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

Reativações pós-silurianas do Lineamento Transbrasiliano na porção sul da Bacia do Parnaíba

O Lineamento Transbrasiliano (LTB) apresenta direção NE-SW. Cerca de 900 km desse sistema interceptam o substrato da Bacia do Parnaíba (BPar), inferido, a partir de dados geológicos e geofísicos, como uma zona de cisalhamento plástica transcorrente dextral. Este trabalho objetivou abordar a assinatura estrutural e os marcadores estratigráficos associados às reativações do LTB na região sul da bacia, ao leste de Palmas (TO). No embasamento cristalino, um estágio tardio do LTB se expressa como uma zona dúctil-frágil também de cinemática dextral de idade ediacarana-cambriana, no NW do Ceará. Nas unidades litoestratigráficas da BPar são distinguidos eventos de reativação em regime frágil ou hidroplástico. Na região de estudo, um evento mais antigo registra cinemática transcorrente sinistral expressa principalmente como bandas de deformação e falhas com direção NE, combinadas a estruturas dilatacionais (incluindo juntas e falhas normais) ou conjugadas/antitéticas de rejeito direcional ou oblíquo, com orientações que variam de NNE a NNW, todas observadas nos litotipos das Formações Sambaíba e Pedra de Fogo, bem como nas mais antigas. Ao sudeste de Alto Parnaíba (MA) são observadas evidências de atividade tectônica sindeposicional durante o Permiano superior. Um segundo conjunto de estruturas composto por falhas normais associadas a uma distensão N/NNW, impressas nos corpos básicos de idade eojurássica da Suíte Mosquito, que, por sua vez, é capeada por depósitos com seixos das vulcânicas, correlacionados à Formação Corda. Um terceiro conjunto de estruturas, caracterizado por falhas normais ou oblíquas com direção NE, registra distensão NW, sendo associada ao evento de rifteamento da Margem Leste brasileira, durante o Cretáceo Inferior. Finalmente, um quarto evento, de ocorrência restrita, envolve distensão NE e está registrado em arenitos correlacionados ao Grupo Urucuia, implicando uma idade máxima neocretácea.The Transbrasiliano lineament trends NE-SW, and about 900 km of it occurs in the substrate of the Parnaíba Basin, inferred to be a plastic shear zone with dextral strike-slip kinematics based on geological and geophysical data. This paper addresses the structural signature and age of Transbrasiliano lineament reactivations in the southern region of the basin, east of the city of Palmas. In the crystalline basement, a late, ductile-brittle stage of Transbrasiliano lineament also displays dextral kinematics of ediacara-cambrian age, as observed in NW Ceará State. In the lithostratigraphic units of the Parnaíba Basin, reactivation events under brittle or hydroplastic conditions are recognized. In the studied region, an older event of sinistral transcurrent kinematics is expressed by NE-trending deformation bands and faults, combined with oblique structures, either dilatational (including joints and normal faults) or conjugate/antithetic strike-slip or oblique-slip structures. Their orientation ranges from NNE to NNW, as observed in the Sambaíba, Pedra de Fogo and older formations. In the southeast of Alto Parnaíba, evidence of neopermian, syndepositional tectonic activity was observed. A second set of structures is extensional joints or oblique-slip and normal faults associated to a N/NNW extension, overprinted in the eojurassic basic rocks of the Mosquito Suite. Sandstones bearing volcanic clasts were correlated to the Corda Formation and overly basic sills. A third set of structures, characterized by NE-trending normal or oblique faults, reflects a NW extension, as it is correlated to the rifting event in the Brazilian Eastern Margin during the Eocretaceous. Finally, a fourth event, with a more restrict occurrence, involves NE extension, as it is also observed in the Urucuia Group sandstones, implying a Neocretaceous age for this event.

Influência militar na atual política brasileira: erosão ou retirada?

Francisco César Alves FerrazHUNTER, Wendy. Eroding Military Influence in Brazil. Politicians against Soldiers. Chapel Hill and London : University of North Carolina Press, 1997 (ISBN 0807846201; paperback: U$ 18,95).

ATLANTIC BIRD TRAITS

Scientists have long been trying to understand why the Neotropical region holds the highest diversity of birds on Earth. Recently, there has been increased interest in morphological variation between and within species, and in how climate, topography, and anthropogenic pressures may explain and affect phenotypic variation. Because morphological data are not always available for many species at the local or regional scale, we are limited in our understanding of intra- and interspecies spatial morphological variation. Here, we present the ATLANTIC BIRD TRAITS, a data set that includes measurements of up to 44 morphological traits in 67,197 bird records from 2,790 populations distributed throughout the Atlantic forests of South America. This data set comprises information, compiled over two centuries (1820–2018), for 711 bird species, which represent 80% of all known bird diversity in the Atlantic Forest. Among the most commonly reported traits are sex (n = 65,717), age (n = 63,852), body mass (n = 58,768), flight molt presence (n = 44,941), molt presence (n = 44,847), body molt presence (n = 44,606), tail length (n = 43,005), reproductive stage (n = 42,588), bill length (n = 37,409), body length (n = 28,394), right wing length (n = 21,950), tarsus length (n = 20,342), and wing length (n = 18,071). The most frequently recorded species are Chiroxiphia caudata (n = 1,837), Turdus albicollis (n = 1,658), Trichothraupis melanops (n = 1,468), Turdus leucomelas (n = 1,436), and Basileuterus culicivorus (n = 1,384). The species recorded in the greatest number of sampling localities are Basileuterus culicivorus (n = 243), Trichothraupis melanops (n = 242), Chiroxiphia caudata (n = 210), Platyrinchus mystaceus (n = 208), and Turdus rufiventris (n = 191). ATLANTIC BIRD TRAITS (ABT) is the most comprehensive data set on measurements of bird morphological traits found in a biodiversity hotspot; it provides data for basic and applied research at multiple scales, from individual to community, and from the local to the macroecological perspectives. No copyright or proprietary restrictions are associated with the use of this data set. Please cite this data paper when the data are used in publications or teaching and educational activities. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data