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Se realiza en este trabajo un recorrido por restos industriales en desuso reconvertidos en hoteles, evidenciándose que la reutilización de estos viejos contenedores para nuevos usos turísticos ha servido por una parte para recuperar patrimonio, mientras por otra se logra una actuación sostenible que evita el despilfarro que supone la nueva construcción. No obstante, queda de relieve también la paradoja de actuaciones de rehabilitación, donde la reutilización puede conllevar un deterioro ambiental, pese a la recuperación patrimonial que en principio supone. This work includes a tour of disused industrial remains transformed into hotels, It is evident that the reuse of these old containers in order to new tourist uses has helped on the one hand to recover heritage, while on the other hand a sustainable action is achieved and it avoids the waste that implies the new construction. However, the paradox of rehabilitation actions is also highlighted, where reuse can lead to environmental deterioration, despite the recovery of heritage that initially it means.

When consumers shop online, it is primarily their visual sense that is being triggered. With technology under development to also provide an experience in the olfactory, taste, and haptic sense, this paper investigates the added value of background music in the online store environment. In particular, a study is conducted with three conditions: a no music condition, a condition with music which is crossmodally incongruent with the online store environment, and a condition with music crossmodally congruent with the online store environment. Crossmodal congruency refers to the crossmodal correspondences (i.e., the tendency of one sensory attribute to be associated with an attribute in another sense) that are shared between the music and the online store environment. Although both musical pieces used were considered as pleasant, consumer reactions were not more positive when compared to the no music condition. Interestingly, the value of the money spent in the no music condition was significantly higher than in both musical conditions. The incongruent music condition, however, did lead to significantly lower consumer reactions for the other variables measured (i.e., pleasure, arousal, and store environment evaluation) when compared to the no music and congruent music condition.

Treatments for patients with sepsis with intermediate lactate values (≥2 and4 mmol/L) are poorly defined.To evaluate multicenter implementation of a treatment bundle (including timed intervals for antibiotics, repeat lactate testing, and intravenous fluids) for hemodynamically stable patients with sepsis and intermediate lactate values in the emergency department.We evaluated patients in annual intervals before and after bundle implementation in March 2013. We evaluated bundle compliance and compared outcome measures across groups with multivariable logistic regression. Because of their perceived risk for iatrogenic fluid overload, we also evaluated patients with a history of heart failure and/or chronic kidney disease.We identified 18,122 patients with sepsis and intermediate lactate values, including 36.1% treated after implementation. Full bundle compliance increased from 32.2% in 2011 to 44.9% after bundle implementation (P 0.01). Hospital mortality was 8.8% in 2011, 9.3% in 2012, and 7.9% in 2013 (P = 0.02). Treatment after bundle implementation was associated with an adjusted hospital mortality odds ratio of 0.81 (95% confidence interval, 0.66-0.99; P = 0.04). Decreased hospital mortality was observed primarily in patients with a heart failure and/or kidney disease history (P 0.01) compared with patients without this history (P 0.40). This corresponded to notable changes in the volume of fluid resuscitation in patients with heart failure and/or kidney disease after implementation.Multicenter implementation of a treatment bundle for patients with sepsis and intermediate lactate values improved bundle compliance and was associated with decreased hospital mortality. These decreases were mediated by improved mortality and increased fluid administration among patients with a history of heart failure and/or chronic kidney disease.

Retailers use atmospheric cues to trigger emotional reactions that enhance consumer behavior. However, introducing cues into a store environment may also trigger sensory overload, due to too much stimulation. This study aims to examine the effects of adding high arousal atmospheric cues in a store environment on affective reactions, approach behavior, and evaluations by making use of different methods (i.e., two lab experiments and one field experiment), by adding various types of atmospheric cues (i.e., cues processed in higher senses versus processed in lower senses), and by differentiating the order in which they are added. Results reveal that when a third high arousal cue is added sensory overload (i.e., rise in perceived arousal and decrease in perceived pleasantness) occurs under the condition that this third cue is processed by a higher sense (i.e. visual or auditory sense). Furthermore, a decrease in approach behavior and evaluations is also observed when these conditions are met. Mediation analyses indicate that this effect on evaluations is mediated by pleasure and approach behavior. The research presented extends previous findings by investigating possible predictors (i.e., number of cues as well as type of cues) of the momentum where sensory overload may take place.

People map different sensory stimuli, and words that describe/refer to those stimuli, onto spatial dimensions in a manner that is non-arbitrary. Here, we evaluate whether people also associate basic taste words and products with characteristic tastes with a distinctive location (e.g., upper right corner) or a more general direction (e.g., more right than left). Based on prior research on taste and location valence, we predicted that sweetness would be associated with higher vertical spatial positions than the other basic tastes. The results of Experiments 1 and 2 support the view that participants do indeed locate the word “sweet” higher in space than the word “bitter”. In Experiment 2, the participants also positioned products that are typically expected to be sweet (cupcake and honey) or bitter (beer and coffee) spatially. Overall, the sweet-tasting products were assigned to higher locations than were the bitter-tasting products. In order to test whether taste/location congruency would also affect product evaluations, a third experiment was conducted. The results of Experiment 3A (between participants) and 3B (within participants) failed to provide any evidence for the existence of consistent taste/location congruency effects. However, in Experiment 3B, the participants evaluated the sweet products as looking more appetizing when presented in upper relative to lower shelf locations. In none of the three studies was an association found between tastes and positions along the horizontal axis. Taken together, these results suggest that sweet and bitter tastes are differentially located in vertical, but not horizontal, space. The potential implications of these findings for both our understanding of the crossmodal correspondences, as well as for taste evaluation, and product placement are discussed. Experiments 1 and 2 were supported by a grant from the Research Foundation - Flanders (grant number 1119717N FWO Vlaanderen). Carlos Velasco would like to thank the Research Funding from the Department of Marketing, BI Norwegian Business School.

This research studies the effect of scent expertise (laymen vs. novice experts vs. experts) on product and taste evaluations of three products that are (in)congruent with an ambient scent and examines whether this effect is mediated by these groups’ awareness of scents in their environment and by how well they are able to identify different scents. Results show that novice experts and experts evaluate an incongruent product less positively than laymen. Laymen score lower than novice experts and experts on odor identification, and lower than experts on odor awareness but not lower than novice experts. The differences in the evaluation between the scent expertise groups cannot be fully explained by differences in their level of odor identification or level of odor awareness.

Ambient scents used by retailers should be pleasant and appropriate. This paper proposes that an ambient scent should also be crossmodally congruent with the store environment. Crossmodal congruency refers to the crossmodal correspondences (i.e., the tendency of one sensory attribute to be associated with an attribute in another sense) that are shared between the ambient scent and the store environment. In this study, a scent crossmodally congruent with the store, a scent crossmodally incongruent with the store and a no scent condition were compared. In order to determine the crossmodal congruency, an index of 11 bi-polar items (e.g., loud versus quiet) was applied to the perception of the store and of the ambient scent. The degree in which they differed resulted in either congruency or incongruency. Results revealed that crossmodal congruency between store and ambient scent leads to higher approach behavior. Furthermore, positive effects were found when comparing the congruent scent with the no scent condition on pleasure, store (environment) evaluation, and word-of-mouth. It is therefore proposed to include the crossmodal congruency between the ambient scent and the store environment as a criteria when selecting an ambient scent. FWO

Efforts to improve outcomes of patients who deteriorate outside the intensive care unit have included the use of rapid response teams (RRTs) as well as manual and automated prognostic scores. Although automated early warning systems (EWSs) are starting to enter clinical practice, there are few reports describing implementation and the processes required to integrate early warning approaches into hospitalists' workflows. We describe the implementation process at 2 community hospitals that deployed an EWS. We employed the Institute for Healthcare Improvement's iterative Plan-Do-Study-Act approach. Our basic workflow, which relies on having an RRT nurse and the EWS's 12-hour outcome time frame, has been accepted by clinicians and has not been associated with patient complaints. Whereas our main objective was to develop a set of workflows for integrating the electronic medical record EWS into clinical practice, we also uncovered issues that must be addressed prior to disseminating this intervention to other hospitals. One problematic area is that of documentation following an alert. Other areas that must be addressed prior to disseminating the intervention include the need for educating clinicians on the rationale for deploying the EWS, careful consideration of interdepartment service agreements, clear definition of clinician responsibilities, pragmatic documentation standards, and how to communicate with patients. In addition to the deployment of the EWS to other hospitals, a future direction for our teams will be to characterize process-outcomes relationships in the clinical response itself. Journal of Hospital Medicine 2016;11:S25-S31. © 2016 Society of Hospital Medicine.

Purpose The purpose of this article was to describe a quality improvement process on a diverse adult intensive care unit (ICU) population for a large healthcare organization for early detection of delirium. Background Delirium is often considered a common unpreventable problem in the ICU. A process for early detection of delirium allows the critical care team to evaluate the patient and intervene to improve or reverse the delirium. Description A business case was first developed, and then using performance improvement methodology combined with quality improvement methods and oversight from a Delirium/Sedation Workgroup, an implementation plan was developed. Intensive care clinical nurse specialists were educated; patients in the ICU were screened for delirium twice daily by bedside nurses using the Confusion Assessment Method. The clinical nurse specialist in each ICU was instrumental for driving the process of change and supporting the bedside nurse and physicians to discuss preventing, screening, and treating delirium. Outcome System-wide process implementation was completed in 1 year, 2011. In 2012, all medical centers had a program in place to decrease the use of benzodiazepines and improve communication in the multidisciplinary teams during daily rounds about the treatment and prevention of delirium. The process of performance improvement is ongoing with continual reassessment and feedback required to ensure sustainability. Conclusions/implications for practice Performance improvement involving 21 medical centers is a large-scale undertaking by an organization. It requires a systematic approach with key stakeholders and advanced practice nurses as subject matter experts involved throughout all phases of the implementation. Bedside clinicians assessing the patient must feel supported and valued members of the process. Challenges of all care providers need to be acknowledged and addressed.

Article-at-a-Glance Background In 2008, Kaiser Permanente Northern California implemented an initiative to improve sepsis care. Early detection and expedited implementation of sepsis treatment bundles that include early goal-directed therapy (EGDT) for patients with severe sepsis were implemented. Methods In a top-down, bottom-up approach to performance improvement, teams at 21 medical centers independently decided how to implement treatment bundles, using a "playbook" developed by rapid cycle pilot testing at two sites and endorsed by a sepsis steering committee of regional and medical center clinical leaders. The playbook contained treatment algorithms, standardized order sets and flow charts, best practice alerts, and chart abstraction tools. Regional mentors and improvement advisers within the medical centers supported team-building and rapid implementation. Timely and actionable data allowed ongoing identification of improvement opportunities. A consistent approach to performance improvement propelled local rapid improvement cycles and joint problem solving across facilities. Results The number of sepsis diagnoses per 1,000 admissions increased from a baseline value of 35.7 in July 2009 to 119.4 in May 2011. The percent of admitted patients who have blood cultures drawn who also have a serum lactate level drawn increased from a baseline of 27% to 97% in May 2011. The percent of patients receiving EGDT who had a second and lower lactate level within six hours increased from 52% at baseline to 92% in May 2011. Conclusion Twenty-one cross-functional frontline teams redesigned processes of care to provide regionally standardized, evidence-based treatment algorithms for sepsis, substantially increasing the identification and risk stratification of patients with suspected sepsis and the provision of a sepsis care bundle that included EGDT.

There is a new manner in the design of the tourist landscapes in rural Spain. The adoration for the popular, the traditional and the colorful are still popular nevertheless there are projects that look towards the future with respect for the environment thus creating projects with sustainable development.

Dentro de las últimas tendencias del arte chileno actual la opción pictórica continúa teniendo gran relevancia, lo que se explica por la pervivencia de una tradición, pero también por la atracción que para los más jóvenes supone la personalidad y relevancia internacional de Roberto Matta. No obstante, y pese a que esta preponderancia de la pintura sobre lienzo es un hecho, también lo es la existencia de artistas que han elegido otros medios de expresión que van desde la escultura hacia esos otros lenguajes más indefinibles dentro de la clasificación tradicional de las artes, como son las instalaciones o esas realizaciones que se incluyen dentro de ese cajón de sastre denominado Arte Visual.; Within the latest tendencies in Chilean art, painting still bears great relevance, a fact which is partly due to the maintenace of an established tradition, but also to the attraction which the personality and international relevance of Robeto Matta holds for the youngest. However, and despite the ruling of painting on canvas, there are also a number of artists who have chosen different means of self-expression, ranging form sculpture to other languages which seem difficult to define in traditional art classification, such as installations or the realisation included within the general category of Visual Art.

El barrio de La Luz en Avilés se levantó a partir de 1957 para dar alojamiento a los trabajadores de la nueva factoría siderúrgica: El proyecto inicial, inspirado en modelos del Movimiento Moderno, con zonas ajardinadas y edificios cruciformes, se fue transformando y abaratando progresivamente. Al final, quedo convertido en un conjunto de bloques impersonales, carentes de cualquier tipo de equipamiento y segregados de la ciudad.; The neighborhood of La Luz in Avilés raised from 1957 to give lodging to the workers of the new steel factory. The initial project, inspired in models of the Modern Movement, with garden zones and cross formeé buildings, went itself transforming and cheapening progressively. The result ws an assembly of impersonal blocks lacking of any type of equipment and segregated of the city.