Should Physicians Be Aware of Rhythm Disturbances in Adults with Systemic Autoimmune Diseases and Anti-Ro52 Antibodies? A Cross-Sectional Study.

Objectives: The association between anti-Ro/SSA antibodies and the appearance of cardiac rhythm disorders in adults is discussed. We aim to study this relationship, together with active treatments and comorbidities, and its impact on daily clinical practice in adults with systemic autoimmune diseases (SADs). Methods: This cross-sectional single-center study was conducted in a tertiary hospital between January 2021 and March 2022. A sample of adult patients followed up in the SAD Unit with a diagnosis of a SAD and previously tested for anti-Ro/SSA and anti-La/SSB were recruited. All of them underwent a 12-lead electrocardiogram. Results: 167 patients were included. 90 (53.9%) were positive for anti-Ro60, 101 (60.5%) for anti-Ro52, and 45 (26.9%) for anti-La/SSB; 52 (31.3%) were triple-negative. 84% were women, and the mean age was 59 years (standard deviation 12.8). The most common SAD was primary Sjögren's syndrome (34.8%), followed by systemic lupus erythematosus (24.6%) and rheumatoid arthritis (22.8%). A statistically significant relationship was found between anti-Ro52 positivity and cardiac rhythm disorders (relative risk = 2.007 [1.197-3.366]), specifically QTc prolongation (relative risk = 4.248 [1.553-11.615]). Multivariate regressions showed a significant association, with diabetes mellitus being the most related comorbidity. The association between anti-Ro52 antibodies and atrioventricular conduction disorders was not significant. Conclusions: The presence of anti-Ro52 antibodies in adult patients with SADs is associated with an increased risk of QTc prolongation. Electrocardiographic screening of patients with SAD, anti-Ro52 antibodies, and other risk factors, like diabetes mellitus or QT-prolonging drugs, seems advisable. Those with baseline electrocardiogram abnormalities or additional risk factors should undergo electrocardiographic monitoring.

Two decades of clear-cutting threats in the Brazilian Amazonian protected areas around the Jirau, Santo Antônio, and Belo Monte large dams.

Deforestation rates in the Amazon have markedly increased in the last few years, affecting non-protected and protected areas (PAs). Brazil is a hotspot of Protected Area Downgrading, Downsizing, and Degazettement (PADDD) events, with most events associated with infrastructure projects. Despite the threats dams impose on PAs, there is a knowledge gap in assessing deforestation in PAs around large dams in the Amazon. This study investigates how deforestation affects Biodiversity Protection Areas (BioPAs) and Indigenous Lands around the Jirau and Santo Antônio (JSA) dams (Madeira River, Rondônia) and Belo Monte dam (Xingu River, Pará) in the Brazilian Amazon. We compared clear-cutting between PAs and control areas and the annual rates of forest change between pre-dam and post-dam periods. We discussed deforestation-related factors (e.g., PADDD events and the presence of management plans or councils). Our results show an increase in deforestation after the operation of the dams when environmental control from licensing agencies decreases and other political and economic factors are in practice. Indigenous Lands experienced a significant increase in deforestation around the Belo Monte dam, which is associated with the demarcation process and land conflicts. Surrounding the JSA dams, sustainable use BioPAs showed high deforestation rates, and 27 PADDD events were reported, four directly related to dams. In addition to dams, deforestation was associated with the crisis of Brazilian democracy and the weakening of environmental policies. In conclusion, the weak environmental control from environmental licensing agencies during dam operation and PADDD events have contributed to increased deforestation rates and additional stresses in the Amazon.

Poverty-Food Insecurity Nexus in the Post-Construction Context of a Large Hydropower Dam in the Brazilian Amazon.

Within the 2030 Sustainable Development Agenda, large hydropower dams are positioned as a sustainable energy source, notwithstanding their adverse impacts on societies and ecosystems. This study contributed to ongoing discussions about the persistence of critical social issues, even after the investments of large amounts of resources in areas impacted by the construction of large hydropower dams. Our study focused on food insecurity and evaluated this issue in the city of Altamira in the Brazilian Amazon, which has been profoundly socially and economically impacted by the construction, between 2011 and 2015, of Brazil's second-largest dam, namely, Belo Monte. A survey in Altamira city featured a 500-household random sample. Structural equation modeling showed conditioning factors of 60% of the population experiencing varying food insecurity degrees. Poverty, female-led households, lower education, youth, and unemployment were strongly linked to higher food insecurity. Crowded, officially impacted, and resettled households also faced heightened food insecurity. Our findings underscore the food insecurity conditions in the region impacted by the Belo Monte dam, emphasizing the need to take into account this crucial issue while planning and implementing hydropower dams.

Balancing food production with climate change mitigation and biodiversity conservation in the Brazilian Amazon.

Climate change mitigation and biodiversity conservation are two major environmental actions that need to be effectively performed this century, alongside ensuring food supply for a growing global human population. These three issues are highly interlinked through land management systems. Thus, major global food production regions located in biodiversity hotpots and with potential for carbon sequestration face trade-offs between these valuable land-based ecosystem services. The state of Mato Grosso in Brazil is one such region, where private lands that have been illegally used for agriculture could be restored to natural vegetation - with potential benefits for climate change mitigation and biodiversity conservation, although with potentially negative effects on food production. To address this challenge, in this study we used a multicriteria nexus modeling approach that considers carbon stocks, priority areas for biodiversity conservation, and the opportunity for food production, to develop scenarios of land allocation that aim to balance the benefits and drawbacks of ecosystem restoration. Results show that forcing landowners to restore their individual lands compromises the potential for a "green land market" throughout the Amazon biome in which private landowners with lower food production capacities (e.g., less connected to markets and infrastructure) would benefit from restoration programs that compensate them for the inclusion of environmental restoration among their economic activities, instead of taking large economic risks to produce more food. We additionally highlight that strategic ecosystem restoration can achieve higher gains in biodiversity and carbon with lower costs of restoration actions and with minimal impacts on agriculture. Analyses like ours demonstrate how scenarios of land allocation that simultaneously address climate mitigation and biodiversity conservation through ecosystem restoration, while also minimizing possible impacts on food production, can be sought to move the world towards a sustainable future.

Complex relationships between soybean trade destination and tropical deforestation.

Over the last few years, understanding of the effects of increasingly interconnected global flows of agricultural commodities on coupled human and natural systems has significantly improved. However, many important factors in environmental change that are influenced by these commodity flows are still not well understood. Here, we present an empirical spatial modelling approach to assess how changes in forest cover are influenced by trade destination. Using data for soybean-producing municipalities in the state of Mato Grosso, Brazil, between 2004 and 2017, we evaluated the relationships between forest cover change and the annual soybean trade destination. Results show that although most of the soybean produced in Mato Grosso during the study period (60%) was destined for international markets, municipalities with greater and more consistent soybean production not destined for international markets during the study period were more strongly associated with deforestation. In these municipalities, soybean production was also significantly correlated with cattle and pasture expansion. These results have important implications for the sustainable management of natural resources in the face of an increasingly interconnected world, while also helping to identify the most suitable locations for implementing policies to reduce deforestation risks.

Large hydropower projects increase stress despite compensation efforts: Evidence from the Brazilian Amazon.

Large hydropower projects continue to be built in developing nations, despite their known negative impacts. Large-scale energy projects strain local infrastructure and reduce access to infrastructure for households that live near them. Here we investigate the link between large-scale hydropower projects and stress. Our results suggest that these projects create stress through two mechanisms: strains on community resources and through the process of displacement. We also ask how compensation and resettlement programs condition these relationships. Using data from the Madeira river basin in the Brazilian Amazon, we find that hydropower projects increase stress by reducing access to energy, water, sanitation and land. Compensation provided was not sufficient to moderate this effect.

Large-scale hydropower impacts and adaptation strategies on rural communities in the Amazonian floodplain of the Madeira River.

Understanding social and environmental impacts and household adaptation strategies in the face of expansions in energy infrastructure projects is essential to inform mitigation and interventions programs that promote well-being. Here we conducted surveys in seven communities distributed across varying degrees of proximity to a hydropower dam complex in the Brazilian Amazon along about 250 km of the floodplain of the Madeira River. Based on interviews with 154 fishers from these communities, we examine how fishers perceived changes in fisheries yields, changes in the composition of fish species, and whether and how adaptation strategies had evolved 8-9 years after the dams' construction. Most respondents (91%) indicated declines in yields after the dams for both upstream and downstream zones. Multivariate analyses revealed statistically significant differences in the composition of species yields in pre-and post-dam periods for all communities and in both upstream and downstream zones (p < 0.001). The composition of yields diversified after the dams, with an apparent decline in yields of species of greatest market value (e.g., catfishes Brachyplatystoma spp., Pseudoplatystoma spp., and jatuarana Brycon spp.), and increases in yields of a set of other smaller bodied and faster growing species (e.g., 'branquinhas' Psectrogaster spp., Potamohinna spp., and sardines Triportheus spp.). Both downstream and upstream fishers indicated that fishing profits decreased since the dams' construction (76.8% and 67.9%, respectively). To cope with these changes, the majority of both upstream and downstream fishers (>70%) stated they have had to devote more time to fishing after the dams were built. The time fishers spend traveling to fishing locations also increased for upstream communities (77.1%), but not for downstream communities. Thirty-four percent of the interviewees changed the gear they use to fish after the dams construction, with twice as many mentioning uses of non-selective gear, such as gillnets, and declining use of traditional fishing gears such as castnets and a trap ("covi"). Fish consumption overall decreased: fish was consumed 'everyday' before the dams, but 1-2 times per week or rarely after the dams were built. Although the species that declined were those of high economic value, 53% of fishers stated fish prices have increased overall after the dams. These results shed light on the potential challenges faced by fishers and which adaptation strategies they have evolved to maintain livelihoods since the construction of the dams.

The impact of hydropower dam construction on malaria incidence: Space-time analysis in the Brazilian Amazon.

During the first two decades of the 21st century, Brazil carried out massive public investments on infrastructure projects, such as large hydropower dams, with potential impact on population health. Here we characterize local malaria transmission and its potential spread during the construction of three large hydropower dams in the Brazilian Amazon. We focus on Porto Velho (PVH), in Rondônia state, where the Santo Antônio and Jirau dams were built (2008-2013), and Altamira region (ATM), in Pará state, where the construction of the Belo Monte dam took place (2011-2016). Analyzed data cover 4 years before, 6 years during, and 4 years after each dam construction. In total, we utilized malaria case notifications entered into the electronic malaria notification system of the Ministry of Health of Brazil between January 2004 and December 2020 (n = 39,977,167 malaria notifications). First, we used Interrupted Time-Series Analysis (ITSA) to assess temporal changes in malaria notifications in the study sites. Then, we conducted a space-time cluster analysis to investigate the potential of malaria spread from the study sites (sources) to elsewhere (sinks). Finally, we present the sociodemographic characteristics of exported cases over time using multivariate logistic regressions. Our results show that there was no upsurge in malaria cases in the study sites and exported cases did not trigger outbreaks in other localities. Exported malaria infections originating from PVH and ATM were typically found in working age literate males involved in mining, farming or traveling. We suggest that efficient control measures, such as ensuring timely diagnosis and treatment; fostering integrated vector control; promoting health education; and prevention, detection and containment of outbreaks, if properly implemented and sustained, may prevent local and introduced malaria outbreaks during and after hydropower dam construction in the Amazon.

Advancing convergence research: Renewable energy solutions for off-grid communities.

Millions of people across the world live off-grid not by choice but because they live in rural areas, have low income, and have no political clout. Delivering sustainable energy solutions to such a substantial amount of the world's population requires more than a technological fix; it requires leveraging the knowledge of underserved populations working together with a transdisciplinary team to find holistically derived solutions. Our original research has resulted in an innovative Convergence Framework integrating the fields of engineering, social sciences, and communication, and is based on working together with communities and other stakeholders to address the challenges posed by delivering clean energy solutions. In this paper, we discuss the evolution of this Framework and illustrate how this Framework is being operationalized in our on-going research project, cocreating hybrid renewable energy systems for off-grid communities in the Brazilian Amazon. The research shows how this Framework can address clean energy transitions, strengthen emerging industries at local level, and foster Global North-South scholarly collaborations. We do so by the integration of social science and engineering and by focusing on community engagement, energy justice, and governance for underserved communities. Further, this solution-driven Framework leads to the emergence of unique approaches that advance scientific knowledge, while at the same time addressing community needs.

Recently constructed hydropower dams were associated with reduced economic production, population, and greenness in nearby areas.

Hydropower dams produce huge impacts on renewable energy production, water resources, and economic development, particularly in the Global South, where accelerated dam construction has made it a global hotspot. We do not fully understand the multiple impacts that dams have in the nearby areas from a global perspective, including the spatial differentiations. In this study, we examined the impacts of hydropower dam construction in nearby areas. We first found that more than one-third of global gross domestic production (GDP) and almost one-third of global population fall within 50 km of the world's 7,155 hydropower dams (<10% of the global land area sans the Antarctic). We further analyzed impacts of 631 hydropower dams (≥1-megawatt capacity) constructed since 2001 and commissioned before 2015 for their effects on economy, population, and environment in nearby areas and examined the results in five regions (i.e., Africa, Asia, Europe, North America, and South America) and by different dam sizes. We found that recently constructed dams were associated with increased GDP in North America and urban areas in Europe but with decreased GDP, urban land, and population in the Global South and greenness in Africa in nearby areas. Globally, these dams were linked with reduced economic production, population, and greenness of areas within 50 km of the dams. While large dams were related with reduced GDP and greenness significantly, small and medium dams were coupled with lowered population and urban land substantially, and large and medium dams were connected to diminished nighttime light noticeably in nearby areas.

Feasibility of hybrid in-stream generator-photovoltaic systems for Amazonian off-grid communities.

While there have been efforts to supply off-grid energy in the Amazon, these attempts have focused on low upfront costs and deployment rates. These "get-energy-quick" methods have almost solely adopted diesel generators, ignoring the environmental and social risks associated with the known noise and pollution of combustion engines. Alternatively, it is recommended, herein, to supply off-grid needs with renewable, distributed microgrids comprised of photovoltaics (PV) and in-stream generators (ISG). Utilization of a hybrid combination of renewable generators can provide an energetically, environmentally, and financially feasible alternative to typical electrification methods, depending on available solar irradiation and riverine characteristics, that with community engagement allows for a participatory codesign process that takes into consideration people's needs. A convergent solution development framework that includes designers-a team of social scientists, engineers, and communication specialists-and communities as well as the local industry is examined here, by which the future negative impacts at the human-machine-environment nexus can be minimized by iterative, continuous interaction between these key actors.

Socioeconomic and environmental effects of soybean production in metacoupled systems.

Human-environment interactions within and across borders are now more influential than ever, posing unprecedented sustainability challenges. The framework of metacoupling (interactions within and across adjacent and distant coupled human-environment systems) provides a useful tool to evaluate them at diverse temporal and spatial scales. While most metacoupling studies have so far addressed the impacts of distant interactions (telecouplings), few have addressed the complementary and interdependent effects of the interactions within coupled systems (intracouplings) and between adjacent systems (pericouplings). Using the production and trade of a major commodity (soybean) as a demonstration, this paper empirically evaluates the complex effects on deforestation and economic growth across a globally important soybean producing region (Mato Grosso in Brazil). Although this region is influenced by a strong telecoupling process (i.e., soybean trade with national and international markets), intracouplings pose significant effects on deforestation and economic growth within focal municipalities. Furthermore, it generates pericoupling effects (e.g., deforestation) on adjacent municipalities, which precede economic benefits on adjacent systems, and may occur during and after the soybean production takes place. These results show that while economic benefits of the production of agricultural commodities for global markets tend to be localized, their environmental costs tend to be spatially widespread. As deforestation also occurred in adjacent areas beyond focal areas with economic development, this study has significant implications for sustainability in an increasingly metacoupled world.

Genetic Susceptibility to Acute Kidney Injury.

Acute kidney injury (AKI) is a widely held concern related to a substantial burden of morbidity, mortality and expenditure in the healthcare system. AKI is not a simple illness but a complex conglomeration of syndromes that often occurs as part of other syndromes in its wide clinical spectrum of the disease. Genetic factors have been suggested as potentially responsible for its susceptibility and severity. As there is no current cure nor an effective treatment other than generally accepted supportive measures and renal replacement therapy, updated knowledge of the genetic implications may serve as a strategic tactic to counteract its dire consequences. Further understanding of the genetics that predispose AKI may shed light on novel approaches for the prevention and treatment of this condition. This review attempts to address the role of key genes in the appearance and development of AKI, providing not only a comprehensive update of the intertwined process involved but also identifying specific markers that could serve as precise targets for further AKI therapies.

Distinguishing septic shock from non-septic shock in postsurgical patients using gene expression.

OBJECTIVES: To obtain a gene expression signature to distinguish between septic shock and non-septic shock in postoperative patients, since patients with both conditions show similar signs and symptoms. METHODS: Differentially expressed genes were selected by microarray analysis in the discovery cohort. These genes were evaluated by quantitative real time polymerase chain reactions in the validation cohort to determine their reliability and predictive capacity by receiver operating characteristic curve analysis. RESULTS: Differentially expressed genes selected were IGHG1, IL1R2, LCN2, LTF, MMP8, and OLFM4. The multivariate regression model for gene expression presented an area under the curve value of 0.922. These genes were able to discern between both shock conditions better than other biomarkers used for diagnosis of these conditions, such as procalcitonin (0.589), C-reactive protein (0.705), or neutrophils (0.605). CONCLUSIONS: Gene expression patterns provided a robust tool to distinguish septic shock from non-septic shock postsurgical patients and shows the potential to provide an immediate and specific treatment, avoiding the unnecessary use of broad-spectrum antibiotics and the development of antimicrobial resistance, secondary infections and increase health care costs.

Evolution and effects of the social-ecological system over a millennium in China's Loess Plateau.

Understanding the regime shifts of social-ecological systems (SES) and their local and spillover effects over a long time frame is important for future sustainability. We provide a perspective of processes unfolding over time to identify the regime shifts of a SES based on changes in the relationships between SES components while also addressing their drivers and local and spillover effects. The applicability of this approach has been demonstrated by analyzing the evolution over the past 1000 years of the SES in China's Loess Plateau (LP). Five evolutionary phases were identified: "fast expansion of cultivation," "slow expansion of cultivation," "landscape engineering for higher production," "transition from cultivation to ecological conservation," and "revegetation for environment." Our study establishes empirical links between the state (phase) of a SES to its drivers and effects. Lessons of single-goal driven and locally focused SES management in the LP, which did not consider these links, have important implications to long-term planning and policy formulation of SES.

Gene Expression Patterns Distinguish Mortality Risk in Patients with Postsurgical Shock.

Nowadays, mortality rates in intensive care units are the highest of all hospital units. However, there is not a reliable prognostic system to predict the likelihood of death in patients with postsurgical shock. Thus, the aim of the present work is to obtain a gene expression signature to distinguish the low and high risk of death in postsurgical shock patients. In this sense, mRNA levels were evaluated by microarray on a discovery cohort to select the most differentially expressed genes between surviving and non-surviving groups 30 days after the operation. Selected genes were evaluated by quantitative real-time polymerase chain reaction (qPCR) in a validation cohort to validate the reliability of data. A receiver-operating characteristic analysis with the area under the curve was performed to quantify the sensitivity and specificity for gene expression levels, which were compared with predictions by established risk scales, such as acute physiology and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA). IL1R2, CD177, RETN, and OLFM4 genes were upregulated in the non-surviving group of the discovery cohort, and their predictive power was confirmed in the validation cohort. This work offers new biomarkers based on transcriptional patterns to classify the postsurgical shock patients according to low and high risk of death. The results present more accuracy than other mortality risk scores.