18,062 research outputs found

    La Covid-19 en Espa√Īa. Los desaf√≠os geopol√≠ticos de la gobernanza de un problema de salud

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    L‚ÄôEspagne a √©t√© l‚Äôun des pays d‚ÄôEurope les plus touch√©s par la pand√©mie. L‚Äôarticle expose les particularit√©s de la d√©centralisation du syst√®me de sant√© entre les Communaut√©s autonomes et montre comment la chronologie des vagues √©pid√©miques et des d√©cisions prises par les autorit√©s pour y faire face a bouscul√© cette organisation si bien que l‚Äôappareil statistique a √©t√© dysfonctionnel au d√©but de la crise. Le gouvernement devait g√©rer des contradictions g√©opolitiques complexes, entre le minist√®re central et les autorit√©s autonomes comp√©tentes, mais aussi avec ses alli√©s et opposants √† la Chambre des d√©put√©s. La crise sanitaire a r√©v√©l√© les d√©fauts de l‚Äôorganisation politico-administrative de l‚ÄôEspagne d√©mocratique, les frictions entre les diff√©rentes r√©gions et nationalit√©s qui composent l‚Äô√Čtat ainsi que celles qui opposent conservateurs et progressistes. Malgr√© cela, les institutions ont n√©anmoins fonctionn√© et su coop√©rer.Spain was one of the European countries most affected by the pandemic. The article explains the particularities of the decentralization of the health system among the autonomous communities and shows how the chronology of the epidemic waves and the decisions taken by the authorities to deal with them disrupted this organization, which is why the statistical apparatus was dysfunctional at the beginning of the crisis. The government had to manage complex geopolitical contradictions, between the central ministry and the competent autonomous authorities, but also with its allies and opponents in the Chamber of Deputies. The health crisis has revealed the flaws in the political-administrative organization of democratic Spain, the friction between the different regions and nationalities that make up the state and between conservatives and progressives but the institutions worked and have been able to cooperate.Espa√Īa fue uno de los pa√≠ses m√°s afectados por la pandemia en Europa. El art√≠culo expone las particularidades de la descentralizaci√≥n del sistema sanitario entre las Comunidades Aut√≥nomas y muestra c√≥mo la cronolog√≠a de las olas epid√©micas y las decisiones tomadas por las autoridades para hacerles frente perturbaron dicha organizaci√≥n hasta el punto de que el aparato estad√≠stico se revel√≥ disfuncional al principio de la crisis. El gobierno debi√≥ lidiar con complejas contradicciones geopol√≠ticas, entre el ministerio central y las autoridades auton√≥micas competentes, pero tambi√©n con sus aliados y opositores en la C√°mara de Diputados. La crisis sanitaria puso de manifiesto los defectos de la organizaci√≥n pol√≠tico-administrativa de la Espa√Īa democr√°tica, las fricciones entre las distintas regiones y nacionalidades que componen el estado, as√≠ como las que existen entre conservadores y progresistas. A pesar de ello, las instituciones funcionaron y lograron cooperar

    On the Effects of Type II Left Censoring in Stable and Chaotic Compartmental Models for Infectious Diseases: Do Small Sample Estimates Survive Censoring?

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    In this paper, we discuss a selection of tools from dynamical systems and order statistics, which are most often utilized separately, and combine them into an algorithm to estimate the parameters of mathematical models for infectious diseases in the case of small sample sizes and left censoring, which is relevant in the case of rapidly evolving infectious diseases and remote populations. The proposed method relies on the analogy between survival functions and the dynamics of the susceptible compartment in SIR-type models, which are both monotone decreasing in time and are both determined by a dual variable: the hazard function in survival prediction and the number of infected people in SIR-type models. We illustrate the methodology in the case of a continuous model in the presence of noisy measurements with different distributions (Normal, Poisson, Negative Binomial) and in a discrete model, reminiscent of the Ricker map, which admits chaotic dynamics. This estimation procedure shows stable results in experiments based on a popular benchmark dataset for SIR-type models and small samples. This manuscript illustrates how classical theoretical statistical methods and dynamical systems can be merged in interesting ways to study problems ranging from more fundamental small sample situations to more complex infectious disease and survival models, with the potential that this tools can be applied in the presence of a large number of covariates and different types of censored data

    Overtourism in mature coastal destinations on the spanish north atlantic coast

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    Coastal tourism in Spain has registered a continuous quantitative growth in recent decades, a process that poses important questions to ensure its sustainability. The main objective of this study is to assess the reality of this tourism product on the North Atlantic coast; using the great sun and sand destination in Galicia, Sanxenxo as a case study. The analysis methodology used has been based on the use of both qualitative and quantitative techniques, where semi-structured interviews have played a decisive role. This work contributes to affirm that the process of strategic governance in consolidated tourist destinations must influence the quality of the offer based on the promotion of its territorial components and their sustainability. The Sanxenxo model is used as an example and prescriber of the great mature destinations of the Atlantic coast, which have grown in recent years under the dynamics of overtourism, where these principles and recommendations become more necessary

    Predicting Long-term Disease-free Survival after Resection of Pancreatic Ductal Adenocarcinoma:A Nationwide Cohort Study

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    Objective: To develop a prediction model for long-term (‚Č•5 years) disease-free survival (DFS) after the resection of pancreatic ductal adenocarcinoma (PDAC). Background: Despite high recurrence rates, 10% of patients have long-term DFS after PDAC resection. A model to predict long-term DFS may aid individualized prognostication and shared decision-making. Methods: This nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best-performing prognostic model was selected by Cox-proportional hazard analysis and Akaike's Information Criterion, presented by hazard ratios (HRs) with 95% confidence intervals (CIs). Internal validation was performed, and discrimination and calibration indices were assessed. Results: In all, 836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. Long-term DFS was seen in 118 patients (14%). Factors predictive of long-term DFS were low preoperative carbohydrate antigen 19-9 (logarithmic; HR 1.21; 95% CI 1.10-1.32), no vascular resection (HR 1.33; 95% CI 1.12-1.58), T1 or T2 tumor stage (HR 1.52; 95% CI 1.14-2.04, and HR 1.17; 95% CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR 1.44; 95% CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR 1.42; 95% CI 1.11-1.81 and HR 1.14; 95% CI 0.96-1.36, respectively), N0 or N1 nodal status (HR 1.92; 95% CI 1.54-2.40, and HR 1.33; 95% CI 1.11-1.60, respectively), R0 resection margin status (HR 1.25; 95% CI 1.07-1.46), no major complications (HR 1.14; 95% CI 0.97-1.35) and adjuvant chemotherapy (HR 1.74; 95% CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (slope 0.99) was achieved. Conclusions: The developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of long-term DFS after resection of pancreatic ductal adenocarcinoma.</p

    ÔĽŅRevision of the Neotropical genus Trigava O‚ÄôBrien, 1999 (Hemiptera, Fulgoromorpha, Dictyopharidae, Nersiini), with descriptions of two new species from Peru and Brazil

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    The Neotropical planthopper genus Trigava O‚ÄôBrien, 1999 (Hemiptera, Fulgoromorpha, Dictyopharidae, Nersiini) is revised. Four species are included: T. brachycephala (Melichar, 1912) (the type species, from Peru), T. obrieni Song, Malenovsk√Ĺ &amp;amp; Deckert, sp. nov. (from Brazil), T. peruensis Song, O‚ÄôBrien &amp;amp; Bartlett, sp. nov. (from Peru), and T. recurva (Melichar, 1912) (from Bolivia and Peru). Lectotypes are designated for Igava brachycephala Melichar, 1912 and Igava recurva Melichar, 1912. All species are described, including habitus photographs and detailed illustrations of the male genitalia. Male and female genitalia are described for this genus for the first time. A key for identification of the species of Trigava and a distribution map are provided

    What are we adding to the bonfire? Cancel culture and university students

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    El objetivo de este trabajo es indagar en la percepci√≥n de un grupo de estudiantes universitarios sobre hechos relacionados con la cancelaci√≥n cultural. Antecedentes: El concepto de censura ha sido analizado desde perspectivas como la de Bourdieu (1990) o Foucault (1999), considerando su evoluci√≥n hacia la correcci√≥n pol√≠tica (Manfredi, 2018) y la cancelaci√≥n cultural (Fourest, 2021; Ochieng, 2022). M√©todo: Se dise√Ī√≥ un cuestionario que fue respondido por 298 sujetos para conocer su posicionamiento sobre estos hechos: (1) supresi√≥n de cuentos en una biblioteca al atribuirles contenidos sexistas (2019); (2) intento de eliminar la pel√≠cula Lo que el viento se llev√≥ de plataformas de difusi√≥n, y supresi√≥n de la novela Matar un ruise√Īor, por connotaciones racistas (2020); (3) retirada de estatuas de espacios p√ļblicos por apolog√≠a del racismo (2020). Resultados: Los resultados ponen de manifiesto que la mayor√≠a se muestran contrarios a la cancelaci√≥n, aunque en distinta medida si los hechos est√°n relacionados con ficci√≥n o con representaci√≥n hist√≥rica. Asimismo, los contrarios a la cancelaci√≥n demuestran tener mayor conocimiento cultural, aunque existe un elevado porcentaje de indecisi√≥n. Discusi√≥n: Los hallazgos son la existencia de una panoplia de percepciones sobre la cancelaci√≥n cultural y una significativa influencia del conocimiento cultural en su percepci√≥n

    Risk Models for Developing Pancreatic Fistula after Pancreatoduodenectomy:Validation in a Nationwide Prospective Cohort

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    OBJECTIVE: To evaluate the performance of published fistula risk models by external validation, and to identify independent risk factors for postoperative pancreatic fistula (POPF).SUMMARY BACKGROUND DATA: Multiple risk models have been developed to predict POPF after pancreatoduodenectomy. External validation in high-quality prospective cohorts is, however, lacking or only performed for individual models.METHODS: A post-hoc analysis of data from the stepped-wedge cluster randomized PORSCH trial was performed. Included were all patients undergoing pancreatoduodenectomy in the Netherlands (January 2018-November 2019). Risk models on POPF were identified by a systematic literature search. Model performance was evaluated by calculating the area under the receiver operating curves (AUC) and calibration plots. Multivariable logistic regression was performed to identify independent risk factors associated with clinically relevant POPF.RESULTS: Overall, 1358 patients undergoing pancreatoduodenectomy were included, of whom 341 patients (25%) developed clinically relevant POPF. Fourteen risk models for POPF were evaluated, with AUCs ranging from 0.62-0.70. The updated alternative fistula risk score had an AUC of 0.70 (95% CI 0.69-0.72). The alternative fistula risk score demonstrated an AUC of 0.70 (95% CI 0.68-0.71), whilst an AUC of 0.70 (95% CI 0.69-0.71) was also found for the model by Petrova et al Soft pancreatic texture, pathology other than pancreatic ductal adenocarcinoma or chronic pancreatitis, small pancreatic duct diameter, higher body-mass index, minimally invasive resection and male sex were identified as independent predictors of POPF.CONCLUSION: Published risk models predicting clinically relevant POPF after pancreatoduodenectomy have a moderate predictive accuracy. Their clinical applicability to identify high-risk patients and guide treatment strategies is therefore questionable.</p

    Likelihood of Young Adult Engagement in Protective Behavioral Strategies for Alcohol Use across Drinking Contexts: Implications for Adaptive Interventions

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    This study examined how young adults‚Äô likelihood to engage in protective behavioral strategies (PBS) to reduce alcohol harms varies across physical and social contexts for drinking. We conducted an online survey with 514 heavy drinking young adults (Mage = 22.4‚ÄČyears, 52% women, 30% Hispanic/Latin(x), 40% non-White). Participants were asked to rate their likelihood to engage in 26 PBS generally, and specifically in six physical contexts (e.g., bar/club), and six social contexts (e.g., in a large group). We conducted regression analyses to examine the overall effect of context on the likelihood to engage in each PBS and post-hoc Tukey tests to assess pairwise comparisons of the differences in likelihood to engage in each PBS across response options for physical and social context. Analyses were conducted using the full sample, and for men and women separately. There were significant differences in six strategies across physical contexts; likelihood to engage in PBS varied across public and private spaces for different strategies. We also found significant differences in five strategies across social contexts; participants were more likely to engage in PBS among larger numbers of people and those who are intoxicated. There were numerous differences in pairwise comparisons of PBS engagement across physical and social contexts for women, while men demonstrated only two differences in PBS across physical context. Results suggest that alcohol interventions for young adults that include PBS should consider tailoring strategies to the individual and the specific context of the drinking event.</p
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