas a integrar nuevos elementos y así modificar la propia configuración interna, la brújula con la que cada analista se orienta.

Assembling the anaerobic gamma-butyrobetaine to TMA metabolic pathway in Escherichia fergusonii and confirming its role in TMA production from dietary L-carnitine in murine models.

IMPORTANCE: The key atherosclerotic TMAO originates from the initial gut microbial conversion of L-carnitine and other dietary compounds into TMA. Developing therapeutic strategies to block gut microbial TMA production needs a detailed understanding of the different production mechanisms and their relative contributions. Recently, we identified a two-step anaerobic pathway for TMA production from L-carnitine through initial conversion by some microbes into the intermediate γBB which is then metabolized by other microbes into TMA. Investigational studies of this pathway, however, are limited by the lack of single microbes harboring the whole pathway. Here, we engineered E. fergusonii strain to harbor the whole two-step pathway and optimized the expression through cloning a specific chaperone from the original host. Inoculating germ-free mice with this recombinant E. fergusonii is enough to raise serum TMAO to pathophysiological levels upon L-carnitine feeding. This engineered microbe will facilitate future studies investigating the contribution of this pathway to cardiovascular disease.

Spectral CT in Emergency.

Spectral CT technology is based on the acquisition of CT images with X-ray at 2 different energy levels which makes possible to distinguish between materials with different atomic numbers using their energy-dependent attenuation, even if those materials have similar density at conventional CT. This kind of technology has gained wide application due to the innumerable uses of their post-processing techniques, including virtual non-contrast images, iodine maps, virtual mono-chromatic images or mixed images without increasing radiation dose. There are several applications of spectral CT in Emergency Radiology that help in the detection, diagnosis and management of various pathologies such as differentiate haemorrhage from the underlaying causative lesion, diagnosis of pulmonary embolisms, demarcation of abscess, characterization of renal stones or reduction of artifacts. The purpose of this review is to provide the emergency radiologist a brief description of the main indications for spectral CT.

The effect of pre-operative sleep quality on post-operative pain and emergence agitation: prospective and cohort study.

OBJECTIVE: Our study aimed to investigate the effect of pre-operative sleep quality on post-operative pain and emergence agitation. MATERIALS AND METHODS: Our study was performed 80 patients with American Society of Anesthesiologists I-II and 18-65 years of age. The patients were divided into poor (Group A, n = 40) and good sleep quality (Group B, n = 40). All patients were operated on under standard general anesthesia. The emergence agitation and pain status of all groups were evaluated in the recovery room and post-operative period. RESULTS: There was no significant difference between the groups regarding demographic data. Post-operative numeric rating scale scores and analgesic consumption were significantly higher in Group A than in Group B (p < 0.05). There was no significant difference between the groups regarding post-operative emergence agitation and extubation quality (p > 0.05). CONCLUSION: In our study, poor pre-operative sleep quality increases post-operative pain and analgesic consumption; however, emergence agitation is not associated with sleep quality in the pre-operative period.

OBJETIVO: Nuestro estudio tuvo como objetivo investigar el efecto de la calidad del sueño preoperatorio sobre el dolor posoperatorio y la agitación de emergencia. MATERIALES Y MÉTODOS: Nuestro estudio se realizó en 80 pacientes con ASA I-II y de 18 a 65 años de edad. Los pacientes se dividieron en mala (grupo A, n = 40) y buena calidad del sueño (grupo B, n = 40). Todos los pacientes fueron operados bajo anestesia general estándar. La agitación de emergencia y el estado del dolor de todos los grupos se evaluaron en la sala de recuperación y en el período postoperatorio. RESULTADOS: No hubo diferencia significativa entre los grupos con respecto a los datos demográficos. Las puntuaciones NRS postoperatorias y el consumo de analgésicos fueron significativamente más altos en el Grupo A que en el Grupo B (p < 0.05). No hubo diferencia significativa entre los grupos con respecto a la agitación de emergencia postoperatoria y la calidad de la extubación (p > 0.05). CONCLUSIÓN: En nuestro estudio, la mala calidad del sueño preoperatorio aumenta el dolor posoperatorio y el consumo de analgésicos; sin embargo, la agitación de emergencia no se asocia con la calidad del sueño en el período preoperatorio.

Prognostic value of metabolic parameters measured by first responders attending patients with severe trauma: associations with the New Injury Severity Score and mortality. / Valor pronóstico de los parámetros metabólicos medidos en la asistencia inicial a pacientes con trauma grave: asociación con la puntuación de la escala NISS y la mortalidad.

OBJECTIVES: Patients with severe or potentially severe trauma must be identified early, a challenge in prehospital settings. This study aimed to analyze the possible diagnostic and prognostic usefulness of analytical markers recorded in the early moments of care. MATERIAL AND METHODS: Observational study of information extracted from the prospective multicenter Code Trauma database for 2016-2019, excluding data for isolated head injuries. Using the New Injury Severity Score (NISS), we classified cases into 4 levels of severity. NISS and mortality were considered the dependent variables in inferential analyses. We calculated the areas under receiver operating characteristic curves, identified optimal cutoff points (Youden index), and calculated positive (PPV) and negative predictive values.. RESULTS: Of the 1039 trauma patients in the registry, 709 were included in the study. Their mean (SD) age was 40.4 (17.3) years, and 77.3% were men. Motorcycle accidents were the most common causes of trauma (in 21%), and mortality was 12.1%. Lactate concentration, pH, PCO2, hemoglobin concentration, hematocrit, and blood sugar were significantly associated with severity and mortality. The PPVs corresponding to pH for the 4 NISS score groups (34-41, 42-49, 50-59, and $ 60) and mortality, respectively, were 61.2, 64.1, 70.7, 62.2, and 66.6. The PPVs of traditionally used clinical variables were lower. CONCLUSION: Patients with more severe trauma had lower pH values and higher PCO2, lactate, and base excess values. PCO2, pH, and blood sugar findings were the best predictors of severity. Metabolic variables are better predictors than traditionally recorded hemodynamic variables.

OBJETIVO: En entornos de emergencia prehospitalarios, la detección temprana de un paciente con trauma grave o potencialmente crítico es un desafío. El objetivo es analizar las posibilidades diagnósticas y pronóstico de los parámetros analíticos obtenidos en los primeros momentos de la asistencia inicial. METODO: Estudio observacional multicéntrico de la base de datos prospectiva "Código Trauma" de 2016-2019 excluyendo el trauma craneoencefálico aislado. La evaluación de las lesiones se realizó utilizando el New Injury Severity Score (NISS). Los pacientes fueron clasificados en 4 grupos según nivel de gravedad. Para el análisis inferencial, las puntuaciones NISS y el resultado de mortalidad se consideraron variables dependientes. Se realizó el análisis de la curva ROC, puntos de corte óptimos mediante el índice de Youden y se calcularon los valores predictivos positivo (VPP) y negativo. RESULTADOS: De los 1.039 pacientes traumatizados del registro, 709 fueron incluidos en el estudio, con una edad media de 40,4 años (DE 17,3), 77,3% eran varones, el mecanismo lesional principal accidentes de moto (21%) y la mortalidad del 12,1%. El pH, lactato, pCO2, hemoglobina, hematocrito y glucemia influyeron significativamente en gravedad y mortalidad. El VPP de mortalidad para pH fue 61,2, 64,1, 70,7, 62,2 y 66,6 para los grupos de NISS 34- 41, 42-49, 50-59 y $ 60 puntos la mortalidad, respectivamente. Las variables clínicas clásicas obtuvieron valores más bajos. CONCLUSIONES: Los pacientes con mayor gravedad presentaron menor pH y concentraciones más altas de pCO2, lactato y exceso de bases. El pH, la pCO2 y la glucemia tuvieron la mayor capacidad predictiva de gravedad. La capacidad predictiva de los valores metabólicos es superior a la de los valores hemodinámicos clásicos.

Moral injury in a global health emergency: a validation study of the Italian version of the Moral Injury Events Scale adjusted to the healthcare setting.

Background: When exposed to events that transgress one's moral beliefs, a plethora of negative consequences may follow, which are captured by the concept of moral injury (MI). Despite its relevance to experiences of healthcare workers during a global health emergency, there is lack of validated MI instruments adapted to the healthcare setting.Objective: The present study aims to provide a validation of the Italian version of the Moral Injury Events Scale (MIES) adjusted to the healthcare setting by assessing its factor structure, internal consistency and construct validity.Methods: A sample of 794 healthcare workers (46% nurses, 51% female) engaged in hospital facilities during the COVID-19 pandemic in Italy completed measures of MI, PTSD, anxiety, depression, burnout, meaning in life and positive affect.Results: Using an exploratory structural equation modelling (ESEM) we assessed the scale factor structure for the entire sample and separately for nurse professional and female healthcare worker groups. Findings support a three-factor solution: Factor 1 'perceived transgressions by others'; Factor 2 'perceived transgressions by self'; and Factor 3 'perceived betrayals by others'. Findings also indicate some level of convergence with measures of PTSD, anxiety, depression and burnout.Conclusion: Results suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency. The low range correlations with measures of psychological distress might potentially indicate that MI, which captures cognitive value judgements rather than manifest symptomatology, may uniquely explain a certain amount of variance. Implications for the development of new empirically derived and theoretical guided tools are discussed, highlighting the need for future research to examine the role of individualising and social binding moral principles in gaining a more nuanced understanding of moral injury experiences amongst healthcare professionals across different socio-cultural settings.

The Italian validation of the MIES adapted to the healthcare setting yielded a three-factor structure: (a) 'perceived transgressions by self'; (b) 'perceived transgressions by others'; (c) 'perceived betrayals by others'.Findings suggest that the MIES may be useful in capturing unique experiences of moral injury amongst healthcare workers engaged in a global health emergency.Future research should consider the role of individualising and social binding moral principles in shaping moral injury experiences among healthcare professionals across different socio-cultural settings.

Some Questions Raised by the Practice of Online Analysis.

In this paper the author explores some of the issues raised by the practice of online analysis. In particular, he emphasizes the difference between the setting and the frame and proposes a theoretical approach of the latter as emerging within the transferential dynamic.

Dans cet article, l'auteur explore certaines des questions soulevées par la pratique de l'analyse en ligne. En particulier, il souligne la différence entre le dispositif et le cadre et propose une approche théorique de ce dernier comme émergeant au sein de la dynamique transférentielle.

En este artículo, el autor explora algunas de las cuestiones que plantea la práctica del análisis virtual. En particular, hace hincapié en la diferencia entre el encuadre y el marco y propone un enfoque teórico de este último como emergente dentro de la dinámica transferencial.

Emergency presentation of abdominal wall hernias: Factors affecting resections and surgical-site complications in complex acute scenarios.

OBJECTIVE: Abdominal wall hernias (AWH) may turn into a complex condition in terms of emergency. This study aims to evaluate the factors which may lead emergency AWH operation to complex surgery. MATERIALS AND METHODS: Univariate and multivariate regression analysis is performed to determine independent factors affecting tissue resection, bowel resection, and surgical-site complications. RESULTS: The type of hernia, time, and content of hernia are independent factors for tissue resection. The time elapsed from the onset of complaints to surgery and comorbid diseases are independent factors for bowel resection. Similarly, the time elapsed from the onset of complaints to surgery and bowel presence in hernia is independent risk factors for surgical-site complications. CONCLUSION: Patients who are operated later than 6 h after the onset of complaints and have comorbidity are more complex surgery.

OBJETIVO: Las hernias de la pared abdominal pueden convertirse en un cuadro complejo en términos de urgencia. Este estudio tiene como objetivo evaluar los factores que pueden llevar a una operación de hernia de la pared abdominal de emergencia a una cirugía compleja. MATERIALS Y MÉTODOS: Se realiza un análisis de regresión univariado y multivariado para determinar los factores independientes que afectan la resección de tejido, la resección intestinal y las complicaciones del sitio quirúrgico. RESULTADOS: El tipo de hernia, el tiempo y el contenido de la hernia son factores independientes para la resección del tejido. El tiempo transcurrido desde el inicio de las molestias hasta la cirugía y las enfermedades comórbidas son factores independientes para la resección intestinal. Del mismo modo, el tiempo transcurrido desde el inicio de las molestias hasta la cirugía y la presencia de intestino en la hernia son factores de riesgo independientes para las complicaciones del sitio quirúrgico. CONCLUSIÓN: Los pacientes que son operados después de las seis horas del inicio de las molestias y presentan comorbilidad son cirugías más complejas.

Changing characteristics of emergency surgery during COVID-19 pandemic: a retrospective cohort study.

BACKGROUND: In other countries, researchers have noticed diverse variations in the features of patients undergoing emergency surgery during the COVID-19 pandemic. In Mexico, there is not information about this issue. METHODS: Workers of the Mexican Government, who required emergency surgeries were studied by the general surgery service of a General Hospital administered by the Institute of Social Security and Services for State Workers Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), through the periods from March-August 2019 (non-exposed) and March-August 2020 (exposed). The analysis included: demographic data, laboratory information, post-operative diagnoses, symptoms' length, days of emergency stay, and post-operative stay. RESULTS: One hundred and ninety-three emergency surgeries were analyzed; 106 in 2019 and 87 in 2020 (a decrease of 18%). Throughout the pandemic, the number of days between the symptoms' onset and surgery was greater: 2019, 7.6 ± 4.6 days; 2020, 14 ± 6.7 days (p < 0.0001). In addition, cases of acute appendicitis decreased (2019-60.3%; 2020-42.5%), and those of acute calculous cholecystitis increased (2019-12.2%; 2020-24.1%). CONCLUSION: Through the COVID-19 pandemic, there were notable changes in the characteristics of Mexican Government's workers who warranted emergency surgery.

ANTECEDENTES: En otros países, han notado diversos cambios en las características de los pacientes sometidos a cirugía de emergencia durante la pandemia de COVID-19. En México no existe información sobre este tema. MÉTODO: Estudiamos a los trabajadores del gobierno mexicano que requirieron tratamiento quirúrgico de emergencia por el servicio de cirugía general de un Hospital General del Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE), durante los periodos de marzo-agosto de 2019 (no expuestos) y marzo-agosto de 2020 (expuestos). El análisis incluyó: datos demográficos, datos de laboratorio, diagnósticos postoperatorios, duración de los síntomas, días de estancia en emergencias y estadía postoperatoria. RESULTADOS: Se analizaron 193 cirugías de emergencia; 106 en 2019 y 87 en 2020 (una disminución del 18%). En la pandemia, el número de días entre el inicio de los síntomas y la cirugía fue mayor: 2019, 7.6 ± 4.6 días; 2020, 14 ± 6.7 días (p < 0.0001). Además, disminuyeron los casos de apendicitis aguda (2019-60,3%; 2020-42,5%) y aumentaron los de colecistitis litiásica aguda (2019-12,2%; 2020-24,1%). CONCLUSIÓN: Durante la pandemia de COVID-19, hubo cambios notables en las características de los trabajadores del gobierno mexicano que ameritaron cirugías de emergencia.

[Analysis of two health attendance models for the non-hospital emergencies in Gipuzkoa: Retrospective study]. / Análisis de dos modelos asistenciales para la atención de las emergencias extrahospitalarias en Guipúzcoa: Estudio retrospectivo.

BACKGROUND AND OBJECTIVE: Out-of-hospital medical emergency services are defined as a functional organization that performs a set of sequential human and material activities. The objective of this study was to compare the mortality of patients attended by the out-of-hospital medical emergency services in 2 neighboring Spanish regions with different models of healthcare transport assistance for emergency care. MATERIAL AND METHOD: Retrospective observational cohort study, done between June 1, 2007 and December 31, 2008 in 2 regions of Gipuzkoa, Alto Deba (AD) and Bajo Deba (BD). The study variables were age, sex and place of exposure (AD/BD), heart rate, blood pressure, initial reason for the call defined by the European Resuscitation Council, unconsciousness and digestive bleeding. 3452 subjects were analyzed. RESULTS: The risk of in situ mortality in BD was 1.31 times higher than in AD (P=.050), that of hospital mortality in BD was 0.71 times lower than in AD (P=.011) and the risk of mortality at one year between counties and the combined mortality (in situ+hospital) did not contribute significant differences. CONCLUSIONS: Mortality (in situ+in-hospital, and one year aftercare) of patients treated by the out-of-hospital emergency medical services in AD (non-medicalized healthcare transport model) was similar to that of the BD region (mixed healthcare transport model).

Incidence of obstetric brachial plexus palsy after a training program in shoulder dystocia.

INTRODUCTION: Shoulder dystocia is a nonpreventable obstetric emergency that causes severe complications, such as obstetric brachial plexus palsy. The objective of the study was to determine the incidence of obstetric brachial plexus palsy and other neonatal complications associated with shoulder dystocia in deliveries managed in a university hospital after the implementation of a simulation-based training that was offered to all the labour and delivery staff on a voluntary basis. MATERIAL AND METHODS: Retrospective observational study including all cases of shoulder dystocia and associated complications (mainly obstetric brachial plexus palsy) documented between January 2017 and December 2020, after the implementation of the training. In addition, we collected retrospective data on cases of obstetric brachial plexus palsy that developed in the hospital before the training (2008-2016). RESULTS: In the 2017-2020 period, in the total of 125 cases of shoulder dystocia (amounting to 1.38% of vaginal deliveries), there were 14 cases of obstetric brachial plexus palsy (11.2% of the cases of shoulder dystocia), 7 clavicle fractures and 1 humerus fracture; none of the cases of obstetric brachial plexus palsy was permanent or required treatment or rehabilitation past six months. In the years preceding the training, there were 7 cases of obstetric brachial plexus palsy, 2 permanent and 5 temporary (3 of which required rehabilitation). CONCLUSION: These results reflect the importance of knowing the morbidity present in the labour and delivery ward and the potential benefit of simulation-based training programmes in the resolution of these obstetric complications.