[Effect on the time of admission to the Intensive Care Unit of the start-up of an Critical Care Outreach Team]. / Efecto sobre el momento del ingreso en la unidad de cuidados intensivos de la puesta en marcha de un servicio extendido de medicina intensiva.

INTRODUCTION: The implementation of the Critical Care Outreach Teams can influence the time of admission of patients to the Intensive Care Unit (ICU). MATERIAL AND METHODS: Retrospective, descriptive, quasi-experimental "before-after" cohort study. All patients admitted to the unit urgently from Monday to Friday for two periods (between February 1, 2022 and June 30 and between February 1, 2023 and June 30, 2023) are included. The patients were divided into regular shift admissions (08-15h) and on-call (15-08h). The secondary objective was to assess whether there were differences in mortality between the two periods. RESULTS: During the first period of the study, 239 patients were admitted. 29.29% entered the ordinary shift and 70.71% on duty shift. During the second period, 211 patients were included with 43.13% of admissions in the ordinary shift. The comparison between the two periods observed a significant increase in the percentage of admissions in the morning hours in the second period (P=.0031). Mortality in the first period was 13.80% and in the second period 9.95%. The comparison between the two periods did not reveal significant differences. CONCLUSIONS: The start-up of the Critical Care Outreach Teams is associated with an increase in the proportion of ICU admissions in the morning period without any observed changes in mortality.

Stream chemistry response to changing nitrogen and sulfur deposition in two mountain areas in the Iberian Peninsula.

Sulfur (S) and nitrogen (N) increasing anthropogenic emissions in the last century has arisen wide concern on the ecological effects of S and N deposition. In this paper, we use bulk deposition and stream water measurements in the central Pyrenees (PYR-C and PYR-AT sites) and Montseny (MSY-TM0) covering different time lengths in the period 1983-2017 to investigate how these mountain environments respond to ongoing changes of regional emissions to the atmosphere. PYR-C, in spite of its position far away from urban and industrial areas, presented higher SO4-S, NO3-N and NH4-N bulk deposition than the Montseny site closer to Barcelona and the inclusion of dry deposition only reversed this pattern for NO3-N. This indicates that distance to pollution sources does not protect these mountain sites from a considerable impact of pollution. Time-trends in SO42- and NO3- concentrations in bulk deposition were similar between sites: SO42- monotonically decreased, while NO3- increased until the mid-2000 s and decreased thereafter. In the period 1983 to 2017, SO2 emissions in Europe (EU-28) decreased by 95%, while in the SO42- concentrations in bulk deposition declined by 35-50% in Pyrenees and Montseny respectively and SO42- concentrations in the streams by 25-35%, respectively. Other sources of SO42- (e.g. episodic African dust) may explain the different reduction rate between anthropogenic emissions and bulk deposition. Net S budget was positive for MSY-TM0 (indicating flushing from the catchment) and negative for the PYR-C site (indicating retention), while it was close to zero for the other Pyrenean site, but in the PYR-C site net retention showed a significant increasing trend tending to lower retention in recent years. Bulk N deposition in the Pyrenees was lower but stream concentrations and export was higher than at Montseny, this leading to less N retention in the Pyrenean sites. However, the MSY-TM0 site showed a trend towards less N retention in recent years. This was driven by higher exports during the wet months, which would correspond to a first stage of N saturation according Stoddard's classification.

Results After Implementing a Program of Intensive Care to Facilitate Organ Donation.

A program of intensive care to facilitate organ donation (ICOD) represents one of the ways to increase donation rate following brain death (BD). OBJECTIVES: To analyze the impact and cost-effectiveness of setting up an ICOD strategy. METHOD: Retrospective cases of BD donors from the Spanish region La Rioja were included, after implementation of an ICOD program (2011-2016). This was activated in cases of devastating neurologic injury where treatment had been rejected following therapeutic futility criteria. Follow-up of kidney and liver transplant patients with the obtained grafts was carried out. RESULTS: A total of 134 potential donors were admitted to intensive care unit (ICU), of whom 106 were selected under the ICOD strategy. BD was diagnosed in 108 cases (25 conventional donors, 83 ICOD donors). A total of 21.6% of potential ICOD donors did not evolve to BD, subsequently dying in the ICU. ICOD cases accounted for more than 50% of donors each year. This cohort had an average stay of 2.4 days in the ICU and accounted for a small proportion of total ICU admissions. A total of 68 (81.9%) ICOD donors were finally effective and 146 grafts were extracted, the majority being abdominal organs (liver and kidney). Probability of survival 1 year after liver transplant (ICOD donor) was 90.9%, with 1 case of primary graft failure. Survival 1 year after kidney transplant (ICOD donor) was 92.7%. No differences were detected in survival rates of kidney and liver transplant patients regarding donor type (ICOD vs conventional). CONCLUSIONS: Implementation of an ICOD program allows an increase in the pool of valid and quality grafts for transplant as well as implying a minimum consumption of intensive medicine resources. The results in transplant patients support this strategy.

Atmospheric phosphorus deposition may cause lakes to revert from phosphorus limitation back to nitrogen limitation.

Recent findings indicate that increased atmospheric deposition of nitrogen of human origin has caused changes in the pattern of ecological nutrient limitation in lakes in the northern hemisphere. An increase in the nitrogen to phosphorus ratio, and hence a shift from pristine nitrogen limitation to human-induced phosphorus limitation of phytoplankton growth, seems to have been driven by deposition of atmospheric nitrogen. These findings challenge the classical paradigm of lake phytoplankton productivity being naturally limited by phosphorus availability. However, atmospheric phosphorus deposition may also be highly relevant. Here we show how dissolved inorganic nitrogen concentration has decreased in the Pyrenean lake district over recent decades, despite there being an increase in deposition of atmospheric nitrogen. This is related to an increased atmospheric phosphorus load in the lake water, as a result of higher atmospheric inputs. These changes are causing phytoplankton to revert from being phosphorus-limited to being nitrogen-limited.

Dust inputs and bacteria influence dissolved organic matter in clear alpine lakes.

Remote lakes are usually unaffected by direct human influence, yet they receive inputs of atmospheric pollutants, dust, and other aerosols, both inorganic and organic. In remote, alpine lakes, these atmospheric inputs may influence the pool of dissolved organic matter, a critical constituent for the biogeochemical functioning of aquatic ecosystems. Here, to assess this influence, we evaluate factors related to aerosol deposition, climate, catchment properties, and microbial constituents in a global dataset of 86 alpine and polar lakes. We show significant latitudinal trends in dissolved organic matter quantity and quality, and uncover new evidence that this geographic pattern is influenced by dust deposition, flux of incident ultraviolet radiation, and bacterial processing. Our results suggest that changes in land use and climate that result in increasing dust flux, ultraviolet radiation, and air temperature may act to shift the optical quality of dissolved organic matter in clear, alpine lakes.

Modelling the effect of climate change on recovery of acidified freshwaters: relative sensitivity of individual processes in the MAGIC model.

The MAGIC model was used to evaluate the relative sensitivity of several possible climate-induced effects on the recovery of soil and surface water from acidification. A common protocol was used at 14 intensively studied sites in Europe and eastern North America. The results show that several of the factors are of only minor importance (increase in pCO(2) in soil air and runoff, for example), several are important at only a few sites (seasalts at near-coastal sites, for example) and several are important at nearly all sites (increased concentrations of organic acids in soil solution and runoff, for example). In addition changes in forest growth and decomposition of soil organic matter are important at forested sites and sites at risk of nitrogen saturation. The trials suggest that in future modelling of recovery from acidification should take into account possible concurrent climate changes and focus specially on the climate-induced changes in organic acids and nitrogen retention.