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With aging, the risk of requiring emergency care increases. Elderly patients who need Emergency Medical Services (EMS) are often vulnerable and dependent, especially when their decision-making ability is reduced, which may intensify the risk of important ethical values being violated. Studies about paramedics’ views on elderly people’s self-determination within EMS settings are scarce. The aim of this study was to explore the attitudes and perceptions of paramedics in a US context regarding self-determination in elderly patients who need emergency care provided by EMS.

The study had an exploratory design, and data were collected using a Delphi technique. A panel of experts consisting of US paramedics was recruited to answer a questionnaire sent out in three rounds. The questionnaire comprised 108 items, derived from a Swedish study on the same topic, rated with a five-point Likert scale ranging from agree to disagree with a predetermined consensus level of 70%.

In total 21 experts agreed to participate, 15 completed all three rounds, leaving a total response rate of 71%. Finally, 87 out of 108 items reached consensus, of which 60 were “agree” and 27 were “disagree.”

The paramedic–patient relationship is a core in assessing and handling ethical challenges within an advanced practice influenced by the paramedics’ educational level and/or the patient’s physical/mental status. Within a “find it fix it” modus operandi, there is a need to increase paramedics’ competence in understanding and handling advanced ethical challenges in relation to ethical values such as autonomy and self-determination in elderly patients.

This paper aims to analyse the most significant disruptive events affecting tourism during the twenty-first century, particularly the 2020 COVID-19 pandemic.

Based on a thorough literature review, this study takes a complexity science approach to the field of tourism to shed light on the challenges of disruptive events in tourism systems.

Focusing on the COVID-19 pandemic, in particular, this study acknowledges that disruptive events are complex and have tremendous impacts on several areas of society: people’s psychological well-being and the health-care system, as well as social, economic, cultural, technological, environmental and political dimensions. Whether they occur alone or interact, these dimensions add varying levels of complexity to the tourism system. In response, the tourism industry can adopt a resilience model as a crisis management tool to address disruptive events affecting this field.

As this paper is mainly theoretical, future empirical research will contribute to refining the findings and testing the usefulness of the proposed model.

The paper looks at examples of successful and unsuccessful of COVID-19 outbreak management in various countries to analyse issues such as crisis management, resilience and tools for coping with the impacts of disruptive events.

This theoretical paper proposes a first taxonomy of the multidimensional impacts of twenty-first-century disruptive events on tourism and dissects the phases of crisis management, with a corresponding conceptual model.

本文分析了21世纪影响旅游业的最为重要的破坏性事件, 尤其关注2020年新型冠状病毒肺炎大流行

本文将复杂性科学方法应用于旅游领域, 通过全面的文献综述, 揭示破坏性事件给旅游系统带来的挑战。

本文承认破坏性事件, 特别是新型冠状病毒肺炎大流行, 复杂且影响巨大, 涉及心理、医疗、社会、经济、文化、技术、环境和政治等诸多方面。这些影响不管是单一的还是相互作用的, 都在不同程度上增加了旅游系统的复杂性。旅游业可以将弹性模型作为危机管理工具, 以应对其领域内的破坏性事件。

本文首次提出了21世纪破坏性事件对旅游业的多维影响的分类法, 并对危机管理的各个阶段进行了剖析。本文还提出了一个综合模型。

由于本文以理论为主, 未来的实证研究将有助于完善研究结果和验证所提出模型的实用性。

本文着眼于不同国家新冠疫情管理的成功和失败案例, 分析危机管理、复原力以及应对破坏性事件影响的方法等问题。

Identificar los eventos disruptivos mundiales más importantes que han afectado el turismo en el siglo XXI poniendo especial atención en la pandemia causada por el COVID-19 en el 2020.

Mediante un enfoque a las ciencias de la complejidad aplicado al turismo y una exhaustiva revisión bibliográfica, este artículo esclarece el reto que significa un evento disruptivo en el turismo.

Los eventos disruptivos, en particular el COVID-19, son complejos y generan un alto impacto tanto en el aspecto psicológico, sanitario, social, económico, cultural, tecnológico, medioambiental y político. En su interacción, todos ellos añaden un diferente grado de complejidad al sistema del turismo. Este artículo propone adoptar un modelo de resiliencia como herramienta de gestión de crisis para afrontar eventos disruptivos en el campo del turismo.

Proponer una primera clasificación de los impactos multidimensionales de los eventos disruptivos del siglo XXI en el turismo y un desglose de las fases de gestión de crisis, como así también proponer un modelo integrador de ambos aspectos propios de un evento disruptivo.

Debido al carácter teórico de este artículo, el modelo integrador sugerido representa un marco prometedor para futuras investigaciones en el plano empírico.

Este artículo presta atención a aquellos países que han gestionado la pandemia de forma exitosa o no, para así tener una mejor noción de gestión de crisis y herramientas para hacer frente a futuros eventos disruptivos.

This study aims to investigate how gamification, namely, WeChat’s cultural gifting function, improves emotional involvement among three generations (Y, X and silver) in mobile payments. It draws attention to the beneficial effects of cultural components and digital intimacy on gamified mobile payment systems.

The data were collected from Y, X and silver generation in Dalian, China. The users were well equipped with the WeChat pay features and had experience. The PLS-SEM software was used to assess the data.

The findings show that consumer word of mouth and loyalty are positively impacted by perceived utility, fun, and enjoyment. Besides, gamification components like fun and playfulness have a favourable effect on how useful mobile payments are judged to be. It demonstrates how delighted and ecstatic users are with WeChat Hongbao. In addition, the positive moderation effect of intimacy on the hypothesised connections shows that all three generations are likely to accept gamified money features. These results provide a substantial contribution to our comprehension of gamification in the context of mobile payment services for all three generations.

The study is distinctive because it focuses on how China’s three generations use WeChat Pay for routine transactions. The framework confirms that the gamification elements improve user performance and encourage continued usage of mobile payment systems.

Este estudio investiga cómo la gamificación, específicamente la función de regalos culturales de WeChat, mejora la participación emocional entre tres generaciones (Y, X y plata) en los pagos móviles. Se presta atención a los efectos beneficiosos de los componentes culturales y la intimidad digital en los sistemas de pago móvil gamificados.

Los datos fueron recopilados de las generaciones Y, X y plata en Dalian, China. Los usuarios estaban familiarizados con las características de pago de WeChat y tenían experiencia. Se utilizó el software PLS-SEM para evaluar los datos.

Los resultados muestran que la reputación y la lealtad del consumidor son positivamente influenciadas por la utilidad percibida, la diversión y el disfrute. Los componentes de gamificación, como la diversión y la jugabilidad, tienen un efecto favorable en cómo se juzga la utilidad de los pagos móviles. Se demuestra cuán encantados están los usuarios con WeChat Hongbao. Además, la moderación positiva de la intimidad en las relaciones supuestas muestra que las tres generaciones tienen probabilidades de aceptar las características de dinero gamificado. Estos resultados contribuyen sustancialmente a nuestra comprensión de la gamificación en el contexto de los servicios de pago móvil para las tres generaciones.

El estudio es novedoso ya que se centra en cómo las tres generaciones de China utilizan WeChat Pay para transacciones rutinarias. El marco confirma que los elementos de gamificación mejoran el rendimiento del usuario y fomentan el uso continuado de los sistemas de pago móvil.

本研究探讨了游戏化, 即微信的文化赠送功能, 如何提高三代人（Y、X和银发族）在移动支付中的情感投入。它引起了人们对文化成分和数字亲密关系对游戏化移动支付系统的有益影响的注意。

数据来自中国大连市的Y、X和银发族用户。用户对微信支付功能非常熟悉, 并具有使用经验。采用PLS-SEM软件对数据进行评估。

结果表明, 消费者的口碑和忠诚度受到了感知效用、乐趣和享受的积极影响。乐趣和趣味等游戏化组件对移动支付的有用性评估产生了积极影响, 展示了用户对微信红包的喜悦和兴奋程度。此外, 亲密关系对假设连接的正向调节效应表明, 三代人都可能接受游戏化货币功能。这些结果为我们理解移动支付服务背景下游戏化对三代人的贡献提供了实质性的帮助。

该研究独特之处在于它着眼于中国三代人如何将微信支付用于日常交易。该框架证实了游戏化元素如何提高用户绩效并鼓励继续使用移动支付系统。

The importance of workers in labour-intensive industries, such as tourism, is undeniable. In this sense, it has been investigated for decades from various methodological approaches. However, in the academic literature on tourism, the partial least squares-structural equation modelling (PLS-SEM) technique has hardly been used.

Therefore, this work uses that technique to contrast which factors define the employees' wages in the Spanish tourism industry. Additionally, an importance-performance map analysis (IPMA) analysis is carried out, which provides informed decision-making.

Thus, the main results obtained are the verification and measurement of the relationships of Human Capital, Labour Conditions and Market with Wages, and the relation between Human Capital and Labour Conditions. Besides, the improvement points in each variable are identified. Especial emphasis is given to those related to Human Capital and, partially, to the Market.

However, there are certain limitations to this study. Mainly, as the indicators used are given by the 2018 Salary Structure Survey, they are stiff and so the design of the model turns to be more difficult.

Considering the turning point that the temporary cessation of the tourism industry activity due to the COVID-19 pandemic has been, it is essential to take advantage of it to identify and correct existing deficiencies. Therefore, this work aims to be a base document for the identification of these problems.

La importancia de los trabajadores de industrias intensivas en mano de obra, como el turismo, es innegable. En este sentido, se ha investigado durante décadas desde diferentes metodologías. Sin embargo, en la literatura académica en turismo, la técnica PLS-SEM path modelling apenas ha sido utilizada.

Por ello, este trabajo emplea esta técnica para contrastar los factores que definen los salarios de los empleados en la industria turística española. Además, se lleva a cabo un análisis IPMA, que permite la toma de decisiones informada.

Así, los principales resultados obtenidos son la verificación y medida de las relaciones del Capital Humano, Condiciones Laborales y Mercado con los Salarios, y la relación entre Capital Humano y Condiciones Laborales. Además, se identifican los puntos de mejora de cada variable. Se presta un interés especial a aquellos relacionados con el Capital Humano y, parcialmente, el Mercado.

Considerando el punto de inflexión que el cese de actividad temporal de la actividad de la industria turística ha supuesto a causa de la pandemia COVID-19, es esencial aprovechar para identificar y corregir las deficiencias existentes. Además, este trabajo pretende ser un documento base para la identificación de estos problemas.

No obstante, existen algunas limitaciones en este estudio. Principalmente los indicadores utilizados proceden de la Encuesta de Estructura Salarial de 2018, son fijos y, por ende, el diseño del modelo se torna más difícil.

This paper aims to examine the influence of police cultural knowledge on the investigation of violent serial crimes. Specifically, it aims to identify whether such knowledge impacts the way in which investigative techniques are implemented. Of particular interest is the police knowledge specific to victims of violent serial crimes.

A case study analysis of five incidents of serial murder and four incidents of serial rape in Australia was conducted. This included a qualitative analysis of cold case files from New South Wales Police, Australia. These data were triangulated with data obtained from interviews with detectives who had investigated incidents of serial murder and serial rape from that agency.

The police cultural knowledge relating to the victims of these crimes at the time of reporting negatively impacted the subsequent investigation of these cases. This resulted in a marked delay in the recognition of cases as part of a series of crimes and a delay in the allocation of investigative resources. This knowledge was informed by police experience in street policing, not from experience in the investigation of violent serial crimes.

This paper is limited to selected cases of serial crimes that occurred in Australia.

This research suggests that police cultural understandings of victims need to be reviewed and changed to include knowledge of serial crime victims, offenders and their crimes. Such changes could contribute to improved recognition of related crimes as being serial in nature, essentially opening the way to preventing further victimisation.

There is no research that considers the impact of police cultural knowledge on the investigation of violent serial crime, and its subsequent contribution to the length of time of the series of crimes remains unconnected.

This paper aims to evaluate the relation between governance and financial efficiency of credit unions in Brazil. The study shows how poor financial efficiency in credit unions may result from undesirable configurations in executive management and other variables related to governance.

The study develops an innovative methodology to classify credit unions according to the level of governance using indicators of representativeness and participation, leadership, management and supervision. This methodology integrates the use of multiple correspondence and cluster analysis. The study then applies stochastic frontier models to analyze how governance affects the indicators of financial efficiency.

The results highlight that better governance substantially increases the efficiency of credit unions in terms of a higher level of credit operations per institution.

The paper uses a pioneering survey applied by the Central Bank to almost the total population of credit unions in Brazil. The results highlight how to operationalize a subjective and broad concept related to cooperative governance to identify the remarkable impacts of good governance practices on the financial efficiency of credit unions.

Rapid prototyping (RP) technology is widely used in many fields in recent years. Bone tissue engineering (TE) is an interdisciplinary field involving life sciences, engineering and materials science. Hydroxyapatite (HAp) are similar to natural bone and it has been extensively studied due to its excellent biocompatibility and osteoconductivity. This paper aims to review nanoscaled HAp-based scaffolds with high porosity fabricated by various RP methods for bone regeneration.

The review focused on the fabrication methods of HAp composite scaffolds through RP techniques. The paper summarized the evaluation of these scaffolds on the basis of their biocompatibility and biodegradability through in vitro and in vivo tests. Finally, a summary and perspectives on this active area of research are provided.

HAp composite scaffold fabricated by RP methods has been widely used in bone TE and it has been deeply studied by researchers during the past two decades. However, its brittleness and difficulty in processing have largely limited its wide application in TE. Therefore, the formability of HAp combined with biocompatible organic materials and fabrication techniques could be effectively enhanced, and it can be used in bone TE applications finally.

This review paper presented a comprehensive study of the various types of HAp composite scaffold fabricated by RP technologies and introduced their potential application in bone TE, as well as future roadmap and perspective.