Lactobacillus plantarum (LP) and Bacillus licheniformis (BL) on the quality of hybrid Pennisetum (HP) silage. The results of this experiment have a certain reference value for the silage production of hybrid Pennisetum and the use of the two additives.In our study, we reported the effects of Lactobacillus plantarum (LP) and Bacillus licheniformis (BL) on the quality of hybrid Pennisetum (HP) silage. The experiment consisted of five treatment groups. The control group did not use additives, and the experimental groups were added with LP or BL of 1 × 105 cfu/g fresh weight (FW) and 1 × 107 cfu/g FW, respectively. The results showed that LP and BL could increase the in vitro fermentation gas production and reduce the ammonia nitrogen (AN) content in HP silage. Water-soluble carbohydrates (WSC), lactic acid (LA) content, and gas production in the LP group were positively correlated with LP addition, and acetic acid (AA) was negatively correlated with addition. The content of WSC and LA in the LP7 group was significantly higher than that in the control group (p < 0.05), and AA was lower than that in the control group (p > 0.05). Dry matter (DM), crude protein (CP), and gas production were negatively correlated with the addition of BL, while acid detergent fiber (ADF) content was positively correlated with the addition of BL. Furthermore, in the above indicators, the BL5 group reached a significant level with the control group (p < 0.05). The results of 16sRNA showed that the use of LP and BL could increase the relative abundance of Lactobacillus and decrease the relative abundance of Weissella in HP silage compared with the control group. In conclusion, LP and BL can significantly improve the quality of HP silage. The LP7 group and the BL5 group have the best silage effect. From the perspective of gas production in in vitro fermentation, the LP7 group had stronger fermentability and higher nutritional value.The purpose of the experiment was to study the effects of different concentrations of  Pennisetum (HP) is a triploid hybrid produced by the Pennisetum americanum and P. purpureum , ABC-2 type transport system permease protein, and LacI family transcriptional regulator, while the use of BL increased the relative abundance of ABC-2 type transport system ATP-binding protein, sucrose-6-phosphatase [EC:3.1.3.24], ABC-2 type transport system permease protein, LacI family transcriptional regulator and probable phosphoglycerate mutase [EC:5.4.2.12]. Similarly, the performance of LP and BL in the top five pathways is also very different. The use of LP decreased the relative abundance of secondary bile acid biosynthesis, fatty acid biosynthesis, D-glutamine and D-glutamate metabolism, and lysine biosynthesis, whereas the use of BL increased the relative abundance of the top five pathways. These results indicate that both LP and BL have a great influence on the function and pathway of the bacterial community in silage, but their modes of action are quite different, which may be related to their mechanism of action in silage, and further research is needed.In vitro fermentation gas production is an important indicator for predicting the degree of feed fermentation, which can reflect the digestion and degradation characteristics of ruminants to feed . The amoThe pH value in the rumen is one of the important indicators to measure the rumen environment. Calsamiglia et al.  indicateLactobacillus sp. and decreased the relative abundance of Weissella sp. in silage. In addition, the use of LP can also increase the relative abundance of Flavobacterium sp. in silage and decrease the relative abundance of Pediococcus sp. In conclusion, both LP and BL can improve the quality of HP silage, and the optimum addition amount of LP is 1 × 107 cfu/g FW, and the optimum addition amount of BL is 1 × 105 cfu/g FW. In terms of gas production by in vitro fermentation, the effect of the LP7 group was better than that of the BL5 group. Therefore, 1 × 107 cfu/g FW LP can be considered an additive in the HP silage process.The use of additives in the silage process can significantly improve the quality of silage. Both LP and BL can increase the in vitro fermentation gas production and reduce the AN content in the silage. Compared with the control group, the content of WSC was significantly increased in the LP7 group, and the contents of DM and CP were significantly increased in the BL5 group. The addition of LP and BL both increased the relative abundance of


The main aim of this work was to study the effect of the nature of the alcohol on the chemical, structural and photocatalytic properties for paracetamol photodegradation of the final solids. The TiCl4/alcohol molar ratio to obtain the corresponding alkoxides (TiEt and TiPr) was 1/10. These alkoxides were calcined at 400 °C to prepare the oxide catalysts (named as TiEt400 and TiPr400). Powder X-ray diffraction (PXRD) of the original samples showed the presence of anatase diffraction peaks in sample TiPr, while TiEt is a completely amorphous material. Contrary to commercial TiO2-P25, the PXRD diagrams of the calcined samples showed anatase as the exclusive crystalline phase in both solids. The specific surface area (SBET) of sample TiPr400 was larger than that of sample TiEt400, and both larger than that of TiO2-P25. The three solids have been tested in the photodegradation of paracetamol in aqueous solution. It has been established that the alcohol used influences the properties and catalytic activity of the final oxides. The synthesized solids exhibit a higher activity than commercial TiO2-P25, because of their structural characteristics and larger SBET.Two titania photocatalysts have been prepared using the sol–gel method using TiCl For some years, there has been a great concern about the presence of emerging contaminants in the environment, since most of the consequences that these compounds can cause and their persistence in the environment are in many cases unknown. Among all the emerging contaminants, some of the most worrying ones are drugs that, due to their wide use by humans, are introduced into ecosystems. Traces of drugs and their metabolites have been found in wastewater, surface and deep water, soil and air, etc., mainly due to the consumption and excretion of drugs (or their metabolites) and the inadequate disposal of unconsumed drugs. The effects of drugs on aquatic organisms have been widely observed by several authors ,2. RossiIn addition, urban, hospital, industrial wastewater, and those of agricultural or livestock origin, are a way for drugs to enter into the aquatic environment. However, what is really worrying about the presence of these pollutants (and mixtures of them) is not only the quantity in which they are found, but also their persistence in the environment, since prolonged exposure has been scarcely studied .N-Acetyl-p-benzoquinone imine, NAPQ). These metabolites pass into the food chain through the aqueous medium [Paracetamol is a frequently used analgesic and antipyretic drug. It enters the environment through unchanged excretion in urine and feces or after undergoing transformations producing toxic metabolites  light in order to study the synergistic effect of TiO2 used in photocatalytic AOPs in the treatment of refinery effluents [2 powders are very significant and have been widely studied; actually, titania is the most widely photocatalysts used, due to their applicability to the treatment of a diversity of pollutants [2 particles migrate to the surface, to reduce and oxidize compounds existing in water and air [Fernandes et al. have tested TiOffluents . Photocallutants ,19,20, allutants ,22. In t and air .2 as a photocatalyst for the degradation of different contaminants as dyes or phenolic molecules such as paracetamol. For instance, concerning titania nanotubes, López-Zavala et al. have reported [A large number of papers have described the synthesis procedures and the effectiveness of TiOreported  that hyd2 nanobelts (TNB) anchored to carbon particles made from soybean husk, and studied the photodegradation and adsorption decolorization of a dye Basic Yellow 28 solution; these authors concluded that the hydroxylated hydrazono-indolium species, and small molecules formed photocatalytically by the TNB, get adsorbed on the carbonaceous portions of the composite [2 properties on the photocatalytic degradation of paracetamol [2-P25  as a photocatalyst in water suspension and under UV light. They studied the effect of pH, concluding that pH 9.0 is optimal under these conditions for drug degradation and that under UV illumination, TiO2 is more efficient than TiO2/cellulose fiber under sunlight [2 nanotubes for paracetamol photo-degradation and studied the effect of the pH on the on the photoreaction rate [2 composite photocatalyst with a dual effect  [2 fibers, and their application in the degradation of organic pollutants, including paracetamol [Elizalde-González et al. prepared TiOomposite . Rimoldiacetamol . Jalloulsunlight . Suryawaion rate . Puri et-Fenton) . Covaliuacetamol .2 by the sol–gel method described by Zhu et al. [2-P25. The chemical, structural, and textural characteristics will be studied by means of the typical characterization techniques for inorganic solids described in The aim of this work is to test the effect of using two different alcohols, ethanol (Et) and Propanol (Pr) in the synthesis of TiOu et al. , on the 2-P25 is also included for comparison. The PXRD pattern of TiEt corresponds to that of an essentially amorphous material, but in that of sample TiPr, weak peaks corresponding to the anatase phase of TiO2 [The PXRD diagrams of both precursors and both oxide samples are included in  of TiO2  (Joint C2-P25 is known to be composed of approximately 80% anatase 20% rutile (JCPDS 21-1276) [2-P25 are more intense and narrower than those of the TiEt400 and TiPr400 samples, suggesting a larger crystallinity of the former.For the calcined samples, TiEt400 and TiPr400, the diffraction peaks  were rec21-1276) ,35, alth2-P25 was 18 nm, while for both oxides prepared in this study it was 13 nm, so there was no effect of the alcohol used during the synthesis on the crystallographic properties of the oxides prepared. This result is also consistent with the recorded X-ray diffractograms, since the diffraction peaks of TiO2-P25 are more intense and symmetric, indicating a greater crystallinity, in agreement with a larger crystallite size.The average crystallite sizes of the oxides along the crystallographic direction (101) (which diffraction corresponds to the most intense peak of the anatase phase) have been calculated from the full width at half maximum (FWHM) of this peak, by using the Scherer equation, for the oxides and the reference materials. The crystallite size of commercial TiO2-P25 are included in −1 is due to the overlapping of the bands due to the normal stretching modes of different O-H groups existing on the surface of the solid, and of the water molecules [−1 is due to the bending mode of water molecules. As these samples have not been calcined, the intensities of the bands due to the water molecules (both bending and stretching modes) are very intense.The FT-IR spectra of precursor alkoxides TiEt, TiPr, the calcined samples TiEt400, TiPr400, and TiOolecules , linked The bands in the low wavenumbers region correspond to the Ti-O, Ti-O-Ti and Ti-OH stretching vibrations. For TiPr, there is a single broad band in this range that can be ascribed to the vibrational mode of Ti-OH units ,37.2-P25 showed the bands at 3400 and 1620 cm−1 due to the stretching vibrations of the O-H groups and the deformation mode of the water molecules. They were less intense and broad than in the precursors since during calcination a certain amount of surface hydroxyl groups have been removed (by condensation and elimination of water), as well as the adsorbed molecular water, although this has been partially recovered by exposing the solids to the atmosphere during handling. The very weak bands just below 3000 cm−1 in the spectra of samples TiEt400 and TiPr400 are due to C-H stretching modes of adsorbed hydrocarbons from the laboratory environment. The weak band around 2200 cm−1 is due to miscancellation of the atmospheric CO2 band and the very sharp and weak band at 1390 cm−1 recorded in some spectra is due to a minor nitrate impurity in the KBr used to dilute the samples. The FT-IR spectrum of the reference material TiO2-P25 shows sharper signals. This confirms, in agreement with the PXRD results, that the reference sample has a higher crystallinity than the samples synthesized and calcined in this work. The three FT-IR spectra show an intense and broad band centered on 400 cm−1 associated to the Ti-O stretching vibration of the crystal lattice.The FT-IR spectra of the calcined samples TiEt400, TiPr400 and of TiO2-P25 was carried out from the adsorption-desorption isotherms of N2 at −196 °C. 2-P25.The textural study of the calcined samples and TiOplateau, which is characteristic of the presence of pores with a bottleneck shape. This pore geometry, which has a narrow outlet and a wide body, causes the emptying of the pore to be delayed during desorption, forming the plateau.The isotherms of the synthesized samples correspond to type IV in the International Union of Pure and Applied Chemistry (IUPAC) classification . This ty2 adsorption-desorption isotherm of TiO2-P25 corresponds to type II according again to the IUPAC classification. This type of isotherms is characteristic of non-porous or macroporous solids, that is, with low or null microporosity and with multilayer adsorption without restriction. In this case, the hysteresis loop of the isotherm is so narrow that the process can be considered reversible.Unlike the previous ones, the NBET [t [BET , externaBET [t , total vBET values increase as P25 < TiEt400 < TiPr400. For each sample, the values of SBET and St are almost coincident, thus suggesting the absence of micropores. The pore volumes are significantly different from one sample to another, so the differences in the specific surface areas can be related to the differences in the pore volumes.The S2H5)4 and Ti(OC3H7)4, and of the final compound  are included in The TG and DTA curves of the oxides  and aliquots were taken periodically and did not need to be filtered since there was no solid catalyst in suspension.At the beginning of the experiment with each catalyst (or for the photolysis reaction), the suspension was kept in the darkness and aliquots were taken at set times until the paracetamol concentration stabilized and remained constant. This step was taken because the concentration of paracetamol can somewhat decrease due to its adsorption on the TiO0 = initial paracetamol concentration; C = concentration at a given time), calculated from the intensity of its band at 243 nm, is plotted vs. the reaction time, up to ca. 2 h of reaction. The concentration of paracetamol did not change significantly in the absence of the catalyst, so we must conclude that there was no photolysis.The result of the photolysis and photodegradation process can be seen in During the time the solids tested were suspended in the solution in the darkness, the decrease in paracetamol concentration in the presence of the catalysts was null or negligible; adsorption of paracetamol was thus negligible. It can be concluded that paracetamol degradation was almost entirely due to the photo-activity of the catalysts. However, the behavior of the three catalysts showed some differences.2-P25, but such a decrease was slower for catalyst TiPr400 and even slower for catalyst TiEt400. The decreases after 10 min reaction were 20, 15, and 5%, respectively, of the initial paracetamol concentration. From this time on, the amount of paracetamol photodegraded on TiO2-P25 remained almost constant, even after 2 h under UV light. However, photodegradation in the presence of the synthetized catalysts continued, but faster on catalyst TiPr400 than on catalyst TiEt400. The origin of the difference in this behavior among the three photocatalysts tested is not clear, but the different photo-activity of commercial TiO2-P25 can be tentatively ascribed to the fact that it contains both anatase and rutile, while those photocatalysts here synthetized are formed entirely of anatase [Once the system was illuminated with UV light, the concentration of paracetamol decreased sharply for commercial TiO anatase ,49,50.BET values on the photocatalytic activity, the relative concentration percentage of paracetamol per surface are unit versus the reaction time with each of the photocatalysts tested has been plotted in 2-P25, followed by TiEt400, but lower when using TiPr400. These data confirm that the higher photo-activity shown by sample TiPr400 is due to its higher specific surface area.To highlight the importance of obtaining solids with a high specific surface, the results of the catalytic activity have been related to the specific surface area of the photocatalysts, since heterogeneous catalysis is a phenomenon that occurs on the surface of the solid. To study the incidence of S2-P25 as a function of irradiation time. The rate equation of this model is [The Langmuir-Hinshelwood model  can be umodel is ,53:/k. These kinetic parameters, calculated from the Ln(Co/C) vs. time plots, are included in Assuming that the adsorption coefficient KThe reagents used to prepare and to characterize the compounds are summarized in 4 is used as a precursor [2.These titanium oxide photocatalysts have been obtained using the sol–gel method described by Zhu et al., in which TiClrecursor . In this4 were dropwise added from a separation funnel. Once the addition was complete, a yellow solution of Ti(OEt)4 was formed, which was left standing for 24 h without stirring, allowing polymerization. The mixture was gently (70 °C) heated for 5 h in a water bath until a gel was formed and ethanol was slowly evaporated. To completely dry the solid, the mixture was placed in an oven at 45 °C overnight. The solid formed was named as TiEt, and it was calcined in a furnace at 400 °C for 1 h in air at using a heating rate of 10 °C/min. The solid obtained after calcination has been designated as TiEt400. The yield was 61%, from the initial amount of TiCl4 used.An amount of 50 mL of ethanol were placed in a beaker with a magnetic stirrer and 5 mL of TiCl4 and n-propanol, with a yield of 69%.A similar procedure was followed to prepare TiPr400 from TiCl−1 range in a Perkin Elmer Spectrum-One spectrometer by the KBr pellet method. The textural properties were determined from the nitrogen adsorption–desorption isotherms recorded at −196 °C, using a Micrometrics Gemini VII 2390t, Surface Area and Porosity apparatus. The thermogravimetric and differential thermal analyses  curves were recorded on a SDT Q600 TA instrument, under an oxygen flow of 20 mL/min of and a heating rate of 10 °C/min from room temperature (RT) to 1000 °C.The powder X-ray diffraction (PXRD) diagrams of the samples have been recorded from 5 to 70° (2θ) at 2°/min, using a Siemens D-5000 diffractometer, operating at 40 kV and 30 mA, and using filtered Cu Kα radiation (λ = 1.5418 Å). The FT-IR spectra were recorded in the 4000–450 cmA MPDS-Basic system from Peschl Ultraviolet, with a PhotoLAB Batch-L reactor and a TQ150-Z0 lamp (power 150 W), integrated in a photon CABINET, was used to check the photo-activity. Its spectrum is continuous, with the main peaks at 366 nm  and 313 nm (4.3 W).All the solutions were analyzed by Visible-Ultraviolet spectroscopy to control the progress of the reaction. The Vis-UV spectra were recorded in a Perkin-Elmer LAMBDA 35 spectrophotometer coupled to a computer using UV WINLAB 2.85 software .2  was added to 750 mL of an aqueous solution of paracetamol (50 ppm), that is, a 1.33 g catalyst/L ratio. The suspension was continuously stirred within the chamber under illumination with a UV quartz lamp. The reactor was cooled with a water flow and the temperature fixed at 25 °C. For comparison, the photodegradation under UV light, in the same conditions, but in the absence of a catalyst (photolysis) was also studied.For each analysis, one gram of TiOThe method used has led to formation of titanium dioxide with the anatase structure, as confirmed by PXRD. The FT-IR analysis and the results of the DTA and TG thermal analysis confirm the results found by X-ray diffraction. The use of different starting alcohols has led to formation of titania powders with different textural features.2-P25, a widely used commercial photocatalyst. The synthesized solids show a higher photocatalytic activity than TiO2-P25, due to the different physicochemical properties of the solids, probably due to the synthesis method used, that allows to obtain quickly, economically and efficiently TiO2 with the anatase structure and with a higher specific surface area than the commercial catalyst.The synthesized solids have been tested in the photodegradation of paracetamol in aqueous solution, and their activity has been compared to that of TiOIt can be concluded that the photocatalytic behavior of the solids tested depends on the value of their specific surface area and, with the results found, the importance of the synthesis method in obtaining solids conceived for their use in heterogeneous photocatalysis reactions, such as paracetamol photodegradation, has been highlighted.· radicals (active species in the photodegradation reaction) will be formed upon photoexcitation. The exclusive presence of anatase, with an indirect band gap, in the samples prepared in this study, contrary to the mixture of anatase and rutile (with a direct band gap), might also account for the differences observed. These findings open new perspectives to develop optimum photocatalysts, by using alcohols with larger hydrocarbon chains or even branched-chain hydrocarbons during the synthesis of the precursors.Photocatalyst TiPr400 shows the best behavior, probably due to its textural properties . This fact is probably related to the longer hydrocarbon chain of the precursor used to prepare this photocatalyst which, upon thermal decomposition, gives rise to a larger amount of gases and vapors, thus accounting for the larger specific surface area and pore structure; probably, the surface concentration of hydroxyl groups is also larger, and thus a larger concentration of OH


Additionally, the energy-saving rate of SV with AC cooling was 14.05%. The study provides new ideas for reducing the energy consumption of rail transit and broadens indoor application scenarios of SV technology.The supply of fresh air for underground rail transit systems is not as simple as opening windows, which is a conventional ventilation (CV) measure adopted in aboveground vehicles. This study aims to improve contaminant dilution and air purification in subway car ventilation systems and the safety of rail transit post-coronavirus disease pandemic era. We designed an air conditioning (AC) terminal system combined with stratum ventilation (SV) to enable energy consumption reduction for subway cars. We experimentally tested the effectiveness of a turbulence model to investigate ventilation in subway cars. Further, we compared the velocity fields of CV and SV in subway cars to understand the differences in their airflow organizations and contaminant removal efficiencies, along with the energy savings of four ventilation scenarios, based on the calculations carried out using computational fluid dynamics. At a ventilation flow rate of 7200 m Urban rail transit is a vital means of alleviating urban traffic congestion and can optimize the layout of urban functions. Statistics from the International Association of Public Transport indicate that the total mileage of rail transit is constantly increasing globally. During 2018–2020, countries such as China, India, Australia, and Indonesia, added 3300 km of operating mileage ,5. VentiThe distribution of respiratory pollutants in subway cars has significantly different characteristics from that in indoor spaces. There are both standing and sitting passengers in subway cars; therefore, the contaminants exhaled by passengers at different heights are stratified within the cars and entrained by the airflow of the ventilation system. Consequently, the exhalations from standing passengers flow to the areas where seated passengers, including children, are breathing, resulting in cross-contamination. Improving the airflow organization of AC systems in subway cars is a recent concept that aims to improve air quality and reduce energy consumption. A previous study proposed a displacement ventilation model for subway cars , in whicIn conventional ventilation (CV) systems installed in subway cars a, fresh Computational fluid dynamics (CFD) was used to study the effects of SV on contaminants dilution, air purification, and energy conservation in subway cars. Jiang et al.  applied 3/h, which was in line with the design parameters of an indoor per-person air supply of 30 m3/h , as established in the Design Code for Heating Ventilation and Air Conditioning in Civil Buildings GB50736-2012. In order to compare the effects of energy conservation and pollutants dilution between SV and CV subway cars, the air supply flow rate of the SV subway car was designed for three working scenarios of 8500, 7850, and 7200 m3/h, based on 240 people per carriage. The ceiling and middle air supply flow rate for the SV subway car was 1:1, based on an equal number of seated and standing passengers. As subway heating mainly consists of heated seats, AC is not the primary heat source. Therefore, summer AC cooling was selected as the ideal study condition; the selected subway car model was one-quarter of the length of a Type-B train, with a whole-car ventilation flow rate of 8500 m2 [2 is more accessible to measure than droplets, CO2 was used to represent exhaled pollutants.The number and location of passengers in the compartment have an important influence on the propagation of pollutants. When there are too many people, bodies will block the airflow and cause many possible flow directions, which is not conducive to capturing the interaction between ventilation and exhaled pollutants. Many researchers ,37 have 2 ,41 are b2 for one standing and one seated passenger’s breathing in the subway car in conditions of active AC cooling were tested and numerically simulated to verify the applicability of the turbulence model. The exhaled CO2 concentrations in the car were monitored at various heights using six Narrow-Band Internet of Things (NB-IoT) sensors. 2 peaks were observed at heights of 800 and 1550 mm, which roughly corresponded with the breathing areas of the seated and standing passengers, respectively, indicating a bimodal distribution of exhaled contaminants in the car. The concentrations of CO2 outside the breathing zones were lower than that inside the breathing zones due to airflow diffusion. The peak error between the experimental and CFD calculations was around 12%, indicating the effectiveness of the CFD method in analyzing exhaled contaminant flow in subway cars.Spatial concentration and distribution of COCRE) is a common index used to measure the ability of a ventilation method to eliminate contaminants [Ce, at the air outlet equals that at point P (Cp) of the indoor contaminant source, then Ce = Cp and CRE = 1, which is equivalent to all the contaminants released by the source per unit time that passes through the air outlet.CRE is the contaminant removal effectiveness at point P in the ventilated space, and Cs, Ce, and Cp are the contaminant concentrations at the air inlet, air outlet, and point P, respectively.Contaminant removal effectiveness  can be re-written as Equation (2), as followsBecause the air inlet of the AC system did not contain COWe compared the differences in the air distribution between the CV and SV cars and assessed their respective airflow velocity fields . The cei2 distribution being 8500 m3/h in the CV car and 8500, 7850, and 7200 m3/h in the SV car. We measured the area-weighted average concentrations of CO2 in a 20-cm-diameter circular area in front of the faces of the standing and seated passengers  and the upper exhaust and under-seat outlet , to quantify the CRE of the two ventilation methods.2 concentrations shown in 2 exhaled by the seated passengers in the CV car portrayed a tendency to float upwards and gradually toward the breathing area of the standing passengers. The CO2 exhaled by the seated passengers in the SV car was guided downward by the middle air inflow and discharged under the seat, shortening the retention time of the contaminants in the car. Based on the concentrations , reflecting the advantage of a targeted air supply using SV.According to the nephogram of COtrations b–d and u2 concentrations corresponding to the four monitoring points for the four calculation scenarios depicted in 2 concentration in the breathing area of the standing passenger was the lowest in the CV car because the entire air supply was supplied from the inlet at the top of the car, which provided a better dilution effect of the contaminants in the upper part of the car. In the SV car, as the top and middle inlets each supplied 50% of the airflow rate, the CO2 concentration in the breathing area of the standing passengers was slightly higher than that in the CV car. The seated passengers were supplied with fresh air in the SV car, so the CO2 concentration in the breathing area of the seated passengers was better in the SV car than in the CV car. Furthermore, as the CO2 exhaled from seated passengers was entrained by the middle air supply and discharged at the air outlet under the seat, the contaminants exhaled by the seated passengers did not float upwards, which occurred in the CV car  in Equation (2). CRE of the upper and lower air outlets. The CRE of the upper part was <1%. Notably, the CRE of the lower part was 1.89% in the CV car, whereas it ranged from 5.85% to 6.93% for the three ventilation rate scenarios in the SV car. The higher CRE for SV versus that of CV confirmed the advantages of SV in terms of contaminant dilution and purification. When the concentration of contaminants increases due to an increase in passengers in the car, the CRE will further improve.We used Equation (2) to calculate the heat) was drawn under AC and ventilation conditions in the car. The temperature of the uncooled airflow area on the left of the boundary line was mainly 300 K, whereas that on the right was 298 K, mainly representing fresh, cooled airflow. In the CV car, the temperature boundary line reached the seated passenger, indicating that the AC ventilation in the car provided poor air supply for seated passengers. In the SV car, the middle air supply airflow extended the fresh cooled air area around the seated passengers, and the temperature boundary line was far from them. Even at a ventilation rate of 7200 m3/h, the uncooled airflow area above 300 K in the car equipped with SV was less than that equipped with CV at the ventilation rate of 8500 m3/h. These findings indicate that SV could dilute the hot air area in the car more effectively due to the dispersed AC airflow. The above findings indicate that the contaminant dilution effect was slightly lower for the standing passengers in the SV car than for those in the CV car; its effect was greater for the seated passengers, and it also optimized the temperature conditions in the subway car.3/h. We compared the summer cooling loads of the CV and SV cars for air supplies of 8500 and 7200 m3/h, respectively, and quantified the energy-saving effects of SV. The cooling load for a single car was itemized on an hourly basis, according to the General Code for Building Energy Conservation and Renewable Energy Utilization GB55015-2021. The calculation parameters for the interior and exterior of the cars were considered according to the Class I comfort conditions for areas that experience hot summers and cold winters, as published in the Design Code for Heating Ventilation and Air Conditioning of Civil Buildings GB50736-2012. Based on the analysis in The main calculation process was as follows:CLc, was calculated using the following equation:A is the heat transfer area of the car expressed in m2; a single Type-B subway car is 19 m long, 2.55 m wide, and 2.1 m high, providing a result of 101.7 m3. λ is the overall thermal transmittance of the cars’ wall (2.3 W/m2 K) [Tw is the calculated temperature of the hourly cooling load outside the car obtained from the Design Code for Heating Ventilation and Air Conditioning in Civil Buildings GB50736-2012 and expressed in °C. Tn is the calculated temperature inside the car expressed in °C and obtained from CFD calculation, and subscripts 1 and 2 represent the CV and SV cars, respectively .The subway car’s unsteady heat transfer cooling load,  W/m2 K) ; Tw is tThe hourly cooling load results shown in M is the fresh air requirement (kg/s); hw is the enthalpy for the calculated AC external temperature in summer, expressed as kJ/kg; and hn is the enthalpy for the calculated parameters of the subway car in summer, expressed in kJ/kg.According to Equations (4) and (5), the fresh-air cooling load of the SV car was lower than that of the CV car, mainly because the fresh-air requirement of the SV car was lower, which reflected energy-saving characteristics of a high-temperature difference and low flow rate.qs is the normal heat dissipation of an active adult man in different room temperatures and occupations, expressed as W; when sitting still in the CV car at 301.5 K, qs,1 = 50.5 W; when sitting still in the SV car at 300 K, qs,2 = 60.5 W. n is the number of people in the subway car, n = 2; ψ is the clustering coefficient (ψ = 1). cclh is the human sensible heat dissipation and cooling load coefficient, considered to be 1 in crowded places.The unsteady heat transfer cooling and fresh-air cooling loads calculated in the previous sections are based on the calculation results of two passengers in the car, one seated and one standing, using the CFD method. Therefore, only two passengers were considered for human body heat dissipation. As the heat dissipation of the human body differs depending on the background temperature of the subway car, the heat dissipation and cooling load of the human body would also differ slightly. Notably, the temperature in the SV model was low, and the temperature of the passenger’s body surface differed from the ambient temperature of the car; therefore, the heat dissipation and cooling load were slightly higher, calculated as shown in Equations (6) and (7):The cooling load of the CV car was calculated using Equation (8):CLtot,1, CLc,1, CLf,1, and CLp,1 represent the total cooling load, unsteady heat transfer cooling load, summer AC fresh-air cooling load, and human heat dissipation cooling load of a CV subway car, respectively. CLtot,2, CLc,2, CLf,2 and CLp,2, respectively, represent the above loads in an SV subway car.The cooling load of the SV car was calculated using Equation (9):η) of the SV car was 14.05%, as shown in Equation (10):Comparing the cooling loads for the CV and SV cars, the energy saving rate 3/h, the CRE was 5.85% for the seated passengers, which was higher than that observed in the CV (1.89%) at the ventilation rate of 8500 m3/h. However, the effectiveness of contaminant removal from the upper part of the car was reduced from 0.94% to 0.65%.A subway car with SV could supply fresh air to seated passengers through targeted ventilation. When the ventilation rate was 7200 m(2)Adding a middle row of air inlets in a subway car equipped with SV caused the air supply in the car to be more uniform. The temperature field of the entire car was significantly reduced in the cooling season, and the distribution area of hot air was also reduced.(3)The hourly cooling load, according to the CFD results, indicated that the cooling energy consumption was 14.05% lower in the Type-B single subway car equipped with SV than in that equipped with CV.The major conclusions of the study are explained below:


The World Health Organization (WHO), in its last review of its International Classification of Diseases, established a new classification for chronic pain. Among the principal categories, of particular interest is chronic primary pain as a new type of diagnosis in those cases in which the etiology of the disease is not clear, being termed as chronic primary visceral pain when it is situated in the thorax, abdomen, or pelvis. Due to the novelty of the term, the objective of the systematic review was to examine the psychopathological and neuropsychological disorders associated with chronic primary visceral pain. We carried out a search of the scientific literature following the PRISMA directives using the Pubmed, Medline, PsycInfo and Scopus databases. A total of 33 articles were selected after applying the inclusion and exclusion criteria. The analysis of the studies showed that most persons with chronic primary visceral pain suffer from at least one psychological disorder; the most prevalent being anxiety, depressive or somatoform disorders. The most frequent psychopathological symptoms are anxiety, depression and somatization. Similarly, the findings are insufficient to determine the existence of deficits in the domains of executive functioning, memory and intelligence. However, the existence of attention biases does seem to be clear. This review supposes a starting point for conceptualizing chronic primary visceral pain. It is necessary to continue further research so as to obtain a better understanding of this pathology and the disorders associated. Chronic pain is one of the most frequent health problems in the adult population, with a variable prevalence of between 11 and 50% worldwide  represents an important condition that, as do the other subcategories, negatively affects the life of a person and the different contexts in which that person's life is led, be it social life, family life or work life, and is associated with a low quality of life, as well as problems with both physical and psychological health  Chronic primary pain.(B) Situated in the thoracic, abdominal or pelvic regions.(C) Associated with significant emotional distress and/or functional impairment.(D) The specific anatomical situation of the pain is compatible with the typical pain coming from specific internal organs.Although the existing relations between the diagnosis of chronic pain and the development of psychopathological and neuropsychological disorders seem to display sufficient evidence, the conceptualization of chronic primary pain as a new diagnostic category presents numerous practical implications that should be explored. One such implication is the possibility of identifying the disorders on a biological, psychological and social level associated with each one of the diagnostic subcategories and, from there, developing specific multidisciplinary treatments for the existing deficits , in English or Spanish, through the following databases: Pubmed, Medline, PsycInfo and Scopus. Given the existence of different diagnostic subtypes in the CPVP and their relation to the disorders under review, we carried out a combined search using the following terms:  AND .In order to be included in this review, the publications had to comply with the following additional criteria: (a) they must be empirical works of research evaluating psychopathological and/or neuropsychological disorders in any of the subtypes of CPVP; (b) they must have a sample of adult persons between 18 and 85 years of age; (c) the CPVP must not be the consequence of an illness; (d) the sample must not have additional illnesses; (e) they must use psychological and/or neuropsychological evaluation tests; (f) they must include the results of the psychological and/or neuropsychological evaluation in the base line; (g) they must include the necessary data for determining the existence of psychopathological and/or neuropsychological disorders in the sample.As exclusion criteria, we discarded: (a) publications in which the abstract made no reference to CPVP or any of the subtypes or the related psychopathological and/or neuropsychological variables; (b) publications that did not specify the subtype of CPVP or in which, when specified, these did not form part of the objectives of the publication.We set out a series of variables concerning the reviewed publications related to the design and methodology of the study: (a) the country in which the research was carried out, (b) the design of the study, (c) the subtypes of CPVP, (d) the existence of a control group and/or other additional groups, (e) the number of participants, (f) the gender and age of the participants, (g) the instruments used to evaluate the CPVP and the psychopathological and neuropsychological disorders, (h) the variables of the CPVP, both psychopathological and neuropsychological, (i) and the results of the evaluation of the CPVP and the psychopathological and neuropsychological disorders.From the results of the bibliographic search, we identified a total of 14,091 articles. After eliminating 1,499 duplicated articles and 11,589 more that were unrelated to the subject matter, we reviewed 1,003 articles based on the title and content of the abstract. Of these, we excluded a further 906 articles as they did not adjust to the objective of the review. A total of 97 articles concerning psychopathological and neuropsychological disorders were taken into consideration for the review, of which 64 were excluded following a reading of the complete text as they did not comply with the inclusion criteria. A total of 33 articles were finally included in the present review. The details are shown in the PRISMA flow diagram of The countries in which the research work of the 33 selected articles was carried out show a high degree of heterogeneity, but the major origins were Germany (15%), the United States (12%), China, India and Italia (9% each). These were followed by Iran, the United Kingdom and Turkey (6% each), as well as Australia, Canada, South Korea, Croatia, France, Ireland, Japan and Norway (3% each).The CPVP diagnosis was made by a health professional in a total of 31 articles (94%), and in the other 2 articles, although the research was carried out in the health context, it was not specified. As for the CPVP subtypes present in the review; the dominant one is the irritable bowel syndrome that appears in 29 of the articles (88%), followed by the chronic primary pelvic pain syndrome (12%). Of those studies whose main pathology is the irritable bowel syndrome, 7 of them (23%) classified the sample in accordance with the subtypes IBS-Constipation (32.1%), IBS-Diarrhea (31.8%), IBS-Mixed (29%) and IBS-Not specified (7.1%).As for the presence of a control group, most of the studies use a healthy control group with no diagnosis (67%), while the rest use only the one group (33%) made up of subjects with the pathologies being investigated. Of the studies with a control group, four (18%) include an additional group with another gastrointestinal pathology to compare with the irritable bowel syndrome, to be precise: inflammatory bowel disease (9%), Crohn's disease (4.5%) and ulcerative colitis (4.5%).The total number of participants evaluated in the reviewed studies is 255,068, these being 18 participants from the smallest sample  and, as with the total number of participants, the proportion of females (52%) and males (48%) is balanced and the mean age is 40.5 years (SD = 7.9).As can be seen in As for CPVP and its subtypes, a total of 13 of the instruments (19.4%) were aimed at its evaluation; the most commonly used being the Rome III Criteria for IBS (25%), the IBS Symptom Severity Scale (IBS-SSS) (21%), the Pain Catastrophizing Scale (PCS) (10%), the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) (8%) and the Visual Analog Scale (VAS) (8%). These instruments evaluated a total of 16 different variables (24.2%), the most commonly evaluated being: the symptoms of irritable bowel syndrome (22%), the severity of the symptoms of irritable bowel syndrome (20%), pain catastrophizing (9%), somatic symptoms (9%) and the specific distress of the gastrointestinal symptoms (5%).As for the psychopathological disorders, 37 of the instruments (55.2%) were aimed at their evaluation, the most commonly used being: the Beck Depression Inventory (BDI) (7%), the Patient Health Questionnaire Depression Scale (PHQ-9) (7%), the Generalized Anxiety Disorder Scale (GAD-7) (6%), the Structured Clinical Interview for DSM-IV (SCID) (6%) and the Hospital Anxiety and Depression Scale (HADS) (5%). These instruments evaluated a total of 25 different variables (37.9%), the most commonly evaluated being: depression (24%), anxiety (22%), psychopathological symptomatology (9%), the quality of life related to health (6%) and the DSM-IV disorders (6%).As for the neuropsychological disorders, 17 of the instruments (25.3%) were aimed at their evaluation, the most commonly used being: the Stroop test (23%), the Wisconsin Card Sorting Test (WCST) (8%), the Mini-Mental State Examination (MMSE (8%), the Attention Network Test (ANT) (8%) and the Wechsler Adult Intelligence (WAIS) (8%). These instruments evaluated a total of 25 different variables (37.9%), the most commonly evaluated being: attention (33%), inhibition (13%), the processing of information (9%), work memory (6%) and cognitive flexibility (6%).The severity of the CPVP and its subtypes were evaluated in a total of 18 articles (55%). The majority of the participants with this pathology presented moderate or severe thoracic, abdominal and/or pelvic symptoms. In particular, in the study of Lackner et al. , the sevThe psychopathological disorders of CPVP and its subtypes were evaluated in a total of 28 articles (85%). The psychological disorders with the greatest prevalence in the participants with this pathology, diagnosed in 9 of these articles (33%), were: those of anxiety, to be precise, generalized anxiety disorder (present in 25% of these articles); mood disorders, to be precise, major depressive disorder (present in 18%); and somatoform disorders (present in 14% of these articles); followed by bipolar disorder (present in 7%) and panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, sleep disorders, substance use disorders, anorexia nervosa, borderline personality disorder, dependent personality disorder, histrionic personality disorder and narcissistic personality disorder (each one present in 4%). It is worth highlighting the study of Liu et al. , which fThe psychopathological symptoms with the greatest prevalence in CPVP, evaluated in 22 of these articles (79%), were: moderate levels of anxiety (present in 46% of these articles), depression (present in 39%) and stress (present in 18%), followed by somatization, compulsive obsession, hostility, psychoticism (each one present in 7%) and interpersonal sensitivity, phobias, paranoid ideation, insomnia, anxiety due to illness, adverse childhood experiences, mentalizing deficits, hypochondria, neuroticism, hysteria, social inhibition, interpersonal cognitive distortions and fear of uncertainty (each one present in 4%). Only Lackner et al. , DybowskThe neuropsychological disorders of CPVP and its subtypes were evaluated in a total of 12 articles (36%). The executive functions, evaluated in 11 of these articles (92%), show uneven results. Aizawa et al.  and WongAttention, evaluated in 8 of these articles (67%), shows congruent results. Aizawa et al.  and WongIn intelligence, evaluated in 2 of these articles (17%) using the Wechsler Adult Intelligence Scale (WAIS), despite the fact that there were no significant differences with respect to the control group; there was evidence of a lower performance level in the fluid and crystallized intelligence tests of the participants with CPVP. In memory, evaluated in 2 of these articles (17%), the results were uneven. Kennedy et al. , using tChen et al.  evaluateThe present study has carried out the first systematic review of the psychopathological and neuropsychological disorders associated with CPVP, in accordance with the new conceptualization of chronic pain from the WHO and the International Association for the Study of Pain (IASP) in the last revision of the ICD-11 ; while in the attention networks of executive control (selective attention), there is evidence of a reduced functioning. On examining the existing correlations, Tkalcic et al.  showed aAs for the findings concerning intelligence, although there were no significant differences with respect to the general population, there was evidence of a lower performance in fluid intelligence and crystallized intelligence. It can be seen that the risk of dementia has only been evaluated in one study . The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2  were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all  Out-of-hospital cardiac arrest (OHCA) is a major health problem worldwide , and itsEmergency systems have been implemented based on scientific evidence ,11, the The difficulty in guaranteeing assistance by emergency dedicated physicians to all types of emergencies of the population has led some EMS to send non-emergency dedicated physicians who are performing primary care consultation tasks to complete the teams of basic life support (BLS) emergency technicians to provide advanced life support (ALS); however, despite sharing specialty and the initial advanced life support training, emergency care is only a small part of the practice of these physicians and, therefore, could lead to less experience ,13,14 anThe objective of the present study is to assess the influence of the type of physician who leads the resuscitation attempt on the survival from emergency-medical-service-witnessed cardiac arrest by comparing the survival results of emergency dedicated physicians (EDPhy) and non-emergency dedicated physicians (N-EDPhy). A BLS emergency medical technician (EMT) team was used as a control group to evaluate the influence of both types of medical leadership.The primary outcome was global survival and survival with a cerebral performance category (CPC) of 1-2  after 1 year, and the secondary outcomes were any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and CPC 1-2 survival at 30 days and 5 years. The shockable and non-shockable rhythms were studied independently.The working hypothesis was that the presence of a physician dedicated exclusively to emergencies (EDPhy) leading the resuscitation attempts could have a positive relationship with survival.This is a multicentre, descriptive, observational study with retrospective data collection from the OHCA database of the EMS “FPUS 061 of Galicia” adapted to the Utsein 2015 style . The eveThe study was specifically designed to compare the influence of the team initially attending OHCAs with the fewest possible confounding variables that could influence the results . The aim was to evaluate the efficacy, i.e., the performance in the best possible conditions (EMS-witnessed VF only) of each part of the EMS.The initial choice of the teams was made by the emergency centre 061 in response to the demands of urgent healthcare by the population, depending on availability and severity and assigned by the dispatcher. The assigned team arrived at the site and began patient assistance; at this time, all the patients were still alive. From this moment, the event to be studied was a cardiac arrest that occurred by chance and was witnessed by the healthcare provider team, who would then immediately initiate a resuscitation attempt. The surviving patients were transferred to various hospitals in the public network. Only those services requested by the general population were included, excluding healthcare locations and hospitals.Each of the 18 autonomous regions in Spain has its own Public Health and Emergency Medical System (EMS). As there is no specialty in emergencies, the physicians who make up the emergency medical systems are mostly specialists in family medicine. All family physicians receive at least one certified advanced life support course and work one 17 to 24 h shift a week in an accident and emergency department for three years during their specialisation period. After concluding their specialty, every physician can voluntarily apply for an advanced life support refresher course once or twice a year.The regional emergency system in the study period was composed of an emergency centre with a specific health phone number (061) and the 112 number for common general emergencies. The system consisted of 103 basic life support (BLS) ambulances with 2 technicians using automated external defibrillators, 10 advanced life support (ALS) ambulances, and 2 helicopters with physicians and nurses. When they were available, these ambulances with emergency dedicated physicians on board were the first option for being sent to the most critical patients, but the shortage of ALS resources caused the EMS to send primary care physicians and nurses as well when they were required to lead a BLS team to ensure ALS. As the EMS 061 was set up in July 1997, the EDPhy working for the EMS were younger and had fewer years of working experience within the period of the study than the N-EDPhy.2 in area, with a gross domestic product below the Spanish average and an average population during the years of the study of approximately 2.7 million inhabitants. The region is very dispersed, with 7 urban centres with a population ranging from approximately 100,000 to 500,000 inhabitants and 313 municipalities.The study was carried out in the Galicia Region of Spain, 49,500 kmOnly cardiac arrests witnessed by emergency health personnel were included. OHCAs detected at EMS arrival were excluded. Only cardiac arrests with medical causes were included  . Causes The main dependent variable to study was survival after an event (a cardiac arrest witnessed by emergency personnel) at the site of care (any return of spontaneous circulation at the site), after hospital admission , and at 30 days, 1 year, and 5 years after the event. The CPC at 30 days, 1 year, and 5 years were also studied.As independent variables, the initial rhythm (shockable and non-shockable), and the team that performed the resuscitation  were considered.The characteristics of the patient groups are presented in the frequency tables as a percentage of the categorical data , and with the median values with interquartile ranges for the continuous data  . To compLogistic regression was used to assess the trends in the participation of a type of emergency team with survival over time, with the initial rhythm, gender, and age range. Crude logistic regression was used to examine the association between exposure and outcome  at each time point . The associations are represented as odds ratios (ORs) with 95% confidence intervals (CIs).The first model was a survival analysis  with the “enter” method, using the type of emergency medical service ; gender ; age range ; and the initial rhythm  as the explanatory covariates. To this end, all the above variables were entered as categorical, using the type of SEM as the first categorical reference variable at each of the moments studied . The second explanatory model was obtained using the same covariates as in the first model but without taking into account the EDPhy medical service.The Hosmer–Lemeshow goodness-of-fit test was used to determine whether the predicted probabilities deviated from the observed probabilities in a way that the binomial distribution did not predict.All the data were processed using the SPSS version 24 statistical package for MS Windows .A total of 8503 resuscitation attempts were carried out during the period studied (2006–2016) . ExcludeThe data results  were disThe incorporation of an EDPhy was positively associated with all the overall survival results  with CPC 1-2 when compared with the N-EDPhy and EMT groups. The presence of an N-EDPhy was negatively related to the 30-day and 1-year survival results when compared with the EMT group .The incorporation of EDPhy was positively and significantly associated with all the overall survival results with CPC 1-2 when compared with N-EDPhy and EMT groups. The presence of N-EDPhy was non-significantly associated with all the survival results compared with the EMT group .After applying a logistic regression model , the parIn a second predictive model, the participation of EMTs, compared with N-EDPhy, was significantly positively associated with all the survival results in the group <65 years and the event survival group (OR = 1.71) and with survival at 30 days (OR = 1.91) and at 1 year (OR = 1.88) in the overall results but did not reach statistical significance in the rest of the groups.The present study shows that the presence of a physician dedicated exclusively to emergencies was significantly related to greater survival results of the cardiac arrest witnessed by emergency personnel.When compared with the EMT control group, the ALS provided by an EDPhy improved all the survival results, whereas the presence of an N-EDPhy did not significantly improve the results, and even worsened some survival results.The overall and EDPhy survival rates are in the range of those published in the studies on the OHCAs witnessed by emergency personnel ,25,26,27The results of this study show that specialisation works in emergencies, as in other fields of medicine. Thus, specific dedication to emergencies was positively associated with survival, meaning that specialisation works in improving survival rates, and this association is probably related to greater exposure to OHCA and experience ,16,17,18On the other hand, the ALS provided by specific emergency personnel should be extended to the largest possible proportion of the population served by the EMS. ALS did not always improve the survival rates of BLS. A benefit in terms of survival was added to BLS performance when ALS was provided by emergency dedicated personnel but not when it was delivered by N-EDPhy. Should only EDPhy be trained in ALS? Should immediate life support with easier recommendations be taught to N-EDPhy?  This disNot all the initiatives adopted by the EMS with the objective of guaranteeing the best assistance translate into positive survival results ,13,33, wThe strength of this study is that it was specifically designed to compare team performance. By including only cardiac arrests in shockable rhythms witnessed by emergency medical personnel, the influence of multiple confounding variables dependent on time , bystander (bystander CPR), the availability of automated external defibrillators, location (access to the scene), and the percentage of each type of initial rhythm was avoided. In this way, it was possible to compare team performance from the time zero of the event, and since the event was presented by chance once the team was at the scene and was not known by the dispatcher beforehand (randomly assigned), a lower influence of the remaining confounding variables was expected. The cerebral performance category and long-term survival were also studied.Regarding the limitations, we should bear in mind that this was not a randomised study. In addition, the process of eliminating the potential confounding variables prior to team assistance resulted in a great reduction in the sample size. On the other hand, the distribution of the remaining confounding variables was not homogeneous, resulting in a disproportion of sex and age. This age disproportion might be explained by the fact that EDPhy were more experienced and could select their resuscitation attempts. It is also necessary to take into account that the model only evaluated the performance of the EMS personnel directly attending to the patient only. In spite of having excluded futile resuscitation attempts, previous medical conditions were not studied, and this could also affect the results. Although the event to be studied was the first 10 min of resuscitation by a team, other EDPhy resources could later arrive for post-resuscitation care or even to continue the resuscitation. It is also worth noting that, before being transferred to tertiary hospitals, the patients were initially transported to public hospitals with different levels of post-resuscitation care that could be at lower levels in those areas with small populations. However, the fact that the benefit in survival was greater in the earlier rates might suggest that the hospital effect was minimal . Lastly,The presence of a physician dedicated exclusively to emergencies as a leader of the resuscitation team significantly improved the survival results of the cardiac arrests witnessed by emergency personnel compared with those witnessed by the teams of primary care physicians.Advanced life support improved the survival results of the basic life support control group when it was provided by an emergency dedicated physician but not when it was delivered by a non-emergency dedicated physician.


The implementation of activities aimed at improving the management of oral anticoagulants in the ACO-ZAR II study achieves a reduction in undertreatment up to 16%, in the use of antiaggregant up to 9%, and in suboptimal control up to 30%, as well as an increase in control from primary health care up to 69.2% and of the penetrance of direct oral anticoagulants up to 28%. (4) Conclusions: In conclusion, the application of activities aimed at optimizing the management of oral anticoagulants in health center patients allowed the improvement of risk assessment and registration, undertreatment, use of antiaggregant, suboptimal control of vitamin K antagonists, control by primary health care center, and the penetrance of direct oral anticoagulants. Atrial fibrillation (AF) is currently the most frequent sustained cardiac arrhythmia with an exponential increase with age , which wAlternatively, AF is independently associated with an increased risk of mortality for all causes 2 times higher in women and 1.5 in men ,19. It pAF is an important public health problem due to prevalence, morbidity, and mortality. However, AF appears in elderly patients that are polymedicated and with associated comorbidities, which makes it the prototype of a chronic-complex patient and a subsidiary of a comprehensive approach and multidisciplinary management .Despite this important public health problem, only antithrombotic treatment is capable of modifying its natural history . At presIn part, primary health care (PHC) has an enormous specific weight in the management of anticoagulation, with the percentage of patients diagnosed and followed up in our clinics ,28 reach®) and Warfarin (Aldocumar®). However, one of the most important limitations of these drugs is the need for frequent monitoring of their interactions and their narrow therapeutic window [Until recently, the standard treatment in oral anticoagulation was the use of dicoumarins or vitamin K antagonists (VKA), represented by acenocoumarol   draws upAccording to the recommendations of the Spanish Agency for Medicines and Medical Devices (AEMPS)  in its TIn this line, we consider the ACO-ZAR I and II study to evaluate and improve the management of patients with atrial fibrillation in treatment with oral anticoagulants (OAC) from primary health care (PHC).The ACO-ZAR project of “Improvement of oral anticoagulants the management in atrial fibrillation patients from primary health care center “Las Fuentes Norte”, as shown in After performing the ACO-ZAR I descriptive study, the ACO-ZAR II study of “Optimisation of oral anticoagulants in primary health care”, in the case of a prospective quasi-experimental study, was carried out on the previous population of the ACO-ZAR I study (385 patients with AF), with the loss of 67 patients due to a lack of follow-up (displacement or death), in the case of a final sample of 318 patients, from June 2016 to July 2017.In this study, the situation of the oral anticoagulants is reassessed by repeating the methodology of the previous study, but after performing activities aimed at patient information in a unified and written format, training of health personnel through clinical sessions and protocolization of care activity can be achieved through the development of quick guides shown in The sources of information were the medical records of our electronic health record and the electronic prescription. The main variables are the existence of atrial fibrillation (FA) diagnosis in electronic health record. The diagnosis is defined using the International Classification of Primary Care (ICPC-3) . Given t2 was calculated from the MDRD-4 equation [This electronic health record includes sustained and non-sustained atrial fibrillation. The CHADS2-VASC scale ,37 was uequation . Liver failure was considered if one of these 3 situations appeared . Associated treatment data , drugs for heart rate control or rhythm control) were obtained from electronic prescription RE.Ethical considerations: The ACO-ZAR project “Optimization of oral anticoagulants in primary health care” was included in the Management Agreement/Program Contract of the Aragonese Health Service 2016–2017, as shown in Statistical analysis: The statistical package SPSS version 25 was used. To observe the type of distribution of variables used, the Kolmogorov–Smirnov test with Lilliefors corrections for describing qualitative variables were used for frequencies and percentages. For describing quantitative variables, means, standard deviations, and ranges were used in the case of normal behavior, as well as the medians and interquartile ranges for the rest of the cases. The respective 95% confidence intervals were obtained.The ACO-ZAR I study revealed that the population with AF treated in our center had a mean age of 76.58 ± 10.62 (with ≥75 years 68%), with a prevalence of 1.7% in the general population, which increased exponentially with age, assuming 2.98% of those more than 40 years old had an abundance of associated comorbidity, mainly arterial hypertension (76.3%), diabetes mellitus (35.2%), chronic renal failure (32.3), heart failure (27.9%), thromboembolic disease (18.8%), and a high degree of polypharmacy (84.5%). p < 0.05%) and were moderate-to-high . CHADS2-VASC increased statistically significantly with age and HAS-BLED showed statistically significant differences depending on the age range. The risks—thromboembolic due to CHADS2-VASC and hemorrhagic due to HAS-BLED—did not follow a normal distribution .Regarding the management of OAC treatment, only 10.5% of patients had an evaluation of thromboembolic risk (CHADS2-VASC) and hemorrhagic risks (HAS-BLED), with 24% undertreatment. Additionally, 13.42% used antiaggregant AAG as primary prevention, 43% had suboptimal control of VKA, 22.10% used DOAC, and 34% was controlled exclusively from the primary health care center.Finally, regarding symptomatic treatment, 68.8% were in rate control and 29.9% were in rhythm control. None of the therapeutic options presented significant differences due to age or associated pathologies. After the correlational analysis, we can observe how the thromboembolic risk increases slightly as the patient gets older, and as it happens when the patient is a woman. Additionally, the thromboembolic risk increases when the patient is polymedicated and decreases when the bleeding risk is lower than 3 points. These data are shown in Alternatively, we can observe how the hemorrhagic risk increases slightly as the patient gets older. Additionally, the hemorrhagic risk decreases when the patient does not have a habitual treatment with antiaggregants or NSAIDs. These data are shown in The results of ACO-ZAR II, after implementation of activities aimed at optimizing the management of OAC in primary health care patients, showed an evaluation and registration of risks of 35.5%; undertreatment of 16%; use of antiaggregant drugs of 9%; suboptimal control of VKA of 30%; control by primary health care center of 69.2%; penetrance of DOAC of 28%; and uptake of the follow-up of DOAC in nursing management of 21.9%. A comparison of the results obtained between the assessment of ACO-ZAR I and those obtained for ACO-ZAR II is shown in The epidemiological results of ACO-ZAR I revealed a frail population due to advanced age, multiple associated comorbidities and polypharmacy, representative of the populations studied at the national level, an important fact when extrapolating our management data with studies with a broader scope than the of the primary health care center itself and national nature, due to the lack of other similar studies of Aragon.Regarding the management of OAC, a low evaluation of thromboembolic and hemorrhagic risks was observed by CHADS2-VASC and HAS-BLED, respectively, of only 10.5%, of which no national data are available in this review. Regarding our undertreatment of 24%, we were at the national level  and high hemorrhagic risk (according to HAS-BLED). Additionally, the percentage of undertreatment as suboptimal control, and the lack of evaluation and management, is also high. For this situation, the application of the activities aimed at optimizing the management of OAC in primary health care patients allowed the achievement of the proposed objectives, improving the evaluation and registration of risks, undertreatment, and the use of antiaggregant, suboptimal control of VKA, and control by primary health care center and DOAC penetrance.Observing the evidence and results obtained, it is increasingly necessary to give importance to AF in general and thromboembolic and hemorrhagic events. CHADS2-VAS C and HAS-BLED scales enable a complete joint evaluation of thromboembolic and hemorrhagic risks to allow a notable improvement in the quality of care and the quality of life of the population with AF. Given the importance of primary health care in clinical practice, the quality of oral anticoagulation, and the changes in the supply of anticoagulant treatment, there is a need to adapt the management model and improve the information provided to the patient and therapeutic adherence to OAC users. These improvements are promoted through the creation of training programs and better action protocols that allow the reorganization of daily clinical activity for the different therapeutic options.More scientific evidence is needed when applying new OAC optimization and management protocols, in addition to considering the possible long-term effects of these management models.


Engineered cementitious composites (ECC) exhibit ultra-high ductility and post-cracking resistance, which makes it an attractive material in civil engineering. First, a monotonic uniaxial tensile test was performed, considering the effects of polyvinyl alcohol (PVA) fiber volume content and water-binder ratio. Then, the effects of the above variables on the tensile characteristics including the tensile stress–strain relationship, deformation capacity, and fracture energy were investigated based on test results; and when the water-binder ratio is 0.28 and the fiber volume content is 2%, the deformation performance of ECC is improved most significantly. Next, combined with damage mechanics theory, the damage evolution mechanism of ECC in monotonic uniaxial tension was revealed, based on which the damage factor and damage evolution equation of ECC were developed and the expressions of model parameters were proposed. Moreover, the comparison between the proposed model and test results demonstrated the accuracy of the proposed model. Finally, to further verify the feasibility of the proposed model, a finite element (FE) simulation analysis of the tensile performance of high-strength stainless steel wire rope (HSSWR) reinforced ECC by adopting the proposed model was compared with test results and the simulation analysis results by using anther existing model, the “trilinear model of ECC”. The comparison shows that the proposed model in this paper can predict more accurately. Engineered cementitious composites (ECC) is a new type of fiber reinforced cementitious composite material proposed in the 1990s and continuously developed in recent decades ,3, whichMany researchers have focused on the constitutive model of ECC in tension in order to give an accurate analytical calculation or numerical analysis of mechanical properties of structures constructed using ECC ,24,25,26Damage modelling is a new approach to describe the mechanical behavior of materials by using damage mechanics theories ,30,31, wTherefore, in this paper, the damage constitutive model of ECC under uniaxial tension was studied experimentally and analytically. The main contents and purposes of this study include: (1) to evaluate the effects of PVA fiber volume content and water-binder ratio on the tensile properties of ECC under uniaxial tensile test; (2) to investigate the damage evolution law of ECC under uniaxial tensile; (3) to develop the damage constitutive model of ECC under uniaxial tension based on the test results; (4) to validate the acceptability and accuracy of the proposed model through FE analysis of high-strength stainless steel wire rope (HSSWR) reinforced ECC under uniaxial tension by adopting this model and existing trilinear model.The component materials of ECC used in this paper are ordinary silicate cement, fly ash, micro-silica fume, silica sand, PVA fiber, superplasticizer, and water. The mix proportions of the test specimens are shown in v) and the water-binder ratio (r) were considered, as listed in In this test, five groups of specimens with thin plate dimensions of 280 mm (length) × 40 mm (width) × 13 mm (thickness) were used, and each group consisted of 5 identical specimens. The volume content of PVA fibers (The test setup and loading device is shown in kε), first-cracking stress (kσ), peak strain (pε), peak stress (pσ), ultimate strain (uε), and fracture energy (fG) for each group of specimens are shown in v) or the water-binder ratio (r) are shown in The tensile mechanical property indicators including first-cracking strain  of a specimen can be expressed as:gL is the gauge length and E0 is initial tensile modulus.Tensile fracture energy is defined as the energy required per unit area of crack extension, and it is a key indicator to describe the crack-control and energy dissipation capabilities of a material ,40,41. AThe calculated result of tensile fracture energy of ECC for each specimen was calculated and given in The uniaxial tensile stress–strain curves of ECC with different fiber volume content and water-binder ratio are shown in The crack pattern and damage evolution process of the specimens under uniaxial tension are shown in The first stage (elastic nondestructive stage) is from the start of loading to the first-cracking point, where the deformation is elastic and the applied external load is mainly borne by the cement mortar matrix. The tensile stress and strain of ECC conform to a linear relationship at this stage and the specimen is basically in a nondestructive state.The second stage (strain-hardening and stable damage stage) is from the first-cracking point to the peak point. At this stage the tensile stress of ECC increased slowly with increasing strain and the number of cracks increased, showing clear strain-hardening and multiple cracking characteristics. The damage of ECC began to appear at the first-cracking section, but the damage development at the cracked section was restrained to a certain extent due to the bridging effect of PVA fibers. With the increase of stress, new cracks continuously appeared on different sections of ECC, which reflected that the damage was dispersed to multiple cracked sections. As a result, the rate of damage development could be slowed down. While reaching the peak stress, no new cracks were generated, and the restraint effect of fibers on the damage was maximized and the damage development rate was minimized.The third stage (strain-softening and unstable damage stage) is the stress decreasing segment after the peak point. At this stage, as the tensile strain increased, the tensile stress began to decrease, and the fibers ruptured at cracked sections or were continuously pulled out from the matrix. Besides, the width of cracks gradually increased with the increasing strain. Due to losing the bridging effect of the fibers in the matrix, the damage increased rapidly at this stage, making the damage in the increasing state of nonconvergence. Finally, the main crack of most specimens formed close to the clamp because of the stress concentration close to the clamp, and the ECC specimen ruptured at the main crack.d) expressed by the variation of the angle between the secant line of a point of the ECC tensile stress–strain curve and the horizontal axis to represent the degree of damage, as shown in In order to reflect the damage development characteristics of ECC in uniaxial tension at different stages, this paper adopts damage factor  should satisfy the following boundary conditions:Besides, the damage factor –(12), the model coefficients b and A) are independent unknown coefficients. These two coefficients can be determined by regression analysis of test results. Specifically, Equation (9) was used to fit the test result of damage factor–strain curve of each specimen to obtain the values of model coefficients B and A of each specimen. Then, b and A are substituted into Equations (13)–(15) to obtain the values of coefficients k, B, and C. The obtained values of model coefficients are given in From the above expressions for the model coefficients (13)–(15), only two coefficients  and the water-binder ratio (r) with correlation coefficients R2 of 0.989 and 0.994, respectively, which are given as follows:v) is 1–2%, and the applicable range of ECC water-binder ratio (r) is 0.24–0.28.As can be seen from In order to further analyze the characteristic of damage evolution in the strain-hardening and strain-softening stages, the first and second order derivatives of the damage factor expression Equation (9) with respect to strain for these stages are derived as follows:It can be seen from Equations (16)–(19) that in the strain-hardening stage; the first-order derivative of the damage factor is greater than 0, but the second order derivative is less than 0. This indicates that in the strain-hardening stage, as the tensile strain increased, the damage increased continuously, but the increasing rate of damage decreased due to the presence of fibers, and the damage in a stable development state. In the strain-softening stage, the first and second order derivatives of the damage are both greater than 0. This demonstrates that in the strain-softening stage, as the tensile strain increased, the damage of the ECC increased continuously, and the increasing rate also increased due to the continuous pulling out or rupture of the PVA fibers, and the damage is in an unstable development state. The above analysis is consistent with the test results of the evolutionary mechanism of damage in b, and A, the measured values (exptb and exptA) of the validation group were compared with the calculated values by using Equations (16) and (17) , as shown in b, and A, are 0.971 and 1.155 respectively, with coefficients of variation of 0.023 and 0.208, which indicates that the Equations (16) and (17) are acceptable for calculating the damage model coefficients (b and A).In order to verify the applicability of the proposed model, existing experimental results in reference  will be In order to verify the accuracy of the damage constitutive model of ECC in uniaxial tension proposed in this paper, the predicted stress–strain curves for ECC under uniaxial tension were obtained by using the proposed model [Equations (9) and (10)] and expressions of model coefficients [Equations (13)–(17)], and were compared with test stress–strain curves and the existing trilinear model ,24,25, aAs can be seen from v), the water-binder ratio (r), first-cracking strain (kε), first-cracking stress (kσ), peak strain (pε), peak stress (pσ), and ultimate strain (uε) of the used ECC are 2%, 0.28, 0.02%, 2.45 MPa, 2.79%, 3.53 MPa and 4%, respectively. The maximum tensile stress (stσ) and its corresponding strain (stε) of the used HSSWR with a nominal diameter of 2.4 mm are 1573 MPa and 2.99%, respectively. The HSSWR reinforced ECC specimen is of the shape of dumbbell, and the HSSWR are symmetrically arranged at the middle height of ECC plate section with equal spacing, as shown in In order to further prove the applicability of the proposed damage constitutive model of ECC in uniaxial tension, this model was incorporated to the FE analysis of the tensile performance of high-strength stainless steel wire ropes (HSSWR) reinforced ECC by using the general FE analysis software ABAQUS. The FE simulation results of by adopting this model would be compared with the results of the uniaxial tension tests on HSSWR reinforced ECC performed by the authors’ research group  and the The three-dimension (3D) nonlinear FE model was used to simulate the tension tests on the HSSWR reinforced ECC specimens, as shown in The mesh size of the elements of ECC and HSSSWR was set to be 10 mm. The interface between ECC and CFRP sheets was assumed to have no relative slip and connected by using the tie constraint feature of ABAQUS . The embBoth the proposed damage constitutive model  and trilinear model ,24,25 wex = sε/stε, y = sσ/stσ, and sσ and sε indicate the tensile stress and strain of HSSSWR, respectively.The tensile constitutive model of HSSSWR proposed by the authors’ previous studies  was adopThe constraint conditions of the specimen were reproduced by constraining the three translational freedom degrees of one end of the specimen and applying loading by using displacement control at the reference point (RP) created at the section centroid of the other end ECC surface at the loaded end were. The details of 3D nonlinear FE modeling of HSSWR reinforced ECC specimens are shown in The predicted load-displacement curves of HSSWR reinforced ECC specimens in tension through FE method by using the proposed model in this paper and the trilinear model ,24,25 ar(1)An increase in the volume content of PVA fibers could enhance the cracking strain, cracking stress, peak strain, ultimate strain, and fracture energy of ECC. An increase in the water-binder ratio could reduce the cracking stress and peak stress, but would increase the cracking strain, peak strain, ultimate strain, deformation capacity, and fracture energy;(2)The damage development process of ECC under uniaxial tension can be divided into three stages: (1) elastic undamaged stage, (2) strain hardening and stable damage stage, and (3) strain-softening and nonconverging damage stage. Adding PVA fibers in ECC could disperse the damage in ECC, and could obviously reduce the damage development rate in the strain hardening and stable damage stage. While reaching the peak stress, the damage development rate was minimized;(3)By comparing with the experimental results, the damage constitutive model and expressions of model parameters for ECC in uniaxial tension proposed in this paper, which considered the effects of PVA fiber volume content and water-binder ratios, was verified to be able to give accurate prediction of the nonlinear stress–strain relationship of ECC, reflecting the damage evolution characteristic of ECC at different stressing stages;(4)Based on FE analysis, the model in this paper can be applied to simulate the nonlinear tensile process of HSSWM-ECC. Compared with the trilinear model used by ECC, the model in this paper has higher accuracy and smaller discreteness;(5)Due to the limitations of the experimental research in this paper, the range of experimental parameters and the number of specimens should be expanded in the future to make the proposed model parameters more accurate. Secondly, the experiments under repeated loads should be explored, and the damage constitutive model of ECC under repeated loads should be proposed. Finally, it may be more meaningful and challenging to apply the proposed model to the analysis of real structures.Through the uniaxial tensile test study of ECC specimens with test variables of PVA fiber volume content and water-binder ratio, the effects of the above variables on the uniaxial tensile performance of ECC and the whole process damage mechanism of ECC were revealed, based on which a damage constitutive model of ECC in uniaxial tension was developed. Finally, by applying it to the finite analysis of tensile properties of the new composite material HSSWR-ECC, the acceptability of this model was verified. The following conclusions can be drawn: