Empowerment in the Public Sector: Testing the Influence of Goal Orientation

Empowerment has emerged as an important new issue in the public sector organization setting in the wake of mainstream new public management (NPM). Nevertheless, few studies in this frame have combined structural (managerial) and psychological (individual) approaches in an integrative study of empowerment. There is also a need to examine the moderating variables involved in this relationship, as well as to extend research on work motivation in public management. This study explores the effect of structural empowerment on psychological empowerment, and it also draws on goal orientation (GO) theory to examine the moderating role of employees’ GO in this link. The model is tested on a sample of 521 Spanish local authority employees. The results do not confirm the direct link between structural and psychological empowerment, but show that learning GO has considerable moderating power in this relationship, and its interaction with structural empowerment affects employees’ psychological empowerment levels

Diseño, simulación y análisis de un vehículo ferroviario en ADAMS/Rail Software

The purpose of this thesis has been the Railway Simulation and a study about it, with the help from the Analysis. To can do the simulation desired it is necessary a railway, then it appeared a new goal: the design of this railway. This is why the title of this Master Thesis: “Railway Design, Simulation and Analysis by ADAMS/ Rail Software”. In this Master Thesis has been used a software called ADAMS/ Rail; to create the design, to do the simulations and to study the analysis. This software is used for this kind of projects. ADAMS/Rail is a specialized environment for modelling rail vehicles. It allows you to create virtual prototypes of rail vehicle, and analyze the virtual prototypes much like you would analyze the physical prototypes. Using ADAMS/Rail, It can quickly create assemblies of rail vehicles, and then analyze them to understand their performance and behaviour. Following the Design, Simulation and Analysis done, it can say that the masses are distributed symmetrically therefore, the vehicle is symmetrical and the vehicle is stable. This conclusion is necessary. In addition is possible to know that the critical velocity is around 340 m/s and the natural frequency is approximately 3Hz. These values are between expected range. Also, it can be pronounced that both bogies (front and rear) have the same behavior and they have not irregularities. This aspect is very important in every Railway Design. As well, concluding that the important parameters studied as Longitudinal and Angular Velocity, Displacement Angle and Rolling, Length and Force Longitudinal and Lateral have a good and correct performance. Finally, it is good to remember the academic goal has been to learn how design a railway, to find out how to extract results and conclusions of simulations and lastly but not less important how ADAMS/Rail Software works. ______________________________________________________________________________________________________________________________El diseño óptimo de un vehículo ferroviario es uno de los sistemas dinámicos más complicados en la ingeniería. Es importante hacer un buen diseño, simulación y análisis de un modelo si se quiere mejorar, por ejemplo, los parámetros de ferrocarril con el fin de hacerlo más cómodo para los pasajeros, ampliar la velocidad o disminuir la contaminación. Es útil el uso de una plantilla o modelo a la hora de la investigación de este tipo de proyectos: es mucho más barato, más fácil y más rápido que hacerlo que con un modelo real. Los objetivos de este proyecto, como el título nos indica, en primer lugar, es el diseño de una plantilla y después, realizar algunas simulaciones. Para realizar este proyecto se utilizará el software ADAMS / Rail. En este Proyecto de fin de carrera se ha utilizado un software llamado ADAMS / Rail, para crear el diseño, realizar las simulaciones y el estudio del análisis. Este software es utilizado para este tipo de proyectos. ADAMS / Rail es un entorno especializado para vehículos ferroviarios de modelado, que le permite crear prototipos virtuales de vehículos ferroviarios, y analizar estos prototipos virtuales al igual que se analizan los prototipos físicos. Se llevará a cabo en primer lugar la simulación de la precarga, después se realizará la simulación lineal, y a continuación la simulación de Estabilidad y simulación dinámica. Una vez realizado el diseño y las simulaciones correspondientes, se hará un análisis de los resultados obtenidos. Por último, es bueno recordar el objetivo académico que ha sido aprender cómo diseñar un vehículo ferroviario, encontrar la manera de extraer los resultados y conclusiones de las simulaciones y, por último pero no menos importante, cómo utilizar y manejar el programa ADAMS / Rail Software.Ingeniería Industria

Evaluación y prevención de la cronificación del dolor postoperatorio tras toracotomía

[spa] ANTECEDENTES El dolor postoperatorio puede cronificarse dando lugar al dolor postoperatorio persistente (DPP), definido como aquel dolor que persiste más allá de los dos meses después de la intervención. Existen una serie de factores que se asocian al desarrollo de este tipo de dolor entre los que destacan el tipo de cirugía y la intensidad de dolor agudo postoperatorio así como factores constitucionales aun no claramente definidos. En el caso de toracotomía se ha comunicado la persistencia de DPP hasta en el 50% de los pacientes al cabo de un año según las series. Cuando la agresión tisular de la cirugía produce lesión nerviosa, como ocurre en la toracotomía, se puede desarrollar un dolor de características neuropáticas que puede persistir de forma prolongada, e incluso indefinida debido a cambios neuroplásticos en la recepción y transmisión de la información nociceptiva. Estos cambios perpetúan la transmisión anómala por mecanismos centrales, ya independientes de la lesión inicial. La interrupción aferente en el sistema nervioso se traduce en algunos individuos en la aparición de dolor espontáneo e hipersensibilidad (alodinia e hiperalgesia). Se ha demostrado recientemente que el dolor neuropático se produce por un desequilibrio entre sustancias excitatorias e inhibitorias a nivel periférico y central, siendo una característica constante la activación de los receptores N-metil- D-aspartato (NMDA) en el mantenimiento de la sensibilización central. La magnitud de la hiperalgesia alrededor de la incisión quirúrgica (hiperalgesia secundaria) en los primeros tiempos del postoperatorio, se relaciona con la persistencia del dolor a los 6 meses y al año, es decir, con el DPP. La ketamina, utilizada como anestésico general desde hace 50 años, es uno de los pocos antagonistas de los receptores NMDA disponibles en clínica que a dosis subanestésicas ha demostrado una reducción del área de hiperalgesia alrededor de la herida quirúrgica en determinadas cirugías. Junto con su actividad anti NMDA a nivel espinal, la ketamina presenta actividad sobre otros sistemas que podrían intervenir en la modulación del dolor. Su eficacia por vía sistémica está limitada por sus efectos indeseables. La ketamina epidural, al alcanzar los receptores NMDA espinales, podría ser más efectiva que por vía sistémica en la reducción del dolor, evitándose asimismo la toxicidad sistémica de la misma. Sin embargo, los estudios publicados hasta el momento son heterogéneos, no pueden ser traducidos en un régimen específico de administración y apenas se ha valorado su implicación en la reducción del DPP. Por otra parte la valoración del dolor neuropático no es fácil, no existe ningún test diagnóstico específico y el seguimiento de su evolución es difícil por la naturaleza subjetiva del dolor. Los test sensoriales cuantitativos (QST) permiten cuantificar el umbral de sensibilidad térmica y mecánica y el área de hiperalgesia periincisional, proporcionando una información más objetiva que las escalas de valoración del dolor. Los QST han sido ampliamente utilizados en investigación animal y en pacientes con dolor crónico. Sin embargo, su utilización en la valoración repetida del dolor agudo postoperatorio está limitada por su complejidad y el tiempo necesario para su realización, por lo que se carece de datos en una de las cirugías con más incidencia de DPP, como es la torácica. Sería necesario disponer de una batería de test que permitan valorar el dolor durante el período perioperatorio de manera sencilla y reproducible. HIPOTESIS Las hipótesis planteadas fueron en primer lugar, que los métodos cuantitativos de valoración del dolor neuropático permiten establecer la evolución del área de hiperalgesia alrededor de la incisión de toracotomía de manera reproducible. En segundo lugar, que la ketamina epidural e intravenosa reducen el área de hiperalgesia secundaria y la persistencia del dolor postoperatorio a largo plazo tras cirugía de toracotomía, siendo la vía epidural más efectiva por su farmacocinética. Estas dos hipótesis se han plasmado en dos trabajos publicados, que constituyen esta tesis. ESTUDIO 1: Tena B, Escobar B, Arguis MJ, Cantero C, Rios J, Gomar C. Reproducibility of Electronic Von Frey and Von Frey monofilaments testing. Clin J Pain. 2012; 28(4):318-23 Se realizó un estudio de reproducibilidad de dos QST que evalúan la sensibilidad mecánica y que se utilizan para valorar la hiperalgesia, los filamentos de von Frey (VFM) y el von Frey Electrónico. Se evaluó la reproducibilidad de los mismos por dos investigadores entrenados en dos grupos de individuos, un grupo de voluntarios sanos y un grupo de pacientes quirúrgicos. Las mediciones se repitieron a las 24 horas y se realizaron en dos áreas corporales diferentes. Se evaluó la reproducibilidad de ambos QST tanto intraobservador comointerobservador así como el tiempo empleado en realizar ambos test. La reproducibilidad intraobservador e interobservador de los filamentos de von Frey fue moderada en ambos grupos. La reproducibilidad intraobservador del von Frey Electrónico fue buena en el grupo de voluntarios y casi perfecta en el grupo de pacientes, mientras que la reproducibilidad interobservador fue casi perfecta en ambos grupos. No hubo diferencias entre las dos áreas analizadas. El tiempo empleado en ambos test fue de 6,03 minutos para los VFM y de 3,16 minutos para el von Frey Electrónico. ESTUDIO 2: Tena B, Gomar C., Rios J. Perioperative epidural or intravenous ketamine does not improve the effectiveness of thoracic epidural analgesia for acute and chronic pain after thoracotomy. Clin J Pain 2013; Nov 25 Posteriormente se realizó un estudio aleatorizado doble ciego en pacientes sometidos a toracotomía. Los pacientes fueron aleatorizados en tres grupos de tratamiento: Grupo Kiv, que recibió ketamina intravenosa 0,5 mg/kg previamente a la incisión quirúrgica y 0,25 mg/kg/h durante las primeras 48 horas del postoperatorio; Grupo Kep que recibió ketamina epidural 0,5 mg/kg previamente a la incisión quirúrgica y 0,25 mg/kg/h durante las primeras 48 horas del postoperatorio; Grupo S, que recibió suero fisiológico. Todos los pacientes recibieron analgesia epidural mediante una PCA (patient controlled analgesia) de ropivacaina y fentanilo durante 48 horas. Se evaluaron escalas subjetivas de valoración del dolor: EVA y NPSI (Inventario de Síntomas de Dolor Neuropático) así como un test de catastrofismo el día previo a la intervención quirúrgica y en el postoperatorio hasta los 6 meses. Se evaluó también el área de hiperalgesia periincisional así como la presencia de hiperalgesia en un área alejada con los dos QST de valoración de la sensibilidad mecánica, los filamentos de von Frey (VFM) y el von Frey Electrónico y un QST de valoración de la sensibilidad vibratoria. Los test sensoriales cuantitativos se realizaron el día previo a la intervención quirúrgica y en el postoperatorio hasta el sexto mes. Se determinó el área de hiperalgesia alrededor de la incisión quirúrgica como el área de una elipse cuyos ejes se determinaron por los umbrales de dolor con los diferentes QST. Se registró también la aparición de efectos indeseables. Se midieron los niveles plasmáticos de ketamina y se analizó la estabilidad de las soluciones. Se incluyeron un total de 104 pacientes. La incidencia de DPP a los 6 meses de la cirugía del 30%. Los valores de EVA en movimiento fueron significativamente inferiores en los grupos que recibieron ketamina a las 24 y 72 horas, pero no hubo diferencias posteriormente. No hubo diferencias en el EVA en reposo, NPSI o test de catastrofismo entre los grupos en ninguno de los tiempos. Asimismo tampoco hubo diferencias en el área de alodinia periincisional entre los grupos en ninguno de los tiempos. No hubo diferencias significativas en cuanto a los efectos adversos entre los tres grupos, y éstos fueron leves en todos los casos. La concentración plasmática de ketamina no mostró diferencias significativas entre los grupos Kiv y Kep y las soluciones administradas se comprobaron estables. CONCLUSIONES Los QST von Frey electrónico y VFM fueron reproducibles y aplicables en pacientes quirúrgicos. El von Frey electrónico mostró una mejor reproducibilidad intra e interobservador tanto en voluntarios como en pacientes y su aplicación precisó menos tiempo. La analgesia epidural torácica eficaz con anestésico local y fentanilo en el postoperatorio de toracotomía se asoció a una incidencia de DPP más baja que la publicada. La adición de ketamina intravenosa o epidural a esta técnica analgésica no redujo la incidencia de DPP ni del área de alodinia/hiperalgesia periincisional en los primeros seis meses. La única ventaja de añadir ketamina fue la disminución del dolor al movimiento en el postoperatorio inmediato. Los efectos indeseables asociados a la ketamina a las dosis empleadas son poco frecuentes y leves. La administración de ketamina por vía epidural no es superior que por vía intravenosa produciendo niveles sistémicos semejantes, lo que indica que su acción no es selectiva epidural cuando se administra por esa vía. Las soluciones empleadas en este estudio mostraron estabilidad física.[eng] BACKGROUND Postoperative pain may persist over time developing a persistent postsurgical pain (PPP), defined as the pain that lasts more than two months after surgery. There are some risk factors that may influence the persistence of pain, such as the type of surgery, the intensity of acute postoperative pain and some not yet well-defined constitutional factors. The incidence of PPP after thoracotomy is estimated about 50% of the patients one year after surgery and it shows neuropathic characteristics. Neuropathic pain may arise when nervous damage occurs during surgery and it may persist along time. Peripheral or central nervous damage is perpetuated by central mechanisms, becoming independent of the initial damage. Interruption of the afferent information in the nervous system leads in some individuals to spontaneous pain and hypersensitivity, such as allodynia and hyperalgesia. Neuropathic pain is established as a result of the unbalance between excitatory and inhibitory substances in the peripheral and central nervous system and the activation of NMDA receptors has been associated to the maintenance of central sensitization. The magnitude of postoperative hyperalgesia has been related to the persistence of pain 6 months and 1 year after surgery. Ketamine, used as an anesthetic agent since 50 years ago, is one of the few NMDA agonists clinically available. It has been demonstrated to reduce the hyperalgesia area around surgical wound when administered at subanesthetic doses in some types of surgeries. Besides its NMDA action at spinal level, ketamine has an activity in other systems which can modulate pain processing. Epidural ketamine could be more effective than intravenous ketamine because of the proximity of its site of action, avoiding systemic adverse effects. However, published studies are heterogeneous and cannot be traduced in a specific administration regimen. Additionally, PPP reduction has not been deeply investigated. On the other hand, the assessment of neuropathic pain is not an easy task. There is no specific diagnosis test and the monitoring of pain evolution is difficult because of the subjective nature of pain. Quantitative sensory testing (QST) can quantify thermal and mechanical sensory thresholds providing more objective information of pain processing than usual pain scales. QST have been extensively used in animal investigation and chronic pain. However, its application in the postoperative period is limited because of its complexity and being time consuming. There is no data of QST evaluation in thoracic surgery, one of the surgeries with a high incidence of PPP. A battery of simple and reproducible tests for the evaluation of postoperative pain would be necessary to obtain clear results in the research of prevention and treatment strategies. HYPOTHESIS The first hypothesis of our investigation was that mechanical QST allow the measurement of the hyperalgesia area around thoracotomy scar in a reproducible way. The second one was that epidural and intravenous ketamine could reduce the secondary hyperalgesia area and the incidence of PPP after thoracotomy, being the epidural route more effective. These two hypothesis have been expressed in the two articles of this thesis. ARTICLE 1: Tena B, Escobar B, Arguis MJ, Cantero C, Rios J, Gomar C. Reproducibility of Electronic Von Frey and Von Frey monofilaments testing. Clin J Pain. 2012; 28(4):318-23 We carried out a study evaluating the reproducibility of two QST which assess mechanical sensibility, the von Frey monofilaments (VMF) and the Electronic von Frey. Reproducibility of both tests was assessed in two groups of individuals: volunteers and surgical patients. Both tests were performed consecutively by two trained investigators. Measurements were made in two different corporal areas and repeated in 24 hours. Intraobserver and interobserver reproducibility and time employed were evaluated. Intraobserver and interobserver reproducibility was moderate for VFM in both groups. Intraobserver reproducibility for Electronic von Frey was good in the volunteers group and almost perfect in the patients group while interobserver reproducibility was almost perfect in both groups. There was no difference between the two areas explored. Time employed was 6,03 and 3,16 minutes for VFM and Electronic von Frey, respectively. ARTICLE 2: Tena B, Gomar C., Rios J. Perioperative epidural or intravenous ketamine does not improve the effectiveness of thoracic epidural analgesia for acute and chronic pain after thoracotomy. Clin J Pain 2013; Nov 25 A randomized double blind study in patients undergoing thoracotomy was carried out. Patients were randomized in three groups of treatment: Group Kiv, receiving 0,5 mg/kg intravenous ketamine previous to surgical incision and 0,25 mg/kg/h intravenous ketamine for 48 hours after surgery; Group Kep, receiving 0,5mg/kg epidural ketamine previous to surgical incision and 0,25mg/kg/h epidural ketamine for 48 hours after surgery and Group S receiving saline serum. All the patients received epidural analgesia by means of a PCA (patient controlled analgesia) of ropivacaine and fentanyl for 48 hours after surgery. We assessed subjective pain scales of VAS and NPSI (Neuropathic Pain Symptoms Inventory) and catastrophizing scale from the day before until 6 months after surgery. The area of hyperalgesia around surgical incision was evaluated with VFM, Electronic von Frey and a vibratory test. Hyperalgesia in a distant area was also explored. These QST were performed the day before surgery and in the postoperative period until the 6th month. The area of hyperalgesia was calculated as an ellipse whose axis was determined by the pain thresholds obtained with QST. The occurrence of adverse effects was also registered. Ketamine plasma concentrations were determined and the stability of the different analgesic preparations was also analyzed. 104 patients were included in the study. The incidence of PPP at 6 months was 30%. VAS values in movement were significantly lower in ketamine groups than in saline group at 24 and 72 h but there were no differences afterwards. There were no differences in VAS at rest, NPSI, catastrophizing scale between groups. The area of hyperalgesia did not show differences between groups at any time. The adverse effects were mild and without differences between groups. Ketamine concentrations were similar by both routes and the analgesic solutions were stable. CONCLUSIONS The QST VFM and Electronic von Frey were reproducible and applicable in surgical patients. The Electronic von Frey showed a better intraobserver and interobserver reproducibility and required less time than VFM. Epidural analgesia with ropivacaine and fentanyl after thoracotomy resulted in a lower incidence of PPP than previously reported. Addition of intravenous or epidural ketamine did not reduce the incidence of PPP or the area of secondary hyperalgesia in the first 6 months. The only advantage of ketamine was the reduction of immediate postoperative pain at movement. The few adverse events associated were mild. Epidural ketamine did not provide better results than intravenous ketamine, with similar plasmatic concentrations indicating a systemic effect of epidural ketamine. The solutions employed in this study demonstrated physical stability

Employees' proactive behavior and innovation performance. Examining the moderating role of informal and formal controls

Purpose – The purpose of this paper is to analyze the degree to which employees’ proactive behavior contributes to innovation performance in firms operating in high-technology sectors. Despite the benefits of these behaviors for individuals and organizations, few studies have analyzed the contextual conditions that enable firms to capture their value in order to improve innovation performance. Drawing on the interactionist perspective, the authors also examine the extent to which informal and formal controls, such as perceived support for innovation and innovation process formalization, can facilitate the contribution of proactive behaviors to improve innovation performance (product and process innovation). Design/methodology/approach – Based on an empirical study with a sample of 173 firms operating in chemical and information technology service sectors, hierarchical regression analysis was used to test the relationship between employees’ proactive behavior and innovation performance, and the moderating effects of informal and formal controls. Findings – The results reveal a positive and significant association between proactive behaviors and product and process innovation performance. Both control mechanisms positively moderate the association between proactive behavior and product innovation, but no moderating role was found for process innovation. Moreover, rather than inhibiting innovation performance, innovation process formalization is positively associated with innovation. More specifically, a curvilinear relationship was found, which implies that when the level of formalization is high, it is able to improve product and process innovation. Practical implications – The findings suggest that managers should consider proactive behavior in selection processes and performance management, and should cultivate a climate to support innovation and establish formal controls for innovation as a way to channel employees’ initiatives into product innovation. Originality/value – This study contributes to the theoretical and managerial understanding of the extent to which proactive employees and organizational controls are able to enhance innovation in a technologically dynamic context

Drivers and internalisation of the EFQM excellence model

Purpose Although the European Foundation for Quality Management (EFQM) Excellence Model has been widely adopted throughout Europe, a thorough examination of the factors that contribute to the internalisation of the model (i.e. a substantive adoption) has been neglected in the literature. The purpose of this paper is to present a model that analyses the drivers of the real internalisation of the EFQM excellence model, with a focus on the role of motives for adoption, and appraisal and compensation systems. Design/methodology/approach An empirical study was carried out based on a sample of Spanish organisations that had been awarded EFQM recognition. Structural equation models, cluster analysis and ANOVA were used to examine the research questions. Findings Internal motives concerning the creation of a participative style are the main driver of internalisation. Moreover, having an appraisal system-oriented towards the development of employees helps the substantive adoption of the EFQM model. These findings reinforce the importance of the soft elements of the EFQM model. Originality/value This study enhances evidence about the motives for adoption and their influence on the internalisation of the EFQM model. It analyses internalisation in a novel context, EFQM recognised organisations, and contributes to the debate about the efficacy of the EFQM model to performance improvement, by unveiling the factors that could foster the internalisation of the model within the organisational routines

The link between Quality Management and Innovation Performance: A content analysis of survey-based research

Previous contributions have reported contradictory findings about the effects of Quality Management (QM) on innovation performance. The purpose of this paper is to critically appraise methodological issues in the literature concerning the link between QM and innovation performance, in order to reveal possible differences in the research design which may explain the heterogeneity of the findings. Through a content analysis of peer-reviewed journal articles on this topic from 1994 to 2016, the authors compare the research designs used, and identify the most prevalent practices in conducting survey-based research. In addition, cross-tabulations are used to analyze the relationships between methodological issues and type of findings. The main findings can be summarized as follows: some papers report incomplete information about methodological issues; they focus on the organizational level of analysis and see higher managers as common informants; there is a lack of research which combines surveys with other methods, as well as of longitudinal designs; and the way QM and innovation performance are measured conditions the findings obtained in the articles reviewed. The characteristics revealed in this analysis provide a platform to assist scholars in developing future stances in this and similar fields of research

Structural empowerment and organisational performance: the mediating role of employees’ well-being in Spanish local governments

We extend the ‘black box’ picture of public management and the ‘balanced view’ of HRM literature to explore, in the public context, the impact of structural empowerment on organisational performance and the mediating role of three employee outcomes: job satisfaction and affective commitment as attitudinal variables related to eudaimonic well-being, and job anxiety as an employee health variable related to hedonic well-being. Using multilevel methodology on a sample of 103 local authorities, results show that structural empowerment is positively associated with organisational performance, both directly and indirectly, via employee health. This evidence supports the mutual gains perspective, but not as intensely as expected (empowerment does not affect attitudinal variables) and differently to the traditional perspective, since empowerment contributes to reduce job anxiety in Spanish local governments

Impact of the program for the prevention of obesity and eating disorders entitled “everybody has a body” in educational centers in Spain. Analysis and proposals/ Impacto del programa de prevención de TCA y obesidad “everybody has a body” en centros educativos en España. Análisis y propuestas

Este artículo tiene como objetivo presentar el programa “Everybody has a body” para la prevención de trastornos de la conducta alimentaria (TCA) y obesidad en población preadolescente, que se ha impartido en varias escuelas de España durante el año 2021, contando con una muestra compuesta por 179 preadolescentes de entre 10 y 12 años. Este programa, elaborado por las investigadoras, tiene un carácter innovador, puesto que integra la prevención de los TCA y la obesidad, desde un enfoque que fomenta un estilo de vida saludable, a través del desarrollo de una conciencia crítica con los cánones de belleza, fortalecimiento de la autoestima e imagen corporal, entre otros. El impacto del programa ha sido positivo, y los participantes han mejorado en todas las dimensiones evaluadas. Los resultados obtenidos manifiestan, sin lugar a dudas, la necesidad de educar en salud en las escuelas. Se postula como una exigencia para cualquier sistema educativo, más allá de las fronteras nacionales, puesto que los TCA y la obesidad se han convertido en un problema global, que afecta a gran parte del planeta, minando la salud y calidad de vida de las personas, generando grandes costes económicos a los gobiernos y aumentando las desigualdades sociales

Incidence of persistent postoperative pain after hepatectomies with 2 regimes of perioperative analgesia containing ketamine

Studies designed to assess persistent postoperative pain (PPP) incidence after hepatectomies are lacking. Our aim was to assess PPP incidence 6 months after hepatectomies with intravenous (IV) or epidural (EPI) analgesia containing ketamine. Prospective observational comparative study between 2 cohorts of patients submitted to hepatectomy. Patients received 1 of 2 analgesic regimes containing ketamine: EPI group or IV group. Visual analog scale (VAS), Neuropathic Pain Symptom Inventory (NPSI), Pain Catastrophizing Scale (PCS), and quantitative sensorial testing (QST: to determine area of hyperalgesia/allodynia) were assessed preoperatively and postoperatively at 2 h, 24 h, 7 days, 1 month, and 6 months. VAS ≥ 1 at 1 and 6 months was considered indicative of PPP and VAS > 3 was considered as not controlled pain. Side effects and complications were registered. Forty-four patients were included: 23 in EPI group and 21 in IV group. Patients in IV group were older and had more comorbidities. No patient presented VAS > 3 at 1 or 6 months. VAS ≥ 1 at 1 and 6 months was 36.4% and 22.7%, respectively. No differences in VAS, NPSI, or PCS were found between groups. Allodynia/hyperalgesia area did not differ between groups and was infrequent and slight. Pain pressure threshold in the wound vertical component was significantly higher in EPI group after 7 days. IV group showed more cognitive side effects. Incidence of PPP at 6 months after open hepatectomies with EPI or IV analgesia containing ketamine was lower than previously reported for other abdominal surgeries. Ketamine influence on low PPP incidence and hyperalgesia cannot be discarded

El patio escolar como espacio educativo: propuesta del patio como acercamiento a la naturaleza.

El estilo de vida ha cambiado si lo comparamos con hace unos años. Hoy en día los niños juegan menos en el exterior, y por lo tanto están menos en contacto con la naturaleza. Podemos encontrar varias razones como es el miedo de los padres a dejar a sus hijos jugando en el exterior y el abuso de las tecnologías. Sin embargo, la naturaleza ofrece una multiplicidad de beneficios y ante esta carencia la escuela se ve obligada a actuar para mejorar esta situación y para ello propongo un patio escolar en contacto con la naturaleza, un lugar en el que los niños puedan experimentar y donde haya cabida a los intereses de todos los niños. Nos encontramos que los patios escolares hoy en día son patios descontextualizados en el que se dan muy pocas conductas debido a la escasez de recursos. Por ello doy una serie de pautas para hacer una transformación del patio escolar en un patio donde sea posible aprender y estar en contacto con la naturaleza