To send 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 sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
Electrochemical reduction of CO2 to formic acid is a good strategy to address both environmental and energy issues. However, some drawbacks including low activity, selectivity, and stability of electrocatalysts must be overcome. We propose a method for tailoring Bi2O2CO3-coated carbon fiber electrodes with higher selectivity and stability for electrochemical CO2 reduction to formic acid. We evaluated the effect of Bi2O2CO3 and Nafion contents on the electrocatalysts performance for CO2 reduction reaction (CO2RR). All electrodes produced only HCOO− in the liquid phase with a maximum faradaic efficiency (FE) of 69%. The electrocatalysts were stable under 24 h of continuous CO2RR operation. The FE increased with the increasing electrolyte concentration and cation radius size, which indicates that the anion stabilization in solution is critical for adequate formate generation. The CO2RR mechanism was proposed with basis on the literature. The structural carbonate of Bi2O2CO3 acts as an intermediate species in the formate production from CO2.
In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.
The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.
A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.
A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.
Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.
The food habits of the South Pacific hake (Merluccius gayi) from Ecuadorian waters were studied by analysing 232 stomachs of specimens ranging from 23.4–83.1 cm in total length (TL). Fish was the most important prey group (Alimentary Index, %AI = 94), Ctenosciaena peruviana being the most represented prey species (%AI = 62.17). PERMANOVA analysis showed dietary differences between the smallest individuals (class I < 30 cm TL) and the largest (class IV 40–45 cm TL; class V ≥ 45 cm TL). In addition, spatial differences in dietary composition were found between the three sampled regions (Manabí, Santa Elena and Guayas). The results of this study indicate that the South Pacific hake is an opportunistic predator feeding on a wide variety of vertebrate and invertebrate organisms.
A new species of the genus Plagiorhynchus Lühe, 1911 from the intestine of the long-billed curlew (Numenius americanus) from northern Mexico is described. Plagiorhynchus (Plagiorhynchus) aznari n. sp. is morphologically distinguished from other congeneric species from the Americas by having a trunk expanded anteriorly and a cylindrical proboscis, armed with 19 longitudinal rows of hooks, with 14–15 hooks each row. Nearly complete sequences of the small subunit and large subunit of the nuclear ribosomal DNA of the new species were determined and compared with available sequences from GenBank. Phylogenetic analyses inferred from the two molecular markers consistently showed that P. (Plagiorhynchus) aznari n. sp. is closely related to P. (Plagiorhynchus) allisonae, and this clade is sister to a clade formed by P. (Prosthorhynchus) transversus and P. (Prosthorhynchus) cylindraceus from Plagiorhynchidae. The new species represents the second record of the genus in Mexico and the fourth species in the Americas. The phylogenetic relationships among the members of the order Polymorphida in this study provide significant insights into the evolution of ecological associations between parasites and their definitive hosts. Our analyses suggest that the colonization of marine mammals, fish-eating birds and waterfowl in Polymorphidae might have occurred independently, from a common ancestor of Centrorhynchidae and Plagiorhynchidae that colonized terrestrial birds and mammals.
The birth of neurocritical care (NCC) can be traced to Harvey Cushing’s “anesthesia chart” and to Walter Dandy, who opened the first three-bed unit in the USA for postoperative neurosurgical patients at Johns Hopkins Hospital in Baltimore, Maryland . Modern NCC is a new field that began in the early 1980s in a few isolated hospitals in the USA and Europe. This new area of expertise was needed to provide specialized care for patients with neurological and neurosurgical problems, which until that time was only offered in general intensive care units (ICUs) or in units of less acuity, such as stroke units. In fact, acute neurologic disorders were estimated to occur in 45% of medical ICU patients and neurologic complications to occur in 33% of patients admitted for non-neurological reasons . Because enlightened neurosurgeons, neurologists, and general intensivists realized that a substantial number of ICU patients could be better served by specialists, Neuro-ICUs (NICUs) were gradually established throughout the USA and Europe during the 1990s, often directed and staffed by neurologists with special interest in internal medicine or anesthesiology. Then in 2002, the Neurocritical Care Society (NCS) was formed, with close to 200 members. In 2005, the United Council for Neurological Subspecialties (UCNS) recognized NCC as a new neurological subspecialty and a process was created to accredit US NCC programs and develop an NCC physician certification. In 2008, Leapfrog recognized neurointensivists (NIs) as part of the critical care pool of physicians – an important development since, except for UCNS certification, no American Board of Medical Specialties (ABMS) critical care certification path had existed for NIs. This boosted the subspecialty to new heights, and the NCS grew to over 2500 members (please visit www.neurocriticalcare.org/practitioners/physicians for more information).
En las sociedades andinas actuales las relaciones de parentesco determinan el tipo de matrimonio y el patrón de residencia posmarital que garantizan el manejo de los recursos, la supervivencia y la estabilidad reproductiva de la población. Sin embargo, es escasa la información disponible en el Área Andina Centro-Sur (AACS) para explicar los sistemas de parentesco durante el poblamiento original del territorio y su impacto en la estructura de las poblaciones locales posteriores a la conquista y colonización europea. En el presente trabajo se investiga el patrón residencial en dos sectores del AACS a partir de datos bioarqueológicos disponibles para el Noroeste Argentino y Norte de Chile. La información necesaria pudo ser recuperada a partir de la arqueología y de la antropología física regional. La muestra proviene de 8 localidades y 44 sitios con fechados que cubren el intervalo cronológico desde 3000 aC hasta 1450 dC, desde grupos arcaicos tempranos hasta comunidades agroalfareras tardías. Se emplearon 1.897 observaciones y 27 variables craneométricas. El análisis se realizó con técnicas estadísticas multivariadas: el cálculo de la varianza generalizada (determinante de la matriz de varianzas y covarianzas) para cada sexo y la estimación de los estadísticos de distancia (D2) y divergencia fenotípica (Fst) entre grupos y sexos. Los resultados revelan el efecto de distintos flujos migratorios que determinaron la estructura de las poblaciones. En todos los casos la varianza generalizada masculina es mayor que la femenina indicando una mayor variabilidad entre sitios y una mayor actividad migratoria. Los valores de D2 y Fst femeninos son mayores entre regiones y localidades con una menor tasa migratoria. Estos resultados indican, en general, la prevalencia de una estrategia de supervivencia basada en un sistema de parentesco que favoreció un modelo de residencia matrilocal.
Cephalopods are important prey in the diet of top predators, such as marine mammals and seabirds. However, detailed information on their trophic relationships in the Patagonian marine ecosystem is scarce, including those cephalopod species with commercial interest. The aims of this study were to evaluate the composition of the cephalopod component in the diet of Otaria byronia and determine the habitat use and trophic levels of their main cephalopod prey by measuring the stable isotopic signature of cephalopod beaks. Between May 2005 and February 2009, fresh faecal samples were collected from two sea lions rookeries in San Matias Gulf. Cephalopods occurred in 39.4% of the 1112 samples collected during the whole period of study. The dominant prey species was Octopus tehuelchus, which occurred in 45.8% of scats containing cephalopod remains, and represented 58.7% in terms of numerical abundance and 52.0% in mass of cephalopods consumed. The second species most consumed was the myopsid Doryteuthis gahi. The significant higher δ15N values of O. tehuelchus beaks in comparison with those of D. gahi showed that these two species have different trophic levels while occupying similar habitat (δ13C values) in neritic waters of the Patagonian shelf.
To assess weight status and eating habits of undergraduate university students in relation to gender and examine the relationships between weight status, physical activity and eating habits.
Cross-sectional study conducted between October 2016 and May 2017.
Young adults in Midwest Brazil.
Undergraduate university students (n 2163) majoring in health care.
Among 2163 students, 69·3 % were female, 65·4 % were aged 20–29 years, 66·8% consumed alcohol and 44·2% did not achieve more than 150 min of physical activity per week. We found significant differences in the consumption of beans (P < 0·04) and full-fat milk (P < 0·01) between women and men. Women also had more sedentary lifestyles (P < 0·01) and showed higher prevalence of overweight (33·8 %) and obesity (5·0 %) than men. Students who did not engage in physical activity were more overweight (P = 0·03), consumed more soft drinks (P < 0·01) and meat with excess fat (P = 0·01). There was a positive association between weight status and fruit (P = 0·02), salad (P < 0·01), greens/vegetables (P < 0·01) and beans (P < 0·01) intake.
