IGO 3.0 Attribution-NonCommercial-NoDerivatives (CC-IGO BY-NC-ND 3.0 IGO) license (https:// creativecommons.org/licenses/by-nc-nd/3.0/igo/legalcode) and may be reproduced with attribution to the IDB and for any non-commercial purpose. No derivative work is allowed.Any dispute related to the use of the works of the IDB that cannot be settled amicably shall be submitted to arbitration pursuant to the UNCITRAL rules. The use of the IDB's name for any purpose other than for attribution, and the use of the IDB's logo shall be subject to a separate written license agreement between the IDB and the user and is not authorized as part of this CC-IGO license.Note that the link provided above includes additional terms and conditions of the license. Our special thanks also go to each of the officials and authorities of the institutions providing the services for being part of this project, sharing the information on the services, and reviewing the records that summarize the information (Annex 9 contains a list of participating institutions). We are also indebted to Jonas Rabinovitch (United Nations) and Santiago Croci (The World Bank) for their great help and their comments on the draft version. What we do know is that Latin American citizens are generally dissatisfied. Their frustrated expectations are reflected in persistent complaints about public services in recent years. Citizens have growing expectations about the quality of these services and the integrity of the actions of public institutions. They are more demanding and better informed; at the same time, they have higher expectations of the quality of public services that the state must provide and of integrity in the management of public resources. This is due, in part, to the growth of the middle class and an ever more digitized society, born in democracy, which requires immediate solutions. It is not about spending more, but spending better.The economic slowdown affecting Latin America and the Caribbean (LAC) makes the task of improving the efficiency of public spending and the quality of public services even more urgent. This urgency is even more intense in times of fiscal austerity and budgetary constraints. It is therefore crucial to innovate and leverage technological innovations with a view to digitizing and simplifying public procedures. Innovation has to be at the heart of the reinvention of the modern state and the modernization of the public administration, above all because LAC is a region where the degree of institutional development does not match economic development and where middle-income emerging economies predominate.In this context, the state's actions need to focus on citizens. The exhaustion of public management models constructed under the traditional logic of Weberian bureaucracy are being experienced. The "fourth revolution" of reinventing the state, which John Micklethwait and Adrian Wooldridge wrote about, represents a real Copernican revolution for bureaucracy that goes beyond the managerial revolution of "new public management." In th...
Since the last century, several geological and geophysical studies have been developed in the Santiago Basin to understand its morphology and tectonic evolution. However, some uncertainties regarding sedimentary fill properties and possible density anomalies below the sediments/basement boundary remain. Considering that this is an area densely populated with more than 6 million inhabitants in a highly active seismotectonic environment, the physical properties of the Santiago Basin are important to study the geological and structural evolution of the Andean forearc and to characterize its seismic response and related seismic hazard. Two and three‐dimensional gravimetric models were developed, based on a database of 797 compiled and 883 newly acquired gravity stations. To produce a well‐constrained basement elevation model, a review of 499 wells and 30 transient electromagnetic soundings were used, which contribute with basement depth or minimum sedimentary thickness information. For the 2‐D modelling, a total of 49 gravimetric profiles were processed considering a homogeneous density contrast and independent regional trends. A strong positive gravity anomaly was observed in the centre of the basin, which complicated the modelling process but was carefully addressed with the available constrains. The resulting basement elevation models show complex basement geometry with, at least, eight recognizable depocenters with maximum sedimentary infill of ~ 500 m. The 3‐D density models show alignments in the basement that correlates well with important intrusive units of the Cenozoic and Mesozoic. Along with interpreted fault zones westwards and eastwards of the basin, the observations suggest a structural control of Santiago basin geometry, where recent deformation associated with the Andean contractional deformation front and old structures developed during the Cenozoic extension are superimposed to the variability of river erosion/deposition processes.
ObjectiveThe appropriate management of patients with Dravet Syndrome (DS) is challenging, given the severity of symptoms and the burden of the disease for patients and caregivers. This study aimed to identify, through a qualitative methodology and a Delphi consensus-driven process, a set of recommendations for the management of DS to guide clinicians in the assessment of the clinical condition and quality of life (QoL) of DS patients, with a special focus on patient- and caregiver-reported outcomes (PROs).MethodsThis study was conducted in five phases, led by a multidisciplinary scientific committee (SC) including pediatric neurologists, epileptologists, a neuropsychologist, an epilepsy nurse, and members of DS patient advocates. In phases 1 and 2, a questionnaire related to patients' QoL was prepared and answered by caregivers and the SC. In phase 3, the SC generated, based on these answers and on a focus group discussion, a 70-item Delphi questionnaire, covering six topic categories on a nine-point Likert scale. In phase 4, 32 panelists, from different Spanish institutions and with a multidisciplinary background, answered the questionnaire. Consensus was obtained and defined as strong or moderate if ≥80% and 67–79% of panelists, respectively, rated the statement with ≥7. Phase 5 consisted of the preparation of the manuscript.ResultsThe panelists agreed on a total of 69 items (98.6%), 54 (77.14%), and 15 (21.43%) with strong and moderate consensus, respectively. The experts' recommendations included the need for frequent assessment of patient and caregivers QoL parameters. The experts agreed that QoL should be assessed through specific questionnaires covering different domains. Likewise, the results showed consensus regarding the regular evaluation of several clinical parameters related to neurodevelopment, attention, behavior, other comorbidities, and sudden unexpected death in epilepsy (SUDEP). A consensus was also reached on the instruments, specific parameters, and caregivers' education in the routine clinical management of patients with DS.ConclusionsThis consensus resulted in a set of recommendations for the assessment of clinical and QoL parameters, including PROs, related to the general evaluation of QoL, neurodevelopment, attention, behavior, other comorbidities affecting QoL, SUDEP, and QoL of caregivers/relatives and patients with DS.
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