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Mountains play a crucial role in the origin and maintenance of Neotropical biodiversity, but there are still unanswered questions about the diversification of the campos rupestres (CR), an herbaceous-shrubby sky-island vegetation in eastern South America. For orchids distributed across this disjunct rock habitat, difficulties with distinguishing morphological taxa add an additional challenge to disentangling the history of divergence. Here, we combined the power of ddRAD genomic data with broad sampling of Bulbophyllum sect. Didactyle (Orchidaceae), across the CR and other Neotropical outcrops, to estimate evolutionary relationships and evaluate the biogeography of the group’s diversification. Although genetic lineages generally align with geographic disjunctions, we also observe distantly related lineages within some previously recognized species. For such taxa, their lack of monophyly and a shared regional divergence pattern suggests a complex history that may include unrecognized diversity. When viewed through the lens of morphological variability, our study raises intriguing questions about the persistence and permeability of species barriers among orchid populations. These results, in addition to the recency of the divergence history of B. sect. Didactyle, provide insights about hypothesized community level vs. species-specific paths of diversification across the Neotropical sky-islands of the CR.

To achieve the ambitious goals of the UN Decade on Ecosystem Restoration, restoration frameworks should embrace the diversity of ecosystems found on Earth, including open-canopy ecosystems, which have been largely overlooked. Considering the paucity of scientific foundations promoting restoration science, policy, and practice for open tropical ecosystems, we provide overarching guidelines to restore the campo rupestre, a Neotropical, open megadiverse grassland that has been increasingly threatened by multiple human activities, especially mining. Restoration techniques for tropical grasslands are still at its infancy, and attempts to restore campo rupestre have had, so far, low to moderate success, highlighting the need for a tailored restoration framework. In a scenario of increasing degradation and scarcity of on-site restoration experiments, we propose 10 principles to improve our ability to plan, implement, and monitor restoration in campo rupestre: (1) include socioeconomic dimensions, (2) implement active restoration, (3) keep low soil fertility, (4) restore disturbance regimes, (5) address genetic structure and adaptation potential, (6) restore geographically restricted and specialized ecological interactions, (7) incorporate functional approaches, (8) use seed-based restoration strategies to enhance biodiversity, (9) translocation is inevitable, and (10) long-term monitoring is mandatory. Our principles represent the best available evidence to support better science and practice for the restoration of campo rupestre and, to some extent, can be useful for other megadiverse, fire-prone, and nutrient-poor ecosystems.

Highlights • Dose to the heart and all its substructures were significantly lower with IMPT compared to VMAT. • Our analysis showed that not all patients benefit equally from proton beam therapy. • Patients with disease involvement overlapping with or are inferior to the most superior aspect of the heart contour appear to have the highest benefit. The median level of the superior aspect of the heart contour began was T7 vertebra., Purpose/objective To use a model-based approach to identify a sub-group of patients with locally advanced lung cancer who would benefit from proton therapy compared to photon therapy for reduction of cardiac toxicity. Material/methods Volumetric modulated arc photon therapy (VMAT) and robust-optimised intensity modulated proton therapy (IMPT) plans were generated for twenty patients with locally advanced lung cancer to give a dose of 70 Gy (relative biological effectiveness (RBE)) in 35 fractions. Cases were selected to represent a range of anatomical locations of disease. Contouring, treatment planning and organs-at-risk constraints followed RTOG-1308 protocol. Whole heart and ub-structure doses were compared. Risk estimates of grade⩾3 cardiac toxicity were calculated based on normal tissue complication probability (NTCP) models which incorporated dose metrics and patients baseline risk-factors (pre-existing heart disease (HD)). Results There was no statistically significant difference in target coverage between VMAT and IMPT. IMPT delivered lower doses to the heart and cardiac substructures (mean, heart V5 and V30, P

Global sustainability rests on a myriad of benefits provided by natural ecosystems that support human livelihoods and well-being, from biodiversity persistence to climate regulation. The undeniable importance of conserving tropical forests has drawn most of the conservation spotlight towards it. However, open ecosystems such as the Brazilian Campo Rupestre (rupestrian grassland), have been historically overlooked despite their high diversity and key associated ecosystem services. We highlight major current threats to the persistence of the Campo Rupestre emphasizing its ecological, social, cultural, geo-environmental, and economic importance. We call attention to the importance of the Campo Rupestre as a reservoir of biodiversity and ecosystem services and offer priority actions that resulted from discussions involving scientists, industry representatives, environmental managers, and other members of civil society. Proposed actions include efforts related to ecological restoration, sustainable ecotourism, protection of traditional ecological knowledge, identification of emerging research questions, and development of tailored public policies. Such issues are integrated into a framework that collectively represents a road map to safeguard the Campo Rupestre from further degradation and steer its historical overexploitation towards sustainable management. Safeguarding the future of non-forest biomes like this poses a challenge to current paradigms of nature conservation. By establishing priorities and guidelines, we propose an actionable plan, which we hope can support informed decision-making policy towards a sustainable use of the Campo Rupestre. Long Term Ecological Research PELD-CRSC-17 Conselho Nacional de Pesquisas CNPq/MCTI Fundação de Amparo à Pesquisa do Estado de São Paulo 2013/50155-0, 2010/51307-0, 2019/07773-1

The campo rupestre is a Neotropical azonal vegetation. Its disjoint distribution and the fact that it is an old climatic buffered infertile landscape (OCBIL) have been associated with the high diversity and endemism observed in this environment. Here, we tested whether a micro-endemic species from campo rupestre shows: (1) limited zygotic gene flow; (2) lower gametic than zygotic gene flow structure; (3) substrate-driven genetic structure and (4) no evidence of Pleistocene local extinction or recolonization. By sequencing intergenic plastid regions, phenotyping inter simple sequence repeats (ISSR) and modelling present and past species suitability distributions for Vellozia auriculata we conclude that (1) zygotic gene flow is limited; (2) gametic gene flow is recurrent, but limited by elevation and distance; (3) there is no support for genetic structure driven by substrate and (4) Pleistocene climatic changes did not restrict the species to refugia, with local persistence. As long-term gene flow restrictions may lead to differentiation and speciation, our data helps to corroborate that the campo rupestre is both a cradle (due to low zygotic gene flow, prolonged isolation and consequent differentiation) and a lineage museum (due to local survival during climate oscillations). We highlight two distinct evolutionarily significant units (ESU), providing information for better conservation practice.

Few studies have investigated populations of conductors concerning their activity in general or work-related health aspects, although these individuals also face important work demands with the potential for developing hearing, physical, and vocal problems. This study was designed to assess physical symptoms (pain, tingling, numbness) in Brazilian conductors by applying the Nordic Musculoskeletal Questionnaire (NMQ) and the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The data were collected online from 166 Brazilian conductors who were actively working for at least 1 year. The NMQ results indicated a high prevalence of symptoms in the shoulder, neck, and lumbar and upper back regions. Participants also complained of pain in the upper limbs, especially on the right side, and spinal regions associated with conducting. Bivariate statistical tests indicated significant relationships between the presence of symptoms in the upper limbs and higher disability scores in the DASH instrument. The body regions mentioned by the participants are similar to those reported in the few studies of conductors in the literature, highlighting that conducting has a specific physical impact and the potential to affect the function of the upper limb in the conductors’ daily activities.

Purpose. To develop a framework to include oxygenation effects in radiation therapy treatment planning which is valid for all modalities, energy spectra and oxygen levels. The framework is based on predicting the difference in DNA-damage resulting from ionising radiation at variable oxygenation levels. Methods. Oxygen fixation is treated as a statistical process in a simplified model of complex and simple damage. We show that a linear transformation of the microscopic oxygen fixation process allows to extend this to all energies and modalities, resulting in a relatively simple rational polynomial expression. The model is expanded such that it can be applied for polyenergetic beams. The methodology is validated using Microdosimetric Monte Carlo Damage Simulation code (MCDS). This serves as a bootstrap to determine relevant parameters in the analytical expression, as MCDS is shown to be extensively verified with published empirical data. Double-strand break induction as calculated by this methodology is compared to published proton experiments. Finally, an example is worked out where the oxygen enhancement ratio (OER) is calculated at different positions in a clinically relevant spread out Bragg peak (SOBP) dose deposition in water. This dose deposition is obtained using a general Monte Carlo code (FLUKA) to determine dose deposition and locate fluence spectra. Results. For all modalities (electrons, protons), the damage categorised as complex could be parameterised to within 0.3% of the value calculated using microdosimetric Monte Carlo. The proton beam implementation showed some variation in OERs which differed slightly depending on where the assessment was made; before the SOBP, mid-SOBP or at the distal edge. Environment oxygenation was seen to be the more important variable. Conclusions. An analytic expression calculating complex damage depending on modality, energy spectrum, and oxygenation levels was shown to be effective and can be readily incorporated in treatment planning software, to take into account the impact of variable oxygenation, forming a first step to an optimised treatment based on biological factors.

South America harbors the highest plant diversity on Earth. The causes of such exceptionally high diversity remain poorly understood, despite great attention devoted to the ecology and evolution of biota in productive and geologically recent ecosystems such as the Amazon forest and the Andes. Evidence suggests ancient and extremely nutrient-poor landscapes are major centers of plant diversity and endemism, and acted as interglacial refugia, but singularities of their evolutionary history have been overlooked. Here, we examine to what extent Ocbil theory (old, climatically-buffered, infertile landscapes) may prove useful in explaining diversification patterns in some of the most diverse Neotropical ecosystems. We propose a theoretical framework that encompasses a mechanistic explanation for the predictions of Ocbil theory, and links ecological and evolutionary processes to vegetation patterns and functional traits. We review diversification patterns and population genetics in campos rupestres vegetation in light of Ocbil theory. We propose areas of future research that will accelerate and improve our understanding on the ecology and evolution of Neotropical biota on ancient, nutrient-poor vegetation. This knowledge is expected to shed light on the complex history of Neotropical plant diversification and, ultimately, provide tools for their sustainable use and conservation.

Objective: We compared the sensitivity of intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT) plans to setup uncertainties in locally advanced non-small cell lung cancer (NSCLC) using probabilistic scenarios. Methods: Minimax robust (MM) and planning target volume (PTV) optimised IMPT and VMAT nominal plans were created with physical dose of 70 Gy in 35 fractions in 10 representative patients. Using population data of setup errors, a fractionated treatment course was simulated, summed (Dsum) and compared to the nominal plan. Three treatment-course simulations were done for each plan. Target robustness criteria were: dose deviation of ≤5% to clinical target volume (CTV) D98% and CTV V95% ≥ 99.9%. Voxelwise simulation repeatability was analysed using Bland–Altman plots. Acceptable limits of agreement were 2% of the prescription dose. Results: All Dsum met target robustness criteria. While fraction VMAT and MM-IMPT doses were excellent, simulated fraction doses in PTV-IMPT were suboptimal. Almost all (>99%) of VMAT and MM-IMPT fraction doses met both target robustness criteria. For PTV-IMPT, only 96.9 and 80.3% of fractions met CTVD98% and V95% criteria respectively. Simulation repeatability was excellent (limits of agreement range: 0.41–1.1 Gy) with strong positive correlations. Conclusion: When considering the whole treatment course, setup errors do not influence robustness irrespective of planning techniques used. However, on a fraction level, VMAT and MM-IMPT plans are superior compared to PTV-IMPT plans. Advances in knowledge: Probabilistic analysis provides a fast and practical method for evaluating VMAT and IMPT plan sensitivity against setup uncertainty. VMAT and robust-optimised IMPT plans have comparable sensitivity to setup uncertainties in conventionally fractionated treatment for NSCLC.

