Debt Sustainability and the Terms of Official Support

We study theoretically and quantitatively how official lending regimes affect a government's decision to raise saving as opposed to defaulting, and its implication for sovereign bond pricing by investors. We reconsider debt sustainability in the face of both output and rollover risk under two types of institutional bailouts: one based on long-maturity, low-spread loans similar to the ones offered by the euro area official lenders; the other, on shorter maturity and high-spread loans, close to the International Monetary Fund standards. We show that official lending regimes raise the stock of safe debt and facilitate consumption smoothing through debt reduction. However, to the extent that bailouts translates into higher future debt stocks and countercyclical deficits in persistent recessions, they also have countervailing effects on sustainability. Quantitatively, the model is able to replicate Portuguese debt and spread dynamics in the years of the bailout after 2011. We show that, depending on the composition of debt by maturity and official lending, sustainable debt levels can vary between 50% of GDP and 180% of GDP depending on the state of the economy and the conditions for market access. Longer maturities have a stronger effect on sustainability than lower spreads

Official Sector Lending Strategies During the Euro Area Crisis

In response to the euro area crisis, European policymakers took a gradual, incremental approach to official lending, at first relying on the approach followed by the International Monetary Fund, then developing their own crisis resolution framework. We review this development, marked by a substantial divergence in the terms of official loans offered to the crisis countries by the IMF and the euro area official lenders. Based on a unique dataset, we use event analysis to assess the impact of changing maturity and spreads of official loans on bond yields, liquidity and market access. In light of the euro area experience, we discuss arguments for rebalancing Debt Sustainability Analysis and programme design towards cash-flow management. While the official assistance granted to crisis countries in the euro area may not be replicable elsewhere, key lessons from it that could foster a reconsideration of the modalities by which official lending institutions handle crises

Perioperative anaemia management: consensus statement on the role of intravenous iron

A multidisciplinary panel of physicians was convened by Network for Advancement of Transfusion Alternatives to review the evidence on the efficacy and safety of i.v. iron administration to increase haemoglobin levels and reduce blood transfusion in patients undergoing surgery, and to develop a consensus statement on perioperative use of i.v. iron as a transfusion alternative. After conducting a systematic literature search to identify the relevant studies, critical evaluation of the evidence was performed and recommendations formulated using the Grades of Recommendation Assessment, Development and Evaluation Working Group methodology. Two randomized controlled trials (RCTs) and six observational studies in orthopaedic and cardiac surgery were evaluated. Overall, there was little benefit found for the use of i.v. iron. At best, i.v. iron supplementation was found to reduce the proportion of patients requiring transfusions and the number of transfused units in observational studies in orthopaedic surgery but not in cardiac surgery. The two RCTs had serious limitations and the six observational limited by the selection of the control groups. Thus, the quality of the available evidence is considered moderate to very low. For patients undergoing orthopaedic surgery and expected to develop severe postoperative anaemia, the panel suggests i.v. iron administration during the perioperative period (weak recommendation based on moderate/low-quality evidence). For all other types of surgery, no evidence-based recommendation can be made. The panel recommends that large, prospective, RCTs be undertaken to evaluate the efficacy and safety of i.v. iron administration in surgical patients. The implementation of some general good practice points is suggeste

APORTES AL CONOCIMIENTO DE LOS YACIMIENTOS AL AIRE LIBRE, NUEVOS CAMPOS DE HOYOS EN NAVARRA

En este artículo se presentan diez nuevos campos de hoyos aparecidos durante los trabajos de control arqueológico de diferentes obras de construcción en la zona media y ribera de Navarra. Caracterizan diferentes momentos cronológicos de la Prehistoria Reciente, con ejemplos entre el Neolítico Inicial y el Hierro Antiguo. This article presents ten new pit fields discovered during the archeological monitoring of different construction works in the Zona Media and Ribera of Navarra. This sites characterize diverse chronological periods of Recent Prehistory, with samples ranging between the First Neolithic and the Ancient Iron Age

Debt Sustainability and the Terms of Official Support

We study theoretically and quantitatively how official lending regimes affect a government's decision to raise saving as opposed to defaulting, and its implication for sovereign bond pricing by investors. We reconsider debt sustainability in the face of both output and rollover risk under two types of institutional bailouts: one based on long-maturity, low-spread loans similar to the ones offered by the euro area official lenders; the other, on shorter maturity and high-spread loans, close to the International Monetary Fund standards. We show that official lending regimes raise the stock of safe debt and facilitate consumption smoothing through debt reduction. However, to the extent that bailouts translates into higher future debt stocks and countercyclical deficits in persistent recessions, they also have countervailing effects on sustainability. Quantitatively, the model is able to replicate Portuguese debt and spread dynamics in the years of the bailout after 2011. We show that, depending on the composition of debt by maturity and official lending, sustainable debt levels can vary between 50% of GDP and 180% of GDP depending on the state of the economy and the conditions for market access. Longer maturities have a stronger effect on sustainability than lower spreads

«Regreso al futuro»: tras la pandemia debemos intensificar la recuperación

El 31 de diciembre de 2019, la sede de la Organización Mundial de la Salud (OMS) en China fue informada de la aparición de casos de neumonía de etiología desconocida en la ciudad de Wuhan, y el tres de enero se notificaban 44 pacientes con esta patología1. Desde entonces, el brote de la enfermedad habría afectado a nivel mundial a más de 12 millones de personas y causado cerca de 600.000 muertes. Este vertiginoso paso de brote localizado a pandemia ha obligado a los sistemas sanitarios a una rápida adaptación de sus recursos materiales y humanos, interrumpiendo la rutina de los servicios hospitalarios a nivel mundial. Los casos relacionados con COVID-19 han saturado los centros obligando a convertir las áreas quirúrgicas en una prolongación de las salas de hospitalización y atención a pacientes críticos. Los equipos quirúrgicos han sido testigos de cambios dramáticos en sus prácticas con una disminución de cirugías, siguiendo el consejo dado en marzo por las sociedades científicas de cancelar la cirugía electiva no oncológica3. Los planes de contingencia de la atención hospitalaria incluían el cese de la actividad quirúrgica inicialmente programada y, según el grado de ocupación por pacientes COVID del centro, toda la cirugía, excepto la indispensable (urgente). Una reciente publicación estimaba que el número de intervenciones canceladas debidas al COVID-19 sería de 28 millones..

Appropriate use of red blood cell transfusion in emergency departments: A study in five emergency departments

BACKGROUND: Transfusion of blood components continues to be an important therapeutic resource into the 21st century. Between 5 and 58% of transfusions carried out are estimated to be unnecessary. According to several studies, at least 20% of packed red blood cell transfusions (RBCT) are administered in hospital emergency departments (ED), but few data are available about the appropriateness of RBCT in this setting. This multicentre, cross-sectional observational study aims to assess the appropriateness of RBCT indications and transfused volumes in patients who attend ED. MATERIALS AND METHODS: The study cohort is made up of consecutive consenting adult patients (≥18 years old) who received RBCT in ED over a 3-month period and for whom relevant clinical data were collected and analysed. RESULTS: Data from 908 RBCT episodes (2±1 units per transfused patient) were analysed. RBCT was considered appropriate in 21.4% (n=195), with significant differences according to RBCT indication (p<0.001), hospital level (p<0.001) and prescribing physician (p=0.002). Pre-transfusion haemoglobin level (Hb) negatively correlated with RBCT appropriateness (r=-0.616; p<0.01). Only 72.4% of appropriate RBCT had a post-transfusion Hb assessment (n=516). Of these, 45% were considered to be over-transfused (n=232), with significant differences according to RBCT indication (p=0.012) and prescribing physician (p=0.047). Overall, 584/1,433 (41%) of evaluable RBC units were unnecessarily transfused. DISCUSSION: The appropriateness of RBCT in ED is similar to other hospital departments, but the rate of over-transfusion was high. These data support the need for a reassessment after transfusion of each RBC unit before further units are prescribed. In view of these results, we recommend that physicians should be made more aware of the need to prescribe RBCT appropriately in order to reduce over-transfusionThis project has received funding from the Spanish Ministry of Health, Social Policy and Equality through the SAS/2377/2010 call for granting aid for the promotion of independent clinical research (Department of Pharmacy and Health Products), file n. EC10-21

La cerámica de estilo Cogotas I y los ciclos culturales en las postrimerías de la Edad del Bronce en Navarra

En el presente artículo se analizan los yacimientos conocidos en Navarra con cerámica decorada de estilo Cogotas I, situándolos en su contexto cronológico y cultural. Se analiza la división del territorio en dos grupos con importantes diferencias culturales