A technological framework based on automatic messaging for improving adherence of diabetic patients

En todo el mundo se ha observado un crecimiento exponencial en la incidencia de enfermedades crónicas como la hipertensión y enfermedades cardiovasculares y respiratorias, así como la diabetes mellitus, que causa un número de muertes cada vez mayor en todo el mundo (Beaglehole et al., 2008). En concreto, la prevalencia de diabetes mellitus (DM) está aumentando de manera considerable en todas las edades y representa un serio problema de salud mundial. La diabetes fue la responsable directa de 1,5 millones de muertes en 2012 y 89 millones de años de vida ajustados por discapacidad (AVAD) (OMS, 2014). Uno de los principales dilemas que suelen asociarse a la gestión de EC es la adherencia de los pacientes a los tratamientos, que representa un aspecto multifactorial que necesita asistencia en lo relativo a: educación, autogestión, interacción entre los pacientes y cuidadores y compromiso de los pacientes. Medir la adherencia del tratamiento es complicado y, aunque se ha hablado ampliamente de ello, aún no hay soluciones “de oro” (Reviews, 2002). El compromiso de los pacientes, a través de la participación, colaboración, negociación y a veces del compromiso firme, aumentan las oportunidades para una terapia óptima en la que los pacientes se responsabilizan de su parte en la ecuación de adherencia. Comprometer e involucrar a los pacientes diabéticos en las decisiones de su tratamiento, junto con expertos profesionales, puede ayudar a favorecer un enfoque centrado en el paciente hacia la atención a la diabetes (Martin et al., 2005). La motivación y atribución de poder de los pacientes son quizás los dos factores interventores más relevantes que afectan directamente a la autogestión de la atención a la diabetes. Se ha demostrado que estos dos factores desempeñan un papel fundamental en la adherencia a la prescripción, así como en el fomento exitoso de un estilo de vida sana y otros cambios de conducta (Heneghan et al., 2013). Un plan de educación personalizada es indispensable para proporcionarle al paciente las herramientas adecuadas que necesita para la autogestión efectiva de la enfermedad (El-Gayar et al. 2013). La comunicación efectiva es fundamental para proporcionar una atención centrada en el paciente puesto que influye en las conductas y actitudes hacia un problema de salud ((Frampton et al. 2008). En este sentido, la interactividad, la frecuencia, la temporalización y la adaptación de los mensajes de texto pueden promover la adherencia a un régimen de medicación. Como consecuencia, adaptar los mensajes de texto a los pacientes puede resultar ser una manera de hacer que las sugerencias y la información sean más relevantes y efectivas (Nundy et al. 2013). En este contexto, las tecnologías móviles en el ámbito de la salud (mHealth) están desempeñando un papel importante al conectar con pacientes para mejorar la adherencia a medicamentos recetados (Krishna et al., 2009). La adaptación de los mensajes de texto específicos de diabetes sigue siendo un área de oportunidad para mejorar la adherencia a la medicación y ofrecer motivación a adultos con diabetes. Sin embargo, se necesita más investigación para entender totalmente su eficacia. Los consejos de texto personalizados han demostrado causar un impacto positivo en la atribución de poder a los pacientes, su autogestión y su adherencia a la prescripción (Gatwood et al., 2014). mHealth se puede utilizar para ofrecer programas de asistencia de autogestión a los pacientes con diabetes y, al mismo tiempo, superar las dificultades técnicas y financieras que supone el tratamiento de la diabetes (Free at al., 2013). El objetivo principal de este trabajo de investigación es demostrar que un marco tecnológico basado en las teorías de cambios de conducta, aplicado al campo de la mHealth, permite una mejora de la adherencia al tratamiento en pacientes diabéticos. Como método de definición de una solución tecnológica, se han adoptado un conjunto de diferentes técnicas de conducta validadas denominado marco de compromiso de retroacción conductual (EBF, por sus siglas en inglés) para formular los mensajes, guiar el contenido y evaluar los resultados. Los estudios incorporan elementos del modelo transteórico (TTM, por sus siglas en inglés), la teoría de la fijación de objetivos (GST, por sus siglas en inglés) y los principios de comunicación sanitaria persuasiva y eficaz. Como concepto general, el modelo TTM ayuda a los pacientes a progresar a su próxima fase de conducta a través de mensajes de texto motivados específicos y permite que el médico identifique la fase actual y adapte sus estrategias individualmente. Además, se adoptan las directrices del TTM para fijar objetivos personalizados a un nivel apropiado a la fase de cambio del paciente. La GST encierra normas que van a ponerse en práctica para promover la intervención educativa y objetivos de pérdida de peso. Finalmente, los principios de comunicación sanitaria persuasiva y eficaz aplicados a la aparición de los mensajes se han puesto en marcha para aumentar la efectividad. El EBF tiene como objetivo ayudar a los pacientes a mejorar su adherencia a la prescripción y encaminarlos a una mejora general en la autogestión de la diabetes mediante mensajes de texto personalizados denominados mensajes de retroacción automáticos (AFM, por sus siglas en inglés). Después de una primera revisión del perfil, consistente en identificar características significativas del paciente basadas en las necesidades de tratamiento, actitudes y conductas de atención sanitaria, el sistema elige los AFM personalizados, los aprueba el médico y al final se transfieren a la interfaz del paciente. Durante el tratamiento, el usuario recopila los datos en dispositivos de monitorización de pacientes (PMD, por sus siglas en inglés) de una serie de dispositivos médicos y registros manuales. Los registros consisten en la toma de medicación, dieta y actividad física y tareas de aprendizaje y control de la medida del metabolismo. El compromiso general del paciente se comprueba al estimar el uso del sistema y la adherencia del tratamiento y el estado de los objetivos del paciente a corto y largo plazo. El módulo de análisis conductual, que consiste en una serie de reglas y ecuaciones, calcula la conducta del paciente. Tras lograr el análisis conductual, el módulo de gestión de AFM actualiza la lista de AFM y la configuración de los envíos. Las actualizaciones incluyen el número, el tipo y la frecuencia de mensajes. Los AFM los revisa periódicamente el médico que también participa en el perfeccionamiento del tratamiento, adaptado a la fase transteórica actual. Los AFM se segmentan en distintas categorías y niveles y los pacientes pueden ajustar la entrega del mensaje de acuerdo con sus necesidades personales. El EBF se ha puesto en marcha integrado dentro del sistema METABO, diseñado para facilitar al paciente diabético que controle sus condiciones relevantes de una manera menos intrusiva. El dispositivo del paciente se vincula en una plataforma móvil, mientras que una interfaz de panel médico permite que los profesionales controlen la evolución del tratamiento. Herramientas específicas posibilitan que los profesionales comprueben la adherencia del paciente y actualicen la gestión de envíos de AFM. El EBF fue probado en un proyecto piloto controlado de manera aleatoria. El principal objetivo era examinar la viabilidad y aceptación del sistema. Los objetivos secundarios eran también la evaluación de la eficacia del sistema en lo referente a la mejora de la adherencia, el control glucémico y la calidad de vida. Se reclutaron participantes de cuatro centros clínicos distintos en Europa. La evaluación del punto de referencia incluía datos demográficos, estado de la diabetes, información del perfil, conocimiento de la diabetes en general, uso de las plataformas TIC, opinión y experiencia con dispositivos electrónicos y adopción de buenas prácticas con la diabetes. La aceptación y eficacia de los criterios de evaluación se aplicaron para valorar el funcionamiento del marco tecnológico. El principal objetivo era la valoración de la eficacia del sistema en lo referente a la mejora de la adherencia. En las pruebas participaron 54 pacientes. 26 fueron asignados al grupo de intervención y equipados con tecnología móvil donde estaba instalado el EBF: 14 pacientes tenían T1DM y 12 tenían T2DM. El grupo de control estaba compuesto por 25 pa cientes que fueron tratados con atención estándar, sin el empleo del EBF. La intervención profesional tanto de los grupos de control como de intervención corrió a cargo de 24 cuidadores, entre los que incluían diabetólogos, nutricionistas y enfermeras. Para evaluar la aceptabilidad del sistema y analizar la satisfacción de los usuarios, a través de LimeSurvey, se creó una encuesta multilingüe tanto para los pacientes como para los profesionales. Los resultados también se recopilaron de los archivos de registro generados en los PMD, el panel médico profesional y las entradas de la base de datos. Los mensajes enviados hacia y desde el EBF y los archivos de registro del sistema y los servicios de comunicación se grabaron durante las cinco semanas del estudio. Se entregaron un total de 2795 mensajes, lo que supuso una media de 107,50 mensajes por paciente. Como se muestra, los mensajes disminuyen con el tiempo, indicando una mejora global de la adherencia al plan de tratamiento. Como se esperaba, los pacientes con T1DM recibieron más consejos a corto plazo, en relación a su estado. Del mismo modo, al ser el centro de T2DM en cambios de estilo de vida sostenible a largo plazo, los pacientes con T2DM recibieron más consejos de recomendación, en cuanto a dietas y actividad física. También se ha llevado a cabo una comparación de la adherencia e índices de uso para pacientes con T1DM y T2DM, entre la primera y la segunda mitad de la prueba. Se han observado resultados favorables para el uso. En lo relativo a la adherencia, los resultados denotaron una mejora general en cada dimensión del plan de tratamiento, como la nutrición y las mediciones de inserción de glucosa en la sangre. Se han llevado a cabo más estudios acerca del cambio a nivel educativo antes y después de la prueba, medidos tanto para grupos de control como de intervención. Los resultados indicaron que el grupo de intervención había mejorado su nivel de conocimientos mientras que el grupo de control mostró una leve disminución. El análisis de correlación entre el nivel de adherencia y las AFM ha mostrado una mejora en la adherencia de uso para los pacientes que recibieron los mensajes de tipo alertas, y unos resultados no significativos aunque positivos relacionados con la adherencia tanto al tratamiento que al uso correlacionado con los recordatorios. Por otra parte, los AFM parecían ayudar a los pacientes que no tomaban suficientemente en serio su tratamiento en el principio y que sí estaban dispuestos a responder a los mensajes recibidos. Aun así, los pacientes que recibieron demasiadas advertencias, comenzaron a considerar el envío de mensajes un poco estresante. El trabajo de investigación llevado a cabo al desarrollar este proyecto ofrece respuestas a las cuatro hipótesis de investigación que fueron la motivación para el trabajo. • Hipótesis 1 : es posible definir una serie de criterios para medir la adherencia en pacientes diabéticos. • Hipótesis 2: es posible diseñar un marco tecnológico basado en los criterios y teorías de cambio de conducta mencionados con anterioridad para hacer que los pacientes diabéticos se comprometan a controlar su enfermedad y adherirse a planes de atención. • Hipótesis 3: es posible poner en marcha el marco tecnológico en el sector de la salud móvil. • Hipótesis 4: es posible utilizar el marco tecnológico como solución de salud móvil en un contexto real y tener efectos positivos en lo referente a indicadores de control de diabetes. La verificación de cada hipótesis permite ofrecer respuesta a la hipótesis principal: La hipótesis principal es: es posible mejorar la adherencia diabética a través de un marco tecnológico mHealth basado en teorías de cambio de conducta. El trabajo llevado a cabo para responder estas preguntas se explica en este trabajo de investigación. El marco fue desarrollado y puesto en práctica en el Proyecto METABO. METABO es un Proyecto I+D, cofinanciado por la Comisión Europea (METABO 2008) que integra infraestructura móvil para ayudar al control, gestión y tratamiento de los pacientes con diabetes mellitus de tipo 1 (T1DM) y los que padecen diabetes mellitus de tipo 2 (T2DM). ABSTRACT Worldwide there is an exponential growth in the incidence of Chronic Diseases (CDs), such as: hypertension, cardiovascular and respiratory diseases, as well as diabetes mellitus, leading to rising numbers of deaths worldwide (Beaglehole et al. 2008). In particular, the prevalence of diabetes mellitus (DM) is largely increasing among all ages and constitutes a major worldwide health problem. Diabetes was directly responsible for 1,5 million deaths in 2012 and 89 million Disability-adjusted life year (DALYs) (WHO 2014). One of the key dilemmas often associated to CD management is the patients’ adherence to treatments, representing a multi-factorial aspect that requires support in terms of: education, self-management, interaction between patients and caregivers, and patients’ engagement. Measuring adherence is complex and, even if widely discussed, there are still no “gold” standards ((Giardini et al. 2015), (Costa et al. 2015). Patient’s engagement, through participation, collaboration, negotiation, and sometimes compromise, enhance opportunities for optimal therapy in which patients take responsibility for their part of the adherence equation. Engaging and involving diabetic patients in treatment decisions, along with professional expertise, can help foster a patient-centered approach to diabetes care (Martin et al. 2005). Patients’ motivation and empowerment are perhaps the two most relevant intervening factors that directly affect self-management of diabetes care. It has been demonstrated that these two factors play an essential role in prescription adherence, as well as for the successful encouragement of a healthy life-style and other behavioural changes (Heneghan et al. 2013). A personalised education plan is indispensable in order to provide the patient with the appropriate tools needed for the effective self-management of the disease (El-Gayar et al. 2013). Effective communication is at the core of providing patient-centred care since it influences behaviours and attitudes towards a health problem (Frampton et al. 2008). In this regard, interactivity, frequency, timing, and tailoring of text messages may promote adherence to a medication regimen. As a consequence, tailoring text messages to patients can constitute a way of making suggestions and information more relevant and effective (Nundy et al. 2013). In this context, mobile health technologies (mHealth) are playing significant roles in improving adherence to prescribed medications (Krishna et al. 2009). The tailoring of diabetes-specific text messages remains an area of opportunity to improve medication adherence and provide motivation to adults with diabetes but further research is needed to fully understand their effectiveness. Personalized text advices have proven to produce a positive impact on patients’ empowerment, self-management, and adherence to prescriptions (Gatwood et al. 2014). mHealth can be used for offering self-management support programs to diabetes patients and at the same time surmounting the technical and financial difficulties involved in diabetes treatment (Free et al. 2013). The main objective of this research work is to demonstrate that a technological framework, based on behavioural change theories, applied to mHealth domain, allows improving adherence treatment in diabetic patients. The framework, named Engagement Behavioural Feedback Framework (EBF), is built on top of validated behavioural techniques to frame messages, guide the definition of contents and assess outcomes: elements from the Transtheoretical Model (TTM), the Goal-Setting Theory (GST), Effective Health Communication (EHC) guidelines and Principles of Persuasive Technology (PPT) were incorporated. The TTM helps patients to progress to a next behavioural stage, through specific motivated text messages, and allow clinician’s identifying the current stage and tailor its strategies individually. Moreover, TTM guidelines are adopted to set customised goals at a level appropriate to the patient’s stage of change. The GST was used to build rules to be applied for enhancing educational intervention and weight loss objectives. Finally, the EHC guidelines and the PPT were applied to increase the effectiveness of messages. The EBF aims to support patients on improving their prescription adherence and persuade them towards a general improvement in diabetes self-management, by means of personalised text messages, named Automatic Feedback Messages (AFM). After a first profile screening, consisting in identifying meaningful patient characteristics based on treatment needs, attitudes and health care behaviours, customised AFMs are selected by the system, approved by the professional, and finally transferred into the patient interface. During the treatment, the user collects the data into a Patient Monitoring Device (PMD) from a set of medical devices and from manual inputs. Inputs consist in medication intake, diet and physical activity, metabolic measurement monitoring and learning tasks. Patient general engagement is checked by estimating the usage of the system and the adherence of treatment and patient goals status in the short and the long term period. The Behavioural Analysis Module, consisting in a set of rules and equations, calculates the patient’s behaviour. After behavioural analysis is accomplished, the AFM library and the dispatch setting are updated by the AFM Manager module. Updates include the number, the type and the frequency of messages. The AFMs are periodically supervised by the professional who also participates to the refinement of the treatment, adapted to the current transtheoretical stage. The AFMs are segmented in different categories and levels and patients can adjust message delivery in accordance with their personal needs. The EBF was integrated to the METABO system, designed to facilitate diabetic patients in managing their disease in a less intrusive approach. Patient device corresponds in a mobile platform, while a medical panel interface allows professionals to monitoring the treatment evolution. Specific tools allow professional to check patient adherence and to update the AFMs dispatch management. The EBF was tested in a randomised controlled pilot. The main objective was to examine the feasibility and acceptance of the system. Secondary objectives were also the assessment of the effectiveness of system in terms of adherence improvement, glycaemic control, and quality of life. Participants were recruited from four different clinical centres in Europe. The baseline assessment included demographics, diabetes status, profile information, knowledge about diabetes in general, usage of ICT platforms, opinion and experience about electronic devices and adoption of good practices with diabetes. Acceptance and the effectiveness evaluation criteria were applied to evaluate the performance of the technological framework. The main objective was the assessment of the effectiveness of system in terms of adherence improvement. Fifty-four patients participated on the trials. Twenty-six patients were assigned in the intervention group and equipped with mobile where the EBF was installed: 14 patients were T1DM and 12 were T2DM. The control group was composed of 25 patients that were treated through a standard care, without the usage of the EBF. Professional’s intervention for both intervention and control groups was carried out by 24 care providers, including endocrinologists, nutritionists, and nurses. In order to evaluate the system acceptability and analyse the users’ satisfaction, an online multi-language survey, using LimeSurvey, was produced for both patients and professionals. Results were also collected from the log-files generated in the PMDs, the professional medical panel and the entries of the data base. The messages sent to and from the EBF and the log-files of the system and communication services were recorded over 5 weeks of the study. A total of 2795 messages were submitted, representing an average of 107,50 messages per patient. As demonstrated, messages decrease over time indicating an overall improvement of the care plan’s adherence. As expected, T1DM patients were more loaded with short-term advices, in accordance with their condition. Similarly, being the focus of T2DM on long-term sustainable lifestyle changes, T2DM received more reminders advices, as for diet and physical activity. Favourable outcomes were observed for treatment and usage adherences of the intervention group: for both the adherence indices, results denoted a general improvement on each care plan’s dimension, such as on nutrition and blood glucose input measurements. Further studies were conducted on the change on educational level before and after the trial, measured for both control and intervention groups. The outcomes indicated the intervention group has improved its level of knowledge, while the control group denoted a low decrease. The correlation analysis between the level of adherences and the AFMs showed an improvement in usage adherence for patients who received warnings message, while non-significantly yet even positive indicators related to both treatment and usage adherence correlated with the Reminders. Moreover, the AFMs seemed to help those patients who did not take their treatment seriously enough in the beginning and who were willing to respond to the messages they received. Even though, patients who received too many Warnings, started to consider the message dispatch to be a bit stressful. The research work carried out in developing this research work provides responses to the four research hypothesis that were the motivation for the work: •Hypothesis 1: It is possible to define a set of criteria to measure adherence in diabetic patients. •Hypothesis 2: It is possible to design a technological framework, based on the aforementioned criteria and behavioural change theories, to engage diabetic patients in managing their disease and adhere to care plans. •Hypothesis 3: It is possible to implement the technological framework in the mobile health domain. •Hypothesis 4: It is possible to use the technological framework as a mobile health solution in a real context and have positive effects in terms of diabetes management indicators. The verification of each hypothesis allowed us to provide a response to the main hypothesis: The Main Hypothesis is: It is possible to improve diabetic adherence through a mHealth technological framework based on behavioural change theories. The work carried out to answer these questions is explained in this research work. The framework was developed and applied in the METABO project. METABO is an R&D project, co-funded by the European Commission (METABO 2008) that integrates mobile infrastructure for supporting the monitoring, management, and treatment of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients.

Investigación y análisis sobre la idoneidad de la práctica del tenis de mesa en la Educación Primaria

Esta investigación surge a raíz de la experiencia profesional del autor, maestro especialista de Educación Física en el C.E.I.P. “Alhambra” de Madrid, cuando de manera progresiva, aprecia que el tenis de mesa puede ser un deporte muy interesante de desarrollar en las sesiones de Educación Física y de promover dentro de los tiempos de recreo. El autor cree que este deporte desarrolla una serie de objetivos motrices, afectivos, cognitivos y sociales que pueden contribuir a la adquisición de las competencias básicas y al desarrollo integral de los alumnos. Es entonces cuando recibe formación sobre el deporte de tenis de mesa y busca los medios necesarios de financiación para que se dote al centro del material necesario. Así la Junta municipal del distrito de Fuencarral-El Pardo instala en el patio del colegio tres mesas de exterior y, con los recursos del colegio y la ayuda de la Asociación de padres y madres (AMPA), se consiguen cinco mesas de interior plegables y todo el material necesario (redes, raquetas, pelotas, etc.). Tras introducir este deporte desde 3º a 6º de Educación Primaria promueve un campeonato en el colegio cuyo índice de participación ronda el 90% del alumnado, estos resultados crean al autor ciertas incertidumbres que son la motivación y punto de partida para realizar esta investigación que analice si la práctica del tenis de mesa puede resultar idónea en la etapa de Educación Primaria. Introducción La legislación actual en materia de educación, Ley Orgánica 2/2006, de 3 de mayo, de Educación (LOE) modificada por la Ley Orgánica 8/2013, de 9 de diciembre, para la mejora de la calidad educativa. (LOMCE), otorga una gran relevancia al deporte en general. "El deporte es una actividad saludable, divertida y formativa que puede tener profundos beneficios no sólo para su salud y su bienestar sino también para el desarrollo personal integral físico, psicológico y psicosocial del niño, además de sobre su desarrollo deportivo" (Pradas, 2009, p. 151), es pues, un momento idóneo para analizar qué deportes se practican en los colegios o por qué se practican unos más que otros. "El tenis de mesa además de ser un deporte para todos, se presenta como un juego atractivo, en donde su práctica resulta muy divertida a cualquier edad, tanto para niños como para adultos, principalmente porque presenta unas reglas de juego simples, no encerrando peligro alguno para la integridad física de sus practicantes durante su juego" (Pradas, 2009, p. 83). Es un deporte que "está abierto a todos, sin distinción de edad o sexo, tanto como deporte de alto nivel como de práctica familiar o social" (Gatien, 1993, p. 16). No obstante, "son escasas las obras sobre tenis de mesa. Pocos libros, tanto de divulgación como de reflexión sobre el tenis de mesa, adornan los estantes de las librerías y las bibliotecas" (Erb, 1999, p.14) y añade “así pues, el medio escolar padece de falta de obras explicativas y pedagógicas referidas a este tema" (Erb, 1999, p.14 ) En particular, se pretenden conseguir cinco objetivos divididos en tres categorías (el centro, el profesorado y el deporte. • A nivel de Centro: - Conocer el porcentaje de colegios que disponen de espacios y materiales adecuados para la práctica del tenis de mesa, así como identificar, de las distintas Direcciones de Área Territoriales (DAT), cuál tiene los colegios mejor dotados tanto en instalaciones como en materiales para desarrollar programas de promoción del tenis de mesa. - Averiguar las posibles causas por las que el tenis de mesa no se practica tanto como otros deportes, analizando los impedimentos que limitan la implantación del tenis de mesa como un deporte habitual en los centros de Educación Primaria. Analizar la opinión del profesorado en cuanto a los materiales y las instalaciones necesarios para el tenis de mesa. • A nivel de profesorado: - Analizar el nivel de conocimiento que tienen los profesionales que imparten la asignatura de Educación Física sobre el tenis de mesa, así como sus necesidades para incluir unidades didácticas de tenis de mesa en sus programaciones didácticas. - Conocer el perfil de profesor ideal que recomienda la utilización del tenis de mesa y averiguar el interés del profesorado por recibir formación específica del tenis de mesa. • A nivel de deporte: - Analizar la opinión de los profesionales sobre la idoneidad del tenis de mesa en la Educación Primaria atendiendo a los objetivos que persigue, a las competencias que desarrolla, a los contenidos, criterios de evaluación y estándares de aprendizaje que se pueden trabajar y a las lesiones que se producen. Metodología La investigación se caracterizó por utilizar una metodología inductiva, al surgir de la experiencia profesional del autor, también fue transversal al analizar la realidad en un momento concreto y de tipo cuantitativa. La población objeto de estudio fue la totalidad de los colegios públicos de la Comunidad de Madrid, siendo los profesores de Educación Física los encargados de facilitar los datos solicitados. Estos datos se obtuvieron utilizando como instrumento de toma de datos el cuestionario auto administrado con preguntas cerradas de opción múltiple previamente validado por un panel de 5 expertos. Las variables indirectas fueron: el género del profesorado, la edad del profesorado, la experiencia profesional y el tipo de destino. El proceso de la toma de datos supuso un lapso de tiempo de 3 meses, desde mayo de 2015 hasta julio de 2015, en este tiempo hubo dos fases de recogida de datos, una online a través del correo electrónico institucional de los colegios públicos de la Comunidad de Madrid y otra “in situ” con cuestionarios de lápiz y papel. En cuanto a los datos que se obtuvieron, sobre una población de 798 colegios, se consiguió una muestra de 276, esto supuso una tasa de respuesta del 34,59%, asumiendo la situación más desfavorable posible (p=q) y un nivel de confianza del 95%, para el total de los 276 cuestionarios cumplimentados, el error máximo fue del ±4,78%. Resultados En cuanto a los resultados obtenidos, se establecieron de acuerdo a tres dimensiones: A nivel de Centro, a nivel de Profesorado y a nivel del Deporte y pretendieron averiguar si se alcanzaron los cinco objetivos planteados. Tras el análisis de los resultados, se apreció que los colegios públicos de la Comunidad de Madrid disponían de las suficientes instalaciones para el tenis de mesa, en cambio, faltaban materiales específicos y formación por parte del profesorado, así como recursos didácticos y un programa de promoción del tenis de mesa. Se apreció un manifiesto interés por parte del profesorado en recibir formación específica de tenis de mesa pues la mayoría recomendaba la utilización del tenis de mesa dentro de la asignatura de Educación Física en Educación Primaria. Por último, los resultados mostraron la cantidad de objetivos motrices, afectivos, cognitivos y sociales que desarrolla el tenis de mesa así como su contribución a la adquisición de las competencias básicas y al objetivo “k” de la Educación Primaria, que indica “Valorar la higiene y la salud, conocer y respetar el cuerpo humano, y utilizar la Educación Física y el deporte como medios para favorecer el desarrollo personal y social”, además, se mostró el bajo índice de lesiones que provoca. Discusión y conclusiones El tenis de mesa es un deporte idóneo para ser practicado y enseñado en la asignatura de Educación Física en la etapa de Educación Primaria debido a la gran cantidad de contenidos que son susceptibles de ser trabajados a través de este deporte y debido a la gran cantidad de valores, individuales y sociales que se pueden fomentar con la práctica del tenis de mesa. Las causas de que hasta ahora, el tenis de mesa no sea un deporte practicado de forma habitual en los colegios públicos de la Comunidad de Madrid a pesar de trabajar muchos contenidos específicos de la asignatura de Educación Física puede deberse a factores externos al deporte del tenis de mesa y susceptibles de ser solucionados con una adecuada inversión en materiales específicos, formación del profesorado y recursos didácticos. Si se dota a los centros de los materiales y recursos didácticos necesarios y dando formación al profesorado, éste introduciría unidades didácticas de tenis de mesa dentro de sus programaciones anuales. La federación española y madrileña de tenis de mesa, deberían desarrollar un programa de promoción dotando de materiales y recursos a los centros, tal y como lo han hecho otras federaciones como la de voleibol, bádminton o de baloncesto, entre otras. ABSTRACT This research arises from the professional experience of the author, specialized teacher of physical education in the CEIP "Alhambra" in Madrid, where progressively, appreciates that table tennis can be a very interesting sport to develop in physical education sessions and promote within the playtimes. The author believes that this sport develops a range of motor, affective, cognitive and social objectives that can contribute to the acquisition of basic skills and the integral development of students. It is then when receives training on the sport of table tennis and seeks ways of funding in order to outfit the center with necessary equipment. The Municipal District of Fuencarral-El Pardo installed three outdoor tables in the schoolyard and with the resources of the school and the support of the Association of Parents (AMPA), five indoor folding tables are achieved as well as all the necessary material (nets, rackets, balls, etc.). After introduce the sport from 3rd to 6th grade of primary education, promotes a championship in the school where the participation rate is around 90% of students, these results create the uncertainties to the author that are the motivation and starting point for this research to analyze whether the practice of table tennis can be ideal at the stage of primary education. Introduction The current legislation on education, Organic Law 2/2006 of 3 May, on Education (LOE) as amended by Organic Law 8/2013, of December 9, to improve educational quality (LOMCE), attaches great importance to the sport in general, "Sport is a healthy, funny and educational activity that can have great benefits not only for their health and well-being but also for the physical, psychological and psychosocial comprehensive personal child development besides on their sports development "(Pradas, 2009, p. 151), is therefore an ideal moment to analyze which sports are practiced in schools or why are practiced some more than others. "The table tennis as well as being a sport for everyone, is presented as an attractive game, where its practice is funny at any age, both children and adults, mainly because it has simple game rules, not enclosing danger for the physical integrity of its practitioners during their game" (Pradas, 2009, p. 83). It is a sport that is "open to all, regardless of age or sex, as high-level sport, as family or social practice" (Gatien, 1993, p. 16). However, "there are few books on table tennis. Few books, both reflexion or popularization about table tennis, adorn the shelves of bookstores and libraries." (Erb, 1999, p.14) and add "So, the school environment suffers from lack of explanatory and educational work related to this issue." (Erb, 1999, p.14) In particular, it is intended to achieve the following objectives within the Community of Madrid: • To determine the percentage of schools that have spaces and materials suitable for practicing table tennis and identify, from the different Directorates of Land Area (DAT), which has the best equipped schools in both facilities and materials to develop programs to promote table tennis. • Find out the possible causes that explained why table tennis is not practiced as much as other sports, analyzing impediments that limit the implementation of table tennis as a regular sport in primary schools. Analyze the opinion of teachers in terms of materials and facilities needed for table tennis. • Analyze the level of knowledge about table tennis among professionals who teach the subject of Physical Education and their needs to include teaching units about table tennis in their teaching programs. • Knowing the profile of the ideal teacher who recommends the use of table tennis and figure out the interest of teachers to receive specific training of table tennis. • Analyze the professional opinion on the suitability of table tennis in Primary Education taking into account the objectives pursued, to develop the skills, content, evaluation criteria and learning standards that can work and injuries involved. Methodology The investigation was characterized by using an inductive methodology, arising from the professional experience of the author, was also transverse to analyze reality in a particular time and quantitative type. The population under study were all the state schools in Madrid region, being the physical education teachers responsible for providing the requested data. These data were obtained using as data collection instrument a self-administered questionnaire with multiple choice questions, because it facilitates the analysis thereof. In terms of obtained data, on a population of 798 schools, a sample of 276 was achieved, this represented a response rate of 34.59%, assuming the worst case scenario (p = q) and a level 95% confidence for the total of the 276 completed questionnaires, the maximum error was ± 4.78%. Results In terms of the results, they were set according to three dimensions: center level, professorate level and Sport level and trying to find out whether the five objectives were achieved. After analyzing the results, it was found that schools possessed sufficient facilities for table tennis, however, lacked specific materials and training by teachers, as well as teaching resources and a program to promote table tennis. A clear interest was noticed by teachers in order to receive specific training in table tennis since most recommended the use of table tennis in the subject of physical education in primary education. Finally, the results proved the number of motor, affective, cognitive and social objectives developed by table tennis and its contribution to the acquisition of basic skills and the objective "k" of primary education, in addition to the low rate of injury it causes. Discussion and conclusions Table tennis is an ideal sport to be practiced and taught in the subject of Physical Education in Primary Education due to the large amount of content that are likely to be worked through this sport and due to the large number of individual and social values that can foster the practice of table tennis. The causes of that so far, table tennis is not a sport practiced regularly in schools despite working many specific contents of the subject of Physical Education may be due to factors outside the sport of table tennis and subject to solved with adequate investment in specific materials, teacher training and educational resources. By endowing the centers with the necessary teaching materials and resources and providing training to teachers, they would introduce teaching units of table tennis within their annual programs. Madrid and the Spanish Federation of table tennis should develop a promotional program by endowing materials and resources to the centers, as did other federations such as badminton and basketball, among others.

Pedestrian wind comfort: feasibility study of criteria homogenisation

One of the aims of COST C14 action is the assessment and evaluation of pedestrian wind comfort. At present there is no general rule available that is applied across Europe. There are several criteria that have been developed and applied in different countries. These criteria are based on the definition of two independent parameters, a threshold effective wind speed and a probability of exceedence of this threshold speed. The difficulty of the criteria comparison arises from the two-dimensional character of the criteria definition. An effort is being made to compare these criteria, trying both to find commonalities and to clearly identify differences, in order to build up the basis for the next step: to try to define common criteria (perhaps with regional and seasonal variations). The first point is to define clearly the threshold effective wind speed (mean velocity definition parameters: averaging interval and reference height) and equivalence between different ways of defining the threshold effective wind speed (mean wind speed, gust equivalent mean, etc.) in comparable terms (as far as possible). It can be shown that if the wind speed at a given location is defined in terms of a probability distribution, e.g. Weibull function, a given criterion is satisfied by an infinite set of wind conditions, that is, of probability distributions. The criterion parameters and the Weibull function parameters are linked to each other, establishing a set called iso-criteria lines (the locus of the Weibull function parameters that fulfil a given criterion). The relative position of iso-criteria lines when displayed in a suitable two-dimensional plane facilitates the comparison of comfort criteria. The comparison of several wind comfort criteria, coming from several institutes is performed, showing the feasibility and limitations of the method.

Formación y determinación del valor del suelo: confrontación y discrepancias entre mecanismos de mercado y regulaciones administrativas

La determinación del valor del suelo implicado en los procesos de urbanización se mueve en una compleja dialéctica en la que algunos fenómenos de naturaleza morfológica como el modelado del espacio social, o el que se deduce de las determinaciones del planeamiento (aprovechamiento especialmente) se enfrentan a instrumentos de regulación que se rigen por normas de carácter administrativo (urbanísticas y expropiatorias, fiscales, financieras-hipotecarias etc.). En ese marco en el que las discrepancias son frecuentes se pretende analizar las posibles actuaciones encaminadas a influir sobre la formación de ese valor en el sentido de limitar las expectativas de aprovechamiento tradicionalmente vinculadas al sistema urbanístico establecido, destacando al respecto la implantación de criterios de sostenibilidad y participación ciudadana, así como que la utilización de normas administrativas de valoración con la finalidad de reducir tales expectativas y tratar de influir sobre el sistema urbanístico en su conjunto, no se considera suficiente para conseguir el logro de tales objetivos. Añadiendo, respecto del conjunto de normas administrativas de determinación del valor del suelo, que si bien las reglas urbanísticas y expropiatorias establecen actualmente reglas objetivas de valoración, a través de la normativa de valoración destinada a entidades financieras, o de carácter fiscal, se introducen criterios subjetivos que tratan de aproximarse al mercado, incluso en el caso del valor catastral, estructuralmente reglado. Esta separación de criterios ha llevado a un enfrentamiento al que ha venido a dar respuesta la reciente sentencia del Tribunal Supremo de 30 de mayo de 2014, que impone los criterios urbanísticos de consideración de situaciones básicas de suelo, frente a los fiscalmente regulados en relación con la normativa catastral en cuanto a la consideración de suelo urbanizable sin desarrollar, que pasa a ser considerado como en situación rural, siendo por tanto aplicables sobre el mismo las reglas de valoración que la normativa catastral establece para esta categoría de suelo (rústico) que no considera, incluso con la posterior modificación, de junio de 2015, incorporada para adaptarse a la mencionada sentencia, expectativas de aprovechamiento. Pero como se ha señalado, la exclusiva utilización de la normativa urbanística de valoración no se considera suficiente para evitar los efectos que sobre el valor de suelo produce la asignación de tales aprovechamientos, por lo que acuerdo con la actual legislación de suelo, deben asimismo potenciarse actuaciones encaminadas a un desarrollo sostenible así como a la participación ciudadana, la transparencia y el control, con la finalidad de lograr un mayor rigor en la utilización del suelo que ha de traducirse en su valoración. ABSTRACT Determining the land value involved in the urbanisation process implies a complex dialectic in which certain morphological natural phenomena like the modelling of social space or that deduced from planning determinations (especially land use) face regulatory instruments governed by administrative norms (urban planning and expropriator, tax, financial-mortgage etc.). In this context where discrepancies are common, the purpose is to analyse the possible actions geared to influence the formation of that value in the sense of limiting land use expectations traditionally linked to the established urban planning system, highlighting the implementation of sustainability criteria and citizen participation, as well as to consider that the administrative standards of evaluation for reducing said expectations, and trying to influence the urban system as a whole, are not considered sufficient for achieving these objectives. We might add, with respect to the set of administrative norms for determining the land value, that while urban and expropriations norms currently provide objective rules of valuation, subjective criteria are introduced trying to approach the market, including the structurally regulated cadastral value through valuation rules aimed at financial or fiscal institutions. This separation of criteria has led to a confrontation to which the recent ruling of the Supreme Court of May 30, 2014 responds. The aforementioned judgement imposes the urban core criteria for basic land use situations against those fiscally regulated in relation to cadastral regulations regarding the consideration of undeveloped building land, which is considered to be in a rural situation, making it subject to the same rules that cadastral valuation norms established for this category of land use (rustic) which do not consider, even with the subsequent amendment of June 2015, introduced to fit that judgment, use expectations. But as noted, the exclusive use of valuation planning regulations is not considered sufficient to avoid the effects on the land value produced by the allocation of said uses, so that according to the current land use legislation, actions aimed at sustainable development as well as citizen participation, transparency and control, shall be enhanced in order to achieve greater rigor in the use of land which should be translated in their valuation.

Determinación y caracterización de los indicadores que intervienen en un sistema integral de iluminación natural y protección solar : aplicado a la incorporación de bandejas en los huecos de fachadas existentes

En esta tesis se estudia cómo lograr el equilibrio entre dos fenómenos naturales que afectan a los huecos de fachadas: la iluminación natural y la ganancia solar. Es decir, el cómo, conseguir la optimización de la iluminación natural que se introduce a través de las ventanas existentes, sin realizar una laboriosa intervención de sustitución de las mismas y el cómo, conseguir la protección de la radiación solar directa de la zona acristalada, para evitar tanto las ganancias térmicas innecesarias como el deslumbramiento que afecta a la calidad lumínica de los recintos. Para el desarrollo esta investigación se ha propuesto una metodología de estudio dividida en dos fases: La primera, de Análisis y Diagnóstico, en la que se han de definir los estándares a cumplir y las variables con las que se evaluarán las bandejas. Y, la segunda, de Evaluación y Comprobación en la que se han de establecer los criterios de valoración y ponderación de cada variable. En la primera fase, se definirán las variables físico-ambientales, para lo que se seleccionarán algunas ciudades a estudiar, a las cuales se les estudiará las necesidades de confort térmico, se determinarán las dimensiones que deben tener las protecciones solares en esas ciudades, además se determinarán las actuaciones a realizar en los huecos de fachada según sea su posición en el plano vertical de la misma. Así mismo, se plantea hacer un análisis de casos reales, para lo que se caracterizarán desde el punto de vista lumínico algunas viviendas, realizando medidas “in situ” y comparando resultados con los que se obtienen de los programas de simulación, para seleccionar las viviendas en las que la realidad y la simulación se aproximen más, una de estas viviendas servirá de modelo en las simulaciones que se realizará en la segunda fase. También, en esta primera fase, mediante un modelo neutro, se estudiará el comportamiento térmico y lumínico del tamaño del hueco en el que se insertará la bandeja posteriormente, para luego estudiar la posición de la bandeja en el plano vertical de la ventana, desde el punto de vista ergonómico. Y finalmente se estudiará, el comportamiento térmico y lumínico del modelo con la bandeja ubicada a 40, 50 y 60cm del techo. En la segunda fase, se establecerá la valoración y ponderación de las variables con las que seleccionar la bandeja que mejor equilibre los aspectos térmicos y lumínicos, teniendo en cuenta estrategias pasivas de acondicionamiento ambiental, como favorecer las ganancias solares en invierno en horas diurnas y evitar las pérdidas de calor en horas nocturnas; y en verano implementar sistemas de sombreamiento en la zona acristalada para evitar las ganancias de calor; y, tanto en verano como en invierno, aprovechar la iluminación natural, para favorecer la iluminancia útil y evitar el deslumbramiento. Una vez definidos los criterios de valoración y ponderación se aplicará a la evaluación térmica y lumínica del modelo neutro con la bandeja, consiguiendo seleccionar la bandeja con mejor comportamiento. Posteriormente se comprobará la metodología de estudio desarrollada en el modelo seleccionado, se evaluará el comportamiento térmico y lumínico, con la incorporación de algunas alternativas de bandeja. Con esta investigación se quiere demostrar que mediante la aplicación de esta metodología de estudio, es posible evaluar y seleccionar bandejas que respondan a las necesidades requeridas en distintos casos de estudio, por lo que se considera que, la bandeja puede ser un elemento arquitectónico aplicable tanto en rehabilitación como en nueva construcción, de espacios en los que sea necesario mejorar sus condiciones lumínicas y térmicas simultáneamente. ABSTRACT This thesis studies how to balance two natural events that affect the window opening of facades: daylighting and solar gain. That is to say, how to achieve optimization of natural light that gets in through the existing windows, without making a laborious intervention of replacing them and how to get protection from direct solar radiation from the glass area, to avoid unnecessary heat gain and glare affecting the light quality of the enclosures. To develop this research, it has been proposed a methodology of study divided into two phases: First phase, Analysis and Diagnostics, in which the variables with which the light shelf are evaluated will be defined along with the standards the light shelves will meet. The second phase, Assessment and Verification, in which the assessment criteria and weighting of each variable will be established. In the first phase, the physical and environmental variables shall be defined, various cities will be selected to be studied, and in each the needs of thermal comfort will be determined along with the dimensions of shading devices in the cities. In addition the actions to be taken in the window opening of the façade will be determined, depending on their position in the vertical plane. An analysis of real cases will be undertaken, which will be characterized from the luminous point of view, performing "in situ" measurements and comparing results with those obtained from simulation programs, to select places/dwellings where reality and simulation are closer, one of these places/dwellings will be a model, in the simulations to perform at the second phase. Also, in this first phase, by a neutral model, the thermal and light behavior of the size of the window opening will be studied, in which the light shelf is inserted later, the position of the light shelf in the vertical plane of the window is studied, from an ergonomic point of view. And finally to study the thermal and light behavior of the model with the light shelf located at 40, 50 and 60cm from the ceiling. In the second phase, the evaluation and weighting of the variables will be established selecting the light shelf that best balances the thermal and daylighting aspects, taking into account passive environmental conditioning strategies; such as getting solar gains in winter during daylight hours, and preventing heat loss during the night hours; and in summer implementing shading systems in the glazing area to avoid heat gains. And in both summer and winter, taking advantage of natural lighting, to improve useful illuminance and avoid glare. Once defined, the evaluation criteria and weighting will be applied to thermal and daylighting evaluation to the neutral model with the light shelf, the best performing light shelf will be selected. The study methodology developed in the selected model will be verified the thermal and daylighting performance with the addition of some light shelf alternative will also be studied. With this research, we want to show that by applying this study methodology it is possible to evaluate and select the light shelf that meets the needs required in different case studies, so it is considered that the light shelf may be an applicable architectural element in both refurbishment and new construction of spaces where necessary to improve their daylighting and thermal conditions simultaneously.

Services Evolution of Two Groundwater Dependent Wetland Ecosystems in the “Mancha Húmeda” Biosphere Reserve (Spain)

A wetland that does not comply with the ecological standards of EU Directive 2000/60/EC cannot properly provide its services. This paper presents a review of the criteria for wetland assessment based on the Spanish experience in two specific Ramsar areas: the Tablas de Daimiel and the Ruidera Lakes. The aim of this article is to consider and promote a holistic awareness of the hydrological cycle and of the wetland area ecosystems within it. The methodology developed under the umbrella of the UNESCO project IGCP 604 is applied to describe the groundwater-wetland-human interrelationship. This methodology was chosen for two reasons: (a) it is designed to assess the services the wetlands provide; (b) it focuses on groundwater dependent wetlands such as the two cases presented here. In each case, although to a different extent, agricultural activities and water management have led to important changes in the services provided by the two ecosystems.

Caracterização geométrica e mecânica de macrofibras poliméricas.

Uma grande diversidade de macrofibras poliméricas para reforço de concreto se encontram disponibilizadas hoje em dia. Por natureza estas fibras apresentam grande diversidade de características e propriedades. Estas variações afetam sua atuação como reforço no concreto. No entanto, não há normas brasileiras sobre o assunto e as metodologias de caracterização de normas estrangeiras apresentam divergências. Algumas normas definem que a caracterização do comportamento mecânico deva ser feita nos fios originais e outras que se devam utilizar métodos definidos para caracterização de materiais metálicos. A norma EN14889-2:2006 apresenta maior abrangência, mas deixa dúvidas quanto à adequação dos critérios de caracterização geométrica das fibras e não define um método de ensaio específico para sua caracterização mecânica. Assim, há a necessidade de estabelecimento de uma metodologia que permita a realização de um programa de controle de qualidade da fibra nas condições de emprego. Esta metodologia também proporcionaria uma forma de caracterização do material para estudos experimentais, o que permitiria maior fundamentação científica desses trabalhos que, frequentemente, fundamentam-se apenas em dados dos fabricantes. Assim, foi desenvolvido um estudo experimental focando a caracterização de duas macrofibras poliméricas disponíveis no mercado brasileiro. Focou-se o estudo na determinação dos parâmetros geométricos e na caracterização mecânica através da determinação da resistência à tração e avaliação do módulo de elasticidade. Na caracterização geométrica foi adotada como referência a norma europeia EN14889-2:2006. As medições do comprimento se efetuaram por dois métodos: o método do paquímetro e o método de análise de imagens digitais, empregando um software para processamento das imagens. Para a medição do diâmetro, além das metodologias mencionadas, foi usado o método da densidade. Conclui-se que o método do paquímetro, com o cuidado de esticar previamente as macrofibras, e o método das imagens digitais podem ser igualmente utilizados para medir o comprimento. Já parar determinar o diâmetro, recomenda-se o método da densidade. Quanto à caracterização mecânica, foi desenvolvida uma metodologia própria a partir de informações obtidas de outros ensaios. Assim, efetuaram-se ensaios de tração direta nas macrofibras coladas em molduras de tecido têxtil. Complementarmente, foi avaliado também o efeito do contato abrasivo das macrofibras com os agregados durante a mistura em betoneira no comportamento mecânico do material. Também se avaliou o efeito do método de determinação da área da seção transversal nos resultados medidos no ensaio de tração da fibra. Conclui-se que o método proposto para o ensaio de tração direta da fibra é viável, especialmente para a determinação da resistência à tração. O valor do módulo de elasticidade, por sua vez, acaba sendo subestimado. A determinação da área da seção da fibra através do método da densidade forneceu também os melhores resultados. Além disso, comprovou-se que o atrito das fibras com o agregado durante a mistura compromete o comportamento mecânico, reduzindo tanto a resistência quanto o módulo de elasticidade. Assim, pode-se afirmar que a metodologia proposta para o controle geométrico e mecânico das macrofibras poliméricas é adequada para a caracterização do material.

Program Evaluation of an After-School Socialization Group Program

Use of evidence-based practice is becoming more expected and necessary for mental health practitioners. This allows for proof, accountability, and rigorous standards to be upheld, facilitates healthcare reimbursement, and provides a wider range of services to more clients. Appropriate monitoring and outcome measurement is essential to determine the effectiveness of a given intervention. An organization providing group social skills interventions for children 7-18 years was analyzed to facilitate the best plan for evaluating treatment effectiveness. Measurable goals and objectives consistent with the organizations mission and values were developed. Appropriate social skills measurement tools were identified. Strengths and weaknesses of each measure were compared, and existing literature was reviewed to ensure cohesion between this evaluation and current standards in literature. Parent report, self report, and teacher report on Piers-Harris II, BASC-2, and Skills Improvement System Rating Scales were determined to be the most relevant measures of social skills development. A timeline for administration and plan for how to implement measurement and use data was suggested as well as considerations for future research.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

Background: The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS). Methods: The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal). Results: DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making. Conclusion: DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Assessment of a simplified experimental procedure to evaluate impact sound reduction of floor coverings

The impact noise reduction provided by floor coverings is usually obtained in laboratory, using the methodology described in the standard EN ISO 140-8, which requires the use of standard acoustic chambers. The construction of such chambers, following the requirements described in the EN ISO 140-1, implies a significant investment, and therefore only a limited number exists in each country. Alternatives to these standard methodologies, that allow a sufficiently accurate evaluation and require lower resources, have been interesting many researchers and manufacturers. In this paper, one such strategy is discussed, where a reduced sized slab is used to determine the noise reduction provided by floor coverings, following the procedure described in the ISO/CD 16251-1 technical document. Several resilient coverings, floating floors and floating slabs are tested and the results are compared with those obtained using the procedures described in the standards EN ISO 140-8 and EN ISO 717-2.

Development and psychometric testing of the clinical learning environment, supervision and nurse teacher evaluation scale (CLES+T): The Spanish version

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011–March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach’s alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach’s alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries.

Willingness Towards Continuous Assessment

Among the factors that affect the convergence towards the European Higher Education Area, university teaching staff's motivation is fundamental, and consequently, it is crucial to empirically know what this motivation depends on. In this context, one of the most relevant changes in the teacher-student relationship is assessment. In fact, the transition from a static assessment -focused on only one temporal point (final exam)- to a dynamic assessment, will require changes in thought and action, both on the part of teachers and students. In this line, the objective of this paper is to analyze the determinants of teaching staff's predisposition to the continuous assessment method. Specifically, we consider the following explanatory dimensions: teaching method used (which measures their degree of involvement with the ongoing adaptation process), type of subject (core, compulsory and optional), and teacher's personal characteristics (professional status and gender). The empirical application carried out at the University of Alicante uses Logit Models with Random Coefficients to capture heterogeneity, and shows that "cooperative learning" is a clear-cut determinant of "continuous assessment" as well as "continuous assessment plus final examination". Also, a conspicuous result, which in turn becomes a thought-provoking finding, is that professional status is highly relevant as a teacher's engagement is closely related to prospects of stability. Consequently, the most relevant implications from the results revolve around the way academic institutions can propose and implement inducement for their teaching staff.

Fostering Teaching Staff's Engagement in Continuous Assessment

Among the factors that affect the convergence towards the European Higher Education Area, university teaching staff's motivation is fundamental, and consequently, it is crucial to empirically know what this motivation depends on. In this context, one of the most relevant changes in the teacher-student relationship is assessment. In fact, the transition from a static assessment -focused on only one temporal point (final exam)- to a dynamic assessment, will require changes in thought and action, both on the part of teachers and students. In this line, the objective of this paper is to analyze the determinants of teaching staff's predisposition to the continuous assessment method. Specifically, we consider the following explanatory dimensions: teaching method used (which measures their degree of involvement with the ongoing adaptation process), type of subject (core, compulsory and optional), and teacher's personal characteristics (professional status and gender). The empirical application carried out at the University of Alicante uses Logit Models with Random Coefficients to capture heterogeneity, and shows that "cooperative learning" is a clear-cut determinant of "continuous assessment" as well as "continuous assessment plus final examination". Also, a conspicuous result, which in turn becomes a thought-provoking finding, is that professional status is highly relevant as a teacher's engagement is closely related to prospects of stability. Consequently, the most relevant implications from the results revolve around the way academic institutions can propose and implement inducement for their teaching staff.

Is the EU’s Governance ‘Good’?: An assessment of EU governance in its partnership with ACP States. IES WORKING PAPER 1/2010

This paper examines both the processes and outcomes of governance in the context of the EU’s relationship with ACP States within the period of the Cotonou Agreement (CA). It discusses and assesses a variety of governance mechanisms, including the European Commission’s use of the governance concept, EPAs, manifestations of partner preferences, the EDF, the revision of the CA, and Fisheries Partnership Agreements. Specific examples of the wielding of each mechanism are assessed based upon two criteria: a) the extent to which the wielding of the mechanism by the EU is a manifestation of “good governance”, and b) the extent to which the EU’s wielding of the mechanism has resulted, or is likely to result, in the sustainable development of and reduction of poverty in ACP countries. The examples are chosen to illustrate contradictions between rhetoric and practice and the consequential negative (actual and potential) impact upon development in ACP States. The final section offers suggestions for improving the EU’s governance processes and their outcomes for development.

An Assessment of the Penalties System for Infringements of EU Competition Law: Can Personal Sanctions be the Missing Piece of the Puzzle? IES WORKING PAPER 6/2013

Competition law seeks to protect competition on the market as a means of enhancing consumer welfare and of ensuring an efficient allocation of resources. In order to be successful, therefore, competition authorities should be adequately equipped and have at their disposal all necessary enforcement tools. However, at the EU level the current enforcement system of competition rules allows only for the imposition of administrative fines by the European Commission to liable undertakings. The main objectives, in turn, of an enforcement policy based on financial penalties are two fold: to impose sanctions on infringing undertakings which reflect the seriousness of the violation, and to ensure that the risk of penalties will deter both the infringing undertakings (often referred to as 'specific deterrence') and other undertakings that may be considering anti-competitive activities from engaging in them (often referred to as 'general deterrence'). In all circumstances, it is important to ensure that pecuniary sanctions imposed on infringing undertakings are proportionate and not excessive. Although pecuniary sanctions against infringing undertakings are a crucial part of the arsenal needed to deter competition law violations, they may not be sufficient. One alternative option in that regard is the strategic use of sanctions against the individuals involved in, or responsible for, the infringements. Sanctions against individuals are documented to focus the minds of directors and employees to comply with competition rules as they themselves, in addition to the undertakings in which they are employed, are at risk of infringements. Individual criminal penalties, including custodial sanctions, have been in fact adopted by almost half of the EU Member States. This is a powerful tool but is also limited in scope and hard to implement in practice mostly due to the high standards of proof required and the political consensus that needs first to be built. Administrative sanctions for individuals, on the other hand, promise to deliver up to a certain extent the same beneficial results as criminal sanctions whilst at the same time their adoption is not likely to meet strong opposition and their implementation in practice can be both efficient and effective. Directors’ disqualification, in particular, provides a strong individual incentive for each member, or prospective member, of the Board as well as other senior executives, to take compliance with competition law seriously. It is a flexible and promising tool that if added to the arsenal of the European Commission could bring balance to the current sanctioning system and that, in turn, would in all likelihood make the enforcement of EU competition rules more effective. Therefore, it is submitted that a competition law regime in order to be effective should be able to deliver policy objectives through a variety of tools, not simply by imposing significant pecuniary sanctions to infringing undertakings. It is also clear that individual sanctions, mostly of an administrative nature, are likely to play an increasingly important role as they focus the minds of those in business who might otherwise be inclined to regard infringing the law as a matter of corporate risk rather than of personal risk. At the EU level, in particular, the adoption of directors’ disqualification promises to deliver more effective compliance and greater overall economic impact.