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protected areas (pAs) are a foundational and essential strategy for reducing biodiversity loss. However, many pAs around the world exist on paper only; thus, while logging and habitat conversion may be banned in these areas, illegal activities often continue to cause alarming habitat destruction. in such cases, the presence of armed conflict may ultimately prevent incursions to a greater extent than the absence of conflict. Although there are several reports of habitat destruction following cessation of conflict, there has never been a systematic and quantitative "before-and-after-conflict" analysis of a large sample of pAs and surrounding areas. Here we report the results of such a study in colombia, using an open-access global forest change dataset. By analysing 39 PAs over three years before and after colombia's peace agreement with the Revolutionary Armed forces of colombia (fARc), we found a dramatic and highly significant increase in the deforestation rate for the majority of these areas and their buffer zones. We discuss the reasons behind such findings from the Colombian case, and debate some general conservation lessons applicable to other countries undergoing post-conflict transitions. The growing warfare ecology literature reports both negative and positive effects of conflict for biodiversity and the natural environment 1-3. This also applies to deforestation, which can be either increased or decreased depending on the specific complex socio-ecological dynamics linked to the conflict itself 3-5. Increased deforestation during conflict is reported for several regions of the world 6 , including Democratic Republic of Congo (DRC) and Liberia 7 or Myanmar and Cambodia 8. In some cases, conflict reduces the institutional capacity to enforce laws and effectively manage the use or protection of natural resources, e.g. as reported for Kenya 9 , DRC 10 , Nepal 11 , and Colombia 5. In other cases, the displacement of people escaping or forced to leave conflict areas, the basic mechanism for the 'refuge effect' 12 , can prove beneficial for habitat and biodiversity protection, e.g. by limiting the pressure of resource extraction 13-15. The demilitarized Zone between North and South Korea is a good example of such a refuge 16. Conflict can largely disrupt economic activities 1 , such as timber logging in Nicaragua 17 , or farming, as in Sierra Leone 18. In the Chechen wars and in the nearby Nagorno-Karabakh conflict, agricultural land was abandoned in warzones, along with reported low re-cultivation rates after the cessation of the conflict 19,20. In other cases post-conflict development results in higher threats to forested ecosystems than conflict

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The rapidly expanding network of roads into the Amazon is permanently altering the world’s largest tropical forest. Most proposed road projects lack rigorous impact assessments or even basic economic justification. This study analyzes the expected environmental, social and economic impacts of 75 road projects, totaling 12 thousand kilometers of planned roads, in the region. We find that all projects, although in different magnitudes, will negatively impact the environment. Forty-five percent will also generate economic losses, even without accounting for social and environmental externalities. Canceling economically unjustified projects would avoid 1.1 million hectares of deforestation and US$ 7.6 billion in wasted funding for development projects. For projects that exceed a basic economic viability threshold, we identify the ones that are comparatively better not only in terms of economic return but also have lower social and environmental impacts. We find that a smaller set of carefully chosen projects could deliver 77% of the economic benefit at 10% of the environmental and social damage, showing that it is possible to have efficient tradeoff decisions informed by legitimately determined national priorities.

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The present document has been prepared by a group of experts, members of cardiology, endocrinology, internal medicine, nephrology and diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is a useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high-risk population, usually underestimated and undertreated. These recommendations result from presentations and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming knowledge, attitude and behavioural barriers, preventing both physicians and patients from effectively adhering to guideline recommendations.

The period following heart failure hospitalization (HFH) is a vulnerable time with high rates of death or recurrent HFH.OBJECTIVE To evaluate clinical characteristics, outcomes, and treatment response to vericiguat according to prespecified index event subgroups and time from index HFH in the Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction (VICTORIA) trial. DESIGN, SETTING, AND PARTICIPANTSAnalysis of an international, randomized, placebo-controlled trial. All VICTORIA patients had recent (<6 months) worsening HF (ejection fraction <45%). Index event subgroups were less than 3 months after HFH (n = 3378), 3 to 6 months after HFH (n = 871), and those requiring outpatient intravenous diuretic therapy only for worsening HF (without HFH) in the previous 3 months (n = 801). Data were analyzed between May 2, 2020, and May 9, 2020.INTERVENTION Vericiguat titrated to 10 mg daily vs placebo. MAIN OUTCOMES AND MEASURESThe primary outcome was time to a composite of HFH or cardiovascular death; secondary outcomes were time to HFH, cardiovascular death, a composite of all-cause mortality or HFH, all-cause death, and total HFH. RESULTS Among 5050 patients in the VICTORIA trial, mean age was 67 years, 24% were women, 64% were White, 22% were Asian, and 5% were Black. Baseline characteristics were balanced between treatment arms within each subgroup. Over a median follow-up of 10.8 months, the primary event rates were 40.9, 29.6, and 23.4 events per 100 patient-years in the HFH at less than 3 months, HFH 3 to 6 months, and outpatient worsening subgroups, respectively. Compared with the outpatient worsening subgroup, the multivariable-adjusted relative risk of the primary outcome was higher in HFH less than 3 months (adjusted hazard ratio, 1.48; 95% CI, 1.27-1.73), with a time-dependent gradient of risk demonstrating that patients closest to their index HFH had the highest risk. Vericiguat was associated with reduced risk of the primary outcome overall and in all subgroups, without evidence of treatment heterogeneity. Similar results were evident for all-cause death and HFH. Addtionally, a continuous association between time from HFH and vericiguat treatment showed a trend toward greater benefit with longer duration since HFH. Safety events (symptomatic hypotension and syncope) were infrequent in all subgroups, with no difference between treatment arms.CONCLUSIONS AND RELEVANCE Among patients with worsening chronic HF, those in closest proximity to their index HFH had the highest risk of cardiovascular death or HFH, irrespective of age or clinical risk factors. The benefit of vericiguat did not differ significantly across the spectrum of risk in worsening HF.

The present document has been prepared by a group of experts, members of Cardiology, Endocrinology, Internal Medicine, Nephrology and Diabetes societies of Latin American countries, to serve as a guide to physicians taking care of patients with diabetes, hypertension and comorbidities or complications of both conditions. Although the concept of metabolic syndrome is currently disputed, the higher prevalence in Latin America of that cluster of metabolic alterations has suggested that metabolic syndrome is useful nosography entity in the context of Latin American medicine. Therefore, in the present document, particular attention is paid to this syndrome in order to alert physicians on a particular high- risk population, usually underestimated and undertreated. These recommendations results from presentation and debates by discussion panels during a 2-day conference held in Bucaramanga, in October 2012, and all the participants have approved the final conclusions. The authors acknowledge that the publication and diffusion of guidelines do not suffice to achieve the recommended changes in diagnostic or therapeutic strategies, and plan suitable interventions overcoming both physicians and patients from effectively adhering to guideline recommendations.