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A control-oriented quality modeling approach is proposed for sewer networks, which can represent quality dynamics using simple equations in order to optimize pollution load from combined sewer overflows in large scale sewer network in real time. Total suspended solid has been selected as the quality indicator, regarding it is easy to be estimated through measuring turbidity and correlated with other quality indicators. The model equations are independent for different elements in sewer network, which allows a scalable usage. In order to ensure accuracy of the proposed models, a calibration procedure and a sensitivity analysis have been presented using data generated by virtual reality simulation. Afterwards, a quality-based model predictive control has been developed based on the proposed models. To validate effectiveness and efficiency of the modelling and optimization approaches, a pilot case, based on the Badalona sewer network in Spain is used. Application results under different scenarios show that the control-oriented modelling approach works properly to cope with quality dynamics in sewers. The quality-based optimization approach can provide strategies in reducing pollution loads in real time., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

An integrated pollution-based real-time control (RTC) approach is proposed for a sewer network (SN) integrated with wastewater treatment plants (WWTPs) in a sanitation system (SS) to mitigate the impacts of pollution from combined sewer overflows (CSOs) on ecosystems. To obtain the optimal solution for the SS while considering both quantity and quality dynamics for multiple objectives, model predictive control (MPC) is selected as the optimal control method. To integrate SN and WWTP management, a feedback coordination algorithm is developed. A closed-loop virtual-reality simulator is used to assess the results of the optimal management approach achieved by applying MPC. The Badalona SS (Spain) provides a pilot case study to assess the efficacy and applicability of the proposed approach. A comparison with local rule-based and volume-based control strategies currently in use indicates that the proposed integrated pollution-based RTC approach can reduce the pollutant loads released to the receiving environment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

This article discusses basic features of nutritional support in critically-ill patients: general indications, the route of administration and the optimal timing for the introduction of feeding. Although these features form the bedrock of nutritional support, most of the questions related to these issues are lacking answers based on the highest grade of evidence. Moreover, prospective randomized trials that might elucidate some o f these questions would probably be incompatible with good clinical practice. Nevertheless, nutritional support in critically-ill patients unable to voluntarily meet their own nutritional requirements is currently an unquestionable part of their treatment and care and is essential to the successful management of their illness., (Copyright © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. All rights reserved.)

An epidemiological study was carried out to investigate asymptomatic Leishmania infantum infection by PCR and ELISA in wild rabbits, humans and domestic dogs in southeastern Spain. Seroprevalence was 0% (0/36) in rabbits, 2% (13/657) in humans and 7% (14/208) in dogs. The prevalence of PCR-positives was 0.6% (1/162) in rabbits tested in a wide range of tissue samples, 2% (8/392) in humans analysed in blood samples and 10% (20/193) and 67% (29/43) in dogs analysed in blood and lymphoid tissue samples, respectively. Results suggest that wild rabbits have a very low risk of becoming chronically infected with L. infantum, and provide further evidence that cryptic L. infantum infection is widespread in the domestic dog population and is also present in a comparatively smaller proportion of healthy humans. The epidemiological and clinical implications of these findings are discussed., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Introduction and Objective: The progressive increase in the demand of urological attendance demands to establish new welfare models that avoid the saturation of consultations and improve the quality in the attention to the user. The objective of this work is to analyze the improvement of the welfare activity developed in Integral the Sanitary Center Alto Palancia, after the restoration of new welfare models based on integration between Attention Primary and Specialized and the putting in practice of the denominated Unique Consultation., Material and Methods: We analyzed the characteristics of the Center, functions and activity of the specialty developed during year 2002. We described to the application of the model of Unique Consultation and the elements of integration with Primary Attention. We analyzed the improvement of the activity through indicators, that we compared with preceding years. In order to determine the degree of satisfaction of the users we made a survey of opinion of patients and/or taken care of relatives in the Center under the new welfare models. Finally we analyzed the advantages that the applied process presents for the patient and the own sanitary institution., Results: 42% of patients have been taken care of by means of the model of Unique Consultation, being the predominant pathology the HBP in the man and the ITUs in the woman. The time of delay for first visit has been reduced from 49 days in single December 2001 to 3 in December 2002. Single 7.7% of patients discharged from the hospital for pursuit by Primary Attention have been sent again to the specialist. The time that the urólogo dedicates to consultations has reduced in a 29%, being this time dedicated to the accomplishment smaller surgery and final reconnaissances (echography, urodynamic studies and others). The opinion survey has shown a satisfaction of the user very elevated., Conclusion: The model of Integral Attention Primary-Specialized and the putting in practice of Unique Consultation applicable to the specialty of Urology, increasing the quality perceived by the user and with evident advantages for the Sanitary Organization.

Introduction and Objectives: Non-transitional cell tumours of the bladder are both a diagnostic challenge for the pathologist and a therapeutic challenge for the urologist, because although uncommon (less than 5% of all malignancies of the bladder) they show different biological behaviours each requiring a unique approach. The most significant pathoanatomical types are: primary epidermoid carcinoma, primary adenocarcinoma and primary sarcoma. This paper presents an analysis of our experience in these types of tumours., Material and Methods: A retrospective study of unusual cases of cancer of the bladder seen in our hospital between 1988-2001. Their biological behaviour and the therapies applied are analysed. The extravesical origin of the tumour was ruled out in all cases., Results: We found 21 cases of the following pathoanatomical varieties: 13 epidermoid carcinomas, 7 adenocarcinomas (3 urachal) and 1 sarcoma. Mean age was very different between epidermoid carcinomas (69.2 +/- 9.1 years) and adenocarcinomas (50.3 +/- 8.1). Tumour behaviour was very aggressive in all three histological varieties. At the time of diagnosis 19 patients had locally advanced stages (> or = T2). Although elective therapy was cystectomy, this was only feasible in 10 cases. Systemic chemotherapy (most frequently M-VAC) and/or local radiotherapy was used in 7 cases. 14 patients have died after a mean survival of 15.7 +/- 11.6 months., Conclusions: Late diagnosis of these tumours and their aggressive biological behaviour involve a gloomy prognosis. Only early diagnosis and radical therapy could improve the prognosis.

Background and Aim of the Study: Clinical experience with the Omnicarbon mechanical valve implanted in the aortic position is reported in this retrospective survey., Methods: A total of 110 patients (mean age 56 years) undergoing isolated aortic valve replacement with Omnicarbon mechanical prostheses at the authors' institution between November 1991 and October 2000 was included. Follow was available in 94.5% of patients (mean follow up 4 years per patient; total follow up was 415 patient-years (pt-yr))., Results: Hospital mortality was 3.6%. There were no instances of valve thrombosis or structural failure. The incidence of valve-related complications (linearized rates in events per 100 pt-yr/actuarial freedom at 9 years, in %) was: valve-related mortality 2.4+/-0.7 / 80.3+/-8.0; non-structural failure 0.7+/-0.4 / 93.8+/-4.2; thromboembolism 0.2+/-0.2 / 99.0+/-1.0; anticoagulant-related hemorrhage 0.9+/-0.5 / 93.7+/-3.3; prosthetic valve endocarditis 0.2+/-0.2 / 99.0+/-1.0; and reoperation 0.7+/-0.4 / 93.8+/-4.2., Conclusion: In the authors' experience the Omnicarbon mechanical prosthesis provides a good clinical performance for up to nine years in the aortic position.

We have analyzed a set of 27 patients diagnosed of penile cancer who have been treated in our Hospital during the last 17 years (since january 1984 to december 2000). The annual incidence was set in 1.7 patients/100,000 men/year. The average age has been 64 years (range 42-85). Patients delayed medical consulting of their lesions for 15 months (2-120). Histologic analysis found an epidermoid carcinoma in 19 patients, and verrucous carcinoma in 8. The average follow-up has been 48 months (range 2-120). As a conclusion we don't belive necessary prophylactic inguinal lymphadenectomy. Correct followup, for early detection of lymph nodes does not worsen survival and it avoids unnecessary operations with a high rate of morbidity. The prognostic factors in our patients have been the presence of lymph nodes and the degree of local extension. We lack of experience with radiotherapy and chemotherapy.

The aim of this work is to build a scale that permits the use of Pilowsky's Illness Behaviour Questionnaire (I.B.Q.), with a Spanish clinical population. To develop this scale we have used a global sample of 627 subjects (359 men and 286 women) from different hospitals and health units in the region of Murcia.