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Objectives: To obtain a gene expression signature to distinguish between septic shock and non-septic shock in postoperative patients, since patients with both conditions show similar signs and symptoms.Methods: Differentially expressed genes were selected by microarray analysis in the discovery cohort. These genes were evaluated by quantitative real time polymerase chain reactions in the validation cohort to determine their reliability and predictive capacity by receiver operating characteristic curve analysis.Results: Differentially expressed genes selected were IGHG1, IL1R2, LCN2, LTF, MMP8, and OLFM4. The multivariate regression model for gene expression presented an area under the curve value of 0.922. These genes were able to discern between both shock conditions better than other biomarkers used for diagnosis of these conditions, such as procalcitonin (0.589), C-reactive protein (0.705), or neutrophils (0.605).Conclusions: Gene expression patterns provided a robust tool to distinguish septic shock from non-septic shock postsurgical patients and shows the potential to provide an immediate and specific treatment, avoiding the unnecessary use of broad-spectrum antibiotics and the development of antimicrobial resistance, secondary infections and increase health care costs. [ABSTRACT FROM AUTHOR]

Highlights • The willingness to pay for the conservation of the Huerta of Murcia was assessed. • Provisioning services are more valued by interviewees than the regulating ones. • The behaviour of huerta under the 3 policies valued most highly is explored. • Land planning policies achieve better results for huerta conservation for 2015–2030. Abstract Traditional Mediterranean irrigated lands, such as the Huerta of Murcia (Spain), constitute characteristic agroecosystems which provide several ecosystem services, both cultural and regulating. Nevertheless, these agroecosystems are threatened by factors linked to the low profitability of agricultural production under present market conditions and the land conversion to non-agricultural uses.In order to assess the perceptions and valuation of the Huerta of Murcia by the local population, an economic valuation survey was carried out, using a contingent valuation method (CVM). Based on the survey, we identified the measures that were most valued with regard to the conservation of the huerta , which were: i) Limitation of the land uptake for urban uses; ii) Creation of programs to conserve ecosystem services, by means of financial support; and iii) Initiatives to promote the production of traditional agricultural products. Finally, we included these measures in a dynamic system model that, once validated, was used to explore the potential impact of such initiatives on the expected future behavior of the Huerta of Murcia.The CVM findings show the importance given to the huerta by the population of the area, beyond the use they usually make of it. The results also allowed the determination of the amount that the local people are willing to pay for the conservation of the environmental services of the Huerta of Murcia.Moreover, the simulation results for the period 2015-2030, obtained using the model, suggest that more direct measures, such as land planning, achieve better results than indirect options, such as those derived from agricultural policy and the implementation of a payment for ecosystem services, even when these latter aspects are combined. Under a scenario combining the three measures valued most highly, the loss of these irrigated lands would be reduced by around 11.5% in 2030, compared to the base trend simulation.Although the policies analyzed would improve the situation in the short and medium term, more ambitious actions would be required for full conservation of this agroecosystem in the long run. [ABSTRACT FROM AUTHOR]

Coastal lagoons host important values and provide irreplaceable services to society. Communication areas with the sea (gullets, ‘golas’ in Spanish) are dynamic environments with a key role in their overall functioning, often representing also strongholds of biodiversity, which increases their conservation value and social demand for nature-based activities. In 2013 the Regional Assembly of the Autonomous Community of Murcia adopted unanimously the creation of a pedestrian walkway to promote ecotourism, environmental education and research in the area of the ‘Encañizadas del Mar Menor’ (EMM, thereafter), a space between the aforementioned lagoon and the Mediterranean Sea. The agreement was conditioned upon the completion of an environmental feasibility study which was commissioned to the University of Murcia. The area affected concentrates several habitats and species of community importance listed in EU Habitat and Bird Directives, including habitat 1140 (Mudflats and sandflats not covered by seawater at low tide) and many seabird and waterbirds. Traditional fishing has not only preserved its ecological uniqueness but increased cultural value. The multi-criteria evaluation developed by a multidisciplinary team has combined the basic information available with specific models of response to the presence of the infrastructure and its use by visitors, especially regarding hydrological and sediment dynamics, and biodiversity (birds and habitats). Although constrained by the complex regulatory and administrative framework, and by the quality of the environmental information available, the design and development of this study provides a model for the evaluation of projects with strong public demand in ecologically sensitive areas of Mediterranean coastal lagoons. The assessment was made on the basis of four groups of viability criteria (socioeconomic, environmental, administrative and legal, technical), weighted by expert panels to rate the alternatives previously drafted. A specific social consultation provided information on the preferences and attitudes of actual users and the regional public on the intervention and its alternatives. A combined analysis of socioeconomic (positive) and environmental (negative) impacts was used to select the alternative that concurrently maximized social preferences and environmental integration. Although the possibility of building a footbridge was rejected, the selected alternative (peripheral boat itinerary) still had good social acceptance, was consistent with ecotourism policies and matched experiences carried out elsewhere. Additional utilities of such multidisciplinary assessments are their performance as public information and participation processes, and the possibility to use them as a basis for drafting initiatives for the valorisation or restoration of other sections of lagoon complexes. [ABSTRACT FROM AUTHOR]

Coastal lagoons count among the marine habitats with the highest biological productivity, playing an important ecological role. Together with wetlands in general and coral reefs, they are also amongst the habitats with the highest value derived from the services they provide. This work aims to assess the natural goods and services provided by the Mar Menor coastal lagoon in Murcia (Spain), as well as the environmental risks it is exposed to. This ecosystem, as many coastal lagoons throughout the world, supports a great variety of important services but the resulting pressures are also the reasons that have led to its deterioration, showing signs of impact, whether environmental, social and even economic. In 2011 the European Commission proposed a common strategy on biodiversity, in an attempt to avoid its decline, and claim it as one of the main bases for sustainable economic development. In this context, this work also looks at the socioeconomic value of this emblematic environment using the contingent valuation method (CVM). A questionnaire was developed and presented to inhabitants and visitors of the Mar Menor area, including a broad representation of professions and activities, to identify stakeholder perception of the environment and how they evaluate the importance of ecological processes for maintaining ecosystem functioning and the goods and services provided. The perception and valuation of goods and services provided by ecosystem functioning and biodiversity in the Mar Menor lagoon depended on the different groups considered (by age, professional activity, residence, educational background or sex), although in general, stakeholders, including fishermen, perceived that tourism services are the most important. Interestingly, the sectors related to construction and fishing were well aware of the risks derived from their own activities. The evaluation of services and the perception of the principal environmental risks and impacts were high for all the groups of users considered, and the indirect use and non-use value of the lagoon ecosystem conservation was established in 43,326,181 Euros/year. [ABSTRACT FROM AUTHOR]

Bisphenol A (BPA), a known endocrine disrupting chemical (EDC) that can mimic the action of oestrogens by interacting with hormone receptors, is potentially able to influence reproductive functions in vertebrates and invertebrates. The freshwater pulmonate Physa acuta is a sensitive organism to xenobiotics appropriate for aquatic toxicity testing in environmental studies. This study was conducted to explore the effects of BPA on the Gastropoda endocrine system. The effects following a range of exposure times (5–96 h) to BPA in P. acuta were evaluated at the molecular level by analysing changes in the transcriptional activity of the endocrine-related genes oestrogen receptor ( ER ), oestrogen-related receptor ( ERR ), and retinoid X receptor ( RXR ), as well as in genes involved in the stress response, such as hsp70 and hsp90 . Real-time reverse transcriptase-polymerase chain reaction (qRT-PCR) analysis showed that BPA induced a significant increase in the mRNA levels of ER , ERR , and RXR , suggesting that these receptors could be involved in similar pathways or regulation events in the endocrine disruptor activity of this chemical at the molecular level in Gastropoda. Additionally, the hsp70 expression was upregulated after 5 and 72 h of BPA exposures, but hsp90 was only upregulated after 5 h of BPA exposure. Finally, we assessed the glutathione-S-transferase (GST) activity after BPA treatment and found that it was affected after 48 h. In conclusion, these data provide, for the first time, evidences of molecular effects produced by BPA in the endocrine system of Gastropoda, supporting the potential of ER , ERR and RXR as biomarkers to analyse putative EDCs in ecotoxicological studies. Moreover, our results suggest that P. acuta is an appropriate sentinel organism to evaluate the effect of EDCs in the freshwater environment. [ABSTRACT FROM AUTHOR]

In order to reduce the production of pollutants, it is most important that landfills are adapted to the climatic conditions of the area where they are located. In this sense, there are very few studies focused on how to reduce leachates from landfills in semiarid regions, which are especially sensitive to the impacts that this type of activity potentially has on water resources. The aim of this study is to identify the best type of landfill cover that reduces leachate production in semiarid regions by means of a Cost-Effectiveness Analysis (CEA). Three types of covers are evaluated: conventional multilayer, monolithic and mixed monolithic. The evaluation of the effectiveness of each alternative has been carried out with the HELP model (Hydrologic Evaluation of Landfill Performance), which allows for the estimation of the reduction of leachates. Results show that mixed monolithic cover is the most cost-effective alternative. In contrast, monolithic cover is an even worse alternative than the status quo, so its implementation may be not recommended in semiarid regions. [ABSTRACT FROM AUTHOR]

[Display omitted] • We assess the importance of the aesthetic quality of an agricultural landscape. • Six attributes of the landscape are valued by the population. • Three groups of the population are distinguished according to their preferences. • The aesthetic quality of the landscape has been mapped. • A diversification landscape policy would increase aesthetic quality levels. Assessing ecosystem services associated with agricultural landscapes is of growing interest to the research and policy/practice communities. One particularly challenging aspect to understand is the value of the aesthetic quality of such landscapes, even though this is one of the main contributions that agricultural landscapes make to cultural ecosystem service provision. Indeed, as increasing demands are placed on agricultural landscapes for food production, infrastructure development and urbanisation, aesthetic qualities can be severely affected, particularly if those landscapes are used for traditional agricultural practices. Here we assess the aesthetic quality of an agricultural landscape by integrating social preferences heterogeneity and spatial aspects of the provision, combining subjective and objective perspectives. We work in landscapes dominated by irrigated flowering fruit trees in Cieza, in south-east Spain as it is an excellent example of a semi-arid Mediterranean agroecosystem that delivers multiple ecosystem services, including aesthetic quality, in addition to food production. Using GIS tools and a choice experiment, we assess the social utility function for this landscape, and demonstrate social preferences heterogeneity for demand for the aesthetic qualities of the landscape. Latent class modelling distinguished three populations, with the majority preferring diversified agricultural landscapes and management policies based on a more natural-looking agricultural landscape. These results provide agroecosystem managers with an additional vision focused on enhancing the combination of the most diverse and natural-looking elements in the landscape in order to underpin the delivery of cultural ecosystem services that also increase social well-being. [ABSTRACT FROM AUTHOR]

Highly modified coasts are associated to sub-optimal provision of ecosystem services, causing biodiversity losses and negative impacts on social welfare. Although ecological arguments can justify the restoration of coastal environments, technical, social and economic issues often pose complex obstacles to implement efficient restorations. Indeed, there is a lack of socioeconomic assessments in both academic literature and policy decision-making showing whether the restoration of highly modified coasts are socially acceptable and economically efficient. This paper presents the case of the Portmán Bay (SE Spain), described as the most polluted coastal area by mining activities in the entire Mediterranean region. The question on how to restore the bay has been under debate for decades and there is not social and political consensus about its restoration yet. Our results suggest that, in terms of social preferences and net benefits, the preferred alternative would be to recover the coast and improve habitat continuity between the bay and other adjacent natural areas. Development of other economic activities incompatible with natural conservation could only compensate social welfare losses by increasing public taxation on private sector. Our results confirm that, once social preferences are taken into account, the restoration of heavily modified coastal ecosystems can be economically efficient even though it implies significant technical constraints and high public expenditures. [Display omitted] • Cost-benefit analysis of a highly modified coastal ecosystem restoration is carried out. • The Portmán Bay is the most polluted coast by mining in the Mediterranean region. • Public is willing to contribute for restoring ecosystems that are gradually scarcer. • The restoration of heavily modified coastal ecosystems can be socially profitable. • Improving habitat continuity is preferred to private port and tourism development. [ABSTRACT FROM AUTHOR]

Triclosan (TCS) is an antibacterial agent widely used in personal care and consumer products and commonly detected in aquatic ecosystems. In the present study, the effects of TCS on endocrine-related genes of Chironomus riparius aquatic larvae, a reference organism in aquatic toxicology, were evaluated. Twenty-four-hour in vivo exposures at 10 µg/L, 100 µg/L, and 1000 µg/L TCS revealed that this xenobiotic was able to alter the transcriptional activity of ecdysone receptor gene ( EcR ), the ultraspiracle gene ( usp ), the estrogen-related receptor gene ( ERR ), and the E74 early ecdysone-inducible gene, as measured by real-time RT-PCR. Moreover, the hsp70 gene, a heat shock protein gene, was upregulated after exposure to TCS. The results of the present work provide the first evidence of the potential disruptive effects of TCS in endocrine-related genes suggesting a mode of action that mimics ecdysteroid hormones in insects. [ABSTRACT FROM AUTHOR]

Badlands are one of the dryland ecosystems where the absence of the regulating ecosystem service (ES) of erosion control enables the provision of cultural ESs, which include, among others, a singular landscape. The lack of consideration of the social value of these areas, due to their low productive value and low biodiversity, has led to their transformation and disappearance. At the same time, the scientific literature that deals with social preferences for the management of these ecosystems is scarce, despite the need to manage these spaces to face the future adverse effects of climate change. This gap can be reduced by establishing a framework for the socio-economic valuation of the Badlands. Therefore, these paper aims to evaluate the social demand for the implementation of management measures to ensure Badlands protection, using as a case study the Region of Murcia Badlands (SE Spain). To this end, a survey was carried out among a representative sample of households in this region; the willingness to pay (WTP) to protect such singular ecosystems and the factors that influence their valuation were studied, especially the spatial component, analysing in detail the protest behaviour (PB). The results show a strong PB in the population (44.29 % of the sample), with a mean WTP of 15.93 €/household/year. Despite the population's preference for the promotion of regulating ESs in eroded areas in general, cultural ESs are more important in the case of Badlands, positively in terms of WTP and negatively for PB. Spatial factors were found to be of great importance in the valuation, showing the existence of local patterns. These results will help decision-makers to achieve more efficient and socially accepted spatial planning in the management of singular eroded areas. [Display omitted] • Society demands Badlands protection by promotion of cultural ecosystem services provision. • Most people have an inaccurate perception of the remoteness of their residence from Badlands. • Spatial factors and valuation of ecosystem services influence social demand. • Willingness to pay hot spots and protest behaviour cold spots exist close to the Badlands. [ABSTRACT FROM AUTHOR]

The freshwater snail Physa acuta is a sensitive organism to xenobiotics that is appropriate for toxicity testing. Cadmium (Cd) is a heavy metal with known toxic effects on several organisms, which include endocrine disruption and activation of the cellular stress responses. There is scarce genomic information on P. acuta ; hence, in this work, we identify several genes related to the hormonal system, the stress response and the detoxification system to evaluate the effects of Cd. The transcriptional activity of the endocrine-related genes o estrogen receptor ( ER ), oestrogen-related receptor ( ERR ), and retinoid X receptor ( RXR ), the heat shock proteins genes hsp70 and hsp90 and a metallothionein ( MT ) gene was analysed in P. acuta exposed to Cd. In addition, the hsp70 and hsp90 genes were also evaluated after heat shock treatment. Real-time reverse transcriptase-polymerase chain reaction (qRT-PCR) analysis showed that Cd presence induced a significant increase in the mRNA levels of ER , ERR and RXR , suggesting a putative mode of action that could explain the endocrine disruptor activity of this heavy metal at the molecular level on Gastropoda. Moreover, the hsp70 gene was upregulated after 24-h Cd treatment, but the hsp90 gene expression was not affected. In contrast, the hsp70 and hsp90 genes were strongly upregulated during heat shock response. Finally, the MT gene expression showed a non-significant variability after Cd exposure. In conclusion, this study provides, for the first time, information about the effects of Cd on the endocrine system of Gastropoda at the molecular level and offers new putative biomarker genes that could be useful in ecotoxicological studies, risk assessment and bioremediation. [ABSTRACT FROM AUTHOR]

Abstract: Although Deficit Irrigation (DI) can help farmers achieve significant water savings, its adoption is still limited. This study aims to identify the factors that affect DI adoption decisions in a water-scarce area, namely, south-eastern Spain, and to evaluate the importance of these factors. The factors were derived from the literature and personal interviews with regional irrigation water managers and other stakeholders. First, Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis was used as the overarching framework to evaluate the various technical, social–political and environmental factors influencing DI adoption in an integrative manner. Second, a two-round Delphi survey was used to validate the SWOT items. The results reveal that the strengths and opportunities of DI adoption are given more weight than its weakness and threats. The technique's capacity for water saving and the specific water scarcity context appear to be the most important reasons for DI implementation. However, knowledge and awareness levels are low across different stakeholder groups, implying a need for improved promotion of the adoption of DI through scientific knowledge transfer. Water policies that promote the adoption of DI are considered an important way forward to ensure the long-term availability and sustainable use of water in agriculture in extreme drought-prone areas. [Copyright &y& Elsevier]

Highlights: [•] Urban river rehabilitation is evaluated using a Cost-Benefit Analysis. [•] The environmental benefits are assessed by a contingent valuation. [•] Three approaches of Cost-Benefit Analysis are introduced. [•] The results of the profitability indicators are provided in probabilistic terms. [•] The inclusion of the environmental benefits in the assessment is argued. [Copyright &y& Elsevier]

Abstract: Traditionally, the benefits of erosion control projects in Mediterranean watersheds were valued by the replacement cost method (RCM). Nowadays, however, environmental economics has provided alternative methods, such as contingent valuation (CV) and others based on stated preferences, the main strength of which is their capacity to capture non-use and future use values, which are essential for the monetary valuation of erosion. This study uses CV to estimate the externalities associated with watershed restoration and erosion control projects conducted in the Aljibe Basin (Almería, Spain). Comparison shows that CV estimates of net environmental benefits are almost double those obtained using standard methods. Thus, the project meets the profitability criteria in the former case but not in the latter. In concrete terms, the Internal Rates of Return are 5.23% versus 2.25%, respectively. The above shows CV to be a useful tool for estimating the social–environmental return on investment in this kind of project. However, as the experimental phase of this study shows, CV is not without certain issues and limitations, the majority of which derive from its hypothetical nature. Moreover, being preference-based, it may be more coherent with a cost–benefit analysis approach. The RCM, on the other hand, is highly detailed in technical terms and, by using physical data, produces more objective results. The two can therefore be considered complementary rather than competing methods, since they view the valuation from different perspectives. [Copyright &y& Elsevier]

The Water Framework Directive of the European Union has become a milestone in the water policy for this area. This Directive aims to achieve a "good ecological status" of bodies of water in the Member States of the European Union by 2015. The Water Framework Directive calls for the application of economic principles, economic approaches, tools and instruments. The functions of this economic analysis include identifying methods to estimate resource and environmental costs. The purpose of this paper is to define the applications of Environmental Economics techniques in a groundwater valuation, taking the Gavilán Aquifer, located in the southeast of Spain, as a case study. This aquifer discharges support a very important wetland, with high biological, recreational and landscaping values. As this groundwater is also used for agricultural purposes, it is an ideal case to test a methodology aimed at measuring both environmental and resource costs. Two valuation techniques % Contingent Valuation Method and Production Function Approach% were applied so as to achieve this goal. The total economic value estimated for this groundwater is 0.454 €/m3, out of which 16.1% is related to environmental and recreational aspects. [ABSTRACT FROM AUTHOR]

• Understanding drivers of sustainable management is key to ensuring nature conservation. • Income and environmental commitment are the main drivers of nature conservation. • Environmental attitudes determine the willingness to pay for nature conservation. • Economic instruments should be based on preference heterogeneity. The aim of this work is to assess and understand the social drivers that determine the willingness to pay for sustainable management measures to preserve a Natura 2000 area. These social drivers of the support for nature conservation were then included in the design of economic instrument to support nature conservation. In a contingent valuation exercise, the local population in the Cabezo de la Jara and Rambla de Nogalte protected areas (SE Spain) stated their willingness to pay for sustainable management measures aimed at their conservation. Among the socio-demographics, environmental attitudes and experiential drivers, income and environmental commitment were found to be the only significant drivers in support of nature conservation, revealing preference heterogeneity. Economic instruments, specifically green taxes and user fees, are proposed, taking into account the sources of heterogeneity in order to ensure financial support for the measures and greater social acceptability. Hence, our research adds to the existing literature through the design of an economic instrument to support nature conservation, considering preference heterogeneity. [ABSTRACT FROM AUTHOR]

[Display omitted] • One hundred and seventy farmers were interviewed in a region of southeast Spain. • Farmers were asked about diffuse pollution mitigation measures and their willingness to be compensated. • The perceived and real costs of the measures are compared by cost effectiveness ratios. • The policy should take into account the differences between crops, impact of the measures and farmers' aptitude. Diffuse water pollution is a major problem in many agroecosystems, especially in irrigated areas linked to ecosystems of high ecological value. Pollution abatement policies imply the modification of agricultural measures and are usually rejected by farmers because of their impact on farm profitability. This paper aims to design an assessment procedure for an implementation programme of agricultural measures aimed at mitigating diffuse pollution, by combining relative effectiveness across measures with the perceived and real cost of the measures. Measures proposed by a law intended to mitigate diffuse pollution and thereby the degradation of the Mar Menor lagoon, a unique natural space in the southeast of Spain, have been used as a case study. The real cost was obtained from the market, and the perceived cost of the measures was obtained from a representative sample of the farmers involved. This work has allowed comparative real and perceived evaluations of the cost-effectiveness of the proposed measures to prioritise them and to reduce information bias, aimed to favours measures adoption. Results show that banning crops less than 100 m from the coast is the most cost-effective measure, followed by the adoption of a nitrate reduction system in desalinated effluent. Divergences between real and perceived cost-effectiveness indicates that good agricultural practices code adoption would require specific actions to reduce these subjective gap. Finally, increasing the acceptability of the policy would imply translating to the farmers information required to reduce the gap between real and perceived cost of the specific agricultural measures. [ABSTRACT FROM AUTHOR]

In many cities, urban pressure is deteriorating peri-urban ecosystems, despite their high capacity to provide ecosystem services. Against this pressure, restoration projects are being developed to improve the environmental conditions of peri-urban ecosystems. The aim of this work is to determine the economic value and degree of acceptability of a restoration project, the Murcia-Río project, analysing spatial effects. This dimension is incorporated when estimating the willingness to pay (WTP) for the project and when dealing with protest behaviour (PB). A survey was carried out to 401 households in Murcia city (SE-Spain) using the contingent valuation method to obtain a monetary value for the project. We identify that distance to both the project area and substitute areas explain WTP and PB. Based on these findings, we recommend that, to maximize the benefits of such actions, interventions should be targeted to areas with high accessibility and low number of substitutes. • Citizens support measures for environmental restoration enhancing ecosystem services in peri-urban areas. • There is high social acceptability for restoration projects in peri-urban riparian agroecosystems. • Travel time to the peri-urban areas and the presence of substitutes influences willingness to pay and protest behavior. • Restoration projects should be targeted to areas with high accessibility and low number of substitutes. [ABSTRACT FROM AUTHOR]

[Display omitted] • Restoration of a peri-urban degraded agroecosystem with allotment gardens provides benefits for the citizens. • Spatial effects and the importance of ES help urban planners to better understand people's preferences for allotment gardens. • The relative importance given to provisioning and cultural services is related to the allotment gardens demand. • The greatest social benefits are perceived in districts close to the new allotment gardens area and without substitutes. Allotment gardens (AGs), one of the basic types of urban gardening, provide goods and services as recreation and climate regulation to the urban population beyond food supply. Ecosystem services (ES) associated with these spaces and spatial factors, such as distances and the presence of substitutes, are of great importance. These aspects, previously studied in the literature, are rarely focused on the economic valuation, through which benefits are revealed. This paper evaluates the creation of AGs in a peri-urban degraded agroecosystem in Murcia (SE-Spain). The values of ES are quantified economically, so are the influences of the socioeconomic and spatial characteristics. A survey was undertaken, from which the willingness to pay (WTP) for owning an AG and the factors influencing the valuation were determined. The results indicate that provisioning services are the ES valued most highly. The valuation of the project for the whole population is 5.4 €/household/month, with a WTP of 17.2 €/household/month for owning an AG plot. Multivariate analysis showed the importance of ES and spatial factors in this valuation. This WTP spatial study shows the existence of local patterns to be considered in the evaluation of new AGs location alternatives. These results will be useful to urban planners in their decision making. [ABSTRACT FROM AUTHOR]

The implementation of sustainable management plans for protected areas is one of the main challenges for public institutions. These plans involve public participation and the assessment of social benefits provided by these open spaces. This work proposes the use of choice experiments methodology for the evaluation of management alternatives for a protected area. The case study within this work is El Valle and Carrascoy Natural Park, which is included in the Natura 2000 Network. This Protected Natural Area (PNA) is located in a peri-urban area; thus, it combines high natural values and high anthropic pressure. A Choice Experiment (CE) was designed through consultation with the Park managers and technicians, and it was applied to a representative sample of the population within the Region of Murcia (South-Eastern Spain). CE allowed an estimation of the value of different management alternatives, classified according to the three main sustainability areas: social; economic; and, environmental. The results show population's demand for environmental management alternatives, such as protection of flora and fauna and promotion of ecotourism, as well as a rejection of quarrying in the PNA. The economic values estimated allow the proposal of a distribution of the annual budget of the PNA according to the social demand. [ABSTRACT FROM AUTHOR]

We analyzed 136 children with tuberculosis disease or infection and a positive QuantiFERON-TB (QFT) assay, followed-up for a median of 21 months (0.4-11years). QFT reversed in 16.9% of cases, with significant decreases in TB1 (-1.72 vs . -0.03 IU/ml, p=0.001) and TB2 (-1.65 vs . -0.43 IU/ml, p=0.005) levels compared to non-reverters. We found a higher QFT reversion rate among children under 5 years (25.0% vs 11.9%, p=0.042), and those with TST induration <15mm (29% vs 13.3%, p=0.055). Our data reveal that, although QFT test remained positive in the majority of children, reversion occurred in 16% of cases in a progressive and stable pattern. Younger age and reduced TST induration were associated with QFT reversion., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Rodríguez-Molino, González Sánchez, Noguera-Julián, Soler-García, Martínez Paz, Méndez-Echevarría, Baquero-Artigao, González Muñoz, Ruíz-Serrano, Monsonís, Sánchez León, Saavedra-Lozano, Santiago-García and Sainz.)

Objective: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since the onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country., Methods: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student's t- test were used to compare epidemiological and demographic variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020)., Results: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions)., Conclusions: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution of the disease are not uniform. It starts in the center of Spain and ends on the coast.

Recent works have demonstrated a significant reduction in cholesterol levels and increased oxidative stress in patients with coronavirus disease 2019 (COVID-19). The cause of this alteration is not well known. This study aimed to comprehensively evaluate their possible association during the evolution of COVID-19. This is an observational prospective study. The primary endpoint was to analyze the association between lipid peroxidation, lipid, and inflammatory profiles in COVID-19 patients. A multivariate regression analysis was employed. The secondary endpoint included the long-term follow-up of lipid profiles. COVID-19 patients presented significantly lower values in their lipid profile (total, low, and high-density lipoprotein cholesterol) with greater oxidative stress and inflammatory response compared to the healthy controls. Lipid peroxidation was the unique oxidative parameter with a significant association with the total cholesterol (OR: 0.982; 95% CI: 0.969-0.996; p = 0.012), IL1-RA (OR: 0.999; 95% CI: 0.998-0.999; p = 0.021) IL-6 (OR: 1.062; 95% CI: 1.017-1.110; p = 0.007), IL-7 (OR: 0.653; 95% CI: 0.433-0.986; p = 0.042) and IL-17 (OR: 1.098; 95% CI: 1.010-1.193; p = 0.028). Lipid abnormalities recovered after the initial insult during long-term follow-up (IQR 514 days); however, those with high LPO levels at hospital admission had, during long-term follow-up, an atherogenic lipid profile. Our study suggests that oxidative stress in COVID-19 is associated with derangements of the lipid profile and inflammation. Survivors experienced a recovery in their lipid profiles during long-term follow-up, but those with stronger oxidative responses had an atherogenic lipid profile.

We carried out a retrospective exploratory study on 173 patients who underwent major surgery and developed septic shock after surgery. Our findings suggest that CEACAM7 rs1001578, rs10409040, and rs889365 polymorphisms could influence septic shock-related death in individuals who underwent major surgery., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2021. Published by Elsevier B.V.)

Pneumonia is the main cause of hospital admission in COVID-19 patients. We aimed to perform an extensive characterization of clinical, laboratory, and cytokine profiles in order to identify poor outcomes in COVID-19 patients., Methods: A prospective and consecutive study involving 108 COVID-19 patients was conducted between March and April 2020 at Hospital Clínico Universitario de Valladolid (Spain). Plasma samples from each patient were collected after emergency room admission. Forty-five serum cytokines were measured in duplicate, and clinical data were analyzed using SPPS version 25.0., Results: A multivariate predictive model showed high hepatocyte growth factor (HGF) plasma levels as the only cytokine related to intubation or death risk at hospital admission (OR = 7.38, 95%CI-(1.28-42.4), p = 0.025). There were no comorbidities included in the model except for the ABO blood group, in which the O blood group was associated with a 14-fold lower risk of a poor outcome. Other clinical variables were also included in the predictive model. The predictive model was internally validated by the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.94, a sensitivity of 91.7% and a specificity of 95%. The use of a bootstrapping method confirmed these results., Conclusions: A simple, robust, and quick predictive model, based on the ABO blood group, four common laboratory values, and one specific cytokine (HGF), could be used in order to predict poor outcomes in COVID-19 patients.

Background: Oxidative stress may be a key player in COVID-19 pathogenesis due to its significant role in response to infections. A defective redox balance has been related to viral pathogenesis developing a massive induction of cell death provoked by oxidative stress. The aim of this study is to perform a complete oxidative stress profile evaluation regarding antioxidant enzymes, total antioxidant capacity and oxidative cell damage in order to characterize its role in diagnosis and severity of this disease., Methods: Blood samples were obtained from 108 COVID-19 patients and 28 controls and metabolites representative of oxidative stress were assessed. The association between lipid peroxidation and 28-day intubation/death risk was evaluated by multivariable regression analysis. Probability of intubation/death to day-28 was analyzed by using Kaplan-Meier curves and tested with the log-rank test., Results: Antioxidant enzymes (Superoxide dismutase (SOD) and Catalase) and oxidative cell damage (Carbonyl and Lipid peroxidation (LPO)) levels were significantly higher in COVID-19 patients while total antioxidant capacity (ABTS and FRAP) levels were lower in these patients. The comparison of oxidative stress molecules' levels across COVID-19 severity revealed that only LPO was statistically different between mild and intubated/death COVID-19 patients. COX multivariate regression analysis identified LPO levels over the OOP (LPO>1948.17 μM) as an independent risk factor for 28-day intubation/death in COVID-19 patients [OR: 2.57; 95% CI: 1.10-5.99; p = 0.029]. Furthermore, Kaplan-Meier curve analysis revealed that COVID-19 patients showing LPO levels above 1948.17 μM were intubated or died 8.4 days earlier on average (mean survival time 15.4 vs 23.8 days) when assessing 28-day intubation/death risk (p < 0.001)., Conclusion: These findings deepen our knowledge of oxidative stress status in SARS-CoV-2 infection, supporting its important role in COVID-19. In fact, higher lipid peroxidation levels are independently associated to a higher risk of intubation or death at 28 days in COVID-19 patients., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Severe status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064-8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540-50.878), p  = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Tamayo-Velasco, Peñarrubia Ponce, Álvarez, Gonzalo-Benito, de la Fuente, Pérez-González, Rico, Jiménez García, Sánchez Rodríguez, Hijas Villaizan, Martín-Fernández, Dueñas, Gómez-Sánchez, Heredia-Rodríguez, Gorgojo-Galindo, Fernández, del Río, Carnicero-Frutos, Muñoz-Moreno, Tamayo, Bernardo and Martínez-Paz.)

Antigen tests or polymerase chain reaction (PCR) amplification are currently COVID-19 diagnostic tools. However, developing complementary diagnosis tools is mandatory. Thus, we performed a plasma cytokine array in COVID-19 patients to identify novel diagnostic biomarkers. A discovery-validation study in two independent prospective cohorts was performed. The discovery cohort included 136 COVID-19 and non-COVID-19 patients recruited consecutively from 24 March to 11 April 2020. Forty-five cytokines' quantification by the MAGPIX system (Luminex Corp., Austin, TX, USA) was performed in plasma samples. The validation cohort included 117 patients recruited consecutively from 15 to 25 April 2020 for validating results by ELISA. COVID-19 patients showed different levels of multiple cytokines compared to non-COVID-19 patients. A single chemokine, IP-10, accurately identified COVID-19 patients who required hospital admission (AUC: 0.962; 95%CI (0.933-0.992); p < 0.001)). The results were validated in an independent cohort by multivariable analysis (OR: 25.573; 95%CI (8.127-80.469); p < 0.001) and AUROC (AUC: 0.900; 95%CI (0.846-0.954); p < 0.001). Moreover, showing IP-10 plasma levels over 173.35 pg/mL identified COVID-19 with higher sensitivity (86.20%) than the first SARS-CoV-2 PCR. Our discover-validation study identified IP-10 as a robust biomarker in clinical practice for COVID-19 diagnosis at hospital. Therefore, IP-10 could be used as a complementary tool in clinical practice, especially in emergency departments.

Acute kidney injury (AKI) is a widely held concern related to a substantial burden of morbidity, mortality and expenditure in the healthcare system. AKI is not a simple illness but a complex conglomeration of syndromes that often occurs as part of other syndromes in its wide clinical spectrum of the disease. Genetic factors have been suggested as potentially responsible for its susceptibility and severity. As there is no current cure nor an effective treatment other than generally accepted supportive measures and renal replacement therapy, updated knowledge of the genetic implications may serve as a strategic tactic to counteract its dire consequences. Further understanding of the genetics that predispose AKI may shed light on novel approaches for the prevention and treatment of this condition. This review attempts to address the role of key genes in the appearance and development of AKI, providing not only a comprehensive update of the intertwined process involved but also identifying specific markers that could serve as precise targets for further AKI therapies.

Sepsis is a major health problem worldwide. It is a time-dependent disease, with a high rate of morbidity and mortality. In this sense, an early diagnosis is essential to reduce these rates. The progressive increase of both the incidence and prevalence of sepsis has translated into a significant socioeconomic burden for health systems. Currently, it is the leading cause of noncoronary mortality worldwide and represents one of the most prevalent pathologies both in hospital emergency services and in intensive care units. In this article, we review the role of both endothelial dysfunction and neutrophil dysregulation in the physiopathology of this disease. The lack of a key symptom in sepsis makes it difficult to obtain a quick and accurate diagnosis of this condition. Thus, it is essential to have fast and reliable diagnostic tools. In this sense, the use of biomarkers can be a very important alternative when it comes to achieving these goals. Both new biomarkers and treatments related to endothelial dysfunction and neutrophil dysregulation deserve to be further investigated in order to open new venues for the diagnosis, treatment and prognosis of sepsis.