The Pacific Alliance and the potential effects of a Trans-Pacific Economic Cooperation Agreement without the United States

This article analyzes the possible consequences of the entry into force of the Trans-Pacific Partnership Agreement (TPP) without the United States for the countries of the Pacific Alliance (PA). It develops a descriptive analysis of the evolution of trade between PA countries and TPP member countries during the period 1980-2015. Gravitational models are also estimated to empirically examine the determinants of trade flows in these countries. As a result, the paper shows that TPP may favor trade flows in PA countries, and that the withdrawal of the U.S. from TPP would not affect these trade flows.Este artículo analiza las posibles consecuencias, para los países de la Alianza del Pacífico (AP), de la entrada en vigor del Acuerdo de Asociación Transpacífico (TPP) sin Estados Unidos. Para ello, se desarrolla un análisis descriptivo de la evolución del comercio de los países de la AP con el resto de los países miembro del TPP durante el periodo 1980-2015. También se estiman modelos gravitacionales para examinar empíricamente los determinantes de los flujos comerciales de estos países. Se encuentra que el TPP puede favorecer los flujos comerciales de los países de la AP y que la salida de Estados Unidos del TPP no afectaría estos flujos comerciales

Biodiversity recovery of Neotropical secondary forests

Old-growth tropical forests harbor an immense diversity of tree species but are rapidly being cleared, while secondary forests that regrow on abandoned agricultural lands increase in extent. We assess how tree species richness and composition recover during secondary succession across gradients in environmental conditions and anthropogenic disturbance in an unprecedented multisite analysis for the Neotropics. Secondary forests recover remarkably fast in species richness but slowly in species composition. Secondary forests take a median time of five decades to recover the species richness of old-growth forest (80% recovery after 20 years) based on rarefaction analysis. Full recovery of species composition takes centuries (only 34% recovery after 20 years). A dual strategy that maintains both old-growth forests and species-rich secondary forests is therefore crucial for biodiversity conservation in human-modified tropical landscapes. Copyright © 2019 The Authors, some rights reserved

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Análisis Numérico Unidimensional del Proceso de Infiltración en Suelos Parcialmente Saturados Reforzados con Geosintéticos Permeables

This article presents a numerical analysis of the water infiltration process on one-dimensional unsaturated soil and soilgeosynthetic columns. The analysis focuses on evaluating the presence of the capillarity barrier under different scenarios of rainfall intensity, initial suction and soil permeability. The results showed a low capacity of the geosynthetic to work as a drainage material when the initial suction in the soil is high, allowing the accumulation of water in the soil above the geosynthetic layer. This research aims to contribute to the state of knowledge on the hydraulic response of geosynthetic-reinforced soils.Este estudio presenta un análisis numérico del proceso de infiltración de agua en columnas unidimensionales de suelo y suelo-geosintético bajo condiciones parcialmente saturadas. El análisis se enfoca en evaluar la presencia de la barrera capilar bajo distintos escenarios de lluvia, presión de poros negativa inicial y permeabilidad del suelo. Los resultados mostraron una baja capacidad del geosintético para actuar como material filtrante cuando el suelo se encuentra en bajos niveles de presión de poros, permitiendo la acumulación de agua en el suelo ubicado por encima del geosintético. Esta investigación aporta al conocimiento de la respuesta hidráulica en la interacción suelogeosintético

Immediate Norepinephrine in Endotoxic Shock:Effects on Regional and Microcirculatory Flow∗

OBJECTIVES: To investigate the effects of immediate start of norepinephrine versus initial fluid loading followed by norepinephrine on macro hemodynamics, regional splanchnic and intestinal microcirculatory flows in endotoxic shock. DESIGN: Animal experimental study. SETTING: University translational research laboratory. SUBJECTS: Fifteen Landrace pigs. INTERVENTIONS: Shock was induced by escalating dose of lipopolysaccharide. Animals were allocated to immediate start of norepinephrine (i-NE) (n = 6) versus mandatory 1-hour fluid loading (30 mL/kg) followed by norepinephrine (i-FL) (n = 6). Once mean arterial pressure greater than or equal to 75 mm Hg was, respectively, achieved, successive mini-fluid boluses of 4 mL/kg of Ringer Lactate were given whenever: a) arterial lactate greater than 2.0 mmol/L or decrease less than 10% per 30 min and b) fluid responsiveness was judged to be positive. Three additional animals were used as controls (Sham) (n = 3). Time × group interactions were evaluated by repeated-measures analysis of variance. MEASUREMENTS AND MAIN RESULTS: Hypotension was significantly shorter in i-NE group (7.5 min [5.5-22.0 min] vs 49.3 min [29.5-60.0 min]; p &lt; 0.001). Regional mesenteric and microcirculatory flows at jejunal mucosa and serosa were significantly higher in i-NE group at 4 and 6 hours after initiation of therapy (p = 0.011, p = 0.032, and p = 0.017, respectively). Misdistribution of intestinal microcirculatory blood flow at the onset of shock was significantly reversed in i-NE group (p &lt; 0.001), which agreed with dynamic changes in mesenteric-lactate levels (p = 0.01) and venous-to-arterial carbon dioxide differences (p = 0.001). Animals allocated to i-NE showed significantly higher global end-diastolic volumes (p = 0.015) and required significantly less resuscitation fluids (p &lt; 0.001) and lower doses of norepinephrine (p = 0.001) at the end of the experiment. Pulmonary vascular permeability and extravascular lung water indexes were significantly lower in i-NE group (p = 0.021 and p = 0.004, respectively). CONCLUSIONS: In endotoxemic shock, immediate start of norepinephrine significantly improved regional splanchnic and intestinal microcirculatory flows when compared with mandatory fixed-dose fluid loading preceding norepinephrine. Immediate norepinephrine strategy was related with less resuscitation fluids and lower vasopressor doses at the end of the experiment.</p

Predicting Tropical Dry Forest Successional Attributes from Space: Is the Key Hidden in Image Texture?

<div><p>Biodiversity conservation and ecosystem-service provision will increasingly depend on the existence of secondary vegetation. Our success in achieving these goals will be determined by our ability to accurately estimate the structure and diversity of such communities at broad geographic scales. We examined whether the texture (the spatial variation of the image elements) of very high-resolution satellite imagery can be used for this purpose. In 14 fallows of different ages and one mature forest stand in a seasonally dry tropical forest landscape, we estimated basal area, canopy cover, stem density, species richness, Shannon index, Simpson index, and canopy height. The first six attributes were also estimated for a subset comprising the tallest plants. We calculated 40 texture variables based on the red and the near infrared bands, and EVI and NDVI, and selected the best-fit linear models describing each vegetation attribute based on them. Basal area (<em>R</em>² = 0.93), vegetation height and cover (0.89), species richness (0.87), and stand age (0.85) were the best-described attributes by two-variable models. Cross validation showed that these models had a high predictive power, and most estimated vegetation attributes were highly accurate. The success of this simple method (a single image was used and the models were linear and included very few variables) rests on the principle that image texture reflects the internal heterogeneity of successional vegetation at the proper scale. The vegetation attributes best predicted by texture are relevant in the face of two of the gravest threats to biosphere integrity: climate change and biodiversity loss. By providing reliable basal area and fallow-age estimates, image-texture analysis allows for the assessment of carbon sequestration and diversity loss rates. New and exciting research avenues open by simplifying the analysis of the extent and complexity of successional vegetation through the spatial variation of its spectral information.</p> </div

Spearman's <i>ρ</i> between descriptive <i>R</i>² and predictive <i>R</i>²_CV values calculated for all linear models resulting from modeling each vegetation attribute as a function of one, two and three textural variables (TV).

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030506#pone-0030506-t001" target="_blank">Table 1</a> for vegetational attributes abbreviations and Methods for explanation of <i>R</i>²_CV calculation.</p

Observed (x-axes) vs. estimated (y-axes) values for the best descriptive (▴) and predictive (red +) linear models for vegetation attributes.

<p>See <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0030506#pone-0030506-t001" target="_blank">Table 1</a> for vegetational attributes abbreviations. Digits 1, 2, and 3 refer to the number of textural variables included in the model as explanatory variables.</p

Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19?

During pregnancy, there is a state of immune tolerance that predisposes them to viral infection, causing maternal-fetal vulnerability to the adverse effects of COVID-19. Bacterial coinfections significantly increase the mortality rate for COVID-19. However, it is known that all drugs, including antibiotics, will enter the fetal circulation in a variable degree despite the role of the placenta as a protective barrier and can cause teratogenesis or other malformations depending on the timing of exposure to the drug. Also, it is important to consider the impact of the indiscriminate use of antibiotics during pregnancy can alter both the maternal and fetal-neonatal microbiota, generating future repercussions in both. In the present study, the literature for treating bacterial coinfections in pregnant women with COVID-19 is reviewed. In turn, we present the findings in 50 pregnant women hospitalized diagnosed with SARS-CoV-2 without previous treatment with antibiotics; moreover, a bacteriological culture of sample types was performed. Seven pregnant women had coinfection with Staphylococcus haemolyticus, Staphylococcus epidermidis, Streptococcus agalactiae, Escherichia coli ESBL +, biotype 1 and 2, Acinetobacter jahnsonii, Enterococcus faecium, and Clostridium difficile. When performing the antibiogram, resistance to multiple drugs was found, such as macrolides, aminoglycosides, sulfa, dihydrofolate reductase inhibitors, beta-lactams, etc. The purpose of this study was to generate more scientific evidence on the better use of antibiotics in these patients. Because of this, it is important to perform an antibiogram to prevent abuse of empirical antibiotic treatment with antibiotics in pregnant women diagnosed with SARS-CoV-2

Vegetational attributes used in the analysis and their abbreviations.

<p>Vegetational attributes used in the analysis and their abbreviations.</p