The low level of physical activity and unhealthy eating patterns reported by the study participants were inconsistent with the national recommendations for a healthy active lifestyle for adults and may contribute to the increasing rate of overweight and obesity in this population. A joint effort between universities and all relevant government agencies is needed to develop and promote school- and community-based interventions.
Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
Patients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
In total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
In the past decades the community-based participatory research method known as PhotoVoice has gained relevance, but there are few published studies on its application in the field of health technology assessment (HTA) and clinical practice guidelines (CPGs). The aim of this presentation was to describe a PhotoVoice project linked to a CPG on major depression in children and adolescents.
The design of the study was adapted to the main objective, which was to enhance the understanding of major depression and improve clinical practice with the contributions of clinicians, methodologists, and patients. Seven adolescents and ten of their family members participated in the study through PhotoVoice sessions and focus groups. The audio recordings of all sessions were transcribed verbatim and coded, and a thematic analysis was undertaken.
Six themes emerged: (i) a lack of understanding and information about depression in childhood and adolescence; (ii) the importance of support groups; (iii) the need to favor early care and access to services; (iv) the adaptation of therapeutic strategies tailored to individual needs; (v) the sensitivity of professionals; and (vi) fostering interaction between the health and education systems. Photographic exhibitions were planned to share the main results. These exhibitions were promoted to increase public awareness and reduce stigmatization, and to reach clinicians and policy makers. From a methodological point of view, the use of PhotoVoice in this study helped to effectively incorporate the lived experiences, concerns, and preferences of patients and their relatives into the CPG. The study also confirmed the value of photographs and participatory methods. The main limitations and strengths of the study, as well as suggestions for future research, are also outlined.
PhotoVoice is a flexible, effective, and innovative method of obtaining information about patients’ perspectives and experiences, and it offers the added value of being able to reach the main stakeholders, including policymakers and the public.
The specificities of non-pharmaceuticals can require adapting classical health technology assessment (HTA) methodologies and developing additional regional approaches to support decision-making processes. However, little information exists regarding the explicit approaches used in different countries. The aim of this work is to provide an overview of the role and activities of the Galician HTA agency (avalia-t, Spain) regarding assessment, appraisal and continued evaluation across the whole life cycle of non-pharmaceutical technologies.
In depth review and analysis of the activities undertaken by avalia-t during the past five years to support the introduction and appropriate use of non-pharmaceutical health care technologies at the regional level.
A multidisciplinary Commission judges the added value of new non-pharmaceuticals and establishes the indications and conditions for use. HTAs, which are mandatory for all relevant technologies, rely on the best available evidence on safety and effectiveness but also provide fit for purpose contextualized information based on organizational data and administrative registers. Interaction with multidisciplinary stakeholders is commonly needed to complement the evidence base (ad hoc working groups, face to face discussions), and post-launch studies can be implemented to analyze the utilization and results in real world practice. Performance indicators and other HTA based products can also be required to ensure the quality of health care (e.g., appropriate use indications, quality indicators, evidence based patient information). In addition, technical and scientific advice/support can be provided at different decision levels of the health organization to promote the quality of care and appropriate use of technologies (e.g., regional mental health program, suicide management strategy, bariatric surgery surveillance registry).
Rigorous, comprehensive and systematic processes for supporting non-pharmaceutical technology adoption and implementation are required. Although it is acknowledged that core information does not differ substantially within countries, contextualized information is recognized as essential for establishing the conditions for use at the regional level.
Decision making regarding national population-based prenatal and newborn screening policies is recognized to be highly challenging. This paper aims to describe the formalized collaboration that has been established between the Spanish National Public Health Screening Advisory Committee (PHSAC) and the Spanish Network of Health Technology Assessment (HTA) agencies to support the development of evidence- and consensus-based recommendations to support this process.
In-depth description and analysis of the strategic and methodological processes that have been implemented within the Spanish National Health System prenatal and newborn screening frameworks, with special emphasis on the role, actions, and responsibilities of HTA agencies.
The role of HTA agencies is threefold: (i) support the PHSAC by providing evidence on safety, effectiveness and cost/effectiveness of the screening tests/strategies, as well as contextualized information regarding costs, organizational, social, legal and ethical issues; (ii) collaborate with the PHSAC in the development of formal evidence- and consensus-based recommendations for defining population screening programs, when required; (iii) analyze real-world data that is generated by piloted programs. This paper will provide real-life examples of how these processes were implemented in practice, with a special focus on the development of the non-invasive prenatal testing (NIPT) policy. Recommendations for NIPT were developed by a multidisciplinary group based on the European network for Health Technology Assessment (EUnetHTA) rapid assessment report and the predictive models that were built using national statistics and other contextualized data.
The current work represents an innovative approach for prenatal and newborn screening policymaking, which are commonly difficult to evaluate due to the low quality of evidence and the confounding public health issues. The paper raises awareness regarding the importance of joint collaborations in areas where evidence is commonly insufficient for decision making.
The Centro de Laseres Pulsados in Salamanca, Spain has recently started operation phase and the first user access period on the 6 J 30 fs 200 TW system (VEGA 2) already started at the beginning of 2018. In this paper we report on two commissioning experiments recently performed on the VEGA 2 system in preparation for the user campaign. VEGA 2 system has been tested in different configurations depending on the focusing optics and targets used. One configuration (long focal length
cm) is for underdense laser–matter interaction where VEGA 2 is focused onto a low density gas-jet generating electron beams (via laser wake field acceleration mechanism) with maximum energy up to 500 MeV and an X-ray betatron source with a 10 keV critical energy. A second configuration (short focal length
cm) is for overdense laser–matter interaction where VEGA 2 is focused onto a
thick Al target generating a proton beam with a maximum energy of 10 MeV and temperature of 2.5 MeV. In this paper we present preliminary experimental results.
Neoechinorhynchus is one of the most speciose genera of acanthocephalans, with approximately 116 described species. A recent study, aimed at establishing the genetic diversity of Neoechinorhynchus in Middle American freshwater fishes, validated nine species molecularly and morphologically and revealed the existence of 10 putative candidate species. Neoechinorhynchus golvani, a parasite commonly found in cichlids throughout Middle America with an allegedly large intraspecific morphological variability, was found to represent a species complex; species delimitation methods uncovered three additional genetic lineages. Here, we re-analyse the morphological and molecular data for N. golvani species complex infecting cichlids in that geographical area. A multivariate analysis of variance (MANOVA) was conducted particularly for the length of apical, middle and posterior hooks of the species/lineages of Neoechinorhynchus in cichlids, revealing morphological variation in the length of apical hooks for Lineage 8, although no morphological distinction was observed for Lineages 9 and 10. A new concatenated phylogenetic analysis of one mitochondrial and two ribosomal DNA genes was used to further corroborate the species delimitation among lineages; Neoechinorhynchus Lineage 8 was found to be morphologically and genetically distinct from its sister taxa, N. golvani and other two undescribed genetic lineages, and is formally described as a new species. Neoechinorhynchus costarricense n. sp. is described from the intestines of eight species of cichlids in Costa Rica. The new species is distinguished from the other species/lineages of Neoechinorhynchus in cichlids mainly by the size of the apical hooks of the proboscis.
Members of the genus Neoechinorhynchus Stiles & Hassall, 1905 are endoparasites of freshwater fishes, brackish water fishes, and freshwater turtles distributed worldwide. In North America, 33 species have been described. One of the most widely distributed species in the eastern United States and Canada is Neoechinorhynchus (Neoechinorhynchus) cylindratus, a common acanthocephalan that infects centrarchid fishes. In the current study, adult specimens of N. (N) cylindratus were collected from largemouth bass (Micropterus salmoides) from the Purificación River in northern Mexico. In the same freshwater system, two additional congeneric species (Neoechinorhynchus (Neoechinorhynchus) emyditoides and Neoechinorhynchus (Neoechinorhynchus) panucensis) were collected and analysed. Sequences of the large subunit, internal transcribed spacers ITS1 and ITS2, 5.8S from nuclear DNA, and sequences of the cytochrome c oxidase subunit I (cox 1) from mitochondrial DNA were generated and aligned with other sequences obtained from GenBank. Maximum likelihood and Bayesian inference analyses inferred for each dataset showed that N. (N) panucensis, N. (N) emyditoides and N. (N) cylindratus were nested within several clades, indicating that these species do not share a common ancestor. Our phylogenies also revealed that the genus Neoechinorhynchus is paraphyletic, requiring further taxonomic revision using phylogenetic systematics and re-examination of morphological and ecological data. The presence of several N. (N) cylindratus adults in northern Mexico allowed us to typify this species for the first time using a combination of morphological and molecular characteristics. The current record shows a wide distribution range of N. (N) cylindratus across Canada, the United States and Mexico in the Nearctic region.
Tapeworms of the family Gryporhynchidae are endoparasites of fish-eating birds distributed worldwide. Currently the family contains 16 genera classified on the basis of the morphology of the rostellar apparatus, rostellar hooks and strobilar anatomy. However, the phylogenetic relationships among the genera are still unknown. In this study, sequences of the near complete 18S (SSU) and 28S (LSU) from rDNA of 13 species of gryporhynchids (adult specimens) representing eight genera (Cyclustera, Dendrouterina, Glossocercus, Gryporhynchidae gen. sp., Neovalipora, Paradilepis, Parvitaenia, Valipora) and one species of metacestode from fish (Neovalipora) were generated. Additionally, sequences of metacestodes of the genera Amirthalingamia, Neogryporhynchus, Paradilepis, Parvitaenia and Valipora from Africa recently added to the GenBank database were analysed. Phylogenetic relationships were inferred using maximum-likelihood (ML) and Bayesian inference of each (SSU and LSU) dataset. The phylogenetic analyses indicated that the family Gryporhynchidae is a well-supported monophyletic group within the Cyclophyllidea. The trees inferred with SSU and LSU datasets had similar topologies and suggested that the genera Glossocercus (two species sequenced) and Paradilepis (four spp.) are monophyletic. In contrast, Dendrouterina, Parvitaenia and Valipora are paraphyletic, suggesting that the species composition of these genera should be critically reviewed. Interestingly, species of the genera that use the same groups of definitive hosts such as herons (Ardeidae), cormorants (Phalacrocoracidae) and ibis (Threskiornithidae) are together in the phylogenetic tree, even though they differ markedly from each other in some morphological characters, especially shape and size of rostellar hooks.
To assess the daily intake of polychlorinated biphenyls not similar to dioxins (NDL-PCB) derived from fish consumption in Spain and compare it with tolerance limits in order to establish a safe threshold so that the nutritional benefits derived from fish consumption may be optimized.
Analysis of NDL-PCB in fish samples and ecological study of the estimated intake of NDL-PCB from fish consumption in different Spanish population groups.
National representative sample of the Spanish population.
The intake of NDL-PCB was estimated in two different scenarios: upper bound (UB) and lower bound (LB). Estimating intake using the average concentration of NDL-PCB found in the fish samples, the intake for ‘other children’ is estimated as: 1·80 (UB) and 5·33 (LB) ng/kg per d at the 50th percentile (P50); 7·39 (UB) and 21·94 (LB) ng/kg per d at the 95th percentile (P95) of fish consumption. Estimated NDL-PCB intake shoots up in the toddler group, reaching values of 30·43 (UB) and 90·37 (LB) ng/kg per d at P95. Estimated intake values are lower than those previously estimated in Europe, something expected since in previous studies intake was estimated through total diet. In adults, our estimated values are 1·59 (UB) and 4·72 (LB) ng/kg per d at P50; 4·95 (UB) and 14·72 (LB) ng/kg per d at P95.
NDL-PCB concentration in fish is under the tolerance limits in most samples. However, daily intake in consumers of large quantities of fish should be monitored and special attention should be given to the youngest age groups due to their special vulnerability and higher exposure.