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England switched to an opt-out system of consent in 2020 aiming to increase the number of organs available. Spain also operates an opt-out system yet has almost twice the organ donations per million population compared with England. We aimed to identify both differences and similarities in the consent policies, documents and procedures in deceased donation between the two countries using comparative qualitative content and discourse analysis. Spain had simpler, locally tailored documents, the time taken for families to review and process information may be shorter, there were more pathways leading to organ donation in Spain, and more robust legal protections for the decisions individuals made in life. The language in the Spanish documents was one of support and reassurance. Documents in England by comparison appeared confusing, since additions were designed to protect the NHS against risk and made to previous document versions to reflect the law change rather than being entirely recast. If England's ambition is to achieve consent rates similar to Spain this analysis has highlighted opportunities that could strengthen the English system-by giving individuals' decisions recorded on the organ donor register legal weight, alongside unifying and simplifying consent policies and procedures to support families and healthcare professionals.
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Consentimiento Informado , Obtención de Tejidos y Órganos , Humanos , Obtención de Tejidos y Órganos/legislación & jurisprudencia , España , Inglaterra , Consentimiento Informado/legislación & jurisprudencia , Donantes de Tejidos/legislación & jurisprudencia , Toma de DecisionesRESUMEN
International evidence shows variation in organ donation and transplantation (ODT) based upon a range of patient characteristics. What is less well understood is the impact of patient "ethnicity/race/immigration background," as these terms are defined and intended differently across countries. We also know that these characteristics do not operate in isolation but intersect with a range of factors. In this paper, we propose a framework that seeks to clarify the definition of the key terms "ethnicity/race/migrant" and to review how these communities are operationalized across European studies about inequities in ODT. Further, patients and the public wish to see Equality Diversity Inclusion (EDI) approaches in their everyday lives, not just in relation to ODT. We propose a 'care pathway/whole-systems' approach to ODT encompassing culturally competent public health interventions for a) the prevention and management of chronic diseases, b) improvements in public engagement for the promotion of the culture of ODT and enhancements in end-of-life care, through to c) enhanced likelihood of successful transplant among migrant/ethnic minority communities. Our framework recognizes that if we truly wish to take an EDI approach to ODT, we need to adopt a more social, human and holistic approach to examining questions around patient ethnicity.
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Obtención de Tejidos y Órganos , Migrantes , Humanos , Vías Clínicas , Minorías Étnicas y Raciales , Etnicidad , Grupos MinoritariosRESUMEN
Pulmonary embolism (PE) is a common medical condition associated with significant morbidity and mortality. It is the third most common cause of death in the United States. Historically, surgery for PE was associated with a high mortality rate, and this led to a significant decrease in the volume of operations being performed. However, significant improvements in patient selection and outcomes for surgical pulmonary embolectomy (SPE) at the end of the 20th century led to a renewed interest in the procedure. SPE was historically reserved for patients presenting with acute PE and hemodynamic collapse or cardiac arrest. Contemporary data has provided sufficient evidence to support earlier intervention for patients with acute PE who demonstrate clinical, laboratory, and echocardiographic signs of right ventricular dysfunction. Institutions with cardiac surgery capabilities are implementing SPE earlier for the management of both massive and submassive PEs with excellent short-term and long-term outcomes. Recently, venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been employed successfully to treat patients with massive PE. Excellent short-term outcomes have been reported for patients suffering from PE after treatment with VA-ECMO. Further research, specifically with randomized controlled trials, is needed to determine the appropriate timing and patient selection for the use of VA-ECMO in patients with PE. These data would lead to updated guidelines and algorithms incorporating VA-ECMO and SPE for patients with PE.
