Hacia un modelo teórico explicativo de la innovación en los distritos de turismo cultural

This paper presents a theoretical model that analyses the direct effect of social capital on innovation, as well as the mediating effect of acquisition of knowledge between both variables in firms in a cultural tourist district. We analyse the bidimensional nature of social capital —bonded capital and bridging capital—. It is an approach to the context and characteristics of cultural tourist districts. We point out several future investigation lines related to the differentiation between types of knowledge and innovation. We propose recommendations about the orientation of relations between companies and institutions of cultural tourist districts.En este trabajo se plantea un modelo teórico que analiza el efecto directo, y mediado por la adquisición de conocimiento, del capital social sobre la innovación desarrollada por las empresas pertenecientes a un distrito turístico cultural. Se analiza el carácter bidimensional del capital social —bonded capital y bridging capital—. Se realiza una aproximación al contexto y las caracteristicas de los distritos turísticos culturales. Se establecen diversas líneas futuras de trabajo vinculadas a la diferenciación entre tipos de conocimiento y de innovación. Se proponen recomendaciones sobre la orientación de las relaciones entre las empresas y con las instituciones de los distritos turísticos culturales

Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain

BACKGROUND: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. METHODS: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. RESULTS: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4-6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4-39.6%). CONCLUSIONS: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).</jats:sec

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

BONDING CAPITAL, EXPLOTACIÓN DE CONOCIMIENTO E INNOVACIÓN INCREMENTAL EN LOS CLUSTERS DE TURISMO CULTURAL: LAS CIUDADES PATRIMONIO DE LA HUMANIDAD EN ESPAÑA

En este trabajo analizamos el papel de la estrategia de conocimiento en explotación para explicar la relación entre capital social en su dimensión bonding y la innovación incremental en el ámbito de los clusters. Hemos aplicado un modelo estructural sobre una muestra de 215 empresas del sector de turismo cultural de las Ciudades Patrimonio de la Humanidad de Espana. Los resultados revelan la existencia de un efecto indirecto significativo del bonding capital sobre la innovación incremental a través del desarrollo de una estrategia de conocimiento en explotación. Estos resultados sugieren que si las empresas de un cluster de turismo cultural son capaces de aprovechar sus redes densas y vínculos fuertes para implantar estrategias de conocimiento en explotación, tenderán a desarrollar mayores innovaciones incrementales

Towards an explanatory model of innovation in the cultural tourism district

En este trabajo se plantea un modelo teórico que analiza el efecto directo, y mediado por la adquisición de conocimiento, del capital social sobre la innovación desarrollada por las empresas pertenecientes a un distrito turístico cultural. Se analiza el carácter bidimensional del capital social —bonded capital y bridging capital—. Se realiza una aproximación al contexto y las caracteristicas de los distritos turísticos culturales. Se establecen diversas líneas futuras de trabajo vinculadas a la diferenciación entre tipos de conocimiento y de innovación. Se proponen recomendaciones sobre la orientación de las relaciones entre las empresas y con las instituciones de los distritos turísticos culturales.ABSTRACT: This paper presents a theoretical model that analyses the direct effect of social capital on innovation, as well as the mediating effect of acquisition of knowledge between both variables in firms in a cultural tourist district. We analyse the bidimensional nature of social capital —bonded capital and bridging capital—. It is an approach to the context and characteristics of cultural tourist districts. We point out several future investigation lines related to the differentiation between types of knowledge and innovation. We propose recommendations about the orientation of relations between companies and institutions of cultural tourist districts

Optical coherence tomography to monitor photodynamic therapy in pathological myopia

AIM: To evaluate the role of optical coherence tomography (OCT) in determining choroidal neovascularisation (CNV) activity before and after photodynamic therapy (PDT) in patients with pathological myopia. METHODS: 33 patients (33 eyes) with pathological myopia and being treated with PDT were included. Every 3 months all patients were evaluated and presence or absence of leakage on fluorescein angiography, presence of intraretinal or subretinal fluid on OCT, and macular and choroidal neovascular complex thickness on OCT, were determined at each examination. RESULTS: The macular thickness decreased significantly after PDT at 6 months (p = 0.001) and at 12 months follow up (p = 0.01). However, no significant changes in CNV thickness were measured after PDT at 6 months of follow up (p = 0.418) and at 12 months of follow up (p = 0.521). Once the diagnosis of CNV associated with pathological myopia was established, before treatment, OCT had a sensitivity of 96.96% for detecting CNV activity. After treatment, OCT had a good sensitivity (95.23%) and a moderate specificity (69,69%) in determining CNV activity, which resulted in a diagnostic efficiency (proportion of correct results) of 79.62%. CONCLUSIONS: OCT appears to be useful for indicating CNV activity. Therefore, it may serve as a complementary technique for deciding the need for PDT and re‐treatment in patients with pathological myopia