Seguimiento de los conflictos derivados del secesionismo catalán

Se examina en este trabajo la tan debatida propuesta de independencia de Cataluña iniciada por el Parlamento Catalán, a través de un proceso participativo, que en realidad se ha convertido en un referéndum encubierto. Esta iniciativa se verá interrumpida, a instancia del Abogado del Estado, por los pronunciamientos de inconstitucionalidad proclamados por el Tribunal Constitucional. También es objeto de debate el derecho a decidir de los ciudadanos que debe ser examinada en el marco de la Soberanía Nacional.Grado en Derech

Modelo de gestión en TI para la optimización y automatización del proceso de servicio al ciudadano de Migración Colombia mediante la metodología BPM

La satisfacción o insatisfacción de un cliente en este caso un ciudadano, surge a partir de su experiencia con el producto y el servicio que la entidad ofrece. Con la modernización del Estado y la implantación de nuevas tecnologías de la información y la comunicación, y por ser éste un medio que el ciudadano utiliza para acercarse a la entidad se hace necesario contar con un modelo de gestión de TI que permita optimizar y automatizar el proceso de servicio al ciudadano en lo referente a la recepción, gestión interna y respuesta a solicitudes. Las entidades públicas deben tener la capacidad de rediseñar y optimizar sus procesos de manera continua, necesitando prácticas, metodologías y herramientas que les permitan mantenerse vigentes y brindar un mejor servicio al ciudadano. BPM (Business Process Management) es la administración de procesos de un negocio. Esta es una metodología que reúne técnicas y disciplinas que conjugan la estrategia, las reglas del negocio y la tecnología. La finalidad de la aplicación de BPM en una organización es conseguir agilidad, eficacia y eficiencia, con un enfoque donde se identifique, levante, modele y controle tanto procesos que se desarrollen manualmente como aquellos automatizados. Se propone integrar suites de BPM (BPMS) con los sistemas misionales para la atención de solicitudes PQRS para optimizar y el proceso de servicio al ciudadano.The satisfaction or dissatisfaction of a client, in this case a citizen, arises from their experience with the product and the service that the entity offers. With the modernization of the State and the implementation of new information and communication technologies, and since this is a means that the citizen uses to get closer to the entity, it is necessary to have an IT management model that allows optimizing and automating the Citizen service process in relation to reception, internal management and response to requests. Public entities must have the ability to continuously redesign and optimize their processes, needing practices, methodologies and tools that allow them to remain current and provide better service to citizens. BPM (Business Process Management) is the management of business processes. This is a methodology that brings together techniques and disciplines that combine strategy, business rules and the technology. The purpose of the application of BPM in an organization is to achieve agility, effectiveness and efficiency, with an approach where both processes that are developed manually and those that are automated are identified, raised, modeled and controlled. It is proposed to integrate BPM suites (BPMS) with the missionary systems for the attention of PQRS requests to optimize and the process of citizen service

Economía colaborativa: ¿Crecimiento económico o cortina de humo para ganancia de grandes multinacionales?

Ensayo de Seminario InternacionalEl presente artículo se basa en analizar los cambios generados con el pasar de los años y el incremento por parte de la población en el uso de nuevas tecnologías, conllevando a la creación e implementación de nuevas estrategias de comercio, dando un giro en la economía tradicional, lo que implica que el consumidor final tenga acceso al producto o servicio de una manera rápida, confiable y económica, sin tener que desplazarse de su lugar de residencia o trabajo, ahorrando tiempo y dinero, por ese motivo se dará enfoque a lo que se conoce como economía colaborativa.1. Resumen 2. Introducción 3. Desarrollo 4. Conclusiones 5. ReferenciasEspecializaciónEspecialista en Análisis y Administración Financier

Efectos del Período Especial en el cine cubano de los años 90

This study explored Cuban cinema of the 1990s, focusing on how films produced during the Special Period reflected the tensions and transformations within Cuban society. Cinema became a vehicle to address political, social, and cultural issues, utilizing cinematic narrative to offer a unique perspective on identity and everyday life during a period of profound change. The intended purpose was to comprehend how Cuban cinema of the 90s functioned as an artistic expression and a reflection on Cuban reality. Additionally, to elucidate how the films captured the duality between nostalgia for the past and a pessimistic perception of the present, while tackling subjects such as migration, the elderly, and human relationships in times of crisis. The conclusions reveal that Cuban cinema of the 90s challenged conventional expectations by addressing controversial themes and questioning political authority. Despite budgetary constraints, films like ‘Strawberry and Chocolate’ and ‘Guantanamera’ transcended national boundaries, resonating with global audiences and demonstrating cinema’s influence as an agent of social change. These films offered an authentic and nuanced look at Cuban reality, showcasing how adverse circumstances can inspire creativity and artistic expression while exploring and expressing the changing and challenging realities of the country. Keywords: Cuban cinema; 1990s; Special Period; Cuban society; ICAIC.Este estudio exploró el cine cubano de la década de los 90, centrándose en cómo las películas producidas durante el Período Especial reflejaron las tensiones y transformaciones de la sociedad cubana. De manera que el cine se convirtió en un vehículo para abordar cuestiones políticas, sociales y culturales, aprovechando la narrativa cinematográfica para ofrecer una perspectiva única sobre la identidad y la vida cotidiana en un período de cambios profundos. El propósito planeado fue comprender cómo el cine cubano de los 90 funcionó como una expresión artística y una reflexión sobre la realidad cubana. Asimismo, explicar cómo las películas capturaron la dualidad entre la nostalgia por el pasado y la percepción pesimista del presente, mientras abordaban temas como la migración, la tercera edad y las relaciones humanas en tiempos de crisis. Las conclusiones revelan que el cine cubano de los 90 desafió las expectativas convencionales al abordar temas polémicos y al cuestionar la autoridad política. A pesar de las limitaciones presupuestarias, las películas como “Fresa y Chocolate” y “Guantanamera” trascendieron las fronteras nacionales, resonando con audiencias globales y demostrando la influencia del cine como agente de cambio social. Estos filmes ofrecieron una mirada auténtica y matizada de la realidad cubana, mostrando cómo las circunstancias adversas pueden inspirar la creatividad y la expresión artística mientras exploran y expresan las realidades cambiantes y desafiantes del país. Palabras clave: Cine cubano; década de los 90; Período Especial; sociedad cubana; ICAIC

Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá

Introducción. Las infecciones por microorganismos resistentes, especialmente las que involucran el torrente sanguíneo, se asocian a un mayor uso de recursos. Sus estimaciones son variables y dependen de la metodología utilizada. Staphylococcus aureus es el agente de sangre aislado con mayor frecuencia en nuestro medio. No existe información sobre el costo asociado con la atención de bacteriemias por S. aureus resistente a meticilina en nuestro país. Objetivo. Presentar una aproximación del costo de atención de las bacteriemias por S. aureus resistente a la meticilina en nueve hospitales de Bogotá. Materiales y métodos. Se incluyeron 204 pacientes en un estudio de cohortes multicéntrico en una razón de 1:1 según la resistencia. Se aproximaron los costos médicos directos con base en las facturas del período de hospitalización; en cuanto al período de la bacteriemia, los costos detallados se calcularon aplicando las tarifas estandarizadas. Resultados. No se encontraron diferencias significativas en las características clínicas y demográficas de los grupos, salvo en los antecedentes de la bacteriemia. El 53 % de los sujetos falleció durante la hospitalización. La estancia y el valor total facturado por la hospitalización fueron significativamente mayores en el grupo con bacteriemia por S. aureus resistente a la meticilina, así como los costos de la estancia en cuidados intensivos, de los antibióticos, los líquidos parenterales, los exámenes de laboratorio y la terapia respiratoria. El incremento crudo del costo de la atención asociado con la resistencia a meticilina fue de 31 % y, el ajustado, de 70 %. Conclusión. Este estudio constituye un respaldo a los tomadores de decisiones para la búsqueda y la financiación de programas de prevención de infecciones causadas por microorganismos resistentes.345-353Introduction: Resistant infections, especially those involving the bloodstream, are associated with a greater use of resources. Their estimates are variable and depend on the methodology used. Staphylococcus aureus is the main pathogen isolated in blood in our hospitals. There is no consolidated data about economic implications of methicillin-resistant S. aureus infection. Objective: To describe the cost of care of methicillin-resistant S. aureus bacteremia in a reference population from nine hospitals in Bogotá. Materials y methods: A multicenter cohort study included 204 patients in a 1:1 ratio according to resistance. Direct medical costs were calculated from hospitalization bills, while the bacteremia period was calculated by applying microcosting based on standard fares. Results: We found no significant differences between groups in demographic and clinical characteristics, except for resistance risk factors. Fifty-three percent of patients died during hospitalization. Hospital stay and total invoiced value during hospitalization were significantly higher in the group with methicillinresistant S. aureus bacteremia. For this group, higher costs in ICU stay, antibiotics use, intravenous fluids, laboratory tests and respiratory support were recorded. A crude increase of 31% and an adjusted increase of 70% in care costs associated with methicillin resistance were registered. Conclusion: Our study supports decision makers in finding and funding infection prevention programs, especially those infections caused by resistant organisms

Mortality among critically ill patients with methicillin-resistant Staphylococcus aureus bacteremia: a multicenter cohort study in Colombia

343-50Objective. To evaluate risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia emergence, its prognosis, and mortality-determining factors in critically ill patients in Colombia. Methods. A multicenter, retrospective cohort study conducted in 2005–2008 at 16 public and private reference health care institutions in Bogotá, Colombia, that form part of a national epidemiological surveillance network and a hospital network with 4 469 beds. Methicillinresistant emergence and mortality were analyzed using descriptive and time-to-event analysis; a multivariate Cox proportional hazard regression model was built to test the association between methicillin resistance and mortality. Results. A total of 372 patients were studied: 186 with MRSA bacteremia, randomly matched with 186 with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. Previous surgery, antibiotic exposure, and hospital-acquired infections were independently associated with methicillin resistance. MRSA caused longer hospital stays among survivors (median 24 versus 18 days, P = 0.014). Mortality predictors were: patient age, creatinine level over 1.21mg/dl at ICU admission, severe sepsis, and inotropic requirement. Appropriate antimicrobial therapy and antimicrobial therapy change were independent protective factors, as was male gender. Conclusions. Methicillin resistance per se was not a mortality-independent prognostic factor. Previous conditions, such as age, baseline renal impairment, severe sepsis, and inotropy demand explained the observed mortality. Appropriate antimicrobial therapy remained a protective factor. A call to improve infection control measures in Colombia is mandatory

Regulatory sites for splicing in human basal ganglia are enriched for disease-relevant information

Genome-wide association studies have generated an increasing number of common genetic variants associated with neurological and psychiatric disease risk. An improved understanding of the genetic control of gene expression in human brain is vital considering this is the likely modus operandum for many causal variants. However, human brain sampling complexities limit the explanatory power of brain-related expression quantitative trait loci (eQTL) and allele-specific expression (ASE) signals. We address this, using paired genomic and transcriptomic data from putamen and substantia nigra from 117 human brains, interrogating regulation at different RNA processing stages and uncovering novel transcripts. We identify disease-relevant regulatory loci, find that splicing eQTLs are enriched for regulatory information of neuron-specific genes, that ASEs provide cell-specific regulatory information with evidence for cellular specificity, and that incomplete annotation of the brain transcriptome limits interpretation of risk loci for neuropsychiatric disease. This resource of regulatory data is accessible through our web server, http://braineacv2.inf.um.es/

Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019 : A systematic analysis for the Global Burden of Disease Study 2019

Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC