Adopting an Environmental Management System can offer firms a number of benefits, but also runs up against some difficulties. Firms need to weigh up these benefits and difficulties to evaluate their ...investment in such a system. This work aims to examine the use of Environmental Management Systems in a strategic sector in Spain: its automotive industry. We identify the main benefits firms obtain from these systems, and the difficulties they face in their implementation and certification. The literature offers homogenous results for the difficulties, but not for the benefits, which are conditioned by the sector and country under analysis. We obtain data via a questionnaire from 228 firms including manufacturers and suppliers. We then carry out a factor analysis to determine the latent constructs relating to benefits and difficulties. According to our results, the benefits of these systems are improvements in the firm's market position, stakeholder relations, and environmental performance, and access to environmental technologies. The difficulties are the requirements of the system, the organisational structure and commitment of the human resources (managers and workers), and the environmental information in terms of establishing objectives, calculating outcomes and establishing workers' environmental responsibilities.
•Analysis of environmental management systems in Spanish automotive industry.•Differentiation of most important benefits and difficulties.•Identification of four latent factors of benefits and three of difficulties.•Proactive environmental management in Spanish automotive industry.
Conditioned pain modulation (CPM) is a promising psychophysical biomarker of central pain mechanisms because it significantly discriminates patients with chronic pain from healthy controls. ...Nevertheless, it is unclear in what extent CPM assessed experimentally is correlated with clinical manifestations of pain. To assess the concurrent validity of CPM, we performed a systematic review of the literature reporting correlations between CPM responses and pain intensity, disability, duration, and area in patients with different chronic pain conditions. We included 32 studies that altogether encompassed data from 1958 patients and provided 62 correlations. The majority of the results (69%) reported nonsignificant correlations between CPM efficiency and clinical manifestations of pain, whereas the remaining results showed a correlation between CPM reduction and worse clinical symptoms of pain. The modality of stimulation, the type of pain, and the stimulation site appear to be critical variables that influenced the pattern of results. Given that most of the studies were conducted with highly heterogeneous methodologies and unclear risk of bias, the findings highlight the need for future studies using standardized measures of clinical and experimental pain before considering CPM as a valid biomarker of pain. We discuss some guidelines to overcome the constraints in this promising line of research.
Special low protein foods (SLPF) are essential in the nutritional management of patients with phenylketonuria (PKU). The study objectives were to: 1) identify the number of SLPF available for use in ...eight European countries and Turkey and 2) analyse the nutritional composition of SLPF available in one of these countries.
European Nutritionist Expert Panel on PKU (ENEP) members (Portugal, Spain, Belgium, Italy, Germany, Netherlands, UK, Denmark and Turkey) provided data on SPLF available in each country. The nutritional composition of Portuguese SLPF was compared with regular food products.
The number of different SLPF available in each country varied widely with a median of 107 ranging from 73 (Portugal) and 256 (Italy). Food analysis of SLPF available from a single country (Portugal) indicated that the mean phenylalanine content was higher in low protein baby cereals (mean 48 mg/100 g) and chocolate/energy bars/jelly (mean 41 mg/100 g). The energy content of different foods from a sub-group of SLPF (cookies) varied widely between 23 and 96 kcal/cookie. Low protein bread had a high fat content mean 5.8 g/100 g (range 3.7 to 10) compared with 1.6 g/100 g in regular bread. Seven of the 12 SLPF sub-groups (58 %) did not declare any vitamin content, and only 4 (33 %) identified a limited number of minerals.
Whilst equal and free access to all SLPF is desirable, the widely variable nutritional composition requires careful nutritional knowledge of all products when prescribed for individual patients with PKU. There is a need for more specific nutritional standards for special low protein foods.
Three critical barriers limit the development of knowledge about service platforms today: ambiguous definitions of what service platforms entail, overemphasis of a digital artifact, and the a-priori ...assumption that an established and mature service platform exists. The logics, mechanisms, and implications associated with the initial development, subsequent transformation, and evolution of service platforms throughout their lifetime are therefore poorly understood. To address these challenges, we use complex systems theory to reconceptualize service platforms as complex adaptive systems and delineate three distinct order levels of emergence in service platforms: first-order, second-order, and third-order emergence. Contextualized for peer-to-peer lending platforms, our study contributes new knowledge of the systemic dynamics of service platforms at different moments in time – initial formation or assemblage, functioning, and evolution, while also identifying and discussing mechanisms that propitiate emergence.
Current non-invasive approaches for detection of urothelial cancers are suboptimal. We developed a test to detect urothelial neoplasms using DNA recovered from cells shed into urine. UroSEEK ...incorporates massive parallel sequencing assays for mutations in 11 genes and copy number changes on 39 chromosome arms. In 570 patients at risk for bladder cancer (BC), UroSEEK was positive in 83% of those who developed BC. Combined with cytology, UroSEEK detected 95% of patients who developed BC. Of 56 patients with upper tract urothelial cancer, 75% tested positive by UroSEEK, including 79% of those with non-invasive tumors. UroSEEK detected genetic abnormalities in 68% of urines obtained from BC patients under surveillance who demonstrated clinical evidence of recurrence. The advantages of UroSEEK over cytology were evident in low-grade BCs; UroSEEK detected 67% of cases whereas cytology detected none. These results establish the foundation for a new non-invasive approach for detection of urothelial cancer.
For decades, educational research has focused on centering the experiences of children of color. From this research arose culturally relevant pedagogies (CRPs) and culturally sustaining pedagogies ...(CSPs). However, as countless teachers focus on developing more inclusive classroom practices, the cultural needs of parents continue to be ignored. One reason for this is that, while being manifestations of funds of knowledge, CRP and CSP are rooted in the classroom and not the home. As such, there is a need for culturally sustaining research that supports/affirms parents. This article presents how testimonios gathered in Spanish with Spanish-dominant mothers serve as counter-narratives to research that positions them as disengaged. The article also features the ways in which mothers subvert attempts to minimize their parental presence. A preliminary framework for culturally sustaining research is also shared. Participants included 10 Spanish-dominant Latinx mothers from a large immigrant community in New York City. Mothers qualified for inclusion if their child (a) attended a local public elementary school, (b) was in Grades 2 to 6, (c) was classified as having a disability, and (d) was classified as an English language learner by their school. Qualifying children were receiving services in one of three special education settings: bilingual inclusive classrooms, transitional bilingual special education, or monolingual inclusive education. This study employed a combination of qualitative research methods and consisted of two phases. During the first phase, 10 mothers took part in two narrative interviews. For the second phase, three focal mothers, chosen from the larger sample, took part in ethnographic case studies consisting of five additional interviews, two home observations, one communal recollection, and sharing of artifacts. (a) Mothers of emergent bilinguals labeled as disabled (MoEBLADs) are systematically excluded from their child's education at both the school and district levels. (b) MoEBLADs internalize these experiences and fault themselves for their limited participation in their children's learning. (c) MoEBLADs subversively make space for themselves in their children's educational experiences by focusing on contributions they can make outside of school. Research about MoEBLADs typically frames them as unwilling to support and/or incapable of supporting their children academically, signaling that many of the deficit-grounded perspectives MoEBLADs encounter in schools are also present in research. Researchers must address how the language of research contributes to the reinforcement and maintenance of deficit-grounded perspectives calling for a need to shift from inclusive research to culturally sustaining research.
The main aims of this paper are to analyse the monetary value of informal care time using different techniques and to identify significant variables associated with the number of caregiving hours.
A ...multicentre study in two Spanish regions in adult caregivers was conducted. A total sample of 604 people was available. A multivariate analysis was performed to identify the variables associated with the number of hours of caregiving time. In the monetary valuation of informal care provided, three approaches were used: replacement cost method, opportunity cost and contingent valuation (willingness to pay and willingness to accept).
The main determinants of the amount of time of informal care provided were age, gender, the level of care receiver´s dependence and the professional care services received (at home and out of home). The value estimated for informal care time ranges from EUROS 80,247 (replacement cost method) to EUROS 14,325 (willingness to pay), with intermediate values of EUROS 27,140 and EUROS 29,343 (opportunity cost and willingness to accept, respectively). Several sensitivity analyses were performed over the base cases, confirming the previous results.
Time of informal care represents a great social value, regardless of the applied technique. However, the results can differ strongly depending on the technique chosen. Therefore, the choice of technique of valuation is not neutral. Among the determinants of informal care time, the professional care received at home has a complementary character to informal care, while the formal care outside the home has a substitute character.
Urine cytology is an essential element of the diagnostic work up of hematuria. A significant proportion of cases continue to be placed in the “atypical” or “suspicious” categories of the Paris system ...for urine cytology, posing difficulty in patient management. We report on the performance of our recently described urine-based assay “UroSEEK” in cases with equivocal diagnosis in patients who are investigated for bladder cancer. Urine samples were collected from two cohorts. The first consisted of patients who presented with hematuria or lower urinary tract symptoms (early detection cohort) and the second of patients that are in follow-up for prior bladder cancer (surveillance cohort). Urine samples were analyzed for mutations in 11 genes and aneuploidy. In the early detection setting, we found high sensitivity and specificity (96% and 88%, respectively) and a strong negative predictive value of 99%. The assay performance was less robust in the surveillance cohort (sensitivity of 74%, specificity of 72%, and negative predictive value of 53%). UroSEEK demonstrated a notable lead time to cancer diagnosis. Seven cases in the early detection cohort and 71 surveillance cases were detected at least 6 months prior to clinical diagnosis. Our results suggest a potential role for UroSEEK assay in guiding management of patients with atypical urine cytology if confirmed in future prospective trials.
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