Reported adverse events during out-of-hospital mechanical ventilation and ventilatory support in emergency medical services and critical care transport crews: a systematic review.

Background: Emergency medical services (EMS) and critical care transport crews constantly face critically-ill patients who need ventilatory support in scenarios where correct interventions can be the difference between life and death; furthermore, challenges like limited staff working on the patient and restricted spaces are often present. Due to these, mechanical ventilation (MV) can be a support by liberating staff from managing the airway and allowing them to focus on other areas; however, these patients face many complications that personnel must be aware of. Aims: To establish the main complications related to out-of-hospital MV and ventilatory support through a systematic review. Methodology: PubMed, BVS and Scopus were searched from inception to July 2021, following the PRISMA guidelines; search strategy and protocol were registered in PROSPERO. Two authors carried out an independent analysis of the articles; any disagreement was solved by mutual consensus, and data was extracted on a pre-determined spreadsheet. Only original articles were included, and risk of bias was assessed with quality assessment tools from the National Institutes of Health. Results: The literature search yielded a total of 2,260 articles, of which 26 were included in the systematic review, with a total of 9,418 patients with out-of-hospital MV; 56.1% were male, and the age ranged from 18 to 82 years. In general terms of aetiology, 12.2% of ventilatory problems were traumatic in origin, and 64.8% were non-traumatic, with slight changes between out-of-hospital settings. Mechanical ventilation was performed 49.2% of the time in prehospital settings and 50.8% of the time in interfacility transport settings (IFTS). Invasive mechanical ventilation was used 98.8% of the time in IFTS while non-invasive ventilation was used 96.7% of the time in prehospital settings. Reporting of adverse events occurred in 9.1% of cases, of which 94.4% were critical events, mainly pneumothorax in 33.1% of cases and hypotension in 27.6% of cases, with important considerations between type of out-of-hospital setting and ventilatory mode; total mortality was 8.4%. Conclusion: Reported adverse events of out-of-hospital mechanical ventilation vary between settings and ventilatory modes; this knowledge could aid EMS providers in promptly recognizing and resolving such clinical situations, depending on the type of scenario being faced.

Association between Body Mass Index with Sugar-Sweetened and Dairy Beverages Consumption in Children from the Mexico-USA Border.

The consumption of sugar-sweetened beverages has been associated with the onset of cardiometabolic diseases. The aim of this study was to describe consumption patterns of sugar-sweetened and dairy beverages and to evaluate their correlation with the body mass index in children residing at the Mexico−USA border. A total of 722 (370 girls, 352 boys) elementary school children aged 9 to 12 years from Tijuana, Mexico, participated in the study. Anthropometric measures were recorded, and a beverage intake questionnaire was completed by the children's parents. Significant age by sex interactions were found on body mass index Z-scores (p < 0.01). Boys showed higher sugar intake (p < 0.05) and total relative energy consumption from sugar (p < 0.05) than girls. The energy consumption from sugar-sweetened and dairy beverages was similar between sexes (p > 0.05). Sugar intake from beverages was higher than the limit recommended by the World Health Organization in boys (66%) and girls (44%). A high frequency of consumption of sugar-sweetened beverages and similar intake of dairy beverages were found in children from the Mexico−USA border. The high consumption of sugar exceeds international recommendations and should be carefully monitored.

Six hundred years of South American tree rings reveal an increase in severe hydroclimatic events since mid-20th century.

South American (SA) societies are highly vulnerable to droughts and pluvials, but lack of long-term climate observations severely limits our understanding of the global processes driving climatic variability in the region. The number and quality of SA climate-sensitive tree ring chronologies have significantly increased in recent decades, now providing a robust network of 286 records for characterizing hydroclimate variability since 1400 CE. We combine this network with a self-calibrated Palmer Drought Severity Index (scPDSI) dataset to derive the South American Drought Atlas (SADA) over the continent south of 12°S. The gridded annual reconstruction of austral summer scPDSI is the most spatially complete estimate of SA hydroclimate to date, and well matches past historical dry/wet events. Relating the SADA to the Australia-New Zealand Drought Atlas, sea surface temperatures and atmospheric pressure fields, we determine that the El Niño-Southern Oscillation (ENSO) and the Southern Annular Mode (SAM) are strongly associated with spatially extended droughts and pluvials over the SADA domain during the past several centuries. SADA also exhibits more extended severe droughts and extreme pluvials since the mid-20th century. Extensive droughts are consistent with the observed 20th-century trend toward positive SAM anomalies concomitant with the weakening of midlatitude Westerlies, while low-level moisture transport intensified by global warming has favored extreme rainfall across the subtropics. The SADA thus provides a long-term context for observed hydroclimatic changes and for 21st-century Intergovernmental Panel on Climate Change (IPCC) projections that suggest SA will experience more frequent/severe droughts and rainfall events as a consequence of increasing greenhouse gas emissions.

Fire damage to cambium affects localized xylem anatomy and hydraulics: the case of Nothofagus pumilio in Patagonia.

PREMISE: Fire scars on trees are created by excessive heat from a fire that kills the vascular cambium. Although, fires are one of the most important forest disturbances in Patagonia, the effects of fire on tree physiology and wood anatomy are still unknown. In this study, we hypothesized that abnormal functioning of the cambium after a fire will induce anatomical changes in the wood. We also assumed that these anatomical changes would affect xylem safety transport. METHODS: We quantified wood anatomical traits in Nothofagus pumilio, the dominant subalpine tree species of Patagonia, using two approaches: time and distance. In the first, anatomical changes in tree rings were compared before, during, and after fire occurrence. In the second, the spatial extent of these changes was evaluated with respect to the wound by measuring anatomical traits in sampling bands in two directions (0° and 45°) with respect to the onset of healing. RESULTS: Reductions in lumen diameter and vessel number were the most conspicuous changes associated with fire damage and observed in the fire ring and subsequent post-fire rings. In addition, the fire ring had more rays than in control rings. In terms of distance, anatomical changes were only restricted to short distances from the wound. CONCLUSIONS: Post-fire changes in wood anatomical traits were confined close to the wound margins. These changes might be associated with a defense strategy related to the compartmentalization of the wound and safety of water transport.

Limitations of Water Resources Infrastructure for Reducing Community Vulnerabilities to Extremes and Uncertainty of Flood and Drought.

Debate and deliberation surrounding climate change has shifted from mitigation toward adaptation, with much of the adaptation focus centered on adaptive practices, and infrastructure development. However, there is little research assessing expected impacts, potential benefits, and design challenges that exist for reducing vulnerability to expected climate impacts. The uncertainty of design requirements and associated government policies, and social structures that reflect observed and projected changes in the intensity, duration, and frequency of water-related climate events leaves communities vulnerable to the negative impacts of potential flood and drought. The results of international research into how agricultural infrastructure features in current and planned adaptive capacity of rural communities in Argentina, Canada, and Colombia indicate that extreme hydroclimatic events, as well as climate variability and unpredictability are important for understanding and responding to community vulnerability. The research outcomes clearly identify the need to deliberately plan, coordinate, and implement infrastructures that support community resiliency.

Influence of precipitation pulses on long-term Prosopis ferox dynamics in the Argentinean intermontane subtropics.

Biological processes in arid communities are associated with episodic precipitation pulses. We postulate that annual to decadal-scale precipitation pulses modulate the dynamics of the intermontane Prepuna woodlands. To study this hypothesis, we have assessed the influence of precipitation pulses on the rates of growth and survival of Prosopis ferox in the Prepuna woodlands during the past century. Tree ages from several P. ferox stands were used to reconstruct the establishment patterns at each sampling site. Ring-width chronologies provided the basis to assess the influence of annual versus multiannual precipitation pulses on radial growth and establishment over time. Both the radial growth and the stand dynamics of P. ferox at the regional scale were found to be largely modulated by climate, with precipitation the dominant factor influencing interannual variations in P. ferox ring-widths. Our analysis of dendrochronological dating data on 885 individuals of P. ferox revealed a period of abundant establishment from the mid-1970s to beginning of 1990 s, which is coincident with an interval of remarkable above-average precipitation. However, tree-growth and establishment patterns at the local scale in the Prepuna also reflected land-use changes, particularly long-term variations in livestock intensity. The P. ferox dynamics documented here substantiates the hierarchical concept of "resource-pulse" in dry ecosystems, with precipitation pulses of different lengths modulating distinct dynamic processes in the P. ferox woodlands. Interannual variations in precipitation influence year-to-year patterns of P. ferox radial growth, whereas multiannual oscillations in rainfall influence episodic events of tree establishment. The long-term interval considered in this study enabled us to disentangle the roles of natural versus human controls on P. ferox dynamics in the region.