Cultural dynamism and business vitality in medium-sized cities—evidence and proposals for sustainable development

This work uses tools recently designed to conduct analyses and proposals around the cultural development of medium-sized cities. The Cultural and Creative Cities Monitor model, or CCCM, is first applied to the 81 cities in Spain with between 50, 000 and 100, 000 inhabitants. We also refer to the UNESCO Culture/2030 Indicators, specifically indicator 8 (Cultural companies), to in-vestigate whether cultural dynamism is related to business vitality in those cities. Our observation of the 29 CCCM indicators and the C3 index, which synthesizes cultural performance, is explained, and these data are complemented with cultural business data (on assets, benefits, and jobs) from a sample of 13, 204 firms. The C3 index values reveal significant differences in the cultural and creative performance of the selected cities according to their location (metropolitan or non-metropolitan) and their administrative rank. Moreover, when comparing the C3 index with the indicators on business activity, evidence indicates a clear positive relationship between cultural dynamism and firm vitality. These results support the contribution of culture to the sustainable development of me-dium-sized Spanish cities and further establish the suitability of the tools used to assist cities in designing appropriate cultural policies

The location of creative clusters in non-metropolitan areas: A methodological proposition

This article studies creative clusters outside metropolitan areas in Spain. Both the notion of cluster and that of creative activity tend to be associated by mainstream research with urban settings; thus, situating them in an non metropolitan or rural localities has required us to adapt the usual methodology to the scale and idiosyncrasies of a rural setting. Based on this new focus, we have been able to identify 761 municipalities that could host creative clusters within an initial area of study of 7367 non-metropolitan municipalities with fewer than 50,000 inhabitants. This methodology also has allowed us to measure intensity, internal composition, and localization, so that those of a more mature or advanced character, having a greater level of specialization and diversity, predominate in places close to metropolitan areas and the Mediterranean axis, whereas in the inner Spain, they are found in a lower proportion and in a more scattered and discontinuous manner. Activities belonging to the Functional Creations sector prevail over those from Communication and Patrimony in the configuration of the clusters, although there are differences in relative specialization according to their mature or advanced level. In addition, some of the most significant indicators of rural dynamism e population growth, human capital, unemployment, and economic activity e show much better behaviour in municipalities with creative clusters

Cultural and creative ecosystems in medium-sized cities: Evolution in times of economic crisis and pandemic

This article seeks to forecast the short-and medium-term impacts of the coronavirus pandemic on the cultural and creative ecosystems of the 81 cities in Spain with between 50, 000 and 100, 000 inhabitants. Data on employment in nine sectors (per NACE Rev. 2) support the characterization of cultural ecosystems based on their dynamism, specialization, and propensity to form clusters (thanks to the co-location of certain sectors, meant to generate inter-sectoral spillovers and cross-sector synergies). The applied methodology consists of comparing these three attributes during and following the 2008 financial crisis. Then, any changes observed are interpreted in light of arguments from the COVID-19 literature, and from our own analysis, in order to assess the probability of recurrence (or nonrecurrence) during the current pandemic. Throughout this process, the metropolitan or non-metropolitan position of cities is taken into consideration. A first conclusion is that, as in the financial crisis, the behavior of ecosystems during the pandemic will be asymmetric. Secondly, metropolitan and non-metropolitan cities will maintain their distinctive sectoral specializations. Non-metropolitan cities appear to be more vulnerable for their strong connection to creative sectors most affected by the pandemic, although some can take advantage of good cultural supply and proximity to metropolitan centers. Metropolitan cities seem more secure, thanks to the higher presence of less vulnerable sectors (due to elevated and accelerating digitization). Nevertheless, most functional clusters were diminished during the financial crisis, and it seems unlikely that sectoral co-locations will re-emerge in a post-pandemic scenario as a business strategy, at least in the short term. Beyond these forecasts, we recommend dealing with certain structural failures of these ecosystems, especially the vulnerability and precariousness of most cultural and creative companies and workers

Geoelectrical and electromagnetic methods applied to paleolimnological studies: Two examples from desiccated lakes in the Basin of Mexico

Paleolimnological studies require a broad understanding of the geometry and depth of the sedimentary fill of lake basins prior to coring campaigns. Seismic methods are routinely employed for the indirect characterization of lake-bottom sediments. However, the use of seismic methods might occasionally be limited due to surface conditions or poor seismic contrasts between the stratigraphic units, which lead to data quality that is too poor to provide sufficient information for the selection of drill sites. Sources of cultural noise are one of the main reasons why seismic methods fail in study areas near or within large cities, such as Mexico City. Under certain conditions, electrical and electromagnetic methods might be a suitable substitute or complement to seismic exploration, as they respond to different physical properties of the subsurface. To evaluate the applicability of such methods, here we present two recent case studies from the desiccated lakes Chalco and Xochimilco both located in urban areas within the Basin of Mexico where electrical resistivity tomography (ERT), transient electromagnetic (TEM) and magnetotelluric (MT) soundings were conducted for the characterization of lake basement and lacustrine sediments. In both examples, the results of the geophysical exploration contributed valuable stratigraphic information for the following drilling and core recovery, which highlights the potential of electrical and electromagnetic methods in paleolimnological studies

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment : A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016

Effectiveness of intensive group and individual interventions for smoking cessation in primary health care settings: a randomized trial

<p>Abstract</p> <p>Objectives</p> <p>Primary: To compare the effectiveness of intensive group and individual interventions for smoking cessation in a primary health care setting; secondary: to identify the variables associated with smoking cessation.</p> <p>Methods</p> <p>Three-pronged clinical trial with randomisation at the individual level. We performed the following: an intensive individual intervention (III), an intensive group intervention (IGI) and a minimal intervention (MI). Included in the study were smokers who were prepared to quit smoking. Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses. The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry (CO). The analysis was based on intention to treat.</p> <p>Results</p> <p>In total, 287 smokers were recruited: 81 in the III, 111 in the IGI, and 95 in the MI. Continued abstinence at 12 months confirmed through CO was 7.4% in the III, 5.4% in the IGI, and 1% in the MI. No significant differences were noted between III and MI on the one hand, and between IGI and MI on the other [RR 7.04 (0.9-7.2) and RR 5.1 (0.6-41.9), respectively]. No differences were noted between IGI and III [RR 0.7 (0.2-2.2)]. In multivariate analysis, only overall visit length showed a statistically significant association with smoking cessation.</p> <p>Conclusions</p> <p>The effectiveness of intensive smoking interventions in this study was lower than expected. No statistically significant differences were found between the results of individual and group interventions.</p> <p>Trial registration number</p> <p>ISRCTN32323770</p

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016.This study was financed by Instituto de Salud Carlos III and Cofinanced by Fondo Europeo de Desarrollo Regional (FEDER). Ministerio de Economía y Competitividad. Gobierno de España. (PI15/00164, PI15/00586, PI15/00566

Interleukin 15 Levels in Serum May Predict a Severe Disease Course in Patients with Early Arthritis

Background: Interleukin-15 (IL-15) is thought to be involved in the physiopathological mechanisms of RA and it can be detected in the serum and the synovial fluid of inflamed joints in patients with RA but not in patients with osteoarthritis or other inflammatory joint diseases. Therefore, the objective of this work is to analyse whether serum IL-15 (sIL-15) levels serve as a biomarker of disease severity in patients with early arthritis (EA). Methodology and Results: Data from 190 patients in an EA register were analysed (77.2% female; median age 53 years; 6-month median disease duration at entry). Clinical and treatment information was recorded systematically, especially the prescription of disease modifying anti-rheumatic drugs. Two multivariate longitudinal analyses were performed with different dependent variables: 1) DAS28 and 2) a variable reflecting intensive treatment. Both included sIL-15 as predictive variable and other variables associated with disease severity, including rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibodies (ACPA). Of the 171 patients (638 visits analysed) completing the follow-up, 71% suffered rheumatoid arthritis and 29% were considered as undifferentiated arthritis. Elevated sIL-15 was detected in 29% of this population and this biomarker did not overlap extensively with RF or ACPA. High sIL-15 levels (β Coefficient [95% confidence interval]: 0.12 [0.06-0.18]; p&0.001) or ACPA (0.34 [0.01-0.67]; p = 0.044) were significantly and independently associated with a higher DAS28 during follow-up, after adjusting for confounding variables such as gender, age and treatment. In addition, those patients with elevated sIL-15 had a significantly higher risk of receiving intensive treatment (RR 1.78, 95% confidence interval 1.18-2.7; p = 0.007). Conclusions: Patients with EA displaying high baseline sIL-15 suffered a more severe disease and received more intensive treatment. Thus, sIL-15 may be a biomarker for patients that are candidates for early and more intensive treatmentThe work of Belen Díaz-Sánchez was supported by the RETICS Programme (Programa de Redes Temáticas de Investigación Colaborativa [Colaborative Research Thematic Network Programme]; RD08/0075 - RIER [Red de Inflamación y Enfermedades Reumáticas; Inflammation and Rheumatic Diseases Network]) from the Instituto de Salud Carlos III, Spain (URL: www.isciii.es) within the VI National Plan for I+D+I 2008–2011 (FEDER). The work of Isidoro González-Álvaro was in part supported by a grant for the Intensification of the Research Tasks in the National Health Care System from Instituto de Salud Carlos III, Spain. The consumables for measurements and data analysis were supported by a Fondo de Investigación Sanitaria grant (08/0754) from the Instituto de Salud Carlos II

Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023

Abstract Complementary feeding (CF) is defined as infant feeding that complements breastfeeding or, alternatively, breastfeeding with a breast milk substitute, and is a process that goes beyond simply providing guidance on what and how to introduce foods. The information provided by health professionals should be up-to-date and evidence-based. There are different guidelines or position papers at the international level, which, although most of the recommendations may be applicable, there are some others that require regionalization or adaptation to the conditions and reality of each area. The Nutrition working group of the Latin American Society of Pediatric Gastroenterology, Hepatology and Nutrition convened a group of experts, representatives from each of the countries that make up the society, with the objective of developing a consensus on CA, incorporating, when possible, local information that adapts to the reality of the region. The purpose of this document is to show the results of this work. Through Delphi methodology, a total of 34 statements or statements regarding relevant aspects of CA were evaluated, discussed and voted upon.Resumen La alimentación complementaria (AC) se define como la alimentación de los lactantes que complementa a la lactancia materna o en su defecto, a la lactancia con un sucedáneo de la leche materna, y es un proceso que va más allá de simplemente una guía sobre qué y cómo introducir los alimentos. La información brindada por parte de los profesionales de la salud debe ser actualizada y basada en evidencia. Existen diferentes guías o documentos de posición a nivel internacional, que, aunque la mayoría de las recomendaciones pueden ser aplicables, hay algunas otras que requieren una regionalización o adecuación a las condiciones y realidad de cada zona. El grupo de trabajo de Nutrición de la Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica convocó a un grupo de expertos, representantes de cada uno de los países que conforman la sociedad, con el objetivo de desarrollar un consenso sobre la AC, que incorporó cuando así fue posible, información local que se adapte a la realidad de la región. El objetivo de este documento es mostrar los resultados de dicho trabajo. A través de metodología Delphi, se evaluaron, discutieron y votaron un total de 34 declaraciones o enunciados con respecto a aspectos relevantes de la AC

A Broad Assessment of Factors Determining Culicoides imicola Abundance: Modelling the Present and Forecasting Its Future in Climate Change Scenarios

Bluetongue (BT) is still present in Europe and the introduction of new serotypes from endemic areas in the African continent is a possible threat. Culicoides imicola remains one of the most relevant BT vectors in Spain and research on the environmental determinants driving its life cycle is key to preventing and controlling BT. Our aim was to improve our understanding of the biotic and abiotic determinants of C. imicola by modelling its present abundance, studying the spatial pattern of predicted abundance in relation to BT outbreaks, and investigating how the predicted current distribution and abundance patterns might change under future (2011–2040) scenarios of climate change according to the Intergovernmental Panel on Climate Change. C. imicola abundance data from the bluetongue national surveillance programme were modelled with spatial, topoclimatic, host and soil factors. The influence of these factors was further assessed by variation partitioning procedures. The predicted abundance of C. imicola was also projected to a future period. Variation partitioning demonstrated that the pure effect of host and topoclimate factors explained a high percentage (>80%) of the variation. The pure effect of soil followed in importance in explaining the abundance of C. imicola. A close link was confirmed between C. imicola abundance and BT outbreaks. To the best of our knowledge, this study is the first to consider wild and domestic hosts in predictive modelling for an arthropod vector. The main findings regarding the near future show that there is no evidence to suggest that there will be an important increase in the distribution range of C. imicola; this contrasts with an expected increase in abundance in the areas where it is already present in mainland Spain. What may be expected regarding the future scenario for orbiviruses in mainland Spain, is that higher predicted C. imicola abundance may significantly change the rate of transmission of orbiviruses