Structure and restructuring in the Spanish economy

Accompanying report for submission in partial fulfllment of the requirements for the award of the Degree of Doctor of Philosophy based on published works to the Faculty of Science and Technology, University of Luton.The changing character of the economic environment in the last quarter of the twentieth century has resulted in a continuous process of restructuring in the economy of Spain, mediated through the structure and regulatory framework of the economy. Three specific themes contributing to restructuring are addressed: globalisation of the economy, European integration, and the role of the public sector. Globalisation ofthe economy is demonstrated through increased international flows of goods, capital, people and information, and by the incorporation of businesses in Spain within the corporate networks of foreign multinational companies. Spanish businesses too have been extending their global reach, especially into Latin America. European integration has been part of the globalisation process. A substantial proportion of international flows are now concentrated within the European Union and business networks have been adapting to the 'Single European Market'. European integration has dominated economic policy, first in measures to secure membership of the European Economic Community, then in measures to adjust to the regulatory environment of the European Community and finally in the race to achieve the Maastricht criteria. The role of the public sector in restructuring has been to 'manage' the market forces unleashed by the liberalisation ofthe economy. Market forces, embracing increased competition and technological change, have driven the restructuring process demanding responses from the government. These responses have increasingly been constrained by the shedding of responsibilities upwards to international organisations and downwards to lower tiers of administration. Isolation, protection and goverrunent intervention in the economy have given way to a more liberal, open and international environment. Transformation in the mode of regulation from state corporatism to neo-liberalism has been accompanied by globalisation of the economy, particularly integration into the European economy and the corporate space of multinational companies. Nevertheless, despite the growing emphasis on globalisation, public policy continues to play a crucial role influencing the pace, if not the direction, of restructuring

Simple new risk score model for adult cardiac extracorporeal membrane oxygenation: simple cardiac ECMO score.

BACKGROUND: Although the use of cardiac extracorporeal membrane oxygenation (ECMO) is increasing in adult patients, the field lacks understanding of associated risk factors. While standard intensive care unit risk scores such as SAPS II (simplified acute physiology score II), SOFA (sequential organ failure assessment), and APACHE II (acute physiology and chronic health evaluation II), or disease-specific scores such as MELD (model for end-stage liver disease) and RIFLE (kidney risk, injury, failure, loss of function, ESRD) exist, they may not apply to adult cardiac ECMO patients as their risk factors differ from variables used in these scores. METHODS: Between 2010 and 2014, 73 ECMOs were performed for cardiac support at our institution. Patient demographics and survival were retrospectively analyzed. A new easily calculated score for predicting ECMO mortality was created using identified risk factors from univariate and multivariate analyses, and model discrimination was compared with other scoring systems. RESULTS: Cardiac ECMO was performed on 73 patients (47 males and 26 females) with a mean age of 48 ± 14 y. Sixty-four percent of patients (47/73) survived ECMO support. Pre-ECMO SAPS II, SOFA, APACHE II, MELD, RIFLE, PRESERVE, and ECMOnet scores, were not correlated with survival. Univariate analysis of pre-ECMO risk factors demonstrated that increased lactate, renal dysfunction, and postcardiotomy cardiogenic shock were risk factors for death. Applying these data into a new simplified cardiac ECMO score (minimal risk = 0, maximal = 5) predicted patient survival. Survivors had a lower risk score (1.8 ± 1.2) versus the nonsurvivors (3.0 ± 0.99), P \u3c 0.0001. CONCLUSIONS: Common intensive care unit or disease-specific risk scores calculated for cardiac ECMO patients did not correlate with ECMO survival, whereas a new simplified cardiac ECMO score provides survival predictability