Desempenho do inhame (taro) em plantio direto e no consórcio com crotalária, sob manejo orgânico.

Estudaram-se os efeitos do plantio direto em cobertura morta de aveia-preta e do consórcio com Crotalaria juncea, em sistema orgânico de produção de inhame, em ensaio na EE de Nova Friburgo(Pesagro-Rio), região serrana do estado do Rio de Janeiro. Utilizouse o delineamento de blocos ao acaso com quatro repetições, em esquema fatorial 2 x 2, onde os tratamentos corresponderam ao: modo de plantio (direto ou convencional) e modo de cultivo (monocultivo ou consórcio com crotalária). O cultivo consorciado com a leguminosa promoveu maior altura nas plantas do inhame, assim como reduziu a queima de folhas pelos raios solares. A população infestante de ervas espontâneas foi mais efetivamente controlada com a combinação entre consórcio e plantio direto. Nenhum dos tratamentos influenciou a produtividade do inhame, que foi considerada satisfatória, indicando o potencial do manejo orgânico adotado

Expressão da esterilidade feminina e da carpeloidia em mamoeiro sob diferentes ambientes de cultivo protegido.

O presente estudo teve por objetivo avaliar a ocorrência de esterilidade feminina e de carpeloidia em mamoeiros hermafroditas 'Baixinho-de-Santa Amália' cultivados sob manejo orgânico, em diferentes tipos de ambiente de proteção,e conduzido com ou sem bifurcação do tronco no transcorrer das quatro estações do ano. Foram construídos três tipos de estruturas de proteção contíguas: (i) estufa (cobertura de plástico); (ii) estufa sombreada (cobertura adicional de tela 'sombrite' - 30% sobre o plástico), e (iii) telado (cobertura exclusiva de tela 'sombrite' - 30%), ao lado de uma área de ambiente natural, a pleno sol. Nestes locais, foram cultivados, dentro das normas técnicas da agricultura orgânica, mamoeiros da cv. Baixinho-de-Santa-Amália. Em metade das plantas, abrangendo todos os ambientes de cultivo, a gema apical foi incisada, logo após a sexagem, visando à bifurcação do tronco. Para efeito de análise de variância, foram considerados quatro blocos por ambiente de cultivo, tendo cada bloco três repetições relativas ao modo de condução das plantas (com e sem bifurcação do tronco). Para análise estatística, procedeu-se à "análise conjunta de experimentos", no caso, os ambientes de cultivo. Nos mamoeiros com tronco bifurcado, houve diminuição do número de frutos carpeloides e aumento do número de flores fêmeas estéreis. No entanto, essa bifurcação não influenciou a frequência de frutos normais. Durante a primavera (setembro a dezembro), e notadamente na estufa, o maior número de frutos carpeloides por planta correlacionou-se a temperaturas mais elevadas, maior amplitude térmica e maior vigor vegetativo; já, a maior ocorrência de flores estaminadas correlacionou-se também a temperaturas elevadas, baixa luminosidade e menor vigor vegetativo. Por outro lado, essas mesmas condições ambientais e fenológicas favoráveis à carpeloidia aumentaram a quantidade de frutos normais, assim contribuindo positivamente para a produtividade do mamoeiro

Avaliação de cultivares de soja, sob manejo orgânico, para fins de adubação verde e produção de grãos.

O objetivo deste trabalho foi avaliar o desempenho de seis cultivares de soja, sob manejo orgânico, para fins de adubação verde e produção de grãos. Utilizou-se delineamento experimental de blocos casualizados, com quatro repetições por tratamento (cultivar). Na época da colheita, 81 dias após a emergência das plântulas, todas as cultivares testadas (Celeste, Surubi, Campo Grande, Mandi, Lambari e Taquari) mostraram excelente nodulação, variando de 545 a 760 mg/planta de massa nodular seca. As cultivares Celeste e Taquari, que produziram, respectivamente, 8,33 e 7,12 t ha-1 de biomassa seca da parte aérea, apresentaram outras características agronômicas vantajosas, tais como: ciclo curto, alta acumulação de nutrientes (N, P, K, Ca e Mg) nos tecidos verdes e bom rendimento de sementes. Esses caracteres indicam potencial de 'Celeste' e 'Taquari' para adubação verde de verão em sistemas de agricultura orgânica. Cinco das cultivares avaliadas revelaram tendência ao acamamento, porém dentro de níveis aceitáveis. As cultivares Celeste, Surubi, Campo Grande, Mandi e Taquari suplantaram em 23%, 32%, 33%, 44% e 70%, respectivamente, a média nacional de produtividade de soja, estimada em 2.398 kg ha-1 nas últimas três safras

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic