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The PT EMT plays a crucial role in emergency assistance during disasters, outbreaks, and mass gatherings, alleviating pressure on hospital emergency departments and supporting local health systems. The EMT Initiative ensures that health services provided in emergencies are safe, timely, equitable, and efficient. This initiative supports the deployment of teams and the development of structures necessary to deliver quality health services in host countries.
Objectives:
Benchmarking for EMT development and deployment to ensure consistent and quality clinical governance and preparedness.
Method/Description:
Analysis of clinical management and supply chain practices based on PT EMT’s experience.
Results/Outcomes:
To enhance clinical performance, the Portuguese team supplemented WHO’s Minimum Standards by developing 25 clinical guides. These guides help in precise assessment of clinical consumables, ensuring the module’s self-reliance and reducing material wastage. They also facilitate the preparation of cargo manifests and optimize the packaging and transport of clinical supplies, adhering to safety standards.
Using WHO’s Essential Medicines List and considering potential deployments in Portuguese-speaking countries, the PT EMT established a robust inventory of essential clinical consumables. This inventory ensures authorized entry into host countries and continuity of care post-deployment. The organization of clinical supplies into three kits allows for autonomous care for up to 15 days, supporting 100 patients daily. This preparedness was recognized and integrated into WHO’s revised Bluebook in 2021.
Conclusion:
Since 2019, this approach has been tested and refined at major events like Fatima’s mass gathering and World Youth Day 2023, demonstrating increased operational efficiency and sustained emergency response capabilities for the PT EMT.
Current literature has shown that poor sleep patterns and social jet lag (SJL) are associated with obesity and weight gain. However, this area remains underexplored in patients who have undergone bariatric surgery. We hypothesised that higher levels of SJL and poorer sleep patterns are associated with lower weight loss, greater caloric/nutrient intake and poorer metabolic outcomes following surgery. This study aims to assess the associations of SJL and subjective sleep with anthropometric, metabolic and dietary parameters during the first year following bariatric surgery. SJL, sleep quality and daytime sleepiness were measured in 122 patients (77 % women; median age 33·0 [28·0 – 41·7]). SJL was estimated by the absolute difference between the midpoint of sleep and wake times on weekdays and weekends. Daytime sleepiness and sleep quality were evaluated using the Epworth Sleepiness Scale (Epworth) and the Pittsburgh Sleep Quality Index, respectively. Multiple linear regressions were employed to evaluate the associations of SJL, sleep quality and daytime sleepiness with weight loss, metabolic and dietary outcomes. Independent variables were negatively associated with weight loss after surgery: SJL at 6 months and 1 year; sleep quality at all time points and sleepiness after one year (P < 0·05). SJL was positively associated with calorie and protein intake after 1-year post-surgery (P < 0·05). Our results show that higher SJL and poorer sleep patterns are associated with worse anthropometric, metabolic and dietary outcomes after bariatric surgery. These findings reinforce the importance of addressing variables related to biological rhythms to optimise post-surgical outcomes in bariatric patients.
New agronomic practices are emerging in the green cane system to utilize sugarcane (Saccharum officinarum L.) straw for energy cogeneration, which necessitates its removal from the soil surface. This study has three main objectives: (1) evaluate the population dynamics and composition of Jamaican crabgrass (Digitaria horizontalis Willd.) and large crabgrass [Digitaria sanguinalis (L.) Scop.] under different sugarcane straw amounts, with and without herbicide treatment; (2) assess the development of sugarcane under different straw amounts; and (3) determine the amount of sugarcane straw that should be kept on the soil surface after harvest to ensure that it does not compromise the chemical control for Digitaria spp. in ratoon cane in a green cane system. We conducted this research at two experimental sites, one at the beginning and the other during the middle of the harvest season, over a span of 2 yr. Our primary treatments consisted of different amounts of sugarcane straw after harvest on the soil surface (0, 5, 10, and 15 Mg ha−1), while secondary treatments included the herbicide application (sulfentrazone + tebuthiuron for the beginning of harvest season and isoxaflutole + tebuthiuron for the middle of harvest season). The Digitaria spp. exhibited higher density (four times more) and dry matter (two times more) in scenarios with a lower sugarcane straw amount (5 Mg ha−1) on the soil surface and no herbicide application. However, a higher straw amount (15 Mg ha−1) contributed to reduced Digitaria spp. infestation and to improved sugarcane yield. According to this research, it is essential to maintain at least 10 Mg ha−1 of sugarcane straw on the soil surface and remove only 5 Mg ha−1 for energy cogeneration.
The numerical range in the quaternionic setting is, in general, a non-convex subset of the quaternions. The essential numerical range is a refinement of the numerical range that only keeps the elements that have, in a certain sense, infinite multiplicity. We prove that the essential numerical range of a bounded linear operator on a quaternionic Hilbert space is convex. A quaternionic analogue of Lancaster theorem, relating the closure of the numerical range and its essential numerical range, is also provided.
The study was carried out in dairy cows to elucidate whether treatment of clinical mastitis quarters with Spectramast® LC (ceftiofur hydrochloride, 125 mg, Zoetis) created a reason for discarding milk from adjacent untreated healthy quarters. The antibiotic was infused once daily in the affected mammary quarter for four days. Forty-nine cows were evaluated after diagnosis of clinical mastitis in three or fewer udder quarters. In all cases, quarters that did not receive treatment had milk samples collected one day after the end of treatment. All milk samples from untreated quarters were below the maximum permissible limit for the presence of antibiotic residues after analysis with the BetaStar S Combo test. Pharmacokinetic and pharmacodynamic characteristics may explain this finding. We conclude that it is feasible to use milk from untreated quarters of animals that have been treated with Spectramast® LC. We also reiterate the need to carry out tests with other pharmacological bases, and that the results found in this experiment cannot be extrapolated to other drugs.
Dairy cattle have considerable importance in the development of the Brazilian economy, being directly linked to economic and social progress. In the first half of 2020, 12.1 billion liters of milk were produced in Brazil and in 2019, there was a new record of 25.01 billion liters produced (IBGE, 2020). This production comes from a wide variety of production systems, coming from smallholder farmers as well as from large companies that use the latest technologies available on the market. Dairy production is a complex activity. For one to obtain economical success, several aspects must be monitored. Maintaining the health of animals is a top priority, and the literature suggests that various diseases are a common challenge for dairy producers. Mastitis is the main disease that affects dairy cows, responsible for considerable economic loss and significant zootechnical and productive challenges (Ruegg, 2017). It is considered the second leading cause of cow culling in dairy herds, behind reproductive problems. Mastitis is characterized by infection of the mammary gland and may or may not occur with inflammation, generating changes in the mammary tissue and properties of the milk. It is classifield into clinical or subclinical mastitis, according to presence or absence of clinical signs, and into contagious or environmental based on the causative agent (Correa et al., 2001).
Recent studies on the quality of life in women with breast cancer show a high prevalence of signs and symptoms that should be the focus of palliative care (PC), leading us to question the current role they play in addressing breast cancer. Therefore, the objective of this review is to map the scope of available literature on the role of PC in the treatment of women with breast cancer.
Methods
This is a methodologically guided scoping review by the Joanna Briggs Institute and adapted to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist for report writing. Systematic searches were conducted in 8 databases, an electronic repository, and gray literature. The searches were conducted with the support of a librarian. The study selection was managed through the RAYYAN software in a blind and independent manner by 2 reviewers. The extracted data were analyzed using the qualitative thematic analysis technique and discussed through textual categories.
Results
A total of 9,812 studies were identified, of which only 136 articles and 3 sources of gray literature are included in this review. In terms of general characteristics, the majority were published in the USA (35.7%), had a cross-sectional design (44.8%), and were abstracts presented at scientific events (19.6%). The majority of interventions focused on palliative radiotherapy (13.6%). Thematic analysis identified 14 themes and 12 subthemes.
