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Nat Ecol Evol ; 2(9): 1393-1402, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30013132


Scientific communication relies on clear presentation of data. Logarithmic scales are used frequently for data presentation in many scientific disciplines, including ecology, but the degree to which they are correctly interpreted by readers is unclear. Analysing the extent of log scales in the literature, we show that 22% of papers published in the journal Ecology in 2015 included at least one log-scaled axis, of which 21% were log-log displays. We conducted a survey that asked members of the Ecological Society of America (988 responses, and 623 completed surveys) to interpret graphs that were randomly displayed with linear-linear or log-log axes. Many more respondents interpreted graphs correctly when the graphs had linear-linear axes than when they had log-log axes: 93% versus 56% for our all-around metric, although some of the individual item comparisons were even more skewed (for example, 86% versus 9% and 88% versus 12%). These results suggest that misconceptions about log-scaled data are rampant. We recommend that ecology curricula include explicit instruction on how to interpret log-scaled axes and equations, and we also recommend that authors take the potential for misconceptions into account when deciding how to visualize data.

Bibliometria , Ecologia/métodos , Conceitos Matemáticos , Projetos de Pesquisa , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Publicações Periódicas como Assunto , Inquéritos e Questionários , Adulto Jovem
BMJ Support Palliat Care ; 4(1): 87-91, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24644778


It is now accepted that teaching in palliative medicine should be integrated throughout the medical undergraduate curriculum. Recommendations suggest the inclusion of knowledge areas such as symptom control, as well as more attitudinal aspects such as teamwork and understanding patient and carer perspectives on illness. These subjects should be taught on a stepwise basis, introducing concepts at an early stage and then be built on throughout training. However, how this is done and how effectively all aspects are taught vary considerably. This article outlines one way of using patient and carer experiences of significant illness, and multi-disciplinary teams, to teach attitudinal concepts behind palliative care to medical students early in their undergraduate careers. Palliative care is considered here in a broad sense, with the relevance to all healthcare professionals emphasised, and specialist palliative care used as an example of holistic care. The sessions consisted of small group discussions with patient and carer representatives as well as discussions with various members of the multi-disciplinary team. These were led by the patient/carer/professionals' experiences and further explored with facilitated questions by the students. The sessions have been evaluated well by all involved, including patients, carers, multi-disciplinary team members and palliative medicine doctors. The learning objectives (to understand patient perspectives, multi-disciplinary working and holistic care) were achieved, along with discussion of professionalism.

Currículo , Educação de Graduação em Medicina/métodos , Cuidados Paliativos/métodos , Medicina Paliativa/educação , Competência Clínica , Humanos , Reino Unido
Palliat Med ; 27(3): 265-72, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-22450158


BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of death worldwide and there are concerns that end-of-life care for these patients is inadequate. Advance care planning is encouraged, with the hope that it will improve communication and avoid unwanted interventions, which have been particular concerns; in practice, these discussions rarely occur. We have little knowledge of the views of patients with COPD on advance care planning. Understanding this could help integrate advance care planning into the routine management of patients with COPD. AIM: To explore the views of people with severe COPD about advance care planning. DESIGN: Qualitative design, with data collection incorporating audio recorded semi-structured interviews. Analysis followed a grounded theory approach. SETTING/PARTICIPANTS: Patients with severe COPD (n =10, Gold Standards Framework criteria) were recruited from primary and secondary care settings. RESULTS: Participants felt they had not been given enough information about their diagnosis and prognosis, and were keen for more discussion with healthcare professionals. They wanted more involvement in decisions about their treatment when those decisions were required. Participants were happy to discuss their general views about future care, but felt uncomfortable with the traditional model of binding 'advance directives'. CONCLUSIONS: Considering advance care planning as a repeated process of discussion of prognosis, concerns and probable preferences for care would be more useful than encouraging binding advance decisions. Further research should assess the effectiveness of this approach. Local coordination of who is responsible for information provision is needed, and greater involvement of patients with COPD in management decisions as they arise.

Planejamento Antecipado de Cuidados , Atitude Frente a Morte , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Pesquisa Qualitativa , Inquéritos e Questionários
Exp Neurol ; 194(2): 376-83, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16022865


Glucocorticoids (GCs), the adrenal steroid hormones released during stress, have well-known anti-inflammatory actions. Despite that, there is increasing evidence that GCs are not uniformly anti-inflammatory in the injured nervous system and, in fact, can be pro-inflammatory. The present report continues this theme. Primary hippocampal cultures were treated with GC concentrations approximating basal, acute (1 h) stress or chronic (24 h) stress conditions and were then exposed to the excitotoxin kainic acid (KA). KA induced expression of the pro-inflammatory cytokines IL-1 beta and TNF-alpha, and chronic high dose GC exposure excacerbated this induction. In a second study, cultures were exposed to the physiological range of GC concentrations for 24 h prior to KA treatment. Low- to mid-range GC concentrations were anti-inflammatory, decreasing expression of IL-1 beta and TNF-alpha, while the highest GC doses either failed to be anti-inflammatory or even potentiated expression further. These findings add to the growing picture of these classically anti-inflammatory hormones potentially having pro-inflammatory effects in the injured CNS.

Citocinas/metabolismo , Glucocorticoides/farmacologia , Hipocampo/imunologia , Mediadores da Inflamação/metabolismo , Neurotoxinas/toxicidade , Animais , Células Cultivadas , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Agonistas de Aminoácidos Excitatórios/farmacologia , Hipocampo/citologia , Hipocampo/efeitos dos fármacos , Interleucina-1/metabolismo , Ácido Caínico/farmacologia , Neurônios/efeitos dos fármacos , Neurônios/imunologia , Neurônios/metabolismo , Ratos , Estresse Fisiológico/induzido quimicamente , Estresse Fisiológico/imunologia , Estresse Fisiológico/fisiopatologia , Fator de Necrose Tumoral alfa/metabolismo , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/fisiologia
J Neurochem ; 84(4): 705-16, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12562515


The CNS can mount an inflammatory reaction to excitotoxic insults that contributes to the emerging brain damage. Therefore, anti-inflammatory drugs should be beneficial in neurological insults. In contrast, glucocorticoids (GCs), while known for their anti-inflammatory effects, can exacerbate neurotoxicity in the hippocampus after excitotoxic insults. We investigated the effect of GCs on the inflammatory response after a neurological insult. Intact control (INT; intact stress response GC profile), adrenalectomized/GC-supplemented (ADX; low basal GC profile) and GC-treated (COR; chronically high GC profile) rats were injected with kainic acid into the hippocampal CA3 region. Lesion size was determined 8-72 h later. The inflammatory response was characterized using immunohistochemistry, RNAse protection assay and ELISA. The INT and COR rats developed larger CA3 lesions than ADX rats. We found that GCs surprisingly caused an increase in relative numbers of inflammatory cells (granulocytes, monocytes/macrophages and microglia). Additionally, mRNA and protein (IL-1beta and TNF-alpha) levels of the pro-inflammatory cytokines IL-1alpha, IL-1beta and TNF-alpha were elevated in COR rats compared with INT and ADX rats. These data strongly question the traditional view of GCs being uniformly anti-inflammatory and could further explain how GCs worsen the outcome of neurological insults.

Encefalomielite/tratamento farmacológico , Glucocorticoides/farmacologia , Doença Aguda , Adrenalectomia , Animais , Contagem de Células , Citocinas/genética , Citocinas/metabolismo , Encefalomielite/induzido quimicamente , Encefalomielite/patologia , Agonistas de Aminoácidos Excitatórios , Granulócitos/patologia , Hipocampo/efeitos dos fármacos , Hipocampo/metabolismo , Hipocampo/patologia , Interleucina-1/genética , Interleucina-1/metabolismo , Ácido Caínico , Macrófagos/patologia , Masculino , Microglia/patologia , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Esteroides/biossíntese , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo