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While global financial capital is abundant, it flows into corporate investments and real estate rather than climate change actions in cities. Political will and public pressure are crucial to redirecting funds. Studies of economic impacts underestimate the costs of climate disasters, especially in cities, so they undermine political commitments while understating potential climate-related returns. The shift of corporate approaches towards incorporating environmental, social, and governance (ESG) impacts offers promise for private-sector climate investments but are recently contested. Institutional barriers remain at all levels, particularly in African cities. Since the Global North controls the world's financial markets, new means of increasing funding for the Global South are needed, especially for adaptation. Innovative financial instruments and targeted use of environmental insurance tools can upgrade underdeveloped markets and align urban climate finance with ESG frameworks. These approaches, however, require climate impact data collection, programs to improve cities' and countries' creditworthiness, and trainings. This title is also available as open access on Cambridge Core.
This paper reports the methods and preliminary findings of Germina, an ongoing cohort study to identify biomarkers and trajectories of executive functions and language development in the first 3 years of life. 557 mother-infant dyads (mean age of mothers 33.7 years, 65.2% white, 48.7% male infants) have undergone baseline and are currently collecting data for other timepoints. A linear regression was used to predict baseline Bayley-III using scores derived from data-driven sparse partial least squares utilizing a multiple holdout framework of 15 domains. Significant associations were found between socioeconomic/demographic characteristics (B = 0.29), epigenetics (B = 0.11), EEG theta (B = 0.14) and beta activity (B = 0.11), and microbiome functional pathways (B = 0.08) domains, and infant development measured by the Bayley-III at T1, suggesting potential interventions to prevent impairments.
Agricultural monoculture negatively impacts soil quality, particularly in fragile soils that yield limited crop production and are highly susceptible to degradation. Increasing plant diversity in production systems can be an alternative for maintaining soil ecosystem services and increasing crop yields. This study investigated the influence of increased plant diversity on soil health and its impact on soybean and cotton yield in an Ultisol in the Brazilian savanna in Mato Grosso State, Brazil. Tested five rates of plant diversity after soybean harvest: (1) very low (VL), (2) low, (3) average, (4) long-term average and (5) high (integrated crop–livestock systems (ICLS)) were tested. Plant diversity improves the health of sandy loam soil, increases C and N fractions in particulate organic matter (POM-C and POM-N) and leads to differences in C utilization by the soil microbial community. High ICLS diversity raises total organic carbon content, being POM-C and POM-N, the labile fractions, more efficient to show changes in sandy loam soil, in the short term, over a period of three years. High diversity promoted yield gains of up to 251 % for cotton and 82 % for soybean in relation to VL plant diversity. Changes in soil microbial composition are able to partially explain crop yield in diversified production systems (R2 ranging from 0.51 to 0.80). Diversifying production components is a sustainable way to maintain biological functions and agricultural quality of loam sandy soil in the Brazilian Cerrado in Mato Grosso.
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.
Fluridone was registered for use in rice production in 2023, offering a new herbicide site of action for growers. However, little information is available on the degree of rice tolerance to this herbicide. Field experiments conducted in 2022 and replicated in 2023 near Colt, AR, evaluated the tolerance of 12 rice cultivars to fluridone, applied preemergence or at the 3-leaf growth stage, in separate experiments. Each experiment consisted of one cultivar. Fluridone rates included 0, 168 (1 × label rate), and 336 (2 × label rate) g ai ha−1 in all experiments. Visible injury varied between years in all experiments, likely due to different environmental conditions. In 2022, injury following preemergence applications of fluridone was below 25% across cultivars. In contrast, in 2023, injury ≥30% occurred to five cultivars, with a maximum of 58% observed for the cultivar ‘DG263L’. In both years, only three cultivars exhibited injury ≥20% following fluridone applications at the 3-leaf stage. Fluridone negatively affected shoot density, groundcover, chlorophyll content, and days to 50% heading in most cultivars when applied preemergence. When fluridone was applied to 3-leaf rice, at least one of the variables evaluated was negatively affected in two and nine cultivars in 2022 and 2023, respectively. Grain yield reductions of at least 18% were observed from eight cultivars in 2022, and a grain yield decrease from 9% to 49% from eight cultivars occurred in 2023 in the preemergence experiments. Fluridone applied to rice at the 3-leaf stage did not cause a yield penalty to any cultivar in 2022, whereas in 2023, a yield loss occurred from eight cultivars. Yield loss from the DG263L cultivar occurred at the 1 × rate in both experiments, indicating that this cultivar appears to be sensitive to fluridone, regardless of the application timing. Based on these findings, fluridone tolerance is cultivar-dependent. Furthermore, preemergence applications of fluridone to rice should be avoided.
