Effects of 2019's social protests on emergency health services utilization and case severity in Santiago, Chile: a time-series analysis.

Background: On October 18th, 2019, protestors gathered across Chile to call for social equity, resulting in widespread civil unrest and violent confrontation with the police. In this study, we quantify the effects of the 2019 Chilean protests on emergency health services utilization and inpatient admission in Santiago. Methods: We used weekly emergency department (ED) admissions (2015-2019) from three large public hospitals near the focal point of protests in Santiago. The exposure period was from October 18th to December 31st, 2019. The outcomes were the number of weekly consultations and hospitalizations by trauma and respiratory causes and the proportion of hospitalizations among consultants per 1,000. We implemented Bayesian structural time series models to calculate the absolute and relative effects and 95% credible intervals (CrI). Findings: During the first ten weeks of protests ED consultations declined on average by 14% for trauma (95%CrI: -40·2%, 11·5%) and 30% for respiratory causes (95%CrI: -89·4%, 30·2%), 7% for respiratory hospitalizations (95%CrI: -43·6%, 30·8%); however, none of these three results were statistically distinguishable from the null. Trauma hospitalizations, on the other hand, increased by 15% (95%CrI: 4·0%, 26·4%), and the proportion of hospitalizations per consultations increased by 40% for trauma (95%CrI: 13·1%, 68·0%) and 59% for respiratory causes (95%CrI: 29·4%, 87·9%). Interpretation: The 2019 Chilean protests affected the use of emergency health services by increasing the trauma hospitalizations and the case hospitalization ratio per 1,000 consultations for trauma and respiratory causes. Crowd-control protocols must be reviewed to prevent the negative effects of civil unrest.

Conocimiento y prácticas del profesional de enfermería sobre prevención de neumonía asociada a ventilación mecánica / Knowledge and practice of nursing personnel in the prevention of mechanical ventilation associated pneumonia

RESUMEN Fundamento: la neumonía asociada a ventilación mecánica representa uno de los mayores problemas en las unidades de cuidados intensivos debido a que agrava el cuadro clínico del paciente, prolonga su estancia en el hospital e incrementa el costo, por todo esto es que el personal de enfermería es el principal actor en el control de estas infecciones ya que estos son eventos asociados a la asistencia sanitaria y en su mayoría prevenibles. Objetivo: evaluar el conocimiento y la práctica del personal de enfermería acerca de las medidas de prevención de neumonía nosocomial en los pacientes con ventilación mecánica. Métodos: se realizó un estudio transversal con enfoque cuantitativo durante el 1ro de junio hasta 31 agosto de 2018, la población de estudio fueron el personal de enfermería de la unidad de cuidados intensivos constituida por 22 enfermeros a los que se les aplicó un cuestionario y una guía de observación estructurada. Resultados: de los enfermero/as evaluados, se evidencia que poseen conocimientos teóricos y prácticos, se resalta los relacionados con el uso de barreras de protección, posición adecuada para realizar la aspiración endotraqueal así como la frecuencia en que se debe aplicar. Conclusiones: existe un adecuado conocimiento teórico y desempeño práctico del personal de enfermería en la atención al paciente crítico ventilado, donde se evidencia que la cantidad de la experiencia laboral no afecta la calidad del cuidado brindada a los pacientes.

ABSTRACT Background: ventilator associated pneumonia represents one of the major problems in the intensive care unit due to the fact that it aggravates the patient's clinical condition, prolongs hospital stay and increases the cost of hospitalization. As infection is preventable and healthcare related, its control is mainly attributed to the nursing staff. Objective: to evaluate the knowledge and nursing practice involved in the methods of prevention of hospital acquired pneumonia in patients with mechanical ventilation. Methods: a quantitative, cross-sectional study was employed from June 1st until August 31st, 2018. A structured, observational guide and a questionnaire was applied to the population composed of 22 nursing personnel in the intensive care unit. Results: of the evaluated nurses, it was found out that they possess knowledge of both theory and practice, particularly, regarding the use of protective barriers, correct position for endotracheal aspiration and as well as the number of times the procedure should be applied. Conclusions: adequate knowledge about theory and practice exists among nurses who attended mechanically ventilated patients in critical condition. Moreover, the quantity of nursing work experience does not affect the quality of care given to the patients.

Small-scale topography modulates elevational α-, ß- and γ-diversity of Andean leaf beetles.

Elevational diversity gradients are typically studied without considering the complex small-scale topography of large mountains, which generates habitats of strongly different environmental conditions within the same elevational zones. Here we analyzed the importance of small-scale topography for elevational diversity patterns of hyperdiverse tropical leaf beetles (Coleoptera: Chrysomelidae). We compared patterns of elevational diversity and species composition of beetles in two types of forests (on mountain ridges and in valleys) and analyzed whether differences in the rate of species turnover among forest habitats lead to shifts in patterns of elevational diversity when scaling up from the local study site to the elevational belt level. We sampled beetle assemblages at 36 sites in the Podocarpus National Park, Ecuador, which were equally distributed over two forest habitats and three elevational levels. DNA barcoding and Poisson tree processes modelling were used to delimitate putative species. On average, local leaf beetle diversity showed a clear hump-shaped pattern. However, only diversity in forests on mountain ridges peaked at mid-elevation, while beetle diversity in valleys was similarly high at low- and mid-elevation and only declined at highest elevations. A higher turnover of species assemblages at lower than at mid-elevations caused a shift from a hump-shaped diversity pattern found at the local level to a low-elevation plateau pattern (with similar species numbers at low and mid-elevation) at the elevational belt level. Our study reveals an important role of small-scale topography and spatial scale for the inference on gradients of elevational species diversity.

Exploring the Leaf Beetle Fauna (Coleoptera: Chrysomelidae) of an Ecuadorian Mountain Forest Using DNA Barcoding.

BACKGROUND: Tropical mountain forests are hotspots of biodiversity hosting a huge but little known diversity of insects that is endangered by habitat destruction and climate change. Therefore, rapid assessment approaches of insect diversity are urgently needed to complement slower traditional taxonomic approaches. We empirically compare different DNA-based species delimitation approaches for a rapid biodiversity assessment of hyperdiverse leaf beetle assemblages along an elevational gradient in southern Ecuador and explore their effect on species richness estimates. METHODOLOGY/PRINCIPAL FINDINGS: Based on a COI barcode data set of 674 leaf beetle specimens (Coleoptera: Chrysomelidae) of 266 morphospecies from three sample sites in the Podocarpus National Park, we employed statistical parsimony analysis, distance-based clustering, GMYC- and PTP-modelling to delimit species-like units and compared them to morphology-based (parataxonomic) species identifications. The four different approaches for DNA-based species delimitation revealed highly similar numbers of molecular operational taxonomic units (MOTUs) (n = 284-289). Estimated total species richness was considerably higher than the sampled amount, 414 for morphospecies (Chao2) and 469-481 for the different MOTU types. Assemblages at different elevational levels (1000 vs. 2000 m) had similar species numbers but a very distinct species composition for all delimitation methods. Most species were found only at one elevation while this turnover pattern was even more pronounced for DNA-based delimitation. CONCLUSIONS/SIGNIFICANCE: Given the high congruence of DNA-based delimitation results, probably due to the sampling structure, our study suggests that when applied to species communities on a regionally limited level with high amount of rare species (i.e. ~50% singletons), the choice of species delimitation method can be of minor relevance for assessing species numbers and turnover in tropical insect communities. Therefore, DNA-based species delimitation is confirmed as a valuable tool for evaluating biodiversity of hyperdiverse insect communities, especially when exact taxonomic identifications are missing.

Changes in arthropod assemblages along a wide gradient of disturbance in Gabon.

Searching for indicator taxa representative of diverse assemblages, such as arthropods, is an important objective of many conservation studies. We evaluated the impacts of a wide gradient of disturbance in Gabon on a range of arthropod assemblages representing different feeding guilds. We examined 4 x 10(5) arthropod individuals from which 21 focal taxa were separated into 1534 morphospecies. Replication included the understory of 3 sites in each of 4 different stages of forest succession and land use (i.e., habitats) after logging (old and young forests, savanna, and gardens). We used 3 complementary sampling methods to survey sites throughout the year. Overall differences in arthropod abundance and diversity were greatest between forest and open habitats, and cleared forest invaded by savanna had the lowest abundance and diversity. The magnitude of faunal differences was much smaller between old and young forests. When considered at this local scale, anthropogenic modification of habitats did not result in a monotonous decline of diversity because many herbivore pests and their associated predators and parasitoids were abundant and diverse in gardens, where plant productivity was kept artificially high year-round through watering and crop rotation. We used a variety of response variables to measure the strength of correlations across survey locations among focal taxa. These could be ranked as follows in terms of decreasing number of significant correlations: species turnover > abundance > observed species richness > estimated species richness > percentage of site-specific species. The number of significant correlations was generally low and apparently unrelated to taxonomy or guild structure. Our results emphasize the value of reporting species turnover in conservation studies, as opposed to simply measuring species richness, and that the search for indicator taxa is elusive in the tropics. One promising alternative might be to consider "predictor sets" of a small number of taxa representative of different functional groups, as identified in our study.

Tomographic multiaxis-differential optical absorption spectroscopy observations of Sun-illuminated targets: a technique providing well-defined absorption paths in the boundary layer.

A novel experimental procedure to measure the near-surface distribution of atmospheric trace gases by using passive multiaxis differential absorption optical spectroscopy (MAX-DOAS) is proposed. The procedure consists of pointing the receiving telescope of the spectrometer to nonreflecting surfaces or to bright targets placed at known distances from the measuring device, which are illuminated by sunlight. We show that the partial trace gas absorptions between the top of the atmosphere and the target can be easily removed from the measured total absorption. Thus it is possible to derive the average concentration of trace gases such as NO(2), HCHO, SO(2), H(2)O, Glyoxal, BrO, and others along the line of sight between the instrument and the target similar to the well-known long-path DOAS observations (but with much less expense). If tomographic arrangements are used, even two- or three-dimensional trace gas distributions can be retrieved. The basic assumptions of the proposed method are confirmed by test measurements taken across the city of Heidelberg.