USING A POINT SYSTEM IN THE MANAGEMENT OF WAITING LISTS: THE CASE OF CATARACTS

The objective of this study is to explore the possibility of applying a point system as a guide to the management of waiting lists in National Health Systems. Following recent contributions in the axiomatic theory of justice, the ethical properties of a point system are illustrated. In addition, we present the results of an experiment whose objective was to develop a point system for cataract extraction, based on social preferences. The results of the experiment have shown that the analytic methods used here, of focus groups, interview-administered questionnaires, conjoint analysis, and rank-ordered logit, can be usefully combined to determine the total priority score for each patient.Point System; Priority Criteria; Waiting Lists; Cataract.

La reforma de la financiación autonómica de 2009

La reforma del sistema de finançament autonòmic del 2009 es va gestar, impulsada per les reformes estatutàries aprovades en els últims anys, singularment la de l’Estatut català, per donar resposta a les principals debilitats mostrades pel sistema anterior. Concretament, per respondre als problemes d’insuficiència financera, a les deficiències del sistema d’anivellament, de la insuficient descentralització tributària i a la feble coresponsabilitat fiscal. Després d’analitzar els antecedents de la reforma i el procés negociador, l’article fa una descripció del nou model i dels diferents elements que l’integren per identificar després tant els aspectes de la reforma que mereixen una valoració positiva com els problemes que aquesta no encerta a resoldre. Aquesta descripció està relacionada tant amb l’autonomia tributària i la coresponsabilitat fiscal de les comunitats com amb els mecanismes d’anivellament pressupostari; a més, s’hi assenyalen també les possibilitats de millora de l’articulació institucional i la governança del sistema.The reform of the autonomous financing system in 2009, motivated by the statutory reforms approved in recent years, particularly the reform of the Catalan Statute, was implemented as a response to the primary weaknesses presented by the previous system, specifically in relation to the problems of financial inadequacy, deficiencies in the capping system, the insufficient tax devolution and the weak fiscal co-responsibility. After analysing the background information of the reform and the negotiating process, the article describes the new model and the different elements integrating it, and then it identifies both the aspects of the reform that deserve a positive evaluation and the problems that it has not managed to solve, in terms of both the tax autonomy and the fiscal co-responsibility of the Communities, and the budget capping mechanisms, also indicating the possibilities of improvement in the institutional articulation and system governance.La reforma del sistema de financiación autonómica de 2009 se gestó, impulsada por las reformas estatutarias aprobadas en los últimos años, singularmente la del Estatuto catalán, para dar respuesta a las principales debilidades mostradas por el sistema anterior, concretamente, a los problemas de insuficiencia financiera, a las deficiencias del sistema de nivelación, a la insuficiente descentralización tributaria y a la débil corresponsabilidad fiscal. Tras analizar los antecedentes de la reforma y el proceso negociador, el artículo realiza una descripción del nuevo modelo y de los diferentes elementos que lo integran, para identificar después tanto los aspectos de la reforma que merecen una valoración positiva como los problemas que la misma no acierta a resolver, en relación tanto con la autonomía tributaria y la corresponsabilidad fiscal de las Comunidades, como con los mecanismos de nivelación presupuestaria, señalando también las posibilidades de mejora de la articulación institucional y la gobernanza del sistema

El trabajo de las mujeres cristianas bajomedievales en la Corona de Aragón

El presente Proyecto Fin de Máster trata sobre el trabajo de las mujeres cristianas bajomedievales en la Corona de Aragón. El estudio está centrado, principalmente, en fuentes bibliográficas, aunque también se han utilizado fuentes primarias editadas, literarias e iconográficas. Con este estudio pretendo demostrar que las mujeres tuvieron un papel activo en los oficios profesionales de la Baja Edad Media y que contribuyeron a la economía familiar. Las encontramos trabajando en el ámbito rural y en el urbano, realizando labores artesanales, comerciales y domésticas, además de ejercer justicia y practicando la prostitución

Analysis of pattern recognition and dimensionality reduction techniques for odor biometrics

In this paper, we analyze the performance of several well-known pattern recognition and dimensionality reduction techniques when applied to mass-spectrometry data for odor biometric identification. Motivated by the successful results of previous works capturing the odor from other parts of the body, this work attempts to evaluate the feasibility of identifying people by the odor emanated from the hands. By formulating this task according to a machine learning scheme, the problem is identified with a small-sample-size supervised classification problem in which the input data is formed by mass spectrograms from the hand odor of 13 subjects captured in different sessions. The high dimensionality of the data makes it necessary to apply feature selection and extraction techniques together with a simple classifier in order to improve the generalization capabilities of the model. Our experimental results achieve recognition rates over 85% which reveals that there exists discriminatory information in the hand odor and points at body odor as a promising biometric identifier

Deliberate donation of umbilical cord blood in the University Hospital Virgen de la Arrixaca (2010-2011). Current situation and influences of the obstetrical-foetal variables

Objetivos: A principios de 2010 el Hospital Universitario Virgen de la Arrixaca puso en marcha, en el servicio de partos, el protocolo de donación voluntaria de sangre de cordón umbilical (SCU). Desde la reflexión y la autoevaluación, planteamos un análisis de nuestra situación actual a través del estudio de la influencia de las variables obstétrico-fetales en la calidad de las muestras. Métodos: Con este fin hemos planteado un trabajo de tipo observacional, descriptivo, retrospectivo y de corte transversal desde mayo de 2010 a noviembre de 2011, con el objetivo de aumentar la calidad de las unidades de SCU y optar por una gestión eficiente que haga sostenible el proyecto. Resultados: Se obtuvieron 123 donaciones potenciales de sangre de cordón y del análisis multivariable de las mismas obtuvimos una correlación positiva significativa entre el número de leucocitos, las semanas de gestación y el parto vaginal. El peso inicial de la unidad se incrementó significativamente a mayor peso del recién nacido y paridad de la donante. Conclusiones: Como conclusiones del estudio nos planteamos esbozar posibles factores predictivos que permitan seleccionar las muestras de mayor calidad y sean complemento de los actuales estándares elaborados por el Banco Público de Málaga. En este sentido nuestros resultados sugieren que en los partos con más semanas de gestación, paridad de la gestante y peso del recién nacido, así como en los partos vaginales, encontramos mayores posibilidades de obtener muestras de alta calidad.Aims: At the beginning of 2010, the University Hospital la Arrixaca, set up the protocol, in the birth delivery service, of umbilical cord blood (U.C.B.) donation. From the reflexion and the self-evaluation, we set out an analysis of our current situation through the study of the influences of the obstetricalfoetal variables in the samples quality. Method: On this purpose, we set out an observational descriptive, retrospective and cross-section study from May 2010 to November 2011, so as to increase the quality of the UCB units and to opt for efficient management that would make the project sustainable. Results: We obtained 123 potential donations of umbilical cord blood and out of the multivariable analysis we obtained a positive and significant correlation between the number of leukocytes, the weeks of pregnancy and the vaginal birth. The initial weight of the unit significantly increased to a heavier weight of the new born and the amount of times a donor has given birth. Conclusions: As conclusions from this study we suggest to outline possible predictive factors that would allow us to select the best quality samples and would be a complement to the current standards produced by the Public Bank of Malaga. In this sense our results suggest that in the deliveries with more weeks of pregnancy, in the amount of times a woman has given birth and in the weight of the new born as well as in the vaginal deliveries we can find more possibilities of obtaining high quality samples

Targeting AgRP neurons to maintain energy balance: lessons from animal models

The current obesity epidemic is a major worldwide health and economic burden. In the modern environment, an increase in the intake of high-fat and high-sugar foods plays a crucial role in the development of obesity by disrupting the mechanisms governing food intake and energy balance. Food intake and whole-body energy balance are regulated by the central nervous system through a sophisticated neuronal network located mostly in the hypothalamus. In particular, the hypothalamic arcuate nucleus (ARC) is a fundamental center that senses hormonal and nutrient-related signals informing about the energy state of the organism. The ARC contains two small, defined populations of neurons with opposite functions: anorexigenic proopiomelanocortin (POMC)-expressing neurons and orexigenic Agouti-related protein (AgRP)-expressing neurons. AgRP neurons, which also co-produce neuropeptide Y (NPY) and γ-Aminobutyric acid (GABA), are involved in an increase in hunger and a decrease in energy expenditure. In this review, we summarize the key findings from the most common animal models targeting AgRP neurons and the tools used to discern the role of this specific neuronal population in the control of peripheral metabolism, appetite, feeding-related behavior, and other complex behaviors. We also discuss how knowledge gained from these studies has revealed new pathways and key proteins that could be potential therapeutic targets to reduce appetite and food addictions in obesity and other diseases

New approaches targeting brown adipose tissue transplantation as a therapy in obesity

Brown adipose tissue (BAT) is raising high expectations as a potential target in the fight against metabolic disorders such as obesity and type 2 diabetes. BAT utilizes fuels such as fatty acids to maintain body temperature by uncoupling mitochondrial electron transport to produce heat instead of ATP. This process is called thermogenesis. BAT was considered to be exclusive to rodents and human neonates. However, in the last decade several studies have demonstrated that BAT is not only present but also active in adult humans and that its activity is reduced in several pathological conditions, such as aging, obesity, and diabetes. Thus, tremendous efforts are being made by the scientific community to enhance either BAT mass or activity. Several activators of thermogenesis have been described, such as natriuretic peptides, bone morphogenic proteins, or fibroblast growth factor 21. Furthermore, recent studies have tested a therapeutic approach to directly increase BAT mass by the implantation of either adipocytes or fat tissue. This approach might have an important future in regenerative medicine and in the fight against metabolic disorders. Here, we review the emerging field of BAT transplantation including the various sources of mesenchymal stem cell isolation in rodents and humans and the described metabolic outcomes of adipocyte cell transplantation and BAT transplantation in obesity. KEYWORDS: Brown adipose tissue; Obesity; Transplantatio

El concierto económico y el cálculo del cupo: una comparación de sus resultados con los del sistema de financiación común

El objetivo de este trabajo es analizar el funcionamiento del sistema de concierto económico (convenio) que regula la financiación de las Comunidades Forales, haciendo un especial hincapié en la metodología de cálculo del cupo y los resultados financieros que ésta genera. La literatura en esta materia, y más concretamente, la que compara los resultados del sistema de financiación foral con los generados por el sistema de financiación de las comunidades autónomas de régimen común, es muy escasa. En este trabajo se hace una simulación de aplicación del sistema común a los territorios forales que permite comparar ambos modelos de financiación, y pone en evidencia las grandes diferencias de recursos que proporcionan uno y otro a las comunidades autónomas

A Simulation Study of an Inverse Controller for Closed and Semiclosed-Loop Control in Type 1 Diabetes

Background: Closed-loop control algorithms in diabetes aim to calculate the optimum insulin delivery to maintain the patient in a normoglycemic state, taking the blood glucose level as the algorithm's main input. The major difficulties facing these algorithms when applied subcutaneously are insulin absorption time and delays in measurement of subcutaneous glucose with respect to the blood concentration. Methods: This article presents an inverse controller (IC) obtained by inversion of an existing mathematical model and validated with synthetic patients simulated with a different model and is compared with a proportional-integral-derivative controller. Results: Simulated results are presented for a mean patient and for a population of six simulated patients. The IC performance is analyzed for both full closed-loop and semiclosed-loop control. The IC is tested when initialized with the heuristic optimal gain, and it is compared with the performance when the initial gain is deviated from the optimal one (±10%). Conclusions: The simulation results show the viability of using an IC for closed-loop diabetes control. The IC is able to achieve normoglycemia over long periods of time when the optimal gain is used (63% for the full closed-loop control, and it is increased to 96% for the semiclosed-loop control

βTrCP controls the lysosome-mediated degradation of CDK1, whose accumulation correlates with tumor malignancy

n mammals, cell cycle progression is controlled by cyclin-dependent kinases, among which CDK1 plays important roles in the regulation of the G2/M transition, G1 progression and G1/S transition. CDK1 is highly regulated by its association to cyclins, phosphorylation and dephosphorylation, changes in subcellular localization, and by direct binding of CDK inhibitor proteins. CDK1 steady-state protein levels are held constant throughout the cell cycle by a coordinated regulation of protein synthesis and degradation. We show that CDK1 is ubiquitinated by the E3 ubiquitin ligase SCFβTrCP and degraded by the lysosome. Furthermore, we found that DNA damage not only triggers the stabilization of inhibitory phosphorylation sites on CDK1 and repression of CDK1 gene expression, but also regulates βTrCP-induced CDK1 degradation in a cell type-dependent manner. Specifically, treatment with the chemotherapeutic agent doxorubicin in certain cell lines provokes CDK1 degradation and induces apoptosis, whereas in others it inhibits destruction of the protein. These observations raise the possibility that different tumor types, depending on their pathogenic spectrum mutations, may display different sensitivity to βTrCP-induced CDK1 degradation after DNA damage. Finally, we found that CDK1 accumulation in patients’ tumors shows a negative correlation with βTrCP and a positive correlation with the degree of tumor malignancy.España, Ministerio de Economía y Competitividad SAF2011-30003Junta de Andalucía, Dirección General de Investigación, Tecnología y Empresa P08- CVI-03603 and P10-CTS-6243