Evaluación de políticas y planes de salud

ResumenLa evaluación de los planes y de las políticas es un elemento clave de su gestión, y ha de hacerse en condiciones reales, las mismas en que se desarrollan los planes o las políticas que se desea evaluar. Como las políticas o los planes suelen incluir un conjunto de componentes que operan simultáneamente, y con frecuencia hay factores ajenos que afectan a los problemas que se quieren abordar con su actuación, su evaluación es compleja. De otro modo, una política efectiva que está reduciendo los efectos de un problema puede ser juzgada como inefectiva (si el problema crece por efecto de otros factores que el programa no pretende abordar), o una política que no consigue modificar el problema que la justifica puede ser juzgada como útil (si la magnitud del problema se reduce independientemente de la política por el efecto de otros factores). Este trabajo aborda la evaluación de políticas, planes o programas complejos de salud, con énfasis en la evaluación de su efectividad, utilizando datos de ejemplos reales. Entre otros aspectos, se revisa la necesidad de identificar los componentes de las políticas y de los planes. Además, se aborda cómo realizar la evaluación del producto o de los resultados del programa mediante indicadores procedentes de otras fuentes. Se valoran aspectos ligados a los plazos e indicadores para la evaluación. Se discute la situación planteada cuando la puesta en marcha de una política o de una intervención se acompaña de un incremento en la magnitud registrada del problema que se pretende abordar, valorando casos en que es atribuible a mejoras en la detección del problema y otros en que se debe a factores ajenos a la intervención. Se comenta la frecuente confusión de efectos entre intervención y otros sucesos, con ejemplos. Finalmente, se cubre también la evaluación de planes que incluyen una amplia variedad de objetivos.AbstractEvaluation of plans and policies is a key element in their administration and must be performed under real conditions. Such evaluation is complex, as plans and policies include a diverse set of components that operate simultaneously. Moreover, external factors frequently influence those same issues that programs attempt to change. Unless plans and policies are evaluated under real conditions, a policy that effectively reduces the effects of a problem may be deemed ineffective (if the problem increases due to the influence of factors the program does not attempt to affect), or a policy that is unable to influence the problem it attempts to solve may be judged useful (if the magnitude of the problem is being reduced through the influence of factors other than the policy). The present article discusses evaluation of health policies, plans or complex programs, with emphasis on effectiveness assessment, using data from real examples. Among other issues, the need to identify the distinct components of policies and plans is reviewed. This article also describes how to evaluate the outcome or results of a program with indicators from other sources. Aspects related to the timing of evaluation and assessment indicators are analyzed. We discuss situations in which the launch of a new policy or intervention is followed by an increase in the reported magnitude of the problem it attempts to solve. These situations are illustrated by cases in which this increase is attributable to improved detection and by others in which the increase is related to factors external to the intervention. The frequent confusion of the effects of the intervention with other events is covered, with data from some examples. Finally, evaluation of plans that include a wide range of objectives is also addressed

Opportunities to accelerate extracellular vesicle research with cell-free synthetic biology

Extracellular vesicles (EVs) are lipid-membrane nanoparticles that are shed or secreted by many different cell types. The extracellular vesicle (EV) research community has rapidly expanded in recent years and are leading efforts to deepen our understanding of EV biological functions in human physiology and pathology. These insights are also providing a foundation on which future EV-based diagnostics and therapeutics are poised to positively impact human health. However, current limitations in our understanding of EV heterogeneity, cargo loading mechanisms and the nascent development of EV metrology are all areas that have been identified as important scientific challenges. The field of synthetic biology is also contending with the challenge of understanding biological complexity as it seeks to combine multidisciplinary scientific knowledge with engineering principles, to build useful and robust biotechnologies in a responsible manner. Within this context, cell-free systems have emerged as a powerful suite of in vitro biotechnologies that can be employed to interrogate fundamental biological mechanisms, including the study of aspects of EV biogenesis, or to act as a platform technology for medical biosensors and therapeutic biomanufacturing. Cell-free gene expression (CFE) systems also enable in vitro protein production, including membrane proteins, and could conceivably be exploited to rationally engineer, or manufacture, EVs loaded with bespoke molecular cargoes for use in foundational or translational EV research. Our pilot data herein, also demonstrates the feasibility of cell-free EV engineering. In this perspective we discuss the opportunities and challenges for accelerating EV research and healthcare applications with cell-free synthetic biology

Structural and Lattice-Dynamical Properties of Tb2O3 under Compression: A Comparative Study with Rare Earth and Related Sesquioxides

[EN] We report a joint experimental and theoretical investigation of the high pressure structural and vibrational properties of terbium sesquioxide (Tb2O3). Powder X-ray diffraction and Raman scattering measurements show that cubic Ia (3 ) over bar (C-type) Tb2O3 undergoes two phase transitions up to 25 GPa. We observe a first irreversible reconstructive transition to the monoclinic C2/m (B-type) phase at similar to 7 GPa and a subsequent reversible displacive transition from the monoclinic to the trigonal P (3) over bar m1 (A-type) phase at similar to I-2 GPa. Thus, Tb2O3 is found to follow the well- known C -> B -> A phase transition sequence found in other cubic rare earth sesquioxides with cations of larger atomic mass than Tb. Our ab initio theoretical calculations predict phase transition pressures and bulk moduli for the three phases in rather good agreement with experimental results. Moreover, Raman-active modes of the three phases have been monitored as a function of pressure, while lattice-dynamics calculations have allowed us to confirm the assignment of the experimental phonon modes in the C- and A-type phases as well as to make a tentative assignment of the symmetry of most vibrational modes in the B-type phase. Finally, we extract the bulk moduli and the Raman-active mode frequencies together with their pressure coefficients for the three phases of Tb2O3 . These results are thoroughly compared and discussed in relation to those reported for rare earth and other related sesquioxides as well as with new calculations for selected sesquioxides. It is concluded that the evolution of the volume and bulk modulus of all the three phases of these technologically relevant compounds exhibit a nearly linear trend with respect to the third power of the ionic radii of the cations and that the values of the bulk moduli for the three phases depend on the filling of the f orbitals.The authors are thankful for the financial support of Generalitat Valenciana under Project PROMETEO 2018/123-EFIMAT and of the Spanish Ministerio de Economia y Competitividad under Projects MAT2015-71035-R, MAT2016-75586-C4-2/3/4-P, and FIS2017-2017-83295-P as well as MALTA Consolider Team research network under project RED2018-102612-T. J.A.S. also acknowledges the Ramon y Cajal program for funding support through RYC-2015-17482. A.M. and P.R.-H. acknowledge computing time provided by Red Española de Supercomputación (RES) and the MALTA Consolider Team cluster. HP-XRD experiments were performed at MPSD beamline of Alba Synchrotron (experiment no. 2016071772). We would like to thank Oriol Blázquez (Universitat de Barcelona) for his contribution to the Raman measurements.Ibañez, J.; Sans-Tresserras, JÁ.; Cuenca-Gotor, VP.; Oliva, R.; Gomis, O.; Rodríguez-Hernández, P.; Muñoz, A.... (2020). Structural and Lattice-Dynamical Properties of Tb2O3 under Compression: A Comparative Study with Rare Earth and Related Sesquioxides. Inorganic Chemistry. 59(14):9648-9666. https://doi.org/10.1021/acs.inorgchem.0c00834S964896665914Pan, T.-M., Chen, F.-H., & Jung, J.-S. (2010). Structural and electrical characteristics of high-k Tb2O3 and Tb2TiO5 charge trapping layers for nonvolatile memory applications. Journal of Applied Physics, 108(7), 074501. doi:10.1063/1.3490179Kao, C. H., Liu, K. C., Lee, M. H., Cheng, S. N., Huang, C. H., & Lin, W. K. (2012). High dielectric constant terbium oxide (Tb2O3) dielectric deposited on strained-Si:C. Thin Solid Films, 520(8), 3402-3405. doi:10.1016/j.tsf.2011.10.173Gray, N. W., Prestgard, M. C., & Tiwari, A. (2014). 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Standardized Outcome Measurement for Patients With Coronary Artery Disease: Consensus From the International Consortium for Health Outcomes Measurement (ICHOM)

Coronary artery disease (CAD) outcomes consistently improve when they are routinely measured and provided back to physicians and hospitals. The International Consortium for Health Outcomes Measurement (ICHOM) established a Working Group to define a standard set of outcome measures and risk factors of CAD care. Members were drawn from 4 continents and 6 countries. Using a modified Delphi method, the Group defined who should be tracked, what should be measured, and when such measurements should be performed. Thirteen specific outcomes were chosen, including acute complications occurring within 30 days of acute myocardial infarction, coronary artery bypass grafting surgery, or percutaneous coronary intervention; and longitudinal outcomes for up to 5 years for patient‐reported health status (Seattle Angina Questionnaire [SAQ‐7], elements of Rose Dyspnea Score, and Patient Health Questionnaire [PHQ‐2]), cardiovascular hospital admissions, cardiovascular procedures, renal failure, and mortality. Baseline demographic, cardiovascular disease, and comorbidity information is included to improve the interpretability of comparisons

Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network

Objectives: To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart). Design Cost-utility analysis. Setting: The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people. Participants: Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries. Outcome measures costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140). Results: A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from 8306 to 7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of 4355 per life saved (30-day mortality) and 495 per QALY. Below a cost threshold of 30,000, results were sensitive to variations in costs and outcomes. Conclusions: The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios

Pressure-induced amorphization of YVO4:Eu3+ nanoboxes

This is an author-created, un-copyedited version of an article published in Nanotechnology. IOP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from it. The Version of Record is available online at http://dx.doi.org/10.1088/0957-4484/27/2/025701A structural transformation from the zircon-type structure to an amorphous phase has been found in YVO4:Eu3+ nanoboxes at high pressures above 12.7 GPa by means of x-ray diffraction measurements. However, the pair distribution function of the high-pressure phase shows that the local structure of the amorphous phase is similar to the scheelite-type YVO4. These results are confirmed both by Raman spectroscopy and Eu3+ photoluminescence which detect the phase transition to a scheelite-type structure at 10.1 and 9.1 GPa, respectively. The irreversibility of the phase transition is observed with the three techniques after a maximum pressure in the upstroke of around 20 GPa. The existence of two D-5(0)-> F-7(0) photoluminescence peaks confirms the existence of two local environments for Eu3+, at least for the low-pressure phase. One environment is the expected for substituting Y3+ and the other is likely a disordered environment possibly found at the surface of the nanoboxes.This work has been performed under financial support from Spanish MINECO under the National Program of Materials (MAT2013-46649-C4-1/2/3/4-P) and the Consolider-Ingenio 2010 Program (MALTA CSD2007-00045). Funding by the Fundacion Caja Canarias (ENER-01) and the EU-FEDER funds is also acknowledged. JR-F thanks the Alexander von Humboldt Foundation for a postdoctoral fellowship and NS thanks the German Research Foundation (DFG) for financial support (Project RA2585/1-1). We acknowledge Diamond Light Source for time on beamline I15 under proposals EE3652 and EE6517. 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