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To summarize insights generated during the preceding four conventions of the European Access Academy (EAA) regarding the interface of patient organizations and medical societies with the evolving European Union (EU) health technology assessment (HTA) process.
Methods
In 2022 and 2023 four EAA conventions were held on the EU HTA regulation, focusing on: (i) its relevance for beating cancer; (ii) stakeholder involvement; (iii) recommended preparatory steps to ensure its successful implementation; and (iv) the role of hematology and oncology as a pacemaker for the EU HTA process. Here we summarize insights generated at the four EAA conventions about the integration of patient and clinician insights in the evolving EU HTA process, including joint scientific consultations (JSC) and joint clinical assessments (JCA).
Results
Throughout the conventions it became clear that the interface of patient associations and clinical societies with the EU HTA process is key for successful implementation of the regulation. All involved stakeholders rely on the principles of evidence-based medicine (EBM), including best internal and external evidence, patient values and expectations, and clinical experience. It was agreed that patient and clinician perspectives on the assessments are needed to balance the technical analysis of best external evidence. While patient input is rather well defined, when and how input from clinical societies is best incorporated during the process remains unclear.
Conclusions
As stipulated by the EBM triad, systematic involvement of patients and clinicians throughout both JSC and JCA is key to ensuring best outcomes for patients and society as a whole, in line with the objectives of the EU HTA regulation.
Avian nests often contain aromatic plant fragments, which has led to propose among others that they repel ectoparasites or vectors of blood parasites (‘nest protection hypothesis’). To date, the relationship between secondary plant provisioning and the parent's blood parasites remains unexplored. We investigated whether the presence of secondary plants in nests during different reproductive stages (before incubation, during incubation and nestling period) was associated with the presence of nest-dwelling ectoparasites and females’ blood-parasite infections in blue tits (Cyanistes caeruleus) during chick rearing. In this species, females are highly exposed to parasites, particularly at the beginning of the breeding season, since they build the nest and incubate alone. They also brood the nestlings while the male assists with provisioning. We found that females that provided fewer plants before incubation were more likely to be infected by Plasmodium. Specifically, Females that did not provide Achillea herbs before incubation were more likely to be infected by both Plasmodium and Haemoproteus, reinforcing the ‘nest protection’ hypothesis. Thus, secondary plants may create an early environment that masks the odour of hosts or repels vectors. Surprisingly, the presence of Lavandula during the nestling period was positively related to Leucocytozoon infection. Given its fastest development among haemosporidians, we speculate that Lavandula herbs are provided by females to reduce mother-to-offspring transmission or as a self-medication strategy. Finally, the number of plant fragments provided before incubation was negatively associated with the number of (Protocalliphora azurea) larvae, whereas there were no associations with the presence of mites (Dermanyssus gallinoides).
We investigate two-dimensional (2-D) axisymmetric flow in toroidal geometry, with a focus on a transition between 2-D three-component flow and 2-D two-component flow. This latter flow state allows a self-organization of the system to a quiescent dynamics, characterized by long-living coherent structures. When these large-scale structures orient in the azimuthal direction, the radial transport is reduced. Such a transition, if it can be triggered in toroidally confined fusion plasmas, is beneficial for the generation of zonal flows and should consequently result in a flow field beneficial for confinement.
The paper offers the first interpretation of David Ricardo’s famous numerical example fully compatible with the primary source. It claims that the sole purpose of the four numbers was to illustrate that the relative value of commodities made in different countries is not determined by the respective quantities of labor devoted to their production. This exception results from unequal ordinary profit rates between countries because capital does not move across national borders as easily as it does within the same country. Likewise, the paper also debunks some entrenched myths about the numerical example. It shows that Ricardo did not leave the terms of trade indeterminate, that the purpose of the four numbers was not about measuring the gains from trade, and that Portugal had no productivity advantage over England. All of this contradicts the way scholars have interpreted Ricardo’s numerical example since the mid-nineteenth century.
This paper reports the results of the collaboration within the European initiative of new Reimbursement and aCCess Approaches (EUreccA) which is concerned with the use of real-world evidence (RWE) in health technology assessment (HTA) decision-making. The work grew from the observation of a large, very experienced group of HTA practitioners which found that the use of RWE varied depending on the type of question asked and the particulars of the data source(s) used. We set out to examine how RWE is used in HTA decision-making and to make proposals on its facilitation.
Methods
Literature reviews covering earlier reviews of RWE use, academic papers, and HTA agency websites were combined with case studies involving interviews with decision-makers in four countries (England, France, Italy, Sweden) to identify the circumstances of breakdown of RWE use and to build a categorization of the uses of RWE and associated difficulties. This evidence supported the creation of a taxonomy of pairings of data sources and the questions they were used to address. The face validity of the approach was tested at an advisory board of senior HTA practitioners.
Results
In total, 27 questions were identified and 10 types of data source, giving 270 pairings. These pairings were linked to relevant methods guidance and to examples of their use, itemizing HTA issues and decisions made. Reports are being prepared for publication, covering the detail of the methods of the literature searches; methods of the country case studies; a description of the taxonomy; and guidance on governance.
Conclusions
When using RWE in HTA decision-making, the detail of the particular data sources and question addressed matter. Recently, both the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Real-World Transparency Initiative have argued for a registry of the uses of RWE. The work described here offers a starting classification of the material that should be held in such a registry, and which in itself could be developed by the stakeholders, both agencies and companies, that use it, furthering trust and confidence.
Qualitative consciousness is conscious experience marked by the presence of sensory qualities, like the experienced painfulness of having a piano dropped on your foot or the consciousness of seeing the brilliant reds and oranges of a sunset. Over his career, philosopher David Rosenthal has defended an influential theoretical approach to explaining qualitative consciousness. This approach involves the development of two theories – the higher-order thought theory of mental state consciousness and the quality-space theory of sensory quality. If the problem of explaining qualitative consciousness is divided into two more manageable pieces, the door opens to a satisfying explanation of what is seen by some to be an intractable explanatory puzzle. This interdisciplinary collection develops, criticizes, and expands upon themes inspired by Rosenthal’s work. The result is an exciting collection of new essays by philosophers and scientists, which will be of interest to all those engaged in consciousness studies.
The recovery of a new partial cranium of Decennatherium rex Ríos et al. 2017 bearing two anterior and two posterior ossicones from the Late Miocene deposits of the site Batallones-10 (MN-10, Cerro de los Batallones, Madrid Basin) sheds light on the complex variability of the cranial appendages of these extinct giraffids. The special features of the anterior ossicones of BAT10’18-C6-40, each formed by two bosses and separated by a septum increase the range of morphological variability found in the anterior ossicones of giraffids. Posterior ossicone variability has already been described in several sivatherine taxa as Sivatherium maurusium (Harris, 1974) but anterior ossicone variability has never been discussed for four-ossicone taxa. This new specimen accounts for the third morphotype found in D. rex anterior ossicones. BAT10’18-C6-40 is identified as an adult D. rex male on the basis of the development of the posterior ossicones. These are large and already show the first large bump which in this taxon is always located on the middle of the dorsal surface at a similar height on the right and left ossicones which agrees with Solounias (1988) who stated that these small irregular protuberances have a somewhat fixed position, suggesting a genetic basis. This new specimen represents a new example of cranial variability in D. rex, and makes it the extinct giraffid with the largest anterior ossicone variability found so far.
This study summarised the association between ultra-processed food (UPF) consumption and dental caries in children and adolescents through a systematic review and meta-analysis. The search of PubMed, Cochrane, Web of Science and Scopus databases using the ‘PECOS’ strategy retrieved 1462 eligible articles. Only studies with humans aged ≤ 19 years; that assessed groups of any UPF or specific UPF items; that measured dental caries as the decayed, filled and missing surfaces or teeth indexes, based on the WHO criteria; cross-sectional, case–control, cohort and all types of interventions that examined the adjusted association between UPF consumption and dental caries were included. All studies received qualitative evaluation. Meta-analysis using random-effects models combined multivariable-adjusted OR for case–control and cross-sectional studies and risk ratio (RR) for longitudinal studies of the highest v. lowest category of UPF consumption. Forty-two studies were included in the qualitative synthesis and twenty-seven in the meta-analysis. The pooled RR was 1·71 (95 % CI 1·31, 2·24), and the pooled OR was 1·55 (95 % CI 1·37, 1·75). The highest OR was found among participants who had dental caries prevalence >70 % (OR = 3·67, 95 % CI 2·16, 6·23). Better evidence quality was found among cohort studies that evaluated children <6 years old. The findings suggest that higher UPF consumption is associated with greater dental caries in children and adolescents. Public health efforts to reduce UPF consumption are needed to improve the oral health of children and adolescents.
This study aimed to evaluate the influence of pH changes on morphometric parameters of casein micelles and a general overview of their conformational structure through microscopy techniques, Raman spectroscopy and multivariate analysis. It was found that casein micelles morphology and protein secondary structure depend strongly upon pH. The changes of arithmetic average roughness (Ra), size, and shape of casein micelles at different pH are properly characterized by atomic force and cryo-transmission electron microscopy. Morphometric changes of casein micelles were correlated correctly with folding and unfolding of casein molecules as evaluated by Raman spectroscopy when the pH was varied. The novelty of this contribution consists in demonstrating that there is a close structure-functionality relationship between the morphometric parameters of proteins and their secondary structure. Knowledge about casein micelles can help improve their use of its diverse applications.
The aim of this study is to evaluate the knowledge of Brazilian dental students about biosafety measures that should be adopted in the clinical setting during the coronavirus disease (COVID-19) pandemic.
Methods:
A cross-sectional study with 1050 dental students was conducted. A semi-structured questionnaire was shared with students. Mean knowledge score on biosafety guidelines during the COVID-19 pandemic was the outcome, with a maximum of 8 scores. Explanatory variables included sociodemographic and educational characteristics, aspects related to biosafety education, actions adopted by the dental schools during the pandemic, and sources of biosafety information. Multivariate linear regression analyses were performed.
Results:
Mean knowledge score was 5.19 (1.28). Female students (β = 0.346; 95% CI: 0.154–0.539), those enrolled in the intermediate (β = 0.525; 95% CI: 0.167–0.883) or final (β = 0.569; 95% CI: 0.200–0.937) stage of course, and those who had already received theoretical-practical training in biosafety (β = 0.464; 95% CI: 0.063–0.866) presented higher mean knowledge scores. Students who did not receive guidance on aerosol control measures before the pandemic (β = −0.324; 95% CI: −0.519 to −0.130) had the lowest score.
Conclusion:
Students presented a medium level of knowledge about dental biosafety measures concerning the COVID-19 pandemic. Sociodemographic characteristics and those related to the institutional profile of the participants, and access to orientation and training in biosafety, may influence their knowledge.
We report the finding of two partial specimens of Cryptolepas rhachianecti (Cirripedia, Coronulidae), a coronulid barnacle known only to inhabit the skin of gray whales (Eschrichtius robustus), in Pleistocene-aged sediments from the Canoa Basin, Ecuador. While the historical range of gray whales includes the North Pacific and North Atlantic, to our knowledge this is the first inferred evidence of a gray whale population having resided within the South Pacific. We describe the two Cryptolepas rhachianecti fossils, use isotopic analysis to investigate evidence of migration in their host whales, and discuss their implications for our understanding of gray whale evolutionary history.
The current COVID-19 pandemic has generated a series of changes in the daily routines of people, including children and teenagers, in an unprecedented way, which constitutes a global challenge in public health. Social isolation has been a prophylactic measure to prevent the spread of the virus; however, it has generated negative impacts on the physical and emotional health of parents, caregivers, children and teenagers around the world. The objective of the present study was to evaluate the effects of confinement caused by the COVID-19 pandemic at the level of nutritional status, dietary and behavioural patterns of elementary school children and teenagers in a small town of Colombia. Anthropometric parameters such as BMI Z-score, waist circumference and waist/height ratio were evaluated in 266 school children and teenagers. A questionnaire with socio-demographic, clinical and lifestyle characteristics and the KIDMED were applied to learn about nutritional aspects. A total of 102 students (38⋅3 %) were classified as having altered nutritional status, being 39 (14⋅7 %) classified as overweight and 36 (13⋅5 %) with obesity. The prevalence of high adherence to the Mediterranean diet was 12 %, 95 % CI (0⋅08, 0⋅16). Overweight was more prevalent in women (26/39, 66⋅7 %; P = 0⋅0439), and obesity was discreetly more frequent in men (19/36, 52⋅7 %; P = 0⋅7193). We observed a worrying nutritional, dietary and behavioural situation in the children and teenagers studied during the confinement associated with the COVID-19 pandemic. This unveils the need to establish strategies and/or public policies in our town that help to promote an adequate biopsychosocial development of the paediatric patient and their family group.
David Ricardo indicated in his famous numerical example in the Principles that it would be advantageous to Portugal to import English cloth made by 100 men, although it could have been produced locally with the labor of only 90 Portuguese men. As the production of the cloth required less quantity of labor in Portugal, it has been commonly inferred that this country had a production cost advantage over England in cloth making. This inference will be proven wrong here by showing that the English cloth had a lower cost of production than the Portuguese cloth. This finding refutes the widespread belief that Ricardo had formulated a new law, principle, or rule for international specialization, known as “comparative advantage.” He used the same rule for specialization as Adam Smith in the Wealth of Nations. Thus, the popular contraposition of Smith’s absolute versus Ricardo’s comparative cost advantage has to be dismissed.
The dispersal of Crocodylus from Africa to Europe during the Miocene is not well understood. A small collection of cranial fragments and postcranial elements from the latest Miocene (6.2 Ma) site of Venta del Moro (Valencia, Spain) have previously been referred to Crocodylus cf. C. checchiai Maccagno, 1947 without accompanying descriptions. Here we describe and figure for the first time the crocodylian remains from Venta del Moro, which represent at least two individuals. Our comparisons indicate that this material clearly does not belong to Diplocynodon or Tomistoma—the only two other crocodylians described so far for the European late Miocene. The material is only tentatively referred to cf. Crocodylus sp. because the apomorphies of this genus are not preserved and a referral to C. checchiai cannot be supported on a morphological basis. However, it is likely that this late Miocene species, originally described from Libya (As Sahabi) and later identified also in Kenya, could have dispersed across the Mediterranean Basin multiple times and colonized the southern areas of Mediterranean Europe, as evidenced by several Crocodylus or Crocodylus-like remains described during the past years.
Emotional intelligence is defined as the ability to process, understand and manage emotions. In bipolar disorder seem to be more conserved, with less functional impairment than other severe mental disorders as schizophrenia. So far, there are few studies analyzing emotional intelligence in bipolar disorder.
Objective
The objective of this research is to better understand the different characteristics and the factors affecting these social-cognitive dysfunctions in bipolar disorder.
Aims
To explore possible factors related to emotional intelligence in these severe mental disorders: symptoms, cognitive functioning, quality of life and psychosocial function.
Material and methods
Twenty-six adults bipolar type I patients were examined using MSCEIT (the most validated test for emotional intelligence), BPRS, YMRS, HDRS, WAIS-IV, TMT and Rey Figure in order to determine the level of emotional intelligence and factors relate.
Results
Bipolar patients show lack of emotional intelligence when compared with general population. Cognitive impairment and age are the principal factors related.
Discussion
Results are discussed and compared with recent literature.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We present the main results from the analysis of the Hα-[NII] emission lines with integral field spectroscopy observations gathered with MEGARA at the GTC of the nearby Seyfert 1.5 galaxy NGC7469. We obtained maps of the ionised gas in the inner 12.5 arcsec × 11.3 arcsec, at spatial scales of 0.62 arcsec, with an unprecedented spectral resolution (R ˜ 20 000). We characterized the kinematics and ionisation mechanism of the distinct kinematic components (Cazzoli et al.2019).
Nowadays the different industries is searching continuous improvements in the welding processes of the components of its products, in order to avoid the disadvantages obtained in the past by joining their parts through conventional fusion welding processes, affecting their microstructural development and consequently decreasing the principal mechanical properties. The friction-stir welding process is a solid state technique which does not reach the melting point of the material, promoting the plasticization of the metal by controlling its microstructure and mechanical behavior. However, the after mentioned advantages are the result of an adequate control of the process parameters, so that the aim of the present investigation is to study the microstructural and mechanical development of 5052-H32 butt joints welded by FSW process using a high wear resistance tool (PCBN tool) as well as the mechanical behavior suffered.
In recent years, suicide rates have increased in adolescents and the young population, so these age groups are considered as populations at risk. Considering that suicidal ideation is the first sign of possible future suicide behavior, the objective of this study is to determine the relative importance of psychological maturity, personality, depression and life satisfaction in predicting suicidal ideation in adolescents. Results show that depressive symptoms is the variable that best predicts suicidal ideation, but psychological maturity, life satisfaction and emotional stability are predictors as well (R2 = .51, p < .001). However, the Multigroup Structural Equation Models analyses carried out show that emotional stability has an indirect relationship with suicidal ideation, through its relationship with depressive symptoms, life satisfaction and identity. Two Multigroup Structural Equation Models were proposed to better understand the relationships between these variables for each sex. The results show that the fit of the model that includes the variable Self-reliance is better for boys than for girls (chi-square contributions of 8.175 for girls and 1.978 for boys) unlike the other model (chi-square contributions of 0.288 for girls and 1.650 for boys). These results suggest that the psychological maturity subscale Self-reliance play a role in suicidal ideation in males but not in females. Although there have been no previous studies on the role of psychological maturity as a predictor of suicidal phenomena, the current study suggests that it is a feature to be considered in the prediction of adolescent suicidal ideation.