Mortality after emergency department discharge: an analysis of 453599 cases. / Mortalidad tras el alta desde el servicio de urgencias hospitalario: análisis de 453.599 episodios.

OBJECTIVES: To quantify and analyze mortality in patients who die within 30 days of discharge home from a hospital emergency department (ED). MATERIAL AND METHODS: All patients older than 14 years of age who were discharged home from the ED of a tertiary care hospital over a 5-year period were included. We collected age, sex, and other demographic variables, as well as the Charlson Comorbidity Index (CCI). The outcome variables of interest were 7-day and 30-day mortality and cause of death. Deaths were classified as expected and directly related to the emergency, expected but not directly related, unexpected and directly related, and unexpected and not directly related. A death was classified as an adverse event if it was directly related to a problem of diagnosis or management in the ED, underestimation of severity, or complications of a procedure. RESULTS: Of 519312 patients attended in the ED, 453 599 were discharged home. Of those discharged, 148 died at home within 7 days (32.63 deaths/100 000 discharges) and 355 died within 30 days (78.48 deaths/100 000 discharges). One hundred thirteen deaths (31.8%) were expected and related to the emergency 24.91/100 000), 169 (47.6%) were expected but unrelated 37.26/100 000), 4 (1.1%) were unexpected and related 1.10/100000), and 69 (19.4%) were unexpected and unrelated 15.21/100000). Deaths were considered adverse events related to ED care in 24.2% of the cases. Underestimation of severity was responsible for the highest proportion (10.7%) of such deaths. The median age of patients who died was 83 years, and the median Charlson comorbidity index (CCI) was 6. The most common cause of death was a malignant tumor (23.0%), followed by congestive heart failure (20.2%) and atherosclerotic cardiovascular disease (13.2%). Unexpected deaths related to ED care were significantly related to a higher proportion of adverse events related to diagnosis (P = .001), management (P = .004), and underestimation of severity (P .001). CONCLUSION: Early deaths after discharge home from a hospital ED occured in patients of advanced age with concomitant conditions. The main clinical settings were neoplastic and cardiovascular disease. Seven-day and 30-day mortality rates directly related to the emergency visit were low. Adverse events related to ED care played a role in about a quarter of the deaths after discharge.

OBJETIVO: Cuantificar y analizar la mortalidad de los pacientes dados de alta directamente desde un servicio de urgencias hospitalario (SUH) y que fallecen dentro de los primeros 30 días en el domicilio. METODO: Se incluyeron todos los pacientes mayores de 14 años dados de alta desde el SUH a domicilio durante 5 años en un hospital terciario. Se recogieron como variables demográficas, edad, sexo e índice de Charlson. Como variable evolutiva se investigó la mortalidad a 30 días, y si esta ocurrió en 7 o menos días o más de 7 días y la causa del fallecimiento. La mortalidad se clasificó como esperada y directamente relacionada, esperada y no directamente relacionada, no esperada y directamente relacionad, y no esperada y no directamente relacionada. Se determinó como evento adverso (EA) relacionada con la mortalidad si la muerte estaba relacionada con un problema diagnóstico o de manejo, de infraestimación de la gravedad o complicaciones del procedimiento. RESULTADOS: Fueron atendidos 519.312 episodios de los que 453.599 fueron dados de alta al domicilio. De estos, 148 fallecieron en domicilio a los 7 días (32,63/100.000 altas) y 355 fallecieron en los 30 días después del alta (78,48/100.000 altas): el 31,8% (n = 113) fueron fallecimientos esperados y relacionados (24,91/100.000 altas), el 47,6% (n = 169) esperados y no relacionados (37,26/100.000 altas), el 1,1% (n = 4) no esperados y relacionados (1,10/100.000 altas) y 19,4% (n = 69) no esperados y no relacionados (15,21/100.000 altas). En un 24,2% de los pacientes se detectaron EA relacionados con la asistencia en urgencias, el más frecuente EA fue la infraestimación de la gravedad (10,7%). La mediana de edad de los pacientes fallecidos era de 83 años y una mediana del índice de comorbilidad de Charlson (ICC) de 6 puntos. La principal etiología de fallecimiento fue la neoplasia maligna (23,0%), seguida de insuficiencia cardiaca congestiva (20,2%) y enfermedad cardiaca arteriosclerótica (13,2%). En los fallecimientos no esperados y relacionados, destaca una mayor proporción de EA por causa de problemas diagnósticos (p = 0,015), de manejo (p = 0,028) y de infraestimación de la gravedad (p = 0,004). CONCLUSIONES: Los pacientes que fallecen de forma precoz tras el alta de SUH en el domicilio son ancianos con comorbilidad y donde las principales causas de muerte son las enfermedades neoplásicas y las enfermedades cardiacas. Las muertes no esperadas y directamente relacionadas son poco frecuentes a los 7 y 30 días del alta. En una cuarta parte de los pacientes se detectaron EA relacionados con la asistencia en urgencias.

Adherence to quality indicators for emergency department treatment of acute poisoning according to patient sex. / Grado de cumplimiento de los indicadores de calidad según el sexo del paciente en las intoxicaciones agudas en urgencias.

OBJECTIVES: To study differences in the emergency department treatment of acute poisoning according to biological sex of patients and to assess adherence to care quality indicators. MATERIAL AND METHODS: Retrospective observational study including all cases of acute poisoning diagnosed in patients over the age of 14 years treated in a tertiary care hospital emergency department over a period of 4 years. We analyzed demographic variables, substance type and reason for acute poisoning, degree of adherence to quality indicators, and discharge destination. RESULTS: A total of 1144 cases were included; 710 patients (62.1%) were female and 434 (37.9%) were male. The proportion of deliberate self-poisoning was higher in females (52.3% vs 41.4% in males; P .001); unintentional poisoning was less frequent in females (in 24.9% vs in 30.3% of males; P = .047). Benzodiazepine poisoning was more frequent in females (in 49.6% vs 41.2%; P = .007). Street drug and alcohol poisoning was less common in females. Adherence to quality indicators was high (> 85%) for both sexes. CONCLUSION: The epidemiologic profile of poisoning is different in females and males. General emergency department adherence to quality indicators can be considered optimal. We detected no qualitative sex-related differences in the care of patients with acute poisoning.

OBJETIVO: Estudiar las diferencias dependiendo del sexo en la atención de pacientes con intoxicaciones agudas en urgencias y en el grado de cumplimiento de los indicadores de calidad (IC). METODO: Estudio observacional y retrospectivo, que incluyó todos los casos de intoxicación aguda de pacientes mayores de 14 años atendidos en el servicio de urgencias de un hospital terciario durante 4 años. Se analizaron variables demográficas, tipo de tóxicos y causa de la intoxicación, el grado de cumplimiento de los IC y destino al alta. RESULTADOS: Se registraron 1.144 casos, un 62,1% (n = 710) eran mujeres. Las mujeres tuvieron mayor número de intoxicaciones voluntarias (52,3% vs 41,4%; p 0,001) y menos de manera accidental (24,9% vs 30,3%; p = 0,047). Los fármacos más frecuentes en mujeres fueron las benzodiacepinas (49,6% vs 41,2%; p = 0,007), y las intoxicaciones por drogas de abuso y alcohol fueron menores que en hombres. Hubo un alto grado de cumplimiento en la mayoría de los IC (> 85%) en ambos sexos. CONCLUSIONES: El perfil epidemiológico de la intoxicación aguda en mujeres es diferente al de los hombres. En general se puede considerar como óptimo el cumplimiento de los IC en urgencias. No existen diferencias cualitativas en la asistencia del paciente intoxicado con respecto a su sexo.

Aedes aegypti oviposition dynamics in towns with low human population density in yungas and dry chaco, Salta, Argentina.

We assessed the presence of Aedes aegypti in five ecorregions of Salta province and compared the oviposition activity of Ae. aegypti using ovitraps in towns of two contrasting ecoregions (yungas and Chaco dry forests) in the province of Salta, Argentina, a major contrast in these ecoregions are rain patterns and altitude. Our aim was to estimate how oviposition activities were associated with the ecoregion and site scale local environmental variables. Mosquito oviposition activity was monitored weekly during the summer using ovitraps. Predictor variables were ecoregion, town, and meteorological variables. The effect of the predictor variables was measured on the response variables using multi-model inference. Besides yungas, the presence of Aedes aegypti was confirmed in towns of dry Chaco and High Monte. The only factor that had a significant effect on the presence of eggs in the ovitraps was the ecoregion, with the frequency of positives being higher in yungas. For the number of eggs, the ecoregion, the night temperature of the first week and the NDVI would explain said variable. Overall, results indicate that the variations between towns would be more related with their ecological and climatic characteristics than with the more immediate meteorological variations.

Meteorological indicators of dengue epidemics in non-endemic Northwest Argentina.

In the last two decades dengue cases increased significantly throughout the world, giving place to more frequent outbreaks in Latin America. In the non-endemic city of San Ramón de la Nueva Orán, located in Northwest Argentina, large dengue outbreaks alternate with several years of smaller ones. This pattern, as well as the understanding of the underlying mechanisms, could be essential to design proper strategies to reduce epidemic size. We develop a stochastic model that includes climate variables, social structure, and mobility between a non-endemic city and an endemic area. Climatic variables were input of a mosquito population ecological model, which in turn was coupled to a meta-population, spatially explicit, epidemiological model. Human mobility was included into the model given the high border crossing to the northern country of Bolivia, where dengue transmission is sustained during the whole year. We tested different hypotheses regarding people mobility as well as climate variability by fitting numerical simulations to weekly clinical data reported from 2009 to 2016. After assessing the number of imported cases that triggered the observed outbreaks, our model allows to explain the observed epidemic pattern. We found that the number of vectors per host and the effective reproductive number are proxies for large epidemics. Both proxies are related with climate variability such as rainfall and temperature, opening the possibility to test these meteorological variables for forecast purposes.

Intestinal amyloidosis: a diagnostic challenge.

Amyloidosis is a disease caused by extracellular deposition of abnormally folded proteins. While gastrointestinal involvement is relatively frequent in its systemic form, isolated gastrointestinal disease is rare. We present the case of a 62-year-old man assessed for iron deficiency anemia and abdominal pain after starting antiplatelet therapy with acetylsalicylic acid and ticagrelor for ischemic heart disease. An esophagogastroduodenoscopy was performed as part of the study, showing thickened folds with pseudopolypoid morphology and nodular mucosa with a preserved crypt pattern in the duodenal bulb and second duodenal portion.

Inference in epidemiological agent-based models using ensemble-based data assimilation.

To represent the complex individual interactions in the dynamics of disease spread informed by data, the coupling of an epidemiological agent-based model with the ensemble Kalman filter is proposed. The statistical inference of the propagation of a disease by means of ensemble-based data assimilation systems has been studied in previous works. The models used are mostly compartmental models representing the mean field evolution through ordinary differential equations. These techniques allow to monitor the propagation of the infections from data and to estimate several parameters of epidemiological interest. However, there are many important features which are based on the individual interactions that cannot be represented in the mean field equations, such as social network and bubbles, contact tracing, isolating individuals in risk, and social network-based distancing strategies. Agent-based models can describe contact networks at an individual level, including demographic attributes such as age, neighborhood, household, workplaces, schools, entertainment places, among others. Nevertheless, these models have several unknown parameters which are thus difficult to prescribe. In this work, we propose the use of ensemble-based data assimilation techniques to calibrate an agent-based model using daily epidemiological data. This raises the challenge of having to adapt the agent populations to incorporate the information provided by the coarse-grained data. To do this, two stochastic strategies to correct the model predictions are developed. The ensemble Kalman filter with perturbed observations is used for the joint estimation of the state and some key epidemiological parameters. We conduct experiments with an agent based-model designed for COVID-19 and assess the proposed methodology on synthetic data and on COVID-19 daily reports from Ciudad Autónoma de Buenos Aires, Argentina.

A hyper-matheuristic approach for solving mixed integer linear optimization models in the context of data envelopment analysis.

Mixed Integer Linear Programs (MILPs) are usually NP-hard mathematical programming problems, which present difficulties to obtain optimal solutions in a reasonable time for large scale models. Nowadays, metaheuristics are one of the potential tools for solving this type of problems in any context. In this paper, we focus our attention on MILPs in the specific framework of Data Envelopment Analysis (DEA), where the determination of a score of technical efficiency of a set of Decision Making Units (DMUs) is one of the main objectives. In particular, we propose a new hyper-matheuristic grounded on a MILP-based decomposition in which the optimization problem is divided into two hierarchical subproblems. The new approach decomposes the model into discrete and continuous variables, treating each subproblem through different optimization methods. In particular, metaheuristics are used for dealing with the discrete variables, whereas exact methods are used for the set of continuous variables. The metaheuristics use an indirect representation that encodes an incomplete solution for the problem, whereas the exact method is applied to decode the solution and generate a complete solution. The experimental results, based on simulated data in the context of Data Envelopment Analysis, show that the solutions obtained through the new approach outperform those found by solving the problem globally using a metaheuristic method. Finally, regarding the new hyper-matheuristic scheme, the best algorithm selection is found for a set of cooperative metaheuristics ans exact optimization algorithms.

Are Mixtec Forgetting Their Plants? Intracultural Variation of Ethnobotanical Knowledge in Oaxaca, Mexico.

Are Mixtec Forgetting Their Plants? Intracultural Variation of Ethnobotanical Knowledge in Oaxaca, Mexico. Erosion of ethnobotanical knowledge in indigenous communities has been reported increasingly in recent decades. This study quantitatively and qualitatively analyzed the variation of ethnobotanical knowledge in communities of the high Mixtec subregion. We interviewed 64 Mixtec about edible and medicinal plants. We evaluated the knowledge (names and knowledge of use) and the active application of the use among people of different ages, gender, education level, migrants, and non-migrants. In general, increasing age, female gender, decreasing formal education, and non-migration are positively correlated with the knowledge and use of plants. The most alarming finding concerns the knowledge of the Mixtec names of plant-people under 30 years old no longer know them. We envision a process of transition and adaptation of the knowledge and uses of plants, but inevitably enormous ethnobotanical knowledge is quickly disappearing along with the Mixtec language. ¿Los mixtecos están olvidando sus plantas? Variación intracultural del conocimiento etnobotánico en Oaxaca, México. La erosión del conocimiento etnobotánico en las comunidades indígenas se ha informado cada vez más en las últimas décadas. Este estudio analizó cuantitativa y cualitativamente la variación del conocimiento etnobotánico en comunidades de la subregión Mixteca alta. Entrevistamos a 64 mixtecos sobre plantas comestibles y medicinales. Evaluamos el conocimiento (nombres y conocimiento de uso) y la aplicación activa del uso entre personas de diferentes edades, género, nivel educativo, migrantes y no migrantes. En general, el aumento de la edad, el género femenino, la baja educación formal y la no migración se correlacionan positivamente con el conocimiento y uso de las plantas. El hallazgo más alarmante se refiere al conocimiento de los nombres mixtecos de las plantas: las personas menores de 30 años ya no los conocen. Visualizamos un proceso de transición y adaptación del conocimiento y usos de las plantas, pero inevitablemente un enorme conocimiento etnobotánico está desapareciendo rápidamente junto con el idioma mixteco.

Vector-Borne Disease Models with Active and Inactive Vectors: A Simple Way to Consider Biting Behavior.

Vector-borne diseases are a serious public health problem, mosquitoes being one of the most important vectors. To analyze the dynamics of this type of disease, Ross-Macdonald models are commonly used. In its simplest formulation and the most common in scientific literature, it is assumed that all mosquitoes are biting at a given rate. To improve this general assumption, we developed a vector-borne disease model with active and inactive vectors as a simple way to incorporate the more general characteristics of mosquito feeding behavior into disease dynamics. Our objective is to obtain an estimate of the Ross-Macdonald biting rate from the feeding parameters that reproduce the same dynamics as the model with active and inactive vectors. Two different cases were analyzed: a SIS-SI model and a SIR-SI model with a single epidemic. Different methods to estimate the biting rate in the Ross-Macdonald model were proposed and analyzed. To compare the results of the models, different epidemiological indicators were considered. When the biting rate is estimated considering that both models have the same basic reproduction number, very similar disease dynamics are obtained. This method is a simple way to incorporate the mosquito feeding behavior into the standard Ross-Macdonald model.

Clinical diagnosis of COVID-19. A multivariate logistic regression analysis of symptoms of COVID-19 at presentation.

INTRODUCTION: The objective of this cross-sectional study was to describe the main symptoms associated with COVID-19, and their diagnostic characteristics, to aid in the clinical diagnosis. METHODS: An analysis of all patients diagnosed by RT-PCR for SARS-CoV-2 between April and May 2020 in Argentina was conducted. The data includes clinical and demographic information from all subjects at the time of presentation (n=67318, where 12% were positive for SARS-CoV-2). The study population was divided into four age groups: pediatric (0-17 years), young adults (18-44 years), adults (45-64 years), and elderly (65-103 years). Multivariate logistic regression was used to measure the association of all symptoms and to create a diagnostic model based on symptoms. RESULTS: Symptoms associated with COVID-19 were anosmia, dysgeusia, headache, low-grade fever, odynophagia, and malaise. However, the presentation of these symptoms was different between the different age groups. In turn, at the time of presentation, the symptoms associated with respiratory problems (chest pain, abdominal pain, and dyspnea) had a negative association with COVID-19 or did not present statistical relevance. On the other hand, the model based on 16 symptoms, age and sex, presented a sensitivity of 80% and a specificity of 46%. CONCLUSIONS: There were significant differences between the different age groups. Additionally, there were interactions between different symptoms that were highly associated with COVID-19. Finally, our findings showed that a regression model based on multiple factors (age, sex, interaction between symptoms) can be used as an accessory diagnostic method or a rapid screening of suspected COVID-19 cases.

Evaluation of the sequential coupling of a bacterial treatment with a physicochemical process for the remediation of wastewater containing Cr and organic pollutants.

A restoration strategy was developed for the treatment of two artificial liquid systems (Minimal Medium, MM, and Water Carbon Nitrogen, WCN) contaminated with Cr(VI), lindane (γ-HCH), phenanthrene (Phe), and reactive black 5 (RB5), through the use of an actinobacteria consortium, coupled with a physicochemical treatment using a column filled with nano-scale zero valent iron particles immobilized on dried Macrocystis pyrifera algae biomass. The Sequential Treatment A (STA: physicochemical followed by biological method) removed the three organic compounds with different effectiveness; however, it was very ineffective for Cr(VI) removal. The Sequential Treatment B (STB: biological followed by the physicochemical method) removed the four compounds with variable efficiencies. The removal of γ-HCH, Phe, and RB5 in both effluents did not present significant differences, regardless of the sequential treatment used. The highest removal of Cr(VI) and total Cr was observed in MM and WCN, respectively. Ecotoxicity tests (L. sativa) of the effluents treated with both methodological couplings demonstrated that the toxicity of WCN only decreased at the end of STA, while that of MM decreased at all stages of both sequential treatments. Therefore, MM would be more appropriate to perform both treatments.

Disease dynamics and mean field models for clustered networks.

Social networks are clustered networks with short mean path length. In this work we analyze the disease dynamics in a class of this type of small-world networks composed of set of households and a set of workplaces. Individuals from each household are randomly assigned to workplaces. In both environments we assumed complete mixing and therefore we obtain highly clustered networks with short mean path lengths. Basic reproduction numbers were computed numerically and we show that at endemic equilibrium the average susceptible proportion is different from the inverse of the basic reproduction number (R0-1). Therefore exist an exponent p≠1 for which p=R0-1. Using this exponent we developed a mean field model which closely capture the disease dynamics in the network. Finally we outline how this model could be use to model vector-borne diseases in social networks.

