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

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

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

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

Prospective, randomized, double-blind study of the effects of transcranial led therapy (TLTC) intervention in the acute phase of severe traumatic brain injury

Introdução: o traumatismo cranioencefálico (TCE) e uma das causas mais frequentes de morbidade e mortalidade em todo o mundo, com impacto importante na qualidade de vida de suas vítimas. Devido a faixa etária acometida, os danos socioeconômicos para a sociedade são enormes. As consequências oriundas do TCE do ponto de vista neuropsicológico são dramáticas e incluem um espectro amplo de alterações comportamentais e sensitivo-motoras, o que acarreta comprometimento diverso da funcionalidade das vítimas. Dentre os novos recursos disponíveis, a estimulação com laser/LED pela da técnica de terapia LED transcraniana (TLTC) vem sendo proposta como uma nova técnica com resultados positivos em pesquisas relacionadas ao tratamento de pacientes com quadro neurodegenerativo. Objetivo: Na fase aguda do TCE grave, avaliar os efeitos do TLTC na reabilitação funcional de pacientes 3 meses após o trauma. Método: Ensaio clínico randomizado controlado, duplo cego, de pacientes na fase aguda de traumatismo cranioencefálico grave que corresponderem aos demais critérios de elegibilidade foram divididos de maneira aleatória e cega em dois grupos: Grupo A (n=16) receberam estimulação TLTC e Grupo B (n=16) receberam estimulação sham. Todos os pacientes passaram por avaliação neuropsicológica 3 meses após o trauma. Resultados: Trinta e dois pacientes foram inclusos, tendo vinte e cinco retornado aos 3 meses para avaliação, sendo 13 do grupo ativo de 12 do grupo placebo. A Mediana da idade foi de 31 anos (IIQ 24-40,5). Todos os pacientes do estudo foram destros. Em relação aos mecanismos de trauma, 28 pacientes tiveram lesões por trauma direto (96,5% IC95% 82,2-99,9), 20 pacientes tiveram lesões por mecanismos de aceleração-desaceleração (68,9% IC95% 49,1- 84,7) e 2 sofreram com mecanismo de golpe/contragolpe (6,9% IC95% 8,5- 22,7). A mediana da escala de coma de Glasgow na cena foi de 7 (IIQ 6-13). Já a mediana do escore da ECG na admissão foi de 6 (IIQ 3-6). Não houve diferença estatística na recuperação cognitiva dos pacientes com TCE grave comparando os grupos ativo x sham (p = 0,6862); foi encontrada melhora no domínio integração domiciliar do Questionário de Integração Comunitária (QIC) Conclusão: A recuperação cognitiva de pacientes com TCE grave após terapia com LED não apresentou melhora significativa, mas uma melhora relevante foi observada quando o domínio integração domiciliar do QIC foi avaliadoIntroduction: traumatic brain injury (TBI) is one of the most frequent causes of morbidity and mortality worldwide, with an important impact on the quality of life of its victims. Due to the age group affected, the socioeconomic damage to society is enormous. The consequences arising from TBI from a neuropsychological point of view are dramatic and include a wide range of behavioral and sensory-motor changes, which causes a different impairment of the victims\' functionality. Among the new resources available, laser/LED stimulation using the Transcranial Led Therapy (TLTC) technique has been proposed as a new technique with positive results in research related to the treatment of patients with neurodegenerative conditions. Objective: In an acute phase of severe TBI, to evaluate the effects of TLTC on the cognitive rehabilitation of patients 3 months after trauma. Method: Randomized controlled trial, double blinded, with patients in the acute phase of severe traumatic brain injury who met the eligibility criteria were randomly and blindly divided into two groups: Group A (n = 16) has received TLTC stimulation and Group B (n = 16) has received placebo or sham stimulation. All patients were evaluated by neuropsychologist 3 months after the trauma. Results: Third two patients were included, and twenty-five patients returned for evaluation 3 months later, with 13 from the active group and 12 from the placebo group. Median age of 31 years (Interquartile interval QII 24-40,5). All patients in the study were right-handed. Regarding the trauma mechanisms, 28 patients had direct trauma injuries (96.5% 95% CI 82.2-99.9), and 20 patients had injuries due to acceleration-deceleration mechanisms (68.9% 95% CI 49.1-84.7) and 2 suffered with a coup/counter-coup mechanism (6.9% CI95% 8.5-22.7). The median of the Glasgow coma scale at the scene was 7 (QII 6-13). The median ECG score at admission was 6 (QII 3-6). There was no statistical difference in cognitive recovery of patients with severe TBI comparing the active x sham groups (p = 0.6862); Improvement was found in home integration domain of Community Integration Questionary (CIQ) Conclusion: Cognitive recovery of patients with severe TBI after LED therapy showed no significant improvement, but a relevant improvement was observed when the domain of home integration of CIQ was evaluate

A qualidade dos ensaios clínicos randomizados publicados no Jornal Vascular Brasileiro

CONTEXTO: A qualidade dos ensaios clínicos randomizados (ECR) define-se como a probabilidade de um estudo planejado gerar resultados sem tendências e que se aproximem da realidade terapêutica. OBJETIVO: Determinar a qualidade dos artigos originais com ECR publicados no Jornal Vascular Brasileiro. MATERIAIS E MÉTODOS: Estudo descritivo transversal com base na busca eletrônica dos artigos originais publicados no Jornal Vascular Brasileiro, entre dezembro de 2004 e setembro de 2009, que tivessem características de ECR. Variável primária: qualidade dos ECR; variáveis secundárias: encaminhamento da pesquisa ao Comitê de Ética em Pesquisa (CEP), utilização do termo de consentimento livre e esclarecido (TCLE), descrição da fonte de fomento, cálculo do tamanho da amostra, teste estatístico utilizado, nível de significância adotado na pesquisa, utilização de estatística descritiva, descrição do intervalo de confiança (IC) e sigilo da alocação. Foram pesquisados dados complementares: número de autores, local de origem e tipo de estudo. Utilizou-se estatística descritiva, cálculo do tamanho da amostra e IC de 95%. RESULTADOS: Entre 114 artigos originais da amostra, 1 foi classificado como ECR, sendo de boa qualidade. Do total, 51 foram encaminhados ao CEP, 41 utilizaram TCLE, em 6 houve descrição do fomento e em 5 houve cálculo do tamanho da amostra. A amostra mostrou distribuição trimodal do número de autores por artigo (4, 5, 6), aparecendo em 20 artigos, cada um dos valores respectivos da moda. São Paulo contribuiu com 48 publicações. O teste do qui-quadrado foi o mais utilizado (38,7%). O nível de significância de 5% foi adotado em 54 artigos, em 90 utilizou-se estatística descritiva e em 18 descreveu-se uso do IC. CONCLUSÃO: Não foi possível determinar a qualidade dos ECR no Jornal Vascular Brasileiro, pois foi encontrado apenas um de boa qualidad

Burnout syndrome and weekly workload of on-call physicians: cross-sectional study

CONTEXT AND OBJECTIVES: Burnout syndrome (BS) is characterized by three dimensions: emotional exhaustion, depersonalization and reduced personal fulfillment. The objectives of this study were to evaluate a possible association between BS and weekly workload, and to describe the prevalence of BS and the sociodemographic and occupational profile of on-call physicians in Maceió. DESIGN AND SETTING: Cross-sectional study in intensive care units (ICU) at public and private hospitals in Maceió. METHODS: A self-administered form was used to evaluate sociodemographic characteristics and BS through the Maslach Burnout Inventory (MBI) among 67 on-call physicians at ICUs in Maceió. Pearson's R correlation test was used to compare workload and emotional exhaustion. For other dimensions, Spearman's S test was used (P < 0.05). Other variables were represented by simple frequencies. The 95% confidence interval was calculated for each variable. RESULTS: Among the physicians studied, 55.22% were female and the mean age was 43.9 ± 8.95 years. The mean weekly workload on call was 43.85 ± 24.49 hours. The frequency of high scores in at least one of the three dimensions of MBI was 70.14%. CONCLUSIONS: Despite the high prevalence of BS, especially among physicians who did not practice regular physical activity, our data did not indicate any significant correlation between weekly workload and any of the three dimensions of BS in this sample. The high prevalence of BS draws attention to the importance of investigating other possible causes, in order to prevent and adequately treat it