Decisin support system for risk assessment and management of floods

The objective of the RAMFLOOD project is to develop and validate a new decision support system (DSS) for the risk assessment and management of emergency scenarios due to severe floods. The DSS combines environmental and geo-physical data from earth observation, with advanced computer simulation and graphical visualisation methods and artificial intelligence techniques, for generating knowledge contributing to the risk prevention of floods and the design of effective response actions maximising the safety of infrastructures and human life

Impacto en los resultados de salud cardiovascular de la implantación del contrato de Dirección Clínica en atención primaria de Tarragona

ObjetivoLos objetivos del presente estudio son: a) determinar la mejora en la salud cardiovascular de una población tras la implantación del contrato de Dirección Clínica en los profesionales de los Equipos de Atención Primaria de Tarragona-Reus y Terres de l’Ebre (provincia de Tarragona), y b) identificar los factores predictivos que determinan una mejor salud cardiovascular tras la implantación del contrato de Dirección Clínica. La implantación del contrato de Dirección Clínica (basada en el liderazgo profesional, feedback de la información asistencial, control de los indicadores de riesgo cardiovascular basados en la evidencia científica concretadas en guías de práctica clínica) mejorará los resultados de salud cardiovascular de la población de referencia.DiseñoSe trata de un estudio antes-después y multicéntrico.EmplazamientoAtención primaria de salud.ParticipantesParticipan 30 centros de salud (totalidad de los centros de salud del ámbito de atención primaria del Institut Català de la Salut).Mediciones principalesCaracterísticas del centro. Variables de proceso: indicadores de buena práctica asistencial, cálculo del riesgo cardiovascular, aplicación de la guía de práctica clínica (hipertensión arterial, diabetes, dislipemia, tabaquismo y factores de riesgo cardiovascular), estándares de calidad de la prescripción farmacológica. Variables de resultados: cifras de riesgo cardiovascular, número de visitas en atención continuada, urgencias hospitalarias e ingresos por angina, infarto agudo de miocardio y accidente cerebrovascular, y cribados poblacionales de factores de riesgo.DiscusiónEste estudio es útil, ya que la dirección clinica pretende ser un motor para que los profesionales lideren la gestión asistencial y, mediante el control de indicadores y la «retroalimentación» de estos resultados a los profesionales, se mejore la calidad asistencial. Con este trabajo se pretende demostrar que una estrategia de gestión puede mejorar la salud cardiovascular de la población. La originalidad de este proyecto se basa en el desarrollo de una nueva herramienta de evaluación basada en una novedosa estrategia de gestión para medir resultados en salud cardiovascular.ObjectiveThe objectives of this study are: 1) to determine the improvement in the cardiovascular health of the population after the introduction of the clinical governance contract for primary care team professionals in Tarragona-Reus and the Terres de l’Ebre area (Tarragona province, Spain); 2) to identify the factors predictive of better cardiovascular health after the introduction of the clinical governance contract. The introduction of the clinical governance contract, which is based on professional leadership, feed-back of care information, and monitoring of indicators of cardiovascular risk based on scientific evidence and concretised in clinical practice guidelines, will improve the cardiovascular health results of the reference population. Improvements in indicators of procedure and result are specified in “Material and methods.”DesignThis is a before-and-after, multicentre study.SettingPrimary health care.ParticipantsTirty health centres (all the primary care Centres in the area).Main measurementsCharacteristics of the centre. Variables in procedures: indicators of good care practice, calculation of cardiovascular risk, application of clinical practice guidelines (hypertension, diabetes, lipaemia, tobacco and cardiovascular risk) and quality standards for drug prescription. Result variables: cardiovascular risk figures, number of ongoing care visits, hospital emergencies and admissions for angina, heart attack or stroke, and risk factor screenings of the population.DiscussionThis study is useful, in that clinical governance aims to be a dynamic device to bring professionals into the leadership of health care management and, through monitoring indicators and feeding the findings back to the professionals, to improve health care quality. The study aims to show that management strategy can improve the populatiońs cardiovascular health. The originality of the study lies in the development of a new tool of evaluation based on a novel management strategy for measuring cardiovascular health findings

Análisis numérico 3D de una rotura de presa utilizando el método VOF y el modelo de turbulencia LES

El presente trabajo muestra un análisis numérico 3D del comportamiento del flujo de agua en una rotura de presa a escala de laboratorio. La simulación se realizó utilizando el software de dinámica de fluidos computacional (CFD) basado en el método de volúmenes finitos (FVM) – OpenFOAM. En el modelo numérico la turbulencia es tratada con la metodología LES (Large Eddy Simulation) y el método VOF (Volume of Fluid) es usado para la captura de la superficie libre del agua. Los resultados numéricos obtenidos se comparan con datos experimentales publicados haciendo uso de las variables de calado y presión. Los resultados muestran que la configuración del código numérico 3D es capaz de reproducir satisfactoriamente la variación temporal de las variables en estudio, con tendencias correctas y una alta correlación con los valores experimentales

3D numerical analysis of a dam - break using VOF method and LES turbulence model

[EN] In this paper, three-dimensional numerical analysis of dam-break flow pattern in a laboratory-scale is reported. The simulation was performed using the open source computational fluid dynamics (CFD) solver based on finite volume method (FVM) – OpenFOAM. Turbulence is treated using large eddy simulation (LES) approach. The free surface is tracked using the Volume of Fluid method (VOF). The numerical results are assessed against published experimental data. Water depth and pressure measures are used to validate the numerical model. The results demonstrate that the 3D numerical configuration satisfactorily reproduces the temporal variation of these variables with correct trends and high correlation with the experimental values.[ES] El presente trabajo muestra un análisis numérico 3D del comportamiento del flujo de agua en una rotura de presa a escala de laboratorio. La simulación se realizó utilizando el software de dinámica de fluidos computacional (CFD) basado en el método de volúmenes finitos (FVM) – OpenFOAM. En el modelo numérico la turbulencia es tratada con la metodología LES (Large Eddy Simulation) y el método VOF (Volume of Fluid) es usado para la captura de la superficie libre del agua. Los resultados numéricos obtenidos se comparan con datos experimentales publicados haciendo uso de las variables de calado y presión. Los resultados muestran que la configuración del código numérico 3D es capaz de reproducir satisfactoriamente la variación temporal de las variables en estudio, con tendencias correctas y una alta correlación con los valores experimentales.Este trabajo fue posible gracias al apoyo financiero otorgado por la Secretaría Nacional de Educación Superior, Ciencia, Tecnología e Innovación (SENESCYT) del Gobierno de la República del Ecuador a través de la beca doctoral del primer autor.Sánchez-Cordero, E.; Boix, J.; Gómez, M.; Bladé, E. (2018). Análisis numérico 3D de una rotura de presa utilizando el método VOF y el modelo de turbulencia LES. Ingeniería del Agua. 22(3):167-176. doi:10.4995/ia.2018.9374SWORD167176223Ancey, C., Iverson, R. M., Rentschler, M., Denlinger, R. P. (2008). An exact solution for ideal dam-break floods on steep slopes. Water Resources Research, 44(1), 567-568. https://doi.org/10.1029/2007WR006353Aricò, C., Nasello, C., Tucciarelli, T. (2007). A marching in space and time (MAST) solver of the shallow water equations. Part II: The 2D model. Advances in Water Resources, 30(5), 1253-1271. https://doi.org/10.1016/j.advwatres.2006.11.004van Balen, W., Blanckaert, K., Uijttewaal, W. S. J. (2010). Analysis of the role of turbulence in curved open-channel flow at different water depths by means of experiments, LES and RANS. Journal of Turbulence, 11(12), 1-34. https://doi.org/10.1080/14685241003789404Biscarini, C., Di Francesco, S., Manciola, P. (2010). CFD modelling approach for dam break flow studies. Hydrology and Earth System Sciences, 14, 705-718. https://doi.org/10.5194/hess-14-705-2010Fraccarollo, L., Toro, E. F. (1995). Experimental and numerical assessment of the shallow water model for two-dimensional dambreak type problems. Journal of Hydraulic Research, 33(6), 843-864. https://doi.org/10.1080/00221689509498555Frazão, S. S., Zech, Y. (2002). Dam Break in Channels with 90° Bend. Journal of Hydraulic Engineering, 128(11), 956-968. https://doi.org/10.1061/(ASCE)0733-9429(2002)128:11(956)Jones, W. P., Wille, M. (1996). Large-eddy simulation of a plane jet in a cross-flow. International Journal of Heat and Fluid Flow, 17(3), 296-306. https://doi.org/10.1016/0142-727X(96)00045-8Kleefsman, K. M. T., Fekken, G., Veldman, A. E. P., Iwanowski, B., Buchner, B. (2005). A Volume-of-Fluid based simulation method for wave impact problems. Journal of Computational Physics, 206(1), 363-393. https://doi.org/10.1016/j.jcp.2004.12.007Liang, D., Lin, B., Falconer, R. A. (2007). Simulation of rapidly varying flow using an efficient TVD-MacCormack scheme. International Journal for Numerical Methods in Fluids, 53(5), 811-826. https://doi.org/10.1002/fld.1305Liu, X., García, M. H. (2008). Three-Dimensional Numerical Model with Free Water Surface and Mesh Deformation for Local Sediment Scour. Journal of Waterway, Port, Coastal, and Ocean Engineering, 134(4), 203-217. https://doi.org/10.1061/(ASCE)0733-950X(2008)134:4(203)Moin, P., Kim, J. (1982). Numerical investigation of turbulent channel flow. Journal of Fluid Mechanics, 118, 341-377. https://doi.org/10.1017/S0022112082001116Salinas-Vázquez, M., Vicente-Rodríguez, W., Chol-Orea, E., Leyva García, V. (2007). Simulación de la turbulencia de un flujo que pasa alrededor de un cilindro de sección cuadrada a partir de la utilización de la simulación de grandes escalas y de fronteras inmersas. Revista Mexicana de Física, 53(6), 461-469.Smagorinsky, J. (1963). General circulation experiments with the primitive equations. I. The basic experiment. Monthly Weather Review, 91, 99-164. https://doi.org/10.1175/1520-0493(1963)091%3C0099:GCEWTP%3E2.3.CO;2Stoker, J. J. (James J. (1957). Water waves: the mathematical theory with applications. Wiley.Stoll, R., Porte-Agel, F. (2006). Dynamic subgrid-scale models for momentum and scalar fluxes in large-eddy simulations of neutrally stratified atmospheric boundary layers over heterogeneous terrain. Water Resources Research, 42, 1-18. https://doi.org/10.1029/2005WR003989Wu, C., Huang, G., Zheng, Y. (1999). Theoretical Solution of Dam-Break Shock Wave. Journal of Hydraulic Engineering, 125(11), 1210-1215. https://doi.org/10.1061/(ASCE)0733-9429(1999)125:11(1210

Large wood transport as significant influence on flood risk in a mountain village

An important issue that is not considered in most flood risk assessments in mountain villages in Spain is the transport of solids associated with the flood flow, in this case, large wood transport. The transport and deposition of this wood in urban areas may be a potentially worse hazard than the flood flow itself. Despite its importance, large wood is a key ecological element in rivers, so removing it could be an unsuccessful approach. Therefore, efforts are needed in the better understanding of wood transport and deposition in streams. To analyse this process, scenario-based 2D hydrodynamic flood modelling was carried out. Since flood risk assessment has considerable intrinsic uncertainty, probabilistic thinking was complemented by possibilistic thinking, considering worst-case scenarios. This procedure obtained a probabilistic flood map for a 500-year return period. Then, a series of scenarios was built based on wood budget to simulate wood transport and deposition. Results allowed us to identify the main infrastructures sensitive to the passing of large wood and simulate the consequences of their blockage due to wood. The potential damage was estimated as well as the preliminary social vulnerability for all scenarios (with and without wood transport). This work shows that wood transport and deposition during flooding may increase potential damage at critical stream configurations (bridges) by up to 50% and the number of potentially exposed people nearby these areas by up to 35%

Resiliencia en sistemas dunares litorales altamente antropizados: la restauración del sistema dunar de la playa del Remolar (Viladecans, Barcelona)

Con el fin de recuperar y restaurar el sistema playa-duna del Remolar (700 m de longitud y más de 100 m de ancho, de dirección 070N), se propusieron en 2004 una serie de medidas de restauración blanda. Para valorar dichas medidas, transcurridos 10 años, se efectuó un estudio de la morfología, sedimentología y de la vegetación del ecosistema. Se realizó el levantamiento de perfiles topográficos y de GPR, un análisis granulométrico y un análisis de las comunidades vegetales encontradas a lo largo de los perfiles topográficos. Los datos obtenidos han sido comparados con datos de un estudio previo, realizado en el 2004. Los resultados muestran que la morfología dunar se ha recuperado, originándose una nueva duna primaria. El sistema presenta actualmente un proceso mayor de agradación que de progradación. La vegetación ha recuperado una composición global de sistema dunar, con una comunidad típica de duna embrionaria y otras de duna primaria, en bandas paralelas a la costa. A pesar de esta mejora, la componente de tipo oportunista y ruderal de la vegetación de duna primaria denota una fuerte herencia antrópica en el sistema

Iber — River modelling simulation tool

Para dar respuesta a los requerimientos en materia de aguas definidos en las directrices, reglamentos y recomendaciones existentes en la legislación española, los cuales están mayoritariamente basados en directivas europeas, se ha desarrollado una herramienta de modelización numérica del flujo de agua en lámina libre en 2 dimensiones. La herramienta, llamada Iber, combina un módulo hidrodinámico, un módulo de turbulencia y un módulo de transporte de sedimentos, y utiliza el método de volúmenes finitos para resolver las ecuaciones correspondientes. Al módulo de cálculo se le ha adaptado una interfaz que se basa en el software de preproceso y posproceso GiD, desarrollado por CIMNE. El resultado es una herramienta de modelización numérica del flujo de agua y sedimentos en ríos y estuarios, que utiliza esquemas numéricos avanzados especialmente estables y robustos en cualquier situación pero especialmente adecuados para flujos discontinuos y, en concreto, para cauces torrenciales y regímenes irregulares.The recent requirements of Spanish regulations and directives, on their turn based on European directives, have led to the development of a new two dimensional open channel flow modelling tool. The tool, named Iber, combines a hydrodynamic module, a turbulence module and a sediment transport module, and is based in the finite volume method to solve the involved equations. The simulation code has been integrated in a pre-process and post-process interface based on GiD software, developed by CIMNE. The result is a flow and sediment modelling system for rivers and estuaries that uses advanced numerical schemes, robust and stable, which are especially suitable for discontinuous flows taking place in torrential and hydrologically irregular rivers.Peer Reviewe

Reliable identification of women with CIN3+ using hrHPV genotyping and methylation markers in a cytology-screened referral population.

Cervical screening aims to identify women with high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia 2-3 (HSIL/CIN2-3) or invasive cervical cancer (ICC). Identification of women with severe premalignant lesions or ICC (CIN3+) could ensure their rapid treatment and prevent overtreatment. We investigated high-risk human papillomavirus (hrHPV) detection with genotyping and methylation of FAM19A4/miR124-2 for detection of CIN3+ in 538 women attending colposcopy for abnormal cytology. All women had an additional cytology with hrHPV testing (GP5+/6+-PCR-EIA+), genotyping (HPV16/18, HPV16/18/31/45), and methylation analysis (FAM19A4/miR124-2) and at least one biopsy. CIN3+ detection was studied overall and in women <30 (n = 171) and ≥30 years (n = 367). Positivity for both rather than just one methylation markers increased in CIN3, and all ICC was positive for both. Overall sensitivity and specificity for CIN3+ were, respectively, 90.3% (95%CI 81.3-95.2) and 31.8% (95%CI 27.7-36.1) for hrHPV, 77.8% (95%CI 66.9-85.8) and 69.3% (95%CI 65.0-73.3) for methylation biomarkers and 93.1% (95%CI 84.8-97.0) and 49.4% (95%CI 44.8-53.9) for combined HPV16/18 and/or methylation positivity. For CIN3, hrHPV was found in 90.9% (95%CI 81.6-95.8), methylation positivity in 75.8% (95%CI 64.2-84.5) and HPV16/18 and/or methylation positivity in 92.4% (95%CI 83.5-96.7). In women aged ≥30, the sensitivity of combined HPV16/18 and methylation was increased (98.2%, 95%CI 90.6-99.7) with a specificity of 46.3% (95%CI 40.8-51.9). Combination of HPV16/18 and methylation analysis was very sensitive and offered improved specificity for CIN3+, opening the possibility of rapid treatment for these women and follow-up for women with potentially regressive, less advanced, HSIL/CIN2 lesions

Intravenous Busulfan and Melphalan as a Conditioning Regimen for Autologous Stem Cell Transplantation in Patients with Newly Diagnosed Multiple Myeloma: A Matched Comparison to a Melphalan-Only Approach

AbstractMelphalan 200 mg/m2 (MEL200) is the standard conditioning regimen administered to newly diagnosed patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT). Few alternatives have been explored in order to improve the antimyeloma activity of this conditioning. We compare i.v. busulfan (BU) 9.6 mg/kg and MEL 140 mg/m2 (MEL140) versus MEL200 mg/m2 as a conditioning regimen before ASCT for newly diagnosed patients with MM. For this purpose, 51 patients receiving i.v. BU plus MEL were compared to 102 patients receiving MEL200 mg/m2 in a 1:2 matched control analysis. Matching criteria included age, clinical stage at diagnosis, and response to induction therapy. No differences in the overall and complete response (CR) rates were observed after ASCT between both groups. After a median follow-up of 63 and 50 months in control and BU plus MEL groups, progression-free survival (PFS) was 24 and 33 months, respectively (P = .10). Most frequent toxicities included mucositis and febrile neutropenia in both groups. No case of sinusoidal obstruction syndrome was observed. Transplant-related mortality was 4% and 2% in BU plus MEL and control groups, respectively. ASCT conditioned with i.v. BU plus MEL may be considered an effective and well-tolerated alternative to a MEL-only approach as a conditioning regimen for patients with MM who are candidates for ASCT. (Clinicaltrials.gov identifier: NCT00560053 and NCT00804947.

Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: A proepective analysis

Purpose: To evaluate the preliminary results of the use of 68 Gy EQD2(α/β=3 Gy) as a dose limit to the lowest dose in the most exposed 2 cm3 of the vagina in order to reduce G2 late vaginal problems in postoperative endometrial carcinoma (EC). Methods: From November 2016 to October 2019, 69 postoperative EC patients receiving vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) were prospectively analyzed. The median EBRT dose was 45 Gy (range: 44-50.4 Gy), 1.8-2 Gy/day, 5 fractions(Fr)/week. VBT was administered with the following schedule: 1Fr of 7 Gy after EBRT and 2 daily Fr × 7.5 Gy in exclusive VBT. The dose was prescribed at 0.5 cm from the applicator surface with an active length of 2.5 cm; 56 patients were treated with vaginal cylinders (49-3.5 cm, 6-3 cm, and 1-2.5 cm) and 13 with the colpostat technique. The overall VBT dose was adjusted to meet the vaginal restriction of < 68 Gy EQD2(α/β=3 Gy) at 2 cm3. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum, and the objective LENT-SOMA criteria for vagina. Results: With a median follow-up of 31.0 months, no vaginal-cuff recurrences were found. Late toxicity: only 1G1(1.4%) rectal toxicity; 21G1(30.4%) and 3G2(4.3%) vaginal complications. Only one (1.4%) of 3 G2 manifested as vaginal shortening. Conclusions: In postoperative EC patients treated with VBT, only one developed G2 vaginal stenosis with the use of 68 Gy EQD2(α/β=3 Gy) as a dose constraint. These preliminary results seem to indicate the value of this dose limit for reducing G2 vaginal stenosis. Nonetheless, these findings should be confirmed in a larger number of patients with longer follow-up. Keywords: Brachytherapy; Postoperative endometrial cancer; Vaginal complications; Vaginal constraint