Las reformas de pensiones en Europa: alternativas negociadas vs. el modelo del Libro Blanco

The consequences of the demographic phenomena and the economic cycle observed in recent years have opened up the debate on the need to reform pension systems in the European Union in order to keep up the level of protection they offer and assure their sustainability in the long term. There are two models proposed to approach them: one based on broad frameworks of negotiation and agreement between social stakeholders and governments, and the other of unilateral cutbacks based on ideas matching the recommendations in the White Book. Two models for reform which point to different kinds of social protection within the EU, the possibilities and consequences of which are still hotly debated.; Las consecuencias de los fenómenos demográficos y de ciclo económico que venimos registrando en las últimas décadas han abierto el debate sobre la reforma necesaria en los sistemas de pensiones de la Unión Europea, con el objetivo de mantener el nivel de protección que ofrecen y garantizar su sostenibilidad en el largo plazo. Dos son los modelos que se plantean para abordarlas: unas basadas en marcos amplios de negociación y acuerdo entre agentes sociales y gobiernos, y otras de corte unilateral impuestas en base a ideas coincidentes con las recomendaciones del Libro Blanco. Dos modelos de reforma que propician una protección social diferente en el seno del UE, y cuyas posibilidades y consecuencias están todavía en pleno debate.; Azken hamarkadetan izan ditugun fenomeno demografikoen eta ziklo ekonomikoen ondorioz, eztabaida piztu da Europar Batasuneko pentsio-sistemen erreformari buruz, sistema horien babes-maila mantendu eta epe luzera haien iraunkortasuna bermatzeko. Bi eredu proposatu dira horretarako: alde batetik, gizarte-eragileen eta gobernuen arteko negoziazio eta hitzarmen zabaletan oinarritutakoak; bestetik, Liburu Zuriko gomendioetan oinarrituta alde bakarretik inposatu nahi direnak.EBren barnean gizarte-babes desberdina eskaintzen duten bi eredu dira, eta zabalik dago oraindik haien aukerei eta ondorioei buruzko eztabaida

Las reformas de pensiones en Europa: alternativas negociadas vs. el modelo del Libro Blanco

The consequences of the demographic phenomena and the economic cycle observed in recent years have opened up the debate on the need to reform pension systems in the European Union in order to keep up the level of protection they offer and assure their sustainability in the long term. There are two models proposed to approach them: one based on broad frameworks of negotiation and agreement between social stakeholders and governments, and the other of unilateral cutbacks based on ideas matching the recommendations in the White Book. Two models for reform which point to different kinds of social protection within the EU, the possibilities and consequences of which are still hotly debated.; Las consecuencias de los fenómenos demográficos y de ciclo económico que venimos registrando en las últimas décadas han abierto el debate sobre la reforma necesaria en los sistemas de pensiones de la Unión Europea, con el objetivo de mantener el nivel de protección que ofrecen y garantizar su sostenibilidad en el largo plazo. Dos son los modelos que se plantean para abordarlas: unas basadas en marcos amplios de negociación y acuerdo entre agentes sociales y gobiernos, y otras de corte unilateral impuestas en base a ideas coincidentes con las recomendaciones del Libro Blanco. Dos modelos de reforma que propician una protección social diferente en el seno del UE, y cuyas posibilidades y consecuencias están todavía en pleno debate.; Azken hamarkadetan izan ditugun fenomeno demografikoen eta ziklo ekonomikoen ondorioz, eztabaida piztu da Europar Batasuneko pentsio-sistemen erreformari buruz, sistema horien babes-maila mantendu eta epe luzera haien iraunkortasuna bermatzeko. Bi eredu proposatu dira horretarako: alde batetik, gizarte-eragileen eta gobernuen arteko negoziazio eta hitzarmen zabaletan oinarritutakoak; bestetik, Liburu Zuriko gomendioetan oinarrituta alde bakarretik inposatu nahi direnak.EBren barnean gizarte-babes desberdina eskaintzen duten bi eredu dira, eta zabalik dago oraindik haien aukerei eta ondorioei buruzko eztabaida

A system dynamics model to predict the human monocyte response to endotoxins

System dynamics is a powerful tool that allows modeling of complex and highly networked systems such as those found in the human immune system. We have developed a model that reproduces how the exposure of human monocytes to lipopolysaccharides (LPSs) induces an inflammatory state characterized by high production of tumor necrosis factor alpha (TNFα), which is rapidly modulated to enter into a tolerant state, known as endotoxin tolerance (ET). The model contains two subsystems with a total of six states, seven flows, two auxiliary variables, and 14 parameters that interact through six differential and nine algebraic equations. The parameters were estimated and optimized to obtain a model that fits the experimental data obtained from human monocytes treated with various LPS doses. In contrast to publications on other animal models, stimulation of human monocytes with super-low-dose LPSs did not alter the response to a second LPSs challenge, neither inducing ET, nor enhancing the inflammatory response. Moreover, the model confirms the low production of TNFα and increased levels of C-C motif ligand 2 when monocytes exhibit a tolerant state similar to that of patients with sepsis. At present, the model can help us better understand the ET response and might offer new insights on sepsis diagnostics and prognosis by examining the monocyte response to endotoxins in patients with sepsisThis work was supported by grants from the “Instituto de Salud Carlos III” (ISCiii), “Fondo de Investigación Sanitaria” (FIS), and Fondos FEDER (PI14/01234, PIE15/00065) to EL-C. EA work contract is supported by the Torres Quevedo program from “Ministerio de Economía y Competitividad” (SPTQ1300X006175XV0). VT work contract is supported by the “Ministerio de Economía y Competitividad” (PTA2013-8265-I

Health-related quality of life in well-differentiated metastatic gastroenteropancreatic neuroendocrine tumors

Spanish Neuroendocrine Tumor Group (GETNE)© 2015, Springer Science+Business Media New York. Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare neoplasms capable of producing hormones. The development of new treatments has improved progression-free survival, albeit with increased toxicity. Health-related quality of life (HRQoL) has become an important endpoint in clinical research to evaluate patients’ well-being in such a contradictory scenario. In this review, we examine key reported outcomes across clinical studies exploring HRQoL in patients with GEP-NETs. We have conducted a review of the literature using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Selection criteria for articles were (1) publication in English between 1995 and 2014, (2) patients with GEP-NET, and (3) analysis of HRQoL, including mental health and psychological symptoms. Forty-nine studies met the inclusion criteria (31 clinical trials, 14 observational studies, and 4 developments of NET-specific HRQoL instruments). The scope and nature of the literature was diverse with 27 instruments used to measure aspects of HRQoL. EORTC QLQ-C30 was the most frequently used, in 38 of the 49 studies. Standardized measures revealed that in spite of generally good HRQoL, GEP-NET patients have specific psychological and physical complaints. The clinical benefit of somatostatin analogs and sunitinib has been clearly supported by HRQoL assessment. Improvement in HRQoL scores or symptom relief over time was also reported in 14 trials of peptide receptor radionuclide therapy, however the absence of randomized studies obviate definitive conclusions. We have also identified several unanswered questions that should be addressed in further research concerning chemotherapy, everolimus, surgery, local ablative therapies, and chemoembolization. Future research should incorporate GEP-NET-specific HRQoL instruments into phase III trials. This review may help both clinicians and researchers to select the most appropriate tools to assess changes in HRQoL in this population.This project was funded in part by a restricted educational grant from Novartis Spain and by support from the Spanish Neuroendocrine Tumor Group (GETNE).Peer Reviewe

Hispania Virtual: las leyes municipales romanas vistas desde tres disciplinas UCM

Depto. de Derecho Romano e Historia del DerechoFac. de DerechoFALSEsubmitte

Análisis de la capa límite atmosférica nocturna durante la campaña experimental CIBA 2008

Ponencia presentada en: XXXI Jornadas Científicas de la AME y el XI Encuentro Hispano Luso de Meteorología celebrado en Sevilla, del 1 al 3 de marzo de 2010.En el mes de junio de 2008 se desarrolló una campaña de medidas en la Capa Límite Atmosférica en el CIBA (Centro de Investigación de la Baja Atmósfera), que se encuentra sobre un extenso páramo de la meseta norte (41º49’ N, 4º56’ W) de características de terreno homogéneo. Se dispuso de instrumentación en una nueva torre meteorológica de 10m, que incluye en varios niveles sensores de temperatura y humedad, anemómetros de cazoletas y veletas, así como un anemómetro sónico. También se dispuso de dos microbarómetros con tecnología de cuarzo en los niveles de 50 y 100m en la torre principal del CIBA (de 100m). Además, tres microbarómetros adicionales se situaron en una disposición triangular de unos 200m de lado en la superficie. Por otra parte, se utilizó un globo cautivo para la determinación de perfiles verticales de temperatura y viento hasta 1000 m de altura. Finalmente, un monitor de partículas GRIMM (MODELO 365), que permite la medida simultánea y continúa de la concentración de partículas materiales de diferentes tamaños (PM10, PM2.5 y PM1) cada 6 segundos, se instaló a 1.5m del suelo. Este trabajo muestra algunos resultados preliminares de la campaña CIBA2008, a partir del análisis de los principales procesos físicos presentes en la Capa Límite Nocturna (NBL), de los diferentes periodos de estabilidad observados y de los correspondientes parámetros turbulentos, así como de las estructuras coherentes detectadas. Las perturbaciones de presión medidas en los diferentes microbarómetros permiten estudiar los principales parámetros ondulatorios a través de transformadas wavelet, y comparar dichas estructuras con las detectadas en los registros de viento y de partículas.Proyectos CGL2006-12474-C03-03 y CGL2009- 12797-C03-03 del Ministerio de Ciencia e Innovación. Grupos de Investigación (Micrometeorología y Variabilidad Climática: 910437) financiados por el Banco Santander y la Universidad Complutense de Madrid (Financiación Grupos UCM-BSCH GR58/08)

Biomarkers and polymorphisms in pancreatic neuroendocrine tumors treated with sunitinib

Several circulating biomarkers and single nucleotide polymorphisms (SNPs) have been correlated with efficacy and tolerability to antiangiogenic agents. These associations remain unexplored in well-differentiated, metastatic pancreatic neuroendocrine tumors treated with the multitargeted tyrosine kinase inhibitor sunitinib. We have assessed the effect on tumor response at 6 months, overall survival, progression-free survival and safety of 14 SNPs, and 6 soluble proteins. Forty-three patients were recruited. Two SNPs in the vascular endothelial growth factor receptor 3 (VEGFR-3) gene predicted lower overall survival: rs307826 with hazard ratio (HR) 3.67 (confidence interval [CI] 95%, 1.35-10.00) and rs307821 with HR 3.84 (CI 95%, 1.47-10.0). Interleukin-6 was associated with increased mortality: HR 1.06 (CI 95%, 1.01-1.12), and osteopontin was associated with shorter PFS: HR 1.087 (1.01-1.16), independently of Ki-67. Furthermore, levels of osteopontin remained higher at the end of the study in patients considered non-responders: 38.5 ng/mL vs. responders: 18.7 ng/mL, p-value=0.039. Dynamic upward variations were also observed with respect to IL-8 levels in sunitinib-refractory individuals: 28.5 pg/mL at baseline vs. 38.3 pg/mL at 3 months, p-value=0.024. In conclusion, two VEGFR-3 SNPs as well as various serum biomarkers were associated with diverse clinical outcomes in patients with well-differentiated pancreatic neuroendocrine tumors treated with sunitinib

Temporal patterns of active fire density and its relationship with a satellite fuel greenness index by vegetation type and region in Mexico during 2003-2014

Background: Understanding the temporal patterns of fire occurrence and their relationships with fuel dryness is key to sound fire management, especially under increasing global warming. At present, no system for prediction of fire occurrence risk based on fuel dryness conditions is available in Mexico. As part of an ongoing national-scale project, we developed an operational fire risk mapping tool based on satellite and weather information. Results: We demonstrated how differing monthly temporal trends in a fuel greenness index, dead ratio (DR), and fire density (FDI) can be clearly differentiated by vegetation type and region for the whole country, using MODIS satellite observations for the period 2003 to 2014. We tested linear and non-linear models, including temporal autocorrelation terms, for prediction of FDI from DR for a total of 28 combinations of vegetation types and regions. In addition, we developed seasonal autoregressive integrated moving average (ARIMA) models for forecasting DR values based on the last observed values. Most ARIMA models showed values of the adjusted coefficient of determination (R2 adj) above 0.7 to 0.8, suggesting potential to forecast fuel dryness and fire occurrence risk conditions. The best fitted models explained more than 70% of the observed FDI variation in the relation between monthly DR and fire density. Conclusion: These results suggest that there is potential for the DR index to be incorporated in future fire risk operational tools. However, some vegetation types and regions show lower correlations between DR and observed fire density, suggesting that other variables, such as distance and timing of agricultural burn, deserve attention in future studiesAntecedentes: Una adecuada planificación del manejo del fuego requiere de la comprensión de los patrones temporales de humedad del combustible y su influencia en el riesgo de incendio, particularmente bajo un escenario de calentamiento global. En la actualidad en México no existe ningún sistema operacional para la predicción del riesgo de incendio en base al grado de estrés hídrico de los combustibles. Un proyecto de investigación nacional actualmente en funcionamiento, tiene como objetivo el desarrollo de un sistema operacional de riesgo y peligro de incendio en base a información meteorológica y de satélite para México. Este estudio pertenece al citado proyecto Resultados: Se observaron en el país distintas tendencias temporales en un índice de estrés hídrico de los combustibles basado en imágenes MODIS, el índice “dead ratio” (DR), y en las tendencias temporales de un ìndice de densidad de incendios (FDI), en distintos tipos de vegetación y regiones del país. Se evaluaron varios modelos lineales y potenciales, incluyendo términos para la consideración de la autocorrelación temporal, para la predicción de la densidad de incendios a partir del índice DR para un total de 28 tipos de vegetación y regiones. Se desarrollaron además modelos estacionales autoregresivos de media móvil (ARIMA en inglés) para el pronóstico del índice DR a partir de los últimos valores observados. La mayoría de los modelos ARIMA desarrollados mostraron valores del coeficiente de determinación ajustado (R2 adj) por encima de 0.7 to 0.8, sugiriendo potencial para ser empleados para un pronóstico del estrés hídrico de los combustibles y las condiciones de riesgo de ocurrencia de incendio. Con respecto a los modelos que relacionan los valores mensuales de DR con FDI, la mayoría de ellos explicaron más del 70% de la variabilidad observada en FDI. Conclusiones: Los resultados sugirieron potencial del índice DR para ser incluido en futuras herramientas operacionales para determinar el riesgo de incendio. En algunos tipos de vegetación y regiones se obtuvieron correlaciones más reducidas entre el índice DR y los valores observados de densidad de incendios, sugiriendo que el papel de otras variables tales como la distancia y el patrón temporal de quemas agrícolas debería ser explorado en futuros estudiosFunding for this work was provided by CONAFOR-CONACYT Project 252620 “Development of a Fire Danger System for Mexico.” This work was also cofinanced by the Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria and European Social Fund (Dr. E. Jiménez grant)S

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age 1200/mm(3) (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality