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RESUMEN Objetivo: Determinar los efectos de la exposición a vapores de gasolina sobre la función pulmonar en vendedores informales. Material y métodos: Estudio descriptivo de corte transversal realizado en expendedores informales de gasolina expuestos a sus vapores en el municipio de Maicao, Colombia. Se registraron datos sociodemográficos, se evaluó la función pulmonar por medio de espirometría, oximetría de pulso y, evaluación de la exposición a biomasa. Resultados: Se evaluaron 74 pacientes. El 87,8% eran de sexo masculino, encontrándose principalmente entre los 18 - 40 años (71,6%). El 21,6% (n=16) de la población reportó tener afecciones respiratorias, el 59,4% obtuvo un VEF1

Resumen Antecedentes: la alta prevalencia de depresión en la adolescencia y sus graves consecuencias, asociadas a su falta de detección y tratamiento, estimulan el interés en la investigación respecto a su prevención e intervención tempranas. Las intervenciones basadas en las tecnologías de la información y la comunicación (TIC), dada su flexibilidad y capacidad de difusión, representan oportunidades innovadoras; no obstante, en Latinoamérica hay poca evidencia sobre su impacto y eficacia. Objetivo y metodología: se realiza un estudio piloto cuantitativo cuasiexperimental que busca evaluar la factibilidad del programa basado en Internet “Cuida tu Ánimo”, mediante las variables de uso y aceptabilidad, y la estimación del efecto, en 215 adolescentes (103 grupo activo, 112 grupo control) de dos instituciones educativas de la ciudad de Medellín. Se evaluaron las interacciones de los adolescentes con el Programa, su uso-aceptabilidad, el nivel de sintomatología depresiva y otros aspectos relacionados. Resultados: los adolescentes reportan alta aceptación y uso muy moderado del Programa. Señalan el aprendizaje sobre depresión y detección temprana del riesgo que les proporcionó el Programa; y recomiendan aumentar la interactividad de la plataforma web, generar contenidos más diversos y entretenidos, y aumentar los niveles de presencialidad de la intervención. Conclusiones: los programas basados en las TIC pueden ser un complemento favorable para la prevención e intervención tempranas de la depresión en adolescentes. Dada la dificultad de asociar la estimación del efecto del Programa con su uso, se recomienda en estudios futuros utilizar un diseño que permita relacionar los indicadores de uso con los de resultado (dosis-efecto). Abstract Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu Ánimo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu Ánimo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).

El desarrollo de la psicología en Guatemala durante las últimas décadas se ha visto fortalecido por varios hitos en su historia como han sido los congresos, encuentros académicos y profesionales, colaboraciones internacionales y conferencias para nombrar algunos. Este número especial de nuestra revista da testimonio de uno de ellos. Gracias a la confianza, apoyo y mentoría de los grandes exponentes de las psicoterapias integrativas de América Latina y de la valiosa y comprometida colaboración de un comité organizador, pudo realizarse en Guatemala, de manera virtual con sólido apoyo tecnológico, el VIII Encuentro Latinoamericano de Psicoterapias Integrativas (ELAPSI). Si bien, el producto final fue de una excelente calidad académica, científica, profesional y sociocultural, también fue de inmenso valor el llegar a concretarlo. Desde el momento en que nos fue confiada la realización del mismo en el marco del VII Encuentro Latinoamericano que se llevó a cabo en Uruguay en 2018, sabíamos que estábamos abriendo brecha. Por primera vez, un ELAPSI sería realizado fuera de América del Sur, en donde históricamente se había congregado la comunidad académica y profesional de las psicoterapias integrativas. Por lo tanto, iniciar el proceso de organización implicaba no solo colocar a Guatemala en el mapa latinoamericano de la integración psicoterapéutica sino también consolidar un equipo organizador que representara las voces integrativas de las Américas particularmente de aquellos países donde hasta el momento estaban casi silenciadas. Los valores de solidaridad, apoyo, entusiasmo y compromiso se hicieron presentes para emprender una tarea que, aunque ambiciosa desde sus albores, fue apasionante.

The family Cynodontidae is composed of freshwater fishes inhabiting drainages east of the Andes in South America. Its fossil record is mostly represented by isolated teeth that are difficult to identify. Here we describe fossil cranial remains of the extant species Hydrolycus scomberoides as well as isolated teeth that were identified as Hydrolycus and cf. Rhaphiodon in sediments of the late Pliocene Ware Formation in the Guajira Peninsula, west of the Andes. Novel, phylogenetically informative characters were found including the number of symphysial teeth, the plane of insertion of the leading teeth onto the dentary, the presence of accessory posterior dentigerous patches, and depressions and outline of the dentary. We performed a phylogenetic analysis combining morphological and molecular characters including both extant and extinct specimens, producing a well-resolved topology that recovers a novel sister-group relationship between the genera Hydrolycus and Cynodon, while the genus Rhaphiodon falls to the base of this clade. This contradicts earlier studies recovering Hydrolycus and Rhaphiodon as sister taxa. The phylogenetic position of Hydrolycus wallacei was found to be unstable. The occurrence of H. scomberoides in the late Pliocene of Guajira is a puzzle that could be explained by different mechanisms, including a persistent drainage connection across the Andes during the late Pliocene, and/or the result of severe drying and subsequent extinction.

Ofimática

BackgroundThe Valneva COVID-19 vaccine (VLA2001; Valneva Austria, Vienna, Austria) is an inactivated whole-virus, adjuvanted SARS-CoV-2 vaccine. We aimed to assess the safety and immunogenicity of primary vaccination with VLA2001 versus the ChAdOx1-S (Oxford-AstraZeneca) adenoviral-vectored vaccine.MethodsIn this immunobridging phase 3 trial (COV-COMPARE), participants aged 18 years and older who were medically stable (as determined by an investigator) were enrolled at 26 sites in the UK. In the double-blind, randomised, controlled arm of the trial, participants aged 30 years and older were randomly assigned (2:1) to receive two doses of VLA2001 (0·5 mL; with 33 antigen units [AU] per dose) or ChAdOx1-S (0·5 mL; with 2·5 × 108 infectious units per dose) on days 1 and 29. In another arm, participants aged 18–29 years received two doses of VLA2001 (same dose) open label on days 1 and 29. The primary immunogenicity outcome was the immune response of a two-dose schedule of VLA2001 on day 43, in adults aged 30 years and older, versus two doses of ChAdOx1-S via superiority of geometric mean titres (GMTs) of neutralising antibodies (GMT ratio of >1 at a two-sided significance level of 5%) and non-inferiority of the seroconversion rate (non-inferiority margin of –10% for the lower limit of the 95% CI for the difference between groups). The primary safety outcome was the frequency and severity of any adverse events in all participants up to day 43. Safety was assessed in all participants who received at least one dose of vaccine. GMTs were assessed in a subset of participants aged 30 years and older who were seronegative at baseline, had at least one evaluable antibody titre measurement after vaccination, and had no confirmed COVID-19 during the study (immunogenicity population); and seroconversion was assessed in the per-protocol population, which comprised the immunogenicity population but excluding any participants with major protocol violations. For each timepoint, only participants with available data were included in the analysis. This study is registered with ClinicalTrials.gov, NCT04864561, and is ongoing.FindingsBetween April 28 and June 3, 2021, 4181 individuals were screened and 4017 enrolled, of whom 2975 (74%) were aged 30 years or older and randomly assigned to receive VLA2001 (n=1978) or ChAdOx1-S (n=997), and 1042 (26%) were aged 18–29 years (all received open-label VLA2001). 4012 participants received at least one dose of vaccine (1040 in the open-label VLA2001 group, 1977 in the randomised VLA2001 group, and 995 in the ChAdOx1-S group). The immunogenicity population comprised 492 participants in the randomised VLA2001 group and 498 in the ChAdOx1-S group; three participants in the VLA2001 group were excluded from the per-protocol population. VLA2001 induced higher neutralising GMTs than did ChAdOx1-S (803·5 [95% CI 748·5–862·6] vs 576·6 [543·6–611·7]; GMT ratio 1·39 [95% CI 1·25–1·56]; pInterpretationVLA2001 has a favourable tolerability profile and met superiority criteria for neutralising antibodies and non-inferiority criterion for seroconversion rates compared with ChAdOx1-S. The data presented here formed the basis of successful marketing approval for use of VLA2001 in primary vaccination in the EU, the UK, Bahrain, and United Arab Emirates.

The Neogene was a critical interval in the establishment of the modern geography and biotic composition of Amazonia. Because the region is covered with rainforest vegetation and lacks extensive out...

Understanding risk for epilepsy among persons who sustain a mild (mTBI) traumatic brain injury (TBI) is crucial for effective intervention and prevention. However, mTBI is frequently undocumented or poorly documented in health records. Further, health records are non-continuous, such as when persons move through health systems (e.g., from Department of Defense to Veterans Affairs [VA] or between jobs in the civilian sector), making population-based assessments of this relationship challenging. Here, we introduce the MINUTE (Military INjuries—Understanding post-Traumatic Epilepsy) study, which integrates data from the Veterans Health Administration with self-report survey data for post-9/11 veterans (n = 2603) with histories of TBI, epilepsy and controls without a history of TBI or epilepsy. This article describes the MINUTE study design, implementation, hypotheses, and initial results across four groups of interest for neurotrauma: 1) control; 2) epilepsy; 3) TBI; and 4) post-traumatic epilepsy (PTE). Using combined survey and health record data, we test hypotheses examining lifetime history of TBI and the differential impacts of TBI, epilepsy, and PTE on quality of life. The MINUTE study revealed high rates of undocumented lifetime TBIs among veterans with epilepsy who had no evidence of TBI in VA medical records. Further, worse physical functioning and health-related quality of life were found for persons with epilepsy + TBI compared to those with either epilepsy or TBI alone. This effect was not fully explained by TBI severity. These insights provide valuable opportunities to optimize the resilience, delivery of health services, and community reintegration of veterans with TBI and complex comorbidity.

Resumen La inestabilidad de hombro es una condicion frecuente en personas involucradas en actividades deportivas de alta demanda fisica. Debido a sus particularidades anatomicas, los adolescentes presentan mayor riesgo de recidiva luego de un primer episodio de luxacion de hombro. El sexo masculino, edad y participacion en actividades deportivas de alto impacto son los principales factores de riesgo para recurrencia. En esta publicacion, reportamos el caso de una adolescente porrista con inestabilidad anterior de hombro con evolucion favorable luego de estabilizacion abierta complementado por una revision del estado del arte de las aproximaciones terapeuticas de la inestabilidad recurrente de hombro en adolescentes.

Premise of research. Melastomataceae are a diverse and primarily tropical family with a particularly sparse fossil record. Various biogeographic interpretations based on phylogenies, extant distrib...

The birth of modern rainforestsThe origin of modern rainforests can be traced to the aftermath of the bolide impact at the end of the Cretaceous. Carvalhoet al.used fossilized pollen and leaves to characterize the changes that took place in northern South American forests at this time (see the Perspective by Jacobs and Currano). They not only found changes in species composition but were also able to infer changes in forest structure. Extinctions were widespread, especially among gymnosperms. Angiosperm taxa came to dominate the forests over the 6 million years of recovery, when the flora began to resemble that of modern lowland neotropical forest. The leaf data also imply that the forest canopy evolved from relatively open to closed and layered, leading to increased vertical stratification and a greater diversity of plant growth forms.Science, this issue p.63; see also p.28

La depresión afecta 300 millones de personas, con un aumento global del 20% en los últimos diez años. Su alta incidencia y prevalencia, contextualizadas en la contemporaneidad, exigen propuestas comprensivas e interventivas pertinentes y eficaces. Se llevó a cabo una investigación para estudiar la utilidad de una intervención basada en internet para prevenir e intervenir tempranamente la depresión en adolescentes de colegios de Medellín. Como estrategia de investigación cualitativa, se realizaron ocho grupos focales con estudiantes y ocho entrevistas en profundidad con los psicologos de las instituciones educativas. Se valora su importancia para la detección temprana de riesgo, la necesidad de contar con espacios presenciales complementarios a las intervenciones basadas en internet, hay una alta aceptación y bajo uso por parte de los estudiantes y una demanda de participación activa en el proceso. Se identifican algunos mitos relativos a la depresión asociados al estigma que pueden ser intervenidos.

