A list of land plants of Parque Nacional do Caparaó, Brazil, highlights the presence of sampling gaps within this protected area

Brazilian protected areas are essential for plant conservation in the Atlantic Forest domain, one of the 36 global biodiversity hotspots. A major challenge for improving conservation actions is to know the plant richness, protected by these areas. Online databases offer an accessible way to build plant species lists and to provide relevant information about biodiversity. A list of land plants of “Parque Nacional do Caparaó” (PNC) was previously built using online databases and published on the website "Catálogo de Plantas das Unidades de Conservação do Brasil." Here, we provide and discuss additional information about plant species richness, endemism and conservation in the PNC that could not be included in the List. We documented 1,791 species of land plants as occurring in PNC, of which 63 are cited as threatened (CR, EN or VU) by the Brazilian National Red List, seven as data deficient (DD) and five as priorities for conservation. Fifity-one species were possible new ocurrences for ES and MG states

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

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

Cell immobilization of Scheffersomyces shehatae UFMG-HM 52.2 in calcium alginate gel aiming ethanol production from sugarcane sugarcane bagasse hemicellulosic hydrolysate in fluidized bed reactor

Importantes produtos úteis à sociedade podem ser obtidos a partir do bagaço de cana-deaçúcar, como por exemplo, o etanol de segunda geração. Para a produção deste álcool, reforçam-se estudos visando alternativas de processos diferenciados, como por exemplo, utilizando células imobilizadas em biorreatores. O presente trabalho teve como objetivos o estudo de condições de imobilização da levedura Scheffersomyces shehatae UFMG-HM 52.2, encapsulada em gel de alginato de cálcio, e a avaliação de condições de produção de etanol a partir de hidrolisado hemicelulósico de bagaço de cana-de-açúcar, com as células imobilizadas em processos operados em reator de leito fluidizado. Inicialmente, o bagaço de cana-de-açúcar foi submetido à hidrólise ácida seguida de concentração e destoxificação do hidrolisado hemicelulósico. Em ensaios fermentativos em frascos Erlenmeyer, com a nova e promissora levedura fermentadora de pentoses, Scheffersomyces shehatae UFMGHM 52.2 na forma livre, testou-se diferentes meios nutricionais para a seleção dos nutrientes importantes na suplementação do hidrolisado hemicelulósico. Após análise, escolheu-se o meio composto por 5 g/l de sulfato de amônio, 3 g/l de extrato de levedura e 3 g/l de extrato de malte para as fermentações subsequentes. Utilizando-se este meio, observou-se valores de fator de rendimento (YP/S) e produtividade volumétrica em etanol (QP) de 0,38 g/g e 0,19 g/l.h, respectivamente. Em uma primeira etapa, determinou-se as condições de imobilização celular da levedura por encapsulamento em gel de alginato de cálcio, utilizando um planejamento experimental 23 completo com três pontos centrais. Avaliou-se a influência da concentração de alginato de sódio, de cloreto de cálcio e tempo de cura, tendo como variáveis resposta YP/S e QP. Pela análise estatística e fermentativa, definiu-se o uso da concentração de 1% de alginato de sódio, 0,2 M de cloreto de cálcio e 12 h de tempo de cura para o processo de imobilização celular. Nesta condição, observou-se valores de YP/S e QP de 0,32 g/g e 0,14 g/l.h, respectivamente. Posteriormente, conduziuse fermentações utilizando células imobilizadas em modo de bateladas repetidas em frascos Erlenmeyer, verificando-se a estabilidade na produção de etanol em cinco ciclos fermentativos consecutivos. Em uma segunda etapa, avaliou-se as condições de produção de etanol utilizando células imobilizadas em reator de leito fluidizado, por meio de planejamento experimental 22 completo com três pontos centrais. Avaliou-se a influência da vazão de aeração e massa de suporte com células imobilizadas, tendo como variáveis resposta YP/S e QP. A partir da análise estatística e fermentativa, verificou-se como melhores condições para o processo, o uso de 200 g de suporte e 200 ml/min de vazão de aeração. Nestas condições, observou-se valores de YP/S e QP de 0,26 g/g e 0,17 g/l.h, respectivamente. Sob estas condições de processo, realizou-se também fermentações em modo de bateladas repetidas, verificando-se a estabilidade do sistema operacional de produção de etanol em sete ciclos fermentativos consecutivos. Por estes resultados, concluiu-se que esse processo fermentativo com células imobilizadas em reator de leito fluidizado apresenta destacada potencialidade, podendo servir como conhecimentos para estudos futuros visando a sua implementação em maiores escalas.Important useful products to society can be obtained from sugarcane bagasse, e.g. secondgeneration ethanol. For the production of this alcohol, studies are focused on alternatives for different processes, e.g., using immobilized cells in bioreactors. This work had as objectives the study of immobilization conditions on the yeast Scheffersomyces shehatae UFMG-HM 52.2, encapsulated in gel of calcium alginate, and evaluating the conditions of ethanol production from sugarcane bagasse hemicellulosic hydrolysate, with the immobilized cells in the process carried out in a fluidized bed reactor. Initially, the sugarcane bagasse was subject to acid hydrolysis followed by concentration and detoxification of hemicellulosic hydrolysate. In fermentation tests in Erlenmeyer flasks, with the novel and promising pentose fermenting yeast, Scheffersomyces shehatae UFMGHM 52.2 in free form, different nutritional media were tested for the selection of important nutrients in the supplementation of hemicellulosic hydrolysate. After the analysis, the medium composed of 5 g/l of ammonium sulfate, 3 g/l of yeast extract and 3 g/l of malt extract was chosen for subsequent fermentations. By using this medium, it was observed values of etanol yield (YP/S) and volumetric productivity (QP) of 0.38 g/g and 0.19 g/l.h, respectively. In a first step, it was determined the yeast cells immobilization conditions by encapsulation in calcium alginate gel using a 23 full factorial design with three central points. The influence of the concentration of sodium alginate, calcium chloride and conditioning time was evaluated, with the response variables YP/S and QP. By statistical and fermentative analysis, it was chosen the concentrations of 1% for sodium alginate, 0.2 M for calcium chloride and 12 h for conditioning time in the immobilization process. In this condition, it was observed values of YP/S and QP of 0.32 g/g and 0.14 g/l.h, respectively. Thus, fermentations were performed applying immobilized cells in Erlenmeyer flasks in repeated batch, where the stability of ethanol production in five consecutive cycles was verified. In a second step, the conditions of ethanol production using immobilized cells in fluidized bed reactor were evaluated, by using a 22 full factorial design with three central points. In this investigation, the influence of aeration rate and mass of suport with immobilized cells was tested, and the response variable were YP/S and QP. By statistical and fermentative analysis, it was found that the best conditions for the process included the use of 200 g of support with immobilized cells and 200 ml/min for aeration rate. Under these conditions, it was observed values of YP/S and QP of 0.26 g/g and 0.17 g/l.h, respectively. Also, under the same conditions, repeated batch fermentations were carried out, where it was verified that ethanol production system stability in seven consecutive fermentation cycles. For these results, it was concluded that this fermentation with immobilized cells in fluidized bed reactor offers outstanding potential and could be used as basis for future studies aiming its implementation in large scales