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The Iberian Pyrite Belt contains one of the largest accumulations of massive sulphide deposits on Earth. Many of these deposits are hosted by latest Devonian black shales rich in terrestrial and marine palynomorphs. Among the marine fossils, the most abundantly reported species is Maranhites mosesii. By means of a multi-analytical methodology, including (1) biometry of specimens, (2) TOFSIMS imaging and spectral analysis of selected specimens and (3) host-rock geochemistry, we detected that cysts of M. mosesii are smaller and lighter in massive sulphide-generating environments than in coeval non-massive sulphide-generating environment. Cysts of M. mosesii sank after encystment and maturated in the seafloor of different subbasins affected by disparate anoxic conditions. The specimens that maturated in anoxic settings enriched in pollutants, like Arsenic (As) and Lead (Pb), were smaller and lighter than those from non-polluted anoxic environments. Their organic walls were also enriched in As. Neither the anoxia nor the pollutants prevented the proliferation of M. mosesii, as this was the most abundant phytoplanktonic species in all environments. To explain this, we suggest that this species developed a successful adaptive mechanism that might involve anaerobic metabolic interchange with the surrounding oxygen-depleted media and high levels of tolerance to stressors. Whatever the reason, it entails a causal relationship between cyst size and seafloor environmental conditions. In consequence, the biometry of M. mosesii can be envisaged as a promising vector for sulphide deposit exploration in the Iberian Pyrite Belt.
Haemosporidians constitute a monophyletic group of vector-borne parasites that infect a wide range of vertebrate hosts, including Neotropical lizards. The remarkable diversity of these host-parasite associations and inadequate research on certain parasite groups have resulted in controversial haemosporidian taxonomy. Herein, we rediscover erythrocytic and non-erythrocytic haemosporidians infecting golden tegus (Tupinambis teguixin) from Brazil and Colombia. The erythrocyte-inhabiting parasite belongs to Plasmodium sp., and the non-erythrocytic form was identified as Saurocytozoon tupinambi, previously attributed to the Family Leucocytozoidae. These non-pigmented haemosporidian parasites do not multiply in the blood. The relationships between the Saurocytozoon and Leucocytozoidae species were discussed for many years, especially during the 1970s. However, cytochrome b (cytb) sequences and the mitochondrial genomes recovered for this species strongly support classifying this parasite as a Plasmodium taxon. Therefore, we proposed a new combination for this parasite, Plasmodium (Saurocytozoon) tupinambi comb. nov., where Saurocytozoon is retained as a subgenus due to its distinct morphology. These results reinforce that a broader definition of Plasmodiidae must include saurian parasites that develop non-pigmented leucocytozoid-like gametocytes.
The Flexible Farrington Algorithm (FFA) is widely used to detect infectious disease outbreaks at national/regional levels on a weekly basis. The rapid spread of SARS-CoV-2 alongside the speed at which diagnostic and public health interventions were introduced made the FFA of limited use. We describe how the methodology was adapted to provide a daily alert system to support local health protection teams (HPTs) working in the 316 English lower-tier local authorities. To minimize the impact of a rapidly changing epidemiological situation, the FFA was altered to use 8 weeks of data. The adapted algorithm was based on reported positive counts using total tests as an offset. Performance was assessed using the root mean square error (RMSE) over a period. Graphical reports were sent to local teams enabling targeted public health action. From 1 July 2020, results were routinely reported. Adaptions accommodated the impact on reporting because of changes in diagnostic strategy (introduction of lateral flow devices). RMSE values were relatively small compared to observed counts, increased during periods of increased reporting, and were relatively higher in the northern and western areas of the country. The exceedance reports were well received. This presentation should be considered as a successful proof-of-concept.
International agencies advocate for population-based cancer screening to prevent cancer-related deaths. The Arturo Lopez Perez Oncology Institute is interested in implementing screening programs, but international recommendations differ on program details such as screening tests, target population, age range, and frequency. A review of international evidence-based recommendations is essential for advising stakeholders on the effective implementation of screening programs.
