GEOCHEMISTRY AND U-Pb GEOCHRONOLOGY OF THE NEOARCHEAN GNEISSES AND PALEOPROTEROZOIC GRANITES FROM JANUÁRIA HIGH: RECORDS OF JUVENILE AND YOUTHFUL EARTH IN THE SÃO FRANCISCO CRATON NUCLEUS (BRAZIL): Geoquímica e geocronologia U-Pb dos gnaisses neoarqueanos e granitos paleoproterozoicos do Alto de Januária: registros da Terra Juvenil e Jovem no núcleo do Cráton São Francisco (Brasil)

Within the proposal of secular evolution of the Earth system divided into seven phases: “Proto-Earth” (4.57–4.45 Ga); “Primordial Earth” (4.45–3.80 Ga); “Primitive Earth” (3.8–3.2 Ga); “Juvenile Earth” (3.2–2.5 Ga); “Youthful Earth” (2.5–1.8 Ga); “Middle Earth” (1.8–0.8 Ga); and “Contemporary Earth” (since 0.8 Ga), the 2.61-2.64 Ga High-K, meta- to peraluminous Januária High orthogneisses are inserted in the context of almost rigid behavior of the lithosphere, by the end of the Juvenile Earth. With protolith origin suggestive of intracrustal partial melting of local older TTG (tonalite-trondhjemite-granodiorite), these orthogneisses are the representatives in the São Francisco craton nucleus of the 2.8 Ga to 2.6 Ga potassic rocks found in archean cratons worldwide, and the occurrence of these rocks is a defining characteristic of the Juvenile Earth. Supported on evidence of the plate tectonic activity in Paleoproterozoic, the 2.14-2.19 Ga Januária High biotite granites are inserted in the context of Youthful Earth and they are the record of accretionary orogeny delineated by the edification of magmatic arc at that time. They are calc-alkaline, I-type rocks typical of subduction-related continental magmatic arcs. These biotite granites are probably derived from a High-K mafic source associated with tonalites.ABSTRACT - Within the proposal of secular evolution of the Earth system divided into seven phases: “Proto-Earth” (4.57–4.45 Ga); “Primordial Earth” (4.45–3.80 Ga); “Primitive Earth” (3.8–3.2 Ga); “Juvenile Earth” (3.2–2.5 Ga); “Youthful Earth” (2.5–1.8 Ga); “Middle Earth” (1.8–0.8 Ga); and “Contemporary Earth” (since 0.8 Ga), the 2.61-2.64 Ga High-K, meta- to peraluminous Januária High orthogneisses are inserted in the context of almost rigid behavior of the lithosphere, by the end of the Juvenile Earth. With protolith origin suggestive of intracrustal partial melting of local older TTG (tonalite-trondhjemite-granodiorite), these orthogneisses are the representatives in the São Francisco craton nucleus of the 2.8 Ga to 2.6 Ga potassic rocks found in Archean cratons worldwide, and the occurrence of these rocks is a defining characteristic of the Juvenile Earth. Supported on evidence of the plate tectonic activity in Paleoproterozoic, the 2.14-2.19 Ga Januária High biotite granites are inserted in the context of Youthful Earth and they are the record of accretionary orogeny delineated by the edification of magmatic arc at that time. They are calc-alkaline, I-type rocks typical of subduction-related continental magmatic arcs. These biotite granites are probably derived from a high-K mafic source associated with tonalites. RESUMO - Dentro da proposta da evolução secular do sistema Terra dividido em sete fases: “Proto-Terra” (4,57–4,45 Ga); “Terra Primordial” (4,45–3,80 Ga); “Terra Primitiva” (3,8–3,2 Ga); “Terra Juvenil” (3,2–2,5 Ga); “Terra Jovem” (2,5–1,8 Ga); “Terra Média” (1,8–0,8 Ga); e “Terra Contemporânea” (desde 0,8 Ga), os ortognaisses meta- a peraluminosos de alto-K de 2,61-2,64 Ga do Alto Januária estão inseridos no contexto de comportamento quase rígido da litosfera, no final da “Terra Juvenil”. Com origem de seu protólito sugestiva de fusão parcial intracrustal dos TTG (tonalito-trondhjemito-granodiorito) locais mais antigos, esses ortognaisses são os representantes no interior do cráton do São Francisco das rochas potássicas de 2,8 Ga a 2,6 Ga encontradas em crátons arqueanos em todo o mundo, e a ocorrência dessas rochas é uma característica definidora da “Terra Juvenil”. Apoiados nas evidências da atividade da tectônica de placas no Paleoproterozóico, os biotita granitos de 2,14-2,19 Ga do Alto de Januária estão inseridos no contexto da “Terra Jovem”, são o registro da orogenia acrescionária delineada pela edificação de arco magmático continental nessa época e tratam-se de rochas cálcio-alcalinas do tipo I, típicas de arcos, provavelmente derivadas de uma fonte máfica de alto K associada a tonalitos

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

Abstract 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

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline