Birds population in different coastal areas of Sindh

Coastal areas of Karachi and Thatta districts including Sandspit, Cape Monze, Gidyani, Korangi Creek, Pitti Creek, Rohri Creek, Shah Bunder, Sando Bunder and Ketti Bunder were surveyed. The coastal areas of Thatta (Shah Bunder, Sando Bunder and Ketti Bunder) are richly populated

Ten new insights in climate science 2022

Non-technical summary We summarize what we assess as the past year's most important findings within climate change research: limits to adaptation, vulnerability hotspots, new threats coming from the climate–health nexus, climate (im)mobility and security, sustainable practices for land use and finance, losses and damages, inclusive societal climate decisions and ways to overcome structural barriers to accelerate mitigation and limit global warming to below 2°C. Technical summary We synthesize 10 topics within climate research where there have been significant advances or emerging scientific consensus since January 2021. The selection of these insights was based on input from an international open call with broad disciplinary scope. Findings concern: (1) new aspects of soft and hard limits to adaptation; (2) the emergence of regional vulnerability hotspots from climate impacts and human vulnerability; (3) new threats on the climate–health horizon – some involving plants and animals; (4) climate (im)mobility and the need for anticipatory action; (5) security and climate; (6) sustainable land management as a prerequisite to land-based solutions; (7) sustainable finance practices in the private sector and the need for political guidance; (8) the urgent planetary imperative for addressing losses and damages; (9) inclusive societal choices for climate-resilient development and (10) how to overcome barriers to accelerate mitigation and limit global warming to below 2°C. Social media summary Science has evidence on barriers to mitigation and how to overcome them to avoid limits to adaptation across multiple fields

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

Reflections by potential health care providers on a research methodology course taught under a primary health care centre: An experience of inter-professional education

أهداف البحث: تتطلب بحوث الصحة العامة نهجا تعاونيا أثناء العمل مع المجتمعات لمكافحة التحديات المتوقعة في الميدان. لذلك، أُضيف برنامج تدريبي في منهجية البحث في كلية كراتشي للطب وطب الأسنان، يركز على مبادئ التعليم المتداخل بين التخصصات، من أجل تحسين خدمات الرعاية الأولية. كانت أهداف هذه الدراسة تقييم مستوى التعلم من قبل المشاركين في مجال التواصل واستكشاف آراء المشاركين حول تقييم برنامج التدريب. طرق البحث: تم اختيار ما مجموعه ٩٦ مشاركا من بينهم أعضاء هيئة تدريس، وطلبة طب، وطلبة خدمة اجتماعية، وفنيون صحيون خلال الفترة من مارس إلى سبتمبر ٢٠١٠. كان البحث متعدد المناهج حيث تم تحليل كفاءات الاتصال في الدورة وانطباعات المشاركين حول تقييم الدورة وعولجت النتائج من ثلاث زوايا. النتائج: أظهرت النتائج أن ٨٧٪ من أعضاء هيئة التدريس استمتعوا بالمساهمة في ”العلاقة المتداخلة بين التخصصات“، وأن ”العمل كفريق“ في المناطق التي ترتكز على المجتمعات قد تم تعلمها إلى حد كبير من قِبَل ٩٠٪ من الطلبة. وقد تعرف ما لا يقل عن ٧٨٪ من الطلبة و٧٠٪ من أعضاء هيئة التدريس على ”الاستماع الفعال“ و”إيصال المعلومات إلى الأسر“، على التوالي، على أنهما أداة تعلم فاعلة. الاستنتاجات: وُجد أن التعلم فعَّال باستخدام العلاقة المتداخلة بين التخصصات بالنسبة لأعضاء هيئة التدريس مقارنة بتعلّم العمل الجماعي بصورة أفضل من قبل الطلبة. إضافة إلى ذلك، كان من الواضح أن إيصال المعلومات للأُسر من قِبَل الطلبة كان أفضل مما كان عليه من قِبَل أعضاء هيئة التدريس