Composição Florística do estrato arbóreo da Floresta Estacional Semidecidual na Planície Aluvial do rio Doce, Linhares, ES, Brasil Floristic composition of the tree layer in Atlantic forest on the rio Doce alluvial floodplain, Espírito Santo State, Brazil

Este trabalho apresenta a flora de espécies arbóreas e palmeiras na floresta estacional semidecidual na planície aluvial do rio Doce, uma área de cerca de 20.000 ha, a partir de Linhares (ES) até próximo à foz no oceano atlântico. Foram determinadas 408 espécies (27 classificadas em gênero) e 59 famílias, entre arbóreas e palmeiras. Por meio da análise de agrupamento, foi evidenciado que a floresta do rio Doce é muito semelhante floristicamente à floresta estacional dos tabuleiros terciários, que estas se agrupam com as florestas estacionais do rio Doce em MG e que, por sua vez, todas estas se agrupam com as florestas ombrófilas do sul da Bahia, sendo o conjunto nitidamente separado das outras formações ombrófilas costeiras. Foram encontradas dezenas de espécies deocorrência restrita ou pouco frequentes em levantamentos na floresta atlântica, enfatizando a importância da área para conservação da biodiversidade. Pelo fato das matas de cacau na região abrangerem mais de 80% dessa área, sugere-se a delimitação de uma Área de Proteção Ambiental, que permita conciliar o cultivo do cacau com a proteção da biodiversidade.<br>The tree and palm flora was studied in the Atlantic forest of the rio Doce alluvial floodplain, in a 20,000ha area, between Linhares (Espírito Santo State) and the Atlantic Ocean. The floristic survey recorded 408 species and 59 families. Floristic composition was compared to other forests of São Paulo, Minas Gerais, Bahia and Rio de Janeiro states using cluster analysis. The forest flora of the study area was most similar to that of forests in Espírito Santo, Minas Gerais, and Bahia. Dozens of species in the study area are restricted and rare in Atlantic forest; this area deserves special attention for biodiversity conservation. The Brazilian government should pay heed to the biological importance of this area and declare it an Environmental Protection Area, a type of conservation unit where sustained exploitation of resources is legal. We understand that, in practical terms, this sort of conservation unit is not very efficient in conserving natural resources, but it would be a start and might contribute to improved awareness, especially by local farmers and politicians

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status