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COVID-19; Niño; Escuelas COVID-19; Nen; Escoles COVID-19; Child; Schools Objective: We describe and analyze the childhood (

The transition from a linear economy to a circular economy (CE) is a real challenge to achieve long‐term sustainability. To push CE in the market, institutional promotion could become a key driver to positively impact both circular consumption and the competitiveness of the market. This paper analyzes the influence that soft and hard initiatives have on circular consumption and market competitiveness. Based on a survey of 1,281 respondents from different types of stakeholders, structural equations modeling statistical analysis was run. Results show that soft initiatives support the achievement of both objectives, whereas hard ones only influence greater circular consumption. However, the perception of the different stakeholders considered is very heterogeneous. It is indicative that not all institutional promotion initiatives are effective. Thus, institutions should guide, in an adequate and differentiated manner, their efforts to promote CE and sustainable development depending on the stakeholder they are targeting.

Trastorno por consumo de opiáceos; Programas de tratamiento de sustitución de opiáceos; Análisis de decisión multicriterio Trastorn per consum d'opiacis; Programes de tractament de substitució d'opiacis; Anàlisi de decisió multicriteri Opioid use disorder; Opioid substitution programmes; Multicriteria decision analysis El objetivo fue establecer los resultados en salud con mayor relevancia en la evaluación de programas de tratamiento de sustitución de opiáceos (PTSO) en pacientes con trastorno por consumo de opiáceos (TCO) en España. Se realizó un análisis de decisión multicriterio con 3 fases: 1) definición de conceptos y criterios a evaluar; 2) cribado y ponderación de criterios mediante un experimento de elecciones discretas; 3) proceso deliberativo. Los criterios de la fase 1 fueron: consumo de sustancias (opiáceos, alcohol, tabaco, estimulantes y cannabis), trastornos mentales (trastorno afectivo ansioso, psicosis, trastorno por déficit de atención e hiperactividad, trastorno límite de personalidad, trastornos de personalidad antisocial, trastorno por juego y otras alteraciones del control de los impulsos), nivel de discapacidad, adherencia, enfermedades médicas (comorbilidades, conductas de riesgo, enfermedades infecciosas y de transmisión sexual), aspectos psicosociales (conducta hostil y/o violenta, presencia de problemas laborales), discapacidad funcional (calidad de vida, satisfacción con el tratamiento y servicio, funcionamiento social). En la fase 2 se determinaron los factores fundamentales en la elección de un PTSO, revisados en el proceso deliberativo: remisión del consumo de sustancias (opiáceos, alcohol y estimulantes), mejoría en el manejo de otros trastornos mentales (psicosis y trastorno límite de la personalidad), mejoría en manejo de comorbilidades médicas y mejoría en el funcionamiento social, con un peso del 56,5%, 21,9%, 11,0% 10,7% respectivamente. Este análisis define los resultados sanitarios más relevantes en PTSO en pacientes con TCO en España, favoreciendo la toma de decisiones y la gestión socio-sanitaria de los recursos existentes. The aim of the current study was to establish the most relevant health outcomes to assess opioid substitution treatment programmes (OSP) in patients with opioid use disorder (OUD) in Spain. A multicriteria decision analysis was applied in 3 phases: 1) concepts and criteria definitions; 2) criteria screening and weighting by means of a discrete choice experiment; 3) deliberative process. Criteria established in phase 1 were: substance use (opioids, alcohol, tobacco, stimulants and cannabis), other mental disorders (affective/anxiety disorder, psychosis, attention deficit hyperactivity disorder, borderline personality disorder, antisocial personality disorder, gambling disorder and other impulse control disorders), level of disability, adherence, medical illnesses (medical comorbidities, risk behaviours, infectious and sexually transmitted diseases), psychosocial aspects (hostile and/ or violent behaviour and work problems), functional disability (quality of life, treatment and service satisfaction, social functionality). In phase 2, the most relevant factors in OSP were determined, and subsequently assessed in the deliberative process: remission of substance use (opioids, alcohol and stimulants), improvement of other mental disorders (psychosis and borderline personality disorder), improvement in comorbidity management, and improvement in social functionality, with a weighting of 56.5%, 21.9%, 11.0%, and 10.7%, respectively. The current analysis defines the main health outcomes in OSP in patients with OUD in Spain, supporting decision making and socio-health management of existing resources.

Background: To evaluate the cost-effectiveness of a secondary prevention programme in patients admitted to the Emergency department due drug-related problems (DRPs) Methods: A decision model compared costs and outcomes of patients admitted to the Emergency department with drug-related problems included in Anatomical Therapeutic Classification (ATC) groups A, B or C was designed, based on the results of a randomized clinical trial (NCT03607097). Model variables and costs, along with their distributions, were obtained from the trial results and the literature. The study was performed from the perspective of the National Health System including only direct costs. The Incremental Cost-Effectiveness ratio (ICER) was analysed regarding the ability of the programme to reduce emergency department revisits. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses. Results: According to the results of the proposed model, the implementation of a secondary prevention programme for DRPs reduces the cost associated with Emergency Department revisits, with an annual net benefit of €87,639. Considering a mortality rate attributable to readmission for DRPs of 4.7%, the cost per life-years gained (LYG) with the implementation of this program was €2,205. In the short term, the reduction in the number of revisits due to the implementation of the programme was the variable that most affected the model, with the benefit threshold value corresponding to a relative reduction of 12.4% of the number of revisits in patients with DRPs to obtain benefits with the implementation of this type of programme. Conclusions: Implementing a secondary prevention programme is cost-effective on patients admitted to the emergency department with DRPs. Implementation costs will be exceeded by reducing revisits to the emergency department.

Objective The aim of this study was to assess the effectiveness and reproducibility of self-assisted Boss-Holzach-Matter (BHM) technique compared with the Spaso (Sp) method for shoulder dislocation. Methods We conducted a follow-up at 1 year from the randomization of 60 patients with shoulder dislocation enrolled in the study "Teaching patients to reduce a shoulder dislocation." Half of these patients had been taught the self-assisted technique, whereas the other half had been treated by a physician's manipulative maneuver for reduction. We surveyed all the enrolled patients to describe recurrence rates and reproducibility for both the techniques without supervision as well as the number of emergency visits. Results In total, 52 patients (age range: 18-44 years) answered the survey from the 60 patients enrolled in the study. The total rate of recurrence was 38.5% (20 patients). For the Sp group, 4 of the 30 patients were lost. There were 9 recurrent patients (30%), and 7 were treated in the emergency department (ED). For the BHM group, 4 of the 30 patients were lost. There were 11 recurrent patients (37%), and 2 were treated in the ED. The difference in self-reduction rates and ED visits for both the groups was statistically significant (p=0.025). Conclusion Teaching the BHM technique to the patients is effective and reproducible without direct supervision. It can decrease the number of visits to the ED and is a valid option to teach the patients at risk of recurrence when not being able to get immediate help. Level of evidence Level I, Therapeutic study.

Author(s): Pogorzelski, David; Nguyen, Uyen; McKay, Paula; Thabane, Lehana; Camara, Megan; Ramsey, Lolita; Seymour, Rachel; Goodman, J Brett; McGee, Sheketha; Fraifogl, Joanne; Hudgins, Andrea; Tanner, Stephanie L; Bhandari, Mohit; Slobogean, Gerard P; Sprague, Sheila; PREP-IT Investigators Executive Committee:; Steering Committee; Adjudication Committee; Data and Safety Monitoring Committee; Research Methodology Core; Patient Centred Outcomes Core; Orthopaedic Surgery Core; Operating Room Core; Infectious Disease Core; Military Core; McMaster University Methods Center; University of Maryland School of Medicine Administrative Center; University of Maryland School of Pharmacy, The PATIENTS Program; PREP-IT Clinical Sites: Lead Clinical Site (Aqueous-PREP and PREPARE); Aqueous-PREP and PREPARE; Aqueous-PREP; PREPARE; PREP-IT Investigators Executive Committee | Abstract: IntroductionPragmatic trials in comparative effectiveness research assess the effects of different treatment, therapeutic, or healthcare options in clinical practice. They are characterized by broad eligibility criteria and large sample sizes, which can lead to an unmanageable number of participants, increasing the risk of bias and affecting the integrity of the trial. We describe the development of a sampling strategy tool and its use in the PREPARE trial to circumvent the challenge of unmanageable work flow.MethodsGiven the broad eligibility criteria and high fracture volume at participating clinical sites in the PREPARE trial, a pragmatic sampling strategy was needed. Using data from PREPARE, descriptive statistics were used to describe the use of the sampling strategy across clinical sites. A Chi-square test was performed to explore whether use of the sampling strategy was associated with a reduction in the number of missed eligible patients.Results7 of 20 clinical sites (35%) elected to adopt a sampling strategy. There were 1539 patients excluded due to the use of the sampling strategy, which represents 30% of all excluded patients and 20% of all patients screened for participation. Use of the sampling strategy was associated with lower odds of missed eligible patients (297/4545 (6.5%) versus 341/3200 (10.7%) p l 0.001).ConclusionsImplementing a sampling strategy in the PREPARE trial has helped to limit the number of missed eligible patients. This sampling strategy represents a simple, easy to use tool for managing work flow at clinical sites and maintaining the integrity of a large trial.

Purpose The purpose of this paper is to further research on the Kaplan and Norton (1996) balanced scorecard (BSC) model after having discerned that previous work has so far neglected to explore the interrelationships between the model’s dimensions and the influence contextual factors may have. Design/methodology/approach The data set used to meet this paper’s main objectives was collected using a structured online survey sent to the member companies of the Catalan Association of Accounting and Management (ACCID). Specifically, the surveys were directed to the heads of the finance departments. From the 3,500 mails sent, 336 companies decided to participate in the study. These figures represent an acceptable response rate of 9.6 per cent. As 83 of the companies declared that they would only use financial indicators, the final study sample totalled 253 firms. Findings The results demonstrate the mediating effects intermediate constructs have, and highlight how important leadership is in achieving success or high performance. These results follow on from previous empirical literature that analysed other management systems such as the Baldrige, the EFQM or the Deming models. In addition, some differences in the relationships as per the contextual factors studied have been detected. Therefore, the conclusions reached in this paper will be of interest to both academics and professionals in perceiving and understanding the logical flow of consequences any decision taken will produce. Originality/value The authors’ main contributions are: to have strictly followed the theoretical BSC model by combining both formative and reflective dimensions using the emerging partial least squares methodology; to have based the study on 253 firms and to have used 37 category indicators which, to our knowledge, are more than any other previous work; to have developed a mediation model designed to appreciate the interrelationships the dimensions in the BSC model have; to have analysed the possible differences there are in the interrelationships between the dimensions using two widely accepted influencing contextual factors in current literature, namely a firm’s size and its typology.

This article presents a systematic review of the literature on quality of service and sustainable practices in the hospitality sector with the objective of analyzing the state of the art, identifying gaps for future lines of research, and defining a future research agenda. The number of articles on these topics, although not particularly high, does demonstrate a growing trend. Despite this growth, however, several untreated lines of research were detected in three specific areas. In the first area, emphasis is placed on the critical factors that affect the quality of service. In the second area are the specific practices and tools of sustainability and quality of service that affect development and business success. Finally, the third section analyses the impact of strategies and the management of sustainable practices and quality of service with respect to business development. Research questions have been defined for each area.

Background: The results of research into the outcomes of physical rehabilitation and its relationship with post-myocardial ischaemia survival and readmissions are inconclusive. Our primary aim was to evaluate the efficacy of a supervised exercise training programme in terms of decreasing hospital cardiac readmission in patients with myocardial ischaemia. Methods: We conducted a randomised controlled trial including patients with myocardial ischaemia. Eligible patients were assigned to a control group receiving standard care or to an intervention group that took part in a supervised exercise training programme. The follow-up period was 12 months after hospital discharge. Results: Of 478 patients assessed for eligibility, 86 were randomised to the control group (n=44) or the intervention group (n=42). Cardiac readmission rates were 14% versus 5% (p=0.268) in the control and intervention groups, respectively, and all-cause readmission rates were 23% versus 15% (p=0.34). There were no deaths in either group. More control patients were treated in the emergency services (50% vs. 24%; p= 0.015). In terms of health-related quality of life, patients in the intervention group presented with significant increases in functional capacity and mobility. More intervention patients returned to work (77.3% vs. 36.0%; p=0.005). Conclusions: The supervised physical exercise programme was effective at reducing the number of emergency room visits and at increasing the percentage of patients who returned to work. It also improved patients exercise capacity and increased their health-related quality of life. Although the results were promising, the programme was not associated with a significant reduction in cardiac and all-cause readmission rates. Funding Agencies|Collegi de Fisioterapeutes de Catalunya [R01/08-09]

The efficient use by crops of nitrogen from manures is an agronomic and environmental issue, mainly in double-annual forage cropping systems linked to livestock production.A six-year trial was conducted for a biennial rotation of four forage crops: oat-sorghum (first year) and ryegrass-maize (second year) in a humid Mediter ranean area. Ten fertilization treatments were introduced: a control (without N);two minerals equivalent to 250 kg N ha-1yr-1 applied at sowing or as sidedressing; dairy cattle manure at a rate of 170, 250 and 500 kg N ha-1yr-1 and four treatments where the two lowest manure rates were supplemented with 80 or 160 kg mineral N ha -1 yr -1.They were distributed according to a randomized block design with three blocks. The highest N mineral soil content was found in the summer of the third rotation, in plots where no manure was applied. The yearly incorporation of manure reduced, in successive cropping seasons, the amount of additional mineral N n eeded as sidedressing to achieve the highest yields.Besides, in the last two years, there was no need for mineral N application for the manure rate of 250 kg N ha -1yr-1. This amount always covered the oat-sorghum N uptake. In the ryegrass-maize sequence uptakes were as high as 3 kg N ha-1yr-1.In the medium term, the intermediate manure rate (250 kg N ha -1 yr -1) optimizes nutrient recycling within the farming system, and it should be considered in the analysis ofthresholds for N of organic orig in to be applied to systems with high N demand.

Circular economy supposes a transformational and radical process of change from a linear to a circular economic model, where every production phase represents a systemic shift at all levels. Nevertheless, CE philosophy is easy to understand but very complex to put into practice. For that reason, using institutional entrepreneurship theory, institutional enablers to push the transition to a more CE in the European Union will be analysed. In particular, the impacts achieved by CE strategies are oriented to priority CE goals. Thus, this empirical study based on a public consultation survey uses structural equation modelling to analyse links between institutional entrepreneurship enablers and impacts on CE strategies oriented to main CE goals. The findings support the effectiveness of acting like an institutional entrepreneur to force transformational and radical changes, although differences are found between enablers and the impacts of CE. The paper concludes with some useful reflections for institutions and policymakers in order to maximise the efforts taken to effect changes at all levels.

Procurement is an important part of drug management and supply for measuring and increasing efficiency at all levels of healthcare institutions. Effective procurement means supplying the right drugs in the right quantities, at the right time, and with recognisable standards of quality. The European Association of Hospital Pharmacists position paper on procurement, released in June 2018,1 states that the knowledge and skills of hospital pharmacists make them specialists in the entire field of medicine procurement. Hospital pharmacists should lead all phases of procurement to ensure continuity of the supply of cost-effective quality medicines to patients. Within the European Union, public procurement …

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Background: There are many different techniques for reducing acute anterior dislocations of the shoulder, and their use depends on surgeon preference. The objective of this study was to compare the pain experienced by a patient performing a self-reduction technique with the pain felt during a reduction performed by a trained physician. Methods: The study was carried out at the emergency department of a tertiary referral center. Patients between 18 and 60 years of age with an acute anterior shoulder dislocation were randomly allocated into 2 groups. In 1 group the emergency doctor actively guided the reduction process with the Spaso technique (Sp group), and in the other group the patient used the Boss-Holzach-Matter (also known as Davos or Aronen) self-reduction technique (BHM group). The pain experienced by the patient during the reduction was recorded by means of a visual analogue scale (VAS) ranging from 0 to 10. Other recorded data included demographic characteristics, reduction time, and success rate. Results: Of 378 patients assessed for eligibility from May 2015 until February 2017, 197 did not meet the inclusion criteria, 58 met exclusion criteria, 22 declined to participate, and 41 withdrew before randomization. Sixty acute anterior shoulder dislocations were randomized into the Sp group (n = 30) or the BHM group (n = 30). The BHM group experienced significantly less pain during reduction than the Sp group (p = 0.047), with mean pain scores of 3.57 (standard deviation [SD] = 2.1]) and 5.26 (SD = 2.9), respectively. No significant difference between groups was found with respect to reduction time (105 seconds [range, 10 to 660 seconds] in the Sp group and 90 seconds [range, 5 to 600 seconds] in the BHM group; p = 0.6) or success rate (67% and 77%, respectively; p = 0.39). Conclusions: The self-reduction technique results in less pain than, and is as efficient in achieving reduction of anterior shoulder dislocations as, the Spaso technique. These findings favor the use of the self-assisted method as an effective first-line treatment for shoulder dislocations seen in the emergency department as well as its use by patients with recurrent dislocation. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Purpose – The purpose of this paper is to examine the motivations for the adoption of quality management practices (QMPs) and the effects exerted by the advanced management information systems (AMIS) as mediating factors in a sector consisting of highly competitive companies with a high mortality rate in recent years: travel agencies. Design/methodology/approach – The results were based on a survey completed by 185 travel agencies with less than 50 employees, covering over 5 per cent of the SME travel agencies in Spain. Structural equation modelling was used to analyse the links between the studied dimensions. Findings – The findings indicate that QMPs have a positive, direct influence on the adoption of AMIS and that the adoption of AMIS has a positive, direct impact on financial performance. The results suggest that quality policies facilitate greater use of financial indicators but not in the use of non-financial indicators, where the key to better business performance lies. Originality/value – Therefore, the results of this paper indicate that being proactive about quality practices can provide travel agencies a great number of benefits through the implementation of AMIS.

This study explores the combined effects of adopting sustainable practices on small tourism companies’ performance. The existing literature provides insufficient data on sustainable behaviour because most studies on environmental practices focus on larger companies in the tourism sector, and a gap exists in social practices. This study is based on a survey of 374 restaurant managers. It uses structural equation modelling to study direct links between three dimensions – quality, environmental practices and social practices – and financial performance and market success factors. Significant differences with earlier studies are found. This study suggests that proactive sustainable practices can benefit small service companies by improving competitiveness even in difficult times. Practical implications are discussed in relation to sustainable practices.

There are many studies that have analysed the effects of quality use on financial improvement. Nevertheless, the bibliography examining the incidence of the combined use of intensive social network strategies and practices of quality management in business is limited. This gap is even more evident when we focus on the service sector and, specifically, on the subsectors in which small, highly competitive, often changing, and high-failure-rate businesses predominate. By analysing 211 surveys administered to travel agency managers in Spain and using structural equation modelling, it is concluded that quality management practices have a direct and significant impact on business performance and on the financial performance of these organisations, in accordance with the existing literature. Nevertheless, significant differences are observed when the sample is segmented by businesses that use social networks intensively and those that do not. This article suggests that betting on strategies of intense social net...

This paper tries to identify the process of creating value by analysing the cause–effect relationships within the perspectives of the balanced scorecard (BSC) model suggested by Kaplan and Norton [(1992). The Balanced Scorecard – measures that drive performance. Harvard Business Review, 70(1), 71–89]. The paper is based on 253 firms from the region of Catalonia (Spain). The main finding of the article is that using a BSC is a good way to understand how the value is created through the investment in human resources. The cause–effect relationships within the perspectives of the BSC model are validated. A formal, systematic and large-scale methodology has been used, giving answer to the claim by the academics for the use of path modelling methodologies to prove the effectiveness of the model. In addition, the internal dimensions of the four perspectives have been validated, too. The conclusions reached in the article may be of interest for both academics and professionals to understand the logical flow of con...

Synopsis Companies' perceptions of Corporate Social Responsibility (CSR) have been partially analysed based on top managers and mostly offer comparisons between men and women. According to our best knowledge, no study has focused on women managers and identified how their personal characteristics and values influence their perceptions of CSR. This paper analyses the differences in attitudes towards the different dimensions of CSR focusing on the viewpoint of women managers. Moreover, it measures how personal and professional backgrounds influence the perception of CSR. A total of 206 women in management positions were surveyed. The findings suggest that women in top management positions in Spain value the stakeholder orientation dimension more than they value other CSR dimensions. Furthermore, the results show that personal and professional backgrounds have a limited impact on women's perceptions of CSR. Finally, our results suggest that entrepreneurial women tend to have a better perception of CSR. Thus, several implications can be drawn for business management, and interesting directions for future research are provided.

Objectives:The aim of this study was to adapt and assess the value of a Multi-Criteria Decision Analysis (MCDA) framework (EVIDEM) for the evaluation of Orphan drugs in Catalonia (Catalan Health Service).Methods:The standard evaluation and decision-making procedures of CatSalut were compared with the EVIDEM methodology and contents. The EVIDEM framework was adapted to the Catalan context, focusing on the evaluation of Orphan drugs (PASFTAC program), during a Workshop with sixteen PASFTAC members. The criteria weighting was done using two different techniques (nonhierarchical and hierarchical). Reliability was assessed by re-test.Results:The EVIDEM framework and methodology was found useful and feasible for Orphan drugs evaluation and decision making in Catalonia. All the criteria considered for the development of the CatSalut Technical Reports and decision making were considered in the framework. Nevertheless, the framework could improve the reporting of some of these criteria (i.e., “unmet needs” or “nonmedical costs”). Some Contextual criteria were removed (i.e., “Mandate and scope of healthcare system”, “Environmental impact”) or adapted (“population priorities and access”) for CatSalut purposes. Independently of the weighting technique considered, the most important evaluation criteria identified for orphan drugs were: “disease severity”, “unmet needs” and “comparative effectiveness”, while the “size of the population” had the lowest relevance for decision making. Test–retest analysis showed weight consistency among techniques, supporting reliability overtime.Conclusions:MCDA (EVIDEM framework) could be a useful tool to complement the current evaluation methods of CatSalut, contributing to standardization and pragmatism, providing a method to tackle ethical dilemmas and facilitating discussions related to decision making.

There are few studies in the literature that examine the combined effect of quality and environmental policies on the financial performance of small service businesses. This gap becomes more evident in highly competitive segments with high mortality rates. This is the case of travel agencies in Spain. This study was carried out by analysing 198 surveys answered by managers of travel agencies, which represents the 5% of the sector. The data obtained were treated with structural equations. The results of this analysis do not find a direct relationship between the implementation of quality policies and financial performance. However, the data show a positive and indirect relationship between them, being both the improvement of the competitiveness as the implementation of environmental policies the mediators between quality and finance. In this sense, this study provides evidence that the commitment to sustainability can be a valid strategy to improve the financial performance of the company.

Although some researchers have recently studied green practices in restaurants, scant previous research has analyzed the impact of these practices on overall performance in this field. Moreover, these studies have generally focused on mega-sized restaurants in the United States. The primary objective of this study is therefore to examine the motivations for the adoption of green practices in restaurants in Spain and the impact of this adoption on firm performance. The results are based on a survey completed by 374 small restaurant managers. Structural equation modeling was used to analyze links between the studied dimensions. The findings indicate that green practices have a strong positive direct influence on operational performance and competitiveness in Spanish restaurants and that they indirectly influence overall firm performance. Therefore, the results of this paper suggest that being proactive about environmental issues can provide restaurants with a great number of benefits that improve firm competitiveness and performance.

Previous research on the International Financial Reporting Standards (IFRS) policy choices of large listed companies found a very strong association between policy choice and country. Nationally based pre-IFRS practices largely explain IFRS policy choices. Nevertheless, some of the policy choices appear to be influenced from abroad, perhaps chosen in order to increase comparability. It has been suggested that smaller companies might be less influenced from abroad, and therefore might display even clearer national profiles of IFRS practice. This paper examines the accounting policy choices made within IFRS financial statements by small listed companies in five major countries. We find highly significant differences between the policies of small and large companies. We also find that small companies make more homogeneous choices, within a country, than large companies do. As a result, the previously published national profiles of the IFRS practices of large companies are misleading in the context of smaller ones.

The objective of this study is to assess the effectiveness of videogames in comparison to simulations in a higher education environment and with regard to their attributes, motivation, and learning outcomes, as three of the main dimensions that play a role in the effectiveness of digital game-based learning. Results demonstrate significant differences between the attributes and motivation dimensions, while no significant differences were found for the learning outcomes. This would imply that although both instructional tools lead students to the desired level of knowledge acquisition, the motivation generated, together with the set of features provided by the games complement each other, leading to a superior learning experience. These results support the inclusion of videogames as a complement to simulations in higher education accounting and business environments and allow us to propose a blended approach that provides the learner with the ‘best of both worlds’. El objetivo de este estudio es evaluar la eficacia de los videojuegos en comparación con las simulaciones en un ambiente de educación superior por lo que respecta a sus atributos, motivación y resultados de aprendizaje como 3 de las principales dimensiones que desempeñan un papel clave en la eficacia del aprendizaje basado en juegos digitales. Los resultados revelan diferencias significativas entre los atributos y las dimensiones de la motivación, si bien no se encontraron diferencias para los resultados de aprendizaje. Esto implicaría que, aunque ambas herramientas instructivas dirigen a los estudiantes al nivel deseado de adquisición de conocimientos, la motivación generada junto con las características que facilitan los juegos se complementan entre sí, lo que permite una experiencia de aprendizaje superior. Estos resultados respaldan la inclusión de los videojuegos como un complemento a las simulaciones en estudios superiores de contabilidad y entornos empresariales y permiten que se proponga un enfoque mixto que provee al aprendiz con «lo mejor de ambos mundos».

PurposeThis paper aims to describe the situation of the agrobiodiversity in La Garrotxa Volcanic Zone Natural Park, a protected area in which the agricultural and animal husbandry sectors play a significant role. It also aims to discuss the activities promoted by the park and by other institutions aimed at conserving and promoting local agrobiodiversity.Design/methodology/approachOne of the three lines of work in the Natural Park in the field of agriculture is the recuperation, conservation and divulgation of notable and/or endangered agricultural species and varieties. This paper describes some of the work carried out in this field.FindingsThe institutions are vital in the recovery of interesting species and varieties, and in order to ensure their conservation it is essential to promote projects in which the agrarian sector can participate.Research limitations/implicationsCollaboration between the institutions and the agrarian sector is essential for the conservation of the agrobiodiversity, although the interests of farmers and the use of certain species and varieties do not always coincide.Practical implicationsThe commercial interest and the knowledge of the use and management of some of the conserved species and varieties may have been lost over time, which makes their implantation difficult. Thus, it is important to restore popular knowledge associated with all species and varieties.Originality/valueIn light of increasingly homogeneous agricultural and stock‐raising practices, activities such as those implemented by the La Garrotxa Volcanic Zone Natural Park have a vital part to play in the conservation of agrobiodiversity.

In the last few years, it has become essential, in order for companies to ensure their survival, to approach the customer and bet on quality. This is due to the importance of tourism in many economies and the increase in supply and demand. For this reason, there are numerous studies found in literature that evaluate the extent to which quality practices impact finances and competitiveness of tourism companies. Furthermore, the usual practice in many of these studies is to classify all types of tourism businesses in the same category, even though there seem to be significant a priori differences between them. The main objects of scrutiny in this study are restaurants and hospitality. The analysis of the aggregate results of two surveys carried out among executives in Spain that employed SEM methodology demonstrates that quality practices have influence, albeit indirectly, on a firm&rsquo, s performance in a positive way. However, separate analysis of subsamples show disparities between hotels and restaurants. This paper illustrates that, although both subgroups operate in the same sector, they obtain different results from implementing quality policies. Therefore, the specific features and typology of the selected tourism company should be considered.

Resumen: Los juegos asfícticos son un comportamiento conocido entre los adolescentes, pero no descrito hasta el momento en la literatura científica española. Se trata de comportamientos que buscan una breve euforia debida a la disminución del flujo de oxígeno en el cerebro. Presentamos el caso de un adolescente de 15 años que falleció en una habitación de su domicilio habitual debido a una ahorcadura accidental durante un juego asfíctico. Se analizan las características del caso y se procede a una revisión de la literatura publicada. El juego de la asfixia es una actividad peligrosa, potencialmente mortal. Casos como el descrito pueden ayudar a que los pediatras y médicos en general conozcan tanto el fenómeno como la peligrosidad del mismo. Su conocimiento es importante para la prevención y detección precoz de comportamientos de riesgo entre los adolescentes. Abstract: Choking games are a known behaviour among adolescents, although they have not been reported in the Spanish scientific literature. They are games which seek a brief euphoria due to the restriction oxygen flow into the brain. The case of a 15 year-old adolescent boy who died in a room due to accidental hanging while playing the choking game is presented. Case characteristics are described and literature reviewed. The choking game is a dangerous and potentially fatal activity. Cases like the one described may be helpful for paediatricians and physicians in recognising this phenomenon and its risks. Knowledge of this activity is important for the prevention and early detection of adolescents risk behaviours.

Electronic prescription is new advance in the use of new technologies on health care. It is a tool that increases quality health care, patient's accessibility and safety in use of drugs and sustainability of the system. Electronic prescription is also a system of prescribing and dispensing in real time, improving coordination between health professionals. The electronic prescription model establishes that the patient comes to the health center where physician diagnostics, makes prescriptions of treatment and, if it is necessary, gives a medication plan to the patient. This medication plan contains currents treatments and a security code. Patients can go to any pharmacy he wants and have to present medication plan and health care card for drug delivery. The electronic prescription is being implemented gradually in Catalonia; Barcelona city is the last zone where Electronic prescription is being implemented. On November, more than 3.100 physicians, 2.450 pharmacies and 870.000 patients are using electronic prescriptions normally and without any remarkable incidences and more than 90.000 drugs are being dispensed every day. Implementation of electronic prescription project is a success in Catalonia, with a good reception from professionals and patients. The model of electronic prescription improves every day to be more useful to professionals and patients.

PurposeThe purpose of this paper is to contribute to the growing literature field of intellectual capital (IC) by analysing corporate IC disclosures by leading Spanish firms over a three‐year period from 2000 to 2002.Design/methodology/approachContent analysis methodology was applied to the annual reports of 12 Spanish companies over a three‐year period.FindingsA statistically significant increase was found in the volume of IC disclosures over a three‐year period. There is a greater volume of communication in the area of external (customer/relational) capital than in either internal or employee capital. This corresponds with the results of other country‐based studies. However, IC reporting remains at a relatively limited level, and disclosures are dominated by customer relational items.Originality/valueThis paper makes an original contribution to the growing body of empirical studies on IC reporting and describes the development of IC reporting in Spain.

Purpose: This paper presents a study of the professional internship models in each Faculty at the Universitat Pompeu Fabra (UPF) of Barcelona, Spain; their relationship to the idiosyncrasy of each type of studies, and their evolution from 2009, before the European Higher Education Area (EHEA), until the 2013-2014 academic year. This study is part of a larger project that comprises the point of view of the three agents involved in the internships: students, academic tutors and in-company tutors. Design/methodology/approach: This paper provides the data obtained from one of the three agents involved, namely the academic supervisor-tutors. We present the methodology used to compile the data before and after EHEA implementation: firstly, by means of deep individual and face-to-face interviews, and in a second stage by means of e-surveys, jointly with quantitative and objective data related to the internships activity during the period of the study. Findings: Following the conclusion of the first part of the study related to the internships before the EHEA, we found four different models of monitoring and assessing the internships; we anticipated the four models would converge into two, and eventually into one. The final model expected was focused on more intensive monitoring. In the second part of the study, even though we found fewer changes in the models than we expected, the impact of the EHEA deployment has been very important in quantitative aspects and in the breadth of the changes. Also, for some Faculties, the internship has become one of the most important subjects of the curricula. Originality/value: This is the first study of the EHEA impact on the professional internships in a Spanish University.

[EN] This paper proposes a framework for context-aware assessment of out-ofclassroom subjects with the support of mobile technologies. The paper discusses: (a) the principles and implications of out-of-classroom activities, e.g. internships, outdoors practicals of topography, of agricultural or marine engineering, virtual university courses, etc.; and (b) context-aware assessment, in which some context elements (location, date and time, environmental circumstances) may be incorporated into the assessment by means of mobile technology. The aim of this framework is to provide the tools that will allow for an enhanced evaluation, by taking into account the context of the activities being carried out. Given the characteristics of the activities, the assessment will be based on submissions prepared by the students, which will automatically incorporate context information that can be relevant for the assessment. The framework will be tested with several groups of students participating in internships and/or international mobility programmes, from different universities (public, private, semi-public).

[EN] A survey has been conducted during the 2013-2014 academic year among the first graduating class after the EHEA in the Faculty of Economics and Business Sciences at Universitat Pompeu Fabra (UPF), with the aim of comprehending the students’ perception of the learning process developed through the out-of-classroom activities of professional internships. In this work such activities are considered an integral part of the knowledge acquisition process, on the basis of the constructivism paradigm of learning-by-doing. The results of the survey show that, in general, student’s perceptions are positive about the overall process, although the weakest point is in the perceived connexion between the theory explained in the classroom and its practical application in the workplace. The conclusion is that from the students’ point of view the introduction of the new post-EHEA internship courses at UPF has been successful in many aspects, while in some other aspects, particularly in the relationship between theory and practice, some further analysis is recommended.

ECDC and EMCDDA Guidance: Prevention and Control of Infectious Diseases among People Who Inject Drugs [1] draws on scientific evidence to identify key components of infectious disease interventions for people who inject drugs (PWID). This commentary presents an assessment of the document from the perspective of five Spanish drug user organisations. In addition to noting ways in which we think the guidance might be strengthened, we also will discuss structural factors that hinder the implementation of disease prevention measures in PWID populations. While the following discussion of ECDC and EMCDDA Guidance makes it clear that more attention needs to be given to some important issues, we would like to emphasise that our intention is not to question the overall value of this document. In fact, we would be very pleased to see European countries implement the seven key intervention components that it recommends: • clean drug injection equipment; • vaccination; • drug dependence treatment; • testing for HIV, hepatitis B, hepatitis C, tuberculosis and other infections; • infectious disease treatment; • health promotion; and • targeted delivery of services The first issue we would like to highlight is the apparent lack of effort by the European Centre for Disease Prevention and Control (ECDC) and European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) to involve affected communities in the development of the guidance document. While we cannot positively determine the backgrounds of all of the authors and technical advisory group members, our guess is that out of the almost 50 people named, only one is a member of our community. Not only is this not right, but surely an opportunity was missed to include input which would have improved the value of the recommendations. In general, we think that in any elaboration of drug policy, PWID should be involved from the beginning. However, we are aware that in order to achieve this aim, it is important to potentiate the empowerment of our community, which is often found living in situations of social exclusion and marginalisation, partly because of stigma and discrimination. This makes it difficult for us to acquire the basic means to participate and to have our voices heard. A notable shortcoming that we have identified regarding the ECDC and EMCDDA Guidance is a lack of attention to how gender and cultural issues should be taken into account in efforts to reach and assist the full array of PWID who need services. For example, women usually are a minority of clients in drug user services. It is easy to overlook gender-specific issues that they face, such as power dynamics that lead to higher-risk sexual practices and to unsafe injecting practices imposed by male injecting partners. Migrants and cultural minorities tend to have less contact with mainstream health services and drug services, and behaviour-change interventions for these groups need to be culturally sensitive in order to be effective. Another matter that requires greater attention, in our opinion, is the role of safe consumption rooms. The ECDC and EMCDDA Guidance briefly discusses safe consumption rooms (which it refers to as “supervised injecting facilities”) as one of multiple aspects of safer injecting behaviour. For many of us who do not have a place to inject or who fear the risk of overdose, safe consumption rooms provide a much-needed alternative to the streets. Therefore we recommend that safe consumption rooms be designated a key intervention along with the other key interventions named in the guidance. In any strategic planning, communities of people who use drugs should be considered as potential care providers for our peers. We greatly appreciate the consideration given to this issue in the guidance, and we would like to comment further on two specific factors. First, the ability of some active drug users to implement prevention activities presents an important opportunity because these individuals hold a unique position. They have ongoing contact with the target population, and they can more easily reach some hidden subgroups of drug users. This interaction happens in key moments when prevention can be more effective. Secondly, there is a need to support and care for former drug users engaged in the implementation of peer interventions because of the potential impact that this work can have on their own recovery process. Former drug users need therapeutic supervision in this situation, preferably from people who are not co-workers. Structural interventions are understandably beyond the scope of the ECDC and EMCDDA Guidance, which seeks to identify good practices directly related to service provision. Nonetheless we believe that it is imperative for all stakeholders involved in implementing the guidance to take into account structural barriers and to be supportive of efforts to remove these barriers. First, there is a need to review the international conventions that criminalise the use of drugs and push PWID into illegal situations where it is more difficult for us to make use of effective prevention measures. Secondly, the ongoing stigmatization of illegal drug use limits service provision as well as hindering our access to existing services. Drug use-associated stigma also conditions the attitudes of health professionals, law enforcement personnel, and others who interact closely with PWID, making it more difficult for us to adopt the preventive measures recommended in the ECDC and EMCDDA Guidance. Important steps to help overcome stigma and discrimination include changing the approach to drug use from a legal to a health problem, making society understand addiction as a disease with its own complexities, and giving voice to PWID. We would like to close by inviting readers to reflect on three questions about the ECDC and EMCDDA Guidance, noting that the document was published in 2011 and that some of the key interventions are supported by a solid evidence base that has been in existence for many years. First, why is there so often a lack of political will to implement these interventions? Secondly, why is their implementation in prisons so low? And finally, why is their level of implementation so different across European countries? It would be difficult to find another at-risk population whose needs have been so widely ignored. Our community’s capacity for lobbying and advocating is still so weak that we daily encounter the denial of basic rights such as the opportunity to access these interventions. Give us voice and respect, more often and in more situations, and we are sure that this will make a difference in the prevention of drug-related harm, including harm from the transmission of hepatitis C and other bloodborne viruses. In accordance with the preceding observations, we suggest that ECDC and EMCDDA should also explore ways to consult with people who inject drugs on an ongoing basis regarding the issues that affect us.

Intrathoracic, abdominal and pelvic inflammations, infections and malignancies may spread along the lymphatic vessels cranially to the lymph nodes of the scalene fat pad. Its biopsy may make other more invasive procedures, such as mediastinoscopy, thoracoscopy, thoracotomy or laparoscopy, unnecessary. For staging of bronchogenic carcinoma, it is mainly indicated when there is involvement of the mediastinal lymph nodes. Stomach cancer and cancer of the cervix tend to metastasize to these nodes. For the latter, scale lymph node biopsy is especially indicated when there is evidence of para-aortic nodal involvement. With the introduction of computed tomography and positron emission tomography in clinical practice, scalene fat pad biopsy has been almost abandoned, but it should be considered among the available diagnostic and staging procedures if involvement of these nodes modifies therapy.

In this paper we propose the use of collaborative tools to enhance traditional e-learning platforms for university courses that are developed outside the school environment, as is the case of a Practicum or internship in a company or external institution. These courses have specific requirements with regard to monitoring, guidance and assessment of students, and we postulate that collaborative tools, usually implemented as cloud-based applications, combined with mobile technologies, today affordable to most students, constitute a suitable platform for implementing the assessment of this type of courses.

Background In recent decades, several studies have assessed the value of cardiac rehabilitation as secondary prevention and have reported substantial reductions in readmissions. However, conclusive evidence is scarce. The present study aims to evaluate the efficacy of a supervised exercise training program for improving percentages of hospital readmission for cardiac causes in patients with myocardial ischemia in the first year after a cardiac event. The effect on all-cause readmission, all-cause mortality, functional capacity, quality of life and adherence to regular exercise is also discussed. Methods/Design This study will be conducted as a randomized controlled trial. Eligible patients will be randomly assigned to a control group receiving standard care or to an intervention group which, in addition to standard care, will take part in a supervised exercise training program consisting of three hours a week (spread over three alternate days) of supervised exercise training for 10 weeks. Both groups will perform an exercise stress test and a blood test during the first and third month after hospital discharge. The follow-up period will be 12 months after hospital discharge. The primary outcome measures will be the percentage of patients readmitted, total number of readmissions and length of hospitalization for cardiac disease during the first year after hospital discharge, and time to first hospital admission for cardiac disease. Discussion A representative group of hospitalized patients after myocardial ischemia will be studied in order to provide comprehensive data on the potential impact of a supervised exercise training program on hospital readmission rates. Funding Agencies|Col.legi de Fisioterapeutes de Catalunya|R01/08-09

We analysed the specific case of how information in the financial press influences economic bubbles. We found considerable flaws in the information market due to several factors: demand, the predominance of what are termed “irrational investors” (herding), and supply, which has the problem that the sources of information are biased and feeds. A financial bubble is a deviation between real value of a financial asset and its persistent market price in time, which also has a speculative origin fed back by the illusion of the owners of these financial values, who will take benefits because of the future prices, which must be higher than the previous ones. The economical information in the media is submitting three problems. First of all, it is information generated by companies. In second place, the information circuit is fed back. A problem of informative independence becomes created, particularly serious in the case of the banks, which are very were as creditors. And in a third place, some informative biases are manifested for the companies of regulated sectors which are starring the economical information in the media.

La Teoria Econòmica està construïda sobre la hipòtesis de racionalitat dels agents econòmics. La racionalitat de l’homo economicus consisteix en què maximitza la seva utilitat tractant d’obtenir els majors beneficis amb el menor esforç, si bé l’aplicació d’aquesta hipòtesi a l’ésser humà no és plena ja que la seva motivació no sempre és biològica i de vegades actua empès per aspectes culturals difícils d’associar a un benefici1. Tanmateix, la hipòtesi de racionalitat s’ha considerat una bona representació dels aspectes essencials del comportament econòmic de l’ésser humà. El problema es presenta quan la Teoria Econòmica no és capaç d’explicar ni resoldre satisfactòriament problemes tan rellevants com les bombolles especulatives i la causa d’aquesta mancança s’atribueix a una construcció inadequada d’aquesta Teoria...