El consejero en la empresa familiar: teoría y praxis

El presente trabajo de investigación, basado en más de diez años de experiencia en asesoramiento a la empresa familiar, tiene por objeto clarificar el papel que debe jugar el asesor de una empresa familiar, dotar a éste de herramientas eficaces y eficientes para el desarrollo de su trabajo con el fin último de ayudar a la familia empresaria en su traspaso generacional. Se realiza un recorrido sobre toda la etapa metodológica común a todas las familias empresarias que por diferentes y muy variados motivos deciden comenzar el camino del protocolo o pacto familiar. Ponemos de manifiesto aquellas herramientas que han resultado de mayor utilidad al asesor para descubrir el complicado mundo de las relaciones interpersonales que tienen lugar en el seno de la familia empresaria y que sin lugar a dudas condicionan su supervivencia.

El valor de la flexibilidad en la valoración de inversiones acuícolas

[EN] The loud initial investments that are necessary to start aquaculture activities, united to the so expanded period of the cycle of production and to the risk that this activity entails, are situations that appoint the future of the activity whose continuity requires necessarily of its economic viability. For it, it is important to pay attention to those studies that justify this economic viability capturing important aspects such like the managerial flexibility or the strategic value embedded in each project of investment, often perceived as critical success factors. From this perspective, it shows the need and the opportunity of this investigation, based on the application of Real Options method to value projects, considering the value of the strategic options embedded in them and that traditional discounted cash flow models does not capture. In short it is applied to a project of investment in a sea bream Sparus aurata offshore fish farm. After the election of the model of cage, the project was valued considering the strategic options to delay or abandon the project according to the events along 10 years. This valuation allowed concluding that the project is highly viable, considering the option to delay from only upon the 9th year analysis, if the preceding years are always unfavourable, being its probability very low. The option to abandon does not have value in this project of investment.[ES] Las fuertes inversiones iniciales que son necesarias para comenzar una actividad acuícola, unidas al período tan dilatado del ciclo de explotación y al riesgo que esta actividad comporta, son situaciones que comprometen el futuro de la actividad cuya continuidad pasa necesariamente por la consecución de la viabilidad económica. Por ello, es importante prestar atención a los estudios que justifiquen esta viabilidad económica considerando aspectos tales como la propia flexibilidad operativa o el valor estratégico que tiene cada proyecto de inversión, a menudo considerados factores críticos para la supervivencia. Desde esta perspectiva, se pone de manifiesto la necesidad y la oportunidad de la investigación, basado en la aplicación del método de Opciones Reales a la valoración de proyectos de inversión, método que considera el valor de las opciones estratégicas incluidas en cada proyecto y que son ignoradas en los métodos tradicionales. En concreto se aplica a un proyecto acuícola de inversión de una plataforma de jaulas flotantes para el cultivo de dorada en mar abierto. Tras la elección del modelo de jaula, la inversión fue valorada incorporando el valor de las opciones estratégicas de diferir la inversión o abandonarla según el desarrollo de los acontecimientos en un horizonte temporal de 10 años. Esta valoración permitió concluir que el proyecto es altamente viable, pudiendo considerarse la opción de diferir sólo en el 9º año de análisis, si los años precedentes se presentan siempre desfavorables, siendo su probabilidad muy baja. La opción de abandono no tiene valor en este proyecto de inversión.Pardo Sempere, L.; Rodríguez Alcaide, JJ. (2005). The value of flexibility in the valuation of aquaculture investments. Economía Agraria y Recursos Naturales - Agricultural and Resource Economics. 5(10):107-126. doi:10.7201/earn.2005.10.06SWORD10712651

Reuse Detector: improving the management of STT-RAM SLLCs

Various constraints of Static Random Access Memory (SRAM) are leading to consider new memory technologies as candidates for building on-chip shared last-level caches (SLLCs). Spin-Transfer Torque RAM (STT-RAM) is currently postulated as the prime contender due to its better energy efficiency, smaller die footprint and higher scalability. However, STT-RAM also exhibits some drawbacks, like slow and energy-hungry write operations that need to be mitigated before it can be used in SLLCs for the next generation of computers. In this work, we address these shortcomings by leveraging a new management mechanism for STT-RAM SLLCs. This approach is based on the previous observation that although the stream of references arriving at the SLLC of a Chip MultiProcessor (CMP) exhibits limited temporal locality, it does exhibit reuse locality, i.e. those blocks referenced several times manifest high probability of forthcoming reuse. As such, conventional STT-RAM SLLC management mechanisms, mainly focused on exploiting temporal locality, result in low efficient behavior. In this paper, we employ a cache management mechanism that selects the contents of the SLLC aimed to exploit reuse locality instead of temporal locality. Specifically, our proposal consists in the inclusion of a Reuse Detector (RD) between private cache levels and the STT-RAM SLLC. Its mission is to detect blocks that do not exhibit reuse, in order to avoid their insertion in the SLLC, hence reducing the number of write operations and the energy consumption in the STT-RAM. Our evaluation, using multiprogrammed workloads in quad-core, eight-core and 16-core systems, reveals that our scheme reports on average, energy reductions in the SLLC in the range of 37–30%, additional energy savings in the main memory in the range of 6–8% and performance improvements of 3% (quad-core), 7% (eight-core) and 14% (16-core) compared with an STT-RAM SLLC baseline where no RD is employed. More importantly, our approach outperforms DASCA, the state-of-the-art STT-RAM SLLC management, reporting—depending on the specific scenario and the kind of applications used—SLLC energy savings in the range of 4–11% higher than those of DASCA, delivering higher performance in the range of 1.5–14% and additional improvements in DRAM energy consumption in the range of 2–9% higher than DASCA.Peer ReviewedPostprint (author's final draft

Evaluation of a New Monoclonal Chemiluminescent Immunoassay Stool Antigen Test for the Diagnosis of Helicobacter pylori Infection: A Spanish Multicentre Study

The stool antigen test (SAT) represents an attractive alternative for detection of Helicobacter pylori. The aim of this study was to assess the accuracy of a new SAT, the automated LIAISON(R) Meridian H. pylori SA based on monoclonal antibodies, compared to the defined gold standard C-13-urea breath test (UBT). This prospective multicentre study (nine Spanish centres) enrolled patients >= 18 years of age with clinical indication to perform UBT for the initial diagnosis and for confirmation of bacterial eradication. Two UBT methods were used: mass spectrometry (MS) including citric acid (CA) or infrared spectrophotometry (IRS) without CA. Overall, 307 patients (145 naive, 162 with confirmation of eradication) were analysed. Using recommended cut-off values (negative SAT = 1.10) the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 67%, 97%, 86%, 92% and 91%, respectively, obtaining an area under the receiver operating characteristic (ROC) curve (AUC) of 0.85. Twenty-eight patients, including seven false positives and 21 false negatives, presented a discordant result between SAT and UBT. Among the 21 false negatives, four of six tested with MS and 11 of 15 tested with IRS presented a borderline UBT delta value. In 25 discordant samples, PCR targeting H. pylori DNA was performed to re-assess positivity and SAT accuracy was re-analysed: sensitivity, specificity, positive predictive value, negative predictive value, accuracy and AUC were 94%, 97%, 86%, 99%, 97% and 0.96, respectively. The new LIAISON(R) Meridian H. pylori SA SAT showed a good accuracy for diagnosis of H. pylori infection

European Registry on Helicobacter pylori Management: Effectiveness of First and Second-Line Treatment in Spain

The management of Helicobacter pylori infection has to rely on previous local effectiveness due to the geographical variability of antibiotic resistance. The aim of this study was to evaluate the effectiveness of first and second-line H. pylori treatment in Spain, where the empirical prescription is recommended. A multicentre prospective non-interventional registry of the clinical practice of European gastroenterologists concerning H. pylori infection (Hp-EuReg) was developed, including patients from 2013 until June 2019. Effectiveness was evaluated descriptively and through a multivariate analysis concerning age, gender, presence of ulcer, proton-pump inhibitor (PPI) dose, therapy duration and compliance. Overall, 53 Spanish hospitals were included, and 10,267 patients received a first-line therapy. The best results were obtained with the 10-day bismuth single-capsule therapy (95% cure rate by intention-to-treat) and with both the 14-day bismuth-clarithromycin quadruple (PPI-bismuth-clarithromycin-amoxicillin, 91%) and the 14-day non-bismuth quadruple concomitant (PPI-clarithromycin-amoxicillin-metronidazole, 92%) therapies. Second-line therapies were prescribed to 2448 patients, with most-effective therapies being the triple quinolone (PPI-amoxicillin-levofloxacin/moxifloxacin) and the bismuth-levofloxacin quadruple schemes (PPI-bismuth-levofloxacin-amoxicillin) prescribed for 14 days (92%, 89% and 90% effectiveness, respectively), and the bismuth single-capsule (10 days, 88.5%). Compliance, longer duration and higher acid inhibition were associated with higher effectiveness. "Optimized" H. pylori therapies achieve over 90% success in Spain

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

La industrialización y el empleo en el medio rural. Una aproximación al problema en Andalucía

Se refiere el autor en primer lugar a los condicionantes de tipo socioeconómico que deben cumplir los programas que intenten resolver el problema del desempleo. Dado que en Andalucía, el paro repercute sobre todo en el sector agrario, propicia la entrada de la mujer en la fuerza activa; lo que produciría una elevación de los ingresos familiares. Andalucía es una de las regiones más afectadas por el desempleo, ocasionado, entre otros motivos, por la falta de un verdadero espíritu empresarial. Cabe esperar que un apoyo del resto de las regiones españolas, unido a un esfuerzo de la propia región, permitan superar esta situación. Manifiestan que en contra de la postura mantenida por ciertos especialistas sobre el hecho de que un desarrollo del sector agroalimentario puede paliar en gran medida el problema del paro a nivel regional, las posibilidades abiertas son más bien limitadas y hay que pensar en otro tipo de actividades, tales como la inversión en obras públicas, de puesta en regadío, vías de comunicación, etc. Temen que nuestra próxima integración en la CEE, de lugar a un mayor alejamiento de Andalucía de los centros de decisión, corrientes de inversión de capital y de los grandes centros de consumo