Top Research Priorities Research Articles

Getting to Hope: Perspectives from Patients and Caregivers Living with Chronic Childhood Illness.

Promoting hope was identified in our prior work as the top priority research question among patients and caregivers with diverse childhood-onset chronic conditions. Here, we aimed to construct a conceptual model to guide future research studies of interventions to improve hope. We conducted eight monthly virtual focus groups and one virtual workshop with patients, caregivers, and researchers to explore key constructs to inform the model. Discussions were facilitated by Patient Co-Investigators. Participants developed a definition of hope and identified promotors and inhibitors that influence the experience of hope. We utilized qualitative methods to analyze findings and organize the promotors and inhibitors of hope within three strata of the socio-ecologic framework: structural, interpersonal, and intrapersonal. Participants identified three types of interventions to promote hope: resources, navigation, and activities to promote social connection. The hope conceptual model can be used to inform the selection of interventions to assess in future research studies aimed at improving hope and the specification of outcome measures to include in hope research studies. Inclusion of the health care system in the model provides direction for identifying strategies for improving the system and places responsibility on the system to do better to promote hope among young patients with chronic illness and their caregivers.

Research priorities in maternal and neonatal health in Africa: results using the Child Health and Nutrition Research Initiative method involving over 900 experts across the continent

Background: Africa will miss the maternal and neonatal health (MNH) Sustainable Development Goals (SDGs) targets if the current trajectory is followed. The African Academy of Sciences has formed an expert maternal and newborn health group to discuss actions to improve MNH SDG targets. The team, among other recommendations, chose to implement an MNH research prioritization exercise for Africa covering four grand challenge areas. Methods: The team used the Child Health and Nutrition Research Initiative (CHNRI) research prioritization method to identify research priorities in maternal and newborn health in Africa. From 609 research options, a ranking of the top 46 research questions was achieved. Research priority scores and agreement statistics were calculated, with sub-analysis possible for the regions of East Africa, West Africa and those living out of the continent. Results: The top research priorities generally fell into (i) improving identification of high-risk mothers and newborns, or diagnosis of high-risk conditions in mothers and newborns to improve health outcomes; (ii) improving access to treatment through improving incentives to attract and retain skilled health workers in remote, rural areas, improving emergency transport, and assessing health systems' readiness; and (iii) improving uptake of proven existing interventions such as Kangaroo Mother Care. Conclusions: The research priorities emphasized building interventions that improved access to quality healthcare in the lowest possible units of the provision of MNH interventions. The lists prioritized participation of communities in delivering MNH interventions. The current burden of disease from MNCH in Africa aligns well with the list of priorities listed from this exercise but provides extra insights into current needs by African practitioners. The MNCH Africa expert group believes that the recommendations from this work should be implemented by multisectoral teams as soon as possible to provide adequate lead time for results of the succeeding programmes to be seen before 2030.

Synchronization for VHF Data Exchange System

In wireless communications, rapid acquisition of synchronization parameters is essential. Very High Frequency (VHF) Data Exchange System (VDES), a new maritime communication system developed on the basis of traditional Automatic Identification System (AIS), uses time division multiple access (TDMA) and belongs to burst communication. Therefore, synchronization is the top priority of VDES research. VDES includes the terrestrial part and satellite part, named as VDE-TER and VDE-SAT, and the two parts have different channel conditions. This paper studies synchronization algorithms for VDE-TER and VDE-SAT respectively on the basis of different channel conditions and focuses on the derivation, the theoretic analysis and performance simulation of the algorithms.

Top 10 research priorities for people living with pulmonary fibrosis, their caregivers, healthcare professionals and researchers

IntroductionPeople with pulmonary fibrosis (PF) experience a high symptom burden, reduced quality of life and a shortened lifespan. Treatment options are limited and little is known about what patients, caregivers...

Adolescent Nutrition—Developing a Research Agenda for the Second Window of Opportunity in Indonesia

Background:Recently, adolescence has been identified as a second window of opportunity for the correction of nutritional inadequacies. However, there is a lack of knowledge on evidence-based integrated nutrition strategies for adolescents in Indonesia.Objective:To provide a research agenda and the prioritization of research actions to tackle outstanding knowledge gaps on adolescent nutrition in Indonesia.Methods:A preliminary set of research topics was listed based on a desk study of the academic literature and policy documents. Second, a stakeholder meeting was held to further identify and discuss research topics related to adolescent nutrition in Indonesia. Third, an online survey was conducted in which respondents were asked to indicate priority research themes for the next 3 to 5 years and to rank a total of 23 research questions.Results:Most (52%) of the respondents who returned the survey (n = 27) prioritize research on implementation and program evaluation, while 30% prefer descriptive and explanatory research, and 19% place priority with intervention and discovery research. However, when we followed up with specific topics for each of these broad research areas, a more nuanced picture emerged, with intervention and discovery research taking a more prominent standing.Conclusions:In order to support the design, implementation, and effectiveness of integrated nutrition programs for Indonesian adolescents, in-depth studies should question the best intervention strategies, modes of delivery, and long-term outcomes, while nationwide and disaggregated data should investigate associations and trends over time and identify vulnerable groups.

Clinical Nurses Research Priorities in Hospital Settings: A Delphi Survey.

This study aimed to identify the research priorities of clinical nurses to develop a research program at a health care services system that includes three hospitals. A Delphi survey was emailed to all clinical nurses in two rounds. The Delphi method was used to collect data from the nurses in regards to their priority research themes, and the data were analyzed using descriptive and comparative statistics. A total of 933 clinical nurses returned the first round of the Delphi survey and 543 nurses answered the second round. Clinical nurses identified 89 potential research themes. Patient safety and ethical challenges were the two highest ranked research priorities. The 40 highest ranked priority research themes were closely associated with issues concerning patient care and ethics. However, the nurses also gave high ratings to issues relating to the work environment, questions about technology implementation, and patient involvement in clinical care decisions.

Research priorities in multiple sclerosis in Latin America: A multi-stakeholder call to action to improve patients care: Research priorities in MS in LATAM

As human and economic resources are limited, especially in Latin America (LATAM), it is important to identify research priorities to improve multiple sclerosis (MS) patients care in the region. The objective was to generate a multidisciplinary consensus on research priorities in MS for patients care in LATAM by involving healthcare professionals and MS patient associations. METHODS: consensus was reached through a four-step modified Delphi method designed to identify and rate research priorities in MS in LATAM. The process consisted of two qualitative assessments, a general ranking phase and a consensus meeting followed by a more detailed ranking phase RESULTS: a total of 62 participants (35 neurologists, 4 nurses, 12 kinesiologists, 7 neuropsychologists and 4 patient association members) developed the process. At the final ranking stage following the consensus meeting, each participant provided their final rankings, and the top priority research questions were outlined. 11 research priorities were identified focusing on healthcare access, costs of the disease, physical and cognitive evaluation and rehabilitation, quality of life, symptoms management, prognostic factors, the need of MS care units and patient's management in emergencies like COVID-19. CONCLUSION: this work establishes MS research priorities in LATAM from multiple perspectives. To pursue the actions suggested could launch the drive to obtain information that will help us to better understand the disease in our region and, especially, to better care for affected patients.

Trends and gaps in climate change and health research in North America

The Intergovernmental Panel on Climate Change (IPCC) 5th Assessment Report (2014) assessed the state of climate change and health knowledge, globally through the Human Health: Impacts, Adaptation, and Co-Benefits Chapter and regionally through chapters, such as the North America Chapter. With IPCC's 6th Assessment Report scheduled to be released in 2021-22, we asked: how has climate change and health research in North America advanced since the IPCC's 5th Assessment Report in 2014? Specifically, we systematically identified and examined trends in the extent, range, and nature of climate-health research conducted in North America. We used a scoping review methodology to systematically identify literature and map publication trends. A search string was used to search five academic databases. Two independent reviewers first screened titles and abstracts, and then the full texts of articles for relevance. Research articles and reviews using systematic methods published since 2013 were eligible for inclusion, and no language restrictions were applied. To be included, articles had to measure and link climatic variables or hazards to health outcomes in North America. Relevant articles were analysed using descriptive statistics to explore publication trends. The number of climate-health articles has significantly increased since the last IPCC Assessment Report. Published research about climate change impacts, heat-related mortality and morbidity, and respiratory illness taking place in urban centres and in the USA continue to dominate the North American climate-health literature, reflected by the high proportion of articles published. Important research gaps on previously neglected climate-sensitive health outcomes, however, are beginning to be filled, including climate change impacts on mental health, nutrition, and foodborne disease. We also observed progress in research that included future projections of climate-health risks; however, projection research is still relatively nascent and under-studied for many climate-sensitive health outcomes in North America, and would benefit from considering social and demographic variables in models. Important research disparities in geographical coverage were noted, including research gaps in Canada and Mexico, and in rural and remote regions. Overall, these publication trends suggest an improved understanding of exposure-response relationships and future projections of climate-health risks for many climate-sensitive health outcomes in North America, which is promising and provides an evidence-base to inform the IPCC 6th Assessment Report. Despite these advancements and considering the urgent policy and practice implications, more research is needed to deepen our understanding of climate-sensitive health outcomes, as well as examine new arising issues that have limited evidence-bases. In particular, transdisciplinary and cross-sector research, that includes the social sciences, examining current and future climate-health adaptation, mitigation, and the adaptation-mitigation nexus should become a top priority for research, given the urgent need for this evidence to inform climate change policies, actions, and interventions.

Respiratory Impacts of Wildland Fire Smoke: Future Challenges and Policy Opportunities. An Official American Thoracic Society Workshop Report.

Wildland fires are diminishing air quality on a seasonal and regional basis, raising concerns about respiratory health risks to the public and occupational groups. This American Thoracic Society (ATS) workshop was convened in 2019 to meet the growing health threat of wildland fire smoke. The workshop brought together a multidisciplinary group of 19 experts, including wildland fire managers, public health officials, epidemiologists, toxicologists, and pediatric and adult pulmonologists. The workshop examined the following four major topics: 1) the science of wildland fire incidence and fire management, 2) the respiratory and cardiovascular health effects of wildland fire smoke exposure, 3) communication strategies to address these health risks, and 4) actions to address wildland fire health impacts. Through formal presentations followed by group discussion, workshop participants identified top priorities for fire management, research, communication, and public policy to address health risks of wildland fires. The workshop concluded that short-term exposure to wildland smoke causes acute respiratory health effects, especially among those with asthma and chronic obstructive pulmonary disease. Research is needed to understand long-term health effects of repeated smoke exposures across fire seasons for children, adults, and highly exposed occupational groups (especially firefighters). Other research priorities include fire data collection and modeling, toxicology of different fire fuel sources, and the efficacy of health protective measures to prevent respiratory effects of smoke exposure. The workshop committee recommends a unified federal response to the growing problem of wildland fires, including investment in fire behavior and smoke air quality modeling, research on the health impacts of smoke, and development of robust clinical and public health communication tools.

Resistance\u2010guided isolation and characterization of antibiotic\u2010producing bacteria from river sediments

BackgroundTo tackle the problem of antibiotic resistance, an extensive search for novel antibiotics is one of the top research priorities. Around 60% of the antibiotics used today were obtained from the genus Streptomyces. The river sediments of Bangladesh are still an unexplored source for antibiotic-producing bacteria (APB). This study aimed to isolate novel APB from Padma and Kapotakkho river sediments having the potential to produce antibacterial compounds with known scaffolds by manipulating their self-protection mechanisms.ResultsThe antibiotic supplemented starch-casein-nitrate agar (SCNA) media were used to isolate antibiotic-resistant APB from the river sediments. The colonies having Streptomyces-like morphology were selectively purified and their antagonistic activity was screened against a range of test bacteria using the cross-streaking method. A notable decrease of the colony-forming units (CFUs) in the antibiotic supplemented SCNA plates compared to control plates (where added antibiotics were absent) was observed. A total of three azithromycin resistant (AZR) and nine meropenem resistant (MPR) isolates were purified and their antagonistic activity was investigated against a series of test bacteria including Shigella brodie, Escherichia coli, Pseudomonas sp., Proteus sp., Staphylococcus aureus, and Bacillus cereus. All the AZR isolates and all but two MPR isolates exhibited moderate to high broad-spectrum activity. Among the isolates, 16S rDNA sequencing of NAr5 and NAr6 were performed to identify them up to species level. The analyses of the sequences revealed that both belong to the genus Streptomyces.ConclusionsThe results from these studies suggest that manipulation of the self-resistance property of APB is an easy and quick method to search for novel APB having the potential to produce potentially novel antibacterial compounds with known scaffolds.

A systematic review of peritoneal dialysis-related peritonitis rates over time from national or regional population-based registries and databases.

Peritoneal dialysis (PD)-related peritonitis is one of the top priorities for care and research among PD stakeholders. This study summarizes PD peritonitis rates from available population-based national or regional registries around the world, examining trends over time. This is a systematic review of PD peritonitis rates in patients treated with PD for kidney failure, from census-based national or provincial/statewide/provider registries or databases. MEDLINE (via PubMed) was searched from inception to August 2020, and inquiries made to national registry personnel using the International Comparisons section of the 2018 United States Renal Data System Annual Data Report as a contact list. Quantitative synthesis was done using weighted random-effects Poisson regression. Of 81 countries that reported utilization of PD, 19 did not have a traditional dialysis registry (governed by either professional societies or government entities), and only 33 monitored PD peritonitis rates correctly and accessibly. There is wide variation in PD peritonitis rates between countries, although the global average has been decreasing over time, from 0.600 episodes/patient-year in 1992 to 0.303 in 2019. Other sources of variability include the continent in which the country is nested and the size of its PD population. PD peritonitis, despite its importance for PD stakeholders, is under-monitored. While the global rate is decreasing over time, the presence and extent of this improvement varies from country to country. There is an opportunity for better monitoring, research into underachieving and overachieving nations and development of international clinical support networks.

Designing a research agenda for coupled innovation towards sustainable agrifood systems

CONTEXTResearchers studying agriculture and researchers studying food share common interests in working on the sustainability of agrifood systems. Yet, they form two distinct scientific communities, which often struggle to work together due to both scientific specialization and existing disconnections between agriculture and food production standards. However, there is today a crucial need for research to generate new knowledge and innovations to meet the numerous challenges towards sustainable agrifood systems. OBJECTIVEThis paper therefore presents how two scientific communities (those of agriculture and food) collectively explored cross-community research topics, which could foster coupled innovation in agrifood systems. METHODSTwo innovative design methods - KCP and matching-building – were combined to propose a dedicated design process fostering this collective exploration of cross-community research topics. RESULTS AND CONCLUSIONSTwenty cross-community priority research topics were thus proposed to address various sustainability challenges. These topics were designed to become common purposes for future research collaborations aiming to produce relevant knowledge to open new avenues for coupled innovation towards more sustainable agrifood systems. The originality of the 20 topics was discussed, in comparison with 25 international papers highlighting research priorities regarding food systems. SIGNIFICANCEThe originality of the paper is thus twofold: the article details the original dedicated design method used to build cross-community research topics, and presents the 20 research topics designed using this method.

Nephrology and Palliative Care Collaboration in the Care of Patients With Advanced Kidney Disease: Results of a Clinician Survey

Rationale & ObjectiveDespite calls for integrating palliative care into chronic kidney disease (CKD) care, uptake remains low. The study aim was to describe clinicians’ perceptions of the clinical and research priorities in CKD care and the main barriers to collaboration.Study DesignThis was a descriptive cross-sectional study using an online survey developed by clinicians and researchers as the primary data collection method.Setting & ParticipantsClinicians in nephrology and palliative care departments (N = 195) at an academic health center in Virginia were invited to participate. Of the 48.7% (n = 95) who responded, most were registered nurses (65.3%) in nephrology (80%) with more than 15 years’ experience (40%).PredictorsFactors including discipline (nursing, social work, and physician) and practice area (palliative care or nephrology) were assessed.OutcomesMain outcomes of interest included clinicians’ perceptions of the role of palliative care, barriers to collaboration, and the top clinical and research priorities for patients with advanced CKD.Analytic ApproachSurvey data were analyzed using SPSS using descriptive statistics.ResultsRespondents reported being comfortable caring for patients near the end of life and endorsed advance care planning and collaboration between nephrology and palliative care teams. However, both rarely happen. Fragmentation, or poor coordination of care, was perceived to be the main barrier to collaboration. Perceptions regarding collaboration facilitation differed; nephrology clinicians identified patient/family education as the most important facilitator while palliative care clinicians identified clinician education as most important. Top clinical priorities differed. Palliative care clinicians reported pain/symptom management as taking priority while nephrology clinicians identified caregiver/family support. Developing interventions to support treatment-related decision making was the top research priority.LimitationsResults reflect perceptions of about half the clinicians at 1 academic health center.ConclusionsAdditional studies to capture patients’ and families’ perspectives and examine end-of-life care processes are needed. Results may inform future targeted interventions.

Technological foresight as support for the planning of research and development centers: the case of EI-UNAM

PurposeThis study aims to present a method to carry out technological foresight exercises in university technological research and development centers (TRDCs). The results support the organizational planning process.Design/methodology/approachThe authors review the literature on the frameworks of foresight. The authors propose the use of quantitative (bibliometrics) and qualitative (expert meeting, Delphi) techniques. The authors apply this method to each research topic of interest of the TRDCs.FindingsThe application of the method to a research topic allows us to analyze the relevant knowledge areas for the development of that topic and its global trend. For each area, the authors identify the specific lines of research with the greatest growth and relevance. Considering these lines, the authors make a diagnosis of the TRDC situation regarding how to provide knowledge to decision-makers.Research limitations/implicationsThe paper reviews the results of the application in the Engineering Institute of the National Autonomous University of Mexico and in the research topic “Seismic risks in civil engineering.” It is necessary to adjust the application of the method in other TRDCs to the conditions of the organization and to the development achieved by the TRDCs in the analyzed research topic.Originality/valueThere is no detailed literature on technological foresight exercises in university TRDCs that support the planning process of the organization. The method represents a proposal to establish priority research topics and specific research lines in research institutes, particularly universities. The authors present the application in a university TRDCs in Mexico.

Investigating factors affecting severity of large truck-involved crashes: Comparison of the SVM and random parameter logit model

Introduction: Reducing the severity of crashes is a top priority for safety researchers due to its impact on saving human lives. Because of safety concerns posed by large trucks and the high rate of fatal large truck-involved crashes, an exploration into large truck-involved crashes could help determine factors that are influential in crash severity. The current study focuses on large truck-involved crashes to predict influencing factors on crash injury severity. Method: Two techniques have been utilized: Random Parameter Binary Logit (RPBL) and Support Vector Machine (SVM). Models have been developed to estimate: (1) multivehicle (MV) truck-involved crashes, in which large truck drivers are at fault, (2) MV track-involved crashes, in which large truck drivers are not at fault and (3) and single-vehicle (SV) large truck crashes. Results: Fatigue and deviation to the left were found as the most important contributing factors that lead to fatal crashes when the large truck-driver is at fault. Outcomes show that there are differences among significant factors between RPBL and SVM. For instance, unsafe lane-changing was significant in all three categories in RPBL, but only SV large truck crashes in SVM. Conclusions: The outcomes showed the importance of the complementary approaches to incorporate both parametric RPBL and non-parametric SVM to identify the main contributing factors affecting the severity of large truck-involved crashes. Also, the results highlighted the importance of categorization based on the at-fault party. Practical Applications: Unrealistic schedules and expectations of trucking companies can cause excessive stress for the large truck drivers, which could leads to further neglect of their fatigue. Enacting and enforcing comprehensive regulations regarding large truck drivers’ working schedules and direct and constant surveillance by authorities would significantly decrease large truck-involved crashes.

Effect of psychological capital on customer value cocreation behavior: the mediating role of employees' innovative behavior

PurposeCustomer value cocreation (VCC) behavior is gaining increased scholarly attention in the services marketing discipline and has become a top research priority in recent times. Despite the growing interest in studying VCC, less scholarly attention has been paid to study the crucial role of frontline service employees in activating customer participation in the VCC process. Hence, to bridge this research gap, the present research expanded VCC research streams by investigating the mediating effect of frontline service employees' innovative behavior in psychological capital and customer VCC behavior relationship.Design/methodology/approachData collected from 255 hotel employee–customer dyads were analyzed through Smart PLS to measure the proposed relationships.FindingsThe results suggest the mediating effect of frontline service employees' innovative behavior in psychological capital and customer VCC behavior relationship.Originality/valueThe current research made a significant contribution to the VCC field by identifying driving forces that encourage customers to exhibit VCC behaviors.

Research and Healthcare Priorities of Individuals Living with COPD

This study describes the research and healthcare priorities of individuals living with COPD. On an online survey, individuals living with COPD assigned a percentage of funding to 22 research priorities and a percentage of time spent communicating with a healthcare provider to 24 healthcare priorities, indicating which topics were most important. For each research and healthcare priority, we examined the selection frequency of the priority and used chi-square analyses to examine differences in priority selection by quartiles of airflow obstruction (percent predicted forced expiratory volume in 1-sec (FEV1%predicted)) and breathlessness burden and exacerbation risk. Based on participants’ responses (N = 148, 47% women; Mean ± Standard Deviation age = 68 ± 9 yrs) relief of breathlessness was the most often selected research (76% of respondents) and healthcare priority (61% of respondents). It was selected most often, regardless of disease severity or breathlessness burden and exacerbation risk. We found differences for disease severity and breathlessness burden and exacerbation risk in some research priorities (e.g., to improve the maximal amount of exercise of adults living with COPD in and out of the home (χ2 (3) = 9.97, Cramer’s V =.28) and healthcare priorities (e.g., increase your ability to exercise (χ2 (3) = 9.72, Cramer’s V =.27)). This study provides empirical evidence that relief of breathlessness is a top research and healthcare priority for individuals living with COPD. Future healthcare and research activities should align with the priorities of individuals with COPD to improve their care by minimizing disease/symptom burden and optimizing health-related quality of life.

Top 10 Research Priorities for U.S. Military En Route Combat Casualty Care.

Within the Military Health System, the process of transporting patients from an initial point of injury and throughout the entire continuum of care is called "en route care." A Committee on En Route Combat Casualty Care was established in 2016 as part of the DoD Joint Trauma System to create practice guidelines, recommend training standards, and identify research priorities within the military en route care system. Following an analysis of currently funded research, future capabilities, and findings from a comprehensive scoping study, members of a sub-working group for research identified the top research priorities that were needed to better guide evidence-based decisions for practice and policy, as well as the future state of en route care. Based on the input from the entire committee, 10 en route care research topics were rank-ordered in the following manner: (1) medical documentation, (2) clinical decision support, (3) patient monitoring, (4) transport physiology, (5) transfer of care, (6) maintaining normothermia, (7) transport timing following damage control resuscitation or surgery, (8) intelligent tasking, (9) commander's risk assessment, and (10) unmanned transport. Specific research questions and technological development needs were further developed by committee members in an effort to guide future research and development initiatives that can directly support operational en route care needs. The research priorities reflect three common themes, which include efforts to enhance or increase care provider capability and capacity; understand the impact of transportation on patient physiology; and increase the ability to coordinate, communicate, and facilitate patient movement. Technology needs for en route care must support interoperability of medical information, equipment, and supplies across the global military health system in addition to adjusting to a dynamic transport environment with the smallest possible weight, space, and power requirements. To ensure an evidence-based approach to future military conflicts and other medical challenges, focused research and technological development to address these 10 en route care research gaps are urgently needed.

Red Nacional de Gestión de Conocimiento, Investigación e Innovación en Tuberculosis en Colombia

RESUMENEl Ministerio de Salud y Protección Social de Colombia, en colaboración con el Instituto Nacional de Salud y la Organización Panamericana de la Salud, convocaron en 2018 a todos los actores asociados al Programa Nacional de Prevención y Control de la Tuberculosis (PNPCT) y el Sistema Nacional de Ciencia, Tecnología e Innovación a la conformación de una red nacional que coordinara la investigación operativa (IO) relacionada con la tuberculosis (TB) en el país. Se realizaron siete talleres en los que se llegó al consenso de establecer la Red Nacional de Gestión de Conocimiento, Investigación e Innovación en Tuberculosis en Colombia (Red TB Colombia). Con más de 180 participantes, organizados en un nodo central y cinco nodos regionales que agrupan a las 37 entidades territoriales, en 2019 la Red TB Colombia realizó cuatro jornadas de capacitación en IO y definió 65 temas priorizados de investigación, ajustados a las líneas estratégicas establecidas por el PNPCT: prevención y atención integral, con foco en los afectados por la TB (41 temas en tres módulos) y compromiso político, protección social y sistemas de apoyo (24 temas en cuatro módulos). La priorización se realizó por el método de comparación por pares. La Red TB Colombia sigue activa y contribuye a la gestión del conocimiento dirigido a eliminar la TB en el país y ha permitido avanzar en la construcción de planes y la ejecución de proyectos locales de IO que generan resultados científicamente validados para fortalecer el PNPCT y mejorar la atención de los pacientes con TB.

An illicit artisanal fishery for North Pacific white sharks indicates frequent occurrence and high mortality in the Gulf of California

AbstractLarge sharks shape ecosystems across their geographic ranges and have become a top research and conservation priority. Eastern North Pacific (ENP) white shark (Carcharodon carcharias) aggregations off the United States and Mexico are well described, but their population status is currently uncertain. Population assessments of ENP white sharks are complicated by migrations across international boundaries, vulnerability at aggregation sites, and undetermined mortality levels. While protective legislation exists both in the United States and Mexico, ongoing incidental and unreported catch may undermine assessments and management. Here, access to a clandestine artisanal fishery provides evidence for white shark abundance and mortality in the Gulf of California that has been underestimated by other methods (e.g., satellite telemetry, [by]catch data). Shark size estimates based on tooth measurements suggest abundance of both juvenile and mature sharks in the region, and updated population models indicate the potential for substantial impacts of this fishery on ENP population viability. The data here, fisher‐provided information, and anecdotal evidence suggest potentially high abundance at two specific regions, making directed future research efforts feasible in the Gulf. These data demonstrate that cryptic life histories and geopolitical boundaries can still limit fundamental understanding of megafauna distribution, necessitating international cooperation for both research and management.