Use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência, and Sociedade Brasileira de Medicina Hospitalar. Part 1 - Competence in bedside echocardiography.

The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.

The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects.

Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.

Ergonomics management model based on good practices of large industrial companies: Structured elements through the fuzzy set theory.

BACKGROUND: Most organizations perceive the concept of ergonomic actions as a local tool used to improve workplace issues. Ergonomics however is not included in global management systems. The paradigm of ergonomics action in large organizations proposed by this study is that of management systems whose primary objective is the pressing need for continuous performance improvement, acquisition of excellence, and integration into all aspects of the business. OBJECTIVE: The general objective of this work is to draw a frame presenting a model of ergonomics management based on good practices in managing this discipline in large industrial companies. METHOD: In this study, we describe a strategy based on the fuzzy set theory to aggregate a group of good practices expressed by experienced ergonomists attached to large industrial companies for handling the lack of ergonomics in an organization. RESULTS: A set of good practices was compiled as a basis for application in ergonomics in large companies. CONCLUSION: This study shows that ergonomics should not be considered an isolated phenomenon but in a strategic, proactive, integrated, and perennial way as one of the management subjects.

Use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência, and Sociedade Brasileira de Medicina Hospitalar. Part 1 - Competence in bedside echocardiography / Uso da ecocardiografia à beira do leito no cuidado do paciente grave - um documento conjunto de consenso da Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência e Sociedade Brasileira de Medicina Hospitalar. Parte 1 - Competência em ecocardiografia à beira do leito

ABSTRACT The use of echocardiography by physicians who are not echocardiographers has become common throughout the world across highly diverse settings where the care of acutely ill patients is provided. Echocardiographic evaluation performed in a point-of-care manner can provide relevant information regarding the mechanism of causes of shock, for example, increasing the rates of correct diagnosis and allowing for faster informed decision-making than through evaluation methods. Considering that the accurate diagnosis of life-threatening situations is essential for professionals working with acutely ill patients, several international associations recommend that physicians responsible for critically ill patients acquire and develop the ability to perform bedside ultrasound examinations, including echocardiographic examinations. However, there is no consensus in the literature regarding which specific applications should be included in the list of skills for nonechocardiographer physicians. Taking into account the multiplicity of applications of echocardiography in different scenarios related to acutely ill patients; the differences in the published protocols, with regard to both the teaching methodology and competence verification; and the heterogeneity of training among highly diverse specialties responsible for their care at different levels, this consensus document aimed to reflect the position of representatives of related Brazilian medical societies on the subject and may thus serve as a starting point both for standardization among different specialties and for the transmission of knowledge and verification of the corresponding competencies.

RESUMO O emprego da ecocardiografia por médicos não ecocardiografistas tem se tornado comum em todo o mundo nos mais diversos ambientes em que se dá o cuidado do paciente agudamente doente. A avaliação ecocardiográfica realizada de forma point-of-care pode fornecer informações pertinentes em relação ao mecanismo das causas de choque, por exemplo, incrementando as taxas de diagnóstico correto e possibilitando a tomada de decisão fundamentada de forma mais rápida do que por meio dos métodos tradicionais de avaliação. Considerando que o diagnóstico preciso de situações ameaçadoras à vida é indispensável a profissionais atuando junto a pacientes agudamente enfermos, diversas entidades associativas internacionais recomendam que médicos responsáveis por pacientes gravemente doentes devam adquirir e desenvolver a habilidade para realizar exames ultrassonográficos à beira do leito, inclusive ecocardiográficos. Entretanto, não há consenso na literatura acerca de quais aplicações específicas devam compor o rol de habilidades do médico não ecocardiografista. Levando-se em consideração a multiplicidade de aplicações da ecocardiografia em diversos cenários relativos ao paciente agudamente enfermo; as diferenças nos protocolos publicados, tanto no que diz respeito à metodologia de ensino como de verificação de competências, bem como a heterogeneidade da formação entre as mais diversas especialidades responsáveis pelo seu cuidado em diferentes níveis, este documento de consenso teve o objetivo de refletir o posicionamento de representantes de sociedades médicas brasileiras afins acerca do tema, podendo, assim, servir de ponto de partida para a uniformização entre diferentes especialidades, bem como para a transmissão de conhecimento e a verificação das competências correspondentes.

The use of bedside echocardiography in the care of critically ill patients - a joint consensus document of the Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência and Sociedade Brasileira de Medicina Hospitalar. Part 2 - Technical aspects / O uso da ecocardiografia à beira do leito no cuidado do paciente grave - um documento conjunto de consenso da Associação de Medicina Intensiva Brasileira, Associação Brasileira de Medicina de Emergência e Sociedade Brasileira de Medicina Hospitalar. Parte 2 - Aspectos técnicos

ABSTRACT Echocardiography in critically ill patients has become essential in the evaluation of patients in different settings, such as the hospital. However, unlike for other matters related to the care of these patients, there are still no recommendations from national medical societies on the subject. The objective of this document was to organize and make available expert consensus opinions that may help to better incorporate echocardiography in the evaluation of critically ill patients. Thus, the Associação de Medicina Intensiva Brasileira, the Associação Brasileira de Medicina de Emergência, and the Sociedade Brasileira de Medicina Hospitalar formed a group of 17 physicians to formulate questions relevant to the topic and discuss the possibility of consensus for each of them. All questions were prepared using a five-point Likert scale. Consensus was defined a priori as at least 80% of the responses between one and two or between four and five. The consideration of the issues involved two rounds of voting and debate among all participants. The 27 questions prepared make up the present document and are divided into 4 major assessment areas: left ventricular function, right ventricular function, diagnosis of shock, and hemodynamics. At the end of the process, there were 17 positive (agreement) and 3 negative (disagreement) consensuses; another 7 questions remained without consensus. Although areas of uncertainty persist, this document brings together consensus opinions on several issues related to echocardiography in critically ill patients and may enhance its development in the national scenario.

RESUMO A ecocardiografia do paciente grave tem se tornado fundamental na avaliação de pacientes em diferentes cenários e ambientes hospitalares. Entretanto, ao contrário de outras áreas relativas ao cuidado com esses pacientes, ainda não existem recomendações de sociedades médicas nacionais acerca do assunto. O objetivo deste documento foi organizar e disponibilizar opiniões de consenso de especialistas que possam auxiliar a melhor incorporação dessa técnica na avaliação de pacientes graves. Dessa forma, a Associação de Medicina Intensiva Brasileira, a Associação Brasileira de Medicina de Emergência e a Sociedade Brasileira de Medicina Hospitalar compuseram um grupo de 17 médicos para formular questões pertinentes ao tópico e debater a possibilidade de consenso de especialistas para cada uma delas. Todas as questões foram elaboradas no formato de escala Likert de cinco pontos. Consenso foi definido, a priori, como um somatório de, ao menos, 80% das respostas entre um e dois ou entre quatro e cinco. A apreciação das questões envolveu dois ciclos de votação e debate entre todos os participantes. As 27 questões elaboradas compõem o presente documento e estão divididas em 4 grandes áreas de avaliação: da função ventricular esquerda; da função ventricular direita; diagnóstica dos choques e hemodinâmica. Ao fim do processo, houve 17 consensos positivos (concordância) e 3 negativos (discordância); outras 7 questões persistiram sem consenso. Embora persistam áreas de incerteza, este documento reúne opiniões de consenso para diversas questões relativas à ecocardiografia do paciente grave e pode potencializar seu desenvolvimento no cenário nacional.

Native multispecies and fast-growing forest root biomass increase C and N stocks in a reclaimed bauxite mining area.

This study is aimed at evaluating C and N stocks in fractions of soil organic matter (SOM) in an area of bauxite mining under recovery with tree species. We have analyzed the long-term recovery of C and N stocks of organic matter fractions from five types of forest cover (Eucalyptus, Anadenanthera peregrina, mixed plantation of 16 native species, a mined area without vegetation cover as a control site, and a natural forest cover as a reference site). The total organic C (TOC) and N (TN) stocks and also organic matter fractions, particulate organic matter (POM), mineral-associated organic matter (MAOM), microbial biomass (MB), and labile C (LC), were determined, as well as the C/N ratio and the carbon management index (CMI). Although the stocks of TOC and LC, CMI, and MB did not differ between the types of forest cover in the 0-60 cm layer, they were lower than the values in the native forest. Forest cover increases the stocks of TOC, LC, MB, and CMI in the area of bauxite mining compared to the control site. In addition, we found that the TOC C and TN stocks and also SOM fractions (LC, C-MAOM, C-POM, N-MAOM, and N-POM) are positively correlated (r ≥ 0.71 for all cases) with volume of roots larger than 2 mm. Therefore, Eucalyptus, A. peregrina, and a mixed of 16 native trees contribute for restoring stocks of soil C and N following bauxite mining in the Brazilian Atlantic Forest.

Analysis of government agencies and stakeholders' twitter communications during the first surge of COVID-19 in Brazil.

BACKGROUND: Official authorities are in charge of communicating with the public in a consistent and coherent manner. The impact of social media on managing the coronavirus 2019 (COVID-19) pandemic potentially influenced social behavior in Brazil. OBJECTIVE: Using Twitter, this study analyzes communications about the COVID-19 pandemic from official agencies of the Brazilian government and key public sector decision-makers. METHOD: We captured public Twitter messages about COVID-19 exchanged between authorities at the federal, state, and municipal levels of government. These messages were further classified into guidance and information messages or disinformation messages. Finally, through analysis of tweets and their frequency, we evidenced the level of information generated by the three levels of government. RESULTS: Our analyses show an underestimation of the magnitude of the pandemic by Brazilian government authorities. None of the spheres of government anticipated the imminent health crisis, did not issue good recommendations and guidelines, and did not take preventive actions. CONCLUSION: The lack of governmental actions and adequate guidance in Brazil has led to an explosive increase in infected people and deaths. Surprisingly, this was not due to technical or structural reasons. It resulted from conflicting communication strategies implemented by the federal, state, and municipal governments in attempts to minimize the effects of COVID-19 on their local health structures.

Influence of different seabird species on trace metals content in Antarctic soils.

The behavior and feeding habits of different species of seabirds can influence the enrichment of trace metals in Antarctic soils. This study aimed to evaluate the influence of different species of seabirds on the concentrations of potentially toxic metals in Antarctic soils. For this, we collected soil samples in areas influenced by penguins, kelp gulls, and giant petrels. We analyzed the concentration of total organic carbon (TOC), total nitrogen (TN), available phosphorus (P) and metals by three different methods of extraction: USEPA 3051A, Mehlich-1, and distilled water. The concentrations of Cr and Hg presented positive correlations with P, TOC, and TN by the USEPA 3051A method, indicating the biotransport of these metals by seabirds. Soils influenced by penguins showed higher levels of P, TOC, TN, Cr, and Hg. Comparing the results from the different extractors, we found that Hg had the highest relative levels in the exchangeable fraction and the soil solution. Therefore, the soils with the influence of penguins present higher levels of biotransported trace metals, but this does not necessarily mean that these birds have a higher biotransport potential, since the concentration of trace metals in these soils may be related to their degree of ornithogenesis.

Pulmonary Benign Metastasizing Leiomyoma: Case Report of Late Occurrence in Postmenopausal Patient / Leiomiomatose Benigna Metastatizante Pulmonar: Relato de um Caso com Ocorrência Tardia em Paciente Pós-menopausa / Leiomiomatosis Benigna Metastatizante Pulmonar: Reporte de un Caso con Ocurrencia Tardía en Paciente Posmenopáusica

Introduction: Pulmonary benign metastasizing leiomyoma (PBML) is a rare condition that occurs most commonly in young women of reproductive age some years after hysterectomy. The aim of this study was to report a PBML case which occurred 33 years after hysterectomy in a postmenopausal patient. Case report: A 59-year-old female diabetic patient, G2P2A0, with dyslipidemia, a non-smoker and ex-alcoholic (quit in the 90s), with pulmonary symptoms was referred to the health service. A chest computed tomography (CT) revealed multiple pulmonary nodules. A previous history of hysterectomy at 26 years of age led to a diagnostic hypothesis of PBML. The patient underwent segmentectomy of the largest nodule (measuring 1.2 x 0.9 cm) located in the left lung. Histopathology and immunohistochemistry studies confirmed the diagnosis of PBML. Conclusion: The patient is currently in good physical condition (regression of previous pulmonary symptoms) and scheduled for clinical follow-up. A new chest CT will be performed in 6 months

Introdução: A leiomiomatose benigna metastatizante pulmonar (LBMP) é uma doença rara, ocorrendo mais comumente em mulheres jovens em idade reprodutiva alguns anos após a realização de histerectomia. O objetivo deste estudo foi relatar um caso de LBMP de ocorrência tardia, 33 anos após a realização de histerectomia, em uma paciente pós-menopausa. Relato do caso: Paciente do gênero feminino, 59 anos, G2P2A0, diabética, dislipidêmica, não tabagista e ex-etilista (parou na década de 1990), foi encaminhada ao serviço médico com sintomas pulmonares, sendo realizada tomografia computadorizada (TC) de tórax que revelou múltiplos nódulos pulmonares. Havia história prévia de histerectomia aos 26 anos de idade, sendo levantada a hipótese diagnóstica de LBMP. Paciente realizou segmentectomia do maior nódulo (medindo 1,2 x 0,9 cm) localizado no pulmão esquerdo. Exame anatomopatológico e imuno-histoquímica confirmaram o diagnóstico de LBMP. Conclusão: Atualmente, a paciente se encontra em seguimento clínico e em bom estado geral (sem os sintomas pulmonares apresentados inicialmente). Será realizada uma nova TC de tórax em seis meses

Introducción: La leiomiomatosis benigna metastatizante pulmonar (LBMP) es una enfermedad rara, que ocurre con mayor frecuencia en mujeres jóvenes en edad reproductiva pocos años después de la histerectomía. El objetivo de este estudio fue reportar un caso de LBMP de inicio tardío, 33 años después de la histerectomía, en una paciente posmenopáusica. Reporte del caso: Paciente de género femenino, 59 años, G2P2A0, diabética, dislipidémica, no fumadora y exalcohólica (parado en los 90), fue remitida al servicio por cuadro pulmonar, siendo sometida a tomografía computarizada (TC) de tórax, que reveló múltiples nódulos pulmonares. Existía antecedente de histerectomía a los 26 años, planteando la hipótesis diagnóstica de LBMP. Paciente fue sometida a segmentectomía del nódulo de mayor tamaño (de 1,2 x 0,9 cm) localizado en el pulmón izquierdo. El examen patológico y la inmunohistoquímica confirmaron el diagnóstico de LBMP. Conclusión: Actualmente la paciente se encuentra en seguimiento clínico y en buen estado general (sin los síntomas pulmonares presentados inicialmente). Se realizará una nueva TC de tórax en seis meses

Seabirds enrich Antarctic soil with trace metals in organic fractions.

Coastal areas of Antarctica are subjected to anthropic contamination from around the world by trace metals biotransported and accumulated by seabird excrements. To explore this hypothesis, this study investigated the influence of seabirds on the contents of trace metals in soil organic fractions from Antarctica under different climatic conditions and from different parent materials. For this, soil profiles from the Maritime Antarctica region were selected based on the criteria of ornithogenesis, parent material, and climate. The contents of C, N, and selected metals (Ba, Co, Cr, Cu, Fe, Mn, Ni, Pb, Sr, and Zn) were analysed in the organic matter associated with minerals (MAOM), the particulate fraction (POM), and in the total soil (MAOM + POM). The ornithogenic soils presented the highest amounts of C and N in the soil, MAOM, and POM as compared to nonornithogenic soils. Seabird activity resulted in an enrichment of Pb, Zn, and Cu. Among these biotransported metals, Cu and Zn seem to originate from natural biogenic processes in marine food chains, unlike Pb, which seems to come from anthropogenic sources. The soils developed from igneous rocks presented higher amounts of Ba, Co, Cu, Fe, Mn, and Sr in the soil, MAOM, and POM than soils from sedimentary rocks. The climate had no clear effect on most metals. Hence, seabirds enrich soils, MAOM, and POM with Cu, Zn, and Pb, whereas the amounts of Ba, Co, Cr, Fe, Mn, Ni, and Sr are mainly lithogenic, associated with the parent material. Monitoring biotransported trace metals in ornithogenic soils is of great importance, since they can create environmental toxicity to terrestrial plants and animals and can influence the food chain in the coastal areas of Antarctica.

Taro Mucilage: Extraction, Characterization, and Application in Cosmetic Formulations.

Taro mucilage, a hydrocolloid present in the rhizome of Colocasia esculenta (L.) Schott, was extracted and characterized by infrared spectroscopy, X-ray diffraction, scanning electron microscopy, thermal analysis, and proximal composition. In addition, cosmetic formulations based on extracted mucilage were developed and studied. The mucilage presented a semicrystalline structure with high thermal stability, the presence of granules along its surface area, and good emulsifying activity. High physical-chemical stability was also found in the mucilage and the cosmetic formulations during storage. All cream samples presented pseudoplastic behavior, with a flow behavior index lower than 1, which is a desirable characteristic for cosmetics, as it improves its applicability. The mucilage demonstrates potential for application in cosmetic products, and its commercial use as an ingredient in cosmetics could be a strategic tool for the creation of a new product chain and adding value to the culture of Colocasia0 esculenta.

Chemical analyses of flowers and leaves for nutritional diagnoses of coffee trees / Diagnóstico nutricional do cafeeiro por meio de análise floral e foliar

ABSTRACT: The chemical analysis of flowers has been studied for some crops. In coffee trees, the flower tissue analysis could anticipate the nutritional diagnosis. This study aimed to: (i) compare the mineral composition of coffee flowers and leaves; and to (ii) generate reference values for nutritional diagnosis of coffee trees, based on flower and leaf analysis. Nutrient content of flowers and leaves and coffee productivity were evaluated in 26 commercial farms located in Manhuaçu, MG, Brazil throughout three years. The critical nutrient content range in flowers are respectively: 2.78 - 3.17, 0.23 - 0.28, 2.80 - 3.12, 0.30 - 0.37, 0.24 - 0.30, 0.15 - 0.18 dag kg-1 of N, P, K, Ca, Mg, and S; and 17 - 21, 12 - 18, 52 - 80, 26 - 43, and 28 - 48 mg kg-1 of Zn, Cu, Mn, Fe, and B. For leaves, the critical nutrient ranges are respectively: 2.63 - 2.86, 0.13 - 0.14, 2.13 - 2.33, 1.04 - 1.22, 0.27 - 0.33, 0.15 - 0.18 dag kg-1 of N, P, K, Ca, Mg, and S; and 9 - 14, 15 - 23, 80 - 115, 99 - 148, and 31 - 37 mg kg-1 of Zn, Cu, Mn, Fe, and B. The nutritional diagnosis of coffee trees for N, P, Ca, Fe, Cu, and Mn can be anticipated using flower analysis.

RESUMO: A análise química de flores tem sido estudada em algumas culturas. Para o cafeeiro, a análise do tecido floral possibilitaria a antecipação do diagnóstico nutricional das lavouras. O estudo objetivou (i) comparar a composição mineral de flores e de folhas de cafeeiros (ii) e gerar normas para diagnose nutricional do cafeeiro com base na análise de tecidos de flores e folhas das plantas. Para isso, foram avaliados os teores de nutrientes em flores e folhas e a produtividade de café em 26 lavouras comerciais na região de Manhuaçu, MG, durante três anos. As faixas críticas de nutrientes determinadas em flores são: 2,78 - 3,17; 0,23 - 0,28; 2,80 - 3,12; 0,30 - 0,37; 0,24 - 0,30; 0,15 - 0,18 dag kg-1 de N, P, K, Ca, Mg e S, e 17 - 21; 12 - 18; 52 - 80; 26 - 43 e 28 - 48 mg kg-1 para Zn, Cu, Mn, Fe e B, respectivamente. As faixas críticas de nutrientes em folhas foram: 2,63 - 2,86; 0,13 - 0,14; 2,13 - 2,33; 1,04 - 1,22; 0,27 - 0,33; 0,15 - 0,18 dag kg-1 de N, P, K, Ca, Mg e S, e 9 - 14; 15 - 23; 80 - 115; 99 - 148 e 31 - 37 mg kg-1 para Zn, Cu, Mn, Fe e B, respectivamente. A diagnose nutricional do cafeeiro, quanto aos nutrientes N, P, Ca, Fe, Cu e Mn, pode ser antecipada por meio da análise de flores.

Rhizosphere microbiological processes and eucalypt nutrition: Synthesis and conceptualization.

In this review, we present the state of art regarding rhizosphere effects on eucalypt plantations. It provides a greater understanding of carbon (C) and nitrogen (N) turnover in forest soils. P organic hydrolysis, soil mineral solubilization, indoleacetic acid, gibberellin, resistance factors, and production of siderophores by rhizosphere microbial populations help to explain the tolerance of Eucalyptus plants to biotic and abiotic stresses and the apparent steady-state condition of C and N soil stocks in many planted forests. This work aims to present the main findings on Eucalyptus rhizosphere processes and highlights their importance for trees nutrition, especially for N mineralization triggered by microbial activation or microbial community structure changes regarding the so-called rhizosphere priming effect and N fixation. Furthermore, we present an explanatory conceptual model of the steady-state condition for soil organic matter (SOM) stocks and its relation with fertilization based on a nutrient balance model. This review also considers the main experimental and modeling studies that demonstrate the quantitative importance of rhizosphere processes to Eucalyptus genus and their shortcomings. This provides a framework for process modeling under scenarios of global climate change. A better understanding of rhizosphere microbiological processes may allow improvements in Eucalyptus nutrition and production, as well as in accurate long-term estimates of SOM stocks and C-CO2 exchanges between forest soils and the atmosphere.

Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence.

BACKGROUND: Lung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography, but the best training method remains uncertain. This study describes a training curriculum allowing trainees to acquire basic competence. METHODS: This multicenter, prospective, and educational study was conducted in 10 Intensive Care Units in Brazil, China, France and Uruguay. One hundred residents, respiratory therapists, and critical care physicians without expertise in transthoracic ultrasound (trainees) were trained by 18 experts. The main study objective was to determine the number of supervised exams required to get the basic competence, defined as the trainees' ability to adequately classify lung regions with normal aeration, interstitial-alveolar syndrome, and lung consolidation. An initial 2-h video lecture provided the rationale for image formation and described the ultrasound patterns commonly observed in critically ill and emergency patients. Each trainee performed 25 bedside ultrasound examinations supervised by an expert. The progression in competence was assessed every five supervised examinations. In a new patient, 12 pulmonary regions were independently classified by the trainee and the expert. RESULTS: Progression in competence was derived from the analysis of 7,330 lung regions in 2,562 critically ill and emergency patients. After 25 supervised examinations, 80% of lung regions were adequately classified by trainees. The ultrasound examination mean duration was 8 to 10 min in experts and decreased from 19 to 12 min in trainees (after 5 vs. 25 supervised examinations). The median training duration was 52 (42, 82) days. CONCLUSIONS: A training curriculum including 25 transthoracic ultrasound examinations supervised by an expert provides the basic skills for diagnosing normal lung aeration, interstitial-alveolar syndrome, and consolidation in emergency and critically ill patients.

Balance design for robust foliar nutrient diagnosis of "Prata" banana (Musa spp.).

The "Cavendish" and "Prata" subgroups represent respectively 47% and 24% of the world banana production. Compared to world average progressing from 10.6 to 20.6 t ha-1 between 1961 and 2016, and despite sustained domestic demand and the introduction of new cultivars, banana yield in Brazil has stagnated around 14.5 t ha-1 mainly due to nutrient and water mismanagement. "Prata" is now the dominant subgroup in N-E Brazil and is fertigated at high costs. Nutrient balances computed as isometric log-ratios (ilr) provide a comprehensive understanding of nutrient relationships in the diagnostic leaf at high yield level by combining raw concentration data. Although the most appropriate method for multivariate analysis of compositional balances may be less efficient due to non-normal data distribution and limited nutrient mobility in the plant, robustness of the nutrient balance approach could be improved using Box-Cox exponents assigned to raw foliar concentrations. Our objective was to evaluate the accuracy of nutrient balances to diagnose fertigated "Prata" orchards. The dataset comprised 609 observations on fruit yields and leaf tissue compositions collected from 2010 to 2016 in Ceará state, N-E Brazil. Raw nutrient concentration ranges were ineffective as diagnostic tool due to considerable overlapping of concentration ranges for low- and high-yielding subpopulations at cutoff yield of 40 Mg ha-1. Nutrient concentrations were combined into isometric log-ratios (ilr) and normalized by Box-Cox corrections between 0 and 1 which may also account for restricted nutrient transfer from leaf to fruit. Despite reduced ilr skewness, Box-Cox coefficients did not improve model robustness measured as the accuracy of the Cate-Nelson partition between yield and the multivariate distance across ilr values. Sensitivity was 94%, indicating that low yields are attributable primarily to nutrient imbalance. There were 148 false-positive specimens (high yield despite nutrient imbalance) likely due to suboptimal nutrition, contamination, or luxury consumption. The profitability of "Prata" orchards could be enhanced by rebalancing nutrients using ilr standards with no need for Box-Cox correction.

A new biostimulation approach based on the concept of remaining P for soil bioremediation.

C:N:P ratio is generally adopted to estimate the amount of nitrogen and phosphorus to be added to soils to accelerate biodegradation of organic contaminants. However, differences in P fixation among soils lead to varying amounts of available P when a specific dose of the element is applied to different soils. Thus, the application of fertilizers to achieve a previously established C:P ratio leads to biodegradation rates that can be lower than the theoretical maximum. In this study, we developed an equation to estimate the dose of P required to maximize organic contaminant biodegradation in soils as a function of remaining P (P-rem), using diesel as a model contaminant. The soils were contaminated with diesel and received six doses of P. CO2 emission was used to estimate biodegradation of hydrocarbons. Biodegradation increased with P doses. The P level that provided the highest hydrocarbon biodegradation rate showed linear and negative correlation with P-rem. The result shows that the requirement for P decreases as the P-rem of the soil increases (or the P-fixing capacity decreases). The dose of P recommended to maximize hydrocarbon biodegradation rate in soil can be estimated by the formula P (mg/dm3) = 436.5-5.39 × P-rem (mg/L).

Spacial distribution of fertigated coffee root system / Distribuição espacial do sistema radicular do cafeeiro fertirrigado

ABSTRACT The development of coffee plant root system changes when subjected to drip irrigation and fertigation. This work aimed to evaluate the effects of different levels of fertigation on the development of coffee root system by drip irrigation in western Bahia. The experiment was carried out with Catuaí Vermelho IAC 144 coffee plants, of about 3.5 years of age, in the "Café do Rio Branco" farm, located in Barreiras - BA, and consisted of a complete randomized blocks design with 3 replicates. Treatments consisted of three levels of nitrogen and potassium fertilization (900/800, 600/500 and 300/250 kg ha-1 year-1 N and K2O), weekly distributed, by means of fertigation, throughout the process. After the fourth harvest, coffee root system was evaluated, and root length density (RLD) and root density (RD) were determined at different sampled layers. The highest root concentration, root length density (RLD), and root density (RD) were observed in the superficial layers of soil (0-20 cm), and under the dripline (30 and 70 cm from the orthotropic branch). Results showed that the lower the N and K2O levels, the higher was the development (RLD and RD) of the coffee root system.

RESUMO O desenvolvimento do sistema radicular do cafeeiro é alterado quando submetido à irrigação localizada e fertirrigação. Este trabalho foi desenvolvido com o objetivo de avaliar os efeitos de diferentes doses de fertirrigação sobre o desenvolvimento do sistema radicular do cafeeiro irrigado por gotejamento na região Oeste da Bahia. Realizou-se o trabalho na fazenda Café do Rio Branco, localizada em Barreiras - BA, em cafeeiros de aproximadamente 3,5 anos de idade, da variedade Catuaí IAC 144. O experimento foi montado em um esquema fatorial 3 x 3, sendo três níveis de adubação nitrogenada e potássica (900/800, 600/500 e 300/250 kg ha-1 ano-1 de N e K2O), em 3 parcelamentos mensais de fertirrigação (2, 4 e 8 vezes). Após a quarta safra, o sistema radicular do cafeeiro foi avaliado e a densidade de comprimento radicular (DCR) e densidade radicular (DR) em diferentes camadas amostradas foram determinadas. A maior concentração de raízes, densidade de comprimento radicular (DCR) e densidade radicular (DR) foi obtida nas camadas superficiais (0-20 cm) e sob a linha lateral (30 e 70 cm de distância do ramo ortotrópico). As menores doses de N e K2O propiciaram maior desenvolvimento (DCR e DR) do sistema radicular do cafeeiro.

Automated retina identification based on multiscale elastic registration.

In this work we propose a novel method for identifying individuals based on retinal fundus image matching. The method is based on the image registration of retina blood vessels, since it is known that the retina vasculature of an individual is a signature, i.e., a distinctive pattern of the individual. The proposed image registration consists of a multiscale affine registration followed by a multiscale elastic registration. The major advantage of this particular two-step image registration procedure is that it is able to account for both rigid and non-rigid deformations either inherent to the retina tissues or as a result of the imaging process itself. Afterwards a decision identification measure, relying on a suitable normalized function, is defined to decide whether or not the pair of images belongs to the same individual. The method is tested on a data set of 21721 real pairs generated from a total of 946 retinal fundus images of 339 different individuals, consisting of patients followed in the context of different retinal diseases and also healthy patients. The evaluation of its performance reveals that it achieves a very low false rejection rate (FRR) at zero FAR (the false acceptance rate), equal to 0.084, as well as a low equal error rate (EER), equal to 0.053. Moreover, the tests performed by using only the multiscale affine registration, and discarding the multiscale elastic registration, clearly show the advantage of the proposed approach. The outcome of this study also indicates that the proposed method is reliable and competitive with other existing retinal identification methods, and forecasts its future appropriateness and applicability in real-life applications.

Diversity and distribution of the endophytic bacterial community at different stages of Eucalyptus growth.

The relationships between plants and endophytic bacteria significantly contribute to plant health and yield. However, the microbial diversity in leaves of Eucalyptus spp. is still poorly characterized. Here, we investigated the endophytic diversity in leaves of hybrid Eucalyptus grandis x E. urophylla (Eucalyptus "urograndis") by using culture-independent and culture-dependent approaches, to better understand their ecology in leaves at different stages of Eucalyptus development, including bacteria with N2 fixation potential. Firmicutes, Proteobacteria (classes alpha-, beta- and gamma-) and Actinobacteria were identified in the Eucalyptus "urograndis" endophytic bacterial community. Within this community, the species Novosphingobium barchaimii, Rhizobium grahamii, Stenotrophomonas panacihumi, Paenibacillus terrigena, P. darwinianus and Terrabacter lapilli represent the first report these bacteria as endophytes. The diversity of the total endophytic bacteria was higher in the leaves from the 'field' (the Shannon-Wiener index, 2.99), followed by the indices obtained in the 'clonal garden' (2.78), the 'recently out from under shade (2.68), 'under shade' (2.63) and 'plants for dispatch' (2.51). In contrast, for diazotrophic bacteria, the highest means of these indices were obtained from the leaves of plants in the 'under shade' (2.56), 'recently out from under shade (2.52)' and 'field' stages (2.54). The distribution of the endophytic bacterial species in Eucalyptus was distinct and specific to the development stages under study, and many of the species had the potential for nitrogen fixation, raising the question of whether these bacteria could contribute to overall nitrogen metabolism of Eucalyptus.