Evaluación del submodelo de fusión de nieve del Modelo TETIS en las cuencas de alta montaña del río American y Carson dentro del proyecto DMIP2

En este trabajo se evalúa el modelo hidrológico distribuido TETIS y su submodelo de fusión de nieve en las cuencas de alta montaña de los ríos American y Carson en Sierra Nevada EE.UU., como parte del proyecto Comparación de Modelos Distribuidos en la fase 2 (DMIP2) National Oceanic and Atmospheric Administration¿s National Weather Service (NOAA).Orozco Medina, I. (2010). Evaluación del submodelo de fusión de nieve del Modelo TETIS en las cuencas de alta montaña del río American y Carson dentro del proyecto DMIP2. http://hdl.handle.net/10251/13813Archivo delegad

Calibration of a conceptual rainfall-runoff model combining manual and automatic optimization for high mountain systems

[EN] The calibration of a conceptual rainfall-runoff model is a complicated process that can take a long time and effort. Its success depends on the experience of the modeler and on the knowledge of the basin. For this reason, in this paper, a combination of manual and automatic calibration has been proposed to obtain the effective parameters of a hydrological model applied to a high mountain basin. This is because calibrating hydrological parameters and snow melting parameters simultaneously may not adequately represent the real conditions of high mountain systems. The methodology proposed in this paper has been implemented using the distributed hydrological TETIS model developed at the Universitat Politècnica de València. The results obtained are acceptable, because the Nash-Sutcliffe efficiency index is reached close to 0.9 in calibration and 0.8 validation, with parameters within the ranges established in the scientific literature.[ES] La calibración de un modelo lluvia-escorrentía es un proceso complicado que puede llevar mucho tiempo y esfuerzo. Su éxito está condicionado a la experiencia del modelador y al conocimiento que se tenga del sistema físico que se desea modelar. Por ello, en este trabajo, se propone una metodología que combina la calibración manual y automática para obtener los parámetros efectivos de un modelo hidrológico aplicado a una cuenca de alta montaña. Lo anterior se debe a que calibrar simultáneamente los parámetros hidrológicos y los parámetros de fusión de nieve puede no representar adecuadamente las condiciones reales de los sistemas de alta montaña. La metodología propuesta ha sido probada usando el modelo hidrológico distribuido TETIS desarrollado en la Universitat Politècnica de València. Los resultados obtenidos son buenos al alcanzarse índices de eficiencia de Nash-Sutcliffe cercanos a 0.9 en calibración y a 0.8 en validación, con parámetros dentro de los rangos establecidos en la literatura científica.Esta investigación ha sido apoyada por la Dirección General de Educación Superior Universitaria (DGESU) de la Secretaría de Educación Pública, a través de su Programa para el Desarrollo Profesional Docente (Folio prodep: UGTO-PTC 613) y por la División de Ingenierías de la Universidad de Guanajuato.Orozco Medina, I.; Ramirez, A.; Francés, F. (2019). Calibración de un modelo lluvia-escorrentía combinando la optimización manual y automática para un sistema de alta montaña. Acta Universitaria (Online). 29:1-15. https://doi.org/10.15174/au.2019.2187S1152

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd

Modelación parsimoniosa y espacialmente distribuida de los procesos de acumulación y fusión de la nieve

La presente tesis doctoral tiene como objetivo investigar los efectos de la variabilidad de los factores de fusión que utiliza el método grado-día, en la modelación de la fusión de nieve y su repercusión en la modelación hidrológica en cuencas de alta montaña. Lo anterior, con la finalidad de proporcionar una alternativa parsimoniosa a la simulación de la fusión de nieve en la modelación hidrológica de este tipo de cuencas, cuya problemática principal es no contar con la información suficiente para aplicar otros modelos de fusión conceptualmente más completos, como los de balance de energía. Para llevar a cabo lo anterior, en esta tesis se han planteado tres conceptualizaciones matemáticas de modelos híbridos de fusión de nieve que se basan en el método clásico grado-día, pero que a diferencia de éste, consideran la variabilidad de los factores de fusión. Estas conceptualizaciones se han implementado en el modelo hidrológico distribuido conceptual con parámetros físicamente basados TETIS, para la modelación de los procesos del ciclo hidrológico. La variabilidad de los factores de fusión se introduce en los modelos híbridos a escala de celda mediante mapas de índices de radiación, los cuales son construidos tomando en cuenta la radiación global de onda corta con cielo despejado, las características morfológicas de la cuenca, la sombra de relieve y la época del año. Asimismo, se utilizan los mapas de factores de fusión determinados a partir de los aportes de energía para la fusión de nieve en función de la ocupación del suelo, obtenidos a partir de trabajos previos encontrados en la literatura científica. Por otro lado, se ha implementado la calibración automática de los parámetros usados por las conceptualizaciones matemáticas propuestas, utilizando el algoritmo de optimización Shuffled Complex Evolution (SCE-UA) desarrollado por la Universidad de Arizona, EE.UU. En la evaluación de los modelos híbridos de fusión implementados, se ha propuesto utilizar tres casos de estudio que son, las subcuencas de los ríos Carson y American de Sierra Nevada, EE. UU., y la cuenca pirenaica-mediterránea de Contraix ubicada en el interior del Parque Nacional de Aigüestortes en los pirineos catalanes España. Estas son cuencas geográficamente cerradas y presentan un régimen hidrológico completamente diferente, debido a su ubicación y a su elevación media. La evaluación ha consistido en analizar tanto los resultados obtenidos con variabilidad de los factores de fusión, a través de los modelos híbridos propuestos, como los obtenidos empleando factores de fusión homogéneos con la conceptualización clásica del método grado-día. En el caso de la modelación de caudales en los puntos de control ubicados en la desembocadura y en el interior de las subcuencas de Sierra Nevada, se ha observado que el efecto que introduce la variabilidad es mínimo. Así como también lo han demostrado las altas eficiencias conseguidas con todos los modelos analizados. Sin embargo, estas eficiencias conseguidas en la modelación de los caudales, no implica la correcta modelación de la nieve, específicamente de los procesos de acumulación y fusión por parte de los modelos implementados. En vista de lo anterior, se ha evaluado el efecto de la variabilidad de los factores de fusión en la modelación de la nieve, a través de la validación puntual y espacial de los resultados obtenidos en la modelación de las subcuencas de Sierra Nevada. Para esto, se utiliza información de las estaciones meteorológicas SNOTEL, de pértigas y de imágenes de satélite. En este caso, los modelos analizados mostraron un comportamiento totalmente diferente en la modelación de la nieve. Asimismo, se observa que el modelo híbrido que introduce la variabilidad, usando los mapas de índices de radiación, es el que mejores resultados proporciona en las validaciones realizadas. La evaluación de los modelos implementados también se ha realizado comparando los resultados analizados anteriormente con los obtenidos para estas mismas subcuencas por otros modelos hidrológicos que han participado en el Distributed Hydrologic Model Intercomparison Project-Phase 2 (DMIP2). Algunos de estos modelos emplean el balance de energía en la modelación de la nieve. En general, los resultados de esta comparación mostraron eficiencias de los modelos propuestos en esta tesis, muy similares a las conseguidas por los modelos del DMIP2 e incluso, en el caso de la modelación de la nieve, se superan las eficiencias de algunos de los modelos del DMIP2. En la última parte de esta tesis se evalúan dos de los modelos implementados utilizando la cuenca de Contraix, con una escala espacial de mayor precisión y una escala temporal de media hora. Estos modelos se han seleccionado en función de los resultados obtenidos en las subcuencas de Sierra Nevada y se han evaluado siguiendo el mismo procedimiento anterior. Lo anterior, con la finalidad de detectar inconsistencias en las conceptualizaciones analizadas producto del cambio de escala y validar los resultados conseguidos en las subcuencas de Sierra Nevada. Los resultados mostraron un comportamiento muy parecido con eficiencias en la modelación de los caudales nuevamente muy similares entre los modelos y con resultados en la modelación de la nieve influenciados por la variabilidad de los factores de fusión. Al igual que para las subcuencas anteriores, los mejores resultados en la cuenca de Contraix se han obtenido con el modelo híbrido que utiliza los mapas de índices de radiación. Finalmente, en esta tesis se demuestra que los resultados en la modelación de los procesos de acumulación y fusión de la nieve en cuencas de alta montaña, pueden mejorarse de manera significativa cuando se utiliza una conceptualización parsimoniosa que considere la variabilidad de los factores de fusión. Asimismo, la influencia de la variabilidad en la modelación de los caudales en la desembocadura de una cuenca, no aporta mayores ventajas que la conceptualización clásica del modelo grado-día. Es por todo ello, que en la selección del modelo a utilizar en estas zonas dependerá de la información disponible, así como el objetivo del modelo y de los resultados que se desee conseguir.Orozco Medina, I. (2014). Modelación parsimoniosa y espacialmente distribuida de los procesos de acumulación y fusión de la nieve [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/36035TESI

The Distributed Model Intercomparison Project- Phase 2: Experiment Design and Summary Results of the Western Basin Experiments

The Office of Hydrologic Development (OHD) of the U.S. National Oceanic and Atmospheric Administration's (NOAA) National Weather Service (NWS) conducted the two phases of the Distributed Model Intercomparison Project (DMIP) as cost-effective studies to guide the transition to spatially distributed hydrologic modeling for operational forecasting at NWS River Forecast Centers (RFCs). Phase 2 of the Distributed Model lntercomparison Project (DMIP 2) was formulated primarily as a mechanism to help guide the U.S. NWS as it expands its use of spatially distributed watershed models for operational river, flash flood, and water resources forecasting. The overall purpose of DMIP 2 was to test many distributed models forced by high quality operational data with a view towards meeting NWS operational forecasting needs. At the same time, DMIP 2 was formulated as an experiment that could be leveraged by the broader scientific community as a platform for the testing, evaluation, and improvement of distributed models. DMIP 2 contained experiments in two regions: in the DMIP 1 Oklahoma basins, and second, in two basins in the Sierra Nevada Mountains in the western USA. This paper presents the overview and results of the DMIP 2 experiments conducted for the two Sierra Nevada basins. Simulations from five independent groups from France, Italy, Spain and the USA were analyzed. Experiments included comparison of lumped and distributed model streamflow simulations generated with uncalibrated and calibrated parameters, and simulations of snow water equivalent (SWE) at interior locations. As in other phases of DMIP, the participant simulations were evaluated against observed hourly streamflow and SWE data and compared with simulations provided by the NWS operational lumped model. A wide range of statistical measures are used to evaluate model performance on a run-period and event basis. Differences between uncalibrated and calibrated model simulations are assessed. Results indicate that in the two study basins, no single model performed best,in all cases. In addition, no distributed model was able to consistently outperform the lumped Model benchmark. However, one or more distributed models were able to outperform the lumped model benchmark in many of the analyses. Several calibrated distributed models achieved higher correlation and lower bias than the calibrated lumped benchmark in the calibration, validation, and combined periods. Evaluating a number of specific precipitation-runoff events, one calibrated distributed model was able to perform at a level equal to or better than the calibrated lumped model benchmark in terms of event-averaged peak and runoff volume error. However, three distributed models were able to provide improved peak timing compared to the lumped benchmark. Taken together, calibrated distributed models provided specific improvements over the lumped benchmark in 24% of the model-basin pairs for peak flow, 12% of the model-basin pairs for event runoff volume, and 41% of the model-basin pairs for peak timing. Model calibration improved the performance statistics of nearly all models (lumped and distributed). Analysis of several precipitation/runoff events indicates that distributed models may more accurately model the dynamics of the rain/snow line (and resulting hydrologic conditions) compared to the lumped benchmark model. Analysis of SWE simulations shows that better results were achieved at higher elevation observation sites. Although the performance of distributed models was mixed compared to the lumped benchmark, all calibrated models performed well compared to results in the DMIP 2 Oklahoma basins in terms of run period correlation and %Bias, and event-averaged peak and runoff error. This finding is noteworthy considering that these Sierra Nevada basins have complications such as orographically-enhanced precipitation, snow accumulation and melt, rain on snow events, and highly variable topography. Looking at these findings and those from the previous DMIP experiments, it is clear that at this point in their evolution, distributed models have the potential to provide valuable information on specific flood events that could complement lumped model simulations. Published by Elsevier B.V.Smith, M.; Koren, V.; Zhang, Z.; Moreda, F.; Cui, Z.; Cosgrove, B.; Mizukami, N.... (2013). The Distributed Model Intercomparison Project- Phase 2: Experiment Design and Summary Results of the Western Basin Experiments. Journal of Hydrology. 507:300-329. doi:10.1016/j.jhydrol.2013.08.04030032950

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study (vol 46, pg 2021, 2022)

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Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition.

International audienceThe Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. Bill & Melinda Gates Foundation