International nosocomial infection control consortium (INICC) report, data summary of 36 countries, for 2004-2009

The results of a surveillance study conducted by the International Nosocomial Infection Control Consortium (INICC) from January 2004 through December 2009 in 422 intensive care units (ICUs) of 36 countries in Latin America, Asia, Africa, and Europe are reported. During the 6-year study period, using Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infections, we gathered prospective data from 313,008 patients hospitalized in the consortium's ICUs for an aggregate of 2,194,897 ICU bed-days. Despite the fact that the use of devices in the developing countries' ICUs was remarkably similar to that reported in US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were significantly higher in the ICUs of the INICC hospitals; the pooled rate of central line-associated bloodstream infection in the INICC ICUs of 6.8 per 1,000 central line-days was more than 3-fold higher than the 2.0 per 1,000 central line-days reported in comparable US ICUs. The overall rate of ventilator-associated pneumonia also was far higher (15.8 vs 3.3 per 1,000 ventilator-days), as was the rate of catheter-associated urinary tract infection (6.3 vs. 3.3 per 1,000 catheter-days). Notably, the frequencies of resistance of Pseudomonas aeruginosa isolates to imipenem (47.2% vs 23.0%), Klebsiella pneumoniae isolates to ceftazidime (76.3% vs 27.1%), Escherichia coli isolates to ceftazidime (66.7% vs 8.1%), Staphylococcus aureus isolates to methicillin (84.4% vs 56.8%), were also higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 7.3% (for catheter-associated urinary tract infection) to 15.2% (for ventilator-associated pneumonia). Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time, and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications 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, 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

Uso de inseticidas para o controle da traça-do-tomateiro e traça-das-crucíferas: um estudo de caso Use of insecticides for controlling the South American Tomato Pinworm and the Diamondback Moth: a case study

Em agosto de 1999, produtores de tomate e brássicas do Núcleo Rural da Taquara tiveram seus cultivos seriamente comprometidos devido à impossibilidade de controle da traça-do-tomateiro e da traça-das-crucíferas. Diversos inseticidas, alguns com o mesmo princípio ativo ou pertencentes ao mesmo grupo químico, eram aplicados de uma a sete vezes por semana sem qualquer eficiência no controle das pragas. Lavouras foram abandonadas em diferentes estádios de desenvolvimento. A fim de definir uma estratégia de controle que viabilizasse a produção de tomate e brássicas na região, foi avaliado em laboratório a eficiência da dose comercial de alguns inseticidas usados no controle das duas pragas. Para isso, foram coletadas duas populações de traça-do-tomateiro e uma população de traça-das-crucíferas. Para traça-do-tomateiro, cartap, abamectin, lufenuron, acefate e deltametrina causaram respectivamente 100, 90, 67, 2 e 0% de mortalidade das larvas. Para traça-das-crucíferas, B. thuringiensis, abamectin, cartap, acefate and deltametrina causaram 100; 96; 86; 79 e 5% de mortalidade respectivamente. De acordo com estes resultados foi recomendada a suspensão imediata do uso de piretróides e organofosforados para o controle das duas pragas. Abamectin e cartap foram recomendados para o controle da traça-do-tomateiro e B. thuringiensis para o controle de traça-das-crucíferas.<br>In August 1999, at the "Núcleo Rural da Taquara", Federal District, Brazil, tomato and brassica crops were severely damaged by the South American Tomato Pinworm (Tuta absoluta) and the Diamondback Moth (Plutella xylostella). During that time growers related that they had been spraying insecticides one to seven times per week without controlling the pests. In the fields it was observed that there were crops with different ages and levels of chemical residues which allowed the pests to multiplicate continuously. Then it was decided that the first step to solve the problem would be to evaluate the efficacy of the recommended field rate of some insecticides in laboratory bioassays. Two Brazilian Tomato Pinworm populations and one Diamondback Moth population were collected. Cartap, abamectin, lufenuron, acephate and deltamethrin caused 100, 90, 67, 2 and 0% of larval mortality to the South American Tomato Pinworm, respectively. B. thuringiensis, abamectin, cartap, acephate and deltamethrin caused 100; 96; 86; 79 and 5% of mortality to the Diamondback Moth, respectively. According to laboratory results it was recommended that the use of pyrethroid and organophosphorous compounds must be suspended immediately. Abamectin and cartap must be used to control the South American Tomato Pinworm and B. thuringiensis must be employed to Diamondback Moth control

Níveis críticos de fósforo, para eucalipto, em casa de vegetação, em função da sua localização no solo Critical phosphorus levels for greenhouse grown eucalyptus as related to the placement of fertilizer p in the soil

A disponibilidade do P é modificada pela aplicação localizada desse elemento no solo, pois diminui sua adsorção, precipitação e fixação, pela redução do contato com o solo. Estudou-se, em casa de vegetação, a calibração de P em função da diferença de teores de P do solo provocada por sua aplicação localizada. Foram utilizadas amostras de Latossolos Vermelho-Amarelos distróficos com textura muito argilosa e de outro com textura média. Utilizaram-se 14 combinações de sete doses de P adicionadas nas partes central e superior da amostra do vaso ("cova") com outras sete doses de P adicionadas no solo circulante à "cova" ("solo externo"). As amostras dos dois locais foram incubadas por 40 dias com P em embalagens separadas e depois acondicionadas no vaso. Uma muda de Eucalyptus pellita foi cultivada na parte média da "cova" de cada vaso por 82 dias. Determinaram-se a produção de matéria seca da parte aérea (MS) e o teor de P por Mehlich-1 nos dois locais do solo em amostras colhidas depois da incubação e antes do plantio e em uma amostra composta pelo solo da "cova" mais o "externo" da parte superior, após a colheita. O efeito da localização foi evidente, pois a produção de MS não se relacionou bem com a quantidade de P aplicada por vaso, e sim com as doses aplicadas nos dois locais. O crescimento da planta dependeu essencialmente da dose aplicada na "cova". Valores elevados do nível crítico para a "cova" não implicam uso de grande quantidade de P por vaso. O teor de P na amostra após a colheita representou bem a disponibilidade média, porém não se relacionou bem com a produção de MS, o que dificulta a obtenção de um nível crítico para amostras que representem a fertilidade média para todo o volume de solo. Mudanças no método de calibração de P são sugeridas em condições de aplicação localizada do P.<br>The availability of P is influenced by the application location of this element to the soil, affecting the adsorption, precipitation and fixation due to the reduction of contact with the soil. This study, carried out in a greenhouse, aimed to calibrate P soil concentrations for Eucalyptus pellita growth as affected by fertilizer placement. Samples of two Oxisols were used. The treatment consisted of 14 combinations of seven P rates, which were placed in holes in the upper mid part of pots (planting hole), and seven P doses applied to the soil around the holes (external soil). Samples of the two soils were incubated separately with P for 40 days before being placed in the pots. One eucalyptus plant was grown in the middle of the fertilizer hole of each pot for 82 days. The shoot dry matter was determined and soil samples were collected from both positions of fertilizer placement before sowing and after harvesting the plant, plus a composite sample of both soil positions after harvest. The soil P content was determined by Mehlich-1. Dry matter yield was not closely related with the applied P per pot, but was related with the rates applied in both positions, which demonstrated the effect of location. Plant growth depended essentially on the dose applied in the "hole". The high critical P level determined for this placement does not express the need of using high amounts of P per pot. The P content determined in the upper soil part after harvest clearly represented the mean P availability, but was not closely related with plant growth, indicating the difficulty of establishing a critical level that would represent the mean fertility of the whole soil volume. We suggest adjustments in the calibration method for P when the element is locally applied

Níveis críticos de fósforo, para milho, em casa de vegetação, de acordo com a sua localização no solo Critical phosphorus levels for greenhouse-grown corn, as a function of its placement in the soil

A aplicação localizada de P no solo apresenta grande influência sobre sua disponibilidade, pois diminui as reações de adsorção, precipitação e fixação, em virtude da redução da superfície de contato com o solo. Em casa de vegetação, estudou-se a calibração de P diante da diferença de teores no solo provocada por sua localização. Foram usadas amostras de um LVAd de Viçosa e de um LVAm de Lassance. Utilizaram-se 14 combinações de sete doses de P adicionadas na parte central e superior do vaso ("cova") com sete doses de P adicionadas no solo circundante à "cova" (solo "externo"). As amostras dos dois locais foram incubadas por 20 d, com calcário, e por 40 d, com P, em embalagens separadas e depois acondicionadas no vaso. As sementes de milho foram semeadas no meio da "cova". As plantas foram cultivadas por 32 d. Determinaram-se a produção de matéria seca da parte aérea, o teor de P por Mehlich-1 nos dois locais do solo em amostras colhidas depois da incubação e antes do plantio e de uma amostra composta pelo solo da "cova" mais o "externo" da parte superior, após a colheita. A produção de matéria seca não se relacionou bem com a quantidade de P aplicada por vaso, mas, sim, com as doses aplicadas nos dois locais, mostrando o efeito da localização. O crescimento da planta dependeu essencialmente da dose aplicada na "cova". Os elevados valores de nível crítico para a "cova" não implicam o uso de grande quantidade de P por vaso. O teor de P na amostra da metade superior do solo do vaso retirada após a colheita representou bem a disponibilidade média, porém não se relacionou bem com o crescimento da planta, o que dificulta a obtenção de um nível crítico para amostras que representem a fertilidade média para todo o volume de solo. Sugerem-se mudanças no método de calibração de P, em condições de aplicação localizada do P.<br>Localized application of P in the soil has great influence on its availability because it reduces de adsorption reactions, precipitation and fixation, due to the lowered soil contact surface area. This study, carried out in a greenhouse, aimed to calibrate P soil concentrations for corn growth as affected by fertilizer placement. Samples of two Oxisols (LVAd and LVAm) were used. The treatment consisted of 14 combinations of 7 P rates, which were placed in holes in the upper mid part of the pot, with 7 P doses applied in the soil around the holes. Soil samples from both localizations were incubated separately with limestone for 20 days and with P for 40 days before being placed in the pots. Corn seeds were sown in the same holes as the fertilizer. The corn plants were grown for 32 days and the shoot dry matter determined. Soil samples were collected from both positions of fertilizer placement before sowing and after harvesting the plant, plus a composite sample of both soil positions after harvest. The soil P content was determined by Mehlich-1. Dry matter yield was not closely related with the applied P per pot, but it was related with the doses applied in both positions, which demonstrated the effect of localization. Plant growth depended essentially on the dose applied in the "hole". The high critical P level determined for this placement does not imply the use of a high amount of P per pot. The P content determined in the upper soil part after the harvest represented well the mean P availability, but did not show a close relationship with plant growth, indicating the difficulty of establishing a critical level that would represent the mean fertility of the whole soil volume. We suggest adjustments in the calibration method for P that would take into account the localized P applications

Prediction of long-term outcomes of HIV-infected patients developing non-AIDS events using a multistate approach

Outcomes of people living with HIV (PLWH) developing non-AIDS events (NAEs) remain poorly defined. We aimed to classify NAEs according to severity, and to describe clinical outcomes and prognostic factors after NAE occurrence using data from CoRIS, a large Spanish HIV cohort from 2004 to 2013. Prospective multicenter cohort study. Using a multistate approach we estimated 3 transition probabilities: from alive and NAE-free to alive and NAE-experienced ("NAE development"); from alive and NAE-experienced to death ("Death after NAE"); and from alive and NAE-free to death ("Death without NAE"). We analyzed the effect of different covariates, including demographic, immunologic and virologic data, on death or NAE development, based on estimates of hazard ratios (HR). We focused on the transition "Death after NAE". 8,789 PLWH were followed-up until death, cohort censoring or loss to follow-up. 792 first incident NAEs occurred in 9.01% PLWH (incidence rate 28.76; 95% confidence interval [CI], 26.80-30.84, per 1000 patient-years). 112 (14.14%) NAE-experienced PLWH and 240 (2.73%) NAE-free PLWH died. Adjusted HR for the transition "Death after NAE" was 12.1 (95%CI, 4.90-29.89). There was a graded increase in the adjusted HRs for mortality according to NAE severity category: HR (95%CI), 4.02 (2.45-6.57) for intermediate-severity; and 9.85 (5.45-17.81) for serious NAEs compared to low-severity NAEs. Male sex (HR 2.04; 95% CI, 1.11-3.84), ag