The impact of COVID-19 on the epidemiology, outcome and management of cardiac arrest

Peer reviewe

Convivial conservation: exploring transformative concepts for the promotion of (bio)diversity in Brazil

A necessidade de conservar o que resta da biodiversidade do planeta tornou-se um consenso tácito ao longo dos últimos 40 anos, colocando a questão de forma definitiva no rol da agenda de problemas ambientais globais a serem socialmente resolvidos. Entretanto a decisão sobre os melhores caminhos para a conservação segue sendo alvo de intensas disputas políticas e a necessidade de compatibilização entre efeitos socioculturais e ecossistêmicos na implementação de projetos de conservação permanece atual. O presente artigo tem como intuito apresentar as bases conceituais da proposta da ‘conservação convivial’, identificando contribuições desta para a construção coletiva de alternativas realistas centradas nas dimensões político-econômicas do desafio de promover a diversidade da vida humana e não humana no planeta. Realizamos uma genealogia do contexto discursivo, histórico e atual, onde a proposta emergiu. Em primeiro lugar, situamos a emergência da conservação convivial no contexto da literatura das ‘transformações para sustentabilidade’, destacando especificamente a contribuição das ciências sociais críticas para a transformação da conservação da biodiversidade. Em seguida, apresentamos as características das principais tendências e linhas paradigmáticas que guiaram as ações e políticas para a conservação da biodiversidade historicamente no Brasil e no mundo, a saber, a ‘conservação fortaleza’, a ‘conservação participativa’ e a ‘conservação neoliberal’. Ademais, avaliamos o estado da arte das atualizações destas linhas no debate global atual, ao apresentar as características principais das tendências ‘neoprotecionista’ e da ‘nova conservação’, em seus distanciamentos e aproximações em relação à ‘conservação convivial’. Por fim, apresentamos os princípios da conservação convivial e as ações que materializam a proposta, em sua interface com o contexto brasileiro e latino-americano. Esperamos que esta apresentação sistemática e criteriosa da conservação convivial possa contribuir para a construção de ferramentas transdisciplinares e democráticas de pesquisa e intervenção em conservação da biodiversidade, especialmente no Brasil.The need to conserve what remains of the planet's biodiversity has become a tacit consensus over the last 40 years, placing the issue definitively on the agenda of global environmental problems to be socially solved. However, the decision on the best pathways for biodiversity conservation continues to be the subject of intense political disputes. Therefore, the need to reconcile sociocultural and ecosystem effects in the implementation of conservation projects remains a current topic of debate. This article aims to present the conceptual bases  of the 'convivial conservation' approach, identifying contributions of this proposal to the collective construction of realistic alternatives that focus on the political-economy  dimensions of the challenge of promoting the diversity of human and non-human life on the planet. We carry out a genealogy of the emergence of convivial conservation, unpacking it’s discursive context, historical and current. First, we situate the emergence of convivial conservation in the context of the 'transformations to sustainability' literature, specifically highlighting the contribution of the critical social sciences to the transformation of biodiversity conservation. Then, we present the characteristics of the main trends and paradigmatic lines that guided the actions and policies for biodiversity conservation historically both in Brazil and worldwide, namely 'fortress conservation', 'participatory conservation' and 'neoliberal conservation'. Furthermore, we evaluate the updates of these lines in the current global debate, presenting the main features of the 'neoprotectionist' and 'new conservation' trends, in their distances and approximations in relation to 'convivial conservation'. Finally, we present the principles of convivial conservation and the actions that concretize the proposal, in its interface with the Brazilian and Latin American context. We hope that this systematic and contextualized presentation of convivial conservation can contribute to the construction of transdisciplinary and democratic tools for research and intervention in biodiversity conservation, especially in Brazil

ERC-ESICM guidelines for prognostication after cardiac arrest: time for an update

About two-thirds of patients who are comatose after resuscitation from cardiac arrest die before hospital discharge, of whom two-thirds die from neurological injury. In these patients, prognostication is crucial in informing clinicians and patient’s relatives. Recently, three studies from different groups of investigators have retrospectively assessed the accuracy of the 2015 ERC-ESICM prognostication algorithm. All these studies consistently confirmed the accuracy of the ERC-ESICM multimodal prognostication strategy in avoiding a falsely pessimistic prediction. Interestingly, this high specificity was confirmed when the 2014 criteria for malignant EEG were replaced with a more recent classification of EEG pattern. Besides improving sensitivity of prediction, this classification also enables a good interrater reliability, favouring guidelines’ implementation

Evaluation of mussel shells powder as reinforcement for pla-based biocomposites

The use of biopolyesters, as polymeric matrices, and natural fillers derived from wastes or by-products of food production to achieve biocomposites is nowadays a reality. The present paper aims to valorize mussel shells, 95% made of calcium carbonate (CaCO3 ), converting them into high-value added products. The objective of this work was to verify if CaCO3, obtained from Mediterranean Sea mussel shells, can be used as filler for a compostable matrix made of Polylactic acid (PLA) and Poly(butylene adipate-co-terephthalate) (PBAT). Thermal, mechanical, morphological and physical properties of these biocomposites were evaluated, and the micromechanical mechanism controlling stiffness and strength was investigated by analytical predictive models. The performances of these biocomposites were comparable with those of biocomposites produced with standard calcium carbonate. Thus, the present study has proved that the utilization of a waste, such as mussel shell, can become a resource for biocomposites production, and can be an effective option for further industrial scale-up

Prognostication after cardiac arrest

Hypoxic-ischaemic brain injury (HIBI) is the main cause of death in patients who are comatose after resuscitation from cardiac arrest. A poor neurological outcome-defined as death from neurological cause, persistent vegetative state, or severe neurological disability-can be predicted in these patients by assessing the severity of HIBI. The most commonly used indicators of severe HIBI include bilateral absence of corneal and pupillary reflexes, bilateral absence of N 2 O waves of short-latency somatosensory evoked potentials, high blood concentrations of neuron specific enolase, unfavourable patterns on electroencephalogram, and signs of diffuse HIBI on computed tomography or magnetic resonance imaging of the brain. Current guidelines recommend performing prognostication no earlier than 72 h after return of spontaneous circulation in all comatose patients with an absent or extensor motor response to pain, after having excluded confounders such as residual sedation that may interfere with clinical examination. A multimodal approach combining multiple prognostication tests is recommended so that the risk of a falsely pessimistic prediction is minimised

Belief heterogeneity and survival in incomplete markets

In complete markets economies (Sandroni [16]), or in economies with Pareto optimal outcomes (Blume and Easley [10]), the market selection hypothesis holds, as long as traders have identical discount factors. Traders who survive must have beliefs that merge with the truth. We show that in incomplete markets, regardless of traders’ discount factors, the market selects for a range of beliefs, at least some of which do not merge with the truth. We also show that impatient traders with incorrect beliefs can survive and that these incorrect beliefs impact prices. These beliefs may be chosen so that they are far from the truth

Microtiming patterns and interactions with musical properties in Samba music

In this study, we focus on the interaction between microtiming patterns and several musical properties: intensity, meter and spectral characteristics. The data-set of 106 musical audio excerpts is processed by means of an auditory model and then divided into several spectral regions and metric levels. The resulting segments are described in terms of their musical properties, over which patterns of peak positions and their intensities are sought. A clustering algorithm is used to systematize the process of pattern detection. The results confirm previously reported anticipations of the third and fourth semiquavers in a beat. We also argue that these patterns of microtiming deviations interact with different profiles of intensities that change according to the metrical structure and spectral characteristics. In particular, we suggest two new findings: (i) a small delay of microtiming positions at the lower end of the spectrum on the first semiquaver of each beat and (ii) systematic forms of accelerando and ritardando at a microtiming level covering two-beat and four-beat phrases. The results demonstrate the importance of multidimensional interactions with timing aspects of music. However, more research is needed in order to find proper representations for rhythm and microtiming aspects in such contexts

Increasing survival after admission to UK critical care units following cardiopulmonary resuscitation

© 2016 The Author(s). Background: In recent years there have been many developments in post-resuscitation care. We have investigated trends in patient characteristics and outcome following admission to UK critical care units following cardiopulmonary resuscitation (CPR) for the period 2004-2014. Our hypothesis is that there has been a reduction in risk-adjusted mortality during this period. Methods: We undertook a prospectively defined, retrospective analysis of the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database (CMPD) for the period 1 January 2004 to 31 December 2014. Admissions, mechanically ventilated in the first 24 hours in the critical care unit and admitted following CPR, defined as the delivery of chest compressions in the 24 hours before admission, were identified. Case mix, withdrawal, outcome and activity were described annually for all admissions identified as post-cardiac arrest admissions, and separately for out-of-hospital cardiac arrest and in-hospital cardiac arrest. To assess whether in-hospital mortality had improved over time, hierarchical multivariate logistic regression models were constructed, with in-hospital mortality as the dependent variable, year of admission as the main exposure variable and intensive care unit (ICU) as a random effect. All analyses were repeated using only the data from those ICUs contributing data throughout the study period. Results: During the period 2004-2014 survivors of cardiac arrest accounted for an increasing proportion of mechanically ventilated admissions to ICUs in the ICNARC CMPD (9.0 % in 2004 increasing to 12.2 % in 2014). Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during this period (OR 0.96 per year). Over this time, the ICU length of stay and time to treatment withdrawal has increased significantly. Re-analysis including only those 116 ICUs contributing data throughout the study period confirmed all the results of the primary analysis. Conclusions: Risk-adjusted hospital mortality following admission to ICU after cardiac arrest has decreased significantly during the period 2004-2014. Over the same period the ICU length of stay and time to treatment withdrawal has increased significantly