El abastecimiento con agua subterránea a la Colonia Clunia Sulpicia (Hispania Citerior Tarraconensis).

Hace 20 siglos, una autoridad romana fundó una ciudad en lo alto de un cerro testigo donde el hallazgo, por habilidad o casualidad, de un pequeño acuífero permitió el abastecimiento de agua. En época romana se perforaron pozos, de los que diecinueve llegaron a una cavidad natural. También se abrió una galería horizontal, para captar agua, y un drenaje en el teatro para eliminar aguas que molestaban. En algún momento, por razones naturales o artificiales, el nivel freático bajó y varios pozos se secaron, obligando al descenso de trabajadores y otras personas. Además de hacer obras complementarias dejaron abundantes grafitis y varias figuritas en barro en la cueva. La ciudad no sobrevive a la Edad Media, los pozos son cegados y las ruinas sufren un proceso de expolio por las localidades vecinas. Recuperada su memoria en el siglo XVIII, en 1908 se redescubre cueva Román, una antigua galería de captación que da acceso a la cueva natural. Esta es explorada y topografiada por el grupo Espeleológico Ribereño desde 1980. A partir de 2013, el Grupo de Tecnologías en Entornos hostiles, de la Universidad de Zaragoza, realiza radiolocalizaciones sistemáticas para la apertura de un acceso directo a la cavidad. Además, se han hecho reconocimientos de inscripciones con escaneos de la cavidad y detalles específicos así como la instalación de dos estaciones de monitorización, exterior e interior, para analizar el funcionamiento hídrico del sistema y la evolución interior del contenido en CO2 del aire de la cavidad. La evolución del nivel piezométrico presenta oscilaciones relativamente importantes y se detecta un retraso de dos meses entre los momentos de fuertes lluvias y el ascenso. El contenido en CO2 presenta una doble periodicidad, anual y diaria. Twenty centuries ago, a Roman authority founded a city on top of an inselberg where the discovery, by skill or chance, of a small aquifer which allowed access to a water supply for the city. In Roman times wells were drilled, of which nineteen reached a natural cavity. A horizontal gallery for water supply was also opened up, and a drainage conduct in the theatre was made to eliminate storm water. At some point, for natural or artificial reasons, the water table dropped and several wells dried up, forcing the descent of workers and other people to do additional work and to carve abundant graffiti and several clay figurines. The city did not survive the Middle Ages, the wells became cesspits and the ruins were plundered by neighbouring villages. It recovered its memory in the eighteenth century, in 1908 a Roman cave was rediscovered, the old water supply gallery, which gives access to the natural cave. This has been explored and surveyed by the Grupo Espeleológico Ribereño since 1980. From 2013, the Grupo de Technologías in Entornos Hostiles (University of Zaragoza) has carried out systematic radiolocation for the opening up of a direct access to the cavity. In addition, recognition of inscriptions with cavity scans and specific details have been made as well as the installation of two monitoring stations, both inside and outside the cavity to analyze the water performance of the system and the internal evolution of the CO2 content of the air in the cavity. The evolution of the piezometric level presents relatively important oscillations and a delay of two months is detected between the moments of heavy rains and the increase of water levels in the cavity. The CO2 content has a double periodicity, annual and daily

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Incidence of traumatic brain injuries in head-injured children with seizures

OnlinePublObjective Incidence and short-term outcomes of clinically important traumatic brain injury (ciTBI) in head-injured children presenting to ED with post-traumatic seizure (PTS) is not described in current literature. Methods Planned secondary analysis of a prospective observational study undertaken in 10 Australasian Paediatric Research in Emergency Department International Collaborative (PREDICT) network EDs between 2011 and 2014 of head-injured children 24 h (9 [2.7%] AR 2.5 [95% CI 0.8–4.2]) and neurosurgery (8 [2.4%] AR 2.0 [95% CI 0.4–3.7]), were higher than those without PTS. Children with PTS and GCS 15 or 14 had no neurosurgery, intubations or death, with two deaths in children with PTS and GCS ≤13. Conclusions PTS was uncommon in head-injured children presenting to the ED but associated with an increased risk of ciTBI in those with reduced GCS on arrival.Meredith L BORLAND, Stuart R DALZIEL, Natalie PHILLIPS, Sarah DALTON, Mark D LYTTLE, Silvia BRESSAN, Ed OAKLEY, Amit KOCHAR, Jeremy FURYK, John A CHEEK, Jocelyn NEUTZE, Nitaa EAPEN, Stephen JC HEARPS, Vanessa C RAUSA, and Franz E BABL, on behalf of the Paediatric Research in Emergency Department International Collaborative, PREDICT, grou

At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods

By September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients. © The Author(s) 2024