Central Caribbean Research Articles

Effects of herbivory by the urchin Diadema antillarum on early restoration success of the coral Acropora cervicornis in the central Caribbean

In an era of coral reef decline, coral restoration is receiving increasing attention, with many recent developments in culture and transplant techniques. However, how the ecological processes operating on coral reefs influence the success of restoration efforts remains largely unexplored, particularly during the first months after outplanting which are considered crucial for colony survival. Herbivory is a key process well-known to maintain a coral-dominated state, and in the Caribbean Sea, the long-spine urchin Diadema antillarum is thought to aid coral success by removing algae from seafloor substrate that might otherwise outcompete coral outplants. In this study, we conducted a three-month manipulative experiment in southeastern Dominican Republic to test the effect of Diadema antillarum density on percent living tissue and growth rate of outplanted fragments of the critically endangered coral species Acropora cervicornis. Increasing herbivore density had no significant effect on coral survival or growth but did increase the percent of living tissue when urchin abundance was 3× ambient levels. The greatest growth and survival outcomes were instead related to the initial size of the outplanted coral and were reduced through predation by the fireworm Hermodice carunculata. Our results highlight the potential importance of considering ecological processes like herbivory and predation to maximize the success of ecological restoration.

Woody debris on beach environments: Magnitudes, collateral effects, and management

Woody Debris (WD) can be an essential component on beaches, influencing both the biological and physical functions and processes of this ecosystem. However, the presence of WD on beaches can conflict with their uses (e.g., tourism, fishing). Along 25 beaches, located on the central Caribbean coast of Colombia, a total of 4,219 WD pieces were found. The average abundance was 1.7 WD items/m, but this value ranged significantly between beaches (from 3.8 items/m to 0.001 items/m). Application of two evaluation indices, based on WD data, highlights that most of the beaches have a very high abundance of WD within overall refuse content and this WD most of time fully covers the beach area. In the same way, a Hierarchical Cluster Analysis (HCA) was developed to show similarities and differences between beaches concerning WD abundances. This analysis highlights that the central Caribbean of Colombia can be divided into three specific groups of beaches according to WD abundances. Current WD patterns of abundance and accumulation are related to beach characteristics as well as the degree of beach exposure. In the same way, WD found in the study area reflects a strong influence of longshore-current transport. Understanding the ecological role that WD currently plays along the study-area beaches is necessary to planning and implementing appropriate management strategies.

Plastic pollution on the Colombian central Caribbean beaches

Along 24 beaches of the Central Caribbean Coast of Colombia, plastic items were collected and grouped into 43 different typologies. The average plastic abundance was 4.54 items/m2 being eight typologies responsible for 82% of all plastic collected. The application of the Clean Coast Index (CCI) and the Plastic Abundance Index (PAI) allows categorization of the study area as “Extremely Dirty” coastal strip with a “Very High Abundance” of plastics. Beaches were statistically grouped into three specific types: moderate, bad and extremely bad environmental conditions. The typology and magnitudes of plastics found in the study area suggest a combination of sources that primarily include dumping and direct activities on the beach. Plastic medical and sanitary waste, ocean/waterway items, and plastic items related to smoking-related activities also were observed.

Interannual variability of the boreal winter subtropical jet stream and teleconnections over the CORDEX-CAM domain during 1980–2010

The interannual variability of the boreal winter (DJF) subtropical jet stream (STJ) is analyzed over the Coordinated Regional Downscaling Experiment—Central America, Mexico, and Caribbean domain (CORDEX-CAM) during 1980–2010. We use simulations with the regional climate model RegCM4 (version 7) at 25 km resolution driven by ERA-Interim (RegERA) and three global models (RegGCMs). The simulations are evaluated using zonal winds at 200 hPa level from ERA-Interim and MERRA2, which show similar results, and no significant trends in the STJ. Despite some biases, RegERA captures the STJ variability and its relationship with several teleconnections. The polarities of the principal mode of variability of the Pacific and Atlantic jets are significantly anti-correlated; they represent the longitudinal extension/retraction and the poleward/equatorward migration of the jet cores, respectively. During El Nino and the + PNA (Pacific North America), the North Pacific jet exit region and the North Atlantic jet show maximum speeds equatorward of their climatological positions. During these conditions, there is an extended and strong STJ over the domain; this pattern also tends to occur during the negative phases of the Arctic and North Atlantic oscillations. The RegGCMs simulate better the principal modes of the Atlantic jet variability than those of the Pacific jet exit region; nevertheless, they reproduce the observed sign of the variations of the jet speeds and their latitudinal changes in the two basins. They also partially capture the sign of the temperature and precipitation anomalies in the domain, which respond to the STJ polarities and their interaction with the teleconnections.

