Combined neuromodulatory interventions in acute experimental pain : assessment of melatonin and non-invasive brain stimulation

Transcranial direct current stimulation (tDCS) and melatonin can effectively treat pain. Given their potentially complementary mechanisms of action, their combination could have a synergistic effect. Thus, we tested the hypothesis that compared to the control condition and melatonin alone, tDCS combined with melatonin would have a greater effect on pain modulatory effect, as assessed by quantitative sensory testing (QST) and by the pain level during the Conditioned Pain Modulation (CPM)-task. Furthermore, the combined treatment would have a greater cortical excitability effect as indicated by the transcranial magnetic stimulation (TMS) and on the serum BDNF level. Healthy males (n = 20), (aged 18–40 years), in a blinded, placebo-controlled, crossover, clinical trial, were randomized into three groups: sublingual melatonin (0.25 mg/kg) + a-tDCS, melatonin (0.25 mg/kg) + sham-(s)-tDCS, or sublingual placebo+sham-(s)- tDCS. Anodal stimulation (2 mA, 20 min) was applied over the primary motor cortex. There was a significant difference in the heat pain threshold ( C) for melatonin+a-tDCS vs. placebo+s-tDCS (mean difference: 4.86, 95% confidence interval [CI]: 0.9 to 8.63) and melatonin+s-tDCS vs. placebo+s-tDCS (mean: 5.16, 95% CI: 0.84 to 8.36). There was no difference between melatonin+s-tDCS and melatonin+a-tDCS (mean difference: 0.29, 95% CI: 3.72 to 4.23). The mean change from the baseline on amplitude of motor evocate potential (MEP) was significantly higher in the melatonin+a-tDCS (19.96% 5.2) compared with melatonin+s-tDCS group (1.36% 5.35) and with placebo+s-tDCS group (3.61% 10.48), respectively (p < 0.05 for both comparisons). While melatonin alone or combined with a-tDCS did not significantly affect CPM task result, and serum BDNF level. The melatonin effectively reduced pain; however, its association with a-tDCS did not present an additional modulatory effect on acute induced pain

Equipamento e método para estimulação elétrica transcraniana

Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreEngenhariaFarmáciaHospital de Clínicas de Porto AlegreMedicinaDepositad

Climate change: the necessary, the possible and the desirable Earth League climate statement on the implications for climate policy from the 5th IPCC Assessment

The development of human civilisations has occurred at a time of stable climate. This climate stability is now threatened by human activity. The rising global climate risk occurs at a decisive moment for world development. World nations are currently discussing a global development agenda consequent to the Millennium Development Goals (MDGs), which ends in 2015. It is increasingly possible to envisage a world where absolute poverty is largely eradicated within one generation and where ambitious goals on universal access and equal opportunities for dignified lives are adopted. These grand aspirations for a world population approaching or even exceeding nine billion in 2050 is threatened by substantial global environmental risks and by rising inequality. Research shows that development gains, in both rich and poor nations, can be undermined by social, economic and ecological problems caused by human-induced global environmental change. Climate risks, and associated changes in marine and terrestrial ecosystems that regulate the resilience of the climate system, are at the forefront of these global risks. We, as citizens with a strong engagement in Earth system science and socio-ecological dynamics, share the vision of a more equitable and prosperous future for the world, yet we also see threats to this future from shifts in climate and environmental processes. Without collaborative action now, our shared Earth system may not be able to sustainably support a large proportion of humanity in the decades ahead

Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities

Background: Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance. Methods: The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Jurua valley in the Amazon region. Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008. Results: The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95% CI 0.20 - 0.58) for the P. falciparum malaria incidence rates, 0.67 (95% CI 0.50 - 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95% CI 0.41 - 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported. Conclusions: In the remote region of the Jurua valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.CNPq [309156/2007-6]PAHO/WHOBrazilian Ministry of HealthUSAI

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

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 &lt;= 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

Learning design with data: towards a pedagogical framework for the use of Building Information Modeling technology as support for design in architecture curricula

Contemporary architectural practice has seen the emergence of new workflows for integrated design and construction, brought about by new expectations of efficiency and sustainability in buildings. Building Information Modeling (BIM) has established itself as a digital tool capable of helping to deliver these new mandates, with potential to impact both design and documentation phases of projects. As such, BIM tools have been finding their way into the curricula of schools of architecture, but mostly as project documentation tools. There seems to exist considerable resistance to the use these tools to assist the design tasks traditionally seen as more intellectual and intuitive, and to involve non-designers early in the design process. This study aimed to examine the state of North American architecture education vis-à-vis the use of BIM tools to assist specifically in design tasks that incorporate those aforementioned new design workflows, and to document course formats and pedagogical strategies being used to that end. Through online surveys and interviews with architecture educators in Canada and the United States, it is concluded that academia is aware of the existence and most capabilities of BIM tools, but also displays a considerable skepticism in relation to the impact of a digital tool that involves the technical realization of the building earlier in the design process. Twelve case studies documenting pioneer formats of design courses involving the support of BIM tools show that the introduction of these new workflows is being done through class simulations of collaborative design involving other students or external industry professionals, the promotion of more robust project visualization deliverables, the development of technical solutions earlier in the design process, analyses of building data to support construction management (cost and logistics), and basic simulations to check for physical behaviour performance. Many pedagogical and coordination strategies are deployed, including intra- and inter-departmental collaboration, emphasis on the workflows instead of on formal outcomes, integrated design competitions, the use of students’ previous design work, partial data analyses, and the use benchmark performance artifacts

[pt] ANÁLISE DO PROCESSO DE GESTÃO DA MUDANÇA EM UM AMBIENTE DE FUSÃO: A PERSPECTIVA DOS TOMADORES DE DECISÃO DA AFFERO TECNOLOGIA

A presente pesquisa é constituída por um estudo de caso, que buscou analisar a percepção dos empreendedores da empresa Affero Tecnologia sobre os fatores críticos relacionados à Gestão de Pessoas e de Comunicação no processo de Gestão da Mudança vivenciado no processo de fusão de quatro empresas. O estudo foi pautado na observação dos principais problemas relacionados às pessoas e comunicação, a saber: dificuldades para comunicação dos objetivos da mudança, dificuldades na compreensão dos objetivos da mudança, dificuldade em promover o trabalho em equipe em processos de mudança e dificuldade em fazer com que os indivíduos adotem as mudanças. Quanto aos resultados, o estudo mostrou que a empresa utilizou os canais de comunicação adequados para transmissão dos objetivos da fusão e realizou ações e eventos que facilitaram a compreensão dos objetivos da mudança por partes dos empregados. Por outro lado, o estudo demonstra que a Affero teve uma participação tardia do Departamento de Recursos Humanos em função da maior ênfase nas questões financeiras e legais no processo de fusão. Além disso, a pesquisa demonstra que a Affero procupou-se com a retenção de talentos, o que diminuiu a resistência na adoção da mudança. Fundamentalmente a Affero necessita hoje da consolidação da governança corporativa exigida em um processo de evolução de pequena para média empresa e a ampliação de sua estrutura de gestão de Pessoas. Além disso, também se faz necessário atenção na implementação de um dos valores corporativos alardeados pela empresa que é a meritocracia.This research consists of a case study that sought to analyze the perceptions of the entrepreneurs of the Affero Technology company regarding the critical factors related to Personnel Management and Communications in the Change Management process experienced in the process of a merger of four companies. The study was based upon the observation of the main problems related to people and communications, namely: difficulties in communicating the objectives of the change, difficulties in understanding the objectives of change, difficulty in promoting teamwork in the change processes and difficulty in getting individuals to adopt the changes. With regard to results, the study showed that the company used suitable communication channels for transmission of the objectives of the merger and implemented actions and events that made it easier for employees to understand the objectives of the change. On the other hand, the study shows that Affero’s Human Resources Department was late in placing greater emphasis on financial and legal matters involved in the merger process. Moreover, the research demonstrates that Affero was concerned about retaining its human talent, which rduced resistance to the adoption of change. Fundamentally, Affero today needs to consolidate the corporate governance required in a process of evolution from a small to medium sized company as well as expanding its Personnel management structure. In addition, attention must also be paid to the implementation of one of the corporate values touted by the company: meritocracy