O USO DO SISTEMA AGROFLORESTAL TAUNGYA NA RESTAURAÇÃO DE RESERVAS LEGAIS: INDICADORES ECONÔMICOS

. Pontal do Paranapanema, in the extremity west of São Paulo state, is a well known region in Brazil due mainly to the land conflicts, mobilized by the MST (Movement of Landless Rural Workers). This land reform movement has changed the rural landscape, where small forest fragments are today surrounded by human settlements. The São Paulo State Forest Code foresees that these settlements, as well as any rural property, must keep 20% of its area covered by natural vegetation. This area, so-called Legal Reserve, must be restored if their original vegetation had been removed or impacted. Thus, this research was carried out in Santa Zelia settlement, in Pontal do Paranapanema, located into 27,5 hectares of Legal Reserve area. Eleven families of this settlement were involved in an agroforestry project, through Taungya agroforestry system, where native trees were intercropped with annual crops for restoration this legal reserve. Three variables had been used for the economic evaluation in the area: Liquid Present Value (VPL), Relation Benefit-Cost (RB/C) and payback. The results showed positive values for eight out to the eleven analyzed families, leading to a conclusion that Agroforestry Systems can be adopted in the recovery of areas of Legal Reserve in rural properties. Its economic viability will mainly depend on intensifying the intercropping and on satisfactory market prices for the annual crops.O Pontal do Paranapanema, extremo oeste do estado de São Paulo, é conhecido em todo Brasil devido aos conflitos pela posse de terra, protagonizados pelo MST (Movimento dos Trabalhadores Rurais Sem Terra), que transformaram significantemente a paisagem da região, onde, atualmente, observam-se pequenas ilhas de assentamentos rurais imersos numa matriz de grandes pastagens. O Código Florestal prevê que esses assentamentos devam manter, no mínimo, 20% de área com cobertura vegetal arbórea. Essa área é conhecida como Reserva Florestal Legal e deve ser restaurada caso se encontre degradada. Assim, esta pesquisa se desenvolveu no assentamento Santa Zélia, município de Teodoro Sampaio, São Paulo, numa área de 27,5 hectares de Reserva Legal, onde onze famílias deste assentamento foram responsáveis pela restauração da área, através do sistema Taungya. Três indicadores foram utilizados para a avaliação econômica da área: Valor Presente Líquido (VPL), Relação Benefício-Custo (RB/C) e payback. A partir disso, verificou-se que resultados econômicos apresentaram valores positivos para oito das onze famílias analisadas, levando à conclusão que sistemas agroflorestais podem ser adotados na recuperação de áreas de Reserva Legal em propriedades rurais. Sua maior ou menor viabilidade econômica irá depender de um manejo mais intenso na área para produção agrícola e de preços satisfatórios para venda no mercado

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

Restoring ecology in restoration: assessment of agroforestry and leguminous species in ecological restoration.

Os remanescentes florestais, refúgios de biodiversidade, estão sob grande pressão antrópica. A Floresta Estacional Semidecidual (Mata Atlântica do Interior) foi a formação florestal mais devastada no bioma Mata Atlântica. Frente ao quadro de destruição florestal, mudanças climáticas e problemas socioeconômicos, somos desafiadosa desenhar e adaptar novos modelos de restauração florestal, associados ao processo de desenvolvimento e geração de renda das comunidades locais. O objetivo deste estudo foi contribuir com a pesquisa em restauração florestal, avaliando práticas de cultivo intercalar de plantas leguminosas e/ou sistemas agroflorestais, como catalisadores da restauração ecológica, na região do Pontal do Paranapanema, estado de São Paulo. A hipótese central testada é se o controle de plantas espontâneas em plantios de restauração ecológica pode ser realizado através de cultivos intercalares e se os cultivos intercalares interferem na fertilidade do solo e no desenvolvimento das espécies florestais.Durante 24 meses foram monitorados e avaliados: a dinâmica das plantas espontâneas, a evolução da fertilidade do solo eo desenvolvimento das espécies florestais em cada tratamento proposto.O delineamento experimental foi inteiramente casualizado com 4 tratamentos em 4 repetições, sendo: (TE) - Testemunha, sem nenhum cultivo intercalar; (SAF) - Sistema Agroflorestal, plantio de feijão na entrelinha da cultura florestal; (FG) - Feijão guandu, plantado na entrelinha da cultura florestal; (LAB) - Labe-labe, plantado na entrelinha da cultura florestal.Os dados foram analisados em ambiente R, através da ANOVA e testeTUKEY a posteriori. Os resultados das plantas espontâneas apontam para a Brachiaria brizantha como a espécie dominante no tratamento TE e que todos os tratamentos foram capazes de controlar a Brachiaria brizantha. Para a fertilidade do solo, não foram observadasdiferenças significativas entre os tratamentos e/ou anos para as variáveis Ca,H+Al, Mg, M.O., N, SB e V%. Foram encontradas diferenças significativas entre os tratamentos e/ou anos para as variáveis P, K, CTC e pH.Em relação ao desenvolvimento das espécies florestais, quando comparados ambos os grupos ecológicos (pioneiras e não pioneiras), observou-se que todos os tratamentos possuem menor mortalidade e maior altura média quando comparados aTE.Os resultados das análises de área basal, para ambos os grupos ecológicos, sugerem que um menor período de uso das entrelinhas favoreça o crescimento em área basal, porém promove alta mortalidade no grupo das não pioneiras.Conclui-se que os manejos de entrelinha com sistemas agroflorestais ou com cultivo de leguminosas, foram eficientes em criar condições favoráveis ao desenvolvimento de espécies florestais, porém o tempo de uso da entrelinha teve influência direta sobre a mortalidade das não pioneiras.The remaining forests fragments, refuges for biodiversity, are under great anthropogenic pressure. Semi deciduousAtlantic Forest (Mata Atlantica Interior) was the most devastated forest formation in the Atlantic Forest biome. Facing forest destruction, climate change and socioeconomic problems, we are challenged to design and adapt new models of ecological restoration, associated with the rural development and income generation for local communities. The objective of this study was to contribute to research on ecological restoration, assessing management practices through the cultivation of leguminous speciesand agroforestry systems, as catalysts for ecological restoration in the region of Pontal Paranapanema, state of São Paulo. During 24 months it was monitored and evaluated the dynamic of weeds, the evolution of soil fertility and the development of forest species in each proposed treatment. The experimental design was completely randomized with 8 treatments and 1 control in 4 repetitions: (TE) - Control, without intercropping cultivation; (SAF) - Agroforestry System with beansintercropped; (FG) - pigeonpea intercropped with forest; (LAB) - Labe-labe intercropped with forest. Data were analyzed in R environment, by ANOVA and Tukey tests retrospectively. The results point to Brachiaria brizantha as dominant specie in TE, and that all treatments were able to control the spontaneous species. There were no significant differences between treatments and / or years for the variables Ca, H+Al, Mg, OM, N, SB and V%. Significant differences were found between treatments and / or years for the variables P, K, CTC and pH. When both functional groups compared, all treatments have lower mortality and higher average height, compared to the control plots. The results of basal area for both functional groups, suggest that a shorter period of use of lines favor the growth of basal area, but promotes high mortality in the group of non-pioneer tree species. The results suggestthat agroforestry and leguminous species cultivation of pigeonpea and labe-labe, are effective in creating favorable conditions for the development of forest species, but intercropping period has a direct influence on mortality of non-pioneer tree species

Guandu bean (Cajanus cajan (L.) Millsp.) on tropical forest restoration/ <br> Feijão guandu (Cajanus cajan (L.) Millsp.) na restauração de florestas tropicais

This work aims to evaluate alternative models in forest restorations by means of agroforestry systems, where a leguminous species is incorporated to the system. The hypothesis is that guandu bean Cajanus cajan (L.) Millsp., in combination and intercropped with native species, can promote restoration by decreasing mortality and increasing tree basal area and height. Cajanus cajan was planted in line with the forest seedlings in 2 x 4 m spacing. Four different treatments were analyzed; 1) control, with no Cajanus cajan ; 2) one seedling of Cajanus cajan between the forest seedlings in the plantation line; 3) two seedlings of Cajanus cajan between the forest seedlings in the plantation line; and 4) full harvest Cajanus cajan six months after plot implementation. In each treatment, 100 native trees (Fifty pioneer, and fifty non pioneer trees) were measured and evaluated in mortality rates, height, and basal diameter. Guandu planting reduced pioneer mortality, increased basal area, and tree height of all species. In spite of the mortality was not affected by guandu density, the density of one plant of guandu was associated with larger basal area and tree average height. The mortality reduction of non pioneers on the absence of guandu trees was interpreted as a response of antropic pioneers to the increased solar radiation. This result points to the differences in tree behavior between fertile gaps (on which the classification on sucessional stages was based) and degraded areas. The positive effects of guandu planting recommend its use for the ecological restoration cost reduction.<p><p>O objetivo deste trabalho é avaliar formas alternativas de restauração de áreas degradadas, utilizando sistemas agroflorestais com uma espécie leguminosa incorporada ao sistema. A hipótese é que o feijão guandu (Cajanus cajan (L.) Millsp.) possa auxiliar o processo de restauração, diminuindo a mortalidade e aumentando a altura e área basal das árvores. O feijão guandu foi plantado na linha de plantio florestal, entre as espécies florestais nativas da região, que foram plantadas em espaçamento 2 X 4m. Foram avaliados quatro tratamentos: plantio florestal sem feijão guandu (testemunha); uma planta de feijão guandu consorciado entre duas plantas de espécies florestais; duas plantas de feijão guandu consorciado entre duas plantas de espécies florestais; e corte raso aos seis meses após o plantio do feijão guandu consorciado com as espécies florestais. Em cada tratamento, foram sorteados 100 indivíduos sendo 50 pioneiras e 50 não pioneiras, nos quais foram medidos mortalidade, altura e diâmetro de colo das plantas. O plantio de guandu reduziu a mortalidade de pioneiras, aumentou a área basal e a altura de todas espécies. Apesar da mortalidade não ter sido afetada pela densidade de guandu, a densidade de uma planta de guandu se associou a maiores área basal e altura média de árvores. A redução da mortalidade de árvores não pioneiras na ausência de guandu foi interpretada como uma resposta de pioneiras antrópicas à maior radiação solar. Este resultado aponta para comportamento diferente entre árvores nas férteis clareiras (nas quais a classificação em estágios sucessionais foi baseada) e em áreas degradadas. Os efeitos positivos do guandu recomendam seu uso para a redução de custos da restauração ecológica

Avaliação econômica de sistemas agroflorestais implantados para recuperação de reserva legal no Pontal do Paranapanema, São Paulo

O Pontal do Paranapanema, extremo oeste do Estado de São Paulo, é conhecido em todo o Brasil devido aos conflitos pela posse da terra, protagonizados pelo Movimento dos Trabalhadores Rurais Sem Terra (MST), que transformou significativamente a paisagem da região, onde atualmente se observam pequenas ilhas de assentamentos rurais imersos numa matriz de grandes pastagens. O Código Florestal prevê que esses assentamentos, assim como qualquer propriedade rural, deve manter 20% de sua área com cobertura vegetal arbórea. Essa área, conhecida como Reserva Florestal Legal, deve ser restaurada, caso não exista. Assim, esta pesquisa se desenvolveu no assentamento Santa Zélia, Município de Teodoro Sampaio, São Paulo, numa área de 15 ha de Reserva Legal. Seis famílias desse assentamento foram responsáveis pela restauração da área, através de módulos agroflorestais (Taungya) temporários. Dois indicadores foram utilizados para avaliação econômica da produção agrícola na área: Valor Presente Líquido (VLP) e Relação Benefício-Custo (RB/C). Os resultados indicaram valores positivos em todas as famílias analisadas, levando à conclusão de que sistemas agroflorestais podem ser adotados na recuperação de áreas de reserva legal em propriedades rurais. Sua maior ou menor viabilidade econômica irá depender de um manejo mais intenso na área para produção agrícola e de preços satisfatórios para venda no mercado.Pontal do Paranapanema, in Western São Paulo State, is a well-known region in Brazil mainly due to the land conflicts mobilized by the MST (Movement of Landless Rural Workers). This land reform movement has changed the rural landscape, where small forest fragments are today surrounded by human settlements. The São Paulo State Forest Code foresees that these settlements, as well as any rural property, must keep 20% of its area covered by natural vegetation. This area, so-called Legal Reserve, must be restored if their original vegetation had been removed or impacted. Thus, this research was carried out in Santa Zelia settlement, in Pontal do Paranapanema, located within 15 hectares of Legal Reserve. Six families of this settlement were involved in an agroforestry project, using temporary Taungya agroforestry modules, where native trees were intercropped with annual crops. Two variables had been used for the economic evaluation of the agricultural production in the area: Liquid Present Value (VPL) and Benefit-Cost Ratio (RB/C). The results show positives values for all the analyzed families, leading to the conclusion that Agroforestry Systems can be adopted in the recovery of areas of Legal Reserve in rural properties. Its economic viability will mainly depend on intensifying the intercropping and satisfactory market prices for the annual crops

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes