Floristic and structural comparisons among palm communities in primary and secondary forest fragments of the Raimundo Irineu Serra Environmental Protection Area - Rio Branco, Acre, Brazil

This study compares the composition and structure of palm communities in fragments of secondary and primary forest within the Raimundo Irineu Serra Environmental Protection Area (APARIS), located at the urban perimeter of Rio Branco, Acre. To evaluate the palm communities, we selected secondary forest areas belonging to three distinct successional stages: 7.5 years; 27.5 years, 37.5 years, and a primary forest fragment. In each forest type we installed five 20 x 20 m plots, where we analyzed floristic composition, vegetation structure, and population demography of all palm species (Arecaceae). In all, we identified 1034 palm individuals, including 12 genera, 19 species. Primary forest exhibited the greatest palm diversity. Structural analysis of each area revealed a scarcity of seedlings (≤ 50 cm tall) and reproductive adults. Fragmentation altered the composition and decreased the richness and diversity of palms within the APARIS, while at the same time, favoring the dominance of certain species, such as A. phalerata.O presente estudo compara a composição e estrutura das comunidades de palmeiras da Área de Proteção Ambiental Raimundo Irineu Serra - APARIS, localizada no perímetro urbano do Município de Rio Branco-Acre. Foram selecionadas três áreas de floresta secundária em estágios sucessionais distintos7,5 anos, 27,5 anos, 37,5 anos de idade, e um fragmento de floresta primária. Em cada área foram instaladas cinco parcelas de 20 X 20m, onde foram analisadas a composição florística, estrutura horizontal e estrutura populacional das palmeiras. Foram identificados 1.034 indivíduos, incluídos em 12 gêneros e 19 espécies de palmeiras. A área de floresta primária apresentou maior diversidade. Na análise da estrutura populacional de cada área, comprovamos a existência de uma escassez de plântulas (≤ 50 cm de altura) e adultos reprodutivos. A fragmentação alterou a composição e diminuiu a riqueza e a diversidade de palmeiras na área da APARIS, enquanto, está favorecendo a dominância de certas espécies como A. phalerata

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Threatened flora from the State of Santa Catarina, Brazil: Arecaceae

ABSTRACT Palms (Arecaceae) are key elements that contribute to the forest biodiversity of the State of Santa Catarina. However, the official List of Endangered Flora Species of that State is incomplete, including only two Arecaceae species (Butia catarinensis Noblick & Lorenzi and B. eriospatha (Mart. Ex Drude) Becc.). Within this context, this study proposes a revision of the Official List of Arecaceae for Santa Catarina, based on the assessment of the conservation status made for each of the State’s native palm species. To assess the conservation status of the palm species in Santa Catarina, important sources on species distribution were used, including the Global Biodiversity Information Facility (GBIF), a compilation of previously published, herbarium information, field observations, and data from the Floristic and Forest Inventory of Santa Catarina (IFFSC). Information for each species was imported into GeoCAT software (Geospatial Conservation Assessment Tool). All 11 native palm species of Santa Catarina were evaluated. Ten species were considered at risk of extinction according to the IUCN Red List categories and criteria. This large number of palm species at risk of extinction calls attention to the urgent need for updates of the Official List of Endangered Species in the State

Native understory palms (Arecaceae) of the Atlantic Forest in Santa Catarina, Southern Brazil

Abstract In this study, we examined the distribution and conservation status of understory palms in the Brazilian state of Santa Catarina using data collected by the Floristic and Forest Inventory of Santa Catarina (IFFSC). Understory palms were systematically sampled within sampling units (SU) distributed over a state-wide 10 × 10 km grid. Among the 206 total SU monitored by IFFSC within Pluvial and Coastal Forest, 86% (n=177 SU) contained understory palms, comprising 1738 individuals from the following species: Bactris setosa, Geonoma elegans, G. gamiova, and G. schottiana. To explore the conservation status of understory palm populations in Santa Catarina, we overlaid a map of federal priority conservation areas on top of IFFSC distribution data for understory palms. Conservation priority levels defined by the Brazilian Environmental Agency (MMA) are rated Extremely High, Very High, High and Insufficiently Known. Ninety-four percent of the SU containing understory palms overlapped priority conservation areas, highlighting the centrality of understory palms in biodiversity conservation. Despite the wide distribution of understory palm communities in Santa Catarina, intense scrutiny of forest remnants is necessary in view of sensitivity to environmental disturbance, so as to guarantee the maintenance of understory palm populations and their ecosystem services

Risk analysis and prediction of visceral leishmaniasis dispersion in São Paulo State, Brazil

<div><p>Visceral leishmaniasis (VL) is an important neglected disease caused by a protozoan parasite, and represents a serious public health problem in many parts of the world. It is zoonotic in Europe and Latin America, where infected dogs constitute the main domestic reservoir for the parasite and play a key role in VL transmission to humans. In Brazil this disease is caused by the protozoan <i>Leishmania infantum chagasi</i>, and is transmitted by the sand fly <i>Lutzomyia longipalpis</i>. Despite programs aimed at eliminating infection sources, the disease continues to spread throughout the Country. VL in São Paulo State, Brazil, first appeared in the northwestern region, spreading in a southeasterly direction over time. We integrate data on the VL vector, infected dogs and infected human dispersion from 1999 to 2013 through an innovative spatial temporal Bayesian model in conjunction with geographic information system. This model is used to infer the drivers of the invasion process and predict the future progression of VL through the State. We found that vector dispersion was influenced by vector presence in nearby municipalities at the previous time step, proximity to the Bolívia-Brazil gas pipeline, and high temperatures (i.e., annual average between 20 and 23°C). Key factors affecting infected dog dispersion included proximity to the Marechal Rondon Highway, high temperatures, and presence of the competent vector within the same municipality. Finally, vector presence, presence of infected dogs, and rainfall (approx. 270 to 540mm/year) drove the dispersion of human VL cases. Surprisingly, economic factors exhibited no noticeable influence on disease dispersion. Based on these drivers and stochastic simulations, we identified which municipalities are most likely to be invaded by vectors and infected hosts in the future. Prioritizing prevention and control strategies within the identified municipalities may help halt the spread of VL while reducing monitoring costs. Our results contribute important knowledge to public and animal health policy planning, and suggest that prevention and control strategies should focus on vector control and on blocking contact between vectors and hosts in the priority areas identified to be at risk.</p></div