Economy and Environmental Problems in the Mexican Coastal States

A canonical correspondence analysis (CCA) for environmental and economic variables was performed for 17 Mexican coastal states. The ordination method allowed us to identify three groups, namely hydroelectric energy generation (I), pollution (II) and harbours (III), which were associated to different human activities. Furthermore, CCA is efficient to help us generate hypotheses for future research. It is therefore advised that CCA should be used for routine analyses into economics.Coastal States of Mexico, Canonical Correspondence Analysis, Diversity Index, Economic Development, Environmental Variables.

Registro fotográfico de un murciélago capturado por Leopardus pardalis (Carnivora: Felidae) en la Reserva de la Biosfera de Calakmul, México

The ocelot faces conservation problems throughout its distribution, mainly due to illegal hunting and habitat transformation. It has been documented that the ocelot diet consists mainly of small nocturnal terrestrial mammals, especially rodents, although it has also been recorded that they can feed on possums, squirrels, rabbits, primates, iguanas, frogs, birds, fish, insects and terrestrial crabs.This note is relevant to the feeding behavior of ocelots in Mexico because it describes a photographic event of an ocelot feeding on a bat, the record was obtained with camera traps placed in the southern core zone of the Calakmul Biosphere Reserve. These cameras were installed to record that species of fauna visitrificiales drinkers (water sources constantly supplied by members of the project) that were placed as part of a pilot project in the years 2018 and 2019 and aim to supply water in the RBC for use of wildlife. As a result of this effort, this photographic record was obtained of an ocelot individual feeding on a bat associated with an artificial drinker.El ocelote enfrenta problemas de conservación a lo largo de su distribución, debido principalmente a la caza ilegal y transformación del hábitat. Se ha documentado que la dieta del ocelote consiste principalmente de pequeños mamíferos terrestres nocturnos, especialmente roedores , aunque también se ha registrado que pueden alimentarse de zarigüeyas, ardillas, conejos, primates, iguanas, ranas, aves, peces, insectos y cangrejos terrestres. La presente nota resulta relevante sobre el comportamiento alimentario de los ocelotes en Mexico debido a que se describe un evento fotográfico de un ocelote alimentándose de un murciélago, el registro fue obtenido con trampas cámara colocadas en la zona nucleo sur de la Reserva de la Biosfera de Calakmul . Estas camaras fueron instaladas para registrar que especies de fauna visitan a los bebederos ariticiales (fuentes de agua abastecidas constantemente por miembros del proyecto) que fueron colocados como parte de un proyecto piloto en los años 2018 y 2019 y tienen como objetivo el abastecimiento de agua en la RBC para uso de la fauna silvestre. Cómo resultado de este esfuerzo, se obtuvo el presente registro fotográfico de un individuo de ocelote alimentandose de un murcielago asociado a un bebedero artificial. &nbsp

Uso de bebederos artificiales por el sereque centroamericano (Dasyprocta punctata) en la reserva de la biosfera de Calakmul, México

Objective: To describe the use of artificial drinking fountains by the central American Agouti (Dasyprocta punctata) in the Calakmul Biosphere Reserve. Design/methodology/approach: Eight artificial drinking fountains were monitored each one with a trap camera with the aim to estimate the relative abundance index and activity patterns of visits to the drinking fountains. The monitoring was during the dry season of 2019. The analyzes were carried out with the InfoStat and R programs. Results: From January to May 2019, with a sampling effort of 1121 days/camera, average abundance of 160.08±85.44. The pattern of visits to the drinking troughs was mainly diurnal. Limitations of the study/implications: The use of trap cameras in the artificial drinking fountains allows us to know the extent of habitat modification in the Calakmul Biosphere Reserve. Findings/conclusions: The implementation of artificial drinking fountains in the RBC during the dry season was a successful action to mitigate the effects of water scarcity. The use of the water resource by the Central American Agouti in artificial drinking fountains was constant, other species of mammals and birds were also observed making use of artificial drinking fountains.Objetivo: Describir el uso de bebederos artificiales por el sereque (Dasyprocta punctata) en la Reserva de la Biosfera de Calakmul. Diseño/metodología/aproximación: Se monitorearon ocho bebederos artificiales cada uno con una cámara trampa con la finalidad de estimar el índice de abundancia relativa y los patrones de actividad de visitas a los bebederos. El monitoreo fue durante la temporada de secas del 2019. Los análisis se realizaron con los programas R e InfoStat. Resultado: De enero a mayo de 2019, con un esfuerzo de muestreo fue de 1121 días/cámara, abundancia promedio de 160.08±85.44. El patrón de visitas a los bebederos fue principalmente diurno. Limitaciones/implicaciones: El uso de cámaras trampa en los bebederos artificiales nos permite conocer los alcances en la modificación del hábitat en la Reserva de la Biosfera de Calakmul (RBC). Hallazgos/conclusiones: La implementación de bebederos artificiales en la RBC durante la temporada de seca fue una acción de éxito para mitigar los efectos de la escases de agua. El aprovechamiento del recurso agua por el sereque en los bebederos artificiales fue constante, también se observaron otras especies de mamíferos y aves haciendo uso de los bebederos artificiales

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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

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

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified