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We analyse the internal dynamics of star-forming HII regions and their efficiency in interacting with the ISM. We use GHaFaS ...(Fabry-Perot) data of the nearby spiral galaxy M83 to perform multiple-Gaussian fitting to the integrated Halpha emission line for 136 HII regions, advanced instrumental response subtraction and to study the Luminosity-velocity dispersion relation. We find that the best way of dealing with instrumental response effects is convolving its actual shape with the Gaussian before fitting and that in our data almost none of the regions need a secondary Gaussian.
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This paper presents a multiproxy palaeoenvironmental study from Abric del Pastor (Alcoy, Spain), a rock shelter which has yielded evidence for Middle Palaeolithic human occupation. The sedimentary ...sequence has been analysed for lipid biomarker n-alkane abundances (ACL, CPI), compound specific leaf wax δ2H and δ13C, and bulk organic geochemistry (TOC, %N, %S), providing a record of past climate and local vegetation dynamics. Site formation processes have been reconstructed through the application of soil micromorphology. Analyses of anthracological, microvertebrate and macrofaunal assemblages from selected subunits are also presented here. Our data indicates that a variable climate marked by predominantly cold conditions persisted through most of the sequence and that Neanderthal occupations in stratigraphic unit IVd, assigned to MIS 4 or late MIS 5, occurred in a landscape setting characterised by a mosaic of biotopes. The presence of key resources inside the ravine where the site is located suggests that the occupation of the rock shelter may have been strategically motivated by a subsistence and mobility strategy which focused on zones of localised ecological resilience, such as intra-mountainous valleys or ravines, during periods of global or regional environmental downturn.
Introduction: the vitamin cobalamin is essential for a proper functioning of the CNS, hematopoiesis, and DNA synthesis. Its deficiency is frequently secondary to pernicious anemia or strict ...vegetarian diets. Case report: an 18-month-old male infant presented with a decreased level of consciousness and movement disorder (tremor and choreiform movements) of several hours' standing. He had a history of delayed acquisition of motor milestones (not standing, monosyllabic language), and progressive loss of these over the last few weeks (head support and sitting). He had been breastfed from birth. His family has a vegetarian diet. In neuroimages, cranial CT and MRI scans showed generalized supratentorial atrophy involving both matters and the basal ganglia. Treatment was started with intramuscular vitamin B12, which increased its levels. Subsequently, the patient was subjected to dietary diversification and oral cyanocobalamin, with clinical normalization after 6 months and radiological normalization after 7 months. Conclusions: we emphasize the importance of vitamin B12 supplementation during pregnancy and lactation in vegetarina mothers and their infants.
Adherence to Enhanced Recovery Protocols (ERPs) is associated with faster functional recovery, better patient satisfaction, lower complication rates and reduced length of hospital stay. Understanding ...institutional barriers and facilitators is essential for improving adherence to ERPs. The purpose of this study was to identify institutional factors associated with adherence to an ERP for colorectal surgery.
A secondary analysis of a nationwide study was conducted including 686 patients who underwent colorectal surgery across twenty-one institutions in Spain. Adherence to ERPs was calculated based upon the components recommended by the Enhanced Recovery After Surgery (ERAS®) Society. Institutional characteristics (i.e., case volume, ERP duration, anesthesia staff size, multidisciplinary meetings, leadership discipline) were captured from each participating program. Multivariable regression was performed to determine characteristics associated with adherence.
The median adherence to ERAS was 68.2% (IQR 59.1%–81.8%). Multivariable linear regression revealed that anesthesiologist leadership (+5.49%, 95%CI +2.81% to +8.18%, P < 0.01), duration of ERAS implementation (+0.46% per year, 95%CI +0.06% to +0.86%, P < 0.01) and the use of regular multidisciplinary meetings (+4.66%, 95%CI +0.06 to +7.74%, P < 0.01) were independently associated with greater adherence. Case volume (−2.38% per 4 cases weekly, 95%CI -3.03 to −1.74, P < 0.01) and number of anesthesia providers (−1.19% per 10 providers, 95%CI +2.23 to −8.18%, P < 0.01) were negatively associated with adherence.
Adherence to ERPs is strongly associated with anesthesiology leadership, regular multidisciplinary meetings, and program duration, whereas case volume and the size of the anesthesia staff were potential barriers. These findings highlight the importance of strong leadership, experience and establishing a multidisciplinary team when developing an ERP for colorectal surgery.
•Qualitative research suggests that institutional factors may be influencing adherence with Enhanced Recovery Protocols.•This multicenter study demonstrated that anesthesiology leadership, multidisciplinary meetings, and program duration are facilitators to ERP adherence.•The number of anesthesiologists and case volume were potential barriers to adherence with ERP guidelines.•Self-declared ERAS institutions should tailor quality improvement initiatives to specific program-level factors, particularly in settings with high case volume and large anesthesia staff sizes.
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