Trade-offs among aboveground, belowground, and soil organic carbon stocks along altitudinal gradients in Andean tropical montane forests

Tropical montane forests (TMFs) play an important role as a carbon reservoir at a global scale. However, there is a lack of a comprehensive understanding on the variation in carbon storage across TMF compartments [namely aboveground biomass (AGB), belowground biomass (BGB), and soil organic matter] along altitudinal and environmental gradients and their potential trade-offs. This study aims to: 1) understand how carbon stocks vary along altitudinal gradients in Andean TMFs, and; 2) determine the influence of climate, particularly precipitation seasonality, on the distribution of carbon stocks across different forest compartments. The study was conducted in sixty 0.1 ha plots along two altitudinal gradients at the Podocarpus National Park (Ecuador) and Río Abiseo National Park (Peru). At each plot, we calculated the amount of carbon in AGB (i.e. aboveground carbon stock, AGC), BGB (i.e. belowground carbon stock, BGC), and soil organic matter (i.e. soil organic carbon stock, SOC). The mean total carbon stock was 244.76 ± 80.38 Mg ha–1 and 211.51 ± 46.95 Mg ha–1 in the Ecuadorian and Peruvian plots, respectively. Although AGC, BGC, and SOC showed different partitioning patterns along the altitudinal gradient both in Ecuador and Peru, total carbon stock did not change with altitude in either site. The combination of annual mean temperature and precipitation seasonality explained differences in the observed patterns of carbon stocks across forest compartments between the two sites. This study suggests that the greater precipitation seasonality of colder, higher altitudes may promote faster turnover rates of organic matter and nutrients and, consequently, less accumulation of SOC but greater AGC and BGC, compared to those sites with lesser precipitation seasonality. Our results demonstrate the capacity of TMFs to store substantial amounts of carbon and suggest the existence of a trade-off in carbon stocks among forest compartments, which could be partly driven by differences in precipitation seasonality, especially under the colder temperatures of high altitudesAuthorizations to work in protected areas were granted by national authorities: Ecuador (MAE-DNB-CM2015-0016) and Perú (001-2016-SERNANP-PNRA-JEF

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

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

Early positive biodiversity effects on total biomass in experimental tree seedling assemblages with and without water limitation

[Questions]: While positive effects of tree diversity on tree community biomass have often been reported in mature stands, the debate on whether diversity effects may be detectable at the seedling level persists, with opposing outcomes found so far. We still lack a comprehensive evaluation of the biodiversity effects (so- called ‘comple-mentarity’ and ‘selection’ effects), as well as the phenotypic drivers at play, underly-ing early-community biomass. Even less is known about whether such biodiversity effects may change under water- limited conditions.[Location]: Seeds from four tree species coexisting in a Mediterranean forest (Spain).[Methods]: We built experimental tree seedling assemblages with three diversity lev-els — monocultures, two- species and four- species mixtures — and under two soil moisture conditions. We quantified the extent to which species richness, species identity, community-weighted mean (CWM) and functional dissimilarity (FD) influ-ence complementarity and selection effects. We computed CWM and FD for seven functional traits related to water and light acquisition; and we calculated the comple-mentarity and selection effects from above- and below- ground biomass measures at the community level.[Results]: Our results showed that complementarity drove the greater biomass in more diverse assemblages at the seedling stage. This pattern was largely favored by a par-ticular species, Quercus faginea, with distinct phenotypic traits (great height, lateral ramification and root biomass with high dry matter content), which induced a positive effect of CWM on community biomass. Moreover, our study showed that the water deficit limited the production of above- ground biomass without interacting with the community’s species richness.[Conclusion]: Our study provides evidence that positive biodiversity effects on com-munity biomass occur early, at the seedling stage, and it highlights the essential role that certain tree species play from their initial development stages by favoring spatresource partitioning. Our work motivates future studies to apply integrated ap-proaches in assessing both the community-wide and species-specific effects to understand the biodiversity–biomass relationship.This work was supported by the Spanish-funded project REMEDINAL-3CM (S2013/MAE-2719). CCB is supported by a postdoctoral fellowship of the Ramón Areces Foundation. BC thanks Coordenação de Aperfeiçoamento de Pessoal de Níıvel Superior - CAPES [DOC- PLENO - Programa de Doutorado Pleno no Exterior (grant Agreement No 99999.001266/2015-02) for a research scholarship. CV was supported by the European Research Council (ERC) Starting Grant Project ‘Ecophysiological and Biophysical Constraints on Domestication in Crop Plants’ (grant ERC- StG -2014- 639706-CONSTRAINTS).Peer reviewe