The European tomato market. An approach by export competitiveness maps.

Most empirical studies examining the export competitiveness of a country in a target market are undertaken by focusing on supply, only analysing the group of competing countries. In addition, if the target market to be analysed is extensive, like the European Union, it is generally analysed as a whole. This study presents an evaluation of the tomato export competitiveness, from a differentiated demand perspective, analysing its main customers markets in the context of European Union. The methodological framework is implemented through Constant Market Share to analyze variations in exports, allowing the portion attributable to competitiveness and segregation into general or specific competitiveness to be quantified. The Constant Market Share was adapted to focus on the differentiated demand so as to observe the influence of the worldwide crisis (2007/08) on the European tomato market. This study allows the analysis of profile changes into the competitor exporting economies. As a contribution to the methodology, this study presents a new graphical way of representing the results of Constant Market Share methodology by means of export competitiveness maps in the European tomato market for the group for each main competitor in each European client market. According to our results, Spain and Belgium are candidate countries to be competitive in the main European markets.

Glycerol as a substrate for actinobacteria of biotechnological interest: Advantages and perspectives in circular economy systems.

Actinobacteria represent a ubiquitous group of microorganisms widely distributed in ecosystems. They have diverse physiological and metabolic properties, including the production of extracellular enzymes and a variety of secondary bioactive metabolites, such as antibiotics, immunosuppressants, and other compounds of industrial interest. Therefore, actinobacteria have been used for biotechnological purposes for more than three decades. The development of a biotechnological process requires the evaluation of its cost/benefit ratio, including the search for economic and efficient substrates for microorganisms development. Biodiesel is a clean, renewable, quality and economically viable source of energy, which also contributes to the conservation of the environment. Crude glycerol is the main by-product of biodiesel production and has many properties, so it has a commercial value that can be used to finance the biofuel production process. Actinobacteria can use glycerol as a source of carbon and energy, either pure o crude. A circular economy system aims to eliminate waste and pollution, keep products and materials in use, and regenerate natural systems. Although these principles are not yet met, some approaches are being made in this direction; the transformation of crude glycerol by actinobacteria is a process with great potential to be scaled on an industrial level. This review discusses the reports on glycerol as a promising source of carbon and energy for obtaining biomass and high-added value products by actinobacteria. Also, the factors influencing the biomass and secondary metabolites production in bioreactors are analyzed, and the tools available to overcome those that generate the main problems are discussed.

Use of glycerol for the production of actinobacteria with well-known bioremediation abilities.

In recent years, there has been an increasing interest in the remediation of contaminated environments, and a suitable solution is in situ bioremediation. To achieve this, large-scale bacterial biomass production should be sustainable, using economic culture media. The main aim of this study was to optimize the physicochemical conditions for the biomass production of an actinobacterium with well-known bioremediation ability using inexpensive substrates and to scale-up its production in a bioreactor. For this, the growth of four strains of actinobacteria were evaluated in minimal medium with glucose and glycerol as carbon and energy sources. In addition, l-asparagine and ammonium sulfate were assayed as alternative nitrogen sources. The strain Streptomyces sp. A5 showed the highest biomass production in shake-flasks culture using glycerol and ammonium sulfate as carbon and nitrogen sources, respectively. Factorial designs with five factors (glycerol concentration, inoculum size, pH, temperature, and agitation) were employed to optimize the biomass production of Streptomyces sp. A5. The maximum biomass production was obtained using 5 g L-1 of glycerol, 0.25 µL of inoculum, pH 7, 30 °C and 200 rpm. Finally, the production was successfully scaled to a 2 L stirred tank bioreactor. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13205-020-02588-5.

Successful remediation of soils with mixed contamination of chromium and lindane: Integration of biological and physico-chemical strategies.

Soils contaminated by organic and inorganic pollutants like Cr(VI) and lindane, is currently a main environmental challenge. Biological strategies, such as biostimulation, bioaugmentation, phytoremediation and vermiremediation, and nanoremediation with nanoscale zero-valent iron (nZVI) are promising approaches for polluted soil health recovery. The combination of different remediation strategies might be key to address this problem. For this reason, a greenhouse experiment was performed using soil without or with an organic amendment. Both soils were contaminated with lindane (15 mg kg-1) and Cr(VI) (100 or 300 mg kg-1). After one month of aging, the following treatments were applied: (i) combination of bioaugmentation (actinobacteria), phytoremediation (Brassica napus), and vermiremediation (Eisenia fetida), or (ii) nanoremediation with nZVI, or (iii) combination of biological treatments and nanoremediation. After 60 days, the wellness of plants and earthworms was assessed, also, soil health was evaluated through physico-chemical parameters and biological indicators. Cr(VI) was more toxic and decreased soil health, however, it was reduced to Cr(III) by the amendment and nZVI and, to a lesser extent, by the biological treatment. Lindane was more effectively degraded through bioremediation. In non-polluted soils, nZVI had strong deleterious effects on soil biota when combined with the organic matter, but this effect was reverted in soils with a high concentration of Cr(VI). Therefore, under our experimental conditions bioremediation might be the best for soils with a moderate concentration of Cr(VI) and organic matter. The application of nZVI in soils with a high content of organic matter should be avoided except for soils with very high concentrations of Cr(VI). According to our study, among the treatments tested, the combination of an organic amendment, biological treatment, and nZVI was shown to be the strategy of choice in soils with high concentrations of Cr(VI) and lindane, while for moderate levels of chromium, the organic amendment plus biological treatment is the most profitable treatment.

Gentle remediation options for soil with mixed chromium (VI) and lindane pollution: biostimulation, bioaugmentation, phytoremediation and vermiremediation.

Gentle Remediation Options (GROs), such as biostimulation, bioaugmentation, phytoremediation and vermiremediation, are cost-effective and environmentally-friendly solutions for soils simultaneously polluted with organic and inorganic compounds. This study assessed the individual and combined effectiveness of GROs in recovering the health of a soil artificially polluted with hexavalent chromium [Cr(VI)] and lindane. A greenhouse experiment was performed using organically-amended vs. non-amended mixed polluted soils. All soils received the following treatments: (i) no treatment; (ii) bioaugmentation with an actinobacteria consortium; (iii) vermiremediation with Eisenia fetida; (iv) phytoremediation with Brassica napus; (v) bioaugmentation + vermiremediation; (vi) bioaugmentation + phytoremediation; and (vii) bioaugmentation + vermiremediation + phytoremediation. Soil health recovery was determined based on Cr(VI) and lindane concentrations, microbial properties and toxicity bioassays with plants and worms. Cr(VI) pollution caused high toxicity, but some GROs were able to partly recover soil health: (i) the organic amendment decreased Cr(VI) concentrations, alleviating toxicity; (ii) the actinobacteria consortium was effective at removing both Cr(VI) and lindane; (iii) B. napus and E. fetida had a positive effect on the removal of pollutants and improved microbial properties. The combination of the organic amendment, B. napus, E. fetida and the actinobacteria consortium was the most effective strategy.

Bioremediation of lindane-contaminated soils by combining of bioaugmentation and biostimulation: Effective scaling-up from microcosms to mesocosms.

The scaling-up of lindane-contaminated soils bioremediation from microcosms to mesocosms bioaugmentated with an actinobacteria quadruple culture and biostimulated with sugarcane filter cake (SCFC) was surveyed. Mesocosms of silty loam soil, clayey soil, and sandy soil were polluted with the pesticide, bioaugmented with the mixed culture, biostimulated with adequate amounts of 0.5 mm SCFC particles, and assessed during 63 days maintaining environmental parameters with minimal intervention. Samples were taken to determine residual lindane, heterotrophic microorganisms, enzymatic activities, and bioremediation effectiveness using ecotoxicity tests with Raphanus sativus, Lactuca sativa, and Lycopersicon esculentum. The bioaugmentation and biostimulation of the three soils improved lindane removal, microbial counts, and enzymatic activities, and reduced pesticide T1/2, regarding the values obtained in non-bioremediated controls. The removal process was significantly affected by the soil type, and the highest pesticide dissipation (82.6%) was detected in bioremediated sandy soil. Ecotoxicity tests confirmed the bioremediation success through a rise in the vigor index of seedlings compared to non-treated soils (R. sativus: 12-22%; L. sativa: 12-20%; L. esculentum: 30-45%). Finally, scanning electron microscopy corroborated soil colonization by actinobacteria. Successful scaling-up of the combined application of an actinobacteria quadruple culture and SCFC as an appropriate strategy for restoring lindane-polluted soils at mesocosms-scale was confirmed.

Early treatment with anti-tumor necrosis factor agents improves long-term effectiveness in symptomatic stricturing Crohn's disease.

BACKGROUND: There is limited evidence on the effectiveness of biological therapy in stricturing complications in patients with Crohn's disease. AIM: The study aims to determine the effectiveness of anti-tumor necrosis factor (TNF) agents in Crohn's disease complicated with symptomatic strictures. METHODS: In this multicentric and retrospective study, we included adult patients with symptomatic stricturing Crohn's disease receiving their first anti-TNF therapy, with no previous history of biological, endoscopic or surgical therapy. The effectiveness of the anti-TNF agent was defined as a composite outcome combining steroid-free drug persistence with no use of new biologics or immunomodulators, hospital admission, surgery or endoscopic therapy during follow-up. RESULTS: Overall, 262 patients with Crohn's disease were included (53% male; median disease duration, 35 months, 15% active smokers), who received either infliximab (N = 141, 54%) or adalimumab (N = 121, 46%). The treatment was effective in 87% and 73% of patients after 6 and 12 months, respectively, and continued to be effective in 26% after a median follow-up of 40 months (IQR, 19-85). Nonetheless, 15% and 21% of individuals required surgery after 1 and 2 years, respectively, with an overall surgery rate of 32%. Postoperative complications were identified in 15% of patients, with surgical site infection as the most common. Starting anti-TNF therapy in the first 18 months after the diagnosis of Crohn's disease or the identification of stricturing complications was associated with a higher effectiveness (HR 1.62, 95% CI 1.18-2.22; and HR 1.55, 95% CI 1.1-2.23; respectively). Younger age, lower albumin levels, strictures located in the descending colon, concomitant aminosalicylates use or presence of lymphadenopathy were associated with lower effectiveness. CONCLUSIONS: Anti-TNF agents are effective in approximately a quarter of patients with Crohn's disease and symptomatic intestinal strictures, and 68% of patients are free of surgery after a median of 40 months of follow-up. Early treatment and some potential predictors of response were associated with treatment success in this setting.

Ross-Macdonald models: Which one should we use?

Ross-Macdonald models are the building blocks of most vector-borne disease models. Even for the same disease, different authors use different model formulations, but a study of the dynamical consequences of assuming different hypotheses is missing. In this work we present different formulations of the basic Ross-Macdonald model together with a careful discussion of the assumptions behind each model. The most general model presented is an agent based model for which arbitrary distributions for latency and infectious periods for both, host and vectors, is considered. At population level we also developed a deterministic Volterra integral equations model for which also arbitrary distributions in the waiting times are included. We compare the model solutions using different distributions for the infectious and latency periods using statistics, like the epidemic peak, or epidemic final size, to characterize the epidemic curves. The basic reproduction number (R0) for each formulation is computed and compared with empirical estimations obtained with the agent based models. The importance of considering realistic distributions for the latent and infectious periods is highlighted and discussed. We also show that seasonality is a key driver of vector-borne disease dynamics shaping the epidemic curve and its duration.