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Oxigenación por Membrana Extracorpórea , Embolia Pulmonar , Enfermedad Aguda , Embolectomía , Humanos , Embolia Pulmonar/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/terapiaRESUMEN
The endpoint in emergent management of acute massive pulmonary embolism (PE) has traditionally been with embolectomy through a standard median sternotomy. This approach is limited in both exposure and concomitant functional morbidity associated with sternotomy. In a previous publication, we described a novel minimally invasive, thoracoscopically assisted approach to pulmonary embolectomy. This approach utilized a small 5-cm left upper parasternal thoracotomy and femoral cardiopulmonary bypass to conduct thoracoscopically assisted surgical pulmonary embolectomy. The first publication featured three patients that had a massive pulmonary embolus that was treated with minimally invasive pulmonary embolectomy, and the initial data was positive and suggested that this approach is safe and feasible. We now broaden our experience with another two patients who underwent this approach, and highlight a number of technical and management modifications that have been made to optimize the procedure. These lessons learned will ideally benefit future surgeons as this approach is more heavily implemented in practice.
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Embolectomía , Embolia Pulmonar , Embolectomía/métodos , Humanos , Embolia Pulmonar/cirugía , Esternotomía , Toracotomía , Resultado del TratamientoRESUMEN
BACKGROUND: 2D baseline and follow-up clinical images are potentially subject to inconsistency due to alteration of imaging parameters. However, no study to date has attempted to quantify the magnitude by which such images can be influenced. OBJECTIVE: The objective of the present study is to identify the magnitude by which images can be influenced by changing the imaging light angle. METHODS: This study is based on the evaluation of 2D frontal images of the face and included a total of 51 subjects of which n = 14 were males and n = 37 were females. Faces were photographed at 0°, 30°, and 60° light angle under identical and standardized conditions. Images were randomized and rated by 27 blinded raters for age, facial attractiveness, body mass index (BMI), temporal hollowing, lower cheek fullness, nasolabial sulcus severity, and jawline contour. RESULTS: Facial attractiveness decreased, facial unattractiveness increased and the evaluated BMI (based on facial assessment) increased statistically significantly at 60°. The assessment of regional facial scores, i.e., temporal hollowing, lower cheek fullness, and jawline contour, showed no statistically meaningful changes both at 30° and at 60° light angle. CONCLUSION: The results indicate that there might be an observed blind range in light angle (0°-30°) which does not influence facial assessment. Increasing the light angle past the threshold value to 60° might result in a statistically significant impact on facial perception which should be accounted for when documenting and/or presenting facial 2D images. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Cara , Fotograbar , Estética , Femenino , Humanos , Masculino , Percepción , SensaciónRESUMEN
INTRODUCTION: Cardiometabolic syndrome (CMS) is diabetes mellitus (or insulin resistance) plus any two of the following risk factors: hypertension, obesity, and hyperlipidemia. The correlation of metabolic syndrome with cardiovascular disease and the increase in the prevalence of patients with risk factors have solidified the importance of continued focus on metabolic syndrome. We retrospectively evaluated single-center data to determine if there is an association between CMS and outcomes. METHODS: The local Society of Thoracic Surgeons Adult Cardiac Database was queried for consecutive coronary bypass (CABG) cases from 2002 to 2010. Short and long-term outcomes were compared between groups of patients with CMS and then risk-adjusted using multiple regression models with adjusted odds ratios and hazard ratios. RESULTS: Of 11 021 CABG cases, 3881 (35.2%) had CMS, with an annual prevalence that increased from 32% to 40% during the study. Patients with CMS were more likely to have prior cerebrovascular diseases, strokes, renal insufficiency, and worse New York Heart Association status. Unadjusted postoperative comparisons revealed that patients with CMS had higher rates of stroke, renal failure, dialysis, deep sternal wound infection, and longer intensive care unit and hospital length of stay. Risk-adjusted odds ratios did not reveal a significant impact on short-term outcomes, however, adjusted hazard ratios continued to demonstrate significant decreases in long-term survival in patients with CMS. CONCLUSIONS: Patients with CMS were more likely to present with increased comorbidities. Patients with CMS undergoing CABG were at risk for worse short-term secondary postoperative outcomes and reduced long-term survival. The data supports the need for further investigation for risk reduction surrounding operative revascularization.
