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

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 middle-income 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 low-income 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 low-income, 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

collembola from the canopy of a mexican tropical deciduous forest

Sampling of the Arthropoda in a tropical deciduous forest was carried out at Chamela, Mexico. The Collembola community was emphasized because it was the most abundant arthropod group in the samples. Salina banksi (Paronellidae) was the most abundant and constant Collembola species. Seasonal variation of the abundance was positively correlated with precipitation and temperature. Canopy and shrub layer from Chamela shared only 12 Collembola species with the leaf litter and soil from the same study area. From reports in the literature, it was determined than Chamelan Collembola are more abundant than elsewhere

abundance of springtails (hexapoda: collembola) and edaphic parameters from a deciduous dry forest

The abundance patterns of leaf litter and soil springtails (Hexapoda: Collembola) from two hydrological watersheds of the Chamela Biological Station (EBCh, UNAM) in Jalisco, Mexico are described and compared based on monthly sampling over one year. This locality, where the dominant vegetation is tropical dry forest, had an atypically high rainfall during the sampling period, with the greatest amount of rain during January. Sampling in both biotopes was random, the areas sampled were of the same size (95 cm(2)), and these were processed in situ using Berlese funnels. In addition, different edaphic characteristics were quantified. The effect of watershed, biotope and seasonality factors on the abundance of Collembola families was analysed. Using Cluster Analysis (CA), the faunistic relationships between the assemblages were explored, and using Canonical Correspondence Analysis (CCA) the relationships between assemblages and the physico-chemical variables of the soil. A total of 24.253 Collembola were obtained, belonging to 13 families. The most abundant were Isotomidae, Entomobryidae, Hypogastruridae and Sminthuridae. The CA showed more similarity between biotopes than between hydrological watersheds, while in the CCA the most important variable to explain the distribution and abundance of the Collembola was humidity

litter and soil arthropods diversity and density in a tropical dry forest ecosystem in western mexico

The composition and temporal changes of edaphic microarthropods in both litter layer and soil were analyzed in a tropical dry forest ecosystem in Western Mexico. Sampling was carried out from June 1991 to July 1992 in two small watersheds at the Chamela Biological Station (Jalisco State, Mexico). At each watershed 10 random cores samples, 11 cm in diameter and 5 cm depth, were taken monthly from each biotope from an area of 100 m(2) supercript stop. Fauna was extracted by Berlese-Tullgren funnels and preserved in 75% ethanol. The total abundance of arthropods was 96,338 specimens, belonging to 33 taxa. Numerically dominant groups were Prostigmata, Cryptostigmata, Collembola and Mesostigmata, which constituted 92.6% of the total abundance. The effect of current monthly precipitation and temperature on density of total Arthropoda and different Orders was also investigated. Precipitation and temperature were significantly correlated with Collembola and Mesostigmata densities and also with total arthropod. The seasonal variation in the amount of litterfall was also significantly related to the abundance of arthropod in the litter layer biotope

Positive and Negative Structures and Processes Underlying Academic Performance: A Chained Mediation Model

This study proposed and tested a comprehensive, chained mediation model of university students’ academic performance. The hypothesized model included adaptive-positive and maladaptive-negative submodels. The structures and processes in the adaptive-positive submodel were hypothesized to facilitate students’ academic performance, whereas the structures and processes in the maladaptive-negative submodel were hypothesized to undermine it. A sample of 373 university students completed a set of questionnaires measuring their approaches to studying, positive and negative affect, evaluation anxiety, use of creative cognition, motivational orientations, and adaptive and maladaptive metacognitions. Participants’ end-of-semester and prior semester academic performance was retrieved from the university registry. A structural equation model explained 90 % of the variance in students’ future academic performance, supported all but one hypothesized intermediate paths, and revealed that only positive affect in studying and prior academic performance predict directly future academic performance. The theoretical and practical implications of these findings are outlined