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

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

Interlaboratory exercise for the analysis of carotenoids and related compounds in dried mango fruit (Mangifera indica L.)

An interlaboratory comparison was done for the analysis of carotenoids in freeze-dried mango. The study was performed from July to September 2018. Mango fruit was freeze-dried, homogenized, and packaged under vacuum conditions in portions of 6 g (test sample). Two test samples were sent to the participating laboratories for analysis. Laboratory results were rated using Z-scores in accordance with ISO 13528 and ISO 17043. The standard deviation for proficiency assessment (also called target standard deviation) was determined using a modified Horwitz function and varied between 10% and 25%, depending on the analyte. Out of 14 laboratories from 10 different countries, 9 laboratories (64%) obtained a satisfactory performance (Z ≤ 2) for the analysis of β-carotene. While for 7 laboratories that analyzed α-carotene, (9Z)-β-carotene, β-cryptoxanthin, and zeaxanthin, 4 laboratories (57%) obtained a satisfactory performance. However, only 2 laboratories out of 7 (29%) obtained a satisfactory performance for lutein. Based on the comparability of the analytical results, this study concludes that freeze-dried mango pulp can be used as a reference material for the analysis of α and β-carotene, (9Z)-β-carotene, β-cryptoxanthin, and zeaxanthin by applying different analytical procedures for their extraction and quantification

Transcriptomic profiles conducive to immune-mediated tumor rejection in human breast cancer skin metastases treated with Imiquimod

Imiquimod is a topical toll-like-receptor-7 agonist currently used for treating basal cell carcinoma. Recently, imiquimod has demonstrated tumor regression in melanoma and breast cancer skin metastases. However, the molecular perturbations induced by imiquimod in breast cancer metastases have not been previously characterized. Here, we describe transcriptomic profiles associated with responsiveness to imiquimod in breast cancer skin metastases. Baseline and post-treatment tumor samples from patients treated with imiquimod in a clinical trial were profiled using Nanostring technology. Through an integrative analytic pipeline, we showed that tumors from patients who achieved a durable clinical response displayed a permissive microenvironment, substantiated by the upregulation of transcripts encoding for molecules involved in leukocyte adhesion and migration, cytotoxic functions, and antigen presentation. In responding patients, Imiquimod triggered a strong T-helper-1 (Th-1)/cytotoxic immune response, characterized by the coordinated upregulation of Th-1 chemokines, migration of Th-1 and cytotoxic T cells into the tumor, and activation of immune-effector functions, ultimately mediating tumor destruction. In conclusion, we have shown that topical imiquimod can induce a robust immune response in breast cancer metastases, and this response is more likely to occur in tumors with a pre-activated microenvironment. In this setting, imiquimod could be utilized in combination with other targeted immunotherapies to increase therapeutic efficacy

Treatment of MOG-IgG-associated disorder with rituximab: An international study of 121 patients

OBJECTIVE: To assess the effect of anti-CD20 B-cell depletion with rituximab (RTX) on relapse rates in myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD). METHODS: Retrospective review of RTX-treated MOGAD patients from 29 centres in 13 countries. The primary outcome measure was change in relapse rate after starting rituximab (Poisson regression model). RESULTS: Data on 121 patients were analysed, including 30 (24.8%) children. Twenty/121 (16.5%) were treated after one attack, of whom 14/20 (70.0%) remained relapse-free after median (IQR) 11.2 (6.3-14.1) months. The remainder (101/121, 83.5%) were treated after two or more attacks, of whom 53/101 (52.5%) remained relapse-free after median 12.1 (6.3-24.9) months. In this 'relapsing group', relapse rate declined by 37% (95%CI=19-52%, p<0.001) overall, 63% (95%CI=35-79%, p = 0.001) when RTX was used first line (n = 47), and 26% (95%CI=2-44%, p = 0.038) when used after other steroid-sparing immunotherapies (n = 54). Predicted 1-year and 2-year relapse-free survival was 79% and 55% for first-line RTX therapy, and 38% and 18% for second-/third-line therapy. Circulating CD19+B-cells were suppressed to <1% of total circulating lymphocyte population at the time of 45/57 (78.9%) relapses. CONCLUSION: RTX reduced relapse rates in MOGAD. However, many patients continued to relapse despite apparent B-cell depletion. Prospective controlled studies are needed to validate these results

Cognitive and psychosocial development of HIV pediatric patients receiving highly active anti-retroviral therapy: a case-control study

<p>Abstract</p> <p>Background</p> <p>The psychosocial development of pediatric HIV patients has not been extensively evaluated. The study objectives were to evaluate whether emotional and social functions are differentially associated with HIV-related complications.</p> <p>Methods</p> <p>A matched case-control study design was conducted. The case group (n = 20) consisted of vertically infected children with HIV (aged 3-18 years) receiving HAART in Greece. Each case was matched with two randomly selected healthy controls from a school-based population. CNS imaging and clinical findings were used to identify patients with HIV-related neuroimaging abnormalities. The Wechsler Intelligence Scale III and Griffiths Mental Abilities Scales were applied to assess cognitive abilities. The age specific Strengths and Difficulties Questionnaire was used to evaluate emotional adjustment and social skills. The Fisher's exact test, student's t-test, and Wilcoxon rank sum test were used to compare categorical, continuous, and ordinal scores, respectively, of the above scales between groups.</p> <p>Results</p> <p>HIV patients without neuroimaging abnormalities did not differ from patients with neuroimaging abnormalities with respect to either age at HAART initiation (p = 0.306) or months of HAART treatment (p = 0.964). While HIV patients without neuroimaging abnormalities had similar cognitive development with their healthy peers, patients with neuroimaging abnormalities had lower mean General (p = 0.027) and Practical (p = 0.042) Intelligence Quotient scores. HIV patients without neuroimaging abnormalities had an increased likelihood of both Abnormal Emotional Symptoms (p = 0.047) and Hyperactivity scores (p = 0.0009). In contrast, HIV patients with neuroimaging abnormalities had an increased likelihood of presenting with Abnormal Peer Problems (p = 0.033).</p> <p>Conclusions</p> <p>HIV patients without neuroimaging abnormalities are more likely to experience maladjustment with respect to their emotional and activity spheres, while HIV patients with neuroimaging abnormalities are more likely to present with compromised social skills. Due to the limited sample size and age distribution of the study population, further studies should investigate the psychosocial development of pediatric HIV patients following the disclosure of their condition.</p