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Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Síndrome Metabólico/cirugía , Anciano , Enfermedad de la Arteria Coronaria/mortalidad , Humanos , Hiperlipidemias , Hipertensión , Resistencia a la Insulina , Tiempo de Internación , Modelos Logísticos , Masculino , Síndrome Metabólico/mortalidad , Persona de Mediana Edad , Obesidad , Complicaciones Posoperatorias/epidemiología , Insuficiencia Renal , Estudios Retrospectivos , Riesgo , Accidente Cerebrovascular , Tasa de Supervivencia , Síndrome , Resultado del TratamientoAsunto(s)
Trasplante de Órganos , Obtención de Tejidos y Órganos , Humanos , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/ética , Trasplante de Órganos/ética , Trasplante de Órganos/legislación & jurisprudencia , Donantes de Tejidos/legislación & jurisprudencia , Donantes de Tejidos/éticaRESUMEN
BACKGROUND: Sarcosine has been investigated as a prostate cancer biomarker with mixed results concerning its predictive power. We performed a case-control evaluation of the predictive value of serum sarcosine for early detection in a population-based cohort of men undergoing prostate-specific antigen (PSA) screening. METHODS: For analysis we used 251 cancer cases and 246 age-matched non-cancer cases from the San Antonio Biomarkers Of Risk (SABOR) screening study. For cancer cases, pre-diagnostic serum was utilized for sarcosine measurement. Controls were defined as men who had been followed at least for 5 years on study with no prostate cancer diagnosis; sarcosine was measured on the initial baseline serum. HPLC-electrospray ionization mass spectrometry was used for serum sarcosine quantification. The association of sarcosine with prostate cancer was assessed using area underneath the receiver-operating characteristic curve (AUC), and logistic regression adjusting for PSA, digital rectal exam, family history, age, race, and history of a prior negative biopsy. Among cancer cases, nominal logistic regression was used for the association of sarcosine with Gleason grade. RESULTS: Sarcosine levels were overlapping between the prostate cancer cases (median 15.8 uM, range 6.2 to 42.5 uM) and controls (median 16.2 uM, range 6.4 to 53.6 uM). The AUC of sarcosine was not statistically different from random chance either for participants with any PSA value (52.2 %) or those with PSA values in the range of 2 to 10 ng/mL (54.3 %). Sarcosine was not predictive of Gleason score and added no independent predictive power to standard prostate cancer risk factors for detection of prostate cancer (all p-values > 0.05). CONCLUSIONS: Serum sarcosine should not be pursued further as a marker for the early detection of prostate cancer.
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Biomarcadores de Tumor/sangre , Detección Precoz del Cáncer/métodos , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/diagnóstico , Sarcosina/sangre , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Objective: A novel simulator developed to offer hands-on practice for the stapled side-to-side cervical esophagogastric anastomosis was tested previously in a single-center study that supported its value in surgical education. This multi-institutional trial was undertaken to evaluate validity evidence from 6 independent thoracic surgery residency programs. Methods: After a virtual session for simulation leaders, learners viewed a narrated video of the procedure and then alternated as surgeon or first assistant. Using an online survey, perceived value was measured across fidelity domains: physical attributes, realism of materials, realism of experience, value, and relevance. Objective assessment included time, number of sutures tearing, bubble test, and direct inspection. Comparison across programs was performed using the Kruskal-Wallis test. Results: Surveys were completed by 63 participants as surgeons (17 junior and 20 senior residents, 18 fellows, and 8 faculty). For 3 of 5 tasks, mean ratings of 4.35 to 4.44 correlated with "somewhat easy" to "very easy" to perform. The interrupted outer layer of the anastomosis rated lowest, suggesting this task was the most difficult. The simulator was rated as a highly valuable training tool. For the objective measurements of performance, "direct inspection" rated highest followed by "time." A total of 90.5% of participants rated the simulator as ready for use with only minor improvements. Conclusions: Results from this multi-institutional study suggest the cervical esophagogastric anastomosis simulator is a useful adjunct for training and assessment. Further research is needed to determine its value in assessing competence for independent operating and associations between improved measured performance and clinical outcomes.
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BACKGROUND AND OBJECTIVES: Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe. METHODS: A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis. RESULTS: Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31). CONCLUSIONS: In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.
