Negociación sindicato - empresa : las ganancias de la cooperación

El papel de los sindicatos y su contribución al comportamiento de las economías, sugiere que existen beneficios cuando hay un mayor nivel de sindicalización y que el proceso de negociación de los sindicatos con las empresas en el mercado laboral podría ser más eficiente, si las partes involucradas cooperaran entre sí, con lo cual se lograría impactar positivamente el mercado laboral y los resultados de las empresas y de la economía en general. Con base en lo anterior, en este trabajo se propone un modelo que, utilizando herramientas de la teoría de juegos, permite establecer los efectos de la cooperación entre dos agentes económicos (Empresa y Sindicato), que tradicionalmente negocian de forma no cooperativa.718/5000 The role of unions and their contribution to the behavior of economies suggests that there are benefits when there is a higher level of unionization and that the negotiation process of unions with companies in the labor market could be more efficient, if the parties involved they will cooperate with each other, with which it will be possible to positively impact the labor market and the results of the companies and the economy in general. Based on the above, this paper proposes a model that, using tools of game theory, allows to establish the effects of cooperation between two economic agents (Company and Trade Union), which traditionally negotiate in a non-cooperative manner.Magíster en EconomíaMaestrí

Early efficacy evaluation of mesenchymal stromal cells (MSC) combined to biomaterials to treat long bone non-unions

Artículo con numerosos autores, sólo se recogen el primero y los pertenecientes a la UAMBackground and study aim: Advanced therapy medicinal products (ATMP) frequently lack of clinical data on efficacy to substantiate a future clinical use. This study aims to evaluate the efficacy to heal long bone delayed unions and non-unions, as secondary objective of the EudraCT 2011-005441-13 clinical trial, through clinical and radiological bone consolidation at 3, 6 and 12 months of follow-up, with subgroup analysis of affected bone, gender, tobacco use, and time since the original fracture. Patients and methods: Twenty-eight patients were recruited and surgically treated with autologous bone marrow derived mesenchymal stromal cells expanded under Good Manufacturing Practices, combined to bioceramics in the surgical room before implantation. Mean age was 39 ±13 years, 57% were males, and mean Body Mass Index 27 ±7. Thirteen (46%) were active smokers. There were 11 femoral, 4 humeral, and 13 tibial non-unions. Initial fracture occurred at a mean ±SD of 27.9 ±31.2 months before recruit- ment. Efficacy results were expressed by clinical consolidation (no or mild pain if values under 30 in VAS scale), and by radiological consolidation with a REBORNE score over 11/16 points (value of or above 0.6875). Means were statistically compared and mixed models for repeated measurements estimated the mean and confidence intervals (95%) of the REBORNE Bone Healing scale. Clinical and radiological con- solidation were analyzed in the subgroups with Spearman correlation tests (adjusted by Bonferroni). Results: Clinical consolidation was earlier confirmed, while radiological consolidation at 3 months was 25.0% (7/28 cases), at 6 months 67.8% (19/28 cases), and at 12 months, 92.8% (26/28 cases including the drop-out extrapolation of two failures). Bone biopsies confirmed bone formation surrounding the bioce- ramic granules. All locations showed similar consolidation, although this was delayed in tibial non-unions. No significant gender difference was found in 12-month consolidation (95% confidence). Higher consoli- dation scale values were seen in non-smoking patients at 6 ( p = 0.012, t -test) and 12 months ( p = 0.011, t -test). Longer time elapsed after the initial fracture did not preclude the occurrence of consolidation. Conclusion: Bone consolidation was efficaciously obtained with the studied expanded hBM-MSCs com- bined to biomaterials, by clinical and radiological evaluation, and confirmed by bone biopsies, with lower consolidation scores in smokersThis research received funding from the European Union’s Sev- enth Framework Programme ( FP7/FP7-HEALTH-2009 ) with the RE- BORNE Project (under G.A. 241876), and the European Union’s Horizon 2020 Programme ( H2020-SC1 2016-2017 ), with the OR- THOUNION Project (under G.A. 7333288

Actions of hormone replacement therapy through the L-arginine nitiric oxide pathway on the cardiovascular and nervous systems of menopausal women

La administración de estrógenos como terapia hormonal sustitutiva (THS) en mujeres menopáusicas mejora la función mental y el estado emocional, efectos que pueden ser dados por el acción favorable en la función endotelial que se manifiesta por aumento del flujo sanguíneo cerebral mediado por óxido nítrico (NO). Sin embargo, la inducción de la síntesis no se limita a las células endoteliales ya que otros tejidos también son estimulados, como el cerebro, así que la mejora observada con suplencia estrogénica de las funciones encefálicas superiores de la mujer menopáusica puede deberse a un doble efecto de la THS, uno por aumento del flujo sanguíneo y otro por incremento de No en el propio sistema nervioso central (SNC). La THS induce la síntesis de No en mujeres menopáusicas, lo que se refleja a nivel sistémico en aumento de los niveles plasmáticos de nitritos y nitratos. El incremento de los metabolitos estables probablemente refleja una mejor producción de No en endotelio vascular, que representa mejoría de la VMF. A nivel del SNC el efecto es selectivo y asimétrico.1. OBJETIVO GENERAL 1 1.1 OBJETIVOS ESPECÍFICOS 1 2. PLANTEAMIENTO DEL PROBLEMA Y JUSTIFICACIÓN 3 3. IMPACTO 1 4. MARCO TEÓRICO 13 4.1 DEFINICIÓN DE TÉRMINOS 13 4.2 MENOPAUSIA Y SISTEMA CARDIOVASCULAR 14 4.3 ACCIONES DE LOS ESTRÓGENOS SOBRE EL SISTEMA CARDIOVASCULAR. 17 4.4 METODOLOGÍA DE LA VASOD1LATAC1ÓN MEDIADA POR FLUJO 20 4.4.1 Prueba 22 4.4.2 Factores de Control en el Momento de Selección de Pacientes 24 4.5 MENOPAUSIA Y SISTEMA NERVIOSO 25 4.5.1 Menopausia y Alteraciones del Estado de Ánimo 25 4.5.2 Menopausia y Alteraciones en la Memoria 26 4.5.3 Terapia Estrogénica, Producción de ON y Sistema Nervioso 27 4.5.4 Inventario de Depresión de Beck (IDB) 28 4.6 TOMOGRAFÍA CON EMISIÓN DE FOTÓN ÚNICO (SPECT) 29 4.6.1 Estudio de Perfusión Normal 29 4.6.2 SPECT con Neuroactivación 30 5. METODOLOGÍA 32 5.1 CARACTERÍSTICAS DEL ENSAYO CLÍNICO 32 5.2 PRUEBAS REALIZADAS 34 6. ANÁLISIS ESTADÍSTICO 37 7. RESULTADOS 39 7.2 SELECCIÓN DE PACIENTES 39 7.2 CARACTERÍSTICAS DE LAS PACIENTES INCLUIDAS 40 7.3 METABOLITOS DEL ÓXIDO NÍTRICO 44 7.4 PRUEBAS DE FLUJO VASCULAR 45 7.4.1 Vasodilatación Mediada por Flujo 45 7.4.2 Variadón de la Velocidad Pico 50 7.5 PRUEBAS DE NEUROPSICOLOGÍA 52 7.5.1 Inventario de Depresión de Beck 52 7.5.2 Prueba de Memoria Reciente 53 7.6 PRUEBAS DE ACTIVIDAD CEREBRAL POR SPECT 55 8. DISCUSIÓN 60EspecializaciónThe administration of estrogens as hormone replacement therapy (HRT) in menopausal women improves mental function and emotional state, effects that may be due to the favorable action on endothelial function that is manifested by an increase in cerebral blood flow mediated by nitric oxide ( NO). However, the induction of synthesis is not limited to endothelial cells as other tissues are also stimulated, such as the brain, so the improvement seen with estrogen supplementation in higher brain functions in menopausal women may be due to a dual effect. of HRT, one due to increased blood flow and the other due to an increase in No in the central nervous system (CNS) itself. HRT induces the synthesis of No in menopausal women, which is reflected at the systemic level in increased plasma levels of nitrites and nitrates. The increase in stable metabolites probably reflects a better production of No in the vascular endothelium, which represents an improvement in VMF. At the CNS level, the effect is selective and asymmetric

Feasibility and safety of treating non-unions in tibia, femur and humerus with autologous, expanded, bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials in a multicentric, non-comparative trial

Background: ORTHO-1 is a European, multicentric, first in human clinical trial to prove safety and feasibility after surgical implantation of commercially available biphasic calcium phosphate bioceramic granules associated during surgery with autologous mesenchymal stromal cells expanded from bone marrow (BM-hMSC) under good manufacturing practices, in patients with long bone pseudarthrosis. Methods: Twenty-eight patients with femur, tibia or humerus diaphyseal or metaphyso-diaphyseal non-unions were recruited and surgically treated in France, Germany, Italy and Spain with 100 or 200 million BM-hMSC/mL associated with 5–10 cc of bioceramic granules. Patients were followed up during one year. The investigational advanced therapy medicinal product (ATMP) was expanded under the same protocol in all four countries, and approved by each National Competent Authority. Findings: With safety as primary end-point, no severe adverse event was reported as related to the BM-hMSC. With feasibility as secondary end-point, the participating production centres manufactured the BM-hMSC as planned. The ATMP combined to the bioceramic was surgically delivered to the non-unions, and 26/28 treated patients were found radiologically healed at one year (3 out of 4 cortices with bone bridging). Interpretation: Safety and feasibility were clinically proven for surgical implantation of expanded autologous BM-hMSC with bioceramic. Funding: EU-FP7-HEALTH-2009, REBORNE Project (GA: 241876).The research leading to these results has received funding from the European Research Council under the European Union's Seventh Framework Programme (FP7/FP7-HEALTH-2009); REBORNE Project (GA: 241876

Características clínicas, histopatológicas y terapéuticas del cáncer de tiroides en Colombia: serie de 1.096 pacientes

Introducción: Los registros poblacionales de cáncer son una aproximación útil para determinar la magnitud del problema, pero son insuficientes como fuente de variables de interés para los clínicos y como generadores de hipótesis de investigación. Con el objetivo de identificar las características clínicas de los pacientes con cáncer de tiroides, el enfoque terapéutico inicial y los costos asociados con el manejo de la enfermedad, se implementó un registro específico en 10 ciudades de Colombia. Materiales y métodos: Se llevó a cabo un estudio descriptivo, observacional entre los años 2013 y 2015. Se desarrolló una herramienta web (www.colombiatiroides.com) consistente en 55 variables con características demográficas, histopatológicas, paraclínicas y terapéuticas, para registrar la información de los pacientes con diagnóstico de cáncer de tiroides que asistieron a consulta de endocrinología, medicina nuclear, cirugía de cabeza y cuello o cirugía endocrina. Resultados: Se incluyó información de 1.096 pacientes con cáncer de tiroides. El promedio de edad fue de 45,5 años; 86,3% eran mujeres; 93,6% de los casos correspondieron a carcinoma papilar. Se documentó asociación entre el tamaño tumoral y el compromiso capsular, extracapsular, linfovascular y ganglionar central y lateral (p=0,000). Los pacientes menores de 45 años presentaron mayor invasión ganglionar central (p=0,000) y lateral (p=0,003), mientras que en los mayores de 45 años los tumores multicéntricos (p=0,032) y la infiltración extracapsular (p=0,036) fueron más frecuentes. El costo directo aproximado por paciente/año fue de $2’532.687 (982 USD). Conclusiones: Los resultados de este registro muestran que el carcinoma diferenciado de tiroides de tipo papilar corresponde al 93,6% dentro de todos los tipos de cáncer de tiroides, proporción que es mayor a la de otras series reportadas en la literatura. El 89% de los pacientes con carcinoma diferenciado de tiroides fueron clasificados como de riesgo alto e intermedio de recurrencia, luego de la terapia inicial del cáncer de tiroides. En pacientes menores de 45 años, la enfermedad tiende a invadir por vía linfática, pero en los mayores de 45 años las extensiones locales son más frecuentes. Finalmente, el costo aproximado de la enfermedad es de USD 982 paciente/año.

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

IL-6 serum levels predict severity and response to tocilizumab in COVID-19: An observational study

Background: Patients with coronavirus disaese 2019 (COVID-19) can develop a cytokine release syndrome that eventually leads to acute respiratory distress syndrome requiring invasive mechanical ventilation (IMV). Because IL-6 is a relevant cytokine in acute respiratory distress syndrome, the blockade of its receptor with tocilizumab (TCZ) could reduce mortality and/or morbidity in severe COVID-19. Objective: We sought to determine whether baseline IL-6 serum levels can predict the need for IMV and the response to TCZ. Methods: A retrospective observational study was performed in hospitalized patients diagnosed with COVID-19. Clinical information and laboratory findings, including IL-6 levels, were collected approximately 3 and 9 days after admission to be matched with preadministration and postadministration of TCZ. Multivariable logistic and linear regressions and survival analysis were performed depending on outcomes: need for IMV, evolution of arterial oxygen tension/fraction of inspired oxygen ratio, or mortality. Results: One hundred forty-six patients were studied, predominantly males (66%); median age was 63 years. Forty-four patients (30%) required IMV, and 58 patients (40%) received treatment with TCZ. IL-6 levels greater than 30 pg/mL was the best predictor for IMV (odds ratio, 7.1; P < .001). Early administration of TCZ was associated with improvement in oxygenation (arterial oxygen tension/fraction of inspired oxygen ratio) in patients with high IL-6 (P = .048). Patients with high IL-6 not treated with TCZ showed high mortality (hazard ratio, 4.6; P = .003), as well as those with low IL-6 treated with TCZ (hazard ratio, 3.6; P = .016). No relevant serious adverse events were observed in TCZ-treated patients. Conclusions: Baseline IL-6 greater than 30 pg/mL predicts IMV requirement in patients with COVID-19 and contributes to establish an adequate indication for TCZ administrationThis study was funded by Spanish Ministry of Economy, Industry and Competitiveness (MINECO) and Instituto de Salud Carlos III (grant nos. RD16/0011/0012 and PI18/ 0371 to I.G.A., grant no. PI19/00549 to A.A., and grant no. SAF2017-82886-R to F.S.-M.) and co-funded by the European Regional Development Fund. The study was also funded by ‘‘La Caixa Banking Foundation’’ (grant no. HR17-00016 to F.S.-M.) and ‘‘Fondos Supera COVID19’’ by Banco de Santander and CRUE. None of these sponsors have had any role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publicatio

Efficacy of clozapine versus standard treatment in adult individuals with intellectual disability and treatment-resistant psychosis (CLOZAID): study protocol of a multicenter randomized clinical trial

BackgroundIntellectual disability (ID) affects approximately 1% of the worldwide population and individuals with ID have a higher comorbidity with mental illness, and specifically psychotic disorders. Unfortunately, among individuals with ID, limited research has been conducted since ID individuals are usually excluded from mental illness epidemiological studies and clinical trials. Here we perform a clinical trial to investigate the effectiveness of clozapine in the treatment of resistant psychosis in individuals with ID. The article highlights the complexity of diagnosing and treating psychopathological alterations associated with ID and advocates for more rigorous research in this field.MethodsA Phase IIB, open-label, randomized, multicenter clinical trial (NCT04529226) is currently ongoing to assess the efficacy of oral clozapine in individuals diagnosed with ID and suffering from treatment-resistant psychosis. We aim to recruit one-hundred and fourteen individuals (N=114) with ID and resistant psychosis, who will be randomized to TAU (treatment as usual) and treatment-with-clozapine conditions. As secondary outcomes, changes in other clinical scales (PANSS and SANS) and the improvement in functionality, assessed through changes in the Euro-QoL-5D-5L were assessed. The main outcome variables will be analyzed using generalized linear mixed models (GLMM), assessing the effects of status variable (TAU vs. Clozapine), time, and the interaction between them.DiscussionThe treatment of resistant psychosis among ID individuals must be directed by empirically supported research. CLOZAID clinical trial may provide relevant information about clinical guidelines to optimally treat adults with ID and treatment-resistant psychosis and the benefits and risks of an early use of clozapine in this underrepresented population in clinical trials.Trial registrationClinicaltrials.gov: NCT04529226. EudraCT: 2020-000091-37

re-habitar El Carmen : Un proyecto sobre patrimonio contemporáneo

El proyecto _re-HABITAR suponía para el propio proceder de la institución un avance más allá del reconocimiento, registro, inventario o protección patrimonial de la arquitectura del siglo XX y del Movimiento Moderno para posicionarse en la acción preventiva y conservativa de ese legado contemporáneo. Para ello, la praxis patrimonial se aferraba a un modelo: el de la vivienda social en España en la segunda mitad del siglo XX; a un caso concreto: el de la barriada de Nuestra Señora del Carmen (Recasens Méndez-Queipo de Llano, 1958); y a un requisito fundamental: analizar un objeto vivo y en uso, aún con la presencia de quienes lo vivieron y usaron desde su origen