The data identify CTGF as an important mediator of atrial structural remodeling during AF. Angiotensin II activates CTGF via activation of Rac1 and nicotinamide adenine dinucleotide phosphate oxidase, leading to up-regulation of Cx43, N-cadherin, and interstitial fibrosis and therefore contributing to the signal transduction of atrial structural remodeling.

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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...

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