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Background: The shortage of nurses during the COVID-19 pandemic made it necessary to recruit nursing students to provide care. Although research suggests that the care that students provided was invaluable, their views on ethical concerns and dilemmas related to the duty of care remain unexplored.Objectives: Using predefined hypotheses, a cross-sectional study was conducted to explore students’ well-being and views on the duty of care.Method: Between May and June 2020, Chilean and Spanish nursing students participated in a web-based survey, including the 5-Item WHO Well-Being Index (WHO-5) and views on the duty of care reported through a scale related to beliefs about pandemics. Student’s t-test, Mann–Whitney U test, χ2 tests, and multivariable log-linear analysis were used to explore differences between nursing students in Spain and Chile and to examine the relationships between categorical variables.Results: Students (N = 183) from both countries self-reported low levels of psychological well-being (WHO-5, M = 10.8, SD = 4.3). Concerning ethical statements, although most students from both countries (71%) agreed that nurses and doctors have a duty of care, significant differences were found concerning the statement that every healthcare worker has a duty to work during a health emergency (39% agreement in Chile and 74% in Spain; p < 0.001).Conclusions: Students reported emotional and ethical challenges associated with the pandemic. Besides receiving help to deal with ethical challenges and given that a significant proportion of students from both countries reported low well-being, we recommend developing strategies to mitigate and enhance students’ well-being.

Background and aimsSelf-exclusion in gambling disorder (GD) is considered a measure to decrease the negative consequences of gambling behavior. Under a formal self-exclusion program, gamblers request to be banned from accessing to the gambling venues or online gambling.The aims of the present study are1) to determine sociodemographic characteristics of a clinical sample of seeking-treatment patients with GD who are self-excluded before arriving at the care unit; 2) to identify personality traits and general psychopathology of this clinical population; 3) to analyze the response to treatment, in terms of relapses and dropouts.Methods1,416 adults seeking treatment for GD, who are self-excluded completed screening tools to identify GD symptomatology, general psychopathology, and personality traits. The treatment outcome was measured by dropout and relapses.ResultsSelf-exclusion was significantly related to female sex and a high sociodemographic status. Also, it was associated with a preference for strategic and mixed gambling, longest duration and severity of the disorder, high rates of general psychopathology, more presence of illegal acts and high sensation seeking rates. In relation to treatment, self-exclusion was associated with low relapse rates.ConclusionsThe patients who self-exclude before seeking treatment have a specific clinical profile, including high sociodemographic status, highest severity of GD, more years of evolution of the disorder and high emotional distress rates; however, these patients' presents better response to treatment. Clinically, it could be expected that this strategy could be used as a facilitating variable in the therapeutic process.

Background This study aimed to explore the internal consistency and factor validity of the 13-item self-report questionnaire Parent-Patient Activation Measure (P-PAM) in a sample of parents of children with Attention-deficit/hyperactivity disorder. Methods In a cross-sectional study, 239 parents were recruited from four outpatient clinics of the Child and Adolescent Mental Health Services and completed the P-PAM along with demographic variables. The factor structure of the P-PAM was examined through exploratory factor analysis, and internal consistency was estimated with the use of both Cronbach’s alpha and McDonald’s omega. A confirmatory factor analysis was used to estimate and test individual parameters. Results The fit indices suggest an acceptable two-factor model of P-PAM and show high internal consistency and reliability for both factors, indicating that the scale measures two concepts. Conclusions Our findings provide evidence for an acceptable factor structure and a high reliability of P-PAM as a measure of parent activation, suggesting that the theoretical factors reflect the construct of parent activation as intuitively compiled into an inner cognitive factor and an outer behavioral factor, which are related.

PPP projects that go bankrupt come to early termination and are usually considered a complete failure. While it is true that this outcome is catastrophic for the project shareholders and creditors, it may not be the case for other relevant stakeholders, such as the granting authority, users and society as a whole. Assessing the global outcome of the project requires several detailed ex-post analyses, such as financial analysis, cost-benefit analysis and value for money analysis. Unfortunately, these analyses are seldom performed. To illustrate this point a case study was analysed: the PPP contract for two toll motorways (R-3 and R-5) and a segment of a ring road (M-50) in the vicinity of Madrid, Spain. The results show that the cost of the project to the Government, although higher than estimated on the pre-feasibility study, will be significantly lower than the first and hasty estimates. The project, despite a lower demand than initially expected, is still highly beneficial to society. Finally, using a PPP for this project has allowed the Granting Authority to avoid risks that have materialized with an important cost.

The effects of climate change on coastal areas are expected to significantly influence the risk for port operations. In the present work, a novel methodology for the quantitative assessment of the performances of upgraded rubble-mound breakwaters under a changing climate is proposed. For each considered upgrading option, the failure probability related to a certain limit state is calculated through the implementation of Monte Carlo (MC) simulations, using the factor of change (FoC) method to include the projected future climate. Three indexes are defined for the immediate and intuitive interpretation of the results: i) the ratio between the calculated and the maximum acceptable failure probability during lifetime (r); ii) the rate of the growth of the failure probability during lifetime (s); iii) the coefficient of variation of the failure probability due to both the intrinsic uncertainty of the MC simulation and the variability of future climate (v). The methodology was applied to the case study of the Catania harbor breakwater, considering the failure of different upgrading solutions due to the collapse of the outer armor layer and to excessive mean overtopping discharge. The results revealed the acceptability of the structural and hydraulic performances of all the tested configurations, under both present and future climate. Moreover, a high climate-related variability of the future failure probability was found. The usefulness of the proposed indexes for designer and decision-makers was also demonstrated. In particular, r gives direct information about the acceptability of the structure performances, enabling the immediate comparison between different configurations and climate scenarios. The index s is fundamental to calculate the appropriate times to implement repair interventions during the structure lifetime. Finally, v allows the identification of those situations which requires the design of highly flexible maintenance plans, able to adapt to a very variable climate avoiding excessive costs.

Motherhood has been proposed as an internal facilitating factor for the recovery of women with mental disorders. However, at the same time, there are significant barriers that may be interfering with the access and adherence to treatment for these women. The present longitudinal study aimed to deepen the sociodemographic and clinical profile of women with children and compulsive buying–shopping disorder (CBSD), and to explore the association between motherhood and response to treatment. The total sample included 77 women with a diagnosis of CBSD (n = 49 mothers) who received cognitive behavioral therapy (CBT) for 12 weeks. No association between psychopathology and motherhood was observed. The group of mothers reported an older age of onset of the CBSD, a lower amount of money spent per compulsive-buying episode, and a higher likelihood of family support for the CBSD. Moreover, this group showed lower risk of relapse. The findings support the theoretical proposal that considers motherhood as an internal facilitating factor for recovery and treatment adherence of mothers with addictions.

An accurate estimation of the historical harbour wave agitation is fundamental for many practical applications, such as port downtime analyses. In practical harbour agitation studies, usually based on numerical propagations from offshore wave climate towards a harbour (wave downscaling), the accuracy in defining the outer wave climate has an impact on wave agitation estimations, especially important for multimodal wave climates. In this paper, several strategies for wave agitation downscaling are presented based on different existing approaches with different accuracy levels for: a) wave downscaling method; b) definition of outer spectral waves. The accuracy/performance of each approach is evaluated by applying, and comparing them with multi-point instrumental data from a field campaign, in a real scenario (Africa basin, Las Palmas Port, Spain) where the multimodality of waves, in addition to the agitation effects from port structures in the far-field, clearly determines the final accuracy of the in-port wave agitation. Improved results have been achieved with the most sophisticated/accurate strategies proposed. A comparative analysis of the advantages, limitations, uncertainty and CPU effort of each one, allows to suggest the preferable strategy, in each situation/context, for practical port wave agitation studies The authors would like to thank the Port Authority of Las Palmas for their cooperation and the information provided; Puertos del Estado (Spanish Ministry of Transport, Mobility and Urban Agenda) for providing the instrumental buoy data. This work has been supported by a FPU (Formación de Profesorado Universitario) grant from the Spanish Ministry of Science, Innovation and Universities to the first author (FPU18/03046). This work has been also partially funded under the State R&D Program Oriented to the Challenges of the Society (PID2020-118285RBI00) of the Spanish Ministry of Science, Innovation and Universities.

Was sind die Faktoren einer gelungenen Implementation von Bildungsstandards, welche Rolle nehmen dabei die Lehrer*innen ein und wie bewerten sie die Implementation des Kernlehrplans von 2011? Für die Untersuchung dieser Fragen wurde eine quantitative Studie mit 112 kath. Religionslehrer*innen durchgeführt, ausgehend von der Hypothese, dass die top-down-Implementation der Bildungsstandards dysfunktional und nicht erfolgreich ist. Ein Fragebogen wurde hierzu konzipiert und mithilfe der quantitativen Analyse ausgewertet. Die Hypothese bestätigend zeigte sich, dass die Anwender*innen nicht von dem neuen Bildungskonzept überzeugt werden konnten, was auch der spürbaren Arbeitsbelastung durch die Implementation sowie der fehlenden Motivation und Volition geschuldet ist. Erfolgversprechender wären u.a. symbiotische Strukturen, andere Formate der Implementationsveranstaltungen, eine stärkere Einbindung der Lehrer*innen in den Bildungsreformprozess und in die Lehrplanentwicklung...

A new numerical methodology reaching an improved characterization of the historical harbor wave agitation climate is presented in this work. A detailed frequency-direction wave spectrum definition of wave agitation patterns within harbor basins is achieved, providing an in-depth description of the whole multidirectional and multireflective wave patterns occurring as a natural harbor response. This constitutes an advance from the monoparametric/aggregated wave height parameter-based approaches, traditionally used for wave agitation characterization, to a multivariate and disaggregated representation of in-port waves and the multiple wave transformation processes within harbor basins. In addition, the wave agitation spectral type concept is proposed, whereby the wave agitation spectral shapes are classified into representative clusters of the historical wave agitation response in a harbor. A detailed multiannual analysis of the wave agitation response, based on the different in-port spectral wave components, their relation with the outer-harbor forcing waves, and their interactions with the harbor structures, can be achieved with the proposed methodology. This improved harbor wave climate characterization can be especially relevant for port operability and downtime analyses. The methodology is applied and validated in Africa basin (Las Palmas Port, Spain). This work was supported by a FPU (Formación de Profesorado Universitario) grant from the Spanish Ministry of Science, Innovation and Universities to the first author (FPU18/03046). This work was also partially funded under the State R&D Program Oriented to the Challenges of the Society (PID2020-118285RB-I00) of the Spanish Ministry of Science, Innovation and Universities.

In this work, a new numerical model for cross-shore beach profile evolution, IH2VOF-SED, is developed. It consists in the bidirectional coupling of a 2D RANS hydrodynamic solver and a sediment transport module. The resulting model is extensively validated against three benchmark cases at different scales, attending to the hydrodynamics, bottom shear stress and bathymetry evolution. Comparisons between experimental and numerical results show a good agreement for both the flow variables and the seabed evolution in all the validation cases without making use of calibration parameters. Additionally, the qualitative analysis of the results is in accordance with previous experimental observations of sediment transport induced by breaking waves. The computational cost is greatly reduced to about 1/10 of other available RANS models. As a novel aspect regarding RANS models, the model is able to simulate the swash zone and changes in the position of the coastline. A good compromise between precision and computational cost is achieved, allowing for an in-depth analysis of the processes leading to the cross-shore profile evolution. The writers are grateful to Iván Cáceres (Polytechnic University of Catalunya) and Tom Baldock (University of Queensland) for providing experimental data for the validation cases. Also, to Moisés Álvarez Cuesta for performing the XBeach simulations. J. García-Maribona is indebted to the MECD (Ministerio de Educación, Cultura y Deporte, Spain) for the funding provided in the FPU (Formación del Profesorado Universitario) studentship (FPU17/04356). M. Maza is sincerely grateful to the Spanish Ministry of Science, Innovation and Universities for the funding provided in the grant Juan de la Cierva Incorporación (BOE de 27/10/2017). The work leading to this paper has been partially funded under the Retos Investigación 2018 (grant RTI2018-097014-B-I00) program of the Spanish Ministry of Science, Innovation and Universities.

Spillway design is key to the effective and safe operation of dams. Typically, the flow is characterized by high velocity, high levels of turbulence, and aeration. In the last two decades, advances in computational fluid dynamics (CFD) made available several numerical tools to aid hydraulic structures engineers. The most frequent approach is to solve the Reynolds-averaged Navier–Stokes equations using an Euler type model combined with the volume-of-fluid (VoF) method. Regardless of a few applications, the complete two-phase Euler is still considered to demand exorbitant computational resources. An assessment is performed in a spillway offset aerator, comparing the two-phase volume-of-fluid (TPVoF) with the complete two-phase Euler (CTPE). Both models are included in the OpenFOAM® toolbox. As expected, the TPVoF results depend highly on the mesh, not showing convergence in the maximum chute bottom pressure and the lower-nappe aeration, tending to null aeration as resolution increases. The CTPE combined with the k–ω&nbsp, SST Sato turbulence model exhibits the most accurate results and mesh convergence in the lower-nappe aeration. Surprisingly, intermediate mesh resolutions are sufficient to surpass the TPVoF performance with reasonable calculation efforts. Moreover, compressibility, flow bulking, and several entrained air effects in the flow are comprehended. Despite not reproducing all aspects of the flow with acceptable accuracy, the complete two-phase Euler demonstrated an efficient cost-benefit performance and high value in spillway aerated flows. Nonetheless, further developments are expected to enhance the efficiency and stability of this model.

Surgical site infection is a challenging complication that places a significant burden on the patient and the health care system. Emphasis is being placed on the prevention and treatment of surgical site infections. We evaluated the accuracy of identifying surgical wrap defects based on defect size, location, and operating room staff experience. Forty sterilization wraps were divided into 4 separate groups based on the size of the puncture defects created. Defects measuring 1.2 mm, 3.7 mm, and 6.8 mm were compared with a control group of surgical wraps with no defects. Defects were randomly placed on an inner or outer line with circumference of 7 cm or 14 cm, respectively. Twenty operating room staff of varying levels of experience evaluated each wrap for defects. The detection rates for the 1.2-mm, 3.7-mm, and 6.8-mm wraps and the wraps with no defects were 3%, 73%, 80%, and 99%, respectively. A significant difference was seen between the detection rates for the small defects vs all other size defects. No significant difference was seen in detection rate based on the location of defects. The detection rate was higher among staff members with greater than 1 year of experience vs those with less than 1 year of experience. Sterilization wrap defects of all sizes went undetected at very high rates. Small defects of 1.2 mm, which have been shown to allow bacterial contamination, were missed 97% of the time. Operating room staff with more experience detected more defects than those with less than 1 year of experience. Wrap defects may be a source of bacterial contamination that may frequently go unnoticed. [ Orthopedics . 2021;44(6):735–e738.]

Frente al problema del calentamiento global y cambio climático, los pequeños rumiantes serán clave para mantener la producción de proteína de origen animal, ya que tienen superioridad en la tolerancia al calor en comparación con otros animales domésticos. Los ovinos de pelo han demostrado ampliamente su habilidad para crecer y reproducirse en escenarios naturales de altas temperaturas y baja disponibilidad de nutrientes. La adaptación que presentan estos ovinos al estrés calórico está dada por una compleja interacción entre los mecanismos de termorregulación y la presencia de factores genéticos, lo cual les confiere una plasticidad fisiológica para tolerar climas calientes sin afectar drásticamente la productividad. Bajo condiciones de México, los ovinos de pelo se encuentran distribuidos en los diferentes climas debido a que no presentan una estacionalidad reproductiva, y esta característica permite a la industria ovina mantener una producción de carne constante a través del año; sin embargo, poca atención se ha puesto sobre su habilidad para producir en condiciones de estrés calórico. En este sentido, la presente revisión tiene como objetivo hacer una descripción de los efectos del estrés calórico sobre el comportamiento reproductivo, el crecimiento de corderos y la termorregulación de ovinos de pelo.

We address the long-term planning of electric power infrastructure under uncertainty. We propose a Multistage Stochastic Mixed-integer Programming formulation that optimizes the generation expansion to meet the projected electricity demand over multiple years while considering detailed operational constraints, intermittency of renewable generation, power flow between regions, storage options, and multiscale representation of uncertainty (strategic and operational). To be able to solve this large-scale model, which grows exponentially with the number of stages in the scenario tree, we decompose the problem using Stochastic Dual Dynamic Integer Programming (SDDiP). The SDDiP algorithm is computationally expensive but we take advantage of parallel processing to solve it more efficiently. The proposed formulation and algorithm are applied to a case study in the region managed by the Electric Reliability Council of Texas for scenario trees considering natural gas price and carbon tax uncertainty for the reference case, and a hypothetical case without nuclear power. We show that the parallelized SDDiP algorithm allows in reasonable amounts of time the solution of multistage stochastic programming models of which the extensive form has quadrillions of variables and constraints.