RESUMO Objetivo: Investigar a aplicabilidade do Índice de Oxigenação Respiratória para identificar o risco de falha de cânula nasal de alto fluxo em pacientes com pneumonia. Métodos: Este estudo retrospectivo observacional de 2 anos foi realizado em um hospital de referência em Bogotá, na Colômbia. Incluíram-se no estudo todos os pacientes em que foi utilizada cânula nasal de alto fluxo pós-extubação como terapia-ponte para a extubação. O Índice de Oxigenação Respiratória foi calculado para avaliar o risco de falha pós-extubação de cânula nasal de alto fluxo. Resultados: Incluíram-se no estudo 162 pacientes. Destes, 23,5% apresentaram falha de cânula nasal de alto fluxo. O Índice de Oxigenação Respiratória foi significativamente menor em pacientes que tiveram falha de cânula nasal de alto fluxo. A mediana (IQ 25 - 75%) foi de 10,0 (7,7 - 14,4) versus 12,6 (10,1 - 15,6), com p = 0,006. O Índice de Oxigenação Respiratória > 4,88 apresentou razão de chances bruta de 0,23 (IC95% 0,17 - 0,30) e RC ajustada de 0,89 (IC95% 0,81 - 0,98) estratificada por gravidade e comorbidade. Após a análise de regressão logística, o Índice de Oxigenação Respiratória apresentou razão de chances ajustada de 0,90 (IC95% 0,82 - 0,98; p = 0,026). A área sob a curva Receiver Operating Characteristic para falha de extubação foi de 0,64 (IC95% 0,53 - 0,75; p = 0,06). O Índice de Oxigenação Respiratória não apresentou diferenças entre pacientes que sobreviveram e que morreram durante internação na unidade de terapia intensiva. Conclusão: O Índice de Oxigenação Respiratória é uma ferramenta acessível para identificar pacientes em risco de falha no tratamento pós-extubação com cânulas nasais de alto fluxo. Estudos prospectivos são necessários para ampliar a utilidade nesse cenário.

ABSTRACT Objective: To investigate the applicability of the Respiratory Rate-Oxygenation Index to identify the risk of high-flow nasal cannula failure in post-extubation pneumonia patients. Methods: This was a 2-year retrospective observational study conducted in a reference hospital in Bogotá, Colombia. All patients in whom post-extubation high-flow nasal cannula therapy was used as a bridge to extubation were included in the study. The Respiratory Rate-Oxygenation Index was calculated to assess the risk of post-extubation high-flow nasal cannula failure. Results: A total of 162 patients were included in the study. Of these, 23.5% developed high-flow nasal cannula failure. The Respiratory Rate-Oxygenation Index was significantly lower in patients who had high-flow nasal cannula failure [median (IQR): 10.0 (7.7 - 14.4) versus 12.6 (10.1 - 15.6); p = 0.006]. Respiratory Rate-Oxygenation Index > 4.88 showed a crude OR of 0.23 (95%CI 0.17 - 0.30) and an adjusted OR of 0.89 (95%CI 0.81 - 0.98) stratified by severity and comorbidity. After logistic regression analysis, the Respiratory Rate-Oxygenation Index had an adjusted OR of 0.90 (95%CI 0.82 - 0.98; p = 0.026). The area under the Receiver Operating Characteristic curve for extubation failure was 0.64 (95%CI 0.53 - 0.75; p = 0.06). The Respiratory Rate-Oxygenation Index did not show differences between patients who survived and those who died during the intensive care unit stay. Conclusion: The Respiratory Rate-Oxygenation Index is an accessible tool to identify patients at risk of failing high-flow nasal cannula post-extubation treatment. Prospective studies are needed to broaden the utility in this scenario.

Although the principle of transparency and openness is not new, recent years have brought increased attention to the need for greater government and private sector accountability driven mostly by the open government, smart disclosure and open data movements. But opening data in the government and private sectors brings about a set of challenges that need to be mitigated if we are to achieve greater information access. This paper aims to contribute to a better understanding of the challenges and motivations for data disclosure in the private sector. We used the sustainable coffee supply chain as a case study, gathering data through a workshop and a series of interviews with coffee supply chain participants and other stakeholders. We identified five challenges and six motivating factors facing data producers along the supply chain. These challenges and motivating factors can be further classified into four areas: market dynamics, information policies, data challenges, and technological capability. We believe that these findings can be generalized to inform discussion and policy design in other market areas. The paper concludes with a proposal for possible future steps to promote openness and innovation in the private sector.

This paper presents a model of a reinforcing feedback structure that clarifies the role of project collaboration in a project for the development of trust. The feedback structure is grounded in data derived from a project where a prototype system was built, and is consistent with the literature on trust, collaboration and diffusion of innovation. Four feedback processes are identified at the core of the development of trust and collaboration, two of them reinforcing in nature, and two of them counterbalancing in nature. Experiments with the model suggest that the initiation of a collaborative project with a new partner may have a potentially slow start due to lack of knowledge about the other parties. Initiation of the collaboration could be accelerated by shaping expectations of benefits or by reducing the perception of risk associated with the project.

Este artículo presenta un modelo rico en retroalimentación que aclara el papel de la colaboración en un proyecto para el desarrollo de la confianza. La estructura de retroalimentación se fundamenta en datos de un proyecto en el que se construyó un sistema prototipo, y es consistente con la literatura que estudia confianza, colaboración y difusión de la innovación. Se identifican cuatro procesos de retroalimentación en el núcleo del desarrollo de confianza y colaboración, dos de ellos son ciclos de refuerzo y los otros dos son ciclos de balance. Experimentos con el modelo sugieren que al iniciar un proyecto de colaboración con un nuevo socio, puede tener potencialmente un inicio lento debido a la carencia de conocimiento acerca de los otros participantes. El inicio de la colaboración puede acelerarse administrando las expectativas de los beneficios o reduciendo la percepción de riesgo asociado con el proyecto.

Governments around the world have been developing digital government applications such as Internet portals. Although there are several potential benefits from such applications (for citizens and for government internal operations), most of them fail to deliver results, and there is still little knowledge about their key success factors. Using institutional theory, particularly the technology enactment framework, the research reported here explores the relationships among contextual, institutional and organizational factors and their impact on the success of state portals in Mexico. Results show that these relationships do exist and that portal success is mainly influenced by contextual factors related to electronic services demand and by organizational processes and structures of the agencies responsible for information technologies in the states.

Los gobiernos de todo el mundo han venido desarrollando aplicaciones de gobierno digital, como los portales de Internet. Aunque existen muchos beneficios potenciales de estas aplicaciones tanto para los ciudadanos como para la administración pública en sus procesos internos, la mayoría de ellas falla en el logro de sus objetivos y poco se sabe aún sobre los factores que determinan su éxito o fracaso. Con base en la teoría institucional, en particular el marco teórico de la promulgación tecnológica, en este estudio se exploran las relaciones entre factores contextuales, institucionales y organizacionales, así como su influencia en el éxito de los portales de gobierno estatal en México. Los resultados muestran que las relaciones existen, y que el éxito de los portales estatales está determinado principalmente por factores contextuales asociados con la demanda de servicios electrónicos y por los procesos y estructuras organizacionales de las dependencias encargadas de las tecnologías de información en las entidades federativas.