Gestión digitalizada de la energía, autoconsumo, movilidad eléctrica y almacenamiento (GAMMA)

[ES] En el actual contexto de transición energética en el que nos encontramos, el desarrollo de nuevas soluciones tecnológicas centradas en el ámbito de la energía y la sostenibilidad es de vital importancia. Para conseguir el objetivo de un mix energético con menos emisiones de CO2 se necesitan herramientas que favorezcan el uso de energías de origen renovable y que faciliten la integración del almacenamiento energético como pieza clave para maximizar el aprovechamiento de estas fuentes de energía [1] [2]. Además, es importante aportar desarrollos tecnológicos que sirvan para mejorar el control de la red eléctrica, las fuentes de energía y los consumos asociados, consiguiendo mejorar la eficiencia energética al compatibilizar de forma dinámica y adaptada los recursos de generación disponibles y las distintas necesidades de uso energético. Dicha operación de recursos requiere la implementación de sistemas de control inteligente automatizados para la coordinación DER, medición inteligente y soporte de respuesta a la demanda, sincronización con el sistema energético global, así como balance local.El proyecto cuenta con la cofinanciación de la Generalitat Valenciana a través del Instituto Valenciano de Competitividad Empresarial, IVACE, y la Unión Europea a través del Fondo Europeo de Desarrollo Regional dentro del Programa Operativo FEDER de la Comunidad Valenciana 2014-2020. (EXP IMDE40/2018/2).Gero-Ciudad, R.; Diaz-Cabrera, JC.; González-Cobos, N.; Quijano-Lopez, A. (2020). Gestión digitalizada de la energía, autoconsumo, movilidad eléctrica y almacenamiento (GAMMA). Grupo Tecma Red. 224-229. http://hdl.handle.net/10251/17859522422

Permeable reactive barriers for the remediation of groundwater in a mining area: results for a pilot-scale project

The Sierra Minera of Cartagena-La Union is located in the Region of Murcia, Southeast of Spain. This zone presents high levels of heavy metals due to natural, geogenic reasons. In addition, the prolonged mining activity, and subsequent abandonment of farms, has had consequences on the environment, including severe affectation of the groundwater in the area. To remediate this situation, the Permeable Reactive Barrier (PRB) technology was assayed, which required in addition to the hydro-geological study of the zone, a careful optimization study for the design and construction of PRBs. For such a purpose a pilot-scale project was developed, and this communication reports some of the most relevant findings obtained after a four-years monitorization period. The selected reactive material for the PRBs was limestone filler. The filler is a waste material produced in many factories in the zone. These residues have good adsorption properties, high alkalinity, low cost and high availability, which make them suitable for use in remediation. The PRB was constituted by a 50% limestone filler and 50% sand, a proportion optimized by means of independent batch experiments. A layer of gravel was placed at the top, and on it a layer of natural soil. The barrier was designed in the form of a continuous trench, because the level of the contaminated groundwater was not very deep. In this way, the barrier could be prepared with standard excavation equipment. Parallel to the barrier, 6 wells where arranged downstream for sample collection. The pH and conductivity of the samples was measured directly in situ, and the content of Zn, Cd, Cu, Fe, and Pb were analyzed in the laboratory. All the samples collected after the PRB was constructed had basic pH values between 7.5 and 8. The conductivity was between 5 and 11 mS / cm except for the well 4, which had a value of 3.70 mS / cm. The concentration values of trace elements were below the detection limit (atomic absorption measurement) in most of cases, or showed values below normal levels of the area. Our results prove that limestone filler is suitable as the active component of PRBs barriers for sites polluted by trace elements. Following this relatively simple technology, there is no risk for human health or ecosystem, and a big cost-saving can be obtained in projects focused to the remediation of areas affected by mining activities

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

Inquisicion y conversos

Centro de Informacion y Documentacion Cientifica (CINDOC). C/Joaquin Costa, 22. 28002 Madrid. SPAIN / CINDOC - Centro de Informaciòn y Documentaciòn CientìficaSIGLEDiputacion Provincial de Toledo (Spain); Ministerio de Cultura, Madrid (Spain); Ministerio de Educacion y Ciencia (MEC), Madrid (Spain); Ministerio de Asuntos Exteriores, Madrid (Spain)ESSpai