Traumatic renewal of values and value criteria in crisis management

This work tries to be an empirical sample in the study of learning in public policies, that is, how learning is linked to policy change. Particularly, we have studied political-administrative elites’ learning process on crisis provoked by oil spill off the coast of Spain. After expounded our premises about policy learning and the working hypothesis that have guided our work, we explain the methodology we have employed: the Nominal Group Technique, its advantages in this kind of research and how we used it. Finally, we display the reflection generated from the empirical work to better understand policy learning process. In this sense, political factors have been revealed as absolutely essential in order to explain what political-administrative elites learn and whatever they decide to implement. Aspects that make crises different from each other (these being technical aspects) show up as less important than political ones. Political aspects make crisis similar, because of political reasons behind the decision, communication, and attention strategies. Two concepts have appeared as the connection of crisis and elites’ learning: sensitization and political profitability. The former means the process of becoming fully aware of the problem, being concerned about it, and predisposed towards a faster and more coherent action. At the same time, it is difficult to imagine a government undertaking polices that involve political costs, or anything proved to be unprofitable. This is especially true of learning and implementation of whatever has been learnt from crisis that happened in distant points of time

Prestige y 11-M : la vertebración política de la gestión de catástrofes

Between 2002 and 2004 Spain was jolted by two big crisis scenarios with a very different nature but two common characteristics. On one hand, they required an immediate response of some magnitude and complex management. On the other, they both caused a very deep impact on Spanish society and politics. Such two characteristics made them especially interesting in order to analyzed multiple aspects related to decisionmaking and “first response” management as a reaction against catastrophes. We can also withdraw several lessons about which factors and criteria are employed by critical actors to evaluate crisis management and “first response” as successful. This article focuses on the lessons learned by analyzing two singular events occurred in Spain and partly associated to very Spanish civic culture keys and political dynamics. At the same time, both of them have similar features and iconic meaning to other more recent crisis occurred in other places around the world. The first case studied is the crisis provoked by the accident of the oil ship “Prestige”, drawn in November 2002, 130 miles away from the Spanish coast in Galicia. It poured around 64.000 tones of oil in the Atlantic Ocean. It provoked a huge ecological disaster mainly in Galicia though to a great extent it reached 2.500Kms of coastal line, from the North of Portugal to the South of France. The second one is the terrorist attack of March 11th, 2004 in Madrid. A cell of Islamist terrorists linked to Al Qaeda made explode simultaneously ten bombs in train stations and suburban trains in four different locations. More than 1.600 people were injured and 191 were killed. The analysis of crisis management success criteria and factors is framed in two competitive research projects 1 . Three different qualitative research techniques are employed: (a) interviews to critical actors involved in crisis management; (b) semistructured questionnaires addressed to key informants; and (c) four workshops, composed by experts, managers and decisionmakers involved in Prestige Oil Spill and M11 crisis. The method used is an original and renewed version of the Nominal Group Technique (NGT). The application of these techniques was complemented with the information obtained out of other sources such as official reports, press releases, articles and specialized monographs and some results of the inquiries carried out by the Spanish Center of Sociological Research (CIS

Back Pain : Pathophysiology, Diagnosis, and Treatment

Although back pain is one of the most common medical conditions [1], with a reported general population prevalence close to 50% along their lifetime in a long-term British survey [2], it does not attract the interest it should from the general population [3], political powers [4,5] and scientific community [6]. Patients keep coming to our offices for a surgical solution to their back pain, hoping that a miraculous operation will solve all their problems [3,7]. Yet, the surgical procedure sometimes does not solve the problem, and it can be the cause of a new nightmare in one third of patients [8,9]. A Japanese study found that 95% of their patients had persistent back pain after surgery at the same level or worse than before the operation [10]. Often patients have little or no information on how they reached this situation and how to take an active part in the treatment process to achieve a successful result [11]. For many, a costly and painful operation seems the fastest way to eliminate this unpleasant condition [12]. Yet, the problem starts much earlier, and we must stress how things begin and progress to prevent the problem from happening and to avoid treating it [13,14]. For example, some have reported a recent worrisome relationship between adolescents' sedentary lifestyle and obesity and the rise in low back pain prevalence in the European population [14]. We must concentrate on what patients know about their back pain and its prevalence in each country. We need to obtain reliable data on the actual incidence of this medical condition to attract the politicians' interest [15]. Then, they are the ones that can pass laws that reduce the weight that children have to carry on their way to school or the amount of time that adults have to stand in their jobs. We also need to concentrate on awakening the general population to how their lifestyle habits should be the first thing to change if we want to reduce the number of people with back pain [16]. The first step is to discover the prevalence of back pain in each country and in each job, social group, and community. Sadly, the general data about the general population are of limited help. To do this, we need questionnaires that help us to gather this information. Unfortunately, most questionnaires designed to evaluate the incidence of back pain are provided in English [17]. However, translating and adapting them to other languages and cultural and social environments is essential for worldwide validity and use [18,19]. Therefore, we aim to focus on this aspect in the Special Issue. Another vital step is to make the population aware of the importance of healthy lifestyle habits to avoid back pain [20]; for example, everybody knows about refraining from smoking, avoiding being overweight, and exercising. Still, perhaps we should focus more on primary school for children and adolescents to acquire healthy habits and prevent future problems [14]. However, families and social environments also have a crucial role to play, besides that of the school. A final consideration is of conservative treatments. For example, in the present opioid pandemic, back muscle strengthening [21], perhaps with regular swimming [22], is a step that should be encouraged before considering medical treatment with medication, not to say before any surgical procedure. To conclude, this Special Issue is devoted to adapting back pain questionnaires to other languages to find the prevalence of this medical condition worldwide, as well as to those aspects that will prevent, minimize, and correct it to make it less common and easier to handle

Decrease in local volumetric bone mineral density (vBMD) in osteoarthritic joints is associated with the increase in cartilage damage: a pQCT study

Osteoarthritis (OA) is one of the most prevalent joint diseases, which causes pain and disability in the adult population. OA affects the osteochondral unit in the joints, which comprises both cartilage and subchondral bone. There has been some progress in understanding the changes in subchondral bone with progression of OA. However, local changes in subchondral bone such as microstructure or volumetric bone mineral density (vBMD) in connection with the defect in cartilage are relatively unexplored. To develop an effective treatment for progression of OA, it is important to understand how the physical environment provided by the subchondral bone affects the overlying cartilage. In this study, we examined the vBMD distribution in the OA joint tissues obtained from total hip replacement surgeries due to OA, using peripheral quantitative CT (pQCT). It was found that there is a significant decrease in vBMD, which co-localizes with the damage in the overlying cartilage. This was not limited to the subchondral bone immediately adjacent to the cartilage defect but continued in the layers below. Bone resorption and cyst formation in the OA tissues were also detected. We observed that the bone surrounding subchondral bone cysts exhibited much higher vBMD than that of the surrounding bones. pQCT was able to detect significant changes in vBMD between OA and non-OA samples, as well as between areas of different cartilage degeneration, which points to its potential as a technique for detection of early OA

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it

Effect of short range order on electronic and magnetic properties of disordered Co based alloys

We here study electronic structure and magnetic properties of disordered CoPd and CoPt alloys using Augmented Space Recursion technique coupled with the tight-binding linearized muffin tin orbital (TB-LMTO) method. Effect of short range ordering present in disordered phase of alloys on electronic and magnetic properties has been discussed. We present results for magnetic moments, Curie temperatures and electronic band energies with varying degrees of short range order for different concentrations of Co and try to understand and compare the magnetic properties and ordering phenomena in these systems.Comment: 15 pages,17 postscript figures,uses own style file

Chronic Headache and Neuromodulation

The immense majority of patients with chronic headaches can be controlled with medical treatments. However, there is a subset of them with poor response, and it is for those patients that new therapeutic strategies are being designed. Neuromodulation has been used for chronic pain management in many areas for the past 50 years. The application of these techniques to the treatment of the most refractory chronic headache disorders has offered hope to these patients. There is a large variety of different techniques, each of them particularly suitable to specific types of chronic headaches. The surgically implanted devices are still in use in some particularly recalcitrant cases. Nevertheless, new percutaneous devices allow new treatment strategies. Percutaneous devices do not always show the same effectivity as surgically implanted stimulating devices, but they are user-friendly and have no serious adverse effects. Thus, they are becoming the treatment of choice once the pharmacological means are no longer effective. In case of failure, the surgical procedures would still be available as a last resort

Nerve Transfers in the Treatment of Peripheral Nerve Injuries

Successful re-innervation of proximal limb peripheral nerve injuries is rare. Axons regenerate at ~1 mm/day, reaching hand muscles by 24 months, finding them atrophied and fibrosed. Peripheral nerve injury repair is often delayed waiting for spontaneous recovery. This waiting time should not be longer than 6 months as after 18 months reinnervation will not achieve effective muscular function. When spontaneous recovery is impossible, referral too late or damage too severe, other options like a transfer from a nearby healthy nerve to the injured one must be considered. They are very successful, and the deficit in the donor site is usually minimal. The most common nerve transfers are a branch of the spinal nerve to the trapezius muscle to the suprascapular nerve, a branch of the long head of the triceps to the axillary nerve, a fascicle of the ulnar nerve to the motor branch of the biceps muscle, two branches of the median nerve to the posterior interosseous nerve and the anterior interosseous nerve to the ulnar nerve. There are many more options that can suit particular cases. Introduced in brachial plexus injury repair, they are now also applied to lower limb, to stroke and to some spinal cord injuries

Nerve Root Reimplantation in Brachial Plexus Injuries

Nerve root avulsion is the most severe form of brachial or lumbosacral plexus injury. Spontaneous recovery is extremely rare, and when all the nerve roots of the affected plexus are avulsed, the therapeutic options are very limited. Nerve root reimplantation has been attempted since the 1990s, first in experimental animal models and afterwards in human beings. Currently, only partial recovery of the proximal limb muscles has been achieved. New therapeutic strategies have been developed to improve motor neuron survival and axonal regeneration, with promising results. Neurotrophic factors and some drugs have been used successfully to improve the regenerating ability, but long-term studies in humans are needed to develop complete recovery of the affected limb