Proposal to inform European institutions regarding the regulation of conscientious objection to abortion.

The aim of this paper is to define a set of proposals to inform European institutions in the regulation of Conscientious Objection to abortion. The board of the European Society of Contraception and Reproductive Health Care (ESC) was informed on the elements that should in the opinion of the authors be included in a future regulation of Conscientious Objection to abortion in Europe. These elements are outlined in this paper and the debate about them could form the basis for recommendations to the international scientific community and the European institutions. As current measures governing the principle of conscientious objection result in negative consequences regarding women's access to sexual and reproductive health services, they should be changed. Healthcare services should adopt measures to guarantee that a woman's right to voluntary abortion is not limited by the practitioner's stance on the principle of conscientious objection. In the countries where conscientious objection is allowed, the regulation must clearly delineate the extent of the duties and the exemptions of professionals based on the principles of established social consensus. The recommendations included in this document specify measures on the rights of women, the rights and duties of the practitioner, the role of institutions and the role of professional associations

Transición agroecológica de agroecosistemas en la finca familiar San Juan, Cienfuegos

Desde 1990 la agricultura cubana se enfrenta a cambios profundos de su estructura agraria. Parte fundamental del estos cambios lo ha constituido la entrega de tierras estatales al sector cooperativo y campesino. Muchas de las tierras entregadas a personas naturales e instituciones, se encontraban ociosas. El presente estudio documenta ocho años (2004- 2011) de conversión agroecológica de una finca tradicional campesina. Con una extensión inicial de 13.4 ha, que posteriormente se amplió a 53 ha, la finca quedó abandonada por un sistema de manejo convencional en monocultivo dedicado a caña de azúcar y ganadería. Se realizó una caracterización detallada que consideró atributos de agroecosistemas sustentables en un proceso cíclico anual de diagnóstico, diseño y evaluación. El análisis enfatizó en los flujos energéticos del sistema productivo. Para la evaluación de la conversión agroecológica se combinaron dos marcos metodológicos (ECOFAS y MESMIS) que permitieron identificar indicadores de sustentabilidad, seleccionados y aplicados de forma participativa. Se incrementó la productividad en términos de cantidad de personas alimentadas por unidad de área y de insumos utilizados hasta sostener con energía (4.89 p/ha/año) y proteínas (10.43 p/ha/año); en tanto, se incrementó 5 veces la eficiencia en el uso de la energía, de 2.3 a 12.3 GJ producido en los productos comestibles por cada GJ invertido en la producción como insumos. Se discuten los mecanismos agroecológicos que dieron lugar a estos resultados, como son el establecimiento y manejo de la agrobiodiversidad, el reciclaje de nutrientes y energía, la aplicación de tecnologías que permiten intensificar el uso de recursos locales y los métodos de gestión, innovación, organización productiva y social en el contexto de la agricultura familiar. Se propone replicar estos resultados a nuevas fincas entregadas en este período de transformación de la agricultura cubana en su camino hacia la sostenibilidad.Since 1990, Cuban agriculture faces deep changes in its agrarian structure. The delivery of state-owned lands to the cooperative and peasant sectors has played an important role in these changes. Many of the delivered lands to individuals and institutions were idler. This study documents eight years (2004-2011) of an agro-ecological conversion of a traditional peasant estate. The state had an initial extension of 13.4 ha which was later extended to 53 ha, and it got abandoned by a system of conventional handling in mono-cultivation dedicated to sugar cane and cattle raising. A detailed characterization was carried out taking into account sustainable agro-ecosystem‟s attributes in a cyclic yearly process of diagnosis, design and evaluation. The analysis emphasized in the energetic flows of the productive system. In order to evaluate the agro-ecological conversion two methodological tools were used (ECOFAS and MESMIS) that made possible to identify sustainability indicators, which were selected and applied in a participative form. Productivity was increased regarding the number of persons fed per an area unit, and the resources used to sustain with energy (4, 89 p/ha/year) and proteins (10,43 p/ha/year); In the meantime, the efficiency regarding the energy use was increased 5 times, from 2.3 a 12.3 GJ, produced from the eatable products per each GJ invested in the process as raw materials. The agro-ecological mechanisms that made possible these results are discussed, such as the establishment and handling of the agro-biodiversity, the recycling of nutrients and energy, the application of technologies that allow intensifying the use of local resources and the methods of management, innovation, productive and social organization in the context of the family agriculture. It is suggested to apply these results to the new delivered estates in this period of transformation of Cuban agriculture in its way to sustainability.Eje A1 Sistemas de producción de base agroecológica (Trabajos científicos)Facultad de Ciencias Agrarias y Forestale

