Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

Purpose: Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown. Methods: In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis. Results: Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former. Conclusion: Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life

Soil penetration resistance analysis by multivariate and geostatistical methods

The penetration resistance (PR) is a soil attribute that allows identifies areas with restrictions due to compaction, which results in mechanical impedance for root growth and reduced crop yield. The aim of this study was to characterize the PR of an agricultural soil by geostatistical and multivariate analysis. Sampling was done randomly in 90 points up to 0.60 m depth. It was determined spatial distribution models of PR, and defined areas with mechanical impedance for roots growth. The PR showed a random distribution to 0.55 and 0.60 m depth. PR in other depths analyzed showed spatial dependence, with adjustments to exponential and spherical models. The cluster analysis that considered sampling points allowed establishing areas with compaction problem identified in the maps by kriging interpolation. The analysis with main components identified three soil layers, where the middle layer showed the highest values of PR.La resistencia a la penetración (RP) es un atributo del suelo que permite identificar zonas con restricciones debido a la compactación, que se traduce en impedancia mecánica para el desarrollo de las raíces y en una menor productividad de los cultivos. El objetivo del presente trabajo fue caracterizar la RP de un suelo agrícola, mediante análisis geoestadístico y multivariado. El muestreo se realizó de manera aleatoria en 90 puntos, hasta una profundidad de 0,60 m. Se determinaron los modelos de distribución espacial de la RP y se delimitaron áreas con problemas de impedancia mecánica de las raíces. La RP presentó distribución aleatoria a 0,55 y 0,60 m de profundidad. La RP en las otras profundidades analizadas mostraron dependencia espacial, con ajustes a modelos exponenciales y esféricos. El análisis jerárquico que consideró puntos de muestreo, permitió establecer zonas con problemas de compactación, identificadas en los mapas obtenidos mediante interpolación por kriging. El análisis de componentes principales permitió identificar tres capas de suelo, donde la capa intermedia fue la que presentó los mayores valores de RP

Soil uses during the sugarcane fallow period: influence on soil chemical and physical properties and on sugarcane productivity

The planting of diversified crops during the sugarcane fallow period can improve the chemical and physical properties and increase the production potential of the soil for the next sugarcane cycle. The primary purpose of this study was to assess the influence of various soil uses during the sugarcane fallow period on soil chemical and physical properties and productivity after the first sugarcane harvest. The experiment was conducted in two areas located in Jaboticabal, São Paulo State, Brazil (21º 14' 05'' S, 48º 17' 09'' W) with two different soil types, namely: an eutroferric Red Latosol (RLe) with high-clay texture (clay content = 680 g kg-1) and an acric Red Latosol (RLa) with clayey texture (clay content = 440 g kg-1). A randomized block design with five replications and four treatments (crop sequences) was used. The crop sequences during the sugarcane fallow period were soybean/millet/soybean, soybean/sunn hemp/soybean, soybean/fallow/soybean, and soybean. Soil use was found not to affect chemical properties and sugarcane productivity of RLe or RLa. The soybean/millet/soybean sequence improved aggregation in the acric Latosol.A diversificação de culturas, no período de reforma do canavial, pode contribuir para a melhoria dos atributos químicos e físicos do solo, incrementando seu potencial produtivo para o próximo ciclo da cana-de-açúcar. O objetivo deste trabalho foi avaliar a influência de diferentes usos do solo, no período de reforma do canavial, nos atributos químicos e físicos do solo e na produtividade da cana-de-açúcar, avaliados após o primeiro corte. O experimento foi conduzido em duas áreas localizadas no município de Jaboticabal, SP (21º 14' 05'' S e 48º 17' 09'' W), em um Latossolo Vermelho eutroférrico (LVef) textura muito argilosa (argila = 680 g kg-1) e um Latossolo Vermelho ácrico (LVw) textura argilosa (argila = 440 g kg-1). O delineamento experimental foi em blocos casualizados com cinco repetições e quatro tratamentos, caracterizados por diferentes usos do solo no período de reforma do canavial (soja/milheto/soja, soja/crotalária/soja, soja/pousio/soja e soja). Os diferentes usos do solo não influenciaram os atributos químicos do solo e a produtividade da cana-de-açúcar no LVef e no LVw. O uso soja/milheto/soja favoreceu a agregação do LVw.UNESP FCAV Department of Soil ScienceUNESP FCAV Department of Soil Scienc