Toward Enhancing Wastewater Treatment with Resource Recovery in Integrated Assessment and Computable General Equilibrium Models.

Sustainable water management is essential to increasing water availability and decreasing water pollution. The wastewater sector is expanding globally and beginning to incorporate technologies that recover nutrients from wastewater. Nutrient recovery increases energy consumption but may reduce the demand for nutrients from virgin sources. We estimate the increase in annual global energy consumption (1,100 million GJ) and greenhouse gas emissions (84 million t CO2e) for wastewater treatment in the year 2030 compared to today's levels to meet sustainable development goals. To capture these trends, integrated assessment and computable general equilibrium models that address the energy-water nexus must evolve. We reviewed 16 of these models to assess how well they capture wastewater treatment plant energy consumption and GHG emissions. Only three models include biogas production from the wastewater organic content. Four explicitly represent energy demand for wastewater treatment, and eight include explicit representation of wastewater treatment plant greenhouse gas emissions. Of those eight models, six models quantify methane emissions from treatment, five include representation of emissions of nitrous oxide, and two include representation of emissions of carbon dioxide. Our review concludes with proposals to improve these models to better capture the energy-water nexus associated with the evolving wastewater treatment sector.

The crucial role of circular waste management systems in cutting waste leakage into aquatic environments.

Waste leakage has become a major global concern owing to the negative impacts on aquatic ecosystems and human health. We combine spatial analysis with the Shared Socioeconomic Pathways to project future waste leakage under current conditions and develop mitigation strategies up to 2040. Here we show that the majority (70%) of potential leakage of municipal solid waste into aquatic environments occurs in China, South Asia, Africa, and India. We show the need for the adoption of active mitigation strategies, in particular circular waste management systems, that could stop waste from entering the aquatic ecosystems in the first place. However, even in a scenario representing a sustainable world in which technical, social, and financial barriers are overcome and public awareness and participation to rapidly increase waste collection rates, reduce, reuse and recycling waste exist, it would be impossible to entirely eliminate waste leakage before 2030, failing to meet the waste-related Sustainable Development Goals.

Next-generation sequencing reveals mitogenome diversity in plasma extracellular vesicles from colorectal cancer patients.

BACKGROUND: Recent reports have demonstrated that the entire mitochondrial genome can be secreted in extracellular vesicles (EVs), but the biological attributes of this cell-free mitochondrial DNA (mtDNA) remain insufficiently understood. We used next-generation sequencing to compare plasma EV-derived mtDNA to that of whole blood (WB), peripheral blood mononuclear cells (PBMCs), and formalin-fixed paraffin-embedded (FFPE) tumor tissue from eight rectal cancer patients and WB and fresh-frozen (FF) tumor tissue from eight colon cancer patients. METHODS: Total DNA was isolated before the mtDNA was enriched by PCR with either two primer sets generating two long products or multiple primer sets (for the FFPE tumors), prior to the sequencing. mtDNA diversity was assessed as the total variant number, level of heteroplasmy (mutant mtDNA copies mixed with wild-type copies), variant distribution within the protein-coding genes, and the predicted functional effect of the variants in the different sample types. Differences between groups were compared by paired Student's t-test or ANOVA with Dunnett's multiple comparison tests when comparing matched samples from patients. Mann-Whitney U test was used when comparing differences between the cancer types and patient groups. Pearson correlation analysis was performed. RESULTS: In both cancer types, EV mtDNA presented twice as many variants and had significantly more low-level heteroplasmy than WB mtDNA. The EV mtDNA variants were clustered in the coding regions, and the proportion of EV mtDNA variants that were missense mutations (i.e., estimated to moderately affect the mitochondrial protein function) was significantly higher than in WB and tumor tissues. Nonsense mutations (i.e., estimated to highly affect the mitochondrial protein function) were only observed in the tumor tissues and EVs. CONCLUSION: Taken together, plasma EV mtDNA in CRC patients exhibits a high degree of diversity. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01816607 . Registered 22 March 2013.

Potential for future reductions of global GHG and air pollutants from circular waste management systems.

The rapidly rising generation of municipal solid waste jeopardizes the environment and contributes to climate heating. Based on the Shared Socioeconomic Pathways, we here develop a global systematic approach for evaluating the potentials to reduce emissions of greenhouse gases and air pollutants from the implementation of circular municipal waste management systems. We contrast two sets of global scenarios until 2050, namely baseline and mitigation scenarios, and show that mitigation strategies in the sustainability-oriented scenario yields earlier, and major, co-benefits compared to scenarios in which inequalities are reduced but that are focused solely on technical solutions. The sustainability-oriented scenario leaves 386 Tg CO2eq/yr of GHG (CH4 and CO2) to be released while air pollutants from open burning can be eliminated, indicating that this source of ambient air pollution can be entirely eradicated before 2050.

Shotgun-metagenomics based prediction of antibiotic resistance and virulence determinants in Staphylococcus aureus from periprosthetic tissue on blood culture bottles.

Shotgun-metagenomics may give valuable clinical information beyond the detection of potential pathogen(s). Identification of antimicrobial resistance (AMR), virulence genes and typing directly from clinical samples has been limited due to challenges arising from incomplete genome coverage. We assessed the performance of shotgun-metagenomics on positive blood culture bottles (n = 19) with periprosthetic tissue for typing and prediction of AMR and virulence profiles in Staphylococcus aureus. We used different approaches to determine if sequence data from reads provides more information than from assembled contigs. Only 0.18% of total reads was derived from human DNA. Shotgun-metagenomics results and conventional method results were consistent in detecting S. aureus in all samples. AMR and known periprosthetic joint infection virulence genes were predicted from S. aureus. Mean coverage depth, when predicting AMR genes was 209 ×. Resistance phenotypes could be explained by genes predicted in the sample in most of the cases. The choice of bioinformatic data analysis approach clearly influenced the results, i.e. read-based analysis was more accurate for pathogen identification, while contigs seemed better for AMR profiling. Our study demonstrates high genome coverage and potential for typing and prediction of AMR and virulence profiles in S. aureus from shotgun-metagenomics data.

Sustainable wastewater management in Indonesia's fish processing industry: Bringing governance into scenario analysis.

The government of Indonesia has pledged to meet ambitious greenhouse gas mitigation goals in its Nationally Determined Contribution as well as reduce water pollution through its water management policies. A set of technologies could conceivably help achieving these goals simultaneously. However, the installation and widespread application of these technologies will require knowledge on how governance affects the implementation of existing policies as well as cooperation across sectors, administrative levels, and stakeholders. This paper integrates key governance variables--involving enforcement capacity, institutional coordination and multi-actor networks--into an analysis of the potential impacts on greenhouse gases and chemical oxygen demand in seven wastewater treatment scenarios for the fish processing industry in Indonesia. The analysis demonstrates that there is an increase of 24% in both CH4 and CO2 emissions between 2015 and 2030 in the business-as-usual scenario due to growth in production volumes. Interestingly, in scenarios focusing only on strengthening capacities to enforce national water policies, expected total greenhouse gas emissions are about five times higher than in the business-as-usual in 2030; this is due to growth in CH4 emissions during the handling and landfilling of sludge, as well as in CO2 generated from the electricity required for wastewater treatment. In the scenarios where there is significant cooperation across sectors, administrative levels, and stakeholders to integrate climate and water goals, both estimated chemical oxygen demand and CH4 emissions are considerably lower than in the business-as-usual and the national water policy scenarios.

Shotgun-Metagenomics on Positive Blood Culture Bottles Inoculated With Prosthetic Joint Tissue: A Proof of Concept Study.

Clinical metagenomics is actively moving from research to clinical laboratories. It has the potential to change the microbial diagnosis of infectious diseases, especially when detection and identification of pathogens can be challenging, such as in prosthetic joint infection (PJI). The application of metagenomic sequencing to periprosthetic joint tissue (PJT) specimens is often challenged by low bacterial load in addition to high level of inhibitor and contaminant host DNA, limiting pathogen recovery. Shotgun-metagenomics (SMg) performed directly on positive blood culture bottles (BCBs) inoculated with PJT may be a convenient approach to overcome these obstacles. The aim was to test if it is possible to perform SMg on PJT inoculated into BCBs for pathogen identification in PJI diagnosis. Our study was conducted as a laboratory method development. For this purpose, spiked samples (positive controls), negative control and clinical tissue samples (positive BCBs) were included to get a comprehensive overview. We developed a method for preparation of bacterial DNA directly from PJT inoculated in BCBs. Samples were processed using MolYsis5 kit for removal of human DNA and DNA extracted with BiOstic kit. High DNA quantity/quality was obtained, and no inhibition was observed during the library preparation, allowing further sequencing process. DNA sequencing reads obtained from the BCBs, presented a low proportion of human reads (<1%) improving the sensitivity of bacterial detection. We detected a 19-fold increase in the number of reads mapping to human in a sample untreated with MolYsis5. Taxonomic classification of clinical samples identified a median of 96.08% (IQR, 93.85-97.07%; range 85.7-98.6%) bacterial reads. Shotgun-metagenomics results were consistent with the results from a conventional BCB culture method, validating our approach. Overall, we demonstrated a proof of concept that it is possible to perform SMg directly on BCBs inoculated with PJT, with potential of pathogen identification in PJI diagnosis. We consider this a first step in research efforts needed to face the challenges presented in PJI diagnoses.

Mitigation pathways towards national ambient air quality standards in India.

Exposure to ambient particulate matter is a leading risk factor for environmental public health in India. While Indian authorities implemented several measures to reduce emissions from the power, industry and transportation sectors over the last years, such strategies appear to be insufficient to reduce the ambient fine particulate matter (PM2.5) concentration below the Indian National Ambient Air Quality Standard (NAAQS) of 40 µg/m3 across the country. This study explores pathways towards achieving the NAAQS in India in the context of the dynamics of social and economic development. In addition, to inform action at the subnational levels in India, we estimate the exposure to ambient air pollution in the current legislations and alternative policy scenarios based on simulations with the GAINS integrated assessment model. The analysis reveals that in many of the Indian States emission sources that are outside of their immediate jurisdictions make the dominating contributions to (population-weighted) ambient pollution levels of PM2.5. Consequently, most of the States cannot achieve significant improvements in their air quality and population exposure on their own without emission reductions in the surrounding regions, and any cost-effective strategy requires regionally coordinated approaches. Advanced technical emission control measures could provide NAAQS-compliant air quality for 60% of the Indian population. However, if combined with national sustainable development strategies, an additional 25% population will be provided with clean air, which appears to be a significant co-benefit on air quality (totaling 85%).

Culturing periprosthetic tissue in BacT/Alert® Virtuo blood culture system leads to improved and faster detection of prosthetic joint infections.

BACKGROUND: Blood culture bottles (BCBs) provide a semiautomated method for culturing periprosthetic tissue specimens. A study evaluating BCBs for culturing clinical samples other than body fluids is needed before implementation into clinical practice. Our objective was to evaluate use of the BacT/Alert® Virtuo blood culture system for culturing periprosthetic tissue specimens. METHODS: The study was performed through the analysis of spiked (n = 36) and clinical (n = 158) periprosthetic tissue samples. Clinical samples were analyzed by the BCB method and the results were compared to the conventional microbiological culture-based method for time to detection and microorganisms identified. RESULTS: The BacT/Alert® Virtuo blood culture system detected relevant bacteria for prosthetic joint infection in both spiked and clinical samples. The BCB method was found to be as sensitive (79%) as the conventional method (76%) (p = 0.844) during the analyses of clinical samples. The BCB method yielded positive results much faster than the conventional method: 89% against 27% detection within 24 h, respectively. The median detection time was 11.1 h for the BCB method (12 h and 11 h for the aerobic and the anaerobic BCBs, correspondingly). CONCLUSION: We recommend using the BacT/Alert® Virtuo blood culture system for analyzing prosthetic joint tissue, since this detect efficiently and more rapidly a wider range of bacteria than the conventional microbiological method.

Mitigation pathways of air pollution from residential emissions in the Beijing-Tianjin-Hebei region in China.

