Technical and economical assessment of the treatment of vinasse from Pisco production using the advanced oxidation process.

The removal of organic matter from Pisco production wastewater was evaluated using coagulation/flocculation, filtration as a pre-treatment, and solar photo-Fenton, with the use of two types of photoreactors: compound parabolic collectors (CPC) and flat plate (FP), with and without utilizing the ozonation process. The overall removal efficiency for chemical oxygen demand (COD) was 63% and 15% using FP and CPC, respectively. Also, for the overall removal efficiency of polyphenols, a percentage of 73% and 43% were obtained using FP and CPC, respectively. When ozone was used in the solar photoreactors, the resulting trends were similar. COD and polyphenol removal, using an FP photoreactor in the solar photo-Fenton/O3 process, resulted in values of 98.8% and 86.2% after the process. COD and polyphenol removal, using solar photo-Fenton/O3 process in a CPC, resulted in values of 49.5% and 72.4%, respectively. The economic indicators of annual worth and economic treatment capacity established that FP reactors represent lower costs than CPCs. These results were corroborated by the economic analyses of the evolution of costs versus COD removed as well as by the cash flow diagrams projected for 5, 10, and 15 years.

What Ibero-American hospitals do when things go wrong? A cross-sectional international study.

OBJECTIVE: To know what hospital managers and safety leaders in Ibero-American countries are doing to respond effectively to the occurrence of adverse events (AEs) with serious consequences for patients. DESIGN: Cross-sectional international study. SETTING: Public and private hospitals in Ibero-American countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru, Portugal and Spain). PARTICIPANTS: A convenience sample of hospital managers and safety leaders from eight Ibero-American countries. A minimum of 25 managers/leaders from each country were surveyed. INTERVENTIONS: A selection of 37 actions for the effective management of AEs was explored. These were related to the safety culture, existence of a crisis plan, communication and transparency processes with the patients and their families, attention to second victims and institutional communication. MAIN OUTCOME MEASURE: Degree of implementation of the actions studied. RESULTS: A total of 190 managers/leaders from 126 (66.3%) public hospitals and 64 (33.7%) private hospitals participated. Reporting systems, in-depth analysis of incidents and non-punitive approaches were the most implemented interventions, while patient information and care for second victims after an AE were the least frequent interventions. CONCLUSIONS: The majority of these hospitals have not protocolized how to act after an AE. For this reason, it is urgent to develop and apply a strategic action plan to respond to this imperative safety challenge. This is the first study to identify areas of work and future research questions in Ibero-American countries.

Ultrasound and heterogeneous photocatalysis for the treatment of vinasse from pisco production.

Production of the distilled alcohol pisco results in vinasse, dark brown wastewater with high polyphenols contents and chemical oxygen demand (COD). No prior research exists on the efficiency of advanced oxidations processes (AOPs) in treating pisco vinasse. Therefore, the purpose of this study was to assess the efficiency of ultraviolet (UV), ultrasound (US), US + UV, heterogeneous photocatalysis (HP), and HP + US treatments. Polyphenols, COD, and color removal, as well as oxidation-reduction potential, were monitored over a 60-minute treatment period. Energy consumption levels and synergies were also calculated. The HP + US treatment achieved the best removal ratios for polyphenols (68%), COD (70%), and color (48%). While the HP treatment was the second most efficient in terms of polyphenols (62%), COD (58%), and color (40%) removal, this AOP comparatively required the least amount of energy. Considering the energy efficiency and relatively high pollutant-removal rates of the HP treatment, this AOP is recommended as a practical alternative for treating pisco vinasse.

Improved landfill leachate quality using ozone, UV solar radiation, hydrogen peroxide, persulfate and adsorption processes.

Advanced oxidation processes based on ozonation, UV solar radiation, hydrogen peroxide, and persulfate were tested for the complete treatment of a specific landfill leachate. As a post-treatment of the advanced oxidation process, an additional adsorption process was carried out using a natural zeolite. Application of the UVsolar/O3/H2O2 process required 140 min of irradiation and the consumption of 0.67 g/L H2O2 to eliminate 56% and 17% of colour and chemical oxygen demand (COD), respectively. When adding persulfate to the system (UVsolar/O3/H2O2/S2O8-2), colour and COD were reduced by 29% and 77%, respectively, with a 0.2 g/L concentration of S2O8-2 requiring 250 min of irradiation time. In an experimental run with landfill leachate, adsorption post-treatment with a natural zeolite resulted in 36%, 99%, and 18% total reductions in COD, ammonium, and chloride, respectively. In another experimental run, adsorption with a zeolite was used as a pre-treatment for the advanced oxidation process (UVsolar/O3/H2O2 and UVsolar/O3/H2O2/S2O8-2). The results were similar to those for adsorption post-treatment, with 30%, 90%, and 20% total reductions in COD, ammonium, and chloride, respectively. Despite improvements, some measured parameters of treated landfill leachate still exceeded Chilean regulations for water quality. Furthermore, Lactuca sativa seeds did not germinate after irrigation with 100% treated landfill leachate or dilutions above 3%. Finally, EC50 values were enhanced during treatment, going from 0.002% for raw landfill leachate to 1.179% after the adsorption process.

A Spanish-language patient safety questionnaire to measure medical and nursing students' attitudes and knowledge / Un cuestionario en espanol sobre seguridad del paciente para medir las actitudes y los conocimientos de los estudiantes de medicina y enfermería

OBJECTIVE: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America. METHODS: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimatedfor each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables. RESULTS: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate. CONCLUSIONS: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

OBJETIVO: Diseñar y validar un cuestionario de evaluación de las actitudes y los conocimientos en materia de seguridad del paciente con una muestra de estudiantes de medicina y enfermería que reciben formación médica en Espana y en cuatro países de América Latina. MÉTODOS: En este estudio transversal se llevó a cabo una revisión bibliográfica y se encuestó a un total de 786 estudiantes de medicina y enfermería de ocho universidades de cinco países (Chile, Colombia, El Salvador, Espana y Guatemala) con objeto de elaborar y corregir un cuestionario en espanol sobre conocimientos y actitudes en materia de seguridad del paciente. El ámbito del cuestionario se basó en cinco dimensiones (factores) presentadas en estudios relacionados con la cultura de la seguridad del paciente encontrados en PubMed y Scopus. Con base en los cinco factores, se elaboraron 25 ítems reactivos. Se calcularon los índices de fiabilidad compuesta y alfa de Cronbach para cada factor, y se realizó un análisis factorial confirmatorio para evaluar la validez. Tras una prueba piloto se corrigió el cuestionario mediante modelos confirmatorios, el cálculo de la máxima probabilidad y la matriz de variancia-covariancia (como insumo). Se utilizaron modelos de regresión lineal múltiple para confirmar la validez externa, considerando las variables relacionadas con la cultura de seguridad del paciente como variables dependientes y los cinco factores como variables independientes. RESULTADOS: El instrumento final fue una encuesta autoadministrada mediante escala de Likert estructurada en cinco puntos ("Cuestionario de Seguridad del Paciente para Estudiantes Latinos"), que consta de 21 ítems agrupados en cinco factores. Los índices de fiabilidad compuesta (prueba estadística de alfa de Cronbach) calculados para los cinco factores fueron aproximadamente de 0,7 o superiores. Los resultados de los análisis de regresión lineal múltiple indicaron un buen ajuste del modelo (índice de bondad de ajuste: 0,9). Las correlaciones ítem-total fueron superiores a 0,3 en todos los casos. La validez convergente y discriminatoria fue adecuada. CONCLUSIONES: El cuestionario disenado y validado en este estudio evalúa las actitudes y los conocimientos de los estudiantes de enfermería y medicina en materia de seguridad del paciente. Este instrumento podría utilizarse para evaluar indirectamente si los estudiantes de disciplinas de la salud están adquiriendo, y por lo tanto, es probable que pongan en práctica, las habilidades profesionales consideradas actualmente como más apropiadas para la seguridad del paciente.

Melanocortin 1 receptor is expressed by uveal malignant melanoma and can be considered a new target for diagnosis and immunotherapy.

PURPOSE: Uveal melanoma is the most common primary malignant ocular cancer in adults. This tumor has a distinct expression pattern of markers compared with cutaneous melanoma. MC1R is under study as a potential target for antitumor immunity. Because of the potential immunogenicity of MC1R, it is important to evaluate its expression on uveal melanomas. METHODS: Two novel monoclonal antibodies (MP1.1C11 and MP1.1B7) were used to examine the expression of MC1R in uveal melanomas. Tissue samples obtained from 17 patients were analyzed for expression of MC1R by immunohistochemistry. Additionally, uveal melanoma cell lines were treated with proinflammatory cytokines, after which MC1R cell surface expression was analyzed by flow cytometry. RESULTS: Results demonstrated that MC1R is expressed by uveal melanoma to a significantly greater extent than other melanoma markers. With the use of MP1.1C11 or MP1.1B7, MC1R was detected in 95% of the tested melanoma tissues, including one liver metastasis. In contrast, MART-1, S100-specific protein, and gp-100 were only expressed by 66%, 33%, and 67% of the analyzed samples, respectively. Results also demonstrated that even though MC1R is mainly located intracellularly, its cell surface expression can be promoted by cytokines such as IFN-gamma, TNF-alpha, IL-4, and IL-10. CONCLUSIONS: These observations support the inclusion of MC1R in the panel of markers for the diagnosis of uveal melanoma. Therapeutic use of MC1R-specific antibodies targeting cytokine-induced MC1R potentially requires expression of the target molecule on the surfaces of tumor cells. Data presented here support MC1R as a new marker and a putative therapeutic target for uveal melanoma.

[Vibrio vulnificus: an infrequent cause of septic shock]. / Vibrio vulnificus: una causa infrecuente de shock séptico.

Vibrio vulnificus is a lactose positive Gram negative rod that lives in warm seas and can infect wounds and produce sepsis. Its infection is acquired after eating oysters or other filtering marine organisms. We report a 53 years old diabetic male who started with fever after a voyage to Central America. He was admitted febrile, hypotense, dehydrated and polypneic. Painful erythematous lesions and lumps were observed in his upper and lower limbs. After 72 hours of evolution, the lesions became violaceous, with crepitating vesicles full of hemorrhagic exudate. He developed a renal failure and a disseminated intravascular coagulation. Blood cultures demonstrated the presence of Vibrio vulnificus and the patient died 68 hours after admission.