Environmental heterogeneity caused by anthropogenic disturbance drives forest structure and dynamics in Brazilian Atlantic Forest

We evaluated how tree community floristic composition, forest structure and dynamics varied over a period of 13 years across a topographic gradient of ravines created by anthropic disturbance in Brazilian Atlantic Forest. The study area is located within a fragment of Atlantic Forest (21° 09' S, 44° 54' W), in Minas Gerais state, Brazil. This work was based on data of tree diameter at 1.3 m from the soil, collected in four inventories. Each individual was recorded as being in one of three stratified topographic classes: hilltop, slope and bottom. We used direct gradient analysis to evaluate floristic compositional changes, phytosociological analysis to evaluate structural variations, and assessed demographic and biomass changes over time through analysis of rates of forest dynamics. The results did not reflect modifications in the patterns of floristic composition and species diversity along the topographic gradient, while differences in forest structural attributes and dynamics may be detected at these smaller spatial scales. Thus, the same species group may employ different strategies against different restrictive environmental factors. Finally, we suggest that floristic composition and species diversity may be less sensitive parameters for post-disturbance responses than forest dynamics and structure

Addressing overtreatment in patients with refractory epilepsy at a tertiary referral center in Brasil.

BACKGROUND: Patients with refractory epilepsy often have impaired quality of life (QOL) as a consequence of seizures and adverse effects of antiepileptic drugs. We assessed the impact of adverse effects on QOL and the utility of a structured instrument to help the physician manage adverse effects in patients with refractory epilepsy. METHODS: Clinical characteristics, drug treatment and adverse effects were evaluated in 102 patients with refractory epilepsy at a single tertiary referral centre. The Adverse Events Profile (AEP) and Quality of Life in Epilepsy-31 (QOLIE-31) questionnaires were completed at baseline and after six months. At baseline, patients with a high burden of adverse effects (AEP scores ≥45) were randomized to an intervention or control group. AEP scores in the intervention group were available to the physician as an instrument to help to reduce adverse effects. RESULTS: Ninety-five patients (93.1%) were on polytherapy. Sixty-six completed the questionnaires and, of these, 43 (65.1%) had a high AE burden and were randomized to the intervention and control group. QOLIE-31 scores were inversely correlated with AEP scores at both visits. Among randomized patients, AEP scores tended to decrease between the baseline and the final visit without significant differences between groups (intervention group: 54.1 ± 6.1 vs 51.1 ± 9.1; control group: 55.8 ± 5.8 vs 50.5 ± 12.2). QOLI-31 scores did not change substantially between visits (intervention group: 45.9 ± 17.4 vs 48.4 ± 14; control group: 47.5 ± 15.7 vs 45.2 ± 18.9). CONCLUSION: A significant proportion of patients had a high toxicity burden which had an impact on their QOL. Reduction of overtreatment is a difficult challenge which cannot be addressed solely by providing a structured assessment of adverse effects, but requires a more comprehensive approach aimed at optimizing the many components of the management strategy