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Wartime violence and authoritarian repression against civilians take various forms. Past research has explored the causes and consequences of violence, but no previous work simultaneously assessed the long-term effects of different types of violence on political identities. This paper contends that indiscriminate attacks can reinforce ingroup identity, whereas the role of civilian agency in selective violence may have a detrimental impact. Equipped with original data capturing municipality-level exposure to both selective and indiscriminate violence during the Spanish civil war (1936–1939) in Biscay (Basque Country), this study examines its legacy on voting behavior (1983–2015). Results indicate that fascist airstrikes increased Basque nationalism while selective violence diminished the popularity of Basque parties. Individual and community-level evidence suggests that airstrikes fostered the intergenerational transmission of political attitudes. Violence can boost national identities, but it can also erode them: it depends on the type. [ABSTRACT FROM AUTHOR]

Local government officials are accountable to citizens, who increasingly demand more transparency given the amount of taxes they pay. This paper analyses the relationship between municipal tax revenues and transparency in Spain. Based on a sample of 141 Spanish municipalities with more than 15,000 inhabitants and applying least squares regression and instrumental variable analysis based on two-stage least squares regression, we find that the most transparent municipalities collected more global taxes. Furthermore, more municipal financing through transfers from other levels of government leads to lower taxes on construction and capital gains generated by real estate transfers. [ABSTRACT FROM AUTHOR]

The aim of this paper is to deepen the analysis of services reshoring in the Spanish services sector, both as a whole and for its constituent elements, examining both intra- and inter-sectoral components. Likewise, it analyzes the impact of this strategy on employment in the services sector, also differentiating between broad reshoring, intra-sectoral reshoring and intersectoral reshoring. The data used come from the Input-Output Tables of the Spanish National Accounts published since 2000. The results show Spanish service companies significantly reduced their contracting of activities abroad between 2008 and 2010, substituting foreign intermediate services for domestic services. This process of reshoring is observed with greater intensity in inputs of the same sector. However, since 2010 Spanish service companies have slightly increased their contracting of foreign services per unit of output, adopting new services offshoring strategies, although to a lesser extent than in the period prior to the recession. In the analysis of the effect of reshoring on services employment can be concluded that services reshoring has not generated employment in the Spanish service sector. [ABSTRACT FROM AUTHOR]

In a world where machines replace unskilled work, an active labor market policy—represented by the combination of an optimal Earned Income Tax Credit (EITC) and income maintenance for the unemployed—provides incentives to increase participation in the labor market and depresses wages for unskilled employees. In this paper, this policy is tested against the alternative of allowing unskilled workers to receive a means-tested basic income (MTBI), as recently adopted by Spain. For a liberal social planner (i.e., includes consumption and leisure in individual utility), the MTBI dominates the active labor market policy. For a conservative social planner (i.e., evaluates social welfare based on individual utility from consumption), the active labor market policy dominates the MTBI. The potential dynamic effects of active labor policy on labor supply were considered in a simulation using updated empirical estimates; it shows that this policy becomes preferable for both types of the social planner. [ABSTRACT FROM AUTHOR]

Extant literature has noted that traditional paper-based reporting is becoming less timely and less useful to decision makers. Stakeholder pressure is making companies use communication channels other than paper-based reporting, such as the Internet. This article seeks to contribute to the literature by analyzing the extent to which firms are using the Internet to communicate their corporate environmental reporting as a transparency information policy to manage corporate legitimacy. Because utility and resource industries are considered sensitive industries with regard to their impact on the natural environment, these firms are expected to offer corporate environmental reporting on the Web to cope with prevailing stakeholders pressures. This article also explores the environmental online disclosures made by Spanish publicly listed companies. Although sample firms practice corporate environmental reporting on the Web, results indicate differences between sample industries' Internet disclosures and the lack of a standardized framework for corporate environmental reporting. [ABSTRACT FROM AUTHOR]

We analyze the impact of the COVID-19 pandemic on electricity consumption patterns. We highlight the importance of decomposing total electricity consumption into consumption by firms and by households to better understand the economic and social impacts of the crisis. While electricity demand by firms has fallen substantially, the demand by households has gone up. In particular, our focus is on Spain where, during the total lockdown, these effects reached –29% and +10% respectively, controlling for temperature and seasonality. While the electricity demand reductions during the second wave were milder, the demand by firms remained 5% below its normal levels. We also document a change in people’s daily routines in response to the stringency of the lockdown measures, as reflected in their hourly electricity consumption patterns. [ABSTRACT FROM AUTHOR]

This paper investigates the possibility of the implementation of Genetic Programming (GP) algorithm on a publicly available COVID-19 data set, in order to obtain mathematical models which could be used for estimation of confirmed, deceased, and recovered cases and the estimation of epidemiology curve for specific countries, with a high number of cases, such as China, Italy, Spain, and USA and as well as on the global scale. The conducted investigation shows that the best mathematical models produced for estimating confirmed and deceased cases achieved R2 scores of 0.999, while the models developed for estimation of recovered cases achieved the R2 score of 0.998. The equations generated for confirmed, deceased, and recovered cases were combined in order to estimate the epidemiology curve of specific countries and on the global scale. The estimated epidemiology curve for each country obtained from these equations is almost identical to the real data contained within the data set [ABSTRACT FROM AUTHOR]

Objectives: The IMPACT trial has compared the benefit in the reduction of moderate/severe exacerbations of single inhaler triple therapy (SITT) with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) versus dual therapy with FF/VI (ICS/LABA) and UMEC/VI (LAMA/LABA) in the treatment of patients with chronic obstructive disease (COPD). This study performs a subgroup analysis of the cohort from Spain in the IMPACT study. Materials and Methods: In IMPACT, a 52-week randomized, double-blind, parallel-group, multicenter study (N = 10,355), patients ⩾40 years of age with COPD and ⩾1 moderate/severe exacerbations in the previous year were randomized 2:2:1 to once-daily FF/UMEC/VI 100/62.5/25 µg, FF/VI 100/25 µg or UMEC/VI 62.5/25 µg administered via the Ellipta inhaler. Here, we present a subgroup analysis of the 499 patients from Spain, included in the intent-to-treat (ITT) population in the study. Endpoint assessed included exposure-adjusted rate of moderate and severe exacerbations. Results: In the Spain cohort, the exposure-adjusted rate of on-treatment moderate/severe COPD exacerbations per year for FF/UMEC/VI was 1.31 versus 1.43 and 1.57 for FF/VI and UMEC/VI, respectively. No new adverse events were identified. The results are consistent with those observed in the overall ITT study population. Conclusion: In the Spain cohort of the IMPACT study, patients receiving triple therapy with FF/UMEC/VI had a lower exposure-adjusted rate of exacerbations compared with FF/VI and UMEC/VI, similar to the overall population. Study Title: A Phase III, 52 Week, Randomized, Double-blind, 3-arm Parallel Group Study, Comparing the Efficacy, Safety and Tolerability of the Fixed Dose Triple Combination FF/UMEC/VI With the Fixed Dose Dual Combinations of FF/VI and UMEC/VI, All Administered Once-daily in the Morning Via a Dry Powder Inhaler in Subjects With Chronic Obstructive Pulmonary Disease URL : https://www.clinicaltrialsregister.eu/ctr-search/search?query=CTT116855/https://clinicaltrials.gov/ct2/show/NCT02164513 Registration number : GSK (CTT116855/NCT02164513). The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

The present paper aims to reliably depict the impact of the European Union Emissions Trading Scheme (EU ETS) on Spain under different assumptions about the industries involved. Prior analyses, based either on highly aggregated macroeconomic or specific electricity industry models, have been limited in degree of detail or scope. Two types of modeling were combined in the present study: general equilibrium was used to assess the impact on different industries and to explain cross-industry changes, and partial equilibrium to suitably model the complex and crucial electricity system. Combining and interrelating these two models yields the effects on price, carbon dioxide (CO2) emissions and distributional patterns in Spain of both the current policy and of an alternative in which all industries take part in the EU ETS. Since Spain is a key participant in this scheme, the conclusions and policy implications stemming from this paper are relevant to and useful for post-Kyoto arrangements. [ABSTRACT FROM AUTHOR]

In many European countries, sectoral bargaining agreements are automatically extended to cover all firms in an industry. Employers and employees can also negotiate firm-specific contracts. The authors of this paper use a large matched employer-employee data set from a 1995 survey in Spain to study the effects of firm-level contracting on the structure of wages. They estimate a series of wage determination models, including specifications that control for individual characteristics, coworker characteristics, the bargaining status of the workplace, and the probability that the workplace was covered by a firm-level contract. They find that firm-level contracting was associated with a 5-10% wage premium, with larger premiums for more highly paid workers. Although they cannot decisively test between alternative explanations for the firm-level contracting premium, they find that workers with firm-specific contracts had substantially longer job tenure than other workers, suggesting that the premium was at least partially a non-competitive phenomenon. [ABSTRACT FROM AUTHOR]

This paper conceptualizes how organized labor in newly industrialized countries both responds to and shapes the presence of foreign multinationals. Four images of multinationals--as "villains," "necessary evils," "arm's length collaborators," and "partners"--are documented and compared using evidence drawn from three countries during the 1950-99 period. Organized labor flatly opposed foreign multinationals early on, under authoritarian regimes, in all three countries--Argentina, South Korea, and Spain--but that stance shifted over time in divergent rather than convergent ways. In Argentina, organized labor alternately viewed multinationals as villains and as a necessary evil, and in Korea it deemed them fit for limited, arm's length collaboration. In Spain, by contrast, unions gradually shifted toward a willing acceptance of multinationals as partners. Organized labor's images of multinationals are found to have resulted from two key factors: democratic versus authoritarian political regimes, and modernizing versus populist labor union mentalities. [ABSTRACT FROM AUTHOR]

The dual character of the Spanish labor market, with permanent workers on the one hand and less favored peripheral workers on the other, became more pronounced following the deregulation of temporary employment. This paper uses the Spanish Labor Force Survey to assess whether, as predicted by labor market segmentation theories, temporary employment is non-transitional (permanent) and involuntary. An analysis of the rates and dynamics of transitions into and out of temporary employment across different groups of working-age respondents shows that much of Spanish temporary employment is involuntary, with temporary workers having limited opportunities for advancement. The evidence points to the need for public policy to address problems posed by the trap that temporary employment has apparently become for growing numbers of workers. [ABSTRACT FROM AUTHOR]

This note illustrates some of the new roles that armed forces are taking on in developed countries, highlighting the structure, capabilities, and missions developed by the Spanish Military Emergency Unit (UME). The note describes some of these new roles assumed by UME, such as its response to the COVID-19 pandemic, and shows, using official temporal and georeferenced data, the growing use of the military to support civilian authorities in response to natural disasters, man-made disasters, and other emergencies alike. In addition, we also analyze public opinion survey data to argue that this is helping to improve society's perception of the armed forces even in a country like Spain where, due to its recent history, a significant part of its population is reluctant to the military. In short, the military is taking on more emergency roles as needs arise and these new roles can help to improve its perception by citizens. [ABSTRACT FROM AUTHOR]

Circular start-ups (CSUs) are gaining popularity to radically rethink the linear resource flows of global production systems and adopt ambitious approaches towards a circular economy from inception. For CSUs, the institutional environment is particularly relevant; this is because the complex nature of sustainability challenges requires a deep engagement with institutions to drive transitions from linear to circular practices. This article analyses how and why institutional factors influence CSUs in the highly entrepreneurial region of Catalonia in Spain. Based on a multiple case study, our findings demonstrate that CSUs are affected by informal institutions through founder motivations, their ability to create opportunities and social values. Formal institutions influence CSUs regarding the previous experience of founders, accessible ecosystem actors and supportive laws and regulations. These findings are important for effective policymaking to develop adequate support mechanisms and understand the particular challenges and opportunities CSUs face compared to traditional start-ups. [ABSTRACT FROM AUTHOR]

Background: Next-generation sequencing liquid biopsy (NGS-LB) for colorectal cancer (CRC) detection and surveillance remains an expensive technology as economies of scale have not yet been realized. Nevertheless, the cost of sequencing has decreased while sensitivity has increased, raising the question of whether cost-effectiveness (CE) has already been achieved from the perspective of European healthcare systems. Objectives: This health economic (HE) modeling study explores the CE of NGS-LB for CRC based on direct treatment costs compared to standard care without liquid biopsy in Spain, France, and Germany. Methods: A structured literature search was used to collect evidence from 2009 to 2020 on the stage-dependent quality of life (quality-adjusted life-years, QALY), efficacy, and total direct treatment costs (TDC) of NGS-LB. A decision-analytic Markov model was developed. Over the remaining lifetime, cumulative life expectancy (LE), TDC, and QALYs were calculated for 60-year-old men and women in CRC stage III with different assumed effects of NGS-LB of 1% or 3% on improved survival and reduced stage progression, respectively. Results: The use of NGS-LB increases LE by 0.19 years in Spanish men (France: 0.19 years, Germany: 0.13 years) and by 0.21 years in Spanish women (France: 0.21 years, Germany: 0.14 years), respectively. The 3% discounted cost per QALY gained was 35,571.95 € for Spanish men (France: 31,705.15 €, Germany: 37,537.68 €) and 35,435.71 € for Spanish women (France: 31,295.57 €, Germany: 38,137.08 €) in the scenario with 3% improved survival and reduced disease progression. Compared to the other two countries, Germany has by far the highest TDC, which can amount to >80k euros in the last treatment year. Conclusion: In this explorative HE modeling study, NGS-LB achieves generally accepted CE levels in CRC treatment from the health system perspective in three major European economies under assumptions of small improvements in cancer recurrence and survival. Confirmation of these findings through clinical trials is encouraged. Plain language summary: Is it worthwhile to use next generation liquid biopsy for cancer recurrence detection on patients with colorectal cancer? Colon cancer is common. Worldwide, almost one million people die from it every year. Next Generation Sequencing Liquid Biopsy is a very sensitive technology for detecting cancer cells and their genetic information in the blood. Therefore, it is a good way to detect cancer and to detect early recurrence of a previously treated tumor. This test procedure is not yet used very often. Therefore, it is still expensive. Furthermore, there are still no studies that have demonstrated that and how liquid biopsy can aid doctors and patients after initial treatment. The research team of this study has developed an analytical model to investigate what performance liquid biopsy should have to demonstrate an affordable patient benefit in terms of quality of life, survival and cost per additional quality-adjusted life year gained. To do this, they studied the existing medical literature and many cost studies on colorectal cancer for the countries of Spain, France and Germany to feed their model. Then, they made different assumptions about the performance of liquid biopsy and did calculations. In the process, they also particularly examined the significance of specific influencing factors such as costs or disease progression in so-called sensitivity analyses. As a result, the authors found that there are large differences in treatment costs for colorectal cancer between the three countries Spain, France and Germany. Furthermore, even small improvements in the progression of cancer and the survival of cancer patients lead to the economic efficiency of liquid biopsy for the health care system. However, these are still thought experiments, so the research team of this study says that there should be further clinical trials to assess the impact of liquid biopsy on cancer progression and patient survival by using this technology. By this, one could confirm or contradict the authors' educated assumptions and possibly pave a new way towards medical progress for people with colorectal cancer. [ABSTRACT FROM AUTHOR]

The gender gap in political/ideological self-positioning literature usually considers that Spain is stagnant within traditional parameters, where women are more right-wing than men. However, an analysis of more than 87,000 opinion polls collected by the CIS over a period of almost 40 years shows that Spain is moving toward the modern gender gap, although following a particular path conditioned by its own history of the 20th century. These findings disagree with the conclusions reached by Inglehart and Norris about Spanish women in their study about the development of modern gender gap. Our research investigates the impact of cohort and period effects on the population aged over 64, whose political identity, in accordance with the theories of political socialization, was formed in a context alien to the modernization process, largely coinciding with the Franco dictatorship in Spain. [ABSTRACT FROM AUTHOR]

In the current context in which tourism is beginning to recover, this study examines the worldwide trend of tourists traveling to destinations with a low impact of the COVID-19 pandemic in a country such as Spain, which is highly dependent on tourism activity. By employing the SEM methodology and an extended theory of planned behavior (TPB), which includes the cognitive and affective dimensions of perceived risk about the pandemic and past behavior, the results show the positive effect that past behavior and the core variables of the TPB have on the behavioral intentions of Spanish tourists, despite the negative impact that their cognitive risk perception has on these core variables. The study's findings have useful practical implications for tourism authorities and stakeholders in Spain and other countries that are also highly dependent on tourism. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data. Methods: Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Results: Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine). Discussion: These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations. [ABSTRACT FROM AUTHOR]

Introduction: Evidence and clinical experience suggest that there are a range of signs of health issues that affect patients who have recovered from acute COVID-19 infection. This condition is commonly referred to as "persistent COVID-19," which is not connected with the severity of the disease. We have identified the prevalence and clinical-epidemiological characteristics of patients with COVID-19 and persistent symptoms treated in primary care centers. This is a descriptive observational study conducted between December 2020 and May 2022, the data were collected from digitized medical records and interviewing 1542 individuals with laboratory-confirmed SARS-CoV-2 infection. These patients were clinically followed for up to 1 year, based on the prevalence of symptoms. When stratifying by the risk of developing persistent COVID-19, 37.09% of the patients exhibited risk factors, with age (over 60 years) and cardiovascular risk factors predominating. The obtained prevalence of persistent COVID-19 at 90 days was 12.39%, with a slight predominance in females (55%) and a mean age of 45.8 years. The most affected systems were the cardiovascular, respiratory, and psychoneurological systems, with predominant symptoms of fatigue (41.88%), dyspnea (32.46%), and headache (14.66%), among others. The average duration of persistent symptoms was 178 days, equivalent to 6 months. In conclusion, over 10% of patients who recover from acute SARS-CoV-2 infection developed long-term consequences. Objective: To measure the prevalence and clinical-epidemiological characteristics of individuals diagnosed with COVID-19 and persistent symptoms treated in primary care centers in Área Sanitaria Sur de Córdoba (Spain) between December 2020 and May 2022. Methods: A retrospective observational study of the population of Área Sanitaria Sur de Córdoba was developed between December 2020 and May 2022. The scope of the study was 1542 individuals, and the prevalence of patients diagnosed with COVID-19 and persistent symptoms was determined based on laboratory-confirmed cases, randomly selected from adults who had progressed beyond the acute phase of the disease. All data were managed by the Área Sanitaria Sur de Córdoba (Spain). Results: The risk factor of exhibiting one or more risk factors associated with developing persistent COVID-19 is 37.09%. The obtained prevalence of persistent COVID-19 at 90 days is 12.39%, it is higher in females (55%) than males and the mean age was 45.8 years. The most affected systems were the cardiovascular, respiratory, and psychoneurological systems, with predominant symptoms of fatigue (41.88%), dyspnea (32.46%), and headache (14.66%), among others. Conclusions: Results confirm that more than 10% of individuals recovering from acute SARS-CoV-2 infection showed long-term consequences and the observed persistent symptom duration was 178 days on average. [ABSTRACT FROM AUTHOR]

Inhaled bronchodilator therapy with long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) in combination is currently the mainstay of treatment for chronic obstructive pulmonary disease (COPD). Treatment guidelines recommend the addition of inhaled corticosteroids (ICS) to LABA/LAMA only in patients with a history of frequent/severe exacerbations and high blood eosinophil counts, or in those with concomitant asthma. Despite this, real-world data suggest that clinicians are not adhering to this guidance and that ICS are frequently overused. This is possibly due to the incorrect assumption that when LABA/LAMA therapy is not sufficient, adding an ICS to the treatment regimen is the logical next step. In this narrative review, we describe global and country-specific guideline recommendations from Germany, Spain, and Japan and compare these with real-world data on LABA/LAMA and ICS use in clinical practice. We also provide a clinical guide to the use of add-on therapies with LABA/LAMA for different patient phenotypes, including (1) patients still symptomatic (but not exacerbating) despite LABA/LAMA treatment; (2) patients still exacerbating despite LABA/LAMA treatment who have high blood eosinophil counts; and (3) patients still exacerbating despite LABA/LAMA treatment who do not have high blood eosinophils or concomitant asthma. Plain language summary: What are the options for patients with COPD when LABA/LAMA is not enough? Treatment guidelines for chronic obstructive pulmonary disease (COPD) recommend dual bronchodilator therapy for the majority of patients, consisting of an inhaled combination of long-acting β2-agonist (LABA) and long-acting muscarinic antagonist (LAMA). Patients whose COPD is not well controlled on LABA/LAMA require further clinical intervention, which may or may not involve treatment with additional drugs. Data from observational studies reflecting routine clinical practice suggest that inhaled corticosteroids (ICS) are often added to LABA/LAMA, even though treatment guidelines recommend only adding ICS in a specific group of patients with a history of exacerbations and high levels of eosinophils (a type of inflammatory cell) in the blood, or in those with current asthma. As long-term ICS use may be associated with an increased risk of side effects such as pneumonia, it is important to avoid overuse of ICS. When a patient's COPD is not well controlled on LABA/LAMA, other treatable conditions should first be ruled out, and factors such as medication adherence, inhaler technique, and co-existing health conditions should also be considered. This review gives advice on what follow-up options physicians should consider when LABA/LAMA is not providing adequate control of a patient's COPD. Specifically, recommendations are given for three different patient profiles: 1. Patients who still have symptoms of COPD (but no acute/sudden worsenings of symptoms, known as exacerbations). 2. Patients who have exacerbations, as well as high levels of eosinophils in the blood. 3. Patients who have exacerbations, but without high levels of eosinophils in the blood or current asthma. [ABSTRACT FROM AUTHOR]

Policy makers and antitrust authorities are concerned about the lack of competition in the fuel retail market and its impact on consumer prices. The aim of this article is to empirically evaluate the role of the intensity of competition and competitors' brand affiliation on retail fuel prices. To this end, we use a panel data set with detailed daily on nearly 8,500 gas stations and 2 million price observations; we estimate a reduced-form fuel price equation that accounts for supply (input costs and local competition) and demand shifters (income, traffic intensity, and location) as well as for brand and time fixed effects. We use an instrumental variable estimation strategy, to account for the endogeneity of the intensity of competition. Our results show that premium brands and low-cost brands affect the prices of rival firms in an opposite way. On the one hand, premium brands soften competition in the local markets where they operate and thereby allow their rivals to set higher prices. Besides, price setting by premium-brand stations react differently depending on whether the nearest rival sells the same brand (a friendly competitor) or some other brand. By contrast, low-cost brands contribute to reducing prices through their own prices (direct effect), thereby encouraging competitors to lower their prices (indirect effect). Our results suggest that regulation limiting the entry of premium operators whilst promoting the entry of low cost gas stations will enhance competition at the retail level. [ABSTRACT FROM AUTHOR]

This paper addresses the current situation of the left in Spain (excluding traditional social democracy) and its future prospects. Since the so-called 15-M movement of May 2011 and the subsequent creation of Podemos (‘We Can’), there has been a perceived possibility of the overcoming the neoliberal offensive and the so-called regime of 1978, the political structure of the last decades. However, it is argued here that the rise of this ‘new left’ does not necessarily imply a strengthening of the subject of transformation, the labour movement, nor the political framework for achieving social rights in the future. [ABSTRACT FROM AUTHOR]

Patient safety is a matter of major concern that involves every health professional. Nowadays, emerging technologies such as smart pumps can diminish medication errors as well as standardise and improve clinical practice with the subsequent benefits for patients. The aim of this paper was to describe the smart pump implementation process in a paediatric intensive care unit (PICU) and to present the most relevant infusion-related programming errors that were prevented. This was a comparative study between CareFusion Alaris Guardrails® and Hospira MedNet® systems, as well as a prospective and intervention study with analytical components carried out in the PICU of Gregorio Marañón General and Teaching Hospital. All intravenous infusions programmed with a pump in the eleven beds of the unit were analyzed. A drug library was developed and subsequently loaded into CareFusion and Hospira pumps that were used during a three month period each. The most suitable system for implementation was selected according to their differences in features and users’ acceptance. Data stored in the pumps were analyzed to assess user compliance with the technology, health care setting and type of errors intercepted. The implementation process was carried out with CareFusion systems. Compliance with the technology was 92% and user acceptance was high. Vacation substitution and drug administration periods were significantly associated with a greater number of infusion-related programming errors. High risk drugs were involved in 48% of intercepted errors. Based on these results we can conclude that implementation of smart pumps proved effective in intercepting infusion-related programming errors from reaching patients. User awareness of the importance of programming infusions with the drug library is the key to succeed in the implementation process. [ABSTRACT FROM AUTHOR]

How did long-term care (LTC) policies and the prevailing governance model affect the working conditions of nursing home workers in Spain during the COVID-19 pandemic? Here, we rely on qualitative analysis of semi-structured interviews and document analysis to answer the research question. The results suggest that lack of coordination between health and social services, underfunding of the LTC system, and the absence of legislative initiatives have harmed caregivers' labor and employment conditions and the effectiveness of managing the crisis. These findings are relevant as they expose the implications of the territorial structure of welfare and sectoral public policies in managing a crisis. [ABSTRACT FROM AUTHOR]

The presence of satisficers among survey respondents threatens survey data quality. To identify such respondents, Oppenheimer et al. developed the Instructional Manipulation Check (IMC), which has been used as a tool to exclude observations from the analyses. However, this practice has raised concerns regarding its effects on the external validity and the substantive conclusions of studies excluding respondents who fail an IMC. Thus, more research on the differences between respondents who pass versus fail an IMC regarding sociodemographic and attitudinal variables is needed. This study compares respondents who passed versus failed an IMC both for descriptive and causal analyses based on structural equation modeling (SEM) using data from an online survey implemented in Spain in 2019. These data were analyzed by Rubio Juan and Revilla without taking into account the results of the IMC. We find that those who passed the IMC do differ significantly from those who failed for two sociodemographic and five attitudinal variables, out of 18 variables compared. Moreover, in terms of substantive conclusions, differences between those who passed and failed the IMC vary depending on the specific variables under study. [ABSTRACT FROM AUTHOR]

The history of democracy is typically a history of struggle against monarchs and other such autocrats. The elevation of one person over others by virtue of blood and birth has come to be seen as anachronistic; yet some monarchies have managed to survive to this day. This paper analyses two examples of the uneasy coalition between popular sovereignty and royal leadership that is constitutional monarchy. Whereas Juan Carlos of Spain has been described as having steered Spain away from dictatorship, Bhumibol of Thailand has come under scrutiny for allegedly lacking a principled approach to democracy. I argue that structural as much as personal factors influenced the ways in which the two monarchies were legitimised - one by positively responding to the modern aspirations of the king's subjects, giving him a "forward legitimacy," the other by revitalising the king's traditional charisma and opting for "backward legitimacy." [ABSTRACT FROM AUTHOR]

The article focuses on the Mondragón system of worker production cooperatives. The Mondragón system of industrial production cooperatives in the Basque country of Spain is a major exception to the time-honored belief that production firms organized on a cooperative basis of worker ownership are doomed to a short and precarious existence. This paper traces the evolution of the Mondragón industrial firms, in association with cooperative educational, banking, and commercial institutions, and examines the personal, cultural, organizational, and economic factors that account for the extraordinary growth and dynamism of the system since its founding in 1956. The authors also describe the lessons of the Mondragón experience they believe are applicable to the development of more successful industrial cooperatives in the U.S. and elsewhere. The first firm of the cooperative system of Mondragón was founded in 1956 by five men supported by a larger group of friends. By the end of 1976 the system had grown to 65 firms with 14,665 members.

This paper explores and tests the differences in downsizing behaviour depending upon three ownership-based traits of the largest Spanish companies: stock versus privately held corporations, foreign versus domestic firms and state-owned versus private companies. From a theoretical standpoint, we develop an explanatory model of downsizing that accounts for techno-economic, institutional, and socio-cognitive explanations which serves as a conceptual basis for generating hypotheses on the role of ownership in downsizing decisions. Probit estimates using a sample of large Spanish firms (1990-1998) confirm that stock corporations and state-owned firms engaged in a privatization process are more likely to downsize than privately held domestic companies. We found less conclusive results about the downsizing behaviour of foreign firms. Finally, our findings corroborate the relevance of organizational decline and institutional factors for predicting the downsizing event. [ABSTRACT FROM AUTHOR]

This paper assesses the economic impact of the European Emissions Trading Scheme Directive on the Spanish electricity sector. Although some other studies have been carried out before, our approach uses a more detailed model for the Spanish electricity sector, which provides more realistic results both for the expected price of the carbon allowance and for the evolution of electricity prices, installed power and firms' revenues in Spain. Results show that the implementation of the Directive will result in a significant increase of electricity prices, and also, due to the Spanish pricing system, in a large increase in the revenues of generating firms, unless the regulator intervenes. Results also show the different implications of different assignment methods. This is especially relevant currently given that most European countries are approving their national assignment plans for 2005-07 and have to revise them for 2008. [ABSTRACT FROM AUTHOR]

Although the National Health System (NHS) is the main healthcare financing body in Spain, an increasing share of the population 'goes private' by obtaining supplementary private healthcare insurance (PHI). Qualitative research is very limited and empirical studies hardly ever provide us with what lies behind the figures. This paper seeks to examine qualitative and quantitative evidence on the individual's motives for the purchase of PHI. We undertook two focus groups together with a representative survey containing open-ended and closed questions among a sample of the Catalan population. Our findings indicate a high degree of heterogeneity in the motives for going private, ranging from the already acknowledged 'quality motive' to simple tradition. A certain share of the population reveals 'captivity' and satisfaction towards the NHS, as well as being unable to afford private alternatives. Furthermore, risk aversion and income was significantly higher for those purchasing PHI. [ABSTRACT FROM AUTHOR]

In this paper we describe the Spanish electricity industry and its current regulatory regime. Special emphasis is given lo the description and discussion of market design issues (including stranded cost recovery), the evolution of market structure, investment in generation capacity and network activities. We also provide a critical assessment of the 1997 regulatory reform, which did not succeed in introducing effective competition, but retained an opaque regulation which has been subject to continuous governmental interventionism. Furthermore, the implementation of the Kyoto agreement could show the lack of robustness of the regulatory regime. [ABSTRACT FROM AUTHOR]

This paper demonstrates the strategic importance of developing a capability to manage human resources based on a set of social responsibility principles (normative and structural) with the aim of responding to the interests of the employees. Such corporate social responsiveness will encourage employees' collaboration and could distinguish the company from other organizations. We have tried empirically to test the existence of a significant and positive relationship between organizational results and the institutionalization of a social responsiveness toward employees. To this end, we carried out a study in the Spanish savings bank sector to analyse the strategic value of corporate responsiveness toward employees from the resource-based view. Our results seem to show that those savings banks that have institutionalized high-commitment practices toward employees have greater profitability. [ABSTRACT FROM AUTHOR]

Background: Chronic cough (CC; cough that lasts 8 weeks or longer) poses major effective assessment challenges. Assessment of CC may vary considerably among medical specialists. Objectives: The aim was to evaluate similarities and consistency of responses across different specialists when performing a basic assessment of CC patients in primary care, and referring patients based on clinical findings or test results. Methods: A modified Delphi approach was used. A survey with 74 statements on initial assessment of CC and referral pathways was addressed to a panel of different specialists, who voted the statements in two rounds. Results: Seventy-seven physicians [18 primary care physicians (PCPs), 24 pulmonologists, 22 allergists, and 13 ear, nose, and throat specialists] from the National Healthcare System of Spain answered the questionnaire. After two rounds, the panel reached a consensus on 63 out of the 74 proposed items (85.1%). Consensus was not reached among the panelists of at least one specialty on 15 out of these 63 agreed items. The panel agreed on those clinical aspects that should be evaluated by PCPs in all patients with CC including the impact of CC on quality of life. Agreement was reached on initial actions to be taken in primary care, including substitution of drugs that may induce cough, performing a chest X-ray, introduction of anti-reflux measures, initiation of empirical anti-reflux pharmacological therapy in some cases, and performing a spirometry with bronchodilator test and hemogram if an etiological diagnosis was not reached. The panelists agreed on a list of diseases that PCPs should assess before referring CC patients. Algorithms were developed for initial assessment and targeted referral of patients with CC from primary care. Conclusion: This study provides the perspective of different medical specialists on how to perform a basic assessment of CC patients in primary care and how and when to refer patients to other specialists. [ABSTRACT FROM AUTHOR]

The article describes the supply and demand of programs for imprisoned perpetrators of intimate partner violence and their consequences on recidivism in a Spanish penal system with multiple interventions. Four aspects are studied with descriptive, multinomial, survival, and canonical correlation analyses—programs' features (number, content, duration, combinations, compliance); users and nonusers' characteristics (socioeconomic profiles, criminological histories, incarceration experiences); the ensuing outcomes (prison behavior and postrelease recidivism); and the profiles of the clients benefiting the most and least from them. The results show great heterogeneity in program supply and in how they are taken, and marked differences in the profiles of nonusers and users of programs of different durations. This helps interpret the main finding that short-program users have lower rates of recidivism, partly due to the programs' more appropriate formats and partly due to the users' less problematic characteristics and higher opportunities to take them. Policy recommendations are accordingly made. [ABSTRACT FROM AUTHOR]

Porcine brucellosis, which is caused by Brucella suis biovar (bv) 2, is a re-emerging disease that causes reproductive problems in pigs in Europe. The pathogenesis and lesions of B. suis intrauterine infection are poorly characterized; characterization could facilitate the diagnosis and investigation of porcine brucellosis. We collected samples of placentas and fetuses for histologic and microbiologic studies during an outbreak of abortions on a pig-breeding farm in Spain. Brucella was cultured from the vaginal swabs obtained from sows that had aborted, some placentas, and fetal tissues (spleen, liver, lung, gastric content); molecular testing confirmed B. suis bv 2 infection. Histologically, there was necrotizing and hemorrhagic placentitis; suppurative hepatitis; lymphoid depletion and sinusoidal histiocytosis in the spleen, lymph nodes, and thymus; and bronchointerstitial pneumonia. Hemorrhages were observed in the umbilical cord, heart, kidneys, and brain. We detected Brucella by immunohistochemistry (IHC) in all of the placentas and fetal organs studied, specifically in the trophoblasts of the chorionic epithelium, in the cytoplasm of macrophages in the chorionic stroma, and extracellularly in necrotic debris. Furthermore, we assessed the lymphocyte population in the placentas through the use of IHC (anti-CD3, anti- Pax5 antibodies), revealing that the lymphocytic response was composed of T cells but not B cells. [ABSTRACT FROM AUTHOR]

This paper examines the evolution of the Spanish gasoline market from the abolition of the state oil monopoly (January 1993) to "complete" liberalisation (October 1998). With the restructuring of the Spanish oil sector during the 1980s and early 1990s, a highly concentrated oligopoly emerged in the automotive fuels market. A system of price ceilings replaced the state administered prices in July 1990. Since then, new domestic and foreign operators have entered the market, particularly along the coast, near import terminals. Prices went up and then declined. These developments can be explained by an interplay of factors such as: the gradual decline in co-operation among the Spanish firms; the loss of market share of the largest of these, Repsol; the entry of independent operators and supermarkets; and the impact of the ceiling price system. By mid-1998 this system was abolished as the government considered it an "impediment" to further market liberalisation. However, some crucial barriers to the entry of new suppliers remain. [ABSTRACT FROM AUTHOR]

The increased use of smartphones in web survey responding did not only raise new research questions but also fostered new ways to research survey completion behavior. Smartphones have many built-in sensors, such as accelerometers that measure acceleration (i.e., the rate of change of velocity of an object over time). Sensor data establish new research opportunities by providing information about physical completion conditions that, for instance, can affect response quality. In this study, we explore three research questions: (1) To what extent do respondents accept to comply with motion instructions? (2) What variables affect the acceleration of smartphones? (3) Do different motion levels affect response quality? We conducted a smartphone web survey experiment using the Netquest opt-in panel in Spain and asked respondents to stand at a fix point or walk around while answering five single questions. The results reveal high compliance with motion instructions, with compliance being higher in the standing than in the walking condition. We also discovered that several variables, such as the presence of third parties, increase the acceleration of smartphones. However, the quality of responses to the five single questions did not differ significantly between the motion conditions, a finding that is in line with previous research. Our findings provide new insights into how compliance changes with motion tasks and suggest that the collection of acceleration data is a feasible and fruitful way to explore survey completion behavior. The findings also indicate that refined research on the connection between motion levels and response quality is necessary. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19 pandemic has challenged healthcare systems worldwide. The aim of this study was to assess the results of a Respiratory Telerehabilitation Program implemented to patients post-COVID-19 in postacute phase of mild to critical course of COVID-19 who had persistent respiratory symptoms and had not received any vaccination. The intervention was performed during confinement. Methods: A quasi-experimental nonrandomized study was conducted in Spain during confinement. Respiratory Telerehabilitation Program was guided by a specialized physical therapist through a web platform (Zoom by Zoom Video Communications, San Jose, CA, USA). Participants were recruited through social webs. Outcome measures included respiratory rate, heart rate, percutaneous oxygen saturation, Mahler's Dyspnea Index, anxiety status, and quality of life [EuroQol 5 Dimension 5 (EQ-5D)]. Results: A total number of 148 participants were recruited, with a final number of 100 participants completing the protocol (50 experimental group (EG)/50 control group (CG)). A total of 500 telerehabilitation sessions were performed for this study. In the EG, pre–post intervention comparative analysis showed significative changes in Mahler's functional dyspnea (p < 0.001), the State-Trait Anxiety Inventory (p < 0.001), oxygen saturation (p < 0.001), heart rate (p < 0.001), quality-of-life questionnaire (p < 0.001), and respiratory rate (p < 0.001). Participants in the CG showed an improvement in all the variables, but the differences were not statistically significant except in Mahler's functional dyspnea (p = 0.001) and in the quality-of-life questionnaire (p = 0.043). Percentage changes in pre–post intervention were calculated and compared between EG and CG. There were statistically significative differences in all the outcomes in favor of the EG. Conclusion: The implementation of a pulmonary telerehabilitation program for COVID-19 not vaccinated survivors in postacute phase with mild to critical course of COVID-19 with respiratory sequelae has proven its benefits in cardiorespiratory variables and dyspnea-related anxiety. [ABSTRACT FROM AUTHOR]

Background: Available evidence suggests that menstrual health and management have been impaired during the COVID-19 syndemic. However, research in this area is scarce, and it is failing to voice the experiences of women and people who menstruate regarding their menstrual experiences. Objectives: This study aimed to explore the experiences of menstrual health and menstrual management among women and people who menstruate in the Barcelona area (Spain) during the COVID-19 syndemic. Design: This is a qualitative study, conducted taking a critical feminist approach, is embedded in the 'Equity and Menstrual Health in Spain' project. Methods: It includes photo-elicitation individual interviews with 34 women and people who menstruate in the area of Barcelona (Spain). Data were collected in person and through telephone calls between December 2020 and February 2021. Analyses were performed using Thematic Analysis. Results: Main findings navigated through the menstrual changes experienced by some participants, especially women living with long COVID-19, and the barriers to access healthcare and menstrual products during COVID-19. While some participants experienced menstrual poverty, this did not appear to be exacerbated during COVID-19. Instead, access to menstrual products was compromised based on products' availability and mobility restrictions. Menstrual management and self-care were generally easier, given that menstrual experiences were almost exclusively relegated to private spaces during lockdown periods. Conclusions: Our findings highlight the need to further research and policy efforts towards promoting menstrual health and equity, considering social determinants of health, and taking intersectional and gender-based approaches. These strategies should be further encouraged in social and health crises such as the COVID-19 syndemic. [ABSTRACT FROM AUTHOR]

Vancomycin-resistant enterococci (VRE) infections and outbreaks are still infrequent in Spain. A six-month outbreak, which took place in a haematology ward, its control and management are described in this study. A total of 22 patients were colonised and two bloodstream infections occurred during this period. Even though there were two waves of new colonised patients, a multidisciplinary approach, quick interventions and enhanced infection control policies were required in order to control this outbreak. [ABSTRACT FROM AUTHOR]

The aim is to analyse that, during the current pandemic situation, the reduction in the number of cases of influenza suggests that the non-pharmaceutical interventions (NPIs) applied to contain the expansion of SARS-CoV-2 also affect the influenza expansion. We analyse the interaction of influenza and SARS-CoV-2 spread based on an extended SEIRD model for the Catalonia region in Spain. We show that the dynamic evolution of the spread of SARS-CoV-2 and influenza generates a small interference. This interference causes a small reduction in the number of cases of seasonal influenza, reducing its expansion over the population. Other elements like the face mask mandates, social distancing and hand cleaning boost the reduction in both expansions. Influenza expansion will present a small reduction in the number of cases due to the interaction with SARS-CoV-2 expansion but mainly because the NPIs applied to the population. [ABSTRACT FROM AUTHOR]

Community members such as migrants are involved to collect data but not included in the actual research process, for example, in developing research guidelines or in using research tools such as data analysis. Participatory methodology enables investigating a specific issue while including the community involved. In the So-Close project, we applied this approach to investigate how we study migration and the role of the cultural heritage of forced migration through four multi-stakeholders participatory focus groups (FGs) in Spain (involving Refugees, NGO and Cultural Institutions representatives, Academics and Policy-Makers). From the FGs, emerged the need to investigate complex issues from various angles and contexts to create sustainable, community-approved, and shared solutions. [ABSTRACT FROM AUTHOR]

Pithomycotoxicosis (facial eczema) is a seasonal hepatogenous photosensitization of sheep caused by the ingestion of sporidesmin contained in the spores of the fungus Pithomyces chartarum. We describe 4 cases of obstructive rhinopathy associated with chronic pithomycotoxicosis naturally occurring in the north of Spain. Sheep were 5 to 7 years old and Latxa breed. A detailed clinical study was conducted together with computerized tomography examination and completed by necropsy and histopathology. All sheep developed a permanent narrowing of the nasal lumen close to the nostrils causing inspiratory dyspnea and snoring. Computerized tomography demonstrated a significant increase of soft tissue in the rostral nasal cavity. Elevated gamma-glutamyl transferase, alanine aminotransferase, and lipase were noted on serum biochemistry. At necropsy, liver atrophy and fibrosis associated with chronic pithomycotoxicosis was identified in 3 of the sheep. All sheep had whitish elevations and rough surfaces on the alar folds and areas adjacent to the nasal surfaces. Histopathologic assessments, which included histochemical and immunohistochemical techniques, of the nasal lesions identified moderate to severe arteriosclerosis in 21.5% to 61.9% of the small arteries evaluated with surrounding fibrosis and edema. No changes associated with hypersensitivity reactions were found. These lesions were similar to the ones described in blood vessels of the liver in chronic pithomycotoxicosis and in our cases. The results of this study suggest a direct action of the sporidesmin on the rostral nasal cavity. Further studies are needed to analyze the impact of the sporidesmin on the sheep nasal mucosa. [ABSTRACT FROM AUTHOR]

Schools, as in the case of other organizations, face complex challenges due to generational phenomena. In addition to an increasingly aging teaching workforce, schools are becoming more age-diverse, with coexisting multiple generations. Two consequences of this situation are the declining availability of relevant and critical knowledge for schools as teachers retire and the difficulties associated with maintaining professional relationships among teachers of different generations. These challenges have highlighted the significance of understanding the relevance of generations of teachers and identifying ways to build on generational diversity. Specifically, intergenerational collaboration and learning are needed to meet these challenges. Accordingly, this study aims to (1) examine generational diversity among teachers, (2) inquire into their interactions and the learning processes accompanying collaborative experiences in professional development, and (3) explore how these experiences and processes can enhance professional learning and practice. To this end, an exploratory mixed methods research project is conducted, comprising a multiphase design with two exploratory sequential studies (QUAL→quan). The participants are a sample of beginner, veteran, and retired teachers from Spain's publicly funded schools. In the qualitative strands of the study, data collection techniques comprise focus groups and semi-structured in-depth interviews followed by thematic analysis. In the quantitative strands, questionnaires (a multidimensional scale and a survey experiment) are the major data sources, which are subjected to descriptive and inferential statistical (factor and conjoint) analyses. The focus is primarily on the qualitative strands. [ABSTRACT FROM AUTHOR]

Organization research on stigma has mostly focused on the stigmatized, limiting the scope for exploring what is possible and lacking recognition of the structural conditions and unequal power relations that create and sustain stigma. Consequently, it overlooks how actors can organize to resist and potentially overcome stigmatization altogether. Addressing this question empirically, we studied the long-term unemployed in Spain using a longitudinal qualitative research design. We develop a typology of responses to stigmatization – getting stuck, getting by, getting out, getting back at and getting organized – that advances our understanding of stigma in several ways. First, our typology captures stigma as a multilevel phenomenon. Second, it makes explicit that stigma can only be understood in relation to its socio-historical contexts and unequal relations of power. Third, it captures how resisting stigma needs to be a collective enterprise and advances the importance of organizing to both challenge stigmatization and explore alternatives. [ABSTRACT FROM AUTHOR]

We study the determinants of the maturity structure of public debt, taking as case study the regional governments of Spain. The structure of public debt is a source of vulnerability and contagion in public debt markets. Our empirical models show that regional governments reacted to increasing financing needs by leaning more toward short-term debt, instead of resorting to longer-term debt to seek the minimization of liquidity risks, a fact that is consistent with theories that predict the willingness of public financial managers to reveal to the markets their fundamental solvency and their commitment to fiscal (consolidation) plans. At the same time, we find that increased central government transfers raise the tendency of markets to hold long-term instruments, which may reflect their expectation that regional debt be bailed out/guaranteed by the center. Finally, we do not find evidence of significant differences in the maturity structure depending on the quality of the issuer. [ABSTRACT FROM AUTHOR]

Despite the recent proliferation of sharing economy platforms, little is known about what drives providers (individual people who own assets) to enter onto a sharing economy platform. The platform does not own the assets that underlie transactions but depends on individuals to provide them. In the burgeoning market of home rental properties, we investigate the role of macro-level factors to explain geographical differences in the number of entries of providers with diverse motivations onto a sharing economy platform. Using a sample of listings posted by property owners on the Airbnb platform across different cities in Spain between 2010 and 2015, we examine how social and economic motivations of providers interact with macro-level antecedents to affect their entry. We show that macro-level drivers have a different effect on the entry of providers depending on the degree of face-to-face interaction between host and guest. We find that industry growth and the availability of underused assets increase the entry onto the platform of hosts who have little face-to-face interaction with guests, while the strictness of regulation decreases their entry. By contrast, the entry of hosts with high face-to-face interaction with guests is not affected by these factors. We discuss theoretical and research implications of the role of social interaction in provider entry and offer practical advice for those in the sharing economy about the role of social interaction in driving providers onto their platforms. [ABSTRACT FROM AUTHOR]

The article presents the highlights of a joint meeting of the Royal Society of Medicine's Colo-Proctology Section in Barcelona, Spain in 1985. The meeting lasted for three days with sessions on various topics including carcinoma of colon and rectum. The first morning was spent discussing Crohn's disease. The second day was spent discussing the treatment for colorectal cancer. Several topics of papers discussed during the meeting include minor anal conditions and a variety of colonic problems.

Gaining access to formal institutions can be problematic for ethnographers. This is especially so when it comes to prisons where people are incarcerated by the state against their will for various crimes committed by them. Here, in such highly controlled environments, some authors have pointed out the lack of openness of correctional facilities to inquiry and the limited cooperation forthcoming from the various authorities that oversee them. Accordingly, this article examines the difficult processes undertaken to negotiate access to a high-security prison in Spain, and then maintain his role there for a 2-year period as a volunteer sports educator in order to explore the multiple meanings given to sport and physical activity in the prison setting by the prisoners, educational staff and the guards. The emotional costs and ethical dilemmas of sustaining working relationships with these different groups over time in order to achieve specific research goals are highlighted and reflections for future studies of prison life are offered. [ABSTRACT FROM AUTHOR]