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Introduction: Oral anticoagulants (OACs) are first-line drugs for stroke prevention in patients with atrial fibrillation (AF). The introduction of new lines of therapy with direct oral anticoagulants (DOACs) has led to a decreased use of vitamin K antagonists (VKAs). Comparative analyses of DOACs in clinical trials are scarce and the comparator has mostly been warfarin. Their impact on health outcomes in observational studies has not always been consistent. The aim of this study is to evaluate the effectiveness and safety of DOACs and VKAs in patients with AF using Real-World Data (RWD). Methods and analysis: Population-based retrospective cohort study using RWD from actual practice. Period: January 2012-December 2020. Inclusion criteria: patients with AF who had not taken OACs in the previous 12 months. Exclusion criteria: <40 years, with severe mitral stenosis, or valvular heart disease or aortic and/or mitral valve procedures. Data source: The Andalusian Population Health Database, Spain. Outcome measures: a) Effectiveness: ischaemic stroke, transient ischaemic attack, systemic and pulmonary embolism, and death; b) Safety: gastrointestinal and intracranial haemorrhaging; Independent variables: age, sex, comorbidities, medication and health resource use, CHA2DS2-VASC, HAS-BLED, and analytical tests. Statistical analysis: crude incidence analysis, survival models, Kaplan-Meier, Cox regression analysis adjusted for possible confounding and paired analysis by propensity score matching. [ABSTRACT FROM AUTHOR]

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Abstract Objectives The hallmarks of germline(g) and/or somatic(s) BRCA1/2 mutation ovarian cancer (BMOC) patients are increased sensitivity to platinum-based chemotherapy (PCT) and PARP inhibitors (PARPi). There is little information on the effectiveness of chemotherapy in heavily pretreated (≥3 CT lines) g/sBMOC patients. Methods g/sBMOC patients who received CT from 2006 to 2016 at 4 cancer centers in Spain were selected. Overall survival (OS) and time to progression (TTP) were calculated with Kaplan Meier and Cox models. Results 135 g/sBMOC patients were identified (6% s BRCA1 / 2 mutations). The median number of chemotherapy lines was 2 (1–7). The 6-years OS rate was 69.4% and 71% in BRCA1 or BRCA2 mutation carriers (p = 0.98). A total of 57 (42%) patients had ≥3 CT lines (3–7), which encompassed a total of 155 treatments. The median overall TTP across all treatment lines beyond 2nd line was 10.2 months (CI 95% 8.4–11.9 months). In the platinum-sensitive setting, TTP was improved with PCT plus PARPi (17.1 m), PCT (12.6 m) or PARPi (12.4 m) versus non-PCT (4.9 m; p < 0.001 all comparisons). In the platinum-resistant setting, these differences in TTP were not statistically significant. A multivariate model confirmed that primary platinum-free interval (PFI) > 12 months and exposure to PCT and PARPi associated with improved outcomes. PARPi exposure did not compromise benefit of subsequent CT beyond 2nd relapse. Conclusions Heavily pretreated g/sBMOC demonstrated CT sensitivity, including for non-PCT choices. Primary platinum-free interval (PFI) >12 months and exposure to both platinum-based chemotherapy and PARPi associate with improved prognosis in heavily pretreated g/sBMOC patients. Highlights • Heavily pretreated g/sBMOC patients remain responsive to chemotherapy in the refractory setting. • Primary platinum-free interval is a strong predictor of the outcome of heavily pretreated g/sBMOC patients. • Exposure to both platinum-based chemotherapy and PARPi correlates with TTP in heavily pretreated g/sBMOC patients. • Our data provide benchmarks for design and interpretation of trials in recurrent disease. [ABSTRACT FROM AUTHOR]

Wind speed forecasts obtained by Numerical Weather Prediction models are limited for fine interpretation in heterogeneous terrain, in which different roughnesses and orographies occur. This limitation is derived from the use of low-resolution and grid-box averaged data. In this paper a dynamical downscaling method is presented to increase the local accuracy of wind speed forecasts. The proposed method divides the wind speed forecasting into two steps. In the first one, the mesoscale model WRF (Weather Research and Forecasting) is used for getting wind speed forecasts at specific points of the study domain. On a second stage, these values are used for feeding the HDWind microscale model. HDWind is a local model that provides both a high-resolution wind field that covers the entire study domain and values of wind speed and direction at very located points. As an example of use of the proposed method, we calculate a high-resolution wind field in an urban-interface area from Badajoz, a South-West Spanish city located near the Portugal border. The results obtained are compared with the values read by a weathervane tower of the Spanish State Meteorological Agency (AEMET) in order to prove that the microscale model improves the forecasts obtained by the mesoscale model. • A method for the accurate estimation of a wind field that meets the local characteristics of the terrain is proposed. • This procedure is based on a dynamic downscaling by coupling the WRF mesoscale model with the HDWind microscale model. • The joint operation of the two models allows to improve the wind estimation provided by the mesoscale model. • The proposed dynamic downscaling supposes a slight increase in simulation time. • This improvement can be useful to improve the estimation of near-surface winds. [ABSTRACT FROM AUTHOR]

Extending previous studies on job crafting, the aim of the present study is to analyze the effect of job crafting on quality of care in residential homes for elderly people in two European countries (Spain and Sweden). We hypothesize that cognitive crafting could be a consequence of behavioral crafting and that it will mediate the relationship between behavioral crafting and the perception of quality of care. A correlational design was used, with two-waves approximately 12 months apart (n = 226). Our results indicate that behavioral job crafting at T1 had an effect on cognitive job crafting at T2, relational job crafting at T1 increases quality of care at T2, and the mediation effect of cognitive job crafting. These results indicate that we must differentiate between the two forms of crafting (behavioral and cognitive), not as indicators of the same latent construct, but as aggregates. Additionally, we point out two main implications for managerial practice. First, as relational job crafting has a direct effect on quality of care, it is important to assure an organizational culture oriented towards employees. Secondly, due to the mediation effect of cognitive job crafting, managers should facilitate meaningful work environments. To do so, jobs should be re-designed, increasing skills variety, identity and significance., Competing Interests: The authors have declared that no competing interests exist.

Aim: To examine the association between organizational change, turnover intentions, overcommitment and perceptions of quality of care among nurses and nursing assistants employed in eldercare organizations., Design: A longitudinal survey (baseline, 12-month follow-up) was used., Methods: A panel sample of 226 eldercare employees in Spain and Sweden responded to survey questions concerning organizational change, turnover intentions, overcommitment and perceptions of quality of care. The data were analysed using structural equational modelling., Results: We found a statistically significant positive relationship between organizational change, employees' turnover intention and overcommitment. We also found a statistically significant negative relationship between organizational change and perceived quality of care., Competing Interests: None of the authors would like to report a conflict of interest., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

The technological transition currently taking place in the labor market is having severe implications for people. One vulnerable group at risk of marketplace exclusion are employees with disabilities. This research explores their job motivation, including the moderated effect of self-efficacy. A 187 employees from Special Employment Centers (SECs) in Spain with intellectual and physical disabilities completed the Internal Motivation Scale, the Psychological Critical States (PCS) and the self-efficacy sub-scale of the Psychological Processes Scale (PPS) tests. Following the International Tests Commission guidelines, the instruments were adapted to the special needs of the participants. We found differences depending on the kind of disability of employees. In employees with intellectual disabilities, their levels of self-efficacy moderated the effect of responsibility for outcomes and meaningfulness of work on motivation. In the case of employees with physical disabilities, the knowledge of results is a predictor of motivation when they had medium or high levels of self-efficacy. Additionally, in this group, responsibility for outcomes and meaningfulness of work had a direct effect on motivation, independently of their levels of self-efficacy. Employees with disabilities should be empowered to make choices and exercise control in their working lives. To do so, human resources managers should promote their wellbeing, taking into consideration the workforce diversity.

Healthcare accreditation models generally include indicators related to healthcare employees' perceptions (e.g. satisfaction, career development, and health safety). During the accreditation process, organizations are asked to demonstrate the methods with which assessments are made. However, none of the models provide standardized systems for the assessment of employees. In this study, we analyzed the psychometric properties of an instrument for the assessment of nurses' perceptions as indicators of human capital quality in healthcare organizations. The Human Capital Questionnaire was applied to a sample of 902 nurses in four European countries (Spain, Portugal, Poland, and the UK). Exploratory factor analysis identified six factors: satisfaction with leadership, identification and commitment, satisfaction with participation, staff well-being, career development opportunities, and motivation. The results showed the validity and reliability of the questionnaire, which when applied to healthcare organizations, provide a better understanding of nurses' perceptions, and is a parsimonious instrument for assessment and organizational accreditation. From a practical point of view, improving the quality of human capital, by analyzing nurses and other healthcare employees' perceptions, is related to workforce empowerment., (© 2012 Wiley Publishing Asia Pty Ltd.)

The aim of this research is to examine the psychometric properties of a Spanish version of the Human System Audit transformational leadership short-scale (HSA-TFL-ES). It is based on the concept of Bass developed in 1985. The HSA-TFL is a part of the wider Human System Audit frame. We analyzed the HSA-TFL-ES in five different samples with a total number of 1,718 workers at five sectors. Exploratory Factor Analysis corroborated a single factor in all samples that accounted for 66% to 73% of variance. The internal consistency in all samples was good (alpha = .92 - .95). Evidence was found for the convergent validity of the HSA-TFL-ES and the Multifactor Leadership Questionnaire. These results suggested that the HSA-TFL short-scale is a psychometrically sound measure of this construct and can be used for a combined and first overall measurement.