Conspecific and Predator Perception of the Red Oophaga pumilio Morph from the Central Caribbean of Costa Rica

Strawberry Poison Frogs (Oophaga pumilio) are common members of leaf litter lowland communities in Central America and exhibit several color morphs throughout their distribution. Color plays a determinant role during intra- and intermorph interactions in many insular populations, but little is known about the variation and perception of visual signals in mainland populations. In this study, we investigated color variation of four body parts—head, back, belly, and throat—in a bright red O. pumilio population of northeastern Costa Rica. We incorporated frog- and bird-specific visual modeling to evaluate the differences in color and brightness between the sexes, from the perspective of conspecifics and avian predators. Furthermore, we measured the color and brightness contrast against natural backgrounds commonly used by these frogs to forage and patrol within territories. Our results revealed that, from the perspective of conspecifics, there is no dichromatism between males and females. However, females had a greater contrast against green and brown backgrounds than males. The bird visual models indicated that males and females are highly conspicuous against common background substrates but that females are easier to detect than males. This study detailing color variants between sexes within a mainland population of O. pumilio contributes to our understanding of color differences in populations of this species.

Central American and Caribbean Consensus for the Treatment of Multiple Sclerosis and Therapeutic Attitudes Facing the COVID-19 Pandemic

Therapeutic decisions for multiple sclerosis have become more complex in the Central American and Caribbean region (CAC), with new treatments appearing every year but with well-known limitations in terms of access and application. Concomitantly, the advent of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, with an increasing number of cases in the region, has increased the need for a consensus on therapeutic decisions to be made for people with multiple sclerosis. Under these circumstances, a reference framework is needed to gather current information to assist neurologists in making therapeutic decisions.
 An evidence-based consensus on the use of disease-modifying therapies for multiple sclerosis was proposed and accomplished by the Central American and Caribbean Multiple Sclerosis Forum (FOCEM), including recommendations for treatment during the pandemic. Using the consensus panel development methodology, after a bibliographic review of the best quality and actualized information, a final report was written; this includes statements that reached more than 70% consensus among the panel of experts.
 The recommendations encompass indications for drugs available for multiple sclerosis, definitions of therapeutic failure, patient follow-up, factors of poor prognosis, discontinuation of treatment, treatment during pregnancy and lactation and specific recommendations to apply during the SARS-CoV-2 pandemic.

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.

This is the second update of the review first published in 2017. Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood pressure to below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown. To determine if lower blood pressure targets (135/85 mmHg or less) are associated with reduction in mortality and morbidity as compared with standard blood pressure targets (140 to 160/90 to 100 mmHg or less) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease). For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials (RCTs) up to November 2019: Cochrane Hypertension Specialised Register, CENTRAL, MEDLINE (from 1946), Embase (from 1974), and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982), along with the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov. We also contacted authors of relevant papers regarding further published and unpublished work. We applied no language restrictions. We included RCTs with more than 50 participants per group that provided at least six months' follow-up. Trial reports had to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions involved lower targets for systolic/diastolic blood pressure (135/85 mmHg or less) compared with standard targets for blood pressure (140 to 160/90 to 100 mmHg or less). Participants were adults with documented hypertension and adults receiving treatment for hypertension with a cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease, or angina pectoris. Two review authors independently assessed search results and extracted data using standard methodological procedures expected by Cochrane. We used GRADE to assess the quality of the evidence. We included six RCTs that involved 9484 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). All RCTs provided individual participant data. None of the included studies was blinded to participants or clinicians because of the need to titrate antihypertensives to reach a specific blood pressure goal. However, an independent committee blinded to group allocation assessed clinical events in all trials. Hence, we assessed all trials at high risk of performance bias and low risk of detection bias. Other issues such as early termination of studies and subgroups of participants not predefined were also considered to downgrade the quality evidence. We found there is probably little to no difference in total mortality (risk ratio (RR) 1.06, 95% confidence interval (CI) 0.91 to 1.23; 6 studies, 9484 participants; moderate-quality evidence) or cardiovascular mortality (RR 1.03, 95% CI 0.82 to 1.29; 6 studies, 9484 participants; moderate-quality evidence). Similarly, we found there may be little to no differences in serious adverse events (RR 1.01, 95% CI 0.94 to 1.08; 6 studies, 9484 participants; low-quality evidence) or total cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization, or death from congestive heart failure) (RR 0.89, 95% CI 0.80 to 1.00; 6 studies, 9484 participants; low-quality evidence). The evidence was very uncertain about withdrawals due to adverse effects. However, studies suggest more participants may withdraw due to adverse effects in the lower target group (RR 8.16, 95% CI 2.06 to 32.28; 2 studies, 690 participants; very low-quality evidence). Systolic and diastolic blood pressure readings were lower in the lower target group (systolic: mean difference (MD) -8.90 mmHg, 95% CI -13.24 to -4.56; 6 studies, 8546 participants; diastolic: MD -4.50 mmHg, 95% CI -6.35 to -2.65; 6 studies, 8546 participants). More drugs were needed in the lower target group (MD 0.56, 95% CI 0.16 to 0.96; 5 studies, 7910 participants), but blood pressure targets were achieved more frequently in the standard target group (RR 1.21, 95% CI 1.17 to 1.24; 6 studies, 8588 participants). We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or less) in people with hypertension and established cardiovascular disease. Several trials are still ongoing, which may provide an important input to this topic in the near future.

Barriers to lung cancer referral, diagnosis, and treatment in Central America and the Caribbean: the health professionals' perspectives.

To identify the perspectives from healthcare providers about the limitations in referral, diagnosis, and treatment of lung cancer (LC) patients. A cross-sectional study through an Internet-based survey was addressed to physicians of multidisciplinary teams in charge of LC patients from Cuba, Curacao, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Jamaica, Panama, and Trinidad and Tobago. The questions focused on physicians' perspectives concerning waiting times and the availability of diagnostic and staging procedures in their settings, as well as the access to systemic therapies and continuous medical education (CME). A total of 152 physicians responded to the online questionnaire (response rate 24.9%). Delays in biopsy results were the main barrier for LC diagnosis as identified by 48.2% of the respondents, followed by patients not being referred in time (31.3%), delays for staging procedures (11.4%), and time taken for biopsy (9%). Almost one-half of physicians perceived that patients are diagnosed in advanced stages. A total of 29 respondent physicians (19.1%) reported limited access to immunohistochemical or genetic analysis for common mutations. Although 73 physicians (48.0%) confirmed that their centers provided radiotherapy and systemic therapy for their patients, immunotherapy was not available in the institutions of 30 physicians (19.7%). A total of 42 practitioners (27.6%) reported that they did not have access to CME on LC topics due to working or budget restrictions. This study revealed among respondents the main barriers for an appropriate management of LC patients in the Central American and Caribbean Region. Further studies must validate these findings.

Completing the Account: The Complex Preparations for the 1926 Central American Games

Abstract Originating almost a hundred years ago, the Central American and Caribbean Games, first known simply as the Central American Games, are the oldest continuing regional games recognized by the International Olympic Committee. Despite their long and distinguished lineage, as well as their professed significance, the Central American and Caribbean Games have not received much scholarly attention. Building on the pioneering work of McGehee, this article provides a more complete account of the preparations for the inaugural Central American Games held in Mexico City in 1926 and the forces that made them possible and shaped them. Recently discovered evidence will be used to show how the political fluidity of postrevolutionary Mexico and the workings of the Olympic Movement affected preparations for the novel event.

The impact of anthropogenic litter on Colombia's central Caribbean beaches

A total of 7563 anthropogenic litter (AL) items, grouped into twelve different typologies, were collected along 25 beaches located on the central Caribbean coast of Colombia. The average AL abundance was 6.05 items/m2, plastic items being the most common reaching a total percentage of 88.9% with an average density of 5.38 items/m2. Application of 3 evaluation indices, based on the AL data, placed most of the beaches into the status of unacceptable conditions of cleanness (Dirty to Extremely Dirty), and into mediocre to unsatisfactory environmental status. Hazardous anthropogenic litter (HAL), occurred in considerable amounts with hazardous items reaching a high of 7% (502 items of 7563 total items collected), and an average of 0.40 items/m2. Beaches were statistically grouped into four specific types that ranged from beaches in good environmental conditions (Group A) to beaches in extremely adverse environmental conditions (Group D). The typology and magnitudes of AL found along the study area suggest a combination of sources that are associated with the multiple usages developed along this region's coast. Anthropogenic litter is mainly related to land-based sources, and these generating source activities can be found in nearby basins and/or on the same beaches where the litter remains. This paper proposes four key actions to specifically reduce AL, as well as an 8-step agenda to address solutions to the broader management of litter problems.

The Southern Caribbean upwelling system off Colombia: Water masses and mixing processes

The upwelling system off the southern Caribbean coast is probably the main source of the nutrients that support biological productivity in the oligotrophic Caribbean Sea. Subtropical underwater (SUW) that forms the subsurface salinity maximum in the Caribbean Sea is the main source of upwelled waters in this system. Profiles of salinity and temperature with depth derived from four oceanographic cruises and Argo floats showed that upwelled waters have a salinity that is ~0.11 g kg−1 lower than the SUW in the central Caribbean Sea and a seasonal variation of approximately 0.09 g kg−1 that reflects the rainy/dry seasons. In addition, the SUW is ~50 m shallower on the continental shelf slope (~100 m) compared to the depth of the SUW in the central Caribbean Sea. The origin of these modified SUW was analyzed using the Mercator numerical model, which reproduces the main vertical characteristics of the subsurface salinity maximum. The modeled data showed that SUW upwelling off of the La Guajira Peninsula and Venezuela arrive into the system via an intense Caribbean Coastal Undercurrent (CaCU, mean speed ~0.28 m s−1). This current is formed in front of the Nicaragua platform from the divergence of subsurface water flow at the salinity maximum depth. The lower salinity observed in the upwelled waters may be the result of intense vertical mixing processes that could occur when the SUW are transported by the CaCU below the Panama-Colombia Gyre (PCG) region before reaching the upwelling zones. The mixing processes—involving double diffusion and mechanical turbulence driven by vertical shear of horizontal currents—were analyzed using the Turner Angle and the Thorpe scale, respectively. Below a depth of 200 m, double diffusion by salt fingers (diffusivities > 5 x 10−5 m2 s−1) was the main process of salt diffusion, generating a downward salt flux of >2 x 10−2 g kg−1 m d−1 between the SUW and the North Atlantic Central Waters (NACW). Above a depth of 100 m, mechanical turbulent diffusion generates a salt flux towards the surface ranging 0.5–4 x 10−2 g kg−1 m d−1, where double diffusion by salt finger is not possible. The diluted SUW is subsequently transported by the CaCU, connecting—at the subsurface level—the PCG region with the upwelling zones off of Colombia and Venezuela. As well as modifying the salt content of the coastal SUW, these mixing processes may also alter the nutrient content of upwelling waters, the ecosystem effects of which are still unknown.

Population status of the American crocodile, Crocodylus acutus (Reptilia: Crocodilidae) and the caiman, Caiman crocodilus (Reptilia: Alligatoridae), in the Central Caribbean of Costa Rica

American crocodile (Crocodylus acutus)(Reptilia:Crocodilidae) and caiman (Caiman crocodilus)(Reptilia:Alligatoridae) population status, in the Costarican Central Caribbean. Two species of crocodilians have been described in Costa Rica, american crocodile (Crocodylus acutus: Cuvier 1807), and caiman (Caiman crocodilus: Linnaeus 1758). In Costa Rica, data has been generated on both species, but populations in the Pacific have received more attention from researchers; due to the fact that the Pacific slope has a greater development, which brings greater social pressure on the attention of the incidents generated by the encounter between humans and crocodiles. This study, performed during 2017, was done in an area of approximately 400 km2, characterized by having a wide and dense network of water courses, which includes the Matina, Pacuare, Reventazón and Parismina rivers. In these rivers, an average of 25 kilometers were traveled from the coastline up stream to the interior of the territory, including the Tortuguero canals, and other water bodies that connect these rivers, as well as in the most important lagoons and secondary channels. Three repetitions were made per segment. A population of 1084 caimans and 503 crocodiles is estimated; for a relative abundance of 8.64 and 2.80 ind/Km respectively. Speaking of caimans, up to 12% of individuals of reproductive age were observed, while for crocodiles that number was only 2%. The presence of both species in the different places studied, turned out to be significantly different for crocodiles and for caimans (Kruskal-Wallis, p≤0,000). Likewise, the size distribution is similar for crocodiles reported in all environments (Kruskal-Wallis, p≤0.15), while for caimans it indicates that there is a different distribution for sizes, according to the environment in which they are found (Kruskal -Wallis, p≤0,000), with a bias against of the Pacuare and Matina rivers. It was possible to estimate a sex ratio of 1.25 and 0.83 males to females, in crocodiles and caimans respectively, with 9 and 11 captures in that same order, in individuals of recruits, juvenile and subadult sizes. The Matina River and the Jalova Lagoon are the two main sites for the observation of crocodiles, their abundances are lower than those reported for the Pacific of Costa Rica, in whereas caimans, with a more homogeneous distribution throughout the sampling area, have a relative abundance considerably more than that reported in Honduras (2.2 ind/km), but lower than the 12.5 reported forLa Rambla de Sarapiquí, in the Northern Zone of Costa Rica.

The Founding and Fracturing of the Mosquito Confederation: Zambos, Tawiras, and New Archival Evidence, 1711–1791

Abstract The purpose of this article is to assess the political, diplomatic, and ethnic dynamics of the Mosquito Kingdom, an Afro-indigenous alliance based along Central America's Caribbean coast, during the eighteenth century. Drawing from new archival sources—most notably those of the National Archives of Costa Rica—this essay first examines the political organization of the Mosquitos, demonstrating that early leaders consolidated their authority by unifying different factions into a powerful confederation with expansionist tendencies. This essay then presents new evidence against the hypothesis that ethnic rivalry was a major source of factional conflict within the kingdom and thereby calls for a reexamination of the causes of the confederation's descent into civil war in 1791.

E&P Notes (September 2019)

E&P Notes (September 2019)

The Past, Present, and Future of FDI: Towards a better Global Economics

We document past, present, and future of FDI trend in recent decades that goes substantially beyond the advanced economies. This rigorous study also examines the influence of FDI on economic growth using macro variables for a global perspective. Six macro variables namely, FDI, physical capital, trade, human capital, labor force, and infrastructure were used in this study. We did a panel analysis on data from 2002 to 2017 and used rigorous two-way fixed effect model. This study finds that both FDI and trade openness enhance economic growth. Open door policies are more beneficial for the entire world; capital also plays a significant role in this process. Further, FDI plays a role with human capital but vocational training, skilled labor force and education are the most important factors to attract FDI. In the last decade, overall sub-Saharan African, EU and Central Asia, Latin America and Caribbean regions have observed a significant economic growth through FDI. The future of FDI in a high populated area is very gleaming. The overall result indicates that FDI accelerates economic growth in the globe.

NSCLC mutation frequency in the central American and Caribbean region.

e14278 Background: Lung Cancer (LC) constitutes a leading cause of death in the World. Non-small cell lung cancer subtype adenocarcinoma (NSCLC-A) has been associated with epidermal growth factor receptor (EGFR) mutations, which is essential for treatment decisions. The EGFR mutation frequency has been proven to have regional variability in this NSCLC-A population. The current study presents the EGFR mutation incidence and T790M frequency in NSCLC-A cases diagnosed in Central American and Caribbean(CA&C) region. Methods: A cross-sectional evaluation was performed in patients diagnosed with NSCLC-A between 2016 and 2018 in five CA&C countries. Patients were obtained from Reference Centers in Dominican Republic, Nicaragua, Panama, Honduras and Costa Rica through the AstraZeneca testing program. EGFR mutations were evaluated through Real-Time PCR. Results: The research included 972 cases. Mean of age at the diagnosis was 62.79(28.12-90.46) years. Overall distribution of cases by gender was female in 52.37% (509/972) and male in 47.64% (463/972). For the group of antiEGFR TKI naïve patients, tissue samples were processed in 67.83% (601/886). For the group of post antiEGFR TKI patients plasma samples were processed in 90.70% (78/86). For the group of antiEGFR TKI naïve patients, EGFR mutations were present in 26.64% (236 / 886), the mean of age was 63.17 years (28.12-113.47). The frequency of Exon 19 was 53.38(126/236)% and Exon 21 was 27.54%(65/236)% and 11.01% (26/236) were complex mutations. T790M mutations in this treatment naïve population was 2.14%(19/886). For the group of post antiEGFR TKI patients the frequency of T790M mutation was 50.00% (43/86) where 78.57% were obtain from plasma samples. Conclusions: The frequency of NSCLC EGFR mutation positive patients in the CA&C region was similar to that previously described in other Latin American (LA) countries. In the treatment naïve population, tissue samples remain the most important sample to analyze for EGFR mutations. T790M mutations can be seen in treatment naïve population. For patients that progressed to an antiEGFR TKI, T790M mutations were seen in a similar frequency as describe in previous LA countries. For post antiEGFR TKI patients, plasma samples were the preferred method to evaluate T790M mutations with an adequate sensibility.

Dynamical Coupling Between Hurricane Matthew and the Middle to Upper Atmosphere via Gravity Waves

AbstractDuring 30 September to 9 October 2016, Hurricane Matthew traversed the Caribbean Sea to the east coast of the United States. During its period of greatest intensity, in the central Caribbean, Matthew excited a large number of concentric gravity waves (GWs or CGWs). In this paper, we report on hurricane‐generated CGWs observed in both the stratosphere and mesosphere from spaceborne satellites and in the ionosphere by ground Global Positioning System receivers. We found CGWs with horizontal wavelengths of ~200–300 km in the stratosphere (height of ~30–40 km) and in the airglow layer of the mesopause (height of ~85–90 km), and we found concentric traveling ionospheric disturbances (TIDs or CTIDs) with horizontal wavelengths of ~250–350 km in the ionosphere (height of ~100–400 km). The observed TIDs lasted for more than several hours on 1, 2, and 7 October 2016. We also briefly discuss the vertical and horizontal propagation of the Hurricane Matthew‐induced GWs and TIDs. This study shows that Hurricane Matthew induced significant dynamical coupling between the troposphere and the entire middle and upper atmosphere via GWs. It is the first comprehensive satellite analysis of gravity wave propagation generated by hurricane event from the troposphere through the stratosphere and mesosphere into the ionosphere.

Treatments for unruptured intracranial aneurysms

BACKGROUND Unruptured intracranial aneurysms are relatively common lesions in the general population, with a prevalence of 3.2%, and are being diagnosed with greater frequency as non-invasive techniques for imaging of intracranial vessels have become increasingly available and used. If not treated, an intracranial aneurysm can be catastrophic. Morbidity and mortality in aneurysmal subarachnoid hemorrhage are substantial: in people with subarachnoid hemorrhage, 12% die immediately, more than 30% die within one month, 25% to 50% die within six months, and 30% of survivors remain dependent. However, most intracranial aneurysms do not bleed, and the best treatment approach is still a matter of debate. OBJECTIVES To assess the risks and benefits of interventions for people with unruptured intracranial aneurysms. SEARCH METHODS We searched CENTRAL (Cochrane Library 2020, Issue 5), MEDLINE Ovid, Embase Ovid, and Latin American and Caribbean Health Science Information database (LILACS). We also searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform from inception to 25 May 2020. There were no language restrictions. We contacted experts in the field to identify further studies and unpublished trials. SELECTION CRITERIA Unconfounded, truly randomized trials comparing conservative treatment versus interventional treatments (microsurgical clipping or endovascular coiling) and microsurgical clipping versus endovascular coiling for individuals with unruptured intracranial aneurysms. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion according to the above criteria, assessed trial quality and risk of bias, performed data extraction, and applied the GRADE approach to the evidence. We used an intention-to-treat analysis strategy. MAIN RESULTS We included two trials in the review: one prospective randomized trial involving 80 participants that compared conservative treatment to endovascular coiling, and one randomized controlled trial involving 136 participants that compared microsurgical clipping to endovascular coiling for unruptured intracranial aneurysms. There was no difference in outcome events between conservative treatment and endovascular coiling groups. New perioperative neurological deficits were more common in participants treated surgically (16/65, 24.6%; 15.8% to 36.3%) versus 7/69 (10.1%; 5.0% to 19.5%); odds ratio (OR) 2.87 (95% confidence interval (CI) 1.02 to 8.93; P = 0.038). Hospitalization for more than five days was more common in surgical participants (30/65, 46.2%; 34.6% to 58.1%) versus 6/69 (8.7%; 4.0% to 17.7%); OR 8.85 (95% CI 3.22 to 28.59; P 2). All the evidence is of very low quality. AUTHORS' CONCLUSIONS There is currently insufficient good-quality evidence to support either conservative treatment or interventional treatments (microsurgical clipping or endovascular coiling) for individuals with unruptured intracranial aneurysms. Further randomized trials are required to establish if surgery is a better option than conservative management, and if so, which surgical approach is preferred for which patients. Future studies should include consideration of important characteristics such as participant age, gender, aneurysm size, aneurysm location (anterior circulation and posterior circulation), grade of ischemia (major stroke), and duration of hospitalizations.

Seasonal climatology and dynamical mechanisms of rainfall in the Caribbean

The Caribbean is a complex region that heavily relies on its rainfall cycle for its economic and societal needs. This makes the Caribbean especially susceptible to hydro-meteorological disasters (i.e. droughts and floods). Previous studies have investigated the seasonal cycle of rainfall in the Caribbean with monthly or longer resolutions that often mask the seasonal transitions and regional differences of rainfall. This has resulted in inconsistent findings on the seasonal cycle. In addition, the mechanisms that shape the climatological rainfall cycle in the region are not fully understood. To address these problems, this study conducts: (i) a principal component analysis of the annual cycle of precipitation across 38 Caribbean stations using daily observed precipitation data; and, (ii) a moisture budget analysis for the Caribbean, using the ERA-Interim Reanalysis. This study finds that the seasonal cycle of rainfall in the Caribbean hinges on three main facilitators of moisture convergence: the Eastern Pacific ITCZ, the Atlantic ITCZ, and the western flank of the North Atlantic Subtropical High (NASH). The Atlantic Warm Pool and Caribbean Low-Level Jet modify the extent of moisture provided by these main facilitators. The expansion and contraction of the western flank of NASH generate the bimodal pattern of the precipitation annual cycle in the northwestern Caribbean, central Caribbean, and with the Eastern Pacific ITCZ the western Caribbean. This study identifies the Atlantic ITCZ as the major source of precipitation for the central and southern Lesser Antilles, which is responsible for their unimodal rainfall pattern. Convergence by sub-monthly transients contributes little to Caribbean rainfall.

The Dark Side of Hurricane Matthew: Unique Perspectives from the VIIRS Day/Night Band

AbstractHurricane Matthew (28 September–9 October 2016) was perhaps the most infamous storm of the 2016 Atlantic hurricane season, claiming over 600 lives and causing over $15 billion (U.S. dollars) in damages across the central Caribbean and southeastern U.S. seaboard. Research surrounding Matthew and its many noteworthy meteorological characteristics (e.g., rapid intensification into the southernmost category 5 hurricane in the Atlantic basin on record, strong lightning and sprite production, and unusual cloud morphology) is ongoing. Satellite remote sensing typically plays an important role in the forecasting and study of hurricanes, providing a top-down perspective on storms developing over the remote and inherently data-sparse tropical oceans. In this regard, a relative newcomer among the suite of satellite observations useful for tropical cyclone monitoring and research is the Visible Infrared Imaging Radiometer Suite (VIIRS) day/night band (DNB), a sensor flying on board the NOAA–NASA Suomi National Polar-Orbiting Partnership (SNPP) satellite. Unlike conventional instruments, the DNB’s sensitivity to extremely low levels of visible and near-infrared light offers new insight into storm properties and impacts. Here, we chronicle Matthew’s path of destruction and peer through the DNB’s looking glass of low-light visible observations, including lightning connected to sprite formation, modulation of the atmospheric nightglow by storm-generated gravity waves, and widespread power outages. Collected without moonlight, these examples showcase the wealth of unique information present in DNB nocturnal low-light observations without moonlight, and their potential to complement traditional satellite measurements of tropical storms worldwide.