La respuesta del Derecho Penal y Administrativo frente a las agresiones a profesionales sanitarios en España

La entrada en vigor de la Ley Orgánica 1/2015 ha supuesto la materialización de importantes modificaciones en el tratamiento punitivo de los supuestos de agresiones a profesionales sanitarios. En particular, y junto con la tipificación expresa como delito de atentado (art. 550 CP) de los supuestos de agresiones a profesionales sanitarios, se incluye como novedad más relevante la previsión de una agravación en el delito de homicidio cuando los hechos resulten constitutivos de un atentado (art. 138.2.b CP). Al hilo de lo anterior, el presente trabajo pretende establecer con nitidez el nuevo panorama concurrente en la esfera sancionatoria (penal y administrativa) en dichos supuestos de agresiones a los mencionados profesionales. The coming into effect of Organic Law 1/2015 has involved relevant changes in the criminal treatment of cases of violence against health professionals. In particular, the reform expressly establishes the offence as assault on the authority, its agents and civil servants (Article 550 Spanish Criminal Code) of the cases of aggression against health professionals. It also includes, as a relevant novelty, the prevision of an aggravated modality of homicide when the facts prove to be constitutive of an assault on the authority, its agents and civil servants (Article 138.2.b Spanish Criminal Code). Consequently, the present paper is devoted to clarifying the current legal framework in the punitive sphere (penal and administrative) in cases of aggression against health professionals

Geophysical Characterization of Hydraulic Properties around a Managed Aquifer Recharge System over the Llobregat River Alluvial Aquifer (Barcelona Metropolitan Area)

Managed aquifer recharge using surface or regenerated water plays an important role in the Barcelona Metropolitan Area in increasing storage volume to help operators cope with the runoff variability and unexpected changes in surface water quality that are aggravated by climate change. The specific aim of the research was to develop a non-invasive methodology to improve the planning and design of surface-type artificial recharge infrastructures. To this end, we propose an approach combining direct and indirect exploration techniques such as electrical resistivity tomography (ERT), frequency domain electromagnetics and data from double-ring infiltration tests, trial pits, research boreholes and piezometers. The ERT method has provided much more complete and representative information in a zone where the recharge project works below design infiltration rates. The geometry of the hydrogeological units and the aquifer-aquiclude contact are accurately defined through the models derived from the interpretation of ERT cross-sections in the alluvial aquifer setting. Consequently, prior to the construction of recharge basins, it is highly recommended to conduct the proposed approach in order to identify the highest permeability areas, which are, therefore, the most suitable for aquifer artificial recharg

ERT monitoring of two Managed Aquifer Recharge ponds in the alluvial aquifer of the Llobregat River (Barcelona, Spain)

Over the past twenty years, there has been growing interest in the use of the subsurface for water storage using shallow ponds, where water is infiltrated to the subsurface and later groundwater is recovered from pumping wells. This scheme is designed as surface Managed Aquifer Recharge (MAR). Llobregat artificial recharge ponds are MAR systems located in alluvial aquifers near Barcelona with strong significance for water supply to the city. The recharge ponds showed low infiltration rates since the beginning (Ca n'Albareda) and a significant decrease after some months (Sant Vicenç). Consequently, different methodologies were designed for monitoring the systems and evaluating the effectiveness of the selected areas and maintenance procedures. For this purpose, we combined the use of Electrical Resistivity Tomography (ERT) with standard hydrogeological methodologies, including water table monitoring from piezometers and infiltration tests. The combination of direct and indirect methods have allowed us to improve the diagnosis of the subsurface involved in the managed recharge system. The ERT technique has shown to be a cost‐effective and high‐resolution tool, flexible and well adaptable for surveying at different scales without disturbing the recharge process. As a consequence, we demonstrate the usefulness of ERT imaging to unveil hydrogeological heterogeneities and monitoring infiltration, clogging effect and clean‐up processes in surface MAR projects

Application of Resistivity and Seismic Refraction Tomography for Landslide Stability Assessment in Vallcebre, Spanish Pyrenees

Geophysical surveys are a noninvasive reliable tool to improve geological models without requiring extensive in situ borehole campaigns. The usage of seismic refraction tomography (SRT), electrical resistivity tomography (ERT) and borehole data for calibrating is very appropriate to define landslide body geometries; however, it is still only used occasionally. We present here the case of a Spanish Pyrenees slow-moving landslide, where ERT, SRT and lithological log data were integrated to obtain a geological three-dimensional model. The high contrasts of P-wave velocity and electrical resistivity values of the upper materials (colluvial debris and clayey siltstone) provided accurate information on the geometry of the materials involved in the landslide body, as well as the sliding surface. Geophysical prospecting allowed us to identify the critical sliding surface over a large area and at a reduced cost and, therefore, gives the geophysical method an advantage over borehole data. The three-dimensional model was used to carry out stability analyses of a landslide in 2D and 3D, which, coherently with previous studies, reveal that the lower part is more unstable than the upper units

Characterization of a Shallow Coastal Aquifer in the Framework of a Subsurface Storage and Soil Aquifer Treatment Project using Electrical Resistivity Tomography (Port de la Selva, Spain)

Water percolation through infiltration ponds is creating significant synergies for the broad adoption of water reuse as an additional non-conventional water supply. Despite the apparent simplicity of the soil aquifer treatment (SAT) approaches, the complexity of site-specific hydro-geological conditions and the processes occurring at various scales require an exhaustive under-standing of the system's response. The non-saturated zone and underlying aquifers cannot be considered as a black box, nor accept its characterization from few boreholes not well distribut-ed over the area to be investigated. The electrical resistivity tomography (ERT) is a non-invasive technology, highly responsive to geological heterogeneities that has demonstrated useful to provide the detailed subsurface information required for groundwater modeling. The relation-ships between the electrical resistivity of the alluvial sediments and the bedrock and the differ-ence in salinity of groundwater, highlight the potential of geophysical methods over other more costly subsurface exploration techniques. The results of our research show that ERT coupled with implicit modeling tools provides information that can significantly help to identify aquifer geometry and characterize the saltwater intrusion of shallow alluvial aquifers. The proposed approaches could improve the reliability of groundwater models and the commitment of stakeholders to the benefits of SAT procedures

A truncating variant of RAD51B associated with primary ovarian insufficiency provides insights into its meiotic and somatic functions

Primary ovarian insufficiency (POI) causes female infertility by abolishing normal ovarian function. Although its genetic etiology has been extensively investigated, most POI cases remain unexplained. Using whole-exome sequencing, we identified a homozygous variant in RAD51B –(c.92delT) in two sisters with POI. In vitro studies revealed that this variant leads to translation reinitiation at methionine 64. Here, we show that this is a pathogenic hypomorphic variant in a mouse model. Rad51bc.92delT/c.92delT mice exhibited meiotic DNA repair defects due to RAD51 and HSF2BP/BMRE1 accumulation in the chromosome axes leading to a reduction in the number of crossovers. Interestingly, the interaction of RAD51B-c.92delT with RAD51C and with its newly identified interactors RAD51 and HELQ was abrogated or diminished. Repair of mitomycin-C-induced chromosomal aberrations was impaired in RAD51B/Rad51b-c.92delT human and mouse somatic cells in vitro and in explanted mouse bone marrow cells. Accordingly, Rad51b-c.92delT variant reduced replication fork progression of patient-derived lymphoblastoid cell lines and pluripotent reprogramming efficiency of primary mouse embryonic fibroblasts. Finally, Rad51bc.92delT/c.92delT mice displayed increased incidence of pituitary gland hyperplasia. These results provide new mechanistic insights into the role of RAD51B not only in meiosis but in the maintenance of somatic genome stability.This work was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Grant 2014/14231-0 (to MMF); FAPESP Grant 2013/02162-8, Nucleo de Estudos e Terapia Celular e Molecular (NETCEM), Conselho Nacional de Desenvolvimento Científico e Tecnológico Grant 303002/2016- 6 (to BBM); and FAPESP Grant 2014/50137-5 (to SELA). This work was supported by MINECO (PID2020-120326RB-I00) and by Junta de Castilla y León (CSI239P18 and CSI148P20). NFM, FSS, and MRMH are supported by European Social Fund/JCyLe grants (EDU/310/2015, EDU/556/2019 and EDU/1992/2020). YBC and RSU are funded by a grant from MINECO (BS-2015–073993 and BFU2017-89408-R). Experiments performed at CNIO were supported by grant PID2019-106707-RB to JM, co-sponsored by EU ERDF funds. SM was supported by an international postdoctoral contract “CNIO Friends”. The proteomic analysis was performed in the Proteomics Facility of Centro de Investigación del Cáncer, Salamanca, Grant PRB3(IPT17/0019 -ISCIII-SGEFI/ERDF). CIC-IBMCC is supported by the Programa de Apoyo a Planes Estratégicos de Investigación de Estructuras de Investigación de Excelencia cofunded by the Castilla–León autonomous government and the European Regional Development Fund (CLC–2017–01). Veitia’s Lab is supported by the University of Paris and the Centre National de la Recherche Scientifique

Si ocurrió un evento adverso piense en decir “lo siento”

Fundamento. La información al paciente víctima de un evento adverso (EA) presenta ciertas particularidades en función del marco legal del país en el que se produzca, especialmente en lo referido al ofrecimiento de una disculpa. En el presente trabajo se pretende establecer los límites y las condiciones que debemos considerar a la hora de trasladar una disculpa al paciente que ha sufrido un EA. Método. Conferencia de consenso entre 26 profesionales de distintas comunidades autónomas, instituciones y perfiles profesionales con experiencia acreditada en la gestión de sistemas de Seguridad del Paciente y Derecho Penal de diferentes ámbitos laborales (sanidad, aseguradoras, inspección, académico). Resultados. El paciente, tras un EA además de ser informado, debiera recibir una disculpa expresada en términos neutros (manifestación empática y de pesar por lo sucedido), sin que el informante se identifique a sí mismo como responsable del daño, culpabilice a terceros, ni ofrezca una compensación en nombre de la compañía aseguradora. El profesional que se siente más directamente involucrado en el incidente es normalmente el menos indicado para informar y disculparse. El informante debe ajustarse al tipo y gravedad del EA. La normativa y condiciones del seguro de responsabilidad aconsejan no ofrecer información concreta sobre la magnitud de la compensación. Conclusiones. La disculpa debe medirse en función del marco normativo que rige en cada país. En nuestro caso procede una respuesta de empatía hacia el paciente, manifestando pesar por lo sucedido (decir lo siento) que puede facilitar la relación con el paciente, reducir su desconfianza y el número de litigios. Background. Disclosing information to a patient who is a victim of an adverse event (AE) presents some particularities depending on the legal framework in the country where the AE occurred. The aim of this study is to identify the limits and conditions when apologizing to a patient who has suffered an AE. Methods. A consensus conference involving 26 professionals from different autonomous communities, institutions, and profiles (health, insurance, inspection, academic) with accredited experience in patient safety management systems and criminal law. Results. Open disclosure should include an apology expressed in neutral terms (showing empathy and regret for what has happened) without the informant being identified as responsible for the damage, blaming third parties, or offering compensation on behalf of the insurance company. The professional who feels most directly involved in the incident is usually the least likely to report it and apologise. The informant profile must conform to the type and severity of the AE. The rules and conditions of liability insurance advise against providing specific information on the amount of compensation. Conclusions. The apology should be offered in terms of the regulatory framework in force in each country. In Spain, an appropriate response of empathy for the patient is warranted, expressing regret for what happened (apologising), which can facilitate the relationship with the patient, mitigate their mistrust, and reduce the number of disputes

The Lipid Paradox is present in ST-elevation but not in non-ST-elevation myocardial infarction patients:Insights from the Singapore Myocardial Infarction Registry

Lowering low-density lipoprotein (LDL-C) and triglyceride (TG) levels form the cornerstone approach of cardiovascular risk reduction, and a higher high-density lipoprotein (HDL-C) is thought to be protective. However, in acute myocardial infarction (AMI) patients, higher admission LDL-C and TG levels have been shown to be associated with better clinical outcomes - termed the 'lipid paradox'. We studied the relationship between lipid profile obtained within 72 hours of presentation, and all-cause mortality (during hospitalization, at 30-days and 12-months), and rehospitalization for heart failure and non-fatal AMI at 12-months in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients treated by percutaneous coronary intervention (PCI). We included 11543 STEMI and 8470 NSTEMI patients who underwent PCI in the Singapore Myocardial Infarction Registry between 2008-2015. NSTEMI patients were older (60.3 years vs 57.7 years, p < 0.001) and more likely to be female (22.4% vs 15.0%, p < 0.001). In NSTEMI, a lower LDL-C was paradoxically associated with worse outcomes for death during hospitalization, within 30-days and within 12-months (all p < 0.001), but adjustment eliminated this paradox. In contrast, the paradox for LDL-C persisted for all primary outcomes after adjustment in STEMI. For NSTEMI patients, a lower HDL-C was associated with a higher risk of death during hospitalization but in STEMI patients a lower HDL-C was paradoxically associated with a lower risk of death during hospitalization. For this endpoint, the interaction term for HDL-C and type of MI was significant even after adjustment. An elevated TG level was not protective after adjustment. These observations may be due to differing characteristics and underlying pathophysiological mechanisms in NSTEMI and STEMI

Salud y sociedad. Influencia de las corrientes de pensamiento en los modelos sanitarios

Este trabajo trata de determinar la influencia de algunas Escuelas y Corrientes Sociológicas y Filosóficas en las Políticas de Salud definidas por los Gobiernos de los diferentes países. Para ello se analizan varios modelos sanitarios, tratando de relacionarlos, con las bases científicas de pensamiento que los sustentan. Además, se profundiza en una corriente que, derivada de los principios neokantianos y de la Escuela Fenomenológica norteamericana, está incidiendo desde 1970, cada vez con más fuerza, en el ámbito de la Sanidad de la mayoría de los países occidentales. Por último, se realizan una serie de reflexiones sobre las consecuencias que, para la población, puede tener la implantación de este tipo de modelo. El objetivo del presente artículo es tratar de analizar, de forma crítica, las concepciones fundamentales de la teoría marxista y funcionalista en función de su aplicación al campo de la Salud