RESUMEN
INTRODUCTION: Studies show that pediatric trauma centers produce better outcomes and reduced mortality for injured children. Yet, most children do not have timely access to a pediatric trauma center and require stabilization locally with subsequent transfer. Investigators have demonstrated that pediatric transport teams (PTT) improve outcomes for critically ill children; however, these studies did not differentiate outcomes for injured children. It may be that moderate to severely injured children actually fare worse with PTT due to slower transport times inherent to their remote locations and thus delays in important interventions. OBJECTIVE: The purpose of this study was to determine if outcomes for injured children are affected by use of PTT for inter-hospital transfer. METHODS: We conducted a retrospective chart review of 1,177 children transferred to a pediatric trauma center for injury care between March 1st, 2012 and December 31st, 2013. We compared children who were transported by PTT (ground/air) to those transported by ground advanced life support (ALS) and air critical care (ACC). We described patient characteristics and transport times. For PTT vs. ALS and ACC, we compared hospital length of stay (LOS), transport interventions and adverse events. RESULTS: 1,177 injured children were transferred by the following modes: 68% ALS, 13% ACC, 11% Ground PTT, and 9% Air PTT. Children transported by PTT were younger and had higher ISS and lower GCS scores. PTT had a longer total transport time, departure preparation time, and patient bedside time. After controlling for age, ISS, GCS, transport mode, distance, and time, we found no significant difference in LOS between PTT vs. ALS and ACC. A subgroup analysis of children with higher ISS scores demonstrated a 65% longer LOS for children transported by ACC vs. PTT. There were no differences between transport teams with regard to acidosis, hypocarbia or hypercarbia, or maintenance of tubes and lines. CONCLUSIONS: Children transported by PTT were younger and sicker (vs. ACC and ALS). Despite longer transport times, children transported by PTT did not have a longer hospital LOS or adverse events during transport. However, for those children with higher ISS, transport by ACC resulted in longer hospital LOS vs. PTT.
Asunto(s)
Hospitales Pediátricos/normas , Grupo de Atención al Paciente/normas , Transferencia de Pacientes/normas , Centros Traumatológicos/normas , Heridas y Lesiones/terapia , Niño , Humanos , Evaluación de Resultado en la Atención de Salud , Grupo de Atención al Paciente/organización & administración , Transferencia de Pacientes/organización & administración , Estudios RetrospectivosRESUMEN
Bioturbators shape their environment with considerable consequences for ecosystem processes. However, both the composition and the impact of bioturbator communities may change along climatic gradients. For burrowing animals, their abundance and composition depend on climatic and other abiotic components, with ants and mammals dominating in arid and semiarid areas, and earthworms in humid areas. Moreover, the activity of burrowing animals is often positively associated with vegetation cover (biotic component). These observations highlight the need to understand the relative contributions of abiotic and biotic components in bioturbation in order to predict soil-shaping processes along broad climatic gradients. In this study, we estimated the activity of animal bioturbation by counting the density of holes and the quantity of bioturbation based on the volume of soil excavated by bioturbators along a gradient ranging from arid to humid in Chile. We distinguished between invertebrates and vertebrates. Overall, hole density (no/ 100 m2) decreased from arid (raw mean and standard deviation for invertebrates: 14 ± 7.8, vertebrates: 2.8 ± 2.9) to humid (invertebrates: 2.8 ± 3.1, vertebrates: 2.2 ± 2.1) environments. However, excavated soil volume did not follow the same clear geographic trend and was 300-fold larger for vertebrates than for invertebrates. The relationship between bioturbating invertebrates and vegetation cover was consistently negative whereas for vertebrates both, positive and negative relationships were determined along the gradient. Our study demonstrates complex relationships between climate, vegetation and the contribution of bioturbating invertebrates and vertebrates, which will be reflected in their impact on ecosystem functions.
Asunto(s)
Ecosistema , Invertebrados , Animales , Chile , Mamíferos , Suelo , VertebradosRESUMEN
Chrysophytes are a large group of heterotrophic, phototrophic, or even mixotrophic protists that are abundant in aquatic as well as terrestrial environments. Although much is known about chrysophyte biology and ecology, it is unknown if they are sexual or not. Here we use available transcriptomes of 18 isolates of 15 putatively asexual species to inventory the presence of genes used in meiosis. Since we were able to detect a set of nine meiosis-specific and 29 meiosis-related genes shared by the chrysophytes, we conclude that they are secretively sexual and therefore should be investigated further using genome sequencing to uncover any missed genes from the transcriptomes.