12 research outputs found
How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort
CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women
COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study
CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/ÎŒL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization
Comprehensive analysis and insights gained from long-term experience of the Spanish DILI Registry
Altres ajuts: Fondo Europeo de Desarrollo Regional (FEDER); Agencia Española del Medicamento; ConsejerĂa de Salud de AndalucĂa.Background & Aims: Prospective drug-induced liver injury (DILI) registries are important sources of information on idiosyncratic DILI. We aimed to present a comprehensive analysis of 843 patients with DILI enrolled into the Spanish DILI Registry over a 20-year time period. Methods: Cases were identified, diagnosed and followed prospectively. Clinical features, drug information and outcome data were collected. Results: A total of 843 patients, with a mean age of 54 years (48% females), were enrolled up to 2018. Hepatocellular injury was associated with younger age (adjusted odds ratio [aOR] per year 0.983; 95% CI 0.974-0.991) and lower platelet count (aOR per unit 0.996; 95% CI 0.994-0.998). Anti-infectives were the most common causative drug class (40%). Liver-related mortality was more frequent in patients with hepatocellular damage aged â„65 years (p = 0.0083) and in patients with underlying liver disease (p = 0.0221). Independent predictors of liver-related death/transplantation included nR-based hepatocellular injury, female sex, higher onset aspartate aminotransferase (AST) and bilirubin values. nR-based hepatocellular injury was not associated with 6-month overall mortality, for which comorbidity burden played a more important role. The prognostic capacity of Hy's law varied between causative agents. Empirical therapy (corticosteroids, ursodeoxycholic acid and MARS) was prescribed to 20% of patients. Drug-induced autoimmune hepatitis patients (26 cases) were mainly females (62%) with hepatocellular damage (92%), who more frequently received immunosuppressive therapy (58%). Conclusions: AST elevation at onset is a strong predictor of poor outcome and should be routinely assessed in DILI evaluation. Mortality is higher in older patients with hepatocellular damage and patients with underlying hepatic conditions. The Spanish DILI Registry is a valuable tool in the identification of causative drugs, clinical signatures and prognostic risk factors in DILI and can aid physicians in DILI characterisation and management. Lay summary: Clinical information on drug-induced liver injury (DILI) collected from enrolled patients in the Spanish DILI Registry can guide physicians in the decision-making process. We have found that older patients with hepatocellular type liver injury and patients with additional liver conditions are at a higher risk of mortality. The type of liver injury, patient sex and analytical values of aspartate aminotransferase and total bilirubin can also help predict clinical outcomes
Taking the pulse of Earth's tropical forests using networks of highly distributed plots
Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests. Resumen: Los bosques tropicales son los ecosistemas mĂĄs diversos y productivos del mundo y entender su funcionamiento es crĂtico para nuestro futuro colectivo. Sin embargo, hasta hace muy poco, los esfuerzos para medirlos y monitorearlos han estado muy desconectados. El trabajo en redes es esencial para descubrir las respuestas a preguntas que trascienden las fronteras y los plazos de las agencias de financiamiento. AquĂ mostramos cĂłmo una comunidad global estĂĄ respondiendo a los desafĂos de la investigaciĂłn en ecosistemas tropicales a travĂ©s de diversos equipos realizando mediciones ĂĄrbol por ĂĄrbol en miles de parcelas permanentes de largo plazo. Revisamos los descubrimientos mĂĄs importantes de este trabajo y discutimos cĂłmo este proceso estĂĄ cambiando la ciencia relacionada a los bosques tropicales. El enfoque central de nuestro esfuerzo implica la conexiĂłn de iniciativas locales de largo plazo con protocolos estandarizados y manejo de datos para producir resultados que se puedan trasladar a mĂșltiples escalas. Conectando investigadores tropicales, elevando su posiciĂłn y estatus, nuestro modelo de Red Social de InvestigaciĂłn reconoce el rol fundamental que tienen, para el descubrimiento cientĂfico, quienes generan o producen los datos. Concebida en 1999 con RAINFOR (SuramĂ©rica), nuestras redes de parcelas permanentes han sido adaptadas en Ăfrica (AfriTRON) y el sureste asiĂĄtico (T-FORCES) y ampliamente replicadas en el mundo. Actualmente todas estas iniciativas estĂĄn integradas a travĂ©s de la ciber-infraestructura de ForestPlots.net, conectando colegas de 54 paĂses en 24 redes diferentes de parcelas. Colectivamente, estas redes estĂĄn transformando nuestro conocimiento sobre los bosques tropicales y el rol de Ă©stos en la biĂłsfera. Juntos hemos descubierto cĂłmo, dĂłnde y porquĂ© el carbono y la biodiversidad de los bosques tropicales estĂĄ respondiendo al cambio climĂĄtico y cĂłmo se retroalimentan. Esta colaboraciĂłn pan-tropical de largo plazo ha expuesto un gran sumidero de carbono y sus tendencias, mostrando claramente cuĂĄles son los factores mĂĄs importantes, quĂ© procesos se ven afectados, dĂłnde ocurren los cambios, los tiempos de reacciĂłn y las probables respuestas futuras mientras el clima continĂșa cambiando. Apalancando lo que realmente es una tecnologĂa antigua, las redes de parcelas estĂĄn generando una verdadera y moderna revoluciĂłn en la ciencia tropical. En el futuro, la humanidad puede beneficiarse enormemente si se nutren y cultivan comunidades de investigadores de base, actualmente con la capacidad de generar informaciĂłn Ășnica y de largo plazo para entender los que probablemente son los bosques mĂĄs preciados de la tierra. Resumo: Florestas tropicais sĂŁo os ecossistemas mais diversos e produtivos da Terra. Embora uma boa compreensĂŁo destas florestas seja crucial para o nosso futuro coletivo, atĂ© muito recentemente os esforços de mediçÔes e monitoramento tem sido amplamente desconexos. Ă essencial formarmos redes para obtermos respostas que transcendam as fronteiras e horizontes das agĂȘncias financiadoras. Neste estudo nĂłs mostramos como uma comunidade global estĂĄ respondendo aos desafios da pesquisa de ecossistemas tropicais, com equipes diversas medindo florestas, ĂĄrvore por ĂĄrvore, em milhares de parcelas monitoradas a longo prazo. NĂłs revisamos as maiores descobertas cientĂficas deste esforço global, e mostramos tambĂ©m como este processo vem mudando a ciĂȘncia de florestas tropicais. Nossa abordagem principal envolve unir iniciativas de base a protocolos padronizados e gerenciamento de dados a fim de gerar resultados robustos em grandes escalas. Ao conectar pesquisadores tropicais e elevar seus status, nosso modelo de Rede de Pesquisa Social reconhece o papel chave do produtor dos dados na descoberta cientĂfica. Concebida em 1999 com o RAINFOR (AmĂ©rica do Sul), nossa rede de parcelas permanentes foi adaptada para Ăfrica (AfriTRON) e Sudeste AsiĂĄtico (T-FORCES), e tem sido extensamente reproduzida em todo o mundo. Agora estas mĂșltiplas iniciativas estĂŁo integradas atravĂ©s da infraestrutura cibernĂ©tica do ForestPlots.net, conectando colegas de 54 paĂses e 24 redes de parcelas. Estas iniciativas estĂŁo transformando coletivamente o entendimento das florestas tropicais e seus papĂ©is na biosfera. Juntos nĂłs descobrimos como, onde e por que o carbono e a biodiversidade da floresta estĂŁo respondendo Ă s mudanças climĂĄticas, e seus efeitos de retroalimentação. Esta duradoura colaboração pantropical revelou um grande sumidouro de carbono persistente e suas tendĂȘncias, assim como tem evidenciado quais os fatores que influenciam essas tendĂȘncias, quais processos florestais sĂŁo mais afetados, onde eles estĂŁo mudando, seus atrasos no tempo de resposta, e as provĂĄveis respostas das florestas tropicais conforme o clima continua a mudar. Dessa forma, aproveitando uma notĂĄvel tecnologia antiga, redes de parcelas acendem as faĂscas de uma moderna revolução na ciĂȘncia das florestas tropicais. No futuro a humanidade pode se beneficiar incentivando estas comunidades locais que agora sĂŁo coletivamente capazes de gerar conhecimentos Ășnicos e duradouros sobre as florestas mais preciosas da Terra. RĂ©sume: Les forĂȘts tropicales sont les Ă©cosystĂšmes les plus diversifiĂ©s et les plus productifs de la planĂšte. Si une meilleure comprĂ©hension de ces forĂȘts est essentielle pour notre avenir collectif, jusqu'Ă tout rĂ©cemment, les efforts dĂ©ployĂ©s pour les mesurer et les surveiller ont Ă©tĂ© largement dĂ©connectĂ©s. La mise en rĂ©seau est essentielle pour dĂ©couvrir les rĂ©ponses Ă des questions qui dĂ©passent les frontiĂšres et les horizons des organismes de financement. Nous montrons ici comment une communautĂ© mondiale relĂšve les dĂ©fis de la recherche sur les Ă©cosystĂšmes tropicaux avec diverses Ă©quipes qui mesurent les forĂȘts arbre aprĂšs arbre dans de milliers de parcelles permanentes. Nous passons en revue les principales dĂ©couvertes scientifiques de ces travaux et montrons comment ce processus modifie la science des forĂȘts tropicales. Notre approche principale consiste Ă relier les initiatives de base Ă long terme Ă des protocoles standardisĂ©s et une gestion de donnĂ©es afin de gĂ©nĂ©rer des rĂ©sultats solides Ă grande Ă©chelle. En reliant les chercheurs tropicaux et en Ă©levant leur statut, notre modĂšle de rĂ©seau de recherche sociale reconnaĂźt le rĂŽle clĂ© de l'auteur des donnĂ©es dans la dĂ©couverte scientifique. Conçus en 1999 avec RAINFOR (AmĂ©rique du Sud), nos rĂ©seaux de parcelles permanentes ont Ă©tĂ© adaptĂ©s Ă l'Afrique (AfriTRON) et Ă l'Asie du Sud-Est (T-FORCES) et largement imitĂ©s dans le monde entier. Ces multiples initiatives sont dĂ©sormais intĂ©grĂ©es via l'infrastructure ForestPlots.net, qui relie des collĂšgues de 54 pays Ă travers 24 rĂ©seaux de parcelles. Ensemble, elles transforment la comprĂ©hension des forĂȘts tropicales et de leur rĂŽle biosphĂ©rique. Ensemble, nous avons dĂ©couvert comment, oĂč et pourquoi le carbone forestier et la biodiversitĂ© rĂ©agissent au changement climatique, et comment ils y rĂ©agissent. Cette collaboration pan-tropicale Ă long terme a rĂ©vĂ©lĂ© un important puits de carbone Ă long terme et ses tendances, tout en mettant en Ă©vidence les facteurs les plus importants, les processus forestiers qui sont affectĂ©s, les endroits oĂč ils changent, les dĂ©calages et les rĂ©actions futures probables des forĂȘts tropicales Ă mesure que le climat continue de changer. En tirant parti d'une technologie remarquablement ancienne, les rĂ©seaux de parcelles dĂ©clenchent une rĂ©volution trĂšs moderne dans la science des forĂȘts tropicales. Ă l'avenir, l'humanitĂ© pourra grandement bĂ©nĂ©ficier du soutien des communautĂ©s de base qui sont maintenant collectivement capables de gĂ©nĂ©rer une comprĂ©hension unique et Ă long terme des forĂȘts les plus prĂ©cieuses de la Terre. Abstrak: Hutan tropika adalah di antara ekosistem yang paling produktif dan mempunyai kepelbagaian biodiversiti yang tinggi di seluruh dunia. Walaupun pemahaman mengenai hutan tropika amat penting untuk masa depan kita, usaha-usaha untuk mengkaji dan mengawas hutah-hutan tersebut baru sekarang menjadi lebih diperhubungkan. Perangkaian adalah sangat penting untuk mencari jawapan kepada soalan-soalan yang menjangkaui sempadan dan batasan agensi pendanaan. Di sini kami menunjukkan bagaimana sebuah komuniti global bertindak balas terhadap cabaran penyelidikan ekosistem tropika melalui penglibatan pelbagai kumpulan yang mengukur hutan secara pokok demi pokok dalam beribu-ribu plot jangka panjang. Kami meninjau semula penemuan saintifik utama daripada kerja ini dan menunjukkan bagaimana proses ini sedang mengubah bidang sains hutan tropika. Teras pendekatan kami memberi tumpuan terhadap penghubungan inisiatif akar umbi jangka panjang dengan protokol standar serta pengurusan data untuk mendapatkan hasil skala besar yang kukuh. Dengan menghubungkan penyelidik-penyelidik tropika dan meningkatkan status mereka, model Rangkaian Penyelidikan Sosial kami mengiktiraf kepentingan peranan pengasas data dalam penemuan saintifik. Bermula dengan pengasasan RAINFOR (Amerika Selatan) pada tahun 1999, rangkaian-rangkaian plot kekal kami kemudian disesuaikan untuk Afrika (AfriTRON) dan Asia Tenggara (T-FORCES) dan selanjutnya telah banyak dicontohi di seluruh dunia. Kini, inisiatif-inisiatif tersebut disepadukan melalui infrastruktur siber ForestPlots.net yang menghubungkan rakan sekerja dari 54 negara di 24 buah rangkaian plot. Secara kolektif, rangkaian ini sedang mengubah pemahaman tentang hutan tropika dan peranannya dalam biosfera. Kami telah bekerjasama untuk menemukan bagaimana, di mana dan mengapa karbon serta biodiversiti hutan bertindak balas terhadap perubahan iklim dan juga bagaimana mereka saling bermaklum balas. Kolaborasi pan-tropika jangka panjang ini telah mendedahkan sebuah sinki karbon jangka panjang serta arah alirannya dan juga menjelaskan pemandu-pemandu perubahan yang terpenting, di mana dan bagaimana proses hutan terjejas, masa susul yang ada dan kemungkinan tindakbalas hutan tropika pada perubahan iklim secara berterusan di masa depan. Dengan memanfaatkan pendekatan lama, rangkaian plot sedang menyalakan revolusi yang amat moden dalam sains hutan tropika. Pada masa akan datang, manusia sejagat akan banyak mendapat manfaat jika memupuk komuniti-komuniti akar umbi yang kini berkemampuan secara kolektif menghasilkan pemahaman unik dan jangka panjang mengenai hutan-hutan yang paling berharga di dunia
Taking the pulse of Earth's tropical forests using networks of highly distributed plots
Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests. Resumen: Los bosques tropicales son los ecosistemas mĂĄs diversos y productivos del mundo y entender su funcionamiento es crĂtico para nuestro futuro colectivo. Sin embargo, hasta hace muy poco, los esfuerzos para medirlos y monitorearlos han estado muy desconectados. El trabajo en redes es esencial para descubrir las respuestas a preguntas que trascienden las fronteras y los plazos de las agencias de financiamiento. AquĂ mostramos cĂłmo una comunidad global estĂĄ respondiendo a los desafĂos de la investigaciĂłn en ecosistemas tropicales a travĂ©s de diversos equipos realizando mediciones ĂĄrbol por ĂĄrbol en miles de parcelas permanentes de largo plazo. Revisamos los descubrimientos mĂĄs importantes de este trabajo y discutimos cĂłmo este proceso estĂĄ cambiando la ciencia relacionada a los bosques tropicales. El enfoque central de nuestro esfuerzo implica la conexiĂłn de iniciativas locales de largo plazo con protocolos estandarizados y manejo de datos para producir resultados que se puedan trasladar a mĂșltiples escalas. Conectando investigadores tropicales, elevando su posiciĂłn y estatus, nuestro modelo de Red Social de InvestigaciĂłn reconoce el rol fundamental que tienen, para el descubrimiento cientĂfico, quienes generan o producen los datos. Concebida en 1999 con RAINFOR (SuramĂ©rica), nuestras redes de parcelas permanentes han sido adaptadas en Ăfrica (AfriTRON) y el sureste asiĂĄtico (T-FORCES) y ampliamente replicadas en el mundo. Actualmente todas estas iniciativas estĂĄn integradas a travĂ©s de la ciber-infraestructura de ForestPlots.net, conectando colegas de 54 paĂses en 24 redes diferentes de parcelas. Colectivamente, estas redes estĂĄn transformando nuestro conocimiento sobre los bosques tropicales y el rol de Ă©stos en la biĂłsfera. Juntos hemos descubierto cĂłmo, dĂłnde y porquĂ© el carbono y la biodiversidad de los bosques tropicales estĂĄ respondiendo al cambio climĂĄtico y cĂłmo se retroalimentan. Esta colaboraciĂłn pan-tropical de largo plazo ha expuesto un gran sumidero de carbono y sus tendencias, mostrando claramente cuĂĄles son los factores mĂĄs importantes, quĂ© procesos se ven afectados, dĂłnde ocurren los cambios, los tiempos de reacciĂłn y las probables respuestas futuras mientras el clima continĂșa cambiando. Apalancando lo que realmente es una tecnologĂa antigua, las redes de parcelas estĂĄn generando una verdadera y moderna revoluciĂłn en la ciencia tropical. En el futuro, la humanidad puede beneficiarse enormemente si se nutren y cultivan comunidades de investigadores de base, actualmente con la capacidad de generar informaciĂłn Ășnica y de largo plazo para entender los que probablemente son los bosques mĂĄs preciados de la tierra. Resumo: Florestas tropicais sĂŁo os ecossistemas mais diversos e produtivos da Terra. Embora uma boa compreensĂŁo destas florestas seja crucial para o nosso futuro coletivo, atĂ© muito recentemente os esforços de mediçÔes e monitoramento tem sido amplamente desconexos. Ă essencial formarmos redes para obtermos respostas que transcendam as fronteiras e horizontes das agĂȘncias financiadoras. Neste estudo nĂłs mostramos como uma comunidade global estĂĄ respondendo aos desafios da pesquisa de ecossistemas tropicais, com equipes diversas medindo florestas, ĂĄrvore por ĂĄrvore, em milhares de parcelas monitoradas a longo prazo. NĂłs revisamos as maiores descobertas cientĂficas deste esforço global, e mostramos tambĂ©m como este processo vem mudando a ciĂȘncia de florestas tropicais. Nossa abordagem principal envolve unir iniciativas de base a protocolos padronizados e gerenciamento de dados a fim de gerar resultados robustos em grandes escalas. Ao conectar pesquisadores tropicais e elevar seus status, nosso modelo de Rede de Pesquisa Social reconhece o papel chave do produtor dos dados na descoberta cientĂfica. Concebida em 1999 com o RAINFOR (AmĂ©rica do Sul), nossa rede de parcelas permanentes foi adaptada para Ăfrica (AfriTRON) e Sudeste AsiĂĄtico (T-FORCES), e tem sido extensamente reproduzida em todo o mundo. Agora estas mĂșltiplas iniciativas estĂŁo integradas atravĂ©s da infraestrutura cibernĂ©tica do ForestPlots.net, conectando colegas de 54 paĂses e 24 redes de parcelas. Estas iniciativas estĂŁo transformando coletivamente o entendimento das florestas tropicais e seus papĂ©is na biosfera. Juntos nĂłs descobrimos como, onde e por que o carbono e a biodiversidade da floresta estĂŁo respondendo Ă s mudanças climĂĄticas, e seus efeitos de retroalimentação. Esta duradoura colaboração pantropical revelou um grande sumidouro de carbono persistente e suas tendĂȘncias, assim como tem evidenciado quais os fatores que influenciam essas tendĂȘncias, quais processos florestais sĂŁo mais afetados, onde eles estĂŁo mudando, seus atrasos no tempo de resposta, e as provĂĄveis respostas das florestas tropicais conforme o clima continua a mudar. Dessa forma, aproveitando uma notĂĄvel tecnologia antiga, redes de parcelas acendem as faĂscas de uma moderna revolução na ciĂȘncia das florestas tropicais. No futuro a humanidade pode se beneficiar incentivando estas comunidades locais que agora sĂŁo coletivamente capazes de gerar conhecimentos Ășnicos e duradouros sobre as florestas mais preciosas da Terra. RĂ©sume: Les forĂȘts tropicales sont les Ă©cosystĂšmes les plus diversifiĂ©s et les plus productifs de la planĂšte. Si une meilleure comprĂ©hension de ces forĂȘts est essentielle pour notre avenir collectif, jusqu'Ă tout rĂ©cemment, les efforts dĂ©ployĂ©s pour les mesurer et les surveiller ont Ă©tĂ© largement dĂ©connectĂ©s. La mise en rĂ©seau est essentielle pour dĂ©couvrir les rĂ©ponses Ă des questions qui dĂ©passent les frontiĂšres et les horizons des organismes de financement. Nous montrons ici comment une communautĂ© mondiale relĂšve les dĂ©fis de la recherche sur les Ă©cosystĂšmes tropicaux avec diverses Ă©quipes qui mesurent les forĂȘts arbre aprĂšs arbre dans de milliers de parcelles permanentes. Nous passons en revue les principales dĂ©couvertes scientifiques de ces travaux et montrons comment ce processus modifie la science des forĂȘts tropicales. Notre approche principale consiste Ă relier les initiatives de base Ă long terme Ă des protocoles standardisĂ©s et une gestion de donnĂ©es afin de gĂ©nĂ©rer des rĂ©sultats solides Ă grande Ă©chelle. En reliant les chercheurs tropicaux et en Ă©levant leur statut, notre modĂšle de rĂ©seau de recherche sociale reconnaĂźt le rĂŽle clĂ© de l'auteur des donnĂ©es dans la dĂ©couverte scientifique. Conçus en 1999 avec RAINFOR (AmĂ©rique du Sud), nos rĂ©seaux de parcelles permanentes ont Ă©tĂ© adaptĂ©s Ă l'Afrique (AfriTRON) et Ă l'Asie du Sud-Est (T-FORCES) et largement imitĂ©s dans le monde entier. Ces multiples initiatives sont dĂ©sormais intĂ©grĂ©es via l'infrastructure ForestPlots.net, qui relie des collĂšgues de 54 pays Ă travers 24 rĂ©seaux de parcelles. Ensemble, elles transforment la comprĂ©hension des forĂȘts tropicales et de leur rĂŽle biosphĂ©rique. Ensemble, nous avons dĂ©couvert comment, oĂč et pourquoi le carbone forestier et la biodiversitĂ© rĂ©agissent au changement climatique, et comment ils y rĂ©agissent. Cette collaboration pan-tropicale Ă long terme a rĂ©vĂ©lĂ© un important puits de carbone Ă long terme et ses tendances, tout en mettant en Ă©vidence les facteurs les plus importants, les processus forestiers qui sont affectĂ©s, les endroits oĂč ils changent, les dĂ©calages et les rĂ©actions futures probables des forĂȘts tropicales Ă mesure que le climat continue de changer. En tirant parti d'une technologie remarquablement ancienne, les rĂ©seaux de parcelles dĂ©clenchent une rĂ©volution trĂšs moderne dans la science des forĂȘts tropicales. Ă l'avenir, l'humanitĂ© pourra grandement bĂ©nĂ©ficier du soutien des communautĂ©s de base qui sont maintenant collectivement capables de gĂ©nĂ©rer une comprĂ©hension unique et Ă long terme des forĂȘts les plus prĂ©cieuses de la Terre. Abstrak: Hutan tropika adalah di antara ekosistem yang paling produktif dan mempunyai kepelbagaian biodiversiti yang tinggi di seluruh dunia. Walaupun pemahaman mengenai hutan tropika amat penting untuk masa depan kita, usaha-usaha untuk mengkaji dan mengawas hutah-hutan tersebut baru sekarang menjadi lebih diperhubungkan. Perangkaian adalah sangat penting untuk mencari jawapan kepada soalan-soalan yang menjangkaui sempadan dan batasan agensi pendanaan. Di sini kami menunjukkan bagaimana sebuah komuniti global bertindak balas terhadap cabaran penyelidikan ekosistem tropika melalui penglibatan pelbagai kumpulan yang mengukur hutan secara pokok demi pokok dalam beribu-ribu plot jangka panjang. Kami meninjau semula penemuan saintifik utama daripada kerja ini dan menunjukkan bagaimana proses ini sedang mengubah bidang sains hutan tropika. Teras pendekatan kami memberi tumpuan terhadap penghubungan inisiatif akar umbi jangka panjang dengan protokol standar serta pengurusan data untuk mendapatkan hasil skala besar yang kukuh. Dengan menghubungkan penyelidik-penyelidik tropika dan meningkatkan status mereka, model Rangkaian Penyelidikan Sosial kami mengiktiraf kepentingan peranan pengasas data dalam penemuan saintifik. Bermula dengan pengasasan RAINFOR (Amerika Selatan) pada tahun 1999, rangkaian-rangkaian plot kekal kami kemudian disesuaikan untuk Afrika (AfriTRON) dan Asia Tenggara (T-FORCES) dan selanjutnya telah banyak dicontohi di seluruh dunia. Kini, inisiatif-inisiatif tersebut disepadukan melalui infrastruktur siber ForestPlots.net yang menghubungkan rakan sekerja dari 54 negara di 24 buah rangkaian plot. Secara kolektif, rangkaian ini sedang mengubah pemahaman tentang hutan tropika dan peranannya dalam biosfera. Kami telah bekerjasama untuk menemukan bagaimana, di mana dan mengapa karbon serta biodiversiti hutan bertindak balas terhadap perubahan iklim dan juga bagaimana mereka saling bermaklum balas. Kolaborasi pan-tropika jangka panjang ini telah mendedahkan sebuah sinki karbon jangka panjang serta arah alirannya dan juga menjelaskan pemandu-pemandu perubahan yang terpenting, di mana dan bagaimana proses hutan terjejas, masa susul yang ada dan kemungkinan tindakbalas hutan tropika pada perubahan iklim secara berterusan di masa depan. Dengan memanfaatkan pendekatan lama, rangkaian plot sedang menyalakan revolusi yang amat moden dalam sains hutan tropika. Pada masa akan datang, manusia sejagat akan banyak mendapat manfaat jika memupuk komuniti-komuniti akar umbi yang kini berkemampuan secara kolektif menghasilkan pemahaman unik dan jangka panjang mengenai hutan-hutan yang paling berharga di dunia
Taking the pulse of Earth's tropical forests using networks of highly distributed plots
Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth's most precious forests
Taking the pulse of Earth\u27s tropical forests using networks of highly distributed plots
Tropical forests are the most diverse and productive ecosystems on Earth. While better understanding of these forests is critical for our collective future, until quite recently efforts to measure and monitor them have been largely disconnected. Networking is essential to discover the answers to questions that transcend borders and the horizons of funding agencies. Here we show how a global community is responding to the challenges of tropical ecosystem research with diverse teams measuring forests tree-by-tree in thousands of long-term plots. We review the major scientific discoveries of this work and show how this process is changing tropical forest science. Our core approach involves linking long-term grassroots initiatives with standardized protocols and data management to generate robust scaled-up results. By connecting tropical researchers and elevating their status, our Social Research Network model recognises the key role of the data originator in scientific discovery. Conceived in 1999 with RAINFOR (South America), our permanent plot networks have been adapted to Africa (AfriTRON) and Southeast Asia (T-FORCES) and widely emulated worldwide. Now these multiple initiatives are integrated via ForestPlots.net cyber-infrastructure, linking colleagues from 54 countries across 24 plot networks. Collectively these are transforming understanding of tropical forests and their biospheric role. Together we have discovered how, where and why forest carbon and biodiversity are responding to climate change, and how they feedback on it. This long-term pan-tropical collaboration has revealed a large long-term carbon sink and its trends, as well as making clear which drivers are most important, which forest processes are affected, where they are changing, what the lags are, and the likely future responses of tropical forests as the climate continues to change. By leveraging a remarkably old technology, plot networks are sparking a very modern revolution in tropical forest science. In the future, humanity can benefit greatly by nurturing the grassroots communities now collectively capable of generating unique, long-term understanding of Earth\u27s most precious forests
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)