Caracterização entomológica e infecção natural de anofelinos em área de Mata Atlântica, com casos autóctones de malária, em regiões montanhosas do Espírito Santo

No Espírito Santo, os casos de malária autóctone estão distribuídos na região serrana próximo aos fragmentos de Mata Atlântica. Uma vez que alguns aspectos da doença são obscuros, a detecção das possíveis espécies de vetores pode auxiliar na elucidação de incertezas epidemiológicas. Estudos entomológicos e de infecção natural foram realizados com anofelinos (Diptera: Culicidae) capturados no município de Santa Tereza, ES. Capturas mensais foram realizadas de março de 2004 a fevereiro de 2006. Armadilhas CDC-CO2 foram utilizadas do crepúsculo (18:00h) ao amanhecer (6:00h), para capturar anofelinos nos seguintes habitats: próximo ao domicílio e área aberta (solo), margem e interior da mata (solo e copa). Armadilhas Shannon também foram utilizadas nos mesmos locais que as de CDC-CO2. Capturou-se o total de 2.290 anofelinos distribuídos em 10 espécies. A maior frequência relativa foi de Anopheles (Kerteszia) cruzii Dyar & Knab / A.(K.) homunculus Komp, sendo a maioria capturada em CDC-CO2 instalada na copa da mata. A principal espécie capturada em armadilha Shannon foi A.(Nyssorhynchus) strodei Root. O maior número de anofelinos foi capturado entre julho e setembro das 18:00h às 22:00h. Provavelmente A.(K.) cruzii é responsável pela transmissão da malária dentro ou próximo aos fragmentos de Mata Atlântica. Entretanto, a participação de outras espécies não pode ser ignorada, visto que 53 por cento da amostragem foi constituída pelo subgênero Nyssorhynchus. A detecção de Plasmodium vivax no tórax de A. cruzii, A. parvus (Chagas) e A. galvaoi Causey, Deane & Deane por meio de PCR reforça esse argumentoAutochthonous malaria cases in the state of Espírito Santo, Brazil, are distributed in mountainous regions surrounded by the Atlantic Forest. While some aspects of this disease are unclear, detection of possible vector species can help to elucidate epidemiological uncertainties. Entomological and natural infection studies were carried out using anophelines (Diptera: Culicidae) captured in the municipality of Santa Tereza, ES. Monthly captures were made from March 2004 to February 2006. CDC-CO2 traps were used from dusk (6:00 P.M.) to dawn (6:00 A.M.) to capture anophelines in the following habitats: near the houses, in open areas (at ground level) and inside, and at the margins of the forest (canopy and ground level). Shannon light traps were also used at the same locations of the CDC-CO2 traps. A total of 2,290 anophelines within 10 species were captured. The relative frequency of Anopheles (Kerteszia) cruzii Dyar & Knab / A.(K.) homunculus Komp was the highest, with the majority captured in CDC-CO2 traps installed in the forest canopy. The main species captured in Shannon traps was A.(Nyssorhynchus) strodei Root. The largest number of anophelines was captured from July to September and from 6:00 P.M. to 10:00 P.M. Anopheles (K.) cruzii is the probable vector for malaria transmission inside or near the Atlantic Forest fragments, but the role of other species cannot be ignored, as 53% of the sampled anophelines belonged to the subgenus Nyssorhynchus. The natural infection of A. cruzii, A. parvus (Chagas) and A. galvaoi Causey, Deane & Deane by Plasmodium vivax detected by PCR from DNA extracted from their thoraxes supports this viewFAPESP 2003/07631-

Epidemiologic aspects of the malaria transmission cycle in an area of very low incidence in Brazil

BACKGROUND: Extra-Amazonian autochthonous Plasmodium vivax infections have been reported in mountainous regions surrounded by the Atlantic Forest in Espírito Santo state, Brazil. METHODS: Sixty-five patients and 1,777 residents were surveyed between April 2001 and March 2004. Laboratory methods included thin and thick smears, multiplex-PCR, immunofluorescent assay (IFA) against P. vivax and Plasmodium malariae crude blood-stage antigens and enzyme-linked immunosorbent assay (ELISA) for antibodies against the P. vivax-complex (P. vivax and variants) and P. malariae/Plasmodium brasilianum circumsporozoite-protein (CSP) antigens. RESULTS: Average patient age was 35.1 years. Most (78.5%) were males; 64.6% lived in rural areas; 35.4% were farmers; and 12.3% students. There was no relevant history of travel. Ninety-five per cent of the patients were experiencing their first episode of malaria. Laboratory data from 51 patients were consistent with P. vivax infection, which was determined by thin smear. Of these samples, 48 were assayed by multiplex-PCR. Forty-five were positive for P. vivax, confirming the parasitological results, while P. malariae was detected in one sample and two gave negative results. Fifty percent of the 50 patients tested had IgG antibodies against the P. vivax-complex or P. malariae CSP as determined by ELISA. The percentages of residents with IgM and IgG antibodies detected by IFA for P. malariae, P. vivax and Plasmodium falciparum who did not complain of malaria symptoms at the time blood was collected were 30.1% and 56.5%, 6.2% and 37.7%, and 13.5% and 13%, respectively. The same sera that reacted to P. vivax also reacted to P. malariae. The following numbers of samples were positive in multiplex-PCR: 23 for P. vivax; 15 for P. malariae; 9 for P. falciparum and only one for P. falciparum and P. malariae. All thin and thick smears were negative. ELISA against CSP antigens was positive in 25.4%, 6.3%, 10.7% and 15.1% of the samples tested for "classical" P. vivax (VK210), VK247, P. vivax-like and P. malariae, respectively. Anopheline captures in the transmission area revealed only zoophilic and exophilic species. CONCLUSION: The low incidence of malaria cases, the finding of asymptomatic inhabitants and the geographic separation of patients allied to serological and molecular results raise the possibility of the existence of a simian reservoir in these areas

Swimming with Predators and Pesticides: How Environmental Stressors Affect the Thermal Physiology of Tadpoles

To forecast biological responses to changing environments, we need to understand how a species’s physiology varies through space and time and assess how changes in physiological function due to environmental changes may interact with phenotypic changes caused by other types of environmental variation. Amphibian larvae are well known for expressing environmentally induced phenotypes, but relatively little is known about how these responses might interact with changing temperatures and their thermal physiology. To address this question, we studied the thermal physiology of grey treefrog tadpoles (Hyla versicolor) by determining whether exposures to predator cues and an herbicide (Roundup) can alter their critical maximum temperature (CTmax) and their swimming speed across a range of temperatures, which provides estimates of optimal temperature (Topt) for swimming speed and the shape of the thermal performance curve (TPC). We discovered that predator cues induced a 0.4uC higher CTmax value, whereas the herbicide had no effect. Tadpoles exposed to predator cues or the herbicide swam faster than control tadpoles and the increase in burst speed was higher near Topt. In regard to the shape of the TPC, exposure to predator cues increased Topt by 1.5uC, while exposure to the herbicide marginally lowered Topt by 0.4uC. Combining predator cues and the herbicide produced an intermediate Topt that was 0.5uC higher than the control. To our knowledge this is the first study to demonstrate a predator altering the thermal physiology of amphibian larvae (prey) by increasing CTmax, increasing the optimum temperature, and producing changes in the thermal performance curves. Furthermore, these plastic responses of CTmax and TPC to different inducing environments should be considered when forecasting biological responses to global warming.Peer reviewe

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Effects of small hydropower dams on macroinvertebrate and fish assemblages in southern Brazil

Hydropower dams affect freshwater biodiversity by virtue of modifying flow regimes and degrading habitat conditions both above and below the water impoundment and diversion structure. In recent decades, there has been a global proliferation of Small Hydropower Plants (SHPs) propelled by incentive policies and a general perception that small dams are less harmful to the environment. However, limited science is available on the effects of SHPs on freshwater biodiversity, which is concerning considering their sheer numbers and the high variability in the size and operation of dams classified as SHPs. We investigated the ecological effects of 12 SHPs on macroinvertebrate and fish assemblages of the Chapeco River Basin, Brazil. Our study included sites located upstream of the SHPs and sites directly affected by their operations (i.e., reservoir, dewatering section and downstream of the powerhouse). This design allowed us to quantify shifts in taxonomic composition and examine the relative role of different SHP attributes (e.g., dam height, reservoir area, age) in explaining these changes. Our results reveal that SHPs modify the composition of both macroinvertebrate and fish assemblages, but the magnitude of such changes vary widely among dams. Both assemblages exhibited directionality in taxonomic shifts, resulting in a gradual replacement of taxa associated with fast-flowing habitats by other groups more commonly associated with standing waters. We also found that changes in assemblage structureare related to structural (dam height, reservoir area) and spatial attributes (distance from headwaters) of SHPs, although the predictive power of these attributes varied taxonomically and among reservoir, dewatering and downstream sites. Overall, our results demonstrate that SHPs have important and heterogeneous effects on freshwater assemblages, which may manifest individually or cumulatively across the riverscape. This suggests that it is unlikely that a priori classifications of dams based on their structural attributes can replace site-specific and cumulative impact assessments. The results also shed light on the need for better understanding of how SHP attributes shape their ecological effects, so that a full assessment of the potential environmental impacts of the wide range of "small" dams is possible

Modelo de autoavaliação para suporte à gestão organizacional: experimentação em indústria do segmento de malharia Model of self-evaluation to support organizational performance: experiment performed in knitted fabric textile industry

Este trabalho apresenta um modelo para suporte à gestão organizacional com foco em autoavaliação fundamentado nos critérios dos principais prêmios de excelência em gestão internacionais e do Brasil. Esta proposta teve por finalidade permitir avaliações personalizadas de desempenho do sistema de gestão e da importância para a organização das práticas de excelência em gestão preconizadas por tais prêmios. O método de pesquisa constituiu-se em fundamentação teórica, análise comparativa de três dos principais prêmios de excelência em gestão internacionais e do Brasil e experimentação do modelo proposto em uma indústria do segmento de malharia. A aplicação do modelo proposto possibilitou uma avaliação personalizada do desempenho do sistema de gestão da organização objeto de estudo e, também, da importância atribuída às práticas de excelência em gestão abordadas nos critérios. O contraste entre desempenho e importância permitiu a identificação de pontos organizacionais prioritários de melhoria da organização.<br>This project aims to present a sample to support organizational management focusing on self-evaluation based on the criteria of the most important international and national excellence awards in management. The objective of the sample was to allow for customized evaluations of performance regarding the management system as well as evaluations of the importance of management excellence practices to the company preconized by those awards. The research methodology was based on a theoretical foundation, comparative analysis of the three main Excellence Awards in Management in Brazil, and on the experiment of the sample proposed in a knitted fabric textile industry. The sample proposed has allowed for a customized performance evaluation of the management system of the company used as the object of study, and the importance of the management excellence practices involved in the criteria. The contrast between performance and importance has allowed defining the major organizational aspects aiming at the company's improvement

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt