Healthcare provider's perceptions of bleeding in patients with acute leukaemia undergoing induction chemotherapy: A qualitative study.

BACKGROUND: Bleeding is a primary outcome for many transfusion-related trials in acute leukaemia (AL) patients, typically graded using the World Health Organisation (WHO) bleeding scale (clinically significant bleed (CSB) is ≥grade 2). This composite outcome fails to differentiate minor bleeds that may not be significant, poorly represents the total burden of bleeding and lacks input from healthcare providers (HCPs) and patients. As part of a multi-step project to create a better bleeding tool for trials, our objective was to identify HCPs' perspectives on the components of CSB in AL patients. STUDY DESIGN AND METHODS: Using qualitative description, we interviewed 19 physicians and nurses who care for AL patients undergoing induction chemotherapy. Participants were recruited from professional organisations, networks and social media. An inductive approach to conventional content analysis was used. RESULTS: HCPs identified features of CSB as the anatomical site of bleeding, amount of bleeding, need for intervention and changes in vital signs. Using these characteristics, bleeding events were categorised into three groups: clinically significant, could evolve into a CSB and not clinically significant. HCPs considered the patient's condition, bleeding history and clinical intuitions when deciding whether a bleed could escalate into serious bleeding. DISCUSSION: Using data from HCPs, we categorised bleeds as clinically significant, could evolve into a CSB, and not significant. A study of patients' perspectives on the importance of different kinds of bleeding is the next step to creating a bleeding definition that is informed by evidence, clinicians and patients.

Reading tea leaves worldwide: Decoupled drivers of initial litter decomposition mass-loss rate and stabilization.

The breakdown of plant material fuels soil functioning and biodiversity. Currently, process understanding of global decomposition patterns and the drivers of such patterns are hampered by the lack of coherent large-scale datasets. We buried 36,000 individual litterbags (tea bags) worldwide and found an overall negative correlation between initial mass-loss rates and stabilization factors of plant-derived carbon, using the Tea Bag Index (TBI). The stabilization factor quantifies the degree to which easy-to-degrade components accumulate during early-stage decomposition (e.g. by environmental limitations). However, agriculture and an interaction between moisture and temperature led to a decoupling between initial mass-loss rates and stabilization, notably in colder locations. Using TBI improved mass-loss estimates of natural litter compared to models that ignored stabilization. Ignoring the transformation of dead plant material to more recalcitrant substances during early-stage decomposition, and the environmental control of this transformation, could overestimate carbon losses during early decomposition in carbon cycle models.

Video Modeling Use in Work Occupations for People With Autism: A Systematic Review.

IMPORTANCE: Occupational therapy practitioners should use evidence-based practices, such as video modeling, to address work occupations supporting people with autism spectrum disorder, including those with co-occurring intellectual and developmental disabilities. OBJECTIVE: To examine the evidence and relevance of video modeling supporting engagement in work occupations for people with autism and to translate these findings to occupational therapy practice. DATA SOURCES: Cochrane Collection Plus, CINAHL, PubMed, ERIC, ProQuest, and peer-reviewed occupational therapy literature from 2008 to 2018. Study Selection and Data Collection: This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study selection and data collection focused on occupational therapy scope of practice, autism spectrum disorder, co-occurring intellectual and developmental disabilities, video modeling, and work occupations for people age 16 yr and older. FINDINGS: A total of 464 articles were screened. Six articles met inclusion criteria. Results indicated moderate evidence for video modeling to support work occupations for people with autism, specifically employment seeking and acquisition and specific job-performance skills. Samples were limited to people younger than age 28 yr and represented varied intellectual abilities, indicating potential for benefits across the spectrum of cognitive functioning. CONCLUSIONS AND RELEVANCE: This systematic review highlights the promising potential of video modeling to address work occupations for people with autism. However, more rigorous effectiveness research is needed, including studies by occupational therapy practitioners. What This Article Adds: Occupational therapy expertise paired with video modeling, as a strengths-based, client-centered, customizable, socially acceptable intervention, can provide meaningful support for work occupations.

Floodplain land cover affects biomass distribution of fish functional diversity in the Amazon River.

Land-cover change often shifts the distribution of biomass in animal communities. However, the effects of land-cover changes on functional diversity remain poorly understood for many organisms and ecosystems, particularly, for floodplains. We hypothesize that the biomass distribution of fish functional diversity in floodplains is associated with land cover, which would imply that fish traits affect behavioral and/or demographic responses to gradients of land cover. Using data from surveys of 462 habitats covering a range of land-cover conditions in the Amazon River floodplain, we fitted statistical models to explain landscape-scale variation in functional diversity and biomass of all fish species as well as subsets of species possessing different functional traits. Forest cover was positively associated with fish biomass and the strength of this relationship varied according to functional groups defined by life history, trophic, migration, and swimming-performance/microhabitat-use traits. Forty-two percent of the functional groups, including those inferred to have enhanced feeding opportunities, growth, and/or reproductive success within forested habitats, had greater biomass where forest cover was greater. Conversely, the biomass of other functional groups, including habitat generalists and those that directly exploit autochthonous food resources, did not vary significantly in relation to forest cover. The niche space occupied by local assemblages (functional richness) and dispersion in trait abundances (functional dispersion) tended to increase with forest cover. Our study supports the expectation that deforestation in the Amazon River floodplain affects not only fish biomass but also functional diversity, with some functional groups being particularly vulnerable.

Modeling surface water dynamics in the Amazon Basin using MOSART-Inundation-v1.0: Impacts of geomorphological parameters and river flow representation.

Surface water dynamics play an important role in water, energy and carbon cycles of the Amazon Basin. A macro-scale inundation scheme was integrated with a surface-water transport model and the extended model was applied in this vast basin. We addressed the challenges of improving basin-wide geomorphological parameters and river flow representation for large-scale applications. Vegetation-caused biases embedded in the HydroSHEDS DEM data were alleviated by using a vegetation height map of about 1-km resolution and a land cover dataset of about 90-m resolution. The average elevation deduction from the DEM correction was about 13.2 m for the entire basin. Basin-wide empirical formulae for channel cross-sectional geometry were adjusted based on local information for the major portion of the basin, which could significantly reduce the cross-sectional area for the channels of some subregions. The Manning roughness coefficient of the channel varied with the channel depth to reflect the general rule that the relative importance of riverbed resistance in river flow declined with the increase of river size. The entire basin was discretized into 5395 subbasins (with an average area of 1091.7 km2), which were used as computation units. The model was driven by runoff estimates of 14 years (1994 - 2007) generated by the ISBA land surface model. The simulated results were evaluated against in situ streamflow records, and remotely sensed Envisat altimetry data and GIEMS inundation data. The hydrographs were reproduced fairly well for the majority of 13 major stream gauges. For the 11 subbasins containing or close to 11 of the 13 gauges, the timing of river stage fluctuations was captured; for most of the 11 subbasins, the magnitude of river stage fluctuations was represented well. The inundation estimates were comparable to the GIEMS observations. Sensitivity analyses demonstrated that refining floodplain topography, channel morphology and Manning roughness coefficients, as well as accounting for backwater effects could evidently affect local and upstream inundation, which consequently affected flood waves and inundation of the downstream area. It was also shown that the river stage was sensitive to local channel morphology and Manning roughness coefficients, as well as backwater effects. The understanding obtained in this study could be helpful to improving modeling of surface hydrology in basins with evident inundation, especially at regional or larger scales.

A Randomized, Double-Blind, Placebo-Controlled Trial of Low-Dose Sertraline in Young Children With Fragile X Syndrome.

OBJECTIVE: Observational studies and anecdotal reports suggest that sertraline, a selective serotonin reuptake inhibitor, may improve language development in young children with fragile X syndrome (FXS). METHODS: The authors evaluated the efficacy of 6 months of treatment with low-dose sertraline in a randomized, double-blind, placebo-controlled trial in 52 children with FXS aged 2 to 6 years. RESULTS: Eighty-one subjects were screened for eligibility, and 57 were randomized to sertraline (27) or placebo (30). Two subjects from the sertraline arm and 3 from the placebo arm discontinued. Intent-to-treat analysis showed no difference from placebo on the primary outcomes: the Mullen Scales of Early Learning (MSEL) expressive language (EL) age equivalent and Clinical Global Impression Scale-Improvement. However, analyses of secondary measures showed significant improvements, particularly in motor and visual perceptual abilities and social participation. Sertraline was well tolerated, with no difference in side effects between sertraline and placebo groups. No serious adverse events occurred. CONCLUSION: This randomized controlled trial of 6 months of sertraline treatment showed no primary benefit with respect to early EL development and global clinical improvement. However, in secondary exploratory analyses, there were significant improvements seen on motor and visual perceptual subtests, the cognitive T score sum on the MSEL, and on one measure of social participation on the Sensory Processing Measure-Preschool. Furthermore, post hoc analysis found significant improvement in early EL development as measured by the MSEL among children with autism spectrum disorder on sertraline. Treatment appears safe for this 6-month period in young children with FXS, but the authors do not know the long-term side effects of this treatment. These results warrant further studies of sertraline in young children with FXS using refined outcome measures as well as longer term follow-up studies to address long-term side effects of low-dose sertraline in early childhood.

Slowing Amazon deforestation through public policy and interventions in beef and soy supply chains.

The recent 70% decline in deforestation in the Brazilian Amazon suggests that it is possible to manage the advance of a vast agricultural frontier. Enforcement of laws, interventions in soy and beef supply chains, restrictions on access to credit, and expansion of protected areas appear to have contributed to this decline, as did a decline in the demand for new deforestation. The supply chain interventions that fed into this deceleration are precariously dependent on corporate risk management, and public policies have relied excessively on punitive measures. Systems for delivering positive incentives for farmers to forgo deforestation have been designed but not fully implemented. Territorial approaches to deforestation have been effective and could consolidate progress in slowing deforestation while providing a framework for addressing other important dimensions of sustainable development.

Imitation in fragile X syndrome. Implications for autism.

To address the specific impairment of imitation in autism, the imitation abilities of 22 children with fragile X syndrome (FXS) with and without autism were compared. Based on previous research, we predicted that children with FXS and autism would have significantly more difficulty with non-meaningful imitation tasks. After controlling for full-scale IQ and age, the groups did not differ in their overall imitation accuracy scores, but analysis of error patterns revealed that children with FXS and autism made more groping errors and additional movements than the comparison group. These error patterns are consistent with the hypothesis that an action production system deficit plays an important role in the overall imitation deficit in autism, at least in children with FXS.

Gross motor development, movement abnormalities, and early identification of autism.

Gross motor development (supine, prone, rolling, sitting, crawling, walking) and movement abnormalities were examined in the home videos of infants later diagnosed with autism (regression and no regression subgroups), developmental delays (DD), or typical development. Group differences in maturity were found for walking, prone, and supine, with the DD and Autism-No Regression groups both showing later developing motor maturity than typical children. The only statistically significant differences in movement abnormalities were in the DD group; the two autism groups did not differ from the typical group in rates of movement abnormalities or lack of protective responses. These findings do not replicate previous investigations suggesting that early motor abnormalities seen on home video can assist in early identification of autism.

Técnicas avançadas de sensoriamento remoto aplicadas ao estudo de mudanças climáticas e ao funcionamento dos ecossistemas amazônicos / Advanced remote sensing techniques for global changes and Amazon ecosystem functioning studies

Este artigo se propõe a apresentar exemplos de questões científicas que puderam ser respondidas no contexto do Projeto LBA (Large Sale Biosphere-Atmosphere Experiment in Amazonia) graças à contribuição de informações derivadas de sensoriamento remoto. Os métodos de sensoriamento remoto permitem integrar informações sobre os vários processos físicos e biológicos em diferentes escalas de tempo e espaço. Nesse artigo, são enfatizados aqueles avanços de conhecimento que jamais seriam alcançados sem a concorrência da informação derivada de sensoriamento.

Sensory processing correlates of occupational performance in children with fragile X syndrome: preliminary findings.

OBJECTIVES: This preliminary study examined sensory processing and its relationship to occupational performance in children with fragile X syndrome (FXS) to guide research and evidence-based practice. METHOD: Fifteen school-aged boys with full-mutation FXS were assessed with three occupational performance measures (School Function Assessment, Vineland Adaptive Behavior Scales, play duration) and three sensory processing measures (Sensory Profile, Tactile Defensiveness and Discrimination Test-Revised, Sensory Approach-Avoidance Rating). Data were analyzed using partial correlation procedures. RESULTS: Several significant correlations were found, independent of effects of age and IQ. Avoidance of sensory experiences (internally controlled) was associated with lower levels of school participation, self-care, and play. Aversion to touch from externally controlled sources was associated with a trend toward greater independence in self-care--opposite of expectations. CONCLUSION: This study links sensory processing vulnerabilities with individual differences in occupational performance and supports a dynamic view of self-organizing systems. Children's uses of avoidant versus independent behaviors may reflect different self-regulatory or coping strategies that potentially mediate the relationship between sensory processing deficits and occupational behaviors and warrant further investigation.

Outgassing from Amazonian rivers and wetlands as a large tropical source of atmospheric CO2.

Terrestrial ecosystems in the humid tropics play a potentially important but presently ambiguous role in the global carbon cycle. Whereas global estimates of atmospheric CO2 exchange indicate that the tropics are near equilibrium or are a source with respect to carbon, ground-based estimates indicate that the amount of carbon that is being absorbed by mature rainforests is similar to or greater than that being released by tropical deforestation (about 1.6 Gt C yr-1). Estimates of the magnitude of carbon sequestration are uncertain, however, depending on whether they are derived from measurements of gas fluxes above forests or of biomass accumulation in vegetation and soils. It is also possible that methodological errors may overestimate rates of carbon uptake or that other loss processes have yet to be identified. Here we demonstrate that outgassing (evasion) of CO2 from rivers and wetlands of the central Amazon basin constitutes an important carbon loss process, equal to 1.2 +/- 0.3 Mg C ha-1 yr-1. This carbon probably originates from organic matter transported from upland and flooded forests, which is then respired and outgassed downstream. Extrapolated across the entire basin, this flux-at 0.5 Gt C yr-1-is an order of magnitude greater than fluvial export of organic carbon to the ocean. From these findings, we suggest that the overall carbon budget of rainforests, summed across terrestrial and aquatic environments, appears closer to being in balance than would be inferred from studies of uplands alone.