Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 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 or ganism 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 ne glected 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 lostinfo:eu-repo/semantics/publishedVersio

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 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,18,19 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

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 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,18,19 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

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Percepções e vivências de cuidadores familiares de idosos acamados

Objetivo: Conhecer as percepções e vivências de cuidadores familiares de idosos acamados. Métodos: Estudo descritivo, exploratório, com abordagem qualitativa, realizado em janeiro de 2015 com quatro cuidadores em uma Unidade de Saúde da Família no município de Araripe-CE. A coleta de dados deu-se a partir de uma entrevista semiestruturada, sendo as informações organizadas através da técnica de análise de conteúdo. A partir da análise dos depoimentos dos cuidadores, emergiram três categorias: o processo de dependência do idoso; dificuldades vivenciadas no cotidiano do cuidador; e satisfação com o serviço de saúde no domicílio. Resultados: O processo de dependência do idoso ocorreu como consequência de processos patológicos, como neoplasia, acidente vascular encefálico e demência. No entanto, notou-se também que os fenômenos fisiológicos, próprios da velhice, também podem levar o indivíduo a tornar-se dependente dos cuidadores. Quanto às dificuldades enfrentadas pelos cuidadores, estes relataram ausência de envolvimento maior da família, haja vista que a centralização do trabalho gera sobrecarga e, consequentemente, afeta o cuidado com o idoso. O trabalho em equipe no contexto domiciliar é fundamental, pois permite um atendimento complementar e integral para o binômio idoso/cuidador. Conclusão: Envelhecer de forma saudável é o grande desafio a ser superado, pois o estabelecimento de hábitos de vida saudáveis é uma dificuldade vivenciada por todos os seguimentos sociais. Faz-se cada vez mais necessária a melhoria do atendimento domiciliar, com vistas à prestação de suporte aos cuidadores com vistas à melhor qualidade de vida do idoso acamado, bem como do cuidador

Percepções e vivências de cuidadores familiares de idosos acamados

Objective: To know the perceptions and experiences of family caregivers of bedridden elderly. Methods: A qualitative descriptive exploratory study conducted in January 2015 with four caregivers in a Family Health Center in the municipality of Araripe, CE. Data were collected through semi-structured interviews and the information was organized using the content analysis technique. A total of three categories emerged from the analysis of the reports of caregivers: the dependence process of the elderly; daily difficulties experienced by the caregiver; and satisfaction with the home care service. Results: The dependence process of the elderly took place as a consequence of pathological processes such as neoplasm, cerebrovascular accident and dementia. However, it could also be observed that physiological phenomena – common in old age – can also make individuals dependent on caregivers. As to the difficulties faced by the caregivers, they reported the need for greater involvement by the family, given that the centralization of work generates an overload and hence affects the care of the elderly. Teamwork in the home care context is fundamental, given that it allows a complementary and comprehensive care to the elderly/caregiver binomial. Conclusion: Healthy aging is a major challenge to be overcome given that the development of a healthy lifestyle is difficult in all social strata. It is necessary to improve home care in order to provide support to caregivers so that the quality of life of bedridden elderly and caregivers is improved.Objetivo: Conocer las percepciones y vivencias de cuidadores familiares de mayores encamados. Métodos: Estudio descriptivo, exploratorio de abordaje cuantitativo realizado en enero de 2015 con cuatro cuidadores de una Unidad de Salud de la Familia del municipio de Araripe-CE. La recogida de datos se dio a partir de una entrevista semiestructurada y las informaciones fueron organizadas a través de la técnica del Análisis de Contenido. A partir del análisis de los relatos de los cuidadores emergieron três categorías: el proceso de dependencia del mayor; las dificultades vivenciadas en el cotidiano del cuidador; y la satisfacción con el servicio de salud del domicilio. Resultados: El proceso de dependencia del mayor se dio como consecuencia de procesos patológicos como la neoplasia, el accidente vascular encefálico y la demencia. Sin embargo, se notó también que los fenômenos fisiológicos, propios de la vejez, también pueden llevar el individuo a depender de los cuidadores. Sobre las dificultades afrontadas por los cuidadores los mismos relataron la ausencia de mayor envolvimiento de parte de la familia ya que la centralización del trabajo genera sobrecarga y, en consecuencia, afecta el cuidado con el mayor. El trabajo del equipo en el contexto domiciliario ES fundamental pues permite una atención complementaria e integral del binomio mayor/cuidador. Conclusión: Envejecer de manera saludable es el gran desafío a superar pues el establecimiento de hábitos de vida saludables es una dificultad vivenciada por todos los seguimientos sociales. Se hace necesario cada vez más la mejoría de la atención domiciliaria para la prestación Del apoyo a los cuidadores para una mejor calidad de vida del mayor encamado así como del cuidador.Objetivo: Conhecer as percepções e vivências de cuidadores familiares de idosos acamados. Métodos: Estudo descritivo, exploratório, com abordagem qualitativa, realizado em janeiro de 2015 com quatro cuidadores em uma Unidade de Saúde da Família no município de Araripe-CE. A coleta de dados deu-se a partir de uma entrevista semiestruturada, sendo as informações organizadas através da técnica de análise de conteúdo. A partir da análise dos depoimentos dos cuidadores, emergiram três categorias: o processo de dependência do idoso; dificuldades vivenciadas no cotidiano do cuidador; e satisfação com o serviço de saúde no domicílio. Resultados: O processo de dependência do idoso ocorreu como consequência de processos patológicos, como neoplasia, acidente vascular encefálico e demência. No entanto, notou-se também que os fenômenos fisiológicos, próprios da velhice, também podem levar o indivíduo a tornar-se dependente dos cuidadores. Quanto às dificuldades enfrentadas pelos cuidadores, estes relataram ausência de envolvimento maior da família, haja vista que a centralização do trabalho gera sobrecarga e, consequentemente, afeta o cuidado com o idoso. O trabalho em equipe no contexto domiciliar é fundamental, pois permite um atendimento complementar e integral para o binômio idoso/cuidador. Conclusão: Envelhecer de forma saudável é o grande desafio a ser superado, pois o estabelecimento de hábitos de vida saudáveis é uma dificuldade vivenciada por todos os seguimentos sociais. Faz-se cada vez mais necessária a melhoria do atendimento domiciliar, com vistas à prestação de suporte aos cuidadores com vistas à melhor qualidade de vida do idoso acamado, bem como do cuidador

The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings

Abstract Objective To analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database. Results The highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9–60.5%) followed by that in men (52.9%; 95% CI 52.6–53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5–62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae