Identification of Agroclimatic risk areas for dairy livestock systems in Valle de Ubaté y Chiquinquirá and Alto Chicamocha

Páginas 170-183En este estudio se determinó la aptitud agroclimática para el sistema ganadero de leche mediante la formulación del “Índice de Aptitud Agroclimática (IAC)”. El índice se construyó a partir del análisis territorial de variables limitantes como la pendiente, la exposición a heladas, el índice de humedad y temperatura para Bos taurus, la frecuencia de ocurrencia de condiciones de déficit hídrico en el suelo calculado mediante balances hídricos, el número de días sin lluvia y la precipitación media acumulada. El índice agroclimático permitió identificar áreas críticas para el sistema de ganadería en los periodos secos de diciembre a febrero, como primer trimestre seco y de junio a agosto como segundo trimestre seco. Los resultados mostraron que en el primer trimestre seco hay una mayor área con limitaciones agroclimáticas en comparación con el segundo trimestre seco; cerca de 192.369 ha ubicadas en la región del Alto Chicamocha presentaron los valores más bajos del IAC, indicando una menor aptitud agroclimática: Sogamoso, Corrales, Tutazá, Belén, Santa Rosa de Viterbo, Floresta, Nobsa, Sotaquirá, Cerinza, Pesca, Chíquiza, Tausa, Samacá, Cucaita, Sogamoso y Firavitoba fueron los municipios con más baja aptitud agroclimática para los dos periodos secos, tanto en términos de las limitantes evaluadas como del IAC. Las áreas con menores limitaciones (con valores más altos del IAC) se observaron en el 12% del área estudiada y correspondieron principalmente a los municipios de Oicatá y Cuitiva en la región del Alto Chicamocha, y Cucunubá en el valle de Ubaté y Chiquinquirá.ABSTRACT: In this study, the agroclimatic suitability for dairy livestock systems was determined with an “Agroclimatic suitability index (ASI)”. The index was constructed from the territorial analysis of restrictive variables such as slope, frost exposure, Bos taurus temperature and humidity index. The soil water deficit frequency was calculated with water balances, days without rain and accumulated average precipitation. The agroclimatic index identified critical areas for dairy livestock systems in the main dry periods (December to February and June to August). The results showed that in the first dry quarter, there was a larger area with agroclimatic limitations as compared to the second dry quarter. About 192,369 ha, located mainly in the Alto Chicamocha, had the lowest IAC values, indicating a lower agroclimatic suitability. Sogamoso, Corrales, Tutaza, Belen, Santa Rosa de Viterbo, Floresta, Nobsa, Sotaquira, Cerinza, Pesca, Chiquiza, Tausa, Samaca, Cucaita, Sogamoso and Firavitoba were the municipalities with the lowest agroclimatic suitability index for the two dry periods. The areas with the lowest limitations (with higher IAC values) were observed in 12% of the studied area and corresponded mainly to the municipalities of Oicata and Cuitiva in the Alto Chicamocha and Cucunuba in the Valle de Ubate and Chiquinquira.Bibliografía: páginas 181-183.Artículo revisado por pares

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

Background The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.publishedVersio

Harvesting Memory, Preserving Home: A Cookbook of the Painted Turtle Farm/Cosechando Memoria, Preservando el Hogar: Un Libro de Cocina de la Granja de la Tortuga Pintada

About this Project In the fall of 2018, 14 of the families and 32 students from two first-year seminars, Crossing Borders: Immigration, Identity, and Development and Immigrant Stories, worked together to create this cookbook. Families submitted their favorite dishes and then invited students to their homes to demonstrate the preparation. As they cooked and ate together, students recorded the steps to make the recipe and listened as connections between food, memory, family, migration, traditions, and religion emerged. Harvesting Memory, Preserving Home: A Cookbook of the Painted Turtle Farm is the product of this undertaking. In it, we offer the collection of recipes as well as a short story from each family, bring meaning to the food we eat, the places life brings us, and the memories we share. Sobre este Projecto En el otoño de 2018, 12 de las familias y 32 estudiantes de dos clases, Cruzando Fronteras: Immigración, Identidad, y Desarrollo y Las Historias Immigrantes trabajaron juntos para cear este libro de cocina. Las familias escogieron platos con una importancia o una memoria especial para preparar en sus casas con los estudiantes. Durante el proceso de concinar y comer juntos, los estudiantes anotaron los pasos para preparar la receta. Ellos escucharon las conexiones entre la comida, la memoria, la familia, la migración, las tradiciones, y la religión. Cosechando Memoria, Preservando el Hogar: Un Libro de Cocina de la Granja de la Tortuga Pintada es el fruto de este proyecto. Ofrecemos la collección de recetas además de una historia breve de cada familia, para dar significado a los alimentos que comemos, los lugares donde la vida nos trae, y las memorias que nos compartimos

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112