Traumatic renewal of values and value criteria in crisis management

This work tries to be an empirical sample in the study of learning in public policies, that is, how learning is linked to policy change. Particularly, we have studied political-administrative elites’ learning process on crisis provoked by oil spill off the coast of Spain. After expounded our premises about policy learning and the working hypothesis that have guided our work, we explain the methodology we have employed: the Nominal Group Technique, its advantages in this kind of research and how we used it. Finally, we display the reflection generated from the empirical work to better understand policy learning process. In this sense, political factors have been revealed as absolutely essential in order to explain what political-administrative elites learn and whatever they decide to implement. Aspects that make crises different from each other (these being technical aspects) show up as less important than political ones. Political aspects make crisis similar, because of political reasons behind the decision, communication, and attention strategies. Two concepts have appeared as the connection of crisis and elites’ learning: sensitization and political profitability. The former means the process of becoming fully aware of the problem, being concerned about it, and predisposed towards a faster and more coherent action. At the same time, it is difficult to imagine a government undertaking polices that involve political costs, or anything proved to be unprofitable. This is especially true of learning and implementation of whatever has been learnt from crisis that happened in distant points of time

La opinión militar española ante el sistema político : (1874-1898)

Tesis Universidad Complutense de Madrid, 1983.Fac. de Ciencias Políticas y SociologíaTRUEProQuestpu

La opinión militar española ante el sistema político : (1874-1898)

Tesis Universidad Complutense de Madrid, 1983.Fac. de Ciencias Políticas y SociologíaTRUEProQuestpu

Prestige y 11-M : la vertebración política de la gestión de catástrofes

Between 2002 and 2004 Spain was jolted by two big crisis scenarios with a very different nature but two common characteristics. On one hand, they required an immediate response of some magnitude and complex management. On the other, they both caused a very deep impact on Spanish society and politics. Such two characteristics made them especially interesting in order to analyzed multiple aspects related to decisionmaking and “first response” management as a reaction against catastrophes. We can also withdraw several lessons about which factors and criteria are employed by critical actors to evaluate crisis management and “first response” as successful. This article focuses on the lessons learned by analyzing two singular events occurred in Spain and partly associated to very Spanish civic culture keys and political dynamics. At the same time, both of them have similar features and iconic meaning to other more recent crisis occurred in other places around the world. The first case studied is the crisis provoked by the accident of the oil ship “Prestige”, drawn in November 2002, 130 miles away from the Spanish coast in Galicia. It poured around 64.000 tones of oil in the Atlantic Ocean. It provoked a huge ecological disaster mainly in Galicia though to a great extent it reached 2.500Kms of coastal line, from the North of Portugal to the South of France. The second one is the terrorist attack of March 11th, 2004 in Madrid. A cell of Islamist terrorists linked to Al Qaeda made explode simultaneously ten bombs in train stations and suburban trains in four different locations. More than 1.600 people were injured and 191 were killed. The analysis of crisis management success criteria and factors is framed in two competitive research projects 1 . Three different qualitative research techniques are employed: (a) interviews to critical actors involved in crisis management; (b) semistructured questionnaires addressed to key informants; and (c) four workshops, composed by experts, managers and decisionmakers involved in Prestige Oil Spill and M11 crisis. The method used is an original and renewed version of the Nominal Group Technique (NGT). The application of these techniques was complemented with the information obtained out of other sources such as official reports, press releases, articles and specialized monographs and some results of the inquiries carried out by the Spanish Center of Sociological Research (CIS

Minimally invasive sacroiliac joint arthrodesis : experience in a prospective series with 24 patients

Background: Sacroiliac (SI) joint pain conservative treatments show poor outcomes. Hypothesis: surgical treatment will show better results. Patients and methods: Prospective series: 24 patients undergoing SI fusion after failure of medical treatment and showing temporary relief with SI infiltration. Period: Nov 2009-July 2013. Gender: 9/15. 11 cases bilaterally (all ). Age: 32-71 years (mean 47.4 years). Height: 161-178 cm (mean 168.2 cm). Weight: 56-84 kg (mean 68.4 kg). Etiology: 12 degenerative/spontaneous, 7 fall on buttocks, 3 coincident with lumbar disc and 2 with lumbar posterolateral fusion. Exclusion criteria: ankylosing spondylitis, osteitis condensans ilii, sacro-iliac joint arthropaty. Demographics, analgesics and NSAID's consumption, incidence and severity of complications, clinical outcome using a visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) and time to returning to work were collected postoperatively at 1, 3 and 6 months, and then at six months interval until last follow-up. Results: Follow-up: 1-4.5 years (mean 23.3 months). No intra-operative or post-operative major complications. No blood transfusions. Patients stayed over-night, and discharged next morning. No crutches used. Time to returning to work: 47.4 days (range 30-67 days). Post-op: marked reduction in VAS and analgesic consumption (preop 8.7, post-op 1 month 3.2, 3 months 2.8, 6 months post-op 2.1, 12 months 1.7, 18 months 1.7, 2 years 1.9, 2½ years 1.8, 3 years 2.0, at 3½ years 2.1, 4 years 2.1 and 4½ 2.1). Mean ODI scores improved from 54.1 preoperatively to 23.9, 21.2, 20.4 and 14.3 at 1, 3, 6 and 12 months postoperatively, and 15.1, 15.5 15.8, 16.0, 16.1, 16.3 and 16.3 at 1½, 2, 2½, 3, 3½, 4 and 4½ years (p<.001). 1 year post-op 22/24 patients would undergo the procedure again. Conclusion: Percutaneous SI joint arthrodesis is effective and safe to treat chronic SI joint pain

High frequency of lumbar fusion in patients denied surgical treatment of the sacroiliac joint

Purpose: Effective treatment of medical conditions relies on proper diagnosis. Clinical trials show the safety and effectiveness of sacroiliac joint (SIJ) fusion in patients with chronic SI joint dysfunction. To what extent is the condition under recognised? Objective: To determine whether under recognition of SIJ pain affects healthcare trajectories in Spanish patients with low back pain. Methods: Retrospective study of characteristics and consequences of 189 patients with persistent SIJ pain seen in an outpatient neurosurgery clinic. Results: Patients with SIJ pain who were denied surgical treatment had a longer pain duration, higher likelihood of prior lumbar fusion, and a high rate (63%) of lumbar fusion within 2 years prior to SIJ pain diagnosis, which, in most cases, provided little benefit. Conclusions: Lack of knowledge of the role of the SIJ in chronic low back pain probably results in diagnostic confusion and may lead to misdirected treatment

Agreement in metastatic spinal cord compression

Background: Metastatic epidural spinal cord compression (ESCC) is a devastating medical emergency. The purpose of this study was to determine the reliability of the 6-point ESCC scoring system and the identification of the spinal level presenting ESCC. Methods: Clinical data and imaging from 90 patients with biopsy-proven spinal metastases were provided to 83 specialists from 44 hospitals. The spinal levels presenting metastases and the ESCC scores for each case were calculated twice by each clinician, with a minimum of 6 weeks' interval. Clinicians were blinded to assessments made by other specialists and their own previous assessment. Fleiss kappa (κ) statistic was used to assess intraobserver and interobserver agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery, and radiation oncology), years of experience, and type of hospital. Results: Intraobserver and interobserver agreement on the location of ESCC was substantial (κ>0.61). Intraobserver agreement on the ESCC score was 'excellent' (κ=0.82), whereas interobserver agreement was substantial (κ=0.64). Overall agreement with the tumor board classification was substantial (κ=0.71). Results were similar across specialties, years of experience and hospital category. Conclusions: The ESCC score can help improve communication among clinicians involved in oncology care