Lessons learned from nationwide vaccine programs: Comparing human papillomavirus, poliomyelitis vaccine, and swine flu

This assessment compares the human papillomavirus (HPV) nationwide vaccine to the poliomyelitis vaccine and the swine flu vaccine with the purpose of finding parallels and lessons in the controversies faced by the development and use of the vaccines. There are a number of great barriers that are facing the HPV vaccine to date. These controversies lie in dealing with the risk involved in taking the vaccine, how much control the government should have in administering the vaccine, how to communicate the risk to the public, and the cost-effectiveness of the vaccine versus treatment for cervical cancer. The lessons for the HPV vaccine that were learned after comparison and assessment of the controversies were: (1) plan ahead of time on how to inform the public if a risk develops from taking the HPV vaccination and it may be better to provide some information while the event is occurring, always being as truthful as possible, and later dispensing more information once all of the facts are known, (2) the human papillomavirus is not something that will become a pandemic in a short amount of time because the virus takes a long time to develop into cervical cancer, so if a major risk begins to show after continuing to develop and administer the vaccine for an amount of time, it may be better to take it off the market for a while and possibly reconfigure it to help eliminate some of the risks, (3) if side reactions and risks do develop and the government assumes liability for these reactions, the cost-effectiveness can be greatly affected, so it is important to be constantly checking to see if all the monetary and health benefits of the vaccine are outweighing any of the negative costs of the vaccine, and lastly, (4) the public must feel that every aspect of the vaccine, both good and bad, has been thought over and the benefits of taking the vaccine prevail over the negatives and that politics and commercial interests have nothing to do with the production and administration of the vaccine. ^

A study of nurses' perceptions of and participation in the resolution of treatment dilemmas for critically ill newborns

This study was an exploratory investigation of variables which are associated with neonatal intensive care nurses' perceptions of and participation in life-sustaining treatment decisions for critically ill newborns. The primary purpose of the research was to examine the extent to which assessment of infants' physical and mental prognoses, parents' preferences regarding treatment, and legal consequences of non-treatment influence nurses' recommendations about life-saving treatment decisions for handicapped newborns. Secondly, the research explored the extent and nature of nurses' reported participation in the resolution of treatment dilemmas for these critically ill newborns. The framework of the study draws upon the work of Crane (1977), Blum (1980), and Pearlman (1982) who have explored the sociological context of decision-making with critical care patients.^ Participants in the study were a volunteer sample of eighty-three registered nurses who were currently working in neonatal intensive care units in five large urban hospitals in Texas. Data were collected through the use of intensive interviews and case study questionnaires. Results from the study indicate that physical and mental prognoses as well as parent preferences and concerns about legal liability are related to nurses' treatment recommendations, but their levels of significance vary according to the type of handicapping condition and whether the treatment questions are posed in terms of initiating aggressive therapy or withdrawing aggressive therapy.^ The majority of nurses reported that the extent of their participation in formal decision-making regarding handicapped newborns was fairly minimal although they provide much of the definitive data used to make decisions by physicians and parents. There was substantial evidence that nurse respondents perceive their primary role as advocates for critically ill newborns, and believe that their involvement in the resolution of treatment dilemmas should be increased. ^

Genetic epidemiologic methods in risk determination in Li-Fraumeni syndrome

Li-Fraumeni syndrome (LFS) is characterized by a variety of neoplasms occurring at a young age with an apparent autosomal dominant transmission. Individuals in pedigrees with LFS have high incidence of second malignancies. Recently LFS has been found to be associated with germline mutations of a tumor-suppressor gene, p53. Because LFS is rare and indeed not a clear-cut disease, it is not known whether all cases of LFS are attributable to p53 germline mutations and how p53 plays in cancer occurrence in such cancer syndrome families. In the present study, DNAs from constitutive cells of two-hundred and thirty-three family members from ten extended pedigrees were screened for p53 mutations. Six out of the ten LFS families had germline mutations at the p53 locus, including point and deletion mutations. In these six families, 55 out of 146 members were carriers of p53 mutations. Except one, all mutations occurred in exons 5 to 8 (i.e., the "hot spot" region) of the p53 gene. The age-specific penetrance of cancer was estimated after the genotype for each family member at risk was determined. The penetrance was 0.15, 0.29, 0.35, 0.77, and 0.91 by 20, 30, 40, 50 and 60 year-old, respectively, in male carriers; 0.19, 0.44, 0.76, and 0.90 by 20, 30, 40, and 50 year-old, respectively, in female carriers. These results indicated that one cannot escape from tumorigenesis if one inherits a p53 mutant allele; at least ninety percent of p53 carriers will develop cancer by the age of 60. To evaluate the possible bias due to the unexamined blood-relatives in LFS families, I performed a simulation analysis in which a p53 genotype was assigned to each unexamined person based on his cancer status and liability to cancer. The results showed that the penetrance estimates were not biased by the unexamined relatives. I also determined the sex, site, and age-specific penetrance of breast cancer in female carriers and lung cancer in male carriers. The penetrance of breast cancer in female carriers was 0.81 by age 45; the penetrance of lung cancer in male carriers was 0.78 by age 60, indicating that p53 play a key role for tumorigenesis in common cancers. ^

SUPERFUND: AN ANALYSIS OF IMPLEMENTATION FAILURE (CERCLA, HEALTH LAW POLICY)

In December, 1980, following increasing congressional and constituent-interest in problems associated with hazardous waste, the Comprehensive Environmental Recovery, Compensation and Liability Act (CERCLA) was passed. During its development, the legislative initiative was seriously compromised which resulted in a less exhaustive approach than was formerly sought. Still, CERCLA (Superfund) which established, among other things, authority to clean up abandoned waste dumps and to respond to emergencies caused by releases of hazardous substances was welcomed by many as an important initial law critical to the cleanup of the nation's hazardous waste. Expectations raised by passage of this bill were tragically unmet. By the end of four years, only six sites had been declared by the EPA as cleaned. Seemingly, even those determinations were liberal; of the six sites, two were identified subsequently as requiring further cleanup.^ This analysis is focused upon the implementation failure of the Superfund. In light of that focus, discussion encompasses development of linkages between flaws in the legislative language and foreclosure of chances for implementation success. Specification of such linkages is achieved through examination of the legislative initiative, identification of its flaws and characterization of attendant deficits in implementation ability. Subsequent analysis is addressed to how such legislative frailities might have been avoided and to attendant regulatory weaknesses which have contributed to implementation failure. Each of these analyses are accomplished through application of an expanded approach to the backward mapping analytic technique as presented by Elmore. Results and recommendations follow.^ Consideration is devoted to a variety of regulatory issues as well as to those pertinent to legislative and implementation analysis. Problems in assessing legal liability associated with hazardous waste management are presented, as is a detailed review of the legislative development of Superfund, and its initial implementation by Gorsuch's EPA. ^

MEDICAL CARE UTILIZATION IN TIME AMONG ELDERLY MEDICARE ENROLLEES IN AN HMO

Investigation into the medical care utilization of elderly Medicare enrollees in an HMO (Kaiser - Portland, Oregon): The specific research topics are: (1) The utilization of medical care by selected determinants such as: place of service, type of service, type of appointment, physician status, physician specialty and number of associated morbidities. (2) The attended prevalence of 3 chronic diseases: hypertension, diabetes and arthritis in addition to pneumonias as an example of acute diseases. The selection of these examples was based on their importance in morbidity/or mortality results among the elderly. The share of these diseases in outpatient and inpatient contacts was examined as an example of the relation between morbidity and medical care utilization. (3) The tendency of individual utilization patterns to persist in subsequent time periods. The concept of contagion or proneness was studied in a period of 2 years. Fitting the negative binomial and the Poisson distributions was applied to the utilization in the 2nd year conditional on that in the 1st year as regards outpatient and inpatient contacts.^ The present research is based on a longitudinal study of 20% random sample of elderly Medicare enrollees. The sample size is 1683 individuals during the period from August 1980-December 1982.^ The results of the research were: (1) The distribution of contacts by selected determinants did not reveal a consistent pattern between sexes and age groups. (2) The attended prevalence of hypertension and arthritis showed excess prevalence among females. For diabetes and pneumonias no female excess was noticed. Consistent increased prevalence with increasing age was not detected.^ There were important findings pertaining to the relatively big share of the combined 3 chronic diseases in utilization. They accounted for 20% of male outpatient contacts vs. 25% of female outpatients. For inpatient contacts, they consumed 20% in case of males vs. 24% in case of females. (3) Finding that the negative binomial distribution fit the utilization experience supported the research hypothesis concerning the concept of contagion in utilization. This important finding can be helpful in estimating liability functions needed for forecasting future utilization according to previous experience. Such information has its relevance to organization, administration and planning for medical care in general. (Abstract shortened with permission of author.) ^

Nurse likelihood to report a pediatric medication error: Examination of the "pre-reporting" period

Each year, hospitalized patients experience 1.5 million preventable injuries from medication errors and hospitals incur an additional $3.5 billion in cost (Aspden, Wolcott, Bootman, & Cronenwatt; (2007). It is believed that error reporting is one way to learn about factors contributing to medication errors. And yet, an estimated 50% of medication errors go unreported. This period of medication error pre-reporting, with few exceptions, is underexplored. The literature focuses on error prevention and management, but lacks a description of the period of introspection and inner struggle over whether to report an error and resulting likelihood to report. Reporting makes a nurse vulnerable to reprimand, legal liability, and even threat to licensure. For some nurses this state may invoke a disparity between a person‘s belief about him or herself as a healer and the undeniable fact of the error.^ This study explored the medication error reporting experience. Its purpose was to inform nurses, educators, organizational leaders, and policy-makers about the medication error pre-reporting period, and to contribute to a framework for further investigation. From a better understanding of factors that contribute to or detract from the likelihood of an individual to report an error, interventions can be identified to help the nurse come to a psychologically healthy resolution and help increase reporting of error in order to learn from error and reduce the possibility of future similar error.^ The research question was: "What factors contribute to a nurse's likelihood to report an error?" The specific aims of the study were to: (1) describe participant nurses' perceptions of medication error reporting; (2) describe participant explanations of the emotional, cognitive, and physical reactions to making a medication error; (3) identify pre-reporting conditions that make it less likely for a nurse to report a medication error; and (4) identify pre-reporting conditions that make it more likely for a nurse to report a medication error.^ A qualitative research study was conducted to explore the medication error experience and in particular the pre-reporting period from the perspective of the nurse. A total of 54 registered nurses from a large private free-standing not-for-profit children's hospital in the southwestern United States participated in group interviews. The results describe the experience of the nurse as well as the physical, emotional, and cognitive responses to the realization of the commission of a medication error. The results also reveal factors that make it more and less likely to report a medication error.^ It is clear from this study that upon realization that he or she has made a medication error, a nurse's foremost concern is for the safety of the patient. Fear was also described by each group of nurses. The nurses described a fear of several things including physician reaction, manager reaction, peer reaction, as well as family reaction and possible lack of trust as a result. Another universal response was the description of a struggle with guilt, shame, imperfection, blaming oneself, and questioning one's competence.^

IDENTIFYING GENETIC VARIANTS AND CHARACTERIZING THEIR ROLE IN CLUBFOOT

Clubfoot is a common, complex birth defect affecting 4,000 newborns in the United States and 135,000 world-wide each year. The clubfoot deformity is characterized by inward and rigid downward displacement of one or both feet, along with persistent calf muscle hypoplasia. Despite strong evidence for a genetic liability, there is a limited understanding of the genetic and environmental factors contributing to the etiology of clubfoot. The studies described in this dissertation were performed to identify variants and/or genes associated with clubfoot. Genome-wide linkage scan performed on ten multiplex clubfoot families identified seven new chromosomal regions that provide new areas to search for clubfoot genes. Troponin C (TNNC2) the strongest candidate gene, located in 20q12-q13.11, is involved in muscle contraction. Exon sequencing of TNNC2 did not identify any novel coding variants. Interrogation of fifteen muscle contraction genes found strong associations with SNPs located in potential regulatory regions of TPM1 (rs4075583 and rs3805965), TPM2 (rs2025126 and rs2145925) and TNNC2 (rs383112 and rs437122). In previous studies, a strong association was found with rs3801776 located in the basal promoter of HOXA9, a gene also involved in muscle development and patterning. Altogether, this data suggests that SNPs located in potential regulatory regions of genes involved in muscle development and function could alter transcription factor binding leading to changes in gene expression. Functional analysis of 3801776/HOXA9, rs2025126/TPM2 and rs2145925/TPM2 showed altered protein binding, which significantly influenced promoter activity. Although the ancestral allele (G) of rs4075583/TPM1 creates a DNA-protein complex, it did not affect TPM1 promoter activity. However and importantly, in the context of a haplotype, rs4075583/G significantly decreased TPM1 promoter activity. These results suggest dysregulation of multiple skeletal muscle genes, TPM1, TPM2, TNNC2 and HOXA9, working in concert may contribute to clubfoot. However, specific allelic combinations involving these four regulatory SNPs did not confer a significantly higher risk for clubfoot. Other combinations of these variants are being evaluated. Moreover, these variants may interact with yet to be discovered variants in other genes to confer a higher clubfoot risk. Collectively, we show novel evidence for the role of skeletal muscle genes in clubfoot indicating that there are multiple genetic factors contributing to this complex birth defect.

Is Group Lending A Good Enforcement Scheme for Achieving High Repayment Rates?: Evidence from Field Experiments in Vietnam

Microfinance institutions employ various kinds of incentive schemes but estimating the effect of each scheme is not easy due to endogeneity bias. We conducted field experiments in Vietnam to capture the role of joint liability, monitoring, cross-reporting, social sanctions, communication and group formation in borrowers’ repayment behavior. We find that joint liability contracts cause serious free-riding problems, inducing strategic default and lowering repayment rates. When group members observe each others’ investment returns, participants are more likely to choose strategic default. Even after introducing a cross-reporting system and/or penalties among borrowers, the default rates and the ratios of participants who chose strategic default under joint liability are still higher than those under individual lending. We also find that joint liability lending often failed to induce mutual insurance among borrowers. Those who had been helped or who had repaid a little in the previous round were more likely to default strategically and repay a little again in the current round and those who paid large amounts were always the same individuals.

Risk sharing with Multilateral Financial Institutions in infrastructure and energy project financing : effect on capital relief for commercial banks

(Matsukawa and Habeck, 2007) analyse the main instruments for risk mitigation in infrastructure financing with Multilateral Financial Institutions (MFIs). Their review coincided with the global financial crisis of 2007-08, and is highly relevant in current times considering the sovereign debt crisis, the lack of available capital and the increases in bank regulation in Western economies. The current macroeconomic environment has seen a slowdown in the level of finance for infrastructure projects, as they pose a higher credit risk given their requirements for long term investments. The rationale for this work is to look for innovative solutions that are focused on the credit risk mitigation of infrastructure and energy projects whilst optimizing the economic capital allocation for commercial banks. This objective is achieved through risk-sharing with MFIs and looking for capital relief in project finance transactions. This research finds out the answer to the main question: "What is the impact of risk-sharing with MFIs on project finance transactions to increase their efficiency and viability?", and is developed from the perspective of a commercial bank assessing the economic capital used and analysing the relevant variables for it: Probability of Default, Loss Given Default and Recovery Rates, (Altman, 2010). An overview of project finance for the infrastructure and energy sectors in terms of the volume of transactions worldwide is outlined, along with a summary of risk-sharing financing with MFIs. A review of the current regulatory framework beneath risk-sharing in structured finance with MFIs is also analysed. From here, the impact of risk-sharing and the diversification effect in infrastructure and energy projects is assessed, from the perspective of economic capital allocation for a commercial bank. CreditMetrics (J. P. Morgan, 1997) is applied over an existing well diversified portfolio of project finance infrastructure and energy investments, working with the main risk capital measures: economic capital, RAROC, and EVA. The conclusions of this research show that economic capital allocation on a portfolio of project finance along with risk-sharing with MFIs have a huge impact on capital relief whilst increasing performance profitability for commercial banks. There is an outstanding diversification effect due to the portfolio, which is combined with risk mitigation and an improvement in recovery rates through Partial Credit Guarantees issued by MFIs. A stress test scenario analysis is applied to the current assumptions and credit risk model, considering a downgrade in the rating for the commercial bank (lender) and an increase of default in emerging countries, presenting a direct impact on economic capital, through an increase in expected loss and a decrease in performance profitability. Getting capital relief through risk-sharing makes it more viable for commercial banks to finance infrastructure and energy projects, with the beneficial effect of a direct impact of these investments on GDP growth and employment. The main contribution of this work is to promote a strategic economic capital allocation in infrastructure and energy financing through innovative risk-sharing with MFIs and economic pricing to create economic value added for banks, and to allow the financing of more infrastructure and energy projects. This work suggests several topics for further research in relation to issues analysed. (Matsukawa and Habeck, 2007) analizan los principales instrumentos de mitigación de riesgos en las Instituciones Financieras Multilaterales (IFMs) para la financiación de infraestructuras. Su presentación coincidió con el inicio de la crisis financiera en Agosto de 2007, y sus consecuencias persisten en la actualidad, destacando la deuda soberana en economías desarrolladas y los problemas capitalización de los bancos. Este entorno macroeconómico ha ralentizado la financiación de proyectos de infraestructuras. El actual trabajo de investigación tiene su motivación en la búsqueda de soluciones para la financiación de proyectos de infraestructuras y de energía, mitigando los riesgos inherentes, con el objeto de reducir el consumo de capital económico en los bancos financiadores. Este objetivo se alcanza compartiendo el riesgo de la financiación con IFMs, a través de estructuras de risk-sharing. La investigación responde la pregunta: "Cuál es el impacto de risk-sharing con IFMs, en la financiación de proyectos para aumentar su eficiencia y viabilidad?". El trabajo se desarrolla desde el enfoque de un banco comercial, estimando el consumo de capital económico en la financiación de proyectos y analizando las principales variables del riesgo de crédito, Probability of Default, Loss Given Default and Recovery Rates, (Altman, 2010). La investigación presenta las cifras globales de Project Finance en los sectores de infraestructuras y de energía, y analiza el marco regulatorio internacional en relación al consumo de capital económico en la financiación de proyectos en los que participan IFMs. A continuación, el trabajo modeliza una cartera real, bien diversificada, de Project Finance de infraestructuras y de energía, aplicando la metodología CreditMet- rics (J. P. Morgan, 1997). Su objeto es estimar el consumo de capital económico y la rentabilidad de la cartera de proyectos a través del RAROC y EVA. La modelización permite estimar el efecto diversificación y la liberación de capital económico consecuencia del risk-sharing. Los resultados muestran el enorme impacto del efecto diversificación de la cartera, así como de las garantías parciales de las IFMs que mitigan riesgos, mejoran el recovery rate de los proyectos y reducen el consumo de capital económico para el banco comercial, mientras aumentan la rentabilidad, RAROC, y crean valor económico, EVA. En escenarios económicos de inestabilidad, empeoramiento del rating de los bancos, aumentos de default en los proyectos y de correlación en las carteras, hay un impacto directo en el capital económico y en la pérdida de rentabilidad. La liberación de capital económico, como se plantea en la presente investigación, permitirá financiar más proyectos de infraestructuras y de energía, lo que repercutirá en un mayor crecimiento económico y creación de empleo. La principal contribución de este trabajo es promover la gestión activa del capital económico en la financiación de infraestructuras y de proyectos energéticos, a través de estructuras innovadoras de risk-sharing con IFMs y de creación de valor económico en los bancos comerciales, lo que mejoraría su eficiencia y capitalización. La aportación metodológica del trabajo se convierte por su originalidad en una contribución, que sugiere y facilita nuevas líneas de investigación académica en las principales variables del riesgo de crédito que afectan al capital económico en la financiación de proyectos.

Políticas de esfuerzo combinado económico-laboral en la retención y atracción del conocimiento científico: un estudio del caso español

El objetivo de este trabajo es la aportación de un caso que evidencie la importancia de realizar esfuerzos tanto en el terreno económico como en el laboral para conseguir una adecuada retención y atracción del conocimiento científico. Para ello, se analizan los datos de un estudio que destaca estas cuestiones para un país como España, que necesita urgentemente mejorar su balance de movilidad investigadora. Los resultados confirman la importancia de la aplicación de estas medidas y las debilidades que presenta en este tipo de políticas el sistema nacional de investigación, desarrollo e innovación (I+D+i). Abstract: The goal of this paper is to disclose a case study which highlights the impor tance of realising effor ts at an economic and labour scale in order to reach an adequate retention and attraction of scientific knowledge. Although science has evolved during different periods through the flow of mankind and ideas, studies about international mobility of scientists are recent in time. It started mid XXth century with the brain drain phenomenon. To alleviate the loss of scientists, countries have disclosed different politics. Some countries like Singapore, Southern Korea, India and China have been successful in bringing scientists back home. Those countries have made huge effor ts in human resources investments and scientific infrastructures, so as to enforce their national R&D&I systems. Despite such experiences and despite the increasement in terms of evidences related with international scientific mobility, few studies and figures have been disclosed. The goal of this current work is to disclose data, which backs up the liability of such kind of politics that combine effor ts in economic and labour terms. For that reason, data has been analyzed from a study which highlights these key aspects for a country like Spain and which recently established a wide range of politics in order to attract scientists. Despite the increasement of financial resources, such politics have turned out unable to reach a proper balance in terms of mobility research. Such data as well as it analysis comes from the development of an annual survey to Spanish scientists during the period 2008- 2011. Based on sample data and analysis an expectations index for the coming year has been constructed. This compares the level of confidence which related the support and prestige of their national R&D&I systems in which they operate. Two groups where surveyed: young researchers which currently work in Spain and as a group are more likely to go working abroad and Spanish scientists who are currently working abroad. Samples were obtained for young researchers were the following: 2008 (217), 2009 (270), 2010 (390) and 2011 (610). In the case of Spanish scientists abroad, the following data were obtained: 2008 (218), 2009 (250), 2010 (241) and 2011 (167). Both groups assume simple random sampling, with a level of confidence of 95%. The results obtained confirm the importance of this combined effor t of labor and economic policies which presents weaknesses of Spanish national R&D&I systems and its application, so that Spain becomes a pole of excellence in terms of attraction and retention of scientific knowledge.

Reliability and reproductibility of skin temperature of overweight subjects by an infrared thermograpy software designed for human beings

The technical improvement and new applications of Infrared Thermography (IRT) with healthy subjects should be accompanied by results about the reproducibility of IRT measurements in different popula-tion groups. In addition, there is a remarkable necessity of a larger supply on software to analyze IRT images of human beings. Therefore, the objectives of this study were: firstly, to investigate the reproducibility of skin temperature (Tsk) on overweight and obese subjects using IRT in different Regions of Interest (ROI), moments and side-to-side differences (?T); and secondly, to check the reliability of a new software called Termotracker®, specialized on the analysis of IRT images of human beings. Methods: 22 overweight and obese males (11) and females (11) (age: 41,51±7,76 years; height: 1,65±0,09 m; weight: 82,41±11,81 Kg; BMI: 30,17±2,58 kg/m²) were assessed in two consecutive thermograms (5 seconds in-between) by the same observer, using an infrared camera (FLIR T335, Sweden) to get 4 IRT images from the whole body. 11 ROI were selected using Termotracker® to analyze its reproducibility and reliability through Intra-class Correlation Coefficient (ICC) and Coefficient of Variation (CV) values. Results: The reproducibility of the side-to-side differences (?T) between two consecutive thermograms was very high in all ROIs (Mean ICC = 0,989), and excellent between two computers (Mean ICC = 0,998). The re-liability of the software was very high in all the ROIs (Mean ICC = 0,999). Intraexaminer reliability analysing the same subjects in two consecutive thermograms was also very high (Mean ICC = 0,997). CV values of the different ROIs were around 2%. Conclusions: Skin temperature on overweight subjects had an excellent reproducibility for consecutive ther-mograms. The reproducibility of thermal asymmetries (?T) was also good but it had the influence of several factors that should be further investigated. Termotracker® reached excellent reliability results and it is a relia-ble and objective software to analyse IRT images of humans beings.

On the leakage-power modeling for optimal server operation

Leakage power consumption is a com- ponent of the total power consumption in data cen- ters that is not traditionally considered in the set- point temperature of the room. However, the effect of this power component, increased with temperature, can determine the savings associated with the careful management of the cooling system, as well as the re- liability of the system. The work presented in this paper detects the need of addressing leakage power in order to achieve substantial savings in the energy consumption of servers. In particular, our work shows that, by a careful detection and management of two working regions (low and high impact of thermal- dependent leakage), energy consumption of the data- center can be optimized by a reduction of the cooling budget.

La identificaciónde de los daños estructurales, herramienta de la nueva atribución de responsabilidades : análisis crítico de la transición del art. 1591 cc al art. 17 LOE

RESUMEN Su objetivo esencial: Regular el proceso de la edificación, está basado en 3 grandes pilares: 1.- Completar la configuración legal de los agentes que intervienen en el mismo, fijando sus obligaciones para así establecer las responsabilidades. 2.- Fomentar la calidad de los edificios. 3.- Fijar las garantías a los usuarios frente a los posibles daños. Estos tres fundamentos están intensamente relacionados, ya que, las obligaciones y responsabilidades de los agentes son la base de la constitución de las garantías a los usuarios, definidas mediante los requisitos básicos que deben satisfacer los edificios. Partiendo del análisis cualitativo y cuantitativo del grado de cumplimiento del objetivo de la nueva Ley, elaborado a través del estudio de sus tres pilares fundamentales, proponemos medidas tendentes a la plena entrada en vigor de la misma. Para ello se deberá desarrollar el Real Decreto previsto en la Disposición Adicional 2ª, una vez conseguido el grado de madurez de los sectores de la edificación y del seguro. En todo este proceso de estudio hemos podido apreciar que la objetiva identificación de los daños y en especial los que afectan la estabilidad del edificio, constituye una herramienta fundamental para la correcta atribución de responsabilidades a los agentes, basada en la aplicación de los tres grados de responsabilidad “ex lege” por daños materiales y sus plazos de prescripción surgidos del nuevo régimen impuesto por el art. 17 LOE Para avalar esta propuesta hemos analizado: 1.- El entorno económico, general y pormenorizado al sector de la edificación, en Europa y España durante el período comprendido entre los años 1990 y 2013, años previos y posteriores a la entrada en vigor de la Ley, dada la influencia de los ciclos de actividad producidos en la regulación del sector, las responsabilidades atribuidas a los agentes, el fomento de la calidad y las garantías ofrecidas a los adquirentes. 2.- Las diversas legislaciones sobre responsabilidades y garantías de los agentes de la edificación en los países de nuestro entorno económico. 3.- La gestación de la LOE, incidiendo en la evolución de los últimos borradores y su tramitación parlamentaria. 4.- El desarrollo doctrinal de la Transición desde el régimen de responsabilidades, fijado por el art. 1591 de Código Civil, y su Jurisprudencia, hacia el nuevo régimen de responsabilidades establecido por el art. 17 LOE. En esta tarea además de apreciar la asimilación, por parte de los Jueces y Magistrados, de los principios doctrinales de la LOE, hemos observado la labor de los peritos, de cuya experta identificación de las causas de los daños depende la justa y eficaz atribución de responsabilidades. 5 -. El grado de eficacia de la LOE a la vista de la estadística siniestral, de la que ya hay datos consolidados, tras la cancelación de casi 15.000 expedientes de reclamación a Arquitectos. 6 -. También hemos estudiado el grado de cumplimiento con el usuario y propietario de las garantías previstas en el art. 19 de la Ley y en la D.A. 1ª, los efectos reales alcanzados y las tareas pendientes por delante. Analizando la atribución de responsabilidades a los agentes de la edificación, dentro del primer pilar fundamental de la LOE, hemos estudiado las actuaciones de los peritos expertos y su incidencia en este objetivo, previa selección de casos de gran interés y dificultad. Fruto de ello se han formulado propuestas tendentes a la especialización de este colectivo, evitando conductas “irregulares” que tanto daño provocan a los agentes reclamados como a los propietarios afectados. Este daño es evidente pudiendo ocasionar condenas injustas, enriquecimientos ilícitos o bien falsas expectativas de satisfacción de daños mal dictaminados y costosas e ineficaces reparaciones. De cara a la consecución del pilar de la calidad de la edificación, mediante los requisitos básicos planteados por la LOE y desarrollados por el Código Técnico de la Edificación (Real Decreto 314/2006, de 17 de marzo), hemos procesado datos de expedientes de reclamaciones por daños que afectan a edificios ejecutados bajo el nuevo régimen LOE. Con esta base se han analizado las causas generadoras de las diversas lesiones y su frecuencia para que de este análisis puedan establecerse pautas de actuación para su prevención. Finalmente, tras demostrar que las garantías obligatorias impuestas por la LOE sólo abarcan un pequeño porcentaje de los posibles daños a la edificación, insistimos en la necesidad de la plena eficacia de la Ley mediante la aprobación de todas las garantías previstas y para todo tipo de edificaciones. En suma, se ha diseñado la tesis como una matriz abierta en la que podremos continuar incorporando datos de la evolución de la doctrina, la jurisprudencia y la estadística de los daños en la edificación. ABSTRACT The approval of Law 38/1999 on November 5, 1999, (Official Gazette BOE 266/1999 of 11.6.1999, p. 38925), was the culmination of a long period of over 20 years of gestation for which deep agreements were needed between all stakeholders affected. Although several parliamentary groups denounced its incomplete approval, regarding mandatory guarantees to the purchaser, its enactment caused general satisfaction among most of the the building agents. This assessment remains after fourteen years since its partial enactment. Its essential purpose, “to regulate the building process”, is based on 3 pillars: 1.- To complete the legal configuration of the agents involved in it, setting their obligations in order to establish their responsibilities. 2.- To promote the buildings quality. 3.- To specify users´guarantees against possible buildings damage. These three issues are strongly related, since the obligations and responsibilities of the actors are the basis of the users’guarantees constitution, defined by the basic performance required by buildings. Based on the qualitative and quantitative analysis of the fulfillment of the new law’s objectives, made by monitoring the three pillars, we propose measures to the full enactment of this Directive, by the development of the Royal Decree, provided in its Second Additional Provision, once maturity in the sectors of the building and insurance is achieved. Throughout this process of study we have seen that the skill identification of damage, particularly those affecting the stability of the building, is an essential tool for the proper allocation of responsibilities of the new regime installed by the art. 17 LOE, based on the application of the three degrees of responsibility "ex lege" for property damage and limitation periods. To support this proposal, we have analyzed: 1.- The evolution of the building sector in Europe and Spain during the years before and after the enactment of the Law, due to the influence of cycles of activity produced in industry regulation, the responsibilities attributed to agents, promotion of the quality and the assurances given to acquirers. 2.- The scope of various laws on liability and building agents warranties in the countries of our economic environment. 3.- The long period of LOE generation, focusing on the developments in recent drafts and parliamentary procedure. 4.- The doctrinal development in the Transition from the regime of responsibilities, set by art. 1591 of the Civil Code, and its Jurisprudence, to the new liability regime established by art. 17 LOE. In this task, while we have noted assimilation by the Judges and Magistrates of the doctrinal principles of the LOE, we have also analyzed the work of experts, whose skilled identification of the damage causes helps the fair and efficient allocation of responsibilities. 5 - The effectiveness of the LOE based on knowledge of the siniestral statistics, which are already consolidated data, after the cancellation of nearly 15,000 claims to Architects. 6.- We have also studied the degree of compliance with the user and owner guarantees, established in art. 19 and the D.A. 1th of the LOE, exposing the real effects achieved and the pending tasks ahead. Analyzing the allocation of the building agents´ responsibilities, within the first cornerstone of the LOE, we have studied the expert witnesses actions and their impact on this duty, selecting cases of great interest and difficulty in this aim. The result of this enterprise has been to propose the specialization of this group, avoiding "irregular" behaviors that create as much damage as the agents claimed to affected owners. This damage is evident and can cause wrong convictions, illicit enrichment, false expectations and inefficient and costly damage repairs. In order to achieve the pillar of building quality through the basic requirements set by the LOE and developed by the Technical Building Code (Royal Decree 314/ 2006 of 17 March), we have analyzed records of damage claims involving buildings executed under the new regime LOE. On this basis we have analyzed the root causes of various damages and their frequency, from these data it will be easy to propose lines of action for prevention. Finally, after demonstrating that mandatory warranties imposed by LOE cover only a small percentage of the potential building damage, we emphasize the need for the full effectiveness of the Law by the obligation all the guarantees provided in the art. 19 LOE, and for all types of buildings. In conclusion, this thesis is designed as an open matrix in which we will continue including data on the evolution of the doctrine, jurisprudence and the statistics of the damage to the building.

Caracterización estructural de los rellenos situados en el trasdós de bóvedas de edificios históricos

El papel esencial de los rellenos en el comportamiento y la estabilidad de las construcciones de fábrica ha sido sorprendentemente ignorado en la bibliografía técnica, contribuyendo este trabajo a cubrir esta laguna del conocimiento. Se presenta en primer lugar la configuración morfológica de los rellenos del trasdós de bóvedas en la Península Ibérica en tres periodos histórico-técnicos: la construcción romana, la románica y la gótica. La clasificación se ha realizado en base a inspecciones visuales de diferentes edificios. En sendos anexos se presentan análisis comparados de la base de datos que se ha reunido y las fichas de las construcciones consideradas. En segundo lugar se ha caracterizado el papel estructural de los rellenos, identificándose las características intrínsecas que se estiman más significativas de dichos rellenos en relación tanto con su propia configuración como con su función estructural. Muy en particular se proponen unas leyes de empujes coherentes con la naturaleza y con las condiciones de contorno de los rellenos y las bóvedas. En esta tesis se ha desarrollado una sencilla, potente y suficiente herramienta de análisis que considera las principales variables que intervienen en el comportamiento de una estructura de fábrica, incluyendo muy particularmente los rellenos. Para ello se ha planteado una herramienta basada en el análisis límite que incluye la comprobación tensional de los diferentes esfuerzos, normales o tangenciales, así como la interfaz entre bóvedas y rellenos, dotándose a los técnicos de una herramienta que permite entender estas estructuras, de complejo funcionamiento. La herramienta propuesta incluye consideraciones energéticas para encontrar la solución más cercana al funcionamiento real. La herramienta se ha calibrado con ejemplos analizados por otros autores con diferentes procedimientos, poniéndose de manifiesto su suficiente precisión y eficacia, especialmente si se tiene en cuenta que requiere sólo de unos datos mínimos. La calibración se ha extendido al ensayo en modelo reducido de este tipo de estructuras en el Laboratorio de Estructuras de la Escuela de Ingenieros de Caminos, Canales y Puertos de Madrid. Fruto de esa calibración, se ha realizado un amplio estudio paramétrico que permite cuantificar la influencia que tienen en el comportamiento estructural variables como el apuntamiento de las bóvedas (relación luz/flecha), su esbeltez (relación luz/canto en clave), la altura de los rellenos rígidos, la altura de los rellenos granulares, etc. Ese estudio ha permitido identificar los puntos críticos, las ratios características que condicionan el comportamiento y, en fin, los aspectos clave del análisis estructural de estas construcciones desde el punto de vista de la interrelación, hasta ahora desconocida, de estructura y relleno, que también es estructura. Ello permitirá orientar de mejor manera las inspecciones de estas estructuras y sus análisis estructurales. Finalmente, la tesis concluye con el desarrollo de tres ejemplos, correspondientes cada uno de ellos a los periodos históricos referidos, en los que se pone de manifiesto el papel crucial de los rellenos en la estabilidad no sólo de las bóvedas sino del resto de elementos estructurales que componen un edificio (pilares, muros, botareles, etc.). Al final se presentan las conclusiones del trabajo y se enumeran las muchas líneas de trabajo que quedan abiertas tras esta tesis. It is surprising that the essential role of the backfill at the extrados of masonry vaults and domes has been ignored or misunderstood in the technical literature. The main purpose of this work is to contribute to overcome such a lacuna. Firstly, the morphological configuration of backfill that can be found in the Iberian Peninsula in Roman, Romanesque and Gothic buildings is also presented. Two annexes are devoted to show the collected database and the result of its analysis. Then, the structural role of backfill is characterised, as well as the intrinsic and most significant properties related both to its configuration and structural function. Thus, specific thrust values are proposed to analyse such structures, taking into account the nature and boundary conditions of walls and vaults. The simple, powerful and sufficient tool of analysis that has been developed is also presented, including the main variables involved, especially the backfill. The limit analysis method, followed by a stress verification, including the extrados of vaults and backfill interface, and an enhanced algorithm based on energetic considerations, are used to provide technicians a tool to understand this type of structures efficiently, in a balanced situation between the rather scarce amount of information and sufficient accuracy and liability. The tool was calibrated by comparing the experimental and theoretical results provided by different authors regarding several examples, as well as our own experimental campaign carried out at the Civil Engineering School of Madrid. A parametric study is also developed, providing original information about the structural importance of several parameters, as the span-to-depth or span-to-rise ratios, relative height of backfill, etc. As a result of this analysis, critical points and tendencies of structural behaviour were detected, helping technicians to inspect and analyse these constructions, also revealing some particularities related to their construction. Furthermore, a set of three examples corresponding to the three structural typologies analysed (Roman, Romanesque and Gothic) is studied. The crucial importance of backfill is then highlighted, not only for the stability of vaults or domes, but also for the equilibrium of walls, pillars and buttresses. Finally, the conclusions of the study and the future research fields are also presented.

Análisis, desarrollo y optimización de un sistema para el diseño de redes topográficas valorando el modelo digital del terreno

El presente trabajo tiene como objetivo general el análisis de las técnicas de diseño y optimización de redes topográficas, observadas mediante topografía convencional (no satelital) el desarrollo e implementación de un sistema informático capaz de ayudar a la definición de la geometría más fiable y precisa, en función de la orografía del terreno donde se tenga que ubicar. En primer lugar se realizará un estudio de la metodología del ajuste mediante mínimos cuadrados y la propagación de varianzas, para posteriormente analizar su dependencia de la geometría que adopte la red. Será imprescindible determinar la independencia de la matriz de redundancia (R) de las observaciones y su total dependencia de la geometría, así como la influencia de su diagonal principal (rii), números de redundancia, para garantizar la máxima fiabilidad interna de la misma. También se analizará el comportamiento de los números de redundancia (rii) en el diseño de una red topográfica, la variación de dichos valores en función de la geometría, analizando su independencia respecto de las observaciones así como los diferentes niveles de diseño en función de los parámetros y datos conocidos. Ha de señalarse que la optimización de la red, con arreglo a los criterios expuestos, está sujeta a los condicionantes que impone la necesidad de que los vértices sean accesibles, y además sean visibles entre sí, aquellos relacionados por observaciones, situaciones que dependen esencialmente del relieve del terreno y de los obstáculos naturales o artificiales que puedan existir. Esto implica la necesidad de incluir en el análisis y en el diseño, cuando menos de un modelo digital del terreno (MDT), aunque lo más útil sería la inclusión en el estudio del modelo digital de superficie (MDS), pero esta opción no siempre será posible. Aunque el tratamiento del diseño esté basado en un sistema bidimensional se estudiará la posibilidad de incorporar un modelo digital de superficie (MDS); esto permitirá a la hora de diseñar el emplazamiento de los vértices de la red la viabilidad de las observaciones en función de la orografía y los elementos, tanto naturales como artificiales, que sobre ella estén ubicados. Este sistema proporcionaría, en un principio, un diseño óptimo de una red constreñida, atendiendo a la fiabilidad interna y a la precisión final de sus vértices, teniendo en cuenta la orografía, lo que equivaldría a resolver un planteamiento de diseño en dos dimensiones y media1; siempre y cuando se dispusiera de un modelo digital de superficie o del terreno. Dado que la disponibilidad de obtener de manera libre el MDS de las zonas de interés del proyecto, hoy en día es costoso2, se planteará la posibilidad de conjuntar, para el estudio del diseño de la red, de un modelo digital del terreno. Las actividades a desarrollar en el trabajo de esta tesis se describen en esta memoria y se enmarcan dentro de la investigación para la que se plantean los siguientes objetivos globales: 1. Establecer un modelo matemático del proceso de observación de una red topográfica, atendiendo a todos los factores que intervienen en el mismo y a su influencia sobre las estimaciones de las incógnitas que se obtienen como resultado del ajuste de las observaciones. 2. Desarrollar un sistema que permita optimizar una red topográfica en sus resultados, aplicando técnicas de diseño y simulación sobre el modelo anterior. 3. Presentar una formulación explícita y rigurosa de los parámetros que valoran la fiabilidad de una red topográfica y de sus relaciones con el diseño de la misma. El logro de este objetivo se basa, además de en la búsqueda y revisión de las fuentes, en una intensa labor de unificación de notaciones y de construcción de pasos intermedios en los desarrollos matemáticos. 4. Elaborar una visión conjunta de la influencia del diseño de una red, en los seis siguientes factores (precisiones a posteriori, fiabilidad de las observaciones, naturaleza y viabilidad de las mismas, instrumental y metodología de estacionamiento) como criterios de optimización, con la finalidad de enmarcar el tema concreto que aquí se aborda. 5. Elaborar y programar los algoritmos necesarios para poder desarrollar una aplicación que sea capaz de contemplar las variables planteadas en el apartado anterior en el problema del diseño y simulación de redes topográficas, contemplando el modelo digital de superficie. Podrían considerarse como objetivos secundarios, los siguientes apartados: Desarrollar los algoritmos necesarios para interrelacionar el modelo digital del terreno con los propios del diseño. Implementar en la aplicación informática la posibilidad de variación, por parte del usuario, de los criterios de cobertura de los parámetros (distribución normal o t de Student), así como los grados de fiabilidad de los mismos ABSTRACT The overall purpose of this work is the analysis of the techniques of design and optimization for geodetic networks, measured with conventional survey methods (not satellite), the development and implementation of a computational system capable to help on the definition of the most liable and accurate geometry, depending on the land orography where the network has to be located. First of all, a study of the methodology by least squares adjustment and propagation of variances will be held; then, subsequently, analyze its dependency of the geometry that the network will take. It will be essential to determine the independency of redundancy matrix (R) from the observations and its absolute dependency from the network geometry, as well as the influence of the diagonal terms of the R matrix (rii), redundancy numbers, in order to ensure maximum re liability of the network. It will also be analyzed first the behavior of redundancy numbers (rii) in surveying network design, then the variation of these values depending on the geometry with the analysis of its independency from the observations, and finally the different design levels depending on parameters and known data. It should be stated that network optimization, according to exposed criteria, is subject to the accessibility of the network points. In addition, common visibility among network points, which of them are connected with observations, has to be considered. All these situations depends essentially on the terrain relief and the natural or artificial obstacles that should exist. Therefore, it is necessary to include, at least, a digital terrain model (DTM), and better a digital surface model (DSM), not always available. Although design treatment is based on a bidimensional system, the possibility of incorporating a digital surface model (DSM) will be studied; this will allow evaluating the observations feasibility based on the terrain and the elements, both natural and artificial, which are located on it, when selecting network point locations. This system would provide, at first, an optimal design of a constrained network, considering both the internal reliability and the accuracy of its points (including the relief). This approach would amount to solving a “two and a half dimensional”3 design, if a digital surface model is available. As the availability of free DSM4 of the areas of interest of the project today is expensive, the possibility of combining a digital terrain model will arise. The activities to be developed on this PhD thesis are described in this document and are part of the research for which the following overall objectives are posed: 1. To establish a mathematical model for the process of observation of a survey network, considering all the factors involved and its influence on the estimates of the unknowns that are obtained as a result of the observations adjustment. 2. To develop a system to optimize a survey network results, applying design and simulation techniques on the previous model. 3. To present an explicit and rigorous formulation of parameters which assess the reliability of a survey network and its relations with the design. The achievement of this objective is based, besides on the search and review of sources, in an intense work of unification of notation and construction of intermediate steps in the mathematical developments. 4. To develop an overview of the influence on the network design of six major factors (posterior accuracy, observations reliability, viability of observations, instruments and station methodology) as optimization criteria, in order to define the subject approached on this document. 5. To elaborate and program the algorithms needed to develop an application software capable of considering the variables proposed in the previous section, on the problem of design and simulation of surveying networks, considering the digital surface model. It could be considered as secondary objectives, the following paragraphs: To develop the necessary algorithms to interrelate the digital terrain model with the design ones. To implement in the software application the possibility of variation of the coverage criteria parameters (normal distribution or Student t test) and therefore its degree of reliability.