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

Eventos adversos relacionados ao acesso intravenoso na terapia da endocardite infecciosa no Instituto Nacional de Cardiologia de 2009 a 2010

Submitted by Anderson Silva ([email protected]) on 2012-09-27T17:08:04Z No. of bitstreams: 1 debora_h_g_paula_ipec_pesquisaclinicadi_0007_2010.pdf: 1005728 bytes, checksum: b98fa20a9a16f91bb1e9a163dcd87107 (MD5)Made available in DSpace on 2012-09-27T17:08:04Z (GMT). No. of bitstreams: 1 debora_h_g_paula_ipec_pesquisaclinicadi_0007_2010.pdf: 1005728 bytes, checksum: b98fa20a9a16f91bb1e9a163dcd87107 (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.Eventos Adversos (EAs) são complicações indesejadas que podem decorrer durante os cuidados prestados ao paciente, não atribuídas à evolução natural da doença de base, podendo resultar em seqüela, prolongando a permanência no hospital ou mesmo levar ao óbito. A utilização do acesso intravenoso no tratamento medicamentoso da endocardite infecciosa (EI) pode trazer EAs ao paciente, com riscos de desfechos desfavoráveis. O objetivo deste estudo é identificar os EAs infecciosos e não infecciosos relacionados à utilização do acesso intravenoso no tratamento da EI no Instituto Nacional de Cardiologia (INC) nos anos de 2009 e 2010. Trata-se de estudo observacional, analítico, e prospectivo, a partir do diagnóstico possível e definitivo para EI, pelos critérios de Duke modificados, através do preenchimento de instrumentos de coleta de dados adaptados de outros estudos primários [International Collaboration on Endocarditis (ICE) e de um estudo piloto de terapia intravenosa (INC)] dos acessos intravenosos [periférico, profundo, hemodiálise, e catéter central de inserção periférica (PICC)]. Foram incluídos 37 episódios de EI, que ocorreram em 35 pacientes. A idade média foi 44,32 ± 15,32 anos; sendo 22 (63%) pacientes do sexo masculino e 13 (37%) do sexo feminino. A amostra estudada totalizou 253 acessos intravenosos sendo 148 acessos periféricos, 85 acessos intravenosos (21 de hemodiálise) profundos de curta permanência não tunelizado (CVP), e 20 cateteres centrais de inserção periférica (PICC). “Hiperemia” e “infiltração” foram os eventos mais frequentes nos acessos periféricos; “febre” foi o evento mais frequente nos acessos profundos; “obstrução” e “exteriorização” mais frequente no PICC. A análise estatística relacionando os EAs com cada tipo de acesso intravenoso mostrou significância estatística para febre (p<0,005), bacteremia (p<0,05), saída acidental e exteriorização (p<0,001), e obstrução (p<0,001). Com relação ao tempo de permanência dos cateteres, o número de cateteres-dia foi 360 para periféricos, 1156 para CVP e 420 para PICC. A construção de curvas de Kaplan Meyer para CVP e PICC mostrou diferença estatística para obstrução (p<0,001) e manuseio (saída acidental, mais exteriorização mais obstrução, p<0,001), sendo estes eventos mais comuns na PICC. Houve mais bacteremias no CVP, mas sem diferença estatística (p=0,23). Observa-se que os eventos descritos decorrem do manuseio inadequado e de possíveis falhas nas técnicas assépticas. Deste modo, é necessário implementação mais rigorosa de medidas efetivas de controle de infecções relacionadas a acessos e ações educativas para evitar complicações mecânicas.Adverse events (AEs) are undesirable complications that may occur during patient care that cannot be attributed to the natural history of the underlying disease. They may result in incapacity, lengthening of hospital stay or even death. The use of intravenous access in the medical treatment of infective Endocarditis (IE) may result in AE to the patient, with unfavorable outcomes. The goal of the present study was to identify the infectious and non-infectious AEs related to the use of intravenous access sites for IE treatment at national Institute of Cardiology (INC) in the years from 2009 to 2010. This is an observational, analytic and prospective study based on cases of IE diagnosed as possible or definite by the modified Duke criteria. A case report form was created for data collection on intravenous lines (peripheral, central vascular, haemodyalisis and peripherally inserted central catheter/ PICC), based on data collection forms from other primary studies[International Collaboration on Endocarditis (ICE), and a pilot study on intravenous therapy (INC)].Thirty-seven episodes of IE in 35 patients were studied. Patients’ mean age was 44.32 ± 15.2 years; 22 patients (63%) were male, and 13 (37%) female. A total of 253 vascular catheters were studied, 148 were peripheral catheters, 85 were short term, non tunneled central venous catheters (21 of which were for haemodyalisis) and 20 were PICC. “Erythema” and “infiltration” were the most frequently observed AEs in the peripheral catheters, while “fever” was the most frequent AEs for CVPs, and “obstruction”, and “externalization” were more frequent in PICCs. Statistical analysis relating AEs with venous catheters type showed significance for fever (p<0.005), bacteraemia (p<0.05), accidental extrusion and externalization (p<0.001), and obstruction (p<0.001). As to the time catheters remained, the number of catheter-days was 360 for peripheral catheters, 1,156 for CVP and 420 for PICC. Kaplan Meyer curves for CVP and PICC showed statistical difference for obstruction (p<0.001) and “manipulation” (accidental extrusion, externalization, and obstruction, p<0.001), and these events were more common in PICC. More bacteraemia occurred in CVP, but this was of no statistical significance (p=0.23). The described adverse events resulted from inadequate handling and breakdown in aseptic techniques. Therefore, it is important that stricter implementation of infection control measures to prevent catheter related infections and educational measures to minimize mechanical complications are implemented

tabel hospitalization per episode

We prepared a database in Access 2003 (Microsoft Corporation) for insertion of data collected. Later these data were transported to a table Excel (Microsoft Corporation) l. The patient-related variables were: age, sex, comorbidities (diabetes, hypertension, rheumatic fever, cancer, HIV and others), allergies, type of microorganism responsible for IE, type of valve at the beginning of the episode, presence of pacemaker or device as internal defibrillator, history of EI, source of acquisition of IE, echocardiographic data (evidence of vegetation, perforation, abscess and fistula), clinical data, date of commencement of treatment, total days planned for the end of treatment, antibiotics, indication for surgery and patient's fate

Data from: Adverse events related to intravenous antibiotic therapy: a prospective observational study in the treatment of infective endocarditis

Objective: The goal of this prospective observational present study was to identify adverse events (AEs) related to the use of intravenous access sites for infective endocarditis (IE) treatment in a tertiary care hospital that can occur during patient care that cannot be attributed to the underlying disease and may result in lengthening of hospital stay or death. Design: This is an observational, analytical and prospective study on AEs resulting from the use of intravenous access sites in patients under antimicrobial treatment for IE. Patients enrolled in the International Collaboration on Endocarditis (ICE) study had their peripheral, short term central catheters (CVC) and peripherally inserted central catheters (PICC) monitored for AEs. Setting: Tertiary care hospital for cardiac surgery in Rio de Janeiro, Brazil. Patients: Patients over 18 years of age, hospitalized in 2009 and 2010 with definite criteria for IE by the modified Duke criteria were included. Main outcome measures: Adverse events related to intravenous catheters: erythema and infiltration, fever, obstruction, externalization and blood stream infection. Results: Thirty-seven episodes of IE in 35 patients were studied. Mean age was 44.32 ± 15.2 years; 22 (63%) were male. 253 vascular catheters were studied, 148 peripheral, 85 CVC (21 of which for haemodialysis) and 20 PICC. The most frequent AEs were “erythema” and “infiltration” for peripheral catheters, “fever” for CVCs, and “obstruction” and “externalization” for PICCs. The number of catheter-days was 360 for peripheral catheters, 1.156 for CVC and 420 for PICC. Kaplan Meier curves for CVC and PICC showed statistical difference for obstruction (p<0.001) in PICCs. More bacteraemia occurred in CVC compared to PICC. Conclusion: The choice of intravenous access sites is critical in the treatment of IE. Close observation for adverse events and stricter implementation of infection control measures and better manipulation of catheters are suggested

Data from: Adverse events related to intravenous antibiotic therapy: a prospective observational study in the treatment of infective endocarditis

Objective: The goal of this prospective observational present study was to identify adverse events (AEs) related to the use of intravenous access sites for infective endocarditis (IE) treatment in a tertiary care hospital that can occur during patient care that cannot be attributed to the underlying disease and may result in lengthening of hospital stay or death. Design: This is an observational, analytical and prospective study on AEs resulting from the use of intravenous access sites in patients under antimicrobial treatment for IE. Patients enrolled in the International Collaboration on Endocarditis (ICE) study had their peripheral, short term central catheters (CVC) and peripherally inserted central catheters (PICC) monitored for AEs. Setting: Tertiary care hospital for cardiac surgery in Rio de Janeiro, Brazil. Patients: Patients over 18 years of age, hospitalized in 2009 and 2010 with definite criteria for IE by the modified Duke criteria were included. Main outcome measures: Adverse events related to intravenous catheters: erythema and infiltration, fever, obstruction, externalization and blood stream infection. Results: Thirty-seven episodes of IE in 35 patients were studied. Mean age was 44.32 ± 15.2 years; 22 (63%) were male. 253 vascular catheters were studied, 148 peripheral, 85 CVC (21 of which for haemodialysis) and 20 PICC. The most frequent AEs were “erythema” and “infiltration” for peripheral catheters, “fever” for CVCs, and “obstruction” and “externalization” for PICCs. The number of catheter-days was 360 for peripheral catheters, 1.156 for CVC and 420 for PICC. Kaplan Meier curves for CVC and PICC showed statistical difference for obstruction (p<0.001) in PICCs. More bacteraemia occurred in CVC compared to PICC. Conclusion: The choice of intravenous access sites is critical in the treatment of IE. Close observation for adverse events and stricter implementation of infection control measures and better manipulation of catheters are suggested

Adverse events related to intravenous antibiotic therapy in the treatment of infective endocarditis

Cristiane da Cruz Lamas. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Submitted by Repositório Arca ([email protected]) on 2019-04-24T16:56:16Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-10-15T12:27:26Z (GMT) No. of bitstreams: 2 ve_Paula_Débora_etal_INI_2012.pdf: 202806 bytes, checksum: 519c5c0c7f2d86f676d94d2a75b68936 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-10-15T12:27:26Z (GMT). No. of bitstreams: 2 ve_Paula_Débora_etal_INI_2012.pdf: 202806 bytes, checksum: 519c5c0c7f2d86f676d94d2a75b68936 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2012Department of Surgery, Instituto Nacional de Cardiologia, Rio de Janeiro, BrazilDepartment of Biostatistics and Bioinformatics, Instituto Nacional de Cardiologia, Rio de Janeiro, BrazilUniversidade do Grande Rio. Duque de Caxias, RJ, Brasil / Instituto Nacional de Cardiologia. Infection Control Committee. Rio de Janeiro, RJ, Brazil.Objective: The goal of this prospective observational study was to identify adverse events (AEs) related to the use of intravenous access sites used for infective endocarditis (IE) treatment in a tertiary care hospital. Design: This is an observational, analytical and prospective study on AEs resulting from the use of intravenous access sites in patients under antimicrobial treatment for IE. Patients enrolled in the International Collaboration on Endocarditis (ICE) study had their peripheral, short-term central catheters (CVC) and peripherally inserted central catheters (PICC) monitored for AEs. Setting: Tertiary care hospital for cardiac surgery in Rio de Janeiro, Brazil. Patients: Patients over 14 years of age, hospitalised in 2009 and 2010 with possible or definite criteria for IE by the modified Duke criteria were included. Main outcome measures: AEs related to intravenous catheters: erythema and infiltration, fever, obstruction, externalisation and blood stream infection. Results: Thirty-seven episodes of IE in 35 patients were studied. Mean patient age was 44.32±15.2 years; 22 (63%) were men. The number of vascular catheters studied were 253, 148 of which were peripheral, 85 CVC (21 of which for haemodialysis) and 20 PICC. The most frequent AEs were ‘erythema’ and ‘infiltration’ for peripheral catheters, ‘fever’ for CVCs and ‘obstruction’ and ‘externalisation’ for PICCs. The number of catheterdays was 360 for peripheral catheters, 1.156 for CVC and 420 for PICC. Kaplan-Meier curves for CVC and PICC showed statistical difference for obstruction (p<0.001) in PICCs. More bacteraemia occurred in CVC compared with PICC. Conclusions: The choice of intravenous access sites is critical in the treatment of IE. Close observation for AEs and stricter implementation of infection control measures and better manipulation of catheters are suggested

tabel venous access

We prepared a database in Access 2003 (Microsoft Corporation) for insertion of data collected. Then the data were transported to a table of type Excel (Microsoft Corporation). The data collected were related to intravenous access: access types (peripheral, deep or hemodialysis), type of catheter, number of catheter lumens, number of insertion attempts, insertion date, date of removal, location of the insertion site, types of coatings (joint tape, hypoallergenic surgical tape, transparent dressing or tape), complications, cause for removal and professional responsible for the puncture

Transcatheter Aortic Valve Replacement: The Experience of One Brazilian Health Care Center

Abstract Objective: Transcatheter aortic valve replacement has been an alternative to invasive treatment for symptomatic severe aortic stenosis in high risk patients. The primary endpoint was 30-day and 1-year mortality from any cause. Secondary endpoints were to compare the clinical and echocardiographic variation pre-and post- transcatheter aortic valve replacement, and the occurrence of complications throughout a 4-year follow-up period. Methods: This prospective cohort, nestled to a multicenter study (Registro Brasileiro de Implante de Bioprótese por Cateter), describes the experience of a public tertiary center in transcatheter aortic valve replacement. All patients who underwent this procedure between October 2011 and February 2016 were included. Results: Fifty-eight patients underwent transcatheter aortic valve replacement. The 30-day all-cause mortality was 5.2% (n=3) and after 1 year was 17.2% (n=10). A significant improvement in New York Heart Association functional classification was observed when comparing pre-and post- transcatheter aortic valve replacement (III or IV 84.4% versus 5.8%; P<0.001). A decline in peak was observed (P<0.001) and mean (P<0.001) systolic transaortic gradient. The results of peak and mean post-implant transaortic gradient were sustained after one year (P=0.29 and P=0.36, respectively). Left ventricular ejection fraction did not change significantly during follow-up (P=0.41). The most frequent complications were bleeding (28.9%), the need for permanent pacemaker (27.6%) and acute renal injury (20.6%). Conclusion: Mortality and complications in this study were consistent with worldwide experience. Transcatheter aortic valve replacement had positive clinical and hemodynamic results, when comparing pre-and post-procedure, and the hemodynamic profile of the prosthesis was sustained throughout follow-up