European Union of Medical Specialists

To gain a better understanding of the global application of soil erosion prediction models, we comprehensively reviewed relevant peer-reviewed research literature on soil-erosion modelling published between 1994 and 2017. We aimed to identify (i) the processes and models most frequently addressed in the literature, (ii) the regions within which models are primarily applied, (iii) the regions which remain unaddressed and why, and (iv) how frequently studies are conducted to validate/evaluate model outcomes relative to measured data. To perform this task, we combined the collective knowledge of 67 soil-erosion scientists from 25 countries. The resulting database, named 'Global Applications of Soil Erosion Modelling Tracker (GASEMT)', includes 3030 individual modelling records from 126 countries, encompassing all continents (except Antarctica). Out of the 8471 articles identified as potentially relevant, we reviewed 1697 appropriate articles and systematically evaluated and transferred 42 relevant attributes into the database. This GASEMT database provides comprehensive insights into the state-of-the-art of soil- erosion models and model applications worldwide. This database intends to support the upcoming country-based United Nations global soil-erosion assessment in addition to helping to inform soil erosion research priorities by building a foundation for future targeted, in-depth analyses. GASEMT is an open-source database available to the entire user-community to develop research, rectify errors, and make future expansions.

Since Darwin published the "Origin," great progress has been made in our understanding of speciation mechanisms. The early investigations by Mayr and Dobzhansky linked Darwin's view of speciation by adaptive divergence to the evolution of reproductive isolation, and thus provided a framework for studying the origin of species. However, major controversies and questions remain, including: When is speciation nonecological? Under what conditions does geographic isolation constitute a reproductive isolating barrier? and How do we estimate the "importance" of different isolating barriers? Here, we address these questions, providing historical background and offering some new perspectives. A topic of great recent interest is the role of ecology in speciation. "Ecological speciation" is defined as the case in which divergent selection leads to reproductive isolation, with speciation under uniform selection, polyploid speciation, and speciation by genetic drift defined as "nonecological." We review these proposed cases of nonecological speciation and conclude that speciation by uniform selection and polyploidy normally involve ecological processes. Furthermore, because selection can impart reproductive isolation both directly through traits under selection and indirectly through pleiotropy and linkage, it is much more effective in producing isolation than genetic drift. We thus argue that natural selection is a ubiquitous part of speciation, and given the many ways in which stochastic and deterministic factors may interact during divergence, we question whether the ecological speciation concept is useful. We also suggest that geographic isolation caused by adaptation to different habitats plays a major, and largely neglected, role in speciation. We thus provide a framework for incorporating geographic isolation into the biological species concept (BSC) by separating ecological from historical processes that govern species distributions, allowing for an estimate of geographic isolation based upon genetic differences between taxa. Finally, we suggest that the individual and relative contributions of all potential barriers be estimated for species pairs that have recently achieved species status under the criteria of the BSC. Only in this way will it be possible to distinguish those barriers that have actually contributed to speciation from those that have accumulated after speciation is complete. We conclude that ecological adaptation is the major driver of reproductive isolation, and that the term "biology of speciation," as proposed by Mayr, remains an accurate and useful characterization of the diversity of speciation mechanisms.

MOTIVATION: The BioTIME database contains raw data on species identities and abundances in ecological assemblages through time. These data enable users to calculate temporal trends in biodiversity within and amongst assemblages using a broad range of metrics. BioTIME is being developed as a community-led open-source database of biodiversity time series. Our goal is to accelerate and facilitate quantitative analysis of temporal patterns of biodiversity in the Anthropocene. MAIN TYPES OF VARIABLES INCLUDED: The database contains 8,777,413 species abundance records, from assemblages consistently sampled for a minimum of 2 years, which need not necessarily be consecutive. In addition, the database contains metadata relating to sampling methodology and contextual information about each record. SPATIAL LOCATION AND GRAIN: ). TIME PERIOD AND GRAIN: BioTIME records span from 1874 to 2016. The minimal temporal grain across all datasets in BioTIME is a year. MAJOR TAXA AND LEVEL OF MEASUREMENT: BioTIME includes data from 44,440 species across the plant and animal kingdoms, ranging from plants, plankton and terrestrial invertebrates to small and large vertebrates. SOFTWARE FORMAT: .csv and .SQL.

