La instrucción de planificación hidrólogica y el régimen ambiental de caudales: principios, realidades y tareas pendientes

El objetivo de este artículo es presentar los contenidos que deben ofrecer las metodologías para la estimación de regímenes ambientales de caudales y analizar el proceso de estimación, implantación y seguimiento que se abre en España en esta materia, como consecuencia de los planes de cuenca que deben aplicarse para dar cumplimiento a la Directiva Marco del Agua. Se presenta un recorrido en la evolución conceptual y metodológica que, en los últimos veinte años, ha tenido la estimación de caudales ecológicos. Una vez enmarcados los conceptos y principios que actualmente se están considerando, se caracterizan y discuten las cualidades que debe tener cualquier régimen ambiental de caudales. Asimismo, se recoge el proceso actual de estimación de regímenes ambientales en España, y se relaciona su estructura metodológica y su desarrollo con los planteamientos conceptuales y técnicos vigentes en el ámbito científico y en la gestión ecohidrológica, reflexionando, por último, sobre las fases de implantación y seguimiento

8-bit softcore microprocessor with dual accumulator designed to be used in FPGA

Context: This paper is presents the design and implementation of an 8-bit softcore RISC microprocessor able to be run on space-optimized FPGA, in order to be used for embedded applications. Method: The design of this microprocessor was developed in Verilog hardware description language and can be implemented in FPGA from different manufacturers; therefore, the user has only to define the input and output ports according to the type of FPGA. This is an accumulator-type processor, but it has two different accumulators that can be used as pointers for indirect addressing. The processor is Harvard with a RAM of 8x256 bits, and a ROM that can be resized from 17x252 bits to 17x8K bits. Additionally, it has one 8-bit input port, one 8-bit output port, and one 8-bit address port, which means that the processor can address more than 256 8-bit output ports/devices. The same applies for input ports. Results: The developed processor, named “ZA-SUA,” was compared with PICOBLAZE softcore and other three similar processors of free distribution in the Web, and some improvements over those were found. Criteria such as the Flip Flops used, occupied LUTs, Slices in use, and maximum delay of each processor were analyzed, all these results were obtained from the implementation of the processors in the Xilinx FPGAs. Conclusions: The designed architecture is composed by two accumulators, which can be used either as source or destination for the operation of the ALU. This fact gives some flexibility to the design, doing it better than a single-accumulator processor, and getting it closer to the register-based processors

8-bit softcore microprocessor with dual accumulator designed to be used in FPGA

Context: This paper is presents the design and implementation of an 8-bit softcore RISC microprocessor able to be run on space-optimized FPGA, in order to be used for embedded applications.Method: The design of this microprocessor was developed in Verilog hardware description language and can be implemented in FPGA from different manufacturers; therefore, the user has only to define the input and output ports according to the type of FPGA. This is an accumulator-type processor, but it has two different accumulators that can be used as pointers for indirect addressing. The processor is Harvard with a RAM of 8x256 bits, and a ROM that can be resized from 17x252 bits to 17x8K bits. Additionally, it has one 8-bit input port, one 8-bit output port, and one 8-bit address port, which means that the processor can address more than 256 8-bit output ports/devices. The same applies for input ports.Results: The developed processor, named “ZA-SUA,” was compared with PICOBLAZE softcore and other three similar processors of free distribution in the Web, and some improvements over those were found. Criteria such as the Flip Flops used, occupied LUTs, Slices in use, and maximum delay of each processor were analyzed, all these results were obtained from the implementation of the processors in the Xilinx FPGAs.Conclusions: The designed architecture is composed by two accumulators, which can be used either as source or destination for the operation of the ALU. This fact gives some flexibility to the design, doing it better than a single-accumulator processor, and getting it closer to the register-based processors

Iahris: New Software to Assess Hydrologic Alteration

Indicators of Hidrologic Alteration in RIverS (IAHRIS) is a software designed to fulfill: 1. Parameters for the characterization of the natural or regulated flow regime, in a section of the river. These parameters evaluate those aspects of the flow regime with the highest environmental meaning (magnitude, variability, seasonality and duration). Their definition has given priority to the consideration of the singular characteristics of the Mediterranean regimes. 2. If the user enters data of the natural flow regime and data for any other flow regime in the same section or reach (altered regime, environmental regime, management scenario, …) the software calculates, furthermore, a set of indicators that assess the degree of hydrologic alteration in comparison with the natural regime. These indicators of alteration have been defined attending to the CIS-WFD recommendations for the Ecological Quality Ratios. The software requires, at least, 15 entire years with data (daily average flows and/or monthly volumes). The type of data entered in IAHRIS determines, directly, the results accomplished. In particular, they depend on the data periodicity –daily or monthly-, and the simultaneous character of the data associated to the natural and the altered flow regimes. IAHRIS is free software, available at the website of the Spanish Ministry of the Environment

Oxigenoterapia

La oxigenoterapia es la modalidad terapéutica más recomendable para el tratamiento de deficiencias de ventilación/perfusión, intercambio de gases e hipoventilación; por tanto, para la Fisioterapia Cardiopulmonar es de significativa importancia conocer su soporte conceptual y aplicación. De acuerdo con lo anterior, se justifica la publicación del presente documento que hace una aproximación teórica de la oxigenoterapia, su definición, indicaciones, sistemas y formas de administración, prescripción, evaluación, cuidados generales y almacenamiento

SEDAH: Servidor de datos para el estudio de la alteración hidrológica

Durante los años 2008, 2009 y 2010 se han llevado a cabo, a nivel estatal, diversas actuaciones encaminadas a evaluar la alteración ecohidrológica de las masas de agua. Esta evaluación se llevó a cabo con la metodología y aplicación IAHRIS. Durante el desarrollo de estos trabajos se constató la necesidad de crear una herramienta que permitiera una mejor adecuación de los valores de la Red Oficial de Estaciones de Aforo (ROEA) a las diferentes herramientas que permiten valorar la alteración hidrológica de los regímenes hidrológicos, con especial atención a su aplicación a través del modelo IAHRIS. La aplicación web creada, denominada SEDAR (Servidor de Datos para Estudio de la Alteración Hidrológica), ayuda a solventar esta tarea, por un lado agilizando el trámite de selección de estaciones de aforo, fechas, tipo de serie de aforo, valoración preliminar de la calidad de los datos, clasificación referencia-alterado de los caudales, exportación de datos, y por otro proporcionando información completada tanto para datos mensuales y diarios, disponiendo de esta manera de un mayor volumen de datos en los formatos nativos de IAHRIS e IHA. De este modo, se dispone de una aplicación de fácil acceso por el usuario y con gran valor para la realización de estudios de alteración hidrológica, propuestas de régimen de caudal ambiental y proyectos de restauración fluvial; además constituye una aplicación base para la incorporación de nuevas funcionalidades de mayor alcance ligadas a la obtención de datos en régimen natural o de referencia

Severe Asthma Standard-of-Care Background Medication Reduction With Benralizumab: ANDHI in Practice Substudy

Background: The phase IIIb, randomized, parallel-group, placebo-controlled ANDHI double-blind (DB) study extended understanding of the efficacy of benralizumab for patients with severe eosinophilic asthma. Patients from ANDHI DB could join the 56-week ANDHI in Practice (IP) single-arm, open-label extension substudy. Objective: Assess potential for standard-of-care background medication reductions while maintaining asthma control with benralizumab. Methods: Following ANDHI DB completion, eligible adults were enrolled in ANDHI IP. After an 8-week run-in with benralizumab, there were 5 visits to potentially reduce background asthma medications for patients achieving and maintaining protocol-defined asthma control with benralizumab. Main outcome measures for non-oral corticosteroid (OCS)-dependent patients were the proportions with at least 1 background medication reduction (ie, lower inhaled corticosteroid dose, background medication discontinuation) and the number of adapted Global Initiative for Asthma (GINA) step reductions at end of treatment (EOT). Main outcomes for OCS-dependent patients were reductions in daily OCS dosage and proportion achieving OCS dosage of 5 mg or lower at EOT. Results: For non-OCS-dependent patients, 53.3% (n = 208 of 390) achieved at least 1 background medication reduction, increasing to 72.6% (n = 130 of 179) for patients who maintained protocol-defined asthma control at EOT. A total of 41.9% (n = 163 of 389) achieved at least 1 adapted GINA step reduction, increasing to 61.8% (n = 110 of 178) for patients with protocol-defined EOT asthma control. At ANDHI IP baseline, OCS dosages were 5 mg or lower for 40.4% (n = 40 of 99) of OCS-dependent patients. Of OCS-dependent patients, 50.5% (n = 50 of 99) eliminated OCS and 74.7% (n = 74 of 99) achieved dosages of 5 mg or lower at EOT. Conclusions: These findings demonstrate benralizumab's ability to improve asthma control, thereby allowing background medication reduction

Aire. Apoyo Integral Respiratorio en Emergencias

El desarrollo de la formación académica en vía aérea difícil concluyó en el texto que se presenta ahora bajo el nombre de AIRE, Apoyo Integral Respiratorio en Emergencias. Este proyecto se inició hace 5 años con el objetivo de desarrollar un curso adquirieran las aptitudes y los conocimientos necesarios para el manejo básico y avanzado de la vía aérea del paciente urgente. Así mismo, respondió a la necesidad creciente de entrenamiento para el manejo avanzado de la vía aérea en el entorno de los servicios de urgencias intra y extra hospitalarias por parte de los médicos generales, especialistas en Medicina de Emergencias, Anestesia, Cirugía General, Medicina Interna, y de todo el personal relacionado con el cuidado del paciente crítico. Fue así como un grupo de conformado por dos emergeciólogos, cuatro residentes de Medicina de Emergencias y una terapeuta respiratoria comenzamos a convertirnos en facilitadores para el aprendizaje de este difícil tema

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe