Search

At present, aquaculture is still subject to social debate. This paper analyzes its social acceptance compared to traditional fishing, mainly by applying the structural equations methodology. This t...

Resumen Introduccion La obesidad morbida es una enfermedad con multiples comorbilidades y limita de forma considerable la calidad y esperanza de vida. La cirugia bariatrica es una alternativa terapeutica eficaz en estos pacientes; actua sobre la disminucion o absorcion de nutrientes, consiguiendo una perdida ponderal significativa y mantenida en el tiempo. El objetivo del estudio es determinar los resultados a largo plazo en cuanto a eficacia en perdida de peso, resolucion de comorbilidades y mejoria de calidad de vida de nuestros pacientes. Material y metodos Estudio retrospectivo que incluye a todos los pacientes intervenidos consecutivamente de cirugia bariatrica laparoscopica en nuestro centro durante 10 anos. En todos los pacientes se recogieron los datos clinicos y antropometricos previos a la cirugia y en sucesivas visitas protocolizadas despues de la cirugia. Al final del seguimiento, se utilizo cuestionario BAROS que registra perdida ponderal, resolucion de comorbilidades, complicaciones y el test de calidad de vida rellenado por los pacientes. Resultados Trescientos cincuenta y tres pacientes (303 BPGYR y 50 GV), 105 hombres y 248 mujeres, con edad media de 42,14 ± 10,16 anos, IMC 48,63 kg/m2 y el 68,5% tenia alguna comorbilidad. El seguimiento medio fue de 5,7 ± 2,6 anos al 96,7% del total de intervenidos. Al final del seguimiento el PSP fue 59,00 ± 19,50, PEIMCP 68,15 ± 22,94, IMC final 32,65 ± 5,98 y un 31,3% de los pacientes con PSP ≤ 50. Resolucion de comorbilidades: 48,7% hipertension arterial, 70,3% DM2, 82,6% dislipidemia y 71,6% sindrome de apnea-hipopnea del sueno. El resultado del test de calidad de vida fue 1,51 ± 0,93, con un 67,2% de pacientes con calidad buena o muy buena, con la puntuacion mas alta en autoestima, seguido de actividad fisica, laboral y social, y la ultima la sexual en la que solo el 40,3% mejoran. El score BAROS fue de 4,35 ± 2,06 con el 84,7% de pacientes en rango de bueno a excelente y un 91,2% del total de los pacientes volveria a intervenirse. Conclusiones La cirugia bariatrica es una tecnica eficaz para disminuir peso, resolver comorbilidades y mejorar la calidad de vida de los pacientes con obesidad morbida, principalmente en el aspecto fisico. En nuestra serie, el porcentaje de seguimiento y tiempo medio se situa dentro del rango de los estandares de calidad establecidos.

To describe clinical features in patients with inflammatory myopathies (IMs) from the Argentine Registry of Inflammatory Myopathies, and their relationship with myositis-specific antibodies (MSAs). This cross-sectional study included 360 adult patients with dermatomyositis (DM), polymyositis (PM), and inclusion body myositis. Demographics, clinical, and serological characteristics were retrospectively recorded (2016–2019). MSAs were determined by immunoblotting. Patients who were positive for anti-Jo-1, Mi-2, and MDA5 were compared against a group of patients, taken as reference group, who were negative for all MSAs. Women 72%, median age at diagnosis was 47.3 years (18–82). The most frequent subtypes were DM (43.9%) followed by PM (30%).The most frequent MSAs were anti-Jo-1 (51/317), 16.1%; MDA5 (12/111), 10.8%, and Mi-2 (23/226), 10.2%. Anti-Jo-1 was associated (p

This study aims to analyze three main variables of electronic word-of-mouth (eWOM) – impact on bookings volume, main attributes of client satisfaction, and best strategy for responding to unfavorab...

Purpose This paper aims to identify the gap existing between the current and future needs regarding digital skills, as well as the training needs for the 2030 horizon in Spanish tourism organisations belonging to five subsectors (accommodation, food and beverage, destination management, visitor attractions and travel agents and tour operators). Design/methodology/approach A mixed research methodology, which combined qualitative and quantitative approaches, served as the basis for this research work. Qualitative research took place between April 2018 and March 2019 and went through three stages: desk research, focus groups and interviews. Quantitative research developed from January to June 2019 by means of an online administered survey (Qualtrics). In total, 139 Spanish tourism organisations participated. Findings Tourism organisations analysed consider that digital skills are still an unresolved issue. Employees are willing to operate in environments where technology has an increasingly leading role. However, organisations believe that there remains a lot to be done until employees have, both at present and by the year 2030, a suitable level of digital skills enabling them to operate in the tourism subsectors analysed. Originality/value This study is framed within the European project called Next Tourism Generation (NTG), which involves 14 partners from eight countries. The findings obtained will help to develop a Europe Blueprint Strategy for digital skills within the tourism and hospitality sector, to provide employees, employers, entrepreneurs, teachers, trainers and students with a set of core digital skills represented in a skills matrix.

Summary Background Belimumab is approved for the treatment of active systemic lupus erythematosus (SLE). Although clinical trials showed a favourable benefit–risk profile, numerical differences in the incidence of mortality and adverse events of special interest (AESIs) have been reported. We assessed the frequency of these events in patients with SLE receiving belimumab or placebo plus standard therapy. Methods BASE was a double-blind, randomised, placebo-controlled, phase 4 trial done in 33 countries. Adults with active SLE were randomly assigned (1:1) to receive intravenous belimumab (10 mg/kg) or placebo, plus standard therapy, for 48 weeks. The primary endpoints were incidences of all-cause mortality and AESIs during the on-treatment period (first-to-last study drug dose + 28 days). Safety analyses were done in the as-treated population (patients grouped by actual treatment received >50% of the time). This study was registered with ClinicalTrials.gov ( NCT01705977 ). Findings Between Nov 27, 2012, and July 28, 2017, we randomly assigned 4018 patients. The as-treated population included 2002 patients in the belimumab group versus 2001 in the placebo group. Ten (0·50%) patients in the belimumab group died versus eight (0·40%) in the placebo group (difference 0·10%, 95% CI −0·31 to 0·51). Incidences were similar in the belimumab and placebo groups for serious infections (75 [3·75%] of 2002 vs 82 [4·10%] of 2001; difference −0·35%, 95% CI −1·55 to 0·85), opportunistic infections and other infections of interest (36 [1·80%] vs 50 [2·50%]; −0·70%, −1·60 to 0·20), non-melanoma skin cancers (4 [0·20%] vs 3 [0·15%]; 0·05%, −0·21 to 0·31) and other malignancies (5 [0·25%] vs 5 [0·25%]; 0·00%, −0·31 to 0·31). A higher proportion of patients in the belimumab group than in the placebo group had infusion and hypersensitivity reactions (8 [0·40%] vs 2 [0·10%]; 0·30%, −0·01 to 0·61), serious depression (7 [0·35%] vs 1 [0·05%]; 0·30%, 0·02 to 0·58), treatment-emergent suicidality (28 [1·42%] of 1972 patients vs 23 [1·16%] of 1986; 0·26%, −0·44 to 0·96), and sponsor-adjudicated serious suicide or self-injury (15 [0·75%] of 1972 patients vs 5 [0·25%] of 1986; post hoc difference 0·50%, 0·06 to 0·94). Interpretation In line with previously published data, incidences of all-cause mortality and AESIs were similar in patients given belimumab and placebo, except for serious infusion or hypersensitivity reactions, serious depression, treatment-emergent suicidality, and sponsor-adjudicated serious suicide or self-injury events. Funding GSK.

Resumen Antecedentes y objetivo La osteoporosis se considera un trastorno generalizado del esqueleto en el que existe una alteracion de la resistencia osea que predispone a la persona a un mayor riesgo de fractura. Este estudio transversal pretende recoger y presentar las principales caracteristicas clinicas de los pacientes que acuden a la consulta de los medicos internistas en Espana. Conocer estas caracteristicas podria facilitar la puesta en marcha de planes de actuacion para mejorar la atencion de estos pacientes de manera mas eficaz y eficiente. Material y metodos A traves del analisis del registro OSTEOMED (Osteoporosis en Medicina Interna), este trabajo presenta las principales caracteristicas clinicas de los pacientes con osteoporosis que acudieron a las consultas de Medicina Interna en 23 centros hospitalarios espanoles entre 2012 y 2017. Se han analizado los motivos de consulta, los valores densitometricos, la presencia de comorbilidades, el tratamiento prescrito y otros factores relacionados con el estilo de vida. Resultados En total se evaluo a 2.024 pacientes con osteoporosis (89,87% mujeres, 10,13% hombres). La edad media de los pacientes fue de 64,1 ± 12,1 anos (mujeres, 64,7 ± 11,5 anos; hombres, 61,2 ± 14,2 anos). No hubo diferencia entre sexos en la historia de caidas recientes (9,1-6,7%), mientras que si se aprecio en la ingesta diaria de calcio de lacteos (553,8 ± 332,6 mg en mujeres vs. 450,2 ± 303,3 mg en hombres; p Conclusiones Estos resultados definen el perfil del paciente con osteoporosis que acude a la consulta de Medicina Interna en Espana. Ademas, ponen de manifiesto el caracter multisistemico de esta entidad que junto con su elevada prevalencia determinan que las consultas especificas de Medicina Interna dedicadas a su manejo son el lugar adecuado para la atencion de estos pacientes.

[EN]: [Introduction]: Many patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications. [Patients and methods]: HCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication. [Results]: Data from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p = 0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p = 0.006 and 84.7%, p < 0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09–0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48–13.92). [Discussion]: Adherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence., [ES]: [Introducción]: Muchos pacientes con virus de la hepatitis C (VHC) presentan comorbilidades que requieren tratamientos complejos. Queremos determinar el impacto del tratamiento con antivirales de acción directa (AAD) para el VHC en la adherencia a medicaciones concomitantes e identificar factores predictivos de no adherencia a comedicaciones. [Pacientes y métodos]: Pacientes tratados con AAD entre 2015 y 2016 se incluyeron en el estudio y se comparó su adherencia a medicaciones concomitantes antes y durante la terapia con AAD en un periodo de tiempo similar. Múltiples variables fueron analizadas para identificar factores asociados a la no-adherencia. Se creó un modelo de regresión multivariable para predecir la no adherencia a medicaciones concomitantes. [Resultados]: Se analizaron datos de 214 pacientes en tratamientos concomitantes. Tras iniciar la terapia con AAD, la adherencia a las comedicaciones disminuyó respecto a la adherencia en ausencia de AAD (29,9% respecto al 36,9%; p = 0,032). El análisis univariante demostró que la polifarmacia y la enfermedad vascular estaban asociadas negativamente con la adherencia a las medicaciones concomitantes (87,8%, p = 0,006 y 84,7%, p < 0,001, respectivamente). El análisis multivariante indicó que la coinfección con VIH/VHB estaba asociada con la adherencia (OR: 0,19; IC 95%: 0,09-0,39), mientras que la polifarmacia era un predictor de no adherencia (OR: 4,54; IC 95%: 1,48-13,92). [Discusión]: El inicio del tratamiento con AAD disminuye la adherencia a la comedicación en pacientes con VHC. La polifarmacia es predictor de no adherencia mientras que la coinfección con VIH/VHB la reduce. Aquellos pacientes polimedicados y en tratamiento con AAD podrían beneficiarse de un seguimiento estrecho para aumentar su adherencia., JAP has received a research extension grant from the Pro-grama de Intensificación de la Actividad de Investigacióndel Servicio Nacional de Salud Carlos III (I3SNS), fromSpain and financial support from ISCIII-Subdirección Gen-eral de Evaluación and the European Regional Development Fund (ERDF) (www.red.es/redes/inicio) (RD16/0025/0040and RD12/0017/0012).Medical Writing support was provided by Vanessa Marfil (Medical Science Consulting, Valencia). This service was funded by Gilead.

According to the literature on ambidexterity, organizations can use structural, contextual or interorganizational approaches to simultaneously explore novel opportunities and exploit existing ones. So far, however, the possibility of combining the three approaches to maximize organizational learning has not been investigated. To deepen this aspect, this paper has as its aim, on the one hand, to offer an integrated vision of organizational ambidexterity, proposing and contrasting a model which —under the dynamic capabilities approach— sees ambidexterity as the result of combining the most important antecedent factors mentioned in the literature, but which have hitherto been studied only on an individual basis. We are referring to structural differentiation, organizational context, and interorganizational relations. On the other hand, the model suggested establishes the mediation role exerted by the organizational context between structural differentiation and interorganizational relations when it comes to reaching ambidexterity. Finally, it is our intention to identify the effects of ambidexterity on performance. A variance-based structural equation modeling (Partial Least Squares) was applied to a sample of Spanish hotel firms. The results obtained show that organizational ambidexterity can be reached resolving the exploration and exploitation tensions both across different organizational units (structural differentiation) and choosing to resolve those tensions outside the firm’s boundaries (interorganizational relations), and taking advantage of an organizational context which, in addition to impacting directly on the achievement of ambidexterity, also appears as a mediator variable between the other two antecedents and ambidexterity, which in turn tells us that this context is the one which enables organizations to carry out the integration of the various (internal or external) knowledge sources. On the other hand, the ambidexterity thus defined, has shown a positive result on organizational performance.

La importancia de la actual crisis económica así como sus efectos sobre el empleo en España en sectores como el de la construcción, motivan el tema de análisis de este artículo cuyo objetivo es conocer la evolución del empleo en las diferentes regiones españolas antes (2001-2006) y durante la actual crisis (2007-2012) en relación con el conjunto de la nación y con las regiones vecinas utilizando, para ello, un análisis shift-share espacialmente modificado. Los resultados muestran el decrecimiento y disminución del peso de la construcción en las diferentes regiones durante la crisis a favor del sector agrícola y servicios. Sólo destaca Castilla-La Mancha como la comunidad en la que el empleo en la construcción crece por encima de la media nacional y tiene mayor peso que en sus regiones vecinas.

Sustainable tourism refers to those tourism activities that respect the natural, cultural, and social en- vironment and the values of a community, which allows it to enjoy a positive exchange of experiences between residents and visitors, where the relationship between the tourist and the community is fair and the benefits of the activity are evenly distributed, and where visitors have a truly participatory attitude in their travel experience. One of the main keys to sustainable tourism is the involvement of the visitors and the host and local community. 2019-20

Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia.The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient.Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55-0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO.

This paper studied the effect of the socio-economic variables related to social vulnerability on wildfire characteristics (ignitions, hectares burned, and ratio hectares burned/ignitions) in Galicia, Spain. The study recognized that wildfires present threats to people and communities, so actions might be taken to address vulnerabilities in ways that mitigate the negative impacts of such fires. Our final aim was to identify those variables that are relevant to the starting and spreading of wildfires that can help improve the prevention and mitigation of wildfires. Panel data collected over 15 years (2001–2015) for the municipalities of Galicia were used in this study. The results show that vulnerability-related socio-economic factors affect the number of wildfires and the extent of the destruction they cause. Indeed, the progressive abandonment of rural areas is one of the most important problems that increases the occurrence of wildfires. This abandonment is connected to population factors such as aging or low density of population, economic factors such as the decrease in income or low cadastral value, and territorial factors such as the decrease in rustic hectares and ranches. We conclude that prevention and mitigation focused on areas prone to wildfires could be enhanced by taking into account these variables.

Introduction: Alpha-1 antitrypsin deficiency (AATD) is a rare respiratory condition characterized by abnormal inflammation, where neutrophils play a key role. Excessive neutrophil activation leads to an increase in the oxygen (O2) intake, causing local hypoxia and increased tissue-injury capacity. Tissue hypoxia is part of the inflammatory process so neutrophils can function effectively under these conditions. However, the mechanisms by which neutrophils mediate tissue damage under hypoxia remain unclear. The study aimed to determine whether hypoxia modifies the cytokine profile in AATD patients. Methods: Neutrophils from 22 AATD patients (6 MZ; 9 SZ; 7 ZZ) and 7 controls (MM) were exposed to hypoxia (1% O2) or normoxia (21% O2) for 4hrs. Pro- and anti-inflammatory cytokine levels were measured with a Luminex Bead-Based Multiplex Assay. Results: Neutrophils from AATD patients (SZ; ZZ) exposed to hypoxia showed an augmented proinflammatory cytokines release (IL-8, IL-12, IL-6, IL-23, IL-4, MIPα, MIPβ) compared to those of controls. Interestingly, the tumour necrosis factor (TNFα) is decreased in AATD patients compared to controls. Conclusion: Hypoxia increases the neutrophil release of proinflammatory cytokines in AATD patients compared to controls, contributing to lung damage in these patients. Funding: Sociedad Valenciana de Neumologia 2015 and 2017 and ISCIII PI17/01250 grants and European Regional Development Funds

Intercultural communication is not only a necessary tool for most international workplaces, but also for higher education so as to better prepare students for their future jobs. To test how intercu...

Introduction Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. Purpose To identify disease and non-disease related factors associated with NP manifestations in early SLE. Methods We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. Statistical methods Independent factors associated with NP involvement were identified using a multivariable Cox regression model. Results Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282–2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335–2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085–5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074–5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130–2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441–0.934, p = 0.0206). Conclusions Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement.

PurposeThis study aims to analyze the relationships between knowledge management, internationalization and ambidexterity, also exploring the influence of these variables on Spanish hotel chain performance. Hypotheses are proposed from the dynamic capabilities and knowledge-management views of the firm.Design/methodology/approachThe research model was tested on a sample of 70 Spanish hotel chains applying variance-based structural equation modeling (partial least squares).FindingsThe results show that Spanish hotel chains that use knowledge management processes achieve a greater degree of internationalization and this increases their organizational ambidexterity. This study can also confirm a direct, positive and significant relationship between organizational ambidexterity and performance.Research limitations/implicationsThis research shows that knowledge may be considered an essential resource to improve hotel firms’ results. Spanish hotel firms should manage their knowledge to stimulate international activity because this could enhance learning capabilities related to organizational ambidexterity and positively influence performance.Originality/valueThe present paper analyzes relationships between variables that had not previously been analyzed in a single model, including knowledge management, the degree of internationalization of hotel chains, ambidexterity and performance.

Synaptic vesicle protein 2A (SV2A), the target of the antiepileptic drug levetiracetam (LEV), is expressed ubiquitously in all synaptic terminals. Its levels decrease in patients and animal models of epilepsy. Thus, changes in SV2A expression could be a critical factor in the response to LEV. Epilepsy is characterized by an imbalance between excitation and inhibition, hence SV2A levels in particular terminals could also influence the LEV response. SV2A expression was analyzed in the epileptic hippocampus of rats which responded or not to LEV, to clarify if changes in SV2A alone or together with glutamatergic or GABAergic markers may predict LEV resistance. Wistar rats were administered saline (control) or pilocarpine to induce epilepsy. These groups were subdivided into untreated or LEV-treated groups. All epileptic rats were video-monitored to assess their number of seizures. Epileptic rats with an important seizure reduction (&gt, 50%) were classified as responders. SV2A, vesicular γ-aminobutyric acid transporter and vesicular glutamate transporter (VGLUT) expression were assessed by immunostaining. SV2A expression was not modified during epilepsy. However, responders showed ≈55% SV2A-VGLUT co-expression in comparison with the non-responder group (≈40%). Thus, SV2A expression in glutamatergic terminals may be important for the response to LEV treatment.

Aims To assess severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during labor and delivery with polymerase chain reaction (PCR) and using immunoglobulin G and M testing to correlate with maternal and perinatal outcomes. Main methods Pregnant women admitted for labor and delivery at two Spanish hospitals were screened for SARS-CoV-2 infection by PCR test and by detection of serum immunoglobulins G and M. Maternal and perinatal outcomes were compared in women with laboratory evidence of SARS-CoV-2 infection with those with negative tests. Key findings Between March 31st and September 30th, 2020, 1211 pregnant women were screened for SARS-CoV-2 infection. The prevalence of laboratory evidence of SARS-CoV-2 infections was 5.4% (n = 65), corresponding to (i) 22 ongoing infections at admission, including two with mild clinical symptoms and 20 asymptomatic women; (ii) 43 cases of previous SARS-CoV-2 exposure; (iii) and 1146 women who were negative for both SARS-CoV-2 PCR and serological test. None of the screened mothers required hospital admission for coronavirus disease before or after delivery, nor were any of the newborns admitted to the intensive care unit. All newborns from mothers with positive PCR on admission were PCR negative. There were no significant differences in maternal or perinatal outcomes among the three studied groups. Significance Ongoing or previous SARS-CoV-2 infection with asymptomatic or mild clinical symptoms detected during screening in pregnant women at labor and delivery do not have a higher rate of adverse maternal or perinatal outcomes.

The hospitality sector has been severely affected by the COVID-19 pandemic, and the situation of rural accommodation is particularly noteworthy due to its close relationship with the environment. In this context, the role of CSR as a strategy that contributes to social, economic, and environmental well-being takes on a crucial role. The main objective of this paper is to contribute to the early scientific literature analysing the influence of CSR strategies on the resilience of rural hotels in the wake of COVID-19. A total of 100 Spanish managers’ responses were analysed through PLS-SEM. The findings demonstrate a positive and significant impact of CSR strategies on resilience levels, and the effect of resilience on hotel performance. Additionally, we have found a mediating and moderating effect in the above-mentioned relationship. In terms of moderation, we show that the relationship is intensified when hotels possess an official sustainability certificate. And in terms of mediation, COVID-19 actions carried out by rural accommodations mediate the CSR-resilience relationship. Thus, the contribution of this study lies in providing solid long-term strategic alternatives based on sustainability to enable rural hotels to cope with cyclical crises and provide new insights in the hospitality industry literature.

Recent literature in the domain of environmental management suggests that employees' behavior is vital to enhance environmental performance. Despite this, little effort has been made to study how human resource management is linked with the environmental performance. Even less attention has been given to a joint consideration of green innovation and green human resources management and their contribution to environmental performance. The purpose of the current study is to investigate the interrelationship between green high performance work system (GPWS) and environmental performance through the mediation of green ambidexterity. A variance-based structural equation modeling (partial least squares) was applied to a sample of Spanish hotel firms. The results indicate that GHPWS facilitate the development of green ambidexterity, and that this variable contributes to improved environmental performance. The results of this study make several contributions to the GHRM and green ambidexterity literature, as well as practical contributions for managers.

REIPI-SEIMC COVID-19 group and COVID@HULP group., [Background] The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality., [Methods] In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model., [Findings] Three distinct phenotypes were derived in the derivation cohort (n=2667)—phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])—and reproduced in the internal validation cohort (n=1368)—phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2·5% (95% CI 1·4–4·3) for patients with phenotype A, 30·5% (28·5–32·6) for patients with phenotype B, and 60·7% (53·7–67·2) for patients with phenotype C (log-rank test p, [Interpretation] Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated., [Funding] Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA., Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA.

Objective To screen pregnant women at risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery using reverse-transcription polymerase chain reaction (RT-PCR) test and serum immunoglobulin (Ig) testing. Method Between March 31 st and August 31 st of 2020, consecutive pregnant women admitted for labor and delivery in a single hospital were screened for SARS-CoV-2 with nasopharyngeal RT-PCR swab tests and detection of serum IgG and IgM. Results We studied 266 pregnant women admitted for labor and delivery. The prevalence of acute or past SARS-CoV-2 infection was 9.0 %, including (i) two cases with respiratory symptoms of SARS-Co-V-2 infection and positive RT-PCR; (ii) four asymptomatic women with positive RT-PCR without clinical symptoms and negative serological tests between two and 15 weeks later; and (iii) two women with false positive RT-PCR due to technical problems. All newborns of the 6 pregnant women with RT-PCR positive had negative RT-PCR and did not require Neonatal Intensive Care Unit admission. There were eighteen asymptomatic women with positive serological IgG tests and negative RT-PCR. Conclusion In our cohort of gravids, we found 2.2 % of women with positive RT-PRC tests and 6.7 % with positive serological tests during the first wave of the SARS-CoV-2 pandemic.

Neuromuscular electrostimulation (NMES) has been used mainly as a method to promote muscle strength, but its effects on improving blood flow are less well known. The aim of this study is to deepen the knowledge about the local and contralateral effects of the application of symmetric biphasic square currents on skin temperature (Tsk). An experimental pilot study was developed with a single study group consisting of 45 healthy subjects. Thermographic evaluations were recorded following the application of NMES to the anterior region of the thigh. The results showed an increase in the maximal Tsk of 0.67% in the anterior region of the thigh where the NMES was applied (p &lt, 0.001) and an increase of 0.54% (p &lt, 0.01) due to cross-education effects, which was higher when the NMES was applied on the dominant side (0.79%, p &lt, 0.01). The duration of the effect was 20 min in the dominant leg and 10 min in the nondominant one. The application of a symmetrical biphasic current (8 Hz and 400 &mu, s) creates an increase in the maximal Tsk at the local level. A temperature cross-education effect is produced, which is greater when the NMES is applied on the dominant side. This could be a useful noninvasive measurement tool in NMES treatments.

Background: Epidemic outbreaks have significant impact on psychological well-being, increasing psychiatric morbidity among the population. We aimed to describe the early psychological impact of COVID-19 and its contributing factors in a large Spanish sample, globally and according to mental status (never mental disorder NMD, past mental disorder PMD, current mental disorder CMD). Methods: An online questionnaire was conducted between 19 and 26 March, five days after the official declaration of alarm and the lockdown order. Data included sociodemographic and clinical information and the DASS-21 and IES questionnaires. We analysed 21 207 responses using the appropriate descriptive and univariate tests as well as binary logistic regression to identify psychological risk and protective factors. Results: We found a statistically significant gradient in the psychological impact experienced in five domains according to mental status, with the NMD group being the least affected and the CMD group being the most affected. In the three groups, the depressive response was the most prevalent (NMD = 40.9%, PMD = 51.9%, CMD = 74.4%, F = 1011.459, P

Firm managers play an important role in the implementation of corporate social responsibility (CSR) actions. Education is emerging as the key factor in developing a sense of moral responsibility amongst the business students who will eventually become company managers and decision makers. The aim of this research is, thus, twofold. First, to analyze the existence of a direct positive correlation between university students’ perception of CSR and its impact on business performance; and second, to examine the extent to which two factors (advantages brought by CSR and responsibilities toward stakeholders) act as mediation variables in the aforementioned correlation. The analysis was performed with a sample of 390 business‐related university students. Amongst the potential contributions made by this study we can highlight the possibility of knowing future managers’ way of thinking and of knowing the aspects where educational centers might improve their CSR teaching.

Gene therapy is an alternative therapy in many respiratory diseases with genetic origin and currently without curative treatment. After five decades of progress, many different vectors and gene editing tools for genetic engineering are now available. However, we are still a long way from achieving a safe and efficient approach to gene therapy application in clinical practice. Here, we review three of the most common rare respiratory conditions—cystic fibrosis (CF), alpha-1 antitrypsin deficiency (AATD), and primary ciliary dyskinesia (PCD)—alongside attempts to develop genetic treatment for these diseases. Since the 1990s, gene augmentation therapy has been applied in multiple clinical trials targeting CF and AATD, especially using adeno-associated viral vectors, resulting in a good safety profile but with low efficacy in protein expression. Other strategies, such as non-viral vectors and more recently gene editing tools, have also been used to address these diseases in pre-clinical studies. The first gene therapy approach in PCD was in 2009 when a lentiviral transduction was performed to restore gene expression in vitro; since then, transcription activator-like effector nucleases (TALEN) technology has also been applied in primary cell culture. Gene therapy is an encouraging alternative treatment for these respiratory diseases; however, more research is needed to ensure treatment safety and efficacy.

Background: The tools available for the postural control assessment in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out todetermine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich's ataxia), and to determine whether the pressure mapping is more sensitive than functional tests. Methods: A cross-sectional study was carried out in a random sample of 10 adult patients with neurological involvement. The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test.Results: The pressure mapping showed a higher mean pressure in the people with Friedreich's ataxia compared to other groups. The highest values of maximum pressure and the area of contact were found in users with spinal cord injury.Conclusions: People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. The relation between the pressure mapping variables and the functional tests were numerous, especially in the multiple sclerosis group.

Alpha-1-antitrypsin deficiency (AATD) and primary ciliary dyskinesia (PCD) are underdiagnosed rare diseases showing a median diagnostic delay of five to ten years, which has negative effects on patient prognosis. Lack of awareness and education among healthcare professionals involved in the management of these patients have been suggested as possible causes. Our aim was to assess knowledge of these diseases among paediatricians and medical school students to determine which knowledge areas are most deficient. A survey was designed with questions testing fundamental aspects of the diagnosis and treatment of AATD and PCD. A score equal to or greater than 50% of the maximum score was set as the level necessary to ensure a good knowledge of both diseases. Our results indicate a profound lack of knowledge of rare respiratory diseases among paediatric professionals and medical students, suggesting that it is necessary to increase rare respiratory diseases training among all physicians responsible for suspecting and diagnosing them, this will allow early diagnosis and the setup of preventive measures and appropriate early-stage treatment. The first step in closing this knowledge gap could be to include relevant material in the medical syllabus.

This paper contributes to the growing research about Human Resource Management (HRM) by examining the interrelationships between High Performance Work System (HPWS) and their effects on firm performance in the hotel industry. Recent studies stress the need to delve deeper into this link considering the role that may be played by certain dynamic capabilities as mediating variables (Patel, Messersmith, & Lepak, 2013; Prieto-Pastor & Martin-Perez, 2014). The current study proposes a multiple mediating model and tests the mediation. More specifically, this research establishes that human resource flexibility (HRF) and organizational ambidexterity (OA) play a mediating role in the HPWS-performance relationship. A variance-based structural equation modeling (Partial Least Squares) has been applied to a sample of Spanish hotel firms. The results obtained support the mediation hypotheses according to which HRF and OA play a critical mediating role in the HPWS-performance relationship.

Purpose The purpose of this paper – based on the conviction that the human resource is by far the most strategic or distinctive resource available to firms competing in hospitality and tourism industries – is to objectively analyze the research on HR developed in the domain of tourism and hospitality management between 1997 and 2016. The aim is to “identify” and “represent” the “intellectual structure” of the field examined. Design/methodology/approach “Bibliometric” methods are utilized: document citation and co-citation analyses, as well as social network analysis (SNA). Findings The paper provides an interesting inventory of the theoretical foundations of knowledge developed around HR in the field under study by different theoretical frameworks and scientific disciplines, such as marketing or psychology. However, its main contribution is to identify an important gap in the literature in the specific area of management. Research limitations/implications The present study has several limitations resulting from the utilization of “bibliometric” methods applied in the analyses performed. As for the implications, these are more than obvious. Originality/value The authors believe that research developed here provides – through a kind of “meta-analysis” – a valuable outlet from which future researchers could benefit, giving them easier access to the theoretical foundations on which HR research in the field in question is based. This work also suggests some paths for future development or research in the field within the context of hospitality and tourism industries.

Purpose Based on the knowledge-based theories of the MNC, this research aims to develop and test a holistic model to analyse the relationship between the strategic knowledge management (SKM) processes undertaken by subsidiaries and MNC performance. Additionally, it focuses on determining the impact that the relational context can have on knowledge creation and transfer inside the internal network of an MNC. Design/methodology/approach The research hypotheses are tested by partial least squares (PLS) with data from a sample of Spanish subsidiaries of foreign multinational firms belonging to high-technology and knowledge-intensive sectors. Findings The results confirm that: the implementation of a SKM by a subsidiary positively impacts on knowledge creation; the knowledge created by a subsidiary positively influences knowledge transfer, increasing the knowledge existing in the MNC; the knowledge transfer across all MNC units has a positive impact on MNC performance; the subsidiary’s relational context arises as a mediating variable between the knowledge created by a subsidiary and its transfer to the rest of the MNC. Originality/value The research proposes a holistic model that contemplates the joint interaction of the variables knowledge creation, knowledge transfer and performance. In addition, the proposed model contemplates the variable SMK of the subsidiary as the beginning of the knowledge creation-knowledge transfer-performance process. Finally, the mediating role of the relational context in the relationship between knowledge creation and transfer is analysed.

The aim of the present study was to determine the agreement between ultrasonography (US), magnetic resonance imaging (MRI), and conventional radiography (CR) in the detection of findings indicative of enthesopathy in spondyloarthritis (SpA) patients. A cross-sectional study was performed in 40 SpA patients. Heel entheses (Achilles tendon and plantar fascia) were bilaterally examined by US, MRI, and CR. The three imaging modalities were carried out by three independent operators blinded to the other imaging modality data. Soft tissue abnormalities indicative of enthesopathy as thickening, structural changes, and bursitis were assessed by both US and MRI, and cortical bone abnormalities indicative of enthesopathy as erosions and enthesophytes were assessed by the three imaging modalities. The unweighted kappa values between US and MRI were 0.80, 0.66, 0.69, 0.70, and 0.70 for thickening, structural changes, bursitis, enthesophytes, and bone erosions, respectively. With respect to the detection of enthesophytes, the unweighted kappa values between CR and both US and MRI were 0.78 and 0.76, respectively. At last, for the recognition of bone erosions, the unweighted kappa values between CR and both US and MRI were 0.38 and 0.45, respectively. Using MRI as standard reference method, US was more sensitive with respect to CR revealing bone erosions. The present study provides evidence about the high overall agreement between US and MRI for all abnormal comparable findings at entheseal level and between US, MRI, and CR for the detection of enthesophytes in SpA patients.

The present research work shows the results obtained in an analysis of the existing literature about one of the ‘topics’ which arouses more interest among economists, geographers, theorists of business organization and strategic management or the actual officials in charge of territory arrangement and planning: that of clusters or industrial firm or groupings. More precisely, a total of 1,344 research papers published in different journals in the areas of economy, management, business, planning and development, urban studies and geography during the period 2000 and 2015 were analysed for the purpose of trying to identify and visualize the intellectual structure or knowledge base of the research developed about the aforementioned phenomena. As for the methodology utilized, of a quantitative nature, it is based on the use of bibliometric techniques – in particular, of document co-citation analysis (DCA) – and of social networks analysis.

Introduction Complex regional pain syndrome (CRPS) type 1 is characterized by the presence of pain, edema, functional impotence, impaired mobility, trophic changes, vasomotor instability and bone demineralization. Material and methods We carried out a retrospective and prospective, descriptive, observational study of 108 patients over 18 years of age with suspected CRPS who met Doury's criteria. We recorded demographic data, clinical characteristics, comorbidities, previous predisposing conditions and triggering factors, such as injury or fracture. We evaluated laboratory data, serial plain X-rays, 3-phase bone scintigraphy with technetium 99 and bone density scan, as well as drug treatment, rehabilitation and disease course. Results In all, 89% of the 108 patients were women with an average age of 54.8 ± 12.4 years. The time between the onset of the symptoms and the first visit to a physician was 3.1 months. The most common triggering factor was injury (91.7%). The most frequent psychological factor was anxiety (42.6%). All the patients reported pain and 99.07% had impaired mobility. The most frequently affected part of the body was the hand (75%; 81/108 patients) followed by the shoulder, in the shoulder-hand syndrome. All the patients had serial X-rays and changes were observed in 93.5%. Three-phase bone scintigraphy revealed evidence of disease in all 32 of the patients who underwent this study. Bone density scanning was performed in 54 patients (50%). All the patients were treated with nonsteroidal anti-inflammatory drugs, mainly diclofenac (60%). Calcium therapy was initiated in 106 patients (98.2%) and vitamin D3 therapy in 97.2%. All the patients received bisphosphonates, primarily alendronate and ibandronate (67.6% and 27.8%, respectively). Thirty-six patients (33.3%) received corticosteroids. All of the evaluated patients underwent rehabilitation involving occupational therapy. The average time to recovery was 6.31 months (range, 4–24). The outcome was favorable in 88.9% of the patients. Conclusion This paper describes the clinical characteristics, therapeutic features and outcome of CRPS type 1 in 108 patients. This syndrome is known to be heterogeneous, and does not always present with the well-known symptoms. We recommend establishing a differential diagnosis including other infectious and inflammatory conditions, and point out the importance of early referral, which enables early treatment.

Objectives This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). Methods A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. Results A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08–3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00–2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14–0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30–1.55) or mortality (HR = 1.23; 95% CI 0.26–4.81). Conclusion Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.

espanolAntecedentes: la cirugia bariatrica es una alternativa terapeutica eficaz en la obesidad morbida para conseguir perdidas de peso importantes y mantenidas en el tiempo, la resolucion de la comorbilidad y una disminucion del riesgo cardiovascular. Material y metodos: estudio retrospectivo que incluyo a todos los pacientes intervenidos consecutivamente mediante baypass gastrico laparoscopico en nuestro centro durante 10 anos, en los que se estudiaron la perdida ponderal, la comorbilidad y los factores de riesgo cardiovascular previos a la cirugia y al final del seguimiento. Resultados: se incluyeron 303 pacientes, 221 mujeres y 82 hombres, con una edad media de 42,3 ± 10,0 anos y un IMC de 48,2 ± 6,0 kg/m2. Se siguio al 96,7 % durante 5,7 ± 2,6 anos de media. La resolucion de la comorbilidad al final del seguimiento fue: 53,4 % para la hipertension arterial, 70,2 % para la diabetes mellitus de tipo 2, 83,9 % para la dislipemia y 71,4 % para el sindrome de apnea-hipopnea del sueno. El riesgo cardiovascular estimado por el algoritmo REGICOR antes y al final del seguimiento fue de 3,2 ± 2,6 y 2,2 ± 1,7, respectivamente, disminuyendo un 32.2 %, al igual que todos los parametros incluidos en su calculo salvo los niveles de HDL-colesterol, que no experimentaron variaciones significativas. El indice de masa corporal y el porcentaje de sobrepeso perdido a los 2 anos y al final del seguimiento fueron de 30,7 ± 5,2 kg/m2 vs. 33.0 ± 6.1 kg/m2 y 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectivamente. Conclusiones: el bypass gastrico es un metodo eficaz para resolver la comorbilidad y disminuir el riesgo cardiovascular, pero es muy importante el seguimiento del mayor numero de pacientes posible y la comunicacion de los resultados a largo plazo para determinar la efectividad real de estos procedimientos. EnglishBackground: bariatric surgery is an effective therapeutic alternative for morbid obesity as it achieves significant weight loss, maintained over time, as well as the resolution of comorbidities and a decreased cardiovascular risk. Material and methods: a retrospective study that included all patients consecutively undergoing laparoscopic gastric bypass in our center for 10 years, in which weight loss, comorbidities, and cardiovascular risk factors were studied prior to surgery and at the end of follow-up. Results: 303 patients, 221 women and 82 men, with a mean age of 42.3 ± 10.0 years and BMI of 48.2 ± 6.0 kg/m2 were included. Of these, 96.7 % were followed for 5.7 ± 2.6 years on average. The resolution of comorbidities at the end of follow-up included: 53.4 % for high blood pressure, 70.2 % for diabetes mellitus type 2, 83.9 % for dyslipemia, and 71.4 % for apnea-hypopnea sleep syndrome. The cardiovascular risk estimated by the REGICOR algorithm before and at the end of follow-up was 3.2 ± 2.6 and 2.2 ± 1.7, respectively, with a decrease by 32.2 %, like all the parameters included in its calculation except for HDL-cholesterol levels, which did not experience significant variations. The body mass index and percentage of overweight lost at 2 years and at the end of the follow-up was 30.7 ± 5.2 kg/m2 vs. 33.0 ± 6.1 kg/m2 and 66.4 ± 17.1 % vs. 57.9 ± 19.5 %, respectively. Conclusion: gastric bypass is an effective method for the resolution of comorbidities and reduction of cardiovascular risk, but it is very important to monitor as many patients as possible, and to report on the long-term results, to determine the real effectiveness of these procedures.

[Background] Detection of epidermal growth factor receptor (EGFR) mutations in exons 18–21 is recommended in all patients with advanced Non-small-cell lung carcinoma due to the demonstrated efficiency of the standard therapy with tyrosine kinase inhibitors in EGFR-mutated patients. Therefore, choosing a suitable technique to test EGFR mutational status is crucial to warrant a valid result in a short turnaround time using the lowest possible amount of tissue material. The Idylla™ EGFR Mutation Test is a simple, fast and reliable method designed for the detection of EGFR mutations from formalin-fixed paraffin-embedded samples. The aim of this study was the Clinical Performace Evaluation of the Idylla™ EGFR Mutation Test on the Idylla™ System., [Methods] EGFR mutational status was determined on 132 archived formalin-fixed paraffin-embedded tissue sections with Idylla™ technology. Results were compared with the results previously obtained by routine method in the reference lab (Therascreen® EGFR RGQ PCR v2, Qiagen in Molecular Pathology lab, Hospital Universitario Virgen del Rocío de Sevilla)., [Results] The overall agreement between results obtained with the Idylla™ EGFR Mutation Test and the Comparator test method was 95.38% (with 1-sided 95% lower limit of 91.7%) showing Positive Diagnostic Agreement of 93.22% and Negative Diagnostic Agreement of 97.18%, with a Limit Of Detection ≤5%., [Conclusions] The Idylla™ EGFR Mutation Test passed its clinical validity performance characteristics for accuracy., Supported by each clinical center. Biocartis provided free-of-charge Idylla™ EGFR Mutation Test cartridges.

The postural control assessments in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out to determine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich&rsquo, s ataxia), and to determine whether the variables extracted from the pressure mapping analysis are more sensitive than functional tests to evaluate the postural trunk control. A case series study was carried out in a sample of 10 adult patients with multiple sclerosis (n = 2), spinal cord injury (n = 4) and Friedreich&rsquo, s ataxia (n = 4). The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test. The participants with Friedreich&rsquo, s ataxia showed a tendency to present a higher mean pressure on the seat of subject&rsquo, s wheelchair compared to other groups. In parallel, users with spinal cord injury showed a tendency to present the highest values of maximum pressure and area of contact. People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. Although it is not possible to establish a strong statistical correlation, the relationships between the pressure mapping variables and the functional tests seem to be numerous, especially in the multiple sclerosis group.

El objetivo principal de este trabajo es desarrollar un estudio descriptivo, detallado y pormenorizado de la producción científica catalogada bajo el descriptor denominado “Sector Hostelería y Turismo” recogidas en las tesis doctorales inscritas en la base de datos TESEO, con la finalidad de cuantificar y trazar de forma cronológica la producción de tesis doctorales por universidades, directores y participación en tribunales, sexo, e idioma. Se trata de identificar algunos de los principales actores que han protagonizado la investigación científica, ofreciendo una panorámica pormenorizada del progreso que se ha ido produciendo en los trabajos catalogados bajo este descriptor, lo que sin duda favorecerá la comprensión de la evolución en este campo del conocimiento científico en los últimos años. The main objective of this research is to develop a descriptive and detailed study of the scientific production classified according to the descriptor "Hospitality and Tourism Sector" included in the doctoral theses registered in the TESEO database, in order to quantify and chronologically trace the production of doctoral theses by universities, directors and participation in committees, gender, and language. The aim is to identify some of the main agents that have carried out scientific research, offering a detailed overview of the progress that has taken place in the studies catalogued under this descriptor, which will undoubtedly favour the understanding of the evolution in this field of scientific knowledge in recent years.

Numerous studies over the years have shown that oxidative stress plays a major role in the development of the disease. Oxidative stress involvement in COPD opens up the possibility of using antioxidant therapies in the treatment of the disease. However, so far, these therapies have shown no clinical benefit indicating that more basic research efforts are needed to understand the underlying mechanisms by which oxidative stress leads to the development of COPD.

Purpose The purpose of this paper is twofold: first, to analyze which policies of human resource management (HRM) contribute to exploratory learning and which to exploitation learning; and second, to determine the influence of the two types of learning on organizational performance. Design/methodology/approach The research hypotheses are tested by partial least squares with data from a sample of 100 Spanish hotels. Findings The results confirm that, in order of importance, selective staffing, comprehensive training and an equitable reward system lead to exploratory learning. Exploitative learning seems to be fundamentally driven by comprehensive training and an equitable reward system (but in a different way than with exploratory learning). Finally, both types of learning have a positive impact on performance. Practical implications Both exploratory and exploitative learning result from HRM practices. To maintain performance expectations managers should develop both learning types, which entails the utilization of the best HRM practices. Originality/value This study presents empirical evidence around the findings of other studies (Laursen and Foss, 2014; Minbaeva, 2013) which call for further research into whether strategic HRM configurations have positive effects on the two learning types. The results find some practices that have a positive effect in both cases, but with different intensities in their explanations. This finding reveals the need for more detailed exploration around which combinations of HRM practices, in terms of exploratory vs exploitative learning, are advisable for organizations. The study also finds that the two learning types have a positive influence on organizational performance.

Introduction: Alpha-1 antitrypsin (AATD) deficiency is an inherited condition that leads to decreased circulating AAT levels, significantly increasing the risk of lung and liver disease. AATD is underdiagnosed. Severity of symptoms in AATD patients are highly variable and neither protein levels nor phenotype are sufficient to identify which patients will develop lung and/or liver disease. Therefore, new strategies and biomarkers for early diagnosis and prognosis of the disease are needed. Rationale and Aims: MicroRNAs (miRNAs) regulate gene expression and have been associated with the pathogenesis of various lung and liver diseases. Circulating miRNAs may serve as diagnostic and prognostic biomarkers of the AATD. This study is aimed is to determine an expression profile of plasma miRNAs in AATD to serve as a diagnostic and prognostic tool for the disease. Material and Methods: Expression profile of plasma miRNAs was determined using GeneChip miRNA 3.0 Arrays (Affymetrix) in 37 patients with DAAT and 19 healthy volunteers. Differentially expressed miRNAs were validated by RT-qPCR in 34 DAAT patients and 14 healthy volunteers. Results: A profile of differentially expressed plasma miRNAs that can potentially serve as biomarkers for the diagnosis and prognosis of AATD was identified. Specifically, miRNA-122, miR-93, miR-107, miR-425 and miR-151a miRNAs have diagnostic value, while miRNA-17, miRNA-106a and miRNA-93 are elevated in patients with emphysema and miRNA-107 and miRNA-23b are increased in patients with liver disease. Conclusions: We have identified a genetic signature that differentiates the different risk groups and the presence of emphysema and hepatopathy in AATD patients.

This paper analyzes the role played by internal knowledge generation and external knowledge acquisition in the impact of agglomeration on the profitability of Spanish hotels. The results are of interest not only because they demonstrate that knowledge management strategies have a partial mediation effect in the relationship between agglomeration and profitability, but also because they find a substitution effect between internal knowledge generation and external knowledge acquisition. The analysis uses a sample of 2003 Spanish hotels and helps us to understand the real reasons behind the district effect.

The purpose of this study consists in analyzing the existing literature on international business from all the research papers published in Journal of International Business Studies (JIBS) during the period of time comprised between 2000 and 2015. The authors apply bibliometric methods to that end –in particular, document citation and co-citation analyses (DCAs)– so that they can try and identify the main research lines within the aforementioned scientific field or domain; in other words, the ‘intellectual structure’ of the discipline examined. Social networks analysis was also used to carry out the representation or visualization of such structure or knowledge base. The highly interdisciplinary nature of the research undertaken, since the study field still keeps its characteristic diversity and interdisciplinarity or the need to integrate a variety of theoretical frameworks or approaches into the development of a widely-accepted theory about the field under study become evident. Amongst these theories would be the new institutional theory, the strategic theory or perspective or others such as the transaction cost theory or the agency theory, applied to the context of internationalization and to the field of international business, on whose integration the future development of this field may largely depend.