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Abstract Background Malnutrition and sarcopenia are highly prevalent in patients with head neck cancer (HNC). An accurate early diagnosis is necessary for starting nutritional support, as both are clearly associated with clinical outcomes and mortality. We aimed to evaluate the applicability and accuracy of body composition analysis using electrical bioimpedance vectorial analysis (BIVA) for diagnosing malnutrition and sarcopenia in patients with HNC cancer undergoing systemic treatment with chemotherapy or radiotherapy. Methods Cross‐sectional, observational study that included 509 HNC patients. A comprehensive nutritional evaluation that included BIVA was performed. Results The prevalence of malnutrition was higher in patients that received treatment with chemotherapy (59.2% vs. 40.8%, P

Background Lung ultrasound (LUS) has emerged as a useful tool in the acute phase of patients admitted for ST‐segment–elevation myocardial infarction. However, its long‐term significance remains uncertain, and risk scores do not include LUS findings as a predictor. This study aims to assess the 1‐year prognostic value of LUS and its ability to enhance existing risk scores. Methods and Results This is a multicenter prospective cohort study involving 373 patients with ST‐segment–elevation myocardial infarction. LUS was performed during the first 24 hours after angiography. LUS results were assessed both as a categorical (wet/dry lung) and continuous variable (LUS score). The primary end point comprised the following major adverse cardiovascular events: all‐cause mortality or hospitalization for heart failure, acute coronary syndrome, or stroke within 1 year. We also evaluated whether LUS could enhance the predictive value of the GRACE (Global Registry of Acute Coronary Events) score. Major adverse cardiovascular events occurred in 51 (13.7%) patients over a median follow‐up of 368 days. After multivariate analysis, the LUS score was an independent predictor (hazard ratio [HR], 1.06 [95% CI, 1.01–1.10]; P=0.009] for each additional B‐line), whereas the categorical classification was an independent predictor in patients with ST‐segment–elevation myocardial infarction Killip I (HR, 3.12 [95% CI, 1.34–7.31]; P=0.009). Incorporating LUS into GRACE resulted in a net reclassification index of 31.6% and a significant increase in the area under the curve; GRACE alone scored 0.705 compared with GRACE+LUS 0.791 (P=0.002). Conclusions Detecting B‐lines on LUS at the acute phase predicts major adverse cardiovascular events at 1 year in patients with ST‐segment–elevation myocardial infarction and enhances the predictive value of the GRACE score. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04526535.

Abstract The Mediterranean‐type climate region of Chile is a globally unique biodiversity hotspot but its protected area system does not adequately represent the biological diversity, nor does it provide equitable access to people. We explored options to expand the protected area system to cost‐effectively improve the conservation of forest ecosystem types while simultaneously enhancing social accessibility to protected areas. Social accessibility is defined as the access of municipalities to cultural ecosystem services provided by protected areas which depends on distance to highly demanded protected areas and income of the municipalities. Using systematic conservation planning methods, we identified priority areas for extending the existing protected area system that: (a) minimise land acquisition cost, (b) maximise social accessibility and (c) optimise for both cost and accessibility. The results show that it is possible to improve social accessibility while simultaneously minimising land cost. Considering cost alone, the protected area system could be expanded to improve biodiversity conservation by 86% at the cost of $47 million USD, which would also increase the accessibility of protected areas by 12%. Accessibility can be increased by a further 18% by jointly considering cost and accessibility without compromising the cost or biodiversity performance. New private conservation policy developed in Chile could help offset the costs of conservation through novel public–private partnerships. Our results can provide specific guidance to policymakers to strategically identify new locations for protected areas which cost‐effectively improve biodiversity conservation, while at the same time reducing inequality in social accessibility. The consideration of social access in reserve design could increase the success of protected areas as a conservation tool by bringing people closer to nature. A free Plain Language Summary can be found within the Supporting Information of this article.

Abstract Mechanisms that reliably and efficiently guide practitioners to find relevant evidence are urgent for conservation decision‐making in Chilean Patagonia. The objective of this study was to systematically collect, characterize, and synthesize the extensive evidence about conservation knowledge in Chilean Patagonia focusing on the impacts of global change drivers on ecosystems and human–nature relationships, identifying knowledge gaps, and providing policy recommendations. The quality of the evidence was assessed through a predefined level‐of‐evidence hierarchy scale, applied to a sample of the studies reviewed. We compiled ~1000 studies documenting that evidence focusing on terrestrial and marine ecosystems has grown exponentially. For terrestrial ecosystems, most studies have addressed climate change, habitat change, and invasive species; while for marine ecosystems, studies have focused on pollution, invasive species, and habitat change. We identified that an important gap is the study of the social dimensions of conservation, and future efforts should focus on incorporating traditional and local knowledge as this can help point the way to ecosystem conservation. The appraisal of the quality of the evidence showed that ~80% of the sample represented reliable evidence with underlying data and an experimental design. Enhanced efforts to deliver this evidence to decision‐makers in a user‐friendly format for evidence uptake in conservation policy are urgent. In this review, we provide a tool that can help practitioners to find evidence reliably to improve decision‐making for the conservation of ecosystems in Chilean Patagonia.

Abstract Latin America and the Caribbean (LAC) is one of the world's most biodiverse regions, but this diversity is threatened by the overexploitation of natural resources and internal social conflicts. In 2018, 33 LAC countries were invited to sign and ratify the landmark Escazú Agreement, which is the first legally binding environmental agreement to explicitly integrate human rights with environmental matters. The agreement outlines an approach to enhance the protection of environmental defenders, increase public participation in environmental decision‐making, and foster cooperation among countries for biodiversity conservation. However, clear mechanisms to implement the ideals of the Agreement are currently lacking. We identify the key provisions of the Agreement and link these to tangible mechanisms which aim to integrate human rights and nature conservation. These mechanisms include technological (e.g., free online data), human‐based (e.g., legal advice from multidisciplinary teams), and nature‐based solutions (e.g., transboundary species management). As environmental assets––and threats to them––span national boundaries, the collaborative and participatory provisions of the agreement could catalyze coordinated transboundary environmental management. Because of the importance of this Agreement for the LAC region, we added a Spanish version of this manuscript in the Supplementary Material (versión del artículo en español en el material suplementario).

Background. Leukocytes contained in the allogeneic packed red blood cell (PRBC) are the cause of certain adverse reactions associated with blood transfusion. Leukoreduction consists of eliminating leukocytes in all blood products below the established safety levels for any patient type. In this systematic review, we appraise the clinical effectiveness of allogeneic leukodepleted (LD) PRBC transfusion for preventing infections and death in patients undergoing major cardiovascular surgical procedures. Methods. We searched randomized controlled trials (RCT), enrolling patients undergoing a major cardiovascular surgical procedure and transfused with LD-PRBC. Data were extracted, and risk of bias was assessed according to Cochrane guidelines. In addition, trial sequential analysis (TSA) was used to assess the need of conducting additional trials. Quality of the evidence was assessed using the GRADE approach. Results. Seven studies met the eligibility criteria. Quality of the evidence was rated as moderate for both outcomes. The risk ratio for death from any cause comparing the LD-PRBC versus non-LD-PRBC group was 0.69 (CI 95% = 0.53 to 0.90; I2 = 0%). The risk ratio for infection in the same comparison groups was 0.77 (CI 95% = 0.66 to 0.91; I2 = 0%). TSA showed a conclusive result in this outcome. Conclusions. We found evidence that supports the routine use of leukodepletion in patients undergoing a major cardiovascular surgical procedure requiring PRBC transfusion to prevent death and infection. In the case of infection, the evidence should be considered sufficient and conclusive and hence indicated that further trials would not be required.

From 1998, the International Astronomical Union (IAU) adopted a new Celestial Reference System: the International Celestial Reference System (ICRS). The first optical materialization was the Hipparcos catalogue, defining the Hipparcos Celestial Reference Frame (HCRF). The compilation of subsequent radio sources catalogues culminated in the current representation of the ICRF, the ICRF2 catalogue that is not sufficiently dense to cover all astrometrical purposes. Linking Hipparcos and ICRF2 is essential to uniformize the reference regardless of whether it is visible (HCRF) or not (ICRF). Many working groups provide their own complementary catalogs, some of whose sources are also in the ICRF2, with different reduction processes for positions. The point is that they provide information in more than one reference for a small number of objects. Some of these projects have been used by us to study the Hipparcos-ICRF2 differences: a certain number of couples of catalogs can be interrelated using a set of parameters. With these couples, we build a closed cycle with the same ending and departure couple. The parameters obtained from each couple affect the next; thus we have an iterative process whose fixed point is the solution that stabilizes it, providing a preliminary link for Hipparcos-ICRF2.