Indigenous livelihood portfolio as a framework for an ecological post-COVID-19 society.

The present economic system is geared towards increasing specialization and infinite growth. This orientation may have led to efficiency and new ways of increasing wealth but it has also led to unsustainable practices and, in some cases, loss of traditional knowledge. Many a systems thinker like the Limits to Growth's Club of Rome have suggested ways to avoid the negative consequences of the current economic system but these entail radical changes that cannot be afforded by deeply-entrenched practices of the worldwide economy. In this paper, another alternative is proposed, which may not only be desirable to an envisioned ecological society but also may also be logical to the unsustainable society of today. Looking at rural indigenous livelihoods may show us how an ecological society should be like. Exemplifying collectivism, indigenous peoples continue to cultivate empathy while at the same time inculcating sense of responsibility. Before "multi-hyphenated" became fashionable, indigenous peoples were already engaged in different occupations that, in turn, result to a diversified livelihood portfolio similar to what banks today advise clients on their investments. However, the difference lies in the indigenous tradition of only having enough for what is needed and rarely hoarding to the point of exhausting resources. This paper proposes that the diverse indigenous livelihood portfolio can be a valuable economic framework for an ecological society. It does not limit growth, but it makes sure growth happens in a sustainable manner.

Predictive value of ophthalmic artery Doppler velocimetry in relation to hypertensive disorders of pregnancy.

PURPOSE: To test the predictive value of ophthalmic artery (OA) Doppler velocimetry in relation to the occurrence of hypertensive disorders of pregnancy (HDP). METHODS: We compared, by analysis of variance, the values of seven OA Doppler variables (peak systolic velocity, second systolic peak velocity [P2], mean velocity, end diastolic velocity, resistance index [RI], pulsatility index [PI], and peak ratio) of 31 women with preeclampsia and 33 women with gestational hypertension vs those of 227 women without HDP. The prognostic value of these variables in relation to the occurrence of HDP was evaluated by the area under the curve (AUC) receiver operating characteristic curve. RESULTS: All OA Doppler variables except RI and PI showed significant (P < .5) differences between groups. After adjustment for confounders, only P2 was an independent predictor of HDP (P < .001), with an AUC of 0.76. The best cut-off point for predicting HDP was P2 ≥ 21.4 cm/s, with sensitivity 69%, specificity 78%, positive likelihood ratio 3.1, negative likelihood ratio 0.4, positive predictive value 47%, and negative predictive value 90%. P2 improved the predictive ability of a model based on clinical variables, incrementing AUC from 0.77 to 0.84 in the final model containing clinical and Doppler variables. CONCLUSION: The elevation of OA P2 in the second trimester of pregnancy is an independent predictor of hypertensive disorders, and improves the discriminatory ability of clinical markers.

Cuidado individual domiciliar de pacientes com fístula arteriovenosa / Individual home care for patients with arteriovenous fistula

Objetivo: analisar o cuidado individual domiciliar de pacientes com fístula arteriovenosa na prevenção de complicações. Método: trata-se de um estudo qualitativo, descritivo e exploratório, com pacientes renais crônicos, orientados e acima dos 18 anos de idade, em uso da fístula arteriovenosa em hemodiálise. Utilizou-se um questionário semiestruturado, analisando os dados pela técnica de Análise de Conteúdo na modalidade Análise de Categoria Temática. Resultados: elencaram-se três categorias: << Cuidado individual domiciliar do paciente com as fístulas arteriovenosas >>; << Estratégias de autocuidado para a prevenção de complicações em pacientes com as fístulas arteriovenosas >>, e, << Autocuidado dos pacientes com as fístulas arteriovenosas: orientações recebidas pelos profissionais de saúde e desafios da prática domiciliar diária >>. Conclusão: torna-se necessário, ao profissional da saúde, adotar estratégias de intervenções mais efetivas em relação às orientações repassadas aos pacientes renais crônicos em uso de fístulas arteriovenosas, visando ao despertar de novas habilidades para exercer seus cuidados domiciliares.(AU)

Objective: to analyze the individual home care of patients with arteriovenous fistula to prevent complications. Method: it is a qualitative, descriptive and exploratory study, with chronic renal patients, oriented and above 18 years of age, using arteriovenous fistula in hemodialysis. A semi-structured questionnaire was used, analyzing the data using the Content Analysis technique in the Thematic Category Analysis modality. Results: three categories were listed: << Individual home care of the patient with arteriovenous fistulas >>; << Self-care strategies for the prevention of complications in patients with arteriovenous fistulas >>, and << Self-care of patients with arteriovenous fistulas: guidelines received by health professionals and challenges of daily home practice >>. Conclusion: it becomes necessary for health professionals to adopt more effective intervention strategies in relation to the guidelines given to chronic renal patients using arteriovenous fistulas, aiming to awaken new skills to exercise their home care.(AU)

Objetivo: analizar la atención domiciliaria individual de pacientes con fístula arteriovenosa para prevenir complicaciones. Método: es un estudio cualitativo, descriptivo y exploratorio, con pacientes renales crónicos, orientados y mayores de 18 años, utilizando fístula arteriovenosa en hemodiálisis. Se utilizó un cuestionario semiestructurado, analizando los datos utilizando la técnica de Análisis de Contenido en la modalidad de Análisis de Categoría Temática. Resultados: se enumeraron tres categorías: <>; <>, y << Autocuidado de pacientes con fístulas arteriovenosas: pautas recibidas por profesionales de la salud y desafíos de la práctica diaria en el hogar>>. Conclusión: se hace necesario que los profesionales de la salud adopten estrategias de intervención más efectivas en relación con las pautas dadas a los pacientes renales crónicos que usan fístulas arteriovenosas, con el objetivo de despertar nuevas habilidades para ejercer su cuidado en el hogar.(AU)

Ecological changes and local knowledge in a giant honey bee (Apis dorsata F.) hunting community in Palawan, Philippines.

One of the traditional livelihood practices of indigenous Tagbanuas in Palawan, Philippines is wild honey hunting and gathering from the giant honey bee (Apis dorsata F.). In order to analyze the linkages of the social and ecological systems involved in this indigenous practice, we conducted spatial, quantitative, and qualitative analyses on field data gathered through mapping of global positioning system coordinates, community surveys, and key informant interviews. We found that only 24% of the 251 local community members surveyed could correctly identify the giant honey bee. Inferential statistics showed that a lower level of formal education strongly correlates with correct identification of the giant honey bee. Spatial analysis revealed that mean NDVI of sampled nesting tree areas has dropped from 0.61 in the year 1988 to 0.41 in 2015. However, those who correctly identified the giant honey bee lived in areas with high vegetation cover. Decreasing vegetation cover limits the presence of wild honey bees and this may also be limiting direct experience of the community with wild honey bees. However, with causality yet to be established, we recommend conducting further studies to concretely model feedbacks between ecological changes and local knowledge.

A review of ecosystem service benefits from wild bees across social contexts.

In order to understand the role of wild bees in both social and ecological systems, we conducted a quantitative and qualitative review of publications dealing with wild bees and the benefits they provide in social contexts. We classified publications according to several attributes such as services and benefits derived from wild bees, types of bee-human interactions, recipients of direct benefits, social contexts where wild bees are found, and sources of changes to the bee-human system. We found that most of the services and benefits from wild bees are related to food, medicine, and pollination. We also found that wild bees directly provide benefits to communities to a greater extent than individuals. In the social contexts where they are found, wild bees occupy a central role. Several drivers of change affect bee-human systems, ranging from environmental to political drivers. These are the areas where we recommend making interventions for conserving the bee-human system.

Does the RIFLE Classification Improve Prognostic Value of the APACHE II Score in Critically Ill Patients?

Introduction. The RIFLE classification defines three severity criteria for acute kidney injury (AKI): risk, injury, and failure. It was associated with mortality according to the gradation of AKI severity. However, it is not known if the APACHE II score, associated with the RIFLE classification, results in greater discriminatory power in relation to mortality in critical patients. Objective. To analyze whether the RIFLE classification adds value to the performance of APACHE II in predicting mortality in critically ill patients. Methods. An observational prospective cohort of 200 patients admitted to the ICU from July 2010 to July 2011. Results. The age of the sample was 66 (±16.7) years, 53.3% female. ICU mortality was 23.5%. The severity of AKI presented higher risk of death: class risk (RR = 1.89 CI:0.97-3.38, P = 0.001), grade injury (RR = 3.7 CI:1.71-8.08, P = 0.001), and class failure (RR = 4.79 CI:2.10-10.6, P = 0.001). The APACHE II had C-statistics of 0.75, 95% (CI:0.68-0.80, P = 0.001) and 0.80 (95% CI:0.74 to 0.86, P = 0.001) after being incorporated into the RIFLE classification in relation to prediction of death. In the comparison between AUROCs, P = 0.03. Conclusion. The severity of AKI, defined by the RIFLE classification, was a risk marker for mortality in critically ill patients, and improved the performance of APACHE II in predicting the mortality in this population.

Ophthalmic artery Doppler velocimetric values in pregnant women at risk for preeclampsia.

OBJECTIVES: The purposes of this study were to describe ophthalmic artery Doppler parameters in pregnant women at risk for preeclampsia in the second trimester, compare them with reference values described in women with healthy pregnancies, and evaluate the association between gestational age and Doppler parameters. METHODS: We conducted an observational study with prospective data collection in which measurements of 7 ophthalmic artery Doppler parameters were obtained in 274 women at 20 to 28 weeks' gestation with clinical risk factors for preeclampsia. The following measurements were obtained: peak systolic velocity, mesodiastolic velocity, mean velocity, end-diastolic velocity, resistive index, pulsatility index, and peak ratio. The observed Doppler values were compared with reference values by a 1-sample t test. To test for linear associations between gestational age and Doppler parameters, the Pearson correlation coefficient was used. RESULTS: Significantly higher ophthalmic artery Doppler velocimetric parameters were observed when compared with the reference values. The mean values of these parameters ± SD were as follows: peak systolic velocity, 37.9 ± 10.3 cm/s (reference, 34.2 cm/s; P < .001); end-diastolic velocity, 7.2 ± 3.1 cm/s (reference, 6.8 cm/s; P = .03); resistive index, 0.81 ± 0.07 (reference, 0.70; P < .001); pulsatility index, 2.17 ± 0.53 (reference, 1.80; P < .001); and peak ratio, 0.53 ± 0.12 (reference, 0.40; P < .001). There was no correlation between the Doppler parameters and gestational age. CONCLUSIONS: Ophthalmic Doppler parameters of women at risk for preeclampsia are significantly higher than reference values for healthy pregnancies, which may indicate an inadequate vascular response to persistent peripheral resistance. Gestational age during the second trimester is not associated with ophthalmic artery Doppler parameters in pregnant women at risk for preeclampsia.

Doppler velocimetry of the orbital vessels in pregnancies complicated by preeclampsia.

Hypertension is one of the most common clinical complications during pregnancy. Preeclampsia, in particular, still accounts for high maternal and fetal morbidity and mortality. Hemodynamic studies have shown that general arteriolar vasoconstriction, which leads to hypoperfusion of target organs, including the eye area, remains the most significant pathological change in preeclampsia. Color Doppler imaging is the most appropriate and the commonly used method for the study of ocular circulation, especially during pregnancy. It enables the visualization and flow measurement of retrobulbar blood vessels. The aim of this review is to evaluate studies that investigated the role of Doppler velocimetry of the maternal orbital vessels, especially the ophthalmic artery, as a tool for the differential diagnosis of hypertensive disorders of pregnancy, for the assessment of the degree and severity of preeclampsia, and for the prediction of these disturbances. The analysis of these studies indicates that the Doppler variables are accurate in the differential diagnosis of hypertensive disorders and in assessing the severity and progression of the preeclampsia and may also be useful markers in the treatment and management of pregnancy-induced hypertension. We found no study evaluating the role of orbital vessels Doppler variables in predicting preeclampsia or in the prognosis of maternal-fetal adverse events.