Esta discusión se centra en evidenciar los impactos menos conocidos de la Convención Sobre la Protección del Patrimonio Mundial, Cultural y Natural de UNESCO, en conexión con las comunidades locales. Esta reflexión surge de mi experiencia personal de trabajo en patrimonio cultural en lugares de conflicto y pos-conflicto como Kosovo, Irak, Afganistán, Chipre y Etiopia entre otros, donde la Convención tiene poco y nada que aportar, además de las cíclicas declaraciones de ¡Salvemos al patrimonio cultural! Todo lo contrario, si analizamos con atención, los conceptos fundamentales que soportan la Convención (territorialidad, identidad y nacionalidad), resultan ser los mismos que en principio detonan los conflictos armados. Es decir, todo lo que la Convención quiere preservar, es lo que las armas quieren cambiar. Para ilustrar mi argumento presento tres ejemplos: Singapur, Kosovo y Camboya, en los que la Convención has servido propósitos políticos que poco tienen que ver con el patrimonio cultural y si con orbitas de poder dinero y superioridad.

Anti-personnel landmines are a major problem in countries that are subject to internal conflicts of a military or public order nature. They also continue to be a great threat to the population and biodiversity, even in post-conflict stages. Those most often used by armed groups are simple or homemade antipersonnel landmines that are designed without any type of technical regulations and standardized production systems. Their low-cost manufacturing and the use of easily accessible explosive substances for agricultural use, such as ammonium, have allowed their indiscriminate use, turning them into a huge public health problem. They are only detected when people or animals activate them, because they do not contain any materials that are detectable by traditional means. The scant literature on these artifacts focuses on injuries caused to humans, and only incidentally on field work. The objective of our study was to describe the behavior of a controlled explosion of a homemade antipersonnel landmine, and to verify the effects caused by the explosion on fauna and the environment. The results enable us to provide guidelines that may be implemented during field investigations, in which forensic veterinarians and related disciplines participate. During the armed conflict in Colombia, homemade improvised antipersonnel landmines were used to neutralize the adversary. Many active artifacts remain buried, causing damage to biodiversity by exploding. The extensive literature describes the effects and injuries caused to humans by conventional landmines. However, there is considerably less information on the behavior and effects of homemade antipersonnel landmines on fauna and good field investigation practices. Our objectives were to describe the characteristics of a controlled explosion of a homemade antipersonnel landmine (using ammonium nitrate as an explosive substance), to compare the effectiveness of some evidence search patterns used in forensic investigation, and to determine the effects on a piece of an animal carcass. The explosion generated a shock wave and an exothermic reaction, generating physical effects on the ground and surrounding structures near the point of explosion. The amputation of the foot in direct contact with the device during the explosion and multiple fractures were the main effects on the animal carcass. Finally, it was determined that finding evidence was more effective in a smaller search area. Many factors can influence the results, which must be weighed when interpreting the results, as discussed in this manuscript.

Resumen La inestabilidad glenohumeral posterior cronica, tiene como presentacion la subluxacion posterior recurrente que se caracteriza por dolor mas que sensacion de inestabilidad; sin embargo si esta acompanada de otras inestabilidades como la anterior o inferior, estariamos ante un escenario diferente, conocido como inestabilidad multidireccional. Si bien la inestabilidad posterior de hombro es una patologia poco comun en comparacion con la inestabilidad anterior, cada vez hay mas investigaciones y literatura del tema, que ha llevado a los especialistas a mejorar el conocimiento y entendimiento del mecanismo y la fisiopatologia de dicha entidad. Nivel de evidencia: IV

Introduction Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatments, will develop by considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The current study examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters (i.e., intrusion, avoidance, negative alterations in cognition and mood [NACM], and arousal) and chronic pain measurements (i.e., pain severity, interference, and disability). Materials and Methods Participants included 103 veterans (ages 26-70, mean = 45.33) participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain. The study was approved by a university system Institutional Review Board and affiliated healthcare system. Results The participants with a provisional PTSD diagnosis based on PCL-5 responses (N = 76) had significantly greater pain severity, interference, and disability than the participants without a provisional diagnosis (N = 23). Correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths. The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements. Conclusion The current study highlights a need to re-examine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches. PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain–related avoidance. Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain. The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.

Evaluate diagnostic accuracy of portable chest radiograph in mechanically ventilated patients taking autopsy findings as the gold standard and the interobserver agreement among intensivists and radiologists.Retrospective study of 422 patients over 22 years who died in the ICU, underwent an autopsy, and had at least one portable chest radiograph 72 h prior to death. Two intensivists and two radiologists independently read each chest radiograph. Sensitivity, specificity, positive and negative likelihood ratios were evaluated. Overall performance metrics accuracy between intensivists and radiologists were compared using a generalized estimating equation. Cohen's kappa coefficient was used to evaluate the interobserver agreement with the following values:0.20:poor, 0.21-0.40:fair, 0.41-0.60:moderate, 0.61-0.80:good, 0.81-1.00:excellent.Overall sensitivity and specificity for pneumonia was 24% and 91% respectively. Overall sensitivity and specificity for ARDS was 68% and 74% respectively. Sensitivity for pneumonia was higher among radiologists (p 0,05). Specificity for ADRS was higher among radiologists (p 0,05). Good interobserver agreement among radiologists and poor correlation between intensivists was found.Chest radiographs has a moderate specificity for ARDS and a high specificity for pneumonia, with limited sensitivity in both entities. Interobserver agreement of portable chest radiograph in the mechanically ventilated patients is higher between radiologists than intensivists.

El cambio cultural asociado a la contemporaneidad ha traído consigo el debilitamiento de las instituciones disciplinares y la caída de los grandes metarrelatos y los valores absolutos como guías orientadoras de los sujetos. Concomitantemente, los marcos referenciales en los que la psicología clínica ha soportado la lectura e intervención de las problemáticas en salud mental son cuestionados en su vigencia y conveniencia para responder a ellas. Objetivo: analizar los procesos de formación e investigación de la psicología clínica para valorar su capacidad de responder a las problemáticas en salud mental en la contemporaneidad. Metodología: investigación de enfoque cualitativo, con perspectiva hermenéutica y técnicas de análisis documental y teoría fundamentada. Resultados: los procesos de formación en psicología clínica en EE. UU., Europa, Iberoamérica y Colombia en la contemporaneidad siguen el modelo de Boulder y sus variantes de Vail y Clinical Science, conservando las premisas ontológicas realistas y su dependencia del método clínico médico. Consecuentemente, los procesos investigativos se centran en la psicopatología y la psicoterapia, dejando rezagadas las reflexiones relativas a la contemporaneidad, las subjetividades y problemáticas emergentes de ella.

Taxonomic resolution is a major challenge in palynology, largely limiting the ecological and evolutionary interpretations possible with deep-time fossil pollen data. We present an approach for fossil pollen analysis that uses optical superresolution microscopy and machine learning to create a quantitative and higher throughput workflow for producing palynological identifications and hypotheses of biological affinity. We developed three convolutional neural network (CNN) classification models: maximum projection (MPM), multislice (MSM), and fused (FM). We trained the models on the pollen of 16 genera of the legume tribe Amherstieae, and then used these models to constrain the biological classifications of 48 fossil Striatopollis specimens from the Paleocene, Eocene, and Miocene of western Africa and northern South America. All models achieved average accuracies of 83 to 90% in the classification of the extant genera, and the majority of fossil identifications (86%) showed consensus among at least two of the three models. Our fossil identifications support the paleobiogeographic hypothesis that Amherstieae originated in Paleocene Africa and dispersed to South America during the Paleocene-Eocene Thermal Maximum (56 Ma). They also raise the possibility that at least three Amherstieae genera (Crudia, Berlinia, and Anthonotha) may have diverged earlier in the Cenozoic than predicted by molecular phylogenies.

Significance The biological interchange between North and South America associated with the formation of the Isthmus of Panama is key to defining current gradients of species diversity. A major gap in our understanding of the interchange is its asymmetry, where mammals of North American origin attained higher diversity in South America than vice versa. The prevailing view is that this asymmetry resulted from higher origination of immigrant mammals in South America. In contrast, we find that asymmetry results from high extinction of native mammals in South America, which reduced the diversity of native mammals available to disperse northwards. These results shed light on the legacy of the biotic interchange to understand the current patterns of species diversity across the Americas., The interchange between the previously disconnected faunas of North and South America was a massive experiment in biological invasion. A major gap in our understanding of this invasion is why there was a drastic increase in the proportion of mammals of North American origin found in South America. Four nonmutually exclusive mechanisms may explain this asymmetry: 1) Higher dispersal rate of North American mammals toward the south, 2) higher origination of North American immigrants in South America, 3) higher extinction of mammals with South American origin, and 4) similar dispersal rate but a larger pool of native taxa in North versus South America. We test among these mechanisms by analyzing ∼20,000 fossil occurrences with Bayesian methods to infer dispersal and diversification rates and taxonomic selectivity of immigrants. We find no differences in the dispersal and origination rates of immigrants. In contrast, native South American mammals show higher extinction. We also find that two clades with North American origin (Carnivora and Artiodactyla) had significantly more immigrants in South America than other clades. Altogether, the asymmetry of the interchange was not due to higher origination of immigrants in South America as previously suggested, but resulted from higher extinction of native taxa in southern South America. These results from one of the greatest biological invasions highlight how biogeographic processes and biotic interactions can shape continental diversity.

Premise of research. The early Eocene Laguna del Hunco (LH) fossil site, northwestern Chubut Province, Argentina, holds one of the best-preserved and most diverse paleofloras worldwide. The paleofl...

During the Mid-Miocene Climatic Optimum (MMCO, 14.7–17.3 Ma), global temperatures were warmer than present, and similar to predicted temperatures for the coming century. Limited paleoclimate data exist from the tropics during this period, despite its potential as an analog for future climate conditions. This study presents new subannual stable isotope data (δ18O and δ13C) from a large population of Miocene Turritella gastropods from the Jimol and Castilletes Formations of the Guajira Peninsula, Colombia. Turritellids are aragonitic marine mollusks that live in shallow coastal waters, and their rapid growth rates allow for high-resolution subannual records. We compare these fossils to modern Turritella gastropods from multiple tropical localities to reconstruct subannual climate conditions. The seasonal range in δ18O in the modern shells correlates with the seasonal variance of local precipitation, once temperature seasonality is accounted for. The Miocene fossils show larger (in some cases >2‰) seasonal variation in δ18O than modern Turritella from the same location, suggesting increased seasonality of precipitation in Miocene northern Colombia relative to today. We propose that this increased seasonality of precipitation was due to a more northerly position of the Intertropical Convergence Zone during the mid-Miocene. The resulting wet Miocene paleoenvironment is in stark contrast to semiarid conditions on the Guajira Peninsula today, indicating that this area of tropical South America has undergone a drastic environmental change since the Miocene.

Throughout the Holocene, two of the most important factors involved in the evolution of tropical coastlines have been fluctuations in sea level and regional climates. The geological record provides insightful realizations of the complex interaction between these two factors, improving our understanding of the evolution of littoral zones. Here we present the sedimentary record of a mangrove swamp located in Punta Galeta, Caribbean coast of Panama. Through the conjunction of geochemical and biological sedimentary indicators, we reconstruct environmental dynamics of the area for the last ~5200 years. Between ~5200 and ~1800 cal yr B.P., the progressive dominance of carbonates and a decrease of mangrove pollen indicate increasing marine influence in the area, probably facilitated by a progressively drier climate. Between 3100 and 1800 cal yr B.P., the embayment was flooded by marine water resulting in a landward migration of mangroves. From ~1800 cal yr B.P. to present, the pollen and organic matter records indicate that mangrove vegetation belt recovered, contributing a large proportion of organic matter to the sediment and advancing the shoreline seaward. The maturation of the mangrove forest has resulted in a progradation process that offsets between 4 and 5 m of sea level rise occurred through the last ~5000 years. This process was facilitated by the progressive decrease in rates of sea level rise and by increasing sedimentation rates resulting from a higher accumulation of organic matter from the more vigorous vegetation and more terrigenic input associated with higher regional precipitation. The record of Punta Galeta demonstrates that the evolution of fringe mangroves throughout the Holocene has been mostly driven by sea level rise, which effects are potentially offset by erosion during times of high precipitation. Thus, across the Caribbean coast, precipitation regimes have played a pivotal role at defining the structure and function of mangrove communities.

The upper Miocene Chagres Formation, cropping out along the Caribbean coast of Panama, has been previously interpreted as the record of the last deep-water connection between the Caribbean and Pacific oceans based on bodyfossil paleodepth estimates. We test this interpretation by presenting an integrated ichnological and sedimentological analysis on eight coastal localities of the Chagres Formation (Toro Limestone and Chagres Sandstone members). The Toro Limestone Member accumulated under fully marine conditions in a mixed carbonate and siliciclastic marine shelf above storm wave base. Fluctuating high-moderate energy conditions modulated by a combination of tides and high energy currents likely led to the sparse bioturbation of Toro Limestone sediments, corresponding to an archetypal Cruziana ichnofacies assemblage. Bioturbation, dominated by Thalassinoides and Ophiomorpha isp., increases in the overlying Chagres Sandstone Member and corresponds to a proximal expression of the Cruziana ichnofacies. The Chagres Sandstone Member was deposited within the lower shoreface-upper offshore transition zone in a shelf with low sedimentation rates under combined storm, wave, and tidal influence, and includes fossils and sediments of continental origin suggesting proximity to a river mouth. Our results suggest that the Chagres Formation accumulated in shallow waters, contrasting with a previously proposed deep-water accumulation, and are consistent with deposition on a tectonically stable platform of the northern Canal Basin at the apex of the Panama orocline.

We studied the impact of age on survival and functional recovery in brain-injured patients.We performed an observational cohort study of all consecutive adult patients with brain injury admitted to ICU in 8 years. To estimate the optimal cut-off point of the age associated with unfavorable outcomes (mRS 3-6), receiver operating characteristic (ROC) curve analyses were used. Multivariate logistic regression analyses were performed to identify prognostic factors for unfavorable outcomes.We included 619 brain-injured patients. We identified 60 years as the cut-off point at which the probability of unfavorable outcomes increases. Patients ≥ 60 years had higher severity scores at ICU admission, longer duration of mechanical ventilation, longer ICU and hospital stays, and higher mortality. Factors identified as associated with unfavorable outcomes (mRS 3-6) were an advanced age (≥ 60 years) [Odds ratio (OR) 4.59, 95% confidence interval (CI) 2.73-7.74, p 0.001], a low GCS score (≤ 8 points) [OR 3.72, 95% CI 1.95-7.08, p 0.001], the development of intracranial hypertension [OR 5.52, 95% CI 2.70-11.28, p 0.001], and intracerebral hemorrhage as the cause of neurologic disease [OR 3.87, 95% CI 2.34-6.42, p 0.001].Mortality and unfavorable functional outcomes in critically ill brain-injured patients were associated with older age (≥ 60 years), higher clinical severity (determined by a lower GCS score at admission and the development of intracranial hypertension), and an intracerebral hemorrhage as the cause of neurologic disease.

To evaluate the effects of interdisciplinary pain management on pain-related disability and opioid reduction in polymorbid pain patients with 2 or more comorbid psychiatric conditions.Two-arm randomized controlled trial testing a 3-week intervention with assessments at pre-treatment, post-treatment, 6-month, and 12-month follow-up.Department of Veterans Affairs medical facility.103 military veterans (N=103) with moderate (or worse) levels of pain-related disability, depression, anxiety, and/or posttraumatic stress disorder randomly assigned to usual care (n=53) and interdisciplinary pain management (n=50). All participants reported recent persistent opioid use. Trial participants had high levels of comorbid medical and mental health conditions.Experimental arm-a 3-week, interdisciplinary pain management program guided by a structured manual; comparison arm-usual care in a large Department of Veterans Affairs medical facility.Oswestry Disability Index (pain disability); Timeline Followback Interview and Medication Event Monitoring System (opioid use). Analysis used generalized linear mixed model with all posttreatment observations (posttreatment, 6-month follow-up, 12-month follow-up) entered simultaneously to create a single posttreatment effect.Veterans with polymorbid pain randomized to the interdisciplinary pain program reported significantly greater decreases in pain-related disability compared to veterans randomized to treatment as usual (TAU) at posttreatment, 6-month, and 12-month follow-up. Aggregated mean pain disability scores (ie, a summary effect of all posttreatment observations) for the interdisciplinary pain program were -9.1 (95% CI: -14.4, -3.7, P=.001) points lower than TAU. There was no difference between groups in the proportion of participants who resumed opioid use during trial participation (32% in both arms).These findings offer the first evidence of short- and long-term interdisciplinary pain management efficacy in polymorbid pain patients, but more work is needed to examine how to effectively decrease opioid use in this population.

The abstract is available here: https://uscholar.univie.ac.at/o:1645618

The abstract is available here: https://uscholar.univie.ac.at/o:1643167