Glufosinate resistance was previously confirmed in three Palmer amaranth accessions from Arkansas (MSR1, MSR2, and CCR). Greenhouse screening results suggested the presence of multiple herbicide resistance. Therefore, this study aimed to determine the postemergence resistance profile of these three glufosinate-resistant Palmer amaranth accessions. Field experiments were also conducted to assess preemergence and postemergence herbicide options to control the accession with the highest glufosinate resistance level (MSR2). A dose-response assay with the three resistant accessions and two susceptible standards was conducted with the herbicides 2,4-D, atrazine, dicamba, diuron, fomesafen, glyphosate, imazethapyr, and mesotrione. The preemergence and postemergence field experiments with MSR2 evaluated 15 and 16 single active ingredients, respectively. The Palmer amaranth accessions that carried glufosinate resistance were also confirmed to be resistant to six other postemergence herbicides: 2,4-D, diuron, fomesafen, glyphosate, imazethapyr, and mesotrione. CCR is also resistant to dicamba. Therefore, accessions MSR1, MSR2, and CCR have evolved resistance to postemergence herbicides pertaining to seven sites of action. A shift toward increased tolerance to atrazine has also been observed among all resistant accessions. Overall, field preemergence treatments with atrazine, pyroxasulfone, or trifludimoxazin obtained the highest MSR2 control levels at all evaluation times and the lowest number of seedlings emerging at 3 and 6 wk after treatment. In the postemergence experiment, only paraquat obtained MSR2 control levels above 90% at all ratings. The lowest number of alive MSR2 plants was observed after postemergence treatments with paraquat or trifludimoxazin. Fields near where glufosinate resistance has been confirmed in Palmer amaranth will likely demand a more diverse and proactive management strategy that relies on combinations of chemical, cultural, and mechanical control tactics. Future efforts should focus on sequential applications and mixture, the elucidation of all resistance mechanisms in the evaluated accessions, and soil-applied dose-response.
Avian Plasmodium parasites can be pathogenic to their vertebrate hosts. Although cases of anaemia are frequently reported in parasitized birds, the potential damage caused by the parasite during the exoerythrocytic reproduction phase remains poorly investigated. Here, we report 2 individuals of red-legged seriemas (Cariama cristata) infected with 2 different lineages of Plasmodium huffi, one of them exhibiting potential malarial-compatible tissue lesions in the spleen, liver, brain and lungs, alongside molecular confirmation of parasite presence in the spleen. Previously classified as specific to birds from the order Piciformes, this parasite has shown different associated lineages amplified across diverse host orders in South America (Anseriformes, Charadriiformes, Columbiformes, Galliformes, Pelecaniformes and Passeriformes). Those infections, however, were defined as abortive due to the absence of gametocytes visualized in blood smear slides. Herein, we confirm P. huffi as a generalist parasite based on the first morphological characterization in the peripheral blood of a bird outside the Piciformes order. This is also the first morphological and molecular description of a Plasmodium species in Cariamiformes. In addition to the morphological analyses, we have also proposed a novel phylogenetic hypothesis based on the partial cytb gene and the near-complete mitochondrial genome of this parasite. Our findings support that the division of the genus Plasmodium into subgenera is not monophyletic, as P. (Huffia) huffi and its associated lineages cluster more closely with Plasmodium (Haemamoeba) gallinaceum than with Plasmodium (Huffia) elongatum.
This study evaluated the effects of capsaicin (CAP) supplementation on the intake, nutrient digestibility, ruminal fermentation, nitrogen balance, microbial protein synthesis and health traits of bulls managed on pasture. Eight crossbred (Holstein x Zebu) cattle averaging 313 ± 31 kg of body weight (BW) were arranged in a replicated 4 × 4 Latin square design (one square of four bulls, rumen fistulated with 4-inch silicone cannulas and one square of four non-fistulated bulls), which were kept on Pangola grass pasture (Digitaria decumbens). Each experimental period consisted of 21 days, with 7 days for data collection (no washout between periods). Bulls were randomly assigned to the following treatments: CON (control): concentrate supplementation at 0.5% live weight (BW) and no additive (CAPCIN®), or concentrate supplementation at 0.5% BW in association with CAPCIN® (NutriQuest, Campinas, Brazil) fed at the inclusion rates of 150 (CAP150), 300 (CAP300) and 450 (CAP450) mg/animal/day. Digestibilities of dry matter, organic matter and neutral detergent fibre showed quadratic responses to CAP supplementation. Rumen pH linearly increased with CAP supplementation. The numbers of lymphocytes and eosinophils were linearly increased with CAP supplementation. The use of encapsulated pepper in supplements of crossbred (Holstein x Zebu) bulls managed on D. decumbens pasture up to 450 mg/animal/day improves nutrients digestibility and ruminal fermentation and can positively influence the health status of beef cattle managed under tropical conditions.
This cross-sectional ecological study described fruit and vegetable (F&V) intake variability across 144 cities in 8 Latin American countries and by city-level contextual variables. Data sources came from health surveys and census data (Argentina, Brazil, Chile, Colombia, El Salvador, Guatemala, Mexico, and Peru). Self-reported frequency of F&V intake was harmonised across surveys. Daily F&V intake was considered as consumption 7 d of the week. Using a mixed-effects model, we estimated age and sex-standardised city prevalences of daily F&V intake. Through Kruskal–Wallis tests, we compared city F&V daily intake prevalence by tertiles of city variables related to women’s empowerment, socio-economics, and climate zones. The median prevalence for daily F&V intake was 55.7% across all cities (22.1% to 85.4%). Compared to the least favourable tertile of city conditions, F&V daily intake prevalence was higher for cities within the most favourable tertile of per capita GDP (median = 65.7% vs. 53.0%), labour force participation (median = 68.7% vs. 49.4%), women achievement-labour force score (median = 63.9% vs. 45.7%), and gender inequality index (median = 58.6% vs. 48.6%). Also, prevalences were higher for temperate climate zones than arid climate zones (median = 65.9% vs. 50.6%). No patterns were found by city level of educational attainment, city size, or population density. This study provides evidence that the prevalence of daily F&V intake varies across Latin American cities and may be favoured by higher socio-economic development, women’s empowerment, and temperate weather. Interventions to improve F&V intake in Latin America should consider the behaviour disparities related to underlying local social, economic, and climate zone characteristics.
Mosquitoes, particularly Aedes aegypti, pose significant public health risks by transmitting diseases like dengue, zika and chikungunya. Bacillus thuringiensis var. israelensis (BTI) is a crucial larvicide targeting mosquitoes while sparing other organisms and the environment. This study evaluated the effects of sublethal BTI doses on Ae. aegypti larvae regarding mortality, development, adult emergence and size, using a wide-area spray application in an urban neighbourhood. Laboratory experiments with four BTI concentrations (0, 0.008, 0.02 and 0.04 ppm) assessed compensatory and over compensatory responses. The spray achieved over 90% larval mortality within 48 h, but accumulating sublethal doses could trigger compensatory and over compensatory effects, enhancing the fitness of survivors. A dose–response relationship was evident, with higher BTI concentrations leading to increased mortality, reduced longevity and fewer pupae. BTI exposure also skewed the sex ratio towards males and altered adult sizes, potentially affecting population dynamics and vectorial capacity. These findings highlight the effectiveness of BTI in Ae. aegypti control and the importance of understanding compensation, overcompensation and density-dependent effects. While wide-area BTI applications can reach inaccessible breeding sites and offer potent mosquito control, careful consideration of ecological and evolutionary consequences is crucial.
Brazil’s public health system serves most of the population, but 25 percent of citizens rely on private health insurance. The National Regulatory Agency for Private Health Insurance and Plans (ANS) regulates private medicine reimbursements, which diverge from the public sector threshold. In 2022, the National Committee for Health Technology Incorporation (CONITEC) set a willingness-to-pay benchmark of BRL40,000 (USD8,215) per quality-adjusted life-year. The ANS has no such benchmark, highlighting a pivotal gap in economic evaluations for private health care.
Methods
This quantitative study investigated the Incremental cost-effectiveness ratios (ICER) for reimbursed medicines in Brazil’s private health sector, comparing them with CONITEC’s benchmarks and international thresholds. Data were extracted from industry reimbursement submissions to the ANS and analyzed for statistical disparity and policy implications.
Results
Preliminary findings found an ICER peak of BRL619,900 (USD127,220) per quality-adjusted life-year for talazoparib, which is used to treat certain advanced breast cancers. This contrasted sharply with CONITEC’s established threshold, indicating a critical need to evaluate ANS policies.
Conclusions
Early results indicate that the ICERs for some medicines surpass CONITEC’s willingness-to-pay limit, suggesting that the ANS should consider establishing a defined cost-effectiveness threshold. This is imperative to harmonize with global standards and maintain sustainable health financing.
Despite medical advancements, endocarditis still results in high mortality rates. Surgery, while often essential, elevates the risk of hyperinflammation, sepsis, and cytokine release. The use of a cytokine filter to prevent this remains controversial. This study reviewed existing literature to assess the efficacy of cytokine filters and to support its integration into supplementary health services.
Methods
An exhaustive search of the MEDLINE, Cochrane Library, Embase, LILACS, and CytoSorbents Corporation databases was conducted to identify relevant meta-analyses and systematic reviews. The study focused on randomized controlled trials and case series studies assessing the efficacy of cytokine filtration. Key variables considered were the duration of antibiotic treatment, severity of endocarditis, and surgical treatment rationale. These factors were crucial for evaluating clinical outcomes and patient survival after surgery.
Results
The systematic reviews yielded mixed outcomes. Two found no benefits for hemoadsorption, while one found that it reduced mortality rates and intensive care unit stays based on observational studies. Randomized controlled trials, however, showed no significant impact for cytokine filters on mortality rates or postoperative hemodynamic parameters. In contrast, case series studies reported potential benefits, but these results were confounded by biases in patient allocation and failure to account for critical variables like antibiotic treatment duration, case severity, and surgical rationale. These discrepancies highlight the complexity of evaluating the effectiveness of cytokine filtration in surgical settings.
Conclusions
Randomized and non-randomized controlled trials on the role of cytokine filters in cardiac surgery for endocarditis reported contradictory findings. Only case series studies suggested benefits from cytokine filters, necessitating further high quality research before recommending their widespread use. Understanding the implications of these results is essential, underscoring the need for more rigorous studies to resolve these inconsistencies.
Informed healthcare policies in Brazil rely on robust health technology assessment (HTA), especially for conditions like non-small cell lung cancer (NSCLC). We present an efficiency frontier analysis to evaluate NSCLC treatments that correlates annual treatment costs with clinical outcomes, offering a systematic approach to enhance decision-making in the Brazilian healthcare context.
Methods
This quantitative study analyzed NSCLC drug costs within the Brazilian healthcare system and the clinical efficacy data of pivotal studies. The data were analyzed using Python and R software. The dataset comprised drug costs and hazard ratios for overall survival. After data preparation, which involved normalization and outlier management, we constructed an efficiency frontier by ranking drugs based on cost and effectiveness. A linear regression model was then developed to extrapolate this frontier, deriving a formula that predicts treatment costs for specified improvements in overall survival.
Results
The analysis delineated an efficiency frontier and revealed cost-effective NSCLC treatments in Brazil. The following linear regression equation was derived: overall survival = (1.033551 − 0.000003) × treatment cost (USD). This allows for the estimation of appropriate treatment costs for new therapies based on their expected clinical outcomes. This initial model provides a foundation for estimating the economic impact of new treatments.
Conclusions
This preliminary efficiency frontier analysis offers a novel perspective for evaluating NSCLC treatment strategies in Brazil to support sustainable healthcare policy decisions. The model is subject to limitations due to the absence of a systematic literature review. However, it represents an initial step towards a more comprehensive HTA framework. Further research should refine the model by including systematic data collection and analysis.
In Brazil, equitable access to medications is critical. There are significant pricing disparities between the National Health System and private health care, which are influenced by the National Committee for Health Technology Incorporation (CONITEC) and Law 14.307. This study investigated these disparities, with aim of proposing strategies for equitable access and sustainability in health care.
Methods
This analysis compared prices between the public and private sectors for trastuzumab and adalimumab. Public sector prices were obtained from the Health Prices Database (HPD) and private sector prices were obtained from the Unimed National Table of Materials and Medications (TNUMM), as of May 2023. The study evaluated the extent of pricing discrepancies, considering Drug Market Regulation Chamber ceiling prices and industry discounts.
Results
The cost of the trastuzumab biosimilar, KANJINTI® (Amgen Inc.), was BRL15.79 (USD3.24) per mg in the private sector, compared with BRL4.50 (USD0.92) per mg in the public sector (a 250% difference). The original version of adalimumab, HUMIRA® (AbbVie), was priced at BRL5,450.38 (USD1,120.53) in the TNUMM versus BRL2,445.46 (USD502.33) in the HPD (a 123% difference). The adalimumab biosimilar, HYRIMOZ® (Sandoz Inc.), was priced at BRL7,723.99 (USD1,586.87) in the TNUMM compared with BRL2,449.19 (USD503.05) in the HPD (a 215% price discrepancy).
Conclusions
The study highlights significant disparities in drug pricing between Brazil’s public and private healthcare sectors. These disparities affect the financial sustainability of private health entities and elevate costs for consumers, potentially increasing reliance on the National Health System. Policy revisions, price parity strategies, and further studies are vital for a sustainable healthcare system.
Introduction: Throughout the course of the dementia, patients generally need a guardian to protect their rights due to the severity of their mental disabilities. The laws and procedures for guardianship for people with disabilities have been updated in several countries based on the UN Convention on the Rights of Persons with Disabilities promulgated in 2006.
Objectives: To compare the law and procedures for guardianship for people with mental disabilities of twelve countries from six continents.
Methods: Narrative review searching for civil codes/guardianship procedures, date of promulgation, scope of the guardian authority, preferred guardian, duration of the guardianship.
Results: Most countries predominantly promulgated their laws after the year 2000, being half of them updated after 2006. Most countries have two types of guardianship scopes: one concerning financial affairs and the other concerning personal affairs (such as welfare and medical care). Generally, guardianship concerning financial matters is the first to be established. In addition, most countries maintain the ward’s right to vote. In five out of twelve countries, there is an order of preference for choosing the guardian, being the spouses and adult children the preferred guardians. All these countries have the possibility of temporary guardianship. Three countries have a maximum period for guardianship with the possibility of renewal, while all others have indefinite time for guardianship duration. Only France explicitly grants the right to the ward to make medical decisions within guardianship procedures. Brazil’s Civil Code restricts guardianship to financial matters, whereas the Civil Procedure Code requires judges to define the scope of guardianship’s authority for each of the activities of the civil life. Since both codes hold equal authority, judges typically determine the extent of guardianship on a case- by-case basis.
Conclusions: Half of the nations have updated their laws after the promulgation of the UN Convention on the Rights of Persons with Disabilities.
Dementia is expected to increase worldwide and further Discussion concerning the rights of people with dementia is still needed. Although there is no ideal legal framework, the comparison of procedures from different countries may lead to valuable insights for further Discussions andassessments.
We prove that every homeomorphism of a compact manifold with dimension one has zero topological emergence, whereas in dimension greater than one the topological emergence of a $C^0-$generic homeomorphism is maximal, equal to the dimension of the manifold. We also show that the metric emergence of a continuous self-map on compact metric space has the intermediate value property.
In Northeastern Brazil, successful release programmes have been implemented for the conservation of West Indian manatees (Trichechus manatus) since the 1990s. Recently, the non-government organization AQUASIS started releasing manatees in the state of Ceará, where oceanographic conditions and the absence of sheltered places pose new challenges for the release and monitoring of manatees. This research investigates the movement of a manatee named Tico, released in Icapuí, Ceará, Brazil, that travelled approximately 4017 km over 62 days through deep oceanic waters. Correlating Tico's trajectory and velocity with surface currents revealed the influence of the North Brazil Current (NBC) and its vortices on his movement. Tico crossed the diluted Amazon River plume with surface salinity as low as 26 g kg−1 in early August, potentially encountering areas of even lower salinity. Additionally, Tico experienced several storms, with significant rainfall during his journey, which may have provided freshwater. The erratic movement patterns and significant weight loss prompted the rescue of Tico on Isla la Blanquilla, Bolivarian Republic of Venezuela. Tico is currently being temporarily housed in Parque Zoológico y Botánico Bararida in Venezuela. Understanding the nature of Tico's long-distance movement could help inform decisions about his future. AQUASIS proposes to return Tico to Brazil, a region with an ecologically and genetically distinct population from Venezuela, for a second release attempt, incorporating lessons learned from the first release. Furthermore, AQUASIS has the necessary human and financial resources to ensure the continuous monitoring of Tico during his readaptation to the wild.
Annona crassiflora is a fruit-bearing tree species native to the Cerrado that has ecological and economic potential, mainly due to the production of attractive and useful fruits for a number of species, including humans. To provide a basis for its conservation and breeding, the objective was to assess the diversity and genetic structure of natural populations of the species using inter-simple sequence repeat (ISSR) molecular markers. Eight populations were analysed in the state of Minas Gerais, Brazil, with 24 individuals randomly sampled in each population, reaching a total of 192 trees. Ten ISSR primers were used, resulting in high genetic diversity for the combined data (H* = 0.35 and I* = 0.52). However, a wide range of representative values was observed in the individual assessment of populations, with JAN, GM and MC standing out for their low genetic diversity, resulting in H* of 0.19, 0.23 and 0.24 and I* of 0.28, 0.34 and 0.35, respectively. An analysis of molecular variance showed greater variation within populations, indicating gene flow (Nm), but genetic differentiation between populations was moderate. Bayesian analysis, although resulting in four genetic groups, revealed the presence of a majority group for the GM and JAN populations. We propose measures to maintain these populations, such as raising awareness of local extractivism and planting genetically divergent seedlings. Furthermore, we recommend including of all populations in conservation and breeding programmes, aiming to cover the maximum genetic variation for the species.
Tail docking is a husbandry practice widely incorporated in sheep farms around the world. It is an irreversible mutilation that impairs animal welfare, both immediately and in the longer term. The defence of tail docking as a practice is centred around the perception that doing so contributes to the promotion of local hygiene, allowing the use of the wool, facilitating reproductive management and reducing the chances of myiasis, a disease caused by the invasion of blowfly larvae in the tissues of warm-blooded animals. However, current understanding of farm animal welfare questions the need to maintain practices such as tail docking. Thus, the aim of this study was to evaluate the effect of tail docking on the incidence of Cochliomyia hominivorax myiasis in sheep in an experimental flock in Brazil during a six-year retrospective cohort study. Relative risk, odds ratio and incidence rate ratio were the association measures adopted. A total of 4,318 data-points were collected and supplied the analytical model. Tail docking did not decrease the risk and, on the contrary, was found to increase the chances of sheep being affected by myiasis. The results support the hypothesis that tail docking is not a protective factor against the occurrence of myiasis and further fuel calls for a rethink of tail docking being deployed as a blanket measure in the prevention of myiasis in sheep.