The role of recruitment and dispersal limitation in tree community assembly in Amazonian forests.

Na publicação: Marcelo B. Medeiros

Changing the computer-patient-physician relationship : a qualitative evaluation of 30-inch computer screens in family medicine exam rooms

The electronic health record (EHR) and use of computers in today's exam rooms is a dramatic change in medicine from decades past. There are concerns about how the computer and EHR might adversely affect patient-provider interaction and that it may be detrimental to PCC. Patient-centered care (PCC) promotes active involvement of the patient in their medical care. Several positive outcomes have been associated with PCC, including: better emotional health, improved symptom burden, improved recovery, and fewer diagnostic tests and referrals both at the time of the visit and in the subsequent 2 months. PCC can therefore help to decrease medical expenditures while improving patient outcomes and satisfaction. It has been proposed that certain exam room and computer configurations combined with uses of the EHR may enhance PCC. If we can better determine how different types of computers affect this interaction, it would help suggest improvements for increasing PCC, thus gaining the aforementioned benefits of decreased cost and improved health outcomes

Patient judgments about hypertension control: The role of variability, trends, and outliers in visualized blood pressure data

Background: Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. Objective: As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, we conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data. Methods: In 3 Web studies, participants (internet sample of patients with hypertension) reviewed a series of vignettes depicting patients with hypertension; each vignette included a graph of a patient's BP. We examined how data visualizations that varied by BP mean and SD (Study 1), the pattern of change over time (Study 2), and the presence of extreme values (Study 3) affected patients' judgments about hypertension control and the need for a medication change. Results: Participants' judgments about hypertension control were significantly influenced by BP mean and SD (Study 1), data trends (whether BP was increasing or decreasing over time--Study 2), and extreme values (ie, outliers--Study 3). Conclusions: Patients' judgment about hypertension control is influenced both by factors that are important predictors of hypertension related-health outcomes (eg, BP mean) and factors that are not (eg, variability and outliers). This study highlights the importance of developing data visualizations that direct attention toward clinically meaningful information

Cultural Norms Create a Preference for Traditional Birth Attendants and Hinder Health Facility-based Childbirth in Indonesia and Ethiopia: A Qualitative Inter-country Study

Cultural barriers to health facility-based childbirth are a common experience worldwide despite wide variations in context. Close-to-community (CTC) maternal health providers play an important role in bridging communities and health systems and their role in maternal health are particularly key. This study explored the views of CTC maternal health providers and other community members on the cultural barriers to health facility-based childbirth in two districts in Indonesia and six districts of Sidama Zone, southern Ethiopia. Employing a qualitative approach, we conducted 110 semi-structured interviews (SSIs) and 7 focus group discussions (FGDs) in Indonesia; 44 SSIs and 14 FGDs in Ethiopia. Participants in both contexts included mothers, husbands, male community members, traditional birth attendants (TBAs), village heads, local administrators, district health officials, maternal health-care workers and CTC maternal health providers. Despite significant geographical and cultural differences, the main findings were similar in the two countries’ study areas. These included: strong cultural-religious beliefs; culture of shyness and privacy around pregnancy; highly gendered decision-making related to pregnancy and childbirth; and preference for the TBA care. TBAs’ close proximity at the time of childbirth and their adherence to traditional practices were important factors influencing preference for TBAs. These cultural barriers interplay with geographical, transportation and financial factors hindering pregnant women from giving birth at a health facility. Intensifying health promotion on health facility-based childbirth, increasing collaboration among CTC maternal health workers e.g. midwives, health extension workers and TBAs, and enhancing responsiveness to traditional practices may overcome cultural barriers to institutional childbirth in Indonesia and Ethiopia

Estimating the global conservation status of more than 15,000 Amazonian tree species

Estimates of extinction risk for Amazonian plant and animal species are rare and not often incorporated into land-use policy and conservation planning. We overlay spatial distribution models with historical and projected deforestation to show that at least 36% and up to 57% of all Amazonian tree species are likely to qualify as globally threatened under International Union for Conservation of Nature (IUCN) Red List criteria. If confirmed, these results would increase the number of threatened plant species on Earth by 22%. We show that the trends observed in Amazonia apply to trees throughout the tropics, and we predict thatmost of the world’s >40,000 tropical tree species now qualify as globally threatened. A gap analysis suggests that existing Amazonian protected areas and indigenous territories will protect viable populations of most threatened species if these areas suffer no further degradation, highlighting the key roles that protected areas, indigenous peoples, and improved governance can play in preventing large-scale extinctions in the tropics in this century

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Assessment and intervention issues and models in School Psychology : the case of Europe and North America

As práticas da Psicologia Escolar parecem ser cada vez mais marcadas pelas necessidades de referenciação/diagnóstico de crianças para o subsistema de educação especial, em detrimento do desenho e implementação de intervenções dirigidas aos problemas específicos dos alunos. A aparente insatisfação dos psicólogos escolares com essa tendência, bem como as dificuldades na utilização de modelos categoriais de diagnóstico em contexto escolar, têm dado origem à progressiva implementação de modelos alternativos de avaliação e intervenção, principalmente de modelos Response to Intervention, Curriculum-Based Measurement e Problem Solving. A controvérsia quanto à natureza verdadeiramente alternativa desses modelos parece, no entanto, longe de se esgotar. Neste artigo são discutidas vantagens e limitações dos diferentes modelos, de acordo com a melhor evidência disponível na literatura, e são ainda equacionadas as suas implicações nas práticas da Psicologia Escolar. Practices in School Psychology seem to be increasingly restricted to referrals/diagnosis of children for the sub-system of special education instead of being focused on the design and implementation of interventions for students with specific problems. The apparent dissatisfaction of school psychologists with this trend and the difficulties dealing with categorical diagnostic models within the school context have stimulated a movement toward the implementation of alternative assessment and intervention models, such as Response to Intervention, Curriculum-Based Measurement and Problem-Solving. However, the controversy about the true alternative nature of these models seems far from being exhausted. The aim of this paper is to discuss the benefits and limitations of the different models according to the best evidence available. We also consider the implications for practices in School PsychologyPractices in School Psychology seem to be increasingly restricted to referrals/diagnosis of children for the sub-system of special education instead of being focused on the design and implementation of interventions for students with specific problems. The apparent dissatisfaction of school psychologists with this trend and the difficulties dealing with categorical diagnostic models within the school context have stimulated a movement toward the implementation of alternative assessment and intervention models, such as Response to Intervention, Curriculum-Based Measurement and Problem-Solving. However, the controversy about the true alternative nature of these models seems far from being exhausted. The aim of this paper is to discuss the benefits and limitations of the different models according to the best evidence available. We also consider the implications for practices in School Psychology(undefined

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost