Multi-objective forest restoration planning in Costa Rica: Balancing landscape connectivity and ecosystem service provisioning with sustainable development.

Degradation, fragmentation, and loss of tropical forests has exponentially increased in the last decades leading to unprecedented rates of species extinctions and loss of ecosystems functions and services. Forest restoration is key to recover ecosystems health and achieve the UN Sustainable Development Goals. However, restoring forests at the landscape scale presents many challenges, since it requires balancing conservation goals and economic development. In this study, we used a spatial planning tool (Marxan) to identify priority areas for restoration satisfying multiple objectives across a biological corridor in Costa Rica. Biological corridors are critical conservation instruments promoting forest connectivity while acknowledging human presence. Increasing forest connectivity requires restoration initiatives that will likely conflict with other land uses, some of them of high national economic importance. Our restoration plan sought to maximize the provision of forest-related services (i.e., seed dispersal, tourism and carbon storage) while minimizing the impact on current land uses and thus avoiding potential conflicts. We quantified seed dispersal and tourism services (birdwatching potential) using species distribution models. We used the carbon sequestration model of InVEST to quantify carbon storage potential. We tested different restoration scenarios that differed in whether land opportunity costs of current uses were considered or not when identifying potential restoration areas, or how these costs were estimated. We showed how a landscape-scale forest restoration plan accounting for only forest connectivity and ecosystem service provision capacity can greatly differ from a plan that considers the potential impacts on local livelihoods. Spatial planning tools can assist at designing cost-effective landscape-scale forest restoration plans, identifying priority areas where forest restoration can maximize ecosystem provision and increase forest connectivity. Special care must be paid to the use of adequate estimates of opportunity cost, to avoid potential conflicts between restoration goals and other legitimate land uses.

A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study.

Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

Prácticas corporales acerca del cuidado de sí en la comunidad indígena Sikuani / Body practice about the self-care in the Sikuani indigenous community

Antecedentes. Las categorías de cuerpo y movimiento se configuran como ejes fundamentales, tanto del quehacer como de la construcción de saberes por parte de los (las) Fisioterapeutas. Este conocimiento, históricamente influido por el contexto sociocultural, erige la condición de sujeto social en tanto que entiende la necesidad de reconocer el patrimonio cultural del país y sus particularidades en la práctica e investigación en salud. Objetivo. Develar, ¿cómo son las prácticas corporales acerca del cuidado de sí, en la comunidad indígena sikuani? Materiales y métodos. Los diarios de campo y la cartografía social fueron usados como descriptores de tales prácticas, siete de las cuales son analizadas en pos de relacionar el sentido y significado de las mismas. Resultados. Se encontraron siete prácticas del cuidado de sí que encarnan el arte de vivir por el que apuesta la comunidad. El cuidarse, el cuidado y el conocimiento de sí, forman parte de la ética del cuidado y que tiene como protagonista de estas prácticas a las mujeres. Conclusión. Un papel importante dentro de la experiencia vuelve a ser el de la mujer, ya que son ellas las encargadas de garantizar el cuidado de los niños y del esposo; sobre su cuerpo recae la responsabilidad de mantener y proveer al núcleo familiar, tan importante para la organización social de la comunidad. Es ella la encargada de influir y direccionar las relaciones dentro de su familia y de garantizar la continuidad de sus tradiciones ancestrales.

Background. The categories of human body and movement are configured as basic axes, not only as tasks, but also in the construction of knowledge by physiotherapists. Historically, this knowledge has been influenced by the sociocultural context, which creates the social subject status, because it understands the need of recognize the cultural patrimony of the country and its particularities in the practice and in the health research. Objective. To deveal, how are the body practices about the self care in the sikuani indigenous community? Materials and methods. The fields diaries and the social cartography were used as descriptors of body practices; from those, seven were analysed to relationate their sense and their meaning. Results. Seven practices of self care that describes the art of living of the community were found. The self care, the care and the self knowledge constitute the care ethics and the main characters of these practices are the females. Conclusion. In this experience, the women's role is very important, because they are in charge to guarantee the care of the children and their housebound. Over their own bodies lies the responsibility to maintain and to provide the familiar nucleon, which is very important for the community social organization. The women are in charge to guide the relationships inside their families and to guarantee the continuity of their ancestral traditions.

A cost-effectiveness evaluation of a home visit program for adolescent mothers.

A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated. The participants (N = 90) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago, Chile. The program was carried out by volunteer community health monitors and evaluated through an experimental, randomized, controlled clinical trial. Cost-effectiveness was examined in comparison with standard health care. Results show higher scores for the intervention group on the mothers' mental health and nutritional state, as well as on the children's levels of linguistic development.