Methods
A rapid scoping review was performed to identify international recommendations on cancer screening programs. Evidence-based recommendations derived from the World Health Organization and the European Union were analyzed. We also searched for evidence-based recommendations from the following health technology assessment agencies with specific sections for evaluating screening strategies: the Canadian Agency for Drugs and Technologies in Health (Canada), the Institute for Quality and Efficiency in Health Care (Germany), the Medical Services Advisory Committee (Australia), and the National Institute of Health and Care Excellence (UK). Additionally, we explored international cancer screening programs implemented by health systems in the aforementioned countries or in countries with implemented screening programs. Finally, we searched for recommendations from scientific societies on cancer screening strategies. This iterative process was repeated for five different cancers.
Results
We found a total of 32 favorable or unfavorable recommendations for breast, cervical, colorectal, lung, gastric, and prostate cancer screening. Breast and cervical cancer had the highest number of favorable recommendations, with complete agreement on the type of test and only small differences regarding age range and periodicity. On the other hand, we found some recommendations against population-based screening for prostate and gastric cancer and limited agreement for both test type and target population. Direct comparisons between the recommendations served as a guide to elaborate a cancer screening program based on the most recommended strategies.
Conclusions
This rapid scoping review allowed us to assess the consistency of cancer screening recommendations. Major differences were found mainly between recommendations from international agencies and scientific societies. As a result, a cancer screening program was designed based on the most recommended strategies.
The World Health Organization (WHO) recommends population-based cancer screening programs for colorectal cancer (CRC). However, CRC screening is not available in Chile´s public health system. The Arturo Lopez Perez Foundation (FALP) is interested in implementing a CRC screening program for their insurance beneficiaries, despite some uncertainties regarding cost effectiveness and budget impact. Exploring co-financing scenarios could reveal feasible choices for program implementation.
Methods
A Markov model was developed to assess the cost effectiveness of a biennial fecal immunochemical test (FIT) strategy for individuals aged 50 to 69 years from a private insurer perspective. Survival probabilities and average costs for each cancer stage at diagnosis were derived from our CRC patients. Benefits were measured as life-years gained. The budget impact was calculated using the expected population of beneficiaries for 20 years. Cost-effectiveness results were reported using the incremental cost-effectiveness ratio (ICER), with a referential threshold of one to three times the gross domestic product per capita (USD16,000 to USD48,000). Shared funding scenarios with national public insurers and out-of-pocket payments were simulated.
Results
CRC screening was cost effective in the base case and shared funding scenarios. Indeed, it showed some benefits and savings in the latter scenario. On the other hand, budget impact values were unaffordable for the base case scenario, revealing that implementing the program would be difficult even with the promising ICER. However, in shared funding scenarios, the budget impact decreased and even showed savings after five years due to the decrease in cancer treatment costs.
Conclusions
CRC screening with a biennial FIT is a cost-effective strategy for FALP beneficiaries, but the budget impact is substantial and poses challenges for its implementation. The use of shared funding strategies could help alleviate the budget impact, making the implementation of a screening program more feasible.
Effectiveness, efficiency, and consistency with patient preferences are requirements for appropriate healthcare. The Complex Treatment Evaluation Committee (CTEC) at the Arturo López Pérez Foundation is a multidisciplinary committee that assesses the appropriateness of high-cost cancer drug prescriptions (HCCDP) and authorizes their use accordingly. Our study aimed to develop a value framework to assess the appropriateness of HCCDP at the Foundation.
Methods
We conducted a literature review to identify appropriateness criteria for oncology prescriptions and the judgments used by the Chilean healthcare system for clinical practice guideline recommendations and reimbursement decisions for these medications. The results were discussed by the CTEC to establish a final value framework through consensus and to define a methodology to assess the appropriateness of HCCDP weekly. Annual indicators were designed to improve the agreed methods and the adequacy of prescriptions.
Results
Criteria for the value framework were grouped into three categories: magnitude of clinical benefit, efficiency, and sustainability. Every criterion should be met to consider an HCCDP as appropriate. Adequacy was evaluated by assessing prescription evidence identified from electronic databases, evidence-based clinical practice guidelines, regulatory agency reports, and health technology assessment reports. From 2019 to 2022, 1,626 cases have been evaluated. Although potentially inappropriate CTEC authorizations have decreased over time, there was a growing mismatch between these decisions and the prescribing behavior of clinicians.
Conclusions
By involving clinicians, managers, and health economists we developed a value framework for the timely assessment of the appropriateness of HCCDP in a hospital setting. Further research on the underlying reasons for the differences observed is needed, along with additional appropriateness criteria such as consistency with the preferences and ethical principles of patients.
Two new species in the genera Diploicia and Physcia are described from the tropical dry forest of Mexico. Both species are supported by morphological, chemical and molecular evidence. Diploicia edulis, a species heavily consumed by invertebrates, is characterized by lecanorine apothecia, a dull brown epihymenium not diffused by a green pigment (K−), a subhymenium conspicuously inspersed with oil droplets, and the diploicin chemosyndrome. We provide the first molecular evidence to support the inclusion of species with lecanorine apothecia in the genus Diploicia. Physcia ornamentalis, previously reported under the name Physcia undulata s. lat. as one of the main construction materials for the bags of a moth caterpillar species (Psychidae), is characterized by a frosted-pruinose thallus, soralia originating in the lobe sinuses, and by lacking soralia in the thalline margin of the apothecia.
To assess the effect of different front-of-package labelling (FOPL) schemes on the objective understanding of the nutritional content and intention to purchase products, in Panama.
Supermarkets across Panama. Participants were exposed to two-dimensional images of fifteen mock-up products presented at random and balanced orders. Participants assigned to the intervention groups were exposed to mock-ups featuring one FOPL scheme: black octagonal warning labels (OWL), traffic-light labelling (TFL) or guideline daily amounts (GDA). The control group was not exposed to any FOPL scheme.
Participants:
Adult supermarket shoppers (n 1200). Participants were blinded to group assignment.
Results:
A similar number of participants were randomised and analysed in each group: OWL (n 300), TFL (n 300), GDA (n 300) and control (n 300). The odds of choosing to purchase the least harmful or none of the options more often was the highest in the OWL group. Compared with the control group, these odds were two times higher in the OWL group (OR 2·13, 95 % CI 1·60, 2·84) and 57 % higher in the TFL (1·57, 1·40–2·56), with no changes in the GDA (0·97, 0·73–1·29). OWL also resulted in the highest odds for correctly identifying the least harmful option and for correctly identifying a product with excessive amounts of sugars, sodium and/or saturated fats.
Conclusions:
OWL performed best in helping shoppers to correctly identify when a product contained excessive amounts of nutrients of concern, to correctly identify the least harmful option and to decide to purchase the least harmful or none of the options, more often.
The quest for social status is usually considered one of the main drivers of the demand for consumer credit. This article provides a nuanced take on consumer credit by exploring the interaction between consumption, borrowing, and class identity. To do so I pursue a cultural class analysis inspired by the work of Pierre Bourdieu. Drawing from 26 semi-structured interviews, the article has two main findings. First, it shows that people engage in borrowing not only to gain prestige, but also to assert their belongingness to symbolic groups, which embody the values of imagined communities. Second, against the idea that borrowing is undertaken mainly for conspicuous consumption, the article's findings show that middle-income families in Chile borrow to consume ‘ordinary’ goods. Through the consumption of these goods, the Chilean middle classes seek to stabilize their class identities through their life trajectories, thereby achieving a sense of place in a changing environment. These findings lead me to focus on the normalization of credit and the process through which borrowing practices turn consumer goods from wants into needs, ratcheting up the demand for credit. The article argues that this is an overlooked way in which competitive dynamics drive the demand for credit, which is a missing link in the explanation for the rise of household debt.
This article discusses the literature on music teacher education programmes for mainstream education in order to undertake critical reflection on what we are doing and why in our university classrooms, what theories are implicit and what could be done to improve our programmes. After analysis, mainly from European contexts, and considering the Spanish one in particular, we find an influence of the economic – and, ultimately, political – rationale on substantial aspects, manifested in apparent disjunctions between musical and educational features, as well as in formal issues, fundamentally due to the European Higher Education Area. In the end, it is concluded that, without renouncing the economic aspects, curricula should be more addressed towards the integration of pedagogical and musical knowledge, and the treatment of aspects related to social justice, if we do not want an uncritical reproduction of rationalities that are often obsolete in the training of pre-service music teachers.
Lolliguncula argus is a squid species endemic to the Tropical Eastern Pacific and caught incidentally by the artisanal fishery around Puerto Angel, Oaxaca (Mexico). Due to the low abundance of Argus brief squid, basic aspects of the species’ reproductive biology have not been adequately studied. Therefore, in this study, we assess size at maturity (L50), gonad maturation, ovarian development and spawning pattern by means of both histological and oocyte size–frequency analyses. Our results are based on 581 squid specimens: 534 females (11.9–82.4 mm dorsal mantle length, DML) and 47 males (16.0–68.2 mm DML) caught by artisanal fishery from May 2017 to April 2018. The L50 was 58.0 mm DML for females and 55.4 mm DML for males. The ovulation pattern in L. argus is asynchronous, with multiple-batch spawning in a relatively short period of time (intermittent spawning). Lolliguncula argus breed in the coastal waters off Puerto Angel, in the western margin of the Gulf of Tehuantepec, and exhibit gregarious behaviour during spawning events, which is associated with the regional oceanographic conditions. Based on these results, we determine that the opportunistic reproductive strategy of L. argus occurs in response to suitable regional environmental conditions.
The evolution of advances in informatics, technology in medicine, and artificial intelligence (AI) offers opportunities to enhance health care during the coronavirus disease 2019 (COVID-19) pandemic. The challenge for biomedical engineers is to implement these developments in clinical practice to improve global health. Populations living in low-income countries do not have access to specialist care and quality diagnostic services for COVID-19. Therefore, an AI system based on a telemedicine platform for diagnosing COVID-19 could help mitigate the lack of highly trained radiologists at regional hospitals and serve as a triage system for rationalizing the use of reverse transcription polymerase chain reaction (RT-PCR) testing and other health resources in low-income countries. Thus, the utility of an AI system for diagnosing COVID-19 in Paraguay was investigated.
Methods
This is a descriptive multicenter observational feasibility study of an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties who attended public hospitals across the country.
Results
Between March 2020 and August 2021, 3,514 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of the patients was 48.6 years (52.8% were men); the most common age ranges were 27 to 59 years, followed by older than 60 years and 19 to 26 years. The most frequent findings on the CT images were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes. Overall, there was 93 percent agreement and 7 percent discordance between the AI system and the RT-PCR test results. Compared with RT-PCR testing, the AI system had a sensitivity of 93 percent and a specificity of 80 percent.
Conclusions
Paraguay has an AI-based telemedicine screening system for the rapid detection of COVID-19 that uses chest CT images of patients with respiratory conditions.
The ichthyofauna of the Atlantic and Pacific coasts off the American continent is very rich. Consequently, a high biodiversity of nematodes parasitizing these vertebrates is also expected. Currently, data on nematode parasites of marine fish off the Americas are fragmented. A review of all adult nematode species reported parasitizing marine fish from off the American continent is herein presented, as well as comments on their patterns of diversity, life cycles and advances in the taxonomic and phylogenetic knowledge. A total of 209 valid species, 19 species inquirendae and 6 dubious records have been recorded, the majority from the fish taxa Eupercaria and Perciformes. The families Sciaenidae, Serranidae and Lutjanidae, as well as the tropical and temperate Atlantic waters, exhibited the highest records of parasitic nematodes. The Cucullanidae, Philometridae and Cystidicolidae were the most speciose families of nematodes, which may be related to technological advances and relatively recent efforts of taxonomists, resulting in description of new taxa and the resolution of taxonomic problems. Numerous taxonomic questions still need resolution and, even though genetic data have been important for this process, the database is very scarce. This is the first review on all currently known nematode species parasitizing marine fish off the Americas and may serve as an important basis of reference for future approaches on these organisms.
This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018–2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20–0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018–2020 was 28% (P = 0.0001 for comparison with 2006–2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018–2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.
Stable isotopes are a powerful tool for reconstructing the past. However, environmental factors not previously considered can lead to misinterpretations. Our study presents a novel analysis of the feeding behavior of the megafauna that inhabited the Pilauco ecosystem in south-central Chile during the last glacial termination. We analyzed a suite of modern plant and animal samples from closed-canopy forests to establish an isotopic baseline with which to compare stable isotope results from fossil megafauna. Using the modern samples as a reference, the δ13C results from the Pilauco megafauna indicate feeding behaviors in forested areas. These results were then calibrated with dental calculus samples and coprolites, which suggest the coexistence of graze- and grass-dominated mixed-feeder diets. The δ15N values found in Pilauco megafauna are not consistent with modern reference data sets or with the low δ15N values of extinct proboscideans from other contemporaneous and nearby sites. Probably, the δ15N values of the Pilauco ecosystem were not primarily affected by climate, but rather by disturbance factors (e.g., grazing effect). Our results indicate that the Pilauco megafauna fed mainly on arboreal vegetation; however, non-isotopic proxies indicate that they were also eating open vegetation (e.g., herbs and grasses).
Artificial intelligence (AI) and innovative technology offer opportunities for enhanced health care during the COVID-19 pandemic. Populations living in low-income countries do not have access to reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 and, thus, depend on the scarce resources of their health system. In this context, an automated screening system for COVID-19 based on AI for a telemedicine platform could be directed towards alleviating the current lack of trained radiologists who can interpret computed tomography images at countryside hospitals.
Methods
This descriptive study was carried out in Paraguay by the Telemedicine Unit of the Ministry of Public Health and Social Welfare in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute and the University of the Basque Country. The utility of the screening system for COVID-19 was analyzed by dividing the results from two tailored AI systems implemented in 14 public hospitals into four likelihood levels for COVID-19.
Results
Between March and October 2020, 911 COVID-19 diagnoses were performed in 14 regional hospitals (62.6% were men and 37.4% were women). The average age of the patients diagnosed with COVID-19 was 50.7 years; 59.1% were aged 19 to 59 years. The two AI systems used have different background information for detecting COVID-19. The most common findings were severe pneumonia and bilateral pneumonia with pleural effusions. The role of computed tomography was to find lesions and evaluate the effects of treatment. The sensitivity of AI for detecting COVID-19 was 93%.
Conclusions
AI technology could help in developing a screening system for COVID-19 and other respiratory pathologies. It could speed up medical imaging diagnosis at regional hospitals for patients with suspected infection during the COVID-19 pandemic and rationalize scarce RT-PCR and specialized human resources in low-income countries. These results must be contextualized with the local or regional epidemiological profile before widespread implementation.
In the early nineteenth century a centralized political entity, the Galinhas kingdom, emerged in southernmost Sierra Leone. Based on sources from Cuban, British, American, Spanish, and Sierra Leonean archives, this article examines the factors accounting for the emergence and consolidation of Galinhas. I argue that the postabolitionist (1808) redeployment of North Atlantic slave trading actors, networks, routes, and spaces, particularly the connection with Cuba and resources from the island, created the conditions for Galinhas's commercial growth and the centralization of its political power. I then problematize the relationship between warfare, the Atlantic slave trade, and state making. During the foundation of a predatory state, before a slaving and political frontier existed, wars were detrimental to trade. When warfare and commerce — or any social activity — coexisted in the same physical space, the interdependent balance between them, which supported the slave trade itself, was disrupted. After the end of the war, political stability boosted slave trading operations.
The Cold War triggered the appearance of U.S.-sponsored re-distributive policies in Latin America with the goal of decreasing the influence of the Soviet Union. We study how organized groups of workers increased the intensity of one of the largest programs of the time, Salvador Allende’s land reform in Chile (1970–1973). Using original data in an event study research design, we find that the local political actions of workers—proxied by land invasions—affected the intensity and location of expropriations. We argue this result can be explained by a threat of political unrest.