Metodología de estudio de preferencias declaradas y reveladas para la implementación del sistema de bici-cleta pública en una ciudad. (Caso de estudio el centro urbano de Sangolquí)

Este trabajo propone una metodología para realizar ESTUDIOS de PREFEREN-CIAS DECLARADAS y PREFERENCIAS REVELADAS de la población en las áreas urbanas de una ciudad, con el propósito de determinar su aceptación o no de la implementación del sistema de BICICLETA PÚBLICA como un medio alternativo de transporte. Si bien la metodología propuesta es aplicable en cualquier ciudad, para efecto de este trabajo y como caso de estudio se elige el Centro Urbano de la Ciudad de Sangolquí. Previo al planteamiento de la metodología que se propone, se investiga la situación actual del transporte público y particular, en especial, en los medios de transporte no motorizado, la utilización de la BICICLETA con sus beneficios y posibles desven-tajas y con la Reglamentación y Normas Técnicas existentes; además, conside-rando los fundamentos de la Ingeniería de Tránsito e Ingeniería de Transporte, y partiendo de la investigación de las ENCUESTAS DE MOVILIDAD que, en general, permiten obtener información del comportamiento en cuanto a desplazamientos de la población y herramientas de análisis de sus tendencias para la planificación de la movilidad en los diferentes territorios, se estudian las Encuestas de Preferencias, DECLARADAS Y REVELADAS, con sus experiencias a nivel nacional e internacio-nal, lo que permite que el presente trabajo esté fundamentado en una base teórica y legal coherente. El procedimiento de aplicación de la METODOLOGÍA PROPUESTA y que se utilizó en el caso de estudio, comprende en síntesis tres etapas: Análisis y Diagnóstico; Desarrollo y Aplicación; y, Evaluación y Estadística, para terminar con Conclusiones y Recomendaciones. En la primera etapa, se determinan los OBJETIVOS DEL ESTUDIO, se realiza el DISEÑO DE LAS ENCUESTAS con las preguntas orientadas a obtener la informa-ción para lograr esos objetivos; se define la ZONA DE ESTUDIO en base a la po-blación, uso de suelo y a los sitios de atracción de viajes, dentro de esta se definen los PUNTOS DE MUESTREO, verificando los más representativos para el estudio, de entre estos se seleccionó uno en el que se aplicó el modelo de encuesta para prueba, ENCUESTA PILOTO, en la cual verificamos si las preguntas son apropia-das para la obtención de la información requerida y las correcciones que debían realizarse a estas. En la etapa siguiente, una vez desarrollado y probado el diseño de las encuestas se define el TAMAÑO DE LA MUESTRA, número de encuestas a realizarse o perso-nas a encuestar, aplicando la fórmula indicada en el capítulo correspondiente, en la cual se consideró la Población de la Zona Definida, el Porcentaje de Confiabilidad y el Porcentaje de Error Permitido; para aplicar las encuestas, TRABAJO DE CAM-PO, se designó el número de encuestadores y se desarrollaron las encuestas en días y horas laborables; realizadas estas, fueron recolectadas, CONTABILIZADAS y sus resultados CODIFICADOS e ingresados en la base de datos para su posterior EVALUACIÓN. En la última etapa, se procede al ANÁLISIS y DETERMINACIÓN de CONCLUSIO-NES, para el procesamiento y análisis de los datos obtenidos se utilizó el SOFT-WARE SPSS 15.0 STATISTICS; para conocer no solo cuántos encuestados de la muestra utilizada sino cuántos del total de la población de la zona elegida estaría de acuerdo o no con la implementación del medio de transporte propuesto, se generó un FACTOR DE EXPANSIÓN, obtenido dividiendo el número de habitantes por zonas para el número de encuestados por zonas. Este factor se aplicó al total de la población para conocer los resultados generales. Finalmente se realizó una CALI-BRACIÓN DE DATOS con el fin de comprobar con algún dato real el nivel de con-fiabilidad de la encuesta realizada

Panamá : país de tránsito a través de Panamá defendida y Panamá en la memoria de los mares.

En dos textos poéticos nacionales, Panamá defendida y Panamá en la memoria de los mares, se destaca la relación de transitismo y dependencia la cual ha provocado un movimiento de liberación nacional. La posición geográfica causa dependencias múltiples. genera una serie de problemas que han sido factores del atraso social, económico político y cultural del país, que se concreta en el concepto de dependencia a los poderes dominantes, ligados con los intereses de la zona de tránsito. España, en primer término, y, actualmente, Los Estados Unidos de Norteamérica. La función referencia] del lenguaje parece ser un factor predominante, pues se parte de una realidad extratextual, pero que se poetiza a través del mensaje que es precisamente el más determinante del arte verbal. En el mensaje poético se concentran las cualidades expresivas con atención relevante en las representaciones simbólicas o metafóricas y en el valor de los recursos derivados del significante, los que producen otra realidad decodificada por el receptor a través del acto comunicativo en el que se relacionan diferentes funciones del lenguaje emotiva, conativa, referencial fática y poética

A REDCap-based model for electronic consent (eConsent): Moving toward a more personalized consent

Introduction: The updated common rule, for human subjects research, requires that consents begin with a \u27concise and focused\u27 presentation of the key information that will most likely help someone make a decision about whether to participate in a study (Menikoff, Kaneshiro, Pritchard. The New England Journal of Medicine. 2017; 376(7): 613-615.). We utilized a community-engaged technology development approach to inform feature options within the REDCap software platform centered around collection and storage of electronic consent (eConsent) to address issues of transparency, clinical trial efficiency, and regulatory compliance for informed consent (Harris, et al. Journal of Biomedical Informatics 2009; 42(2): 377-381.). eConsent may also improve recruitment and retention in clinical research studies by addressing: (1) barriers for accessing rural populations by facilitating remote consent and (2) cultural and literacy barriers by including optional explanatory material (e.g., defining terms by hovering over them with the cursor) or the choice of displaying different videos/images based on participant\u27s race, ethnicity, or educational level (Phillippi, et al. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2018; 47(4): 529-534.). Methods: We developed and pilot tested our eConsent framework to provide a personalized consent experience whereby users are guided through a consent document that utilizes avatars, contextual glossary information supplements, and videos, to facilitate communication of information. Results: The eConsent framework includes a portfolio of eight features, reviewed by community stakeholders, and tested at two academic medical centers. Conclusions: Early adoption and utilization of this eConsent framework have demonstrated acceptability. Next steps will emphasize testing efficacy of features to improve participant engagement with the consent process

Association between Depression and C-Reactive Protein

Objective. Depression has been associated with increased cardiovascular disease risk, and a depression-related elevation of high sensitivity C-reactive protein (hs-CRP) has been proposed as a possible mechanism. The objective of this paper is to examine association between depression and high sensitivity C-reactive protein (hs-CRP). Methods. Subjects consisted of 508 healthy adults (mean age 48.5 years; 49% women, 88% white) residing in central Massachusetts. Data were collected at baseline and at quarterly intervals over a one-year period per individual. Multivariable linear mixed models were used to assess the association for the entire sample and by gender. Results. The mean Beck Depression Inventory score was 5.8 (standard deviation (SD) 5.4; median 4.3), and average serum hs-CRP was 1.8 mg/L (SD 1.7; median 1.2). Results from the multivariable linear mixed models show that individuals with higher depression scores have higher levels of hs-CRP. Analyses by gender show persistence of an independent association among women, but not among men. Body mass index (BMI = weight(kg)/height(m)2) appears to be a partial mediator of this relationship. Conclusion. Depression score was correlated to hs-CRP levels in women. Further studies are required to elucidate the biological mechanisms underlying these associations and their implications

Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam- 12 month follow up results: A cluster randomized controlled feasibility trial

INTRODUCTION: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. The country needs novel, large-scale, and sustainable interventions to improve hypertension control. We report the 12 month follow-up results of a cluster randomized feasibility trial in Hung Yen province, Vietnam, which evaluated the feasibility and acceptability of two community-based interventions to improve hypertension control: a storytelling and a didactic intervention. METHODS: The storytelling intervention included stories in the patients\u27 own words about coping with hypertension and didactic content about the importance of healthy lifestyle behaviors in controlling elevated blood pressure levels. The didactic intervention included only didactic content, which were general recommendations for managing several important risk factors for hypertension and other non-communicable diseases. The storytelling intervention was delivered by two DVDs three months apart; the didactic intervention included only one DVD. The trial was conducted in patients with poorly controlled hypertension from 4 communes (communities), which were equally randomized to the two interventions. RESULTS: The mean age of the 160 patients was 66 years and 54% were men. Between baseline enrollment and the 12 month follow-up, mean systolic blood pressure declined by 10.8 mmHg (95% CI: 6.5-14.9) in the storytelling group and by 5.8 mmHg (95% CI: 1.6-10.0) in the didactic content group. The storytelling group also experienced more improvement in several health behaviors, including increased levels of physical activity and reduced consumption of salt and alcohol. CONCLUSIONS: We observed considerable long-term beneficial effects of both interventions, especially of our storytelling intervention, among patients with inadequately controlled hypertension. A large scale randomized trial should more systematically compare the short and long-term effectiveness of the two interventions in controlling hypertension. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02483780

Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam: a cluster-randomized controlled feasibility trial

BACKGROUND: Vietnam is experiencing an epidemiologic transition with an increased prevalence of non-communicable diseases. Novel, large-scale, effective, and sustainable interventions to control hypertension in Vietnam are needed. We report the results of a cluster-randomized feasibility trial at 3 months follow-up conducted in Hung Yen province, Vietnam, designed to evaluate the feasibility and acceptability of two community-based interventions to improve hypertension control: a storytelling intervention, We Talk about Our Hypertension, and a didactic intervention. METHODS: The storytelling intervention included stories about strategies for coping with hypertension, with patients speaking in their own words, and didactic content about the importance of healthy lifestyle behaviors including salt reduction and exercise. The didactic intervention included only didactic content. The storytelling intervention was delivered by two DVDs at 3-month intervals; the didactic intervention included only one installment. The trial was conducted in four communes, equally randomized to the two interventions. RESULTS: The mean age of the 160 study patients was 66 years, and 54% were men. Most participants described both interventions as understandable, informative, and motivational. Between baseline and 3 months, mean systolic blood pressure declined by 8.2 mmHg (95% CI 4.1-12.2) in the storytelling group and by 5.5 mmHg (95% CI 1.4-9.5) in the didactic group. The storytelling group also reported a significant increase in hypertension medication adherence. CONCLUSIONS: Both interventions were well accepted in several rural communities and were shown to be potentially effective in lowering blood pressure. A large-scale randomized trial is needed to compare the effectiveness of the two interventions in controlling hypertension. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02483780

Root-colonizing bacteria enhance the levels of (E)-β-caryophyllene produced by maize roots in response to rootworm feeding.

When larvae of rootworms feed on maize roots they induce the emission of the sesquiterpene (E)-β-caryophyllene (EβC). EβC is attractive to entomopathogenic nematodes, which parasitize and rapidly kill the larvae, thereby protecting the roots from further damage. Certain root-colonizing bacteria of the genus Pseudomonas also benefit plants by promoting growth, suppressing pathogens or inducing systemic resistance (ISR), and some strains also have insecticidal activity. It remains unknown how these bacteria influence the emissions of root volatiles. In this study, we evaluated how colonization by the growth-promoting and insecticidal bacteria Pseudomonas protegens CHA0 and Pseudomonas chlororaphis PCL1391 affects the production of EβC upon feeding by larvae of the banded cucumber beetle, Diabrotica balteata Le Conte (Coleoptera: Chrysomelidae). Using chemical analysis and gene expression measurements, we found that EβC production and the expression of the EβC synthase gene (tps23) were enhanced in Pseudomonas protegens CHA0-colonized roots after 72 h of D. balteata feeding. Undamaged roots colonized by Pseudomonas spp. showed no measurable increase in EβC production, but a slight increase in tps23 expression. Pseudomonas colonization did not affect root biomass, but larvae that fed on roots colonized by P. protegens CHA0 tended to gain more weight than larvae that fed on roots colonized by P. chlororaphis PCL1391. Larvae mortality on Pseudomonas spp. colonized roots was slightly, but not significantly higher than on non-colonized control roots. The observed enhanced production of EβC upon Pseudomonas protegens CHA0 colonization may enhance the roots' attractiveness to entomopathogenic nematodes, but this remains to be tested

COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol

BACKGROUND: Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. METHODS: We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. DISCUSSION: Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. TRIAL REGISTRATION: NCT03375918. PROTOCOL VERSION: 1.0 (November 10, 2020)

Age- and Sex-Specific Analyses of Diet Quality and 4-Year Weight Change in Nonobese Adults Show Stronger Associations in Young Adulthood

Background: Although the general importance of diet quality in the prevention of unintentional weight gain is known, it is unknown whether its influence is age or sex dependent. Objective: The aim of this study was to investigate whether the strength of the association between diet quality and 4-y weight change was modified by age and sex. Methods: From the Dutch population-based Lifelines Cohort, 85,618 nonobese adult participants (age 18-93 y), recruited between 2006 and 2013, were included in the study. At baseline, diet was assessed with a 110-item food-frequency questionnaire. The Lifelines Diet Score, based on international evidence for diet-disease relations at the food group level, was calculated to assess diet quality. For analyses, the score was divided in quintiles (Qs). Body weight was objectively measured at baseline and after a median follow-up of 44 mo (25th-75th percentile: 35-51 mo). In between, body weight was self-reported twice. Linear mixed models were used to investigate the association between diet quality and weight change by sex and in 6 age categories (18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 y). Results: Mean 4-y weight change decreased over age categories. Confounder-adjusted linear mixed models showed that the association between diet quality and weight change was modified by sex (P-interaction = 0.001). In women, the association was also modified by age (P-interaction = 0.001). Poor diet quality was most strongly associated with weight gain in the youngest men [Q1 compared with Q5: +0.33 kg/y (95% CI: 0.10, 0.56)] and women [+0.22 kg/y (95% CI: 0.07, 0.37)]. In contrast, in women aged ≥70 y, poor diet quality was associated with greater weight loss [-0.44 kg/y (95% CI: -0.84, -0.05)]. Conclusions: Poor diet quality was related to higher weight gain, especially in young adults. Oppositely, among women aged ≥70 y, poor diet quality was related to higher weight loss. Therefore, a healthful diet is a promising target for undesirable weight changes in both directions