Ingestion of vegetables containing heavy metals is one of the main ways in which these elements enter the human body. Once entered, heavy metals are deposited in bone and fat tissues, overlapping noble minerals. Slowly released into the body, heavy metals can cause an array of diseases. This study aimed to investigate the concentrations of cadmium, nickel, lead, cobalt and chromium in the most frequently consumed foodstuff in the São Paulo State, Brazil and to compare the heavy metal contents with the permissible limits established by the Brazilian legislation. A value of intake of heavy metals in human diets was also calculated to estimate the risk to human health. Vegetable samples were collected at the São Paulo General Warehousing and Centers Company, and the heavy metal content was determined by atomic absorption spectrophotometry. All sampled vegetables presented average concentrations of Cd and Ni lower than the permissible limits established by the Brazilian legislation. Pb and Cr exceeded the limits in 44 % of the analyzed samples. The Brazilian legislation does not establish a permissible limit for Co contents. Regarding the consumption habit of the population in the São Paulo State, the daily ingestion of heavy metals was below the oral dose of reference, therefore, consumption of these vegetables can be considered safe and without risk to human health.

A synthesis on the feeding flexibility in freshwater teleosts concerning seasonal, spatial, ontogenetic, individual and behavioral variation of freshwater teleosts is provided. The occurrence of a flexible diet is a striking aspect of tropical riverine ichthyofauna where most species may switch from a food item to another as soon as the relative abundance of the feeding resource in use oscillates, motivated by seasonal and spatial environmental alterations. There is a trophical change in almost all species during ontogeny, whereas in most populations, individuals may show feeding preferences or make use of distinct feeding tactics that lead towards a differentiated intraspecific foraging. These considerations highlight the difficulty on setting up reliable specific species feeding patterns in tropical teleosts

Motivated by recent experiments, we consider the hydrodynamic capture of a microswimmer near a stationary spherical obstacle. Simulations of model equations show that a swimmer approaching a small spherical colloid is simply scattered. In contrast, when the colloid is larger than a critical size it acts as a passive trap: the swimmer is hydrodynamically captured along closed trajectories and endlessly orbits around the colloidal sphere. In order to gain physical insight into this hydrodynamic scattering problem, we address it analytically. We provide expressions for the critical trapping radius, the depth of the "basin of attraction," and the scattering angle, which show excellent agreement with our numerical findings. We also demonstrate and rationalize the strong impact of swimming-flow symmetries on the trapping efficiency. Finally, we give the swimmer an opportunity to escape the colloidal traps by considering the effects of Brownian, or active, diffusion. We show that in some cases the trapping time is governed by an Ornstein-Uhlenbeck process, which results in a trapping time distribution that is well-approximated as inverse-Gaussian. The predictions again compare very favorably with the numerical simulations. We envision applications of the theory to bioremediation, microorganism sorting techniques, and the study of bacterial populations in heterogeneous or porous environments.

OBJETIVO: Validar o Índice de Barthel para idosos atendidos em ambulatórios, no Brasil, por meio de análises de confiabilidade e validade. MÉTODOS: Para comprovação da confiabilidade, utilizou-se a consistência interna e, para a verificação da validade, a análise fatorial e as validades de critério convergente e discriminante. RESULTADOS: A confiabilidade, estimada pelo alfa de Cronbach, apresentou o valor de 0,90 para a escala total. A análise da validade de critério convergente, utilizando a Medida de Independência Funcional, identificou correlação satisfatória para a maioria dos domínios. Na análise fatorial, que manteve apenas um domínio e os 10 itens da escala original, a variância explicada foi de 63,8%. CONCLUSÃO: Os resultados permitem recomendar sua utilização para avaliar a capacidade funcional de idosos em atendimento ambulatorial no Brasil.

Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

A novel strain of human coronaviruses, named by the International Committee on Taxonomy of Viruses (ICTV) 1 as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged and caused an infectious disease. This disease has recently been referred to by the World Health Organisation (WHO) as the "coronavirus disease 2019" (COVID-19). Since the first report of this disease in December 2019 in Wuhan, China, 2,3 COVID-19 has aggressively spread across the globe. WHO declared it a pandemic on March 11. COVID-19 presents with many different clinical manifestations, ranging from asymptomatic cases to mild and severe disease, with or without pneumonia. 4 Patients with common allergic conditions do not develop additional distinct symptoms and do not seem to be at an increased risk of severe disease. Allergic children show a mild course, like other children. 5 COVID-19 cases with pre-existing COPD, or complicated by secondary bacterial pneumonia, are more severe, and this may be due to a complex immune pathogenesis. Whether systemic corticosteroids have a deleterious effect on COVID-19 infection is still a matter of discussion. Clinical evidence does not support corticosteroid treatment for SARS-CoV-2 pneumonia. 6 Moreover, corticosteroid therapy in patients with MERS (Middle East respiratory syndrome) was not associated with a difference in mortality after adjustment for time-varying confounders but was associated with delayed MERS coronavirus RNA clearance. 7

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA-disseminated and implemented in over 70 countries globally-is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.

Although highly weathered soils cover considerable areas in tropical regions, little is known about exploration by roots in deep soil layers. Intensively managed Eucalyptus plantations are simple forest ecosystems that can provide an insight into the belowground growth strategy of fast-growing tropical trees. Fast exploration of deep soil layers by eucalypt fine roots may contribute to achieving a gross primary production that is among the highest in the world for forests. Soil exploration by fine roots down to a depth of 10 m was studied throughout the complete cycle in Eucalyptus grandis plantations managed in short rotation. Intersects of fine roots, less than 1 mm in diameter, and medium-sized roots, 1-3 mm in diameter, were counted on trench walls in a chronosequence of 1-, 2-, 3.5-, and 6-year-old plantations on a sandy soil, as well as in an adjacent 6-year-old stand growing in a clayey soil. Two soil profiles were studied down to a depth of 10 m in each stand (down to 6 m at ages 1 and 2 years) and 4 soil profiles down to 1.5-3.0 m deep. The root intersects were counted on 224 m(2) of trench walls in 15 pits. Monitoring the soil water content showed that, after clear-cutting, almost all the available water stored down to a depth of 7 m was taken up by tree roots within 1.1 year of planting. The soil space was explored intensively by fine roots down to a depth of 3 m from 1 year after planting, with an increase in anisotropy in the upper layers throughout the rotation. About 60% of fine root intersects were found at a depth of more than 1 m, irrespective of stand age. The root distribution was isotropic in deep soil layers and kriged maps showed fine root clumping. A considerable volume of soil was explored by fine roots in eucalypt plantations on deep tropical soils, which might prevent water and nutrient losses by deep drainage after canopy closure and contribute to maximizing resource uses.

mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. However, it may be disruptive and results achieved are not always reaching the goals. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity. Patients largely use over-the-counter medications dispensed in pharmacies. Shared decision making centered around the patient and based on self-management should be the norm. Mobile Airways Sentinel networK (MASK), the Phase 3 ARIA initiative, is based on the freely available MASK app (the Allergy Diary, Android and iOS platforms). MASK is available in 16 languages and deployed in 23 countries. The present paper provides an overview of the methods used in MASK and the key results obtained to date. These include a novel phenotypic characterization of the patients, confirmation of the impact of allergic rhinitis on work productivity and treatment patterns in real life. Most patients appear to self-medicate, are often non-adherent and do not follow guidelines. Moreover, the Allergy Diary is able to distinguish between AR medications. The potential usefulness of MASK will be further explored by POLLAR (Impact of Air Pollution on Asthma and Rhinitis), a new Horizon 2020 project using the Allergy Diary.

Abstract Rising water temperatures in rivers due to climate change are already having observable impacts on river ecosystems. Warming water has both direct and indirect impacts on aquatic life, and further aggravates pervasive issues such as eutrophication, pollution, and the spread of disease. Animals can survive higher temperatures through physiological and/or genetic acclimation, behavioral and phenological change, and range shifts to more suitable locations. As such, those animals that are adapted to cool‐water regions typically found in high altitudes and latitudes where there are fewer dispersal opportunities are most at risk of future extinction. However, sub‐lethal impacts on animal physiology and phenology, body‐size, and trophic interactions could have significant population‐level effects elsewhere. Rivers are vulnerable to warming because historic management has typically left them exposed to solar radiation through the removal of riparian shade, and hydrologically disconnected longitudinally, laterally, and vertically. The resilience of riverine ecosystems is also limited by anthropogenic simplification of habitats, with implications for the dispersal and resource use of resident organisms. Due to the complex indirect impacts of warming on ecosystems, and the species‐specific physiological and behavioral response of organisms to warming, predicting how river ecosystems will change in the future is challenging. Restoring rivers to provide connectivity and heterogeneity of conditions would provide resilience to a range of expected co‐occurring pressures, including warming, and should be considered a priority as part of global strategies for climate adaptation and mitigation. This article is categorized under: Science of Water > Water and Environmental Change Water and Life > Nature of Freshwater Ecosystems Water and Life > Stresses and Pressures on Ecosystems

BACKGROUND: Analyze how the COVID-19 (SARS-CoV-2) pandemic and its social restriction measures affect sleep quality and the immunological system. METHODS: An integrative bibliographical review was carried out using scientific articles from the last five years, from the PUBMED databases, with the descriptors: Sleep; Quarantine; COVID-19; Immunity; Mental Health. Besides the books "Oxford textbook of sleep disorders", "Cellular and molecular immunology", and "Treaty of Infectology". RESULTS: Sleep affects immunity. This happens through the regulation of immunological markers and their cells. Therefore, the COVID-19 pandemic can promote sleep disturbances and harm the immune system function. CONCLUSION: Sleep exercises a direct influence on immunity maintenance and immunological response. Circadian rhythm alterations, associated with the psychological problems imposed by the COVID-19 pandemic compromise the quality of sleep and, for that reason, the immune system.

Abstract Drought and salinity are the main limiting environmental factors that restrict the establishment of soya bean plants. In order to recommend genotypes for cultivation under adverse drought and saline stress conditions, multi‐environment trials (MET) are needed. However, MET analysis is usually performed considering a single trait, which provides lower reliability in recommending genotypes when compared to multi‐trait analysis. Thus, this study was carried out to investigate the stability of multi‐trait stability index (MTSI) in 46 soya bean cultivars under the effects of drought and saline stress on seed germination and initial seedling growth. Drought and saline stresses were imposed by seed exposure to −0.20 MPa iso‐osmotic solutions with polyethylene glycol—PEG 6000 (119.6 g/L) or NaCl (2.36 g/L) for 12 days at 25°C. The germination rate, seedling length and seedling dry matter were measured. We showed here how genotypic stability can be quantified by MTSI when comparing drought and salinity conditions in relation to non‐stressful environment (control) and how this index can be employed under different conditions. When considering the index for multiple environments, we can select as the most stable genotypes TMG 716 RR, FPS Antares RR, AS 3610 IPRO, NS 7300 IPRO and FPS Solar IPRO among the 46 tested genotypes. Owing to high stability and gains with selection verified for these genotypes under salinity and drought conditions, they can be used as genitors in breeding programs aimed at obtaining offspring with higher resistance to antibiotic stresses.

AIMS: Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. METHODS: MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. STAKEHOLDERS: Include patients, health care professionals (pharmacists and physicians), authorities, patient's associations, private and public sectors. RESULTS: MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. EU GRANTS 2018: MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). LESSONS LEARNT: (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.

