Brechas de servicio en un ?rea de una compa??a a?rea

El presente trabajo de investigaci?n tiene como objetivo principal determinar si existen brechas del servicio en un ?rea espec?fica de una compa??a a?rea. Para este fin, se utilizar?n diversas bases te?ricas que permitir?n analizar y entender el modelo de las cinco brechas del servicio. Mediante este modelo, se podr?n identificar las posibles brechas en el proceso del servicio, las cuales pueden afectar directamente la satisfacci?n del cliente. El modelo propuesto parte desde la primera brecha: la del conocimiento, no saber lo que el cliente espera de la compa??a; la segunda brecha: de los dise?os, procesos y est?ndares; la tercera brecha: del desempe?o del servicio; la cuarta: de la comunicaci?n y, finalmente, la quinta brecha: del cliente, la divergencia entre la expectativa y la percepci?n del servicio, desde el punto de vista del cliente. Se aplicar?n dos m?todos de investigaci?n: el modelo Servqual, que ayudar? a establecer si existe o no una brecha entre la expectativa y la percepci?n del cliente, la cual puede ocurrir si se genera una diferencia entre las expectativas del cliente y lo que finalmente obtiene, despu?s de haber recibido el servicio; y, el m?todo de an?lisis Kano, que permitir? determinar si las variables propuestas en la investigaci?n causan o no las otras cuatro brechas en el servicio y qu? valoraci?n tiene para los clientes. La recolecci?n de los datos para ambos m?todos de investigaci?n se realiz? mediante encuestas, cada una enfocada y siguiendo la metodolog?a que se aplica para cada uno de los modelos mencionados. Finalmente, se mostrar?n los resultados obtenidos de la investigaci?n y las conclusiones

Aggression, Impulsivity and Suicidal Behavior in Depressive Disorders: A Comparison Study between New York City (US), Madrid (Spain) and Florence (Italy)

The association of aggression and impulsivity with suicidal behavior (SB) in depression may vary across countries. This study aimed (i) to compare aggression and impulsivity levels, measured with the Brown-Goodwin Scale (BGS) and the Barratt Impulsivity Scale (BIS), respectively, between New York City (NYC) (US), Madrid (Spain) and Florence (Italy) (ANOVA); and (ii) to investigate between-site differences in the association of aggression and impulsivity with previous SB (binary logistic regression). Aggression scores were higher in NYC, followed by Florence and Madrid. Impulsivity levels were higher in Florence than in Madrid or NYC. Aggression and impulsivity scores were higher in suicide attempters than in non-attempters in NYC and in Madrid. SB was associated with aggression in NYC (OR 1.12, 95% CI 1.07–1.16; p p = 0.032). Impulsivity was linked with SB in NYC (OR 1.01, 95% CI 1.00–1.02; p p < 0.001). The higher suicide rates in NYC, compared to Madrid or Florence, may be, in part, explained by these cross-cultural differences in the contribution of aggression-impulsivity to SB, which should be considered by future research on SB prevention

Study of chirally motivated low-energy K−K^- optical potentials

The $K^-$ optical potential in the nuclear medium is evaluated self consistently from a free-space $K^-N$ $t$ matrix constructed within a coupled-channel chiral approach to the low-energy $\bar K N$ data. The chiral-model parameters are fitted to a select subset of the low-energy data {\it plus} the $K^-$ atomic data throughout the periodic table. The resulting attractive $K^-$ optical potentials are relatively `shallow', with central depth of the real part about 55 MeV, for a fairly reasonable reproduction of the atomic data with $\chi^2 / N \approx 2.2$. Relatively `deep' attractive potentials of depth about 180 MeV, which result in other phenomenological approaches with $\chi^2 / N \approx 1.5$, are ruled out within chirally motivated models. Different physical data input is required to distinguish between shallow and deep $K^-$ optical potentials. The ($K^{-}_{\rm stop},\pi$) reaction could provide such a test, with exclusive rates differing by over a factor of three for the two classes of potentials. Finally, forward ($K^-,p$) differential cross sections for the production of relatively narrow deeply bound $K^-$ {\it nuclear} states are evaluated for deep $K^-$ optical potentials, yielding values considerably lower than those estimated before.Comment: 22 pages, 3 figures, minor revisions, Nucl. Phys. A in pres

WHODAS 2.0 as a Measure of Severity of Illness: Results of a FLDA Analysis

WHODAS 2.0 is the standard measure of disability promoted by World Health Organization whereas Clinical Global Impression (CGI) is a widely used scale for determining severity of mental illness. Although a close relationship between these two scales would be expected, there are no relevant studies on the topic. In this study, we explore if WHODAS 2.0 can be used for identifying severity of illness measured by CGI using the Fisher Linear Discriminant Analysis (FLDA) and for identifying which individual items of WHODAS 2.0 best predict CGI scores given by clinicians. One hundred and twenty-two patients were assessed with WHODAS 2.0 and CGI during three months in outpatient mental health facilities of four hospitals of Madrid, Spain. Compared with the traditional correction of WHODAS 2.0, FLDA improves accuracy in near 15%, and so, with FLDA WHODAS 2.0 classifying correctly 59.0% of the patients. Furthermore, FLDA identifies item 6.6 (illness effect on personal finances) and item 4.5 (damaged sexual life) as the most important items for clinicians to score the severity of illness

Life cycle and suicidal behavior among women

It is nowadays accepted that, independently of methodological issues, women commit fewer suicides than men but make more frequent attempts. Yet, female suicidal risk varies greatly along the lifetime and is linked to the most significant moments in it. A wide analysis of the existing literature was performed to provide a narrative description on the evolution of female suicidal rates from childhood to old age, considering the milestones in their life history. A detailed analysis of gender differences in suicidal behavior is key to establish preventive measures and priorities. More specific studies are needed to adapt future interventions on female suicideJ. Lopez-Castroman was supported by a Fundamental Foundation research grant for this stud

Impaired Decoding of Fear and Disgust Predicts Utilitarian Moral Judgment in Alcohol-Dependent Individuals

The definitive version is available at www3.interscience.wiley.comBackground: Recent studies of moral reasoning in patients with alcohol use disorders have indicated a “utilitarian” bias, whereby patients are more likely to endorse emotionally aversive actions in favor of aggregate welfare (e.g., throwing a dying person into the sea to keep a lifeboat of survivors afloat). Here, we investigate the underlying psychological and neuropsychological processes. Methods: Alcohol-dependent individuals (n = 31) and healthy comparison participants (n = 34) completed a validated moral judgment task, as well as measures of impulsivity, mood symptoms (anxiety and depression), and emotional face recognition. Results: Alcohol-dependent individuals were more likely to endorse utilitarian choices in personal moral dilemmas compared with controls and rated these choices as less difficult to make. Hierarchical regression models showed that poorer decoding of fear and disgust significantly predicted utilitarian biases in personal moral dilemmas, over and above alcohol consumption. Impulsivity and mood symptoms did not predict moral decisions. Conclusions: These findings suggest that impaired fear and disgust decoding contributes to utilitarian moral decision-making in alcohol-dependent individuals.This work is supported by the “Red de Trastornos Adictivos”, RETICS Program, Instituto de Salud Carlos III, Spanish Ministry of Health (PI: AVG) and the Junta de Andaluc ıa under the Research Project P07.HUM 03089 (PI: MPG). MCP is funded by FPU predoctoral research grant (AP 2008-01848) from Spanish Ministry of Education and Science

Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents.

BACKGROUND: Self-harm (SH) in adolescence has previously been shown to significantly overlap with both attention deficit hyperactivity disorder (ADHD) and emotional dysregulation (ED). Our objective as such was to investigate the relationship between self-harm and ADHD in our population and consider its clinical relevance. METHODS: This case series analysis examined 124 presentations of SH in 13- to 17 year-olds to Accident and Emergency Departments in South West London (97F:27M). Strength and Difficulties Questionnaires (SDQs) were used to screen for ADHD/hyperactivity and ED, and scores were compared with reference data obtained from Meltzer et al. (1999, International Review of Psychiatry (Abingdon, England), 15, 185). RESULTS: Mean SDQ ADHD/hyperactivity scores were significantly higher in our SH sample compared to reference data (p < .0001). Furthermore, significantly greater ED scores were found in our sample compared with the control reference data. CONCLUSION: Our findings contribute to the evidence for an important link between ADHD and clinical presentations of SH and suggest there to be value in screening girls presenting to A&E with self-harm for ADHD. We speculate that ED plays a role in the evolution of SH in dysregulated ADHD. We recommend that clinicians assessing adolescents have self-harmed to be aware of possible ADHD symptoms and screen as appropriate; however, future research examining the temporal association between ADHD, emotional dysregulation and self-harm is required to establish causal direction

Many continuous variables such as the duration of the common cold should be analyzed using the relative scale

Alba et al. compared the heterogeneity of meta-analyses on the basis of the type of outcome, and concluded that meta-analyses that evaluate continuous outcomes showed substantially higher I-square values than meta-analyses of binary outcomes. However, in a proper comparison, like should be compared with like.Non peer reviewe

Acceptability and attitude towards use of digital interventions in substance use disorders psychosocial treatment: : a study of healthcare providers at a Methadone Clinic in Kenya

Digital interventions have been used for psychosocial treatment in substance use disorder but there is limited research on their application in Kenya. Determining the acceptability and attitude towards use of digital intervention in substance use disorder psychosocial treatment is important. The aim of this study was to assess the acceptability and attitude of healthcare providers towards use of digitalinterventions for psychosocial treatment at a methadone clinic in Kenya. A descriptive cross-sectional survey was carried out among healthcare providers. A structured self-administered questionnaire was used to collect data on sociodemographic variables, acceptability and attitude towards use of digital interventions in substance use disorder treatment. Technology acceptance model (TAM) was used as conceptual basis for this study. Data was analyzed using SPSS whereby a descriptive analysis was conducted and Pearson’s coefficient used to assess the relationship between the TAM constructs. The data is summarized in tables, figures graphs. Twenty-one health care providers participated comprising 76.2% females and mean age of 33 (SD 6.9) years, of which 66.7% had training in addiction and 23.8% had ever used digital intervention previously. Acceptability was high with 90.5% agreeing that psychosocial treatment can be provided through digital interventions, 80.9% reported digital intervention would improve access to treatment and 76.2% viewed a digital intervention as cost effective. Majority (76.2%) agreed that digital intervention can influence substance use and patients would benefit from the intervention. Using the technology acceptance model, perceived ease of use was associated with perceived usefulness and attitude toward using; and perceived usefulness was associated with attitude towards use. The findings show  high acceptability and positive attitude towards use of digital interventions in substance use disorder treatment among the health care providers at a methadone clinic. This can inform design and implementation of digital interventions among individuals with substance use disorders in Kenya