Six hundred years of South American tree rings reveal an increase in severe hydroclimatic events since mid-20th century

South American (SA) societies are highly vulnerable to droughts and pluvials, but lack of long-term climate observations severely limits our understanding of the global processes driving climatic variability in the region. The number and quality of SA climate-sensitive tree ring chronologies have significantly increased in recent decades, now providing a robust network of 286 records for characterizing hydroclimate variability since 1400 CE. We combine this network with a self-calibrated Palmer Drought Severity Index (scPDSI) dataset to derive the South American Drought Atlas (SADA) over the continent south of 12°S. The gridded annual reconstruction of austral summer scPDSI is the most spatially complete estimate of SA hydroclimate to date, and well matches past historical dry/wet events. Relating the SADA to the Australia–New Zealand Drought Atlas, sea surface temperatures and atmospheric pressure fields, we determine that the El Niño–Southern Oscillation (ENSO) and the Southern Annular Mode (SAM) are strongly associated with spatially extended droughts and pluvials over the SADA domain during the past several centuries. SADA also exhibits more extended severe droughts and extreme pluvials since the mid-20th century. Extensive droughts are consistent with the observed 20th-century trend toward positive SAM anomalies concomitant with the weakening of midlatitude Westerlies, while low-level moisture transport intensified by global warming has favored extreme rainfall across the subtropics. The SADA thus provides a long-term context for observed hydroclimatic changes and for 21st-century Intergovernmental Panel on Climate Change (IPCC) projections that suggest SA will experience more frequent/severe droughts and rainfall events as a consequence of increasing greenhouse gas emissions

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Adubação nitrogenada e potássica na produtividade do capim Mombaça sobre adubação fosfatada

O atendimento das exigências nutricionais das plantas forrageiras é um dos fatores que interfere na produção e na qualidade das plantas. Diante disso, objetivou-se avaliar os efeitos da adubação nitrogenada e potássica em cobertura sobre as características morfológicas e produtivas da gramínea Panicum maximum cv. Mombaça cultivados sobre adubação fosfatada natural. O delineamento experimental adotado foi em blocos casualizados com quatro repetições. Obtendo assim um esquema fatorial com dois fatores (6 x 2). O primeiro fator foi composto por seis doses de adubação fosfatada (0, 35, 70, 140, 210, 280 kg ha-1de P2O5) e o segundo fator está relacionado com a adubação de cobertura com nitrogênio e potássio. Quanto à adubação de cobertura, as parcelas que constituía uma área de 20 m² foram divididas ao meio, sendo aplicados 100 kg ha-1 de Ureia e 60 kg ha-1 de Cloreto de Potássio. A ureia foi dividida em duas aplicações mensalmente de 50 kg ha-1. A adubação de cobertura com nitrogênio e potássio, em função do aumento da dose da fonte de fosfato natural residual proporcionou resposta quadrática na maioria dos indicadores analisados. Observou-se que a maior altura, nos tratamentos com adubação de cobertura, foi de 100,6 cm de altura na dose 201,06 kg de P2O5 em comparação com 74,9 cm de altura na dose de 165,7 kg de P2O5 sem adubação de cobertura. Assim, tanto a adubação fosfatada quanto a adubação de cobertura contribuíram para o desenvolvimento das plantas, podendo ser uma ferramenta importante para elevar os índices produtivos da forrageira

Prediction of major adverse cardiac, cerebrovascular events in patients with diabetes after acute coronary syndrome

BACKGROUND AND OBJECTIVES: The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. METHODS: Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine-Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. RESULTS: Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine-Gray models show that the 'PG-HACKER' risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. CONCLUSION: The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes

Democracia e violência: a modernização por baixo Democracy and violence

A violência no Rio, ao contrário do que se é levado a crer pela sua reelaboração mítica, não é produzida primordialmente pela pobreza e pela exclusão. O déficit do Estado é uma causa muito mais importante do fenômeno nos anos 80. E há certas formas de violência juvenil no Rio - o "surfe ferroviário", o "arrastão" - que devem ser entendidas em termos de uma modernização por baixo da sociedade brasileira.<br>Contrarily to what one is lead to believe by its mytical reelabo-ration violence in Rio is not primordially produced by poverty and exclusion. The lack of state services is much more important as a cause of violence during the eighties. Moreover, some forms of youthfull violence are best understood as a kind of restricted modernization