Air pollution is one of the most harmful consequences of China's rapid economic development and urbanization. Particularly in the Beijing-Tianjin-Hebei (BTH) regions, particulate matter concentrations have consistently exceeded the national air quality standards. Over the last years, China implemented ambitious measures to reduce emissions from the power, industry and transportation sectors, with notable success during the 11th and 12th Five Year Plan (FYP) periods. However, such strategies appear to be insufficient to reduce the ambient PM2.5 concentration below the National Air Quality Standard of 35 µg m-3 across the BTH region within the next 15 years. We find that a comprehensive mitigation strategy for the residential sector in the BTH region would deliver substantial air quality benefits. Beyond the already planned expansion of district heating and natural gas distribution in urban centers and the foreseen curtailment of coal use for households, such a strategy would redirect some natural gas from power generation units towards the residential sector. Rural households would replace biomass for cooking by liquid petroleum gas (LPG) and electricity, and substitute coal for heating by briquettes. Jointly, these measures could reduce the primary PM2.5 and SO2 emissions by 28% and 11%, respectively, and the population-weighted PM2.5 concentrations by 13%, i.e., from 68 µg m-3 to 59 µg m-3. We estimate that such a strategy would reduce premature deaths attributable to ambient and indoor air pollution by almost one third.

[Frequency and variables associated with perceived devaluation-discrimination in victims of the armed conflict in Colombia]. / Frecuencia y variables asociadas a estigma-discriminación percibido en víctimas del conflicto armado colombiano.

There is no information on frequency of perceived devaluation-discrimination in victims of the armed conflict in Colombia. The aim of this study was thus to determine the frequency of perceived devaluation-discrimination and associated variables among victims of the armed conflict in municipalities in the Department of Magdalena, Colombia. A cross-sectional study was conducted among victims enrolled in the Program for Psychosocial Care and Comprehensive Healthcare for Victims. Depressive symptoms were quantified with four dichotomous items (three or more were classified as high level of depressive symptoms), and perceived devaluation-discrimination was quantified with six dichotomous items (two or more were classified as high perceived devaluation-discrimination). A total of 943 adults participated (M = 47.9; SD = 14.2); 67.4%, women; 109 (11.6%) reported high level of depressive symptoms and 217 (23%) showed high perceived devaluation-discrimination. High perceived devaluation-discrimination was associated with high level of depressive symptoms (OR = 6.47; 95%CI: 4.23-9.88). In conclusion, one-fourth of the victims of the armed conflict in Magdalena reported high perceived devaluation-discrimination, which was significantly associated with high level of depressive symptoms.

Se desconoce la frecuencia de complejo estigma-discriminación percibido en víctimas del conflicto armado colombiano. El objetivo del estudio fue establecer la frecuencia y variables asociadas al estigma-discriminación percibido en víctimas del conflicto armado, en municipios del Departamento del Magdalena, Colombia. Se realizó un estudio transversal con víctimas registradas en el Programa de Atención Psicosocial y Salud Integral a Víctimas. Los síntomas depresivos se cuantificaron con cuatro ítems dicotómicos (tres o más se clasificaron como alto nivel de síntomas depresivos) y el estigma-discriminación percibido se cuantificó con seis incisos dicotómicos (dos o más afirmaciones se categorizó como alto estigma-discriminación percibido). Participaron 943 adultos (M = 47,9; DE = 14,2); 67,4%, mujeres; 109 (11,6%) informaron alto nivel de síntomas depresivos y 217 (23%) presentaron alto estigma-discriminación percibido. El alto estigma-discriminación percibido se asoció a alto nivel de síntomas depresivos (OR = 6,47; IC95%: 4,23-9,88). Se concluye que un cuarto de las víctimas del conflicto armado en Magdalena informa alto estigma-discriminación percibido; éste se asocia significativamente a alto nivel de síntomas depresivos.

É desconhecida a frequência do complexo estigma-discriminação percebido em vítimas do conflito armado colombiano. O objetivo do estudo foi estabelecer a frequência e variáveis associadas ao estigma-discriminação percebido em vítimas do conflito armado, em municípios do Departamento de Magdalena, Colômbia. Foi realizado um estudo transversal com vítimas registradas no Programa de Atenção Psicossocial e Saúde Integral às Vítimas. Os sintomas depressivos foram quantificados com quatro itens dicotômicos (três ou mais foram classificados como alto nível de sintomas depressivos), e o estigma-discriminação percebido foi quantificado com seis subsecções dicotômicas (com duas ou mais afirmações foi categorizado como alto estigma-discriminação percebido). Participaram 943 adultos (M = 47,9; DP = 14,2); 67,4%, mulheres; 109 (11,6%) informaram alto nível de sintomas depressivos e 217 (23%) presentaram um alto estigma-discriminação percebido. O alto estigma-discriminação percebido foi associado à alto nível de sintomas depressivos (OR = 6,47; IC95%: 4,23-9,88). Concluiu-se que um quarto das vítimas do conflito armado em Magdalena informa alto estigma-discriminação percebido, que foi associado significativamente à alto nível de sintomas depressivos.

Frecuencia y variables asociadas a estigma-discriminación percibido en víctimas del conflicto armado colombiano / Frequency and variables associated with perceived devaluation-discrimination in victims of the armed conflict in Colombia / Frequência e variáveis associadas à estigma-discriminação percebido em vítimas do conflito armado colombiano

Resumen: Se desconoce la frecuencia de complejo estigma-discriminación percibido en víctimas del conflicto armado colombiano. El objetivo del estudio fue establecer la frecuencia y variables asociadas al estigma-discriminación percibido en víctimas del conflicto armado, en municipios del Departamento del Magdalena, Colombia. Se realizó un estudio transversal con víctimas registradas en el Programa de Atención Psicosocial y Salud Integral a Víctimas. Los síntomas depresivos se cuantificaron con cuatro ítems dicotómicos (tres o más se clasificaron como alto nivel de síntomas depresivos) y el estigma-discriminación percibido se cuantificó con seis incisos dicotómicos (dos o más afirmaciones se categorizó como alto estigma-discriminación percibido). Participaron 943 adultos (M = 47,9; DE = 14,2); 67,4%, mujeres; 109 (11,6%) informaron alto nivel de síntomas depresivos y 217 (23%) presentaron alto estigma-discriminación percibido. El alto estigma-discriminación percibido se asoció a alto nivel de síntomas depresivos (OR = 6,47; IC95%: 4,23-9,88). Se concluye que un cuarto de las víctimas del conflicto armado en Magdalena informa alto estigma-discriminación percibido; éste se asocia significativamente a alto nivel de síntomas depresivos.

Abstract: There is no information on frequency of perceived devaluation-discrimination in victims of the armed conflict in Colombia. The aim of this study was thus to determine the frequency of perceived devaluation-discrimination and associated variables among victims of the armed conflict in municipalities in the Department of Magdalena, Colombia. A cross-sectional study was conducted among victims enrolled in the Program for Psychosocial Care and Comprehensive Healthcare for Victims. Depressive symptoms were quantified with four dichotomous items (three or more were classified as high level of depressive symptoms), and perceived devaluation-discrimination was quantified with six dichotomous items (two or more were classified as high perceived devaluation-discrimination). A total of 943 adults participated (M = 47.9; SD = 14.2); 67.4%, women; 109 (11.6%) reported high level of depressive symptoms and 217 (23%) showed high perceived devaluation-discrimination. High perceived devaluation-discrimination was associated with high level of depressive symptoms (OR = 6.47; 95%CI: 4.23-9.88). In conclusion, one-fourth of the victims of the armed conflict in Magdalena reported high perceived devaluation-discrimination, which was significantly associated with high level of depressive symptoms.

Resumo: É desconhecida a frequência do complexo estigma-discriminação percebido em vítimas do conflito armado colombiano. O objetivo do estudo foi estabelecer a frequência e variáveis associadas ao estigma-discriminação percebido em vítimas do conflito armado, em municípios do Departamento de Magdalena, Colômbia. Foi realizado um estudo transversal com vítimas registradas no Programa de Atenção Psicossocial e Saúde Integral às Vítimas. Os sintomas depressivos foram quantificados com quatro itens dicotômicos (três ou mais foram classificados como alto nível de sintomas depressivos), e o estigma-discriminação percebido foi quantificado com seis subsecções dicotômicas (com duas ou mais afirmações foi categorizado como alto estigma-discriminação percebido). Participaram 943 adultos (M = 47,9; DP = 14,2); 67,4%, mulheres; 109 (11,6%) informaram alto nível de sintomas depressivos e 217 (23%) presentaram um alto estigma-discriminação percebido. O alto estigma-discriminação percebido foi associado à alto nível de sintomas depressivos (OR = 6,47; IC95%: 4,23-9,88). Concluiu-se que um quarto das vítimas do conflito armado em Magdalena informa alto estigma-discriminação percebido, que foi associado significativamente à alto nível de sintomas depressivos.

Multiple-victimisation due to armed conflict and emotional distress in the State of Magdalena, Colombia / Polivictimización por el conflicto armado y sufrimiento emocional en el Departamento del Magdalena, Colombia

Abstract Background: Emotional distress is common in Colombian armed conflict victims. Multiple-victimisation is associated with an increase in emotional distress than victimisation due a single event. However, the association between poly-victimisation and emotional distress among victims of the armed conflict in Colombia has not been documented. Objective: To study the association between multiple-victimisation and emotional distress in victims of armed conflict in the State of Magdalena, Colombia. Methods: A cross-sectional study was designed, with a secondary analysis of registration of the Psychosocial Care Program and Victim Integral Health (PAPSIVI) in the State of Magdalena, from 2013 to 2014. The profile formula grouped demographic variables, victimising events, and a set of symptoms of emotional distress (perceived discrimination, depressive and anxiety-stress). Odds ratio (OR, 95%CI) were established as measures of association. Results: A total of 943 people were included, with 67.4% women, and ages between 18 and 94 years (mean 47.9 ±14.2). A total of 109 (11.7%) suffered from multiple victimisation. Multiple victimisation events were associated with more emotional distress, depressive symptoms (OR = 1.5; 95%CI, 1.3-1.8), perceived stigma (OR = 1.3; 95%CI, 1.1-1.5), and anxiety-stress (OR = 1.2; 95%CI 1.0-1.4) than a single event. Conclusions: There are more emotional distress in multiple victimisations than in a single victimisation event during armed conflict in this region of Colombia. Further studies are required on this topic.

Resumen Introducción: El sufrimiento emocional es frecuente en víctimas del conflicto armado colombiano. La polivictimización se asocia a mayor número de sufrimientos emocionales que la victimización debida un único evento. Sin embargo, hasta la fecha no se ha documentado la asociación entre polivictimización y sufrimiento emocional en víctimas del conflicto armado en Colombia. Objetivo: Estudiar la asociación entre polivictimización y sufrimiento emocional en víctimas del conflicto armado del Departamento del Magdalena, Colombia. Métodos: Se diseñó un estudio transversal, un análisis secundario del registro del Programa de Atención Psicosocial y Salud Integral a Víctimas (PAPSIVI) del Departamento del Magdalena, 2013-2014. El formulario de caracterización agrupó variables demográficas, eventos victimizantes y un conjunto de manifestaciones de sufrimiento emocional (discriminación percibida, depresión y ansiedad). Se establecieron razones de disparidades como medidas de asociación. Resultados: Se incluyó a 943 personas, el 67,4% mujeres, con edad de 18-94 anos (media, 47,9 ± 14,2). Un total de 109 (11,7%) presentaron polivictimización. La polivictimización se asoció a mayor sufrimiento emocional que la victimización por un único evento, síntomas depresivos (odds ratio = 1,5; intervalo de confianza del 95%, 1,3-1,8), estigmatización percibida (odds ratio = 1,3; intervalo de confianza del 95%, 1,1-1,5) y ansiedad-estrés (odds ratio = 1,2; intervalo de confianza del 95%, 1,0-1,4). Conclusiones: La polivictimización incrementa el sufrimiento emocional más que la victimización por un único evento en personas víctimas del conflicto armado en esta región colombiana. Es necesario investigar más en esta área.

[Multiple-Victimisation due to Armed Conflict and Emotional Distress in the State of Magdalena, Colombia]. / Polivictimización por el conflicto armado y sufrimiento emocional en el Departamento del Magdalena, Colombia.

BACKGROUND: Emotional distress is common in Colombian armed conflict victims. Multiple-victimisation is associated with an increase in emotional distress than victimisation due a single event. However, the association between poly-victimisation and emotional distress among victims of the armed conflict in Colombia has not been documented. OBJECTIVE: To study the association between multiple-victimisation and emotional distress in victims of armed conflict in the State of Magdalena, Colombia. METHODS: A cross-sectional study was designed, with a secondary analysis of registration of the Psychosocial Care Program and Victim Integral Health (PAPSIVI) in the State of Magdalena, from 2013 to 2014. The profile formula grouped demographic variables, victimising events, and a set of symptoms of emotional distress (perceived discrimination, depressive and anxiety-stress). Odds ratio (OR, 95%CI) were established as measures of association. RESULTS: A total of 943 people were included, with 67.4% women, and ages between18 and 94 years (mean 47.9±14.2). A total of 109 (11.7%) suffered from multiple victimisation. Multiple victimisation events were associated with more emotional distress, depressive symptoms (OR=1.5; 95%CI, 1.3-1.8), perceived stigma (OR=1.3; 95%CI, 1.1-1.5), and anxiety-stress (OR=1.2; 95%CI 1.0-1.4) than a single event. CONCLUSIONS: There is more emotional distress in multiple victimisations than in a single victimisation event during armed conflict in this region of Colombia. Further studies are required on this topic.

Avances en el conocimiento de la prehabilitación y presentación del proyecto promoción de la ambulación precoz en pacientes de cirugía no cardíaca (PAMP) / Avanços no Conhecimento da Pré-reabilitação e Apresentação do Projeto Promoção da deambulação precoce em pacientes com cirurgia não cardíaca (PAMP) / Improvements in the knowledge of prehabilitation and presentation of the project: promotion of early ambulation in non-cardiac surgery patients (PAMP)

Introducción: La prehabilitación es un programa multidisciplinario que combina un conjunto de intervenciones (caminata, ejercicios aeróbicos, entrenamiento de los músculos inspiratorios, educación sobre nutrición y manejo psicológico) orientadas hacia el mejoramiento de la capacidad funcional de los pacientes antes de asumir cualquier tipo de cirugía. Su propósito es el de preparar físicamente a los pacientes que van a cirugía (especialmente población adulta y adulta mayor) y favorecer una rehabilitación rápida, la reducción de las complicaciones en el post operatorio, y una preparación adecuada para el egreso hospitalario. A pesar del conocimiento de la importancia de esta intervención poco se sabe sobre su beneficio en los resultados post operatorios de pacientes de cirugía no cardíaca. Objetivo: Describir la prehabilitación, los alcances de la evidencia científica en este tópico y presentar el proyecto promoción de la ambulación precoz en pacientes de cirugía no cardíaca (PAMP) como un modelo de investigación en cirugía no cardíaca y prehabilitacion. Metodología: Se realizó una revisión no sistemática de la literatura de los fundamentos de la prehabilitación, sus orígenes, tipos de intervenciones, importancia y su eficacia en la reducción de eventos en el post operatorio de pacientes de cirugía no cardíaca. Adicionalmente se llevó a cabo una revisión de la literatura que incluyó revisiones sistemáticas y metaanálisis de ensayos clínicos sobre intervenciones evaluadas sobre prehabilitación de cirugía no cardíaca. Finalmente, se describió el alcance del proyecto PAMP en todas sus fases y su progreso hacia la implementación de un ensayo clínico de prehabilitación en Colombia mediante el estudio PAMP fase II. Conclusiones: Se requiere implementar estrategias multidisciplinarias innovadoras que promuevan mejores resultados en el post operatorio de pacientes sometidos a cirugía no cardíaca...(AU)

Introduction: Prehabilitation is a multidisciplinary program that combines a set of interventions (walking, aerobic exercises, inspiratory muscle training, nutrition education and psychological management) aimed at improving the functional capacity of patients before assuming any type of surgery. Its purpose is to physically prepare patients before going to surgery (especially the adult and older adult population) and favor rapid rehabilitation, reduction of post-operative complications, and adequate preparation for hospital discharge. Despite the knowledge of the importance of this intervention it is not a practice implemented and little is known about its benefit in the postoperative results of non-cardiac surgery patients. Objective: To describe the prehabilitation and the scope of the scientific evidence in this topic. To present the PAMP project as a research model of prehabilitation in non-cardiac surgery. Methodology: We performed a non - systematic review of the literature on the fundamentals of prehabilitation, its origins, types of interventions, importance and its efficacy in the reduction of postoperative events in noncardiac surgery patients. Furthermore, we performed a literature review including systematic reviews and meta-analyzes of clinical trials on interventions of prehabilitation programs. Finally, this article presents the scope of the PAMP project in all its phases and its progress towards the implementation of a clinical trial of prehabilitation in Colombia through the PAMP phase II study was described. Conclusions: It is necessary to implement innovative multidisciplinary strategies that promote better results in the postoperative period of patients undergoing noncardiac surgery...(AU)

Introdução: Introdução: A pré-reabilitação é um programa multidisciplinar que combina um conjunto de intervenções (caminhada, aeróbica, treinamento muscular inspiratório, nutrição e psicologia) destinado a melhorar a capacidade funcional dos pacientes antes de fazer a cirurgia. O objetivo da pré-reabilitação é para reduzir as complicações que podem ocorrer durante o período pré-operatório (pré, trans e pós-operatório) em pessoas adultas e idosas. As complicações pré-reabilitação em todo o mundo é de 200 milhões e cerca de 1 milhão de doentes morrem durante os primeiros 30 dias depois de ter feito a cirurgia. A estimativa de risco antes da cirurgia identifica aos pacientes que necessitam de um acompanhamento mais intensivo e maior atenção depois da cirurgia. Embora a avaliação de risco antes da cirurgia pode melhorar a predição de mortalidade pós-operatória em cirurgia não cardíaca, pouco se sabe sobre a eficácia da pré-reabilitação como complemento na avaliação do risco para prevenir complicações e a norte pós-operatórias. Objetivo: Este documento é uma revisão da literatura sobre a prática de pré-reabilitação em pacientes cirúrgicos não cardíacos. Metodologia: Isso inclui uma revisão da sua definição e uma descrição geral do tipo de intervenções ou atividades implementadas. Resultados: Explica a evidência sobre o impacto desses programas sobre a evolução do paciente no pós-operatório; uma revisão de fato sobre a pré-reabilitação, a melhor prova da pré-reabilitação relatada em revisões sistemáticas e metaanálises. Conclusões: o avanço associado com a pesquisa nacional relacionada com a avaliação do estilo de vida sedentário e os fatores associados à inatividade, antes da cirurgia de pacientes não cardíacos e do estudo em progresso PAMP-Phase II (Promoção da deambulação pré-cirúrgica) um projeto piloto de pré-reabilitação liderado pela enfermagem em pacientes agendados para cirurgia não cardíaca na Colômbia...(AU)

[In vitro activity of ceftaroline against Spanish isolates of Staphylococcus aureus: a multicenter study]. / Estudio multicéntrico sobre la actividad in vitro de ceftarolina frente a Staphylococcus aureus aislados en España.

INTRODUCTION: Ceftaroline fosamil is a new-generation antimicrobial agent of cephalosporins subgroup. It is the first commercially available beta-lactam antibiotic that exhibits activity against methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study is to determine the in vitro Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values of ceftaroline against S.aureus strains (including MRSA). MATERIAL AND METHODS: A multicenter study involving four hospitals representative of the Spanish geography was performed. MIC and MBC values against both the methicillin-resistant and sensitive strains of S.aureus (MRSA and methicillin-sensitive S.aureus [MSSA]) were determined using a broth microdilution method. RESULTS: A total of 266 S.aureus strains were analyzed (95 MRSA and 171 MSSA). Ceftaroline bacterial sensitivity showed a mean MIC of 0.227 µg/ml (SD=0.146; range, 0.06 to 1 µg/ml). All MIC values of the 266 strains tested belonged to the sensitive category (value ≤ 1 µg/ml). Intermediate or resistant strains were not detected. MIC50 and MIC90 values for MRSA were 0.25 and 0.5 µg/ml, respectively (range=0.125-1 µg/ml). MSSA strains showed MIC50 and MIC90 values of 0.125 and 0.25 µg/ml, respectively (range=0.125-0.5 µg/ml). MBC50 and MBC90 values for MRSA were 0.5 and 1 µg/ml, respectively (range=0.125-1 µg/ml). MSSA strains showed MBC50 and MBC90 values of 0.25 and 0.25 µg/ml, respectively (range=0.125-0.5 µg/ml). CONCLUSION: Ceftaroline shows excellent in vitro activity against S.aureus, including MRSA strains. Therefore, this antibiotic may be a promising alternative for the treatment of infections caused by this bacterium.