Actividades en el espacio-tiempo del intercambio modal: oportunidades para el usuario en un sistema de transporte público inconcluso

El intercambio modal es hoy en día una práctica común y deseada en las políticas de transporte público urbano. En el caso de Santiago de Chile, fue un efecto colateral de la reforma del transporte público llevada a cabo en el año 2007 (Transantiago). Esta subestimación y la carencia generalizada de infraestructuras apropiadas permitieron a las personas la introducción de nuevas actividades en medio de sus desplazamientos, facilitando la resolución de necesidades simples, como compras de alimentos. Para comprender este fenómeno se analiza un punto de Santiago (Estación de Metro La Cisterna) que muestra cómo el uso que las personas le dan al intercambio modal abre oportunidades para renovar la ciudad y complementar el servicio que ofrece el sistema de transporte público

TRANSPORTE, MOVILIDAD Y ACCESIBILIDAD: CAMPOS Y MÉTODOS EMERGENTES PARA EL ANÁLISIS GEOGRÁFICO CONTEMPORÁNEO

El transporte, la movilidad y la accesibilidad son hoy campos relevantes para comprender la relación sinérgica que existe entre los sistemas de desplazamiento, la distribución de la oferta de bienes y servicios y los comportamientos que los ciudadanos realizan (o no) en sus territorios. El presente trabajo, a partir de una revisión bibliográfica, da cuenta de la relevancia de estos temas para disciplinas como la geografía, así como la pertinencia de los métodos para el abordaje de desafíos en el ámbito de la investigación académica, como del diseño y operación de sistemas de transporte, planes de infraestructura o instrumentos de ordenamiento territorial. De forma complementaria, el trabajo releva la nueva oportunidad de reflexionar respecto de estos campos temáticos, destacando sus tensiones, restricciones y mutaciones, a la luz de ciudades que crecen y se complejizan cada vez más rápidamente, instalando nuevos desafíos en la concreción de desarrollos urbanos más accesibles y sostenibles. Palabras clave, poner: Transporte, movilidad, accesibilidad, análisis espacial. Abstract: Transportation, mobility and accessibility are re- levant fields for understanding the synergetic be- tween travel systems, the distribution of the supply of goods and services and the behavior of citizens in their territories. This work, based on a bibliographic review, shows the relevance of these issues for disci- plines such as geography, as well as the relevance of the methods for addressing challenges in the field of academic research, such as design and operation of transportation systems, infrastructure plans or ins- truments of land use planning. Additionally, this work proposes to reflect on the- se thematic fields, highlighting their tensions, res- trictions and mutations, in view that cities grow and become increasingly complex, generating new cha- llenges in the realization of more accessible and sus- tainable urban developments. Keywords: Transportation, Mobility, Accessibility, Spatial Analysis

Actividades en el espacio-tiempo del intercambio modal: oportunidades para el usuario en un sistema de transporte público inconcluso

El intercambio modal es hoy en día una práctica común y deseada en las políticas de transporte público urbano. En el caso de Santiago de Chile, fue un efecto colateral de la reforma del transporte público llevada a cabo en el año 2007 (Transantiago). Esta subestimación y la carencia generalizada de infraestructuras apropiadas permitieron a las personas la introducción de nuevas actividades en medio de sus desplazamientos, facilitando la resolución de necesidades simples, como compras de alimentos. Para comprender este fenómeno se analiza un punto de Santiago (Estación de Metro La Cisterna) que muestra cómo el uso que las personas le dan al intercambio modal abre oportunidades para renovar la ciudad y complementar el servicio que ofrece el sistema de transporte público

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO < 80% and 24% having DLCO < 60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO < 60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Anales del III Congreso Internacional de Vivienda y Ciudad "Debate en torno a la nueva agenda urbana"

Acta de congresoEl III Congreso Internacional de Vivienda y Ciudad “Debates en torno a la NUEVa Agenda Urbana”, ha sido una apuesta de alto compromiso por acercar los debates centrales y urgentes que tensionan el pleno ejercicio del derecho a la ciudad. Para ello las instituciones organizadoras (INVIHAB –Instituto de Investigación de Vivienda y Hábitat y MGyDH-Maestría en Gestión y Desarrollo Habitacional-1), hemos convidado un espacio que se concretó con potencia en un debate transdisciplinario. Convocó a intelectuales de prestigio internacional, investigadores, académicos y gestores estatales, y en una metodología de innovación articuló las voces académicas con las de las organizaciones sociales y/o barriales en el Foro de las Organizaciones Sociales que tuvo su espacio propio para dar voz a quienes están trabajando en los desafíos para garantizar los derechos a la vivienda y los bienes urbanos en nuestras ciudades del Siglo XXI

Worldwide trends in underweight and obesity from 1990 to 2022 : a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

A list of authors and their affiliations appears online. A supplementary appendix is herewith attached.Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.peer-reviewe

Estrategias colectivas de movilidad en un espacio mixto. La Plaza de Maipú en Santiago de Chile

Geógrafo, Magíster en Desarrollo Urbano y doctorando en Arquitectura y Estudios Urbanos de la Universidad Católica de Chile. Ha sido asesor técnico del Directorio de Transporte Público Metropolitano y de la Subsecretaría de Transportes de Chile en temas de promoción del uso del transporte público. Es miembro del Laboratorio de Ciudad y Movilidad de la Universidad Católica de Chile donde desarrolla su investigación doctoral y contribuye en proyectos de investigación sobre espacio público, movilidad y transporte

ENCADENAMIENTO DE DESPLAZAMIENTOS: EL TRANSPORTE PÚBLICO DE SANTIAGO COMO PRODUCTOR DE ACTIVIDAD COMERCIAL

El encadenamiento de desplazamientos corresponde a una estrategia de movilidad que permite a las personas satisfacer múltiples necesidades con desplazamientos de bajo costo. En Santiago de Chile esta estrategia fue universalizada por la implementación de Transantiago, modificando la estructura de la ciudad. Este texto corresponde a un estudio exploratorio sobre este fenómeno y para ello se analiza un punto de intercambio modal dinámico (Metro Elisa Correa) localizado en un sector que históricamente estuvo desprovisto de servicios y que hoy posee vendedores ambulantes, comercio establecido y grandes almacenes. No obstante, este dinamismo parece ser frágil y depende de la variabilidad de los flujos y de las políticas de transporte público