Effectiveness and Safety of Ustekinumab in Ulcerative Colitis: Real-world Evidence from the ENEIDA Registry.

BACKGROUND AND AIMS: The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. METHODS: Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. RESULTS: A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. CONCLUSIONS: Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.

The Transformation of Higher Education After the COVID Disruption: Emerging Challenges in an Online Learning Scenario.

Crisis requires society to renew itself, albeit in a disruptive way. The current Covid-19 pandemic is transforming ways of working, living, and relating to each other on a global level, suddenly and dramatically. This paper focuses on the field of education to show how higher education institutions are undergoing radical transformations driven by the need to digitalize education and training processes in record time with academics who lack innate technological capabilities for online teaching. The university system must strive to overcome this situation to be competitive and provide high-quality education in a scenario of digital transformation, disruptive technological innovations, and accelerated change. To achieve these goals, this paper explains some barriers and challenges that universities encounter, as well as technological resources and methodologies they have used in the current scenario to transform higher education to face Covid-19 disruption. The discussion and conclusion synthesize significant insights that can be applied to the digitalization of education in the foreseeable future.

Going beyond the curve: Strategic measures to recover hotel activity in times of COVID-19.

Hospitality firms are facing unprecedented challenges on a global scale. The catastrophic effects of the COVID-19 pandemic and its multiple devastating global consequences have initiated a profoundly disruptive transformation in the hospitality sector, as firms attempt to adapt their activity to the current uncertain scenario. This study draws on the crisis management literature to identify the key drivers of hotel recovery in the event of a disaster or an external crisis, like current pandemic. A sample of 237 Spanish hotel managers evaluated and ranked the strategic measures. Based on this evidence, measures were statistically examined to identify which ranked as most significant in helping hospitality managers. The results yield valuable theoretical and practical insights to guide hospitality managers towards business adaptation and recovery by highlighting key strategic measures for implementation in the short term.

A co-designed method to guide decision-making in protected area visitor centres.

Protected areas (PAs) constitute the largest global effort for biodiversity conservation and the maintenance of ecosystem services. Science-based management, grounded in methods co-designed by scientists and managers, is necessary to improve the efficiency of PAs to achieve these goals and to promote sustainable development. Visitor centres (VCs) in PAs play an important role to facilitate the supply of recreational ecosystem services and to promote environmental awareness. In this study, scientists and managers co-developed a method to assess visitors' perceptions of the recreational activities carried out in VCs and how they depend on the type of visitors. The research was performed at 13 PAs in Andalusia (Spain). A questionnaire that measures users' satisfaction with the services provided by VCs was implemented in two phases: 1) selection of items through the critical incident technique, and 2) validation of the scale by using exploratory and confirmatory factor analysis. The main result is an instrument composed of 18 indicators classified into three dimensions: information, facilities and service received from personnel. The instrument provides additional information useful for managers, such as homogeneity of valuation throughout the PA network and sociocultural factors that may explain the differences in visitors' valuation. The instrument developed could either be used directly or adapted for recreation management in other similar PAs. The proposed methodology can also be reproduced to validate other measurement instruments. This study illustrates how the development of a collaborative research method by scholars and practitioners can improve recreational management in PAs.

Indicadores de calidad en la esofagogastroduodenoscopia: estudio comparativo de los resultados tras un programa de mejora en un hospital terciario / Quality indicators for esophagogastroduodenoscopy: A comparative study of outcomes after an improvement programme in a tertiary hospital

Introducción: El registro y la medición de los indicadores de calidad suponen una oportunidad de mejora. Sin embargo, no existen experiencias previas en nuestro medio sobre su cumplimiento en la esofagogastroduodenoscopia (EGD). Objetivo: Analizar el cumplimiento de los criterios de calidad de las EGD y evaluar la mejora tras la realización de un programa de formación. Pacientes y métodos Estudio comparativo de 2 cohortes: una, retrospectiva (grupo control) y otra, prospectiva (grupo intervención), antes y después de un programa de formación que consistió en una sesión informativa y la mejora del programa de elaboración de informes. Se utilizaron los indicadores de calidad propuestos por la American Society for Gastrointestinal Endoscopy y el American College of Gastroenterology. Resultados: Se incluyeron un total de 1.200 EGD de forma secuencial (600 en cada grupo). Tras el programa de formación se observó una mejoría significativa en los siguientes indicadores: indicación documentada (93 vs. 99,8%; p<0,01), exploraciones completas documentadas (94,7 vs. 97,3%; p<0,01), actuación correcta (63,7 vs. 87,9%; p<0,01), toma adecuada de biopsias según protocolos (57,9 vs. 83,8%; p<0,01), fotodocumentación de lesiones descritas (84,1 vs. 94,9%; p<0,01], fotodocumentación por segmentos (52,9 vs. 70,5%; p<0,01) y valoración global correcta (56,9 vs. 90,5%; p<0,01). La toma de biopsias para celiaquía, la indicación documentada, la exploración completa y la actuación correcta, si procedía, consiguieron superar el estándar recomendado. Conclusión: Un programa de formación muy sencillo mejora los indicadores de calidad de la EGD, alcanzando la mayoría los estándares recomendados por la American Society for Gastrointestinal Endoscopy y el American College of Gastroenterology (AU)

Introduction: There is an opportunity for improvement in the recording and measuring of quality indicators. However, no previous experiences exist in our field in terms of their compliance in esophagogastroduodenoscopy (EGD). Objective: To analyse compliance with EGD quality criteria and evaluate improvement after conducting a training programme. Patients and methods: Comparative study of 2 cohorts: one retrospective (control group) and one prospective (intervention group), before and after a training programme consisting of an information session and the report writing improvement programme. The quality indicators proposed by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology were used. Results: A total of 1,200 EGDs were included in a sequential manner (600 in each group). Following the training programme, a significant improvement was observed in the following indicators: documented indication (93 vs. 99.8%; P<0.01), documented full examinations (94.7 vs. 97.3%; P<0.01), correct performance (63.7 vs. 87.9%; P<0.01), appropriate biopsies according to protocols (57.9 vs. 83.8%; P<0.01), photo-documentation of described lesions (84.1 vs. 94.9%; P<0.01), photo-documentation per segment (52.9 vs. 70.5%; P<0.01) and correct overall assessment (56,9 vs. 90.5%; P<0.01). Biopsies for coeliac disease, documented indication, full examination and correct performance, if it went ahead, exceeded the recommended standard. Conclusion: A very simple training programme improves EGD quality indicators, with the majority reaching the standards recommended by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology (AU)

Quality indicators for esophagogastroduodenoscopy: A comparative study of outcomes after an improvement programme in a tertiary hospital. / Indicadores de calidad en la esofagogastroduodenoscopia: estudio comparativo de los resultados tras un programa de mejora en un hospital terciario.

INTRODUCTION: There is an opportunity for improvement in the recording and measuring of quality indicators. However, no previous experiences exist in our field in terms of their compliance in esophagogastroduodenoscopy (EGD). OBJECTIVE: To analyse compliance with EGD quality criteria and evaluate improvement after conducting a training programme. PATIENTS AND METHODS: Comparative study of 2 cohorts: one retrospective (control group) and one prospective (intervention group), before and after a training programme consisting of an information session and the report writing improvement programme. The quality indicators proposed by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology were used. RESULTS: A total of 1,200 EGDs were included in a sequential manner (600 in each group). Following the training programme, a significant improvement was observed in the following indicators: documented indication (93 vs. 99.8%; P<0.01), documented full examinations (94.7 vs. 97.3%; P<0.01), correct performance (63.7 vs. 87.9%; P<0.01), appropriate biopsies according to protocols (57.9 vs. 83.8%; P<0.01), photo-documentation of described lesions (84.1 vs. 94.9%; P<0.01), photo-documentation per segment (52.9 vs. 70.5%; P<0.01) and correct overall assessment (56,9 vs. 90.5%; P<0.01). Biopsies for coeliac disease, documented indication, full examination and correct performance, if it went ahead, exceeded the recommended standard. CONCLUSION: A very simple training programme improves EGD quality indicators, with the majority reaching the standards recommended by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology.

Environmental strategy and performance in small firms: a resource-based perspective.

In spite of the widespread recognition of the important roles that small and medium sized enterprises (SMEs) play in most economies, limited research has focused on their impacts on the natural environment and the strategies such enterprises adopt to reduce these impacts. It is usually assumed that SMEs lack the resources to implement proactive environmental strategies that go beyond minimum regulatory compliance. In this study of 108 SMEs in the automotive repair sector in Southern Spain, we found that SMEs undertake a range of environmental strategies from reactive regulatory compliance to proactive pollution prevention and environmental leadership. These strategies are associated with three organizational capabilities: shared vision, stakeholder management, and strategic proactivity, hypothesized based on the unique strategic characteristics of SMEs--shorter lines of communication and closer interaction within the SMEs, the presence of a founder's vision, flexibility in managing external relationships, and an entrepreneurial orientation. We also found that firms with the most proactive practices exhibited a significantly positive financial performance.