Papel del Formato Comercial en la Lealtad al Establecimiento Minorista

En entornos altamente competitivos como los minoristas, caracterizados por una creciente heterogeneidad de la demanda y por la proliferaci¢n de nuevas formas comerciales, cada vez son m s comunes los comportamientos de compra cruzada entre establecimientos. Esto convierte la fidelizaci¢n de los clientes en un desaf¡o estrat‚gico clave para los operadores minoristas en la consolidaci¢n de su posici¢n en el mercado. Con el objeto de comprender mejor esta realidad, se establece un marco te¢rico explicativo de los distintos perfiles de lealtad al establecimiento minorista por parte de los consumidores. M s espec¡ficamente se analiza el papel de los formatos comerciales en la estructura de lealtad observable en el mercado. Mediante un an lisis emp¡rico sobre los patrones de gasto en alimentaci¢n de una muestra de 580 hogares espa¤oles se evidencia que, aunque los consumidores regularmente simultanean compras en distintos formatos comerciales, concretamente el supermercado, el descuento y el hipermercado, exhiben una alta lealtad comportamental hacia una £nica ense¤a dentro de cada tipo de formato seleccionado. El patr¢n observado pone de manifiesto que los formatos comerciales definen perfiles diferenciados de establecimiento afines a los beneficios buscados en distintas situaciones de compra.Lealtad al establecimiento, compra cruzada, formato comercial, comercio minorista de alimentaci¢n.

Media aritm?tica : dificultades en alumnos del grado d?cimo

132 P?ginasEn este Trabajo se estudian las dificultades que presentan alumnos del Grado d?cimo, de la instituci?n educativa Celmira Huertas de Ibagu?, en la comprensi?n de las propiedades conceptuales de la media aritm?tica, observando e identificando las confusiones que se generan al resolver problemas o al analizar resultados que requieran la comprensi?n de los aspectos estad?sticos, abstractos y ser representante de los datos de la media aritm?tica. El objetivo de este trabajo fue contribuir a la comprensi?n de las dificultades de estudiantes de Grado d?cimo en relaci?n a las propiedades conceptuales de la media aritm?tica, identificando dificultades en el razonamiento que se presentan en alumnos de la Instituci?n Educativa Celmira Huertas de Ibagu?, sobre la media aritm?tica y conociendo las estrategias que m?s utilizan cuando resuelven problemas relacionados con los aspectos estad?stico y abstracto. La informaci?n se obtuvo mediante la aplicaci?n de cuestionarios y la realizaci?n de entrevistas. Las categor?as que se utilizaron para el an?lisis de la informaci?n se determinaron despu?s de un an?lisis preliminar de las respuestas de los alumnos de tal manera que ellas permitieran tener en cuenta la naturaleza y el contexto de los enunciados de los 6 problemas propuestos y las respuestas de los alumnos, haciendo ?nfasis en la soluci?n, en los errores y en el razonamiento que cada uno hac?a en cada ejercicio. Palabras Claves: Comprensi?n, Concepto, Dificultades, Media aritm?tica, Propiedades conceptuales.ABSTRACT. In this work we study the difficulties presented by tenth grade students of the educational institution Celmira Huertas Ibagu? conceptual understanding of the properties of the arithmetic mean, observing and identifying the confusions that are generated to solve problems or to analyze results requiring an understanding of the statistical, abstract and be representative of the data from the arithmetic mean. The goal of this work was to contribute to the understanding of the difficulties of tenth grade students in relation to the conceptual properties of the arithmetic mean, identifying the difficulties in the reasoning shown by students of School of Ibague Celmira Huertas on arithmetic?s and the knowledge of the strategies use when solving problems related to statistical and abstract aspects. The information was obtained through the use of questionnaires and interviews. The categories that were used for data analysis were determined after a preliminary analysis of the responses of the students so that they would allow to take into account the nature and context of the sentences of the 6 problems posted and the responses of students with emphasis on the solution, errors and the reasoning everyone demonstrated while solving each exercise.La Facultad de Ciencias de la Educaci?n de la Universidad del Tolima, el director, codirector y el jurado calificador, no son responsables de los conceptos, ni de las ideas expuestas por los autores del presente trabajo. Art?culo 16, Acuerdo 032 de 1976 y Art?culo 29, Acuerdo 064 de 1991, emanados por el Consejo Acad?mico de la Universidad del Tolima.1. ANTECEDENTES DEL PROBLEMA 16 1.1 INVESTIGACIONES SOBRE LA COMPRENSI?N DE PROPIEDADES 16 2. PLANTEAMIENTO DEL PROBLEMA 20 2.1 DEFINICI?N DEL PROBLEMA 20 2.1.1 Razones que sustentan el problema 20 2.1.2 El problema 21 3. OBJETIVOS 22 3.1 OBJETIVO GENERAL 22 3.2 OBJETIVOS ESPEC?FICOS 22 4. JUSTIFICACI?N 23 5. MARCO TE?RICO 25 5.1 FORMACI?N DE CONCEPTOS EN LA ENSE?ANZA DE LA MATEM?TICA 25 5.2 CONOCIMIENTO FORMAL. 25 5.3 CONOCIMIENTO CURRICULAR 25 5.4 CONOCIMIENTO PERSONAL 26 5.5 RESUMEN 26 5.6 COMPONENTES DE UN CONCEPTO 26 5.7 VINNER: CONCEPTO E IMAGEN DEL CONCEPTO. 27 5.8 ARTIGUE: CONCEPTO Y CONCEPCI?N 28 5.9 LA EDUCACI?N MATEM?TICA REALISTA (EMR) 30 5.10 LINEAMIENTOS CURRICULARES Y FORMACI?N DE CONCEPTOS. 33 5.11 EL CONCEPTO DE LA MEDIA ARITM?TICA 37 5.11.1 Conocimiento Formal 37 5.11.2 Unos problemas y propiedades de la Media aritm?tica 39 5.11.3 Atributos Relevantes 43 5.12 CONOCIMIENTO CURRICULAR 45 5.12.1 Definici?n curricular 45 5.12.2 Unos problemas de la Media Aritm?tica 45 5.12.3. Atributos relevantes e irrelevantes 46 5.13 CONOCIMIENTO PERSONAL 47 5.13.1 Estudios sobre dificultades de los alumnos 47 5.13.2 Dificultades con la media aritm?tica 50 6. MARCO METODOL?GICO 60 6.1 TIPO DE INVESTIGACI?N 60 6.2 CONDICIONES DE APLICACI?N DE LOS INSTRUMENTOS 60 6.2.1 Instituci?n educativa donde se llev? a cabo el estudio 60 6.2.2 ?rea de Matem?ticas de la instituci?n Educativa 61 6.2.3 Curso en donde se obtuvo la informaci?n 61 6.3 INSTRUMENTOS 61 6.4 CATEGOR?AS DE AN?LISIS 62 6.4.1 Enunciado del problema 62 6.4.2 Respuestas de los alumnos 63 6.5 PRESENTACI?N Y AN?LISIS DE CADA PREGUNTA DEL CUESTIONARIO 64 6.5.1 Situaci?n 1 65 6.5.2 Situaci?n 2 67 6.5.3 Situaci?n 3 68 6.5.4 Situaci?n 4 69 6.5.5 Situaci?n 5 70 6.5.6 Situaci?n 6 71 6.6 ENTREVISTA 75 6.7 AN?LISIS DE RESULTADOS 75 7. CONCLUSIONES 101 8. PROYECCIONES Y RECOMENDACIONES 105 REFERENCIAS 106 ANEXOS 11

Psychiatric comorbidities in Asperger syndrome are related with polygenic overlap and differ from other Autism subtypes

There is great phenotypic heterogeneity within autism spectrum disorders (ASD), which has led to question their classification into a single diagnostic category. The study of the common genetic variation in ASD has suggested a greater contribution of other psychiatric conditions in Asperger syndrome (AS) than in the rest of the DSM-IV ASD subtypes (Non_AS). Here, using available genetic data from previously performed genome-wide association studies (GWAS), we aimed to study the genetic overlap between five of the most related disorders (schizophrenia (SCZ), major depression disorder (MDD), attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorders (OCD) and anxiety (ANX)), and AS, comparing it with the overlap in Non_AS subtypes. A Spanish cohort of autism trios (N = 371) was exome sequenced as part of the Autism Sequencing Consortium (ASC) and 241 trios were extensively characterized to be diagnosed with AS following DSM-IV and Gillberg's criteria (N = 39) or not (N = 202). Following exome imputation, polygenic risk scores (PRS) were calculated for ASD, SCZ, ADHD, MDD, ANX, and OCD (from available summary data from Psychiatric Genomic Consortium (PGC) repository) in the Spanish trios' cohort. By using polygenic transmission disequilibrium test (pTDT), we reported that risk for SCZ (Pscz = 0.008, corrected-PSCZ = 0.0409), ADHD (PADHD = 0.021, corrected-PADHD = 0.0301), and MDD (PMDD = 0.039, corrected-PMDD = 0.0501) is over-transmitted to children with AS but not to Non_AS. Indeed, agnostic clustering procedure with deviation values from pTDT tests suggested two differentiated clusters of subjects, one of which is significantly enriched in AS (P = 0.025). Subsequent analysis with S-Predixcan, a recently developed software to predict gene expression from genotype data, revealed a clear pattern of correlation between cortical gene expression in ADHD and AS (P < 0.001) and a similar strong correlation pattern between MDD and AS, but also extendable to another non-brain tissue such as lung (P < 0.001). Altogether, these results support the idea of AS being qualitatively distinct from Non_AS autism and consistently evidence the genetic overlap between AS and ADHD, MDD, or SCZ

Temperature but not leptin prevents semi-starvation induced hyperactivity in rats: implications for anorexia nervosa treatment

The hypothesis linking hyperactivity with weight loss associated hypoleptinemia in anorexia nervosa gained momentum after a study showing that leptin suppressed semi-starvation induced hyperactivity in rats. Alternatively, ambient temperature is a key modulating factor of activity in semi-starved rats. The aim of the study is to compare the efficacy of leptin with increased ambient temperature in the prevention of hyperactivity in semi-starved rats. 74 Sprague-Dawley male rats were employed in two experiments with the difference residing in the length of baseline. After an extended (28 days), or shorter (14 days) baseline with free access to food and the running wheel, housed at 21 degrees C, animals were either ad-lib feed or food restricted (60% of food ingested during previous week) and infused with same amount of leptin at 21 degrees C, 25 degrees C, or vehicle at 21 degrees C, 25 degrees C and 32 degrees C for a week. Animals housed at 32 degrees C significantly reduced wheel running and weight loss during food restriction while animals given leptin did not yield no differences in activity or weight loss. Moreover, unlike animals housed at 32 degrees C, body temperature of leptin infused animals housed at 21 degrees C was significantly reduced during food restriction. Furthermore, leptin treated rats without a preceding stable pattern of activity displayed a severe dysregulation of circadian rhythm in activity and a collapse of body temperature. Housing temperature plays a more critical role than leptin in the regulation of semi-starvation induced hyperactivity in rats, which may be of relevance for the management of hyperactivity in anorexia nervosa

Increasing Competitiveness through the Implementation of Lean Management in Healthcare

The main aim of this paper was two-fold: first, to design a participative methodology that facilitates lean management implementation in healthcare by adopting the action research approach; second, to illustrate the usefulness of this methodology by applying it to the sleep unit of a public hospital in Spain. This methodology proposes the implementation of lean management in its broadest sense: adopting both lean principles and some of its practical tools or practices in order to achieve competitive advantage. The complete service value chain was considered when introducing changes through lean management implementation. This implementation involved training and involving staff in the project (personnel pillar), detecting and analysing "waste" in value chain processes (processes pillar) and establishing control and measurement mechanisms in line with objectives (key performance indicators pillar) and putting in place improvement actions to achieve these objectives. The application of this methodology brought about an improvement in the management of patient flow in terms of effectiveness, efficiency and quality but also an internal transformation towards lean culture

Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country

Background: It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods: Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results: Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions: Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA

Percutaneous mitral repair: current and future devices

Mitral regurgitation (MR) is the second most common valvular heart disease and its prevalence is increasing with population ageing. In the recent years we have witnessed the development of several transcatheter devices to correct MR in patients at high-risk for surgery. The majority of evidence regarding safety and efficacy of this new therapy comes from MitraClip studies. However, new alternatives on the field of valve repair have emerged with promising results. The aim of this review is to portrait the landscape of transcatheter mitral repair alternatives, from currently used devices to those that will have a role in the near future

COVID-19 and Sick Leave: An Analysis of the Ibermutua Cohort of Over 1,651,305 Spanish Workers in the First Trimester of 2020

Objectives: The worldwide SARS-COV2 pandemic has impacted the health of workers and companies. The aim is to quantify it according to sick leave. Methods: Using ICD-9 codes, we analyzed Ibermutua records of all sick leaves during the first trimester of 2020, compared to during the same months of 2017, 2018, and 2019. We stratified the analysis by causes, patient sex, activity sectors, and regional data. All sick leaves were adjusted by the number of Ibermutua-affiliated persons in each period. Results: In March 2020, there was an unprecedented (116%) increase in total sick leaves, mainly due to infectious and respiratory diseases. Men and women were equally affected. All activity sectors were impacted, with the highest increase (457%) observed among health-related workers, especially due to contagious disease. The incidences of sick leaves were heterogeneous among different regions. Cost-analysis of sick leaves during the first trimester of 2020 compared with in previous years showed 40.3% increment (mean 2,813 vs. 2,005 euro per 100 affiliated workers). Conclusions: The SARS-COV2 pandemic is having a huge impact on workers' health, as shown by data regarding sick leaves in March 2020. This is associated with greater economic burden for companies, both due to the cost associated with sick leaves and the losses in productivity due to confinement

The social return on investment of a new approach to heart failure in the Spanish National Health System

AIMS: We aim to agree on a set of proposals to improve the current management of heart failure (HF) within the Spanish National Health System (SNHS) and apply the social return on investment (SROI) method to measure the social impact that these proposals would generate. METHODS AND RESULTS: A multidisciplinary working team of 16 experts was set up, with representation from the main stakeholders regarding HF: medical specialists (cardiologists, internal medicine physicians, general practitioners, and geriatric physicians), nursing professionals, health management professionals, patients, and informal caregivers. This team established a set of proposals to improve the management of HF according to the main areas of HF care: emergency and hospitalization, primary care, cardiology, and internal medicine. A forecast-type SROI method, with a 1-year time frame, was applied to measure the social impact resulting from the implementation of these proposals. The required investment and social return were estimated and summarized into a ratio indicating how much social return could be generated for each euro invested. Intangible returns were included and quantified through financial proxies. The approach to improve the management of HF consisted of 28 proposals, including the implementation of a case management nurse network, standardization of operational protocols, psychological support, availability of echocardiography machines at emergency departments, stationary units and primary care, early specialist visits after hospital discharge, and cardiac rehabilitation units, among others. These proposals would benefit not only patients and their informal caregivers but also the SNHS. Regarding patients, proposals would increase their autonomy in everyday activities, decrease anxiety, increase psychological and physical well-being, improve pharmacological adherence and self-care, enhance understanding of the disease, delay disease progression, expedite medical assessment, and prevent the decrease in work productivity associated with HF management. Regarding informal caregivers, proposals would increase their quality of life; improve their social, economic, and emotional well-being; and reduce their care burden. The SNHS would benefit from shorter stays of HF patients at intensive care units and reduction of hospitalizations and admissions to emergency departments. The investment needed to implement these proposals would amount to euro548m and yield a social return of euro1932m, that is, euro3.52 for each euro invested. CONCLUSIONS: The current management of HF could be improved by a set of proposals that resulted in an overall positive social return, varying between areas of analysis. This may guide the allocation of healthcare resources and improve the quality of life of patients with HF