The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Desempenho de cordeiros Santa Inês alimentados com dietas completas contendo feno de maniçoba Performance of Santa Inês lambs fed total mixed rations containing different ratios of concentrate to ceara rubbertree hay

Avaliou-se o desempenho de cordeiros alimentados com dieta completa formulada com diferentes proporções de feno de maniçoba. Foram utilizados 32 animais Santa Inês machos, não-castrados (idade inicial de 70 dias e peso vivo de 16,02±2,37 kg), distribuídos em delineamento inteiramente casualizado, com quatro tratamentos e oito repetições. As dietas foram constituídas de concentrado e feno de maniçoba (FM) nas proporções de 20, 40, 60 e 80%. As proporções de feno na dieta não influenciaram os consumos de MS, PB e CT, cujas médias diárias foram 1,214; 0,201 e 0,816 kg, respectivamente. Os níveis de feno tiveram efeito linear positivo sobre o consumo de FDN e efeito linear negativo sobre o consumo de EM e CNF. O ganho de peso diário foi afetado pelos níveis de feno na dieta, apresentando médias de 290,84; 293,62; 253,35 e 208,48 g, respectivamente, para as dietas com 20, 40, 60 e 80% de feno de maniçoba. As dietas influenciaram a conversão (Y = 3,332+0,028x) e a eficiência alimentar (Y = 0,280,0013x). Pela análise econômica, observaram-se relações custo:benefício de 1,49; 1,57; 1,69 e 1,84 para os níveis de 20, 40, 60 e 80% de feno de maniçoba na dieta. O custo operacional efetivo por quilograma de carcaça produzida foi de R$3,68; R$ 3,49; R$3,23 e R$ 2,98, respectivamente, para as dietas com 20, 40, 60 e 80% de feno. A inclusão de 80% de feno de maniçoba em dietas completas possibilitou a obtenção de desempenho satisfatório dos cordeiros e melhor retorno financeiro.<br>The objective of this trial was to investigate the effect of different dietary ratios of concentrate (C) to ceara rubbertree hay (CRH; Manihot Glaziovii Muell. Arg.) on performance of lambs. Thirty two intact Santa Inês lambs averaging 70 days of age and 16.02±2.371 kg of body weight were fed one of the following four treatments as total mixed rations: 80C:20CRH (diet A), 60C:40CRH (diet B), 40C:60CRH (diet C), or 20C:80CRH (diet D) in a completely randomized design (eight repetitions/treatment). Increasing levels of CRH in the diet had no significant effect on the intakes of dry matter, crude protein, and total carbohydrates which averaged 1.214, 0.201, and 0.816 kg/day, respectively. However, intake of neutral detergent fiber increased linearly while the opposite was observed for intakes of metabolizable energy and nonfiber carbohydrates by increasing the proportion of CRH in the diet. The average daily gain was significantly affected by the different dietary ratios of C:CRH averaging 290.84, 293.62, 253.35, and 208.48 g/d, respectively, for diets A, B, C, and D. Significant linear effects were also observed for feed conversion (Y = 3.332 + 0.028x) and feed efficiency (Y = 0.28-0.0013x) when the proportion of CRH was increased from diet A to diet D. The profit:cost ratio and the cost per kg of carcass averaged, respectively, 1.49, 1.57, 1.69, and 1.84 and R$3.68, R$3.49, R$3.23, and R$2.98 with 20, 40, 60 and 80% of CRH hay in the diet. It can be concluded that the C:CRH ratio of 20:80 (diet D) resulted in satisfactory performance and improved income of Santa Inês lambs

Use and traditional knowledge of Byrsonima crassifolia and B. coccolobifolia (Malpighiaceae) in a Makuxi community of the Roraima savanna, northern Brazil

ABSTRACT Byrsonima crassifolia and B. coccolobifolia, popularly known as mirixis, muricis, mantecos or nances, are common fruit species in the Amazonian savannas. Their fruits are used in the preparation of juices and other beverages, while the other parts of the plants are used for different purposes in some indigenous communities. The aim of the present ethnobotanical study was to investigate the knowledge and traditional uses of mirixis in the Darora Indigenous Community, of the Makuxi ethnicity, in the São Marcos Indigenous Land, state of Roraima, northern Brazil. The knowledge on these species among the residents was analyzed considering their gender and age. A survey was carried out by means of semi-structured interviews with 60 respondents (36 men and 24 women), between 18 and 84 years of age. Data from the interviewees was compared between genders and two age groups (< 40 and &#8805; 40 years of age). Ethnobotanical indices (Informant diversity value; Informant equability value) were calculated, and no significant differences were found in the diversity of uses between genders (U = 283.0000, p > 0.05) and age groups (U = 359.5000, p > 0.05), indicating that the knowledge on the species is evenly distributed among residents. Results show that both species are used for different purposes in the food, fuelwood and medicinal categories in the Darora Community, and this knowledge is widely shared among adult men and women of all ages

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora