El fracaso de la política ambiental mexicana: Una revisión de los límites de la gestión sectorial

Este trabajo tiene como objetivos principales: a) La revisión del marco teórico centrado en la transversalidad y las funciones de los ecosistemas; b) El estudio del marco institucional, basado en el análisis del régimen jurídico de algunos organismos multisectoriales de la administración pública federal, y c) El análisis de la información proveniente de los actores gubernamentales y sociales involucrados en la extinción de abejas. Esta investigación abarca los campos del derecho, la administración pública y la ecología. La metodología utilizada es de corte cualitativo, con base en el análisis de textos legislativos, así como la revisión de la literatura académica y diversas fuentes hemerográficas, sobre el objeto de la investigación. Las conclusiones señalan algunos factores relativos al fracaso de la administración ambiental de carácter sectorial, con énfasis en la falta de coordinación entre las diversas instituciones públicas y los actores sociales; así como la urgencia para la adopción de una gestión y una política transversal, más acorde a los fines de la sostenibilidad ambienta

El fracaso de la política ambiental mexicana: Una revisión de los límites de la gestión sectorial

Este trabajo tiene como objetivos principales: a) La revisión del marco teórico centrado en la transversalidad y las funciones de los ecosistemas; b) El estudio del marco institucional, basado en el análisis del régimen jurídico de algunos organismos multisectoriales de la administración pública federal, y c) El análisis de la información proveniente de los actores gubernamentales y sociales involucrados en la extinción de abejas. Esta investigación abarca los campos del derecho, la administración pública y la ecología. La metodología utilizada es de corte cualitativo, con base en el análisis de textos legislativos, así como la revisión de la literatura académica y diversas fuentes hemerográficas, sobre el objeto de la investigación. Las conclusiones señalan algunos factores relativos al fracaso de la administración ambiental de carácter sectorial, con énfasis en la falta de coordinación entre las diversas instituciones públicas y los actores sociales; así como la urgencia para la adopción de una gestión y una política transversal, más acorde a los fines de la sostenibilidad ambienta

U potrazi za novim paradigmama u meksičkoj javnoj upravi: profesionalizam i novi nacionalni sustav borbe protiv korupcije

The paper explores public administration development in México within two fields: the career civil service and the anticorruption policy. The differentiation between the institutional arrangements based on the classic formula of exclusive competences of each level of government and that of concurrent competences, more akin to modern federalism, has been used in the analysis. A qualitative and quantitative analysis of the institutional framework of the career civil service, at both the federal and subnational levels, sheds light on the predominance of patronage. This situation is dysfunctional with respect to the structure, objectives, and functionality of the National Anticorruption System. Finally, it is pointed out that México needs a new institutional structure in the career civil service based on a formula of shared competences, given that the absence or extreme weakness of public administration could hinder the efficacy of new institutional arrangements for combating corruption.Rad analizira razvoj meksičke javne uprave u okviru dvaju novih polja: karijerne državne službe i antikorupcijske politike. Koristi se razlikovanje institucionalnih aranžmana zasnovanih na klasičnoj formuli o isključivim nadležnostima svake razine vlasti i onoj o konkurirajućim nadležnostima, svojstvenoj modernom federalizmu. Kvalitativna i kvantitativna analiza institucionalnog okvira karijerne državne službe na razini federacije te na subnacionalnim razinama daje uvid u dominantnu praksu patronaže. Takva je situacija disfunkcionalna za strukturu, ciljeve i funkcionalnost Nacionalnog antikorupcijskog sustava. Na kraju se zaključuje da je u Meksiku potrebna nova institucionalna struktura karijerne državne službe zasnovana na formuli o podijeljenim nadležnostima, budući da izostanak ili krajnja slabost javne uprave može onemogućiti efikasno funkcioniranje novih institucionalnih aranžmana za borbu protiv korupcije

En busca de los arreglos institucionales para una nueva gobernanza global ambiental

Over recent decades the planet’s ecosystems have been subjected to severe damage, as a result of their unprecedented exploitation, despite the institutional arrangements generated since the recognition of these environmental problems by the international community. This article examines some theoretical approaches to global governance, looking for answers regarding the interactive processes, institutions and sociopolitical actors immersed in the building of a new world governance. By means of a qualitative methodology, this work analyses the main weaknesses of the current institutional frameworks and the international sectorial organizations on the matters of environment, climate change and sustainable development. It is concluded that a root cause of the problem is the absence of authentic global governance systems to tackle the socioecological crisis, as the actual institutional frameworks consist of a chaotic conglomerate of formal and informal instruments, which lack the effective social and institutional articulation mechanisms needed by the complex, dynamic and interactive nature of the contemporary environmental quandary. The architecture of the new governance systems could be supported upon the multilevel, transversal and transnational integration of the institutional frameworks, as a basis for the reconfiguration of actors, processes and structures of the global environmental governance in the twenty-first century.En las últimas décadas, los ecosistemas del planeta han sido sometidos a un severo deterioro, producto de una explotación sin precedentes en la historia del homo sapiens. Esta problemática ambiental se ha mantenido a pesar de los arreglos institucionales construidos desde su reconocimiento por la comunidad internacional. En el presente artículo se reflexiona sobre los procesos interactivos, las instituciones y los actores sociopolíticos inmersos en la construcción de una nueva gobernanza mundial. Mediante una metodología cualitativa, se analizan las disfuncionalidades más relevantes de los marcos institucionales y las organizaciones internacionales sectoriales en materia de medio ambiente, cambio climático y desarrollo sostenible. Se concluye que una causa fundamental de las deficiencias es la falta de auténticos sistemas de gobernanza global para abordar la crisis socioecológica. Los actuales marcos institucionales constituyen un caótico conglomerado de instrumentos formales e informales, sin los mecanismos eficaces de articulación social e institucional que demanda la naturaleza compleja, dinámica e interactiva de la problemática ambiental contemporánea. La arquitectura de los nuevos sistemas de gobernanza podría sustentarse en la integración multinivel, transversal y transnacional de los marcos institucionales, como una base para reconfigurar los actores, los procesos y las estructuras de la gobernanza global ambiental en el siglo XXI

Prognostic factors of Infective Endocarditis in Patients on Hemodialysis: A Case Series from a National Multicenter Registry.

Background: Infective endocarditis (IE) is a severe complication associated with high mortality. Objectives: To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD. Methods: From January 2008 to April 2015, 2,488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD. Results: A total of 126 patients (63% male, median age: 66 years; IQR: 54-74 years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1,177 patients, 50%; p 70 years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization. Conclusions. HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality.pre-print714 K

Megaproyectos urbanos y productivos. Impactos socio-territoriales

El desarrollo de megaproyectos productivos trae consigo oportunidades para el crecimiento económico, la generación de empleos y el desarrollo regional. No obstante, en la actualidad, los grandes temas como la expansión urbana, el desarrollo industrial, las cementeras, la minería, el uso intensivo del agua y demás recursos naturales, preocupan a las comunidades por los impactos generados y porque en lo general, no consideran la racionalidad y responsabilidad ambiental y social hacia el entorno. En este contexto son diversos los estudios científicos que, en el marco de la política de económica imperante, intentan posicionarse como alternativas a proyectos económicos que confrontan los intereses particulares y comunitarios y que afectan la salud humana y ambiental. Megaproyectos urbanos y productivos. Impactos socio-territoriales, reúne veinticinco textos académicos sobre las afectaciones que éstos emprendimientos tienen para la sociedad y el entorno. Los temas expuestos recogen experiencias en el desarrollo urbano, industrial, turístico, portuario y aeroportuario, entre otros. Así mismo se retoman temas como la ética, la dialéctica, la política y la economía y su relación en el emprendimiento de megaproyectos. La búsqueda de esquemas productivos racionales y responsables con el entorno, que reivindiquen el derecho de las comunidades a un medio ambiente sano, a la preservación del territorio y sus recursos y de las formas de vida tradicionales, son los referentes para la realización del presente libro. Como elemento central se concibe el territorio como contenedor de identidad y vida, siendo preocupación y tema de estudio de la comunidad académica, las organizaciones de la sociedad civil y las redes de activistas organizados.UAEM, CONACyT, se

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries