Ungulates mitigate the effects of drought and shrub encroachment on the fire hazard of Mediterranean oak woodlands.

Climate change is increasing the frequency of droughts and the risk of severe wildfires, which can interact with shrub encroachment and browsing by wild ungulates. Wild ungulate populations are expanding due, among other factors, to favorable habitat changes resulting from land abandonment or land-use changes. Understanding how ungulate browsing interacts with drought to affect woody plant mortality, plant flammability, and fire hazard is especially relevant in the context of climate change and increasing frequency of wildfires. The aim of this study is to explore the combined effects of cumulative drought, shrub encroachment, and ungulate browsing on the fire hazard of Mediterranean oak woodlands in Portugal. In a long-term (18 years) ungulate fencing exclusion experiment that simulated land abandonment and management neglect, we investigated the population dynamics of the native shrub Cistus ladanifer, which naturally dominates the understory of woodlands and is browsed by ungulates, comparing areas with (no fencing) and without (fencing) wild ungulate browsing. We also modeled fire behavior in browsed and unbrowsed plots considering drought and nondrought scenarios. Specifically, we estimated C. ladanifer population density, biomass, and fuel load characteristics, which were used to model fire behavior in drought and nondrought scenarios. Overall, drought increased the proportion of dead C. ladanifer shrub individuals, which was higher in the browsed plots. Drought decreased the ratio of live to dead shrub plant material, increased total fuel loading, shrub stand flammability, and the modeled fire parameters, that is, rate of surface fire spread, fireline intensity, and flame length. However, total fuel load and fire hazard were lower in browsed than unbrowsed plots, both in drought and nondrought scenarios. Browsing also decreased the population density of living shrubs, halting shrub encroachment. Our study provides long-term experimental evidence showing the role of wild ungulates in mitigating drought effects on fire hazard in shrub-encroached Mediterranean oak woodlands. Our results also emphasize that the long-term effects of land abandonment can interact with climate change drivers, affecting wildfire hazard. This is particularly relevant given the increasing incidence of land abandonment.

Fire suppression and land-use strategies drive future dynamics of an invasive plant in a fire-prone mountain area under climate change.

Woody invasive alien species can have profound impacts on ecosystem processes and functions, including fire regulation, which can significantly affect landscape resilience. Acacia dealbata, a widespread invasive alien plant in the Iberian Peninsula, holds well-known fire-adaptation traits (e.g., massive soil seed banks and heat-stimulated seed germination). In this study, we assess to what extent fire suppression and land-use strategies could affect the potential distribution of A. dealbata in a fire-prone transboundary protected mountain area of Portugal and Spain, using Habitat Suitability Models. Specifically, we predicted changes in habitat suitability for A. dealbata between years 2010 and 2050. We explored the potential impacts of two land-use strategies ('Business-as-usual' or 'High Nature Value farmlands') combined with three levels of fire suppression effectiveness using the biomod2 package in R. We also considered the potential effects of two climate change scenarios (RCP4.5 and RCP8.5). Our modeling approach demonstrated a strong capacity to predict habitat suitability using either climate or land-cover information alone (AUC climate = 0.947; AUC LC = 0.957). According to climate-based models, A. dealbata thrives under conditions characterized by higher precipitation seasonality, higher precipitation in the warmest month, and higher minimum temperature in the coldest month. Regarding land cover, A. dealbata thrives mainly in landscapes dominated by urban areas and evergreen forest plantations. Our models forecasted that habitat suitability by 2050 could either increase or decrease depending on the specific combinations of fire suppression, land-use, and climate scenarios. Thus, a combination of business-as-usual and fire-exclusion strategies would enhance habitat suitability for the species. Conversely, management promoting High Nature Value farmlands would decrease the available suitable habitat, particularly under low fire suppression efforts. These findings suggest that promoting sustainable farming activities could impede the spread of A. dealbata by reducing habitat availability, while strategies aiming at fire-exclusion could facilitate its expansion, likely by enabling establishment and large seed production. This study highlights the complex interplay between fire-prone invasive species, fire and land-use strategies, and climate change; and thus the need to consider the interactions between land-use and fire management to promote invasive species control and landscape resilience.

Climate- and fire-smart landscape scenarios call for redesigning protection regimes to achieve multiple management goals.

Integrated management of biodiversity and ecosystem services (ES) in heterogeneous landscapes requires considering the potential trade-offs between conflicting objectives. The UNESCO's Biosphere Reserve zoning scheme is a suitable context to address these trade-offs by considering multiple management zones that aim to minimise conflicts between management objectives. Moreover, in Mediterranean ecosystems, management and planning also needs to consider drivers of landscape dynamics such as wildfires and traditional farming and forestry practices that have historically shaped landscapes and the biodiversity they host. In this study, we applied a conservation planning approach to prioritise the allocation of management zones under future landscape and climate scenarios. We tested different landscape management scenarios reflecting the outcomes of climate-smart and fire-smart policies. We projected the expected landscape dynamics and associated changes on the distribution of 207 vertebrate species, 4 ES and fire hazard under each scenario. We used Marxan with Zones to allocate three management zones, replicating the Biosphere Reserves zoning scheme ("Core area", "Buffer zone" and "Transition area") to address the various management objectives within the Biosphere Reserve. Our results show that to promote ES supply and biodiversity conservation, while also minimising fire hazard, the reserve will need to: i) Redefine its zoning, especially regarding Core Areas, which need a considerable expansion to help mitigate changes in biodiversity and accommodate ES supply under expected changes in climate and species distribution. ii) Revisit current management policies that will result in encroached landscapes prone to high intensity, uncontrollable wildfires with the potential to heavily damage ecosystems and compromise the supply of ES. Our results support that both climate- and fire-smart policies in the Meseta Ibérica can help develop multifunctional landscapes that help mitigate and adapt to climate change and ensure the best possible maintenance of biodiversity and ES supply under uncertain future climate conditions.

What happens to the pleural space affected by malignant effusion after bedside pleurodesis?

BACKGROUND AND OBJECTIVES: Evaluate radiological characteristics of postpleurodesis pleural space of patients with recurrent malignant pleural effusion(RMPE). METHODS: Prospective cohort study including patients with RPME treated with bedside pleurodesis. We used CT scans to calculate pleural cavity volume immediately before pleurodesis(iCT) and 30 days after(CT30). Radiological evolution was calculated by the difference between pleural volumes on CT30 and iCT(Δvolume). We categorized initial pleural volume as small(<500 mL) or large space(≥500 mL) and Δvolume as positive(>254.49 mL), unchanged(≥-268.77-≤ 254.49 mL), or negative(<-268.77 mL). Futhermore, we analyzed clinical effectiveness, pleural elastance, and adverse events. RESULTS: A total of 87 patients were analyzed. Pleural volume varied from 35-2750 mL in iCT and from 0-2995 mL in CT30(P = 0.753). A total of 54 patients had initial small pleural space(62.06%) and 33 large(37.93%). Clinical failure occurred in 7.4% of small space group and in 24.6% of large(P = 0.051, OR4.0(CI:1.098-14.570)). In small space group, 27.77% evolved with positive, 66.66% with unchanged and 5.55% with negative Δvolume. In the large space group these numbers were respectively 21.21%, 27.27%, and 51.51%. CONCLUSIONS: There is significant variability on pleural space volume. However, pleural volume remains unchanged in many cases. Besides that, more than half patients with initial large space coursed with relevant reduction. Finally, patients with initial small space presented a greater chance of clinical success.

The dynamics and drivers of fuel and fire in the Portuguese public forest.

The assumption that increased wildfire incidence in the Mediterranean Basin during the last decades is an outcome of changes in land use warrants an objective analysis. In this study we examine how annual area burned (BA) in the Portuguese public forest varied in relation to environmental and human-influenced drivers during the 1943-2011 period. Fire behaviour models were used to describe fuel hazard considering biomass removal, cover type changes, area burned, post-disturbance fuel accumulation, forest age-classes distribution and fuel connectivity. Biomass removal decreased rapidly beyond the 1940s, which, along with afforestation, increased fuel hazard until the 1980s; a subsequent decline was caused by increased fire activity. Change point analysis indicates upward shifts in BA in 1952 and in 1973, both corresponding to six-fold increases. Fire weather (expressed by the 90th percentile of the Canadian FWI during summer) increased over the study period, accounting for 18 and 36% of log(BA) variation before 1974 and after 1973, respectively. Regression modelling indicates that BA responds positively to fire weather, fuel hazard and number of fires in descending order of importance; pre-summer and 2-year lagged precipitation respectively decrease and increase BA, but the effects are minor and non-significant when both variables are included in the model. Land use conflicts (expressed through more fires) played a role, but it was afforestation and agricultural abandonment that supported the fire regime shifts, explaining weather-drought as the current major driver of BA as well. We conclude that bottom-up factors, i.e. human-induced changes in landscape flammability and ignition density, can enhance or override the influence of weather-drought on the fire regime in Mediterranean humid regions. A more relevant role of fuel control in fire management policies and practices is warranted by our findings.

Characterization of biophysical contexts leading to severe wildfires in Portugal and their environmental controls.

Characterizing the fire regime in regions prone to extreme wildfire behavior is essential for providing comprehensive insights on potential ecosystem response to fire disturbance in the context of global change. We aimed to disentangle the linkage between contemporary damage-related attributes of wildfires as shaped by the environmental controls of fire behavior across mainland Portugal. We selected large wildfires (≥100 ha, n = 292) that occurred during the 2015-2018 period, covering the full spectrum of large fire-size variation. Ward's hierarchical clustering on principal components was used to identify homogeneous wildfire contexts at landscape scale on the basis of fire size, proportion of high fire severity, and fire severity variability, and their bottom-up (pre-fire fuel type fraction, topography) and top-down (fire weather) controls. Piecewise Structural Equation Modeling was used to disentangle the direct and indirect relationships between fire characteristics and fire behavior drivers. Cluster analysis evidenced severe and large wildfires in the central region of Portugal displaying consistent fire severity patterns. Thus, we found a positive relationship between fire size and proportion of high fire severity, which was mediated by distinct fire behavior drivers involving direct and indirect pathways. A high fraction of conifer forest within wildfire perimeters and extreme fire weather were primarily responsible for those interactions. In the context of global change, our results suggest that pre-fire fuel management should be targeted at expanding the fire weather settings in which fire control is feasible and promote less flammable and more resilient forest types.

Drivers and implications of the extreme 2022 wildfire season in Southwest Europe.

Wildfire is a common phenomenon in Mediterranean countries but the 2022 fire season has been extreme in southwest Europe (Portugal, Spain and France). Here we provide a preliminary but comprehensive analysis of 2022's wildfire season in southwest Europe. Burned area has exceeded the 2001-2021 median by a factor of 52 in some regions and large wildfires (>500 ha) started to occur in June-July, earlier than the traditional fire season. These anomalies were associated with record-breaking values of fuel dryness, atmospheric water demand and pyrometeorological conditions. Live fuel moisture content was below the historical minima for almost 50 % of the season in some regions. A few large wildfires were responsible for 82 % of the burned area and, in turn, 47 % of the area burned occurred in protected areas. Shrublands, transitional woodlands and conifer forests (but not eucalypt plantations) were the land cover types most affected by extreme fires. As climate change intensifies, we can expect such fire seasons to become the new normal in large parts of the continent, potentially leading to major negative impacts on rural economies. These results highlight the need for landscape level fuel management also in protected areas, to avoid fire-induced biodiversity losses and landscape scale degradation. Our results have important policy implications and indicate that fire prevention should be explicitly addressed within continental forest legislation and strategies.

Estimates of fine fuel litter biomass in the northern Great Basin reveal increases during short fire-free intervals associated with invasive annual grasses.

Exotic annual grasses invasion across northern Great Basin rangelands has promoted a grass-fire cycle that threatens the sagebrush (Artemisia spp.) steppe ecosystem. In this sense, high accumulation rates and persistence of litter from annual species largely increase the amount and continuity of fine fuels. Here, we highlight the potential use and transferability of remote sensing-derived products to estimate litter biomass on sagebrush rangelands in southeastern Oregon, and link fire regime attributes (fire-free period) with litter biomass spatial patterns at the landscape scale. Every June, from 2018 to 2021, we measured litter biomass in 24 field plots (60 m × 60 m). Two remote sensing-derived datasets were used to predict litter biomass measured in the field plots. The first dataset used was the 30-m annual net primary production (NPP) product partitioned into plant functional traits (annual grass, perennial grass, shrub, and tree) from the Rangeland Analysis Platform (RAP). The second dataset included topographic variables (heat load index -HLI- and site exposure index -SEI-) computed from the USGS 30-m National Elevation Dataset. Through a frequentist model averaging approach (FMA), we determined that the NPP of annual and perennial grasses, as well as HLI and SEI, were important predictors of field-measured litter biomass in 2018, with the model featuring a high overall fit (R2 = 0.61). Model transferability based on extrapolating the FMA predictive relationships from 2018 to the following years provided similar overall fits (R2 ≈ 0.5). The fire-free period had a significant effect on the litter biomass accumulation on rangelands within the study site, with greater litter biomass in areas where the fire-free period was <10 years. Our findings suggest that the proposed remote sensing-derived products could be a key instrument to equip rangeland managers with additional information towards fuel management, fire management, and restoration efforts.

A Novel Percutaneous Technique for Left Ventricular Assist Device Deactivation Using a Left Atrial Appendage Occluder in the Outflow Cannula.

Reverse cardiac remodeling may occur in some left ventricular assist device (LVAD) recipients. Although considered the standard therapy, surgical device explantation with repeat sternotomy might be undesirable or very high risk. On the other hand, there are few data reporting minimally invasive percutaneous LVAD deactivation. We describe a case of a man with LVAD malfunction due to driveline fracture and left ventricular (LV) function recovery who had a Heart Mate II deactivated with a percutaneous technique using a left atrial appendage occluder (LAAO) positioned inside the outflow cannula. To the best of our knowledge, this the first report of LVAD deactivation with the fully recapturable LAAO device. We propose that the use of a LAA occluder to obstruct HM II outflow cannula is feasible and safe.

On the development of a regional climate change adaptation plan: Integrating model-assisted projections and stakeholders' perceptions.

Climate change is expected to have strong social-ecological implications, with global but especially regional and local challenges. To assess the climatic vulnerability of a given territory, it is necessary to evaluate its exposure to climate change and its adaptive capacity. This study describes the development of an Action Plan for Adapting to Climate Change in the Tâmega and Sousa Region, a mountainous inter-municipal community in the North of Portugal. The goals were to identify the main impacts of climate change on water resources, agriculture, forests, biodiversity, and socioeconomic sectors, as well as to develop a plan, merging local and scientific knowledge through a transdisciplinary lens. This study describes an approach that combines modelling methods, applied in the different sectors, and participatory methods, based on the analysis of the perceptions of local actors. Results indicate that the target region will experience a generalized increase in temperature and a decrease in precipitation, which will negatively impact all studied social-ecological dimensions. Overall, local business and institutional agents perceive the primary and tourism sectors as the most vulnerable in the region. The described framework demonstrates the engagement process between relevant scientific experts and local practitioners, as well as how it is critical to understand the impacts of climate change and to support the co-design of an adaptation plan, which in turn can guide political and economic decision-making towards effective implementation of the plan. In addition, the difficulties and challenges encountered during this process are discussed to support future plans and strategies for local adaptation.

Forest fires in Mediterranean countries: CO2 emissions and mitigation possibilities through prescribed burning.

Forest fires are an integral part of the ecology of the Mediterranean Basin; however, fire incidence has increased dramatically during the past decades and fire is expected to become more prevalent in the future due to climate change. Fuel modification by prescribed burning reduces the spread and intensity potential of subsequent wildfires. We used the most recently published data to calculate the average annual wildfire CO(2) emissions in France, Greece, Italy, Portugal and Spain following the IPCC guidelines. The effect of prescribed burning on emissions was calculated for four scenarios of prescribed burning effectiveness based on data from Portugal. Results show that prescribed burning could have a considerable effect on the carbon balance of the land use, land-use change and forestry (LULUCF) sector in Mediterranean countries. However, uncertainty in emission estimates remains large, and more accurate data is needed, especially regarding fuel load and fuel consumption in different vegetation types and fuel layers and the total area protected from wildfire per unit area treated by prescribed burning, i.e. the leverage of prescribed burning.

Creatine Supply Attenuates Ischemia-Reperfusion Injury in Lung Transplantation in Rats.

Ischemia-reperfusion injury (IRI) is one of the factors limiting the success of lung transplantation (LTx). IRI increases death risk after transplantation through innate immune system activation and inflammation induction. Some studies have shown that creatine (Cr) protects tissues from ischemic damage by its antioxidant action. We evaluated the effects of Cr supplementation on IRI after unilateral LTx in rats. Sixty-four rats were divided into four groups: water + 90 min of ischemia; Cr + 90 min of ischemia; water + 180 min of ischemia; and Cr + 180 min of ischemia. Donor animals received oral Cr supplementation (0.5 g/kg/day) or vehicle (water) for five days prior to LTx. The left lung was exposed to cold ischemia for 90 or 180 min, followed by reperfusion for 2 h. We evaluated the ventilatory mechanics and inflammatory responses of the graft. Cr-treated animals showed a significant decrease in exhaled nitric oxide levels and inflammatory cells in blood, bronchoalveolar lavage fluid and lung tissue. Moreover, edema, cell proliferation and apoptosis in lung parenchyma were reduced in Cr groups. Finally, TLR-4, IL-6 and CINC-1 levels were lower in Cr-treated animals. We concluded that Cr caused a significant decrease in the majority of inflammation parameters evaluated and had a protective effect on the IRI after LTx in rats.

A prospective controlled randomized multicenter study to evaluate the severity of compensatory sweating after one-stage bilateral thoracic sympathectomy versus unilateral thoracic sympathectomy in the dominant side.

OBJECTIVE: To evaluate the contribution that unilateral thoracic sympathectomy in dominant side or two-stage bilateral thoracic sympathectomy can have as strategies to reduce the incidence of compensatory sweating after sympathectomy for palmar hyperhidrosis. METHODS: This is a prospective, controlled, randomized multicenter trial of 200 participants with palmar hyperhidrosis, which will be randomized into two arms: (a) one-stage bilateral thoracic sympathectomy (control arm); or (b) unilateral thoracic sympathectomy in dominant side (intervention arm). At six months the participants submitted to unilateral procedure can make the contralateral surgery if they wanted it, creating a third group called two-stage bilateral sympathectomy. Participants will be evaluated for the degree of sweating by the Hyperhidrosis Disease Severity Scale (HDSS) and of quality of life questionnaires. RESULTS: 96 participants out of the 200 proposed have been included so far, with 48 participants randomized to each arm. From the sample 61 (63.5%) are female, with a mean age of 24 (20-32) years. There were exclusive palmar hiperhydrosis in 14 cases (14.5%), palmar and plantar hyperhidrosis in 36 (37.5%) cases, palmar and axillar hyperhidrosis in 12 (12,5%) cases and palmar-axillary-plantar hyperhidrosis in 34 (35,4%) cases. The age at the beginning of the disease was childhood (78%), with mean of time of disease 15 (11-22) years. CONCLUSIONS: If one or both hypothesis: (a) unilateral sympathectomy in dominant hand is a satisfactory treatment; b) two-stage bilateral sympathectomy causes less compensatory sweating than in one stage are confirmed there is a chance that surgical therapy for palmar hyperhidrosis can be changed for better.

Analysing eucalypt expansion in Portugal as a fire-regime modifier.

Eucalypts, especially blue gum (Eucalyptus globulus), have been extensively planted in Portugal and nowadays dominate most of its forest landscapes. Large-scale forestation programs can intensify fire activity, and blue gum plantations are often viewed as highly flammable due to the nature and structure of the fuel complex. The role of eucalypt plantations in the fire regime of Mediterranean climate regions is increasingly debated following the recent catastrophic wildfires in Portugal and elsewhere. In this study we examined the effects of eucalypt forestation on burned area (BA), fire size, and fire severity in Portugal. This was based on fire and vegetation mapping and statistics, fire weather data, satellite imagery, and national forest inventory data. Eucalypt BA comprised an average of 12.5% of total BA (1980-2017) and did not increase over time and with eucalypt expansion. Eucalypt metrics did not explain interannual BA variability after accounting for the effects of other variables. Forest fires started within eucalypt stands were the least likely to become large, and large fire size was irresponsive to forest composition. Likewise, forest type was a generally minor influence in mega-fire severity and accounted for just 1.4-8.6% of surface fuel-hazard metrics variation. In general, large-scale conversion of maritime pine to eucalypt stands (1970-2015) implied lower fuel accumulation. Fire activity results are consistent with fuel hazard results and express trade-offs between short-rotation forestry and fire behaviour in blue gum stands, with high spotting potential versus modest crown fire likelihood. We found no support for the contention of a modified fire regime as a result of eucalypt forestation in Portugal, but the rising undermanaged and abandoned blue gum estate, especially after large-fire seasons, is a concern for the future. However, it remains to be determined whether post-fire eucalypt regrowth is a higher fire threat than native vegetation in the same context.

The role of videopericardioscopy in evaluating indeterminate pericardial effusions.

BACKGROUND: The pericardial biopsy has opened a new perspective for the etiologic diagnosis of pericardial effusions, because adequate pericardial visualization via the use of a video camera can provide more accurate results. We assessed the usefulness of videopericardioscopy for the diagnosis and treatment of pericardial effusion of indeterminate origin. METHODS: We conducted a retrospective study of clinical data from patients who underwent videopericardioscopy examination for pericardial effusion without an established diagnosis. The video-assisted pericardioscopy procedure was performed through a small incision in the xiphoid area. RESULTS: From January 1998 to January 2007, 101 consecutive patients underwent videopericardioscopy evaluation for pericardial effusion. Ten patients were excluded because of lack of data. Fifty men and 41 women were included (mean age, 50 years; range, 14-76 years). All of the patients had moderate or significant pericardial effusion as demonstrated by echocardiography or computed tomography. The following diagnoses for the pericardial effusions were established: nonspecific inflammation, 50 cases (54.94%); neoplastic disorders, 22 cases (24.17%); tuberculous, 11 cases (12.08%); bacterial inflammatory process, 3 cases (3.29%); chylopericardial, 2 cases (2.19%); fungal infection, 2 cases (2.19%); and viral infection, 1 case (1.09%). Pericardioscopy evaluation provided the definitive diagnosis via the pericardial biopsy in 36.26% of the cases and via the results of fluid analyses in 13.18% of the cases; the use of both methods established the definitive diagnosis in 45.05% of the cases in this group of patients. The overall morbidity rate was 4.3%, and the most common complication was arrhythmia due to intraoperative manipulation, which ceased with the removal of the instruments from the pericardial cavity. We had 1 death, by cardiac tamponade, in the perioperative period. CONCLUSION: Videopericardioscopy is a safe and efficient method for obtaining a better diagnosis of and satisfactory therapeutic results for pericardial effusions of indeterminate cause, and such results are obtained via an improved exploration of the pericardial cavity.

Scientific support to prescribed underburning in southern Europe: What do we know?

Prescribed burning is a technically demanding and usually highly scrutinized and debated practice. Barriers of various natures have constrained the development of prescribed burning in forests (PUB) in southern Europe, with insufficient research and outreach among the contributing factors. This paper synthesizes PUB knowledge in the region and identifies research needs. PUB research in the western Mediterranean basin was fostered by international cooperative projects that studied the ecological and management ramifications of low-intensity burning for fire hazard mitigation. Effects of PUB on soil and vegetation are minor and short-lived and regulated through forest floor moisture content, fire intensity, tree resistance to fire, and ignition patterns. Generic burn prescriptions are available and specific burn windows targeting site-specific burn objectives can be developed with the existing software tools. However, the need to increase the depth and breadth of PUB research is apparent. Current knowledge is based upon pine forests, particularly Pinus pinaster, as past research has overlooked hardwoods; was obtained across a limited number of research teams and study sites; and essentially reflects short-term treatments. Fuel consumption by PUB effectively decreases fire potential, but post-treatment fuel dynamics and effects on wildfire spread and severity warrant further study. Future work should devote more attention to the socioeconomic, biodiversity and carbon storage implications of PUB and should expand to encompass cumulative effects and the whole PUB regime and its variation; long-term experiments and monitored management programs are crucial to this end.

Measurement of the Inter-Rater Reliability Rate Is Mandatory for Improving the Quality of a Medical Database: Experience with the Paulista Lung Cancer Registry.

BACKGROUND: Database quality measurement should be considered a mandatory step to ensure an adequate level of confidence in data used for research and quality improvement. Several metrics have been described in the literature, but no standardized approach has been established. We aimed to describe a methodological approach applied to measure the quality and inter-rater reliability of a regional multicentric thoracic surgical database (Paulista Lung Cancer Registry). STUDY DESIGN: Data from the first 3 years of the Paulista Lung Cancer Registry underwent an audit process with 3 metrics: completeness, consistency, and inter-rater reliability. The first 2 methods were applied to the whole data set, and the last method was calculated using 100 cases randomized for direct auditing. Inter-rater reliability was evaluated using percentage of agreement between the data collector and auditor and through calculation of Cohen's κ and intraclass correlation. RESULTS: The overall completeness per section ranged from 0.88 to 1.00, and the overall consistency was 0.96. Inter-rater reliability showed many variables with high disagreement (>10%). For numerical variables, intraclass correlation was a better metric than inter-rater reliability. Cohen's κ showed that most variables had moderate to substantial agreement. CONCLUSIONS: The methodological approach applied to the Paulista Lung Cancer Registry showed that completeness and consistency metrics did not sufficiently reflect the real quality status of a database. The inter-rater reliability associated with κ and intraclass correlation was a better quality metric than completeness and consistency metrics because it could determine the reliability of specific variables used in research or benchmark reports. This report can be a paradigm for future studies of data quality measurement.