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Molanes-López EM, Ferrer JM, Dougnon AO, Gado AA, Sanoussi A, Ousmane N, Lazoumar RH, Charle-Cuéllar P. Cost-effectiveness of severe acute malnutrition treatment delivered by community health workers in the district of Mayahi, Niger. Hum Resour Health 2024; 22:22. [PMID: 38553707 PMCID: PMC10979590 DOI: 10.1186/s12960-024-00904-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND A non-randomized controlled trial, conducted from June 2018 to March 2019 in two rural communes in the health district of Mayahi in Niger, showed that including community health workers (CHWs) in the treatment of severe acute malnutrition (SAM) resulted in a better recovery rate (77.2% vs. 72.1%) compared with the standard treatment provided solely at the health centers. The present study aims to assess the cost and cost-effectiveness of the CHWs led treatment of uncomplicated SAM in children 6-59 months compared to the standard national protocol. METHODS To account for all relevant costs, the cost analysis included activity-based costing and bottom-up approaches from a societal perspective and on a within-trial time horizon. The cost-effectiveness analysis was conducted through a decision analysis network built with OpenMarkov and evaluated under two approaches: (1) with recovery rate and cost per child admitted for treatment as measures of effectiveness and cost, respectively; and (2) assessing the total number of children recovered and the total cost incurred. In addition, a multivariate probabilistic sensitivity analysis was carried out to evaluate the effect of uncertainty around the base case input data. RESULTS For the base case data, the average cost per child recovered was 116.52 USD in the standard treatment and 107.22 USD in the CHWs-led treatment. Based on the first approach, the CHWs-led treatment was more cost-effective than the standard treatment with an average cost per child admitted for treatment of 82.81 USD vs. 84.01 USD. Based on the second approach, the incremental cost-effectiveness ratio of the transition from the standard to the CHWs-led treatment amounted to 98.01 USD per additional SAM case recovered. CONCLUSIONS In the district of Mayahi in Niger, the CHWs-led SAM treatment was found to be cost-effective when compared to the standard protocol and provided additional advantages such as the reduction of costs for households. TRIAL REGISTRATION ISRCTN with ID 31143316. https://doi.org/10.1186/ISRCTN31143316.
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Affiliation(s)
- Elisa M Molanes-López
- Department of Statistics and Operational Research, Faculty of Medicine, Universidad Complutense de Madrid (UCM), 28040, Madrid, Spain
| | - José M Ferrer
- Department of Statistics and Operational Research, Faculty of Medicine, Interdisciplinary Mathematics Institute, Universidad Complutense de Madrid (UCM), HUMLOG Research Group, 28040, Madrid, Spain
| | | | | | - Atté Sanoussi
- Nutrition Direction, Ministry of Health, 623, Niamey, Niger
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Rodriguez-Ascaso A, Molanes-López EM, Pérez-Martín J, Letón E. Performance of students with different accessibility needs and preferences in "Design for All" MOOCs. PLoS One 2024; 19:e0299090. [PMID: 38451899 PMCID: PMC10919722 DOI: 10.1371/journal.pone.0299090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Recent research has shown that Massive Open Online Courses (MOOCs) create barriers for students with disabilities. Not taking into account their needs in the design, production or delivery of MOOCs may be one of the main causes behind this. It leads to poor compliance with suitable learning designs and web accessibility standards, as well as a lack of knowledge about the students' needs. The objective of our research is to analyze the learning performance of the students in MOOCs on topics related to Design for All, offered in an Open edX-based platform. Accessibility support was conceived from the outset, including compliance of both the platform and the learning resources with the WCAG 2.1 accessibility standard, and with a subset of the principles of Universal Design for Learning. Additionally, students were consulted on their accessibility needs and preferences, following publicly available modeling schemes and previous research. From a sample of 765 students, who completed at least one of the graded assessment activities of the course, a multilevel multiple logistic regression model was fitted. Based on that model, the results indicate that: a) users of screen readers and users of captions show a statistically significant positive association with a good performance when compared to students with no preferences, with an odds ratio of, respectively, OR = 13.482 and OR = 13.701; b) students who have low vision or very low vision show a significant negative association with a good performance when compared to users of screen readers and to users of captions, with OR = 26.817 and OR = 27.254, respectively.
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Affiliation(s)
- Alejandro Rodriguez-Ascaso
- Department of Artificial Intelligence, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Elisa M. Molanes-López
- Department of Statistics and Operations Research, Faculty of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Jorge Pérez-Martín
- Department of Artificial Intelligence, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Emilio Letón
- Department of Artificial Intelligence, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
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Aguinaga-Barrilero A, Juarez I, Vaquero-Yuste C, Molina-Alejandre M, Gutiérrez-Calvo A, Lasa I, López A, Gómez R, Molanes-López EM, Martin-Villa JM. Higher prevalence of LAP+ (Latency TGFβ-Associated Peptide) T cells at the tissue level in patients with early gastric cancer. Cell Immunol 2022; 382:104635. [PMID: 36332356 DOI: 10.1016/j.cellimm.2022.104635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/13/2022] [Accepted: 10/22/2022] [Indexed: 01/13/2023]
Abstract
The presence of cells with regulatory functions in patients with cancer is one of the mechanisms whereby the immune system cannot confront tumor growth. We sought to determine the prevalence of immunoregulatory T-cell subpopulations, expressing the latency TGFβ-associated peptide (LAP), in patients with gastric adenocarcinoma. T cells were enriched from blood or gastric tissue (tumoral, TT or tumor-free, TF) samples from 22 patients, 6 with early (EGC) and 16 with advanced gastric cancer (AGC). CD4, CD8, LAP, FoxP3 and IFN-γ were measured by cytometry. CD8 + LAP + cells were increased at tumoral sites, especially in early stages of the disease, as compared to tumor-free explants (EGC 5.28 % [4.67-6.64]*; AGC 2.90 % [1.37-4.44]; TF 3.14 % [2.33-4.16]; *p < 0.05 vs TF). Likewise, the LAP+/CD8 + LAP- ratio is increased in gastric samples from patients with early disease (EGC 0.38 [0.30-0.45]*, AGC 0.12 [0.07-0.14]; TF 0.12 [0.09-0.31]; *p < 0.05 vs AGC).Disease progression is accompanied by decreased LAP membrane expression and, probably, increased LAP secretion, therefore limiting the response to the tumor.
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Affiliation(s)
- Ana Aguinaga-Barrilero
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Ignacio Juarez
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Christian Vaquero-Yuste
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Marta Molina-Alejandre
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Alberto Gutiérrez-Calvo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Inmaculada Lasa
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Adela López
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Remedios Gómez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | - Elisa M Molanes-López
- Departamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Martin-Villa
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Larrainzar-Garijo R, Molanes-López EM, Cañones-Martín M, Murillo-Vizuete D, Valencia-Santos N, Garcia-Bogalo R, Corella-Montoya F. Computer-Assisted Surgery Enables Beginner Surgeons, Under Expert Guidance, to Achieve Long-Term Clinical Results not Inferior to Those of a Skilled Surgeon in Knee Arthroplasty. Indian J Orthop 2022; 56:1439-1448. [PMID: 35923307 PMCID: PMC9283583 DOI: 10.1007/s43465-022-00666-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study is to determine whether the use of a surgical navigation system in total knee replacement (TKR) enables beginner and intermediate surgeons to achieve clinical PROM outcomes as good as those conducted by expert surgeons in the long term. METHODS We enrolled 100 consecutive patients whose total navigated knee arthroplasty (TKA) was performed in our institution from 2008 to 2010. According to the principal surgeon's surgical experience, the patients were divided into three groups: (1) beginner surgeons, with no more than 30 previous knee replacement performances, (2) intermediate surgeons, with more than 30 but not more than 300, and (3) expert surgeons, with more than 300 knee replacements. Demographic data collected on the cohort included gender, laterality, age, and body mass index (BMI). The outcome measures assessed were Forgotten Joint Score (FJS), implant positioning, limb alignment, and prosthesis survival rate. A margin of equivalence of ± 18.5 points in the FJS scale was prespecified in terms of the minimal clinically important difference (MCID) to compare the FJS results obtained in the long period between the groups of interest. RESULTS The mean follow-up was 11.10 ± 0.78, 10.86 ± 0.66, and 11.30 ± 0.74 years, respectively, for each of the groups. The long-term FJS mean score was 80.86 ± 21.88, 81.36 ± 23.87, and 90.48 ± 14.65 for each group. The statistical analysis proved noninferiority and equivalence in terms of the FJS results reported in the long term by patients in Groups 1 or 2 compared to those in Group 3. More specifically, it has been proved that the mean difference between groups is within the interval of equivalence defined in terms of the MCID. The overall prostheses survival rate was 93.7%. CONCLUSION Navigated assisted TKA, under expert guidance, can be as effective when performed by beginner or intermediate surgeons as performed by senior surgeons regarding the accuracy of implant positioning, limb alignment, and long-term clinical outcome.
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Affiliation(s)
- Ricardo Larrainzar-Garijo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Elisa M. Molanes-López
- Unidad Departamental de BioestadísticaDepartamento de Estadística e Investigación Operativa, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
| | - Miguel Cañones-Martín
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - David Murillo-Vizuete
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | | | - Raul Garcia-Bogalo
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain
| | - Fernando Corella-Montoya
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Via Este 80, 28031 Madrid, Spain ,Departamento Cirugía, Facultad de Medicina, Universidad Complutense Madrid, Madrid, Spain
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Juarez I, Gutierrez A, Vaquero-Yuste C, Molanes-López EM, López A, Lasa I, Gómez R, Martin-Villa JM. TGFB1 polymorphisms and TGF-β1 plasma levels identify gastric adenocarcinoma patients with lower survival rate and disseminated disease. J Cell Mol Med 2020; 25:774-783. [PMID: 33274798 PMCID: PMC7812301 DOI: 10.1111/jcmm.16131] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/16/2020] [Accepted: 11/06/2020] [Indexed: 12/09/2022] Open
Abstract
TGF‐β1 is involved in tumour growth. Four TGFB1 SNPs and TGF‐β1 production by stimulated PBMC were determined in seventy‐eight gastric adenocarcinoma patients. In addition, TGF‐β1 levels were measured in the plasma of further thirty patients. rs1800471‐G/C genotype was prevalent in patients (20.7%) compared to controls (8.4%), as it also was the rs1800468 SNP‐G/A genotype in stage IV patients (20.7%) compared to stage I, II and III patients, combined (10.3%). Conversely, the T/T rs1800469 SNP‐T/T genotype was absent in the former group and present in 19.0% in the latter. Furthermore, the rs1800469‐C/rs1800470‐T (CT) haplotype was found in 15.0% of stage IV patients as compared to 3.0% of the remaining patients (3.0%) and also identifies patients with worse five‐year life expectancy (P = .03). TGF‐β1 synthesis by stimulated PBMCs was significantly lower in patients with the risk SNPs or haplotype, compared to the alternative genotype. Finally, TGF‐β1 plasma levels were lower in patients with worse life expectancy. Analysis of TGFB1 SNPs and measurement of plasma TGF‐β1 levels serves to identify patients at risk of developing a more aggressive disease.
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Affiliation(s)
- Ignacio Juarez
- Department of Immunology, Ophthalmology and ENT, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | | | - Christian Vaquero-Yuste
- Department of Immunology, Ophthalmology and ENT, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Elisa M Molanes-López
- Department of Statistics and Operations Research, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Adela López
- Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | | | - Remedios Gómez
- Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - José Manuel Martin-Villa
- Department of Immunology, Ophthalmology and ENT, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
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López-Ratón M, Cadarso-Suárez C, Molanes-López EM, Letón E. Confidence intervals for the symmetry point: an optimal cutpoint in continuous diagnostic tests. Pharm Stat 2016; 15:178-92. [DOI: 10.1002/pst.1734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 11/10/2015] [Accepted: 11/23/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Mónica López-Ratón
- Biostatistics Unit, Department of Statistics and Operations Research; USC; San Francisco s/n Santiago de Compostela 15782 Spain
| | - Carmen Cadarso-Suárez
- Biostatistics Unit, Department of Statistics and Operations Research; USC; San Francisco s/n Santiago de Compostela 15782 Spain
| | - Elisa M. Molanes-López
- Biostatistics Section, Department of Statistics and Operations Research; UCM; Plaza Ramón y Cajal s/n Madrid 28040 Spain
| | - Emilio Letón
- Department of Artificial Intelligence; UNED; C/ Juan del Rosal 16 Madrid 28040 Spain
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Molanes-López EM, Letón E. Inference of the Youden index and associated threshold using empirical likelihood for quantiles. Stat Med 2011; 30:2467-80. [DOI: 10.1002/sim.4303] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 05/13/2011] [Indexed: 11/05/2022]
Affiliation(s)
| | - Emilio Letón
- Department of Artificial Intelligence; UNED; C/Juan del Rosal 16 28040 Madrid Spain
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