How to govern the digital transformation of health services

The impact of digitalization of health services has been profound and is expected to be even more profound in the future. It is important to evaluate whether digital health services contribute to health system goals in an optimal way. This should be done at the level of the service, not the 'digital transformation'. Decisions to adopt new digital health services, at different levels of the health care system, are ideally based on evidence regarding their performance in light of health system goals. In order to evaluate this, a broad perspective should be taken in evaluations of digital health services. Attainment of the broad health system goals, including quality, efficiency and equity, are objectives against which to judge new digital health services. These goals in a broad sense are unaltered by the process of digitalization. Governance should be designed and tailored in such a way to capture all relevant changes in an adequate way. When evaluating digital health services many specific aspects need to be considered. Like for other innovations and (new) technologies, such promises may or may not materialize and potential benefits may also be accompanied by unintended and/or negative (side) effects in the short or long term. Hence, the introduction, implementation, use and funding of digital health technologies should be carefully evaluated and monitored. Governments should play a more active role in the further optimization both of the process of decision making (both at the central and decentral level) and the related outcomes. They need to find a balance between centralized and decentralized activity. Moreover, the broader preparation of the health care system to be able to deal with digitalization, from education, through financial and regulatory preconditions, to implementation of monitoring systems to monitor its effects on health system performance remains important.Peer reviewe

Diagnóstico del estado del bilingüismo en Bogotá - (Informe final)

El capital humano es uno de los elementos fundamentales que estimulan el desarrollo económico y social de una sociedad. Un capital humano suficientemente formado puede traducirse en reducción de reducción de la pobreza (Banerjee & Duflo, 2011), el aumento de los salarios (Mincer, 1974), la movilidad social (Bonilla, 2010; Angulo et al., 2012), y mayores tasas de crecimiento económico (Barro, 1991; Mankiw et al., 1992). Una señal de capital humano es justamente el bilingüismo, por lo que cada vez más adquiere una importancia inusitada (Sánchez, 2015) El presente estudio tiene como objetivo central reconocer el bilingüismo como una de las herramientas más importantes para acceder al nuevo orden mundial de la globalización cultural y económica. La globalización se ha ido acelerando gracias al rápido crecimiento de las tecnologías, especialmente aquellas soportadas por el sector de las comunicaciones. Al mismo tiempo, los negocios y la comercialización de bienes y servicios se ha venido facilitando; sin embargo, la ausencia de personas bilingües limita la capacidad de generar confianza y hacer negocios internacionales. Una ciudad sin la capacidad bilingüe de sus ciudadanos está condenada a que sus vecinas sin este problema atraigan fácilmente los negocios que de otro modo podrían conseguirse. La inversión extranjera, por ejemplo, requiere de una oferta de personas bilingües para que no se generen cuellos de botella en las regiones donde los extranjeros deciden invertir. Empresas y negocios de todo el mundo colocan sus puntos de lanza en la región de América Latina en aquellas ciudades donde se facilita la logística, los servicios y, por supuesto, el idioma. Uno de los casos más emblemáticos de este fenómeno es el sector de servicios de base tecnológica e industrias creativas: allí el bilingüismo es un claro determinante de las inversiones extranjeras. De ahí que, si una ciudad como Bogotá no está preparada con una oferta de personal bilingüe, la ciudad puede ver estancado el desarrollo económico del sector y las externalidades e impactos productivos que se generan en el resto de los sectores. Esto hace muy costoso para Colombia y, para Bogotá en particular, las carencias en Bilingüismo. Este documento se divide en 6 apartados incluyendo esta introducción. En el capítulo 2 se hace un diagnóstico de la oferta actual de profesionales bilingües en la ciudad. En el capítulo 3 se explica el contexto de la demanda del talento humano bilingüe, en donde se especifica el tipo de empresas de los sectores de servicios de base tecnológica e industrias creativas. En el capítulo 4 se identifican oportunidades de mejora y buenas prácticas a nivel internacional, así como un análisis de las diferentes alternativas. El capítulo 5, por su parte, identifica y evalúa las diferentes iniciativas, acciones y proyectos que se han realizado en materia de bilingüismo en Colombia y en Bogotá en los últimos años. Finalmente, el capítulo 6 propone acciones, iniciativas y da lineamientos de políticas públicas que permitan avanzar en el nivel de bilingüismo en la ciudad y posicionarla como una de las más atractivas para atraer inversión extranjera en los sectores enunciados

The spatial organization of multinational firms

Using six years of firm-level data covering 224 regions of the enlarged European Union, we evaluate the importance to a firm of locating its activities (production, headquarters, R&D, logistics and sales) close together. We find that, after controlling for regional characteristics, being closely located to a previous investment positively affects firm location choice. However, the impact of distance is dependent on the type of investment (production or service). The impact dies out faster for service activities. Finally, we show that a surprisingly positive effect comes from locating a new production plant close to an existing production investment, but in another country

Association between hypo- and hyperkalemia and outcome in acute heart failure patients : the role of medications

Background The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. Methods Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes. Results Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34-1.58] for hyperkalemia and 1.22 [1.06-1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02-1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function. Conclusions In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.Peer reviewe

Time delays to reach dispatch centres in different regions in Europe. Are we losing the window of opportunity? - The EUROCALL study

Aim: In out of hospital cardiac arrest (OHCA) the start of Cardiopulmonary Resuscitation (CPR) by a single rescuer may be delayed considerably if the total time (TT) to connect the telephone call to the Emergency Medical Communication Centre (EMCC) is prolonged. EUROCALL investigated the TT-EMCC and its components using different calling procedures. Methods: This prospective, multicentre, randomised study was performed in April 2013. Telephone calls were randomly allocated to time of call, and to those connecting directly to the EMCC (1-step procedure) and those diverted before connecting to the EMCC (2-step procedure). Results: Twenty-one EMCCs from 11 countries participated in the study. Time to first ringtone was similar between 1-step 3.7 s (IQR 1.0-5.2) and 2-step calls 4.0 s (IQR 2.4-5.2). For the 1878 1-step calls, the median TT-EMCC was 11.7 s (IQR 8.7-18.5). For the 1550 2-step calls, the median time from first ringtone to first call-taker was 7 s (IQR 4.6-11.9) and from first call-taker to EMCC was 18.7 s (IQR 13.4-29.9). Median TT-EMCC was 33.2 s (IQR 24.7-46.1) and was significantly longer than the TT-EMCC observed with the 1-step procedure (P <0.0001). Significant differences existed among participating regions between and within different countries both for 1-step and 2-step procedures. Conclusion: TT-EMCC was significantly shorter in a 1-step procedure compared to a 2-step procedure. Regional differences existed between countries but also within countries. This may be relevant in cases of OHCA and other situations where patient outcome is critically time-dependent. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Ciudades del mundo: informe de la cultura 2013

Gestión del conocimientoEl Foro de la Cultura en las Ciudades del Mundo fue creado en 2012 por Londres, Nueva York, Shanghái, París, Tokio, Sídney, Johannesburgo y Estambul. El foro tiene como base la iniciativa de Ciudades del mundo: informe de la cultura, creada por el alcalde de Londres.Competitivida

Gene expression profiling of pre-eclamptic placentae by RNA sequencing

Pre-eclampsia is a common and complex pregnancy disorder that often involves impaired placental development. In order to identify altered gene expression in pre-eclamptic placenta, we sequenced placental transcriptomes of nine pre-eclamptic and nine healthy pregnant women in pools of three. The differential gene expression was tested both by including all the pools in the analysis and by excluding some of the pools based on phenotypic characteristics. From these analyses, we identified altogether 53 differently expressed genes, a subset of which was validated by qPCR in 20 cases and 19 controls. Furthermore, we conducted pathway and functional analyses which revealed disturbed vascular function and immunological balance in pre-eclamptic placenta. Some of the genes identified in our study have been reported by numerous microarray studies (BHLHE40, FSTL3, HK2, HTRA4, LEP, PVRL4, SASH1, SIGLEC6), but many have been implicated in only few studies or have not previously been linked to pre-eclampsia (ARMS2, BTNL9, CCSAP, DIO2, FER1L4, HPSE, LOC100129345, LYN, MYO7B, NCMAP, NDRG1, NRIP1, PLIN2, SBSPON, SERPINB9, SH3BP5, TET3, TPBG, ZNF175). Several of the molecules produced by these genes may have a role in the pathogenesis of pre-eclampsia, and some could qualify as biomarkers for prediction or detection of this pregnancy complication.Peer reviewe