Democracia en condiciones menos favorables.

In this paper it is argued how democracy in Latin-America, in non-ideal conditions, can overcome some of the dangers which beset it: basically, inequality and corruption. From the excellent recent book of Roberto Gargarella (2015), the idea that maybe is the equality the great and unachieved promise among the ideals of constitutionalism in this region of the world is accepted. it is also accepted that an important part of the reason for this absence of equality lies in the institutional design, in the engine room of the constitution, concretely in an hypertrophy of presidentialism. A complementary suggestion is added: the ideal of a constitutional democracy presupposes the existence of a state with an autonomous, efficient, professional and robust public administration. Only with a well-designed tax system and an administration apt to carry out the proper functions it is possible to build a well-ordered society able to reduce significantly corruption and to ground a republican and common good oriented democracy of equal persons.En este texto se argumenta como puede la democracia en Latinoamérica, en condiciones noideales, superar algunos de los peligros que la acechan: desigualdad y corrupción, fundamentalmente. Se toma como base el magnífico libro reciente de Roberto Gargarella (2015), y se acepta con él que tal vez sea la igualdad la gran promesa incumplida entre los ideales del constitucionalismo en esta región del mundo. Se acepta también que parte de la responsabilidad de ello reside en el diseño institucional, en la sala de máquinas de la constitución, en concreto en una hipertrofia del presidencialismo. Se añade la sugerencia de que el ideal de la democracia constitucional presupone la existencia de un estado con una administración pública autónoma, eficiente, profesional y robusta. sólo con un sistema tributario bien diseñado y con una administración apta para llevar a cabo las funciones que le son propias es posible construir una sociedad bien ordenada, capaz de reducir significativamente la corrupción y de sentar las bases de una democracia republicana de personas iguales orientada hacia el bien común

University autonomy and governance

Fa ja deu anys, en un estudi molt rellevant sobre les universitats europees, els autors Aghion et al. (2007) resumien en dos els factors que feien de les universitats europees insuficientment competitives: un finançament, públic i privat, insuficient i una governança ineficient. Aquest text aborda la segona qüestió. Més concretament, d’un aspecte, el jurídic, de la segona qüestió. La ubicació concreta de l’autonomia universitària a la Constitució espanyola de 1978 i la manera en què la jurisprudència constitucional ha entès aquesta ubicació representa entre nosaltres una dificultat afegida a l’hora de dissenyar el nostre futur. No es tracta d'un estudi per juristes sinó que es limita a explicar com la jurisprudència constitucional ha entès i quines mancances representa. Així mateix, es mostren les dificultats que aquesta doctrina comporta i algunes reflexions de futur. Ten years ago, in a very relevant study on European universities, the authors Aghion et al. (2007) summarized in two the factors that they did of the insufficiently competitive European universities: a financing, public and private, insufficient and an inefficient governance. This text addresses the second question. More specifically, one aspect, the legal one, of the second question. The concrete location of university autonomy in the Spanish Constitution of 1978 and the way in which constitutional jurisprudence has understood this location represents an added difficulty in designing our future among us. This is not a study for legal cholars but simply explains how constitutional jurisprudence has understood and what shortcomings it represents. Likewise, the difficulties that this doctrine implies and some reflections of the future are shown

Democracia En Condiciones Menos Favorables

En este texto se argumenta como puede la democracia en Latinoamérica, en condiciones noideales, superar algunos de los peligros que la acechan: desigualdad y corrupción, fundamentalmente. Se toma como base el magnífico libro reciente de Roberto Gargarella (2015), y se acepta con él que tal vez sea la igualdad la gran promesa incumplida entre los ideales del constitucionalismo en esta región del mundo. Se acepta también que parte de la responsabilidad de ello reside en el diseño institucional, en la sala de máquinas de la constitución, en concreto en una hipertrofia del presidencialismo. Se añade la sugerencia de que el ideal de la democracia constitucional presupone la existencia de un estado con una administración pública autónoma, eficiente, profesional y robusta. sólo con un sistema tributario bien diseñado y con una administración apta para llevar a cabo las funciones que le son propias es posible construir una sociedad bien ordenada, capaz de reducir significativamente la corrupción y de sentar las bases de una democracia republicana de personas iguales orientada hacia el bien común

Clinical evolution of post-transplant diabetes mellitus.

The long-term clinical evolution of prediabetes and post-transplant diabetes mellitus (PTDM) is unknown. We analysed, in this cohort study, the reversibility, stability and progression of PTDM and prediabetes in 672 patients using repeated oral glucose tolerance tests (OGTTs) for ≤5 years. Most patients were on tacrolimus, steroids and mycophenolate. About half developed either PTDM or prediabetes. The incidence of PTDM was 32% and bimodal: early PTDM (≤3 months) and late PTDM. Early PTDM reverted in 31%; late PTDM developed in patients with post-transplant prediabetes. The use of OGTTs was necessary to detect around half of PTDM. Pretransplant obesity was a major risk factor for early PTDM, for its persistence and for late PTDM {odds ratio [OR] 1.18 [95% confidence interval (CI) 1.09-1.28]}. At 3 months, higher HbA1c promoted [OR 2.37 (95% CI 1.38-4.06)], while insulin sensitivity protected against [OR 0.64 (95% CI 0.48-0.86)] late PTDM. At 3 months, 28% had prediabetes; of these, 36% remained stable, 43% normalized and 21% developed late PTDM. Pretransplant obesity [OR 1.20 (95% CI 1.04-1.39)] and higher HbA1c [OR 3.80 (95% CI 1.45-9.94)] at 3 months promoted while insulin sensitivity protected against [OR 0.57 (95% CI 0.34-0.95)] evolution from prediabetes to late PTDM. Immunosuppressive levels or acute rejection did not influence PTDM. Most (84%) of the patients with normal tests at 3 months remained stable without evolving into PTDM; 14% developed prediabetes. PTDM and prediabetes are very common in renal transplantation. Classic metabolic factors like obesity, prediabetes and insulin resistance promote the evolution of PTDM and prediabetes. Patients with normal glucose metabolism rarely develop PTDM. OGTT is necessary to detect PTDM and prediabetes and thus should be included in clinical practice

Cytomegalovirus infection management in solid organ transplant recipients across European centers in the time of molecular diagnostics: An ESGICH survey

Background: Scant information is available about how transplant centers are managing their use of quantitative molecular testing (QNAT) assays for active cytomegalovirus (CMV) infection monitoring in solid organ transplant (SOT) recipients. The current study was aimed at gathering information on current practices in the management of CMV infection across European centers in the era of molecular testing assays. Methods: A questionnaire-based cross-sectional survey study was conducted by the European Study Group of Infections in Immunocompromised Hosts (ESGICH) of the Society of Clinical Microbiology and Infectious Diseases (ESCMID). The invitation and a weekly reminder with a personal link to an Internet service provider (https://es.surveymonkey.com/) was sent to transplant physicians, transplant infectious diseases specialists, and clinical virologists working at 340 European transplant centers. Results: Of the 1181 specialists surveyed, a total of 173 responded (14.8%): 73 transplant physicians, 57 transplant infectious diseases specialists, and 43 virologists from 173 institutions located at 23 different countries. The majority of centers used QNAT assays for active CMV infection monitoring. Most centers preferred commercially available real-time polymerase chain reaction (RT-PCR) assays over laboratory-developed procedures for quantifying CMV DNA load in whole blood or plasma. Use of a wide variety of DNA extraction platforms and RT-PCR assays was reported. All programs used antiviral prophylaxis, preemptive therapy, or both, according to current guidelines. However, the centers used different criteria for starting preemptive antiviral treatment, for monitoring systemic CMV DNA load, and for requesting genotypic assays to detect emerging CMV-resistant variants. Conclusions: Significant variation in CMV infection management in SOT recipients still remains across European centers in the era of molecular testing. International multicenter studies are required to achieve commutability of CMV testing and antiviral management procedures