Eco-efficiency evaluation in wastewater treatment plants considering greenhouse gas emissions through the data envelopment analysis-tolerance model.

The eco-efficiency evaluation in wastewater treatment plants (WWTPs) is used to know and improve the environmental and economic efficiency of these processes, systems, products, and services. The eco-efficiency evaluations in WWTP contemplate the inputs to be minimized, the desirable results to be maximized, and the undesired results to be minimized. Data envelopment analysis (DEA) is a widely used method to evaluate the eco-efficiency of WWTPs; integrating several approaches in a single index, traditional DEA models do not take into account the uncertainty in the data. This study evaluates the eco-efficiency of a sample of Catalan WWTPs, considering the uncertainty of the data (DEA tolerance model), and it is for the first time that together with CO2, other greenhouse gas (GHG) such as CH4 and N2O are considered as part of the process outputs. GHG emissions were quantified using methods reported in the literature. Seven hundred twenty-nine eco-efficiency scores were estimated for each WWTP instead of a single score like conventional DEA models, analyzing optimistic and pessimistic scenarios. The WWTPs were classified according to the estimated eco-efficiency scores, accounting for the uncertainty in each of the scenarios, and demonstrating the changes in the performance of the WWTPs in the different scenarios. Only two WWTPs were eco-efficient in all the scenarios evaluated. This approach provides essential information to improve efficiency and innovation in the wastewater sector.

Risks for methicillin-resistant Staphylococcus aureus colonization or infection among patients with HIV infection.

BACKGROUND: Risks for methicillin-resistant Staphylococcus aureus (MRSA) among those with HIV infection have been found to vary, and the epidemiology of USA-300 community-acquired (CA) MRSA has not been adequately described. METHODS: We conducted a retrospective review of HIV-infected out-patients from January 2002 to December 2007 and employed multivariate logistic regression (MLR) to identify risks for MRSA colonization or infection. Pulsed-field gel electrophoresis (PFGE) was used to identify USA-300 strains. RESULTS: Seventy-two (8%) of 900 HIV-infected patients were colonized or infected with MRSA. MLR identified antibiotic exposure within the past year [odds ratio (OR) 3.4; 95% confidence interval (CI) 1.5-7.7] and nadir CD4 count <200 cells/microL (OR 2.5; 95% CI 1.2-5.3) as risks for MRSA colonization or infection. Receipt of antiretroviral therapy (ART) within the past year was associated with decreased risk (OR 0.16; 95% CI 0.07-0.4). Eighty-nine percent of available strains were USA-300. MLR identified skin or soft tissue infection (SSTI) as the only predictor for infection with USA-300 (OR 5.9; 95% CI 1.4-24.3). CONCLUSION: Significant risks for MRSA among HIV-infected patients were CD4 count nadir <200 cells/microL and antibiotic exposure. Only the presence of an SSTI was associated with having USA-300, and thus the use of patient characteristics to predict those with USA-300 was limited. In addition, ART within the previous year significantly reduced the risk of MRSA colonization or infection.

The association between antibiotic use and resistance: the role of secondary antibiotics.

Using susceptibility rates of Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae over time as markers, we assessed the significance of the change of susceptibility rates to imipenem, ceftriaxone, cefepime, piperacillin/tazobactam, and ciprofloxacin over time and the relationship to antibiotic use for the period 2000-2006. Antibiotic use-susceptibility relationships were assessed using longitudinal regression analysis. The variables "time" and define daily doses (DDD)/1,000 patient days for the specific drug related to the susceptibility rates of that particular model's dependent variable were considered as the main effects, with significance determined at the 0.05 level. Decreases in susceptibility of the target organisms were common over the period of observation. Decreasing susceptibility trends over time were not statistically associated with the primary drug (e.g., organism susceptibility rate to imipenem with imipenem usage). However, secondary drug use was associated with susceptibility rates (e.g., susceptibility of E. cloacae to cefepime with piperacillin/tazobactam usage). These results suggest that antibiotic use-resistance relationships are influenced by the use of secondary antibiotics. Thus, a resistance problem may not be adequately addressed by simply altering the utilization of the primary antibiotic.

Can antibiotic-resistant nosocomial infections be controlled?

Three decades ago infection-control programmes were created to control antibiotic-resistant nosocomial infections, but numbers of these infections have continued to increase, leading many to question whether control is feasible. Meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci were major problems during the 1990s. Many hospitals have tried antibiotic control but with limited efficacy against these pathogens. Studies of antibiotic restriction, substitution, and cycling have been promising, but more definitive data are needed. Increased compliance with hand hygiene would help but is unlikely to control this problem alone as a result of frequent contamination of other surfaces even when hands are cleansed and high transmission rates when hand hygiene is neglected. For 17 years, the Centers for Disease Control and Prevention have recommended contact precautions for preventing nosocomial spread of important antibiotic-resistant pathogens. Many studies confirm that this approach works when sufficient active-surveillance cultures are undertaken to detect the reservoir for spread. However, most healthcare facilities have not yet tried this approach.

[Feminization of old age in Puerto Rico]. / Femenización de la vejez en Puerto Rico.

As a result of the inequality of gender in life expectancy, there is a higher proportion of women than men in old age. The problems and changes that take place in this stage of life are basically women' problems so it can be stated that aging is a women's issue. Women face prejudices nor only for being women but also for being old, sexist and ageist prejudices. This article discusses areas in which women are affected as they aged such as: discrimination and ageism, poverty and loneliness, physical and social losses and changes. It will also present the positive aspects of being old and female.

[Public policy and elderly women]. / Política pública y mujer de edad avanzada.

Talking about the aging population is talking about aged women. The census data in Puerto Rico reflects a considerable increase in this population sector. This increase represents a challenge to the provision of human services and to the formulation and implementation of public policy to this cohort. The public policy should be guided to end the existing inequality among sexes, recognize and deal adequately with the particular needs of the elderly women. Three areas of the public policy that are essential regarding the elderly women are: economic security, health care, and social services.

Transverse myelitis associated with probable cat-scratch disease in a previously healthy pediatric patient.

We evaluated a pediatric patient for transverse myelitis associated with Bartonella henselae infection. There was no adenopathy in our patient, but the diagnosis was made serologically. It is necessary to keep cat-scratch disease in mind even in the absence of typical findings.

Características del abuso y maltrato de personas ancianas en Puerto Rico / Features of elder abuse and mistreatment in Puerto Rico

PURPOSE OF THE STUDY: This descriptive study seeks to understand the prevalence and the phenomenon of abuse and mistreatment among the elderly (60+) in Puerto Rico. The various forms of elder abuse are defined, including socio demographic characteristics, recurrence of abuse, characteristics of perpetrators (abusers), risk factors, and history of health conditions, among others. METHODS: A random sample group was selected among the cases filed with the Protective Services Unit of the Family Department Adults Services during 1999 throughout 2000 (fiscal year). The study included the regions of Aguadilla, Arecibo, Bayamón, Caguas, Carolina, Guayama, Humacao, Mayagüez, Ponce and San Juan. A total of 255 cases were evaluated of which 246 fulfilled the pre-established criteria. The procedures followed were in accordance with privacy and ethical standards. FINDINGS: The most common type of abuse identified is neglect, followed by emotional or psychological abuse, physical abuse, financial exploitation and sexual abuse. Cognitive and social impairment and the need for assistance are important risk factors for elder abuse. Most abusers are family members (especially the elders' offspring). Mitigating factors that explain or increase the risk of elderly abuse are physical or psychological illness of family members or caregiver and/or lack of access to resources. RECOMMENDATIONS: A systematic approach to appropriately report and document patient abuse is recommended. It is necessary to educate the public about the rights of the elderly. Educating professionals, caregivers, and the public on abuse is critical to prevention. The lack of awareness about elder abuse can lead to the public not being able to detect and/or denounce the elderly abuse and may result in death of the victim or aggressors.