Democracy in Latin America: status and prospects

The purpose of this essay is to examine the status of democracy in Latin American countries as well as the prospects upcoming for the region in the present decade. We will provide a map of the subject that includes a basic definition of democracy, an overview of theories about how democracies arise and may be maintained, as a continuum, and a review of what we know empirically about Latin American democratization. We suggest a model in which political culture and social structure influence each other, and that both directly influence political processes, which in turn mediates between these causal factors and the actual emergence of democratic rules of the political game in every particular country. The approach is completed with a series of lapop Data that shows up how far and in what direction democracy is taking place in Lati

Late Holocene Lake-level Variation in Southeastern Lake Superior: Tahquamenon Bay, Michigan

Internal architecture and ages of 71 beach ridges in the Tahquamenon Bay embayment along the southeastern shore of Lake Superior on the Upper Peninsula of Michigan were studied to generate a late Holocene relative lake-level curve. Establishing a long-term framework is important to examine the context of historic events and help predict potential future changes critical for effective water resource management. Ridges in the embayment formed between about 4,200 and 2,100 calendar years before 1950 (cal. yrs. B.P.) and were created and preserved every 28 ± 4.8 years on average. Groups of three to six beach ridges coupled with inflections in the lake-level curve indicate a history of lake levels fluctuations and outlet changes. A rapid lake-level drop (approximately 4 m) from about 4,100 to 3,800 cal. yrs. B.P. was associated with a fall from the Nipissing II high-water-level phase. A change from a gradual fall to a slight rise was associated with an outlet change from Port Huron, Michigan/Sarnia, Ontario to Sault Ste. Marie, Michigan/Ontario. A complete outlet change occurred after the Algoma high-water-level phase (ca. 2,400 cal. yrs. B.P.). Preliminary rates of vertical ground movement calculated from the strandplain are much greater than rates calculated from historical and geologic data. High rates of vertical ground movement could have caused tectonism in the Whitefish Bay area, modifying the strandplain during the past 2,400 years. A tectonic event at or near the Sault outlet also may have been a factor in the outlet change from Port Huron/Sarnia to Sault Ste. Marie

Population structure and growth of polydorid polychaetes that infest cultured abalone Haliotis midae

Polydorid polychaetes can infest cultured abalone thereby reducing productivity. In order to effectively control these pests, their reproductive biology must be understood. The population dynamics and reproduction of polydorids infesting abalone Haliotis midae from two farms in South Africa is described using a length-based, age-structured model. Shells were infested mainly by introduced Boccardia proboscidea. Polydora hoplura and Dipolydora capensis were also present but in numbers too few to identify factors influencing infestation. At both farms, B. proboscidea lived for a minimum of 12 months. Growth rate, size at maturity, maximum size, infestation intensity, recruitment, percentage of the population brooding and mortality appear to be affected by abalone feeding regime and water temperature, and these factors need to be considered in controlling infestation. Brooders and recruits were present throughout the year, but increased significantly during mid- to late winter/early spring when water temperature and day length increased. Treatment measures should therefore be implemented throughout the year but with increased effort when water temperature increases

Return to drug use and overdose after release from prison: a qualitative study of risk and protective factors

BACKGROUND: Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners. METHODS: This qualitative study included former prison inmates (N = 29) who were recruited within two months after their release. Interviewers conducted in-person, semi-structured interviews which explored participants' experiences and perceptions. Transcripts were analyzed utilizing a team-based method of inductive analysis. RESULTS: The following themes emerged: 1) Relapse to drugs and alcohol occurred in a context of poor social support, medical co-morbidity and inadequate economic resources; 2) former inmates experienced ubiquitous exposure to drugs in their living environments; 3) intentional overdose was considered "a way out" given situational stressors, and accidental overdose was perceived as related to decreased tolerance; and 4) protective factors included structured drug treatment programs, spirituality/religion, community-based resources (including self-help groups), and family. CONCLUSIONS: Former inmates return to environments that strongly trigger relapse to drug use and put them at risk for overdose. Interventions to prevent overdose after release from prison may benefit from including structured treatment with gradual transition to the community, enhanced protective factors, and reductions of environmental triggers to use drugs

Evaluation of Criteria to Detect Masked Hypertension

The prevalence of masked hypertension, out-of-clinic daytime systolic/diastolic blood pressure (SBP/DBP)≥135/85 mmHg on ambulatory blood pressure monitoring (ABPM) among adults with clinic SBP/DBP<140/90 mmHg, is high. It is unclear who should be screened for masked hypertension. We derived a clinic blood pressure (CBP) index to identify populations for masked hypertension screening. Index cut-points corresponding to 75% to 99% sensitivity and prehypertension were evaluated as ABPM testing criterion. In a derivation cohort (n=695), the index was clinic SBP+1.3*clinic DBP. In an external validation cohort (n=675), the sensitivity for masked hypertension using an index ≥190 mmHg and ≥217 mmHg and prehypertension status was 98.5%, 71.5% and 82.5%, respectively. Using NHANES data (n=11,778), we estimated that these thresholds would refer 118.6, 44.4 and 59.3 million US adults, respectively, to ABPM screening for masked hypertension. In conclusion, the CBP index provides a useful approach to identify candidates for masked hypertension screening using ABPM

South Pole Station ozonesondes: variability and trends in the springtime Antarctic ozone hole 1986&ndash;2021

Balloon-borne ozonesondes launched weekly from South Pole station (1986&ndash;2021) measure high vertical resolution profiles of ozone and temperature from surface to 30&ndash;35 km altitude. The launch frequency is increased in late winter before the onset of rapid stratospheric ozone loss in September. Ozone hole metrics show the yearly total column ozone and 14&ndash;21 km column ozone minimum values and September loss rates remain on an upward (less severe) trend since 2001. However, the data series also illustrate interannual variability, especially in the last three years (2019&ndash;2021). Here we show additional details of these three years by comparing minimum ozone profiles and the July&ndash;December 14&ndash;21 km column ozone time series. The 2019 anomalous vortex breakdown showed stratospheric temperatures began warming in early September leading to reduced ozone loss. The minimum total column ozone of 180 Dobson Units (DU) was observed on 24 September. This was followed by two stable and cold polar vortex years in 2020 and 2021 with total column ozone minimums at 104 DU (01 October) and 102 DU (07 October), respectively. These years also showed broad zero ozone (saturation loss) regions within the 14&ndash;21 km layer by the end of September which persisted into October. Validation of the ozonesonde observations is conducted through the ongoing comparison of total column ozone (TCO) measurements with the South Pole ground-based Dobson spectrophotometer. The ozonesondes show a constant positive offset of 2 &plusmn; 3 % (higher) than the Dobson following a thorough evaluation/homogenization of the ozonesonde record in 2018.</p

Cost-effectiveness of dapagliflozin for patients with heart failure across the spectrum of ejection fraction:A pooled analysis of DAPA-HF and DELIVER data

Aim: To assess the cost-effectiveness of dapagliflozin in addition to usual care, compared with usual care alone, in a large population of patients with heart failure (HF), spanning the full range of left ventricular ejection fraction (LVEF). Methods and results: Patient-level data were pooled from HF trials (DAPA-HF, DELIVER) to generate a population including HF with reduced, mildly reduced and preserved LVEF, to increase statistical power and enable exploration of interactions among LVEF, renal function and N-terminal pro-B-type natriuretic peptide levels, as they are relevant determinants of health status in this population. Survival and HF recurrent event risk equations were derived and applied to a lifetime horizon Markov model with health states defined by Kansas City Cardiomyopathy Questionnaire total symptom score quartiles; costs and utilities were in the UK setting. The base case incremental cost-effectiveness ratio (ICER) was £6470 per quality-adjusted life year (QALY) gained, well below the UK willingness-to-pay (WTP) threshold of £20 000/QALY gained. In interaction sensitivity analyses, the highest ICER was observed for elderly patients with preserved LVEF (£16 624/QALY gained), and ranged to a region of dominance (increased QALYs, decreased costs) for patients with poorer renal function and reduced/mildly reduced LVEF. Results across the patient characteristic interaction plane were mostly between £5000 and £10 000/QALY gained. Conclusions: Dapagliflozin plus usual care, versus usual care alone, yielded results well below the WTP threshold for the UK across a heterogeneous population of patients with HF including the full spectrum of LVEF, and is likely a cost-effective intervention.</p

Cost-effectiveness of dapagliflozin for patients with heart failure across the spectrum of ejection fraction:A pooled analysis of DAPA-HF and DELIVER data

Aim: To assess the cost-effectiveness of dapagliflozin in addition to usual care, compared with usual care alone, in a large population of patients with heart failure (HF), spanning the full range of left ventricular ejection fraction (LVEF). Methods and results: Patient-level data were pooled from HF trials (DAPA-HF, DELIVER) to generate a population including HF with reduced, mildly reduced and preserved LVEF, to increase statistical power and enable exploration of interactions among LVEF, renal function and N-terminal pro-B-type natriuretic peptide levels, as they are relevant determinants of health status in this population. Survival and HF recurrent event risk equations were derived and applied to a lifetime horizon Markov model with health states defined by Kansas City Cardiomyopathy Questionnaire total symptom score quartiles; costs and utilities were in the UK setting. The base case incremental cost-effectiveness ratio (ICER) was £6470 per quality-adjusted life year (QALY) gained, well below the UK willingness-to-pay (WTP) threshold of £20 000/QALY gained. In interaction sensitivity analyses, the highest ICER was observed for elderly patients with preserved LVEF (£16 624/QALY gained), and ranged to a region of dominance (increased QALYs, decreased costs) for patients with poorer renal function and reduced/mildly reduced LVEF. Results across the patient characteristic interaction plane were mostly between £5000 and £10 000/QALY gained. Conclusions: Dapagliflozin plus usual care, versus usual care alone, yielded results well below the WTP threshold for the UK across a heterogeneous population of patients with HF including the full spectrum of LVEF, and is likely a cost-effective intervention.</p