Valencia Region Research Articles

Hiking accommodation provision in the mountain areas of Valencia Region, Spain: a tool for combating the depopulation of rural areas

ABSTRACT Rural areas in Spain are currently suffering from a serious problem known as depopulation. One of the strategies to reverse the depopulation process is the rise of sports tourism. The main objective of this research is to analyse the offer of hiking accommodation in order to be able to propose sports products and services adapted to the clients. We intend to text whether the accommodation offer meets the needs and expectations of hikers and, therefore, whether the area is attractive and generates a tourist product with added value. A qualitative methodology was used through interviews. The profiles interviewed are made up of the different interest groups that revolve around sports tourism in both the private and public spheres. A total of 16 semi-structured interviews were carried out, lasting between 40 and 70 min. The results indicate that the different hiking lodgings have been adapting their offer to make it more competitive, as indicated by previous research on attraction factors. However, it could be interesting to combine the efforts of the different accommodations in order to improve the destination. The implications of this study are various: they describe the current situation in terms of sports tourism in the inland area of Castellón, laying the foundations for setting possible short and medium-term objectives. On the other hand, they provide a larger corpus of information on the idiosyncrasy of the area studied, which translates into a transfer of knowledge that can be used by public administrations and by private companies.

Development of sectorial and territorial information system to monitor GHG emissions as local and regional climate governance tool: Case study in Valencia (Spain)

Regional and local decision-makers need high quality GHG emission inventories to invest efficiently available resources in climate change mitigation measures. Nevertheless, decision-makers lack of tools to achieve GHG emissions inventories with enough rigor, accuracy and completeness. Thus, a territorial and sectorial information system (SITE) has been developed to monitor GHG emissions as local and regional climate governance tool. This system combines the advantages of both, top-down and bottom-up approaches, to achieve an innovative hybrid approach to account and manage efficiently GHG emissions. The implementation of SITE in Valencia region (Spain) as a case study has quantified 163 indicators in 542 municipalities. Regional gross GHG emissions in 2019 were 30 Mt. CO2 while the fixation was 6 Mt. CO2 eq. 1.8% municipalities emit 34% of total emissions. 34% municipalities fix more than they emit. Finally, sectoral analysis demonstrates that only 20% indicators are responsible for 85% of total emissions.

Assessment of COVID-19 Lockdown Impact on the Air Quality in Eastern Spain: PM and BTX in Urban, Suburban and Rural Sites Exposed to Different Emissions

In early 2020, the COVID-19 pandemic spread globally, and severe measures to control it were implemented. This study investigates the impact of the lockdown on the air quality of three provinces in the Valencia region, eastern Spain, in the years 2015–2020, focusing on particulate matter (PM). A thorough statistical analysis using different approaches is conducted. Hourly patterns are also assessed. In addition, the role of meteorological parameters on PM is explored. The results indicate an overall PM10 reduction of 16.5% when comparing the lockdown in 2020 and the 2015–2019 period, while PM2.5 increased by 3.1%. As expected, urban zones experienced higher reductions than suburban zones, which experienced a PM concentration increase. The impact of the drastic drops of benzene, toluene and xylene (77.4%, 58.0% and 61.8%, respectively) on the PM values observed in urban sites is discussed. Our study provides insights on the effect of activity changes over a wide region covering a variety of air quality stations, urban, suburban and rural, and different emission types. The results of this work are a valuable reference and suggest the need for considering different factors when establishing scientific air pollution control strategies.

Enhanced Detection of Drug-Resistant Tuberculosis with the First WHO Mutation Catalogue in the Valencia Region (Spain), A Low Burden Setting

Enhanced Detection of Drug-Resistant Tuberculosis with the First WHO Mutation Catalogue in the Valencia Region (Spain), A Low Burden Setting

Examining the Effectiveness of Catch Crops as a Nature-Based Solution to Mitigate Surface Soil and Water Losses as an Environmental Regional Concern

