Use of Phragmites australis for controlling phospohrus contamination in anthropogenic wetland ecosystems

This is an Author's Accepted Manuscript of an article published in J. M. Carricondo, J. V. Oliver-Villanueva, J. V. Turégano, J. A. González & J. Mengual (2021) Use of Phragmites australis for controlling phosphorus contamination in anthropogenic wetland ecosystems, Environmental Technology, 42:19, 3055-3064, DOI: 10.1080/09593330.2020.1720311 [copyright Taylor & Francis], available online at: http://www.tandfonline.com/10.1080/09593330.2020.1720311[EN] Continuous phosphorus discharges in bodies of water, generated by human activities, such as agriculture, domestic effluences or wastewater from industrial processes, produce contaminated water and eutrophication. For this reason, efficient and low-cost systems that can remove phosphorus from contaminated water are necessary. In addition, it is important to generate renewable energy such as the energy produced in biomass power plants, taking advantage of the available biomass waste in each place. When producing this renewable energy, the resulting ash is a residue that can be used for phosphorus removal by adsorption processes. Moreover, according to the concept of the circular economy, the ash waste generated in this bio energy process should be reduced as much as possible. One of the advantages of this research being that surplus phosphorus-laden ash can be reused as fertilizer in agricultural fields. Considering this, the efficiency of reed ash (RA) (Phragmites australis) has been analysed in batch experiments, as well as the effect of several parameters on the removal of phosphate, such as contact time, phosphate-ash ratio, ash dose and temperature. Significant results obtained show that RA can be used to improve water quality.Carricondo, JM.; Oliver Villanueva, JV.; Turegano Pastor, JV.; González Romero, JA.; Mengual Cuquerella, J. (2021). Use of Phragmites australis for controlling phospohrus contamination in anthropogenic wetland ecosystems. Environmental Technology. 42(19):3055-3064. https://doi.org/10.1080/09593330.2020.1720311S305530644219Rodrigo, M. A., Valentín, A., Claros, J., Moreno, L., Segura, M., Lassalle, M., & Vera, P. (2018). Assessing the effect of emergent vegetation in a surface-flow constructed wetland on eutrophication reversion and biodiversity enhancement. Ecological Engineering, 113, 74-87. doi:10.1016/j.ecoleng.2017.11.021Ahmad, S. S., Reshi, Z. A., Shah, M. A., Rashid, I., Ara, R., & Andrabi, S. M. A. (2014). Phytoremediation Potential ofPhragmites australisin Hokersar Wetland - A Ramsar Site of Kashmir Himalaya. International Journal of Phytoremediation, 16(12), 1183-1191. doi:10.1080/15226514.2013.821449Chandra, R., & Yadav, S. (2011). Phytoremediation of CD, CR, CU, MN, FE, NI, PB and ZN from Aqueous Solution UsingPhragmites Cummunis, Typha AngustifoliaandCyperus Esculentus. International Journal of Phytoremediation, 13(6), 580-591. doi:10.1080/15226514.2010.495258Brix, H., Schierup, H.-H., & Arias, C. A. (2007). Twenty years experience with constructed wetland systems in Denmark – what did we learn? Water Science and Technology, 56(3), 63-68. doi:10.2166/wst.2007.522Vybernaite-Lubiene, I., Zilius, M., Giordani, G., Petkuviene, J., Vaiciute, D., Bukaveckas, P. A., & Bartoli, M. (2017). Effect of algal blooms on retention of N, Si and P in Europe’s largest coastal lagoon. Estuarine, Coastal and Shelf Science, 194, 217-228. doi:10.1016/j.ecss.2017.06.020Del Barrio Fernández, P., Gómez, A. G., Alba, J. G., Díaz, C. Á., & Revilla Cortezón, J. A. (2012). A model for describing the eutrophication in a heavily regulated coastal lagoon. Application to the Albufera of Valencia (Spain). Journal of Environmental Management, 112, 340-352. doi:10.1016/j.jenvman.2012.08.019Uddin, M. N., & Robinson, R. W. (2018). Can nutrient enrichment influence the invasion of Phragmites australis? Science of The Total Environment, 613-614, 1449-1459. doi:10.1016/j.scitotenv.2017.06.131Ailstock, M. S., Norman, C. M., & Bushmann, P. J. (2001). Common ReedPhragmites australis: Control and Effects Upon Biodiversity in Freshwater Nontidal Wetlands. Restoration Ecology, 9(1), 49-59. doi:10.1046/j.1526-100x.2001.009001049.xColeman, H. M., & Levine, J. M. (2006). Mechanisms underlying the impacts of exotic annual grasses in a coastal California meadow. Biological Invasions, 9(1), 65-71. doi:10.1007/s10530-006-9008-6Farnsworth, E. J., & Meyerson, L. A. (2003). Comparative ecophysiology of four wetland plant species along a continuum of invasiveness. Wetlands, 23(4), 750-762. doi:10.1672/0277-5212(2003)023[0750:ceofwp]2.0.co;2Holdredge, C., & Bertness, M. D. (2010). Litter legacy increases the competitive advantage of invasive Phragmites australis in New England wetlands. Biological Invasions, 13(2), 423-433. doi:10.1007/s10530-010-9836-2Verhoeven, J. T. A., & Setter, T. L. (2009). Agricultural use of wetlands: opportunities and limitations. Annals of Botany, 105(1), 155-163. doi:10.1093/aob/mcp172Pinto, E., Almeida, A., & Ferreira, I. M. P. L. V. O. (2016). Essential and non-essential/toxic elements in rice available in the Portuguese and Spanish markets. Journal of Food Composition and Analysis, 48, 81-87. doi:10.1016/j.jfca.2016.02.008Li, M., Liu, J., Xu, Y., & Qian, G. (2016). Phosphate adsorption on metal oxides and metal hydroxides: A comparative review. Environmental Reviews, 24(3), 319-332. doi:10.1139/er-2015-0080Correll, D. L. (1998). The Role of Phosphorus in the Eutrophication of Receiving Waters: A Review. Journal of Environmental Quality, 27(2), 261-266. doi:10.2134/jeq1998.00472425002700020004xSharpley, A. N., Chapra, S. C., Wedepohl, R., Sims, J. T., Daniel, T. C., & Reddy, K. R. (1994). Managing Agricultural Phosphorus for Protection of Surface Waters: Issues and Options. Journal of Environmental Quality, 23(3), 437-451. doi:10.2134/jeq1994.00472425002300030006xMaiga Y, von Sperling M, Mihelcic J. Constructed Wetlands. In: Rose JB and Jiménez-Cisneros B (eds) Global Water Pathogen Project. http://www.waterpathogens.org (Haas C, Mihelcic JR and Verbyla ME) (eds) Part 4 Management Of Risk from Excreta and Wastewater). http://www.waterpathogen 2017.Vymazal, J., & Březinová, T. (2016). Accumulation of heavy metals in aboveground biomass of Phragmites australis in horizontal flow constructed wetlands for wastewater treatment: A review. Chemical Engineering Journal, 290, 232-242. doi:10.1016/j.cej.2015.12.108Zhang, Y., Song, C., Ji, L., Liu, Y., Xiao, J., Cao, X., & Zhou, Y. (2018). Cause and effect of N/P ratio decline with eutrophication aggravation in shallow lakes. Science of The Total Environment, 627, 1294-1302. doi:10.1016/j.scitotenv.2018.01.327Rai, P. K. (2008). Heavy Metal Pollution in Aquatic Ecosystems and its Phytoremediation using Wetland Plants: An ecosustainable approach. International Journal of Phytoremediation, 10(2), 133-160. doi:10.1080/15226510801913918Meuleman, A. F. M., Beekman, J. P., & Verhoeven, J. T. A. (2002). Nutrient retention and nutrient-use efficiency in Phragmites australis stands after wasterwater application. Wetlands, 22(4), 712-721. doi:10.1672/0277-5212(2002)022[0712:nranue]2.0.co;2Važić, T., Svirčev, Z., Dulić, T., Krstić, K., & Obreht, I. (2015). Potential for energy production from reed biomass in the Vojvodina region (north Serbia). Renewable and Sustainable Energy Reviews, 48, 670-680. doi:10.1016/j.rser.2015.04.034Matsumura, Y., Minowa, T., & Yamamoto, H. (2005). Amount, availability, and potential use of rice straw (agricultural residue) biomass as an energy resource in Japan. Biomass and Bioenergy, 29(5), 347-354. doi:10.1016/j.biombioe.2004.06.015Kumari, M., & Tripathi, B. D. (2015). Efficiency of Phragmites australis and Typha latifolia for heavy metal removal from wastewater. Ecotoxicology and Environmental Safety, 112, 80-86. doi:10.1016/j.ecoenv.2014.10.034Boluda, R., Andreu, V., Gilabert, M. A., & Sobrino, P. (1993). Relation between reflectance of rice crop and indices of pollution by heavy metals in soils of albufera natural park (Valencia, Spain). Soil Technology, 6(4), 351-363. doi:10.1016/0933-3630(93)90025-aYadav, D., Kapur, M., Kumar, P., & Mondal, M. K. (2015). Adsorptive removal of phosphate from aqueous solution using rice husk and fruit juice residue. Process Safety and Environmental Protection, 94, 402-409. doi:10.1016/j.psep.2014.09.005UGURLU, A. (1998). Phosphorus removal by fly ash. Environment International, 24(8), 911-918. doi:10.1016/s0160-4120(98)00079-8Abbas, M. N. (2014). Phosphorus removal from wastewater using rice husk and subsequent utilization of the waste residue. Desalination and Water Treatment, 55(4), 970-977. doi:10.1080/19443994.2014.922494El-Sobky, E.-S. E. A. (2017). Effect of burned rice straw, phosphorus and nitrogen fertilization on wheat ( Triticum aestivum L.). Annals of Agricultural Sciences, 62(1), 113-120. doi:10.1016/j.aoas.2017.05.007Smol, M., Kulczycka, J., Henclik, A., Gorazda, K., & Wzorek, Z. (2015). The possible use of sewage sludge ash (SSA) in the construction industry as a way towards a circular economy. Journal of Cleaner Production, 95, 45-54. doi:10.1016/j.jclepro.2015.02.051Mor, S., Chhoden, K., & Ravindra, K. (2016). Application of agro-waste rice husk ash for the removal of phosphate from the wastewater. Journal of Cleaner Production, 129, 673-680. doi:10.1016/j.jclepro.2016.03.088Seliem, M. K., Komarneni, S., & Abu Khadra, M. R. (2016). Phosphate removal from solution by composite of MCM-41 silica with rice husk: Kinetic and equilibrium studies. Microporous and Mesoporous Materials, 224, 51-57. doi:10.1016/j.micromeso.2015.11.011Ahmaruzzaman, M. (2010). A review on the utilization of fly ash. Progress in Energy and Combustion Science, 36(3), 327-363. doi:10.1016/j.pecs.2009.11.003Langmuir, I. (1916). THE CONSTITUTION AND FUNDAMENTAL PROPERTIES OF SOLIDS AND LIQUIDS. PART I. SOLIDS. Journal of the American Chemical Society, 38(11), 2221-2295. doi:10.1021/ja02268a002Chen, Y., Wang, F., Duan, L., Yang, H., & Gao, J. (2016). Tetracycline adsorption onto rice husk ash, an agricultural waste: Its kinetic and thermodynamic studies. Journal of Molecular Liquids, 222, 487-494. doi:10.1016/j.molliq.2016.07.090Ma, Z., Li, Q., Yue, Q., Gao, B., Li, W., Xu, X., & Zhong, Q. (2011). Adsorption removal of ammonium and phosphate from water by fertilizer controlled release agent prepared from wheat straw. Chemical Engineering Journal, 171(3), 1209-1217. doi:10.1016/j.cej.2011.05.027Vassileva, P., & Voikova, D. (2009). Investigation on natural and pretreated Bulgarian clinoptilolite for ammonium ions removal from aqueous solutions. Journal of Hazardous Materials, 170(2-3), 948-953. doi:10.1016/j.jhazmat.2009.05.062SHI, Z., LIU, F., & YAO, S. (2011). Adsorptive removal of phosphate from aqueous solutions using activated carbon loaded with Fe(III) oxide. New Carbon Materials, 26(4), 299-306. doi:10.1016/s1872-5805(11)60083-8Wu, Y., Li, X., Yang, Q., Wang, D., Xu, Q., Yao, F., … Huang, X. (2019). Hydrated lanthanum oxide-modified diatomite as highly efficient adsorbent for low-concentration phosphate removal from secondary effluents. Journal of Environmental Management, 231, 370-379. doi:10.1016/j.jenvman.2018.10.059Vohla, C., Kõiv, M., Bavor, H. J., Chazarenc, F., & Mander, Ü. (2011). Filter materials for phosphorus removal from wastewater in treatment wetlands—A review. Ecological Engineering, 37(1), 70-89. doi:10.1016/j.ecoleng.2009.08.003Xia, P., Wang, X., Wang, X., Song, J., Wang, H., Zhang, J., & Zhao, J. (2016). Struvite crystallization combined adsorption of phosphate and ammonium from aqueous solutions by mesoporous MgO⿿loaded diatomite. Colloids and Surfaces A: Physicochemical and Engineering Aspects, 506, 220-227. doi:10.1016/j.colsurfa.2016.05.101Wong, A., Navarro, E. A., & Abril, A. J. (2013). Microalgal oil production for use in rice farms in Albufera (València) region. International Journal of Green Economics, 7(2), 181. doi:10.1504/ijge.2013.057437Delivand, M. K., Barz, M., & Gheewala, S. H. (2011). Logistics cost analysis of rice straw for biomass power generation in Thailand. Energy, 36(3), 1435-1441. doi:10.1016/j.energy.2011.01.026Schiemenz, K., & Eichler-Löbermann, B. (2010). Biomass ashes and their phosphorus fertilizing effect on different crops. Nutrient Cycling in Agroecosystems, 87(3), 471-482. doi:10.1007/s10705-010-9353-9Ahmed, M. J. (2017). Application of raw and activated Phragmites australis as potential adsorbents for wastewater treatments. Ecological Engineering, 102, 262-269. doi:10.1016/j.ecoleng.2017.01.04

Techniques and crops for efficient rooftop gardens in Bologna, Italy

Urban rooftop farming favours local food production. Although rooftop farming is perceived as 33 a sustainable system, there is a lack of quantitative studies on rooftop farming. There we set up 34 experiments in the community rooftop garden of a public housing building in Bologna, Italy, 35 between 2012 and 2014. We grew lettuce, a leafy vegetable, using three techniques: nutrient 36 film, floating hydroponic and soil cultivation. We also grew tomato, chilli pepper, eggplant, 37 melon, watermelon on soils. Data was analysed by life cycle assessment for environmental and 38 economic performance. Results reveal that the best techniques of lettuce cultivation to address 39 global warming were floating in the summer, with 65-85% less environmental impact per kg 40 than nutrient film; and soil production in the winter, with 85-95% less environmental impact. 41 Furthermore, floating production was 25% cheaper in summer and soil was 65% cheaper in 42 winter, compared to the nutrient film technique. For soil production, eggplants and tomatoes 43 showed the best environmental performances of about 74 g CO2 per kg. Eggplant production in 44 soil gave in the cheapest crop of 0.13 € per kg

Urine cell-based DNA methylation classifier for monitoring bladder cancer

Background: Current standard methods used to detect and monitor bladder cancer (BC) are invasive or have low sensitivity. This study aimed to develop a urine methylation biomarker classifier for BC monitoring and validate this classifier in patients in follow-up for bladder cancer (PFBC). Methods: Voided urine samples (N = 725) from BC patients, controls, and PFBC were prospectively collected in four centers. Finally, 626 urine samples were available for analysis. DNA was extracted from the urinary cells and bisulfite modificated, and methylation status was analyzed using pyrosequencing. Cytology was available from a subset of patients (N = 399). In the discovery phase, seven selected genes from the literature (CDH13, CFTR, NID2, SALL3, TMEFF2, TWIST1, and VIM2) were studied in 111 BC and 57 control samples. This training set was used to develop a gene classifier by logistic regression and was validated in 458 PFBC samples (173 with recurrence). Results: A three-gene methylation classifier containing CFTR, SALL3, and TWIST1 was developed in the training set (AUC 0.874). The classifier achieved an AUC of 0.741 in the validation series. Cytology results were available for 308 samples from the validation set. Cytology achieved AUC 0.696 whereas the classifier in this subset of patients reached an AUC 0.768. Combining the methylation classifier with cytology results achieved an AUC 0.86 in the validation set, with a sensitivity of 96%, a specificity of 40%, and a positive and negative predictive value of 56 and 92%, respectively. Conclusions: The combination of the three-gene methylation classifier and cytology results has high sensitivity and high negative predictive value in a real clinical scenario (PFBC). The proposed classifier is a useful test for predicting BC recurrence and decrease the number of cystoscopies in the follow-up of BC patients. If only patients with a positive combined classifier result would be cystoscopied, 36% of all cystoscopies can be prevented

Association Among Polyphenol Intake, Uric Acid, and Hyperuricemia: A CrossSectional Analysis in a Population at High Cardiovascular Risk

Dietary polyphenol intake has been associated with a decreased risk of hyperuricemia, but most of this knowledge comes from preclinical studies. The aim of the present study was to assess the association of the intake of different classes of polyphenols with serum uric acid and hyperuricemia. This cross- sectional analysis involved baseline data of 6332 participants. Food polyphenol con- tent was estimated by a validated semiquantitative food frequency questionnaire and from the Phenol-Explorer database. Multivariable-adjusted linear regression models with serum uric acid (milligrams per deciliter) as the outcome and polyphenol intake (quintiles) as the main independent variable were fitted. Cox regression models with constant follow-up time (t=1) were performed to estimate the prevalence ratios (PRs) of hyperuricemia (≥7 mg/dL in men and ≥6 mg/dL in women). An inverse association between the intake of the phenolic acid class (β coefficient, −0.17 mg/dL for quintile 5 versus quintile 1 [95% CI, −0.27 to −0.06]) and hydroxycinnamic acids (β coefficient, −0.19 [95% CI, −0.3 to −0.09]), alkylmethoxyphenols (β coefficient, −0.2 [95% CI, −0.31 to −0.1]), and methoxyphenols (β coefficient, −0.24 [95% CI, −0.34 to −0.13]) subclasses with serum uric acid levels and hyperuricemia (PR, 0.82 [95% CI, 0.71– 0.95]; PR, 0.82 [95% CI, 0.71– 0.95]; PR, 0.80 [95% CI, 0.70– 0.92]; and PR, 0.79 [95% CI, 0.69– 0.91]; respectively) was found. The intake of hydroxybenzoic acids was directly and significantly as- sociated with mean serum uric acid levels (β coefficient, 0.14 for quintile 5 versus quintile 1 [95% CI, 0.02– 0.26]) but not with hyperuricemia

Joint Observation of the Galactic Center with MAGIC and CTA-LST-1

MAGIC is a system of two Imaging Atmospheric Cherenkov Telescopes (IACTs), designed to detect very-high-energy gamma rays, and is operating in stereoscopic mode since 2009 at the Observatorio del Roque de Los Muchachos in La Palma, Spain. In 2018, the prototype IACT of the Large-Sized Telescope (LST-1) for the Cherenkov Telescope Array, a next-generation ground-based gamma-ray observatory, was inaugurated at the same site, at a distance of approximately 100 meters from the MAGIC telescopes. Using joint observations between MAGIC and LST-1, we developed a dedicated analysis pipeline and established the threefold telescope system via software, achieving the highest sensitivity in the northern hemisphere. Based on this enhanced performance, MAGIC and LST-1 have been jointly and regularly observing the Galactic Center, a region of paramount importance and complexity for IACTs. In particular, the gamma-ray emission from the dynamical center of the Milky Way is under debate. Although previous measurements suggested that a supermassive black hole Sagittarius A* plays a primary role, its radiation mechanism remains unclear, mainly due to limited angular resolution and sensitivity. The enhanced sensitivity in our novel approach is thus expected to provide new insights into the question. We here present the current status of the data analysis for the Galactic Center joint MAGIC and LST-1 observations

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Filled poly(2,6-dimethyl-1,4-phenylene oxide) dense membranes by silica and silane modified silica nanoparticles: characterization and application in pervaporation

The effects of silica and silane modified silica fillers on the pervaporation properties of poly (2,6-dimethyl-1,4-phenylene oxide) (PPO) dense membranes have been studied. Crystallinity, thermal and mechanical properties of unfilled and filled PPO membranes with silica and silane modified silica nanoparticles were investigated. The surface energy together with the solubility parameters of the membranes and the nanoparticles were determined. Pervaporation separation of methanol/methyl tert butyl ether (MTBE) mixtures over the entire range of concentration were carried out using both filled and unfilled membranes. The results are discussed in terms of the solubility and the diffusivity of each liquid component in the membranes. Flory-Huggins theory was used to predict the sorption methanol selectivity. Compared to the unfilled PPO membrane, the filled PPO membranes exhibit higher methanol selectivity and lower permeability. For methanol concentration in liquid feed mixture lower than 50 wt%, methanol selectivity of the filled PPO membranes with silane modified silica is better than that of the silica filled and unfilled PPO membranes

Gas transport properties of polypropylene/clay composite membranes

Polypropylene membranes modified with natural and organically modified montmorillonite clays were prepared. The permeability, diffusivity and solubility of helium, oxygen and nitrogen were determined for the unfilled and filled membranes over the temperature range 25-65 degrees C. Physical properties of polypropylene membranes were investigated using X-ray diffraction, thermogravimetric analyser, tensile testing and differential scanning calorimetry. The results showed that the filled membranes exhibit lower gas permeability compared to the unfilled polypropylene membrane. For helium, a reduced diffusivity is mainly responsible for the reduction in the permeability, in contrast, for nitrogen and oxygen, both diffusivity and solubility were reduced by the presence of fillers. The X-ray diffraction spectra showed that the incorporation of the unmodified and modified clay did not affect the crystallographic nature of polypropylene

Historia y desarrollo de la Pediatría de Atención Primaria en Aragón

Health Primarya Care is defined as essential health care based on practical, scientifically founded, socially acceptable methods and avalibles technologies to all individuals and families in the community through full participation and at a cost that community and the country can support. Authors describes the historical development of Primary Care Pediatrics Pediaría The quality of care, Teaching, Research Teamwork, Coordination, Emergencies, Institutional Participation, Community Medicine and Health Promotion, Palliative Care and Challenges for the Future.La Atención Primaria de Salud (APS) se define como la atención sanitaria esencial basada en métodos y tecnologías prácticos, científicamente fundados, socialmente aceptables ,puesta al alcance de todos los individuos y familias de la comunidad mediante la plena participación y a un coste que la comunidad y el país puedan soportar, en todas y cada una de las etapas de su desarrollo. Se describe el desarrollo histórico de la Pediatría de Atención Primaria en Aragón. Se analizan como aspectos principales la calidad de la atención, Coordinación, Docencia, Trabajo en equipo Investigación, Coordinación con hospitales de referencia, Atención continuada y Urgencias, Participación institucional, Medicina comunitaria y Promoción de la Salud Ética, Cuidados paliativos y Retos de futuro