Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.

In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. METHODOLOGY: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available. PRIMARY AND SECONDARY OUTCOMES: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. RESULTS: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

ESPAñOL: En este estudio, evaluamos y pronosticamos las oportunidades acumulativas para que los residentes accedan a los servicios de radioterapia en Cali, Colombia, teniendo en cuenta la congestión del tráfico, utilizando una nueva metodología centrada en las personas con un enfoque de equidad. Además, identificamos 1-2 ubicaciones óptimas donde los nuevos servicios maximizarían la accesibilidad. Utilizamos datos abiertos y macrodatos disponibles públicamente. Cali está entre las ciudades Sudamericanas más afectadas por la congestión del tráfico.Metodología: Usando un enfoque centrado en las personas, probamos una plataforma digital basada en la web desarrollada a través de un diseño participativo iterativo. La plataforma integra datos abiertos, incluyendo la ubicación de los servicios de radioterapia, los microdatos sociodemográficos desagregados de la población y los lugares de residencia, y los macrodatos de tiempos de viaje de la API de Google Distance Matrix. Usamos algoritmos genéticos para identificar ubicaciones óptimas para nuevos servicios. Pronosticamos oportunidades acumulativas de accesibilidad (ACO, por sus siglas en inglés) para el tráfico que va desde la congestión máxima hasta condiciones de flujo libre, con evaluaciones horarias hechas del 6 al 12 de julio de 2020 y del 23 al 29 de noviembre de 2020. La plataforma digital interactiva está públicamente disponible.Resultados Primarios y Secundarios: Presentamos estadísticas descriptivas y mapas de calor de la distribución de la población basados en isócronas de ACO de 20 minutos para viajes en coche. No existe un estándar nacional o internacional establecido para estos umbrales de tiempo de viaje. La mayoría de los informantes clave encontraron razonable el umbral de 20 minutos. Estas isócronas conectan el centroide poblacional ponderado de la zona de análisis de tráfico del lugar de residencia con la zona correspondiente del servicio de radioterapia con menor tiempo de viaje bajo condiciones variables de tráfico, que van desde el flujo libre hasta niveles de congestión de tráfico máximo. Además, realizamos un análisis bivariado de series temporales para evaluar la accesibilidad geográfica basada en el estrato económico. Identificamos 1-2 ubicaciones óptimas donde los nuevos servicios maximizarían el ACO de 20 minutos durante la congestión máxima del tráfico.Resultados: La congestión del tráfico redujo significativamente la accesibilidad a los servicios de radioterapia, afectando particularmente a las poblaciones vulnerables. Por ejemplo, el ACO urbano de 20 minutos en coche se redujo del 91% de la población urbana de Cali para viajes de hasta 20 minutos al servicio con flujo libre de tráfico, al 31% cuando hay congestión pico de tráfico durante la semana del 6 al 12 de julio de 2020. Los porcentajes representan la población con viajes de hasta 20 minutos en coche desde la residencia hasta el servicio de radioterapia. Grupos étnicos específicos, individuos con menor nivel educativo y residentes en las afueras de Cali experimentaron efectos desproporcionados, con la accesibilidad disminuyendo al 11% durante el tráfico máximo en comparación con el 81% durante el tráfico de flujo libre para hogares de bajos ingresos. Predecimos que agregar estratégicamente suficientes servicios en 1-2 ubicaciones en el este de Cali mejoraría notablemente la accesibilidad y reduciría las inequidades. Las ubicaciones recomendadas para los nuevos servicios se mantuvieron consistentes en nuestras dos mediciones.Estos hallazgos subrayan la importancia de priorizar la equidad y la atención integral en la accesibilidad a la atención médica. También ofrecen un enfoque práctico para optimizar las ubicaciones de los servicios para mitigar las disparidades. Es factible y accesible expandir este enfoque para abarcar otros modos de transporte, servicios y ciudades, o actualizar las mediciones. El nuevo enfoque y los datos son particularmente relevantes para las autoridades de planificación y los actores del desarrollo urbano.

PORTUGUêS: Neste estudo, avaliamos e previmos as oportunidades cumulativas para os residentes acessarem serviços de radioterapia em Cali, Colômbia, levando em consideração o congestionamento do tráfego, utilizando uma nova metodologia centrada nas pessoas com um foco na equidade. Além disso, identificamos 1-2 locais ideais onde os novos serviços poderiam maximizar a acessibilidade. Utilizamos dados abertos e big data disponíveis publicamente. Cali está entre as cidades sulamericanas mais afetadas pela congestionamento do tráfego.Metodologia: Usando uma abordagem centrada em pessoas, testamos uma plataforma digital baseada na web que foi desenvolvida através de um design participativo iterativo. A plataforma integra dados abertos, incluindo a localização dos serviços de radioterapia, microdados sociodemográficos desagregados por população e locais de residência, e big data da API Google Distance Matrix para os tempos de viagem. Utilizamos algoritmos genéticos para identificar locais ideais para novos serviços. Previmos oportunidades cumulativas de acessibilidade (ACO, por suas siglas em inglês) para o tráfego que varia desde o congestionamento máximo até condições de fluxo livre, com avaliações horárias de 6 a 12 de julho de 2020 e de 23 a 29 de novembro de 2020. A plataforma digital interativa está disponível publicamente.Resultados Primários e Secundários: Apresentamos estatísticas descritivas e mapas de calor da distribuição populacional baseados em isócronas de ACO de 20 minutos para viagens de carro. Não existe um padrão nacional ou internacional estabelecido para esses limites de tempo de viagem. A maioria dos entrevistados-chave considerou razoável o limite de 20 minutos. Essas isócronas conectam o centroide ponderado pela população da zona de análise de tráfego no local de residência e sua zona correspondente do serviço de radioterapia com o menor tempo de viagem sob condições variáveis de tráfego (que vão desde fluxo livre até níveis máximos de congestionamento do tráfego). Além disso, realizamos uma análise bivariada de séries temporais para avaliar a acessibilidade geográfica baseada na estratificação econômica. Identificamos 1-2 locais ideais onde os novos serviços maximizariam a ACO de 20 minutos durante o pico de congestionamento do tráfego.Resultados: O congestionamento do tráfego reduziu significativamente a acessibilidade aos serviços de radioterapia, afetando particularmente as populações vulneráveis. Por exemplo, a ACO urbana de 20 minutos de carro foi reduzida de 91% durante um fluxo livre de tráfego, para 31% durante picos de congestionamento de tráfego entre a semana de 6 a 12 de julho de 2020. As porcentagens representam a população com viagens de até 20 minutos de carro de sua residência até o serviço de radioterapia. Grupos étnicos específicos, indivíduos com menor nível educacional e residentes nos arredores de Cali experimentaram resultados desproporcionais, com a acessibilidade diminuindo para 11% durante o tráfego com congestionamento máximo em comparação com 81% durante o fluxo livre de tráfego para domicílios de baixa renda. Prevemos que adicionar estrategicamente serviços suficientes em 1-2 locais no leste de Cali melhoraria significativamente a acessibilidade e reduziria as desigualdades. Os locais recomendados para os novos serviços permaneceram consistentes em ambas medições. Esses resultados ressaltam a importância de priorizar a equidade e o atendimento integral na acessibilidade aos cuidados de saúde. Eles também oferecem uma abordagem prática para otimizar os locais dos serviços a fim de minimizar as desigualdades. A expansão dessa abordagem para abranger outros modos de transporte, serviços e cidades, ou a atualização das medições, é viável e acessível. A nova abordagem e os dados são particularmente relevantes para as autoridades de planejamento e os agentes do desenvolvimento urbano.

FRANçAIS: Dans cette étude, nous avons évalué et prévu les opportunités cumulées pour les résidents d'accéder aux services de radiothérapie à Cali, en Colombie, tout en tenant compte de la congestion du trafic en utilisant une nouvelle méthodologie centrée sur les personnes avec axée sur l'équité. De plus, nous avons identifié 1 à 2 emplacements optimaux où de nouveaux services maximiseraient l'accessibilité. Nous avons utilisé des données ouvertes et des macrodonnées tenues à disposition du public. Cali est l'une des villes d'Amérique du Sud les plus touchées par la congestion du trafic.Méthodologie: En utilisant une approche centrée sur les personnes, nous avons testé une plateforme numérique basée sur le web développée à travers une conception participative itérative. La plateforme intègre des données ouvertes, y compris la localisation des services de radiothérapie, les microdonnées sociodémographiques désagrégées de la population et les lieux de résidence, ainsi que les mégadonnées des temps de trajet de l'API Google Distance Matrix. Nous avons utilisé des algorithmes génétiques pour identifier les emplacements optimaux pour de nouveaux services. Nous avons prévu les opportunités cumulatives d'accessibilité (ACO, désignant l'acronyme en anglais) pour le trafic allant de la congestion maximale aux conditions de flux libre, avec des évaluations horaires du 6 au 12 juillet 2020 et du 23 au 29 novembre 2020. La plateforme numérique interactive est disponible publiquement.Résultats Primaires et Secondaires: Nous présentons des statistiques descriptives et des cartes thermiques de la distribution de la population basées sur des ACO de 20 minutes pour les trajets en voiture. Il n'existe pas de norme nationale ou internationale établie pour ces seuils de temps de trajet. La majorité des informateurs clés ont trouvé le seuil de 20 minutes raisonnable. Ces isochrones relient le centroïde pondéré par la population de la zone d'analyse du trafic au lieu de résidence à la zone correspondante du service de radiothérapie avec le temps de trajet le plus court sous des conditions de trafic variables allant du flux libre aux niveaux de congestion de trafic maximum. De plus, nous avons réalisé une analyse bivariée des séries chronologiques pour évaluer l'accessibilité géographique en fonction de la stratification économique. Nous avons identifié 1 à 2 emplacements optimaux où de nouveaux services maximiseraient l'ACO de 20 minutes pendant la congestion maximale du trafic.Résultats: La congestion du trafic a considérablement réduit l'accessibilité aux services de radiothérapie, affectant particulièrement les populations vulnérables. Par exemple, l'ACO urbain de 20 minutes en voiture est passé de 91 % de la population urbaine de Cali pour des trajets de jusqu'à 20 minutes vers le service avec un flux de trafic libre à 31 % lors des pics de congestion de trafic pendant la semaine du 6 au 12 juillet 2020. Les pourcentages représentent la population avec des trajets de jusqu'à 20 minutes en voiture depuis la résidence jusqu'au service de radiothérapie. Des groupes ethniques spécifiques, des individus ayant un niveau d'éducation inférieur et des résidents des périphéries de Cali ont subi des effets disproportionnés, avec une accessibilité diminuant à 11 % pendant le trafic maximal par rapport à 81 % pendant le flux de trafic libre pour les ménages à faible revenu. Ajouter suffisamment de services à 1-2 emplacements stratégiques dans l'est de Cali a le potential d'améliorer considérablement l'accessibilité et réduirait les inégalités. Les emplacements recommandés pour les nouveaux services sont restés cohérents dans nos deux mesures. Ces conclusions soulignent l'importance de prioriser l'équité et une prise en charge globale dans le cadre de l'accessibilité aux soins de santé. Elles offrent également une approche pratique pour optimiser les emplacements des services afin de réduire les disparités. Il est faisable et abordable d'étendre cette approche pour inclure d'autres modes de transport, services et villes, ou pour mettre à jour les mesures. La nouvelle approche et les données sont particulièrement pertinentes pour les autorités de planification et les acteurs du développement urbain.

Epigenetic Mechanisms and Posttranslational Modifications in Systemic Lupus Erythematosus.

The complex physiology of eukaryotic cells is regulated through numerous mechanisms, including epigenetic changes and posttranslational modifications. The wide-ranging diversity of these mechanisms constitutes a way of dynamic regulation of the functionality of proteins, their activity, and their subcellular localization as well as modulation of the differential expression of genes in response to external and internal stimuli that allow an organism to respond or adapt to accordingly. However, alterations in these mechanisms have been evidenced in several autoimmune diseases, including systemic lupus erythematosus (SLE). The present review aims to provide an approach to the current knowledge of the implications of these mechanisms in SLE pathophysiology.

Unification of Efforts to Improve Global Access to Cancer Therapeutics: Report From the 2022/2023 Access to Essential Cancer Medicines Stakeholder Summit.

PURPOSE: There is an urgent need to improve access to cancer therapy globally. Several independent initiatives have been undertaken to improve access to cancer medicines, and additional new initiatives are in development. Improved sharing of experiences and increased collaboration are needed to achieve substantial improvements in global access to essential oncology medicines. METHODS: The inaugural Access to Essential Cancer Medicines Stakeholder Meeting was organized by ASCO and convened at the June 2022 ASCO Annual Meeting in Chicago, IL, with two subsequent meetings, Union for International Cancer Control World Cancer Congress held in Geneva, Switzerland, in October 2022 and at the ASCO Annual Meeting in June of 2023. Invited stakeholders included representatives from cancer institutes, physicians, researchers, professional societies, the pharmaceutical industry, patient advocacy organizations, funders, cancer organizations and foundations, policy makers, and regulatory bodies. The session was moderated by ASCO. Past efforts and current and upcoming initiatives were initially discussed (2022), updates on progress were provided (2023), and broad agreement on resulting action steps was achieved with participants. RESULTS: Summit participants recognized that while much work was ongoing to enhance access to cancer therapeutics globally, communication and synergy across projects and organizations could be enhanced by providing a platform for collaboration and shared expertise. CONCLUSION: The summit resulted in new cross-stakeholder insights and planned collaboration addressing barriers to accessing cancer medications. Specific actions and timelines for implementation and reporting were established.

C/Can City Engagement Process: An Implementation Framework for Strengthening Cancer Care in Cities in Low- and Middle-Income Countries.

The effective implementation of locally adapted cancer care solutions in low- and middle-income countries continues to be a challenge in the face of fragmented and inadequately resourced health systems. Consequently, the translation of global cancer care targets to local action for patients has been severely constrained. City Cancer Challenge (C/Can) is leveraging the unique value of cities as enablers in a health systems response to cancer that prioritizes the needs of end users (patients, their caregivers and families, and health care providers). C/Can's City Engagement Process is an implementation framework whereby local stakeholders lead a staged city-wide process over a 2- to 3-year period to assess, plan, and execute locally adapted cancer care solutions. Herein, the development and implementation of the City Engagement Process Framework (CEPF) is presented, specifying the activities, outputs, processes, and indicators across the process life cycle. Lessons learned on the application of the framework in the first so-called Key Learning cities are shared, focusing on the early outputs from Cali, Colombia, the first city to join C/Can in 2017. Creating lasting change requires the creation of a high-trust environment to engage the right stakeholders as well as adapting to local context, leveraging local expertise, and fostering a sustainability mindset from the outset. In the short term, these early learnings inform the refinement of the approach in new cities. Over time, the implementation of this framework is expected to validate the proof-of-concept and contribute to a global evidence base for effective complex interventions to improve cancer care in low- and middle-income countries.

Effect of triamcinolone in regional anesthesia for fast-track knee replacement. Case series / Serie de casos: Efecto de triamicinolona en anestesia regional fast track para reemplazo de rodilla

BACKGROUND: Many adjuvants have been studied to improve the quality of analgesia and to prolong its duration. To date, there are no reports on the use of triamcinolone. CASE: We present a brief report of 10 patients receiving a single shot ACB and IPACK blockade with a small dose of triamcinolone for Fast-Track Knee Replacement to prolong analgesia. CONCLUSION: We think this is a valuable opioid-sparing option, cheaper than new adjuvants, and safer than the use of continuous infusion. This technique should be evaluated in clinical trials.

ANTECEDENTES: Muchos agentes farmacológicos que se utilizan como adyuvantes en la anestesia regional han sido estudiados con el fin de mejorar la calidad de la analgesia y prolongar la duración del efecto. Hoy en día no existen reportes del uso de triamcinolona en dichos procedimientos. CASO: Consiste en el reporte breve de 10 pacientes que se les realizo ACB además de un bloqueo IPACK con una sola inyección de anestesia local con el adyuvante triamcinolona, con el objetivo de prolongar la analgesia en la cirugía de reemplazo de rodilla Fast-Track. CONCLUSIÓN: Consideramos que una valiosa opción para el ahorro de opioide, más económica que las nuevas opciones de mercado y más seguras que el uso de infusiones continuas. Esta técnica debería ser evaluada en ensayos clínicos.