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.

Global wood anatomical perspective on the onset of the Late Antique Little Ice Age (LALIA) in the mid-6th century CE.

Linked to major volcanic eruptions around 536 and 540 CE, the onset of the Late Antique Little Ice Age has been described as the coldest period of the past two millennia. The exact timing and spatial extent of this exceptional cold phase are, however, still under debate because of the limited resolution and geographical distribution of the available proxy archives. Here, we use 106 wood anatomical thin sections from 23 forest sites and 20 tree species in both hemispheres to search for cell-level fingerprints of ephemeral summer cooling between 530 and 550 CE. After cross-dating and double-staining, we identified 89 Blue Rings (lack of cell wall lignification), nine Frost Rings (cell deformation and collapse), and 93 Light Rings (reduced cell wall thickening) in the Northern Hemisphere. Our network reveals evidence for the strongest temperature depression between mid-July and early-August 536 CE across North America and Eurasia, whereas more localised cold spells occurred in the summers of 532, 540-43, and 548 CE. The lack of anatomical signatures in the austral trees suggests limited incursion of stratospheric volcanic aerosol into the Southern Hemisphere extra-tropics, that any forcing was mitigated by atmosphere-ocean dynamical responses and/or concentrated outside the growing season, or a combination of factors. Our findings demonstrate the advantage of wood anatomical investigations over traditional dendrochronological measurements, provide a benchmark for Earth system models, support cross-disciplinary studies into the entanglements of climate and history, and question the relevance of global climate averages.

Understanding climate change impacts on biome and plant distributions in the Andes: Challenges and opportunities.

Aim: Climate change is expected to impact mountain biodiversity by shifting species ranges and the biomes they shape. The extent and regional variation in these impacts are still poorly understood, particularly in the highly biodiverse Andes. Regional syntheses of climate change impacts on vegetation are pivotal to identify and guide research priorities. Here we review current data, knowledge and uncertainties in past, present and future climate change impacts on vegetation in the Andes. Location: Andes. Taxon: Plants. Methods: We (i) conducted a literature review on Andean vegetation responses to past and contemporary climatic change, (ii) analysed future climate projections for different elevations and slope orientations at 19 Andean locations using an ensemble of model outputs from the Coupled Model Intercomparison Project 5, and (iii) calculated changes in the suitable climate envelope area of Andean biomes and compared these results to studies that used species distribution models. Results: Future climatic changes (2040-2070) are projected to be stronger at high-elevation areas in the tropical Andes (up to 4°C under RCP 8.5), while in the temperate Andes temperature increases are projected to be up to 2°C. Under this worst-case scenario, temperate deciduous forests and the grasslands/steppes from the Central and Southern Andes are predicted to show the greatest losses of suitable climatic space (30% and 17%-23%, respectively). The high vulnerability of these biomes contrasts with the low attention from researchers modelling Andean species distributions. Critical knowledge gaps include a lack of an Andean wide plant checklist, insufficient density of weather stations at high-elevation areas, a lack of high-resolution climatologies that accommodates the Andes' complex topography and climatic processes, insufficient data to model demographic and ecological processes, and low use of palaeo data for distribution modelling. Main conclusions: Climate change is likely to profoundly affect the extent and composition of Andean biomes. Temperate Andean biomes in particular are susceptible to substantial area contractions. There are, however, considerable challenges and uncertainties in modelling species and biome responses and a pressing need for a region-wide approach to address knowledge gaps and improve understanding and monitoring of climate change impacts in these globally important biomes.

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.

Different climate sensitivity for radial growth, but uniform for tree-ring stable isotopes along an aridity gradient in Polylepis tarapacana, the world's highest elevation tree species.

Tree growth is generally considered to be temperature limited at upper elevation treelines, yet climate factors controlling tree growth at semiarid treelines are poorly understood. We explored the influence of climate on stem growth and stable isotopes for Polylepis tarapacana Philipi, the world's highest elevation tree species, which is found only in the South American Altiplano. We developed tree-ring width index (RWI), oxygen (δ18O) and carbon (δ13C) chronologies for the last 60 years at four P. tarapacana stands located above 4400 m in elevation, along a 500 km latitude aridity gradient. Total annual precipitation decreased from 300 to 200 mm from the northern to the southern sites. We used RWI as a proxy of wood formation (carbon sink) and isotopic tree-ring signatures as proxies of leaf-level gas exchange processes (carbon source). We found distinct climatic conditions regulating carbon sink processes along the gradient. Current growing-season temperature regulated RWI at northern-wetter sites, while prior growing-season precipitation determined RWI at arid southern sites. This suggests that the relative importance of temperature to precipitation in regulating tree growth is driven by site water availability. By contrast, warm and dry growing seasons resulted in enriched tree-ring δ13C and δ18O at all study sites, suggesting that similar climate conditions control carbon-source processes along the gradient. Site-level δ13C and δ18O chronologies were significantly and positively related at all sites, with the strongest relationships among the southern drier stands. This indicates an overall regulation of intercellular carbon dioxide via stomatal conductance for the entire P. tarapacana network, with greater stomatal control when aridity increases. This manuscript also highlights a coupling (decoupling) between physiological processes at leaf level and wood formation as a function of similarities (differences) in their climatic sensitivity. This study contributes to a better understanding and prediction of the response of high-elevation Polylepis woodlands to rapid climate changes and projected drying in the Altiplano.

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.

Low growth resilience to drought is related to future mortality risk in trees.

Severe droughts have the potential to reduce forest productivity and trigger tree mortality. Most trees face several drought events during their life and therefore resilience to dry conditions may be crucial to long-term survival. We assessed how growth resilience to severe droughts, including its components resistance and recovery, is related to the ability to survive future droughts by using a tree-ring database of surviving and now-dead trees from 118 sites (22 species, >3,500 trees). We found that, across the variety of regions and species sampled, trees that died during water shortages were less resilient to previous non-lethal droughts, relative to coexisting surviving trees of the same species. In angiosperms, drought-related mortality risk is associated with lower resistance (low capacity to reduce impact of the initial drought), while it is related to reduced recovery (low capacity to attain pre-drought growth rates) in gymnosperms. The different resilience strategies in these two taxonomic groups open new avenues to improve our understanding and prediction of drought-induced mortality.

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.

Detecting Nothofagus pumilio Growth Reductions Induced by Past Spring Frosts at the Northern Patagonian Andes.

Extreme climatic events, such as late frosts in spring during leaf flush, have considerable impacts on the radial growth of temperate broadleaf trees. Albeit, all broadleaved species are potentially vulnerable, damage depends on the particularities of the local climate, the species, and its phenology. The impact of late spring frosts has been widely investigated in the Northern Hemisphere, but the potential incidence in Southern Hemisphere tree species is still poorly known. Here, we reconstruct spring frost occurrence at 30 stands of the deciduous tree Nothofagus pumilio in its northern range of distribution in the Patagonian Andes. We identified tree ring-width reductions at stand level not associated with regional or local drought events, matching unusual minimum spring temperatures during leaf unfolding. Several spring frosts were identified along the northern distribution of N. pumilio, being more frequent in the more continental Argentinean forests. Spring frost in 1980 had the largest spatial extent. The spring frosts in 1980 and 1992 also induced damages in regional orchards. Spring frost damage was associated with (i) a period of unusually warm temperatures at the beginning of leaf unfolding, followed by (ii) freezing temperatures. This study helps expand our understanding of the climatic constraints that could determine the future growth and dynamics of Andean deciduous forests and the potential use of tree-rings as archives of extreme events of spring frosts in northern Patagonia.

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.

Early-Warning Signals of Individual Tree Mortality Based on Annual Radial Growth.

Tree mortality is a key driver of forest dynamics and its occurrence is projected to increase in the future due to climate change. Despite recent advances in our understanding of the physiological mechanisms leading to death, we still lack robust indicators of mortality risk that could be applied at the individual tree scale. Here, we build on a previous contribution exploring the differences in growth level between trees that died and survived a given mortality event to assess whether changes in temporal autocorrelation, variance, and synchrony in time-series of annual radial growth data can be used as early warning signals of mortality risk. Taking advantage of a unique global ring-width database of 3065 dead trees and 4389 living trees growing together at 198 sites (belonging to 36 gymnosperm and angiosperm species), we analyzed temporal changes in autocorrelation, variance, and synchrony before tree death (diachronic analysis), and also compared these metrics between trees that died and trees that survived a given mortality event (synchronic analysis). Changes in autocorrelation were a poor indicator of mortality risk. However, we found a gradual increase in inter-annual growth variability and a decrease in growth synchrony in the last ∼20 years before mortality of gymnosperms, irrespective of the cause of mortality. These changes could be associated with drought-induced alterations in carbon economy and allocation patterns. In angiosperms, we did not find any consistent changes in any metric. Such lack of any signal might be explained by the relatively high capacity of angiosperms to recover after a stress-induced growth decline. Our analysis provides a robust method for estimating early-warning signals of tree mortality based on annual growth data. In addition to the frequently reported decrease in growth rates, an increase in inter-annual growth variability and a decrease in growth synchrony may be powerful predictors of gymnosperm mortality risk, but not necessarily so for angiosperms.

Victor and Erika Webnovela: An Innovative Generation @ Audience Engagement Strategy for Prevention.

Entertainment-education (E-E) approaches for young audiences continue to evolve in order to keep stride with younger generations' affinity for technology. E-E and novelas have been used with a wide variety of audiences in the United States, in particular hard-to-reach Latino populations, and have demonstrated effectiveness in disseminating culturally relevant prevention information for a wide variety of health-related risk factors and behaviors. This study discusses the formative research and active engagement of Latino youth living in Langley Park, Maryland, for the development and filming of an innovative 6-episode webnovela titled Victor and Erika (V&E). V&E is part of a larger branding strategy of the Adelante Positive Youth Development intervention that seeks to prevent substance abuse, sexual risk, and interpersonal violence among Latino youth; V&E is also an intervention component. The V&E webnovela is a dramatic portrayal of the lives of 2 immigrant Latino teenagers that also disseminates risk prevention messages. The storyline represents the turning the corner (to a better life) theme that underlies the Adelante intervention brand. Formative research was conducted for character development (n = 20) and creative development of the episodes (n = 14). Results of the formative research showed that youth recommended inclusion of the following topics in V&E episodes: sex, unintended pregnancy, fidelity, trust, family dynamics, immigration status, violence, school dropout, respect, home life, and poverty. Detailed character and episode descriptions are provided, and the implications of using the V&E series as a tool for in-person and online engagement of youth and the dissemination of prevention messages are also discussed.

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.