«Agotamiento» en la era digital

La Sentencia del Tribunal de Justicia de la Unión Europea de 3 de julio de 2012 ha abierto intensos debates acerca de la aplicabilidad de la regla conocida como del «agotamiento del derecho de distribución» a todas aquellas obras de propiedad intelectual recogidas en formato digital en un soporte no físico. Hasta 2012 se entendía que la regla del agotamiento sólo era aplicable a aquellas obras de propiedad intelectual comercializadas en un soporte (o corpus mysticum) físico; sin embargo, el Tribunal hace una interpretación por la cual actualiza está regla a la economía digital, entendiendo que cuando (como en el caso juzgado) se celebra un contrato de licencia de uso de programa de ordenador sin limitación temporal y éste es descargado directamente online desde la web del titular de los derechos el contrato es análogo a una compraventa a los efectos de entender aplicable la regla del agotamiento. En este artículo se analizan las fases por las que ha pasado la economía digital en cuanto a la transmisión de contenidos digitales (divididas en tres periodos) así como otras figuras próximas a la regla del agotamiento como son la doctrina de la primera venta y la licencia implícita; así como las consecuencias desde un punto de vista económico que puede tener una interpretación más o menos expansiva de las posibilidades del titular de los derechos de introducir medidas tecnológicas de protección en las obras de propiedad intelectual que comercializa, conocidas como Digital Right Management.The judgment of the Court of Justice of the European Union of 3 July 2012 (UsedSoft v. Oracle) opened intense debates about the applicability of the rule known as «exhaustion of the right of distribution» to all those works of intellectual property collected in digital format on a non-physical medium. Until 2012 it was understood that the rule of exhaustion was only applicable to those works of intellectual property marketed in a physical support (or corpus mysticum). Nevertheless, the Court makes an interpretation in which it updates the rule to the digital economy understanding that when (as in the case in court) a license agreement without temporal limitation for the use of a computer program is concluded and the program is downloaded directly online from the rights holder's websíte, the contract is analogous to a sale with regards to the rule of exhaustion. This article analyses the phases through which the digital economy has gone through in terms of the transmission of digital content (divided into three periods) as well as other figures close to the rule of exhaustion as the doctrine of the first sale and the implied license; as well as the consequences that could have a more or less expansive interpretation of the possibilities of the right holder to introduce technological protection measures in the works of intellectual property that he commercializes known Digital Right Management, from an economic point of view

La Propiedad Intelectual en Latinoamérica y su Rol en el Desarrollo Económico y Social

This article deals with the establishment and evolution of intellectual property rights in Latin America. It goes through the contexts in which these rights have been in-corporated into the domestic legal framework. Although Latin American economies are more or less fragile from the point of view of intellectual property, the conclusions indicate that there are several challenges to be faced, but that the countries of the region have the potential to overcome them and advance in the protection and use of their intellectual assets

Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

STUDY AIM: The surge of admissions due to severe COVID-19 increased the patients-to-critical care staffing ratio within the ICUs. We investigated whether the daily level of staffing was associated with an increased risk of ICU mortality (primary endpoint), length of stay (LOS), mechanical ventilation and the evolution of disease (secondary endpoints). METHODS: We employed a retrospective multicentre analysis of the international Risk Stratification in COVID-19 patients in the ICU (RISC-19-ICU) registry, limited to the period between March 1 and May 31, 2020, and to Switzerland. Hierarchical regression models were used to investigate crude and adjusted effects of the critical care staffing ratio on study endpoints. We adjusted for disease severity and weekly caseload. RESULTS: Among the 38 participating Swiss ICUs, 17 recorded staffing information. The study population included 437 patients and 2,342 daily assessments of patient-to-critical care staffing ratio. Median of daily patient-to-nurse ratio started at 1.0 [IQR 0.5–1.5; calendar week 9] and peaked at 2.4 (IQR 0.4–2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1–5.0; calendar week 9) and peaked at 6.8 (IQR 6.3–7.3; calendar week 19). Neither the patient-to-nurse (adjusted OR 1.28, 95% CI 0.85–1.93; doubling of ratio) nor the patient-to-physician ratio (adjusted OR 1.07, 95% CI 0.87–1.32; doubling of ratio) were associated with ICU mortality. We found no association of daily critical care staffing on the secondary endpoints in adjusted models. CONCLUSION: We found no association of reduced availability of critical care staffing resources in Swiss ICUs with overall ICU length of stay nor mortality. Whether long-term outcome of critically ill patients with COVID-19 have been affected remains to be studied

Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort.

STUDY AIM The surge of admissions due to severe COVID-19 increased the patients-to-critical care staffing ratio within the ICUs. We investigated whether the daily level of staffing was associated with an increased risk of ICU mortality (primary endpoint), length of stay (LOS), mechanical ventilation and the evolution of disease (secondary endpoints). METHODS We employed a retrospective multicentre analysis of the international Risk Stratification in COVID-19 patients in the ICU (RISC-19-ICU) registry, limited to the period between March 1 and May 31, 2020, and to Switzerland. Hierarchical regression models were used to investigate crude and adjusted effects of the critical care staffing ratio on study endpoints. We adjusted for disease severity and weekly caseload. RESULTS Among the 38 participating Swiss ICUs, 17 recorded staffing information. The study population included 437 patients and 2,342 daily assessments of patient-to-critical care staffing ratio. Median of daily patient-to-nurse ratio started at 1.0 [IQR 0.5-1.5; calendar week 9] and peaked at 2.4 (IQR 0.4-2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1-5.0; calendar week 9) and peaked at 6.8 (IQR 6.3-7.3; calendar week 19). Neither the patient-to-nurse (adjusted OR 1.28, 95% CI 0.85-1.93; doubling of ratio) nor the patient-to-physician ratio (adjusted OR 1.07, 95% CI 0.87-1.32; doubling of ratio) were associated with ICU mortality. We found no association of daily critical care staffing on the secondary endpoints in adjusted models. CONCLUSION We found no association of reduced availability of critical care staffing resources in Swiss ICUs with overall ICU length of stay nor mortality. Whether long-term outcome of critically ill patients with COVID-19 have been affected remains to be studied

Dynamics of disease characteristics and clinical management of critically ill COVID-19 patients over the time course of the pandemic: an analysis of the prospective, international, multicentre RISC-19-ICU registry.

BACKGROUND It remains elusive how the characteristics, the course of disease, the clinical management and the outcomes of critically ill COVID-19 patients admitted to intensive care units (ICU) worldwide have changed over the course of the pandemic. METHODS Prospective, observational registry constituted by 90 ICUs across 22 countries worldwide including patients with a laboratory-confirmed, critical presentation of COVID-19 requiring advanced organ support. Hierarchical, generalized linear mixed-effect models accounting for hospital and country variability were employed to analyse the continuous evolution of the studied variables over the pandemic. RESULTS Four thousand forty-one patients were included from March 2020 to September 2021. Over this period, the age of the admitted patients (62 [95% CI 60-63] years vs 64 [62-66] years, p < 0.001) and the severity of organ dysfunction at ICU admission decreased (Sequential Organ Failure Assessment 8.2 [7.6-9.0] vs 5.8 [5.3-6.4], p < 0.001) and increased, while more female patients (26 [23-29]% vs 41 [35-48]%, p < 0.001) were admitted. The time span between symptom onset and hospitalization as well as ICU admission became longer later in the pandemic (6.7 [6.2-7.2| days vs 9.7 [8.9-10.5] days, p < 0.001). The PaO2/FiO2 at admission was lower (132 [123-141] mmHg vs 101 [91-113] mmHg, p < 0.001) but showed faster improvements over the initial 5 days of ICU stay in late 2021 compared to early 2020 (34 [20-48] mmHg vs 70 [41-100] mmHg, p = 0.05). The number of patients treated with steroids and tocilizumab increased, while the use of therapeutic anticoagulation presented an inverse U-shaped behaviour over the course of the pandemic. The proportion of patients treated with high-flow oxygen (5 [4-7]% vs 20 [14-29], p < 0.001) and non-invasive mechanical ventilation (14 [11-18]% vs 24 [17-33]%, p < 0.001) throughout the pandemic increased concomitant to a decrease in invasive mechanical ventilation (82 [76-86]% vs 74 [64-82]%, p < 0.001). The ICU mortality (23 [19-26]% vs 17 [12-25]%, p < 0.001) and length of stay (14 [13-16] days vs 11 [10-13] days, p < 0.001) decreased over 19 months of the pandemic. CONCLUSION Characteristics and disease course of critically ill COVID-19 patients have continuously evolved, concomitant to the clinical management, throughout the pandemic leading to a younger, less severely ill ICU population with distinctly different clinical, pulmonary and inflammatory presentations than at the onset of the pandemic