A reference architecture for multi-level SLA management

There is a global trend towards service-orientation, both for organizing business interactions but also in modern IT architectures. At the business-level, service industries are becoming the dominating sector in which solutions are flexibly composed out of networked services. At the IT level, the paradigms of Service-Oriented Architecture and Cloud Computing realize service-orientation for both software and infrastructure services. Again, flexible composition across different layers is a major advantage of this paradigm. Service Level Agreements (SLA) are a common approach for specifying the exact conditions under which services are to be delivered and, thus, are a prerequisite for supporting the flexible trading of services. However, typical SLAs are just specified at a single layer and do not allow service providers to manage their service stack accordingly. They have no insight on how SLAs at one layer translate to metrics or parameters at the various lower layers of the service stack. In this paper, we present a reference architecture for a multi-level SLA management framework. We discuss the fundamental concepts and detail the main architectural components and interfaces. Furthermore, we show how the framework can be flexibly used for different industrial scenarios

Clinical and nutritional effectiveness of a nutritional protocol with oligomeric enteral nutrition in patients with oncology treatment-related diarrhea

Background: Poor nutritional status and diarrhea are common complications in cancer patients. Methods: This multicenter, observational, prospective study evaluated the effectiveness of an oligomeric enteral nutrition (OEN) protocol in the improvement of nutritional status and reduction of diarrhea symptoms. Nutritional status was assessed with the Subjective Global Assessment (SGA), Body Mass Index (BMI) and albumin levels. Diarrhea was evaluated by the frequency and consistency of stools (Bristol Stool form scale). Results: After 8 weeks of OEN protocol, the nutritional status improved in 48.3% of patients, with an increased proportion of patients at risk of malnourishment (+27.3%) at the expense of a decrease of moderately (-19.9%) and severely (-7.3%) malnourished patients (p < 0.001). Serum albumin and BMI significantly increased after 8 weeks of OEN treatment (p < 0.005). OEN showed a 71.1% effectiveness in the improvement of stool consistency. The mean number of stools per day significantly decreased from baseline (4.17 stools/day) to week 8 (1.42 stools/day; p = 0.0041). The nutritional status significantly improved even in those patients with persistent diarrhea. Conclusion: The proposed OEN protocol seemed to be effective in improving the nutritional status, frequency and consistency of stools in patients with oncology treatment-related diarrhea even in persistent cases

Impact of an oral nutritional protocol with oligomeric enteral nutrition on the quality of life of patients with oncology treatment-related diarrhea

Background: Nutritional status can influence the quality of life (QoL) of cancer patients. Methods: This subanalysis evaluated the impact of an oral oligomeric enteral nutrition (OEN) protocol on the QoL of patients with oncology treatment-related diarrhea (OTRD) in a multicenter, observational, prospective study (DIAPOENO study). QoL was assessed with the Nottingham Health Profile (NHP) at baseline and after eight weeks of OEN treatment. In the overall population, all the NHP categories significantly improved after eight weeks of OEN treatment: energy levels (p < 0.001), pain (p < 0.001), emotional reactions (p < 0.001), sleep (p < 0.001), social isolation (p = 0.023), and physical abilities (p = 0.001). QoL improvement was higher in patients with improved or maintained nutritional status and in those with improved consistency of stools with the OEN protocol. However, QoL did not significantly improve in patients with worse nutritional status and with worse or maintained stool consistency with the OEN protocol. QoL improved regardless of disease severity. Multivariate logistic regression analysis showed that weight change was significantly associated with improved QoL (OR 2.90–5.3), except for social isolation, in models unadjusted and adjusted to age, sex, oncology treatment, and stool consistency. Conclusion: In this subanalysis, the OEN protocol was associated with improved QoL

Energy Self-Sufficiency Urban Module (ESSUM): GIS-LCA-based multi-criteria methodology to analyze the urban potential of solar energy generation and its environmental implications

The concentration of the population in cities has turned them into sources of environmental pollution, however, cities have a great potential for generating clean energy through renewable sources such as a responsible use of solar energy that reaches its rooftops. This work proposes a methodology to estimate the level of energy self-sufficiency in urban areas, particularly in a district of the city of Zaragoza (Spain). First, the Energy Self-Sufficiency Urban Module concept (ESSUM) is defined, then the self-sufficiency capacity of the city or district is determined using Geographical Information Systems (GIS), Light Detection and Ranging (LiDAR) point clouds and cadastral data. Secondly, the environmental implications of the implementation of these modules in the rooftops of the city using the LCA methodology are calculated. The results obtained show that total self-sufficiency of Domestic Hot Water (DHW) can be achieved using 21 % of available rooftop area, meanwhile the rest of rooftop area, dedicated to photovoltaic (PV), can reach 20 % of electricity self-sufficiency, supposing a final balance of a reduction in CO2 emissions of 12,695.4 t CO2eq/y and energy savings of 372,468.5 GJ/y. This corresponds to a scenario where full self-sufficiency of DHW was prioritized, with the remaining roof area dedicated to PV installation. In addition, other scenarios have been analyzed, such as the implementation of the energy systems separately

Heating energy consumption and environmental implications due to the change in daily habits in residential buildings derived from COVID-19 crisis: The case of Barcelona, Spain

The COVID-19 crisis has changed daily habits and the time that people spend at home. It is expected that this change may have environmental implications because of buildings’ heating energy demand. This paper studies the energy and environmental implications, from a Life Cycle Assessment (LCA) approach, due to these new daily habits in residential buildings at their current level of thermal insulation, and in different scenarios of thermal retrofit of their envelope. This study has a building-to-building approach by using Geographical Information Systems (GIS) for the residential housing stock in the case of Barcelona, Spain. The results show that a change in daily habits derived from the pandemic can increase the heating energy consumption and carbon dioxide emission in residential buildings by 182%. Retrofitting all buildings of Barcelona, according to conventional energy renovation instead of nearly Zero Energy Buildings (nZEB), will produce between 2.25 × 107 and 2.57 × 107 tons of carbon dioxide. Retrofitting the building stock using energy recovery is the option with better energy and emission savings, but also is the option with higher payback time for buildings built until 2007. The methodology presented can be applied in any city with sufficient cadastral data, and is considered optimal in the European context, as it goes for calculating the heating energy consumption

SEOM clinical guidelines for the treatment of head and neck cancer (2020)

Head and neck cancers (HNC) are defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2017 publication, the Spanish Society of Medical Oncology (SEOM) presents an update of the squamous cell HNC diagnosis and treatment guideline. Most relevant diagnostic and therapeutic changes from the last guideline have been updated: introduction of sentinel node biopsy in early oral/oropharyngeal cancer treated with surgery, concomitant radiotherapy with weekly cisplatin 40 mg/m2 in the adjuvant setting, new approaches for HPV-related oropharyngeal cancer and new treatments with immune-checkpoint inhibitors in recurrent/metastatic disease

Ischaemic Stroke in the Time of Coronavirus Disease 2019

Each year, between 1.1 and 1.5 million Europeans have a stroke1. Two to three out of 10 patients die as a consequence of it and about one third remains functionally dependent2. As we know, the likelihood of a favourable outcome in this disease relies heavily on patients presenting promptly after symptoms onset and on hospitals providing immediate access to optimized stroke care

Hemorragia subaracnoidea de la convexidad cerebral causada por telangiectasia hereditaria hemorrágica

Sr. Editor: La hemorragia subaracnoidea de la convexidad cerebral (HSAc) se caracteriza por colecciones hemáticas en uno o varios surcos adyacentes, sin sangrado en el parénquima cerebral, cisura interhemisférica, cisternas basales o ventrículos1, 2, 3. Se ha asociado a múltiples etiologías como traumatismos, enfermedad aneurismática, oclusión de venas corticales, síndrome de leucoencefalopatía posterior reversible, síndrome de vasoconstricción cerebral reversible (SVCR), angiopatía amiloide cerebral (AAC), vasculitis primaria del sistema nervioso central, coagulopatías, consumo de cocaína o etanol, abscesos cerebrales, cavernomas o malformaciones arteriovenosas1, 2, 3, 4. A continuación presentamos un caso de HSAc como manifestación de telangiectasia hereditaria hemorrágica (THH). Varón de 47 años con antecedente de epistaxis repetidas desde la infancia e historia familiar de epistaxis en la madre, tío y abuelo maternos, quienes requirieron cauterización de telangiectasias en la cavidad nasal. Refería una cefalea opresiva frontal izquierda, de intensidad y frecuencia crecientes (hasta hacerse diaria) en los últimos 5 meses. Esta aumentaba con la maniobra de Valsalva, asociando vértigo y vómitos, ..

Parámetros ecocardiográficos de cardiopatía auricular y detección de fibrilación auricular en el ictus criptogénico

Sr, Editor: Los ictus cardioembólicos representan un 20-30% del total de los ictus isquémicos. Con la introducción en 2014 del término «ESUS» o «ictus embólico de origen indeterminado» y ante el importante número de ictus criptogénicos no lacunares, la hipótesis de una fuente embólica no conocida ha llevado a una búsqueda exhaustiva. Esta incluye la monitorización cardiaca prolongada, lo que aumenta la sensibilidad para identificar arritmias proembolígenas paroxísticas. Si bien en un inicio no se conocía la capacidad de dichos paroxismos cardiacos para ocasionar eventos isquémicos, estudios paralelos sobre la fisiopatología del ictus cardioembólico han demostrado que fibrilaciones auriculares (FA) paroxísticas de 5-6 min ya aumentan el riesgo de ictus. La escasa duración de estos episodios y el hecho de que puedan ser asintomáticos y distanciados del momento del cuadro neurológico explican su inclusión durante el ingreso hospitalario en el conjunto de ictus de etiología indeterminada. La heterogeneidad de dicho grupo, junto con el limitado uso de la monitorización cardiaca prolongada, ya sea por mala tolerancia de los pacientes o por la escasez y disparidad de los dispositivos, ha incentivado la búsqueda de parámetros que se correlacionen con mayor incidencia de FA con el objetivo de aumentar la rentabilidad de la prueba. Estos parámetros incluyen aspectos electrocardiográficos, bioquímicos y ecocardiográficos, y en el análisis de muchos de ellos se ha visto su relación, no solo con la FA, sino también su asociación directa con ictus isquémicos o recurrencias..

Expert recommendations on the management of patients with metastatic castration-resistant prostate cancer who progress after CHAARTED or LATITUDE

Objective: Our aim was to provide practical recommendations on the management of patients with metastatic castration-resistant prostate cancer (mCRPC) who have progressed after docetaxel plus androgen-deprivation therapy (ADT) or abiraterone plus ADT. Methods: Systematic literature review (SLR), nominal group meeting, and Delphi process. A panel of 12 experts was established who defined the scope, users, and sections of the document. We performed an SLR in order to assess the efficacy and safety of available drugs in patients with mCRPC. Abstracts from the American Society of Oncology and European Society for Medical Oncology meetings were also examined. The results were discussed during an expert meeting in which 14 recommendations were generated. The level of agreement with the recommendations was also tested by 13 additional experts following the Delphi process. Recommendations were voted by means of scores ranging from 0 (total disagreement) to 10 (total agreement). We defined agreement when at least 70% of the experts voted ¿7. Next, we assigned a level of evidence and grade to the recommendation using the Oxford Centre for Evidence-based Medicine Levels of Evidence, following which the final document was drafted. Results: The literature search did not find any articles meeting the inclusion criteria. Finally, 13 out of 14 recommendations were accepted after two Delphi rounds (two were modified after the first round). They pertain to general and individual case-based treatment recommendations. Conclusions: In mCRPC patients who have progressed after docetaxel or abiraterone plus ADT in the metastatic hormone-sensitive prostate cancer setting, these recommendations may support treatment decision-making, due to the lack of evidence or other globally accepted sequencing algorithms