Brazilian Network on Global Climate Change Research (Rede CLIMA):: structure, scientific advances and future prospects

In order to create the necessary scientific knowledge for Brazil to understand and deal with thecauses and consequences of climate change, the federal government created, in 2007, the BrazilianNetwork on Global Climate Change Research (Rede CLIMA). Rede CLIMA needs to discuss issues,pose questions, develop methodologies and technological products, find answers, and suggestsolutions that are relevant to society. In its first phase, it focused mainly on providing infrastructureand consolidating the sub-networks. Several scientific advances were also achieved, a selectionof which are presented in sections focusing on climate modelling, agriculture, energy and water,human development and mobility, biodiversity and ecosystem services, and human health. Now,in its second phase, the objective is to straighten collaboration between sub-networks by meansof interdisciplinary projects. It is argued that in order to succeed the Network needs to fosterresearch whose merit is measured not exclusively by academic production.A fim de criar o conhecimento científico necessário para o Brasil entender e lidar com as causas e consequências das mudanças climáticas, o governo federal criou, em 2007, a Rede Brasileira de Pesquisa em Mudanças Climáticas Globais (Rede CLIMA). A Rede CLIMA precisa discutir questões, fazer perguntas, desenvolver metodologias e produtos tecnológicos, encontrar respostas e sugerir soluções que sejam relevantes para a sociedade. Em sua primeira fase, a Rede concentrou-se em fornecer infraestrutura e consolidar suas sub-redes. Houve também vários avanços científicos, alguns dos quais são apresentados em seções focadas em modelagem climática, agricultura, energia e água, desenvolvimento e mobilidade humana, biodiversidade e serviços dos ecossistemas, e saúde humana. Agora, em sua segunda fase, o objetivo é estabelecer colaborações entre sub-redes por meio de projetos interdisciplinares. Argumenta-se que, para que tenha sucesso, a Rede precisa fomentar pesquisas de longo-prazo cujo mérito não seja medido apenas pela produção acadêmica

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys