Shells and humans: molluscs and other coastal resources from the earliest human occupations at the Mesolithic shell midden of El Mazo (Asturias, Northern Spain)

Human populations exploited coastal areas with intensity during the Mesolithic in Atlantic Europe, resulting in the accumulation of large shell middens. Northern Spain is one of the most prolific regions, and especially the so-called Asturian area. Large accumulations of shellfish led some scholars to propose the existence of intensification in the exploitation of coastal resources in the region during the Mesolithic. In this paper, shell remains (molluscs, crustaceans and echinoderms) from stratigraphic units 114 and 115 (dated to the early Mesolithic c. 9 kys cal BP) at El Mazo cave (Asturias, northern Spain) were studied in order to establish resource exploitation patterns and environmental conditions. Species representation showed that limpets, top shells and sea urchins were preferentially exploited. One-millimetre mesh screens were crucial in establishing an accurate minimum number of individuals for sea urchins and to determine their importance in exploitation patterns. Environmental conditions deduced from shell assemblages indicated that temperate conditions prevailed at the time of the occupation and the morphology of the coastline was similar to today (rocky exposed shores). Information recovered relating to species representation, collection areas and shell biometry reflected some evidence of intensification (reduced shell size, collection in lower areas of exposed shores, no size selection in some units and species) in the exploitation of coastal resources through time. However, the results suggested the existence of changes in collection strategies and resource management, and periods of intense shell collection may have alternated with times of shell stock recovery throughout the Mesolithic.This research was performed as part of the project “The human response to the global climatic change in a littoral zone: the case of the transition to the Holocene in the Cantabrian coast (10,000–5000 cal BC) (HAR2010-22115-C02-01)” funded by the Spanish Ministry of Economy and Competitiveness. AGE was funded by the University of Cantabria through a predoctoral grant and IGZ was funded by the Spanish Ministry of Economy and Competitiveness through a Juan de la Cierva grant. We also would like to thank the University of Cantabria and the IIIPC for providing support, David Cuenca-Solana, Alejandro García Moreno and Lucia Agudo Pérez for their help. We also thank Jennifer Jones for correcting the English. Comments from two anonymous reviewers helped to improve the paper

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Management of surgical waiting list in public hospitals

Hospitals are considered public utility companies and are supposed to be non-profit institutions; usually they function in a politieal and highly complex environment. Managerial authority is shared between doctors and administrators and each of the two groups aims to formulate its own individual policies and pursue objectives that may not coincide or may even be in direct opposition to one another. This situation is certain to affeet hospital performance and it must be taken into account when proposing any kind of results analysis. Improving the efficieney of Hospital performance establishing quantitative target values to those objectives, some of them involving intangible benefits, is the main objective of any Hospital Administration. The purpose of this study is to analyze through the M.C.D.M. approach, the inner coherency of the goals expressed by administrative Authorities. Also, applying Multicriteria Decision techniques we intend to design the real performance of surgical services at a local general hospital offering the decision centre a suitable methodology that allows us to analyze whether or not it is possible to improve fue running of the services, taking into account all the real constraints, e.g. space, staff availability and financial support

Las matemáticas como soporte de las decisiones en economía y empresa.

La toma de decisiones sobre problemas propios de su ámbito competencial es una de las tareas de mayor importancia con las que se ha de enfrentar un titulado en Economía o en Gestión y/o Dirección de Empresas. El término “decisión” puede tener diferentes matices según en qué contexto se esté empleando (derecho, economía, ingeniería, etc.) pero en todos los casos existen elementos comunes sobre los que se puede razonar para construir un modelo, matemático o no, válido en cualquier situación. Un individuo enfrentado con la toma de decisiones debe escoger una alternativa dentro de un conjunto de acciones posibles. Para ello es necesario manejar y evaluar información acerca de factores muy diversos, algunos de ellos solo parcialmente conocidos, que influyen en los cursos de acción y en sus resultados. La Teoría de la Decisión, en este marco, es una disciplina matemática que incluye una amplia gama de métodos y modelos que afrontan el proceso de decisión desde diversas perspectivas o corrientes de pensamiento. Pretendemos, con este trabajo, explicitar las matemáticas que deben servir de soporte a tales métodos y modelos

Una reflexión sobre la incorporación de las matemáticas en los planes de estudio del grado en Economía y Empresa

El proyecto Tuning Educational Structures in Europe, considera que las competencias relacionadas con las Matemáticas pertenecen al “modulo soporte” de los contenidos base de las titulaciones de Grado de Economía y Dirección de Empresas. El Libro Blanco sobre dichos estudios recoge las competencias y destrezas relevantes que deberán adquirir los estudiantes, pudiéndose observar como todas las competencias genéricas instrumentales que se explicitan son proporcionadas por las Matemáticas: capacidad de resolución de problemas, capacidad de análisis y síntesis, capacidad de toma de decisiones…Las Matemáticas aportarán además, competencias genéricas sistémicas (capacidad de adaptación a nuevas situaciones…) y competencias específicas para la aplicabilidad de los conceptos. En el Real Decreto de Grado se establece el contenido de los planes de estudio de los títulos universitarios oficiales de Grado, distinguiendo materias troncales y materias complementarias que serán determinadas discrecionalmente por las Universidades. El contenido de estas últimas podrá comportar una ampliación de los contenidos de materias troncales o la adquisición de objetivos formativos de carácter transversal Este es el marco de una reflexión sobre la necesidad de incorporar asignaturas de Matemáticas en los estudios de Grado y sobre el modo en que se debe llevar a cabo su incorporación a los planes de estudio de nuevo formato

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially