La calidad peatonal como método para evaluar entornos de movilidad urbana

El creciente interés por integrar elementos de la estructura y el diseño de la ciudad en la evaluación y la gestión de la movilidad urbana ha contribuido al desarrollo de nuevos métodos e instrumentos que profundicen en este aspecto. La identificación de entornos de movilidad podría considerarse un avance conceptual y metodológico importante en este sentido, puesto que abre nuevas posibilidades para la generación de métodos que comprendan mejor la vinculación entre movilidad y entorno urbano desde una perspectiva que pueda ser útil en la práctica de la planificación. Este artículo se dirige a profundizar sobre la cuestión apuntada, particularizando en el caso específico de la movilidad peatonal. De este modo, se presenta el método de caracterización peatonal de entornos de movilidad (CPEM) como herramienta útil para evaluarlos desde el punto de vista de su calidad peatonal, utilizando los cuatro factores siguientes: accesibilidad, seguridad, confort y atracción. Para comprobar la consistencia y la utilidad de CPEM respecto a su objetivo inicial, éste ha sido aplicado al caso práctico de dos entornos de movilidad previamente identificados en un corredor del área metropolitana de Granada (España).El creixent interès per integrar elements de l'estructura i el disseny de la ciutat en l'avaluació i en la gestió de la mobilitat urbana ha contribuït a desenvolupar mètodes i instruments nous que aprofundeixin en aquest aspecte. La identificació d'entorns de mobilitat es podria considerar un avenç conceptual i metodològic important en aquest sentit, que obre noves possibilitats per a la generació de mètodes que comprenguin millor la vinculació entre mobilitat i entorn urbà des d'una perspectiva que pugui ser útil per practicar la planificació. Aquest article es dirigeix a aprofundir sobre la qüestió apuntada, particularitzant en el cas específic de la mobilitat de vianants. D'aquesta manera, es presenta el mètode de caracterització d'entorns de mobilitat per a vianants (CPEM) com a eina útil per avaluarne des del punt de vista de la qualitat que mostren per als vianants, utilitzant els quatre factors següents: accessibilitat, seguretat, confort i atracció. Per comprovar la consistència i la utilitat del CPEM respecte al seu objectiu inicial, aquest ha estat aplicat al cas pràctic de dos entorns de mobilitat prèviament identificats en un corredor de l'àrea metropolitana de Granada (Espanya).L'intérêt chaque fois plus grand, pour intégrer les éléments de la structure et le design de la ville en l'évaluation et aménagement de la mobilité urbaine, a contribué au développement de nouveaux méthodes et outils qui approfondissent cet aspect. L'identification des environnements de mobilité pourrait être considéré comme une avancée conceptuelle et méthodologique importante dans ce sens, ce qui ouvre de nouvelles possibilités pour générer des méthodes permettant de mieux comprendre le lien entre la mobilité et de l'environnement urbain dans une perspective qui peut être utile dans la pratique de planification. Cet article prétend approfondir cette question, en particularisant dans le cas spécifique de la mobilité piétonnière. De cette façon, on présente la méthode de Caractérisation Piétonnière d'Environnements de Mobilité (CPEM) comme une outil pour évaluer les environnements de mobilité dans le point de vue de sa qualité piétonnière, en utilisant les quatre facteurs suivants: accessibilité, sécurité, confort et attraction. Pour vérifier la consistance et l'utilité de CPEM par rapport à son objectif initial, on a appliqué au cas pratique de deux «environnements de mobilité» au préalable identifiés dans un corridor de l'agglomération urbaine de Grenade (Espagne).Over the last years there has been a growing interest to integrate structure, urban design and travel patterns. The incorporation of this knowledge into practice, namely mobility planning, has been positively affected by the development of new planning tools. Despite the innovation of mobility environment approach as a novel instrument for mobility planning, new methods seem to be needed. They aim to deepen our understanding of the relationships between urban structure and travel pattern through mobility environment concept. The article aims to gain insight into this problem using the particular case of pedestrian mobility. A method to characterize the pedestrian quality of mobility environments is presented here (CPEM). CPEM assesses the pedestrian quality through four walkability aspects: accessibility, security, comfort and attractiveness. To illustrate the worth of this method, a practical implementation to the context of the metropolitan area of Granada, Spain, is presented. The paper describes this case, explores the advantages and disadvantages of CPEM, and finally anticipates some issues for future research

The Impact of Children on Australian Couples' Wealth Accumulation

Existing estimates of the cost of children focus on what parents spend on their children, which has limited relevance to parents’ financial capacity to meet those costs. An alternative indicator of the affordability of children, their impact upon couples’ wealth accumulation, is estimated using the lifecycle model and Australian household panel data. The results suggest children have a very small impact upon wealth accumulation, seemingly at odds with the large ‘costs’ implied from expenditure-based estimates. In reconciling these highly divergent estimates we argue that the net-wealth approach is an intuitively more appealing indicator of the financial impost of children

High attaining students, marketisation and the absence of care: everyday experiences in an urban academy

This article draws on the work of Nel Noddings to suggest that the current neoliberal, marketised system of education is eroding caring relationships in schools. Data are drawn from a small-scale qualitative study of an ethnically diverse group of high attaining sixth form students from a successful urban academy. Based on this data, we argue that two fundamental aspects of care, students’ relationships with their teachers and an attention to their personal and social concerns, were neglected because of the overriding focus on examination success to maintain the school’s position in the education marketplace. The article offers detailed evidence from the students’ perspective to support the claim that the marketisation of the education system leads to students being valued only in as far as they bring value to the school. It also suggests that care is one of the main casualties in such a system

Presidential Election Laws and Multipartism in Latin America

This article examines the interaction between the rules governing presidential elections and multipartism in Latin America. Data from 16 Latin American systems are examined through the use of a multivariate model to gain an understanding of the independent impact of presidential electoral formula (plurality vs. majority), the timing of presidential and legislative elections (concurrent vs. nonconcurrent) and legislative district magnitude on legislative multipartism, and by extension, on the number of relevant political parties operating in the nation. The findings demonstrate the strong and significant impact which formula and timing have on multipartism. They also point to the importance of examining the interaction between elections for different constituent institutions. Finally, they underscore the applicability of Duverger's law to presidential elections.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68710/2/10.1177_106591299404700103.pd

Risk Adjustment Measures and Outcome Measures for Prehospital Trauma Research: Recommendations from the Emergency Medical Services Outcomes Project (EMSOP)

Objectives:  The objectives were to conduct a comprehensive, systematic review of the literature for risk adjustment measures (RAMs) and outcome measures (OMs) for prehospital trauma research and to use a structured expert panel process to recommend measures for use in future emergency medical services (EMS) trauma outcomes research. Methods:  A systematic literature search and review was performed identifying the published studies evaluating RAMs and OMs for prehospital injury research. An explicit structured review of all articles pertaining to each measure was conducted using the previously established methodology developed by the Canadian Physiotherapy Association (“Physical Rehabilitation Outcome Measures”). Results:  Among the 4,885 articles reviewed, 96 RAMs and/or OMs were identified from the existing literature (January 1958 to February 2010). Only one measure, the Glasgow Coma Scale (GCS), currently meets Level 1 quality of evidence status and a Category 1 (strong) recommendation for use in EMS trauma research. Twelve RAMs or OMs received Category 2 status (promising, but not sufficient current evidence to strongly recommend), including the motor component of GCS, simplified motor score (SMS), the simplified verbal score (SVS), the revised trauma score (RTS), the prehospital index (PHI), EMS provider judgment, the revised trauma index (RTI), the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the field trauma triage (FTT), the pediatric triage rule, and the out‐of‐hospital decision rule for pediatrics. Conclusions:  Using a previously published process, a structured literature review, and consensus expert panel opinion, only the GCS can currently be firmly recommended as a specific RAM or OM for prehospital trauma research (along with core measures that have already been established and published). This effort highlights the paucity of reliable, validated RAMs and OMs currently available for outcomes research in the prehospital setting and hopefully will encourage additional, methodologically sound evaluations of the promising, Category 2 RAMs and OMs, as well as the development of new measures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87101/1/j.1553-2712.2011.01148.x.pd

Maintenance therapy with oxytocin antagonists for inhibiting preterm birth after threatened preterm labour (Review)

Background: In some women, an episode of preterm labour settles and does not result in immediate preterm birth. Subsequent treatment with tocolytic agents such as oxytocin receptor antagonists may then have the potential to prevent the recurrence of preterm labour, prolonging gestation, and preventing the adverse consequences of prematurity for the infant. Objectives: To assess the effects of maintenance therapy with oxytocin antagonists administered by any route after an episode of preterm labour in order to delay or prevent preterm birth. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013), sought ongoing and unpublished trials by contacting experts in the field and searched the reference lists of relevant articles. Selection criteria: Randomised controlled trials comparing oxytocin antagonists with any alternative tocolytic agent, placebo or no treatment, used for maintenance therapy after an episode of preterm labour. Data collection and analysis: We used the standard methods of The Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group. Two review authors independently undertook evaluation of methodological quality and extracted trial data. Main results: This review includes one trial of 513 women. When compared with placebo, atosiban did not reduce preterm birth before 37 weeks (risk ratio (RR) 0.89; 95% confidence intervals (CI) 0.71 to 1.12), 32 weeks (RR 0.85; 95% CI 0.47 to 1.55), or 28 weeks (RR 0.75; 95% CI 0.28 to 2.01). No difference was shown in neonatal morbidity, or perinatal mortality. Authors' conclusions: There is insufficient evidence to support the use of oxytocin receptor antagonists to inhibit preterm birth after a period of threatened or actual preterm labour. Any future trials using oxytocin antagonists or other drugs as maintenance therapy for preventing preterm birth should examine a variety of important infant outcome measures, including reduction of neonatal morbidity and mortality, and long-term infant follow-up. Future research should also focus on the pathophysiological pathways that precede preterm labour

Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

Background: Mechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA). Objective: Evaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA. Design: Pragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. We also conducted a health economic evaluation and a systematic review of all trials of out-of-hospital mechanical chest compression. Setting: Four UK ambulance services (West Midlands, North East England, Wales and South Central), comprising 91 urban and semiurban ambulance stations. Clusters were ambulance service vehicles, which were randomly assigned (approximately 1 : 2) to the LUCAS-2 device or manual CPR. Participants: Patients were included if they were in cardiac arrest in the out-of-hospital environment. Exclusions were patients with cardiac arrest as a result of trauma, with known or clinically apparent pregnancy, or aged < 18 years. Interventions: Patients received LUCAS-2 mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene. Main outcome measures: Survival at 30 days following cardiac arrest; survival without significant neurological impairment [Cerebral Performance Category (CPC) score of 1 or 2]. Results: We enrolled 4471 eligible patients (1652 assigned to the LUCAS-2 device and 2819 assigned to control) between 15 April 2010 and 10 June 2013. A total of 985 (60%) patients in the LUCAS-2 group received mechanical chest compression and 11 (< 1%) patients in the control group received LUCAS-2. In the intention-to-treat analysis, 30-day survival was similar in the LUCAS-2 (104/1652, 6.3%) and manual CPR groups [193/2819, 6.8%; adjusted odds ratio (OR) 0.86, 95% confidence interval (CI) 0.64 to 1.15]. Survival with a CPC score of 1 or 2 may have been worse in the LUCAS-2 group (adjusted OR 0.72, 95% CI 0.52 to 0.99). No serious adverse events were noted. The systematic review found no evidence of a survival advantage if mechanical chest compression was used. The health economic analysis showed that LUCAS-2 was dominated by manual chest compression. Limitations: There was substantial non-compliance in the LUCAS-2 arm. For 272 out of 1652 patients (16.5%), mechanical chest compression was not used for reasons that would not occur in clinical practice. We addressed this issue by using complier average causal effect analyses. We attempted to measure CPR quality during the resuscitation attempts of trial participants, but were unable to do so. Conclusions: There was no evidence of improvement in 30-day survival with LUCAS-2 compared with manual compressions. Our systematic review of recent randomised trials did not suggest that survival or survival without significant disability may be improved by the use of mechanical chest compression. Future work: The use of mechanical chest compression for in-hospital cardiac arrest, and in specific circumstances (e.g. transport), has not yet been evaluated

Microorganisms and spatial distribution of the sinkholes of the Yucatan Peninsula, underestimated biotechnological potential?

Investigación basada en el potencial bio-tecnológico de las micro-especies que habitan los cenotes de la Península de YucatánAbstract Objective: To detect the spatial distribution of the sinkholes of the Peninsula of Yucatan (SPY) and identify those cenotes where microorganisms have been registered. Methods: The geographic coordinates of the SPYs were obtained from various databases, as well as from scientific publications relating to the terminology ‘sinkholes’, ‘karst systems’ and ‘cenotes’. All coordinates were transformed into the Universal Transverse Mercator reference system (UTM) with datum WGS84. An infrared composite image was created with 432 RGB bands from the Landsat 8 satellite. The points with the location of the cenotes were imported into the Software TerrSet. Results: Total 1026 coordinates of sinkholes were recorded in the Yucatan Peninsula. In 18 sinkholes (<2%), microorganisms have been recovered and identified in various taxonomic levels, and only 6 sinkholes (<0.6%) has their biotechnological potential been evaluated. Conclusions: The microorganisms that inhabit the sinkholes of the Yucatan Peninsula are a reservoir with practically unexplored biotechnological potential.CONACY

Adjuvant interferon gamma in patients with drug – resistant pulmonary tuberculosis: a pilot study

BACKGROUND: Tuberculosis (TB) is increasing in the world and drug-resistant (DR) disease beckons new treatments. METHODS: To evaluate the action of interferon (IFN) gamma as immunoadjuvant to chemotherapy on pulmonary DR-TB patients, a pilot, open label clinical trial was carried out in the Cuban reference ward for the management of this disease. The eight subjects existing in the country at the moment received, as in-patients, 1 × 10(6 )IU of recombinant human IFN gamma intramuscularly, daily for one month and then three times per week up to 6 months as adjuvant to the indicated chemotherapy, according to their antibiograms and WHO guidelines. Sputum samples collection for direct smear observation and culture as well as routine clinical and thorax radiography assessments were done monthly. RESULTS: Sputum smears and cultures became negative for acid-fast-bacilli before three months of treatment in all patients. Lesion size was reduced at the end of 6 months treatment; the lesions disappeared in one case. Clinical improvement was also evident; body mass index increased in general. Interferon gamma was well tolerated. Few adverse events were registered, mostly mild; fever and arthralgias prevailed. CONCLUSIONS: These data suggest that IFN gamma is useful and well tolerated as adjunctive therapy in patients with DR-TB. Further controlled clinical trials are encouraged

Home-based health promotion for older people with mild frailty: the HomeHealth intervention development and feasibility RCT.

BACKGROUND: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. OBJECTIVES: (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). DESIGN: Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. INTERVENTION DEVELOPMENT: Two systematic reviews (including systematic searches of 14 databases and registries, 1990-2016 and 1980-2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65-94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the 'HomeHealth' intervention in collaboration with older people and multidisciplinary stakeholders. 'HomeHealth' comprised 3-6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. FEASIBILITY RCT: Single-blind RCT, individually randomised to 'HomeHealth' or treatment as usual (TAU). SETTING: Community settings in London and Hertfordshire, UK. PARTICIPANTS: A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. MAIN OUTCOME MEASURES: Feasibility - recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. RESULTS: We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire -3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. CONCLUSIONS: Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. FUTURE WORK: A large, definitive RCT of the HomeHealth service is warranted. STUDY REGISTRATION: This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information