La dirección general en la era de la hiperconectividad: las nuevas coordenadas

En els darrers 10-15 anys s'han produït canvis de gran rellevància a l'escenari competitiu que han empès les empreses a abordar grans transformacions en els seus sistemes d'organització i gestió. Tanmateix, se sap poc sobre l'impacte que totes aquestes transformacions han tingut sobre el dia a dia del director general i sobre com els màxims responsables de les organitzacions adapten els seus rols, funcions i prioritats a les noves exigències. L'objectiu d'aquest treball és estudiar com els canvis en l'entorn competitiu i els que les pròpies organitzacions han emprès per adaptar-s'hi estan reconfigurant els rols i les tasques que exerceixen els directius i, particularment, l'alta direcció. Per dur a terme aquesta anàlisi, hem combinat la investigació teòrica, basada en l'anàlisi de la literatura recent, amb la investigació empírica, fonamentada en un treball de camp realitzat sobre una mostra representativa de 52 alts directius. Els resultats obtinguts demostren que tant els canvis en l'entorn competitiu com les transformacions empreses per les mateixes organitzacions per adaptar-s'hi estan reconfigurant els rols, prioritats i estils de direcció dels seus màxims executius, modificant l'enfocament i l'abast de les seves responsabilitats, transformant la seva manera d'exercir el lideratge i incorporant noves variables a les seves estratègies de direcció. El treball conclou amb una sèrie de propostes per a la revisió, actualització i adaptació dels rols i prioritats directives a les noves condicions competitives i organitzatives que s'imposen a les organitzacions del segle XXI: (1) l'èmfasi en propòsit, visió, missió i valors; (2) la creació d’una identitat corporativa potent i atractiva; (3) l'adopció de nous estils de lideratge; (4) una direcció més orientada a l'exterior i amb més atenció als stakeholders; (5) el focus en les persones i en el seu desenvolupament; (6) la importància de la capacitació i de l’aprenentatge organitzatiu; i (7) la presa de decisions més ràpides i freqüents.En los últimos 10-15 años se han producido cambios de gran relevancia en el escenario competitivo que han empujado a las empresas a abordar grandes transformaciones en sus sistemas de organización y gestión. Sin embargo, poco se sabe sobre el impacto que todas estas transformaciones han tenido sobre el día a día del director general y sobre cómo los máximos responsables de las organizaciones adaptan sus roles, funciones y prioridades a las nuevas exigencias. El objetivo de este trabajo es estudiar cómo los cambios en el entorno competitivo y los que las propias organizaciones, a su vez, han acometido para adaptarse a ellos están reconfigurando los roles y tareas que desempeñan los directivos y, particularmente, la alta dirección. Para llevar a cabo este análisis hemos combinado la investigación teórica, basada en el análisis de la literatura reciente, con la investigación empírica, fundamentada en un trabajo de campo realizado sobre una muestra representativa de 52 altos directivos. Los resultados obtenidos demuestran que tanto los cambios en el entorno competitivo como las transformaciones acometidas por las propias organizaciones para adaptarse a ellos están reconfigurando los roles, prioridades y estilos de dirección de sus máximos ejecutivos, modificando el enfoque y alcance de sus responsabilidades, transformando su forma de ejercer el liderazgo e incorporando nuevas variables a sus estrategias de dirección. El trabajo concluye con una serie de propuestas para la revisión, actualización y adaptación de los roles y prioridades directivas a las nuevas condiciones competitivas y organizativas que se imponen en las organizaciones del siglo XXI: (1) el énfasis en propósito, visión, misión y valores; (2) la creación de una identidad corporativa potente y atractiva; (3) la adopción de nuevos estilos de liderazgo; (4) una dirección más orientada al exterior y con mayor atención a los stakeholders; (5) el foco en las personas y en su desarrollo; (6) la importancia de la capacitación y del aprendizaje organizativo; y (7) la toma de decisiones más rápidas y frecuentes.In the last 10-15 years there have been major changes in the competitive scenario that have pushed companies to undertake major transformations in their organization and management systems. However, little is known about the impact that all these transformations have had on the CEO's day-to-day and how the heads of organizations adapt their roles, functions and priorities to the new demands. The objective of this work is to study how the changes in the competitive environment and those that the organizations themselves, in turn, have undertaken to adapt to them are reconfiguring the roles and tasks carried out by managers and, particularly, by senior management. To carry out this analysis we have combined theoretical research, based on the analysis of recent literature, with empirical research, based on fieldwork carried out on a representative sample of 52 senior managers. The results obtained show that both the changes in the competitive environment and the transformations undertaken by the organizations themselves to adapt to them are reconfiguring the roles, priorities and management styles of their top executives, modifying the focus and scope of their responsibilities, transforming their way of exercising leadership and incorporating new variables into their management strategies. The paper concludes with a series of proposals for reviewing, updating and adapting managerial roles and priorities to the new competitive and organizational conditions imposed on 21st century organizations: (1) the emphasis on purpose, vision, mission and values; (2) the creation of a powerful and attractive corporate identity; (3) the adoption of new styles of leadership; (4) a more outward-oriented direction with greater attention to stakeholders; (5) the focus on people and their development; (6) the importance of training and organizational learning; and (7) faster and more frequent decision making

La modulación arquitectónica como sistema de proyectar en Santiago de Benicalaf

[EN] The current rules of projecting contemporary architecture are different from other historical periods. There are some rules and laws that composes each different styles. The treaty writers recover classical composition with order and balancing geometric figures, especially for façades and doorways, improving the architectural production at that time. The architects of the 17th century knew the treaties and they applied on their buildings, so we can talk about a culture architecture and by analysing their works, it brings us closer to its process. Such is the case of the façade of the church of Santiago de Benicalaf (Valencia) -Spain- in which by following the most relevant Spanish treaties, many of those rules are reflected. This study allows us to get closer to the architect, in addition to establishing the architectural work as an architectural reference within its heritage context.[ES] Bien es sabido que las reglas de proyectar la Arquitectura contemporánea son muy distintas a otros periodos históricos e incluso, entre los distintos estilos existen distintas leyes que las diferencian. Con la aparición de los tratadistas se recuperó la tradición clásica de composición con el orden y figuras geométricas equilibrantes, sobre todo para fachadas y portadas. El usar los conocimientos de los tratados implicaba que los Maestros tenían una formación en Arquitectura y, por lo tanto, se puede hablar de una arquitectura culta y al analizar las obras, nos acerca más a su proceso. Tal es el caso de la fachada de la iglesia de Santiago de Benicalaf (Valencia) -Spain- en el que al seguir los tratados de mayor relevancia, es decir, los conocidos en tierras españolas, se ven reflejadas muchas de esas reglas y que nos permiten acercarnos al artífice, además de asentar la obra arquitectónica como referente arquitectónico dentro de su contexto patrimonial.Cortés Meseguer, L.; Pardo Conejero, J.; Congost, J.; Pérez Llopis, J. (2020). Architectural modulation as a projecting system in Santiago de Benicalaf. EGE Revista de Expresión Gráfica en la Edificación. 0(13):47-63. https://doi.org/10.4995/ege.2020.14609OJS476301

Lower incisor dentoalveolar compensation and symphysis dimensions among Class I and III malocclusion patients with different facial vertical skeletal patterns

Objective: To compare lower incisor dentoalveolar compensation and mandible symphysis morphology among Class I and Class III malocclusion patients with different facial vertical skeletal patterns. Materials and Methods: Lower incisor extrusion and inclination, as well as buccal (LA) and lingual (LP) cortex depth, and mandibular symphysis height (LH) were measured in 107 lateral cephalometric x-rays of adult patients without prior orthodontic treatment. In addition, malocclusion type (Class I or III) and facial vertical skeletal pattern were considered. Through a principal component analysis (PCA) related variables were reduced. Simple regression equation and multivariate analyses of variance were also used. Results: Incisor mandibular plane angle (P < .001) and extrusion (P  =  .03) values showed significant differences between the sagittal malocclusion groups. Variations in the mandibular plane have a negative correlation with LA (Class I P  =  .03 and Class III P  =  .01) and a positive correlation with LH (Class I P  =  .01 and Class III P  =  .02) in both groups. Within the Class III group, there was a negative correlation between the mandibular plane and LP (P  =  .02). PCA showed that the tendency toward a long face causes the symphysis to elongate and narrow. In Class III, alveolar narrowing is also found in normal faces. Conclusions: Vertical facial pattern is a significant factor in mandibular symphysis alveolar morphology and lower incisor positioning, both for Class I and Class III patients. Short-faced Class III patients have a widened alveolar bone. However, for long-faced and normal-faced Class III, natural compensation elongates the symphysis and influences lower incisor position

Polygenic Innate Immunity Score to Predict the Risk of Cytomegalovirus Infection in CMV D+/R- Transplant Recipients. A Prospective Multicenter Cohort Study

Several genetic polymorphisms of the innate immune system have been described to increase the risk of cytomegalovirus (CMV) infection in transplant patients. The aim of this study was to assess the impact of a polygenic score to predict CMV infection and disease in high risk CMV transplant recipients (heart, liver, kidney or pancreas). On hundred and sixteen CMV-seronegative recipients of grafts from CMV-seropositive donors undergoing heart, liver, and kidney or pancreas transplantation from 7 centres were prospectively included for this purpose during a 2-year period. All recipients received 100-day prophylaxis with valganciclovir. CMV infection occurred in 61 patients (53%) at 163 median days from transplant, 33 asymptomatic replication (28%) and 28 CMV disease (24%). Eleven patients (9%) had recurrent CMV infection. Clinically and/or functionally relevant single nucleotide polymorphisms (SNPs) from TLR2, TLR3, TLR4, TLR7, TLR9, AIM2, MBL2, IL28, IFI16, MYD88, IRAK2 and IRAK4 were assessed by real time polymerase chain reaction (RT-PCR) or sequence-based typing (PCR-SBT). A polygenic score including the TLR4 (rs4986790/rs4986791), TLR9 (rs3775291), TLR3 (rs3775296), AIM2 (rs855873), TLR7 (rs179008), MBL (OO/OA/XAO), IFNL3/IL28B (rs12979860) and IFI16 (rs6940) SNPs was built based on the risk of CMV infection and disease. The CMV score predicted the risk of CMV disease with an AUC of the model of 0.68, with sensitivity and specificity of 64.3 and 71.6%, respectively. Even though further studies are needed to validate this score, its use would represent an effective model to develop more robust scores predicting the risk of CMV disease in donor/recipient mismatch (D+/R-) transplant recipients

HACEK infective endocarditis: epidemiology, clinical features outcome: A case-control study

OBJECTIVES: The study aimed to describe the epidemiology, microbiological and clinical features of a population sample of 17 patients with HACEK-IE and to compare them with matched control patients with IE caused by Viridans group Streptococci (VGS-IE). METHODS: Description of definite (14; 82.2%) and possible (3; 17.6%) HACEK-IE included in the 'Infective Endocarditis Hospital Clínic of Barcelona' (IE-HCB) database between 1979 and 2016. Furthermore, a retrospective case-control analysis was performed, matching each case to three VGS-IE controls registered in the same database during the same period of time. RESULTS: Seventeen out of 1,209 IE cases (1.3%, 95%CI 0.69-1.91) were due to HACEK group. The most frequent isolated HACEK species were Aggregatibacter spp (11; 64.7%). Intracardiac vegetations were present in 70.6% of cases. Left heart failure (LHF) was present in 29.4% of cases. Ten patients (58.8%) required in-hospital surgery and none died during hospitalization. In the case-control analysis, there was a trend toward larger vegetations in the HACEK-IE group (median (IRQ) size=11.5 (10.0-20.0) mm vs 9.0 (7.0-13.0) mm; p=0.068). Clinical manifestations, echocardiographic findings, LHF rate, systemic emboli and other complications were all comparable (p >0.05). In-hospital surgery and mortality were similar for both groups. One-year mortality was lower for HACEK-IE (1/17 vs. to 6/48, p=0.006). CONCLUSIONS: HACEK-IE represented 1.3% of all IE cases. Clinical features and outcome were comparable with the VGS-IE control group. Despite the trend to

Effectiveness of vancomycin plus cloxacillin compared with vancomycin, cloxacillin and daptomycin single therapies in the treatment of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in a rabbit model of experimental endocarditis

Objectives: To investigate if the addition of cloxacillin to vancomycin enhances the activity of both monotherapies for treating MSSA and MRSA experimental endocarditis (EE) in rabbits. Methods: Vancomycin plus cloxacillin was compared with the respective monotherapies and daptomycin. In vitro time-kill studies were performed using standard (105 cfu) and high (108 cfu) inocula of five MRSA, one glycopeptide-intermediate (GISA) and five MSSA strains. One MSSA (MSSA-678) and one MRSA (MRSA-277) strain were selected to be used in the in vivo model. A human-like pharmacokinetics model was applied and the equivalents of cloxacillin 2 g/4 h IV and daptomycin 6 mg/kg/day IV were administered. To optimize vancomycin activity, dosage was adjusted to achieve an AUC/MIC ≥400. Results: Daptomycin sterilized significantly more vegetations than cloxacillin (13/13, 100% versus 9/15, 60%; P = 0.02) and showed a trend of better activity than vancomycin (10/14, 71%; P = 0.09) and vancomycin plus cloxacillin (10/14, 71%; P = 0.09) against MSSA-678. Addition of cloxacillin to vancomycin (13/15, 87%) was significantly more effective than vancomycin (8/16, 50%; P = 0.05) and showed similar activity to daptomycin (13/18, 72%; P = 0.6) against MRSA-277. In all treatment arms, the bacterial isolates recovered from vegetations were re-tested and showed the same daptomycin susceptibility as the original strains. Conclusions: Vancomycin plus cloxacillin proved synergistic and bactericidal activity against MRSA. Daptomycin was the most efficacious option against MSSA and similar to vancomycin plus cloxacillin against MRSA. In settings with high MRSA prevalence, vancomycin plus cloxacillin might be a good alternative for empirical therapy of S. aureus IE

Deciphering multiple sclerosis disability with deep learning attention maps on clinical MRI

Deep learning; Disability; Structural MRIAprendizaje profundo; Discapacidad; Resonancia magnética estructuralAprenentatge profund; Discapacitat; Ressonància magnètica estructuralThe application of convolutional neural networks (CNNs) to MRI data has emerged as a promising approach to achieving unprecedented levels of accuracy when predicting the course of neurological conditions, including multiple sclerosis, by means of extracting image features not detectable through conventional methods. Additionally, the study of CNN-derived attention maps, which indicate the most relevant anatomical features for CNN-based decisions, has the potential to uncover key disease mechanisms leading to disability accumulation. From a cohort of patients prospectively followed up after a first demyelinating attack, we selected those with T1-weighted and T2-FLAIR brain MRI sequences available for image analysis and a clinical assessment performed within the following six months (N = 319). Patients were divided into two groups according to expanded disability status scale (EDSS) score: ≥3.0 and < 3.0. A 3D-CNN model predicted the class using whole-brain MRI scans as input. A comparison with a logistic regression (LR) model using volumetric measurements as explanatory variables and a validation of the CNN model on an independent dataset with similar characteristics (N = 440) were also performed. The layer-wise relevance propagation method was used to obtain individual attention maps. The CNN model achieved a mean accuracy of 79% and proved to be superior to the equivalent LR-model (77%). Additionally, the model was successfully validated in the independent external cohort without any re-training (accuracy = 71%). Attention-map analyses revealed the predominant role of frontotemporal cortex and cerebellum for CNN decisions, suggesting that the mechanisms leading to disability accrual exceed the mere presence of brain lesions or atrophy and probably involve how damage is distributed in the central nervous system.MS PATHS is funded by Biogen. This study has been possible thanks to a Junior Leader La Caixa Fellowship awarded to C. Tur (fellowship code is LCF/BQ/PI20/11760008) by “la Caixa” Foundation (ID 100010434). The salaries of C. Tur and Ll. Coll are covered by this award

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group