Nature-based solutions and carbon dioxide removal

The negative impacts of climate change call for an urgent global response, to mitigate emissions and strengthen the adaptive capacity of social, economic, and environmental structures. In Latin America and the Caribbean, in a context of high vulnerability and three simultaneous crises affecting the region, development models need to be transformed, to bring about a sustainable transition. During this process, national and local policies must harness the full potential of climate action, through adoption of new technologies, innovation, productive reorganization, and identification of synergies. This is why nature-based solutions and carbon dioxide removal measures and technologies are critical to achieving climate goals. Against this backdrop, this paper examines the opportunities and challenges of large-scale implementation of such measures in the region, emphasizing the need to accelerate ongoing efforts, expand the research frontier and manage risks.Abstract .-- Introduction .-- I. Greenhouse gas emission reduction targets and Nationally Determined Contributions. The problem of insufficiency and global climate targets .-- II. Carbon dioxide removal measures and technologies, and their relevance to Latin America and the Caribbean: regional overview, challenges, and opportunities .-- III. The problem of land degradation and desertification. Deforestation: the global context with a focus on Latin America and the Caribbean .-- IV. Carbon Dioxide Removal: techniques and rationales .-- V. Some CDR governance agenda for global consideration .-- VI. Case study: impact of carbon dioxide removal measures and/or technologies on sustainable development objectives in Latin America and the Caribbean .-- VII. Conclusion

Soluciones basadas en la naturaleza y remoción de dióxido de carbono

En un contexto de alta vulnerabilidad y tres crisis que afectan de manera simultánea a América Latina y el Caribe, es necesaria una transformación de los modelos de desarrollo en la región que conduzca hacia una transición sostenible. En ese proceso, las políticas nacionales y locales deben ser capaces de aprovechar al máximo el potencial de la acción climática, a través de la adopción de nuevas tecnologías, la innovación, la reorganización productiva y la identificación de sinergias. Por esta razón, las soluciones basadas en la naturaleza y las medidas y tecnologías de remoción de dióxido de carbono cobran especial relevancia para contribuir al cumplimiento de las metas climáticas. En el presente documento, se examinan las oportunidades y los retos de la implementación a gran escala de estas medidas en la región, haciendo hincapié en la necesidad de acelerar los esfuerzos ya realizados, ampliar la frontera de investigación y gestionar los riesgos. Los resultados permiten reconocer las limitaciones existentes y los vínculos entre objetivos, políticas y herramientas, así como los cobeneficios que conlleva la implementación de dichas medidas.Resumen .-- Introducción .-- I. Metas de reducción de emisiones de gases de efecto invernadero y las Contribuciones Nacionalmente Determinadas. El problema de la insuficiencia y las metas climáticas globales .-- II. Las medidas y tecnologías de remoción de dióxido de carbono y su importancia para América Latina y el Caribe: panorama regional, retos y oportunidades .-- III. El problema de la degradación de los suelos y la desertificación. La deforestación: el contexto global centrado en América Latina y el Caribe .-- IV. Medidas y tecnologías de remoción de dióxido de carbono: técnicas y fundamentos .-- V. Gobernanza de las medidas y tecnologías de remoción de dióxido de carbono para su consideración global .-- VI. Caso de estudio: impacto de las medidas y/o tecnologías de remoción de dióxido de carbono sobre los objetivos de desarrollo sostenible en América Latina y el Caribe .-- VII. Conclusiones

Volume 10

Introduction Dr. Roger A. Byrne An Analysis of Media Framing in Cases of Violence Against Women by Taylor Hogg Writing in the Discipline of Nursing by Tiffany Carter Photography by Brandyn Johnson The Hidden Life of Beef Cattle: A Study of Cattle Welfare on Traditional Ranches and Industrial Farms by Haleigh James Bloodworth\u27s by Josh Baker and Tyler Cernak Prosimians: Little Bodies, Big Significance by Kirsten Bauer Skinformed by Allie Snavely Coopertition and Gracious Professionalism: The Effects of First Robotics Folklore and Culture on the Stem Community by Mary Zell Galen Tilt by Eric Powell And Thomas Wise The Millennial Generation and Protest Politics: How Social Media Affects Civic Engagement by Katie Kinsey Effects of Intergenerational Daycares: Parents\u27 Perception of Early Childhood Socialization with Elderly Populations by Beth Barbolla, Maeleigh Ferlet, Rebecca Morra Speech and Intelligence: Does My Use of AAE Label Me Incompetent? By Michala Day Stimulation of Dendritic Cells with Dimethylfumarate Leads to Cd-4 Th2 T-Cells Immune Responses in Multiple Sclerosis and Psoriasis by Alexandra Evangelista, Max Flores, Harley Hodges, and Clardene Jones The Hunt by Harrison Samaniego The Rise of Structural Individualism: Millennial Attitudes Towards Welfare and Poverty by Jamesha Watson A Rhetorical Analysis of Pope Francis\u27s Address to U.S. Congress on September 24, 2015: A Petition for the Revival of Community and Common Values by Abby Gargiulo Photomontage Poster by Heather Green Love You to Death: Repressed Desires in Poe\u27s The Black Cat by Haley Klepatzki Muhammad Ali by Juan Guevara No end to it, baby : Pynchon, Communication, and The Crying of Lot 49 by Dani Bondurant The Sun Has Set on Britain By Michael Joseph Link, Jr. The Handbettering Campaign by Pamela Dahl Ceremony Marks FDR\u27s Continuance as Leader as War Goes On: An Analysis Of FDR\u27s Fourth Inauguration and How It Reflected the Effect of the War in American Society by Maeve Losen How White Is for Witching and Get Out Challenge Western Xenophobia by Charlotte Murphe

Size and Shape Constraints of (486958) Arrokoth from Stellar Occultations

We present the results from four stellar occultations by (486958) Arrokoth, the flyby target of the New Horizons extended mission. Three of the four efforts led to positive detections of the body, and all constrained the presence of rings and other debris, finding none. Twenty-five mobile stations were deployed for 2017 June 3 and augmented by fixed telescopes. There were no positive detections from this effort. The event on 2017 July 10 was observed by the Stratospheric Observatory for Infrared Astronomy with one very short chord. Twenty-four deployed stations on 2017 July 17 resulted in five chords that clearly showed a complicated shape consistent with a contact binary with rough dimensions of 20 by 30 km for the overall outline. A visible albedo of 10% was derived from these data. Twenty-two systems were deployed for the fourth event on 2018 August 4 and resulted in two chords. The combination of the occultation data and the flyby results provides a significant refinement of the rotation period, now estimated to be 15.9380 ± 0.0005 hr. The occultation data also provided high-precision astrometric constraints on the position of the object that were crucial for supporting the navigation for the New Horizons flyby. This work demonstrates an effective method for obtaining detailed size and shape information and probing for rings and dust on distant Kuiper Belt objects as well as being an important source of positional data that can aid in spacecraft navigation that is particularly useful for small and distant bodies.Fil: Buie, Marc W.. Southwest Research Institute.; Estados UnidosFil: Porter, Simon B.. Southwest Research Institute.; Estados UnidosFil: Tamblyn, Peter. Southwest Research Institute.; Estados UnidosFil: Terrell, Dirk. Southwest Research Institute.; Estados UnidosFil: Parker, Alex Harrison. Southwest Research Institute.; Estados UnidosFil: Baratoux, David. Géosciences Environnement Toulouse; Francia. Centre National de la Recherche Scientifique; FranciaFil: Kaire, Maram. Ministry of Higher Education Research and Innovation; Senegal. Asociación Senegalesa para la Promoción de la Astronomía; SenegalFil: Leiva, Rodrigo. Southwest Research Institute.; Estados UnidosFil: Verbiscer, Anne J.. University of Virginia; Estados UnidosFil: Zangari, Amanda M.. Southwest Research Institute.; Estados UnidosFil: Colas, François. Centre National de la Recherche Scientifique. Observatoire de Paris; Francia. Sorbonne University; Francia. Centre National de la Recherche Scientifique; FranciaFil: Diop, Baidy Demba. Direction de la Formation et de la Communication; SenegalFil: Samaniego, Joseph I.. University of Colorado; Estados UnidosFil: Wasserman, Lawrence H.. Lowell Observatory; Estados UnidosFil: Benecchi, Susan D.. Planetary Science Institute; Estados UnidosFil: Caspi, Amir. Southwest Research Institute.; Estados UnidosFil: Gwyn, Stephen. Herzberg Astronomy and Astrophysics Research Centre; CanadáFil: Kavelaars, J. J.. Herzberg Astronomy and Astrophysics Research Centre; CanadáFil: Ocampo Uría, Adriana C.. National Aeronautics and Space Administration; Estados UnidosFil: Rabassa, Jorge Oscar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; ArgentinaFil: Skrutskie, M. F.. University of Virginia; Estados UnidosFil: Soto, Alejandro. Southwest Research Institute.; Estados UnidosFil: Tanga, Paolo. Université Côte d’Azur; Francia. Centre National de la Recherche Scientifique; FranciaFil: Young, Eliot F.. Southwest Research Institute.; Estados UnidosFil: Stern, S. Alan. Southwest Research Institute.; Estados UnidosFil: Andersen, Bridget C.. University of Virginia; Estados UnidosFil: Arango Pérez, Mauricio E.. Universidad de Antioquia; ColombiaFil: Arredondo, Anicia. Massachusetts Institute of Technology; Estados UnidosFil: Artola, Rodolfo Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Astronomía Teórica y Experimental. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Instituto de Astronomía Teórica y Experimental; ArgentinaFil: García Migani, Esteban Andrés. Universidad Nacional de San Juan. Facultad de Ciencias Exactas, Físicas y Naturales. Departamento de Geofísica y Astronomía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Juan; Argentin

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p&lt;00001), age 70 years or older versus younger than 70 years (230 [165-322], p&lt;00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p&lt;00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research