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To describe the process of the development of evidence-based guidelines on the assessment and clinical management of internal contamination with transuranic actinides (specifically plutonium, americium, and curium) in incidents where workers, emergency responders, and the public might uptake these radionuclides internally through inhalation, ingestion, or wound contamination.
Methods
The World Health Organization (WHO) set up a guidelines development group (GDG) that follows the protocol required for producing evidence-based recommendations as described elsewhere. The GRADE® approach was applied throughout the process, including developing research questions formulation, prioritization and rating the importance for the outcomes, assessing the certainty of the evidence, considering contextual factors, and making recommendations.
Results
Through 3 working group meetings held 2023-2024, the GDG defined and rated patient-important health outcomes, and evidence gathered through systematic reviews and its certainty rating, working towards formulating the recommendations using an evidence-to-recommendation (EtR) framework.
Conclusions
The WHO protocol for developing health care management guidelines uses a transparent and robust evidence-based GRADE® approach. Once published, these guidelines will provide the first evidence-based recommendations for assessment and clinical management of internal contamination with transuranic actinides.
Growing evidence suggests that psychedelic-assisted therapies can alleviate depression, anxiety, posttraumatic stress, and substance use disorder, offering relatively safe profiles, enhanced efficacy, and lasting effects after a few applications. Athletes often experience high levels of stress and pressure, making them susceptible to these psychiatric conditions. However, the effects of psychedelic substances on athletic performance remain largely unknown. Before potential acceptance, evaluating their impact on physical and physiological measures beyond mental health outcomes is crucial. Here, we aim to explore this topic and highlight research directions to advance our understanding. Preclinical studies suggest that psilocybin/psilocin, lysergic acid diethylamide (LSD), N,N-dimethyltryptamine (DMT), and ayahuasca possess anti-inflammatory and anti-nociceptive properties. Studies investigating the effects of classical psychedelics or 3,4-methylenedioxymethamphetamine (MDMA) on factors such as muscle strength, motor coordination, locomotion, endurance, fluid and electrolyte balance, hormonal regulation, and metabolism are still scarce. While adhering to regulatory frameworks, further research in animal models, athletes, and non-athletes is needed to address these gaps, compare psychedelics with commonly used psychoactive drugs, and explore the potential prophylactic and regenerative benefits of specific interventions.
Recent research on the organisation and growth of large settlements (both urban and non-urban) has prompted a reassessment of factors driving population aggregation. Systematic aerial and ground survey of the South Caucasus mega-fortress Dmanisis Gora, described here, contributes to the understanding of large fortress settlements in the South Caucasus (c. 1500–500 BC) as part of this wider debate. Substantial defensive walls and stone architecture in the outer settlement contrast with low-intensity occupation, possibly by a seasonally mobile segment of the population. The exceptional size of Dmanisis Gora helps add new dimensions to population aggregation models in Eurasia and beyond.
The genus Enenterum Linton, 1910 comprises species which parasitize herbivorous kyphosid fish. In the present study, a new species is described based on fresh specimens collected from Kyphosus incisor from Rio de Janeiro. The new species is characterized by having the oral sucker infundibuliform with 10 lobes, prepharynx two times longer than pharynx, presence of oesophagus, testes slightly lobed, round ovary and rectum with muscular sphincter connected to the anus. New genetic sequences include partial 18S and 28S rDNA and ITS1-5.8S-ITS2. The phylogenetic analyses place Enenterum gomesae n. sp. as sister of Enenterum aureum, corroborating the morphological analyses. Enenterum aureum (=E. pimelopteri) previously described from Kyphosus spp. from Rio de Janeiro is now considered E. gomesae n. sp. The new species represents the only South American species so far described for this genus.
Risk-based surveillance is now a well-established paradigm in epidemiology, involving the distribution of sampling efforts differentially in time, space, and within populations, based on multiple risk factors. To assess and map the risk of the presence of the bacterium Xylella fastidiosa, we have compiled a dataset that includes factors influencing plant development and thus the spread of such harmful organism. To this end, we have collected, preprocessed, and gathered information and data related to land types, soil compositions, and climatic conditions to predict and assess the probability of risk associated with X. fastidiosa in relation to environmental features. This resource can be of interest to researchers conducting analyses on X. fastidiosa and, more generally, to researchers working on geospatial modeling of risk related to plant infectious diseases.
Our study aim was to identify high-risk areas of neonatal mortality associated with bacterial sepsis in the state of São Paulo, Southeast Brazil. We used a population-based study applying retrospective spatial scan statistics with data extracted from birth certificates linked to death certificates. All live births from mothers residing in São Paulo State from 2004 to 2020 were included. Spatial analysis using the Poisson model was adopted to scan high-rate clusters of neonatal mortality associated with bacterial sepsis (WHO-ICD10 A32.7, A40, A41, P36, P37.2 in any line of the death certificate). We found a prevalence of neonatal death associated with bacterial sepsis of 2.3/1000 live births. Clusters of high neonatal mortality associated with bacterial sepsis were identified mainly in the southeast region of the state, with four of them appearing as cluster areas for all birth weight categories (<1500 g, 1500 to <2500 g and ≥ 2500 g). The spatial analysis according to the birth weight showed some overlapping in the detected clusters, suggesting shared risk factors that need to be explored. Our study highlights the ongoing challenge of neonatal sepsis in the most developed state of a middle-income country and the importance of employing statistical techniques, including spatial methods, for enhancing surveillance and intervention strategies.
Linkage fabrics are gaining in popularity and finding applications in architecture, aerospace, healthcare, and fashion because they can deliver materials with bespoke flexibility and strength through the geometric design of linkage nodes. In this article, we provide a perspective on linkage fabrics as a new class of programmable materials. We describe the theory and design principles of these linkage fabrics and show how they can be designed and simulated using digital tools, and fabricated using 3D printing. This digital approach overcomes a major obstacle to the adoption of these materials, namely their complexity. We show how simulation methods can be verified and calibrated through experimental testing. This perspective article also discusses design-led research challenges for linkage fabrics such as the development of wearable assistive devices for those with physical disabilities.
The end of free movement and the introduction of the post-Brexit migration system represent the most important changes to the UK migration system in half a century. Coinciding with the aftereffects of the pandemic, the result has been very large changes both to the numbers of those coming for work and study, and to their composition, both in terms of countries of origin and in the sectors and occupations of new migrants. It has also resulted in a political backlash, resulting in significant further changes to the system announced in December 2023. I discuss the evidence to date of the impact of recent migration trends on the UK economy and labour market, distinguishing between different sectors.
This study aimed to analyze stress, anxiety, depression, and self-efficacy levels among Spanish out-of-hospital emergency medical professionals from February 1, 2021, to April 30, 2021.
Methods:
A nationwide survey was completed by 1666 Emergency Medical Services (EMS) workers. The Depression, Anxiety, and Stress Scale (DASS-21) and the General Self-Efficacy Scale (GSE) were used. Data analysis used chi-squared, análisis of variance (ANOVA), and logistic regressions.
Results:
The sample comprised 833 (50%) men, with an average age of 44.3 ± 9.9 y (range: 19-67 y). Occupational distribution included 453 (27.2%) physicians, 474 (28.4%) nurses, and 739 (44.4%) emergency medical technicians (EMTs). EMTs exhibited higher odds of severe or extremely severe depression compared with physicians (odds ratio [OR]: 1.569; 95% confidenceinterval [95% CI]: 1.213-2.030) and nurses (OR: 1.561; 95% CI: 1.211-2.012). EMTs also displayed higher probabilities of severe or extremely severe anxiety compared with nurses (OR: 1.944; 95% CI: 1.529-2.701). Furthermore, EMTs demonstrated elevated probabilities of severe or extremely severe stress compared with physicians (OR: 1.387; 95% CI: 1.088-1.770). However, no significant differences were found in self-efficacy, with a median value of 73 [20].
Conclusions:
Out-of-hospital EMS workers experienced mental health challenges, showing varying levels of depression, stress, and anxiety across different occupational groups. EMTs were particularly affected.
The poultry red mite (Dermanyssus gallinae) causes severe welfare concerns for laying hens arising from anaemia and disease transmission, and has been identified as an associated risk factor in cannibalistic feather pecking. Previous work suggests that essential oils may offer an alternative to synthetic acaricides to control D. gallinae. Such alternatives are needed due to the limitations of synthetic acaricides (eg availability, resistance, environmental concerns and product residues). The aim of the current study was to ensure that selected essential oils have no negative impact on either hen welfare or egg production. To achieve this aim, small groups of laying hens were confined in poultry huts for a period of eight weeks during which time the interior of the huts was sprayed at weekly intervals with one of four different treatments: i) Thyme essential oil at 5× the LC90 level (the concentration of oil previously found to kill 90% of D. gallinae under laboratory conditions) for D. gallinae in 500 ml of water, ii) Pennyroyal essential oil at 5× the LC90 level for D. gallinae in 500 ml of water, iii) Solvent-only (huts treated with 500 ml of water); and iv) Pseudo-spray where huts were not treated with any product, but subjected to sham-spraying. The results suggest that pennyroyal essential oil would not be suitable for further development as an acaricide for D. gallinae, since this treatment had to be terminated early in the study period as a result of concerns about the welfare of hens exposed to this oil. Conversely, there were few differences in feather condition, hen weight, feed intake, feeding efficiency, egg production or egg weight between thyme-treated huts and huts that were either pseudo-sprayed or sprayed with solvent-only (water). It is concluded that thyme essential oil is a promising candidate for further development as an acaricide for D. gallinae to help safeguard the welfare of laying hens in commercial poultry systems.
Data from neurocognitive assessments may not be accurate in the context of factors impacting validity, such as disengagement, unmotivated responding, or intentional underperformance. Performance validity tests (PVTs) were developed to address these phenomena and assess underperformance on neurocognitive tests. However, PVTs can be burdensome, rely on cutoff scores that reduce information, do not examine potential variations in task engagement across a battery, and are typically not well-suited to acquisition of large cognitive datasets. Here we describe the development of novel performance validity measures that could address some of these limitations by leveraging psychometric concepts using data embedded within the Penn Computerized Neurocognitive Battery (PennCNB).
Methods:
We first developed these validity measures using simulations of invalid response patterns with parameters drawn from real data. Next, we examined their application in two large, independent samples: 1) children and adolescents from the Philadelphia Neurodevelopmental Cohort (n = 9498); and 2) adult servicemembers from the Marine Resiliency Study-II (n = 1444).
Results:
Our performance validity metrics detected patterns of invalid responding in simulated data, even at subtle levels. Furthermore, a combination of these metrics significantly predicted previously established validity rules for these tests in both developmental and adult datasets. Moreover, most clinical diagnostic groups did not show reduced validity estimates.
Conclusions:
These results provide proof-of-concept evidence for multivariate, data-driven performance validity metrics. These metrics offer a novel method for determining the performance validity for individual neurocognitive tests that is scalable, applicable across different tests, less burdensome, and dimensional. However, more research is needed into their application.
The purpose of this paper is to review the evolution of public policy toward the favelas of Rio de Janeiro since 1972–73. I choose these years because they are the ones at which available published accounts on the topic cease. One of my objectives is to re-actualize existing information on that subject. At the same time, I wish to bring forth some considerations on the relationships between civil society, especially its most deprived classes, and the particular form of authoritarian state now dominant in Brazil.
This article will attempt to “map” the class structure of Latin American societies on the basis of several recent empirical studies and statistics provided by such organizations as the International Labour Office (ILO), the Regional Employment Program for Latin America (PREALC), and the UN Economic Commission for Latin America (ECLA). This formal exercise should help clarify existing class structures by reducing a large and complex list of designations to a manageable number. On the basis of this classification, changes in class composition and struggles during the last two decades will then be examined. The article is thus divided in two parts, one dealing with class structure and the other with class dynamics.
The purpose of this article is to review recent trends in the process of urbanization in major Latin American cities. Abundant literature on Third World urbanization in the 1960s and 1970s painted a fairly coherent picture of the process during these decades. That image, which has been generally accepted in both academic and policy circles, serves as the backdrop against which contemporary trends will be evaluated here. The population in Latin America was becoming rapidly urbanized, but the process has been frequently described as “distorted” in a number of ways by the common condition of underdevelopment in which these countries found themselves.
This article seeks to examine empirically several recent hypotheses on the evolution of Latin American urbanization based on data from five countries in the Caribbean Basin. The hypotheses were advanced by the senior author in an earlier article in this journal (Portes 1989). They concern three major aspects discussed in the literature on Latin American cities: changes in urban primacy, spatial polarization within the largest cities, and the urban informal economy as a countercyclical mechanism. The hypotheses contradict much of the scholarly consensus on the character of Latin American urbanization as summarized in a number of publications (Beyer 1967; Hardoy 1975; Portes and Walton 1976; Roberts 1978; Portes and Johns 1989).
This article proposes a framework for the analysis of social classes in Latin America and presents evidence on the composition of the class structure in the region and its evolution during the last two decades, corresponding to the years of implementation of a new economic model in most countries. The paper is an update of an earlier article on the same topic published in this journal at the end of the period of import substitution industrialization. Relative to that earlier period, the present era registers a visible increase in income inequality, a persistent concentration of wealth in the top decile of the population, a rapid expansion of the class of micro-entrepreneurs, and a stagnation or increase of the informal proletariat. The contraction of public sector employment and the stagnation of formal sector labor demand in most countries have led to a series of adaptive solutions by the middle and lower classes. The rise of informal self-employment and micro-entrepreneurialism throughout the region can be interpreted as a direct result of the new adjustment policies. We explore other, less orthodox adaptive strategies, including the rise of violent crime in the cities and migration abroad by an increasingly diversified cross-section of the population. The impact that changes in the class structure have had on party politics and other forms of popular political mobilization in Latin American countries is discussed.
Major social and economic changes in Latin America brought about by adoption of the neoliberal model of development have been documented in the recent research literature. We ask to what extent such changes have affected the character of popular collective mobilizations in major cities of the region. We present data from six recent field studies in major Latin American cities that identify goals pursued by contemporary popular movements and organizations and the strategies they adopt to achieve them. These studies provide an overview of how urban society has reacted to the constraints, crises, and opportunities brought about by the new model of development and cast light on what has changed and what remains the same in determinants of popular collective demand-making in major metropolitan areas. Theoretical and practical implications of these results are discussed.