Digital Transformation and Local Government Response to the COVID-19 Pandemic: An Assessment of Its Impact on the Sustainable Development Goals.

This paper analyzes how Digital Transformation (DT) processes have influenced the Attitude of local governments (LGs) toward the COVID-19 pandemic and their effect on achieving the United Nations' Sustainable Development Goals (SDGs). The data were collected from LGs in Spain (n = 124) through a questionnaire in which the IT skills of their workers, the DT processes, budgets, degree of regulatory compliance, and implementation of trust seals were measured, together with the IT security measures adopted. The contrast between the proposed model and the results showed that the direct influence of IT security influences the government's attitude toward COVID-19 and DT implementing actions to achieve SDGs. The findings of this work are of great value both for the actors involved in the design and implementation of public policies and for those responsible for local governance in their objective to improve citizens' experience of the services provided and in exceptional situations such as the one experienced as a result, of-COVID-19.

Anterior release of elbow flexion contractures in children with obstetrical brachial plexus lesions.

PURPOSE: A flexion contracture of the elbow is common in upper obstetric brachial plexus palsy. One less than 30° involves no major aesthetic or functional abnormalities, whereas for one greater than 30°, conservative treatment with serial splints produces variable results. We evaluated anterior release of the elbow with partial tenotomy of the anterior brachialis muscle and of the biceps, for their effect on elbow flexion contractures. METHODS: We performed 10 anterior releases of the elbow with lengthening of the distal tendons of the biceps and the anterior brachialis muscle. All patients had upper obstetric brachial plexus palsies (C5-C6) and elbow flexion contractures of 35° or greater (range, 35° to 60°). The flexion strength of the elbow was 4 or higher on the British Medical Research Council scale, and the patients had no bone abnormalities in the elbow region. RESULTS: After a mean follow-up period of 3 years, the mean gain in extension was 28° (range, 20° to 35°). All patients maintained flexion strength. Elbow extension was 2° less than obtained at surgery and was maintained during follow-up. All patients were satisfied or very satisfied, and none presented major complications, except hypertrophic scarring to a greater or lesser extent at the incision site. CONCLUSIONS: Anterior release of the elbow is a useful method for treating elbow flexion contractures of more than 35° and can reduce the deformity to bring it within functional range without compromising flexion. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Coastal fish farms are settlement sites for juvenile fish.

Two south-west Mediterranean fish farms were monitored over a period of 22 months to test if sea-cage fish farms act as settlement habitats for juvenile fish. Twenty juvenile fish species were found to settle at farms throughout the year. Fish assemblage composition varied markedly over time and was dependent on the spawning period for each species. The most abundant species were Obladamelanura, Atherina sp., Diplodussargus, Boopsboops and Lizaaurata. Up to 3783+/-1730 individuals/cage were found closely associated with the cages. Highest densities were observed during the warmer summer and autumn months. Zooplankton sampling and stomach content analyses of the most abundant species were done to assess prey availability, selectivity and diet overlap among species. Copepods were the main prey item for all juvenile fish species, irrespective of fish size. Ivlev's Index indicated that food was not a limiting factor for juvenile fish at farms. Furthermore, food pellets from the farm affected the food chain by modifying the fatty acid profiles of farm-associated zooplankton and juveniles of L. aurata and O. melanura. These results show that aquaculture can directly influence the body composition of juvenile fish that recruit to sea-cage fish farms.

Self-assembly in two-dimensions of colloidal particles at liquid mixtures.

The aim of this work is to simulate the formation of colloidal rings, circular clusters, and voids induced by oily lenses at the air-water interface. The presence of two liquids with different surface tension leads to the formation of a nonhomogeneous interface. In this case, the total interaction potential is assumed to be composed of only two terms; the first one is due to the (repulsive) pairwise dipolar force between partly immersed charged microspheres, whereas the second depends on the position of the particle at the interface and is connected to the interfacial stress caused by the difference of surface tension between both liquids. This simple potential is able to reproduce the experimental rings, circular clusters and voids found by different authors.

Gestión de riesgos y seguridad de los pacientes en Atención Primaria. Identificación de riesgos / Health risk management and patient safety in Primary Care. Risk identification

Introducción. Las reclamaciones por efectos adversos en Atención Primaria ya son frecuentes. Un objetivo fundamental de la gestión de riesgos sanitarios es conseguir la máxima seguridad de los pacientes; por ello, el conocimiento de los efectos adversos reclamados es de sumo interés. Objetivo. Identificar los problemas y situaciones de riesgo que dieron lugar a las reclamaciones patrimoniales durante 1995-2001 al Insalud, en el ámbito de la Atención Primaria. Material y método. Es un estudio observacional, descriptivo, transversal. Un grupo de expertos clínicos analizó los 460 expedientes reclamados. El análisis estadístico fue realizado con SPSS versión 11 y S-PLUS versión 6.0. Resultados. La edad media de los perjudicados era de 42,80 años, predominando el sexo masculino (53 %) y el medio rural (52 %) sobre el urbano; el fallecimiento del paciente constaba en el 40,60 % de los expedientes; el hecho causal ocurrió en la consulta (54,60 %) y en el horario de urgencias (39,20 %). La calidad de los registros clínicos se consideró inaceptable en el 58 % de los casos. Los errores de diagnóstico (62,8 %) y los errores en la técnica empleada (42,4 %: inyectables, extravasaciones) constituyen los motivos más frecuentes de reclamación Los médicos son los profesionales más implicados (74,70 %). Los inspectores médicos consideraron como praxis no adecuada (total o parcialmente) en el 16 % de las reclamaciones; los peritos de la compañía aseguradora en el 24,50 %; el grupo de expertos en el 37 %. Discusión. La escasa calidad técnica de la documentación clínica, el elevado porcentaje de fallecimientos recogidos en las reclamaciones y el alto número de ellas sin daño clínico son datos destacables

Introduction. Claims due to adverse effects in primary health care are frequent yet. One basic objective of risk health management is to obtain the mayor safety for patients, so the knowledge of the adverse effects demanded is of enormous importance. Objective. To Identify problems and/or risk situations originated patrimonial claims over 1995-2001 period against Insalud, in the Primary Care level. Material and method. An observational, descriptive, transversal, study. A clinical experts team analysed the 460 administrative dossiers. The statistic analysis was made with the SPSS version 11 and S-Plus version 6.0 programs. Results. The mean age of affected was 42.80 years, prevailing the male sex (53 %) and the rural sites (52 %) over urban one; death of patient was present in the 40.60 %; the causal fact of claim occurred in the surgery hours (54.60 %) and in the emergency hours (39.20 %). The quality of clinic dossiers was considered unacceptable in 58 % of analysed cases. Diagnostic errors (62.80 %) and errors in the applied technology (42.40 %) were the most frequent causes and motives of claim. Doctors are the professionals most involved (74.70 %). Medical Inspectors found practice not adequate (total o partial) in 16 % of dossiers; experts of insurance company in 24.50 % of it. The expert team found not adequate praxis in 37 %. Discussion. The very low technical quality of clinical dossiers, the high percentage of deceased patients and the high number of claims without clinical harm are noticeable facts

La transferencia de riesgos en el Sistema Nacional de Salud: el aseguramiento de la responsabilidad patrimonial. Problemas y opciones / The risk transfer in the National Healthcare System: the liability insurance. Problems and options

El aseguramiento de la responsabilidad profesional e institucional es la forma más habitual de transferir los riesgos económicos derivados de la actividad sanitaria. El mercado asegurador presenta actualmente ciertas características que determinan una denominada "crisis aseguradora", que combina aspectos relacionados con la demanda y con la oferta: el constante incremento de las reclamaciones y de su coste; la tolerancia "cero" de la población en la aparición de resultados no esperados; el incremento de las primas de las pólizas, la reducción de garantías de las mismas; el largo período que tardan en resolverse las reclamaciones; la disminución de los rendimientos financieros de las aseguradoras; la necesidad de las compañías de financiar los costes con las primas de las pólizas; el abandono del sector de compañías aseguradoras fuertes, como el paradigmático abandono de la aseguradora St Paul. Muchos países están introduciendo modificaciones legales que pretenden modificar esta situación. En España los incrementos de las primas en los últimos 9 años oscilan entre casi el 500 % y el 700 % en el ámbito de gestión del extinguido Instituto Nacional de la Salud (INSALUD); actualmente, las pólizas del sistema sanitario público sobrepasan los 70 millones de euros anuales, e incorporan un aumento de las cláusulas de exclusión y del importe de las franquicias. La regulación de la responsabilidad patrimonial de las Administraciones Públicas hace secundaria la contratación de estos seguros, proponiéndose diversas opciones que podrían bien eliminar la conveniencia de su contratación, bien enlentecer la escalada de los precios de este tipo de pólizas

The insurance of professional and institutional responsability is the most customary form to transfer the economic risks arising from malpractice liability. This insurance market presents some characteristics building an "insurance crisis", mixing aspects related to the demand and to the offer: a steady rise in the claims number and cost, the "zero tolerance" of people towards the adverse events, the policy 's constant rise premiums, the diminishing policy's underwriting, the strong insurance companies leaving the sector, notably The St Paul. A lot of countries are implementing legal changes intended to modified the present status. In Spain, in the last nine years, the increase in the policy's price, in the extinguished Instituto Nacional de la Salud (INSALUD), were between almost 500 % and the 700 %; in this moment, the cost of the public healthcare system liability policies are over seventy million Euro per year, and an increased number of exclusion clauses as well as deductibles are included. The Spanish regulations of the objective responsability of public administration made the insurance contract not necessary, proposing some other different possibilities to get down the policy's cost

A family of driving forces to suppress chaos in jerk equations: Laplace domain design.

A family of driving forces is discussed in the context of chaos suppression in the Laplace domain. This idea can be attained by increasing the order of the polynomial in the expressions of the driving force to account for the robustness and/or the performance of the closed loop. The motivation arises from the fact that chaotic systems can be controlled by increasing the order of the Laplace controllers even to track arbitrary orbits. However, a larger order in the driving forces can induce an undesirable frequency response, and the control efforts can result in either peaking or large energy accumulation. We overcame these problems by showing that considering the frequency response (interpreted by norms), the closed-loop execution can be improved by designing the feedback suppressor in the Laplace domain. In this manner, the stabilization of the chaotic behavior in jerk-like systems is achieved experimentally. Jerk systems are particularly sensitive to control performance (and robustness issues) because the acceleration time-derivative is involved in their models. Thus, jerky systems are especially helped by a robust control design.

Two-dimensional colloidal aggregation: concentration effects.

Extensive numerical simulations of diffusion-limited (DLCA) and reaction-limited (RLCA) colloidal aggregation in two dimensions were performed to elucidate the concentration dependence of the cluster fractal dimension and of the different average cluster sizes. Both on-lattice and off-lattice simulations were used to check the independence of our results on the simulational algorithms and on the space structure. The range in concentration studied spanned 2.5 orders of magnitude. In the DLCA case and in the flocculation regime, it was found that the fractal dimension shows a linear-type increase with the concentration phi, following the law: d(f)=d(fo)+aphi(c). For the on-lattice simulations the fractal dimension in the zero concentration limit, d(fo), was 1.451+/-0.002, while for the off-lattice simulations the same quantity took the value 1.445+/-0.003. The prefactor a and exponent c were for the on-lattice simulations equal to 0.633+/-0.021 and 1.046+/-0.032, while for the off-lattice simulations they were 1.005+/-0.059 and 0.999+/-0.045, respectively. For the exponents z and z', defining the increase of the weight-average (S(w)(t)) and number-average (S(n)(t)) cluster sizes as a function of time, we obtained in the DLCA case the laws: z=z(o)+bphi(d) and z'=z'(o)+b'phi(d'). For the on-lattice simulations, z(o), b, and d were equal to 0.593+/-0.008, 0.696+/-0.068, and 0.485+/-0.048, respectively, while for the off-lattice simulations they were 0.595+/-0.005, 0.807+/-0.093, and 0.599+/-0.051. In the case of the exponent z', the quantities z'(o), b', and d' were, for the on-lattice simulations, equal to 0.615+/-0.004, 0.814+/-0.081, and 0.620+/-0.043, respectively, while for the off-lattice algorithm they took the values 0.598+/-0.002, 0.855+/-0.035, and 0.610+/-0.018. In RLCA we have found again that the fractal dimension, in the flocculation regime, shows a similar linear-type increase with the concentration d(f)=d(fo)+aphi(c), with d(fo)=1.560+/-0.004, a=0.342+/-0.039, and c=1.000+/-0.112. In this RLCA case it was not possible to find a straight line in the log-log plots of S(w)(t) and S(n)(t) in the aggregation regime considered, and no exponents z and z' were defined. We argue however that for sufficiently long periods of time the cluster averages should tend to those for DLCA and, therefore, their exponents should coincide with z and z' of the DLCA case. Finally, we present the bell-shaped master curves for the scaling of the cluster size distribution function and their evolution when the concentration increases, for both the DLCA and RLCA cases.