Tourism is one of the economic driving forces of Spain: the consolidation of existing tourist destinations and new market niches encourage an upward trend of tourism. The economic impacts produced by ...tourism are one of the major concerns of the authorities; the question is whether it is possible to continue growing without compromising our environment. This work attempts to answer this issue by analysing one of the tourism segments with higher growth in recent years: rural tourism. Using a model of partial least squares (PLS), we will analyse the environmental impacts from the point of view of the supply and its relationships with the environmental management conducted. We will also analyse the rural establishments from a global point of view and, depending on their category, explain the factors which determine the sustainable behaviour of providers, and identify that the establishments of low categories have a more sustainable conduct.
Although literature on open eco-innovation has recently increased, empirical research on this topic in traditional low-tech sectors is still relatively scarce. The present paper examines how open ...innovation activities can promote eco-innovations in the food industry, an industry that is sometimes considered a technological laggard with traditionally low cooperation. The paper focuses on the relationship between a firm's interactions with stakeholders, particularly the breadth and the depth of the firm's knowledge network and the firm's propensity to develop different types of eco-innovations. Using a novel and more accurate measure of breadth and depth and addressing endogeneity with instrumental variables, the paper studies their influence on technological eco-innovation in a random sample of 279 food firms in Spain. The results show that coordination difficulties and bounded rationality explain an inverted U shape in the relationship of breadth of external knowledge sources and the propensity to eco-innovate both in product and process eco-innovations. Additionally, our findings confirm that it is important to rely on deep, frequent and intense relationships with stakeholders in order to create the required atmosphere to foster fluent knowledge sharing among partners specially to develop eco-process innovations, but a learning effect appears. Future research should extend the analysis to other countries and sectors to address the limitations of this study.
•External search breadth is positively related to eco-innovation propensity.•Coordination with partners diminishes eco-innovation propensity.•Deep relationships improve knowledge flow among partners.•Deep, frequent and intense relationships foster eco-process innovations.
Environmental concern has been on the rise in recent years and a proposal for a circular economy (CE) as a tool for sustainable development has received attention from governments, practitioners, and ...academics. In this sense, the literature on the topic has grown from 12 scientific articles published in 2008 to 2355 in 2020, which represents an almost two hundredfold increase in around a decade. However, CE is a relatively new subject, and much research remains to be conducted; it is therefore important to gain an adequate understanding of the subject to address more specific, related issues. The purpose of this review is to identify the main trends in CE and their evolution. It presents an advanced bibliometric method consisting of a combination of co-word analysis and social network analysis developed to identify the main topics and trends in this field. The results show the evolution of research, frequency, and relevance of the terms studied, links between them, and their density and network visualisation. Bibliometric tools have further been applied to obtain the research outputs of the main journals, as well as the authors and research topics that have been addressed during this period. New directions for future research lines are also proposed.
•Exponential rise in Circular Economy research: 12 papers in 2008 and 2300 in 2020•Split of research in two main areas: conceptualisation and more technical issues•Electronic equipment waste and water issues, as most recurrent research topics•‘Recycle’, the most quoted R and ‘reuse’, the R with the most room for improvement•Change in leading role on Circular Economy research from China to European Union
The objective of this article is to assess the safety of intraspinal infusion of autologous bone marrow mononuclear cells (BMNCs) and, ultimately, to look for histopathological signs of cellular ...neurotrophism in amyotrophic lateral sclerosis (ALS) patients. We conducted an open single arm phase I trial. After 6 months observation, autologous BMNCs were infused into the posterior spinal cord funiculus. Safety was the primary endpoint and was defined as the absence of serious transplant‐related adverse events. In addition, forced vital capacity (FVC), ALS‐functional rating scale (ALS‐FRS), Medical Research Council scale for assessment of muscle power (MRC), and Norris scales were assessed 6 and 3 months prior to the transplant and quarterly afterward for 1 year. Pathological studies were performed in case of death. Eleven patients were included. We did not observe any severe transplant‐related adverse event, but there were 43 nonsevere events. Twenty‐two (51%) resolved in ≤2 weeks and only four were still present at the end of follow‐up. All were common terminology criteria for adverse events grade ≤2. No acceleration in the rate of decline of FVC, ALS‐FRS, Norris, or MRC scales was observed. Four patients died on days 359, 378, 808, and 1,058 post‐transplant for reasons unrelated to the procedure. Spinal cord pathological analysis showed a greater number of motoneurons in the treated segments compared with the untreated segments (4.2 ± 0.8 motoneurons per section mns per sect and 0.9 ± 0.3 mns per sect, respectively). In the treated segments, motoneurons were surrounded by CD90+ cells and did not show degenerative ubiquitin deposits. This clinical trial confirms not only the safety of intraspinal infusion of autologous BMNC in ALS patients but also provides evidence strongly suggesting their neurotrophic activity. STEM CELLS2012;30:1277–1285
The main purpose of this paper is to analyse the association between open inbound knowledge strategies and the performance of eco‐innovative firms in the food and beverage industry. We propose a ...mixed framework based on the eco‐innovation literature and the open innovation approach. We consider the characteristics in a traditional sector based upon a resource‐based perspective. Three types of firms are distinguished in terms of their sales growth in the Spanish food industry from the least to the most successful eco‐innovators. Using multinomial logistic regression models, it is shown that the diversity of collaborators (breadth of external sources of knowledge) and joint adoption of product and process eco‐innovations are positively associated with the probability of achieving high sales growth. Moreover, we find an inverted U‐shaped relationship between the breadth of the external search and firm performance, but only for the group of the most successful firms. Moreover, operational flexibility, knowledge‐based capabilities and company size are also positively related to the group of successful eco‐innovators.
Drawing on the Sustainable Development Goals of the UN 2030 Agenda, the implementation of circular economy business models (CEBMs) is key for reducing the impacts of business production modes on the ...environment and is especially suited to, and necessary in, the bioeconomy sector. The purpose of this literature review article is to analyse how firms in this sector can achieve a higher level of circularity in their business models, and how this circularity is positive for the triple bottom line. Building on the theories of social capital, new institutionalism and the triple bottom line (TBL), this article proposes a model to better understand how forest bioeconomy firms can develop high-circularity business models that lead them to excel on the TBL. This study combines internal aspects of the business (e.g., social capital, dynamic capabilities, entrepreneurial orientation) with situational variables (social/cultural, regulatory, technological, economic/financial drivers) to explain the level of circularity of business models in bioeconomy firms, as a prior step to enhancing their TBL. The interactionist model proposed is new to the literature and improves our understanding of how the level of circularity of a BM can be enhanced. The propositions derived will help to structure and design future research.
Literature on diversity in organisations is limited and even fewer studies investigate its impact on innovation. Therefore, the aim of this research is to study how gender diversity within R&D teams, ...among other factors, impacts innovation, drawing on data from an innovation survey in Spain. Our findings support the assertion that gender diversity within R&D teams generates certain dynamics that foster novel solutions leading to radical innovation. The results indicate that gender diversity is positively related to radical innovation. However it does not promote incremental innovation in the same way. The positive relation occurs under particular conditions of the task (a higher degree of novelty), as the two types of innovation might require different skills for their effective performance. These results have several implications for academics, politicians and practitioners.
Abstract
Objective
To assess the impact of the empathy of physicians, perceived by patients with chronic pain, regarding pain relief and health-related quality of life (HR-QoL).
Methods
A prospective ...noninterventional study was conducted in 2,898 patients with moderate to severe chronic pain who were referred to pain clinics. The same physician visited each patient at baseline and after one and three months. Study questionnaires included the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), the Life Orientation Test–Revised (LOT-R), the Pain Coping Questionnaire (CAD-R), the Brief Pain Inventory Short Form (BPI-SF), and the EuroQol-5D (EQ-5D). Regression analyses were used to evaluate the independent contribution of the changes in perceived empathy over pain intensity and improvement of HR-QoL.
Results
BPI-SF scores for pain intensity, rated as worst, least, average, and current pain, decreased significantly (P < 0.001) from baseline to month 3, with reductions of 33.7%, 42.5%, 40.0%, and 46.9%, respectively. Pain intensity decreased from 6.3 ± 1.5 at baseline to 4.7 ± 1.8 at one month and 3.8 ± 1.9 at three months (P < 0.050). Significant (P < 0.001) improvements in the EQ-5D tariff (+37.1%) and EQ-5D VAS (+26.7%) were also recorded. In the linear regression analysis, JSPPPE and LOT-R, but not CAD-R, were significantly associated with pain relief and HR-QoL.
Conclusions
Physicians’ empathy and patients’ dispositional optimism have a role in determining positive outcomes in patients with chronic pain. Physicians’ empathy may therefore be a suitable, yet relatively unexplored, target for intervention.
The low overall prevalence of systemic sclerosis (SSc) and the low proportion of male patients have resulted in a scarcity of studies assessing sex differences in Ssc patients, and contradictory ...results have often been show among those studies that have been performed.
A prospective study was conducted with the Spanish RESCLE register to analyse the influence of gender on survival of SSc patients.
In total, 1506 SSc patients (1341 women, 165 men) were recruited from 21 centres. Older age at onset (OR 1.02), shorter time from onset to diagnosis (OR 0.96), smoking (OR 2.57), interstitial lung disease (ILD) (OR 1.58), less predisposition to sicca syndrome and to antinuclear antibody positivity (OR 0.29 and 0.43, respectively), and higher compliance with the ACR 1980 criteria (OR 1.79) were independently associated with the male sex. During follow-up, 30.4% of men versus 14.6% of women died (p<0.001). Survival at 10 years from the onset of symptoms was 75.3% for men and 92.9% for women (p<0.001), and the difference remained after selecting only SSc-related deaths (85.6% vs. 96.1%, p<0.001). The mortality predictive factors were diffuse SSc (OR 2.26), ILD (OR 1.82), digital ulcers (OR 1.38), tendon friction rubs (OR 1.74), male sex (OR 1.53), increased age at onset (OR 1.13) and isolated PH (considering only deaths from diagnosis), both in the overall (OR 3.63) and female cohorts (OR 3.97). The same risk factors were observed in the male cohort, except for isolated PH and ILD.
The present study confirms the existence of epidemiological, clinical, laboratory and prognostic gender differences in systemic sclerosis patients.
To assess the clinical manifestations and prognosis of Spanish patients with systemic sclerosis (SSc) according to their immunological profile.
From the Spanish Scleroderma Study Group or RESCLE ...(Registro de ESCLErodermia as Spanish nomenclature) Registry we selected those patients in which anti-centromere (ACA), anti-topoisomerase I (ATA), and anti-RNA polymerase III (ARA) antibodies had been determined, and a single positivity for each SSc specific antibody was detected. Demographic, clinical, laboratory, and survival data were compared according to the serologic status of these antibodies.
Overall, 209 SSc patients were included. In 128 (61%) patients ACA was the only positive antibody, 46 (22%) were only positive for ATA, and 35 (17%) for ARA. Of note, the three groups were mutually exclusive. In univariate analysis, patients with ACA presented more frequently limited cutaneous SSc (lcSSc) (p<0.001), whereas diffuse cutaneous SSc (dcSSc) was the most frequent subtype in patients with ATA (54%) and ARA (62%) (both p<0.001). Positive patients for ARA showed the highest prevalence of joint involvement (p<0.001) and those from ATA group had a higher prevalence of interstitial lung disease (ILD) (p<0.001). Scleroderma renal crisis was more frequent in the ARA group (p<0.001). In multivariate analysis, ACA were associated with female gender and were protective for dcSSc and ILD. ATA were found to be protective for lcSSc and they were independently associated with interstitial reticular pattern. ARA positivity was independently associated with dcSSc. We did not find differences in mortality between the three groups.
In Spanish SSc patients, the presence of SSc specific antibodies conferred a distinctive clinical profile.
PDF
