Impacts of climate and land use changes on the hydrological and erosive response of a humid and dry Mediterranean catchment

The impacts of climate and land use changes on streamflow and sediment export were evaluated for a humid (São Lourenço) and a dry (Guadalupe) Mediterranean catchment, using the Soil and Water Assessment Tool (SWAT) model. SWAT was able to produce viable streamflow and sediment export simulations for both catchments, which provided a baseline for investigating climate and land use changes under the A1B and B1 emission scenarios for the period between 2071 and 2100. Compared to the baseline period (1971-2000), climate change scenarios forecasted a decrease in annual precipitation in both catchments (humid, both scenarios: -12%; dry, both scenarios: -8%), but with strong increases during winter. Land use changes followed a socio-economic storyline in which traditional agriculture was replaced by more profitable land uses, i.e. corn and commercial forestry at the humid site and sunflower at the dry site. Climate changes led to a decrease of streamflow in both catchments (humid, both scenarios: -13%; dry, A1B: -14%; B1: -18%), mostly as a consequence of the projected decrease in rainfall. Land use changes led to small increases in flow discharge, but a higher increase was observed for the dry site under scenario A1B (humid, A1B: +0.3%; B1: +1%; dry, A1B: +6%; B1: +0.3%). The combination of climate and land use scenarios was mostly dominated by the climatic response, since a decrease in streamflow was observed for both catchments (humid, A1B: -13%; B1: -12%; dry, A1B: -8%; B1: -18%). Regarding the erosive response, clear differences were observed between catchments mostly due to differences in both the present-day and forecasted vegetation types. Climate scenarios led to a decrease in sediment export at the humid catchment (A1B: -11%; B1: -9%) and to an increase at the dry catchment (A1B: +24%; B1: +22%) in the first case due to the predominant vegetation type (vineyards and maritime pine) providing year-round cover, while in the second, due to annual crops (wheat and pasture) exposing soils during winter. For land use scenarios, the same contrast occurred between catchments (humid, A1B: -18%; B1: -10%; dry, A1B: +257%; B1: +9%) due to the expansion of permanent cover vegetation in one case and annual crops in the other. Climate and land use changes had off-setting effects on sediment export at the humid catchment (A1B: -29%; B1: -22%), as a result of reduced precipitation and cultivation of more soil-protective crops. A different response was observed for the dry catchment (A1B: +222%; B1: +5%), as the increase in sediment export associated with the cultivation of highly erosion-prone crops was not aggravated by the higher rainfall amounts forecasted for winter months. The results of the present study highlight that indirect impacts of climate change, like land use changes, might be similar or more severe than direct impacts

Post-intervention Status in Patients With Refractory Myasthenia Gravis Treated With Eculizumab During REGAIN and Its Open-Label Extension

OBJECTIVE: To evaluate whether eculizumab helps patients with anti-acetylcholine receptor-positive (AChR+) refractory generalized myasthenia gravis (gMG) achieve the Myasthenia Gravis Foundation of America (MGFA) post-intervention status of minimal manifestations (MM), we assessed patients' status throughout REGAIN (Safety and Efficacy of Eculizumab in AChR+ Refractory Generalized Myasthenia Gravis) and its open-label extension. METHODS: Patients who completed the REGAIN randomized controlled trial and continued into the open-label extension were included in this tertiary endpoint analysis. Patients were assessed for the MGFA post-intervention status of improved, unchanged, worse, MM, and pharmacologic remission at defined time points during REGAIN and through week 130 of the open-label study. RESULTS: A total of 117 patients completed REGAIN and continued into the open-label study (eculizumab/eculizumab: 56; placebo/eculizumab: 61). At week 26 of REGAIN, more eculizumab-treated patients than placebo-treated patients achieved a status of improved (60.7% vs 41.7%) or MM (25.0% vs 13.3%; common OR: 2.3; 95% CI: 1.1-4.5). After 130 weeks of eculizumab treatment, 88.0% of patients achieved improved status and 57.3% of patients achieved MM status. The safety profile of eculizumab was consistent with its known profile and no new safety signals were detected. CONCLUSION: Eculizumab led to rapid and sustained achievement of MM in patients with AChR+ refractory gMG. These findings support the use of eculizumab in this previously difficult-to-treat patient population. CLINICALTRIALSGOV IDENTIFIER: REGAIN, NCT01997229; REGAIN open-label extension, NCT02301624. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that, after 26 weeks of eculizumab treatment, 25.0% of adults with AChR+ refractory gMG achieved MM, compared with 13.3% who received placebo

Minimal Symptom Expression' in Patients With Acetylcholine Receptor Antibody-Positive Refractory Generalized Myasthenia Gravis Treated With Eculizumab

The efficacy and tolerability of eculizumab were assessed in REGAIN, a 26-week, phase 3, randomized, double-blind, placebo-controlled study in anti-acetylcholine receptor antibody-positive (AChR+) refractory generalized myasthenia gravis (gMG), and its open-label extension

Conceções dos alunos do 1.º Ciclo do Ensino Básico sobre o sistema digestivo

Este estudo exploratório teve como objetivo determinar os conhecimentos dos alunos do 1º Ciclo do Ensino Básico (1.º CEB) sobre o sistema digestivo. Usou-se uma adaptação do método seguido por Dantas (2006). O instrumento de recolha de dados utilizado foi o desenho. Solicitou-se a 69 alunos (37 raparigas e 32 rapazes) do 4.º ano, de quatro escolas do distrito de Santarém, que elaborassem um desenho sobre a constituição do aparelho digestivo humano. Os alunos fizeram os desenhos em sala de aula individualmente e legendaram os órgãos ilustrados. Posteriormente, os orgãos de cada desenho foram classificados em duas categorias: órgãos do tubo digestivo e órgãos anexos. Conclui-se que a maioria dos alunos adquiriram os conhecimentos básicos sobre o sistema digestivo. No entanto, apesar da maioria representar a sequência correta dos órgãos do tubo digestivo, alguns deles não foram ilustrados com a forma ou a posição relativa adequadas, como o caso de ambos os intestinos e, principalmente, do ânus e do reto. Os órgãos anexos, à exceção do fígado, foram menos representados e a sua localização também teve algumas incorreções. Estes resultados, ao mostrarem as lacunas de uma amostra de alunos quanto aos seus conhecimentos sobre a composição do sistema digestivo humano, podem ser relevantes para a prática dos professores do 1.º CEB, na medida em que podem contribuir para aperfeiçoar o ensino desse sistema. (Abstract: This exploratory research aimed to assess the knowledge of primary schools students about the digestive system. We used an adaptation of the method followed by Dantas (2006). The instrument for data collection used was drawings. We asked 69 students (37 girls and 32 boys) at key stage two, from 4 schools of Santarém, to draw the human digestive system. The students have done the drawings individually and titled the organs illustrated. Then, the organs of each drawing were classified in two categories: digestive tract and the digestive accessory organs. We have concluded that the majority of students acquired the basic knowledge about the digestive system. Although the majority have represented the correct sequence of the digestive tract organs, some of them were not illustrated with the right shape or position, such as both intestines and mainly the anus and the rectum. The digestive accessory organs, except the liver, were less represented and their location also had some mistakes. Nevertheless, its location was not always the correct one. These results, by showing the gaps of a sample of students about their knowledge about the composition of the human digestive system, could be relevant to improve the teaching of that system.

Delirium assessment in postoperative patients: Validation of the Portuguese version of the Nursing Delirium Screening Scale in critical care

Background and objectives: The aim of this study was to validate the Portuguese version of the Nursing Delirium Screening Scale (Nu-DESC) for use in critical care settings. Methods: We simultaneously and independently evaluated all postoperative patients admitted to a surgical Intensive Care Unit (SICU) over a 1-month period for delirium, using the Portuguese versions of both the Nu-DESC and the Intensive Care Delirium Screening Checklist (ICDSC) within 24 hours of admission by both the research staff physician and one bedside nurse. We determined the diagnostic accuracy of the Nu-DESC using sensitivity, specificity and ROC curve analyses. We assessed reliability between nurses and the research staff physician for Nu-DESC by intraclass correlation coefficient (ICC). We assessed agreement and reliability between Nu-DESC and ICDSC by overall and specific proportions of agreement and by kappa statistics. Results: Based on the ICDSC, we diagnosed delirium in 12 of the 78 patients. Reliability between nurses and the staff physician for total Nu-DESC score was high. Agreement between nurses and staff physician in the delirium diagnosis was perfect. The proportion of overall agreement between Nu-DESC and ICDSC in the delirium diagnosis was 0.88 and the kappa ranged from 0.79 to 0.93. Nu-DESC Sensitivity was 100 and specificity was 86%. Conclusions: The Portuguese version of the Nu-DESC appears to be an accurate and reliable assessment and monitoring instrument for delirium in critical care settings. Keywords: Delirium, Postoperative care, Critical car

Avaliação do delírio em pacientes pós-operatórios: validação da versão portuguesa da Nursing Delirium Screening Scale na terapia intensiva

EXPERIÊNCIA E OBJETIVOS: O objetivo desse estudo foi validar a versão portuguesa da escala Nursing Delirium Screening Scale (Nu-DESC) para uso em anbientes de terapia intensiva. MÉTODOS: Simultânea e independentemente, avaliamos para ocorrência de delírio todos os pacientes pós-operatórios internados em uma Unidade de Terapia Intensiva Cirúrgica (UTIC) ao longo de um período de um mês, utilizando as versões portuguesas de Nu-DESC e da escala Intensive Care Delirium Screening Checklist (ICDSC) dentro de 24 horas a contar da internação, tanto pelo médico da equipe de pesquisa como pelo enfermeiro diretamente encarregado do paciente. Determinamos a acurácia diagnóstica de Nu-DESC utilizando análises de sensibilidade, especificidade e da curva ROC. Avaliamos a confiabilidade entre enfermeiros/médico da equipe de pesquisa para Nu-DESC pelo coeficiente de correlação intraclasse (CCI). Avaliamos concordância e confiabilidade entre Nu-DESC e ICDSC por percentuais globais e específicos de concordância, e por estatística kappa. RESULTADOS: Com base na escala ICDSC, diagnosticamos delírio em 12 dos 78 pacientes. Para o escore Nu-DESC total, consideramos como alta a confiabilidade entre enfermeiros/médico da equipe. Quanto ao diagnóstico, consideramos perfeita a concordância entre enfermeiros e médico da equipe. O percentual de concordância global entre Nu-DESC e ICDSC para o diagnóstico de delírio foi 0,88, e kappa variou de 0,79 a 0,93. A sensibilidade da escala Nu-DESC foi 100%, e a especificidade, 86%. CONCLUSÕES: A versão portuguesa da escala Nu-DESC parece ser instrumento de avaliação e monitoramento acurado e confiável para o diagnóstico de delírio em ambientes de terapia intensiva

Náusea e vômito no pós-operatório: validação da versão em português da escala de intensidade de náuseas e vômitos pós-operatórios

JUSTIFICATIVA E OBJETIVO: A Escala de Intensidade de Náuseas e Vômitos Pós-Operatórios (NVPO) foi desenvolvida para definir NVPOs clinicamente importantes. O objetivo deste estudo foi traduzir, retraduzir e validar a Escala de Intensidade de NVPO para uso em unidades de recuperação pósanestésica (RPA) portuguesas. MÉTODO: A Escala de Intensidade de NVPO foi traduzida e retraduzida de acordo com as diretrizes disponíveis. A equipe de pesquisadores conduziu um estudo prospectivo e observacional de coorte em uma RPA. Durante três semanas, avaliamos as NVPO em 157 pacientes adultos internados após cirurgia. As mensurações foram feitas com o uso da Escala Visual Analógica (EVA) nos intervalos de seis e 24 horas durante o período pós-operatório. Avaliamos a confiabilidade e a discordância do observador com o uso do coeficiente de correlação interclasses (CCI) e da medida de discordância baseada na informação (MDBI). Comparamos os escores EVA entre os pacientes com NVPO clinicamente significantes (&gt; 50) e não significantes (< 50). RESULTADOS: Trinta e nove pacientes (25%) apresentaram NVPO em seis horas e 54 (34%) em 24 horas. Trinta e seis pacientes apresentaram náusea em seis horas e 54 em 24 horas. Entre os pacientes com NVPO, os escores de seis pacientes (15%) e nove pacientes (27%) foram clinicamente significantes na Escala de Intensidade de NVPO em seis e 24 horas, respectivamente. A confiabilidade foi boa tanto para os escores da Escala de Intensidade de NVPO quanto para EVA e a discordância entre observadores foi ligeiramente superior para EVA. A mediana dos escores EVA foi maior nos pacientes com escores clinicamente significantes na Escala de Intensidade de NVPO. CONCLUSÃO: A Escala de Intensidade de NVPO parece ser um instrumento de avaliação e monitoramento preciso e confiável de NVPO em RPA

Postoperative Nausea and Vomiting: Validation of the Portuguese Version of the Postoperative Nausea and Vomiting Intensity Score

Background and objectives: The Postoperative Nausea and Vomiting (PONV) Intensity Scale was developed to define clinically important PONV. The aim of this study was to translate, retranslate and validate the PONV Intensity Scale for use in Portuguese Post Anesthetic Care Unit (PACU) settings. Methods: The PONV Intensity Scale was translated and back-translated in accordance with available guidelines. The research team conducted an observational and cohort prospective study in a PACU. One-hundred fifty-seven adult patients admiited after surgery over three weeks were evaluated for PONV. Measurements included nausea visual analogic scale (VAS) at 6 and 24 hours, postoperatively. We assessed reliability and observer disagreement using interclass correlation (ICC) and Information-Based Measure of Disagreement (IBMD). We compared VAS scores between patients with clinically significant (≥50) and not significant (<50) PONV. Results: Thirty-nine patients (25%) had PONV at 6 hours and 54 (34%) had PONV at 24 hours. Thirty-six and 54 patients experienced nausea at 6 and 24 hours, respectively. Among patients with PONV, 6 patients (15%) and 9 patients (27%) had a clinically significant PONV intensity scale score at 6 and at 24 hours, respectively. The reliability was good both for PONV intensity scale score and for VAS and observer disagreement was slightly higher for VAS. The median nausea VAS scores were higher in patients with clinically significant PONV Intensity score. Conclusions: The PONV Intensity Scale appears to be an accurate and reliable assessment and monitoring instrument for PONV in the PACU settings. Keywords: Postoperative Care, Postoperative Nausea and Vomiting, Questionnaires, Recovery Roo