Critical transitions in the Amazon forest system.

The possibility that the Amazon forest system could soon reach a tipping point, inducing large-scale collapse, has raised global concern1-3. For 65 million years, Amazonian forests remained relatively resilient to climatic variability. Now, the region is increasingly exposed to unprecedented stress from warming temperatures, extreme droughts, deforestation and fires, even in central and remote parts of the system1. Long existing feedbacks between the forest and environmental conditions are being replaced by novel feedbacks that modify ecosystem resilience, increasing the risk of critical transition. Here we analyse existing evidence for five major drivers of water stress on Amazonian forests, as well as potential critical thresholds of those drivers that, if crossed, could trigger local, regional or even biome-wide forest collapse. By combining spatial information on various disturbances, we estimate that by 2050, 10% to 47% of Amazonian forests will be exposed to compounding disturbances that may trigger unexpected ecosystem transitions and potentially exacerbate regional climate change. Using examples of disturbed forests across the Amazon, we identify the three most plausible ecosystem trajectories, involving different feedbacks and environmental conditions. We discuss how the inherent complexity of the Amazon adds uncertainty about future dynamics, but also reveals opportunities for action. Keeping the Amazon forest resilient in the Anthropocene will depend on a combination of local efforts to end deforestation and degradation and to expand restoration, with global efforts to stop greenhouse gas emissions.

Speciation in savanna birds in South America: The case of the Least Nighthawk Chordeiles pusillus (Aves: Caprimulgidae) in and out of the Amazon.

The Least Nighthawk Chordeiles pusillus is widespread wherever there are savannas in the South American tropics, often in isolated patches, such as white-sands savannas in the Amazon rainforest realm. Here, we investigate genetic relationships between populations of the Least Nighthawk to understand historical processes leading to its diversification and to determine dispersal routes between northern and southern savannas by way of three hypothesized dispersal corridors by comparing samples from white-sand savannas to samples from other savannas outside of the Amazon rainforest region. We use 32 mtDNA samples from the range of C. pusillus to infer a dated phylogeny. In a subset of 17 samples, we use shotgun sequences to infer a distance-based phylogeny and to estimate individual admixture proportions. We calculate gene flow and shared alleles between white-sand and non-Amazonian populations using the ABBA-BABA test (D statistics), and Principal Component Analysis (PCA) to examine genetic structure within and between lineages. Finally, we use species distribution modelling (SDM) of conditions during the Last Glacial Maximum (LGM), currently, and in the future (2050-2080) to predict potential species occurrence under a climate change scenario. Two main clades (estimated to have diverged around 1.07 million years ago) were recovered with mtDNA sequences and Single Nucleotide Polymorphism (SNPs) and were supported by NGSadmix and PCA: one in the Amazon basin white-sand savannas, the other in the non-Amazonian savannas. Possible allele sharing between these clades was indicated by the D-statistics between northern non-Amazonian populations and the white-sand savanna population, but this was not corroborated by the admixture analyses. Dispersal among northern non-Amazonian populations may have occurred in a dry corridor between the Guianan and the Brazilian Shield, which has since moved eastward. Our data suggest that the lineages separated well before the Last Glacial Maximum, consequently dispersal could have happened at any earlier time during similar climatic conditions. Subsequently, non-Amazonian lineages became more divergent among themselves, possibly connecting and dispersing across the mouth of the Amazon River across Marajó island during favourable climatic conditions in the Pleistocene.

Human impacts outpace natural processes in the Amazon.

Amazonian environments are being degraded by modern industrial and agricultural activities at a pace far above anything previously known, imperiling its vast biodiversity reserves and globally important ecosystem services. The most substantial threats come from regional deforestation, because of export market demands, and global climate change. The Amazon is currently perched to transition rapidly from a largely forested to a nonforested landscape. These changes are happening much too rapidly for Amazonian species, peoples, and ecosystems to respond adaptively. Policies to prevent the worst outcomes are known and must be enacted immediately. We now need political will and leadership to act on this information. To fail the Amazon is to fail the biosphere, and we fail to act at our peril.

Intramedullary Metastatic Endometrial Adenocarcinoma in a Goat.

A 7-year-old female goat developed progressive ataxia, which progressed to sternal recumbency. Clinical examination revealed a slight elevation in the sacral spine (S1-S2), tetraparesis, perineal hypoaesthesia and absent tail and anal reflexes. Due to unresponsiveness to treatment with corticosteroids, the goat was euthanized. At necropsy, a 4.0 × 5.7 × 2.5 cm tumour mass was found in the uterine body and right uterine horn. In the cauda equina (L6‒S2), a 3 cm tumour associated with a 2 cm ventral intraosseous sacral haematoma was also found. The tumours were characterized by neoplastic proliferation of columnar epithelial cells with a predominant tubular pattern. Neoplastic cells with glandular cytoplasm stained with acid Alcian blue and periodic acid‒Schiff. Other metastases were found in the lungs, right ovary, dura mater and nerve roots of the medullary cone. Neoplastic cells were immunolabelled for cytokeratin but were negative for vimentin, and the tumour was diagnosed as metastatic endometrial tubular adenocarcinoma. To our knowledge, this is the first report of intramedullary metastasis to the spinal cord of this tumour in any species except humans.

Urban expansion and its impact on water security: The case of the Paraíba do Sul River Basin, São Paulo, Brazil.

Increasing demand for water is one of the most challenging problems that human societies face today and has encouraged new studies to examine water security and water management. Seeking to discuss this important issue in the Brazilian context, we analyzed the impacts of urban expansion on water security in a basin located in the most populated region of Brazil. To quantify increased water demand, we combined urban sprawl and regional population increase projections. In this context, our study contributes to discussions on water security by addressing the importance of integration between water and urban planning. Simulations indicate good performance in reproducing actual water system conditions. The finding demonstrates that urban expansion in the region is mainly driven by road proximity. Urban occupation is projected to increase in 170% by 2050, increasing water demands for domestic use in 38%. Results indicate the feasibility of including landscape and socioeconomic constrains in order to obtain potential domestic water demand scenarios by using land use and land cover change modelling to assess urban expansion and population growth. For the study region, our findings suggest that although urban sprawl increases water demand, urban supply will not be compromised given the large volume of available water in the basin. However, the indirect consequences of urban sprawl, such as industrialization and agricultural intensification, may compromise the quality of this resource and require better water use management in the region.

Breaking Bad News: A Study on Formal Training in a High-Risk Obstetrics Setting.

Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task. Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center. Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017. Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol. Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for "knowledge" (p < 0.001), "emotions," (p = 0.004) and "strategy and summary" (p = 0.002). Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

Family Conferences in Prenatal Palliative Care.

Background: Fetal malformations are diagnosed prenatally in nearly 3% of pregnancies, and ∼1.2% are major malformations. After prenatal diagnosis, it is imperative to consider families' values and to support their decision-making process. Prenatal palliative care is a growing field mainly based on family conferences. The prenatal care setting is unique and differs from postnatal and adult care. There are no descriptions of family conferences in prenatal palliative care. The descriptions of themes that emerge from the prenatal care conference charts may guide professionals in this delicate task, and help determine the causes of suffering and identify family values before the birth of the infant. Aim: To perform a content analysis of medical records of family conferences and to describe the main themes observed during prenatal palliative care follow-up after the diagnosis of a life-limiting fetal condition. Design: This is a retrospective study of medical records of family conferences from a perinatal palliative care group, the GAI group, between May 2015 and September 2016. Setting/Participants: Families with estimated perinatal mortality >50% and eligibility for follow-up at our tertiary fetal medicine center were enrolled. We included women who participated in at least one family conference with the GAI group and who had given birth at the clinic or delivered at another center and returned for the postnatal family conference. Results: Fifty women met the inclusion criteria. Five main themes and 18 categories emerged from the charts and are described in detail. A model of follow-up in prenatal palliative care is proposed based on the themes and categories identified. Conclusions: This analysis may guide health professionals who seek to better identify family needs and values and organize follow-up during prenatal palliative care.

Comprometimento da saúde no pós-alta de pacientes tratados por hanseníase e fatores relacionados: revisão de escopo / Post-discharge health impairment of patients treated for leprosy and related factors: scope review / Deterioro de la salud tras el alta en pacientes tratados por lepra y factores re-lacionados: una revisión general

Objetivo: mapear evidências na literatura científica sobre o comprometimento de saúde no pós-alta de pacientes tratados por Hanseníase e fatores relacionados. Materiais e Método: revisão de escopo realizada a partir das bases de dados CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS e Web of Science em março de 2021, norteados pela estratégia mnemônica que auxilia na identificação do Problema, Conceito e Contexto propostos pelo Instituto Joanna Briggs, sistematizados por meio do fluxograma PRISMA-ScR e registrados na Open Science Framework (osf.io/vmdc6). Foram incluídos estudos sobre a temática publicados até fevereiro de 2021 no cenário nacional e internacional. Resultados: dos dez artigos incluídos na amostra final, nove evidenciaram algum grau de comprometimento funcional, demonstrando fragilidades no acompanhamento desde o diagnóstico até o período pós-alta. Conclusões: evidencia-se acometimentos com maior frequência sobretudo de ordem física, que impactam diretamente a funcionalidade nas atividades de vida diária e social dessas pessoas. As fragilidades no monitoramento pós-alta foram relacionadas ao déficit de profissionais capacitados, ao desconhecimento de técnicas de avaliação e classificação do grau de incapacidade, à carência na oferta de educação em saúde, à dificuldade de acesso aos serviços de saúde, ao atraso no tratamento dos episódios reacionais e reabilitação biopsicossocial e à ausência da sistematização do cuidado.(AU)

Objective: to map evidence in the scientific literature on the post-discharge health impairment of patients treated for leprosy and related factors. Materials and Method: scope review carried out from the CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS and Web of Science databases in March 2021, guided by the mnemonic strategy that helps to identify the Problem, Concept and Context proposed by the Joanna Institute Briggs, systematized through the PRISMA-ScR flowchart, and registered in the Open Science Framework (osf.io/vmdc6). Studies on the subject published until February 2021 in the national and international scenario were included. Results: of the ten articles included in the final sample, nine showed some degree of functional impairment, demonstrating weaknesses in follow-up from diagnosis to the post-discharge period. Conclusions: there is evidence of more frequent involvement, especially of a physical nature, which directly impact the functionality of these people's daily and social activities. Weaknesses in post-discharge monitoring were related to the lack of trained professionals, lack of knowledge of assessment techniques and classification of the degree of disability, lack of health education provision, difficulty in accessing health services, delay in treatment of reactional episodes and biopsychosocial rehabilitation and the absence of systematization of care.(AU)

Objetivo: mapear en la literatura científica las evidencias sobre el deterioro de la salud post-alta en pacientes tratados por lepra y factores relacionados. Materiales y Métodos: revisión de alcance realizada a partir de las bases de datos CINAHL, LILACS, MEDLINE, PUBMED, SCOPUS y Web of Science en marzo de 2021, guiada por la estrategia mnemotécnica que ayu-da a identificar el Problema, Concepto y Contexto propuesta por el Instituto Joanna Briggs, sistematizada a través del flujograma PRISMA-ScR y registrada en el Open Science Framework (osf.io/vmdc6). Fueron incluidos estudios sobre el tema, publicados hasta febrero de 2021, en el escenario nacional e internacional. Resultados: de los diez artículos incluidos en la muestra final, nueve mostraron algún grado de deterioro funcional, demostrando debilidades en el seguimiento desde el diagnóstico hasta el período posterior al alta. Conclusiones: se evidencia con mayor frecuencia ataques sobre todo de orden físico que impactan directamente en la funcionalidad en las actividades de la vida diaria y social de las personas. Fragilidades en el seguimiento postoperatorio relacionadas con el déficit de profesionales capacitados, el desco-nocimiento de las técnicas de evaluación y clasificación del grado de incapacidad, la carencia en la oferta de educación en salud, la dificultad de acceso a los servicios de salud, el retraso en el tratamiento de los episodios reaccionarios y la rehabilitación biopsicosocial y la ausencia de...(AU)

Evaluation of matrix effect on the determination of rare earth elements and As, Bi, Cd, Pb, Se and In in honey and pollen of native Brazilian bees (Tetragonisca angustula - Jataí) by Q-ICP-MS.

Bees are considered the main pollinators in natural and agricultural environments. Chemical elements from honey and pollen have been used for monitoring the environment, the health of bees and the quality of their products. Nevertheless, there are not many studies on honey and pollen of native Brazilian bees. The goal of this work was to determine important chemical elements (Sc, Y, La, Ce, Pr, Nd, Sm, Eu, Gd, Dy, Ho, Er, Tm, Lu and Yb) along with As, Bi, Cd, Pb, Se and In, in honey and pollen of native Brazilian bees, assessing analytical interferences from the matrix. A proposed analytical method was developed for these elements by quadrupole ICP-MS. Matrix effect was verified in honey matrix in the quantification of As, Bi and Dy; and in pollen matrix for Bi, Cd, Ce, Gd, La, Pb and Sc. The quality of the method was considered satisfactory taking into consideration the recovery rate of each element in the spiked solutions: honey matrix (91.6-103.9%) and pollen matrix (94.1-115.6%). The quantification limits of the method ranged between 0.00041 and 10.3µgL-1 for honey and 0.00041-0.095µgL-1 for pollen. The results demonstrate that the method is accurate, precise and suitable.

When One Knows a Fetus Is Expected to Die: Palliative Care in the Context of Prenatal Diagnosis of Fetal Malformations.

BACKGROUND: Fetal malformations occur in 2% of gestations and are the fifth most common cause of neonatal death in the world. In many cases, fetal malformations result in neonatal death or long stay in intensive care facilities. Families that continue the pregnancy in such a situation need to make choices and cope with an overwhelming number of potential issues. Palliative care starting at the prenatal period is a growing field that allows the entire family to prepare for this difficult situation. OBJECTIVE: To perform a systematic review of published data on palliative care in the prenatal period. DESIGN: PubMed and the Cochrane Library were searched using the keywords ("perinatal" OR "prenatal" OR "fetal") AND "palliative care" and also ("perinatal" OR "prenatal" OR "fetal") AND "hospice." SETTING/SUBJECTS: Studies focusing on the long-term impact of prenatal palliative care published up to December 2015 were used. MEASUREMENTS: Quantitative and qualitative studies. RESULTS: In total, 541 studies were retrieved; 29 articles met the inclusion criteria. Studies were organized into different categories according to the design or main focus. The majority of studies retrieved were reflexives or presented a narrative proposal on palliative care started in the prenatal period (45%). Clinical studies comprised 17% of all articles found. No studies were found on the long-term impact of prenatal palliative care. CONCLUSIONS: Prenatal palliative care is a growing field and an important supportive care measure that can help grieving parents and families who do not want to or cannot interrupt their pregnancy. More studies should be carried out, specifically concerning long-term impact of prenatal palliative care. Guidelines and training of health professionals must be developed so that more families can benefit from this type of care.

O sofrimento psicológico de pacientes com patologias bucais à perspectiva da Psicologia / Psychological distress of patients with oral pathologies in the perspective of Psychology

Objetivo: Investigar as naturezas do sofrimento psicológico ocasionado por problemas bucais. Métodos: Esta pesquisa adotou uma abordagem qualitativa e caráter exploratório-descritivo, utilizando-se da entrevista semiestruturada e da observação assistemática como instrumentos de coleta de dados. Para a análise dos dados da pesquisa foi utilizada a análise do conteúdo e a amostra da pesquisa foi de 25 participantes, entre homens e mulheres, que buscaram atendimento odontológico em uma clínica de Manaus, Amazonas, Brasil nos meses de maio e junho de 2020. Resultados: todos os participantes foram afetados psiquicamente pela existência de problemas bucais, o que gerou problemas de autoestima e autoimagem. Com o início do tratamento, os participantes relataram uma melhora na autoestima, não minimizando, contudo, outros tipos de sentimentos provenientes do problema bucal, como desconforto, dores e bullying. Conclusão: Problemas bucais podem gerar sofrimento psicológico aos pacientes, prejudicando sua autoimagem, acarretando, muitas das vezes, no isolamento e dificuldade em relacionar-se com outras pessoas. Portanto, um sorriso harmonioso é importante não somente por questões estéticas, mas para que o indivíduo se sinta bem consigo mesmo.

Aim:To investigate the nature of psychological distress caused by oral problems. Methods: This research adopted a qualitative approach and exploratory-descriptive design, employing, as data collection tools, a semi-structured interview and an unsystematic observation. For the research's data analysis, content analysis was used, and the research sample featured 25 participants, between men and women, who sought out dental care in a Manaus, Amazonas, Brazil dental clinic between May and June 2020. Results: All the participants were affected psychologically by the existence of oral problems, which led to self-esteem and self-image problems. With the start of treatment, the participants reported an improvement in self-esteem and self-image, not minimizing, however, other types of feelings that come with oral problems, like discomfort, pain, and bullying. Conclusion: Oral problems can cause psychological pain to the patients, harming their self-esteem and self-image, often leading to isolation and trouble interacting with other people. Therefore, a harmonious smile is important not only for esthetic reasons, but also for individuals to feel good about themselves.

Description of brachial plexus of sloth (Bradypus variegatus) / Descrição do plexo braquial do bicho-preguiça (Bradypus variegatus)

The species Bradypus variegatus is known as the common sloth, an endemic mammal from neotropical regions, which has been suffering from devastating anthropogenic activities. Our study aimed to describe the brachial plexus of B. variegates, regarding the origin and distribution of nerves, through the sampling of 10 adult females. Analyses were carried out at the Anatomy Section, "Departamento de Morfologia e Fisiologia Animal", "Universidade Federal Rural de Pernambuco", under license no. 034/2015 of the Ethics Committee on the Use of Animals. The results determined that the brachial plexus of the common sloth starts from the fifth cervical spine segment until the second thoracic segment. This area contains the long and suprascapular thoracic nerves, which originate immediately from the medullary segment 5 and 6, respectively, and from the pectoral, subscapular, axillary, radial, musculocutaneous, medial, forearm and ulnar medial cutaneous nerves, arising from a trunk comprised of cervical spine nerves (C) 7, C8, C9, and thoracic (T) 1 and T2. Regarding other wild and domestic animals, different suggestions were observed about the origin of the plexus in B. variegatus, however, the constituent nerves and their innervation areas did not demonstrate any discrepancies.(AU)

A espécie Bradypus variegatus é conhecida como preguiça-comum. Trata-se de um mamífero endêmico de regiões neotropicais que vem sofrendo com a ação antrópica devastadora. Esses Bradipodídeos possuem três dedos nos membros torácicos e pélvicos, são arborícolas consagrados e descem ao solo apenas para excretar e trocar de árvore. O estudo teve como objetivo descrever o plexo braquial de B. variegatus em relação à origem e distribuição dos nervos. Para tal, utilizou-se 10 fêmeas adultas. As análises foram realizadas no Pavilhão de Anatomia do Departamento de Morfologia e Fisiologia Animal da Universidade Federal Rural de Pernambuco, sob a licença nº 034/2015 do Comitê de Ética no Uso de Animais. Os cadáveres foram obtidos após morte natural, fixados em formaldeído a 20%, conservados em solução salina a 30% em tanques e dissecados para a visualização dos nervos destinados a inervar os membros e músculos torácicos. Uma vez feito, constatou-se que o plexo braquial da preguiça-comum se origina do quinto segmento espinal cervical, se estendendo até o segundo segmento torácico. Sendo formado pelos nervos torácico longo e supraescapular, de origem imediatamente do segmento medular 5 e 6, respectivamente, e pelos nervos peitorais, subescapulares, axilar, radial, musculocutâneo, mediano, cutâneo medial do antebraço e ulnar, decorrentes de um tronco formado a partir de nervos espinais cervicais (C) 7, C8, C9, e torácicos (T) 1 e T2. Em comparação a outros animais silvestres e domésticos foram observadas diferentes disposições em relação à origem do plexo de B. variegatus, todavia, os nervos constituintes e suas áreas de inervação não apresentaram discrepâncias.(AU)

Nutritional aspects and their influences on the pathophysiology ofAlzheimer's disease: A systematic review / Aspectos nutricionais e suas influências na fisiopatologia da doença de Alzheimer: uma revisão sistemática

The objective of this study was to conduct a review about the nutritional aspects and their influences on the pathophysiology of Alzheimer's disease. The review describes the pathophysiology of Alzheimer's disease, the generally indicated diets, and the nutritional factors that may aggravate the disease based on a literature review using the following keywords in English and Portuguese: "Alzheimer's disease", "physiopathology", "nutritional aspects", and "antioxidants". A total of 100 articles were found, 48 in Lilacs and 52 in MedLine, but only 54 articles were selected for the review. The use of antioxidants as free radical scavengers is generally indicated in diets for Alzheimer's patients. Studies also suggest that caffeine, vitamin B12, and folic acid have neuroprotective effects. Cohort studies found that a high intake of saturated fatty acids and obesity increase the risk of Alzheimer's disease. People with Alzheimer's disease should avoid diets high in carbohydrates and saturated fats, and prefer foods high in antioxidants.

O objetivo do presente trabalho foi conduzir uma revisão sobre os aspectos nutricionais e suas influências na fisiopatologia da doença de Alzheimer. Descreveram-se a fisiopatologia da doença de Alzheimer, os alimentos em geral indicados e os fatores nutricionais que podem agravar a doença. Para tanto, foi realizada uma revisão da literatura usando as seguintes palavras-chave em inglês e em português: "doença de Alzheimer", "fisiopatologia", "aspectos nutricionais" e "antioxidantes". Um total de 100 artigos por meio da busca com as palavras-chave foram selecionados para o estudo nas bases de dados, estando 48 artigos disponíveis na base Lilacs e os outros 52, na base MedLine, no entanto, foram selecionados para a revisão 54 artigos. Com base na revisão, pode-se perceber que o emprego de substâncias antioxidantes como os sequestradores de radicais livres são alimentos, em geral, indicados para portadores da doença de Alzheimer. Estudos também sugerem efeito neuroprotetor da cafeína, vitamina B12 e o ácido fólico. Estudos de corte demonstram que uma alta ingestão calórica de ácidos graxos saturados e a obesidade aumentam o risco da doença de Alzheimer. Dessa forma, por meio deste estudo, foi possível perceber que os portadores da doença de Alzheimer devem evitar dietas ricas em carboidratos e ácidos graxos saturados e ingerir alimentos preferencialmente ricos em antioxidantes.