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

Mantenimiento de la diversidad en pastizales invadidos : mecanismos asociados a la interacción entre disturbios, recursos y la disponibilidad de propágulos

Fil: Molina, Cecilia Denisse. Universidad de Buenos Aires. Facultad de Agronomía. Escuela para Graduados; Argentina.La diversidad de los pastizales es amenazada por agentes del cambio global. Aumentos en la carga de nutrientes, exclusión a los regímenes de disturbios y la invasión por especies exóticas promueven la dominancia y reducen la diversidad vegetal. Contrariamente, disturbios que generen micrositios y reduzcan la dominancia, junto con la adición de propágulos, contrarrestarían esos efectos negativos. En esta tesis se estudiaron los mecanismos por los cuales la adición de nutrientes afecta la diversidad a diferentes escalas y bajo diferentes disturbios. Además, se estudió cómo diferentes disturbios y la fenología de especies nativas e invasoras promueven la restauración de plantas. Con dos experimentos a campo donde se manipularon los nutrientes disponibles (N-P-K) y diferentes tipos de disturbios se demostró que la reducción de la diversidad a diferentes escalas espaciales dependió del disturbio del sistema. En sitios dominados, la pérdida de diversidad se debió principalmente a la competencia por la luz. Cuando aumenta la luz debido a cortes mecánicos, la pérdida de diversidad fue consecuencia tanto del aumento de los nutrientes como de la competencia aérea generada por las especies beneficiadas por la fertilización. Bajo pastoreo doméstico el impacto negativo de los nutrientes no fue tan marcado debido, probablemente, a un efecto de compensación dado por el consumo de especies dominantes. Con un tercer experimento en un pastizal invadido se evaluó cómo los micrositios, generados por disturbios selectivos hacia una especie invasora, y la adición de especies nativas con diferentes nichos temporales conducen a la recuperación de la diversidad. Se demostró que la restauración de la diversidad de pastos nativos requiere considerar las diferencias fenológicas entre las especies nativas sembradas y las invasoras presentes junto con generar disturbios selectivos a la/s invasora/s. En conjunto, esta tesis reveló patrones y mecanismos operantes detrás la pérdida y recuperación de la diversidad en pastizales.Doctorado en Ciencias Agropecuarias182 p. : tbls., grafs

Mowing does not redress the negative effect of nutrient addition on alpha and beta diversity in a temperate grassland

Species loss due to an increasing the number of added nutrients has been explained by both light competition through biomass increase and by niche dimension reduction as a result of species-specific limiting soil resources trade-offs. Disturbances, by reducing community biomass, species dominance and increasing light availability, may counteract above-ground nutrient effects. However, it is unknown if diversity loss at local or spatial scales generated by increasing the number of added nutrients can be redressed with canopy disturbance. We evaluated if local (alpha) and spatial scale (beta) diversity loss generated by the number of added nutrients can be reverted by disturbances in Flooding Pampa grasslands, Argentina. In a 4-year replicated field experiment, we added soil resources combining nitrogen, phosphorus and potassium to obtain 0, 1, 2 or 3 nutrients and manipulated the regime of canopy disturbance by seasonal mowing and biomass removal. We found that the increasing the number of added nutrients strongly reduced local and spatial plant diversity, despite biomass and light changes generated by mowing. In mown plots, nutrient-driven local diversity loss intensified along time, thus increasing species dominance. While mowing did not affect dominant species loss, increasing the number of added nutrients promoted rare species loss and reduced spatial dissimilarity. Furthermore, mowing increased local and spatial diversity regardless of light or biomass effects, suggesting alternative pathway effects for disturbance. Synthesis. Our results demonstrate that even when disturbance generated a positive effect on local and spatial diversity, it did not completely counteract the negative effect of number of added nutrients. Thus, the relative importance of above- and below-ground resource competition may change when chronic disturbances alter community dominance. Under low light availability, above-ground competition may drive species richness loss but when disturbance reduces light limitation, the increasing the number of added nutrients may reduce niche dimensionality and thus species coexistence. In sum, faced with the need to manage eutrophized grasslands, our study showed that disturbance may not completely mitigate the negative effect of multiple nutrient inputs on local and spatial grassland diversity.Fil: Molina, Cecilia Denisse. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Tognetti, Pedro Maximiliano. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Métodos Cuantitativos y Sistemas de Información; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; ArgentinaFil: Graff, Barbara Pamela. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Recursos Naturales y Ambiente; ArgentinaFil: Chaneton, Enrique Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentin

Retos para lograr en México la cultura de la paz y los derechos humanos

Violence in Mexico, is the symptom of the failure of the culture of peace and human rights, the failure of the strategy undertaken by the last two governments have not given positive results, far from diminishing this type of violence has intensified. Undoubtedly, we have to make the decision and change the paradigm, this is putting the country on the path of human rights and a solid culture of peace, to generate in the community a different attitude. The problems of violence must be integrally managed, because for peace to flourish it requires a deep and solid foundation in society, in which participating governments and the international community at large, for there is no doubt that building peace it is the prerequisite for economic, social and democratic development of the peoples.La violencia en México es el síntoma del fracaso de la cultura de la paz y los derechos humanos, la estrategia emprendida por los últimos dos gobiernos no ha dado resultados positivos, pues lejos de disminuir este tipo de violencia, la ha recrudecido. Indudablemente, tenemos que tomar la decisión y cambiar de paradigma, esto es encaminar al país por el sendero de los derechos humanos y una cultura sólida de la paz, para generar en la colectividad una actitud distinta. Los problemas de violencia deben ser manejados integralmente, pues para que la paz prospere se requiere de una cimentación profunda y sólida en la sociedad, en la que participan los gobiernos y la comunidad internacional en general, pues no hay duda de que la construcción de la paz es el requisito previo para el desarrollo económico, social y democrático de los pueblos

Tree invasion in secondary grasslands diminishes herbaceous biomass and diversity: A study of mechanisms behind the process

Questions: How is plant biomass, composition and diversity in secondary grasslands affected by tree invasion? How do light conditions generated by invasive trees and soil legacy affect grassland's structure and functioning? Which mechanism is more important?. Location: Inland Pampa, Buenos Aires, Argentina. Methods: We established a long-term manipulative reciprocal transplant experiment by transplanting soil monoliths coming from two origins: grasslands (G) and invaded woody patches (W) into three different habitats: open grasslands (OG), woody patches (WP), and artificially shaded grasslands (SG). Results: Seven years after the beginning of the experiment, litter, above- and below-ground herbaceous biomass decreased from OG to WP habitats, with SG habitats showing intermediate values. However, differences between OG and WP habitats disappeared when tree (coarse) roots, and tree litter biomass were considered. No significant differences between the origin of the soil monoliths (G or W) were detected (p > 0.10), except for herbaceous roots biomass that, contrary to expectations, was higher in all habitats when the transplanted soil monoliths came from a W origin. Additionally, biomass of C3 grasses was higher in WP habitats and biomass of C4 grasses was higher in OG habitats, while biomass of forbs had the highest biomass in SG habitats. The inverse Simpson's index decreased from OG (2.08), through SG (1.73) to WP habitats (1.14), suggesting higher dominance in WP. Conclusions: Our study helps to glimpse the main mechanism driving community changes after tree invasions in temperate grassland communities. We demonstrated that light reduction beneath the tree canopies has a more important role than soil legacy in determining structure and functioning of grasslands, even though invasion of Gleditsia triacanthos also affected soil properties such as water content and organic carbon.Fil: Ferraina, Antonella. Universidad de Buenos Aires. Facultad de Agronomía; Argentina. Instituto Nacional de Tecnología Agropecuaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Molina, Cecilia Denisse. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; ArgentinaFil: Mazía, Cristina Noemí. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Piñeiro, Gervasio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; ArgentinaFil: Miranda, Isabel. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Chaneton, Enrique Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentin

Development of phytotoxicity indexes and their correlation with ecotoxicological, stability and physicochemical parameters during passive composting of poultry manure

Both raw and composted poultry manure is applied as soil amendment. The aims of this study were: (1) to develop phytotoxicity indexes for organic wastes and composts, and (2) to assess the correlation among phytotoxicity indexes, ecotoxicological endpoints and stability and physicochemical parameters during passive composting of poultry manure. Six 2-m³ composting piles were constructed and four parameter groups (physicochemical and microbiological parameters, ecotoxicological endpoints, and biological activity) were determined at four sampling times during 92days. Extracts were used to carry out acute toxicity tests on Daphnia magna, Lactuca sativa and Raphanus sativus. Composting decreased average toxicity 22.8% for the 3 species and D. magna was the most sensitive species. The static respiration index decreased from 1.12 to 0.46mgO₂gOMh⁻¹ whilst organic matter reduced by 64.1% at the end of the process. Escherichia coli colonies remained higher than values recommended by international guidelines. The D. magna immobilization test allowed the assessment of possible leachate or run-off toxicity. The new phytotoxicity indexes (RGIC₀.₈ and GIC₈₀%), proposed in this study, as well as salinity, proved to be good maturity indicators. Hence, these phytotoxicity indexes could be implemented in monitoring strategies as useful ecotoxicological tools. Multivariate analyses demonstrated positive correlations between ecotoxicological endpoints (low toxicity) and biological activity (stability). These two parameter groups were associated at the final sampling time and showed negative correlations with several physicochemical parameters (organic and inorganic contents). The final poultry manure compost was rendered stable, but immature and, thus, unsuitable for soil amending

Land use affected nutrient mass with minor impact on stoichiometry ratios in Pampean soils

The effect of land use on soil nitrogen (N) and phosphorous (P) stocks and the stoichiometry ratios are not fully understood. We determined the impact of land use on total N and P stocks along with some of their fractions and carbon (C), N and P ratios in soils of the Pampas. The effect of human activities on N and P fluxes in agroecosystems was also assessed. We sampled 386 soils under contrasting land uses down to 1 m depth. Well drained uncultivated soils were used as control treatment, paired with forest, cropped and flooded soils. Significant effects of land use on N and P stocks were detected to 1 m depth. Cropping decreased soil total N and P contents, mineralizable N and extractable P by an average of 14, 21 and 63% respectively. Conversely, forest soils had larger total N stocks (17%), mineralization (10%) and extractable P (37%) than uncropped controls. Flooded lands had the lowest fertility. Nitrogen and P pools under cultivation decreased higher as soils had higher initial levels N and P. In some low fertility soils, cropping led to N and P increases. Stoichiometry ratios were minimally impacted by land use. The ratio of the cumulative P surface balance to the N surface balance for the last 140 years was + 0.01 kg P/kg N in uncropped control soils and − 0.08 kg P/kg N in cropped soils. Despite this difference, the soil N/P ratio was unaffected by land use indicating that processes at the profile level regulated it.Fil: Alvarez, Roberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Biociencias Agrícolas y Ambientales. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones en Biociencias Agrícolas y Ambientales; ArgentinaFil: Gimenez, Analía Verónica. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Caffaro, Maria Marta. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones en Biociencias Agrícolas y Ambientales. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones en Biociencias Agrícolas y Ambientales; ArgentinaFil: Pagnanini, Federico. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Recondo, Verónica. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Molina, Cecilia Denisse. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Berhongaray, Gonzalo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Mendoza, Maria Rosa. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Ramil, Denise Amalia. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Facio, Facundo. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: de Paepe, Josefina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Steinbach, Haydee S.. Universidad de Buenos Aires. Facultad de Agronomía; ArgentinaFil: Cantet, Rodolfo Juan Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Agronomía; Argentin

A global metagenomic map of urban microbiomes and antimicrobial resistance

We present a global atlas of 4,728 metagenomic samples from mass-transit systems in 60 cities over 3 years, representing the first systematic, worldwide catalog of the urban microbial ecosystem. This atlas provides an annotated, geospatial profile of microbial strains, functional characteristics, antimicrobial resistance (AMR) markers, and genetic elements, including 10,928 viruses, 1,302 bacteria, 2 archaea, and 838,532 CRISPR arrays not found in reference databases. We identified 4,246 known species of urban microorganisms and a consistent set of 31 species found in 97% of samples that were distinct from human commensal organisms. Profiles of AMR genes varied widely in type and density across cities. Cities showed distinct microbial taxonomic signatures that were driven by climate and geographic differences. These results constitute a high-resolution global metagenomic atlas that enables discovery of organisms and genes, highlights potential public health and forensic applications, and provides a culture-independent view of AMR burden in cities.Funding: the Tri-I Program in Computational Biology and Medicine (CBM) funded by NIH grant 1T32GM083937; GitHub; Philip Blood and the Extreme Science and Engineering Discovery Environment (XSEDE), supported by NSF grant number ACI-1548562 and NSF award number ACI-1445606; NASA (NNX14AH50G, NNX17AB26G), the NIH (R01AI151059, R25EB020393, R21AI129851, R35GM138152, U01DA053941); STARR Foundation (I13- 0052); LLS (MCL7001-18, LLS 9238-16, LLS-MCL7001-18); the NSF (1840275); the Bill and Melinda Gates Foundation (OPP1151054); the Alfred P. Sloan Foundation (G-2015-13964); Swiss National Science Foundation grant number 407540_167331; NIH award number UL1TR000457; the US Department of Energy Joint Genome Institute under contract number DE-AC02-05CH11231; the National Energy Research Scientific Computing Center, supported by the Office of Science of the US Department of Energy; Stockholm Health Authority grant SLL 20160933; the Institut Pasteur Korea; an NRF Korea grant (NRF-2014K1A4A7A01074645, 2017M3A9G6068246); the CONICYT Fondecyt Iniciación grants 11140666 and 11160905; Keio University Funds for Individual Research; funds from the Yamagata prefectural government and the city of Tsuruoka; JSPS KAKENHI grant number 20K10436; the bilateral AT-UA collaboration fund (WTZ:UA 02/2019; Ministry of Education and Science of Ukraine, UA:M/84-2019, M/126-2020); Kyiv Academic Univeristy; Ministry of Education and Science of Ukraine project numbers 0118U100290 and 0120U101734; Centro de Excelencia Severo Ochoa 2013–2017; the CERCA Programme / Generalitat de Catalunya; the CRG-Novartis-Africa mobility program 2016; research funds from National Cheng Kung University and the Ministry of Science and Technology; Taiwan (MOST grant number 106-2321-B-006-016); we thank all the volunteers who made sampling NYC possible, Minciencias (project no. 639677758300), CNPq (EDN - 309973/2015-5), the Open Research Fund of Key Laboratory of Advanced Theory and Application in Statistics and Data Science – MOE, ECNU, the Research Grants Council of Hong Kong through project 11215017, National Key RD Project of China (2018YFE0201603), and Shanghai Municipal Science and Technology Major Project (2017SHZDZX01) (L.S.