Rediseño de un sendero interpretativo turístico para la observación de anfibios y aplicación de herramientas lúdicas evaluativas en la empresa de biocomercio Wikiri, cantón Rumiñahui

This research work indicates the results of two touristic proposals for the ecuadorian company, Wikiri (a private company dedicated to the sustainable biotrade of amphibian species from Ecuador). The first proposal corresponded to the redesign of the environmental interpretation trail existing in Wikiri for the in situ observation of amphibians; the second proposal corresponded to the application of recreational tools to determine the knowledge level acquired by visitors at the end of the tours in the company and, above all, to create a critical thinking about environmental conservation. The research was carried out under a mixed approach, with the application of a survey, interviews, bibliographic search and field visits. For this, 92 responses were obtained from people who have visited the Wikiri facilities. The obtained results show the diagnosis of the visitors to the company, the visitors profile and their interest, the current state of the trail in order to propose its redesign with its respective signage. These are key aspects on which the company should focus to increase the number of visits. Finally, the ideal playful tools were determined, to be applied at Wikiri Frogpark to evaluate the knowledge acquired by its visitors.El presente trabajo de investigación muestra los resultados de dos propuestas turísticas para la empresa ecuatoriana Wikiri (empresa privada dedicada al biocomercio sostenible de especies de anfibios del Ecuador). La primera propuesta se enfoca en el rediseño del sendero de interpretación ambiental que existe actualmente en Wikiri para la observación de anfibios in situ; la segunda propuesta corresponde a la aplicación de herramientas lúdicas para identificar el nivel de captación de conocimientos adquiridos, por parte de los visitantes, después de efectuar los recorridos en el centro de investigación, con el objetivo de generar conciencia sobre la conservación ambiental. La investigación se llevó a cabo bajo el enfoque mixto cualitativo y cuantitativo, con la aplicación de encuesta, entrevistas, búsqueda bibliográfica y visitas de campo. Se obtuvieron 92 respuestas de personas que visitaron las instalaciones de Wikiri. Los resultados obtenidos evidencian el diagnóstico de las visitas del público a la empresa, determinando el perfil e interés del visitante, el estado actual del sendero, para proponer su rediseño, y su respectiva señalética. Estos son puntos clave, en los cuales debe enfocarse la empresa para incrementar el número de visitas que recibe. Finalmente, se determinó cuáles son las herramientas lúdicas idóneas para aplicarlas dentro de Wikiri Sapoparque y evaluar el conocimiento adquirido por sus visitantes

Efecto de la labranza y fertilización nitrogenada en los cultivos de fréjol y maíz sobre indicadores biológicos de la calidad de un suelo andino del Ecuador

Biological parameters are used as early indicators of the quality of an agricultural soil (ICS), due to their quick response to the anthropic soil management. The main objective of this research was to determine the effect of the tillage system: no-till (SD) and conventional tillage (LC), and to the nitrogen fertilization in bean and corn crop on certain biological indicators of soil quality. The study was carried out on a mollisol from the Andean region of Ecuador. Microbial biomass (MB), microbial respiration (RM), and enzyme activity (acid phosphatase, hydrolysis of fluorescein diacetate [FDA], and β-glucosidase [β-G]) were determined. The results showed that the phosphatase presented the highest activity under LC, the FDA responded to the effect of high nitrogen levels application (N), the activity of the β-G enzyme was higher under LC. Additionally, the principal component analysis selected these biological indicators studied as ICS. It is concluded that the biological indicators of the soil were affected by the management practices studied.Los parámetros biológicos son usados como indicadores tempranos en la calidad de un suelo (ICS) agrícola, ya que responden rápidamente al manejo antrópico. El objetivo de esta investigación fue determinar el efecto del sistema de labranza: siembra directa (SD) y labranza convencional (LC), y de la fertilización nitrogenada después de los cultivos de fréjol y maíz, sobre ciertos indicadores biológicos de la calidad del suelo. El estudio se realizó sobre un molisol de la región andina del Ecuador. Se determinó la biomasa microbiana (BM), respiración microbiana (RM), y actividad enzimática (fosfatasa ácida, hidrólisis de la fluoresceína-diacetato [FDA], y β-glucosidasa [β-G]). Los resultados mostraron que la fosfatasa presentó la mayor actividad bajo LC, la FDA respondió al efecto de los niveles altos de nitrógeno (N), la actividad de la enzima β-G fue mayor en LC. Adicionalmente, el análisis de componentes principales seleccionó a los indicadores biológicos estudiados, como ICS. Se concluye que los indicadores biológicos del suelo fueron afectados por las prácticas de manejo estudiadas

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Noticeable Shifts in Soil Physicochemical and Biological Properties after Contrasting Tillage Management in Crop Rotations of Bean, Maize, and Amaranth in Ecuadorian Highland Soils

Soil biological properties are sensitive indicators of soil quality changes due to perturbations occurred under agricultural management. The effects of contrasting tillage, increasing nitrogen fertilization doses, and crop rotations [e.g., bean, maize, bean (BMB) and bean, amaranth, bean (BAB)] on soil physicochemical and biological properties in an Andean soil from Ecuadorian highlands were evaluated in this study. Acid phosphatase, β-Glucosidase, fluorescein diacetate hydrolysis, microbial biomass carbon (Cmic), soil basal respiration (BR), arbuscular mycorrhizal fungi (AMF) spore density, total glomalin content (TGRSP), and soil physicochemical properties were analyzed. Conventional tillage (CT) and crop rotation showed significant effects on soil physicochemical and biological properties. Towards the final crop rotations, no-tillage (NT) promoted BR, TGRSP, and higher AMF spore density in both crop rotations; the Cmic kept stable along time in BMB and BAB, while BR doubled its value when compared to CT. Results indicated that the AMF spore density increased by 308% at the end of the BMB, and 461% at the end of the BAB, while TGRSP increased by 18% and 32% at the end of BMB and BAB, respectively. Biological traits demonstrated to be strongly associated to the organic matter accumulation originated from crop residues under the NT post-harvest which improved soil moisture, biological activity, and AMF interaction. The conservative soil management system has definitively improved general soil properties when compared to soil conditions under the intensive soil management system in this research

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society