931 resultados para Tidal flats.
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Background: The Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have a impact on the respiratory system and the recommendations for mechanical ventilation of patients with IAH/ACS remain unclear. Our study characterize the influence of elevated intra-abdominal pressure (IAP) and positive end-expiratory pressure (PEEP) on airway plateau pressure (PPLAT) and bladder pressure (PBLAD). Methods: Nine (n=9) deeply anesthetized swine were mechanically ventilated via tracheostomy: volume-controlled mode at tidal volume = 10 ml/kg, frequency=15, Inspiratory:Expiratory ratio=1:2 and PEEP of 1 and 10 cmH2O (PEEP1 and PEEP10, respectively). A tracheostomy tube was place in the peritoneal cavity and different levels of IAP were applied utilizing a CPAP system. Measurements were performed during both PEEP1 and PEEP10. Results: PBLAD increased as experimental IAP rose. Minimal underestimation of IAP by PBLAD was observed. Applying PEEP10 did not significantly affect the correlation between experimental IAP and PBLAD. PBLAD (in cmH2O) was reflected by changes in PPLAT regardless of the PEEP.
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Objetivo: Caracterizar a los pacientes que recibieron ventilación mecánica en las unidades de cuidado intensivo (UCI) de la Fundación Santa Fe de Bogotá entre los años 2009 y 2013. Metodología: Se analizó una cohorte retrospectiva de los pacientes en UCI que requirieron soporte ventilatorio mecánico al ingreso a la unidad independientemente de la causa. Resultados: La media de edad de los pacientes fue 63,83 años; el diagnóstico más frecuente de ingreso fue revascularización miocárdica, seguido por neumonía y recambio valvular aórtico; en el 43% de los casos la causa de la falla fue el estado postoperatorio. Los modos ventilatorios más frecuentemente utilizados fueron SIMV (27,5%) y ventilación asistida controlada (26,12%). El 50% de los pacientes fueron ventilados con PEEP < 6 cmH2O. La mortalidad bruta fue del 15%. 22% de los pacientes tuvieron estancia prolongada en UCI. Se aplicó protocolo de retiro de ventilación mecánica en el 77% de los pacientes. La duración de la ventilación mecánica es mayor a medida que aumenta la edad del paciente entre los 60 y los 80 años. La mortalidad es cercana al 50% alrededor de los 50 años y mayor a 80% después de los 80 años. El soporte ventilatorio por cinco o más días aumentó la mortalidad a 80% o más. Discusión y Conclusiones: Estos resultados son comparables a los encontrados en estudios previos. Este estudio puede ser considerado como el primer paso para generar un registro adecuado de la ventilación de la mecánica de las unidades de cuidado intensivo del país.
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Introducción La ventilación en posición prona ha demostrado mejorar la oxigenación y la mecánica ventilatoria en pacientes con síndrome de dificultad respiratoria aguda (SDRA). Nosotros evaluamos si la posición prona disminuye el riesgo de mortalidad en pacientes adultos con SDRA vs. ventilación en posición supino. Metodología. Se realizó un metanálisis de ensayos clínicos controlados aleatorizados (ECAs) que compararon pacientes en posición prono vs supino. Se realizó una búsqueda en Pubmed, Embase, Cochrane Library y LILACS. Se evaluó mortalidad, estancia hospitalaria, días de ventilación mecánica y efectos adversos. Resultados. Siete ECAs (2119 pacientes) fueron incluidos en el análisis. La posición prona mostró una tendencia no significativa a disminuir la mortalidad (OR 0.76; IC 95% 0.54–1.06; p=0.11). Al estratificar por subgrupos se encontró una disminución significativa en el riesgo de mortalidad en los pacientes ventilados con volumen corriente bajo (OR 0.58; IC 95%: 0.38-0.87; p=0.009), pronación prolongada (OR 0.6; IC 95% 0.43–0,83, p=0,002), instauración antes de 48h de evolución de la enfermedad (OR 0.49; IC 95% 0.35–0.68; p=0.0001) e hipoxemia severa (OR 0,51; IC 95% 0.36–1.25; p=0.0001). Los efectos adversos relacionados con la pronación fueron el desarrollo de ulceras por presión y obstrucción del tubo orotraqueal.
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Introduction: During the past years, alveolar recruitment maneuvers (RM) have produced growing interest due to their beneficial potential in pulmonary protection, and have been introduced in clinical practice. Objective: To describe and analyze the knowledge of MR and its application at seven intensive care units in the city of Cali, Colombia. Methods and materials: Descriptive Cross-Sectional Study with an intentional sample of 64 professionals working in seven intensive care units and who apply MR. The self-completed survey was made up of thirteen questions, and the application period was two months. Results: Out of 64 professionals surveyed, 77.8% of them follow a protocol guide; 54.7% employes during RM the ideal Positive end-expiratory pressure (PEEP), which maintains a saturation > 90% and a PaO2 > 60 mmHg; 42.1% tolerates airway pressures between 35 and 50 cmH2O; 48.4% perform RM with a progressive increase of the PEEP and a low tidal volume. Conclusions: Regarding the knowledge related to RM, heterogeneity was found in the answers. There is currently no consensus about which is the most effective and secure way to implement an MR. This study can be the starting point to create awareness towards the revision of knowledge, capacities and abilities that are required to perform RM.
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Los pacientes con enfermedad renal crónica (ERC) terminal se caracterizan por presentar alteraciones nutricionales que se perpetúan independiente de la modalidad de la Terapia de Reemplazo Renal (TRR). En la diálisis peritoneal, tanto APD (automated peritoneal dialysis) como la CAPD (continuous ambulatory peritoneal dialysis) existe un alto riesgo de pérdida de albúmina por el filtrado peritoneal, sin diferencias claras en el estatus nutricional. El presente estudio caracteriza el estado nutricional de los pacientes incidentes en diálisis peritoneal de RTS Bogotá Regional 1, con un seguimiento de un año, para conocer los cambios en las variables nutricionales. Se realizó un estudio de cohortes retrospectivo, analizando 2 grupos según el tipo de diálisis peritoneal escogida (APD o CAPD), con un análisis análisis descriptivo trimestral de las características nutricionales y posteriormente una comparación entre las 2 modalidades de TRR. Encontrando un promedio de edad de 60,8 años, la mayoría hombres y etiología principal nefropatía diabética. La mayoría de las variables nutricionales permanecieron sin cambios durante seguimiento. El Test de equilibrio peritoneal para glucosa y creatinina mostró valores promedio bajo y promedio alto y la mayoría de pacientes un rango nutricional normal. Al comparar APD y CAPD, solo se encontraron de forma aislada, diferencias significativas en algunas variables aisladas. Este es el primer estudio en Colombia que evalúa diferentes aspectos nutricionales en diálisis peritoneal. Aunque con limitaciones metodológicas, es un punto de partida para la realización de estudios más robustos que del estado nutricional de los pacientes en diálisis peritoneal
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Esta dissertação teve como objetivo principal analisar como a Estratégia da Inovação poderia ser empregada em benefício da competitividade das organizações hoteleiras, tendo em vista as experiências de inovação dos Hotéis Portas da Amazônia e Faraó. Os Hotéis Portas da Amazônia e Faraó destacam-se pela realização de experiências inovadoras, o primeiro apresenta uma proposta de Hotel Histórico, nasceu a partir da restauração de um casarão do início do século XIX e atende o segmento do Turismo Internacional e o segundo uma proposta de Hotel Temático, sendo entitulado o primeiro hotel temático do norte. O acirramento da concorrência no mercado hoteleiro de Belém-Pará, devido aos novos entrantes (grandes redes hoteleiras) e substitutos como flats, está provocando a redução das margens de lucro ademais está obrigando os gestores das empresas de micro e pequeno porte a repensarem suas estratégias de competição. Sendo que a inovação é uma estratégia que pode contribuir para criação e sustentação da vantagem competitiva. A metodologia adotada nesta investigação foi inicialmente o levantamento bibliográfico. Além disso, foram aplicadas entrevistas semi-estruturadas para os gestores dos hotéis. A entrevista baseou-se no Radar da Inovação para a classificação das Estratégias de Inovação. A investigação revelou que o empresário do Hotel Portas da Amazônia realizou uma inovação em modelo de negócios e inovação em descoberta de um novo mercado. Porém, no Hotel Faraó, identificou-se apenas um caso de inovação incremental em suas instalações como na decoração do prédio, pois para a proposta de um hotel temático, a gestão precisaria explorar a experiência do cliente. Nos dois casos, constatou-se que várias dimensões da inovação são negligenciadas como ofertas, experiências do consumidor e a inovação na organização.
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Wydział Filologii Polskiej i Klasycznej: Instytut Filologii Polskiej
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Although shorebirds spending the winter in temperate areas frequently use estuarine and supratidal (upland) feeding habitats, the relative contribution of each habitat to individual diets has not been directly quantified. We quantified the proportional use that Calidris alpina pacifica (Dunlin) made of estuarine vs. terrestrial farmland resources on the Fraser River Delta, British Columbia, using stable isotope analysis (δ13C, δ15N) of blood from 268 Dunlin over four winters, 1997 through 2000. We tested for individual, age, sex, morphological, seasonal, and weather-related differences in dietary sources. Based on single- (δ13C) and dual-isotope mixing models, the agricultural habitat contributed approximately 38% of Dunlin diet averaged over four winters, with the balance from intertidal flats. However, there was a wide variation among individuals in the extent of agricultural feeding, ranging from about 1% to 95% of diet. Younger birds had a significantly higher terrestrial contribution to diet (43%) than did adults (35%). We estimated that 6% of adults and 13% of juveniles were obtaining at least 75% of their diet from terrestrial sources. The isotope data provided no evidence for sex or overall body size effects on the proportion of diet that is terrestrial in origin. The use of agricultural habitat by Dunlin peaked in early January. Adult Dunlin obtained a greater proportion of their diet terrestrially during periods of lower temperatures and high precipitation, whereas no such relationship existed for juveniles. Seasonal variation in the use of agricultural habitat suggests that it is used more during energetically stressful periods. The terrestrial farmland zone appears to be consistently important as a habitat for juveniles, but for adults it may provide an alternative feeding site used as a buffer against starvation during periods of extreme weather. Loss or reduction of agricultural habitat adjacent to estuaries may negatively impact shorebird fitness, with juveniles disproportionately affected.
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Salt marshes constitute habitat islands for many endemic animal species, particularly along the California coast, where urban sprawl has fragmented this habitat. Recreational activities in salt marshes have increased recently, posing an interesting problem: how do endemic species lacking alternative habitat modify their tolerance to humans? We assessed seasonal and site variations in three tolerance parameters (distances at which animals became alert, fled, and moved after fleeing) of California's endangered Belding’s Savannah Sparrow ((Passerculus sandwichensis beldingi). We approached individuals on trails in three salt marshes with different levels of vehicle and pedestrian traffic. Belding’s Savannah Sparrows became aware and fled at shorter distances in the salt marsh coincident with greater levels of recreational activity as a result of habituation or visual obstruction effects. Seasonal effects in tolerance varied between sites. Alert and flight initiation distances were higher in the pre-nesting than in the non-breeding season in the site with the highest levels of recreational use likely due to greater exposure of breeding individuals; however, the opposite seasonal trend was found in each of the two sites with relatively lower human use, probably because individuals were less spatially attached in the non-breeding season when they foraged in aggregations. Distance fled was greater in the non-breeding than in the breeding season. Our findings call for dynamic management of recreational activities in different salt marshes depending on the degree of exposure to humans and seasonal variations in tolerance. We recommend a minimum approaching distance of 63 m and buffer areas of 1.3 ha around Belding's Savannah Sparrows.
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This paper investigates the use of data assimilation in coastal area morphodynamic modelling using Morecambe Bay as a study site. A simple model of the bay has been enhanced with a data assimilation scheme to better predict large-scale changes in bathymetry observed in the bay over a 3-year period. The 2DH decoupled morphodynamic model developed for the work is described, as is the optimal interpolation scheme used to assimilate waterline observations into the model run. Each waterline was acquired from a SAR satellite image and is essentially a contour of the bathymetry at some level within the inter-tidal zone of the bay. For model parameters calibrated against validation observations, model performance is good, even without data assimilation. However the use of data assimilation successfully compensates for a particular failing of the model, and helps to keep the model bathymetry on track. It also improves the ability of the model to predict future bathymetry. Although the benefits of data assimilation are demonstrated using waterline observations, any observations of morphology could potentially be used. These results suggest that data assimilation should be considered for use in future coastal area morphodynamic models.
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The improved empirical understanding of silt facies in Holocene coastal sequences provided by such as diatom, foraminifera, ostracode and testate amoebae analysis, combined with insights from quantitative stratigraphic and hydraulic simulations, has led to an inclusive, integrated model for the palaeogeomorphology, stratigraphy, lithofacies and biofacies of northwest European Holocene coastal lowlands in relation to sea-level behaviour. The model covers two general circumstances and is empirically supported by a range of field studies in the Holocene deposits of a number of British estuaries, particularly, the Severn. Where deposition was continuous over periods of centuries to millennia, and sea level fluctuated about a rising trend, the succession consists of repeated cycles of silt and peat lithofacies and biofacies in which series of transgressive overlaps (submergence sequences) alternate with series of regressive overlaps (emergence sequences) in association with the waxing and waning of tidal creek networks. Environmental and sea-level change are closely coupled, and equilibrium and secular pattern is of the kind represented ideally by a closed limit cycle. In the second circumstance, characteristic of unstable wetland shores and generally affecting smaller areas, coastal erosion ensures that episodes of deposition in the high intertidal zone last no more than a few centuries. The typical response is a series of regressive overlaps (emergence sequence) in erosively based high mudflat and salt-marsh silts that record, commonly as annual banding, exceptionally high deposition rates and a state of strong disequilibrium. Environmental change, including creek development, and sea-level movement are uncoupled. Only if deposition proceeds for a sufficiently long period, so that marshes mature, are equilibrium and close coupling regained. (C) 2002 Elsevier Science B.V. All rights reserved.
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Recent sedimentological and palynological research on subfossil Holocene banded sediments from the Severn Estuary Levels suggested seasonality of deposition, registered by variations in mineral grain-size and pollen assemblages between different parts of the bands. Here we provide data that strengthen this interpretation from sampling of modern sediments and pollen deposition on an active mudflat and saltmarsh on the margin of the Severn Estuary, and comparison with a vegetation survey and contemporary records of climate, river and tidal regimes. The results of grain-size analysis indicate deposition of comparatively coarse-grained silts during the relatively cool and windy conditions of winter and comparatively fine-grained sediments during relatively warm and calm summer months. Pollen analysis demonstrates the significance of long-term storage of pollen grains and fern spores in the estuarine waterbody, superimposed on which seasonal variations in pollen inputs from local and regional vegetation remain detectable. Copyright (C) 2007 John Wiley & Sons, Ltd.
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Holocene silts (salt marshes) and highest intertidal-supratidal peats are superbly exposed on a 15 kin coastal transect which reveals two laterally extensive units of annually banded silts (Beds 3, 7) associated with three transgressive-regressive silt-peat cycles (early sixth-early fourth millennium BC). Bed 3 in places is concordantly and gradationally related to peats above and below, but in others transgresses older strata. Bed 7 also grades up into peat, but everywhere overlies a discordance. The banding in Bed 3 at three main and two minor sites was resolved and characterized texturally at high-resolution (2.5/5 mm contiguous slices) using laser granulometry (LS230 with PIDS) and a comprehensive scheme of data-assessment. Most of Bed 3 formed very rapidly, at peak values of several tens of millimetres annually, in accordance with modelled effects of sea-level fluctuations on mature marshes (bed concordant and gradational) and on marshes growing up after coastal erosion and retreat (bed with discordant base). Using data from the modern Severn Estuary, the textural contrast within bands, and its variation between bands, points to a variable but overall milder mid-Holocene climate than today. The inter-annual variability affected marsh dynamics, as shown by the behaviour of the finely divided plant tissues present. Given local calibration, the methodology is applicable to other tidal systems with banded silts in Britain and mainland northwest Europe. (c) 2006 Elsevier Ltd. All rights reserved.
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The foraminiferal-rich pelagic Bateig Limestone forms several varieties of the important building stones quarried at Bateig Hill in southeastern Spain. Three principal ichnofabrics (Bichordites, mottled-Palaeophycus and mottled-Ophiomorpha) are recognized, which are present in at least two (possibly up to four) repeated successions (cycles). Each succession begins with an erosional event. The Bichordites ichnofabric represents a new type of facies, formed as thin turbidity/grain flow, stratiform units derived from sediment slips off a fault into deep water. Each slipped unit became almost completely bioturbated by infaunal echinoids, colonizing by lateral migration. Because of the thinness of the units, successive colonizations tended to truncate the underlying burrows giving rise to a pseudo-stratification. As the Bichordites ichnofabric accumulated on the fault apron, thus reducing the effective height of the fault scarp, the substrate gradually came under the influence of currents traversing the shelf. This led to a change in hydraulic regime, and to the mottled-Palaeophycus and mottled-Ophiomorpha ichnofabrics in sediment deposited under bed load transport, and associated with laminar and cross-stratified beds and local muddy intervals. Reactivation of the fault triggered erosion and channeling and a return to grain flow sedimentation, and to the Bichordites ichnofabric of the succeeding cycle. The highest unit of the Bateig Limestone is formed entirely of cross-stratified calcarenites with occasional Ophiomorpha (Ophiomorpha-primary lamination ichnofabric) and is similar to many shallow marine facies but they still bear a significant content of pelagic foraminifera. The sedimentary setting bears resemblance with that described for the Pleistocene Monte Torre Paleostrait and the modem Strait of Messina (Italy), where the narrow morphology of the depositional area enhanced tidal currents and allowed for high-energy sandy deposition in relatively deep areas. More data on the Miocene paleogeography of the Bateig area should provide further testing for this hypothesis. The ichnofacies and stacking of the Bateig Limestone differ from the classic Seilacherian model in that they reflect changes in hydraulic process and are associated with faulting and subsidence and changes in sediment supply. Recognition of the unusual ichnofabrics and their relationships provides a clear indication of the overall dynamic setting. (c) 2006 Elsevier B.V. All rights reserved.