Robots, exports and top income inequality: evidence for the U.S.

The last decades have witnessed a revolution in manufacturing production characterized by increasing technology adoption and a strong expansion of international trade. Simultaneously, the income distribution has exhibited both polarization and concentration among the richest. Combining datasets from the U.S. Census Bureau, the U.S. Internal Revenue Service, the International Federation of Robotics, EU KLEMS, and COMTRADE, we study the causal effect of industrial automation on income inequality in the U.S. during 2010–2015. We exploit spatial and time variations in exposure to robots arising from past differences in industry specialization across U.S. metropolitan areas and the evolution of robot adoption across industries. We document a robust positive impact of robotics on income for only the top 1 percent of taxpayers, which is largest for top income fractiles. Therefore, industrial automation fuels income inequality and, particularly, top income inequality. According to our estimates, one more robot per thousand workers results in relative increments of the total taxable income accruing to fractiles P99 to P99.9, P99.9 to P99.99 and P99.99 to P100, of 2.1 percent, 3.5 percent and 5.9 percent, respectively. We also find that robotization leads to increased exports to high-income and upper-middle-income economies, and that this is one of the key mechanisms behind the surge in top income inequality.Centro de Estudios Distributivos, Laborales y Sociale

Tratamiento cognitivo-conductual grupal del trastorno de pánico con o sin agorafobia en un centro de salud mental público

The efficacy of cognitive-behavior therapy (CBT) in the treatment of panic disorder (TP) with or without agoraphobia is well documented, but less is known about group CBT effectiveness. The purpose of this study is to investigate the effectiveness of a combination of the main techniques used in a specific version of CBT for the treatment of this disorder: the Control Panic Program. The treatment consisted of 12 weekly group sessions, following the guidelines proposed by Martin (2007) to implement the Barlow program in a group format (Barlow 1988). All patients showed significant gains in all dimensions assessed, with a high degree of remission in panic attacks’ physiological symptoms and significant improvement in associated symptoms. Results warrant recommending this model for the treatment of panic disorder in public mental health consultancies.La eficacia de la terapia cognitivo-conductual (TCC) en el tratamiento del trastorno de pánico (TP) con o sin agorafobia está bien documentada; sin embargo, se conoce menos su efectividad en formato grupal. El propósito de este estudio es investigar la efectividad de una combinación de las principales técnicas utilizadas en una versión específi ca de TCC en formato grupal para este trastorno: el Modelo de Control del Pánico. El tratamiento consistió en 12 sesiones grupales semanales siguiendo la guía propuesta por Martín (2007) para aplicar en grupo el programa de Barlow (1988). Todos los pacientes tuvieron ganancias signifi cativas en todas las dimensiones evaluadas con alto grado de remisión de sintomatología fi siológica de las crisis de pánico y mejora signifi cativa en los síntomas asociados. Los resultados sugieren la recomendación de este modelo de tratamiento para el abordaje de los trastornos de pánico en una consulta pública de salud mental

Intervención psicológica escalonada con trastornos mentales comunes en Atención Primaria.

A model of psychological intervention for common mental disorders in Primary Care is analized. Two clinical psychologists and four resident psychologists interviewed 566 users to treat mild to moderate anxiety / depression disorders, bereavement or nonorganic insomnia disorders. Standardized assessment leads to a stepped intervention: indication of no treatment, brief group or individual intervention in Primary Care Center (PCC) or referral to Mental Health.Socio-demographic and clinical variables describe the sample and allow comparison betwen groups. Of the 566 interviewees, the mean age was 37 years, 70% were women, 50% with psychopharmacological treatment and 10% on sick leave. The steps of intervention were: 19% were intervention indication of no treatment, 71% PCC intervention and 10% were referred to Mental Health. Adaptive, emotional and generalized anxiety disorders were predominant, with significant differences between centers depending on the location and clinical psychologist integration mode in PCC.Integrating the clinical psychologist in PCC improve access to psychological interventions and reduces mild to moderate mental disorders medication. Assessment prevents unnecessary treatment onset and increases the likelihood of appropriate treatment indications, which is cost-effective.Se analiza un modelo de intervención psicológica para trastornos mentales comunes realizado en seis centros de Atención Primaria (CAP). Dos psicólogos/as clínicos/as (PC) y cuatro psicólogas internas residentes (PIR) entrevistan a 566 usuarios para intervenir en trastornos leves o moderados de ansiedad y/o depresión, duelo e insomnio no orgánico. Tras una evaluación estandarizada se propone una intervención escalonada en función del diagnóstico y la gravedad del trastorno: indicación de no tratamiento, intervención breve en CAP (grupal o individual) o derivación.Se recogen variables sociodemográficas y clínicas que permiten describir la muestra y hacer comparaciones entre grupos. De las 566 personas derivadas la edad media fue de 37 años, el 70 % son mujeres, 50% en tratamiento psicofarmacológico y 10% de baja laboral. Se indica no tratamiento al 19%, intervención en CAP al 71% y derivación a salud mental al 10%. Predominan trastornos adaptativos, afectivos y de ansiedad generalizada, existiendo diferencias significativas según ubicación del CAP y modo integración del PC en el CAP.La mayor accesibilidad a intervenciones psicológicas integrando al PC en AP reduce la medicalización de patologías mentales leves y/o moderadas. La evaluación previene el inicio de tratamientos innecesarios, aumentando la probabilidad de indicación apropiada de tratamiento, lo que resultaría coste-efectivo

Psicoterapia grupal en duelo. Experiencia de la psicología clínica en Atención primaria.

La “Estrategia en Salud Mental del Sistema Nacional de Salud” recomienda crear recursos grupales para los trastornos mentales comunes y hacerlo en atención primaria, siendo el duelo motivo de consulta frecuente.Al introducir las intervenciones psicológicas en Atención Primaria en Murcia, se propone al equipo de médicos tratamientos breves de probada eficacia para trastornos frecuentes. El trabajo realizado con un grupo de psicoterapia grupal centrado en el duelo ha tenido como finalidad, evitar la cronicidad. Los tratamientos son aplicados por un residente de psicología clínica. Se elige el formato grupal por ser el más eficiente.El grupo se desarrolla en 6 sesiones, con evaluación (pre-post) estandarizada. En el duelo se utilizan el BDI, el STAI y el Inventario de Texas Revisado de Duelo. Las sesiones son de corte cognitivo conductual, teniendo en cuenta el componente emocional.Se exponen los resultados y reflexiones del trabajo

Clinical, virological and biochemical evidence supporting the association of HIV-1 reverse transcriptase polymorphism R284K and thymidine analogue resistance mutations M41L, L210W and T215Y in patients failing tenofovir/emtricitabine therapy

Background: Thymidine analogue resistance mutations (TAMs) selected under treatment with nucleoside analogues generate two distinct genotypic profiles in the HIV-1 reverse transcriptase (RT): (i) TAM1: M41L, L210W and T215Y, and (ii) TAM2: D67N, K70R and K219E/Q, and sometimes T215F. Secondary mutations, including thumb subdomain polymorphisms (e.g. R284K) have been identified in association with TAMs. We have identified mutational clusters associated with virological failure during salvage therapy with tenofovir/emtricitabine-based regimens. In this context, we have studied the role of R284K as a secondary mutation associated with mutations of the TAM1 complex. Results: The cross-sectional study carried out with >200 HIV-1 genotypes showed that virological failure to tenofovir/emtricitabine was strongly associated with the presence of M184V (P < 10-10) and TAMs (P < 10-3), while K65R was relatively uncommon in previously-treated patients failing antiretroviral therapy. Clusters of mutations were identified, and among them, the TAM1 complex showed the highest correlation coefficients. Covariation of TAM1 mutations and V118I, V179I, M184V and R284K was observed. Virological studies showed that the combination of R284K with TAM1 mutations confers a fitness advantage in the presence of zidovudine or tenofovir. Studies with recombinant HIV-1 RTs showed that when associated with TAM1 mutations, R284K had a minimal impact on zidovudine or tenofovir inhibition, and in their ability to excise the inhibitors from blocked DNA primers. However, the mutant RT M41L/L210W/T215Y/R284K showed an increased catalytic rate for nucleotide incorporation and a higher RNase H activity in comparison with WT and mutant M41L/L210W/T215Y RTs. These effects were consistent with its enhanced chain-terminated primer rescue on DNA/DNA template-primers, but not on RNA/DNA complexes, and can explain the higher fitness of HIV-1 having TAM1/R284K mutations. Conclusions: Our study shows the association of R284K and TAM1 mutations in individuals failing therapy with tenofovir/emtricitabine, and unveils a novel mechanism by which secondary mutations are selected in the context of drug-resistance mutations

Vigilancia de gripe en España. Resumen de la temporada 2012-2013, semanas 40/2012 -09/2013 (del 1 de octubre de 2012 al 3 de marzo de 2013)

La actividad gripal registrada en España, desde el inicio de la temporada 2012-2013, hasta la semana 09/2013 (del 25 de febrero al 3 de marzo de 2013) ha sido moderada y asociada a una circulación mayoritaria de virus de la gripe B. Esta es la segunda temporada tardía después de la pandemia de 2009 con un pico de máxima tasa de incidencia de gripe en la semana 08/2013 (una semana posterior que en la temporada previa 2011-12). Se ha mantenido una transmisión intensa de la actividad gripal durante un periodo prolongado, observándose valores de la tasa de detección viral superiores al 50% durante ocho semanas consecutivas hasta el momento, desde la semana 02/2013 hasta la semana 09/2013. Se han notificado 267 casos graves hospitalizados confirmados de gripe, de los cuales han fallecido 23. El mayor porcentaje de casos graves de gripe se registró en los mayores de 64 años y correspondieron en su mayoría (66%) a infecciones por virus de la gripe B. Como en temporadas anteriores, el 78% de los casos presentaba algún factor de riesgo de complicaciones por gripe. De los casos pertenecientes a los grupos elegibles para vacunación, el 42% había recibido la vacuna antigripal de esta temporada. La actividad gripal en la región templada del hemisferio norte ha sido moderada con predominio en Europa de virus B y A(H1N1)pdm09, entre los subtipados, una distribución diferente a la observada en Norte América, en donde ha predominado el virus A(H3N2). La actividad gripal en los países templados del hemisferio sur se situó de nuevo en niveles de inter-temporada

DR_SEQAN: a PC/Windows-based software to evaluate drug resistance using human immunodeficiency virus type 1 genotypes

BACKGROUND: Genotypic assays based on DNA sequencing of part or the whole reverse transcriptase (RT)- and protease (PR)-coding regions of the human immunodeficiency virus type 1 (HIV-1) genome have become part of the routine clinical management of HIV-infected individuals. However, the results are difficult to interpret due to complex interactions between mutations found in viral genes. RESULTS: DR_SEQAN is a tool to analyze RT and PR sequences. The program output includes a list containing all of the amino acid changes found in the query sequence in comparison with the sequence of a wild-type HIV-1 strain. Translation of codons containing nucleotide mixtures can result in potential ambiguities or heterogeneities in the amino acid sequence. The program identifies all possible combinations of 2 or 3 amino acids that derive from translation of triplets containing nucleotide mixtures. In addition, when ambiguities affect codons relevant for drug resistance, DR_SEQAN allows the user to select the appropriate mutation to be considered by the program's drug resistance interpretation algorithm. Resistance is predicted using a rule-based algorithm, whose efficiency and accuracy has been tested with a large set of drug susceptibility data. Drug resistance predictions given by DR_SEQAN were consistent with phenotypic data and coherent with predictions provided by other publicly available algorithms. In addition, the program output provides two tables showing published drug susceptibility data and references for mutations and combinations of mutations found in the analyzed sequence. These data are retrieved from an integrated relational database, implemented in Microsoft Access, which includes two sets of non-redundant core tables (one for combinations of mutations in the PR and the other for combinations in the RT). CONCLUSION: DR_SEQAN is an easy to use off-line application that provides expert advice on HIV genotypic resistance interpretation. It is coded in Visual Basic for use in PC/Windows-based platforms. The program is freely available under the General Public License. The program (including the integrated database), documentation and a sample sequence can be downloaded fro

Perspectivas actuales de las fuentes del Derecho

Presentación / Rafael de Asís Roig. - Fuentes del Derecho y comunidad civil / Dionisio Llamazares Fernández. - Las fuentes del derecho y su problemática actual / Antonio Enrique Pérez Luño. - Fuentes del Derecho y sociedad civil : la participación de ésta en la creación normativa, desde la perspectiva del ordenamiento jurídico internacional / Montserrat Abad Castelos. - La tutela de la libertad religiosa en la Unión Europea y su incidencia en el ordenamiento interno español / Adoración Castro Jover. - Sistema normativo de la Unión Europea (naturaleza de las fuentes) / Carlos Moreiro González. - La incidencia de la Unión Europea en el sistema interno de fuentes de los Estados miembros / Ana Garriga Domínguez. - Las fuentes del Derecho Islámico / Mario Losano. - Multiculturalidad, Derecho islámico y ordenamiento secular; los supuestos de la poligamia y el repudio / Agustín Motilla de la Calle. - Interculturalidad y fuentes del Derecho : algunas reflexiones desde el Derecho Internacional / Carlos Fernández Liesa . - La definitiva secularización de la legislación sobre la interrupción del embarazo en España / Daniel Capodiferro Cubero. - Interculturalidade e Fontes do Direito. - A ética da racionalidade do outro como princípio e critério objetivo na análise da interculturalidade e sua relação quanto à legitimação das fontes do direito / Artur César de Souza. - El papel de los nuevos movimientos sociales en la regulación jurídica de la globalización / Jose Antonio García Saez. - Relaciones entre ordenamientos jurídicos en el ámbito de la Unión Europea / Cristina Hermida del LLano. - La incidencia «interesada» de la Directiva 2003/86/CE en la última reforma de la Ley de extranjería española / Encarnación La Spina. - La lex mercatoria : una excepción a la legitimidad del orden jurídico-político moderno / Francisco López Ruiz. - Un paralelismo entre las teorías de los principios y la jurisprudencia de conceptos: la ruptura del puente entre las fuentes del Derecho y la sociedad civil / Luis Lloredo Alix. - La configuración de un derecho cultural sobre lo religioso como una propuesta para la plena integración de las personas de origen musulman residentes en Europa / Andrés Murcia González. - Sobre algunas concepciones de la jurisprudencia en la cultura jurídica norteamericana / Oscar Pérez de la Fuent

Early- versus late-onset systemic sclerosis. Differences in clinical presentation and outcome in 1037 patients

Peak age at onset of systemic sclerosis (SSc) is between 20 and 50 years, although SSc is also described in both young and elderly patients. We conducted the present study to determine if age at disease onset modulates the clinical characteristics and outcome of SSc patients. The Spanish Scleroderma Study Group recruited 1037 patients with a mean follow-up of 5.2 ± 6.8 years. Based on the mean ± 1 standard deviation (SD) of age at disease onset (45 ± 15 yr) of the whole series, patients were classified into 3 groups: age ≤ 30 years (early onset), age between 31 and 59 years (standard onset), and age ≥ 60 years (late onset). We compared initial and cumulative manifestations, immunologic features, and death rates. The early-onset group included 195 patients; standard-onset group, 651; and late-onset, 191 patients. The early-onset group had a higher prevalence of esophageal involvement (72% in early-onset compared with 67% in standard-onset and 56% in late-onset; p = 0.004), and myositis (11%, 7.2%, and 2.9%, respectively; p = 0.009), but a lower prevalence of centromere antibodies (33%, 46%, and 47%, respectively; p = 0.007). In contrast, late-onset SSc was characterized by a lower prevalence of digital ulcers (54%, 41%, and 34%, respectively; p < 0.001) but higher rates of heart conduction system abnormalities (9%, 13%, and 21%, respectively; p = 0.004). Pulmonary hypertension was found in 25% of elderly patients and in 12% of the youngest patients (p = 0.010). After correction for the population effects of age and sex, standardized mortality ratio was shown to be higher in younger patients. The results of the present study confirm that age at disease onset is associated with differences in clinical presentation and outcome in SSc patients

DR_SEQAN: a PC/Windows-based software to evaluate drug

This article is available from: http://www.biomedcentral.com/1471-2334/6/44[Background] Genotypic assays based on DNA sequencing of part or the whole reverse transcriptase (RT)- and protease (PR)-coding regions of the human immunodeficiency virus type 1 (HIV-1) genome have become part of the routine clinical management of HIV-infected individuals. However, the results are difficult to interpret due to complex interactions between mutations found in viral genes.[Results] DR_SEQAN is a tool to analyze RT and PR sequences. The program output includes a list containing all of the amino acid changes found in the query sequence in comparison with the sequence of a wild-type HIV-1 strain. Translation of codons containing nucleotide mixtures can result in potential ambiguities or heterogeneities in the amino acid sequence. The program identifies all possible combinations of 2 or 3 amino acids that derive from translation of triplets containing nucleotide mixtures. In addition, when ambiguities affect codons relevant for drug resistance, DR_SEQAN allows the user to select the appropriate mutation to be considered by the program's drug resistance interpretation algorithm. Resistance is predicted using a rule-based algorithm, whose efficiency and accuracy has been tested with a large set of drug susceptibility data. Drug resistance predictions given by DR_SEQAN were consistent with phenotypic data and coherent with predictions provided by other publicly available algorithms. In addition, the program output provides two tables showing published drug susceptibility data and references for mutations and combinations of mutations found in the analyzed sequence. These data are retrieved from an integrated relational database, implemented in Microsoft Access, which includes two sets of nonredundant core tables (one for combinations of mutations in the PR and the other for combinations in the RT)[Conclusion] DR_SEQAN is an easy to use off-line application that provides expert advice on HIV genotypic resistance interpretation. It is coded in Visual Basic for use in PC/Windows-based platforms. The program is freely available under the General Public License. The program (including the integrated database), documentation and a sample sequence can be downloaded from http:// www2.cbm.uam.es:8080/lmenendez/DR_SEQAN.zipThis work has been supported in part by the Fundación para la Investigación y Prevención del SIDA en España (FIPSE), through grants 36200/01 and 36460/05. An institutional grant of Fundación Ramón Areces to Centro de Biología Molecular "Severo Ochoa" is also acknowledged.Peer reviewe