Analysis of the digital divide in the mobility ecosystem of the Barcelona Metropolitan Area

Aquest estudi busca emmarcar la bretxa digital relacionada amb les solucions innovadores de mobilitat a la regió de l'Àrea Metropolitana de Barcelona. Per a això, l'estudi aplica un enfocament de mètode mixt, combinant una revisió de la literatura i una anàlisi de dades d'una enquesta quantitativa. Els resultats del projecte permeten avançar en la comprensió dels factors que condueixen a la bretxa digital existent entre la provisió de serveis de mobilitat i la seva adopció. La revisió de la literatura proporciona una fotografia de la bretxa digital relacionada amb la mobilitat que afecta principalment els grups en risc d'exclusió, agreujant les situacions de pobresa i injustícia social. D'altra banda, el projecte analitza els resultats de l'enquesta realitzada a Barcelona, que forma part del treball realitzat dins del projecte europeu DIGNITY H2020. Les respostes revelen bretxes en l'ús de la tecnologia, destacant especialment els baixos nivells d'accés i ús entre les persones majors i les de baix nivell educatiu, provocats principalment per la falta de confiança en l'ús de les tecnologies, la falta d'habilitats digitals, així com les limitacions relacionades amb la seguretat i el cost dels serveis de transport. Finalment, l'estudi assenyala algunes recomanacions per a potencials polítiques que poden ajudar als planificadors urbans, als professionals i als proveïdors de serveis de transport a avançar cap a un futur ecosistema de mobilitat urbana sostenible i inclusiu.Este estudio busca enmarcar la brecha digital relacionada con las soluciones innovadoras de movilidad en la región del Área Metropolitana de Barcelona. Para ello, el estudio aplica un enfoque de método mixto, combinando una revisión de la literatura y un análisis de datos de una encuesta cuantitativa. Los resultados del proyecto permiten avanzar en la comprensión de los factores que conducen a la brecha digital existente entre la provisión de servicios de movilidad y su adopción. La revisión de la literatura proporciona una fotografía de la brecha digital relacionada con la movilidad que afecta principalmente a los grupos en riesgo de exclusión, agravando las situaciones de pobreza e injusticia social. Por otra parte, el proyecto analiza los resultados de la encuesta realizada en Barcelona, que forma parte del trabajo realizado dentro del proyecto europeo DIGNITY H2020. Las respuestas revelan brechas en el uso de la tecnología, destacando especialmente los bajos niveles de acceso y uso entre las personas mayores y las de bajo nivel educativo, provocados principalmente por la falta de confianza en el uso de las tecnologías, la falta de habilidades digitales, así como las limitaciones relacionadas con la seguridad y el coste de los servicios de transporte. Por último, el estudio señala algunas recomendaciones para potenciales políticas que pueden ayudar a los planificadores urbanos, a los profesionales y a los proveedores de servicios de transporte a avanzar hacia un futuro ecosistema de movilidad urbana sostenible e inclusivo.This study seeks to frame the digital gap related to the innovative mobility solutions in the region of Barcelona Metropolitan Area. To that end, the study applies a mixed-method approach, combining a literature review and a quantitative survey data analysis. The project results allow to advance on the understanding of the factors leading to the existing digital gap between mobility service provision and uptake. The literature review provides insight into the digital mobility-related gap which affects mainly groups at risk of exclusion, aggravating situations of poverty and social injustice. Furthermore, the project reports on findings from the user survey conducted in Barcelona, which forms part of the work done within the European project DIGNITY H2020. The results reveal gaps in the use of technology, highlighting particularly low levels of access and uptake among older people and those with low education levels, caused mainly by lack of confidence in using technologies, lack of digital skills, as well as limitations regarding safety and cost of the transport services. Finally, the study marks out some potential policy recommendations that can help urban planners, practitioners and transport services providers head towards sustainable, future-proof and inclusive urban mobility ecosystem

Neurocardiogenic injury in subarachnoid hemorrhage: A wide spectrum of catecholamin-mediated brain-heart interactions

Background: The purpose of this review was to summarize the up-to-date knowledge on clinical presentation and management of neurocardiogenic injury and to deliver the evidence of common pathophysiology of this broad spectrum of disorders.Methods: Medline and EmBase databases were searched to obtain original research articles and review papers using the following key words: neurocardiogenic injury, stress cardiomyopathy,tako-tsubo, subarachnoid hemorrhage, ECG abnormalities, catecholamine toxicity, neuropulmonary edema.Results: Various forms of cerebral pathology, most importantly subarachnoid hemorrhage (SAH), are accompanied by transient cardiac dysfunction with ST-segment elevation and QT interval prolongation and T wave inversion with simultaneous release of cardiac troponin. In the past 20 years a great deal of data emerged concerning stress cardiomyopathy (‘tako-tsubo’) presenting as a rare transient apical ballooning syndrome following stressful life events with symptoms and signs resembling acute myocardial infarction (AMI), yet without significant coronary artery stenosis. Both forms of cardiac dysfunction are mediated by catecholamine toxicity, triggered by physical and psychological distress, leading to a specific type of neurogenic myocardial stunning reflected by histopathological image of contraction band necrosis.Conclusions: Neurocardiogenic injury should be carefully differentiated from AMI. Cardiac dysfunction in SAH heralds increased mortality. The criteria for the diagnosis of stress cardiomyopathy should be revised to comprise the diversity of its clinical symptomatology and to include cardiac dysfunction accompanying cerebral pathology.

Rola osteoprotegeryny w modulowaniu powstawania miażdżycy i możliwość wykorzystania jej oznaczenia w celu stratyfikacji ryzyka sercowo-naczyniowego

Proces tworzenia blaszki miażdżycowej jest silnie związany z rozwijającym się stanem zapalnymw ścianie naczynia. Od dawna trwają prace nad znalezieniem takich markerów stanuzapalnego, których oznaczenie pozwoliłoby na ocenę zagrożenia wystąpieniem powikłańmiażdżycy, także w obrębie tętnic wieńcowych. Jak dotąd, ze względu na małą swoistość,oznaczenie takich markerów stanu zapalnego w chorobach układu krążenia, jak białkoC-reaktywne nie pozwala na wykluczenie obecności choroby niedokrwiennej serca. Corazwiększe nadzieje wiąże się z oznaczeniem białka — osteoprotegeryny (OPG), będącego elementemosi RANKL/OPG/RANK, zaangażowanego w kontrolę metabolizmu kostnego. Istniejądoniesienia o dodatnim związku pomiędzy stężeniem OPG a nasileniem miażdżycy obwodowej,stopniem uwapnienia tętnic wieńcowych, występowaniem zdarzeń sercowo-naczyniowychoraz niekorzystnym rokowaniem w ostrych zespołach wieńcowych. Chociaż związek pomiędzymetabolizmem kostnym a zaawansowaniem miażdżycy z pewnością wymaga dalszych badań,oznaczenie OPG może być cennym uzupełnieniem oceny ryzyka sercowo-naczyniowego zarównow populacji osób zdrowych, jak i u chorych z już rozpoznaną chorobą wieńcową

The DIGNITY project: toward a system of inclusive digital mobility in the Barcelona metropolitan area

Recent developments in the transport and mobility sectors are radically altering mobility patterns; these include digitization, smart mobility applications, and local digital services, which offer a wide range of innovations that are adaptable to rapidly-evolving lifestyles. However, many services currently are offered as an "online" mode or incorporate digital elements, and the lack of adequate digital literacy or of specific competencies / skills can be expected to generate situations of exclusion. The DIGNITY project (https://www.dignity-project.eu/), a European initiative in the European Union's H2020 framework, aims to promote an ecosystem of digital mobility services that is sustainable, integrated, and user-friendly, and which improves accessibility, social inclusion, daily mobility experiences, and everyday life of all residents. The project selected four pilot studies in five EU countries (Spain, Italy, Belgium, the Netherlands, and Germany) for their innovative proposals in sustainable inclusive mobility. The case studies apply the DIGNITY approach, which is based on conducting workshops, interviews, and surveys. Here, we specifically address the study based in Barcelona, which is at the forefront in smart urban transformation. The digital divide in mobility in the Barcelona Metropolitan Area was evaluated using a mixed approach of combining literature review with a quantitative survey. The results reveal the needs and perceptions of people about local mobility, as well as the gaps in the use of technology products and services.Objectius de Desenvolupament Sostenible::10 - Reducció de les DesigualtatsObjectius de Desenvolupament Sostenible::9 - Indústria, Innovació i InfraestructuraPostprint (published version

Developing personas to improve understanding of users’ needs in digital mobility: An experience of the DIGNITY project in the Barcelona Metropolitan Area

This paper contributes to the understanding of the end users’ needs and capabilities in digital mobility by presenting a set of personas developed using data from a population-representative survey conducted among 601 Barcelona Metropolitan Area (BMA) residents. The questionnaires were carried out within the framework of the DIGNITY project. The results show that large parts of the population cannot access digital technologies or lack the skills required to use them effectively. As a result, they are not able to take advantage of many digital mobility solutions. The personas in this paper thus present important information on the diversity of potential users, in a way that designers and other stakeholders can find inspiring. This can help them to create inclusive mobility ecosystem, that fit the users’ needs better, resulting in more people being able to use the solutions.This research was done as part of the DIGNITY project, which received funding from the European Union’s Horizon 2020 Research and Innovation Programme under the Grant Agreement number 875542 and was also partially funded by the Spanish Ministry of Science, Innovation and Universities, project RTI2018-095518-B-C22 (MCIU/AEI/FEDER).Peer ReviewedPostprint (author's final draft

Peripartum cardiomyopathy — case report

Kardiomiopatia połogowa (PPCM) jest ostro przebiegającą postacią kardiomiopatii rozstrzeniowej, która objawia się niewydolnością serca w ostatnim miesiącu ciąży lub w ciągu 5 miesięcy od porodu. Śmiertelność opisywana w poszczególnych publikacjach waha się od 7 do 50%. W artykule przedstawiono opis piorunującego przebiegu PPCM u 25-letniej kobiety, ze wstrząsem kardiogennym we wstępnym okresie, a następnie stopniową poprawę wymagającą kolejnych kroków diagnostycznych i terapeutycznych.Peripartum cardiomyopathy (PPCM) is fast extending cardiomyopathy, which is manifested by heart failure in the last month of pregnancy or within 5 months after childbirth. Mortality described in various publications ranges from 7 to 50%. The article describes fast process of PPCM in 25-year-old woman with cardiogenic shock in the initial period, and then a gradual improvement, which requires diagnostic and therapeutic steps

Right ventricular thrombus successfully dissolved with novel oral anticoagulant therapy

Pacjentka w wieku 71 lat bez objawów podmiotowych została przyjęta na Oddział Kardiologii z powodu zmiany w obrębie koniuszka prawej komory, przypadkowo stwierdzonej w tomografii komputerowej jamy brzusznej. W przezklatkowym badaniu echokardiograficznym zaobserwowano hipoechogeniczną, przyścienną strukturę o morfologii skrzepliny w świetle prawej komory (o wymiarach 32 mm × 16 mm) z obecnością hipokinezy przyległych segmentów ściany serca. W trakcie hospitalizacji wykluczono obecność choroby wieńcowej, zatorowości płucnej i systemową chorobę tkanki łącznej. Za pomocą rezonansu magnetycznego serca uwidoczniono hipointensywną skrzeplinę w koniuszku prawej komory, a kontrolna tomografia komputerowa serca potwierdziła stabilne wymiary i charakter zmiany. Na podstawie powyższego obrazu klinicznego wdrożono przewlekłe leczenie przeciwkrzepliwie nowymi doustnymi antykoagulantami (NOAC). Kontrolne badanie echokardiograficzne wykonane po 3 miesiącach od wypisania ze szpitala wykazało całkowitą regresję skrzepliny i normalizację odcinkowych zaburzeń kurczliwości prawej komory. Niniejszy opis przypadku dokumentuje możliwość zastosowania NOAC w celu leczenia incydentalnej, przyściennej skrzepliny w prawej komorze.A 71-year-old asymptomatic female was admitted to the department of cardiology on account of incidental finding of a tumour- like mass located in the apex of right ventricle, which was revealed during contrast-enhanced computed tomography of the abdominal cavity. Transthoracic echocardiography showed hypoechogenic right ventricular mass (32 mm × 16 mm), suggestive of thrombus with hypokinesia of the surrounding right ventricular wall. Coronary artery disease, connective tissue disease and pulmonary embolism were excluded. Cardiac magnetic resonance imaging indicated the presence of hypo-intense mural thrombus, while repeated computed tomography confirmed stable size and character of the lesion. The anticoagulation therapy with novel oral anticoagulant (NOAC) was instituted. Following three months of treatment, the echocardiographic assessment confirmed complete disappearance of thrombus and resolution of regional wall motion abnormalities. The present case indicates that NOAC can be utilised as effective agents in case of incidental right ventricular mural thrombus, unrelated to pulmonary embolism

Compliance with pharmacological treatment among patients after minimally invasive coronary bypass grafting

Background: We sought to evaluate patients’ adherence to optimal pharmacotherapy as recommended by the European Society of Cardiology, together with the assessment of potential clinical determinants of medical non-compliance in a large cohort of patients after endoscopic atraumatic coronary artery bypassing (EACAB).Methods: This cross sectional study was conducted in a group of 706 individuals who underwent EACAB between April 1998 and December 2010. Data covering current pharmacological treatment with antiplatelet agents, beta-blockers (BB) (or heart rate lowering calcium channel blockers [CCB] in case of intolerance and/or poor efficacy of beta-blockade), angiotensin-converting enzyme (ACE) inhibitors (or angiotensin receptor blockers [ARB]) and statins was acquired. Mean duration of observation after the surgery was 2132 ± 1313 days.Results: Complete follow-up data has been obtained from 415 living patients (341 males). Amongst them, 353 (85%) received antiplatelet agents, while BB or CCB were routinely ingested by 349 (84%) patients. Statins were used by 310 (74.7%) individuals and 274 (66%) subjects took ACE inhibitors or ARB. Baseline demographic and clinical features, including major co-morbidities had no impact on patients’ compliance with all investigated medications. There was no clear association between adherence to treatment and risk of rehospitalization or occurrence of major cerebral and cardiovascular events.Conclusions: EACAB patients’ compliance with pharmacotherapy guidelines is insufficient and is unrelated to demographic and clinical features of the subjects. Multidisciplinary approach involving health education, enhancement in prescription drug affordability and a better rapport between doctors and patients should be incorporated into clinical practice to overcome therapeutic disobedience