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Emigrantes e Inmigrantes , Trasplante de Riñón , Adulto , Niño , Humanos , Europa (Continente) , Emigración e Inmigración , EtnicidadRESUMEN
There are many outdoor robotic applications where a robot must reach a goal position or explore an area without previous knowledge of the environment around it. Additionally, other applications (like path planning) require the use of known maps or previous information of the environment. This work presents a system composed by a terrestrial and an aerial robot that cooperate and share sensor information in order to address those requirements. The ground robot is able to navigate in an unknown large environment aided by visual feedback from a camera on board the aerial robot. At the same time, the obstacles are mapped in real-time by putting together the information from the camera and the positioning system of the ground robot. A set of experiments were carried out with the purpose of verifying the system applicability. The experiments were performed in a simulation environment and outdoor with a medium-sized ground robot and a mini quad-rotor. The proposed robotic system shows outstanding results in simultaneous navigation and mapping applications in large outdoor environments.
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BACKGROUND: Previous clinical and anatomic investigations have identified the clinical relevance of facial biomechanics. Based on this new understanding, principles for facial aesthetic procedures were established: Lateral Face First, Deep Layers First, and Upper Face First. OBJECTIVE: To test the upper face first principle by showing that an injection sequence, starting in the upper face is superior to an injection sequence starting in the lower face. METHODS: This study was designed as an interventional split-face study administering the same amount and type of soft tissue filler for the upper, middle, and lower face but in a different sequence: upper, middle, lower face versus lower, middle, and upper face. A total of 15 patients (5 males and 10 females) with a mean age of 39.4 years (9.6) and a mean BMI of 23.4 kg/m2 (1.7) were studied. Follow-up at D0, D30, and D90 was conducted utilizing semiquantitative scores and objective 3D imaging. RESULTS: Despite not reaching statistical significance, midfacial volume and jawline contouring were rated better at every follow-up visit (D0, D30, D90) when treated with the upper versus the lower face first injection algorithm. The global aesthetic improvement scale showed statistically significantly better values for the upper face first algorithm when compared to the lower face first algorithm at all evaluated time points with all p < 0.001. CONCLUSION: Applying the upper face first injection algorithm seems to result in better aesthetic outcomes when directly compared to the lower face first algorithm. Semiquantitative and objective outcome measurements confirm its clinical effectiveness.
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Técnicas Cosméticas , Masculino , Femenino , Humanos , Adulto , Estudios Prospectivos , Resultado del Tratamiento , Inyecciones , CaraRESUMEN
Maternal physiological hypercholesterolemia MPH, maternal total cholesterol (TC) levels at term of pregnancy ≤280 mg/dL) occurs to assure fetal development. Maternal supraphysiological hypercholesterolemia (MSPH, TC levels >280 mg/dL) is a pathological condition associated with maternal, placental, and fetal endothelial dysfunction and early neonatal atherosclerosis development. Small extracellular vesicles (sEVs) are delivered to the extracellular space by different cells, where they modulate cell functions by transporting active signaling molecules, including proteins and miRNA. AIM: To determine whether sEVs from MSPH women could alter the function of endothelial cells (angiogenesis, endothelial activation and nitric oxide synthesis capacity). METHODS: This study included 24 Chilean women (12 MPH and 12 MSPH). sEVs were isolated from maternal plasma and characterized by sEV markers (CD9, Alix and HSP70), nanoparticle tracking analysis, transmission electron microscopy, and protein and cholesterol content. The endothelial cell line HMEC-1 was used to determine the uptake of labeled sEVs and the effects of sEVs on cell viability, endothelial tube formation, endothelial cell activation, and endothelial nitric oxide expression and function. RESULTS: In MSPH women, the plasma concentration of sEVs was increased compared to that in MPH women. MSPH-sEVs were highly taken up by HMEC-1 cells and reduced angiogenic capacity and the expression and activity of eNOS without changing cell viability or endothelial activation compared to MPH-sEVs. CONCLUSION: sEVs from MSPH women impair angiogenesis and nitric oxide synthesis in endothelial cells, which could contribute to MSPH-associated endothelial dysfunction.
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Vesículas Extracelulares , Hipercolesterolemia , Recién Nacido , Femenino , Humanos , Embarazo , Hipercolesterolemia/metabolismo , Células Endoteliales/metabolismo , Mujeres Embarazadas , Placenta/metabolismo , Óxido Nítrico/metabolismo , Colesterol/metabolismo , Vesículas Extracelulares/metabolismoRESUMEN
BACKGROUND: We aim to identify the incidence and timing of dysfunction and failure of stented bioprosthetic valves in the pulmonary position in congenital heart disease patients. METHODS: A total of 482 congenital heart disease patients underwent 484 stented bioprosthetic pulmonary valve implantations between 2008 and 2018. There were 164 porcine valves (Porcine) and 320 bovine pericardial valves (Pericardial) implanted. Primary endpoints were survival, valve dysfunction, and valve failure. RESULTS: Pericardial valves were implanted in older patients (22.0, interquartile range [IQR] 14-33 vs 16.0, IQR 11-23 years, P < 0.001). Five-year survival (96.7% vs 97.9%) for the Pericardial and Porcine groups, respectively, were similar, P > 0.05. Forty-six (34%) Porcine and 75 (27%) Pericardial group patients met criteria for valve dysfunction at a median echocardiographic follow-up time of 7.43 years (IQR 4.1-9.5 years) and 3.26 years (IQR 1.7-4.7 years), respectively. More Pericardial group patients suffered from at least mild late PR while late median peak gradient was higher in the Porcine group, P < .001 for both. Risk factors for valve dysfunction included decreasing patient age for the entire cohort (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.00-1.04, P = .015) and lack of anticoagulation at discharge for the Porcine group (HR 3.06, 95% CI 1.03-9.10, P = .044) but not the Pericardial group. Five-year cumulative incidence of dysfunction was 39% for the Pericardial group and 17% for the Porcine group. CONCLUSIONS: Porcine stented and bovine pericardial stented valves can be implanted in the pulmonary position in all age groups safely. However, despite similar rates of valve failure, bovine pericardial stented valves have a higher incidence of valve dysfunction at mid-term follow-up.
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Bioprótesis , Cardiopatías Congénitas , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Válvula Pulmonar , Animales , Bovinos , Porcinos , Válvula Pulmonar/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Bioprótesis/efectos adversos , Cardiopatías Congénitas/cirugía , Cardiopatías Congénitas/etiología , Diseño de Prótesis , Válvula Aórtica/cirugíaRESUMEN
Ecuador has both high richness and high endemism, which are increasingly threatened by anthropic pressures, including roads. Research evaluating the effects of roads remains scarce, making it difficult to develop mitigation plans. Here, we present the first national assessment of wildlife mortality on roads that allow us to (1) estimate roadkill rates per species, (2) identify affected species and areas, and (3) reveal knowledge gaps. We bring together data from systematic surveys and citizen science efforts to present a dataset with 5010 wildlife roadkill records from 392 species, and we also provide 333 standardized corrected roadkill rates calculated on 242 species. Systematic surveys were reported by ten studies from five Ecuadorian provinces, revealing 242 species with corrected roadkill rates ranging from 0.03 to 171.72 ind./km/year. The highest rates were for the yellow warbler Setophaga petechia in Galapagos (171.72 ind./km/year), the cane toad Rhinella marina in Manabi (110.70 ind./km/year), and the Galapagos lava lizard Microlophus albemarlensis (47.17 ind./km/year). Citizen science and other nonsystematic monitoring provided 1705 roadkill records representing all 24 provinces in Ecuador and 262 identified species. The common opossum Didelphis marsupialis, the Andean white-eared opossum Didelphis pernigra, and the yellow warbler Setophaga petechia were more commonly reported (250, 104, and 81 individuals, respectively). Across all sources, we found 15 species listed as "Threatened" and six as "Data Deficient" by the IUCN. We recommend stronger research efforts in areas where the mortality of endemic or threatened species could be critical for populations, such as in Galapagos. This first country-wide assessment of wildlife mortality on Ecuadorian roads represents contributions from academia, members of the public, and government, underlining the value of wider engagement and collaboration. We hope these findings and the compiled dataset will guide sensible driving and sustainable planning of infrastructure in Ecuador and, ultimately, contribute to reduce wildlife mortality on roads.
