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1.
Curr Biol ; 34(9): R371-R379, 2024 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-38714168

RESUMO

The global restoration agenda can help solve the biodiversity extinction crisis by regenerating biodiversity-rich ecosystems, maximising conservation benefits using natural regeneration. Yet, conservation is rarely the core objective of restoration, and biodiversity is often neglected in restoration projects targeted towards carbon sequestration or enhancing ecosystem services for improved local livelihoods. Here, we synthesise evidence to show that promoting biodiversity in restoration planning and delivery is integral to delivering other long-term restoration aims, such as carbon sequestration, timber production, enhanced local farm yields, reduced soil erosion, recovered hydrological services and improved human health. For each of these restoration goals, biodiversity must be a keystone objective to the entire process. Biodiversity integration requires improved evidence and action, delivered via a socio-ecological process operating at landscape scales and backed by supportive regulations and finance. Conceiving restoration and biodiversity conservation as synergistic, mutually reinforcing partners is critical for humanity's bids to tackle the global crises of climate change, land degradation and biodiversity extinction.


Assuntos
Biodiversidade , Conservação dos Recursos Naturais , Conservação dos Recursos Naturais/métodos , Mudança Climática , Ecossistema , Recuperação e Remediação Ambiental/métodos , Sequestro de Carbono
2.
ACS Omega ; 9(17): 19020-19030, 2024 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-38708199

RESUMO

With the recent legalization of cannabis in multiple jurisdictions and widespread use as a medical treatment, there has been an increased focus on product safety and the potential impacts of contaminants on human health. One factor that has received little attention is the possible exposure to potentially hazardous levels of toxic elements from rolling (smoking) papers. The elemental composition of rolling papers is largely unregulated, with a minority of jurisdictions regulating papers only when they are part of a final cannabis product. This study reports the concentrations of 26 elements in commercially available rolling papers and estimates potential maximum exposures relative to USP232 and ICH Q3D dosages in pharmaceutical compounds. Exposure estimates indicate that the concentrations of several elements in some products, particularly Cu, Cr, and V, may present a potential hazard to frequent users. Several elements, including Ag, Ca, Ba, Cu, Ti, Cr, Sb, and possibly others, are likely present in elevated quantities in some papers due to product design and manufacturing processes. Our results further suggest that Cu-based pigments are used by a number of manufacturers and that regular use of these products might result in exposures as high as 4.5-11 times the maximum exposure limits. Further research to quantify the contribution of rolling papers to elemental exposure under realistic smoking conditions is warranted.

3.
Neurol Clin ; 42(2): 615-632, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575270

RESUMO

This article discusses extremely common odontogenic pain conditions, which may occasionally present to the neurology clinic mimicking headache, and other uncommon orofacial pain conditions, which may do the same. Typical presentations, investigative strategies, and management are discussed, as well as highlighting key diagnostic criteria and the importance of involving oral or dental specialists where diagnostic uncertainty exists.


Assuntos
Doenças do Sistema Nervoso , Neuralgia do Trigêmeo , Humanos , Dor Facial/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Cefaleia/diagnóstico , Cefaleia/etiologia , Cefaleia/terapia , Doenças do Sistema Nervoso/complicações , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico
4.
Emerg Infect Dis ; 30(5): 1009-1012, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38666632

RESUMO

We report a cluster of serogroup B invasive meningococcal disease identified via genomic surveillance in older adults in England and describe the public health responses. Genomic surveillance is critical for supporting public health investigations and detecting the growing threat of serogroup B Neisseria meningitidis infections in older adults.


Assuntos
Infecções Meningocócicas , Neisseria meningitidis Sorogrupo B , Humanos , Inglaterra/epidemiologia , Idoso , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis Sorogrupo B/genética , Neisseria meningitidis Sorogrupo B/isolamento & purificação , Masculino , Idoso de 80 Anos ou mais , Genômica/métodos , Feminino , História do Século XXI , Genoma Bacteriano , Pessoa de Meia-Idade
5.
Genome Biol Evol ; 16(4)2024 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-38669452

RESUMO

A pangenome captures the genomic diversity for a species, derived from a collection of genetic sequences of diverse populations. Advances in sequencing technologies have given rise to three primary methods for pangenome construction and analysis: de novo assembly and comparison, reference genome-based iterative assembly, and graph-based pangenome construction. Each method presents advantages and challenges in processing varying amounts and structures of DNA sequencing data. With the emergence of high-quality genome assemblies and advanced bioinformatic tools, the graph-based pangenome is emerging as an advanced reference for exploring the biological and functional implications of genetic variations.


Assuntos
Genoma de Planta , Genômica/métodos , Plantas/genética , Análise de Sequência de DNA/métodos , Variação Genética , Biologia Computacional/métodos
6.
Curr Biol ; 34(6): R251-R254, 2024 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-38531320

RESUMO

An analysis of over 1 million old-growth tropical forest trees reveals that ∼2.2% of species comprise 50% of the individuals in Africa, Amazonia, and Southeast Asia, suggesting that the ecological mechanisms underpinning tree community assembly are ubiquitous across the tropics.


Assuntos
Árvores , Clima Tropical , África , Brasil , Ecossistema , Florestas
8.
Glob Chang Biol ; 30(3): e17208, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38441414

RESUMO

Substantial global restoration commitments are occurring alongside a rapid expansion in land-hungry tropical commodities, including to supply increasing demand for wood products. Future commercial tree plantations may deliver high timber yields, shrinking the footprint of production forestry, but there is an as-yet unquantified risk that plantations may expand into priority restoration areas, with marked environmental costs. Focusing on Brazil-a country of exceptional restoration importance and one of the largest tropical timber producers-we use random forest models and information on the economic, social, and spatial drivers of historic commercial tree plantation expansion to estimate and map the probability of future monoculture tree plantation expansion between 2020 and 2030. We then evaluate potential plantation-restoration conflicts and opportunities at national and biome-scales and under different future production and restoration pathways. Our simulations show that of 2.8 Mha of future plantation expansion (equivalent to plantation expansion 2010-2020), ~78,000 ha (3%) is forecast to occur in the top 1% of restoration priority areas for terrestrial vertebrates, with ~547,500 ha (20%) and ~1,300,000 ha (46%) in the top 10% and 30% of priority areas, respectively. Just ~459,000 ha (16%) of expansion is forecast within low-restoration areas (bottom 30% restoration priorities), and the first 1 Mha of plantation expansion is likely to have disproportionate impacts, with potential restoration-plantation overlap starkest in the Atlantic Forest but prominent in the Pampas and Cerrado as well. Our findings suggest that robust, coherent land-use policies must be deployed to ensure that significant trade-offs between restoration and production objectives are navigated, and that commodity expansion does not undermine the most tractable conservation gains under emerging global restoration agendas. They also highlight the potentially significant role an engaged forestry sector could play in improving biodiversity outcomes in restoration projects in Brazil, and presumably elsewhere.


Assuntos
Biodiversidade , Ecossistema , Animais , Brasil , Agricultura Florestal , Probabilidade
9.
JAMA Netw Open ; 7(2): e2356430, 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38411964

RESUMO

Importance: Co-located bridge clinics aim to facilitate a timely transition to outpatient care for inpatients with opioid use disorder (OUD); however, their effect on hospital length of stay (LOS) and postdischarge outcomes remains unclear. Objective: To evaluate the effect of a co-located bridge clinic on hospital LOS among inpatients with OUD. Design, Setting, and Participants: This parallel-group randomized clinical trial recruited 335 adult inpatients with OUD seen by an addiction consultation service and without an existing outpatient clinician to provide medication for OUD (MOUD) between November 25, 2019, and September 28, 2021, at a tertiary care hospital affiliated with a large academic medical center and its bridge clinic. Intervention: The bridge clinic included enhanced case management before and after hospital discharge, MOUD prescription, and referral to a co-located bridge clinic. Usual care included MOUD prescription and referrals to community health care professionals who provided MOUD. Main Outcomes and Measures: The primary outcome was the index admission LOS. Secondary outcomes, assessed at 16 weeks, were linkage to health care professionals who provided MOUD, MOUD refills, same-center emergency department (ED) and hospital use, recurrent opioid use, quality of life (measured by the Schwartz Outcome Scale-10), overdose, mortality, and cost. Analysis was performed on an intent-to-treat basis. Results: Of 335 participants recruited (167 randomized to the bridge clinic and 168 to usual care), the median age was 38.0 years (IQR, 31.9-45.7 years), and 194 (57.9%) were male. The median LOS did not differ between arms (adjusted odds ratio [AOR], 0.94 [95% CI, 0.65-1.37]; P = .74). At the 16-week follow-up, participants referred to the bridge clinic had fewer hospital-free days (AOR, 0.54 [95% CI, 0.32-0.92]), more readmissions (AOR, 2.17 [95% CI, 1.25-3.76]), and higher care costs (AOR, 2.25 [95% CI, 1.51-3.35]), with no differences in ED visits (AOR, 1.15 [95% CI, 0.68-1.94]) or deaths (AOR, 0.48 [95% CI, 0.08-2.72]) compared with those receiving usual care. Follow-up calls were completed for 88 participants (26.3%). Participants referred to the bridge clinic were more likely to receive linkage to health care professionals who provided MOUD (AOR, 2.37 [95% CI, 1.32-4.26]) and have more MOUD refills (AOR, 6.17 [95% CI, 3.69-10.30]) and less likely to experience an overdose (AOR, 0.11 [95% CI, 0.03-0.41]). Conclusions and Relevance: This randomized clinical trial found that among inpatients with OUD, bridge clinic referrals did not improve hospital LOS. Referrals may improve outpatient metrics but with higher resource use and expenditure. Bending the cost curve may require broader community and regional partnerships. Trial Registration: ClinicalTrials.gov Identifier: NCT04084392.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Adulto , Humanos , Masculino , Feminino , Tempo de Internação , Assistência ao Convalescente , Qualidade de Vida , Alta do Paciente , Pacientes Internados , Hospitais , Transtornos Relacionados ao Uso de Opioides/terapia
10.
Am J Physiol Regul Integr Comp Physiol ; 326(5): R416-R426, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38406845

RESUMO

Cerebrovascular reactivity (CVR) decreases with advancing age, contributing to increased risk of cognitive impairment; however, the mechanisms underlying the age-related decrease in CVR are incompletely understood. Age-related changes to T cells, such as impaired mitochondrial respiration, increased inflammation, likely contribute to peripheral and cerebrovascular dysfunction in animals. However, whether T-cell mitochondrial respiration is related to cerebrovascular function in humans is not known. Therefore, we hypothesized that peripheral T-cell mitochondrial respiration would be positively associated with CVR and that T-cell glycolytic metabolism would be negatively associated with CVR. Twenty middle-aged adults (58 ± 5 yr) were recruited for this study. T cells were separated from peripheral blood mononuclear cells. Cellular oxygen consumption rate (OCR) and extracellular acidification rate (ECAR, a marker of glycolytic activity) were measured using extracellular flux analysis. CVR was quantified using the breath-hold index (BHI), which reflects the change in blood velocity in the middle-cerebral artery (MCAv) during a 30-s breath-hold. In contrast to our hypothesis, we found that basal OCR in CD8+ T cells (ß = -0.59, R2 = 0.27, P = 0.019) was negatively associated with BHI. However, in accordance with our hypothesis, we found that basal ECAR (ß = -2.20, R2 = 0.29, P = 0.015) and maximum ECAR (ß = -50, R2 = 0.24, P = 0.029) were negatively associated with BHI in CD8+ T cells. There were no associations observed in CD4+ T cells. These associations appeared to be primarily mediated by an association with the pressor response to the breath-hold test. Overall, our findings suggest that CD8+ T-cell respiration and glycolytic activity may influence CVR in humans.NEW & NOTEWORTHY Peripheral T-cell metabolism is related to in vivo cerebrovascular reactivity in humans. Higher glycolytic metabolism in CD8+ T cells was associated with lower cerebrovascular reactivity to a breath-hold in middle-aged adults, which is possibly reflective of a more proinflammatory state in midlife.


Assuntos
Linfócitos T CD8-Positivos , Leucócitos Mononucleares , Adulto , Humanos , Pessoa de Meia-Idade , Circulação Cerebrovascular/fisiologia , Respiração , Suspensão da Respiração
11.
J Aerosol Med Pulm Drug Deliv ; 37(2): 64-76, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38354286

RESUMO

Background: Hyperosmolar aerosols appear to promote or suppress upper airway dysfunction caused by dehydration in a composition-dependent manner. We sought to explore this composition dependence experimentally, in an interventional human clinical study, and theoretically, by numerical analysis of upper airway ion and water transport. Methods: In a double-blinded, placebo-controlled clinical study, phonation threshold pressure (PTP) was measured prenasal and postnasal inhalation of hypertonic aerosols of NaCl, KCl, CaCl2, and MgCl2 in seven human subjects. Numerical analysis of water and solute exchanges in the upper airways following deposition of these same aerosols was performed using a mathematical model previously described in the literature. Results: PTP decreased by 9%-22% relative to baseline (p < 0.05) for all salts within the first 30 minutes postadministration, indicating effective laryngeal hydration. Only MgCl2 reduced PTP beyond 90 minutes (21% below baseline at 2 hours postadministration). By numerical analysis, we determined that, while airway water volume up to 15 minutes postdeposition is dictated by osmolarity, after 30 minutes, divalent cation salts, such as MgCl2, better retain airway surface liquid (ASL) volume by slow paracellular clearance of the divalent cation. Fall of CFTR chloride flux with rise in ASL height, a promoter of airway acidification, appears to be a signature of permeating cation (NaCl) and nonpermeating anion (mannitol) aerosol deposition. For hypertonic aerosols that lack permeating cation and include permeating anion (CaCl2 and MgCl2), this acid-trigger signature does not exist. Conclusions: Nonpermeating cation and permeating anion hypertonic aerosols appear to hydrate upper airways longer and, rather than provoke, may reduce laryngeal dysfunction such as cough and bronchoconstriction.


Assuntos
Sais , Cloreto de Sódio , Humanos , Administração por Inalação , Cátions Bivalentes , Cloreto de Cálcio , Aerossóis e Gotículas Respiratórios , Ânions , Água , Concentração de Íons de Hidrogênio , Aerossóis , Solução Salina Hipertônica
12.
J R Coll Physicians Edinb ; 54(1): 38-40, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38396339

RESUMO

Pancreatic exocrine insufficiency (PEI) is an under-diagnosed condition. Untreated PEI can result in developing gastrointestinal symptoms and long-term complications including weight loss, nutrient deficiencies, sarcopenia and osteoporosis. Current best practice recommends testing for PEI in certain disorders including chronic pancreatitis, cystic fibrosis, pancreatic cancer and post-pancreatic surgery. However, there is increasing evidence that PEI is associated with a number of conditions in addition to the aforementioned diseases. These 'at-risk' conditions are a heterogeneous group of diseases, for example, diabetes mellitus, people living with human immunodeficiency virus, high alcohol intake, and coeliac disease. The pathophysiology of some of 'at-risk' conditions is becoming increasingly recognised; therefore, the list of associated conditions are in evolving process. We present a case of a 60-year-old male with Parkinson's disease and persistent abdominal pain who was found to have low faecal elastase levels indicative of severe PEI. His past medical history included none of the known risk factors for PEI. After examining the literature, we report a similar pathophysiological process underlying the development of pancreatitis and Parkinson's disease which is dysfunction of the Unfolded Protein Response. We suggest further research to assess the prevalence of PEI in the population of patients with Parkinson's disease.


Assuntos
Insuficiência Pancreática Exócrina , Pancreatite Crônica , Doença de Parkinson , Masculino , Humanos , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Insuficiência Pancreática Exócrina/complicações , Insuficiência Pancreática Exócrina/diagnóstico , Pâncreas , Pancreatite Crônica/complicações , Fatores de Risco
13.
J Environ Manage ; 354: 120240, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38340671

RESUMO

Captive breeding is often seen as a solution to sustainably increasing the supply of individuals in the wildlife trade. To be an effective conservation measure this requires robust systems to verify the authenticity of captive-bred species. The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) monitors the international trade in Listed species-which for many taxa is dominated by captive-bred individuals-using the Review of Captive Trade (RCT) process. A key question is how best to identify laundered or inauthentic captive-bred trade and how has this changed over time and space. We develop targeted assessments based on multiple RCT criteria to identify probable instances of laundering and misuse of source and purpose codes in international trade records, and apply this to 39,167 records of captive trade from 2000 to 2020 spanning 53,674,762 individuals. We find a very low proportion of trade volume (1.8%, 37,835 individuals) misreported as originating from non-existent, registered Appendix I-breeding facilities, and low instances of exporter-reported captive trade being recorded by importers as wild-sourced (<4%) or ranched (1%). We also find that <2% of species-year-exporter records have abrupt shifts from wild to captive sources, potentially indicating laundering. Conversely, we find high incidences of exporter- and importer-reported trade differing in whether the trade was commercial or not - a phenomenon we attribute to differing definitions, not illegal activity. Our results indicate a low incidence of concerning international trade being reported, but we suggest this likely stems from reporting requirements that limit our assessments. We highlight additional trade data that, if embedded into Party's annual reports, would vastly improve inferential potential, greatly increasing the number of records (Appendix II and III species) that could be verified with minimal effort for management authorities.


Assuntos
Comércio , Conservação dos Recursos Naturais , Animais , Espécies em Perigo de Extinção
14.
Br Dent J ; 236(2): 117-123, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38278909

RESUMO

Introduction This paper explores the declared and formal and informal taught endodontic curriculum within an undergraduate dental programme in the UK as part of a wider study, which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines.Method The declared curriculum was identified through existing course guides and seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum.Results Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines and the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum.Conclusion This study highlights disparities between current evidence-based guidelines and the declared and taught curriculum in relation to pulp management in a UK dental school. Recommendations are that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, plus engagement with clinical lecturers, to enable more standardised teaching.


Assuntos
Currículo , Faculdades de Odontologia , Humanos , Aprendizagem , Estudantes , Inquéritos e Questionários , Reino Unido , Ensino
15.
Int Endod J ; 57(4): 416-430, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38214015

RESUMO

AIM: To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. METHODOLOGY: All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. RESULTS: Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). CONCLUSIONS: This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.


Assuntos
Pulpite , Humanos , Pulpite/tratamento farmacológico , Pulpite/cirurgia , Estudos de Coortes , Pulpotomia , Dor , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico
16.
Immunohorizons ; 8(1): 114-121, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38276916

RESUMO

Sneathia vaginalis is a Gram-negative vaginal species that is associated with pregnancy complications. It produces cytopathogenic toxin A (CptA), a pore-forming toxin. To determine whether CptA is expressed in vivo and to examine the mucosal Ab response to the toxin, we examined human midvaginal swab samples obtained during pregnancy for IgM, IgA, and IgG Abs with CptA affinity. This subcohort study included samples from 93 pregnant people. S. vaginalis relative abundance was available through 16S rRNA survey. There were 22 samples from pregnancies that resulted in preterm birth in which S. vaginalis relative abundance was <0.005%, 22 samples from pregnancies that resulted in preterm birth with S. vaginalis ≥0.005%, 24 samples from pregnancies that resulted in term birth with S. vaginalis <0.005%, and 25 samples from pregnancies that resulted in term birth with S. vaginalis ≥0.005%. IgM, IgA, and IgG with affinity for CptA were assessed by ELISA. The capacity for the samples to neutralize CptA was quantified by hemolysis assay. All three Ab isotypes were detectable within different subsets of the samples. There was no significant association between relative abundance of S. vaginalis and the presence of any Ab isotype. The majority of vaginal swab samples containing detectable levels of anti-CptA Abs neutralized the hemolytic activity of CptA, with the strongest correlation between IgA and neutralizing activity. These results demonstrate that S. vaginalis produces CptA in vivo and that CptA is recognized by the host immune defenses, resulting in the production of Abs with toxin-neutralizing ability.


Assuntos
Etilaminas , Nascimento Prematuro , Recém-Nascido , Gravidez , Feminino , Humanos , Formação de Anticorpos , RNA Ribossômico 16S , Imunoglobulina G , Imunoglobulina M , Imunoglobulina A
17.
Contemp Clin Trials ; 136: 107409, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38086444

RESUMO

The HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis (HOPE Trial) is a multicenter randomized trial addressing chronic pain among patients receiving maintenance hemodialysis for end-stage kidney disease. The trial uses a sequential, multiple assignment design with a randomized component for all participants (Phase 1) and a non-randomized component for a subset of participants (Phase 2). During Phase 1, participants are randomized to Pain Coping Skills Training (PCST), an intervention designed to increase self-efficacy for managing pain, or Usual Care. PCST consists of weekly, live, coach-led cognitive behavioral therapy sessions delivered by video- or tele-conferencing for 12 weeks followed by daily interactive voice response sessions delivered by telephone for an additional 12 weeks. At 24 weeks (Phase 2), participants in both the PCST and Usual Care groups taking prescription opioid medications at an average dose of ≥20 morphine milligram equivalents per day are offered buprenorphine, a partial opioid agonist with a more favorable safety profile than full-agonist opioids. All participants are followed for 36 weeks. The primary outcome is pain interference ascertained, for the primary analysis, at 12 weeks. Secondary outcomes include additional patient-reported measures and clinical outcomes including falls, hospitalizations, and death. Exploratory outcomes include acceptability, tolerability, and efficacy of buprenorphine. The enrollment target of 640 participants was met 27 months after trial initiation. The findings of the trial will inform the management of chronic pain, a common and challenging issue for patients treated with maintenance hemodialysis. NCT04571619.


Assuntos
Buprenorfina , Dor Crônica , Humanos , Analgésicos Opioides/uso terapêutico , Buprenorfina/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Estudos Multicêntricos como Assunto , Manejo da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Diálise Renal/efeitos adversos
18.
Conserv Biol ; 38(1): e14149, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37424370

RESUMO

Oil palm is a major driver of tropical deforestation. A key intervention proposed to reduce the footprint of oil palm is intensifying production to free up spare land for nature, yet the indirect land-use implications of intensification through market forces are poorly understood. We used a spatially explicit land-rent modeling framework to characterize the supply and demand of oil palm in Indonesia under multiple yield improvement and demand elasticity scenarios and explored how shifts in market equilibria alter projections of crop expansion. Oil palm supply was sensitive to crop prices and yield improvements. Across all our scenarios, intensification raised agricultural rents and lowered the effectiveness of reductions in crop expansion. Increased yields lowered oil palm prices, but these price-drops were not sufficient to prevent further cropland expansion from increased agricultural rents under a range of price elasticities of demand. Crucially, we found that agricultural intensification might only result in land being spared when the demand relationship was highly inelastic and crop prices were very low (i.e., a 70% price reduction). Under this scenario, the extent of land spared (∼0.32 million ha) was countered by the continued establishment of new plantations (∼1.04 million ha). Oil palm intensification in Indonesia could exacerbate current pressures on its imperiled biodiversity and should be deployed with stronger spatial planning and enforcement to prevent further cropland expansion.


Cambios en el uso de suelo causados por la reacción del mercado a la intensificación de la palma aceitera en Indonesia Resumen La palma aceitera es una de las principales causas de la deforestación. Una intervención importante propuesta para reducir la huella de esta palma es la intensificación de la producción para que el suelo sobrante sea usado por la naturaleza, pero se sabe muy poco sobre las implicaciones del uso indirecto de suelo de la intensificación a través de las fuerzas del mercado. Usamos un marco de modelos de renta de suelo espacialmente explícito para caracterizar la oferta y demanda de la palma aceitera en Indonesia bajo varios escenarios de mejoras en la producción y elasticidad de demandas y exploramos cómo los cambios en el equilibrio del mercado alteran las proyecciones de la expansión agrícola. La oferta de palma aceitera fue susceptible a los precios de los cultivos y a las mejoras en la producción. La intensificación elevó la renta agrícola y redujo la efectividad de la reducción de la expansión agrícola en todos nuestros escenarios. El aumento en la producción bajó los precios de la palma, pero estas caídas no fueron suficientes para evitar la expansión agrícola a partir de las rentas agrícolas elevadas bajo un rango de elasticidad de precios de demanda. Más importante, descubrimos que la intensificación agrícola puede sólo resultar en que sobre el suelo cuando la relación de demanda casi no sea elástica y los precios de las cosechas sean muy bajos (una reducción del 70% en los precios). Bajo este escenario, la extensión de suelo sobrante (∼0.32 millones de ha) fue contrarrestado por el establecimiento continuo de nuevos sembradíos (∼1.04 millones de ha). La intensificación de la palma aceitera en Indonesia podría agravar las presiones existentes sobre su biodiversidad en peligro y debería implementarse con una mayor planeación espacial y aplicación para prevenir una expansión agrícola superior.


Assuntos
Arecaceae , Conservação dos Recursos Naturais , Indonésia , Agricultura , Biodiversidade , Arecaceae/fisiologia
19.
Glob Chang Biol ; 30(1): e16981, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37888836

RESUMO

Indigenous Peoples are long-term custodians of their lands, but only recently are their contributions to conservation starting to be recognized in biodiversity policy and practice. Tropical forest loss and degradation are lower in Indigenous lands than unprotected areas, yet the role of Indigenous Peoples' Lands (IPL) in biodiversity conservation has not been properly assessed from regional to global scales. Using species distribution ranges of 11,872 tropical forest-dependent vertebrates to create area of habitat maps, we identified the overlap of these species ranges with IPL and then compared values inside and outside of IPL for species richness, extinction vulnerability, and range-size rarity. Of assessed vertebrates, at least 76.8% had range overlaps with IPL, on average overlapping ~25% of their ranges; at least 120 species were found only within IPL. Species richness within IPL was highest in South America, while IPL in Southeast Asia had highest extinction vulnerability, and IPL in Dominica and New Caledonia were important for range-size rarity. Most countries in the Americas had higher species richness within IPL than outside, whereas most countries in Asia had lower extinction vulnerability scores inside IPL and more countries in Africa and Asia had slightly higher range-size rarity in IPL. Our findings suggest that IPL provide critical support for tropical forest-dependent vertebrates, highlighting the need for greater inclusion of Indigenous Peoples in conservation target-setting and program implementation, and stronger upholding of Indigenous Peoples' rights in conservation policy.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Humanos , Animais , Vertebrados , Biodiversidade , Povos Indígenas
20.
Plant Biotechnol J ; 22(3): 544-554, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37961986

RESUMO

Inversions, a type of chromosomal structural variation, significantly influence plant adaptation and gene functions by impacting gene expression and recombination rates. However, compared with other structural variations, their roles in functional biology and crop improvement remain largely unexplored. In this review, we highlight technological and methodological advancements that have allowed a comprehensive understanding of inversion variants through the pangenome framework and machine learning algorithms. Genome editing is an efficient method for inducing or reversing inversion mutations in plants, providing an effective mechanism to modify local recombination rates. Given the potential of inversions in crop breeding, we anticipate increasing attention on inversions from the scientific community in future research and breeding applications.


Assuntos
Edição de Genes , Melhoramento Vegetal , Melhoramento Vegetal/métodos , Edição de Genes/métodos , Plantas/genética , Inversão Cromossômica/genética , Genoma de Planta/genética
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