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The Romans were among the first societies to extensively exploit fish resources, establishing large-scale salting and preservation plants where small pelagic fish were fermented to produce sauces such as garum. Here, the authors demonstrate that, despite being crushed and exposed to acidic conditions, usable DNA can be recovered from ichthyological residues at the bottom of fish-salting vats. At third-century AD Adro Vello (O Grove), Galicia, they confirm the use of European sardines (Sardina pilchardus) and move beyond morphology to explore population range and admixture and reveal the potential of this overlooked archaeological resource.
Notre société segmentée par l’âge offre peu de possibilités d’interactions intergénérationnelles authentiques. Cela contribue aux stéréotypes et préjugés envers les personnes de tous âges, particulièrement les adultes aînés. Pour favoriser une société plus inclusive et lutter contre l’âgisme, un changement de paradigme sociétal devient nécessaire. À partir d’une recherche basée sur la conception et l’apprentissage intergénérationnel, nous avons cherché à mieux caractériser ces apprentissages afin de développer des formations spécifiques pour les appuyer. Basé sur un questionnaire préliminaire (n=79), nous avons conçu un atelier pilote (français/anglais) avec huit adultes aînées et huit jeunes adultes au cours duquel les participants ont dû réaliser en binôme une vidéo sur TikTok. Nos résultats indiquent que l’apprentissage intergénérationnel doit se fonder sur une pédagogie active, les activités et les objectifs pédagogiques doivent être multiples pour être réalisées en binômes intergénérationnels, le format doit permettre de développer une relation de confiance et l’évaluation doit être personnelle.
Sustainable agricultural practices have become increasingly important due to growing environmental concerns and the urgent need to mitigate the climate crisis. Digital agriculture, through advanced data analysis frameworks, holds promise for promoting these practices. Pesticides are a common tool in agricultural pest control, which are key in ensuring food security but also significantly contribute to the climate crisis. To combat this, Integrated Pest Management (IPM) stands as a climate-smart alternative. We propose a causal and explainable framework for enhancing digital agriculture, using pest management and its sustainable alternative, IPM, as a key example to highlight the contributions of causality and explainability. Despite its potential, IPM faces low adoption rates due to farmers’ skepticism about its effectiveness. To address this challenge, we introduce an advanced data analysis framework tailored to enhance IPM adoption. Our framework provides (i) robust pest population predictions across diverse environments with invariant and causal learning, (ii) explainable pest presence predictions using transparent models, (iii) actionable advice through counterfactual explanations for in-season IPM interventions, (iv) field-specific treatment effect estimations, and (v) assessments of the effectiveness of our advice using causal inference. By incorporating these features, our study illustrates the potential of causality and explainability concepts to enhance digital agriculture regarding promoting climate-smart and sustainable agricultural practices, focusing on the specific case of pest management. In this case, our framework aims to alleviate skepticism and encourage wider adoption of IPM practices among policymakers, agricultural consultants, and farmers.
Objectives/Goals: To evaluate the impact of social determinants of health (SDOH), specifically socioeconomic status and medical insurance coverage, on access to mental health services for adults aged 60 and older served by Federally Qualified Health Centers (FQHCs) in Puerto Rico. Methods/Study Population: A secondary retrospective analysis of electronic health records from FQHCs in Puerto Rico will be conducted to examine the relationship between SDOH needs and mental health service utilization among adults aged 60 years and older receiving primary care. SDOH data will be collected using the PRAPARE® tool, assessing factors such as socioeconomic status, insurance coverage, and emotional support, with a focus on identifying unmet needs. Multivariable and logistic regression models, using Stata v.17, will be employed to evaluate correlations between these SDOH factors and mental health service utilization, adjusting for age, gender, and mental health conditions. This analysis aims to quantify the impact of SDOH on access to mental health services and elucidate key barriers to care for older adults in Puerto Rico. Results/Anticipated Results: We anticipate that lower socioeconomic status, lack of supplemental insurance, and inadequate family support will be strongly associated with the underutilization of mental health services among older adults in Puerto Rico. These disparities are expected to be more pronounced in individuals with limited income, weaker family networks, leading to significant gaps in access to necessary mental health care. Barriers such as healthcare insecurity, financial hardship, and fragmented support systems will likely emerge as major obstacles. By including patients from both rural and urban regions, the study will capture the distinct challenges each population faces, enhancing the contextual relevance of the findings to broader populations, ultimately informing policy and developing intervention strategies. Discussion/Significance of Impact: The findings will provide crucial insights for developing targeted interventions to enhance mental health care access for older adults in Puerto Rico. These results will inform policy development and public health strategies, addressing disparities and promoting equitable care in underserved populations.
What factors contribute to closing the turnout gender gap after female enfranchisement? In the wake of franchise expansion, we test whether being a poll officer—and hence being exposed to election management—boosted the politicisation and mobilisation of women. In the context of the Spanish Second Republic (1931–1939), we exploit a lottery that assigned recently enfranchised women to be poll officers in the first election women were allowed to vote (1933). We use an original individual-level panel database and show that women randomly selected as polling officers were as likely to participate in subsequent elections than men, while the gender turnout gap persisted among the rest. Further analyses suggest that being poll officers made women more receptive to political organisations mobilisation strategies, and their presence had positive externalities by encouraging other women to participate. Our findings highlight the potential benefits of exposure to election engineering among groups previously excluded or less engaged with democracy.
Understanding the complex dynamics of climate patterns under different anthropogenic emissions scenarios is crucial for predicting future environmental conditions and formulating sustainable policies. Using Dynamic Mode Decomposition with control (DMDc), we analyze surface air temperature patterns from climate simulations to elucidate the effects of various climate-forcing agents. This improves upon previous DMD-based methods by including forcing information as a control variable. Our study identifies both common climate patterns, like the North Atlantic Oscillation and El Niño Southern Oscillation, and distinct impacts of aerosol and carbon emissions. We show that these emissions’ effects vary with climate scenarios, particularly under conditions of higher radiative forcing. Our findings confirm DMDc’s utility in climate analysis, highlighting its role in extracting modes of variability from surface air temperature while controlling for emissions contributions and exposing trends in these spatial patterns as forcing scenarios change.
Children and adolescents diagnosed with autism spectrum disorder (ASD) present feeding problems that may influence food acceptance and refusal. However, data regarding dietary intake variability in this population are either not available in the literature or not well-known. This cross-sectional study aimed to identify the within-person and between-person variability, and the number of days needed for a 24-hour recall (24HR) to estimate the usual intake of children and adolescents with ASD. Data were collected from 284 patients assisted at a public neuropediatric health service in the city of Pelotas, Southern Brazil. Food consumption was assessed using three non-consecutive 24HR. Within-person (S2w) and between-person (S2b) variances, the variance ratio (VR) and the distribution of energy, macronutrients and micronutrients were obtained using the Multiple Source Method® (version 1.0.1). The number of days of 24HR needed was calculated for correlation coefficients of 0·7, 0·8 and 0·9. For most nutrients, S2w was greater than S2b, resulting in VR > 1, except for age-group analyses where children up to 5 years old showed VR < 1. Two to three days of 24HR were estimated for most nutrients, considering a correlation coefficient of 0·8. Differences were observed according to sex and age group, with adolescents requiring more days of 24HR. These findings indicate the need to assess dietary variability among individuals with ASD according to the characteristics of this investigated population.
Brazilian landowners are obligated to conserve a minimum percentage of native vegetation within their properties (termed a ‘legal reserve’), but non-compliance can be compensated elsewhere through a biodiversity offset. Recent changes in rules for legal reserve compensation (LRC) have increased the allowed spatial scale and softened the ecological criteria required to select properties for compensation, potentially leading to considerable biodiversity losses. In this paper, we analyse whether these rules promote the conservation of tree species on private lands through LRC in the Cerrado biome, the most biodiverse savannah in the world. We modelled the potential distribution of 126 Cerrado tree species and simulated several potential biodiversity offsets to calculate expected species losses under former and current LRC rules. Our results show that biodiversity offsets established under current and former LRC rules can lead to up to 100% tree species losses. In contrast, setting a minimum similarity threshold between watersheds can reduce median tree species loss in biodiversity offsets to as low as 3% and prevents LRC with no common species between sites. Therefore, the current rule is expected to strongly impact biodiversity in the Cerrado. Similarity in species composition between watersheds must be considered in order to implement LRC offsets that effectively conserve Cerrado biodiversity on private lands.
Action mechanisms of therapeutic alliance in stepped and digital interventions remain unclear.
Aims
(a) To compare the development of therapeutic alliance between psychosocial treatment as usual (PTAU) and a stepped digital intervention designed to prevent distress in cancer patients; (b) to analyse the level of agreement between patients’ and therapists’ therapeutic alliance ratings; and (c) to explore variables associated with therapeutic alliance in the digital intervention.
Method
A multicentre randomised controlled trial with 184 newly diagnosed breast cancer women was conducted. Patients were assigned to digital intervention or PTAU. Therapeutic alliance was assessed at 3, 6 and 12 months after inclusion using the working alliance inventory for patients and therapists. Age, usability (system usability scale), satisfaction (visual analogue scale), type and amount of patient–therapist communication were analysed as associated variables.
Results
Patients and therapists established high therapeutic alliance in the digital intervention, although significantly lower compared with PTAU. The development of patients’ therapeutic alliance did not differ between interventions, unlike that of the therapists. No agreement was found between patients’ and therapists’ therapeutic alliance ratings. Patients’ therapeutic alliance was associated with usability and satisfaction with app, whereas therapists’ therapeutic alliance was associated with satisfaction with monitoring platform.
Conclusions
A stepped digital intervention for cancer patients could develop and maintain strong therapeutic alliance. Neither the type nor amount of communication affected patients’ therapeutic alliance, suggesting that flexible and available digital communication fosters a sense of care and connection. The association between usability and satisfaction with digital tools highlights their importance as key therapeutic alliance components in digital settings.
Oral supplementation with probiotics, prebiotics, and synbiotics is a novel potential complementary therapy for addressing overweight and obesity through gut microbiota modulation. This systematic review provides a comprehensive summary of the existing evidence to guide future research. Literature searches were conducted in four databases to identify human trials published until May 2024 that examined the impact of probiotic, prebiotic, or synbiotic interventions on faecal microbiota composition changes in overweight and obese participants from Latin American and Caribbean populations (LACPs). Of the 13,090 identified records, five randomised controlled trials (RCTs) from Brazil, Mexico, and Chile met the inclusion criteria for this review. The included RCTs evaluated different forms of therapies over short-term interventions (6 or 8 weeks), with sample sizes ranging from 21 to 39 participants across the studies. Variations in the reported outcomes were observed due to differences in supplement formulation, dosage, population characteristics, and methodological heterogeneity. The findings indicate that the available data are inadequate to establish definitive conclusions regarding the impact of biotic treatments on gut microbiota profiles in LACP. Further research with larger sample sizes and precise microbiota analysis is required to elucidate the implications of dietary interventions on gut microbiota in obesity and related disorders.
Left ventricular assist devices (LVAD) are a therapeutic option in patients with advanced heart failure (HF) not a candidate for cardiac transplant as destination therapy (DT). However, important uncertainties remain regarding the use of LVAD in the long-term in real practice settings. When planning registries, it is important to choose the appropriate outcomes that ensure comparability and reduce the possibility of bias.
Aim
The purpose of this study was to establish a minimum dataset (MDS) that should be collected in all LVAD for DT registries to meet the needs and demands of Health Technology Assessment (HTA) doers and health professionals.
Methods
To design the MDS for LVAD, a preliminary list of outcome domains and data items were developed attending to the gaps and research needs derived from existing evidence coming from HTA carried out at the European Network of Health Technology Assessment (EUnetHTA) level. The list of data items and domains was agreed upon by all involved HTA organizations and a three-round Delphi was conducted among an experienced panel of cardiologists to rate the importance of the items for measuring uncertainty gaps.
Results
After the three-round Delphi process, the expert panel reached a consensus regarding eighteen outcomes and forty-seven variables divided into seven main domains (safety, effectiveness, patient acceptability, satisfaction, healthcare system impact, pharmaceutical management, and technique-related factors).
Conclusions
The MDS of outcomes and measures, developed based on research gaps and needs, can allow for standardizing data collection and improving the quality of data for decision making and practice.
Bagrada bug, Bagrada hilaris (Burmeister) (Hemiptera: Pentatomidae), is an invasive pest of cole crops in the United States. Because it also feeds on widespread weeds and persists in natural habitats surrounding crop fields, conventional control strategies are often ineffective at providing long-term control. One egg parasitoid, Gryon aetherium Talamas (Hymenoptera: Scelionidae), is a promising biological control candidate because of its ability to parasitise B. hilaris buried eggs. Recently, adventive populations of G. aetherium were recovered from sentinel eggs in California along with a native egg parasitoid, Ooencyrtus californicus Girault (Hymenoptera: Encyrtidae). A better understanding of these parasitoid species’ spatial preference for foraging and their possible competitive interactions will help evaluate their host suppression potential. We compared the foraging abilities of these two parasitoid species for eggs deposited below and above ground. We also investigated the effect of interspecific competition on host suppression and the ability of O. californicus to parasitise eggs previously parasitised by G. aetherium. G. aetherium parasitised naturally and manually buried eggs, whereas O. californicus did not. In another experiment, O. californicus parasitised eggs glued to cards, but not in the presence of sand. Results suggest that G. aetherium may be negatively affected by the presence of O. californicus, and there was a slight but significant reduction in total host mortality when the parasitoids were present together. However, the inability of O. californicus to forage in soil likely limits negative interactions between these two species, and the two parasitoids may ultimately complement each other.
This study identified health susceptibility using socioeconomic and environmental indicators, focusing on their impact on population health, by using a health vulnerability index (HVI). The aim was to map vulnerabilities using the HVI among beneficiaries of a health maintenance organization (HMO) in the metropolitan region of Belo Horizonte (MRBH), to enhance access, efficiency, equity, and quality in health services.
Methods
Established in 2012 by Belo Horizonte’s municipality using 2010 census data, the HVI incorporates eight socioeconomic and sanitation indicators. This methodology was extended to all HMO beneficiaries in the MRBH using georeferencing to assess their vulnerability levels (low, medium, high, or very high) and proximity to health facilities.
Results
The findings revealed that 5.44 percent of the HMO’s clients reside in areas categorized as high or very high risk, which corresponds to more than 70,000 individuals. Notably, 91.8 percent of these high-risk beneficiaries are situated in the suburban and peripheral areas of the region and predominantly utilize health facilities located on the outskirts of Belo Horizonte or within the metropolitan area. This distribution underscores a notable disparity in healthcare accessibility and service utilization patterns, with a marked inclination toward the use of emergency services among these populations.
Conclusions
The study underscores a strong correlation between vulnerability and the type of healthcare service utilized, with vulnerable groups often resorting to emergency services, which leads to fragmented care. It highlights the need to improve service processes, particularly for those reliant on public transport, and advocates for an integrated approach to health interventions that promotes equitable healthcare access in complex socioeconomic landscapes.
Effective participation of individuals with disabilities in health technology assessment (HTA) processes is paramount. Aware of the reality of people with physical and organic disabilities, COGAMI (a not-for-profit umbrella organization of disability associations) conducted an internal study to gather perspectives on the participation of people with disabilities in HTA processes.
Methods
An ad hoc questionnaire of four open-ended questions was designed and distributed via email to COGAMI’s socio-health commission, representing 23 entities and 4,000 people in Galicia. A thematic analysis of the responses obtained was carried out.
Results
Consensus underscores the fundamental role of individuals with disabilities and their representative organizations in HTA processes, though currently, only those with greater resources actively participate. The participants found that insufficient information reaching patient organizations hinders participation (e.g., lack of awareness in proposal submission), complicating their involvement. Additional challenges include accessibility and the digital divide. Proposed solutions involve enhancing communication channels and information accessibility, establishing collaborative frameworks nationally, and actively considering the disability condition to ensure a fair and equitable implementation.
Conclusions
This study suggests the need for concrete actions to enhance the participation of individuals with disabilities in HTA processes. Recommendations include improving communication channels, capacity building, and recognizing disability as a key element in HTA.
The RedETS horizon scanning (HS) program in Spain is focused on identifying non-pharmaceutical emerging health technologies. HS is organized in three steps: (i) identification using different sources (PubMed, the biomedical press, and others); (ii) screening performed by the HS Working Group and clinicians; and (iii) prioritization using the PriTec tool. This study aimed to evaluate the accuracy of RedETS HS in identifying disruptive emerging technologies for our health system.
Methods
Data from brief files and full reports related to the identified emerging technologies were collected. Full health technology assessment (HTA) reports were also reviewed. The period of analysis was from 2016 to 2023. The information collected included the name, type, category, and indication of the emerging technology and the source of identification. An ad hoc Excel spreadsheet was designed to collect the information. The analysis consisted of a description of the variables and an assessment of concordance between the emerging technologies identified and those with full HTA reports.
Results
There were 338 emerging technologies identified. These technologies were mainly therapeutic (52.1%) or diagnostic (25.7%). In addition, about 45 percent were medical devices and 15.7 percent were in vitro diagnostic tests; imaging comprised 7.4 percent. Most of the emerging technologies were identified through the biomedical press (22.2%), PubMed (23.6%) and industry (20.3%). In a preliminary analysis of these main sources, 31 percent of the technologies identified by HS had full HTA reports, with all of these being identified three years before the HTA.
Conclusions
HS systems might help identify the most relevant technologies for healthcare systems, enabling them to be more ready to incorporate the new technologies. Therefore, HS must be able to detect emerging technologies that will have an impact on the health system. Periodic evaluation of the accuracy of HS programs will improve their impact in the HTA process.
An early dialogue (ED) is non-binding scientific advice given to industry in the initial stages of technology development to help create evidence that the health technology assessment (HTA) agency will request. ED could also be used in the academic ecosystem. We report our experience with the clinical validation of an algorithm to predict persistent remission in patients with rheumatoid arthritis treated with biological therapy.
Methods
A systematic review (SR) was undertaken to compare optimization algorithms with current clinical management. The review focused on the effectiveness and safety of these tools and included clinical practice guidelines, SRs, and primary studies. Several meetings took place between the research team and HTA researchers to integrate HTA requirements (e.g., choice of comparators, relevant outcomes, quality of life, and patient groups) into the study design to ensure the quality and accuracy assurance of data collected as well as the proper monitoring of good clinical practice.
Results
Local clinical practice guidelines pointed to the importance of optimization strategies to select the most suitable patients in remission. However, there is currently no validated algorithm to select these patients. The literature search retrieved 1,809 references. There were no primary studies identified and only two ongoing randomized controlled trials met the inclusion criteria: REMRABIT-Plus (OPTIBIO) and PATIO. There were some important differences between the studies with respect to the patient populations and stages of the disease. Based on these results, the review will continue in “living evidence” mode, with the aim of collecting new evidence as it becomes available.
Conclusions
There is currently an unfulfilled need between research projects in the academic context and HTA that can be resolved with ED. Collaboration in the early stages of technology development is fundamental to improving the appropriateness of data produced for future HTAs. This will facilitate quality decision-making on the incorporation of procedures into the National Health Service.
The participation of people with mental health conditions or patient representatives is of relevance in the health technology assessment (HTA) field, although there are some challenges that need to be considered. This study was designed to gain the perspectives of patient representatives with experience participating in HTA projects, with the aim of delving into the main issues and proposing ideas for the future.
Methods
A structured interview, based on five open-ended questions, was formulated and distributed via email. Five patient representatives from the Saúde Mental FEAFES Galicia (the Federation of Associations of Family Members and Persons with Mental Illness of Galicia, Spain) who had actively engaged in HTA projects over the past five years participated in the study. The collected data were analyzed using thematic analysis.
Results
Participants underscored the pivotal role of involving persons with mental health conditions and their representatives in HTA and emphasized the importance of knowing their perspectives, preferences, and values. Challenges included the complexity of HTA reports and processes, in terms of length and the technical language used, and socioeconomic barriers. Proposed solutions included material adaptation, streamlined processes, and institutional and professional support. Future recommendations emphasized improving awareness, disseminating the HTA field, fostering active participation, and emphasizing the relevance of participating in the HTA process. Of particular significance was the encouragement of training and capacity building among patients with mental health conditions.
Conclusions
This study reveals the need to strengthen and facilitate the participation of individuals with mental health conditions in HTA processes, and emphasizes the importance of knowing their perspectives, preferences, and values. Recommendations include training and capacity building, simplifying materials and processes, and providing adequate support.
Recent advancements in Earth system science have been marked by the exponential increase in the availability of diverse, multivariate datasets characterised by moderate to high spatio-temporal resolutions. Earth System Data Cubes (ESDCs) have emerged as one suitable solution for transforming this flood of data into a simple yet robust data structure. ESDCs achieve this by organising data into an analysis-ready format aligned with a spatio-temporal grid, facilitating user-friendly analysis and diminishing the need for extensive technical data processing knowledge. Despite these significant benefits, the completion of the entire ESDC life cycle remains a challenging task. Obstacles are not only of a technical nature but also relate to domain-specific problems in Earth system research. There exist barriers to realising the full potential of data collections in light of novel cloud-based technologies, particularly in curating data tailored for specific application domains. These include transforming data to conform to a spatio-temporal grid with minimum distortions and managing complexities such as spatio-temporal autocorrelation issues. Addressing these challenges is pivotal for the effective application of Artificial Intelligence (AI) approaches. Furthermore, adhering to open science principles for data dissemination, reproducibility, visualisation, and reuse is crucial for fostering sustainable research. Overcoming these challenges offers a substantial opportunity to advance data-driven Earth system research, unlocking the full potential of an integrated, multidimensional view of Earth system processes. This is particularly true when such research is coupled with innovative research paradigms and technological progress.
Amazon parrots stand out as one of the most illegally traded Psittacids in the neotropics. However, the lack of effective tools for determining the geographical origin of confiscated individuals has impeded the development of well-informed release programmes. In this study, we evaluated the efficacy of the cytochrome oxidase subunit I (COI) gene to identify phylogeographical groups and infer the origins of seized individuals across six Amazon parrot species. Through comprehensive genetic and phylogenetic analyses of 140 COI sequences from individuals with documented geographical origin, a genetic reference database was assembled. The most likely origin of 156 seized parrots was inferred by comparing their genotype to this database. Within the Yellow-headed Parrot Amazona ochrocephala species complex, our analyses revealed the presence of seven distinct phylogeographical groups, exposing a notable poaching impact in the Middle Magdalena’s river valley. For the Southern Mealy Amazon A. farinosa, three distinct genetic groups were identified, with seized individuals showing comparable proportions originating from both the Cis- and Trans-Andean regions. Noteworthy genetic differentiation was observed between individuals of Festive Amazon A. festiva from the Caquetá–Amazon Rivers and those from the Meta River, with two seized individuals assigned to the former. The Scaly-naped Amazon A. mercenaria exhibited genetic divergence between individuals from the central Andes and the Sierra Nevada de Santa Marta. In contrast, the Orange-winged Amazon A. amazonica and Red-lored Amazon A. autumnalis did not display significant phylogeographical structure. However, analyses of seized individuals of A. amazonica suggested a potential underestimation of its genetic diversity and structure. This study illustrates the utility of mitochondrial molecular markers in determining the most probable area of origin for confiscated Amazon parrots, aiding in release programmes and enhancing the monitoring of natural populations.