School Based Health Centers Should Provide Contraception to Teens

Many students are sexually active, and hundreds of thousands experience pregnancy every year. Smith, Novello, and Chacko’s research found that students at a school where contraception is available on site were more likely to access contraception and less likely to experience pregnancy – illustrating the power of school based health centers (SBHCs) to help students take responsibility and protect their own futures. Yet the majority of SBHCs are prohibited from dispensing contraception. To remove barriers in access to contraception and help reduce teen pregnany, policymakers, school administrators, and health providers should ensure that SBHCs follow youth-friendly protocols and provide confidential access to contraception.

A Tale of Two States: What We Learn from California and Texas

Teen birth rates and teen pregnancy prevention strategies vary widely across individual states in the US, which has the highest overall teen birth rate among developed nations. California and Texas, the two most populous states currently accounting for a quarter of all teen births, have taken very different approaches to addressing adolescent reproductive health. This case study examines the racial/ethnic composition and socioeconomic factors of these two states from 1981 to 2008. State programs and policies implemented between 1991 and 2008 as well as changes in access to contraception and public–private partnerships are discussed. Based on the lessons learned from California, a similar multifaceted campaign in Texas may be effective in reducing teen births.

Beneficial Effects of a Semi-Intensive Stroke Unit are Beyond the Monitor.

BACKGROUND AND PURPOSE Precise mechanisms underlying the effectiveness of the stroke unit (SU) are not fully established. Studies that compare monitored stroke units (semi-intensive type, SI-SU) versus an intensive care unit (ICU)-based mobile stroke team (MST-ICU) are lacking. Although inequalities in access to stroke unit care are globally improving, acute stroke patients may be admitted to Intensive Care Units for monitoring and followed by a mobile stroke team in hospital's lacking an SU with continuous cardiovascular monitoring. We aimed at comparing the stroke outcome between SI-SU and MST-ICU and hypothesized that the benefits of SI-SU are driven by additional elements other than cardiovascular monitoring, which is equally offered in both care systems. METHODS In a single-center setting, we compared the unfavorable outcomes (dependency and mortality) at 3 months in consecutive patients with ischemic stroke or spontaneous intracerebral hemorrhage admitted to a stroke unit with semi-intensive monitoring (SI-SU) to a cohort of stroke patients hospitalized in an ICU and followed by a mobile stroke team (MST-ICU) during an equal observation period of 27 months. Secondary objectives included comparing mortality and the proportion of patients with excellent outcomes (modified Rankin Score (mRS) 0-1). Equal cardiovascular monitoring was offered in patients admitted in both SI-SU and MST-ICU. RESULTS 458 patients were treated in the SI-SU and compared to the MST-ICU (n = 370) cohort. The proportion of death and dependency after 3 months was significantly improved for patients in the SI-SU compared to MST-ICU (p < 0.001; aOR = 0.45; 95% CI: 0.31-0.65). The shift analysis of the mRS distribution showed significant shift to the lower mRS in the SI-SU group, p < 0.001. The proportion of mortality in patients after 3 months also differed between the MST-ICU and the SI-SU (p < 0.05), but after adjusting for confounders this association was not significant (aOR = 0.59; 95% CI: 0.31-1.13). The proportion of patients with excellent outcome was higher in the SI-SU (59.4 vs. 44.9%, p < 0.001) but the relationship was no more significant after adjustment (aOR = 1.17; 95% CI: 0.87-1.5). CONCLUSIONS Our study shows that moving from a stroke team in a monitored setting (ICU) to an organized stroke unit leads to a significant reduction in the 3 months unfavorable outcome in patients with an acute ischemic or hemorrhagic stroke. Cardiovascular monitoring is indispensable, but benefits of a semi-intensive Stroke Unit are driven by additional elements beyond intensive cardiovascular monitoring. This observation supports the ongoing development of Stroke Centers for efficient stroke care. © 2015 S. Karger AG, Basel.

The Continuing Practice and Impact of Discrimination

This chapter provides a detailed discussion of the evidence on housing and mortgage lending discrimination, as well as the potential impacts of such discrimination on minority outcomes like homeownership and neighborhood environment. The paper begins by discussing conceptual issues surrounding empirical analyses of discrimination including explanations for why discrimination takes place, defining different forms of discrimination, and the appropriate interpretation of observed racial and ethnic differences in treatment or outcomes. Next, the paper reviews evidence on housing market discrimination starting with evidence of segregation and price differences in the housing market and followed by direct evidence of discrimination by real estate agents in paired testing studies. Finally, mortgage market discrimination and barriers in access to mortgage credit are discussed. This discussion begins with an assessment of the role credit barriers play in explaining racial and ethnic differences in homeownership and follows with discussions of analyses of underwriting and the price of credit based on administrative and private sector data sources including analyses of the subprime market. The paper concludes that housing discrimination has declined especially in the market for owner-occupied housing and does not appear to play a large role in limiting the neighborhood choices of minority households or the concentration of minorities into central cities. On the other hand, the patterns of racial centralization and lower home ownership rates of African-Americans appear to be related to each other, and lower minority homeownership rates are in part attributable to barriers in the market for mortgage credit. The paper presents considerable evidence of racial and ethnic differences in mortgage underwriting, as well as additional evidence suggesting these differences may be attributable to differential provision of coaching, assistance, and support by loan officers. At this point, innovation in loan products, the shift towards risk based pricing, and growth of the subprime market have not mitigated the role credit barriers play in explaining racial and ethnic differences in homeownership. Further, the growth of the subprime lending industry appears to have segmented the mortgage market in terms of geography leading to increased costs of relying on local/neighborhood sources of mortgage credit and affecting the integrity of many low-income minority neighborhoods through increased foreclosure rates.

Barriers to Timely Screening Colonoscopy

Objective: Colorectal cancer (CRC) can be largely prevented or effectively treated in its early stages, yet disparities exist in timely screening. The aim of this study was to explore the disparities in CRC screening on the basis of health insurance status including private, Medicare, Medicaid, and State Administered General Assistance (SAGA). Methods: A retrospective chart review for the period January 2000 to May 2007 (95 records) was conducted at two clinic sites; a private clinic and a university hospital clinic. All individuals at these sites who met study criteria (>50 years old with screening colonoscopy) were included. Age, gender, date of first clinic visit when screening referral was made, and date of completed procedure (screening colonoscopy) were recorded. Groups were dichotomized between individuals with private health insurance and individuals with public health insurance. Individuals with any history of CRC, known pre-cancerous conditions as well as family history of CRC requiring frequent colonoscopy were excluded from the study. Linear model analysis was performed to compare the average waiting time to receiving screening colonoscopy between the groups. T-test was performed to analyze age or gender related differences between the two groups as well as within each group. Results: The average waiting time (33 days) for screening colonoscopy in privately insured individuals was significantly lower than publicly insured individuals (200 days). The time difference between the first clinic visit and the procedure was statistically significant (p < 0.0001) between the two groups. There was no statistical difference (p=0.089) in gender between these groups (public vs. private). There were also no statistically significant gender or age related differences found within each group. Conclusions: Disparities exist in timely screening for CRC and one of the barriers leading to delayed CRC screening includes health insurance status of an individual. Even within the insured group, type of insurance plays major role. There is a negative correlation between public health insurance status and timely screening. Differences in access to medical care and delivery of care experienced by patients who are publicly insured through Medicaid, Medicare, and SAGA, suggests that the State of Connecticut needs to implement changes in health care policies that would provide timely screening colonoscopy. It is evident that health insurance coverage facilitates timely access to healthcare. Therefore, there is a need for increased efforts in advocacy for policy, payment and physician participation in public insurance programs. A state-wide comprehensive program involving multiple components targeting different levels of change such as provider, patients and the community should help reduce some of the observed causes of healthcare disparities based on the insurance status.

THE IMPLEMENTATION OF FEDERAL FAMILY PLANNING POLICY: AN ANALYSIS OF FACTORS AFFECTING STATE EXPENDITURES, FISCAL YEARS 1976-1981 (WOMEN, BUDGET, POPULATION)

The purpose of this study was to analyze the implementation of national family planning policy in the United States, which was embedded in four separate statutes during the period of study, Fiscal Years 1976-81. The design of the study utilized a modification of the Sabatier and Mazmanian framework for policy analysis, which defined implementation as the carrying out of statutory policy. The study was divided into two phases. The first part of the study compared the implementation of family planning policy by each of the pertinent statutes. The second part of the study identified factors that were associated with implementation of federal family planning policy within the context of block grants.^ Implemention was measured here by federal dollars spent for family planning, adjusted for the size of the respective state target populations. Expenditure data were collected from the Alan Guttmacher Institute and from each of the federal agencies having administrative authority for the four pertinent statutes, respectively. Data from the former were used for most of the analysis because they were more complete and more reliable.^ The first phase of the study tested the hypothesis that the coherence of a statute is directly related to effective implementation. Equity in the distribution of funds to the states was used to operationalize effective implementation. To a large extent, the results of the analysis supported the hypothesis. In addition to their theoretical significance, these findings were also significant for policymakers insofar they demonstrated the effectiveness of categorical legislation in implementing desired health policy.^ Given the current and historically intermittent emphasis on more state and less federal decision-making in health and human serives, the second phase of the study focused on state level factors that were associated with expenditures of social service block grant funds for family planning. Using the Sabatier-Mazmanian implementation model as a framework, many factors were tested. Those factors showing the strongest conceptual and statistical relationship to the dependent variable were used to construct a statistical model. Using multivariable regression analysis, this model was applied cross-sectionally to each of the years of the study. The most striking finding here was that the dominant determinants of the state spending varied for each year of the study (Fiscal Years 1976-1981). The significance of these results was that they provided empirical support of current implementation theory, showing that the dominant determinants of implementation vary greatly over time. ^

Crecimiento económico, mercado inmobiliario y ausencia de política de suelo : un análisis de la expansión del espacio residencial de la Ciudad de Buenos Aires en los 2000

A pesar del crecimiento económico y del notable dinamismo que caracterizó al mercado inmobiliario y la construcción a partir de la recuperación económica de 2003 en Argentina, se restringieron las históricas condiciones para acceder a una vivienda en ámbitos urbanos bien servidos y ubicados. En la lógica actual del contexto macroeconómico y en la lógica del comportamiento territorial y de los agentes económicos del mercado inmobiliario pueden rastrearse algunos elementos para comprender este aspecto que tan caro le vale al derecho a la ciudad. Para atender esta hipótesis se pregunta lo siguiente: ¿Cuál fue la evolución territorial del precio del suelo entre 2001 y 2006 en la ciudad de Buenos Aires?, ¿cuáles fueron los principales factores que motivaron tal comportamiento y, específicamente, qué papel jugaron los agentes económicos del mercado inmobiliario en esa dinámica?, y ¿qué efectos viene teniendo el contexto macroeconómico actual el singular comportamiento de este mercado en el acceso a la vivienda?

Mejora del autocuidado de pacientes diabéticos en zonas rurales de Panamá a través de tecnologías tic

Durante años, los países de América Latina y en especial Panamá han sufrido grandes cambios sociales, demográficos y epidemiológicos que han provocado un crecimiento de la incidencia y prevalencia de varias enfermedades crónicas no transmisibles como: las cardiopatías, el cáncer y la diabetes. Actualmente, la suma de estas afecciones causa la mayoría de las muertes y discapacidades en la región. Las necesidades de salud varían de un país a otro, inclusive en el interior de un mismo país o de una misma región debido a factores demográficos, socioculturales, económicos y políticos propios de la región, lo cual favorece la desigualdad en el acceso a los servicios de salud. Este hecho pone de manifiesto un aspecto importante de esta tesis de doctorado, que es facilitar el autocuidado de los pacientes diabéticos en tres zonas rurales de Panamá, contribuyendo de esta manera a la planeación e implantación de nuevos servicios TIC en salud para los pacientes diabéticos de tres zonas rurales de Panamá. El objetivo principal de esta tesis doctoral es desarrollar una contextualización del paciente diabético en zonas rurales de Panamá y modelar su autocuidado mediante el uso de las TIC. A través del modelo se busca mejorar la calidad de vida de los pacientes y propiciar estados de equidad en salud. Se continúa con la implementación del modelo en tres zonas rurales diferentes de Panamá. Se concluye con una fase de validación en la que se demuestra que el enfermo de diabetes aumenta la conciencia de la importancia de su tratamiento mejorando su estado de salud y su calidad de vida. La demostración clínica de este resultado está fuera del ámbito de la tesis doctoral. Abstract Through the years, countries of Latin America, Panama in particular have endured great social, demographic and epidemiologic changes, which in turn caused an increase in the occurrence and prevalence of chronic non transmissible diseases, such as: cardiopathy, cancer and diabetes. The sum of these afflictions causes most of the deaths and disabilities in the region nowadays. The healthcare needs vary from one country to another, furthermore the healthcare needs are different from one rural area to another in a given country or region, due demographic, sociocultural, economic and political factors, this favors the inequality in access to health care services. This facts shows one important aspect of this Ph. D. thesis, which is to facilitate the self-care of diabetic patients in three rural areas of Panama, contributing to the planning and implementation of new ICT services in healthcare for diabetic patients in rural areas of Panama. The primary goal of this Ph.D thesis is to develop a contextualization of the diabetic patient in country side of Panama and to model its self-care by means of the use of the ICT. Through model one looks for to improve the quality of life of the patients and to cause states of fairness in health. It continues with the implementation of ICT through a conceptualized model in three different rural areas of Panama. It concludes with a validation phase which shows how the awareness of the diabetes patient increases, about the importance of his/her treatment for the improvement of health and quality of life. The clinic demonstration of this result is not part of this thesis.

A framework for building distributed social network websites

Las redes son la esencia de comunidades y sociedades humanas; constituyen el entramado en el que nos relacionamos y determinan cómo lo hacemos, cómo se disemina la información o incluso cómo las cosas se llevan a cabo. Pero el protagonismo de las redes va más allá del que adquiere en las redes sociales. Se encuentran en el seno de múltiples estructuras que conocemos, desde las interaciones entre las proteínas dentro de una célula hasta la interconexión de los routers de internet. Las redes sociales están presentes en internet desde sus principios, en el correo electrónico por tomar un ejemplo. Dentro de cada cliente de correo se manejan listas contactos que agregadas constituyen una red social. Sin embargo, ha sido con la aparición de los sitios web de redes sociales cuando este tipo de aplicaciones web han llegado a la conciencia general. Las redes sociales se han situado entre los sitios más populares y con más tráfico de la web. Páginas como Facebook o Twitter manejan cifras asombrosas en cuanto a número de usuarios activos, de tráfico o de tiempo invertido en el sitio. Pero las funcionalidades de red social no están restringidas a las redes sociales orientadas a contactos, aquellas enfocadas a construir tu lista de contactos e interactuar con ellos. Existen otros ejemplos de sitios que aprovechan las redes sociales para aumentar la actividad de los usuarios y su involucración alrededor de algún tipo de contenido. Estos ejemplos van desde una de las redes sociales más antiguas, Flickr, orientada al intercambio de fotografías, hasta Github, la red social de código libre más popular hoy en día. No es una casualidad que la popularidad de estos sitios web venga de la mano de sus funcionalidades de red social. El escenario es más rico aún, ya que los sitios de redes sociales interaccionan entre ellos, compartiendo y exportando listas de contactos, servicios de autenticación y proporcionando un valioso canal para publicitar la actividad de los usuarios en otros sitios web. Esta funcionalidad es reciente y aún les queda un paso hasta que las redes sociales superen su condición de bunkers y lleguen a un estado de verdadera interoperabilidad entre ellas, tal como funcionan hoy en día el correo electrónico o la mensajería instantánea. Este trabajo muestra una tecnología que permite construir sitios web con características de red social distribuída. En primer lugar, se presenta una tecnología para la construcción de un componente intermedio que permite proporcionar cualquier característica de gestión de contenidos al popular marco de desarrollo web modelo-vista-controlador (MVC) Ruby on Rails. Esta técnica constituye una herramienta para desarrolladores que les permita abstraerse de las complejidades de la gestión de contenidos y enfocarse en las particularidades de los propios contenidos. Esta técnica se usará también para proporcionar las características de red social. Se describe una nueva métrica de reusabilidad de código para demostrar la validez del componente intermedio en marcos MVC. En segundo lugar, se analizan las características de los sitios web de redes sociales más populares, con el objetivo de encontrar los patrones comunes que aparecen en ellos. Este análisis servirá como base para definir los requisitos que debe cumplir un marco para construir redes sociales. A continuación se propone una arquitectura de referencia que proporcione este tipo de características. Dicha arquitectura ha sido implementada en un componente, Social Stream, y probada en varias redes sociales, tanto orientadas a contactos como a contenido, en el contexto de una asociación vecinal tanto como en proyectos de investigación financiados por la UE. Ha sido la base de varios proyectos fin de carrera. Además, ha sido publicado como código libre, obteniendo una comunidad creciente y está siendo usado más allá del ámbito de este trabajo. Dicha arquitectura ha permitido la definición de un nuevo modelo de control de acceso social que supera varias limitaciones presentes en los modelos de control de acceso para redes sociales. Más aún, se han analizado casos de estudio de sitios de red social distribuídos, reuniendo un conjunto de caraterísticas que debe cumplir un marco para construir redes sociales distribuídas. Por último, se ha extendido la arquitectura del marco para dar cabida a las características de redes sociales distribuídas. Su implementación ha sido validada en proyectos de investigación financiados por la UE. Abstract Networks are the substance of human communities and societies; they constitute the structural framework on which we relate to each other and determine the way we do it, the way information is diseminated or even the way people get things done. But network prominence goes beyond the importance it acquires in social networks. Networks are found within numerous known structures, from protein interactions inside a cell to router connections on the internet. Social networks are present on the internet since its beginnings, in emails for example. Inside every email client, there are contact lists that added together constitute a social network. However, it has been with the emergence of social network sites (SNS) when these kinds of web applications have reached general awareness. SNS are now among the most popular sites in the web and with the higher traffic. Sites such as Facebook and Twitter hold astonishing figures of active users, traffic and time invested into the sites. Nevertheless, SNS functionalities are not restricted to contact-oriented social networks, those that are focused on building your own list of contacts and interacting with them. There are other examples of sites that leverage social networking to foster user activity and engagement around other types of content. Examples go from early SNS such as Flickr, the photography related networking site, to Github, the most popular social network repository nowadays. It is not an accident that the popularity of these websites comes hand-in-hand with their social network capabilities The scenario is even richer, due to the fact that SNS interact with each other, sharing and exporting contact lists and authentication as well as providing a valuable channel to publize user activity in other sites. These interactions are very recent and they are still finding their way to the point where SNS overcome their condition of data silos to a stage of full interoperability between sites, in the same way email and instant messaging networks work today. This work introduces a technology that allows to rapidly build any kind of distributed social network website. It first introduces a new technique to create middleware that can provide any kind of content management feature to a popular model-view-controller (MVC) web development framework, Ruby on Rails. It provides developers with tools that allow them to abstract from the complexities related with content management and focus on the development of specific content. This same technique is also used to provide the framework with social network features. Additionally, it describes a new metric of code reuse to assert the validity of the kind of middleware that is emerging in MVC frameworks. Secondly, the characteristics of top popular SNS are analysed in order to find the common patterns shown in them. This analysis is the ground for defining the requirements of a framework for building social network websites. Next, a reference architecture for supporting the features found in the analysis is proposed. This architecture has been implemented in a software component, called Social Stream, and tested in several social networks, both contact- and content-oriented, in local neighbourhood associations and EU-founded research projects. It has also been the ground for several Master’s theses. It has been released as a free and open source software that has obtained a growing community and that is now being used beyond the scope of this work. The social architecture has enabled the definition of a new social-based access control model that overcomes some of the limitations currenly present in access control models for social networks. Furthermore, paradigms and case studies in distributed SNS have been analysed, gathering a set of features for distributed social networking. Finally the architecture of the framework has been extended to support distributed SNS capabilities. Its implementation has also been validated in EU-founded research projects.

The water footprint of a river basin with a special focus on groundwater: The case of Guadalquivir basin (Spain).

In addition to revealing the hidden link between products or consumption patterns of populations and their needs in terms of water resources, the water footprint (WF) indicator generates new debates and solutions on water management at basin scale. This paper analyses the green and blue WF of the Guadalquivir basin and its integration with environmental water consumption, with a special emphasis on the WF from groundwater and its consequences on current and future depletion of surface water. In a normal year, green WF (agriculture and pastures) amounts to 190 mm on a total green water consumption of 410 mm, while the blue WF (50 mm) represents half of the total blue water flows. This constitutes a first overview and alternative interpretations of the WF as human water appropriation are introduced. The blue WF is almost entirely associated to agriculture (40 mm). The presentation of its evolution over the period 1997?2008 reveals the rising WF from groundwater (13 mm in 2008), 86% being current consumption of surface flows. This evolution is particularly ascribed to the recent development of irrigated olive groves from groundwater. To prevent a higher pressure on the environment, this new use, like all others (thermo-solar plants, tourism, etc.), could have been obtained from the reallocation of water from crops with low water productivity. It means that water is not lacking in the Guadalquivir basin if the governance setting integrates more flexibility and equity in the allocation of water to address climatic variability and the emergence of new demands.

Estudios corológicos de plantas vasculares en la cuenca media del Tajo

Se ha realizado un estudio de la distribución de plantas vasculares en un territorio situado entre las provincias de Cuenca, Guadalajara, Madrid y Toledo (España). El territorio estudiado está en la Submeseta Sur de la península ibérica, al sur del Sistema Central, norte de los Montes de Toledo y oeste del Sistema Ibérico, en zonas sedimentarias con poco relieve y clima mediterráneo, con grandes contrastes de temperatura y precipitaciones muy irregulares. Coincide con las regiones naturales llamadas: “Alcarrias”, “Campiñas de Madrid y Guadalajara” y “Vegas de los ríos de la Cuenca del Tajo”. Es lo que he llamado Cuenca Media del Tajo. En una primera fase se ha estudiado la flora regional para adquirir conocimientos previos mediante las consultas bibliográficas y de herbarios, se ha contado con bases de datos disponibles para MA, MACB, MAF, JACA, AH, ABH, VAL, SALA y EMMA. Se han revisado las aportaciones propias que en los últimos años he realizado en el territorio en relación a los temas tratados en la tesis. El trabajo de campo ha consistido en la realización de inventarios de presencia de flora. Ha sido muy importante la tarea herborizadora para llegar a la correcta identificación de las especies colectadas en los inventarios. De esta forma el autor ha confeccionado un herbario propio JML que en el territorio muestreado ha reunido cerca de 15000 números en las cuatro provincias estudiadas. Se ha hecho un muestreo sistemático del territorio con unos 6000 listados de plantas. Se ha tomado como unidad de muestreo la cuadrícula de UTM de 1 km de lado incluida como una centésima parte de la cuadrícula de UTM de 10 km. Se han seguido criterios para uniformizar el muestreo. Se ha apuntado el tiempo empleado y la superficie muestreada estimada en cada toma de datos. El criterio mínimo que tienen que cumplir todas las cuadrículas en el área estudiada ha sido que para cada cuadrícula de UTM de 5 km se han realizado al menos 5 inventarios en 5 cuadrículas diferentes de UTM de 1 km y al menos en una hora de tiempo. La unidad de comparación ha sido la cuadrícula UTM de 5 km. Se han informatizado los inventarios de campo, para ello se ha creado la base de datos TESIS en Microsoft office –Access-. Las principales tablas son LOCALIDAD, en la que se anotan las características del lugar muestreado y ESPECIES, que lista las especies de flora consideradas en las cuatro provincias del estudio. Por medio de formularios se han rellenado las tablas; destaca la tabla ESPECIE INVENTARIO que relaciona las tablas ESPECIES y LOCALIDAD; esta tabla cuenta en este momento con unos 165.000 registros. En la tabla ESPECIES_FPVI se visualizan las especies recopiladas. Se ha creado un indicador llamado FPVI “Flora permanentemente visible identificable” que consiste en atribuir a cada especie unos índices que nos permiten saber si una determinada planta se puede detectar en cualquier época del año. Los resultados presentados son: Creación de la base de datos TESIS. El Catálogo Florístico de la Cuenca Media del Tajo, que es el catálogo de la flora de las cuatro provincias desde el principio de la sistemática hasta las Saxifragáceas. En total se han recopilado 1028 taxones distribuidos en 77 familias. Se ha calculado el índice FPVI, para las especies del catálogo. La finalidad para la que se ha diseñado este índice es para poder comparar territorios. Para el desarrollo de ambos resultados ha sido fundamental el desarrollo de la tabla ESPECIES_PVI de la base de datos TESIS. En la tabla ESPECIES_PVI se han apuntado las características ecológicas y se revisa la información bibliográfica disponible para cada especie; las principales fuentes de información consultadas han sido Flora iberica, el proyecto “Anthos” y las bases de datos de los herbarios. Se ha apuntado sí se ha visto, sí está protegida o sí en un endemismo. Otros resultados son: la localización de las cuadrículas de UTM de 10 km, con mayor número de endemismos o especies singulares, con mayor valor botánico. Se ha realizado un par de ejemplos de estudios de autoecología de especie, en concreto Teucrium pumilum y Clematis recta. Se han confeccionando salidas cartográficas de distribución de especies. Se ha elaborado el herbario JML. Se ha presentado una sencilla herramienta para incluir inventarios florísticos, citas corológicas, consultas de autoecología o etiquetado de pliegos de herbario. Como colofón, se ha colaborado para desarrollar una aplicación informática de visualización, análisis y estudio de la distribución de taxones vegetales, que ha utilizado como datos de partida un porcentaje importante de los obtenidos para esta tesis. ABSTRACT I have made a study of the distribution of vascular plants in a territory located between the provinces of Cuenca, Guadalajara, Madrid and Toledo (Spain). The studied area is in the “Submeseta” South of the Iberian Peninsula, south of the Central System, north of the Montes de Toledo and west of the Iberian System, in sedimentary areas with little relief and Mediterranean climate, with big temperature contrasts and irregular rainfall. Coincides with the natural regions called "Alcarrias", "countryside of Madrid and Guadalajara" and “Vegas River Tagus Basin”. This is what I have called Middle Tagus Basin. In a first step we have studied the regional flora to acquire prior knowledge through the literature and herbaria consultations, it has had available databases for MA, MACB, MAF, JACA, AH, ABH, VAL, SALA and EMMA herbaria. The contributions I have made in the last years in the territory in relation to the topics discussed in the thesis have been revised. The field work consisted of conducting inventories presence of flora. Botanize was a very important task to get to the correct identification of the species collected in inventories. In this way the author has made his own herbarium JML in the sampled area has met at least 15000 samples in the four studied provinces. There has been a systematic sampling of the territory with nearly 6,000 listings of plants. Was taken as the sampling unit grid UTM 1 km side included as a hundredth of the UTM grid of 10 km from side. Criteria have been taken to standardize the sampling. Data were taken of the time spent and the estimated sampled surface. The minimum criteria they have to meet all the grids in the study area has been that for each UTM grid of 5 km have been made at least 5 stocks in 5 different grids UTM 1 km and at least one hour of time. The unit of comparison was the UTM grid of 5 km. I have computerized inventories of field, for it was created a database in Access- Microsoft office -TESIS. The main tables are LOCALIDAD, with caracteristics of the sampled location and ESPECIES, which lists the plant species considered in the four provinces of the study, is. Through forms I filled in the tables; highlights ESPECIE INVENTARIO table that relates the tables ESPECIES and LOCALIDAD, this table is counted at the moment with about 165,000 records. The table ESPECIES FPVI visualizes all recollected species. We have created an indicator called FPVI "Flora permanently visible identifiable" that attributes to each species indices that allow us to know whether a given plant can be detected in any season. The results presented are: Creating data base TESIS. The Floristic Books Middle Tagus Basin, which is a catalog of the flora of the four provinces since the beginning of the systematic until Saxifragaceae. In total 1028 collected taxa in 77 families. We calculated FPVI index for species catalog. The purpose for which this index designed is, to compare territories. For the development of both results, it was essential to develop the table ESPECIES_PVI TESIS data base. Table ESPECIES_PVI has signed the ecological characteristics and bibliographic information available for each species is revised; the main sources of information has been Flora iberica, the Anthos project databases of herbaria. Targeted species has been recorded, when seen, protected or endemism. Have also been located UTM grids of 10 km, with the largest number of endemic or unique species and more botanical value. There have been a couple of species autecology studies, namely Teucrium pumilum and Clematis recta, as an example of this type of study. They have been putting together maps of species distribution. We made herbarium JML. I have presented a simple tool to include floristic inventories, chorological appointments, consultations or to tag autoecology herbarium specimens. To cap it has worked to develop a computer application for visualization, analysis and study of the distribution of plant taxa, which has used as input data a significant percentage of those obtained for this thesis.

Accessibility instruments for planning practice: bridging the gap between academic research and decision-making.

One of the core objectives of urban planning practice is to provide spatial equity in terms of opportunities and use of public space and facilities. Accessibility is the element that serves this purpose as a concept linking the reciprocal relationship between transport and land use, thus shaping individual potential mobility to reach the desired destinations. Accessibility concepts are increasingly acknowledged as fundamental to understand the functioning of cities and urban regions. Indeed, by introducing them in planning practice, better solutions can be achieved in terms of spatial equity. The COST Action TU1002 "Accessibility instruments for planning practice" was specifically designed to address the gap between scientific research in measuring and modelling accessibility, and the current use of indicators of accessibility in urban planning practice. This paper shows the full process of introducing an easily understandable measure of accessibility to planning practitioners in Madrid, which is one of the case studies of the above-mentioned COST action. Changes in accessibility after the opening of a new metro line using contour measures were analyzed and then presented to a selection of urban planners and practitioners in Madrid as part of a workshop to evaluate the usefulness of this tool for planning practice. Isochrone maps were confirmed as an effective tool, as their utility can be supplemented by other indicators, and being GIS-based, it can be easily computed (when compared with transport models) and integrated with other datasets.

Incidencia de la protección de las denominaciones geográficas en el comercio internacional agroalimentario

Las denominaciones geográficas contribuyen a la sostenibilidad económica, social y medioambiental de la producción agraria en todos los países, independientemente de su grado de desarrollo. La presente investigación pretende, de forma general, analizar la forma en que puede mejorarse su reconocimiento y generación de valor añadido para el productor y la sociedad. Para ello, se ha valorado si la protección internacional que se otorga a las denominaciones geográficas es homogénea y suficiente en el ámbito multilateral. Posteriormente, se identifican los instrumentos con los que cuenta la Unión Europea para ejercer el liderazgo en el comercio internacional para la protección de las denominaciones geográficas y se exploran las posibles sinergias y conflictos con el registro de marcas. Además, se ha prestado una especial atención a la forma en la que las denominaciones geográficas pueden impulsar en los países en desarrollo la generación de valor añadido de los productos ligado a la calidad vinculada a su origen y un reparto más equitativo del mismo, profundizando en el caso del café. Dado que el método Delphi se valora como idóneo para el apoyo realizar diagnósticos precisos y servir de soporte a la toma de decisiones, la fase empírica se ha centrado en aplicarlo en un grupo seleccionado de expertos con gran experiencia en el ámbito de las denominaciones geográficas, realizando dos rondas de cuestionarios y alcanzado un elevado grado de consenso. Ello se ha complementado con el desarrollo de una decena de entrevistas cualitativas no estructuradas a élites. Como resultado de la fase empírica, se ha obtenido un diagnóstico de la situación actual de las denominaciones geográficas, presentado en forma de matriz DAFO, y se han propuesto una serie de medidas a implantar por la administración española y de la Unión Europea, encaminadas a mejorar el sector de las denominaciones geográficas en el comercio internacional. ABSTRACT Geographical indications play a key role in environmental, social and economic sustainabily of agricultura worldwide. This research aims to analyze the way their recognition and protection can be enhanced to create value added for the producer and the whole society. It has been reviewed the multilateral and European frame of protection of geographical indications and the relation with trademarks to evaluate the need of improvement. Moreover, it has been explored the way geographical indications contribute to increase value added and equity in developing countries, with special attention to the case of coffee. Thanks to the use of the Delphi method and qualitative interviews to relevant experts during the empirical research, it has been posible to make an accurate SWOT analysis of geographical indications sector and define measures to improve the Spanish and European quality policy, some of them related to international trade.

Rhesus monkeys know when they remember

Humans are consciously aware of some memories and can make verbal reports about these memories. Other memories cannot be brought to consciousness, even though they influence behavior. This conspicuous difference in access to memories is central in taxonomies of human memory systems but has been difficult to document in animal studies, suggesting that some forms of memory may be unique to humans. Here I show that rhesus macaque monkeys can report the presence or absence of memory. Although it is probably impossible to document subjective, conscious properties of memory in nonverbal animals, this result objectively demonstrates an important functional parallel with human conscious memory. Animals able to discern the presence and absence of memory should improve accuracy if allowed to decline memory tests when they have forgotten, and should decline tests most frequently when memory is attenuated experimentally. One of two monkeys examined unequivocally met these criteria under all test conditions, whereas the second monkey met them in all but one case. Probe tests were used to rule out “cueing” by a wide variety of environmental and behavioral stimuli, leaving detection of the absence of memory per se as the most likely mechanism underlying the monkeys' abilities to selectively decline memory tests when they had forgotten.

Acesso ao tratamento oncológico no município de São Paulo: o câncer de mama como condição traçadora

Acompanhando a tendência mundial, o Brasil apresenta um processo de envelhecimento de sua população, caracterizado pelo aumento das condições crônicas, inclusive do câncer. O quadro convoca mudanças profundas nos sistemas de saúde, demandando a implantação de Redes de Atenção, a fim de garantir acesso a todos os níveis de atenção, superando a fragmentação do cuidado. Com o intuito de conhecer os avanços no que se refere à atenção oncológica em rede, analisou-se o acesso ao tratamento do câncer em São Paulo, especialmente a partir do surgimento da Lei dos sessenta dias. Foram considerados os sistemas de monitoramento da atenção oncológica no município, além de analisados os itinerários assistenciais de usuárias, utilizando o câncer de mama como condição traçadora. Não foi possível identificar uma redução do tempo de espera para iniciar o tratamento, a partir do banco do Registro Hospitalar de Câncer de são Paulo, considerando que não há completude na base a partir de 2013, sendo observado que o tempo indicado na lei foi ultrapassado nos dois anos anteriores. Da mesma forma, notou-se um aumento da proporção de estádios avançados nesse período. Ainda com relação à variável tempo, as informações no SIGA demonstraram que, em 2013, o tempo médio para uma consulta em Onco-mastologia nos serviços de gestão municipal que estão sob regulação foi de apenas 4 dias. Por meio dos Sistemas de Informação Ambulatorial e Hospitalar, observou-se um aumento estatisticamente significativo na produção de radioterapia e de cirurgias oncológicas entre os anos 2011 e 2014, e uma tendência de redução dos procedimentos quimioterápicos. O Sistema de Informação sobre Câncer de Mama demonstrou aumento no percentual de mamografias alteradas, aspecto que, ao ser analisado em conjunto com o aumento da proporção de estadiamentos avançados, pode ser indicativo de maior dificuldade no acesso ao diagnóstico precoce do câncer de mama. Observou-se que a judicialização esteve muito relacionada a acesso a medicamentos quimioterápicos, de prescrição após a entrada nos serviços especializados, o que confirma que o acesso ao tratamento de câncer de mama no município não apresenta grandes barreiras. Um importante efeito visualizado com o surgimento da Lei foi a padronização dos protocolos de acesso aos serviços de gestão municipal e estadual. Entretanto, a rede de oncologia em São Paulo continua fragmentada dentre seus componentes estruturais, as ações permanecem no plano da construção de fluxos de encaminhamento, ficando restrita à atenção especializada. A atenção oncológica na cidade é atravessada pelo setor privado, o que deixa na dependência dos prestadores a disponibilização de vagas para acesso e o fluxo interno de cada serviço. O poder ainda continua com os grandes prestadores, não sendo bem conhecidos os caminhos para o acesso a algumas instituições, nem publicizadas as informações sobre fila e tempo de espera. A legislação sozinha não é indutora de melhoria de acesso, nem muito menos de garantia de integralidade. Um importante desafio para o SUS é a integração dos serviços e a construção de redes de atenção com centralidade na APS, garantindo, acima de tudo, o diagnóstico em tempo oportuno e a efetiva gestão sobre os serviços privados contratados de média e alta complexidade.