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Las diferentes leyes autonómicas de patrimonio cultural y el borrador de la reforma de la Ley del Patrimonio Histórico Español (Ministerio de Cultura y Deporte 2021) reflejan la evolución de los conceptos patrimoniales, ampliando las categorías a proteger. Es el caso, por ejemplo, de la arquitectura defensiva e industrial o del paisaje cultural, que no se entenderían sin su entorno y sin la huella y la articulación del territorio dejada por el ser humano a lo largo del tiempo. La complejidad de estas categorías patrimoniales, compuestas por elementos de naturaleza material e inmaterial, requiere de una comprensión de sus procesos evolutivos, así como de una gestión integral de posibles afecciones desde las primeras etapas de la evaluación ambiental de proyectos. Una propuesta que ha intentado paliar las dificultades asociadas a esta complejidad es la herramienta redactada por el Consejo Internacional de Museos y Sitios (ICOMOS) denominada Evaluación de Impacto Patrimonial, que tiene como objetivo la prevención de impactos en la salvaguarda de sitios declarados Patrimonio Mundial. En este artículo analizamos la práctica de las Evaluaciones de Impacto Patrimonial en Europa y su relación con el procedimiento de Evaluación del Impacto Ambiental de proyectos, a través de una revisión bibliográfica, con el propósito de documentar los análisis publicados al respecto y hacer una valoración crítica de su uso, evaluando sus ventajas e inconvenientes. more...

Temporary activities and events may have significant environmental impacts. However, they are often outside the scope of environmental assessment (EA) processes. Environmental requirements in authorisation processes of activities are rare, except for some major events in sensitive areas. This paper analyses firstly the environmental impacts of outdoor temporary activities and events through a literature review; all the analysed activities may have significant negative impacts. Then the authorisation of temporary activities, and their inclusion in EA systems, in a sample of jurisdictions worldwide was analysed. Applying EA processes is more an exception than a rule for temporary activities. The paper discusses the factors that influence activities' impacts, the conflict between precaution and operation, and the benefits and drawbacks of the application of different EA schemes to temporary activities, concluding with some proposals to improve the consideration of environmental aspects in activities' authorisation. Before the authorisation of activities and events, their environmental impacts should be analysed, and taken into account. This can be achieved through regulations in management plans submitted to strategic environmental assessment, through screening processes or through environmental impact assessment when significant impacts are expected. This article is protected by copyright. All rights reserved. Integr Environ Assess Manag 2023;00:0-0. © 2023 SETAC. more...

BACKGROUND: High intraoperative PEEP with recruitment manoeuvres may improve perioperative outcomes. We re-examined this question by conducting a patient-level meta-analysis of three clinical trials in adult patients at increased risk for postoperative pulmonary complications who underwent non-cardiothoracic and non-neurological surgery. METHODS: The three trials enrolled patients at 128 hospitals in 24 countries from February 2011 to February 2018. All patients received volume-controlled ventilation with low tidal volume. Analyses were performed using one-stage, two-level, mixed modelling (site as a random effect; trial as a fixed effect). The primary outcome was a composite of postoperative pulmonary complications within the first week, analysed using mixed-effect logistic regression. Pre-specified subgroup analyses of nine patient characteristics and seven procedure and care-delivery characteristics were also performed. RESULTS: Complete datasets were available for 1913 participants ventilated with high PEEP and recruitment manoeuvres, compared with 1924 participants who received low PEEP. The primary outcome occurred in 562/1913 (29.4%) participants randomised to high PEEP, compared with 620/1924 (32.2%) participants randomised to low PEEP (unadjusted odds ratio [OR]=0.87; 95% confidence interval [95% CI], 0.75-1.01; P=0.06). Higher PEEP resulted in 87/1913 (4.5%) participants requiring interventions for desaturation, compared with 216/1924 (11.2%) participants randomised to low PEEP (OR=0.34; 95% CI, 0.26-0.45). Intraoperative hypotension was associated more frequently (784/1913 [41.0%]) with high PEEP, compared with low PEEP (579/1924 [30.1%]; OR=1.87; 95% CI, 1.60-2.17). CONCLUSIONS: High PEEP combined with recruitment manoeuvres during low tidal volume ventilation in patients undergoing major surgery did not reduce postoperative pulmonary complications. CLINICAL TRIAL REGISTRATION: NCT03937375 (Clinicaltrials.gov). more...

Live Fuel Moisture Content (LFMC) is one of the main factors affecting forest ignitability as it determines the availability of existing live fuel to burn. Currently, LFMC is monitored through spectral vegetation indices or inferred from meteorological drought indices. While useful, neither approach provides mechanistic insights into species-specific LFMC variation and they are limited in the ability to forecast LFMC under altered future climates. Here, we developed a semi-mechanistic model to predict daily variation in LFMC across woody species from different functional types by adjusting a soil water balance model which estimates predawn leaf water potential (Ψpd). Our overarching goal was to balance the trade-off between biological realism, which enhances model applicability, and parameterization complexity, which may limit its value within operational settings. After calibration, model predictions were validated against a dataset comprising 1659 LFMC observations across peninsular Spain, belonging to different functional types and from contrasting climates. The overall goodness of fit for our model (R2 = 0.5) was better than that obtained by an existing models based on drought indices (R2 = 0.3) or spectral vegetation indices (R2 = 0.1). We observed the best predictive performance for seeding shrubs (R2 = 0.6) followed by trees (R2 = 0.5) and resprouting shrubs (R2 = 0.4). Through its relatively simple parameterization, the approach developed here may pave the way for a new generation of process-based models that can be used for operational purposes within fire risk mitigation scenarios. This work was partly founded by the Spanish Government, grant number RTI2018-094691-B-C31 (MCIU/AEI/FEDER, EU) . R.B-R. ac-knowledges the Community of Madrid for the predoctoral contract PEJD-2019-PRE/AMB-15,644 funded by the Youth Employment Initia-tive (YEI) . M. De C. was supported by the Spanish Ministry of Science and Innovation via competitive grant CGL2017-89149-C2-2-R. UNED founding for open access publishing. more...

Background We aimed to examine whether using a high fraction of inspired oxygen (FIO2) in the context of an individualised intra- and postoperative open-lung ventilation approach could decrease surgical site infection (SSI) in patients scheduled for abdominal surgery. Methods We performed a multicentre, randomised controlled clinical trial in a network of 21 university hospitals from June 6, 2017 to July 19, 2018. Patients undergoing abdominal surgery were randomly assigned to receive a high (0.80) or conventional (0.3) FIO2 during the intraoperative period and during the first 3 postoperative hours. All patients were mechanically ventilated with an open-lung strategy, which included recruitment manoeuvres and individualised positive end-expiratory pressure for the best respiratory-system compliance, and individualised continuous postoperative airway pressure for adequate peripheral oxyhaemoglobin saturation. The primary outcome was the prevalence of SSI within the first 7 postoperative days. The secondary outcomes were composites of systemic complications, length of intensive care and hospital stay, and 6-month mortality. Results We enrolled 740 subjects: 371 in the high FIO2 group and 369 in the low FIO2 group. Data from 717 subjects were available for final analysis. The rate of SSI during the first postoperative week did not differ between high (8.9%) and low (9.4%) FIO2 groups (relative risk [RR]: 0.94; 95% confidence interval [CI]: 0.59–1.50; P=0.90]). Secondary outcomes, such as atelectasis (7.7% vs 9.8%; RR: 0.77; 95% CI: 0.48–1.25; P=0.38) and myocardial ischaemia (0.6% [n=2] vs 0% [n=0]; P=0.47) did not differ between groups. Conclusions An oxygenation strategy using high FIO2 compared with conventional FIO2 did not reduce postoperative SSIs in abdominal surgery. No differences in secondary outcomes or adverse events were found. Clinical trial registration NCT02776046. more...

Research Highlights: Pre-programmed cell death in old Aleppo pine needles leads to low moisture contents in the forest canopy in July, the time when fire activity nears its peak in the Western Mediterranean Basin. Here, we show, for the first time, that such needle senescence may increase fire behavior and thus is a potential mechanism explaining why the bulk of the annual burned area in the region occurs in early summer. Background and Objectives: The brunt of the fire season in the Western Mediterranean Basin occurs at the beginning of July, when live fuel moisture content is near its maximum. Here, we test whether a potential explanation to this conundrum lies in Aleppo pine needle senescence, a result of pre-programmed cell death in 3-years-old needles, which typically occurs in the weeks preceding the peak in the burned area. Our objective was to simulate the effects of needle senescence on fire behavior. Materials and Methods: We simulated the effects of needle senescence on canopy moisture and structure. Fire behavior was simulated across different phenological scenarios and for two highly contrasting Aleppo pine stand structures, a forest, and a shrubland. Wildfire behavior simulations were done with BehavePlus6 across a wide range of wind speeds and of dead fine surface fuel moistures. Results: The transition from surface to passive crown fire occurred at lower wind speeds under simulated needle senescence in the forest and in the shrubland. Transitions to active crown fire only occurred in the shrubland under needle senescence. Maximum fire intensity and severity were always recorded in the needle senescence scenario. Conclusions: Aleppo pine needle senescence may enhance the probability of crown fire development at the onset of the fire season, and it could partly explain the concentration of fire activity in early July in the Western Mediterranean Basin. We acknowledge funding from the Natural Science Foundation in China (31850410483), the talent proposals from Sichuan Province (2020JDRC0065), the Southwest University of Science and Technology talents fund and the Spanish MICINN (AGL2015-69151-R). R.B.-R. acknowledges the Community of Madrid for the predoctoral contract PEJD-2019-PRE/AMB-15644 funded by the Youth Employment Initiative (YEI). more...

Background The effects of individualised perioperative lung-protective ventilation (based on the open-lung approach [OLA]) on postoperative complications is unknown. We aimed to investigate the effects of intraoperative and postoperative ventilatory management in patients scheduled for abdominal surgery, compared with standard protective ventilation. Methods We did this prospective, multicentre, randomised controlled trial in 21 teaching hospitals in Spain. We enrolled patients who were aged 18 years or older, were scheduled to have abdominal surgery with an expected time of longer than 2 h, had intermediate-to-high-risk of developing postoperative pulmonary complications, and who had a body-mass index less than 35 kg/m(2). Patients were randomly assigned (1: 1: 1: 1) online to receive one of four lung-protective ventilation strategies using low tidal volume plus positive end-expiratory pressure (PEEP): open-lung approach (OLA)-iCPAP (individualised intraoperative ventilation [individualised PEEP after a lung recruitment manoeuvre] plus individualised postoperative continuous positive airway pressure [CPAP]), OLA-CPAP (intraoperative individualised ventilation plus postoperative CPAP), STD-CPAP (standard intraoperative ventilation plus postoperative CPAP), or STD-O-2 (standard intraoperative ventilation plus standard postoperative oxygen therapy). Patients were masked to treatment allocation. Investigators were not masked in the operating and postoperative rooms; after 24 h, data were given to a second investigator who was masked to allocations. The primary outcome was a composite of pulmonary and systemic complications during the first 7 postoperative days. We did the primary analysis using the modified intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT02158923. Findings Between Jan 2, 2015, and May 18, 2016, we enrolled 1012 eligible patients. Data were available for 967 patients, whom we included in the final analysis. Risk of pulmonary and systemic complications did not differ for patients in OLA-iCPAP (110 [46%] of 241, relative risk 0.89 [95% CI 0.74-1.07; p=0.25]), OLA-CPAP (111 [47%] of 238, 0.91 [0.76-1.09; p=0.35]), or STD-CPAP groups (118 [48%] of 244, 0.95 [0.80-1.14; p=0.65]) when compared with patients in the STD-O-2 group (125 [51%] of 244). Intraoperatively, PEEP was increased in 69 (14%) of patients in the standard perioperative ventilation groups because of hypoxaemia, and no patients from either of the OLA groups required rescue manoeuvres. Interpretation In patients who have major abdominal surgery, the different perioperative open lung approaches tested in this study did not reduce the risk of postoperative complications when compared with standard lung-protective mechanical ventilation. more...

Primary chylous pericardial effusion is a rare entity with few cases reported so far. We report a case of idiopathic etiology in a previously healthy 16-year-old boy. The patient presented with intermittent chest pain and dizziness caused by a chronic pericardial effusion. An echocardiogram revealing a pericardial effusion and open pericardiocentesis with a drainage of approximately of 500 ml of chylous fluid established the diagnosis. Patient had no history of trauma, cardiac surgery, central insertion of subclavian catheters or blunt injury. Computed tomography ruled out malignancies in the abdomen and chest. Clinical, laboratory and radiological investigations for the possible underlying cause of the condition were not determined. Management with a dietary regimen consisting of a medium-chain triglyceride-rich diet, octreotide pharmacological treatment and initial subxiphoid resection with pericardial tube drainage was unsuccessful. Surgical approach was required consisting of pericardio-peritoneal window with trans-abdominal ligation (clipping) of the thoracic duct above the diaphragm. Postoperative outcome was uneventful and there was a rapid recovery after surgical management. more...