Rest energy expenditure is decreased during the acute as compared to the recovery phase of sepsis in newborns

<p>Abstract</p> <p>Background</p> <p>Little is known with respect to the metabolic response and the requirements of infected newborns. Moreover, the nutritional needs and particularly the energy metabolism of newborns with sepsis are controversial matter. In this investigation we aimed to evaluate the rest energy expenditure (REE) of newborns with bacterial sepsis during the acute and the recovery phases.</p> <p>Methods</p> <p>We studied nineteen neonates (27.3 ± 17.2 days old) with bacterial sepsis during the acute phase and recovery of their illness. REE was determined by indirect calorimetry and VO₂and VCO₂measured by gas chromatography.</p> <p>Results</p> <p>REE significantly increased from 49.4 ± 13.1 kcal/kg/day during the acute to 68.3 ± 10.9 kcal/kg/day during recovery phase of sepsis (P < 0.01). Similarly, VO₂(7.4 ± 1.9 <it>vs </it>10 ± 1.5 ml/kg/min) and VCO₂(5.1 ± 1.7 <it>vs </it>7.4 ± 1.5 ml/kg/min) were also increased during the course of the disease (P < 0.01).</p> <p>Conclusion</p> <p>REE was increased during recovery compared to the sepsis phase. REE of septic newborns should be calculated on individualized basis, bearing in mind their metabolic capabilities.</p

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Software CMAP TOOLS® para a construção de mapas conceituais: a avaliação dos estudantes de enfermagem

O mapeamento conceitual (MC) é uma estratégia de ensino que pode ser utilizada para resoluções de casos clínicos, porém de trabalhosa execução manuscrita. O estudo teve por objetivos descrever os desafios e as contribuições do software Cmap Tools® para a construção de mapas conceituais para resolução de caso clínico. Para isso, utilizou-se método descritivo, qualitativo, com estudantes da 3ª série de Graduação em Enfermagem da Universidade Federal de São Paulo. A estratégia de ensino foi aplicada e os dados foram coletados pela técnica do grupo focal. Os resultados evidenciaram que o software facilita e garante a organização, visualização e correlação dos dados, porém com dificuldades iniciais relacionadas ao manejo das ferramentas que dispõe. Concluiu-se que o software Cmap Tools® favoreceu a construção dos MC por seus recursos de formatação e autoformatação e que estratégias de orientação deveriam ser implantadas para a fase inicial de utilização

Barreiras e facilitadores para a implementação da telemedicina nas Américas

Con millones de personas en el mundo en situación de distanciamiento físico por el COVID-19, las tecnologías de la información y comunicaciones (TICs) se han posicionado como uno de los medios principales de interacción y colaboración. Ya al inicio de este milenio se empezaban a mencionar las siguientes ventajas: mayor acceso a la información y a la prestación de servicios; fortalecimiento educativo; control de calidad de los programas de detección y reducción de los costos de la atención de en salud. Sin embargo, entre las principales barreras de adopción de la telemedicina se encuentran las de índole: tecnológicas; humanas y sociales; psico-sociales y antropológicas; de Gobernanza y económicas. En estos 20 años se logró un aumento en los recursos y capacidad técnica, una mejora en la educación digital, un empoderamiento del paciente en su tratamiento y un mayor interés público en esta área. En especial se considera exitosa la conformación de equipos interdisciplinarios, las redes académicas y profesionales y las consultas médicas virtuales. Después de revisar el estado de la telemedicina en la Región de las Américas, los autores recomiendan adoptar medidas urgentes para poner en práctica políticas y programas nacionales de telemedicina, incluyendo el marco normativo y presupuesto necesario, cuya implementación se realice de manera integral e interoperable y que se sustente de redes académicas, de colaboración e instituciones especializadas. Dichas políticas deben generar un contexto habilitante que den sostenibilidad al avance logrado, considerando los aspectos mencionados en las posibles barreras.With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers—especially technological, human and social, psychosocial, anthropological, economic, and governance-related—have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.Fil: Garcia Saiso, Sebastian. Organización Panamericana de la Salud; Estados UnidosFil: Marti, Myrna C.. No especifíca;Fil: Malek Pascha, Victoria. No especifíca;Fil: Pacheco, Adrian. No especifíca;Fil: Luna, Daniel Roberto. Hospital Italiano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Medicina Traslacional e Ingeniería Biomédica - Hospital Italiano. Instituto de Medicina Traslacional e Ingeniería Biomédica.- Instituto Universitario Hospital Italiano de Buenos Aires. Instituto de Medicina Traslacional e Ingeniería Biomédica; ArgentinaFil: Plazzotta, Fernando. Hospital Italiano; ArgentinaFil: Nelson, Jennifer. Banco Interamericano de Desarrollo.; Estados UnidosFil: Tejerina, Luis. Banco Interamericano de Desarrollo.; Estados UnidosFil: Bagolle, Alexandre. Banco Interamericano de Desarrollo.; Estados UnidosFil: Savignano, Maria Celeste. Gobierno de la Ciudad de Buenos Aires; ArgentinaFil: Baum, Analia. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: Orefice, Pablo J.. No especifíca;Fil: Haddad, Ana Estela. Universidade de Sao Paulo; BrasilFil: Messina, Luiz Ary. No especifíca;Fil: Lopes, Paulo. No especifíca;Fil: Rubió, Francesc Saigí. Universitat Oberta de Catalunya; EspañaFil: Otzoy, Daniel. Red Centroamericana de Informática En Salud; GuatemalaFil: Curioso, Walter H.. Universidad Continental; PerúFil: Luna, Antonio. Gobierno de la Ciudad de Buenos Aires; ArgentinaFil: Medina, Felipe Mejia. No especifíca;Fil: Sommer, Janine. Hospital Italiano; ArgentinaFil: Otero, Paula Daniela. Hospital Italiano; ArgentinaFil: González Bernaldo De Quiros, Fernán. Provincia de Buenos Aires. Ministerio de Salud; ArgentinaFil: D’Agostino, Marcelo. Organización Panamericana de la Salud; Argentin

Dinâmica da estrutura fitossociológica da regeneração natural em sub-bosque de Mimosa scabrella Bentham em área minerada, em Poços de Caldas, MG Phytosociology structure dynamics of natural regeneration in understory of Mimosa scabrella Bentham in mined area, Poços de Caldas, Brazil

Como estratégia de reabilitação de área minerada foram realizados, no ano agrícola 1982/1983, hidrossemeadura de gramíneas e leguminosa e o plantio puro de Mimosa scabrella Bentham em Poços de Caldas, MG. Em 1997 foi implantado um conjunto de 19 parcelas permanentes de 50 m² nessa área, para caracterização inicial do processo de regeneração natural. Em 2000, foi realizado o segundo inventário nas parcelas, para caracterização do processo de dinâmica da regeneração natural, que é o objeto deste trabalho. O processo de dinâmica da regeneração natural foi caracterizado mediante análises quantitativas e qualitativas da composição florística e da estrutura horizontal e vertical. O povoamento florestal do Retiro-Branco está sobre intensa atividade de estruturação, caracterizando o estágio inicial do processo de sucessão. O declínio do povoamento puro de Mimosa escabrella está modificando a ordem anteriormente estabelecida para o processo de sucessão da área, provocando a diversificação de condições de sítio e, assim, selecionando a ocupação deste em função dos grupos ecológicos, sendo as espécies pioneiras as mais favorecidas. As espécies secundárias são as de maior dominância nas maiores classes de altura e de diâmetro, sendo as principais responsáveis pela edificação do estrato superior, em especial a espécie Miconia sellowiana. As espécies que apresentaram melhor desempenho na colonização e estruturação da regeneração natural do Retiro-Branco, nos dois inventários, foram Miconia sellowiana, Psychotria sessilis, Leandra melastomoides, Clethra scabra, Myrsine umbellata, Miconia pepericarpa, Tibouchina candolleana, Cordia superba, Cestrum amictum, Alchornea triplinervia, Casearia sylvestris, Blepharocalyx salicifolius, Myrcia rostrata e Schinus terebinthifolius, sendo indicadas como espécies para uso nos programas de reabilitação de áreas mineradas em condições semelhantes sobre a estratégia sucessional.<br>As part of mine rehabilitation strategy, herbaceous species hydroseeding and Mimosa scabrella Bentham seedling planting was carried out in 1982/1983 the Retiro-Branco bauxite mine site. In 1997, 19 sample plots of 50m² were established for initial characterization of the natural regeneration process. In 2000, a second inventory was performed in those same sample plots, to characterize natural regeneration dynamics. This process was characterized by means of quantitative and qualitative analyses of floristic composition and horizontal and vertical structures. The forest succession at Retiro-Branco was found to be undergoing intense restructuring activity, characterizing initial stage of succession. The decline of Mimosa scabrella pure stands is modifying the successional order that previously occurred in this area, causing diversity in site conditions. Occupation of these sites occurs by ecological groups, pioneer species being favored in the process. Secondary species, especially Miconia sellowiana, dominate the classes with greatest height and diameter, and are the most responsible for construction of the superior stratum. Species which presented the best performance in colonization and structuring of natural regeneration at Retiro-Branco for both inventories were Miconia sellowiana, Psychotria sessilis, Leandra melastomoides, Clethra scabra, Myrsine umbellata, Miconia pepericarpa, Tibouchina candolleana, Cordia superba, Cestrum amictum, Alchornea triplinervia, Casearia sylvestris, Blepharocalyx salicifolius, Myrcia rostrata and Schinus terebinthifolius. These are indicated as promising species for rehabilitation programs of mined areas with similar conditions of sucessional strategy