Benthic estuarine communities in Brazil: moving forward to long term studies to assess climate change impacts

Abstract Estuaries are unique coastal ecosystems that sustain and provide essential ecological services for mankind. Estuarine ecosystems include a variety of habitats with their own sediment-fauna dynamics, all of them globally undergoing alteration or threatened by human activities. Mangrove forests, saltmarshes, tidal flats and other confined estuarine systems are under increasing stress due to human activities leading to habitat and species loss. Combined changes in estuarine hydromorphology and in climate pose severe threats to estuarine ecosystems on a global scale. The ReBentos network is the first integrated attempt in Brazil to monitor estuarine changes in the long term to detect and assess the effects of global warming. This paper is an initial effort of ReBentos to review current knowledge on benthic estuarine ecology in Brazil. We herein present and synthesize all published work on Brazilian estuaries that has focused on the description of benthic communities and related ecological processes. We then use current data on Brazilian estuaries and present recommendations for future studies to address climate change effects, suggesting trends for possible future research and stressing the need for long-term datasets and international partnerships

International collaboration to protect health workers from infectious diseases in Ecuador Colaboración internacional para proteger al personal sanitario de las enfermedades infecciosas en Ecuador

The Healthy Hospital Project, an international collaboration, aimed to strengthen Ecuador's capacity to promote healthier and safer hospitals by reducing occupational transmission of infectious diseases. Team members conducted a needs assessment to identify workplace hazards and health risks in three hospitals. A survey of health care workers' knowledge and practices of occupational health (OH) and infection control (IC) revealed positive practices such as a medical waste disposal program and widespread dissemination of health information. Challenges identified included a high frequency of recapping needles and limited resources for workers to apply consistent IC measures. The survey revealed underreporting of needlestick injuries and limited OH and safety (OHS) training. Therefore, project collaborators organized a training workshop for health care workers that aimed to overcome the identified obstacles by integrating interdisciplinary local, national, and international stakeholders to build capacity and institutionalize work-related infection prevention and control measures. The knowledge transferred and experience gained led to useful hospital-based projects and serves as a basis for implementation of other OHS projects nationwide. International interdisciplinary, interinstitutional collaboration in OHS and IC can build capacity to address OHS concerns in health care.<br>El objetivo del Proyecto Hospitales Saludables, resultado de una colaboración internacional, fue fortalecer la capacidad del Ecuador de promover hospitales más saludables y seguros al reducirse la transmisión ocupacional de las enfermedades infecciosas. Los miembros del equipo realizaron una evaluación en tres hospitales para detectar los peligros y los riesgos para la salud en el lugar de trabajo. Tras llevar a cabo una encuesta de conocimientos y prácticas de los trabajadores sanitarios en lo que se refiere a salud ocupacional y control de infecciones, se encontraron aspectos positivos, como un programa de eliminación de desechos médicos y la difusión generalizada de información sanitaria. En cuanto a los retos, se detectó una alta frecuencia de volver a colocar el protector de la punta de la aguja antes de desecharla y recursos limitados para que los trabajadores puedan aplicar uniformemente medidas de control de infecciones. En esa misma encuesta se reveló que se notificaba una cantidad menor de la real de pinchazos en los dedos y una capacitación limitada en salud y seguridad ocupacionales. Por consiguiente, como parte del proyecto y con miras a superar los obstáculos señalados, se organizó un taller de capacitación para los trabajadores sanitarios en el cual participaron los interesados directos locales, nacionales e internacionales en diferentes disciplinas, a efectos de desarrollar capacidades e institucionalizar medidas de control y prevención de infecciones relacionadas con el trabajo. Los conocimientos transferidos y la experiencia adquirida dieron lugar a proyectos útiles basados en hospitales y sirven de base para ejecutar otros proyectos de salud y seguridad ocupacionales en todo el país. La colaboración interdisciplinaria e interinstitucional a nivel internacional en salud y seguridad ocupacionales y control de infecciones tiene el potencial de desarrollar capacidades para atender estos problemas en las actividades de atención de la salud

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk