Determinants of intensive insulin therapeutic regimens in patients with type 1 diabetes: data from a nationwide multicenter survey in Brazil

Background: To evaluate the determinants of intensive insulin regimens (ITs) in patients with type 1 diabetes (T1D).Methods: This multicenter study was conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,591 patients (56.0% female, 57.1% Caucasian). Insulin regimens were classified as follows: group 1, conventional therapy (CT) (intermediate human insulin, one to two injections daily); group 2 (three or more insulin injections of intermediate plus regular human insulin); group 3 (three or more insulin injections of intermediate human insulin plus short-acting insulin analogues); group 4, basal-bolus (one or two insulin injections of long-acting plus short-acting insulin analogues or regular insulin); and group 5, basal-bolus with continuous subcutaneous insulin infusion (CSII). Groups 2 to 5 were considered IT groups.Results: We obtained complete data from 2,961 patients. Combined intermediate plus regular human insulin was the most used therapeutic regimen. CSII was used by 37 (1.2%) patients and IT by 2,669 (90.2%) patients. More patients on IT performed self-monitoring of blood glucose and were treated at the tertiary care level compared to CT patients (p < 0.001). the majority of patients from all groups had HbA1c levels above the target. Overweight or obesity was not associated with insulin regimen. Logistic regression analysis showed that economic status, age, ethnicity, and level of care were associated with IT (p < 0.001).Conclusions: Given the prevalence of intensive treatment for T1D in Brazil, more effective therapeutic strategies are needed for long term-health benefits.Farmanguinhos/Fundacao Oswaldo Cruz/National Health MinistryBrazilian Diabetes SocietyFundacao do Amparo a Pesquisa do Estado do Rio de JaneiroConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Estado Rio de Janeiro, Unit Diabet, BR-20551030 Rio de Janeiro, BrazilBaurus Diabet Assoc, São Paulo, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilFed Univ Hosp Porto Alegre, Porto Alegre, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Fed Rio de Janeiro, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilSanta Casa Misericordia, Belo Horizonte, MG, BrazilSanta Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilHosp Geral de Bonsucesso, Rio de Janeiro, BrazilHosp Univ Clementino Fraga Filho IPPMG, Rio de Janeiro, BrazilUniv Hosp São Paulo, São Paulo, BrazilFac Ciencias Med Santa Casa São Paulo, São Paulo, BrazilUniv São Paulo, Inst Crianca, Hosp Clin, São Paulo, BrazilUniv São Paulo, Fac Med Ribeirao Preto, Hosp Clin, Ribeirao Preto, BrazilAmbulatorio Fac Estadual Med Sao Jose Rio Preto, Ribeirao Preto, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilClin Endocrinol Santa Casa Belo Horizonte, Belo Horizonte, MG, BrazilUniv Estadual Londrina, Londrina, BrazilUniv Fed Parana, Hosp Clin, Porto Alegre, RS, BrazilInst Crianca Com Diabet Rio Grande Sul, Rio Grande Do Sul, RS, BrazilGrp Hosp Conceicao, Inst Crianca Com Diabet, Porto Alegre, RS, BrazilHosp Univ Santa Catarina, Florianopolis, SC, BrazilInst Diabet Endocrinol Joinville, Joinville, BrazilHosp Reg Taguatinga, Brasilia, DF, BrazilHosp Geral Goiania, Goiania, Go, BrazilCtr Diabet & Endocrinol Estado Bahia, Goiania, Go, BrazilUniv Fed Maranhao, Sao Luis, BrazilCtr Integrado Diabet & Hipertensao Ceara, Fortaleza, Ceara, BrazilUniv Fed Sergipe, Aracaju, BrazilHosp Univ Alcides Carneiro, Campina Grande, BrazilHosp Univ Joao de Barros Barreto, Belem, Para, BrazilFed Univ São Paulo State, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, Diabet Unit, São Paulo, BrazilUniv Hosp São Paulo, São Paulo, BrazilEscola Paulista Med, Ctr Diabet, Ribeirao Preto, BrazilWeb of Scienc

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Alternative phosphate fertilizer and phosphorus adsorption kinetics in different soil mineralogy treated with biochar

A demanda mundial por alimentos, fibras e energia obriga a exploração de novas áreas e aumento de produtividade em áreas cultivadas. Em solos tropicais, com elevado grau de intemperização, o P é o nutriente mais limitante à produção vegetal, havendo a necessidade de fertilizações em quantidade e frequência elevadas. O desenvolvimento de novas fontes de P reutilizando subprodutos industriais e, ou, fontes marginais apresenta relevância para assegurar o fornecimento de fertilizantes, preservando recursos naturais. No solo, os fenômenos químicos de sorção e dessorção são os principais processos que controlam a dinâmica de P. Os oxihidróxidos de Fe e Al possuem elevada capacidade de reter o P, tornando a mineralogia importante fator de controle da disponibilidade deste nutriente. A adição de materiais orgânicos como o biocarvão pode contribuir para reduzir a sorção de P. Assim, o objetivo principal deste estudo foi avaliar a eficiência agronômica de fertilizantes fosfatados alternativamente acidulados com efluente ácido e estudar a cinética de sorção e fracionamento de P em solos de diferentes mineralogias tratados com biocarvão. No capítulo I, no estudo sobre fertilizantes, foi montado um experimento em casa de vegetação com os tratamentos arranjados em um esquema fatorial (8 x 2) +1 , sendo oito fertilizantes fosfatados: Araxá, Patos de Minas e Bayovar in natura, estes mesmos em suas formas parcialmente aciduladas (FNPA) com efluente e duas fontes solúveis de P (superfosfato simples e superfosfato triplo), em duas doses de P (300 e 600 mg dm -3 ), mais um controle, sem a aplicação de P. Foram cultivados milho, soja e aveia-branca em sucessão. Foram avaliados a eficiência agronômica e os teores de metais pesados no tecido vegetal. A acidulação com efluente foi eficiente no aumento da reatividade e consequente melhoria da eficiência agronômica dos fosfatos naturais. Não houve incrementos nos teores de metais potencialmente tóxicos nos tecidos foliares com a aplicação das fontes de P. No capítulo II, no estudo sobre interação solo-P, em um solo de fertilidade construída, utilizou-se um novo método de fracionamento com extração sequencial que, em resumo, estabelece as frações de P nos compartimentos: solúvel, lábil, associado aos oxihidróxidos de Fe e Al de baixa cristalinidade, com baixa energia de viiretenção de P (ABE), e associado aos oxihidróxidos de Fe e Al de alta cristalinidade com alta energia de retenção de P (AAE). Foi coletada uma amostra após cada etapa do fracionamento para especiação do P por espectroscopia de absorção de raiosX (XANES), com intuito de estabelecer quais são as espécies extraídas em cada etapa. A técnica XANES confirmou que diferentes frações de P no solo são extraídas durante as etapas de fracionamento. No capítulo III, no estudo de cinética de adsorção, dois solos de mineralogia contrastante foram tratados com ou sem calagem e, ou, biocarvão e postos para agitar numa solução com concentração de P equivalente a 50 % da capacidade máxima de adsorção de P de cada tratamento, durante os tempos de 0,5; 1, 3, 12, 24, 72, 120, 240 e 480 h. Após cada tempo, foi coletado o sobrenadante e determinado o P na solução de equilíbrio. Ao final dessa etapa de adsorção, iniciou-se o fracionamento de P pelo método descrito no capítulo II nos tempos de 1, 12, 24, 120, 240, 480 h. Assim, foram determinados o modelo cinético de adsorção e os efeitos dos tratamentos na distribuição de P nos diferentes compartimentos ao longo dos tempos de agitação. A adsorção de P é rápida, principalmente no solo de mineralogia gibbsítica, assumindo um modelo cinético de pseudo-segunda ordem. A calagem reduziu a velocidade da adsorção e manteve o P em frações mais lábeis por mais tempo. A adição de biocarvão não apresentou alteração significativa sobre a cinética de adsorção de P.In highly weathered tropical soils phosphorus (P) is the most limiting nutrient to plant nutrition, been necessary copious and elevated doses of fertilizers. In this context, the development of new P sources reusing industrial sub products and/or marginal sources to ensure the fertilizers supply, preserving natural resources is of high importance. In soil, the sorption and desorption chemical phenomena are the main processes that control P dynamics. The Fe and Al oxihydroxides have a high P retention capacity, making the soil mineralogy an important factor controlling P availability. The addition of organic materials such as bio-char can contribute to the reduction of P sorption. Thus, the main objective of this study is to assess the agronomic efficiency of phosphate fertilizers acidulated with an acid effluent and to study the P sorption and fractioning kinetics in soils with different mineralogy which had been previously trated with biochar. In Chapter I, an (8 x 2) + 1 factorial experiment in a greenhouse, with eight different phosphate fertilizers (Araxa, Patos de Minas and Bayovar in natura and acidulated, simple superphosphate and triple superphosphate) and two P doses (300 and 600 mg dm -3 ), plus a no P application treatment (control) was assembled. Maize, soy and white-wheat were cultivated in succession and the agronomic efficiency and heavy metal content in plant tissue were analyzed. The acidulation with effluent was efficient as it increased the reactivity and consequently improved the agronomic efficiency when compared to the in natura P sources. There was no increase in potentially toxic metals in the plant tissue. Chapter II, a soil-P interaction study, where a new sequential fractioning method was applied on a soil with constructed fertility, allowing to segregate P fractions in the following compartments: soluble, labile, associated to Fe and Al oxyhydroxides of low crystallinity and low P retention energy (ALE) and associated to Fe and Al oxyhydroxides of high crystallinity and high P retention energy (AHE). After each fractioning step a sample was collected and analyzed by X-ray absorption near edge structure (XANES), in order to establish which species are extracted ixin each step. The analysis confirmed that different soil P fractions were extracted during each step. Chapter III, an adsorption kinetic study, two soils of contrasting mineralogy where treated with and without the addition of lime and /or bio-char P solution with concentrations equivalent to 50% of the P-maximum adsorption capacity of each soil where shacked for: 0,5; 1; 3; 12; 24; 72; 120; 240; 480 h. After each shacking time the supernatant was collected and the P in the equilibrium solution was determined. After the adsorption, the same fractioning method presented in Chapter II was applied on each shaking time. Thereafter, the kinetic adsorption model and the effects of each treatment in the P distribution in each compartment were determined. Adsorption of P is swift, principally in gibbsite soils, which presented a kinetic model of pseudo-second order. Liming reduced the adsorption velocity and kept the P in labile fractions for a longer time. Bio-char addition presented no significant effect on the P adsorption kinetics.Conselho Nacional de Desenvolvimento Científico e Tecnológic

Mecanismos de interação química de metais, ânions inorgânicos, ácidos orgânicos e proteína em materiais purificados, solo artificial e solo cultivado

The soil is a complex system with several phases, where abundant interfaces phenomena happen, which determines the mobility/availability of nutrients and contaminants into the environment. The deep understanding of these chemical mechanisms is a challenge, and it is often necessary to use models with reduced numbers of components and high purity, in order to isolate the effects of environmental variables such as minerals type, pH and time. Also, sophisticated analytical techniques may be used to elucidate the mechanisms involved at atomic and molecular scales. Here, mechanisms of some chemical reactions for some nutrients such as P and Zn, macromolecules such as protein and humic substances, as well as a contaminant such as Cd and As were evaluated, using pure systems, artificial soil or soil samples from cultivated areas. The main conclusions were: (i) the previous adsorption with citrate decreased P adsorption on hematite surface. The P-hematite surface complex in bidentate configuration had a faster absorption than the monodentate, and the bidentate was preferentially desorbed by citrate; (ii) As(V) was adsorbed on inner and outer- sphere complexes on the hematite and hausmannite surfaces, hausmannite showing a higher adsorption than hematite. The transformation from hausmannite to manganite should increase As(V) adsorption an its stability, thus hausmannite could be a good option as As(V) filter; (iii) the adsorption on hematite surface promoted a prominent conformational change in the secondary structures of BSA protein, toward a less \"packed\" and more \"unfolded\" protein forms, and the pH near the isoelectric point maximized its adsorption; (iv) Ca increased the adsorption of humic substances in the minerals present in weathered soils. Ternary complexes \"mineral-Ca-humic substances\" were responsible for this increment; and organic molecules less humified and/or with lower molecular weight were preferentially adsorbed on minerals\' surfaces; (v) less Zn was adsorbed at pH 4.5, which was preferentially retained in aluminosilicate minerals, while at pH 6.5, more Zn was adsorbed and Zn sorbed on Fe oxide, and Zn-P precipitates were identified. However, after 6 months, these ones decreased or disappeared, and the fraction of Zn sorbed to aluminosilicate minerals incresed; (vi) Cd and Zn are rapidly adsorbed on soils under native vegetation or highly fertilized agricultural soils, and agricultural soils adsorb more these metals than soil under native vegetation. These metals, however, were easily desorbable by EDTA; (vii) the soil mineralogy determined the main Zn fractions adsorbed on the soil, the fraction of Zn adsorbed to kaolinite was present in all soil samples, regardless of origin and management; agricultural management and time increased the amount of Zn in less mobile fraction, and Zn associated with P was present in highly fertilized soils.O solo é um complexo sistema com variadas fases que alojam reações de interfaces que determinam a mobilidade/disponibilidade de nutrientes e contaminantes no ambiente. O entendimento profundo dos mecanismos que regem as reações é um desafio, sendo muitas vezes necessária a utilização de modelos com número reduzido de componentes e de alta pureza, a fim de que se isolem os efeitos de variáveis ambientais como tipo de minerais, pH e tempo. Podem também ser aplicadas sofisticadas técnicas analíticas para elucidar os mecanismos envolvidos. Nesse trabalho, procurou-se avaliar mecanismos de algumas reações químicas que envolvem os nutrientes P e Zn, macromoléculas como proteína e substâncias húmicas, bem como os contaminantes Cd e As; todos eles em matrizes puras ou em amostras de terra de áreas cultivadas e sob vegetação nativa (VN). As principais conclusões foram: (i) o complexo de superfície P-hematita em configuração bidentada teve adsorção mais rápida do que a monodentada, sendo a bidentada preferencialmente desorvida pelo ânion citrato, cuja adsorção anterior ao fosfato diminuiu a adsorção de P na superfície da hematita; (ii) o As(V) é adsorvido em complexos de esfera interna e externa nas superfícies de hematita e de hausmanita, sendo maior a adsorção na hausmanita, que se mostrou uma opção plausível de filtro para As(V); (iii) o processo de adsorção da proteína BSA em hematita teve forte dependência do pH do meio, sendo o pH próximo ao ponto isoelétrico da proteína o que maximizou a adsorção, sendo que houve considerável mudança conformacional nas estruturas secundárias da BSA após adsorção, o que a tornou menos \"empacotada\" e mais \"desdobrada\", (iv) o Ca aumentou a adsorção de substancias húmicas nos minerais estudados por meio de complexos ternários \"mineral-Ca-substâncias húmicas\", e houve preferência de adsorção nas superfícies dos minerais presentes em solos intemperizados, por moléculas orgânicas menos humificadas e/ou de menor peso molecular; (v) em pH 4,5 houve menor adsorção de Zn, sendo esse retido preferencialmente em minerais alumino-silicatados, enquanto em valores de pH 6,5 as espécies de Zn ligadas a óxido de Fe e aquele precipitado com P também foram identificadas. Contudo, após seis meses de incubação, essas espécies diminuíram ou desapareceram, sendo as espécies de Zn adsorvidas aos minerais alumino-silicatados dominantes após longo tempo de incubação; (vi) Cd e Zn foram adsorvidos rapidamente em solos sob VN ou solos agrícolas altamente fertilizados, sendo que solos agrícolas adsorveram mais esses metais do que o solo sob VN. Porém, apesar da maior adsorção, esses metais ainda foram dessorvíveis por EDTA; (vii) a fração de Zn adsorvido à caulinita esteve presente em todas as amostras de solo, independentemente da origem e do manejo, mas o manejo agrícola e o tempo de incubação aumentaram a quantidade de Zn associado a frações de menor mobilidade. Além disso, a espécie de Zn associado ao fosfato esteve presente em solos altamente fertilizados, e a composição mineralógica do solo determinou a distribuição das frações de Zn adsorvido no solo

Acid Ammonium Citrate as P Extractor for Fertilizers of Varying Solubility

ABSTRACT: There are several globally accepted methods to chemically characterize P-fertilizers, but not all are suitable to predict the agronomic efficiency of the P sources in terms of plant nutrition. Our aim was to investigate the performance of P extractors for fertilizers, investigating the consistency of different methods for P sources of varying properties and the related plant responses. The experiment was carried out in a greenhouse, using corn as a model plant. Phosphorus values extractable in water, 2 % citric acid, 2 % formic acid, ammonium neutral citrate + water, and acid ammonium citrate were evaluated for eight P fertilizers of varied solubility and correlated with P uptake by corn. The extractors citric acid and formic acid recovered no predictive amounts of P from crystalline apatite sources (Araxá and Patos phosphate rocks, PRs). However, they showed a satisfactory performance for Bayóvar PR and partially acidulated PRs but extracted low amounts of P from soluble P sources such as superphosphates. Neutral ammonium citrate + water extractors could accurately predict the efficiency of soluble P sources but underestimated the performance of Bayóvar (a reactive PR). In contrast, the extractor acid ammonium citrate, AAC, (pH 3) accurately predicted the agronomic efficiency of all P fertilizers. We therefore suggest AAC as an effective predictor of the agronomic effectiveness of any inorganic phosphorus sources

Agronomic efficiency of phosphate fertilizers produced by the re-use of a metallurgical acid residue

The production of fertilizers with industrial wastes reduces the environmental impacts of waste disposal and improves environmental sustainability by generating added-value products. Our objective with this study was to evaluate the agronomic performance and potential soil/plant contamination with heavy metals of alternative phosphate (P) fertilizers, obtained from the acidulation of phosphate rocks (PR) by a metallurgical acidic waste. Seven P fertilizers were evaluated: three PR (Araxá, Patos, and Bayóvar), their respective acidulated products (PAPR), and triple superphosphate fertilizer (TSP). A greenhouse trial was carried out to test the agronomic performances of fertilizers in a sequentially cultivated maize-soybean-white oat. The reaction of PR with acid waste was effective to increase their solubility and improve plant yield and P uptake compared to their natural PR. There was a cumulative recovery by plants of 1.4 and 8.1% of added P via PR and PAPR, respectively. No increase in heavy metal (Cd, Pb, Cr, and Ni) availability in soil or accumulation in shoots was observed, indicating that the PAPR were environmentally safe. The usage of acid waste to produce P fertilizers therefore represents a strategic way to employ marginal products for the production of fertilizers