A System of Integral Quality Indicators as a Tool for Beach Management

Esta tesis parte de la concepción de la playa como un sistema integral en el que se desarrollan procesos interrelacionados. El análisis de estos procesos y del marco físico y administrativo donde se producen, es el hilo conductor del proyecto. Para realizar el estudio, se han analizado los procesos de las playas de la Selva Marítima, en el Sur de la Costa Brava (al Nordeste del Mediterráneo). La zona constituye un buen ejemplo de un área litoral altamente afectada por el turismo. El análisis del marco legal y administrativo ha revelado algunas carencias importantes. No existe una política específica de playas que contemple la gestión de los aspectos básicos de gestión. La consecuencia de ello es que la información que se dispone sobre las playas españolas es bastante parcial. Actualmente, en el marco de la Gestión Integrada de Zonas Costeras (GIZC), se están desarrollando estrategias (nacional/regional) que incluyen indicadores de procesos que hasta la fecha actual no han sido objeto de programas de monitoreo y que pueden corregir esta tendencia.La revisión de las herramientas de gestión de playas utilizadas o potencialmente utilizadas en la gestión de la zona de estudio (Bandera Azul, Índice del CEDEX, Índice de CANTABRIA, Índices del ACA) ha revelado algunas deficiencias que son importantes para la gestión de estas playas: el uso, la seguridad y el socorrismo, el paisaje, la comunidad natural o algunos servicios, son los más importantes. Además, dichas herramientas no integran el análisis de las funciones que debe asumir una playa de acuerdo con sus características. Por otro lado, desde hace unos años se están utilizando los Sistemas de Gestión Medioambiental (SGMA) para la gestión de playas. Los SGMA son una buena herramienta de gestión de playas porque permiten una gestión proactiva y ordenada, pero necesitan ser complementados con herramientas de monitoreo adecuadas. En este trabajo también se han analizado el enfoque y los problemas que tienen los gestores locales. El conocimiento de la información disponible y las características de la zona de estudio ha llevado a analizar los procesos más importantes en la gestión de playas: la frecuentación y la producción de residuos. La información obtenida en el desarrollo de este proyecto ha permitido elaborar un índice de calidad de playas para la zona de estudio. Este Índice incorpora los aspectos importantes, ausentes en otras herramientas de gestión. En la asignación de importancias, para la agregación de índices parciales se ha tenido en cuenta la opinión de los usuarios y expertos. El Índice ha sido diseñado para ser incluido en el marco de los SGMA e incluye el análisis de las Funciones. Puede ser usado en distintas fases del SGMA. Las más importantes son el Diagnóstico Medioambiental Inicial, la definición de los Aspectos Medioambientales Significativos, el Control Operacional y la evaluación de la Mejora Continua. Los resultados del Indicador, de los sub-indices y los índices parciales obtenidos para la zona de estudio, indican distintas situaciones. Los valores agregados son altos: para el BQI (0,63-0,85) y para los indicadores de las funciones, RF (0,53-0,73), NF (0,80-0,92) y PF (0,50-1). En el caso de los valores de los indicadores parciales, mientras algunos procesos como la calidad del agua, la calidad ambiental, las instalaciones y los servicios, las actividades, la confortabilidad, la ausencia de contaminación en el agua y en la arena, y la calidad física, se encuentran en buen estado, otros como el uso de la playa, la calidad del entorno, la seguridad y la componente natural, tienen valores bastante bajos. La futura gestión de las playas debe dirigirse al control del uso, de la transformación del entorno de la playa y a la preservación de la comunidad natural de las playas. Además, la dotación de recursos que garanticen la seguridad y asistencia de los usuarios, la protección de las infraestructuras y la limpieza de las playas debe ser también prioritaria.This thesis stemmed from the idea that the beach is an integrated system where different and interconnected processes occur. The analyses of these processes and of the physical and administrative framework in which they occur, was the thread of the project. In the development of the study, the processes for the beaches of La Selva Marítima, located in the south of the Costa Brava (northwestern Mediterranean) were analysed. This area is a good example of a coastal area highly affected by tourism dynamics. The analysis of the legal and administrative framework uncovered some important shortcomings. No specific beach policy exists that accounts for the management of all basic aspects. As a consequence, the information available is partial. Strategies (national/regional) are currently being developed in the framework of the Integrated Coastal Zone Management (ICZM) strategy, including indicators of processes that, until now, have been excluded from monitoring programs. This may change the current situation of a lack of information. A review of beach assessment measurements (Blue Flag and CEDEX, ACA and CANTABRIA Index) used or potentially used for management of the studied area, revealed important deficiencies in the management of beaches, of which the most important were use, safety and rescue services, landscape, the natural community and certain services. Furthermore, these tools do not take analyses of beach functions into account. In recent years, Environmental Management Systems for Beaches (EMSBs) have begun to be used for beach management. EMSBs allow for the application of proactive and clear management practices, although they need to be complemented with adequate monitoring tools. This research also analysed the work, focus and problems of local managers. Varied management goals are not usual (many processes remain unmanaged) and management is sometimes exclusively service-oriented. Tools that evaluate beach quality do not cover problematic aspects for local managers, such as sediment management, coordination between responsible authorities, or emergency situations. The information available and the characteristics of the studied area demonstrated the need to analyse two particularly important beach management processes: beach use and waste/litter production. Information obtained in the development of this project led to the creation of a Beach Quality Index (BQI) for the studied beaches. This index took into account important issues not represented in other management tools. In the process of allocating weights for the purpose of aggregating partial indexes, user and expert opinions were taken into account. The BQI, which also took account of function analysis, was designed to be used with EMSBs, and can be included at different EMSB stages. The most important index factors are initial environmental diagnosis, the definition of environmentally significant aspects, operational control, and the assessment of steady improvement. Results obtained for beaches for the BQI, its subindices and partial indices, indicated arrange of situations. Aggregated values were high for the BQI (0.63-0.85), and also for the subindices (RF (0.53-0.73), NF (0.80-0.92) and PF (0.50-1)). High scores were typically obtained for partial indices such as water quality, environmental quality, services and facilities, activities, comfort, absence of water and sand pollution, and physical quality. Scores for beach use, surrounding quality, safety, and naturality were low. Future management of studied beaches should focus on the weakest aspects, such as controls over use, transformation of beach environs, and preservation of natural beach communities. Other priorities should be the allocation of resources that guarantee user safety, protection of human facilities, and beach cleaning.Postprint (published version

Simulation of interactive motor behaviours in game theory framework for upper-limb rehabilitation

An increasing number of individuals are affected by neurological diseases worldwide. Nowadays, stroke is the leading cause of adult disability in western countries, with upper limb hemiparesis being one of the most common consequences. Therefore, there is a growing interest in developing robotic interfaces to provide neurologically affected individuals the right amount of assistance to guarantee a great recovery. The interactive control of such rehabilitation robots with a stroke survivor is critical to motor recovery, and a successful rehabilitation requires the patient to be engaged in motor task execution. This thesis focuses on the new development of an interactive robot controller, and aims to ensure that differential game theory can be used as a framework to describe various interactive behaviours between a robot and a human user. In this thesis, it will be simulated the interaction between a robot and an injured human user who is recovering after stroke in the game theory framework, demonstrating that it can induce a stable interaction between the two partners by identifying each other’s control law and allow them to successfully perform the task with minimum effort. In this thesis is expected to find a detailed description of the different interactive motor behaviours that exist between a rehabilitation robot and a human user: collaboration, cooperation, competition and co-activity. It will also contain the simulation of these behaviours. In the description of the human-robot interactive motor behaviours, it will be seen that some of these behaviours are modelled in the simulation in the game theory framework, such as collaboration, cooperation and competition, while co-activity consists on a problem where the robot and the human are modelled as two independent linear quadratic regulators. Finally, it will be provided a comparison between the use of a game theory controller and the use of a linear quadratic regulator controller for the development of a rehabilitation robot and it will be demonstrated why a game theory controller is a better option for robots that work in physical contact with humans

A wider view of assessments of ecosystem services in coastal areas : the perspective of social-ecological complexity

This research was carried out under the framework of POLICLIMA project (CSO2016-76842-C2-1-R). The first author was supported by a PhD grant (FI-2017) from the Agència de Gestió d'Ajuts Universitaris. The second author was supported by Ramón y Cajal contract (RYC-2013-13392) from the Ministerio de Economía y Competitividad.Through complex interactions and feedback processes between coastal ecological and social components at different temporal and spatial scales, coastal environments coproduce a range of ecosystem services (ES) and benefit different social groups. In these highly populated areas, multiple actors, interests, and activities coexist, leading to intensified conflicts between stakeholders. The research presented here aims to understand how coastal social-ecological complexity is studied within coastal ES literature. A systematic review of the literature consisting of 199 manuscripts was performed using the PRISMA method (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The results show that coastal ES research has been focused on understanding ecological processes for ES provision and value. Hence, coastal ES studies fall short of considering the social components and social-ecological interactions of coastal systems: ES flows, demand, coproduction, power relations, institutions and governance, temporal and spatial scales, value pluralism, uncertainty, and human well-being multidimensions and distribution. The partial integration of social-ecological complexity within coastal ES research limits coastal ES management because nonlinear interactions among social and ecological components are not well understood, particularly stakeholders' relations, their roles, and the links to ES. Finally, we propose a conceptual framework that integrates the gaps identified during the review. The framework places coproduction and power relations as the core factors of assessments of coastal ES, as means to understand complex, nonlinear social-ecological interactions and feedback processes. Hence, it also provides necessary tools to address normative issues of coastal management such as control, access, trade-offs, and benefits

Supply Chain Planning in Stable Demand and Fashion Products

In recent years, terms such as supply chain or supply chain planning have become increasingly important in the industrial sector. Nowadays, everyone is aware that a good performance in supply chain activities is essential to business success. But what are the keys to do a good supply chain planning? Do they depend on the product? What changes? To answer these questions, we will study how the supply chain is planned for two very different types of product: stable demand and fashion products. Moreover, we will do it through the study of two leading companies in these industries: Unilever and Inditex, to learn the best practices in each sector and see how the different features of the products affect to the supply chain planning.Outgoin

Ethical considerations in elderly patients with acute coronary syndrome

Acute coronary syndrome (ACS) is one of the main causes of mortality and morbidity in the elderly. The prevalence of ACS increases with age and patients with advanced age have some co-morbidities that require an individualized approach, which includes a comprehensive geriatric assessment. Ageism is a matter of great concern. In this scenario, some ethical conflicts may arise which should be anticipated, considered, and solved. Clinicians will need to prioritize and allocate resources, to avoid futility/proportionality, which is not always easy to assess in these patients. This review aims to summarize the evidence regarding ethical conflicts that may arise in the management of patients with ACS and advanced age. We will discuss how to choose the best option (which frequently is not the only one) with the lowest risk for harm, considering and respecting the patients' decision. The four basic principles of bioethics (beneficence, non-maleficence, autonomy, and justice) are thoroughly reviewed, and discussed, regarding their role in the decision making process

Increasing the length of the time series from altimetry satellites by means of extrapolation: the case of the Mediterranean coast of the Iberian Peninsula

Las series temporales de los satélites altimétricos son, con las de los mareógrafos, una de las dos fuentes principales de información sobre la evolución del nivel del mar. Sus principales ventajas sobre las series de los mareógrafos estriban en que permiten acceder a información espacialmente continua, en registrar cambios absolutos, y en una contrastada precisión. Algunos problemas anteriormente existentes en áreas costeras, como el problema del píxel mixto o aparentes errores en la calibración, han sido superados, o filtrados por la principal fuente de información de este tipo de registros, el Sea Level Research Group de la Universidad de Colorado. Sin embargo, el problema de la escasa duración de las series temporales (empezaron a funcionar en julio de 1992) no ha sido aún resuelto. En este trabajo se propone una metodología que permite alargar la serie hacia el pasado basándose en un análisis de correlación múltiple con datos procedentes de los registros de los mareógrafos, existentes desde décadas antes del lanzamiento de los satélites. Los resultados obtenidos indican que con cierto margen de error es posible interpretar la evolución del nivel del mar en cada celdilla de los satélites altimétricos desde los años 40 en el caso del litoral mediterráneo peninsular.The time series of the altimetric satellites are of the two main sources of information on the evolution of the level of the sea. Its main advantages over the series of tide gauges are that they allow access to information spatially continuous, recording absolute changes. Some problems previously encountered in coastal areas, such as the mixed pixel problem or apparent calibration errors, have been overcome or filtered by the University of Colorado's Sea Level Research Group's main source of information. However, the problem of the short duration of the time series (which began to operate in July 1992) has not yet been solved. This paper proposes a methodology that allows extending the series to the past based on a multiple correlation analysis with data from the records of the gauges, which had existed for decades before the launch of the satellites. The obtained results indicate that it is possible to interpret the evolution of sea level in each cell of the altimetric satellites since the 1940s in the case of the peninsular Mediterranean littoral

Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality

New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block

Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%-95%), negative predictive value (96%-97%), efficiency (91%-94%) and area under the receiver operating characteristic curve (0.92-0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%-94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block

Development of an instrument to measure the degree of critical patient's satisfaction with nursing care: research protocol

Aim: To investigate and understand patient's satisfaction with nursing care in the intensive care unit to identify the dimensions of the concept of"satisfaction" from the patient's point of view. To design and validate a questionnaire that measures satisfaction levels in critical patients. Background: There are many instruments capable of measuring satisfaction with nursing care; however, they do not address the reality for critical patients nor are they applicable in our context. Design: A dual approach study comprising: a qualitative phase employing Grounded Theory and a quantitative and descriptive phase to prepare and validate the questionnaire. Methods: Data collection in the qualitative phase will consist of: in-depth interview after theoretical sampling, on-site diary and expert discussion group. The sample size will depend on the expected theoretical saturation n = 27-36. Analysis will be based on Grounded Theory. For the quantitative phase, the sampling will be based on convenience (n = 200). A questionnaire will be designed on the basis of qualitative data. Descriptive and inferential statistics will be used. The validation will be developed on the basis of the validity of the content, the criteria of the construct and reliability of the instrument by the Cronbach's alpha and test-retest approach. Approval date for this protocol was November 2010. Discussion: Self-perceptions, beliefs, experiences, demographic, socio-cultural epistemological and political factors are determinants for satisfaction, and these should be taken into account when compiling a questionnaire on satisfaction with nursing care among critical patients

Percepción de las enfermeras de UCI en relación al cuidado satisfactorio: convergencias y divergencias con la percepción del paciente crítico

Objetivo: Explorar las convergencias y divergencias entre la percepción de las enfermeras y los pacientes críticos, en relación a los cuidados satisfactorios proporcionados y recibidos. Métodos: Forma parte de un estudio cualitativo más amplio, según la Teoría Fundamentada. Realizado en 3 Unidades de Cuidados Intensivos con 34 boxes. Muestreo teórico por perfiles con n = 19 pacientes y n = 7 enfermeras tras la saturación de datos. El reclutamiento de pacientes incluidos en los perfiles de edad avanzada y larga estancia se dilató en el tiempo por la baja incidencia de estos. La recogida de datos consistió en: entrevista en profundidad a los pacientes críticos, grupo de discusión de enfermeras expertas en el cuidado al paciente crítico y diario de campo. Análisis temático de Teoría Fundamentada según Strauss y Corbin: codificación abierta, axial y selectiva. Se siguieron los criterios de rigor de Guba y Lincoln, de calidad de Calderón y los de reflexividad ética de Gastaldo y McKeever. Se obtuvo informe favorable del comité de ética del centro y consentimiento informado de los participantes. Resultados: Emergen 4 categorías coincidentes: las competencias profesionales, los cuidados humanos, técnicos y continuados. La combinación de estos elementos producen sentimientos de seguridad, tranquilidad, sentirse persona permitiendo al paciente una relación cercana y de confianza con la enfermera que realiza cuidados individualizados. No se han encontrado categorías divergentes. Conclusiones: Las percepciones de las enfermeras en relación a los cuidados coinciden con las percepciones de los pacientes críticos tanto en la definición como en las dimensiones sobre el cuidado satisfactorio