Smoking Cessation Smartphone App Use Over Time: Predicting 12-Month Cessation Outcomes in a 2-Arm Randomized Trial

BACKGROUND: Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes. OBJECTIVE: In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership. METHODS: Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups. Logistic regression was used to determine the association of group membership with the primary outcome of 30-day point prevalence of smoking abstinence at 12 months. Finally, the baseline characteristics associated with group membership were examined using logistic and multinomial logistic regression. The analyses were conducted separately for each app. RESULTS: For iCanQuit, participants were clustered into 3 groups: "1-week users" (610/1069, 57.06%), "4-week users" (303/1069, 28.34%), and "26-week users" (156/1069, 14.59%). For smoking cessation rates at the 12-month follow-up, compared with 1-week users, 4-week users had 50% higher odds of cessation (30% vs 23%; odds ratio [OR] 1.50, 95% CI 1.05-2.14; P=.03), whereas 26-week users had 397% higher odds (56% vs 23%; OR 4.97, 95% CI 3.31-7.52; P<.001). For QuitGuide, participants were clustered into 2 groups: "1-week users" (695/1064, 65.32%) and "3-week users" (369/1064, 34.68%). The difference in the odds of being abstinent at 12 months for 3-week users versus 1-week users was minimal (23% vs 21%; OR 1.16, 95% CI 0.84-1.62; P=.37). Different baseline characteristics predicted the trajectory group membership for each app. CONCLUSIONS: Patterns of 1-, 3-, and 4-week smartphone app use for smoking cessation may be common in how people engage in digital health interventions. There were significantly higher odds of quitting smoking among 4-week users and especially among 26-week users of the iCanQuit app. To improve study outcomes, strategies for detecting users who disengage early from these interventions (1-week users) and proactively offering them a more intensive intervention could be fruitful

Alternativas para una optimización de la normativa arquitectónico-urbanística de Nueva Córdoba

Las normativas Arquitectónico urbanísticas de una Ciudad tienen una influencia decisiva sobre la calidad de vida de sus habitantes. El proyecto en curso ha procurado generar criterios y modalidades técnicas concretas para la optimización de las normas que regulan la organización y el crecimiento de nuestra ciudad. El proyecto indaga, para el caso del Barrio de Nueva Córdoba sobre como perfeccionar el código vigente a fin de optimizar su aplicación. Del trabajo en curso, ya se pueden obtener valiosos criterios a considerar a la hora de proponer ajustes al código existente. Así también, se ha detectado valiosa información proveniente de la comparación con códigos de ciudades como Bs. As. en Argentina o Asunción en Paraguay, fruto esto de un convenio oportunamente firmado con la Facultad de Arquitectura de la Universidad Columbia de Asunción del Paraguay. Las hipótesis en estudio indagan entre otros elementos sobre el hecho de que las normas producen efectos indeseables, como la supresión de hecho de dobles alturas y soluciones formales y tipológicas de mayor interés que la hipotética “homogeneidad” implicada en las ordenanzas vigentes desde el año 1987. El análisis y trabajo posterior buscó alternativas que, sin volver a foja cero las normas vigentes, corrijan este y otros problemas de la norma. Las normativas arquitectónico – urbanísticas determinan, en un alto grado, el carácter de la ciudad y su arquitectura. Por esta razón, se considera que la comparación entre las normativas de diferentes ciudades ha permitido proporcionar un material de gran valor y utilidad a la hora de combinar los potenciales que subyacen en cada normativa, favoreciendo la calidad espacial, arquitectónica y urbana para la zona de estudio específica del presente proyecto de investigaciónFil: Dutari, Santiago Ian. Universidad Católica de Córdoba. Facultad de Arquitectura; ArgentinaFil: Viale Lescano, Santiago Carlos. Universidad Católica de Córdoba. Facultad de Arquitectura; ArgentinaFil: Etkin, Ana Cecilia. Universidad Católica de Córdoba. Facultad de Arquitectura; Argentin

Resistance to autosomal dominant Alzheimer's disease in an APOE3 Christchurch homozygote: a case report.

We identified a PSEN1 (presenilin 1) mutation carrier from the world's largest autosomal dominant Alzheimer's disease kindred, who did not develop mild cognitive impairment until her seventies, three decades after the expected age of clinical onset. The individual had two copies of the APOE3 Christchurch (R136S) mutation, unusually high brain amyloid levels and limited tau and neurodegenerative measurements. Our findings have implications for the role of APOE in the pathogenesis, treatment and prevention of Alzheimer's disease

Utilidad de escalas para mejorar la sospecha diagnóstica de apendicitis aguda en la sala de Emergencia del Hospital General Puyo, 2021

Context: Over the years, several scales have been developed to support the diagnosis and predict the severity of cases with a framework suggestive of acute appendicitis. In this investigation, these scales are compared. Objective: To determine the degree of diagnostic certainty of the Alvarado and RIPASA scales as diagnostic support for Acute Appendicitis, at Hospital General Puyo, from 2021 to December 2021. Methodology: Analytical, comparative, retrospective research, with diagnostic accuracy. Population and sample: Clinical histories of 105 adult patients admitted with a diagnosis of acute appendicitis during the study period. The SPSS v25.0 program was used, sensitivity (S), specificity (E), predictive values (PPV and NPV), likelihood ratios (LR+ and LR-), diagnostic OR (ORD), 95% CI and Receiver Operating Characteristic (ROC) curves. As reference questions, the criterion of the surgeon and the histopathological examination were taken. To compare both curves, the Hanley and McNeil statistics were used. Results: Diagnostic accuracy: Alvarado: Sensitivity: 49.0% (35.9%-62.3%), Specificity: 50.0% (37.1%-62.9%); Positive Predictive Value: 48.1% (34.2%-62.2%); Negative Predictive Value: 50.9% (37.0-64.7%), Positive Likelihood Ratio: 0.9 (0.7-1.4), Negative Likelihood Ratio: 1.0 (0.7 -1.5); Odds diagnostic ratio: 0.9 (0.4-2.1), Area under the curve: 51.8% (40.6%-63.0%). RIPASA: Sensitivity: 76.5% (62.2%-86.7%), Specificity: 12.9% (5.8%-25.5%), Positive Predictive Value: 45.3% (34.7 %-56.4%), Negative Predictive Value: 36.8% (17.2%-61.4%), Positive Likelihood Ratio: 0.88 (0.73-1.06), Negative Likelihood Ratio: 1.82 (0.78-4.25), Odds diagnostic ratio: 0.48 (0.17-1.35), Area under the curve: 60.8% (49.7%-71.9%). Conclusions: There were no significant differences between the RIPASA and Alvarado scales in relation to the diagnostic accuracy of acute appendicitis at the Hospital General de Puyo. In both cases, the performance was “discrete”; but, due to the characteristics of the show, this finding should not be generalizedContexto: A través de los años se han desarrollado varias escalas para apoyar el diagnóstico y predecir la gravedad de los casos con un cuadro sugestivo de apendicitis aguda. En esta investigación se comparan dos de estas escalas. Objetivo: Determinar el grado de certeza diagnóstica de las escalas Alvarado y RIPASA como apoyo diagnóstico de Apendicitis Aguda, en la población del oriente del Hospital General Puyo, desde enero 2021 hasta diciembre 2021. Metodología: Investigación analítica, comparativa, retrospectiva, de exactitud diagnóstica. Población y muestra: Historias clínicas de 105 pacientes adultos admitidos con diagnóstico de apendicitis aguda en el periodo de estudio. Se utilizó el programa SPSS v25.0, se calcularon la sensibilidad (S), especificidad (E), valores predictivos (VPP y VPN), razones de verosimilitud (LR+ y LR-), OR diagnóstico (ORD), IC 95% y curvas Receiver Operating Characteristic (ROC). Como pruebas de referencia se tomaron el criterio del cirujano y, el examen histopatológico. Resultados: Exactitud diagnóstica: Alvarado: Sensibilidad: 49,0% (35,9%-62,3%), Especificidad: 50,0 % (37,1%-62,9%); Valor Predictivo Positivo: 48,1% (34,2%-62,2%); Valor Predictivo Negativo: 50,9% (37,0%-64,7%), Razón de verosimilitud positiva: 0,9 (0,7-1,4), Razón de verosimilitud negativa: 1,0 (0,7-1,5); Odss ratio diagnóstico: 0,9 (0,4-2,1), Área bajo la curva: 51,8% (40,6%-63,0%). RIPASA: Sensibilidad: 76,5% (62,2%-86,7%), Especificidad: 12,9% (5,8%-25,5%), Valor Predictivo Positivo: 45,3% (34,7%-56,4%), Valor Predictivo Negativo: 36,8% (17,2%-61,4%), Razón de verosimilitud positiva: 0,88 (0,73-1,06), Razón de verosimilitud negativa: 1,82 (0,78-4,25), Odss ratio diagnóstico: 0,48 (0,17-1,35), Área bajo la curva: 60,8% (49,7%-71,9%).&nbsp;&nbsp; Conclusiones: No hubo diferencias significativas entre las escalas RIPASA y Alvarado en relación a la exactitud diagnóstica de apendicitis aguda en el Hospital General de Puyo. En ambos casos, el rendimiento fue “discreto”; pero, debido a las características de la muestra, no debería generalizarse este hallazgo.&nbsp;&nbsp

Categorización del estado de conservación de las serpientes de la República Argentina

A más de una década de la primera Lista Roja de herpetofauna amenazada propuesta por la Asociación Herpetológica Argentina (AHA 2000), se recategorizaron las serpientes a partir de nueva información taxonómica, biogeográfica y bio-ecológica, además de modificaciones metodológicas respecto a la evaluación anterior. Mediante la participación de 18 especialistas de toda la Argentina se reevaluaron 136 taxones de serpientes (130 en la anterior) incluyendo varios cambios taxonómicos (8 taxones nuevos para Argentina y 2 sinonimizados), obteniéndose como resultado la inclusión de 49 especies en la lista roja (5 En Peligro, 17 Amenazadas, 27 Vulnerables), 15 Insuficientemente Conocidas y 72 No Amenazadas. En relación con la categorización anterior de la AHA: un taxón descendió de Vulnerable a No Amenazado, 11 No amenazados y 4 Insuficientemente Conocidos fueron elevados a distintas categorías de amenaza, 7 taxones Vulnerables fueron elevados a Amenazados, un taxón fue elevado de Amenazado a En Peligro. De 8 taxones no evaluados en 2000, uno categorizó No Amenazado, 4 Insuficientemente Conocidos, uno Vulnerable y 2 Amenazados. Estas modificaciones son el resultado de: (1) Mayor información sistemática, biogeográfica y bio-ecológica disponible para la evaluación; (2) Cambios en cuanto a las presiones antrópicas sobre las especies o sus hábitats; (3) Modificaciones metodológicas que incluyeron instructivos para aplicar los conceptos, la discusión y consenso entre especialistas y el análisis de las incertidumbres.After more than a decade from the first red list of threatened herpetofauna proposal by the Asociación Herpetológica Argentina (2000), we re-categorized snakes from new taxonomic, biogeographical and bio-ecological information as well as methodological changes in the former evaluation. Through the participation of 18 specialists from all over Argentina, 136 taxa of snakes (130 in the previous) were re-evaluated including several taxonomic changes (8 new taxa added to Argentina, and 2 sinonimies). The results were the inclusion of 49 species in the red list (5 Endangered, 17 Threatened, 27 Vulnerable), 15 Insufficiently Known and 72 Not Threatened. Compared to the former categorization of the AHA: one taxon descended from Vulnerable to Not Threatened, 11 Not Threatened and 4 Insufficiently Known were elevated to different categories of threat, 7 taxa were elevated from Endangered to Vulnerable, one from Vulnerable to Endangered. From the 8 taxa not evaluated in 2000, one categorized Not Threatened, 4 Insufficiently Known, one Vulnerable, and 2 Threatened. These changes are the result of: (1) increased systematic, biogeographical and bio- ecological information available for the evaluation, (2) Changes in human pressures on the species or their habitats, (3) methodological changes that included recommendations to apply concepts, discussion and consensus among specialists and the analysis of uncertainties.Asociación Herpetológica Argentina (AHA

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Expansion of Signal Transduction Pathways in Fungi by Extensive Genome Duplication

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Expansion of Signal Transduction Pathways in Fungi by Extensive Genome Duplication

[EN] Plants and fungi use light and other signals to regulate development, growth, and metabolism. The fruiting bodies of the fungus Phycomyces blakesleeanus are single cells that react to environmental cues, including light, but the mechanisms are largely unknown [1]. The related fungus Mucor circinelloides is an opportunistic human pathogen that changes its mode of growth upon receipt of signals from the environment to facilitate pathogenesis [2]. Understanding how these organisms respond to environmental cues should provide insights into the mechanisms of sensory perception and signal transduction by a single eukaryotic cell, and their role in pathogenesis. We sequenced the genomes of P. blakesleeanus and M. circinelloides and show that they have been shaped by an extensive genome duplication or, most likely, a whole-genome duplication (WGD), which is rarely observed in fungi [3-6]. We show that the genome duplication has expanded gene families, including those involved in signal transduction, and that duplicated genes have specialized, as evidenced by differences in their regulation by light. The transcriptional response to light varies with the developmental stage and is still observed in a photoreceptor mutant of P. blakesleeanus. A phototropic mutant of P. blakesleeanus with a heterozygous mutation in the photoreceptor gene madA demonstrates that photosensor dosage is important for the magnitude of signal transduction. We conclude that the genome duplication provided the means to improve signal transduction for enhanced perception of environmental signals. Our results will help to understand the role of genome dynamics in the evolution of sensory perception in eukaryotes.European funds (European Regional Development Fund, ERDF); Spanish Ministerio de Economı´a y Competitividad; Junta de Andalucí

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe