Mapping disparities in education across low- and middle-income countries

Analyses of the proportions of individuals who have completed key levels of schooling across all low- and middle-income countries from 2000 to 2017 reveal inequalities across countries as well as within populations. Educational attainment is an important social determinant of maternal, newborn, and child health(1-3). As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting(4-6). The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness(7,8); however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health(9-11). Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but-to our knowledge-no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries(12-14). By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.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 (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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

New species of Rhabdosynochus Mizelle and Blatz, 1941 (Monogenoidea: Diplectanidae) from the gills of Centropomid fishes (Teleostei) off the Pacific coast of Mexico.

Ficha diagnostica del holotipo de Rhabdosynochus lituparvus, especie descrita en este protologo

Morphophysiological status of the yellow snapper Lutjanus argentiventris (Peters, 1869) in the Macapule Lagoon (Gulf of California, Mexico) in 2013-2015

In December 2013, June and December 2014, and July 2015, a total of 123 specimens of L. argentiventris were captured in the Macapule Lagoon with gillnets of 50 mm mesh size. The total length and weight of each specimen were recorded. The liver, stomach, and gutted weight were weighed to the nearest gram (g) and the data used to calculate the following morpho-physiological indices: 1) the Fulton's condition factor (CF) using the equation: CF = W~t~/L~t~3 * 100, where W~t~ = total weight and L~t~ = total length; 2) the hepatosomatic index (HSI) using the equation: HSI = W~h~/W~t~*100, where W~h~ = liver weight and W~t~ = total weight of the individual; and 3) the gastric repletion index (GRI) using the equation GRI = W~s~/W~t~ *100, where W~s~ = stomach weight and W~t~ = total weight. Parameters of the length-weight relationship of L. argentiventris were estimated using the equation: W = aL^b^, where W = weight of the fish (g), L = total length (cm), a = y-intercept or the initial growth coefficient, b = slope or the growth coefficient. Blood samples of 1±0.1 mL were extracted (only of fish larger than 10 cm total length) by caudal puncture with a disposable plastic syringe containing 0.5 mL of heparinized solution (Sigma-Aldrich). The blood samples were centrifuged at 9,500 g at 4ºC during 10 minutes to separate the blood cells from the plasma. Total protein concentrations were determined following Bradford's method (1976), which is based on the reaction of the amino groups with the dye Coomassie Blue G-250. Triglycerides, glucose, and cholesterol concentrations were determined with colorimetric commercial kits Randox, U.K (Apún-Molina et al., 2015);. Absorbance was determined with a microplate reader (Multiskan Go, Thermo Scientific UV, United States) and concentrations were calculated from a standard solution of substrates

Physicochemical measurements in the Macapule Lagoon (Gulf of California, Mexico) in 2013-2015

The Macapule Lagoon (25º 21' and 25º 24' N; 108º 30' and 108º 45' W) is part of the San Ignacio-Navachiste-Macapule lagoon system, located in the southern region of the Gulf of California (Fig. 1). In 2000, it has been declared an "Area of Reserve and Refuge for Migratory Birds and Wildlife – Gulf of California Islands". This lagoon is very productive due to its location in the Gulf of California (Lluch-Cota et al. 2007). Water temperature, dissolved oxygen, pH, and salinity were measured in situ with an YSI (55-12FT) probe and a portable refractometer (RHS-10ATC). Nutrient (nitrate, ammonium, and phosphate) concentrations were determined in the laboratory during each sampling month using a photometer (YSI, 9500)