Elegir el momento oportuno: éxito y fracaso de los intentos de reforma de las cámaras altas en Canadá, Italia, y Bélgica

Objetivos: desde una perspectiva comparada, se analizan los intentos de reforma institucional de las cámaras altas de Bélgica (2014), Italia (2016) y Canadá (2015), con vistas a identificar los factores que dificultan y facilitan el éxito de dichas reformas. Metodología: el artículo propone una conceptualización multidimensional de éxito –que va más allá de la aprobación formal, incluyendo la consecución de objetivos programáticos, el apoyo político, la legitimidad procedimental y la perdurabilidad– y un marco explicativo basado en las corrientes múltiples; ambos elementos son seguidamente aplicados al análisis comparado sistemático de los tres casos. Resultados: el estudio revela una gran variación en los resultados de éxito en los tres casos y parece confirmar provisionalmente las hipótesis sobre la existencia de diferentes configuraciones causales para las diferentes dimensiones del éxito y sobre la necesidad de acoplamiento de condiciones facilitadoras de las diferentes corrientes. Conclusiones: de esta forma, el artículo muestra las ventajas de la aplicación al estudio de estas reformas institucionales de algunas contribuciones de la investigación sobre políticas públicas y la utilidad de los enfoques explicativos configurativos, que permiten reconocer el efecto combinado de diferentes factores explicativos en la producción de reformas de diferentes tipos y con distintos grados de éxito

"A Theoretical Perspective on Multi-level Systems in Europe: Constitutional Power and Partisan Conflict"

types: ArticleThis article distinguishes three constitutionally defined categories of multi-level systems – confederations, federal arrangements and regionalized arrangements, which differ in whether their lower-level governments enjoy constitutional protection and whether we find a constitutional hierarchy between central and lower levels of government. We argue that the constitutional category a multi-level system belongs to systematically shapes first, the dominant mode of day-to-day intergovernmental coordination, second, the mode of formal competence (re)allocation; and third, the relative impact of party (in)congruence across central and lower-level governments on these coordination processes, respectively. The article then specifies the indicators used to test the hypotheses across the range of case studies. It finally shows how the multi-level systems covered in this special issue span the confederal – federal – regionalized spectrum and thus allow for an encompassing comparative assessment of multi-level dynamics and their long-term evolution.ESR

Elucidating the burden of recurrent and chronic digital ulcers in systemic sclerosis: long-term results from the DUO Registry

Objectives Digital ulcers (DUs) occur in up to half of patients with systemic sclerosis (SSc) and may lead to infection, gangrene and amputation with functional disability and reduced quality of life. This study has elucidated the burden of SSc-associated DUs through identification of four patient categories based on the pattern of DU recurrence over a 2-year observation period.Methods Patients with SSc-associated DUs enrolled in the Digital Ulcers Outcome Registry between 1 April 2008 and 19 November 2013, and with 2years of observation and 3 follow-up visits during the observation period were analysed. Incident DU-associated complications were recorded during follow-up. Work and daily activity impairment were measured using a functional assessment questionnaire completed by patients after the observation period. Potential factors that could predict incident complications were identified in patients with chronic DUs.Results From 1459 patients, four DU occurrence categories were identified: 33.2% no-DU; 9.4% episodic; 46.2% recurrent; 11.2% chronic. During the observation period, patients from the chronic category had the highest rate of incident complications, highest work impairment and greatest need for help compared with the other categories. Independent factors associated with incident complications included gastrointestinal manifestations (OR 3.73, p=0.03) and previous soft tissue infection (OR 5.86, p=0.01).Conclusions This proposed novel categorisation of patients with SSc-associated DUs based on the occurrence of DUs over time may help to identify patients in the clinic with a heavier DU burden who could benefit from more complex management to improve their functioning and quality of life