Transición agroecológica de agroecosistemas en la finca familiar San Juan, Cienfuegos

Desde 1990 la agricultura cubana se enfrenta a cambios profundos de su estructura agraria. Parte fundamental del estos cambios lo ha constituido la entrega de tierras estatales al sector cooperativo y campesino. Muchas de las tierras entregadas a personas naturales e instituciones, se encontraban ociosas. El presente estudio documenta ocho años (2004- 2011) de conversión agroecológica de una finca tradicional campesina. Con una extensión inicial de 13.4 ha, que posteriormente se amplió a 53 ha, la finca quedó abandonada por un sistema de manejo convencional en monocultivo dedicado a caña de azúcar y ganadería. Se realizó una caracterización detallada que consideró atributos de agroecosistemas sustentables en un proceso cíclico anual de diagnóstico, diseño y evaluación. El análisis enfatizó en los flujos energéticos del sistema productivo. Para la evaluación de la conversión agroecológica se combinaron dos marcos metodológicos (ECOFAS y MESMIS) que permitieron identificar indicadores de sustentabilidad, seleccionados y aplicados de forma participativa. Se incrementó la productividad en términos de cantidad de personas alimentadas por unidad de área y de insumos utilizados hasta sostener con energía (4.89 p/ha/año) y proteínas (10.43 p/ha/año); en tanto, se incrementó 5 veces la eficiencia en el uso de la energía, de 2.3 a 12.3 GJ producido en los productos comestibles por cada GJ invertido en la producción como insumos. Se discuten los mecanismos agroecológicos que dieron lugar a estos resultados, como son el establecimiento y manejo de la agrobiodiversidad, el reciclaje de nutrientes y energía, la aplicación de tecnologías que permiten intensificar el uso de recursos locales y los métodos de gestión, innovación, organización productiva y social en el contexto de la agricultura familiar. Se propone replicar estos resultados a nuevas fincas entregadas en este período de transformación de la agricultura cubana en su camino hacia la sostenibilidad.Since 1990, Cuban agriculture faces deep changes in its agrarian structure. The delivery of state-owned lands to the cooperative and peasant sectors has played an important role in these changes. Many of the delivered lands to individuals and institutions were idler. This study documents eight years (2004-2011) of an agro-ecological conversion of a traditional peasant estate. The state had an initial extension of 13.4 ha which was later extended to 53 ha, and it got abandoned by a system of conventional handling in mono-cultivation dedicated to sugar cane and cattle raising. A detailed characterization was carried out taking into account sustainable agro-ecosystem‟s attributes in a cyclic yearly process of diagnosis, design and evaluation. The analysis emphasized in the energetic flows of the productive system. In order to evaluate the agro-ecological conversion two methodological tools were used (ECOFAS and MESMIS) that made possible to identify sustainability indicators, which were selected and applied in a participative form. Productivity was increased regarding the number of persons fed per an area unit, and the resources used to sustain with energy (4, 89 p/ha/year) and proteins (10,43 p/ha/year); In the meantime, the efficiency regarding the energy use was increased 5 times, from 2.3 a 12.3 GJ, produced from the eatable products per each GJ invested in the process as raw materials. The agro-ecological mechanisms that made possible these results are discussed, such as the establishment and handling of the agro-biodiversity, the recycling of nutrients and energy, the application of technologies that allow intensifying the use of local resources and the methods of management, innovation, productive and social organization in the context of the family agriculture. It is suggested to apply these results to the new delivered estates in this period of transformation of Cuban agriculture in its way to sustainability.Eje A1 Sistemas de producción de base agroecológica (Trabajos científicos)Facultad de Ciencias Agrarias y Forestale

Transición agroecológica de agroecosistemas en la finca familiar San Juan, Cienfuegos

Desde 1990 la agricultura cubana se enfrenta a cambios profundos de su estructura agraria. Parte fundamental del estos cambios lo ha constituido la entrega de tierras estatales al sector cooperativo y campesino. Muchas de las tierras entregadas a personas naturales e instituciones, se encontraban ociosas. El presente estudio documenta ocho años (2004- 2011) de conversión agroecológica de una finca tradicional campesina. Con una extensión inicial de 13.4 ha, que posteriormente se amplió a 53 ha, la finca quedó abandonada por un sistema de manejo convencional en monocultivo dedicado a caña de azúcar y ganadería. Se realizó una caracterización detallada que consideró atributos de agroecosistemas sustentables en un proceso cíclico anual de diagnóstico, diseño y evaluación. El análisis enfatizó en los flujos energéticos del sistema productivo. Para la evaluación de la conversión agroecológica se combinaron dos marcos metodológicos (ECOFAS y MESMIS) que permitieron identificar indicadores de sustentabilidad, seleccionados y aplicados de forma participativa. Se incrementó la productividad en términos de cantidad de personas alimentadas por unidad de área y de insumos utilizados hasta sostener con energía (4.89 p/ha/año) y proteínas (10.43 p/ha/año); en tanto, se incrementó 5 veces la eficiencia en el uso de la energía, de 2.3 a 12.3 GJ producido en los productos comestibles por cada GJ invertido en la producción como insumos. Se discuten los mecanismos agroecológicos que dieron lugar a estos resultados, como son el establecimiento y manejo de la agrobiodiversidad, el reciclaje de nutrientes y energía, la aplicación de tecnologías que permiten intensificar el uso de recursos locales y los métodos de gestión, innovación, organización productiva y social en el contexto de la agricultura familiar. Se propone replicar estos resultados a nuevas fincas entregadas en este período de transformación de la agricultura cubana en su camino hacia la sostenibilidad.Since 1990, Cuban agriculture faces deep changes in its agrarian structure. The delivery of state-owned lands to the cooperative and peasant sectors has played an important role in these changes. Many of the delivered lands to individuals and institutions were idler. This study documents eight years (2004-2011) of an agro-ecological conversion of a traditional peasant estate. The state had an initial extension of 13.4 ha which was later extended to 53 ha, and it got abandoned by a system of conventional handling in mono-cultivation dedicated to sugar cane and cattle raising. A detailed characterization was carried out taking into account sustainable agro-ecosystem‟s attributes in a cyclic yearly process of diagnosis, design and evaluation. The analysis emphasized in the energetic flows of the productive system. In order to evaluate the agro-ecological conversion two methodological tools were used (ECOFAS and MESMIS) that made possible to identify sustainability indicators, which were selected and applied in a participative form. Productivity was increased regarding the number of persons fed per an area unit, and the resources used to sustain with energy (4, 89 p/ha/year) and proteins (10,43 p/ha/year); In the meantime, the efficiency regarding the energy use was increased 5 times, from 2.3 a 12.3 GJ, produced from the eatable products per each GJ invested in the process as raw materials. The agro-ecological mechanisms that made possible these results are discussed, such as the establishment and handling of the agro-biodiversity, the recycling of nutrients and energy, the application of technologies that allow intensifying the use of local resources and the methods of management, innovation, productive and social organization in the context of the family agriculture. It is suggested to apply these results to the new delivered estates in this period of transformation of Cuban agriculture in its way to sustainability.Eje A1 Sistemas de producción de base agroecológica (Trabajos científicos)Facultad de Ciencias Agrarias y Forestale

Conserving Ecosystem Diversity in the Tropical Andes

Documenting temporal trends in the extent of ecosystems is essential to monitoring their status but combining this information with the degree of protection helps us assess the effectiveness of societal actions for conserving ecosystem diversity and related ecosystem services. We demonstrated indicators in the Tropical Andes using both potential (pre-industrial) and recent (~2010) distribution maps of terrestrial ecosystem types. We measured long-term ecosystem loss, representation of ecosystem types within the current protected areas, quantifying the additional representation offered by protecting Key Biodiversity Areas. Six (4.8%) ecosystem types (i.e., measured as 126 distinct vegetation macrogroups) have lost >50% in extent across four Andean countries since pre-industrial times. For ecosystem type representation within protected areas, regarding the pre-industrial extent of each type, a total of 32 types (25%) had higher representation (>30%) than the post-2020 Convention on Biological Diversity (CBD) draft target in existing protected areas. Just 5 of 95 types (5.2%) within the montane Tropical Andes hotspot are currently represented with >30% within the protected areas. Thirty-nine types (31%) within these countries could cross the 30% CBD 2030 target with the addition of Key Biodiversity Areas. This indicator is based on the Essential Biodiversity Variables (EBV) and responds directly to the needs expressed by the users of these countries

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection