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Renewable energies play an important role as a solution to the challenge of satisfying the growing global energy demand without jeopardizing the achievements in the fight against climate change. Given this panorama, different countries, including Spain, have developed policies to promote renewable energies. One of the technologies that benefit from these policies is photovoltaics. In Spain, the number of grid-connected photovoltaic installations has increased significantly in recent years. It is interesting to analyze the panorama of these facilities and identify the trends in their design criteria. In this line, in this work, the projects of 70 grid-connected photovoltaic installations distributed across Spain were analyzed. For that purpose, benchmarking techniques were applied, facilitating the systematization of information, the intercomparison of plants and the identification of trends and efficient solutions. A set of characteristic indicators of each installation was defined, and a statistical analysis of them was developed. Likewise, a tool was developed that allows the designers of this type of photovoltaic plant to compare the design parameters chosen for their installations with those of the surrounding area. Therefore, this work provides knowledge about the current panorama of photovoltaic implementation applicable to its future advance. [ABSTRACT FROM AUTHOR]

We have studied the diversity of culturable halophilic Archaea at Rambla Salada, Murcia (south-eastern Spain). We made 8 samplings at different places in this habitat during the years 2006 and 2007 and isolated a total of 49 strains, which were identified by means of phenotypic tests and the hypervariable V1-V3 region of the 16S rRNA gene sequences (around 500 bp). The ribosomal data showed that the isolates belonged to 12 genera within the Halobacteriaceae family, with Haloferax and Natrinema being the most abundant. Five strains showed less than 97% sequence identity with validly described species and may well represent new taxa. All the strains grew best with around 25% w/v salts, required high concentrations of NaCl and magnesium and produced red to pink colonies. They were facultative anaerobes with both respiratory and fermentative metabolisms. The diversity of the archaeal community was analysed with the MOTHUR package. We identified 14 OTUs at the 3% genetic distance level and found quite high diversity. Rarefaction curves of richness estimators and diversity indices demonstrated that our collection of isolates represented the archaeal community at Rambla Salada that can be isolated under the conditions used in this work. This is the first report to be published on the culturable archaea at Rambla Salada, an area of considerable ecological interest. [ABSTRACT FROM AUTHOR]

Abstract: An analysis of models for the estimation of hourly diffuse irradiation based on the interrelations between the hourly diffuse fraction kd and the hourly clearness index kt , has concluded that kt is not a sufficient variable for parametrizing the effect of clouds on diffuse irradiation. A detailed study of the dispersion recorded by this diffuse component for a specific clearness index under partly cloudy sky conditions has led to analyzing how the variability in the instantaneous clearness index influences this dispersion. The data sets correspond to 10years of hourly and instantaneous value records of global and diffuse radiation collected in Córdoba, Spain. In addition to the inclusion of the sine of solar elevation as a variable into the kd –kt correlations, this model propose the inclusion of others parameters related to the variability in the normalized clearness index within an hour and with the fluctuations presented by the time series of the instantaneous values of that index. Also presented is the implementation of an algorithm permitting both the determination of the hourly diffuse irradiation and the discrimination between the different sky conditions in those situations known by the designation partly cloudy sky. [Copyright &y& Elsevier]

On-demand pressurised irrigation networks are analysed from the point of view of energy requirements. The Fuente Palmera Irrigation District, Southern Spain, was analysed and simulated using four alternative management scenarios for several levels of water demand using a model based on the hydraulic simulator EPANET. Results showed that substantial reductions in the power requirements at the pumping station along with energy saving of up to 27% could be achieved by adopting techniques such as pressure dynamic regulation and sectoring. In order to optimise energy consumption in these types of networks, a semi-arranged demand model, where hydrants are enabled to irrigate in homogeneous groups according to their hydraulic characteristics, is proposed. [Copyright &y& Elsevier]

A methodology based on indicators was developed to study the quality of service provided in irrigation distribution networks. The indicators were divided into network descriptors and operational indicators, some calculated periodically and others in real time. The methodology has been applied to the Palos de la Frontera irrigation district (Spain) using information on flows, volumes, and pressures collected via remote metering devices linked to a central computer database. The results showed that the service provided in the district has good quality in terms of flow adequacy, distribution efficiency, and pressure and supply reliability. Problems dealing with the remote control system have been identified. Categories for the indicators have been established, studying the percentage of control points included in each and their probability of occurrence. The methodology is useful to determine the main problems in a distribution service and areas in the network which need improvement. [ABSTRACT FROM AUTHOR]

Abstract: The performance of three diffuse hourly irradiation models on tilted surfaces was evaluated by making a database of hourly global and diffuse solar irradiation on a horizontal surface, as well as global solar irradiation on a tilted surface, recorded in a solar radiation station located at Córdoba University (Spain). The method for a comparison of the performance of these models was developed from a study of the “utilizable energy” statistics, a value representing, for a specific period of time, the mean monthly radiation that exceeded a critical level of radiation. This model comparison method seemed to us to be highly suitable since it provides a way of comparing the capacity of these models to estimate, however, much energy is incident on a tilted surface above a critical radiation level. Estimated and measured values were compared using the normalized RMBE and RRMSE statistics. According to the results of the method let us verify that, of the three models evaluated, one isotropic and two anisotropic, the Reindl et al. anisotropic model was the one giving the best results. [Copyright &y& Elsevier]

A model is developed using data from an on-demand pressurized water distribution network located in sector VIII of the Genil-Cabra irrigation district of Santaella, Córdoba (southern Spain), to simulate an irrigation season and calculate the flows that circulate in the system at any given time during the irrigation day. Using the results obtained by the model, water demand frequencies can be estimated. These results are compared to those attained by Clément’s and Mavropoulos’s formulas. This procedure enables us to determine to what extent it is possible to adjust statistical distributions to the demand obtained by both models and to verify if the hypotheses upon which these models are based are, in fact, fulfilled. Moreover, we are able to study which periods are the most appropriate for determining peak demand. Our results show that the statistical methods slightly underestimate demand because demand tends to be concentrated at two peak times during the day: one at mid-morning and another in the late afternoon. Nonetheless, the design flow obtained by the models is valid for designing the system. After studying the demand frequencies, we concluded that a better fit is achieved when a more flexible distribution such as the gamma distribution is used. [ABSTRACT FROM AUTHOR]

A regulating reservoir between the water supply source and the delivery system buffers the system from fluctuating demands. In addition, the system can reduce energy costs, by storing water pumped during off-peak energy tariff times and by improving the operation of pumping stations. A model is proposed to determine a regulating reservoir's capacity and establish an annual pumping schedule that accounts for energy costs. The optimal reservoir size and operation minimize the sum of the amortized reservoir construction and annual pumping costs (annual total cost). The solution was determined using a dichotomic searching procedure that includes one algorithm to calculate the optimal reservoir dimensions using Newton's method and another algorithm to determine the optimal annual pumping to the reservoir based on the concept of ‘emptying period’. The model was applied to a pressurized irrigation delivery system located in southern Spain. The analysis used historical hourly water demand data. A cluster analysis was used to screen non-typical demand data from the data set before extracting a typical temporal demand pattern. The analysis indicated that the addition of a regulating reservoir with optimal size and operation scheme was cost effective. Total costs can be further reduced by adjusting the demand pattern to better match with off-peak energy tariff times. [ABSTRACT FROM AUTHOR]

Time should be considered in carrying out the design and management of demand irrigation distribution systems. In this paper, a method to characterize the pumping flow in demand pressurized systems throughout the day and irrigation season is presented. This method considers the temporal evolution of water requirements during the irrigation season and water demand concentration in certain periods of the irrigation day due to different electrical energy charges. The model was established based on data from an actual water distribution network of an irrigation district in southern Spain. The results differed significantly from those obtained using approaches based on establishing a uniform working probability for the outlets of the water distribution network at all hours of the irrigation day, which underestimated the circulating flows or system capacity. The most probable pumping flow with uniform probability was 3.1 m3/s, a smaller value than those obtained in the off-peak and average energy tariff times (4 and 3.4 m3/s, respectively). The total energy head required at the booster pumping in each period of the irrigation season was simulated. 10,000 randomly chosen scenarios were simulated for each irrigation day and each energy tariff time. The heterogeneous vertical stratification between 50 and 103 m of the required piezometric head was obtained as a function of the demanded flow for the water distribution system. This paper includes a pump selection algorithm for recommending least cost or optimum pump combinations in the distribution network and to evaluate the system’s energy cost. The pump recommendations show that the optimal solution could have saved 41% of the pumping cost of the Fuente Palmera irrigation district. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic kidney disease (CKD) is a progressive condition affecting metabolic pathways and physiological mechanisms. In Spain, CKD prevalence has risen, increasing patients requiring renal replacement therapy (RRT). Managing nutritional status in advanced CKD (ACKD) patients is crucial as it influences disease progression and quality of life. This study aims to describe the nutritional status of predialysis patients at University Hospital Reina Sofia, Cordoba, Spain, and develop a quick and easy model for estimating body fat percentage without bioimpedance., Methods and Results: This cross-sectional study, conducted from February to May 2023, involved 106 patients from the ACKD consultation at the University Hospital Reina Sofia. Inclusion criteria were stage 3 or 4 CKD patients who consented to participate. Data included demographic and anthropometric variables, with body composition assessed using a Tanita BC-545N bioimpedance analyzer. The sample included 32 females (30.5%) and 73 males (69.5%), with an average BMI of 30.31 (SD 5.48). Significant findings were higher body fat percentage in women (37.82%) than men (27.86%; P < 0.001) and notable differences in waist circumference and waist-to-hip ratio between sexes. Multiple linear regression showed waist circumference, height, and sex as significant predictors of body fat percentage, with an intraclass correlation coefficient of 0.71 (95% CI = 0.59-0.79)., Conclusion: Accurately assessing body composition in CKD patients is crucial as traditional measures like BMI may not capture health risks effectively. The developed model offers a practical alternative to bioimpedance for estimating body fat percentage, potentially improving CKD management and patient outcomes. Further validation in diverse populations and integration with lifestyle interventions is needed., Competing Interests: Declaration of competing interest The authors declare that there are no conflicts of interest regarding the publication of this manuscript. The research was conducted independently, without any commercial or financial relationships that could be construed as a potential conflict of interest. All sources of funding for this study have been properly acknowledged, and no author has any financial or personal interest in the entities or organizations that may have been affected by the conclusions of this research., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The evidence for the health benefits of physical activity is growing; however, the prevalence of unhealthy lifestyles continues to contribute to the increase in chronic non-communicable diseases. We know that occupational-time physical activity does not provide the same benefits as leisure-time physical activity, which has been shown to reduce mortality and pain. We also know that multiple factors influence pain; however, there are no studies that specifically analyze the impact of type of working time and occupational-time physical activity on the impairment of daily activities due to pain. We aimed to study the influence of both personal and occupational factors on the impairment of daily activities due to pain, assessing whether leisure-time physical activity acts as a protective factor. Methods : A cross-sectional, population-based design was used based on the 2017 National Health Survey in Spain (ENSE). Sociodemographic, leisure-time physical activity, and work-related variables were collected. The outcome variable was the impairment of daily activities due to pain. Ordinal logistic regression was applied, and the analysis was complemented with simple correspondence analysis. Results : A total of 1,441 workers between 18 and 65 years of age were studied. Significant differences were found between sexes for all variables except age and leisure-time physical activity. Logistic regression revealed significant associations between sex, primary and secondary education levels, no leisure-time physical activity, and overweight with impairment of daily activities due to pain. Simple correspondence analysis showed that the categories doing leisure-time physical activity several times a week as well as several times a month are closer to the categories of little or no pain. Conclusion : Female gender, low educational level, overweight, and lack of leisure-time physical activity were associated with increases in impairment of daily activities due to pain. Occupational-time physical activity and work shift were not related to impairment of daily activities due to pain. Implications for Occupational Health Practice : Occupational Health Nursing interventions through education and counseling on the importance of leisure-time physical activity promotion programs potentially can reduce the impairment of daily activities due to pain in working populations., Competing Interests: Conflict of InterestThe author(s) declared no potential conflicts of interest concerning the research, authorship, and/or publication of this article.

Objectives: RECALSEEN project aims to analyze the structure, activity, and outcomes of the departments of endocrinology and nutrition (S-U&#95;EyN) of the Spanish National Health System (SNHS). Based on the results obtained, the challenges for the specialty are analyzed and proposals for improvement policies are made. In this paper 2021 survey data and activity data from the 2007-2019 from the Minimum Basic Data Set (MBDS) are presented., Material and Methods: Cross-sectional descriptive study of the S-U&#95;EyN of acute general hospitals of the NHS in 2020. Data were obtained through: 1. an "ad hoc" survey answered by the S-U&#95;EyN' consultants; and 2. analysing the acute general hospital discharges from S-U&#95;EyN and discharges with endocrine-metabolic comorbidities registered in the minimum basis data set (MBDS) of the SNHS., Results: 112 responses from S-U&#95;EyN were obtained from a total of 154 general acute hospitals of the NHS (73%). The 2021 S-U&#95;EyN sample includes 24 more centers than in 2017. 54% of the S-U&#95;EyN were endocrinology departments. The median number of endocrinologists per S-U&#95;EyN was 7. The estimated rate of endocrinologists was 2.5 per 100,000 inhabitants. S-U&#95;EyN showed a high level of collaboration with primary care teams and other hospital units. Use of telemedicine by S-U&#95;EyN experienced a high increase in 2020. Notable differences in resources and activity have been found between hospitals and Autonomous Communities. There was a wide margin for improvement in quality management., Conclusions: RECALSEEN is a useful project for the analysis of S-U&#95;EyN. The remarkable variability found in the indicators of structure, activity and management probably indicates a wide margin for improvement., (Copyright © 2023 SEEN and SED. Published by Elsevier España, S.L.U. All rights reserved.)

Recent advances in molecular profiling, have reclassified medulloblastoma, an undifferentiated tumor of the posterior fossa, in at least four diseases, each one with differences in prognosis, epidemiology and sensibility to different treatments. The recommended management of a lesion with radiological characteristics suggestive of MB includes maximum safe resection followed by a post-surgical MR < 48 h, LCR cytology and MR of the neuroaxis. Prognostic factors, such as presence of a residual tumor volume > 1.5 cm 2 , presence of micro- or macroscopic dissemination, and age > 3 years as well as pathological (presence of anaplastic or large cell features) and molecular findings (group, 4, 3 or p53 SHH mutated subgroup) determine the risk of relapse and should guide adjuvant management. Although there is evidence that both high-risk patients and to a lesser degree, standard-risk patients benefit from adjuvant craneoespinal radiation followed by consolidation chemotherapy, tolerability is a concern in adult patients, leading invariably to dose reductions. Treatment after relapse is to be considered palliative and inclusion on clinical trials, focusing on the molecular alterations that define each subgroup, should be encouraged. Selected patients can benefit from surgical rescue or targeted radiation or high-dose chemotherapy followed by autologous self-transplant. Even in patients that are cured by chemorradiation presence of significant sequelae is common and patients must undergo lifelong follow-up.

Objective: To propose malnutrition screening methods for the elderly population using predictive multivariate models. Due to the greater risk of nutrition deficiencies in ageing populations, nutritional assessment of the elderly is necessary in primary health care., Design: This was a cross-sectional study. Multivariate models were obtained by means of discriminant analysis and binary logistic regression. The diagnostic accuracy of each multivariate model was determined and compared with the Chang method based on receiver operating characteristic curves. The optimal cut-point, sensitivity, specificity and Youden index were estimated for each of the models., Setting: The province of Cordoba, Spain., Participants: Two hundred fifty-five patients over the age of 65 years from three health centres and three nursing homes., Results: Fourteen models for predicting risk of malnutrition were obtained, six by discriminant multivariate analysis and eight by binary logistic regression. Sensitivity ranged from 55·6 to 93·1 % and specificity from 64·9 to 94 %. The maximum and minimum Youden indexes were 0·77 and 0·49, respectively. We finally selected a model which does not require a blood test., Conclusions: The proposed models simplify nutritional assessment in the elderly and, except for number 2 of those calculated by binary logistic regression, have better diagnostic accuracy than the Spanish version of the Mini Nutritional Assessment screening tool. The selected model, whose validation is necessary for the future with other different samples, provides good diagnostic accuracy, and it can be performed by non-medical personnel, making it an accessible, easy and rapid tool in daily clinical practice.

The aim was to find out if there are any such differences due to gender in a cohort of workers followed for ten years, comparing their lifestyles and following the evolution of the main cardiovascular risk factors (CVRF) and their impact on cardiovascular risk. An observational longitudinal study of 698 civil servants workers (186 women and 512 men) of a local government office from Córdoba (Spain), was conducted over the period 2003-2014. We compared the initial and final prevalence of physical activity, smoking, obesity, hypertension, metabolic syndrome and diabetes. Cardiovascular risk was also assessed using the REGICOR (Registre Gironí del Cor) and SCORE (Systematic Coronary Risk Evaluation) equations. There was a greater rise in the prevalence of hypertension and hypercholesterolemia in the cohort in women than in men (94.2% vs. 38% and 92% vs 21.1%), while the reduction in smoking also differed by gender (26.4% vs. 36.5%). It could be that since women present a lower cardiovascular risk profile, they are treated less or less effort is made to keep the risk factors low, resulting in a worse evolution of smoking, hypercholesterolemia and hypertension in women.

Background: The link between the dietary pattern known as the Mediterranean diet (MedDiet) and lower morbidity/mortality is well known, and its efficacy in the primary prevention of cardiovascular diseases has been proven in recent years. However, adherence to the MedDiet seems to be related to socioeconomic status. The objective was to analyze whether their adherence to the MedDiet differs from the rest of the working population. Material and methods: A transversal study was carried out on adherence to the MedDiet. One thousand six hundred nine workers were studied, of whom 626 belonged to the group of workers at risk of social exclusion. Results: It was found that 43.9% of the permanent staff had a high adherence, compared to the figure of 20.9% for the population at risk of exclusion ( p  < .01). No differences were evident between men and women in the same category of workers (41.7% vs. 47.9% in permanent staff and 22.5% vs. 40.5% in workers at risk of social exclusion). The lowest adherence to the MedDiet (11.4%) was found in the group of young women at risk of social exclusion. Their consumption of healthy foods was significantly lower than the group of older women, while their consumption of less healthy foods (cakes/pastries, butter and fizzy drinks) was higher. Conclusions: It is difficult to draw conclusions about whether it is the most expensive foods contained in the MedDiet which cause this difference in adherence, since, there is also a higher expenditure on non-essential products such as cakes/pastries, fizzy drinks and tobacco. Key messagesPeople at risk of social exclusion and specially the younger women have a lower adherence to the Mediterranean diet than other occupational social classes.The higher consumption of butter, fizzy drinks and cakes/pastries is the dietary habit which most affects adherence to the Mediterranean diet in the group of people at risk of exclusion.It is not possible to ensure that the higher cost of any foods included in the Mediterranean diet, such as fish and fruit, is the main cause of this difference in adherence.

Antibiotic resistance is one of the biggest threats to human and animal health. Methicillin-resistant Staphylococcus spp. (MRS) and vancomycin-resistant Enterococcus spp. (VRE) are of increasing importance in hospital and/or nosocomial infections and represent a potential risk of transmission to humans from infected or colonized companion animals. Studies on the risk factors associated with colonization by multiresistant bacteria in animals are scarce. The present study aimed to estimate the prevalence and incidence of MRS and VRE in canine patients hospitalized in a veterinary hospital and to identify the risk factors for its acquisition and persistence. Nasal and perianal swabs were obtained from 72 dogs. Antimicrobial susceptibility assays and molecular detection of mecA and van genes were performed. A prevalence of 13.9% and incidence of 26.5% was observed in dogs colonized by MRS at hospital admission and release, respectively, higher values than those described in most veterinary studies. Thirty-five Staphylococcus isolates had mecA gene and showed higher resistance levels to most of the antimicrobials evaluated. Previous and concomitant use of antibiotics and corticosteroids has been associated with an increase in MRS colonization. The use of antibiotics in other animals living with the canine patients has also been identified as an associated factor, suggesting cross transmission. The presence of van-resistant genes from Enterococcus spp. was not detected. Pets should be considered possible vehicles of transmission and reservoirs for MRS bacteria and veterinary hospitals should be considered high-risk environments for the occurrence and spread of nosocomial infections and resistant bacteria., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aim: To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom., Methodology: The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it., Findings: Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care… for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But… is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be., Conclusion: The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness., 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.)

Objective: Metabolic syndrome (MetS) has become a worldwide epidemy as the result of a high prevalence of obesity and a sedentary lifestyle. This study was aimed to determine the predictive capacity of some anthropometric indexes on the metabolic syndrome MetS., Methods: A cross-sectional study was carried out in 636 workers with an overall prevalence of MetS of 14.3%. Receiver Operating Characteristic curves have been carried out to determine the cut-off values. Diagnostic accuracy was determined from the sensitivity and specificity, predictive values, validity index, and Youden index., Results: Waist-to-Height Ratio (WHtR) and Body Round Index (BRI) were the variables with the highest area under the curve (AUC) both with 0.89 CI 95% (0.858-0.927), followed by Waist Circumference with 0.87 CI 95% (0.83-0.909). The most outstanding cut-off values were: WtHR (0.54), with a sensitivity of 90.1% and a specificity of 76.1% and BRI (4.15) achieved a sensitivity and specificity of 90.1% and 76.1%, respectively., Conclusions: WHtR and BRI are the anthropometric indicators that best discriminate the incidence and prevalence of MetS on the working population. In addition, they show a significant discriminatory capability of abdominal obesity., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Outpatient parenteral antibiotic treatment (OPAT) has proven efficacious for treating infective endocarditis (IE). However, the 2001 Infectious Diseases Society of America (IDSA) criteria for OPAT in IE are very restrictive. We aimed to compare the outcomes of OPAT with those of hospital-based antibiotic treatment (HBAT)., Methods: Retrospective analysis of data from a multicenter, prospective cohort study of 2000 consecutive IE patients in 25 Spanish hospitals (2008-2012) was performed., Results: A total of 429 patients (21.5%) received OPAT, and only 21.7% fulfilled IDSA criteria. Males accounted for 70.5%, median age was 68 years (interquartile range [IQR], 56-76), and 57% had native-valve IE. The most frequent causal microorganisms were viridans group streptococci (18.6%), Staphylococcus aureus (15.6%), and coagulase-negative staphylococci (14.5%). Median length of antibiotic treatment was 42 days (IQR, 32-54), and 44% of patients underwent cardiac surgery. One-year mortality was 8% (42% for HBAT; P < .001), 1.4% of patients relapsed, and 10.9% were readmitted during the first 3 months after discharge (no significant differences compared with HBAT). Charlson score (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.04-1.42; P = .01) and cardiac surgery (OR, 0.24; 95% CI, .09-.63; P = .04) were associated with 1-year mortality, whereas aortic valve involvement (OR, 0.47; 95% CI, .22-.98; P = .007) was the only predictor of 1-year readmission. Failing to fulfill IDSA criteria was not a risk factor for mortality or readmission., Conclusions: OPAT provided excellent results despite the use of broader criteria than those recommended by IDSA. OPAT criteria should therefore be expanded., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality., Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk., Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality., Conclusion: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group., (Copyright © 2019. Published by Elsevier B.V.)

Aim: To validate the Mini Nutritional Assessment (MNA) in a Spanish population over 65 years of age with varying degrees of independence., Design: This cross-sectional validation study used the Chang nutritional assessment method as a reference test., Participants: 248 subjects (72.2% female), with a mean age of 81.3, completed the study. They were classified into three groups: (i) autonomous patients who were able to take part in activities outside their home; (ii) patients who require help with daily self-care; (iii) patients living in a residential health care facility., Setting: Three health centres and three residential care homes situated in Cordoba (Spain)., Results: The kappa values for intra-observer and inter-observer agreement were 0.870 and 0.784, respectively. The intra-class correlation coefficient intra-observer was 0.874 and the inter-observer was 0.789. The sensitivity and specificity readings for the diagnostic accuracy of MNA were 63.2% and 72.9% in the total sample, respectively. The area under the curve was 0.726. For patients in the Group A, B and C, the sensitivity was 89.3%, 60.7% and 18.8%, and the specificity was 23.3%, 56.8% and 94.1%, respectively., Conclusion: The results for the reliability of the survey were excellent, and its internal consistency was acceptable. The diagnostic accuracy, as measured by the sensitivity and specificity readings, was lower than that obtained with the original survey. It can therefore be considered more suitable for a population with limited autonomy, and less appropriate for independent patients. The results may not be relevant to patients outside of the Cordova region in Spain., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Cardiff Anomalous Perceptions Scale (CAPS) is a psychometric measure of hallucinatory experience. It has been widely used in English and used in initial studies in Spanish but a full validation study has not yet been published. We report a validation study of the Spanish-language CAPS, conducted in both Spain and Colombia to cover both European and Latin American Spanish. The Spanish-language version of the CAPS was produced through back translation with slight modifications made for local dialects. In Spain, 329 non-clinical participants completed the CAPS along with 40 patients with psychosis. In Colombia, 190 non-clinical participants completed the CAPS along with 21 patients with psychosis. Participants completed other psychometric scales measuring psychosis-like experience to additionally test convergent and divergent validity. The Spanish-language CAPS was found to have good internal reliability. Test-retest reliability was slightly below the cut-off, although could only be tested in the Spanish non-clinical sample. The scale showed solid construct validity and a principal components analysis broadly replicated previously reported three component factor structures for the CAPS., Competing Interests: VB is the recipient of a Wellcome Trust Seed Award in Science [200589/Z/16/Z]. JH-L has received honoraria for giving talks fromSanofi and Janssen. The other authors have declared that no competing interests exist. We would like to confirm that our declaration of interest does not alter our adherence to PLOS ONE policies on sharing data and materials.

Bladder cancer is the fourth most common cancer in men and the ninth most common in women in the Western world. The management of bladder carcinoma requires a multidisciplinary approach. Optimal treatment depends on several factors, including histology, stage, patient status, and possible comorbidities. Here we review recent findings on the treatment of muscle-invasive bladder carcinoma, advanced urothelial carcinoma, upper tract urothelial carcinoma, non-urothelial carcinoma, and urologic complications arising from the disease or treatment. In addition, we present the recommendations of the Spanish Oncology Genitourinary Group for the treatment of these diseases, based on a focused analysis of clinical management and the potential of current research, including recent findings on the potential benefit of immunotherapy. In recent years, whole-genome approaches have provided new predictive biomarkers and promising molecular targets that could lead to precision medicine in bladder cancer. Moreover, the involvement of other specialists in addition to urologists will ensure not only appropriate therapeutic decisions but also adequate follow-up for response evaluation and management of complications. It is crucial, however, to apply recent molecular findings and implement clinical guidelines as soon as possible in order to maximize therapeutic gains and improve patient prognosis.

A comparative study of the behaviour of left-sided infective endocarditis (left-sided IE) due to Streptococcus agalactiae (GBS) with left-sided IE caused by Staphylococcus aureus (SA). A prospective, multicentre cohort study in eight public hospitals in Spain, from January 1984 to December 2015; comparative analysis and factors associated with mortality. In total, there were 1754 episodes of left-sided IE; 41 (2.3%) caused by GBS vs. 344 (19.6%) due to SA, definitive IE 39 vs. 324 cases, males, 25 vs. 213, respectively. There were no differences in age or comorbidity, and healthcare-associated acquirement was 10% vs. 43%, p 0.001. Transthoracic echocardiogram (TTE) was performed in 95% vs. 96.8% and a transesophageal echocardiogram (TEE) in 61% vs. 56%. Vegetations were detected in 80% and measured > 1 cm in a similar proportion. It affected native valves in 85.4% vs. 82.6% and late prosthetic valve in 14.6% vs. 9.6%. The course was acute in both groups. There were more skin manifestations in SA left-sided IE, 7.3% vs. 32%, p 0.001. Both groups had similar complications, but in SA, there was more renal failure, 24% vs. 45%, p 0.010. Surgical risk and operated patients were similar. Mortality was proportionally higher in the SA group, without significance 29% vs. 43% (150), p 0.09. Heart failure, septic shock and neurological deterioration conditioned mortality: HR 1.96, 1.69 and 1.37 (CI 95% 1.40-2.73; 1.19-2.39 and 0.99-1.88 respectively) and to a lesser degree SA as aetiology agent and age. Left-sided IE caused by GBS is similar in severity to left-sided IE caused by SA.

Objective: To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE)., Patients and Methods: A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality., Results: A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%)., Conclusion: This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection., (Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to perform a retrospective study by genotyping 154 isolates from human listeriosis cases occurred in the region of Andalusia (southern Spain) in the period 2005-2009., Material and Methods: Serotyping was performed for 1 and 4 somatic antigens using commercial Listeria antisera, and by multiplex-PCR serogrouping according to the method described by Doumith et al. (2004). The antimicrobial susceptibility was performed by Epsilon test and interpreted by CLSI criteria. PFGE was performed according to the PulseNet protocol with the ApaI enzyme. The similarity of PFGE profiles was evaluated using the Bionumerics software. The multiplex PCR protocol described by Chen and Knabel (2007) was used for the identification of isolates belonging to L. monocytogenes ECI, ECII, and ECIII epidemic clones., Results: The 154 isolates were grouped into four serotypes: 4b [94 (61%)] strains, 1/2b [30 (19%)] strains, 1/2a [27 (18%)] strains, and 1/2c [3 (2%)] strains, with 100% of susceptibility to ampicillin and cotrimoxazole. A further sixty-two ApaI distinct pulsotypes were recognized. Thirty-seven isolates (24%) showed unique ApaI pulsotypes, and the remaining 117 strains (76%) were assigned to 25 ApaI clusters (60% in clusters of more than two isolates). The EC markers were found in 62 (40.3%) of the L. monocytogenes isolates tested. The ECI marker was present in 43 (46.2%) 4b serotype isolates, ECII in 10 (10.7%) 4b serotype isolates, and ECIII in 9 (33,3%) 1/2a serotype isolates., Discussion: A large proportion of the human listeriosis cases under investigation could be grouped into molecular subtype clusters, and our cases could be related to international food-borne outbreaks., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Between March and May of 2011, a cluster of three fatal cases of meningococcal sepsis occurred in Andalusia, Spain, in a municipality with a population of around 20,000 inhabitants. The cases were in their mid-teens to early thirties and were notified to the epidemiological surveillance system of Andalusia (Sistema de Vigilancia Epidemiológica de Andalucía, SVEA) during a 68-day period from March through May 2011. All three were infected with the same strain of Neisseria meningitidis serogroup C genosubtype VR1:5-1;VR2:10-8. None of the cases had been previously vaccinated against N. meningitidis serogroup C. Antibiotic post-exposure chemoprophylaxis was administered to close contacts of every diagnosed case. Once the cluster was confirmed, the local population was informed through the media about the control measures taken by the health authorities. The vaccination history against N. meningitidis serogroup C of the population under 25 years-old in the municipality was checked. Vaccination was offered to unimmunised individuals younger than 25 years of age and an additional dose of vaccine was offered to those who had been vaccinated between 2000 and 2006 with a vaccination schedule of three doses before the first year of age. No further cases occurred since the beginning of these actions.

Introduction: The aim of this study is to describe the epidemiological, clinical characteristics, and outcome of patients with left-side endocarditis caused by gram-negative bacteria., Method: Prospective multicenter study of left-sided infective endocarditis reported in the Andalusian Cohort for the Study of Cardiovascular Infections between 1984 and 2008., Results: Among the 961 endocarditis, 24 (2.5%) were caused by gram-negative bacilli. The most common pathogens were Escherichia coli, Pseudomonas aeruginosa and Salmonella enterica. Native valves (85.7%) were mainly affected, most of them with previous valve damage (57%). Comorbidity was greater (90% vs 39%; P=.05) than in endocarditis due to other microorganism, the most frequent being, diabetes, hepatic cirrhosis and neoplasm. A previous manipulation was found in 47.6% of the cases, and 37% were considered hospital-acquired. Renal failure (41%), central nervous system involvement (33%) and ventricular dysfunction (45%) were the most frequent complications. Five cases (21%) required cardiac surgery, mostly due to ventricular dysfunction. More than 50% of cases were treated with aminoglycosides, but this did not lead to a better outcome or prognosis. Mortality (10 patients) was higher than that reported with other microorganisms (41% vs 35%; P=.05)., Conclusions: Left-sided endocarditis due to gram-negative bacilli is a rare disease, which affects patients with major morbidities and often with a previous history of hospital manipulations. Cardiac, neurological and renal complications are frequent and associated with a high mortality. The association of aminoglycosides in the antimicrobial treatment did not involve a better outcome or prognosis., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Background: Our aims were to develop a Spanish version of the short portable mental status questionnaire (SPMSQ) (Pfeiffer's test) and to validate the resultant Spanish version of the test among a general population aged 65 years or older., Patients, Material and Methods: First, we developed the Spanish version of the SPMSQ by means of a cross-cultural adaptation methodology. Patients were the assessed by independent teams in two sessions the same day. The first team (two trained psychiatrists and one trained family physician) carried out a standardised neuropsychological assessment to diagnose cognitive impairment/dementia according to ICD-10 criteria which was regarded as the reference "gold standard" to calculate validity parameters (sensitivity and specificity). The second team (family physicians/nurses) assessed the presence of cognitive impairment with the Spanish version of the SPMSQ., Results: 255 subjects (66.7%, females) underwent the assessment. Mean age was 74.5 years and 65.5% of them were illiterate. The inter-rater reliability and test-retest reliability of the SPMSQ Spanish version were 0.738 (p < 0.001), and 0.925 (p < 0.001), respectively,with a convergent validity of 0.74 (p < 0.001) and a discriminant validity of 0.230 (p < 0.001). The internal consistency was high with an *value of 0.82. The area under the ROC curve was 0.89. Sensitivity and specificity were 85.7 and 79.3, respectively (cut-off of 3 or more)., Conclusions: The Spanish version of the SPMSQ test has a good reliability and validity. For clinical use, a cut-off of 3 appears to be most useful. When illiterate patients are assessed, the it is recommended to employ a cut-off of 4 or more.

Background: The objective of the study is to assess the degree of ambulatory use of prophylactic antithrombotic therapy in patients with chronic atrial fibrillation (CAF) in a county health area., Patients and Methods: A cross-sectional, prospective survey carried out in patients admitted at a community-hospital, detected 44 patients with CAF., Results: The inappropriateness of anti-thrombotic therapy (48%) was associated with no having a previous echocardiography (p < 0.004), not being controlled in a hospital (p < 0.02) and in patients without information on the cardioembolic risks (p < 0.0007)., Conclusions: The antithrombotic prophylaxis is scarcely used in patients affected by CAF in the county health area studied.

A prospective, multicenter study was carried out over a period of 10 months. All patients with clinically significant bacteremia caused by Enterococcus spp. were included. The epidemiological, microbiological, clinical, and prognostic features and the relationship of these features to the presence of high-level resistance to gentamicin (HLRG) were studied. Ninety-three patients with enterococcal bacteremia were included, and 31 of these cases were caused by HLRG (33%). The multivariate analysis selected chronic renal failure, intensive care unit stay, previous use of antimicrobial agents, and Enterococcus faecalis species as the independent risk factors that influenced the development of HLRG. The strains with HLRG showed lower levels of susceptibility to penicillin and ciprofloxacin. Clinical features (except for chronic renal failure) were similar in both groups of patients. HLRG did not influence the prognosis for patients with enterococcal bacteremia in terms of either the crude mortality rate (29% for patients with bacteremia caused by enterococci with HLRG and 28% for patients not infected with strains with HLRG) or the hospital stay after the acquisition of enterococcal bacteremia. Hemodynamic compromise, inappropriate antimicrobial therapy, and mechanical ventilation were revealed in the multivariate analysis to be the independent risk factors for mortality. Prolonged hospitalization was associated with the nosocomial acquisition of bacteremia and polymicrobial infections.