Do surrogates predict patient preferences more accurately after a physician-led discussion about advance directives? A randomized controlled trial.

BACKGROUND: Caregivers frequently assume the role of surrogate decision-makers but often are unable to accurately predict patients' preferences. This trial aims to find if the use of the Advance Directives documents as a communication tool, improves the agreement between patients and caregivers. METHODS: This trial occurred in a palliative care service of a Portuguese hospital center. A prospective, single-blinded, controlled, randomized trial, enrolling patients and caregivers as a dyad was conducted. Participants individually fulfilled an Advance Directive document, in which patients reported their end-of-life preferences and caregivers reported their decisions as patients' health surrogates. Dyads were randomly assigned to the Intervention or the Control group, in which the physician respectively promoted an open discussion about patients' Advance Directives or evaluated patients' clinical condition. Caregivers' Advance Directives as surrogates were collected one month later. Proportions of agreement and Cohen's κ were used to access agreement and reliability, respectively, between the dyads. RESULTS: Results from 58 dyads were analyzed. We observed an improvement in agreement between the caregivers' answers and the patients' wishes on two-thirds (8/12) of the answers, in the Intervention group, contrasting to one-quarter (3/12) of the answers, in the Control group, despite statistical significance in differences wasn´t obtained. CONCLUSIONS: Although not reaching statistical significance, the results suggest that discussions of advance directives with physicians may lead to better prepared surrogates. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT05090072 . Retrospectively registered on 22/10/2021.

Portación nasal de Staphylococcus aureus en el personal de salud de áreas críticas de un Hospital Pediátrico durante julio-setiembre 2018 / Nasal carriage of Staphylococcus aureus in health personnel in critical areas of a Pediatric Hospital during July-September 2018 / Transporte nasal de Staphylococcus aureus em profissionais de saúde em áreas críticas de um Hospital Pediátrico durante julho-setembro de 2018

Las infecciones intrahospitalarias (IIH) son causa de elevada morbimortalidad y representan un problema sanitario importante. El personal de salud es reservorio y potencial transmisor de los agentes etiológicos de las mismas. S. aureus es uno de los microorganismos implicados, por lo tanto es importante conocer la frecuencia de portación en el personal de salud y establecer el perfil de susceptibilidad antimicrobiana para contribuir con la elaboración de medidas de prevención incluyendo actividades educativas. Objetivo: Conocer la frecuencia de portación de S. aureus, distribución y antibiotipos de las cepas presentes en el personal sanitario del Hospital Pediátrico de Referencia (HPR). Materiales y métodos: Se realizó un estudio descriptivo durante el periodo julio-setiembre del año 2018. Se incluyeron muestras de hisopados nasales de trabajadores de la salud de distintas áreas de internación que consintieron participar en el estudio. Se excluyeron aquellos que recibieron antibióticos dentro de los 3 meses previos al estudio. Las muestras fueron sembradas en agar sangre ovina al 5% (ASO) y se incubaron a 35-37ºC en aerobiosis por 24-48 horas. La identificación de las colonias sospechosas de Staphylococcus aureus por métodos convencionales y MALDI-TOF. El patrón de resistencia antimicrobiana de S. aureus se detectó por disco-difusión. En los cultivos resistentes a meticilina (SAMR) se determinó la presencia del gen mecA y se realizó la tipificación del SCCmec por pruebas de reacción en cadena de polimerasa. Resultados: Se obtuvieron 225 hisopados a partir de 225 trabajadores, presentaron desarrollo 212. En 49 se recuperaron cultivos de S. aureus. Correspondieron a SAMR 11 de las 49 cepas, todas portaban el gen mecA. Hubo predominio en el personal de enfermería (7/11), en los servicios de hemato-oncología (3/11) y cuidados intensivos neonatales (4/11). Asociaron resistencia a macrólidos y clindamicina 8 de 11 aislamientos SAMR, a gentamicina 2 y a mupirocina uno. El SCCmec más frecuentemente identificado fue el tipo IV (7/11). Conclusiones: Los resultados muestran la presencia de cepas SAMR entre el personal de salud del CHPR y aportan información complementaria para efectuar prevención y control de las IIH, actuando sobre todo en el personal de salud encargado de la atención de pacientes susceptibles.

Hospital-acquired infections (IIH) are a cause of high morbidity and mortality and represent a major health problem. Health personnel are reservoirs and potential transmitters of their etiological agents. S. aureus is one of the microorganisms involved, therefore it is important to know the frequency of carriage in health personnel and establish the antimicrobial susceptibility profile to contribute to the development of prevention measures, including educational activities. Objective: To know the frequency of carriage of S. aureus, distribution and antibiotypes of the strains present in the health personnel of the Reference Pediatric Hospital (HPR). Materials and methods: A descriptive study was carried out during the period July-September 2018. Nasal swab samples from health workers from different hospitalization areas who agreed to participate in the study were included. Those who received antibiotics within 3 months prior to the study were excluded. The samples were seeded in 5% sheep blood agar (ASO) and incubated at 35-37ºC in aerobiosis for 24-48 hours. Identification of suspicious Staphylococcus aureus colonies by conventional methods and MALDI-TOF. The antimicrobial resistance pattern of S. aureus was detected by disc diffusion. In methicillin-resistant cultures (MRSA), the presence of the mecA gene was determined and SCCmec was typified by polymerase chain reaction tests. Results: 225 swabs were obtained from 225 workers, 212 showed development. S. aureus cultures were recovered from 49. 11 of the 49 strains corresponded to MRSA, all of them carried the mecA gene. There was a predominance in the nursing staff (7/11), in the hematology-oncology services (3/11) and neonatal intensive care (4/11). They associated resistance to macrolides and clindamycin in 8 of 11 MRSA isolates, 2 to gentamicin, and 1 to mupirocin. The most frequently identified SCCmec was type IV (7/11). Conclusions: The results show the presence of MRSA strains among the health personnel of the CHPR and provide complementary information to carry out prevention and control of IIH, acting especially on the health personnel in charge of the care of susceptible patients.

As infecções hospitalares (HII) são causa de alta morbidade e mortalidade e representam um importante problema de saúde. Os profissionais de saúde são reservatórios e potenciais transmissores de seus agentes etiológicos. O S. aureus é um dos micro-organismos envolvidos, por isso é importante conhecer a frequência de portadores em profissionais de saúde e estabelecer o perfil de suscetibilidade antimicrobiana para contribuir no desenvolvimento de medidas de prevenção incluindo atividades educativas. Objetivo: Conhecer a frequência de portadores de S. aureus, distribuição e antibiótipos das cepas presentes no pessoal de saúde do Hospital Pediátrico de Referência (HPR). Materiais e métodos: Foi realizado um estudo descritivo durante o período de julho a setembro de 2018. Foram incluídas amostras de swab nasal de profissionais de saúde de diferentes áreas de internação que concordaram em participar do estudo. Aqueles que receberam antibióticos nos 3 meses anteriores ao estudo foram excluídos. As amostras foram semeadas em 5% de ágar sangue de carneiro (ASO) e incubadas a 35-37ºC em aerobiose por 24-48 horas. Identificação de colônias suspeitas de Staphylococcus aureus por métodos convencionais e MALDI-TOF. O padrão de resistência antimicrobiana de S. aureus foi detectado por difusão em disco. Em culturas resistentes à meticilina (MRSA), a presença do gene mecA foi determinada e SCCmec foi tipificado por testes de reação em cadeia da polimerase. Resultados: 225 swabs foram obtidos de 225 trabalhadores, 212 apresentaram desenvolvimento. Culturas de S. aureus foram recuperadas de 49. 11 das 49 cepas correspondiam a MRSA, todas carregavam o gene mecA. Houve predominância na equipe de enfermagem (7/11), nos serviços de hematologia-oncologia (3/11) e de terapia intensiva neonatal (4/11). Eles associaram resistência a macrolídeos e clindamicina em 8 de 11 isolados de MRSA, 2 à gentamicina e 1 à mupirocina. O SCCmec mais frequentemente identificado foi o tipo IV (7/11). Conclusões: Os resultados mostram a presença de cepas de MRSA entre os profissionais de saúde do CHPR e fornecem informações complementares para realizar a prevenção e controle da HII, atuando principalmente sobre os profissionais de saúde responsáveis ​​pelo atendimento de pacientes suscetíveis.

Sowing forests: a synthesis of seed dispersal and predation by agoutis and their influence on plant communities.

Granivorous rodents have been traditionally regarded as antagonistic seed predators. Agoutis (Dasyprocta spp.), however, have also been recognized as mutualistic dispersers of plants because of their role as scatter-hoarders of seeds, especially for large-seeded species. A closer look shows that such definitions are too simplistic for these Neotropical animals because agoutis can influence plant communities not only through seed dispersal of large seeds but also through predation of small seeds and seedlings, evidencing their dual role. Herein, we summarize the literature on plant-agouti interactions, decompose agouti seed dispersal into its quantitative and qualitative components, and discuss how environmental factors and plant traits determine whether these interactions result in mutualisms or antagonisms. We also look at the role of agoutis in a community context, assessing their effectiveness as substitutes for extinct megafaunal frugivores and comparing their ecological functions to those of other extant dispersers of large seeds. We also discuss how our conclusions can be extended to the single other genus in the Dasyproctidae family (Myoprocta). Finally, we examine agoutis' contribution to carbon stocks and summarize current conservation threats and efforts. We recorded 164 interactions between agoutis and plants, which were widespread across the plant phylogeny, confirming that agoutis are generalist frugivores. Seed mass was a main factor determining seed hoarding probability of plant species and agoutis were found to disperse larger seeds than other large-bodied frugivores. Agoutis positively contributed to carbon storage by preying upon seeds of plants with lower carbon biomass and by dispersing species with higher biomass. This synthesis of plant-agouti interactions shows that ecological services provided by agoutis to plant populations and communities go beyond seed dispersal and predation, and we identify still unanswered questions. We hope to emphasise the importance of agoutis in Neotropical forests.

Uso de método anticonceptivo previo al embarazo, asesoramiento y preferencia posterior en puérperas del Hospital de Clínicas / Use of contraceptive method prior to pregnancy, counseling and subsequent preference in postpartum women at Hospital de Clínicas / Uso de método contraceptivo antes da gravidez, aconselhamento e posterior preferência em puérperas no Hospital de Clínicas

Los derechos sexuales y reproductivos son derechos que todo individuo debe conocer. La planificación familiar se logra mediante la utilización de métodos anticonceptivos. Si bien se ofrece un amplio abanico de estos en el hospital, no todos reciben orientación, siendo el periodo grávido-puerperal una oportunidad única para realizar la consejería en anticoncepción. El objetivo es evaluar el uso de anticonceptivos previo al embarazo, el asesoramiento durante el puerperio y la elección de anticonceptivo posterior en una población de este hospital. Se realizó un estudio observacional descriptivo transversal realizado a partir de encuesta durante el puerperio de las puérperas del Hospital de Clínicas, en el periodo 01/02/2019 a 31/07/2019. Se evaluaron 220 pacientes. 79,5% de los embarazos no fue planificado. Del total de entrevistadas 35,5% no utilizaba método anticonceptivo previo al embarazo y 33% no habían tenido asesoramiento. Previo al embarazo, los anticonceptivos más usados fueron los anticonceptivos orales combinados (64,1%) y 50% refiere un uso no correcto. 81,6% recibió asesoramiento durante le puerperio. Los anticonceptivos que las pacientes refieren haber recibido mayor información durante el puerperio fueron: implante subdérmico (65,8%) y DIU (48%). 44,1% no recibió información de las contraindicaciones y efectos adversos. Los anticonceptivos más elegidos fueron: implante subdérmico (41,4%), ligadura tubaria (21,8%) y DIU (14,5%). La eficacia (60,1%) y facilidad de uso (43,9%) fueron los motivos más frecuentes de elección. La mayoría de los embarazos fueron no planificados y casi una tercera parte no utilizaba método anticonceptivo previo y nunca habían recibido asesoramiento. Durante el puerperio, la mayoría refiere haber sido asesorada en planificación familiar y optado por alguno de los métodos anticonceptivos siendo los más frecuentemente elegidos los métodos reversibles de larga duración por su facilidad de uso y eficacia.

Sexual and reproductive rights are rights that every individual must know. Family planning is achieved through the use of contraceptive methods. Although a wide range of these are offered in the hospital, not all of them receive counseling, and the pregnancy-puerperal period is a unique opportunity to carry out contraception counseling. The objective is to evaluate the use of contraceptives prior to pregnancy, counseling during the puerperium and the choice of later contraception in a population of this hospital. A cross-sectional descriptive study was carried out based on a survey during the puerperium of the puerperal women of the Hospital de Clínicas, in the period 01/02/2019 to 31/07/2019. 220 patients were evaluated. 79.5% of the pregnancies were unplanned. Of the total interviewed, 35.5% did not use contraception prior to pregnancy and 33% had not had counseling. Before pregnancy, the most used contraceptives were combined oral contraceptives (64.1%) and 50% reported incorrect use. 81.6% received counseling during the puerperium. The contraceptives that the patients reported having received more information during the puerperium were: subdermal implant (65.8%) and IUD (48%). 44.1% did not receive information on contraindications and adverse effects. The most chosen contraceptives were: subdermal implant (41.4%), tubal ligation (21.8%) and IUD (14.5%). Efficacy (60.1%) and ease of use (43.9%) were the most frequent reasons for choice. Most of the pregnancies were unplanned and almost a third were not using prior contraception and had never received counseling. During the puerperium, the majority reported having been counseled on family planning and opted for one of the contraceptive methods, the long-lasting reversible methods being the most frequently chosen for their ease of use and efficacy.

Os direitos sexuais e reprodutivos são direitos que todo indivíduo deve conhecer. O planejamento familiar é realizado por meio do uso de métodos anticoncepcionais. Embora muitos deles sejam oferecidos no hospital, nem todos recebem aconselhamento, e o período gravídico-puerperal é uma oportunidade única para realizar aconselhamento anticoncepcional. O objetivo é avaliar o uso de anticoncepcionais antes da gravidez, o aconselhamento durante o puerpério e a escolha da contracepção posterior em uma população deste hospital. Realizou-se estudo transversal descritivo com base em inquérito no puerpério das puérperas do Hospital de Clínicas, no período de 02/01/2019 a 31/07/2019. 220 pacientes foram avaliados. 79,5% das gestações não foram planejadas. Do total de entrevistadas, 35,5% não usavam anticoncepcionais antes da gravidez e 33% não haviam feito aconselhamento. Antes da gravidez, os anticoncepcionais mais usados eram os anticoncepcionais orais combinados (64,1%) e 50% relataram o uso incorreto. 81,6% receberam aconselhamento durante o puerpério. Os contraceptivos que as pacientes relataram ter recebido mais informações durante o puerpério foram: implante subdérmico (65,8%) e DIU (48%). 44,1% não receberam informações sobre contra-indicações e efeitos adversos. Os anticoncepcionais mais escolhidos foram: implante subdérmico (41,4%), laqueadura (21,8%) e DIU (14,5%). Eficácia (60,1%) e facilidade de uso (43,9%) foram os motivos de escolha mais frequentes. A maioria das gestações não foi planejada e quase um terço não estava usando anticoncepcionais anteriores e nunca havia recebido aconselhamento. No puerpério, a maioria relatou ter sido orientada sobre planejamento familiar e optado por um dos métodos contraceptivos, sendo os métodos reversíveis de longa duração os mais escolhidos pela facilidade de uso e eficácia.

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics.

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data.

Micro- or macroscale? Which one best predicts the establishment of an endemic Atlantic Forest palm?

Historically, macroecology and microecology have diverged with regard to the niche concept. A better understanding of functioning ecological systems, however, depends on an integrative approach to this concept at different spatial scales. A mixed approach, merging macro- and microscale by validating ecological niche modeling (ENM) with the results of in situ experiments and environmental data collection was used to understand if areas identified by ENM as highly suitable for adult palms are also adequate for seedling establishment. Syagrus weddelliana's (Arecaceae) distribution range falls within the Atlantic Rain Forest, and more specifically Serra dos Órgãos region (Rio de Janeiro state), southeastern Brazil. The following steps were performed: (a) ENM to delimit the area of occurrence of S. weddelliana and locate experimental areas; (b) a seed sowing experiment in areas with presence or absence of the species in areas of high or low environmental suitability at 36 experimental stations; and (c) characterization of each microhabitat which was related back to the macroscale results of ENM. Evidence of biotic and abiotic limitations was found for S. weddelliana distribution. Areas of higher suitability had lower seed predation rates and, consequently, higher seed germination rates. On the other hand, areas with low environmental suitability at the macroscale were divided into two types: areas with microhabitat similar to that of areas with high environmental suitability that had some germination despite high predation and areas with different environmental conditions that had no germination and high predation rates. Seedlings and adults had different abiotic requirements. Microhabitat conditions were more important for the initial establishment of S. weddelliana than macroclimatic variables. This finding demonstrates that macro- and microecological information works in a complementary way to a better understanding of the distribution of S. weddelliana.

Effects of howler monkey reintroduction on ecological interactions and processes.

Rewilding has been an increasingly popular tool to restore plant-animal interactions and ecological processes impaired by defaunation. However, the reestablishment of such processes has seldom been assessed. We investigated the restoration of ecological interactions following the reintroduction of the brown howler monkey (Alouatta guariba) to a defaunated Atlantic forest site. We expected the reintroduction to restore plant-animal interactions and interactions between howlers and dung beetles, which promote secondary seed dispersal. We estimated the number of interactions expected to be restored by the reintroduction to provide the baseline interaction richness that could be restored. We followed the reintroduced howler monkeys twice a week for 24 months (337 hours total) to assess their diet. We used howler monkey dung in secondary seed dispersal experiments with 2484 seed mimics to estimate the removal rates by dung beetles and collected the beetles to assess community attributes. We compared the potential future contribution of howler monkeys and other frugivores to seed dispersal based on the seed sizes they disperse in other areas where they occur. In 2 years, howler monkeys consumed 60 animal-dispersed plant species out of the 330 estimated. Twenty-one dung beetle species were attracted to experimentally provided dung; most of them were tunnelers, nocturnal, and large-sized (>10 mm). On average 30% (range 0-100%) of the large seed mimics (14 mm) were moved by dung beetles. About 91% of the species consumed by howlers (size range 0.3-34.3 mm) overlapped in seed size with those removed by dung beetles. In our study area, howler monkeys may consume more large-seeded fruit species than most other frugivores, highlighting their potential to affect forest regeneration. Our results show reintroductions may effectively restore ecological links and enhance ecological processes.

Estimating interaction credit for trophic rewilding in tropical forests.

Trophic rewilding has been suggested as a restoration tool to restore ecological interactions and reverse defaunation and its cascading effects on ecosystem functioning. One of the ecological processes that has been jeopardized by defaunation is animal-mediated seed dispersal. Here, we propose an approach that combines joint species distribution models with occurrence data and species interaction records to quantify the potential to restore seed-dispersal interactions through rewilding and apply it to the Atlantic Forest, a global biodiversity hotspot. Using this approach, we identify areas that should benefit the most from trophic rewilding and candidate species that could contribute to cash the credit of seed-dispersal interactions in a given site. We found that sites within large fragments bearing a great diversity of trees may have about 20 times as many interactions to be cashed through rewilding as small fragments in regions where deforestation has been pervasive. We also ranked mammal and bird species according to their potential to restore seed-dispersal interactions if reintroduced while considering the biome as a whole and at finer scales. The suggested approach can aid future conservation efforts in rewilding projects in defaunated tropical rainforests.This article is part of the theme issue 'Trophic rewilding: consequences for ecosystems under global change'.

Living and lost mammals of Rio de Janeiro's largest biological reserve: an updated species list of Tinguá / Mamíferos atuais e extintos na maior Reserva Biológica do Rio de Janeiro: uma lista atualizada de espécies do Tinguá

Abstract: The Tinguá Biological Reserve (TBR) is the largest protected area of this category in Rio de Janeiro state. Here, for the first time, we present the historical composition of terrestrial mammals' assemblage of TBR region. An inventory was conducted using transect surveys, nonstandard transects, survey of museum specimens and informal reports. Considering all the data, eighty-five species were recorded, placing TBR as the second one in the number of mammals recorded in "Serra do Mar" ecoregion of Atlantic Forest and in the Rio de Janeiro state. Among the species with historical records are the jaguar (Panthera onca) and the golden-lion-tamarin (Leontopithecus rosalia) while the current presence of the maned wolf (Chrysocyon brachyurus) was recorded for the first time. Priority studies should focus on Chiroptera, Rodentia and Didelphimorphia orders, especially in the most remote areas of the reserve, and long-term surveys of endangered species. Besides hunting, fragmentation of its interior by roads, pipelines and transmission lines and exotic species, TBR is also threatened by the urban growth around it and the pressure to reduce its area and its protection category, demanding greater attention by the high levels of governance of protected areas in Brazil.

Resumo: A Reserva Biológica Tinguá (RBT) é a maior área protegida desta categoria no estado do Rio de Janeiro. Aqui, pela primeira vez, apresentamos a composição histórica da assembleia de mamíferos terrestres da região da RBT. Um inventário foi realizado utilizando amostragem por transectos, transectos não padronizados, busca por espécimes em museu e relatos. Considerando todos os dados, foram registradas oitenta e cinco espécies, colocando a RBT como a segunda no número de mamíferos registrados na ecorregião "Serra do Mar" da Mata Atlântica e no estado do Rio de Janeiro. Entre as espécies com registros históricos estão a onça-pintada (Panthera onca) e o mico-leão-dourado (Leontopithecus rosalia), enquanto a presença atual do lobo-guará (Chrysocyon brachyurus) foi registrada pela primeira vez. Estudos prioritários devem se concentrar nas ordens de Chiroptera, Rodentia e Didelphimorphia, especialmente nas áreas mais remotas da reserva, e pesquisas de longo prazo sobre espécies ameaçadas de extinção. Além da caça, a fragmentação em seu interior por estradas, gasodutos e linhas de transmissão e a presença de espécies exóticas, a TBR é ameaçada também pelo crescimento urbano no entorno e pela pressão para reduzir sua área e categoria de proteção, exigindo maior atenção dos altos níveis de gestão de áreas protegidas no Brasil.

Credit of ecological interactions: A new conceptual framework to support conservation in a defaunated world.

As defaunation spreads through the world, there is an urgent need for restoring ecological interactions, thus assuring ecosystem processes. Here, we define the new concept of credit of ecological interactions, as the number of interactions that can be restored in a focal area by species colonization or reintroduction. We also define rewiring time, as the time span until all the links that build the credit of ecological interactions of a focal area have become functional again. We expect that the credit will be gradually cashed following refaunation in rates that are proportional to (1) the abundance of the reintroduced species (that is expected to increase in time since release), (2) the abundance of the local species that interact with them, and (3) the traits of reintroduced species. We illustrated this approach using a theoretical model and an empirical case study where the credit of ecological interactions was estimated. This new conceptual framework is useful for setting reintroduction priorities and for evaluating the success of conservation initiatives that aim to restore ecosystem services.

Medium and large-sized mammals of the Reserva Ecológica de Guapiaçú, Cachoeiras de Macacu, RJ / Mamíferos de médio e grande porte da Reserva Ecológica de Guapiaçú, Cachoeiras de Macacu, RJ

Medium and large-sized terrestrial mammals develop important functions in ecosystems maintenance. However, this group is the most vulnerable to local extinctions, through habitat loss or hunting. This study inventoried the community of medium and large mammals in the Reserva Ecológica de Guapiaçú (REGUA), Cachoeiras de Macacu, RJ, providing data on species composition, richness and abundance. Species were registered through the use of camera traps, sign survey and visual encounters on pre-existing trails and roads. The study was conducted from January to October 2012, with each month considered as a sample unit. An effort of 1568 cameras-day and 120 km traveled, resulted on 302 records of 22 species of medium and large-sized mammals, belonging to eight orders. This value corresponds to more than three-quarters of the richness described from this group in the Atlantic Forest of Rio de Janeiro state. Five species are under some level of regional, national or global threat. Three game species, Pecari tajacu, Cuniculus paca and Dasyprocta leporina were abundant in the area. The observed richness was comparable to that found in other studies conducted in rain forests. Thus, for its high number of species, including those under some degree of threat, we conclude that REGUA is an important area to mammal conservation, especially in the Atlantic Forest of Rio de Janeiro state.

Mamíferos de médio e grande porte desempenham funções importantes para a manutenção dos ecossistemas. Porém, esse grupo é um dos mais vulneráveis a extinções locais, seja pela perda de hábitat ou pela caça. Neste estudo foi inventariada a comunidade de médios e grandes mamíferos na Reserva Ecológica de Guapiaçú (REGUA), Cachoeiras de Macacu, RJ, sendo descritos dados de composição, riqueza e abundância. As espécies foram registradas através do uso de armadilhas fotográficas, busca por vestígios e visualizações diretas em trilhas e estradas pré-existentes. O estudo foi realizado de janeiro a outubro de 2012, sendo cada mês considerado uma unidade amostral. A partir de um esforço de 1568 câmeras-dia e de 120 km caminhados, obtivemos 302 registros de 22 espécies de mamíferos de médio e grande porte, pertencentes a oito Ordens. Esse valor corresponde a mais que três quartos da riqueza de espécies descrita para esse grupo na Mata Atlântica do estado do Rio de Janeiro. Cinco espécies encontram-se sob algum nível de ameaça regional, nacional ou global. Três espécies cinegéticas,Pecari tajacu, Cuniculus paca eDasyprocta leporina foram abundantes na área. A riqueza observada foi comparável è encontrada em outros estudos realizados em florestas ombrófilas densas. Assim, por seu elevado número de espécies, incluindo aquelas sob algum grau de ameaça, concluímos que a REGUA é um lugar de destaque para a conservação da biodiversidade de mamíferos, especialmente na Mata Atlântica do estado do Rio de Janeiro.

Prenatal maternal stress predicts autism traits in 6½ year-old children: Project Ice Storm.

Research implicates prenatal maternal stress (PNMS) as a risk factor for neurodevelopmental disorders; however few studies report PNMS effects on autism risk in offspring. We examined, prospectively, the degree to which objective and subjective elements of PNMS explained variance in autism-like traits among offspring, and tested moderating effects of sex and PNMS timing in utero. Subjects were 89 (46F/43M) children who were in utero during the 1998 Quebec Ice Storm. Soon after the storm, mothers completed questionnaires on objective exposure and subjective distress, and completed the Autism Spectrum Screening Questionnaire (ASSQ) for their children at age 6½. ASSQ scores were higher among boys than girls. Greater objective and subjective PNMS predicted higher ASSQ independent of potential confounds. An objective-by-subjective interaction suggested that when subjective PNMS was high, objective PNMS had little effect; whereas when subjective PNMS was low, objective PNMS strongly affected ASSQ scores. A timing-by-objective stress interaction suggested objective stress significantly affected ASSQ in first-trimester exposed children, though less so with later exposure. The final regression explained 43% of variance in ASSQ scores; the main effect of sex and the sex-by-PNMS interactions were not significant. Findings may help elucidate neurodevelopmental origins of non-clinical autism-like traits from a dimensional perspective.

Prenatal diagnosis of a large fetal cervical teratoma by three-dimensional ultrasonography: a case report.

CONTEXT: The cervical teratomas are rare, benign tumors, they are formed by the three embryonic layers, and they represent only 6% of teratomas. The prognosis depends mainly on the size and location of the lesion, on the tumor growth rate, and on the level of tracheal compression. Prenatal diagnosis is usually reached with the aid of a two-dimensional ultrasonography (2DUS) after the 15th week of gestation, which shows a large heterogeneous mass in the cervical region, plus a polyhydramnios, on the Doppler mode which also shows the vascularization of the tumor. CASE REPORT: We report a case of cervical teratoma diagnosed on the 31st week of gestation with the aid of a 2DUS and color Doppler mode. We focus on the main findings obtained with the three-dimensional ultrasonography in surface mode, and we highlight the importance of this methodology for the indirect evaluation of the neonatal prognosis.

[Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy]. / Remoção de corpo estranho da via aérea de criança por broncoscopia através de traqueotomia ou traqueostomia.

OBJECTIVE: Most foreign bodies in the airway are removed by respiratory endoscopy. Rarely, the removal of the foreign body has to be performed through endoscopic control by tracheotomy or tracheostomy. This article reports three cases of foreign body removal in children performed by tracheal opening. DESCRIPTION: Retrospective review of records with report of three cases of children who aspirated foreign bodies into the airway. In the first case, there was rupture of the tracheostomy tube, with aspiration of its distal portion. Endoscopic removal was performed by tracheostomy. The second child aspirated a pen cap. It could not be removed by endoscopy because it would not pass through the subglottic region. Cervical tracheotomy was performed and the foreign body was removed with endoscopic control. In the last case, the foreign body was in the left main bronchus. It was removed by bronchoscopy through tracheostomy opening. All children presented good outcome after the endoscopic procedure. The trachea of the patient submitted to tracheotomy was sutured after the foreign body removal. Tracheostomy was not necessary. In the children with previous tracheostomy, the tube was put back after the foreign body removal. COMMENTS: Most foreign bodies in the airway of children can be removed by endoscopy. When the foreign body is too large to pass through the subglottic region, or so sharp that it can injure the airway, the use of tracheotomy or tracheostomy is indicated.

Remoçäo de corpo estranho da via aérea de criança por broncoscopia através de traqueotomia ou traqueostomia / Bronchoscopic removal of foreign body from airway through tracheotomy or tracheostomy

OBJETIVO: a maioria dos corpos estranhos aspirados para a via aérea é removida através de endoscopia respiratória. Em situações raras, a retirada deste material tem que ser realizada sob controle endoscópico, através de traqueotomia ou traqueostomia. A seguir, relatamos casos de crianças cuja remoçäo de corpos estranhos aspirados para a via aérea foi realizada por abertura traqueal. DESCRIÇÄO: revisäo retrospectiva de prontuários, com relato de três crianças que aspiraram corpos estranhos para a via aérea. A primeira apresentou ruptura da cânula de traqueostomia, com aspiraçäo da porçäo distal da mesma. Foi realizada remoçäo endoscópica através do traqueostoma. A segunda aspirou tampa de caneta, que näo conseguia ser removida endoscopicamente, pois a mesma trancava e näo passava na regiäo subglótica. Foi realizado, entäo, traqueotomia cervical e remoçäo do corpo estranho sob controle endoscópico. A terceira apresentou corpo estranho aspirado para o brônquio principal esquerdo (palito de madeira), que foi removido através de broncoscopia, realizada pelo orifício da traqueostomia. Todas as crianças toleraram o procedimento endoscópico, com remoçäo do corpo estranho. No paciente em que foi realizada traqueotomia, a traquéia foi suturada após retirada do corpo estranho, näo havendo necessidade de realizaçäo de traqueostomia. Nas crianças com traqueostomia prévia, a mesma foi recolocada após a retirada do corpo estranho. COMENTARIOS: uma minoria dos corpos estranhos aspirados para a via aérea de criança näo pode ser removido somente por endoscopia. Quando o corpo estranho é demasiadamente largo que näo passa na regiäo subglótica, ou pontiagudo que possa traumatizar a via aérea, a remoçäo pode ser realizada por endoscopia, através de traqueotomia ou traqueostomia.