Inspiration for the Future: The Role of Inspiratory Muscle Training in Cystic Fibrosis

Cystic fibrosis (CF) is an inherited, multi-system, life-limiting disease characterized by a progressive decline in lung function, which accounts for the majority of CF-related morbidity and mortality. Inspiratory muscle training (IMT) has been proposed as a rehabilitative strategy to treat respiratory impairments associated with CF. However, despite evidence of therapeutic benefits in healthy and other clinical populations, the routine application of IMT in CF can neither be supported nor refuted due to the paucity of methodologically rigorous research. Specifically, the interpretation of available studies regarding the efficacy of IMT in CF is hampered by methodological threats to internal and external validity. As such, it is important to highlight the inherent risk of bias that differences in patient characteristics, IMT protocols, and outcome measurements present when synthesizing this literature prior to making final clinical judgments. Future studies are required to identify the characteristics of individuals who may respond to IMT and determine whether the controlled application of IMT can elicit meaningful improvements in physiological and patient-centered clinical outcomes. Given the equivocal evidence regarding its efficacy, IMT should be utilized on a case-by-case basis with sound clinical reasoning, rather than simply dismissed, until a rigorous evidence-based consensus has been reached

Disentangling regional and local tree diversity in the Amazon

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordWe analyzed the most extensive data set of tree inventory plots spread over the complete Amazon basin and Guiana shield. We aimed to separate the regional and local tree alpha‐diversity to investigate the drivers of diversity at the relevant scale. Our results are consistent with the partitioning of total tree alpha‐diversity into regional and local components, which are controlled by evolutionary‐ and ecological processes, respectively. Regional diversity is correlated with palaeo‐climatic stability (31%), and long‐term large‐scale ecosystem dynamics (14%), as represented by the age of the geological formation. Both mechanisms contribute to high diversity in the central to western Amazon. Actual rainfall seasonality is correlated with regional tree diversity to a certain extent (19%), but we argue that this is of little consequence for the evolutionary drivers of the regional species pool. Frequency of disturbance is the main process driving local diversity, although its explanatory power is relatively small (17%).The first author was supported by PAN‐AMAZONIA project, Inst. Internacional de Educação do Brasil (BECA program) and Conselho Nacional de Ciência e Tecnologia (CNPq – Brazil)