Development and Validity Assessment of a Chronic Obstructive Pulmonary Disease Knowledge Questionnaire in Low- and Middle-Income Countries

Rationale: The majority of the morbidity and mortality related to chronic obstructive pulmonary disease (COPD) occurs in low- and middle-income countries (LMICs). Despite the increasing burden of COPD, disease-specific knowledge among healthcare workers (HCWs) and patients in LMICs remains limited. COPD knowledge questionnaires are valid and reliable tools to assess COPD knowledge and can be employed in settings with limited health literacy. Objective: To develop and assess validity and reliability of a COPD knowledge questionnaire among individuals with COPD in three LMIC settings. Methods: Twelve questions were generated by an expert team of sixteen researchers, physicians, and public health professionals to create an LMIC-specific COPD knowledge questionnaire. Content was based on previous instruments, clinical guidelines, focus group discussions, and questionnaire piloting. Participants with COPD completed the questionnaire across three diverse LMIC settings before and three months after delivery of a standardized COPD specific education package by a local community health worker (CHW) trained to deliver the education to an appropriate standard. We utilized paired t-tests to assess improvement in knowledge post-intervention. Results: Questionnaire development initially yielded 52 items. Based on community feedback and expertise, items were eliminated and added yielding a final 12-item questionnaire, with a maximum total score of 12. A total of 196 participants with COPD were included this study in Nepal (n=86), Peru (n=35) and Uganda (n=75). Mean (± SD) baseline score was 8.0 ± 2.5 and 3-months post-education the mean score was 10.2 ± 1.7 among participants. The CHW-led COPD educational intervention improved COPD knowledge among community members by 2.2 points (95% CI 1.8 to 2.6, t=10.9, p<0.001). Internal consistency using Cronbach’s alpha was 0.75. Conclusion: The LMIC COPD-KQ demonstrates face and content validity and acceptable internal consistency through development phases, suggesting a reliable and valid COPD education instrument that can be utilized to assess educational interventions across LMIC settings. Clinical trial registered with ClinicalTrials.gov (NCT03365713

Modelación hidrológica con el modelo SWAT empleando diferentes distribuciones espaciales del tipo suelo en la cuenca del Río Mixteco

La cuenca del río Mixteco se ubica en el estado de Oaxaca, México y comprende una superficie total de 6 559.20 km2; esta presenta fuerte degradación de sus recursos naturales, derivado principalmente de las acciones antrópicas asociadas a una mala administración de sus recursos naturales. El objetivo de este trabajo fue evaluar el comportamiento del escurrimiento superficial mediante el modelo SWAT (Soil and Water Assessment Tool) en la cuenca del río Mixteco utilizando tanto la distribución espacial de suelo del INEGI (Instituto Nacional de Estadística y Geografía) como la obtenida a través de la técnica de DSM (Mapeo Digital de Suelos). La modelación con INEGI (ModINEGI) correspondió al mapa edafológico de la Serie II escala 1:250,000 y la modelación con DSM (ModDSM) se obtuvo a partir de covariables ambientales. Los indicadores de evaluación del desempeño del modelo SWAT durante la fase de calibración fueron R2 = 0.88 y NSE = 0.87 para ModDSM y R2 = 0.85 y NSE = 0.85 para ModINEGI; sin embargo, durante el periodo de validación, los resultados de ModDSM (R2 = 0.83 y NSE = 0.81) fueron mejores que los de ModINEGI (R2 = 0.83 y NSE = 0.61). Por lo tanto, los resultados indican que la variación espacial de los tipos de suelo obtenida a través de la técnica de DSM, en combinación con la cobertura vegetal y la distribución de las pendientes a nivel cuenca, permiten al modelo SWAT simular de forma adecuada el comportamiento del escurrimiento superficial

Self-organization of developing embryo using scale-invariant approach

<p>Abstract</p> <p>Background</p> <p>Self-organization is a fundamental feature of living organisms at all hierarchical levels from molecule to organ. It has also been documented in developing embryos.</p> <p>Methods</p> <p>In this study, a scale-invariant power law (SIPL) method has been used to study self-organization in developing embryos. The SIPL coefficient was calculated using a centro-axial skew symmetrical matrix (CSSM) generated by entering the components of the Cartesian coordinates; for each component, one CSSM was generated. A basic square matrix (BSM) was constructed and the determinant was calculated in order to estimate the SIPL coefficient. This was applied to developing <it>C. elegans </it>during early stages of embryogenesis. The power law property of the method was evaluated using the straight line and Koch curve and the results were consistent with fractal dimensions (fd). Diffusion-limited aggregation (DLA) was used to validate the SIPL method.</p> <p>Results and conclusion</p> <p>The fractal dimensions of both the straight line and Koch curve showed consistency with the SIPL coefficients, which indicated the power law behavior of the SIPL method. The results showed that the ABp sublineage had a higher SIPL coefficient than EMS, indicating that ABp is more organized than EMS. The fd determined using DLA was higher in ABp than in EMS and its value was consistent with type 1 cluster formation, while that in EMS was consistent with type 2.</p