Is Mandevilla (Apocynaceae, Mesechiteae) monophyletic? Evidence from five plastid DNA loci and morphology

In order to test the monophyly of Mandevilla Lindl., the largest genus in tribe Mesechiteea (Apocynaceae, Apocynoideae). and its affinities to other genera, in the tribe. maximum parsimony analysis was conducted on a data set comprising DNA sequence, from five plastid loci (rp/16. rps16, and trnK introns: trnS(GEE)-trnG(LPC) intergenic spacer; and matK gene), as well as morphological data for 65 taxa of Mesechiteae (48, Mandevilla) and nine taxa from other tribes of the subfamily. Mandevilla, as circumscribed by Pichon, was found to be monophyletic. whereas Woodson's circumscription proved to be polyphyletic. Thus defined, Mandevilla form, it strongly supported clade that call be divided into six clades of species groups. Most of the infrageneric taxa of Mandevilla proposed by Woodson and Pichon are polyphyletic. Many of the diagnostic characters previously used to define taxonomic groups are shown to have arisen multiple times, rendering them unsuitable lot classificatory purposes. The similar growth form and tubular flowers of Macrosiphonia Mull. Arg. and Telosiphonia (Woodson) Henr, two geographically disjunct segregates, represent the most extreme case of parallel evolution within Mandevilla, with their striking similarities most likely correlated to colonization of open. dry habitats and pollination by hawkmoths.93456559

Association of knowledge, preventive counseling and personal health behaviors on physical activity and consumption of fruits or vegetables in community health workers

Abstract\ud \ud Background\ud There is evidence that if a health professional is active and has a healthy diet, he/she is more likely to advise patients about the benefits of physical activity and healthy eating The aims of this study were to: (1) describe the personal physical activity, consumption of fruits and vegetables behaviors and nutritional status of community health workers; (2) evaluate the association between knowledge, delivery of preventive counseling and personal behaviors among community health workers.\ud \ud \ud Methods\ud This was a cross-sectional study conducted in a nationally sample of health professionals working in primary health care settings in Brazil in 2011. This survey was part of the second phase of the Guide for Useful Interventions for Activity in Brazil and Latin America project, and data were collected through telephone interviews of 269 community health workers from the Unified Health Care system of Brazil. We applied questionnaires about personal reported behaviors, knowledge and preventive counseling in physical activity and consumption of fruits and vegetables. We calculated the prevalence and associations between the variables with logistic regression.\ud \ud \ud Results\ud The proportion of community health workers that practiced 150 minutes per week of physical activity in leisure time or transportation was high (64.9%). Half of community health workers were overweight and only 26.2% reported consuming five portions/day of fruits or vegetables. Most community health workers reported counseling about physical activity for more than six months (59.7%), and most were not knowledgeable of the fruits and vegetables and physical activity recommendations. Meeting the fruits and vegetables recommendations was associated with correct knowledge (OR = 4.5; CI95% 1.03;19.7), with reporting 150 minutes or more of physical activity per week (OR = 2.0; CI95% 1.03;3.7) and with reporting physical activity in leisure time (OR = 2.0; CI95% 1.05;3.6). Regular physical activity counseling was associated with reporting 10–149 minutes per week (OR = 3.8; CI95% 1.1;13.3) and with more than 150 minutes of physical activity per week (OR = 4.9; CI95% 1.5;16.5).\ud \ud \ud Conclusion\ud Actions to promote physical activity and healthy eating and to improve knowledge among community health workers within the health care system of Brazil could have a potential positive influence on delivery of preventive counseling to patients on this topic

COVID-19-related absence among surgeons: development of an international surgical workforce prediction model

Background: During the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks. Methods: An international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent). Results Based on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7–12, this decreased to 9.2–13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19. Conclusion: This framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Systematics And Character Evolution Of Vinceae (apocynaceae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Vinceae comprises 9 genera and about 153 species. The genera differ greatly in a number of morphological traits, especially those relating to fruit and seeds, which resulted in their placement in different tribes and/or subtribes by earlier taxonomists. Here, 378 new chloroplast DNA sequences from 98 species from 5 tribes of the rauvolfioid grade were analyzed phylogenetically to test the monophyly of Vinceae, its 6 subtribes, and constituent genera, as well as the sectional treatments of Rauvolfia, and to find morphological synapomorphies for major clades. Vinceae, as currently circumscribed, was found to be monophyletic as were four of the six subtribes. Kopsia and Ochrosia were confirmed as successive sister groups to the rest. All nine genera currently recognized in the tribe were resolved as monophyletic, Laxoplumeria and Tonduzia for the first time. The broad circumscription of Petchia and Ochrosia proposed by previous authors was supported. The pantropical genus Rauvolfia is divided into two major lineages: one comprised entirely of paleotropical species, and the other the neotropical species, a recurring geographic pattern in the family. Surprisingly, the Hawaiian species of Vinceae have probably arisen by two different trans-oceanic routes, either by long-distance dispersal from Australasian (Ochrosia spp.) or Caribbean (Rauvolfia sandwicensis) ancestors. Within Rauvolfia, most of the sections, series and subseries recognized in previous classifications are paraphyletic. Only 2 of the 14 sections of Rauvolfia proposed by Pichon and 1 of the 11 sections proposed by Rao that are not monospecific were found to be monophyletic. Mapping of 30 morphological characters onto the molecular tree identified an unlobed upper wreath on the style head as an unambigous synapomorphy characterizing the tribe as well as synapomorphies for each of its genera. The two earliest-branching genera, Kopsia and Ochrosia, have dextrorse corolla lobe aestivation, in contrast to the sinistrorse corollas of the other Vinceae and the great majority of genera throughout the rauvolfioid grade. Drupes have arisen in parallel at least three times within Vinceae. The adaptations of the endocarp for water dispersal are possibly ancestral in the tribe, and the observed morphological differences between the drupaceous fruits of Kopsia/Ochrosia versus Petchia and Rauvolfia may be due to their abiotic versus biotic dispersal mode, respectively.6599122Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [06/01216-7]Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Calycine colleters of seven species of Apocynaceae (Apocynoideae) from Brazil

The structure and organization of calycine colleters belonging to four genera of Apocynaceae are described. Calycine colleters were found in all species. All colleters had the same histological composition, but morphological differences were observed in four species. Most colleters were of the standard type, and possible deviations resulted in three morphological types: bifurcated, laminar, and sessile. Mechanisms of cell separation, proliferation, and elongation may explain the origin of the new types. As a consequence of morphological changes, the secretory surface was expanded in the bifurcated, laminar, and sessile glands. Most colleters were in a post-secretory phase, but a hydrophilic secretion was observed in Mandevilla pycnantha and Mesechites mansoana. A larger secretory surface, together with the extension of the secretory phase in adult flowers, were major shifts in the calycine colleters of Apocynaceae, and are possibly correlated with the functional and ecological aspects of these organs. Three patterns of distribution of calycine colleters were observed: alternate, opposite, or indefinitely distributed. The alternate pattern was not homogeneous, and three subtypes were recognized: four-, five-, and ten-grouped colleters. The number of calycine colleters was variable between taxa and even within the same species.152338739