The main goal of this research was to conduct a biophysical, economic, social, and perception-based approach to foresee the solutions that could be used to mitigate the soil loss problem cost-effectively in “La Ribera del Xúquer” district (Valencia Region, Spain). To achieve these goals, a farmer perception survey was carried out, and an assessment of the biophysical impact of catch crops on soil organic matter, bulk density, steady-state infiltration rate (double-ring infiltrometer) and runoff generation, and soil erosion (rainfall simulation experiments) was carried out in 2016. For the biophysical approach, two paired plots, i.e., catch crops vs. glyphosate herbicide treatment (in advance, control plot), were selected under clementine citrus production. The results show that soil organic matter increased from 1.14 to 1.63%, and bulk density decreased from 1.47 to 1.27 g cm−3 after 10 years of treatments using catch crops. They also facilitated higher infiltration rates from 16.7 to 171 mm h−1 and a delay in runoff generation from 149 to 654 s for control and catch crop plots. Both runoff rates (from 50.6 to 3.1%) and soil erosion (from 3.9 to 0.04 Mg ha−1 h−1) were reduced once the catch crops were deployed in the field. After surveying (2018–2019), farmers stated the use of catch crops as a speck of dirt and a cause of possible loss of reputation when used. Moreover, farmers (N = 73) would accept the catch crops as an effective nature-based alternative only if a subsidy of 131.17€ ha−1 would be paid. The survey results also demonstrated that the farmers' community would see catch crop more as a benefit for the planet's health and society. Few constraints, such as ageing of the farmers’ population, lack of education and negative perception for other management factors, are the critical detrimental factors for adopting catch crops as a nature-based solution to reduce soil and water losses. There is a need for an effective agrarian extension service to change the fate of the current agriculture and achieve sustainability by adopting new management strategies in contemporary agricultural practices.

Analytical fault tree and diagnostic aids for the preservation of historical steel truss bridges

Historical steel bridges represent an important construction typology integrating the constructive heritage of the past century that needs to be preserved. Exposure to fatigue phenomenon, aging, improper design or execution, extreme events, and other aggressive environmental agents can seriously compromise the conservation and performance of these structures as some recent catastrophic collapses have shown (Mississippi River bridge, Minneapolis, Minnesota 2007; Kinzua Bridge State Park, Pennsylvania 2003).In this context, the diagnostic of historical steel bridges becomes of basic importance to identify and implement maintenance, monitoring and conservation strategies. Fault Trees are useful tools for practitioners that provide a complete overview of possible failures. In the related literature, this instrument is mainly applied with approaches that are based on previous experience or failures detected in similar structures, and so the Fault Tree can only provide qualitative support.This paper proposes a new method to achieve an “Analytical” Bridge Fault Tree linking the technician’s experience and the numerical simulations of different fault scenarios. The latter are achieved by a numerical model able to consider fatigue failure and different concurring causes in the analysis (e.g., and aggressive phenomena, corrosion, defects, lack of maintenance). The proposed approach was applied to a historical railway steel truss bridge located in the East of Spain (Valencia Region) in order to show its applicability and potential.

Real-World Management and Clinical Outcomes of Stroke Survivors With Atrial Fibrillation: A Population-Based Cohort in Spain.

Objective: Despite the continuous update of clinical guidelines, little is known about the real-world management of patients with atrial fibrillation (AF) who survived a stroke. We aimed to assess patterns of therapeutic management of stroke survivors with AF and clinical outcomes using data from routine practice in a large population-based cohort. Methods: A population-based retrospective cohort study of all patients with AF who survived a stroke, from January 2010 to December 2017 in the Valencia region, Spain (n = 10,986), was carried out. Treatment strategies and mean time to treatment initiation are described. Temporal trends are shown by the management pattern during the study period. Factors associated with each pattern (including no treatment) vs. oral anticoagulant (OAC) treatment were identified using logistic multivariate regression models. Incidence rates of clinical outcomes (mortality, stroke/TIA, GI bleeding, and ACS) were also estimated by the management pattern. Results: Among stroke survivors with AF, 6% were non-treated, 23% were prescribed antiplatelets (APT), 54% were prescribed OAC, and 17% received OAC + APT at discharge. Time to treatment was 8.0 days (CI 7.6–8.4) for APT, 9.86 (CI 9.52–10.19) for OAC, and 16.47 (CI 15.86–17.09) for OAC + APT. Regarding temporal trends, management with OAC increased by 20%, with a decrease of 50% for APT during the study period. No treatment and OAC + APT remained relatively stable. The strongest predictor of no treatment and APT treatment was having the same management strategy pre-stroke. Those treated with APT had the highest rates of GI bleeding and recurrent stroke/TIA, and untreated patients showed the highest rates of mortality. Conclusion: In this large population-based cohort using real-world data, nearly 30% of AF patients who suffered a stroke were untreated or treated with APT, which overall is not recommended. Treatment was started within 2 weeks as recommended, except for OAC + APT, which was started later. The strong association of APT treatment or non-treatment with the same treatment strategy before stroke occurrence suggests a strong therapeutic inertia and opposes recommendations. Patients under these two strategies had the highest rates of adverse outcomes. An inadequate prescription poses a great risk on patients with AF and stroke; thus monitoring their management is necessary and should be setting-specific.

Human papillomavirus vaccines effectiveness to prevent genital warts: A population-based study using health system integrated databases, 2009–2017

ObjectivesTo assess the effectiveness of the HPV vaccines in preventing genital warts (GW) in women aged 14–23 years and to estimate the incidence of GW in the whole population aged from 14 to 65. DesignPopulation-based retrospective cohort study using real-world data from the Valencia health system Integrated Databases (VID). Study populationAll subjects aged 14–65 years residing in the Valencia Region during 2009–2017 (n = 4,492,724), including a cohort of 563,240 females aged 14–23 years followed-up for the vaccine effectiveness (VE) estimations. Main outcome measuresIncident cases of GW defined as the first activation of GW-related codes (ICD-9-CM 078.11 or ICD-10-CM A63.0) in hospital, primary and specialized care during the study period. Adjusted VE was estimated as (1-Relative Risk (RR)) × 100 by a negative binomial Bayesian model. ResultsThere were 23,049 cases of GW in the overall population and 2,565 in the females’ cohort 14–23 years old. The incidence rate (IR) (in 100,000 persons-year) was 69.1 (95% CI 68.21–69.99) in the population overall, being higher in men (72.73; 95% CI 71.45–74.04). The IR of GW was 104.08 (95% CI 100.79–108.94) in the cohort of young women. The RR of GW increased with age from 14 to 21 years, reaching a plateau from 21 to 23. The VE of a complete schedule was 74% (95% CrI 68–79) for quadrivalent HPV vaccine (HPV4v). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine (HPV2v) in girls up to 21 years old. GW IR tends to be higher in unvaccinated cohorts covered by HPV4v vaccine than in unvaccinated cohorts not covered by HPV4v vaccine. ConclusionsA complete HPV4v vaccination schedule was 74% effective in reducing GW in our population. Our results also suggest an indirect protection to unvaccinated and HPV2v vaccinated girls.

Feasibility of a hybrid clinical trial for respiratory virus detection in toddlers during the influenza season

BackgroundTraditional clinical trials are conducted at investigator sites. Participants must visit healthcare facilities several times for the trial procedures. Decentralized clinical trials offer an interesting alternative. They use telemedicine and other technological solutions (apps, monitoring devices or web platforms) to decrease the number of visits to study sites, minimise the impact on daily routine, and decrease geographical barriers for participants. Not much information is available on the use of decentralization in randomized clinical trials with vaccines.MethodsA hybrid clinical trial may be assisted by parental recording of symptoms using electronic log diaries in combination with home collected nasal swabs. During two influenza seasons, children aged 12 to 35 months with a history of recurrent acute respiratory infections were recruited in 12 primary health centers of the Valencia Region in Spain. Parents completed a symptom diary through an ad hoc mobile app that subsequently assessed whether it was an acute respiratory infection and requested collection of a nasal swab. Feasibility was measured using the percentage of returned electronic diaries and the validity of nasal swabs collected during the influenza season. Respiratory viruses were detected by real-time PCR.ResultsNinety-nine toddlers were enrolled. Parents completed 10,476 electronic diaries out of the 10,804 requested (97%). The mobile app detected 188 potential acute respiratory infections (ARIs) and requested a nasal swab. In 173 (92%) ARI episodes a swab was taken. 165 (95.4%) of these swabs were collected at home and 144 (87.3%) of them were considered valid for laboratory testing. Overall, 152 (81%) of the ARIs detected in the study had its corresponding valid sample collected.ConclusionsHybrid procedures used in this clinical trial with the influenza vaccine in toddlers were considered adequate, as we diagnosed most of the ARI cases on time, and had a valid swab in 81% of the cases. Hybrid clinical trials improve participant adherence to the study procedures and could improve recruitment and quality of life of the participants and the research team by decreasing the number of visits to the investigator site.This report emphasises that the conduct of hybrid CTs is a valid alternative to traditional CTs with vaccines. This hybrid CT achieved high adherence of participant to the study procedures.Trial registration2019–001186-33 (EudraCT).

Role of age and birth month in infants hospitalized with RSV-confirmed disease in the Valencia Region, Spain.

BackgroundRSV is the leading cause of hospital admissions in infants and the principal cause of bronchiolitis in young children. There is a lack of granular data on RSV‐associated hospitalization per season using laboratory confirmed results. Our current study addresses this issue and intends to fill this gap.MethodsThe study was conducted from 2014 through 2018, in 4 to 10 hospitals in the Valencia Region, Spain. Infants included in this study were admitted in hospital through the Emergency Department with a respiratory complaint and tested by RT‐PCR for RSV in a central laboratory.ResultsIncidence rates of RSV‐associated hospitalization varied by season and hospital. Overall, the highest incidence rates were observed in 2017/2018. RSV‐associated hospitalization was highest in infants below 3 months of age and in those born before or at the beginning of the RSV season. Almost 54% of total infants hospitalized with laboratory confirmed RSV were found to be born outside the season, from April to October. The RSV positivity rate by ICD‐10 discharged codes varied by season and age with results from 48% to 57% among LRI (J09‐J22).ConclusionThe study was instrumental in bringing forth the time unpredictability of RSV epidemics, the critical impact of age, and the comparable distribution of RSV‐associated hospitalization in infants born on either side of the RSV season. These data could help in better characterization of the population that drives the healthcare burden and is crucial for the development of future immunization strategies, especially with upcoming vaccines in against RSV.

The Influence of Infection and Colonization on Outcomes in Inpatients With COVID-19: Are We Forgetting Something?

The COVID-19 epidemic has been a great challenge to health systems and especially hospitals. A prospective observational epidemiological study was planned as of February 26, 2020 in a tertiary hospital in the Valencia region. The total number of patients followed up with complete information during the first year was 2,448. Among other variables, the comorbidities of the patients were collected (and grouped in the Charson index), the stay in the intensive care unit (ICU), the co-infections, and the colonizations. Data on nosocomial infections due to said virus were also collected. The median days from the onset of symptoms to diagnosis were 4 + 4.6, while an additional 4.4 days had to pass for the patients to be admitted to the ICU. The factors associated with a higher risk of death were those with coinfection, especially with Candida auris [odds ratio (OR): 4.6], a situation that also occurred in the ICU (OR: 3.18). Charlson Index comorbidity and C. auris colonization were also very important both in general hospitalization and in the ICU.

Analysis of sedentariness in women from a gender and equity perspective

ABSTRACT This cross-sectional study aimed to analyse the social and gender-related factors influencing sedentariness in women, including occupation and family size (FS). We included women aged 45–70 years participating in the Breast Cancer Screening Programme of the Valencia Region (BCSP-VR) between November 2018 and October 2019 (n = 121,988). The response variable was sedentariness measured by sitting time in hours/day (h/day) (<3 h/day and ≥3 h/day). The explanatory variables were age, educational level, country of origin, living alone, childcare responsibilities, FS, disability, body mass index (BMI) and smoking status. Logistic regression models were adjusted for the whole sample and were stratified by occupation and FS. The variables that increased the odds of sedentariness were age ≥65 years (OR = 1.28; CI = 1.20–1.36), high educational level (OR = 1.39; CI = 1.31–1.47), non-manual occupation (OR = 2.38; CI = 2.27–2.48), living alone (OR = 1.11; CI = 1.05–1.17), disability (OR = 1.37; CI = 1.20–1.56) and BMI ≥ 30 (OR = 1.33; CI = 1.28–1.38). The variables decreasing the odds were large (OR = 0.90; CI = 0.87–0.96) and medium FS (OR = 0.93; CI = 0.90–0.97). Older age, high educational level and high BMI conferred a higher odd of sedentary lifestyle, independently of occupation and FS with statistical differences. Protective factors were childcare responsibilities in non-working women (OR = 0.86; CI = 0.74–0.99), large FS in women with manual occupations (OR = 0.88; CI = 0.80–0.97) and medium FS in housewives (OR = 0.91; CI = 0.86–0.97). This study identified social and gender-related inequalities in the factors influencing sedentariness, which were related to the type of occupation and FS. Highlights There are social and gender inequalities in the factors influencing sedentariness Non-manual occupation increases the risk of sedentary lifestyle Belonging to a medium or large family decreases the risk of sedentary behaviour Childcare responsibilities are related to lower sitting time throughout the day

Retrospective screening for SARS-CoV-2 among influenza-like illness hospitalizations: 2018-2019 and 2019-2020 seasons, Valencia region, Spain.

On 9 March 2020, the World Health Organization (WHO) Global Influenza Programme (GIP) asked participant sites on the Global Influenza Hospital Surveillance Network (GIHSN) to contribute to data collection concerning severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). We re‐analysed 5833 viral RNA archived samples collected prospectively from hospital admissions for influenza‐like illness (ILI) in the Valencia Region of Spain by the Valencia Hospital Surveillance Network for the Study of Influenza and Other Respiratory Viruses (VAHNSI) network (four hospitals, catchment area population 1 118 732) during the pre‐pandemic 2018/2019 (n = 4010) and pandemic 2019/2020 (n = 1823) influenza seasons for the presence of SARS‐CoV‐2. We did not find evidence for community‐acquired SARS‐CoV‐2 infection in hospital admissions for ILI in our region before early March 2020.

The impact of childhood RSV infection on children's and parents' quality of life: a prospective multicenter study in Spain

Background Several immunisation candidates against RSV are in late-stage clinical trials. To evaluate the benefits of a potential vaccination programme, both economic and health benefits will be needed. Health benefits are usually measured in Health-related Quality of Life (HRQoL) loss using standardised questionnaires. However, there are no RSV-specific questionnaires validated for children under 2 years, in whom most RSV episodes occur. Therefore, HRQoL estimates are taken from literature or inadequate tools. We determined HRQoL loss and direct costs due to an RSV episode in children younger than 2 years and their caregivers during a month of follow up, using a new questionnaire administered online.Methods An observational prospective multicentre surveillance study was conducted in children aged younger than two years. Children were recruited from 8 primary care centres and 1 hospital in the Valencia region and Catalonia (Spain). RSV-positive cases were obtained by immunochromatographic test. HRQoL was assessed using a new ad-hoc 38 item-questionnaire developed. Parents of infected children completed 4 questionnaires at four timepoints (day 0, 7, 14 and 30) after diagnosis.Results 117 children were enrolled in the study and 86 (73.5%) were RSV + . Median (interquartile range; IQR) scores were 0.52 (0.42–0.68), 0.65 (0.49–0.79), 0.82 (0.68–0.97) and 0.94 (0.81–1), for days 0, 7, 14 and 30, respectively. Compared to total recovery (Q30), HRQoL loss was 37.5%, 31.5% and 8.9% on days 0, 7 and 14 since diagnosis of the disease. The total median cost per patient (including treatments) was €598.8 (IQR: 359.63–2425.85).Conclusions RSV had almost 40% impact on HRQoL during the first week since onset of symptoms and the median cost per episode and patient was about €600. These results represent a substantial input for health-economic evaluations of future RSV-related interventions such as vaccination.

Biomonitoring of Phthalates, Bisphenols and Parabens in Children: Exposure, Predictors and Risk Assessment.

Exposure to emerging contaminants, such as phthalates, bisphenols and parabens in children has been associated with possible neurodevelopment and endocrine alterations. In the present study, the biomonitoring of biomarkers in children (5–12 years old) from the Valencia Region (Spain) have been implemented using urines from the BIOVAL program. More than 75% of the children studied (n = 562) were internally exposed (>LOQ) to bisphenols and parabens, and the whole population assessed (n = 557) were exposed to at least one phthalate. The geometric means (GM) of the concentrations of bisphenol A, methyl paraben and propyl paraben were 0.9, 1.4 and 0.39 ng/mL, respectively. Regarding phthalates, monoethyl phthalate GM was 55.0 ng/mL and diethyl hexyl phthalate (as the sum of five metabolites) GM was 60.6 ng/mL. Despite the studied population being widely exposed, the detection frequencies and concentrations were in general lower than in previous studies involving children in Spain and in other countries in recent years. Furthermore, the risk assessment study concluded that the internal exposure to phthalates, bisphenols and parabens is lower than the guidance values established, and, therefore, a health risk derived from the exposure to these compounds in the studied population is not expected.

Industry 4.0 in industrial districts: regional innovation policy for the Toy Valley district in Spain

ABSTRACT This study is focused on how Industry 4.0 is diffused within a Marshallian industrial district (MID) through collective action. It explains how MIDs adopt Industry 4.0 through collective initiatives for digitization, bypassing many barriers to change through the utilization of a collective project built upon a key feature of MIDs: cooperation. Results from interviews show a real living lab built upon a place-based bottom-up-oriented policy initiative co-designed by policymakers, collective actors and local firms, aimed at facilitating transition into Industry 4.0 in the Toy Valley district in the Valencia region of Spain. The results contribute to the emergent literature on district digitization.

Treatment patterns and appropriateness of antipsychotic prescriptions in patients with schizophrenia

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although it has a low prevalence compared to other mental conditions, it has a negative impact on social and occupational functions. This study aimed to assess the appropriateness of antipsychotic medications administered to schizophrenic patients and describe current treatment patterns for schizophrenia. A retrospective cohort study was conducted in all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. A total of 19,718 patients were eligible for inclusion. The main outcome assessed was inappropriateness of the pharmacotherapeutic management, including polypharmacy use. Altogether, 30.4% of patients received antipsychotic polypharmacy, and 6.8% were prescribed three or more antipsychotics. Overdosage affected 318 individuals (1.6%), and 21.5% used concomitant psychotropics without an associated psychiatric diagnosis. Women and people with a comorbid condition like anxiety or depression were less likely to receive antipsychotic polypharmacy. In contrast, increased polypharmacy was associated with concomitant treatment with other psychoactive drugs, and only in user on maintenance therapy, with more visits to the mental health hospital. Overall, we observed a high level of inappropriateness in antipsychotic prescriptions. Greater adherence to guidelines could maximize the benefits of antipsychotic medications while minimizing risk of adverse effects.

Cut-Off Lows and Extreme Precipitation in Eastern Spain: Current and Future Climate

This study presents a seasonal synoptic climatology of cut-off lows (COLs) that produced extreme precipitation in the Valencia region of Spain during 1998–2018 and uses simulations with the Weather Research and Forecasting (WRF) model to study how extreme COL precipitation may change in a future warmer climate. COLs were shown to be the main producer of extreme precipitation in the Valencia region, especially during the transition seasons. The strongest raining COL events occurred during September–November. Six-day composites of thermodynamic and dynamic fields and precipitation show that COLs that produce extreme precipitation in this region remain stationary over Spain for 2–3 days and tend to produce precipitation over the Valencia region for at least two consecutive days. In the low levels these COLs are characterized by low pressure over the Mediterranean sea and winds with an easterly, onshore component thus fueling precipitation. Comparison of current and future climate ensembles of WRF simulations of 14 September–November extreme precipitation producing COL events suggest that in a warmer climate extreme COL precipitation may increase by as much as 88% in northeastern Spain and 61% in the adjoining Mediterranean Sea. These projected increases in extreme COL precipitation in the northeast of Spain present additional challenges to a region where COL flooding already has significant socio-economic impacts. Additionally, about half of the future climate COL event simulations showed increases in precipitation in the Valencian region of eastern Spain. These results provide important nuance to projections of a decreasing trend of total precipitation in the Iberian Peninsula as the climate warms.

A data generator for covid-19 patients’ care requirements inside hospitals

This paper presents the generation of a plausible data set related to the needs of COVID-19 patients with severe or critical symptoms. Possible illness’ stages were proposed within the context of medical knowledge as of January 2021. The parameters chosen in this data set were customized to fit the population data of the Valencia region (Spain) with approximately 2.5 million inhabitants. They were based on the evolution of the pandemic between September 2020 and March 2021, a period that included two complete waves of the pandemic.Contrary to expectation and despite the European and national transparency laws (BOE-A2013-12887, 2013; European Parliament and Council of the European Union, 2019), the actual COVID-19 pandemic-related data, at least in Spain, took considerable time to be updated and made available (usually a week or more). Moreover, some relevant data necessary to develop and validate hospital bed management models were not publicly accessible. This was either because these data were not collected, because public agencies failed to make them public (despite having them indexed in their databases), the data were processed within indicators and not shown as raw data, or they simply published the data in a format that was difficult to process (e.g., PDF image documents versus CSV tables). Despite the potential of hospital information systems, there were still data that were not adequately captured within these systems.Moreover, the data collected in a hospital depends on the strategies and practices specific to that hospital or health system. This limits the generalization of "real" data, and it encourages working with "realistic" or plausible data that are clean of interactions with local variables or decisions (Gunal, 2012; Marin-Garcia et al., 2020). Besides, one can parameterize the model and define the data structure that would be necessary to run the model without delaying till the real data become available. Conversely, plausible data sets can be generated from publicly available information and, later, when real data become available, the accuracy of the model can be evaluated (Garcia-Sabater and Maheut, 2021).This work opens lines of future research, both theoretical and practical. From a theoretical point of view, it would be interesting to develop machine learning tools that, by analyzing specific data samples in real hospitals, can identify the parameters necessary for the automatic prototyping of generators adapted to each hospital. Regarding the lines of research applied, it is evident that the formalism proposed for the generation of sound patients is not limited to patients affected by SARS-CoV-2 infection. The generation of heterogeneous patients can represent the needs of a specific population and serve as a basis for studying complex health service delivery systems.

Recreational noise pollution of traditional festivals reduces the juvenile productivity of an avian urban bioindicator

Noise is a pollutant of emergent concern for ecologists and conservation biologists. Recreational noise pollution, especially unpredictable and intermittent sounds, and its effects on wildlife and biodiversity have been poorly studied. Researchers have paid very little attention to the effect of noisy traditional festivals (fireworks and powder-guns). This study aimed to explore the effect of these recreational activities on the juvenile productivity of an urban avian bioindicator: the house sparrow. We studied five pairs of localities in the Valencia Region (E Spain) with noisy traditional festivals. Each pair was composed of one locality with festivals during the breeding season and the closest similar locality, but with festivals outside the reproductive period (controls). Both locality types were sampled twice each spring (May–June of 2019 and 2020). Sampling dates were selected as 15 and 30 days after noisy festivals ended, while the control localities were sampled 1 day after the census of their correspondent town pair with noisy breeding season festivals. The ratio of the juveniles/adults detected during surveys in the influence area of festivals (100-m buffer around the parades route) was used as a house sparrow breeding success proxy. Data were analysed using GLMM: year (2019/2020), festivals season (breeding/non-breeding), survey (15/30 days), and their interactions were included as fixed factors. Pair of localities and locality nested within the pair were random factors. In 2019, juvenile productivity was lower in the towns with noisy traditional festivals during the breeding season than in the control towns. The 2020 festivals were cancelled due to COVID-19. In spring 2020, house sparrow juvenile productivity was the same in both town groups. Lockdown did not increase this species’ juvenile productivity in the control localities in 2020 versus 2019.