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

Pollination service provided by honey bees to buzz-pollinated crops in the Neotropics.

Generalist honey bees grant significant pollination services worldwide. Although honey bees can provide compensatory pollination services, their service to buzz-pollinated crops, compared to specialized pollinators, is not clear. In this study, we assessed the contribution of Africanized honey bees (AHB) and native sonicating bees (NBZ) to the pollination of eggplant (Solanum melongena) and annatto (Bixa orellana) in Yucatan, Mexico, one of the largest producers of these crops in the Americas and a region with one of the largest densities of honey bees in the world. We first compared the relative frequency and abundance of both bee types on flowers of both crops. Secondly, we controlled access to flowers to compare the number and weight of fruit and number of seed produced after single visits of AHB and native bees. For a better assessment of pollination services, we evaluated the productivity of individual flowers multiply visited by AHB. The results were compared against treatments using pollinator-excluded flowers and flowers that were supplied with additional pollen, which allowed an overall measure of pollination service provision (PSP). Our results showed that AHB were the predominant flower visitors in both crops and that were poorly efficient on individual visits. Notably, fruit quantity and seed number increased concomitantly with the number of AHB visits per flower on eggplant, but not on annatto. Estimation of PSP revealed no pollination deficit on eggplant but that a deficit existed on the pollination services to annatto. We found that AHB numerical predominance compensates their poor individual performance and can complement the services of native bees on eggplant, but not on annatto. We discuss possible explanations and implications of these results for buzz-pollinated crops in the neotropics an area with little assessment of pollination services and a high density of honey bees

Tacinga armata J. G. Freitas & E. M. Almeida 2021, sp. nov.

&lt;i&gt;Tacinga armata&lt;/i&gt; J.G.Freitas &amp; E.M.Almeida &lt;i&gt;sp. nov&lt;/i&gt;. (Figures 1, 4A&ndash;C, 5B, 6A, 7A). &lt;p&gt; &lt;b&gt;Type:&mdash;&lt;/b&gt; BRAZIL. Para&iacute;ba: Monteiro, Povoado Morcego, 745 m a.s.l., 7&ordm;49&prime;50&Prime;S, 37&ordm;07&prime;55&Prime;W, 03 January 2014, fr., &lt;i&gt;Ara&uacute;jo s.n.&lt;/i&gt; (holotype EAN!).&lt;/p&gt; &lt;p&gt; &lt;b&gt;Diagnosis:&mdash;&lt;/b&gt; &lt;i&gt;Tacinga armata&lt;/i&gt; resembles &lt;i&gt;T. palmadora&lt;/i&gt; and &lt;i&gt;T. werneri&lt;/i&gt; from which differs by its thicker stem-segments (0.6&ndash;1.3 cm &lt;i&gt;vs&lt;/i&gt;. up to 0.8 cm), larger (up to 5.5 cm &lt;i&gt;vs&lt;/i&gt;. up to 2.0 cm) and thicker (1.5 mm &lt;i&gt;vs&lt;/i&gt;. ~ 1 mm) spines, globose fruits (&lt;i&gt;vs.&lt;/i&gt; oblongs), pericarp spines short and falling out after maturation (&lt;i&gt;vs&lt;/i&gt;. unarmed, with densely hairy areoles), fruits attached to stem-segments for a long time after ripening (&lt;i&gt;vs&lt;/i&gt;. immediately deciduous after maturation), and seeds 48&ndash;52 per fruit (&lt;i&gt;vs&lt;/i&gt;. 8&ndash;38 seeds).&lt;/p&gt; &lt;p&gt; &lt;b&gt;Description:&mdash;&lt;/b&gt; Terrestrial or saxicolous, erect shrub 30&ndash;80 cm tall, usually growing as isolated individuals; stemsegments oblong, 5&ndash;15 &times; 3.5&ndash;5.5 &times; 0.6&ndash;1.3 cm, erect, flat, spiny, without podaria, epidermis dark green, shoots 1&ndash;3, apical; areoles circular, 2&ndash;3 mm in diameter, disposed in 4&ndash;6 clockwise spirals, 60&ndash;108 per stem-segment (denser towards apex), hairs whitish, woolly, located in the center of the areoles, glochids golden, arranged in a crown shape around areolar hairs; spines 6&ndash;15 per areole, rigidly acicular, radial spines 5&ndash;12, 1.0&ndash; 4.5 cm long, white tipped brownish, central spines 1(&ndash;3), 1.5&ndash;5.5 cm long, longer and slightly thicker than radial ones, golden when young and gradually changing to whitish with age. Leaves subulate, 0.5&ndash;0.8 &times; 0.2&ndash;0.3 cm, fleshy, light green tipped reddish, early deciduous. Flowers 3.5&ndash;4.0 &times; 1.5&ndash;2.5 cm, apical or marginal in the distal stem-segments; pericarpel oblong, 2.0&ndash; 2.5 cm high, 1.6&ndash;2.0 cm in diameter, deeply depressed and forming an apical tube; flower bracts subtending each areole, subulate, fleshy, green, early deciduous; flower areoles disposed in 3&ndash;4 clockwise spirals, spines and hairs present; perianth triseriate, perianth segments 18 in total, tube relatively short, external perianth segments 0.7&ndash;1.0 cm long, cymbiform, fleshy, red, internal segments 1.5&ndash;2.0 cm long, oblong, erect, petaloid, apex acuminate with a terminal hair, red; stamens numerous, included, 0.5&ndash;1.0 cm long, red, surrounding the stigma lobes; anthers white (anthesis) or cream (after anthesis); stigma 6-lobed, yellowish, lobes exserted in relation to the stamens. Fruits remaining firmly attached to stem-segments after ripening; young fruits oblong, 2.5 &times; 1.8 cm, podaria slightly raised, funiculus 1.6 cm in diameter, 0.9&ndash;1.0 cm deep, pericarp light green, spiny, areoles with glochids and hairs, spines 1&ndash;5 per areole, 0.5&ndash;2.0 cm long, deciduous; mature fruits globose, about 3 cm in diameter, funiculus slightly depressed, pericarp dark green to pinkish (with age), mesocarp yellowish green, pulp translucent with reddish fibers. Seeds pyriform, 48&ndash;52 per fruit, two different kinds, small atrophied seeds up to 0.2 cm in diameter, large developed seeds up to 0.4 cm in diameter, tegument bony, perisperm woolly, whitish, mesosperm rigid, cream, endosperm membranaceous, brownish, embryo J-shaped, occupying all the seed cavity.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Etymology:&mdash;&lt;/b&gt; The specific epithet is from the Latin &lt;i&gt;armatus&lt;/i&gt; &ldquo;armed&rdquo;, in reference to the size of spines and their density on the plant (including flowers and fruits).&lt;/p&gt; &lt;p&gt; &lt;b&gt;Phenology:&mdash;&lt;/b&gt; On its natural habitat, flowering and fruiting were observed in December to January and September. Under cultivation, flowering occurred in October and March. These differences in flowering and fruiting could be product of the more or less constant conditions under cultivation (&lt;i&gt;vs&lt;/i&gt;. the variable environmental conditions in nature) where, moreover, the plants have more availability of water and nutrients. Each flower remains open for two hours early in the morning (08:00 to 10:00 hr, GMT-3) and one hour late in the afternoon (16:00 to 17:00 hr). Fruits are observed approximately 15 days after anthesis and complete maturation takes at least four months. They stay firmly attached to the stem-segments for a long time after ripening.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Distribution and habitat:&mdash;&lt;/b&gt; &lt;i&gt;Tacinga armata&lt;/i&gt; is known from five populations, each of approximately 2,000 individuals inhabiting areas of ca. 9,000 0 m 2. The type locality, &ldquo;povoado do Morcego&rdquo;, is located 8 km north of Monteiro (Para&iacute;ba, Brazil) at small isolated outcrop hills in the mountain complex known as &ldquo;Serras da Jabitac&aacute;&rdquo;. The other four populations are located in adjacent mountains (2 to 77 km afar from type locality) of the Serra da Bolandeira and Serra do Paulo in the Borborema Plateau. In this area, &lt;i&gt;T&lt;/i&gt;. &lt;i&gt;armata&lt;/i&gt; grows in full sun at 700&ndash;1100 m altitude in a xeric environment composed of compacted soils and granitic outcrops harboring shrubby caatinga vegetation (Fig. 1J&ndash;L). EMA found &lt;i&gt;T&lt;/i&gt;. &lt;i&gt;armata&lt;/i&gt; occurring together with &lt;i&gt;T&lt;/i&gt;. &lt;i&gt;palmadora&lt;/i&gt; in a mountain of the Serra da Bolandeira in Sert&acirc;nia, Pernambuco (see Fig. 1K). We believe both species might occur sympatrically at other localities in these mountain ranges.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Conservation status:&mdash;&lt;/b&gt; According to IUCN (2019) criteria, &lt;i&gt;Tacinga armata&lt;/i&gt; should be considered vulnerable to extinction (VU-B1a) due to its restricted geographic distribution (5 localities, EOO = 20 km 2, and AOO = 1,011.257 km 2), inhabiting areas under severe fragmentation or close to agricultural land.&lt;/p&gt; &lt;p&gt; &lt;b&gt;Cytogenetic notes:&mdash;&lt;/b&gt; &lt;i&gt;Tacinga armata&lt;/i&gt; has a 2CDNA = 6.28 pg, and a chromosome number 2 &lt;i&gt;n&lt;/i&gt; = 66. Chromosomes are mostly metacentric and submetacentric, and relatively symmetrical. Chromosome size ranging from 1.9 to 2.2 &micro;m. Four chromosomes have CMA + bands, two with interstitial bands and two with terminal ones (Fig. 6A). This species has a number and pattern of CMA + bands similar to those of &lt;i&gt;T&lt;/i&gt;. &lt;i&gt;werneri&lt;/i&gt; (2 &lt;i&gt;n&lt;/i&gt; = 66, Alves &lt;i&gt;et al&lt;/i&gt;. 2019) and &lt;i&gt;T&lt;/i&gt;. &lt;i&gt;lilae&lt;/i&gt; (2 &lt;i&gt;n&lt;/i&gt; = 66, Majure &lt;i&gt;et al&lt;/i&gt;. 2012). &lt;i&gt;T. palmadora&lt;/i&gt;, the other most similar species, has a lower chromosome number (2 &lt;i&gt;n&lt;/i&gt; = 22) and a smaller 2CDNA (2.38 pg) but similar CMA + / DPI- (2t /2i) band patterns (Alves &lt;i&gt;et al&lt;/i&gt;. 2019).&lt;/p&gt; &lt;p&gt; &lt;b&gt;Additional material examined:&lt;/b&gt; &mdash; BRAZIL. Bahia: Para&iacute;ba, S&atilde;o Jo&atilde;o do Tigre, in&iacute;cio da subida para Serra do Paulo, pr&oacute;ximo ao riacho, 890 m, 08&deg;05&prime;37&Prime;S, 36&deg;39&prime;38&Prime;W, 20 September 2020, fl., fr., &lt;i&gt;Almeida 3181&lt;/i&gt; (CAGD1037, EAN); Monteiro, s&iacute;tio Pendur&atilde;o, 720 m, 07&deg;50&prime;13&Prime;S, 37&deg;07&prime;06&Prime;W, 20 September 2020, fl., fr., &lt;i&gt;Almeida 3182&lt;/i&gt; (CAGD1038, EAN); Pernambuco, Po&ccedil;&atilde;o, distrito do Quat&iacute;, 1086 m, 08&deg;08&prime;35&Prime;S, 36&deg;42&prime;03&Prime;W, 20 September 2020, fl., fr., &lt;i&gt;Almeida 3172&lt;/i&gt; (CAGD1028, EAN); Sert&acirc;nia, Pico da Bolandeira, 1037 m, 07&deg;58&prime;34&Prime;S, 37&deg;20&prime;53&Prime;W, 21 September 2020, fl., fr., &lt;i&gt;Almeida 3188&lt;/i&gt; (CAGD1047, EAN).&lt;/p&gt;Published as part of &lt;i&gt;Freitas, Juliana Gomes, Alves, Lania Isis Ferreira, Zappi, Daniela Cristina, Almeida, Erton Mendonça De, Peraza-Flores, Lizandro N., Amaral, Daniel Oliveira Jordão Do, Araújo, Daniel Bruno Pereira &amp; Batista, Fabiane Rabelo Da Costa, 2021, Novelties in Cactaceae from Eastern Brazil: Adding two new species and one new nothospecies to Tacinga (Opuntioideae), pp. 239-252 in Phytotaxa 490 (3)&lt;/i&gt; on pages 241-244, DOI: 10.11646/phytotaxa.490.3.2, &lt;a href="http://zenodo.org/record/5756420"&gt;http://zenodo.org/record/5756420&lt;/a&gt

Tacinga Britton & Rose 1919

Key to species of &lt;i&gt;Tacinga&lt;/i&gt; &lt;p&gt;1. Plants scandent, stem-segments 25&ndash;70 cm long, cylindric or slightly flat at apex............................................................................2&lt;/p&gt; &lt;p&gt;- Plants erect, decumbent or creeping, stem-segments 3&ndash;22 cm long, usually flat..............................................................................3&lt;/p&gt; &lt;p&gt; 2. Stem-segments completely cylindric, reddish; flower segments yellowish to brownish, sometimes purplish, anthers darkening after anthesis, style longer than stamens, pericarp with glochids 0.3&ndash;0.4 cm long, areoles without woolly hairs........... &lt;i&gt;Tacinga funalis.&lt;/i&gt;&lt;/p&gt; &lt;p&gt; - Stem-segments cylindric, the distal ones flat toward apex, dark green or purplish, flower segments light green or whitish, anthers whitish green, style as long as the stamens, pericarp with glochids 0.1&ndash;0.2 cm long, areoles with woolly hairs.................................................................................................................................................................................................................. &lt;i&gt;Tacinga braunii&lt;/i&gt;&lt;/p&gt; &lt;p&gt;3. Plants spiny.........................................................................................................................................................................................4&lt;/p&gt; &lt;p&gt;- Plants unarmed.................................................................................................................................................................................11&lt;/p&gt; &lt;p&gt;4. Stem-segments, pericarp and fruits with whitish prominent stomata, areoles densely spiny, spines radially arranged, 1&ndash;5 central spines..................................................................................................................................................................................................5&lt;/p&gt; &lt;p&gt;- Stem-segments, pericarp and fruits without visible stomata, areoles scarcely spiny, spine perpendicular or inclined to stemsegments, only 1 central spine............................................................................................................................................................7&lt;/p&gt; &lt;p&gt;5. Stem-segments with podaria slightly raised, spines thin and up to 3.0 cm long, golden or yellowish, pericarp and fruits unarmed..............................................................................................................................................................................................................6&lt;/p&gt; &lt;p&gt; - Stem-segments without visible podaria, spines thick and up to 5.5 cm long, whitish tipped brownish, pericarp and young fruits spiny..................................................................................................................................................................................... &lt;i&gt;T. armata&lt;/i&gt;&lt;/p&gt; &lt;p&gt; 6. Fruits with 20&ndash;30 seeds, pulp reddish...................................................................................................................................... &lt;i&gt;T. lilae&lt;/i&gt;&lt;/p&gt; &lt;p&gt; - Fruits with 6&ndash;15 seeds, pulp translucent or greenish..................................................................................................... &lt;i&gt;T. palmadora&lt;/i&gt;&lt;/p&gt; &lt;p&gt; 7. Stem-segments orbicular or obovate, young stem-segments areoles with long hairs........................................................ &lt;i&gt;T. saxatilis&lt;/i&gt;&lt;/p&gt; &lt;p&gt;- Stem-segments oblong or subcylindric, young stem-segments areoles without hairs.......................................................................8&lt;/p&gt; &lt;p&gt;8. Stem-segments with thin acicular cylindric spines, fruits oblong......................................................................................................9&lt;/p&gt; &lt;p&gt;- Stem-segments with thick acicular cylindric spines, sometimes slightly flattened at base, fruits globose......................................10&lt;/p&gt; &lt;p&gt; 9. Flowers with reflexed segments, fruits orangish with no color variation around areoles.............................................. &lt;i&gt;T. &times; flammea&lt;/i&gt;&lt;/p&gt; &lt;p&gt; - Flowers with erect segments, fruits whitish with a green ring surrounding the areoles..................................................... &lt;i&gt;T. werneri&lt;/i&gt;&lt;/p&gt; &lt;p&gt; 10. Stem-segments oblong (9&ndash;15 &times; 6&ndash;8 cm), spines erect................................................................................................... &lt;i&gt;T. gladispina&lt;/i&gt;&lt;/p&gt; &lt;p&gt; - Stem-segments subcylindric (3&ndash;8 &times; 1.5&ndash;3 cm), spines contorted....................................................................................... &lt;i&gt;T. &times; quipa&lt;/i&gt;&lt;/p&gt; &lt;p&gt; 11. Plants creeping, stem-segments subcylindric, pericarpel areoles with reddish hairs................................................ &lt;i&gt;T. subcylindrica&lt;/i&gt;&lt;/p&gt; &lt;p&gt; - Plants decumbent, stem-segments flat, pericarpel areoles without hairs........................................................................ &lt;i&gt;T. inamoena&lt;/i&gt;&lt;/p&gt;Published as part of &lt;i&gt;Freitas, Juliana Gomes, Alves, Lania Isis Ferreira, Zappi, Daniela Cristina, Almeida, Erton Mendonça De, Peraza-Flores, Lizandro N., Amaral, Daniel Oliveira Jordão Do, Araújo, Daniel Bruno Pereira &amp; Batista, Fabiane Rabelo Da Costa, 2021, Novelties in Cactaceae from Eastern Brazil: Adding two new species and one new nothospecies to Tacinga (Opuntioideae), pp. 239-252 in Phytotaxa 490 (3)&lt;/i&gt; on pages 250-251, DOI: 10.11646/phytotaxa.490.3.2, &lt;a href="http://zenodo.org/record/5756420"&gt;http://zenodo.org/record/5756420&lt;/a&gt