The area occupied by tropical forests in South America has continually experienced shrinkage since the Miocene, with the formation of the Dry Diagonal, which is composed of seasonally dry tropical forests and savannas (Caatinga, Cerrado, and Chaco). Here, we contribute to the understanding of the establishment of the Dry Diagonal by testing the hypotheses of “ancestral fragmentation” and of “colonization” to explain the current distribution of species in rocky humid formations of Cerrado, a Neotropical savanna in Brazil. Populations of Mandirola hirsuta (Gesneriaceae) were sampled in 25 localities; these cover the species’ entire geographical distribution, and the plastid intergenic regions psbA-trnH and trnQ-5′-rps16 were sequenced. The findings show that intrapopulation genetic variability was low, whereas interpopulation variability was high. We detected seven genetic groups that were geographically well delimited, and no signs of recent population expansion were observed. Divergence between the seven main lineages took place between the late Miocene and the Pliocene periods. In Approximate Bayesian Computation, the fragmentation scenario had a significantly higher probability than the colonization scenario. Results support the hypothesis of a former broader distribution for the humid vegetation, which was fragmented with the expansion of savannas; results also indicate population differentiation promoted by a rapid expansion of the Dry Diagonal.

Background Radiotherapy is an essential treatment component for patients with stage III non-small-cell lung cancer. Despite advances, survival remains poor. Proton beam therapy holds the promise of improving cure rates without increasing treatment-related toxicity. However, precision in dose delivery is sensitive to setup uncertainties. The conventional method of adding a margin to account for this problem can be inadequate. We aimed to use the probabilistic scenarios methodology to assess the robustness of intensity modulated proton therapy (IMPT) and volumetric arc therapy (VMAT). Methods Plans were optimised by minimax robust optimisation (MM) and margin-based (planning target volume [PTV]) methods (MM–IMPT, PTV–IMPT, and VMAT). Robustness was assessed with probabilistically simulated setup errors. 35 perturbed doses were summed to model a treatment course. The CTV-D98 (dose to 98% of the clinical target volume) of each summed dose distribution was compared with the nominal plan and considered robust if within 5%. The variance of the CTV-D98 in IMPT and VMAT plans were compared using Levene's Test. Findings 700 simulations from 20 plans were analysed. Despite dose variation over a simulated course of treatment, the robustness of each summed plan was within clinical limits. There was significantly less variance in the perturbed CTV-D98 in the MM–IMPT than in PTV–IMPT plans (4·43 cGy 2 vs 16·17, F =50·993, p 2 vs 4·04, F =0·312, p=0·577). Target conformality improved with increasing number of beams and robust optimisation. All summed plans met normal tissue dose constraints. Interpretation Initial results showed that fractionation reduced uncertainties in dose distribution due to setup errors. Robustness of MM–IMPT and VMAT plans were similar. Although the present analysis has not considered range uncertainties and organ motion, the simulations highlight differences in plan qualities with different optimisation strategies. The probabilistic scenarios methodology might be used to estimate robustness of IMPT plans in stage III non-small-cell lung cancer. Funding Cancer Research UK.

Commercially available pencil beam proton therapy treatment planning systems rely on a combination of in air and in phantom measurements. The analytical algorithms describe the scatter of and geometrical variation as the beam penetrates deeper in tissue. In previous work we showed that the accuracy of this approach is limited. Alternatively, stochastic algorithms (Monte Carlo, Boltzmann equation solvers) are used which are more precise but are much slower. This paper proposes a new parameterization of the physical dose deposition properties of a proton pencil beam and shows that it predicts all properties well even in sparse measurement conditions (i.e., not all energies for pencil beams are measured), decreasing the amount of beams needing to be measured by at least 50%.

Background: This presentation proposal focuses on a specific quanti-qualitative research activity of a broader process called Open Health in Ferrara. This step involves two public institutions (Hospital University and Local Health Authority of Ferrara), those manage and provide health-care services, and the department of Political and Social Sciences Bologna University, that supervises the research part. In particular the research team collected data, categorized and mapped the main opportunities and threats in the cancer pathways to empowering and involving patients and local communities. Methods: From the combined effects of e-learning and presence training, focus group, questionnaire, divulgative meetings with citizens and a good consideration of social communication importance, from the start of the pilotage September 2015 to April 2017, we realized direct involving 200 health and social professionals, citizens and policymakers. We analyze the main features of the pathways and to collect suggestion about patient experience, professionals experience of integrated care to improve the continuity of care of cancer pathways. Results: Data show the main critical points in the communication and information about symptoms and perception of feeling of abandonment and opportunities to have a second opinion, alternatives of care, efficacy of care and patient reported outcomes. There are also low perception from professionals as a interdisciplinary network

Design and Shielding of Radiotherapy Treatment Facilities provides readers with a single point of reference for protection advice to the construction and modification of radiotherapy facilities. The book assembles a faculty of national and international experts on all modalities including megavoltage and kilovoltage photons, brachytherapy and high-energy particles, and on conventional and Monte Carlo shielding calculations. This book is a comprehensive reference for qualified experts and radiation-shielding designers in radiation physics and also useful to anyone involved in the design of radiotherapy facilities.

Primary testicular lymphoma (PLT) represents 5% of testis tumors, the incidence increases in patients older than 60 years of age. Bilateral hydrocele is an unusual clinical presentation. Relapse in the central nervous system and in the contralateral testis is often observed. The US shows hypoechoic nodular lesions with a complete structural involvement of didymus and hypervascularization at Color Doppler. Orchiectomy should be performed in all cases as it is indispensable for the histopathological diagnosis and to characterize the immunophenotypic features. The most common histotype is diffuse large-B cell lymphoma. Combined biological approach and chemotherapy with rituximab and doxorubicin has radically changed the prognosis of disease. The authors report two patients of 81 and 82 years-old who referred for evaluation of massive bilateral hydrocele causing severe limitation of deambulation. Negative cytological findings for neoplastic cells in the scrotal effusion made difficult the differential diagnosis between inflammatory and malignant disease. Histopathologic findings made a diagnosis of high grade diffuse large B-cell NHL, respectively stage IV-E and stage III-E. The 82 years old patient was treated with 6 chemotherapy cycles of rituximab, cyclophosphamide, vincristine, prednisone. The exitus was dued to the umbilical hernia complications. In the 81 years old patient, cognitive deficit and severe impairment of general conditions constituted an absolute contraindication to polychemotherapy treatment. Rapid tumor progression led the patient to exitus 2 months after diagnosis. In both patients the delayed diagnosis of PLT was probably due to the reduction of welfare protection in the elderly with adverse social conditions.

Routing in Delay-/Disruption-Tolerant Networking (DTN) requires specific solutions as link impairments prevent the use of ordinary Internet algorithms, based on a timely dissemination of network topology information. Among DTN routing algorithms there is a dichotomy between opportunistic and deterministic (scheduled) solutions. The former are numerous and apply to terrestrial environments; CGR is the most widely supported algorithm designed for scheduled connectivity, and it is usually applied to space networks. However, in an attempt to provide a unified approach, an opportunistic variant of CGR, Opportunistic CGR (OCGR) has been recently proposed by some of the authors. Performance evaluations are normally carried out for opportunistic solutions by means of simulators, such as The ONE considered in this paper. CGR by contrast is more often studied by means of small testbeds. As the simulation approach could be complementary for CGR, and essential for OCGR, the authors have recently ported both of them into The ONE, by developing and releasing as free software a specific additional package. The aim of this paper is to show the rationale of this choice and discuss the many challenges that needed to be tackled to achieve this primary goal.

We present a study of the under-response of the new Gafchromic EBT3 films and a procedure to accurately perform 2D and 3D proton dosimetry measurements for both pristine and spread out Bragg peaks (SOBP) of any energy. These new films differ from the previous EBT2 generation by a slightly different active layer composition, which we show has not effected appreciably their response. The procedure and the beam quality correction factor curve have been benchmarked using 29 MeV modulated proton beams. In order to show the correction to apply when EBT3 films are used as treatment verification tools in anthropomorphic phantoms, two simulation studies involving clinical energies are presented: a SOBP for eye treatments and a SOBP to treat 20 cm deep and 5 cm thick tumours. We find maximum under-responses of 37%, 30% and 7.7% for the modulated 29 MeV beam, eye and deep tumour treatment, respectively, which were attained close to the end of the peak tails, due to a higher proportion of very low energy protons. The maximum deviations between corrected and uncorrected doses were for the three cases, respectively, 20.7%, 8.3% and 2.1% of the average dose across flat region of the SOBP. These values were obtained close to the distal edge of the SOBPs, where the proportion of low energy protons was not as high as on the tail, but there still was a number of protons high enough to deposit a reasonable amount of dose in the films.

We present a new simulation method to predict the maximum possible yield of X-rays produced by electron beams accelerated by petawatt lasers irradiating thick solid targets. The novelty of the method lies in the simulation of the electron refiluxing inside the target implemented with the Monte Carlo code Fluka. The mechanism uses initial theoretical electron spectra, cold targets and refiluxing electrons forced to re-enter the target iteratively. Collective beam plasma effects are not implemented in the simulation. Considering the maximum X-ray yield obtained for a given target thickness and material, the relationship between the irradiated target mass thickness and the initial electron temperature is determined, as well as the effect of the refiluxing on X-ray yield. The presented study helps to understand which electron temperature should be produced in order to generate a particular X-ray beam. Several applications, including medical and security imaging, could benefit from laser generated X-ray beams, so an understanding of the material and the thickness maximizing the yields or producing particular spectral characteristics is necessary. On the other more immediate hand, if this study is experimentally reproduced at the beginning of an experiment in which there is an interest in laser-driven electron and/or photon beams, it can be used to check that the electron temperature is as expected according to the laser parameters.

Acquired renal arteriovenous fistulas (AVFs) include those that occur as a complication of renal biopsy.The authors report the case of a woman with recent-onset grade I hypertension, who was referred to our staff for sonographic studies of the kidneys and urinary tract. Laboratory data revealed microhematuria and proteinuria0.5 g/24 h, and renal function was borderline (MDRD GFR 58 mL/min). Renal sonography of the left kidney revealed an anechoic, arboriform area at the level of the pelvis, which was suggestive of hydronephrosis. The color Doppler examination showed turbulent flow within the anechoic area, with high-velocity arterial flow and arterialization of the venous waveform at spectral analysis. Selective renal angiography later confirmed the presence of a middle renal AVF with pseudoaneurysm, which had been provoked by a renal biopsy performed over 10 years earlier in another center. Since the patient was currently in good health, the prescribed management consisted solely of close clinical and US follow-up.AV fistulas are among the most commonly diagnosed renovascular malformations. The case reported here underlines the importance of using color Doppler ultrasound when obstructive uropathy is suspected, especially in patients who have undergone renal biopsy.Sommario INTRODUZIONE: Tra le fistole arterovenose (FAV) acquisite vi sono quelle che si formano quale complicanza dell’esecuzione di una biopsia renale. CASO CLINICO: Gli autori riportano il caso di una paziente giunta in ambulatorio di ecografia nefrologica per l’esecuzione di un’ecografia dei reni e delle vie urinarie per un’ipertensione sistolica di I grado di recente insorgenza. Negli esami di laboratorio era presente microematuria con proteinuria0.5 g/24 ore. La funzionalità renale risultava ai limiti inferiori della norma (FG 58 mL/min secondo la formula MDRD). L’esame ecografico evidenziava una formazione anecogena “arboriforme” centropielica a livello del rene sinistro suggestiva per idronefrosi. Il color Doppler mostrava viceversa presenza di flusso turbolento all’interno dell’area anecogena stessa, con flusso arterioso elevato e arterializzazione del flusso venoso all’analisi spettrale. La successiva angiografia renale selettiva confermava il sospetto ecografico di FAV mediorenale sinistra con pseudoaneurisma, conseguente ad una biopsia renale effettuata più di 10 anni prima presso altro Centro. Essendo la paziente in pieno benessere veniva consigliato un più stretto follow-up clinico-ecografico. DISCUSSIONE: Tra le malformazioni vascolari renali di non rara osservazione sono le FAV. Il caso descritto ribadisce l’importanza dell’impiego dell’eco color Doppler (ECD) nel sospetto di uropatia ostruttiva, per diagnosticare una FAV, specialmente nei pazienti già sottoposti a biopsia renale.

Department of Emergency Medicine, Sapienza University, Post Graduate School in Emergency-Urgency Medicine, Sant’Andrea Hospital, Rome, Italy University of North Dakota School of Medicine and Biomedical Sciences Grand Forks, ND, USA Department of Medicine, University of Padova, Italy Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA Department of Nephrology, Dialysis and Dietology, SM della Misericordia Hospital, Rovigo, Italy Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy Department of Nephrology Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy GREAT: Global Research in Acute Conditions Team Network