RESUMEN

Diverse enteric pathogens, transmitted through human and animal feces, can cause gastroenteritis. Enteric viruses, such as human Aichi virus, specifically genotype A (AiV-A), are emerging pathogens that cause illnesses even at low doses and are spreading globally. This research developed a reverse transcription quantitative polymerase chain reaction (RT-qPCR) assay targeting the 3CD junction and a reverse transcription colorimetric loop-mediated isothermal amplification (RT-cLAMP) duplex assay targeting junctions 2BC and 3CD of the AiV-A genome for rapid and sensitive detection of this virus in metropolitan and regional wastewater samples in Queensland, Australia. The performance of these assays was evaluated using control materials and by analyzing wastewater samples. In serially diluted control materials, RT-qPCR provided quantifiable data (mean 1.51 log10 GC/2 µL of nucleic acid) down to a dilution of 1 × 10-5 pg/µL. In comparison, the duplex RT-cLAMP assay detected down to 1 × 10-4 pg/µL, indicating that its sensitivity was one order of magnitude less than that of RT-qPCR. Of the 38 wastewater samples from 38 metropolitan and regional wastewater treatment plants (WWTPs) in Queensland, Australia, 21 (55.3 %) tested positive by RT-qPCR with concentrations ranging from 3.60 to 6.23 log10 GC/L. In contrast, only 15 (39.5 %) of 38 wastewater samples were positive using the duplex RT-cLAMP assay. The methods demonstrated substantial qualitative agreement (κ = 0.730), with a concordance of 86.5 %, demonstrating the reliability of RT-cLAMP for detecting AiV-A in wastewater samples. The duplex RT-cLAMP assay, despite demonstrating reduced detection sensitivity, has proven effective and holds promise as a supplementary approach, especially in settings with limited resources where rapid and affordable testing is crucial.

Asunto(s)

Monitoreo del Ambiente , Kobuvirus , Técnicas de Amplificación de Ácido Nucleico , Aguas Residuales , Aguas Residuales/virología , Kobuvirus/genética , Queensland , Técnicas de Amplificación de Ácido Nucleico/métodos , Monitoreo del Ambiente/métodos , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Técnicas de Diagnóstico Molecular/métodos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa/métodos

RESUMEN

Surface waters are vulnerable to contamination by human and animal feces, posing risks to human health due to potential exposure to enteric pathogens. This research developed a colorimetric loop-mediated isothermal amplification (cLAMP) assay to detect sewage associated Bacteroides dorei HF183/BacR287 (HF183) marker in wastewater and environmental water samples. The host sensitivity and host specificity of the assay were evaluated, and their performance was compared to the Bacteroides HF183 qPCR assay using control materials (gBlocks), environmental water samples seeded with untreated sewage, and ambient environmental water samples. In serial dilutions of control materials, qPCR produced quantifiable data across all dilutions, while cLAMP detected the marker down to 0.001 pg/µL of control materials, which was two orders of magnitude less sensitive than qPCR. All untreated sewage samples (n = 12) tested positive for HF183 by both the qPCR and cLAMP assays, demonstrating a host sensitivity value of 1.00 (maximum value of 1.00). The host specificity by analysing 70 non-human fecal nucleic acid samples revealed cLAMP's specificity value of 0.81 compared to qPCR's 0.64. When testing sewage-seeded environmental water samples, both methods detected HF183 for the lowest amount of sewage, indicating similar detection sensitivity. The application of cLAMP for tracking sewage pollution in environmental waters showed promising results, with moderate agreement between cLAMP and qPCR (κ = 0.510). However, cLAMP occasionally missed detections compared to qPCR, particularly in low-concentration samples. Overall, the cLAMP HF183 assay demonstrated promising potential as a rapid and sensitive method for detecting sewage pollution, offering a viable alternative to qPCR in certain environmental monitoring scenarios.

Asunto(s)

Bacteroides , Aguas del Alcantarillado , Aguas del Alcantarillado/microbiología , Bacteroides/genética , Colorimetría/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Monitoreo del Ambiente/métodos , Heces/microbiología , Humanos , Contaminación del Agua , Técnicas de Diagnóstico Molecular

RESUMEN

The Fundão mine tailings dam rupture of 2015, in the Rio Doce basin, Brazil, resulted in the deposition of tailings downstream of the dam. It has yet to be determined if metals associated with the tailings have contributed toxicity to organisms, burying a time bomb that could be ticking. Currently the data on toxicity to benthic and aquatic organisms have not been assessed sufficiently to allow an informed assessment using an approach based on weight-of-evidence. This study was conducted to ascertain if sediments at "hot spots" that received Fundão tailings reflected elevated concentrations of metals and if these concentrations were sufficient to result in toxicity to freshwater organisms. The lines-of-evidence considered included assessing metals concentrations in relation to sediment quality criteria, establishing biogeochemical characterizations, completing an evaluation of potential metal release upon resuspension to provide information on bioavailability, and identifying acute and chronic toxicity effects using sensitive native species for waters (water flea, Daphnia similis) and sediments (burrowing midge larvae, Chironomus sancticaroli). Only porewater concentrations of iron and manganese exceeded Brazilian surface water criteria, whereas most trace elements exhibited no enrichment or elevated environmental indexes. The concentrations of bioavailable metals were assessed to be low, and metal concentrations did not increase in the overlying water upon resuspension; rather, they decreased through time. Toxicity testing in resuspended waters and bulk sediments resulted in no acute or chronic toxicity to either benthic or aquatic species. The low metal bioavailability and absence of toxicity of the tailings-enriched sediments was attributed to the strong binding and rapid removal of potentially toxic metal ions caused by oxyhydroxides and particles in the presence of iron-rich particulates. The findings of these sediment hot-spot studies indicate the Fundão dam release of tailings more than six years ago is not causing the current release of toxic concentrations of metals into the freshwaters of the Rio Doce. Integr Environ Assess Manag 2024;20:148-158. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Asunto(s)

Oligoelementos , Contaminantes Químicos del Agua , Monitoreo del Ambiente , Contaminantes Químicos del Agua/toxicidad , Contaminantes Químicos del Agua/análisis , Metales/toxicidad , Metales/análisis , Hierro , Brasil

RESUMEN

STUDY DESIGN: A retrospective comparative study. OBJECTIVE: The aim of this study was to compare the length and diameter of thoracic pedicles in patients with adolescent idiopathic scoliosis (AIS) as measured on preoperative magnetic resonance imaging (pMRI) to intraoperative computed tomography (iCT) scan. SUMMARY OF BACKGROUND DATA: Optimally sized pedicle screw placement during instrumented posterior spinal fusion for AIS can maximize correction and minimize screw pullout. While iCT-guided navigation can quickly estimate screw position and size, this technology is not universally available. Many surgeons utilize pMRI, when obtained, to estimate screw sizes. Data comparing these measurements on pMRI and iCT is limited. We hypothesized that in patients with surgical magnitude AIS, pedicle length, and diameter measured on pMRI would have at least moderate reliability compared to those made on iCT images. MATERIALS AND METHODS: The pMRI and iCT for 60 patients with structural thoracic curves who underwent posterior spinal fusion for AIS at a single center between 2009 and 2017 were analyzed. Bilateral T5-T12 vertebral levels were evaluated for pedicle chord length and pedicle isthmic diameter on both pMRI and iCT. Between-study reliability and interrater reliability was evaluated for each level of the thoracic spine. RESULTS: There is good reliability for pedicle length [intraclass correlation coefficient (ICC)=0.8, 95% confidence interval (CI): 0.78-0.83] and diameter (ICC=0.86, 95% CI: 0.84-0.88) between pMRI and iCT. When assessed by level, T6 has the lowest reliability for length (ICC=0.52, 95% CI: 0.33-0.67) and diameter (ICC=0.55, 95% CI: 0.35-0.69). Interrater reliability ranged from moderate-to-good reliability for all pedicle measurements for both length and diameter on pMRI and iCT. CONCLUSION: Pedicle measurements made on pMRI may be used with reasonable reliability to predict pedicle dimensions visualized on iCT, allowing surgeons to preoperatively plan pedicle screw sizes based off magnetic resonance imaging.

Asunto(s)

Cifosis , Tornillos Pediculares , Escoliosis , Fusión Vertebral , Adolescente , Humanos , Cifosis/cirugía , Imagen por Resonancia Magnética , Reproducibilidad de los Resultados , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/cirugía , Tomografía Computarizada por Rayos X/métodos

RESUMEN

BACKGROUND: Isolated fractures of the olecranon process of the ulna in pediatric patients with open physes are classically considered pathognomonic for osteogenesis imperfecta (OI). The purpose of this study was to distinguish the clinical manifestations of isolated olecranon fractures in patients with and without OI to help practitioners assess when further evaluation for OI may be necessary. METHODS: All patients younger than 18 years old who were treated for an isolated olecranon fracture at a pediatric tertiary care center between 2009 and 2021 were identified. Patients without radiographs available for review, those with known skeletal dysplasia other than OI, and patients with multiple fractures (eg, polytraumas) or with concomitant dislocations were excluded. Of the 701 patients identified, 403 were included for analysis. Demographic variables, mechanism of injury, treatment type, and determination of OI diagnosis were collected. Patients with a previously confirmed diagnosis of OI or with genetic confirmation of OI following their fracture were designated as OI (+), and the remainder were designated OI (-). The Mann-Whitney U and χ2 tests were used to compare groups. RESULTS: Of the 403 patients, the median age was 7.8 years (interquartile range 5.2 to 12.5), and 270 (67%) were male. There were 14 confirmed cases of OI (3.5%). The OI (+) and OI (-) groups did not differ significantly by age or sex (P>0.05). OI (+) patients were more likely to sustain an injury from low-energy mechanisms (86% vs. 32%, P<0.001), sustain displaced fractures (86% vs. 21%, P<0.001) and undergo operative treatment (86% vs. 20%, P<0.001), and to report a history of previous fracture (79% vs. 16%, P<0.001) than OI (-) patients. 36% of OI (+) patients sustained a second olecranon fracture during the study period; there were no subsequent olecranon fractures in the OI (-) group. CONCLUSIONS: Isolated olecranon fractures may not be pathognomonic for OI. However, orthopaedists must be vigilant about the possibility of OI in patients who sustain displaced, isolated olecranon fractures under low-energy mechanisms with a history of previous fracture(s). LEVEL OF EVIDENCE: Level III.

Asunto(s)

Lesiones de Codo , Fracturas Óseas , Olécranon , Osteogénesis Imperfecta , Fracturas del Cúbito , Adolescente , Niño , Fracturas Óseas/complicaciones , Humanos , Masculino , Olécranon/diagnóstico por imagen , Olécranon/lesiones , Osteogénesis Imperfecta/complicaciones , Osteogénesis Imperfecta/diagnóstico por imagen , Fracturas del Cúbito/cirugía

RESUMEN

OBJECTIVE: To examine the incidence of postoperative neonatal acute kidney injury (AKI) following general surgical procedures and to test the hypothesis that postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrations predict AKI. The secondary objective was to evaluate for an association between AKI and hospital mortality. STUDY DESIGN: Prospective observational study of infants undergoing abdominal and thoracic surgical procedures in the neonatal intensive care unit from October 2018 to March 2020. The primary outcome was incidence of neonatal AKI (defined by the neonatal modified Kidney Diseases Improving Global Outcomes criteria) following each procedure to postoperative day 5. Severe AKI was defined as stage 2 or 3 AKI. Urine samples were obtained pre- and postoperatively at 6 time points to evaluate for levels of uNGAL. Secondary outcomes were in-hospital mortality and length of stay. RESULTS: Subjects (n = 141) underwent a total of 192 general surgical procedures during the study period. Neonatal AKI and severe AKI occurred following 36 (18%) and 15 (8%) procedures (n = 33 subjects). Percent change of uNGAL from 24 hours preoperatively to 24 hours postoperatively was greater in subjects with neonatal AKI (190.2% [IQR 0.0, 1666.7%] vs 0.7% [IQR -31.2%,140.2%], P = .0374). The strongest association of uNGAL and AKI occurred at 24 hours postoperatively (area under the receiver operator curves of 0.81, 95% CI 0.72, 0.89). Increased mortality risk was observed in subjects with any postoperative AKI (aOR 11.1 95% CI 2.0, 62.8, P = .0063) and severe AKI (aOR 13.8; 95% CI 3.0, 63.1, P = .0007). CONCLUSION: Elevation in uNGAL 24 hours postoperative was associated with AKI. Neonates with postoperative AKI had increased mortality.

Asunto(s)

Lesión Renal Aguda/diagnóstico , Lipocalina 2/orina , Procedimientos Quirúrgicos Operativos/efectos adversos , Lesión Renal Aguda/orina , Biomarcadores/orina , Femenino , Mortalidad Hospitalaria , Humanos , Lactante , Masculino , Periodo Posoperatorio , Estudios Prospectivos , Factores de Riesgo

RESUMEN

BACKGROUND: Patients with adolescent idiopathic scoliosis (AIS) are commonly monitored for curve progression with spinal radiographs; however, the utility of magnetic resonance imaging (MRI) screening is unclear. The purpose of this study was to assess the findings of screening MRI for patients with a nonsurgical curve size ordered during routine clinical care and compare them with MRI ordered for patients with large curves as part of preoperative screening. METHODS: All consecutive patients with presumed AIS who underwent entire-spine MRI with a presumed diagnosis of idiopathic scoliosis at a single institution between 2017 and 2019 were retrospectively reviewed. Patients were stratified based on MRI indication into the following groups: preoperative evaluation, pain, neurological symptoms, abnormal radiographic curve appearance, rapidly progressive curve, and other. Neural axis abnormalities recorded included concern for tethered spinal cord, syringomyelia, and Chiari malformation. The MRI findings of preoperative patients with large curves were compared with all other patients. The number needed to diagnose (NND) a neurological finding was calculated in patients whose MRIs were ordered during routine clinical care. The amount charged for each patient undergoing entire-spine MRI was determined by review of our institution's Financial Decision Support system. RESULTS: There were 344 patients included in this study with 214 (62%) MRIs performed for preoperative evaluation. Although MRI abnormalities were found in 49% of patients, only 7.0% (24/344) demonstrated neural axis abnormalities with no difference between preoperative and other indications (P=0.37). For patients with nonsurgical curves undergoing MRI due to a complaint of back pain (n=28), there were no neural axis abnormalities, and a lower rate of disk herniation/degenerative changes detected compared with preoperative MRI (3.6% vs. 18%, P=0.06). Among the 15 patients undergoing MRI for a neurological concern, 1 had a neural axis abnormality that required surgical detethering. The NND for MRI to detect a neural axis abnormality that potentially required neurosurgical intervention in nonpreoperative patients with a neurological concern was 34.4. The average cost for MRI was $17,816 (range: $2601 to $22,411) with a total cost of $2,368,439 for nonsurgical curves. CONCLUSIONS: Entire-spine MRI for nonpreoperative indications including pain, abnormal radiographic curve appearance, and rapid curve progression has minimal utility for patients with AIS. For patients with neurological complaints, the NND a potentially treatment-altering finding with MRI is 34.4. LEVEL OF EVIDENCE: Level II-diagnostic.

Asunto(s)

Escoliosis , Siringomielia , Adolescente , Niño , Humanos , Imagen por Resonancia Magnética , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Columna Vertebral

Asunto(s)

COVID-19 , Telemedicina , Humanos , SARS-CoV-2

RESUMEN

OBJECTIVE: To evaluate whether extremely low gestational age neonates (ELGANs) randomized to erythropoietin have better or worse kidney-related outcomes during hospitalization and at 22-26 months of corrected gestational age (cGA) compared with those randomized to placebo. STUDY DESIGN: We performed an ancillary study to a multicenter double-blind, placebo-controlled randomized clinical trial of erythropoietin in ELGANs. RESULTS: The prevalence of severe (stage 2 or 3) acute kidney injury (AKI) was 18.2%. We did not find a statistically significant difference between those randomized to erythropoietin vs placebo for in-hospital primary (severe AKI) or secondary outcomes (any AKI and serum creatinine/cystatin C values at days 0, 7, 9, and 14). At 22-26 months of cGA, 16% of the cohort had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2, 35.8% had urine albumin/creatinine ratio >30 mg/g, 23% had a systolic blood pressure (SBP) >95th percentile for age, and 40% had a diastolic blood pressure (DBP) >95th percentile for age. SBP >90th percentile occurred less often among recipients of erythropoietin (P < .04). This association remained even after controlling for gestational age, site, and sibship (aOR 0.6; 95% CI 0.39-0.92). We did not find statistically significant differences between treatment groups in eGFR, albumin/creatinine ratio, rates of SBP >95th percentile, or DBP >90th or >95th percentiles at the 2 year follow-up visit. CONCLUSIONS: ELGANs have high rates of in-hospital AKI and kidney-related problems at 22-26 months of cGA. Recombinant erythropoietin may protect ELGANs against long-term elevated SBP but does not appear to protect from AKI, low eGFR, albuminuria, or elevated DBP at 22-26 months of cGA.

Asunto(s)

Lesión Renal Aguda/epidemiología , Eritropoyetina/uso terapéutico , Recien Nacido Extremadamente Prematuro , Proteínas Recombinantes/uso terapéutico , Lesión Renal Aguda/clasificación , Albuminuria/epidemiología , Método Doble Ciego , Femenino , Edad Gestacional , Tasa de Filtración Glomerular , Humanos , Hipertensión/epidemiología , Recién Nacido , Enfermedades del Prematuro/epidemiología , Masculino , Insuficiencia Renal Crónica/epidemiología

RESUMEN

Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic. Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing to continue to treat patients with a variety of allergic and immunologic conditions. During this time, many allergy and immunology clinicians have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement. Some concerns have been temporarily alleviated since March 2020 to aid with patient care in the setting of COVID-19. Other changes are ongoing at the time of this publication. Members of the Telemedicine Work Group in the American Academy of Allergy, Asthma & Immunology (AAAAI) completed a telemedicine literature review of online and Pub Med resources through May 9, 2020, to detail Pre-COVID-19 telemedicine knowledge and outline up-to-date telemedicine material. This work group report was developed to provide guidance to allergy/immunology clinicians as they navigate the swiftly evolving telemedicine landscape.

Asunto(s)

Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Telemedicina/organización & administración , Alergia e Inmunología/organización & administración , Betacoronavirus , COVID-19 , Codificación Clínica , Seguridad Computacional , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Hipersensibilidad/terapia , Control de Infecciones/organización & administración , Reembolso de Seguro de Salud , Pandemias , SARS-CoV-2 , Sociedades Médicas , Telemedicina/economía

RESUMEN

As a landscape becomes increasingly fragmented through habitat loss, the individual patches become smaller and more isolated and thus less likely to sustain a local population. Metapopulation theory is appropriate for analyzing fragmented landscapes because it combines empirical landscape features with species-specific information to produce direct information on population extinction risks. This approach contrasts with descriptions of habitat fragments, which provide only indirect information on risk. Combining a spatially explicit metapopulation model with empirical data on endemic species' ranges and maps of habitat cover, we calculated the metapopulation capacity-a measure of a landscape's ability to sustain a metapopulation. Mangroves provide an ideal model landscape because they are of conservation concern and their patch boundaries are easily delineated. For 2000-20015, we calculated global metapopulation capacity for 99 metapopulations of 32 different bird species endemic to mangroves. Northern Australia and Southeast Asia had the highest richness of mangrove endemic birds. The Caribbean, Pacific coast of Central America, Madagascar, Borneo, and isolated patches in Southeast Asia in Myanmar and Malaysia had the highest metapopulation losses. Regions with the highest loss of habitat area were not necessarily those with the highest loss of metapopulation capacity. Often, it was not a matter of how much, but how the habitat was lost. Our method can be used by managers to evaluate and prioritize a landscape for metapopulation persistence.

---

Uso de la Teoría de Metapoblaciones para la Conservación Práctica de las Aves Endémicas de Manglares Resumen A medida que un paisaje se fragmenta cada vez más debido a la pérdida de hábitat, los parches se vuelven más pequeños y aislados y, por lo tanto, menos propensos a sostener a una población local. La teoría de metapoblaciones es adecuada para analizar paisajes fragmentados porque combina características empíricas del paisaje con información de cada especie para producir información directa sobre los riesgos de extinción de la población. Este enfoque contrasta con las descripciones de los fragmentos de hábitat que solo proporcionan información directa sobre el riesgo. Mediante la combinación de un modelo metapoblacional espacialmente explícito con datos empíricos de los rangos de distribución de especies endémicas y mapas de la cobertura del hábitat, calculamos la capacidad de la metapoblación - una medida de la capacidad del paisaje para sostener una metapoblación. Los manglares proporcionan un paisaje modelo ideal porque son de interés para la conservación y los límites de los parches son delineados fácilmente. Calculamos la capacidad de la metapoblación global para el período 2000-2015 de 99 metapoblaciones de 32 especies de aves endémicas de manglares. El norte de Australia y el sudeste de Asia tuvieron la mayor riqueza de aves endémicas de manglares. El Caribe, la costa del Pacífico de Centroamérica, Madagascar, Borneo y parches aislados en el sudeste de Asia en Myanmar y Malasia tuvieron las mayores pérdidas de metapoblaciones. Las regiones con mayor pérdida hábitat fueron necesariamente aquellas con mayor pérdida de capacidad de la metapoblación. A menudo no era una cuestión de cuánto, sino cómo se perdió el hábitat. Nuestro método se puede utilizar por manejadores para evaluar y priorizar un paisaje para la persistencia de la metapoblación.

Asunto(s)

Conservación de los Recursos Naturales , Modelos Biológicos , Animales , Australia , Aves , Borneo , Región del Caribe , América Central , Ecosistema , Madagascar , Malasia , Mianmar , Dinámica Poblacional

RESUMEN

OBJECTIVES: Evaluate the independent and synergistic associations of fluid overload and acute kidney injury with outcome in critically ill pediatric patients. DESIGN: Secondary analysis of the Acute Kidney Injury in Children Expected by Renal Angina and Urinary Biomarkers (NCT01735162) prospective observational study. SETTING: Single-center quaternary level PICU. PATIENTS: One-hundred forty-nine children 3 months to 25 years old with predicted PICU length of stay greater than 48 hours, and an indwelling urinary catheter enrolled (September 2012 to March 2014). Acute kidney injury (defined by creatinine or urine output on day 3) and fluid overload (≥ 20% on day 3) were used as outcome variables and risk factors for ICU endpoints assessed at 28 days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Acute kidney injury and fluid overload occurred in 19.4% and 24.2% respectively. Both acute kidney injury and fluid overload were associated with longer ICU length of stay but neither maintained significance after multivariate regression. Delineation into unique fluid overload/acute kidney injury classifications demonstrated that fluid overload patients experienced a longer ICU and hospital length of stay and higher rate of mortality compared with fluid overload patients, regardless of acute kidney injury status. Fluid overload/acute kidney injury patients had increased odds of death (p = 0.013). After correction for severity of illness, ICU length of stay remained significantly longer in fluid overload/acute kidney injury patients compared with patients without both classifications (17.4; 95% CI, 11.0-23.7 vs 8.8; 95% CI, 7.3-10.9; p = 0.05). Correction of acute kidney injury classification for net fluid balance led to acute kidney injury class switching in 29 patients and strengthened the association with increased mechanical ventilation and ICU length of stay on bivariate analysis, but reduced the increased risk conferred by fluid overload for mortality. CONCLUSIONS: The current study suggests the effects of significant fluid accumulation may be delineable from the effects of acute kidney injury. Concurrent fluid overload and acute kidney injury significantly worsen outcome. Correction of acute kidney injury assessment for net fluid balance may refine diagnosis and unmask acute kidney injury associated with deleterious downstream sequelae. The unique effects of fluid overload and acute kidney injury on outcome in critically ill patients warrant further study.

Asunto(s)

Lesión Renal Aguda/epidemiología , Enfermedad Crítica/terapia , Fluidoterapia/efectos adversos , Lesión Renal Aguda/etiología , Adolescente , Biomarcadores/sangre , Niño , Preescolar , Creatinina/sangre , Enfermedad Crítica/mortalidad , Femenino , Fluidoterapia/métodos , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Prospectivos , Respiración Artificial/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , Desequilibrio Hidroelectrolítico/epidemiología , Desequilibrio Hidroelectrolítico/etiología

RESUMEN

OBJECTIVE(S): To test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. STUDY DESIGN: Quality improvement project that occurred between March 2015 and September 2017 in a single center, level IV neonatal intensive care unit. Infants were screened for high-risk nephrotoxic medication exposure (≥3 nephrotoxic medication within 24 hours or ≥4 calendar days of an intravenous [IV] aminoglycoside). If infants met criteria, a daily serum creatinine (SCr) was obtained until 2 days after end of exposure or end of AKI, whichever occurred last. The study was divided into 3 eras: pre-Nephrotoxic Injury Negated by Just-in-time Action (NINJA), initiation, and sustainability. Differences for 5 metrics across 3 eras were compared: SCr surveillance, high nephrotoxic medication exposure rate (per 1000 patient-days), AKI rate (per 1000 patient-days), nephrotoxin-AKI percentage, and AKI intensity (number of AKI days per 100 susceptible patient-days). RESULTS: Comparing the initiation with sustainability era, there was a reduction in high nephrotoxic medication exposures from 16.4 to 9.6 per 1000 patient-days (P = .03), reduction in percentage of nephrotoxic medication-AKI from 30.9% to 11.0% (P < .001), and reduction in AKI intensity from 9.1 to 2.9 per 100 susceptible patient-days (P < .001) while maintaining a high SCr surveillance rate. This prevented 100 AKI episodes during the 18-month sustainability era. CONCLUSION(S): A systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.

Asunto(s)

Lesión Renal Aguda/prevención & control , Protocolos Clínicos , Unidades de Cuidado Intensivo Neonatal , Mejoramiento de la Calidad , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Alabama/epidemiología , Sistemas de Información en Farmacia Clínica , Creatinina/sangre , Hospitalización , Humanos , Recién Nacido , Grupo de Atención al Paciente , Farmacéuticos , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos

RESUMEN

The Eastern Arc Mountains of Tanzania and the Atlantic Forest of Brazil are two of the most fragmented biodiversity hotspots. Species-area relationships predict that their habitat fragments will experience a substantial loss of species. Most of these extinctions will occur over an extended time, and therefore, reconnecting fragments could prevent species losses and allow locally extinct species to recolonize former habitats. An empirical relaxation half-life vs. area relationship for tropical bird communities estimates the time that it takes to lose one-half of all species that will be eventually lost. We use it to estimate the increase in species persistence by regenerating a forest connection 1 km in width among the largest and closest fragments at 11 locations. In the Eastern Arc Mountains, regenerating 8,134 ha of forest would create >316,000 ha in total of restored contiguous forest. More importantly, it would increase the persistence time for species by a factor of 6.8 per location or ∼2,272 years, on average, relative to individual fragments. In the Atlantic Forest, regenerating 6,452 ha of forest would create >251,000 ha in total of restored contiguous forest and enhance species persistence by a factor of 13.0 per location or ∼5,102 years, on average, relative to individual fragments. Rapidly regenerating forest among fragments is important, because mean time to the first determined extinction across all fragments is 7 years. We estimate the cost of forest regeneration at $21-$49 million dollars. It could provide one of the highest returns on investment for biodiversity conservation worldwide.

Asunto(s)

Conservación de los Recursos Naturales/métodos , Ecosistema , Extinción Biológica , Bosques , Animales , Biodiversidad , Aves , Brasil , Conservación de los Recursos Naturales/economía , Conservación de los Recursos Naturales/tendencias , Tanzanía , Factores de Tiempo , Árboles , Clima Tropical

RESUMEN

OBJECTIVE: To determine the range and heterogeneity of outcomes reported in randomized controlled trials of interventions for children with chronic kidney disease (CKD). STUDY DESIGN: The Cochrane Kidney and Transplant Specialized Register was searched to March 2016. Randomized trials involving children across all stages of CKD were selected. All outcome domains and measurements were extracted from included trials. The frequency and characteristics of the outcome domains and measures were evaluated. RESULTS: From 205 trials included, 6158 different measurements of 100 different outcome domains were reported, with a median of 22 domains per trial (IQR 13-41). Overall, 52 domains (52%) were surrogate, 38 (38%) were clinical, and 10 (10%) were patient-reported. The 5 most commonly reported domains were blood pressure (76 [37%] trials), relapse/remission (70 [34%]), kidney function (66 [32%]), infection (61 [30%]), and height/pubertal development (51 [25%]). Mortality (14%), cardiovascular disease (4%), and quality of life (1%) were reported infrequently. The 2 most frequently reported outcomes, blood pressure and relapse/remission, had 56 and 81 different outcome measures, respectively. CONCLUSIONS: The outcomes reported in clinical trials involving children with CKD are extremely heterogeneous and are most often surrogate outcomes, rather than clinical and patient-centered outcomes such as cardiovascular disease and quality of life. Efforts to ensure consistent reporting of outcomes that are important to patients and clinicians will improve the value of trials to guide clinical decision-making. In our study, non-English articles were excluded.

Asunto(s)

Evaluación de Resultado en la Atención de Salud , Insuficiencia Renal Crónica/terapia , Adolescente , Factores de Edad , Presión Sanguínea , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Pruebas de Función Renal , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Recurrencia , Adulto Joven

RESUMEN

Palm oil is the most widely traded vegetable oil globally, with demand projected to increase substantially in the future. Almost all oil palm grows in areas that were once tropical moist forests, some of them quite recently. The conversion to date, and future expansion, threatens biodiversity and increases greenhouse gas emissions. Today, consumer pressure is pushing companies toward deforestation-free sources of palm oil. To guide interventions aimed at reducing tropical deforestation due to oil palm, we analysed recent expansions and modelled likely future ones. We assessed sample areas to find where oil palm plantations have recently replaced forests in 20 countries, using a combination of high-resolution imagery from Google Earth and Landsat. We then compared these trends to countrywide trends in FAO data for oil palm planted area. Finally, we assessed which forests have high agricultural suitability for future oil palm development, which we refer to as vulnerable forests, and identified critical areas for biodiversity that oil palm expansion threatens. Our analysis reveals regional trends in deforestation associated with oil palm agriculture. In Southeast Asia, 45% of sampled oil palm plantations came from areas that were forests in 1989. For South America, the percentage was 31%. By contrast, in Mesoamerica and Africa, we observed only 2% and 7% of oil palm plantations coming from areas that were forest in 1989. The largest areas of vulnerable forest are in Africa and South America. Vulnerable forests in all four regions of production contain globally high concentrations of mammal and bird species at risk of extinction. However, priority areas for biodiversity conservation differ based on taxa and criteria used. Government regulation and voluntary market interventions can help incentivize the expansion of oil palm plantations in ways that protect biodiversity-rich ecosystems.

Asunto(s)

Biodiversidad , Conservación de los Recursos Naturales , Producción de Cultivos , Aceites de Plantas/economía , África , Animales , Especies en Peligro de Extinción , Bosques , Aceite de Palma , América del Sur

RESUMEN

Deforestation causes habitat loss, fragmentation, degradation, and can ultimately cause extinction of the remnant species. Tropical montane birds face these threats with the added natural vulnerability of narrower elevational ranges and higher specialization than lowland species. Recent studies assess the impact of present and future global climate change on species' ranges, but only a few of these evaluate the potentially confounding effect of lowland deforestation on species elevational distributions. In the Western Andes of Colombia, an important biodiversity hotspot, we evaluated the effects of deforestation on the elevational ranges of montane birds along altitudinal transects. Using point counts and mist-nets, we surveyed six altitudinal transects spanning 2200 to 2800 m. Three transects were forested from 2200 to 2800 m, and three were partially deforested with forest cover only above 2400 m. We compared abundance-weighted mean elevation, minimum elevation, and elevational range width. In addition to analysing the effect of deforestation on 134 species, we tested its impact within trophic guilds and habitat preference groups. Abundance-weighted mean and minimum elevations were not significantly different between forested and partially deforested transects. Range width was marginally different: as expected, ranges were larger in forested transects. Species in different trophic guilds and habitat preference categories showed different trends. These results suggest that deforestation may affect species' elevational ranges, even within the forest that remains. Climate change will likely exacerbate harmful impacts of deforestation on species' elevational distributions. Future conservation strategies need to account for this by protecting connected forest tracts across a wide range of elevations.

Asunto(s)

Aves , Conservación de los Recursos Naturales , Ecosistema , Distribución Animal , Animales , Biodiversidad , Cambio Climático , Colombia , Clima Tropical

RESUMEN

Conservation and restoration priorities often focus on separate ecosystem problems. Inspired by the November 11th (2011) landslide event near Manizales, and the current poor results of Colombia's Article 111 of Law 99 of 1993 as a conservation measure in this country, we set out to prioritize conservation and restoration areas where landslide prevention would complement bird conservation in the Central Andes. This area is one of the most biodiverse places on Earth, but also one of the most threatened. Using the case of the Rio Blanco Reserve, near Manizales, we identified areas for conservation where endemic and small-range bird diversity was high, and where landslide risk was also high. We further prioritized restoration areas by overlapping these conservation priorities with a forest cover map. Restoring forests in bare areas of high landslide risk and important bird diversity yields benefits for both biodiversity and people. We developed a simple landslide susceptibility model using slope, forest cover, aspect, and stream proximity. Using publicly available bird range maps, refined by elevation, we mapped concentrations of endemic and small-range bird species. We identified 1.54 km(2) of potential restoration areas in the Rio Blanco Reserve, and 886 km(2) in the Central Andes region. By prioritizing these areas, we facilitate the application of Article 111 which requires local and regional governments to invest in land purchases for the conservation of watersheds.

RESUMEN

Species are going extinct rapidly, while taxonomic catalogues are still incomplete for even the best-known taxa. Intensive fieldwork is finding species so rare and threatened that some become extinct within years of discovery. Recent bird extinctions in Brazil's coastal forests suggest that some species may have gone extinct before we knew of their existence.

Asunto(s)

Aves/fisiología , Clasificación/métodos , Especies en Peligro de Extinción/tendencias , Extinción Biológica , Animales , Aves/clasificación , Brasil , Especies en Peligro de Extinción/estadística & datos numéricos , Especificidad de la Especie , Factores de Tiempo

RESUMEN

We aspired to set conservation priorities in ways that lead to direct conservation actions. Very large-scale strategic mapping leads to familiar conservation priorities exemplified by biodiversity hotspots. In contrast, tactical conservation actions unfold on much smaller geographical extents and they need to reflect the habitat loss and fragmentation that have sharply restricted where species now live. Our aspirations for direct, practical actions were demanding. First, we identified the global, strategic conservation priorities and then downscaled to practical local actions within the selected priorities. In doing this, we recognized the limitations of incomplete information. We started such a process in Colombia and used the results presented here to implement reforestation of degraded land to prevent the isolation of a large area of cloud forest. We used existing range maps of 171 bird species to identify priority conservation areas that would conserve the greatest number of species at risk in Colombia. By at risk species, we mean those that are endemic and have small ranges. The Western Andes had the highest concentrations of such species-100 in total-but the lowest densities of national parks. We then adjusted the priorities for this region by refining these species ranges by selecting only areas of suitable elevation and remaining habitat. The estimated ranges of these species shrank by 18-100% after accounting for habitat and suitable elevation. Setting conservation priorities on the basis of currently available range maps excluded priority areas in the Western Andes and, by extension, likely elsewhere and for other taxa. By incorporating detailed maps of remaining natural habitats, we made practical recommendations for conservation actions. One recommendation was to restore forest connections to a patch of cloud forest about to become isolated from the main Andes.

Asunto(s)

Biodiversidad , Aves/fisiología , Conservación de los Recursos Naturales/métodos , Ecosistema , Distribución Animal , Animales , Colombia , Mapeo Geográfico