We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The European Resuscitation Council (ERC) establishes guidelines for cardiopulmonary resuscitation (CPR) under standard conditions and special circumstances but without specific instructions for nighttime situations with reduced visibility. The aim of this study was to evaluate the feasibility of performing CPR at night under two different conditions, in darkness with ambient light and with the additional illumination of a headlamp, as well as to determine the quality of the maneuver.
Methods:
A crossover, randomized pilot study involving nineteen lifeguards was conducted, with each participant performing two five-minute CPR tests: complete darkness with headlamp and natural night environment at the beach without additional lighting. Both tests were conducted with a 30:2 ratio of chest compression (CC) to ventilations using mouth-to-pocket mask technique in the darkness of the night with a 30-minute break between them. Outcome measures included quality of CPR, number of CCs, mean depth of CCs, mean rate of CCs, and number of effective ventilations. Results were reported as the mean or median difference (MD) between the two groups with 95% confidence interval (CI) using techniques for paired data.
Results:
There were no statistically significant differences between the two lighting conditions for the outcomes of CPR quality, mean depth of CCs, or number of effective ventilations. The number of CCs was lower when performed without the headlamp (MD: -8; 95%CI, -15 to 0). In addition, the mean rate of CCs was lower when performed without the headlamp (MD: -3; 95%CI, -5 to -1).
Conclusions:
The rescuers performed CPR at night with good quality, both in darkness and with the illumination of a headlamp. The use of additional lighting with a headlamp does not appear to be essential for conducting resuscitation.
To describe the frequency of prognostic awareness (PA) in a population of advanced cancer patients in a Latino community and to explore the relationship between accurate PA with emotional distress and other covariates.
Methods
In this cross-sectional study performed in Puente Alto, Chile, advanced cancer patients in palliative care completed a survey that included a single question to assess PA (Do you believe your cancer is curable? yes/no). Patients reporting that their cancer was not curable were considered as having accurate PA. Demographics, emotional distress, quality of life, and patient perception of treatment goals were also assessed. Analyses to explore associations between PA and patient variables were adjusted.
Results
A total of 201 patients were included in the analysis. Mean age was 65, 50% female. One hundred and three patients (51%) reported an accurate PA. In the univariate analysis, accurate PA was associated with not having a partner (p = 0.012), increased emotional distress (p = 0.013), depression (p = 0.003), and were less likely to report that the goal of the treatment was to get rid of the cancer (p < 0.001). In the multivariate analysis, patients with accurate PA had higher emotional distress or depression, were less likely to have a partner, and to report that the goal of the treatment was to get rid of the cancer.
Significance of results
Half of a population of Latino advanced cancer patients reported an accurate PA. Accurate PA was associated with increased emotional distress, which is similar to what has been reported in other countries. Weaknesses in prognostic disclosure by clinicians, local cultural factors, or higher motivation to seek prognostic information among distressed cancer patients could explain this association. Strategies to emotionally support patients when discussing prognostic information should be implemented.
Schistosomiasis, a parasitic disease caused by Schistosoma species, remains highly prevalent in tropical regions, where it contributes significantly to hepatic and vascular complications. Despite the well-established role of parasitic eggs in driving inflammation and organ damage, the specific vascular mechanisms remain poorly understood. Given the role of angiogenesis and vascular remodelling in tissue repair, the angiopoietins (ANGs) could be promising biomarkers to evaluate disease progression. This study aims to explore the relationship between ANG levels with parasitic load in patients with schistosomiasis. In this cross-sectional study, 126 schistosomiasis patients were stratified into three groups based on parasitic egg burden: negative, low, and moderate/high. Demographic, clinical, and laboratory data were collected, and serum ANGs were quantified via enzyme-linked immunosorbent assays. Parasitic load was assessed through stool examination, quantifying the number of Schistosoma eggs per gram of faeces. Additional clinical parameters, including liver abnormalities and blood chemistry, were evaluated. The ANG-2 levels and the ANG-2/ANG-1 ratio were significantly elevated in patients with higher egg burdens, particularly in the moderate/high group. The ANG-2/ANG-1 ratio was notably higher in patients with hepatosplenic schistosomiasis. While systemic blood pressure and oxygen saturation showed no significant differences between groups, patients with elevated triglycerides had lower ANG-2 levels. Elevated ANG-2 levels and an increased ANG-2/ANG-1 ratio correlate with higher parasitic burdens, reinforcing their potential as biomarkers for disease severity. These findings underscore the role of egg-induced inflammation in schistosomiasis pathophysiology and suggest that ANGs could aid in early diagnosis and treatment decisions, particularly in populations with high parasitic loads.
Objectives/Goals: A limited number of Hispanic researchers compete successfully for NIH career development and research grants. We adapted an established K Club model from the University of Pittsburgh with high success rates to Hispanics in Puerto Rico (PR). The K to R Club’s goal is to increase the successful submission of K- and R-type NIH grants in the HCTRECD Program. Methods/Study Population: K to R Club is an inviting environment that exposes scholars to established funded investigators in PR from all career stages. It creates a forum to discuss different grant mechanisms and explains the selection, submission, and review process. The Club promotes the right mentor selection and mentoring team. It facilitates networking with principal investigators local/external to share their success stories, career development experiences, and grant submission tips. It offers mock review sessions of sections of the grant proposal to provide feedback from invited established investigators during the grant writing process. The Club meets 1–2 times per month in-person or virtual for 1 hour and anonymous evaluations were submitted after each session. Results/Anticipated Results: K to R Club 1st year had 11 sessions with 15 invited speakers. Sessions included: 1 Kickoff, 2 funding opportunities, 2 coaching, 7 successful stories of Diversity Supplement, and F99/K00, K22, K23, K99/R00, R01, and R21 awardees. The highest attendance was for the Kickoff (48). Evaluations response rates ranged from 15 to 62 with the highest participation from women (78% vs. 22% men). Most respondents were PhD (45%) and MD (29%). K to R Club sessions were rated as excellent (84%), 74% agreed that the sessions changed their knowledge very much, and 78% reported it changed their ability to apply for funding very much. Interest in submitting NIH supplements in 12 months was higher (68%) vs. 6 months (48%). Interest in requesting mock reviews for K or R grants in 6 months (91%) vs. 12 months (17%). Discussion/Significance of Impact: The 1st year of the K to R Club had an active attendance and increased the interest in submission of NIH grants. We are working on strategies to increase evaluations’ response rates to improve and address future session needs due to the low response rates recorded. Currently, the semester is full of mock review sessions for grant applications (4 Ks and 1 R01).
This study aimed to assess the extent to which first-morning void (FMV) urine samples can estimate sodium and potassium excretion compared with 24-hour (24-h) urine samples at the population level. We conducted a cross-sectional study collecting urine samples (FMV and 24-h) and two non-consecutive 24-h dietary recalls in a sub-sample from the Portuguese IAN-AF sampling frame. Six predictive equations were used to estimate 24-h sodium and potassium excretion from FMV urine samples. Pearson correlation coefficients were calculated to compare the association between FMV and 24-h urine collections. Cross-classifications into tertiles were computed to calculate the agreement between measured and estimated excretion with and without calibration. Pearson correlation coefficients were calculated to compare the excretion estimation from FMV and reported intake from 24-h dietary recalls. Bland–Altman plots assessed the agreement between two-day dietary recall and the best-performing calibrated equation. Data from eighty-six subjects aged 18–84 were analysed. Estimated sodium and potassium concentrations from the predictive equations moderate or strongly correlated with the measured 24-h urine samples. The Toft equation was the most predictive and reliable, displaying a moderate correlation (r=0.655) with no risk of over or underestimation of sodium excretion (p=0.096). Tanaka and Kawasaki equations showed a similar moderate correlation (r=0.54 and r=0.58, respectively) but tended to underestimate the 24-h urine excretion of potassium (p<0.001). Calibrated predictive equations using FMV urine samples provide a moderately accurate alternative and resource-efficient option for large-scale nutritional epidemiology studies when 24-h urine collection is impractical.
Loneliness may lead individuals to spend more time on the internet and increase the likelihood of experiencing internet-use disorders. Similarly, individuals with internet-use disorders may feel lonelier. In the present systematic review and meta-analysis, pre-registered in PROSPERO (CRD42023390483), we quantified associations between internet-use-disorder symptoms (e.g. internet gaming disorder and online gambling disorder) and loneliness. We searched PubMed, Web of Science, and an institutional database aggregator for references that compared degrees of loneliness in groups of individuals with and without symptoms of internet-use disorder. Means and standard deviations of loneliness, or alternatively, odds ratios, were transformed into Cohen’s d for statistical pooling through a random-effects model. After screening 2,369 reports, we extracted data from 23 studies. The total number of individuals across the studies was 36,484. Participants were between 13 and 30 years of age (median 20). The pooled difference between those with and without internet-use-disorder symptoms yielded a standardized effect (Cohen’s d) of 0.53 (95% CI 0.35–0.7). While heterogeneity was high, there was no indication of publication or small sample biases. Similar effect sizes were found when limiting to specific types of internet-use disorder symptoms. Moreover, meta-regressions did not show an effect of age, sex, or sample size. Individuals with symptoms of internet-use disorders scored 49.35 (43.84–54.85) points on the UCLA-Loneliness scale on average, compared to 43.78 (37.47–50.08) in individuals without symptoms of internet-use disorders (Standardized Mean Difference: 5.18, 95% CI = 2.05–8.34). Individuals with internet-use-disorder symptoms experience greater loneliness. The effect appears moderately sized.
Our study compares individual and team bidding in standard auction formats: first-price, second-price and ascending-price (English) auctions with independent private values. In a laboratory experiment, we find that individuals overbid more than teams in first-price auctions and deviate more from bidding their own value in second-price auctions. However, we observe no difference in bidding behavior in English auctions. Based on control variables, we provide evidence that the observed difference could be explained by better reasoning abilities of teams. Emotions seem to play a role in determining bids, but the effect of emotions on bidding does not differ between individuals and teams.
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.
Achieving sustainability on the ground poses a challenge in decoding globally defined goals, such as sustainable development goals, and aligning them with local perspectives and realities. This decoding necessitates the understanding of the multifaceted dimensions of the sustainability challenges in a given context, including their underlying causes. In case studies from Brazilian drylands, we illustrate how an enhanced multiscale participatory method, combined with systems thinking tools, can shed light on systemic structures that currently entrench unsustainable development trajectories. This method offers insights into co-designing potential pathways toward sustainable futures and unlocking transformative capacities of the local population.
Technical summary
Translating United Nations global sustainable development goals (SDGs) into actions that address local realities and aspirations is an urgent challenge. It requires new thinking and approaches that foster the discussion about the main challenges to implementing the SDGs at multiple levels. This paper presents a novel multiscale participatory approach that combines the popular Three Horizons diagram with the formalism of causal loop diagrams in systems thinking. We present results from six multi-stakeholder dialogues held across drylands in Brazil with a focus on desired futures aligned with SDGs. Focusing on identifying the root causes and systemic structures of unsustainability, participants identified lock-ins, leverage points, and interventions for how these could be changed. The core lock-ins are the discontinuity of public policies, and the historical land and power concentration reinforced by the current expansion of large-scale agricultural, mining, and energy projects. The proposed interventions are structural and – if implemented – would contribute to achieving SDGs in an integrated manner. The unique approach developed in this study can provide leverage as it bridges the inclusivity of participatory visioning with the change potential of systems thinking tools to tackle root causes and unleash societal transformations.
Social media summary
We are not achieving SDGs. Understanding root causes of unsustainability is critical to move toward sustainable and just futures.
The establishment of the possible presence of life on Mars (past or present) is based on the study of planetary analogues, which allow in situ analysis of the environments in which living organisms adapt to often extreme conditions. Although Mars has been a candidate for hosting life, based on observations made decades ago, it is thanks to the characteristics identified in environments, mainly volcanic, that it has been possible to calibrate instruments and detail the features of the red planet. In this paper, we present a review of the main characteristics of different planetary analogues, particularly deepening the study of Antarctica, to later expose the factors studied in Deception Island that have contributed to considering it as an analogue of Mars from different perspectives. Although geological and geomorphological studies on the analogies of the island already exist, detailed analyses that present the approach of astrobiological analogues are required, thus allowing further research.
As societies grapple with mitigating or adapting to climate change, law plays a prominent role in the social relations that constitute a response. In this essay, we briefly review of the many different perspectives on law and climate change offered by the authors in this special issue of Law and Society Review. From transnational human rights activism to constitutional litigation to local practices and all around the globe, both the powerful and the marginalized draw on legal institutions and actors in multiple arenas and at multiple scales to address the consequences of climate change. Together, these articles show that law is not confined to courtrooms or judicial systems or regulations; rather, law offers both limitations and opportunities in the ongoing struggle over climate change.
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.
In laboratory testing, a novel hydrogen peroxide gas plasma endoscope sterilizer consistently reduced vegetative organisms, but not bacterial spores, to undetectable levels in the presence of high organism load (≥6.5 log10) and organic material and salts. These findings highlight the importance of meticulous cleaning of endoscopes prior to sterilization.
This cross-sectional study aimed to identify patterns of food preparation and examine their demographic and socio-economic drivers, along with impacts on health and nutritional status, physical activity, and diet quality. Dietary data from a national-representative sample (n = 5005, 3–84 years) of the Portuguese National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015/16) were classified by preparation locations (at or away from home) and analysed via hierarchical clustering. Logistic regression models were used to examine associations between demographic and socio-economic factors and food preparation patterns and between these patterns and health and nutritional status, physical activity, and diet quality. The most common food preparation pattern (followed by 45.4% of participants) represented the highest intake of foods prepared by away-from-home establishments. Adolescents (vs. children, OR = 0.29, 95%CI = 0.17, 0.49) and older adults (vs. adults, OR = 0.37, 95%CI = 0.26, 0.53) had lower odds of following this pattern, whereas adult men (vs. women, OR = 4.20, 95%CI = 3.17, 5.57) had higher odds. Higher education, higher household income, and having children/adolescents in the household also increased the odds of eating foods prepared away from home, whereas living in rural areas or in food-insecure households decreased the odds. Noticeably, adults consuming more foods prepared away from home had lower odds of being overweight or obese (OR = 0.74, 95%CI = 0.56, 0.97), but higher odds of sedentarism (OR = 1.45, 95%CI = 1.08, 1.96) and poor diet (OR = 3.01, 95%CI = 2.08, 4.34) compared to those consuming more foods prepared at home by themselves. Dietary patterns marked by high away-from-home food preparation prevail. While these correlated with higher socio-economic status, sedentarism, and poorer diet — relatively to patterns with greater reliance on homecooked food — they were not linked to higher odds of obesity.
One of the most relevant risk factors for suicide is the presence of previous attempts. The symptomatic profile of people who reattempt suicide deserves attention. Network analysis is a promising tool to study this field.
Objective
To analyze the symptomatic network of patients who have attempted suicide recently and compare networks of people with several attempts and people with just one at baseline.
Methods
1043 adult participants from the Spanish cohort “SURVIVE” were part of this study. Participants were classified into two groups: single attempt group (n = 390) and reattempt group (n = 653). Different network analyses were carried out to study the relationships between suicidal ideation, behavior, psychiatric symptoms, diagnoses, childhood trauma, and impulsivity. A general network and one for each subgroup were estimated.
Results
People with several suicide attempts at baseline scored significantly higher across all clinical scales. The symptomatic networks were equivalent in both groups of patients (p > .05). Although there were no overall differences between the networks, some nodes were more relevant according to group belonging.
Conclusions
People with a history of previous attempts have greater psychiatric symptom severity but the relationships between risk factors show the same structure when compared with the single attempt group. All risk factors deserve attention regardless of the number of attempts, but assessments can be adjusted to better monitor the occurrence of reattempts.
Marambio (Seymour) Island is located in the James Ross Archipelago east of the Antarctic Peninsula. Although several research groups have carried out studies on the biodiversity on the island for decades, surveys of bryophytes have not been developed. That is why there are currently only six species of mosses recorded in the northern part of the island. During the 2021–2022 summer Antarctic field trip, 15 mosses species were surveyed in Marambio Island. Of the total number of collected species, nine are reported for the first time for Marambio Island. For the remaining four species, their distributions are now expanded to Marambio Island.
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.
We introduce a versatile high-repetition-rate solid tape target system suitable for relativistic laser-plasma driven secondary sources. We demonstrate the operation and stability monitoring based on a petawatt laser focused at 1 Hz. Experiments were carried out at the VEGA-3 laser system of the Centro de Láseres Pulsados facility where results for different tape materials and thicknesses are presented. Experimental proton spectra were recorded by a Thomson parabola spectrometer and a time-of-flight detector. In addition, non-invasive detectors, such as a target charging monitor and ionization chamber detectors, were tested as metrology for the stability of the source. Degradation of the proton signal at high-repetition-rate operation was observed and it was solved by online optimization of the relative focus position of the target and laser beam parameters. We report the use of the tape target for bursts of 1000 shots at 1 Hz with mean cut-off energies of about 10 MeV in optimized interaction conditions.
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.