Significance of results
Our findings offer a comprehensive view of the evidence on PC in the treatment of breast cancer. Although a methodological quality assessment was not conducted, these results could guide professionals interested in the topic to position themselves in the current context. Additionally, a quick synthesis of recommendations on different palliative therapies is provided, which should be critically observed. Finally, multiple knowledge gaps are highlighted, which could be used for the development of future studies in this field.
The current investigation assessed a) the performance of the FOCUS ADHD mobile health application (App) in increasing pharmacological treatment adherence and improving patients’ knowledge of attention-deficit/hyperactivity disorder (ADHD) and b) the impact of implementing a financial incentive for using the App (i.e., a discount on medication).
Methods
In a randomized, blind, parallel-group clinical trial, 73 adults diagnosed with ADHD were allocated into three groups for 3 months: a) Pharmacological treatment as usual (TAU); b) TAU and the App (App Group); and c) TAU and the App + a commercial discount on the purchase of medication prescribed for ADHD treatment (App + Discount Group).
Results
There was no significant difference in mean treatment adherence between groups, assessed as a medication possession ratio (MPR). However, the App + Discount Group exhibited greater medication intake registrations compared with the App Group during the initial phase of the trial. The financial discount also produced a 100% App adoption rate. App use did not increase ADHD knowledge, though knowledge scores were high at baseline. The usability and quality of the App were rated favorably.
Conclusions
The FOCUS ADHD App achieved a high adoption rate and positive evaluations by users. Use of the App did not increase adherence to treatment as measured by MPR, but, for App users, the addition of a financial incentive to use the App produced an increase in treatment adherence in terms of medication intake registrations. The present results offer encouraging data for combining incentives with mobile digital health solutions to positively impact treatment adherence in ADHD.
Several countries maintain universal health coverage, which implies responsibility to organize delivery formats of healthcare services and products for citizens. In Brazil, the health system has a principle of universal access for more than 30 years, but many deficiencies remain and the country observes a day practice for those seeking judicial decisions to determine provision of healthcare.
The objective of this study was to investigate the prevalence and carry out epidemiology using sociodemographic data from patients with symptoms suggestive of coronavirus disease (COVID-19) (SARS-CoV-2) in 3 bordering Brazilian municipalities.
Methods:
An epidemiological survey of positive cases of COVID-19 through reverse transcriptase polymerase chain reaction (RT-PCR) was carried out in 1874 patients, seen in the Unified Health System (SUS), ages between 0 and 99 years, who had symptoms suggestive of COVID-19, from the cities of Assis Chateaubriand, Tupãssi, and Formosa do Oeste.
Results:
It was possible to observe that of the 1874 patients seen in the public health network of the 3 municipalities, 354 were diagnosed as positive. The predominance of cases was in female patients (51.97%) and in patients who lived in urban areas (93.50%), and the predominant age group was 20–29 years (19.78%).
Conclusion:
The result of this study demonstrated the epidemiological profile of patients with respiratory and flu-like symptoms, positive for COVID-19, in 3 municipalities bordering Paraguay and Argentina. It was evident that the age group has its specificities regarding the susceptibility of the infection. Although the borders are closed, there was probably a spread of the virus in this region, due to the diversion, which showed an increase during the pandemic period.
Early Neolithic funerary practices and the meaning of complete ceramic vessels found isolated are poorly researched topics in western Iberia. However, recent archaeological salvage excavations at Armazéns Sommer and Palácio Ludovice in Lisbon have revealed individual burial pits of male individuals laid in a foetal position and directly associated with necked vessels. These discoveries suggest that finds of isolated vessels, known since the beginning of the twentieth century in Portugal and usually found fortuitously apparently without archaeological context, may also have originally belonged to similar burials, unnoticed by their finders. This hypothesis opens new perspectives for the interpretation of such finds, which are inventoried in the present article.
Congenital transmission of Chagas disease plays an important role in endemic countries because it is not a diagnosis that is encountered frequently in prenatal care. Due to limited information regarding congenital transmission of Trypanosoma cruzi in Mexico, the present study aimed to investigate protozoan infectivity and modulation of immune responses in human placental explants infected with T. cruzi Ia Mexican strains. The Inc-5 strain showed increased infectivity and modulated IL-1β, IL-10 and TLR-4, decreasing their expression after 24 h of infection. Both strains (Inc-5 and Ninoa) stimulated the production of TNF-α and decreased IL-6 levels 96 h after infection. An important detachment of the syncytiotrophoblast caused by infection with T. cruzi was observed after 24 h of infection. In this study, ex vivo infection of human placental villi was performed to better understand interactions involving parasitic T. cruzi and human placental tissue. It was concluded that the strains of TcIa present parasitism in placental tissue, modulation of the innate immune system of the placenta, and cause intense detachment of the syncytiotrophoblast, a fact that may be more associated with abortion and premature birth events than the congenital transmission itself, justifying the low rate of this transmission mechanism by this genotype.
Cover crop residue left on the soil surface as organic mulch in no-tillage crop production provides several environmental benefits, including weed suppression. Thus, many farmers who use cover crops attempt to reduce the use of agricultural inputs, especially herbicides. Therefore, our objectives were to study the potential of different cover crop species to suppress weeds and produce an in situ organic mulch and to evaluate the effect of the organic mulch with and without spraying glyphosate on weed suppression for vegetable (tomato [Solanum lycopersicum L.] and broccoli [Brassica oleracea L. var. botrytis]) growth and yield. Five cover crop treatments (sunn hemp [Crotalaria juncea L.], jack bean [Canavalia ensiformis (L.) DC.], pearl millet [Pennisetum glaucum (L.) R. Br.], forage sorghum [Sorghum bicolor (L.) Moench ssp. bicolor], and no cover crop [control]) were used in the main plots; and glyphosate was or was not sprayed on the flattened cover crop in the subplots of this split-plot experimental design. Organic mulch from pearl millet, sorghum, and sunn hemp resulted in lower weed biomass during the early seasons of both tomato and broccoli than mulch from jack bean and no cover crop (control). Spraying glyphosate after roller-crimping reduced weed biomass by 103 g m−2 and 20 g m−2 by 45 and 60 d after transplanting (DATr) of tomato, respectively, and resulted in a better tomato yield compared with not spraying. Glyphosate reduced weed biomass by 110 g m−2 in the early season of broccoli (30 DATr) but did not affect yield. Terminating high-biomass cover crops with a roller-crimper is a promising technique for weed management in vegetable crops that has the potential to reduce or even eliminate the need for herbicide.
Cognitive impairment is common in bipolar disorder and is emerging as a therapeutic target to enhance quality of life and function. A systematic search was conducted on PubMed, PsycInfo, Cochrane, clinicaltrials.gov, and Embase databases for blinded or open-label randomized controlled trials evaluating the pro-cognitive effects of pharmacological, neurostimulation, or psychological interventions for bipolar disorder. Twenty-two trials were identified, evaluating a total of 16 different pro-cognitive interventions. The methodological quality of the identified trials were assessed using the Cochrane Risk of Bias tool. Currently, no intervention (i.e., pharmacologic, neurostimulation, cognitive remediation) has demonstrated robust and independent pro-cognitive effects in adults with bipolar disorder. Findings are preliminary and methodological limitations limit the interpretation of results. Methodological considerations including, but not limited to, the enrichment with populations with pre-treatment cognitive impairment, as well as the inclusion of individuals who are in remission are encouraged. Future trials may also consider targeting interventions to specific cognitive subgroups and the use of biomarkers of cognitive function.
Denture-related stomatitis caused by Candida spp. affects elderly individuals using partial/total prosthesis, provoking several discomforts including burning sensation and altered taste. Herein, we have studied 52 denture-wearing individuals (>60 years-old), attended at the dentistry clinic of UNIVALE, aiming to isolate Candida spp. directly from the stomatitis lesions and to evaluate their potential to produce virulence attributes. A low prevalence of denture-related stomatitis was reported in these patients (4/52; 7.7%). Candida albicans was isolated in the 4 selected patients, with the ability to form biofilm over a polystyrene surface and to produce aspartic protease, esterase and hemolysin. However, neither phospholipase nor caseinase activities were detected. Planktonic-growing yeasts were susceptible to amphotericin B and caspofungin, while the susceptibility to azoles (fluconazol, itraconazole and voriconazole) varied depending on either the isolate or antifungal. Relevantly, biofilm-forming C. albicans cells exhibited resistance to all studied antifungals. So, new effective drugs against resistant C. albicans isolates causing denture-related stomatitis are urgently required.
In this research paper we describe the technological properties of beneficial lactic acid bacteria (LAB) obtained from a dairy production chain and the development of a fermented milk produced with Lactobacillus casei MRUV6. Fifteen LAB isolates (Lactobacillus sp., Pediococcus sp. and Weissela sp.) presented acidifying abilities (pH ranges from 0.73 to 2.11), were able to produce diacetyl (except by 5 isolates) and exopolysaccharides, and two were proteolytic. L. casei MRUV6 was selected for producing a fermented milk, stored up to 35 d at 4 and 10°C. Counts on MRS agar with added vancomycin (10 mg/l) and MRS agar with added bile salts (1.5% w/v) ranged from 9.7 to 9.9 log CFU/g, independently of the tested conditions, indicating stability and intestinal resistance of L. casei MRUV6, despite some significant differences (P < 0.05). The study demonstrated the technological potential of a potential probiotic candidate strain, L. casei MRUV6, to be used as a starter culture in the dairy industry.
The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.
Design:
The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman’s correlations, weighted Cohen’s kappa (κw), percentage of agreement and energy-adjusted Pearson’s correlation coefficients were calculated.
Setting:
Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).
Subjects:
A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.
Results:
Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman’s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman’s coefficients from 0·17 to 0·37, energy-adjusted Pearson’s coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.
Conclusion:
The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.
To assess the reliability and validity of body weight (BW) and body image (BI) perception reported by parents (in children) and by adolescents in a South American population.
Design
Cross-sectional study. BW perception was evaluated by the question, ‘Do you think you/your child are/is: severely wasted, wasted, normal weight, overweight, obese?’ BI perception was evaluated using the Gardner scale. To evaluate reliability, BW and BI perceptions were reported twice, two weeks apart. To evaluate validity, the BW and BI perceptions were compared with WHO BMI Z-scores. Kappa and Kendall’s tau-c coefficients were obtained.
Setting
Public and private schools and high schools from six countries of South America (Argentina, Peru, Colombia, Uruguay, Chile, Brazil).
Participants
Children aged 3–10 years (n 635) and adolescents aged 11–17 years (n 400).
Results
Reliability of BW perception was fair in children’s parents (κ=0·337) and substantial in adolescents (κ=0·709). Validity of BW perception was slight in children’s parents (κ=0·176) and fair in adolescents (κ=0·268). When evaluating BI, most children were perceived by parents as having lower weight. Reliability of BI perception was slight in children’s parents (κ=0·124) and moderate in adolescents (κ=0·599). Validity of BI perception was poor in children’s parents (κ=−0·018) and slight in adolescents (κ=0·023).
Conclusions
Reliability of BW and BI perceptions was higher in adolescents than in children’s parents. Validity of BW perception was good among the parents of the children and adolescents with underweight and normal weight.
This chapter explains the role of experiments as a means of reconfiguring urban infrastructure regimes. Urban areas are sites of circulation, shaped by socio-technical and socio-ecological flows that enable certain economic and social activities, but which are fundamentally made by urban politics and how these politics frame resource use. Reconfigurations of the urban infrastructure regime of the scale required in a transition to sustainability does not require a total overhaul of the physical or social systems which underline them. It entails a reconfiguration of the dynamics of circulation.
Here is where experiments play a key role making a politics of circulation, questioning the urban politics that underpin resource transformation. Experiments shake the whole infrastructure lattice that enables the resource politics that allow the city go unquestioned. They allow for shifts that are able to challenge the tracks of particular innovation trajectories. Ultimately, experiments are a means to maintaining the fabric of the city and the discourses of hope that support climate change action.