O experimento foi conduzido com o objetivo de avaliar os coeficientes de digestibilidade aparente (CDa) da matéria seca (MS), energia bruta (EB) e proteína bruta (PB) do farelo de soja (FS), milho (MO), trigo (TG), farelo de trigo (FT), milheto (MT), triticale (TC), farinha de varredura de mandioca (FM) e óleo de soja (OS) para tilápia do Nilo da linhagem tailandesa. Foram utilizados 100 animais revertidos sexualmente, com peso médio de 37,61 ± 4,98 g distribuídos em dois tanques de alimentação de 500L e coleta de fezes pelo sistema modificado de Guelph em dois aquários (150 L cada). A determinação dos CDa foi realizada pelo método indireto, sendo utilizado como indicador 0,1% de óxido de cromo (Cr2O3) incorporado à ração. Os CDa para a MS, PB e EB foram de 65,49, 89,58 e 71,38 para FS; 73,22, 93,40 e 76,63 para MO; 86,51, 96,30 e 87,07 para TG; 66,79, 91,00 e 68,81 para FT; 77,96, 94,91 e 89,12 para MT; 68,51, 94,78 e 80,55 TC; 91,11, 97,52 e 91,40% para FV, respectivamente; e para a EB do OS o CDa foi 89,85%, apresentando valores de proteína (%) e energia (kcal/kg) digestíveis de 42,19 e 3057,63 para FS; 7,18 e 3037,03 para MO; 11,01 e 3423,66 para TG; 13,44 e 2825,88 para FT; 13,88 e 3755,55 para MT; 13,74 e 3230,69 para TC; 1,76 e 3280,09 para FM, respectivamente, e 8485,28 kcal/kg de ED para o OS. Os resultados demonstraram que a tilápia do Nilo utiliza eficientemente a energia e proteína desses ingredientes. Os valores de energia e proteína digestíveis devem ser utilizados para elaborar rações completas.

BACKGROUND: Large observational implementation studies are needed to triangulate the findings from randomized control trials as they reflect "real-world" everyday practice. In a pilot study, we attempted to provide additional and complementary insights on the real-life treatment of allergic rhinitis (AR) using mobile technology. METHODS: A mobile phone app (Allergy Diary, freely available in Google Play and Apple App stores) collects the data of daily visual analog scales (VAS) for (i) overall allergic symptoms, (ii) nasal, ocular, and asthma symptoms, (iii) work, as well as (iv) medication use using a treatment scroll list including all medications (prescribed and over the counter (OTC)) for rhinitis customized for 15 countries. RESULTS: A total of 2871 users filled in 17 091 days of VAS in 2015 and 2016. Medications were reported for 9634 days. The assessment of days appeared to be more informative than the course of the treatment as, in real life, patients do not necessarily use treatment on a daily basis; rather, they appear to increase treatment use with the loss of symptom control. The Allergy Diary allowed differentiation between treatments within or between classes (intranasal corticosteroid use containing medications and oral H1-antihistamines). The control of days differed between no [best control], single, or multiple treatments (worst control). CONCLUSIONS: This study confirms the usefulness of the Allergy Diary in accessing and assessing everyday use and practice in AR. This pilot observational study uses a very simple assessment (VAS) on a mobile phone, shows novel findings, and generates new hypotheses.

Effective team working plays a crucial role in Physical and Rehabilitation Medicine (PRM). As part of its role of optimizing and harmonizing clinical practice across Europe, the Professional Practice Committee of Union of European Medical Specialists (UEMS) Physical and Rehabilitation Medicine (PRM) Section reviewed patterns of team working and debated recommendations for good practice at a meeting of national UEMS delegates held in Riga, Latvia, in September 2008. This consensus statement is derived from that discussion and from a review of the literature concerning team working. Effective team working produces better patient outcomes (including better survival rates) in a range of disorders, notably following stroke. There is limited published evidence concerning what constitute the key components of successful teams in PRM programmes. However, the theoretical basis for good team working has been well-described in other settings and includes agreed aims, agreement and understanding on how best to achieve these, a multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise and to speak openly. UEMS PRM Section strongly recommends this pattern of working. PRM specialists have an essential role to play in interdisciplinary teams; their training and specific expertise enable them to diagnose and assess severity of health problems, a prerequisite for safe intervention. Training spans 4-5 years in Europe, and includes knowledge and critical analysis of evidence-based rehabilitation strategies. PRM physicians are therefore well-placed to coordinate PRM programmes and to develop and evaluate new management strategies. Their broad training also means that they are able to take a holistic view of an individual patient's care.