Ecuador tiene gran riqueza y alto endemismo de especies, mismas que están amenazadas por presiones antrópicas como las carreteras. Sin embargo, la investigación en este campo es escasa, dificultando el desarrollo de planes de mitigación. Presentamos la primera evaluación nacional de mortalidad de fauna silvestre en carreteras que nos permite 1) estimar tasas de atropellamiento por especies, 2) identificar especies y áreas afectadas, y 3) revelar vacíos de información. Compilamos datos de estudios sistemáticos y esfuerzos de ciencia ciudadana en Ecuador para presentar una base de datos que comprende 5010 registros de atropellamientos correspondientes a 392 especies, también proveemos 333 tasas de atropellamiento estandarizadas para 242 especies. Monitoreos sistemáticos fueron reportados por diez estudios de cinco provincias del Ecuador, revelando 242 especies con una tasa de mortalidad que varía entre 0.03 y 171.72 ind./km/año. Las tasas de atropellamiento más altas correspondieron a la reinita amarilla Setophaga petechia en Galápagos (171.72 ind./km/año), el sapo de la caña Rhinella marina in Manabí (110.70 ind./km/año), y la lagartija de lava de Galápagos Microlophus albemarlensis (47.17 ind./km/año). La ciencia ciudadana y monitoreos no sistemáticos proporcionaron 1705 registros representando a las 24 provincias de Ecuador y a 262 especies identificadas. La zarigüeya común Didelphis marsupialis, la zarigüeya orejiblanca andina Didelphis pernigra y la reinita amarilla Setophaga petechia fueron las más reportadas (250, 104 y 81 individuos respectivamente). Considerando todas las fuentes de datos encontramos 15 especies clasificadas como amenazadas y seis como datos insuficientes por la UICN. Recomendamos mayores esfuerzos de investigación en áreas donde la mortalidad de especies endémicas o amenazadas puede ser crítica para las poblaciones, como en Galápagos. Esta primera evaluación de mortalidad silvestre en carreteras ecuatorianas representa contribuciones de varios sectores, incluidos la academia, ciudadanía y el gobierno, resaltando el valor de una mayor participación y colaboración. Esperamos que estos hallazgos y la base de datos guíen la planificación sostenible de infraestructuras viales en Ecuador y contribuyan a reducir la mortalidad animal en las carreteras por medio de una conducción vehicular más cautelosa.
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To protect biodiversity we must understand its structure and composition including the bacteria and microparasites associated with wildlife, which may pose risks to human health. However, acquiring this knowledge often presents challenges, particularly in areas of high biodiversity where there are many undescribed and poorly studied species and funding resources can be limited. A solution to fill this knowledge gap is sampling roadkill (animals that die on roads as a result of collisions with circulating vehicles). These specimens can help characterize local wildlife and their associated parasites with fewer ethical and logistical challenges compared to traditional specimen collection. Here we test this approach by analyzing 817 tissue samples obtained from 590 roadkill vertebrate specimens (Amphibia, Reptilia, Aves and Mammalia) collected in roads within the Tropical Andes of Ecuador. First, we tested if the quantity and quality of recovered DNA varied across roadkill specimens collected at different times since death, exploring if decomposition affected the potential to identify vertebrate species and associated microorganisms. Second, we compared DNA stability across taxa and tissues to identify potential limitations and offer recommendations for future work. Finally, we illustrate how these samples can aid in taxonomic identification and parasite detection. Our study shows that sampling roadkill can help study biodiversity. DNA was recovered and amplified (allowing species identification and parasite detection) from roadkill even 120 hours after death, although risk of degradation increased overtime. DNA was extracted from all vertebrate classes but in smaller quantities and with lower quality from amphibians. We recommend sampling liver if possible as it produced the highest amounts of DNA (muscle produced the lowest). Additional testing of this approach in areas with different environmental and traffic conditions is needed, but our results show that sampling roadkill specimens can help detect and potentially monitor biodiversity and could be a valuable approach to create biobanks and preserve genetic data.
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Animales Salvajes , Bancos de Muestras Biológicas , Animales , Humanos , Vertebrados , Mamíferos , Anfibios , ADNRESUMEN
The application of lidar remote-sensing technology has revolutionized the practice of settlement and landscape archaeology, perhaps nowhere more so than in the Maya lowlands. This contribution presents a substantial lidar dataset from the Puuc region of Yucatan, Mexico, a cultural subregion of the ancient Maya and a distinct physiographic zone within the Yucatan peninsula. Despite the high density of known sites, no large site has been fully surveyed, and little is known about intersite demography. Lidar technology allows determination of settlement distribution for the first time, showing that population was elevated but nucleated, although without any evidence of defensive features. Population estimates suggest a region among the most densely settled within the Maya lowlands, though hinterland levels are modest. Lacking natural bodies of surface water, the ancient Puuc inhabitants relied upon various storage technologies, primarily chultuns (cisterns) and aguadas (natural or modified reservoirs for potable water). Both are visible in the lidar imagery, allowing calculation of aguada capacities by means of GIS software. The imagery also demonstrates an intensive and widespread stone working industry. Ovens visible in the imagery were probably used for the production of lime, used for construction purposes and perhaps also as a softening agent for maize. Quarries can also be discerned, including in some cases substantial portions of entire hills. With respect to agriculture, terrain classification permits identification of patches of prime cultivable land and calculation of their extents. Lidar imagery also provides the first unequivocal evidence for terracing in the Puuc, indeed in all northern Yucatan. Finally, several types of civic architecture and architectural complexes are visible, including four large acropolises probably dating to the Middle Formative period (700-450 B.C.). Later instances of civic architecture include numerous Early Puuc Civic Complexes, suggesting a common form of civic organization at the beginning of the Late Classic demographic surge, (A.D. 600-750).
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Arqueología/métodos , Tecnología de Sensores Remotos/métodos , Civilización , Geografía , Historia Antigua , Rayos Láser , MéxicoRESUMEN
We describe a new species of Pristimantis from southern Ecuador, province of Zamora Chinchipe. The new species is closely related to an undescribed species of Pristimantis from Reserva Tapichalaca, Ecuador and with species of a clade historically assigned to the P. unistrigatus species group, such as P. parvillus, P. luteolateralis, P. walkeri, among others. The new species of Pristimantis is a miniaturized new frog (females 17.11.1 mm; males 13.20.9 mm), characterized by the presence of -shaped scapular folds, with two subconical tubercles on the medial and posterior regions of folds; tympanic membrane and tympanic annulus present but not externally visible; a prominent rostral papilla present; upper eyelid with one elongated conical tubercle; a conical tubercle on heels; groin with orange or yellow spots. The new species of Pristimantis is distributed in a restricted area in the Cordillera del Condor, a highly-diverse mountain range threatened by multiple anthropogenic activities. We recommend assigning the new species to the Endangered IUCN threatened category because it is only known from three nearby localities within mining concessions.
Asunto(s)
Anuros , Aves , Distribución Animal , Animales , Ecuador , Femenino , Masculino , FilogeniaRESUMEN
The shortage of available organ donors is a significant problem worldwide, and various efforts have been carried out to avoid the loss of potential organ donors. Among them, organ donation from cardiocirculatory deceased donors (DCD), in which withdrawal of life-sustaining therapies is ongoing (Maastricht type III donors), is one emerging strategy. Thanks to the latest advances in transplantation and organ preservation, such as normothermic regional perfusion (NRP), ex vivo perfusion techniques, and good organization and communication among prehospital care providers, emergency departments, intensive care units, and transplantation units, DCD is rapidly increasing; it's estimated that it will increase the number of donations of lungs and splanchnic organs by more than 40%. Although Maastricht type II DCD requires a 24/7 available experienced extra corporeal membrane oxygenation (ECMO) team in the institution, Maastricht DCD type III could be organized in secondary care and spoke hospitals without in loco ECMO facilities for NRP. This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.