Endoscopic ultrasound-guided gallbladder drainage with long-term lumen-apposing metal stent indwell: 1-year results from a prospective nationwide observational study.

BACKGROUND AND AIM: This study aimed to determine safety and risk factors for adverse events (AEs) of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with long-term indwell of lumen-apposing metal stents (LAMS). METHODS: This study is a multicenter prospective observational study on consecutive high surgical-risk patients requiring gallbladder drainage who underwent EUS-GBD with LAMS over 12 months. Centralized telephone follow-up interviews were conducted every 3 months for 1 year. Patients were censored at LAMS removal, cholecystectomy, or death. AE-free survival was determined using log-rank tests. Cumulative risks were estimated using life-table analysis. RESULTS: Eighty-two patients were included (53.7% male, median [interquartile range] age of 84.6 [76.5-89.8] years, and 85.4% with acute cholecystitis). Technical success was achieved in 79 (96.3%), and clinical success in 73 (89%). No patient was lost to follow-up; 45 patients (54.9%) completed 1-year follow-up with in situ LAMS. Median (interquartile range) LAMS indwell time was 364 (47-367) days. Overall, 12 (14.6%) patients presented 14 AEs, including 5 (6.1%) recurrent biliary events (3 acute cholangitis, 1 mild acute pancreatitis, and 1 acute cholecystitis). Patients with pancreatobiliary malignancy had an increased risk of recurrent biliary events (33% vs 1.5%, P = 0.001). The overall 1-year cumulative risk of recurrent biliary events was 9.7% (4.1-21.8%). The 1-year risk of AEs and of severe AEs was 18.8% (11-31.2%) and 7.9% (3.3-18.2%), respectively. Pancreatobiliary malignancy was the single risk factor for recurrent biliary events; LAMS misdeployment was the strongest risk factor for AEs. CONCLUSIONS: Long-term LAMS indwell does not increase the risk of delayed AEs following EUS-GBD.

Endoscopic removal of lumen-apposing metal stents - risk factors for stent embedment, complex removals, and adverse events: analysis from a multicenter prospective case series.

BACKGROUND: Removing lumen-apposing metal stents (LAMSs) may be difficult and even harmful, but these features have seldom been analyzed. We aimed to generate a comprehensive assessment of the feasibility and safety of LAMS retrieval procedures. METHODS: A prospective multicenter case series including all technically successfully deployed LAMSs between January 2019 and January 2020 that underwent endoscopic stent removal. All retrieval-related data were prospectively recorded using standardized telephone questionnaires as part of centralized follow-up that ended after stent removal had been performed. Multivariable logistic regression models assessed the potential risk factors for complex removal. RESULTS: For the 407 LAMSs included, removal was attempted in 158 (38.8 %) after an indwell time of 46.5 days (interquartile range [IQR] 31-70). The median (IQR) removal time was 2 (1-4) minutes. Removal was labelled as complex in 13 procedures (8.2 %), although advanced endoscopic maneuvers were required in only two (1.3 %). Complex removal risk factors were stent embedment (relative risk [RR] 5.84, 95 %CI 2.14-15.89; P = 0.001), over-the-wire deployment (RR 4.66, 95 %CI 1.60-13.56; P = 0.01), and longer indwell times (RR 1.14, 95 %CI 1.03-1.27; P = 0.01). Partial and complete embedment were observed in 14 (8.9 %) and five cases (3.2 %), respectively. The embedment rate during the first 6 weeks was 3.1 % (2/65), reaching 15.9 % (10/63) during the following 6 weeks (P = 0.02). The adverse event rate was 5.1 %, including seven gastrointestinal bleeds (5 mild, 2 moderate). CONCLUSIONS: LAMS removal is a safe procedure, mostly requiring basic endoscopic techniques attainable in conventional endoscopy rooms. Referral to advanced endoscopy units should be considered for stents with known embedment or long indwell times, which may require more technically demanding procedures.

Association between HLA DNA Variants and Long-Term Response to Anti-TNF Drugs in a Spanish Pediatric Inflammatory Bowel Disease Cohort.

The genetic polymorphisms rs2395185 and rs2097432 in HLA genes have been associated with the response to anti-TNF treatment in inflammatory bowel disease (IBD). The aim was to analyze the association between these variants and the long-term response to anti-TNF drugs in pediatric IBD. We performed an observational, multicenter, ambispective study in which we selected 340 IBD patients under 18 years of age diagnosed with IBD and treated with anti-TNF drugs from a network of Spanish hospitals. Genotypes and failure of anti-TNF drugs were analyzed using Kaplan-Meier curves and Cox logistic regression. The homozygous G allele of rs2395185 and the C allele of rs2097432 were associated with impaired long-term response to anti-TNF drugs in children with IBD after 3 and 9 years of follow-up. Being a carrier of both polymorphisms increased the risk of anti-TNF failure. The SNP rs2395185 but not rs2097432 was associated with response to infliximab in adults with CD treated with infliximab but not in children after 3 or 9 years of follow-up. Conclusions: SNPs rs2395185 and rs2097432 were associated with a long-term response to anti-TNFs in IBD in Spanish children. Differences between adults and children were observed in patients diagnosed with CD and treated with infliximab.

Prospective comparative study of the treatment of Helicobacter pylori with antibiotic susceptibility testing-guided triple therapy compared to quadruple therapy with bismuth-metronidazole-tetracycline subcitrate.

INTRODUCTION: the current indicated first-line treatment for Helicobacter pylori (H. pylori) infection is the quadruple therapy with bismuth (Pylera®), or the quadruple concomitant therapy without bismuth. The triple therapy was abandoned due to its low eradication rates, partly derived from an increase in antibiotic resistance. The aim of this study was to compare the H. pylori eradication rates guided by antibiotic susceptibility testing (AST) versus Pylera®. METHODS: a specimen was taken prospectively for culture and antibiotic susceptibility testing (AST) from all patients diagnosed with H. pylori infection using gastroscopy, and they were randomized to receive triple therapy depending on the results of the AST, or quadruple therapy with Pylera®. The eradication rates of both groups were analyzed using fecal antigen. The adherence and side effects of the treatment were also analyzed. RESULTS: of the 108 patients with H. pylori infection, 55 received Pylera® and 53 AST-guided triple therapy. The eradication rates were 92.7 % with Pylera® and 90.6 % in the AST-guided group, and the difference was statistically significant. There were also no differences found in adherence or side effects. CONCLUSIONS: the treatment of H. pylori with AST-guided triple therapy is effective, especially in regions with high rates of antibiotic resistance.

Luetic gastritis: an uncommon cause of gastritis.

A 41-year-old patient presented to the Dermatology clinic with a papular rash on the trunk and orange-colored maculopapular lesions on the soles of both feet. This was associated with general symptoms including myalgia, fatigue, epigastric pain, nausea and vomiting. The patient had been taking omeprazole and cinitapride with little improvement.

Severe cardiorespiratory complications derived from propofol sedation monitored by an endoscopist.

INTRODUCTION: deep sedation with propofol monitored by an endoscopist in different endoscopy units is a controversial subject and the source of conflicts of interest between the various scientific societies of Anesthesiology and Gastroenterology. Many studies have already demonstrated the efficacy, efficiency and low incidence of complications associated with sedation when under the control of a trained endoscopist vs an anesthesiologist. MATERIAL AND METHODS: the rate of severe cardiorespiratory complications during various endoscopic examinations (gastroscopy, colonoscopy, endoscopic retrograde cholangiopancreatography [ERCP] and endoscopic ultrasound [EUS]) where sedation was controlled by an endoscopist within our unit, from 2011 to 2016, was reviewed. RESULTS: during the study period, 33,195 examinations were analyzed. The rate of cardiorespiratory complications was 0.13% and the majority were severe desaturations. Most cases responded to an opening in the airway associated with the interruption of drug infusion and an ambu bag was required in a few cases. There were no statistically significant differences between the different groups, except for mean age, risk by type of examination and ASA risk, where the difference between ERCP and the rest of examinations was statistically significant. CONCLUSION: there is a high level of evidence in the scientific literature suggesting that sedation controlled by a trained endoscopist is safe, effective and efficient. However, further prospective studies are required in order to confirm this conclusion due to the fact that the majority of studies to date are retrospective.

Corrigendum: Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients.

This corrects the article DOI: 10.1038/ajg.2016.439.

Endoscopic diverticulotomy using Ligasure™. / Diverticulotomía endoscópica utilizando Ligasure™.

INTRODUCTION: Endoscopic treatment of Zenker diverticulum is considered feasible, effective and safe. The use of the Ligasure™ vessel sealer provides adequate and quick dissection of tissue, achieving effective haemostasis. PATIENTS AND METHODS: Retrospective, descriptive study of all patients with Zenker diverticulum who were treated by endoscopic diverticulotomy using Ligasure™. The procedure was performed in the endoscopy unit under deep sedation controlled by the endoscopist. Patients were subsequently admitted for observation and, after discharge, were followed-up in the outpatient clinic. RESULTS: Eight patients, 5 women and 3 men, mean age 78±15 years, 25% ASA I, 36% ASA II, 14% ASA III and 25% ASA IV. Main symptom: dysphagia. Diverticula size: 1-7cm. Technical success: 100%. COMPLICATIONS: one patient with upper gastrointestinal bleeding. Average stay: 24h. Seven patients: asymptomatic; one patient with partial improvement, requiring repeat endoscopic intervention. Surgery and morbidity and mortality: 0%. CONCLUSION: The treatment of Zenker diverticulum by endoscopic diverticulotomy using the Ligasure™ vessel sealer is highly effective, fast and safe, and could be considered the treatment of choice.

Fecal Gluten Peptides Reveal Limitations of Serological Tests and Food Questionnaires for Monitoring Gluten-Free Diet in Celiac Disease Patients.

OBJECTIVES: Treatment for celiac disease (CD) is a lifelong strict gluten-free diet (GFD). Patients should be followed-up with dietary interviews and serology as CD markers to ensure adherence to the diet. However, none of these methods offer an accurate measure of dietary compliance. Our aim was to evaluate the measurement of gluten immunogenic peptides (GIP) in stools as a marker of GFD adherence in CD patients and compare it with traditional methods of GFD monitoring. METHODS: We performed a prospective, nonrandomized, multicenter study including 188 CD patients on GFD and 84 healthy controls. Subjects were given a dietary questionnaire and fecal GIP quantified by enzyme-linked immunosorbent assay (ELISA). Serological anti-tissue transglutaminase (anti-tTG) IgA and anti-deamidated gliadin peptide (anti-DGP) IgA antibodies were measured simultaneously. RESULTS: Of the 188 celiac patients, 56 (29.8%) had detectable GIP levels in stools. There was significant association between age and GIP in stools that revealed increasing dietary transgressions with advancing age (39.2% in subjects ≥13 years old) and with gender in certain age groups (60% in men ≥13 years old). No association was found between fecal GIP and dietary questionnaire or anti-tTG antibodies. However, association was detected between GIP and anti-DGP antibodies, although 46 of the 53 GIP stool-positive patients were negative for anti-DGP. CONCLUSIONS: Detection of gluten peptides in stools reveals limitations of traditional methods for monitoring GFD in celiac patients. The GIP ELISA enables direct and quantitative assessment of gluten exposure early after ingestion and could aid in the diagnosis and clinical management of nonresponsive CD and refractory CD. Trial registration number NCT02711397.

Initial experience with EUS-guided cholangiopancreatography for biliary and pancreatic duct drainage: a Spanish national survey.

BACKGROUND: EUS-guided cholangiopancreatography (ESCP) allows transmural access to biliopancreatic ducts when ERCP fails. Data regarding technical details, safety, and outcomes of ESCP are still unknown. OBJECTIVE: To evaluate outcomes of ESCP in community and referral centers at the initial development phase of this procedure, to identify the ESCP stages with higher risk of failure, and to evaluate the influence on outcomes of factors related to the endoscopist. DESIGN: Multicenter retrospective study. SETTING: Public health system hospitals with experience in ESCP in Spain. PATIENTS: A total of 125 patients underwent ESCP in 19 hospitals, with an experience of <20 procedures. INTERVENTION: ESCP. MAIN OUTCOME MEASUREMENTS: Technical success and complication rates in the initial phase of implantation of ESCP are described. The influence of technical characteristics and endoscopist features on outcomes was analyzed. RESULTS: A total of 125 patients from 19 hospitals were included. Biliary ESCP was performed in 106 patients and pancreatic ESCP was performed in 19. Technical success was achieved in 84 patients (67.2%) followed by clinical success in 79 (63.2%). Complications occurred in 29 patients (23.2%). Unsuccessful manipulation of the guidewire was responsible for 68.2% of technical failures, and 58.6% of complications were related to problems with the transmural fistula. LIMITATIONS: Retrospective study. CONCLUSION: Outcomes of ESCP during its implantation stage reached a technical success rate of 67.2%, with a complication rate of 23.2%. Intraductal manipulation of the guidewire seems to be the most difficult stage of the procedure.

[Community-onset and nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus in Spanish hospitals]. / Bacteriemias de presentación comunitaria y nosocomial por Staphylococcus aureus resistente a meticilina en hospitales españoles.

INTRODUCTION: Community-onset infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are increasing. However, there is little information about community-onset bacteremia (CB) due to MRSA in Spain. The objectives of this study were to evaluate the prevalence, clinical and molecular epidemiology, clinical features, and prognosis of CB due to MRSA in comparison with nosocomial bacteremia (NB). METHODS: Prospective multicenter cohort study; all new cases of bacteremia due to MRSA occurring during June 2003 in 59 Spanish hospitals were included. Episodes diagnosed during the first 48 hours of admission were considered CB, and otherwise, NB. Isolates were typed by pulsed field electrophoresis and multilocus sequence typing. Staphylococcal cassete chromosome mec types and Panton-Valentine leukocidin genes were studied by polymerase chain reaction. RESULTS: Sixty-four cases were included; 21 (33%) were classified as CB. In all CB cases, a relation was found with health care, or the isolate proved to be clonally related to nosocomial isolates. There were no significant differences between the groups in terms of demographic data, underlying conditions, prognosis, or characteristics of the isolates. Regarding the source of bacteremia, catheter-related cases were more frequent in NB than CB (39.5% vs 5%, P=0.005), whereas a urinary source was more frequent in CB than NB (25% vs 0%, P=0.001). Most isolates belonged to 2 clones related to the pandemic "pediatric" clone. CONCLUSION: MRSA should be considered in empiric treatment for certain infectious syndromes in patients with healthcare-associated community-onset sepsis.

Patient Satisfaction in the Peruvian Health Services: Validation and Application of the HEALTHQUAL Scale.

During recent years, public-private partnerships (PPPs) in the health sector have been an attractive alternative for improving healthcare services in developing countries such as Peru. Therefore, it is fundamental to consider a comprehensive set of healthcare qualities, like the HEALTHQUAL scale, when we measure dimensions of healthcare service quality. Currently, no studies have applied HEALTHQUAL in Peruvian hospitals. The purposes of this study were to (1) validate and evaluate the application of the HEALTHQUAL scale to measure user satisfaction in outpatient services at two PPP hospitals in Peru; and (2) test the relationship between user satisfaction, efficiency, and loyalty. A descriptive, cross-sectional study based on the HEALTHQUAL scale was carried out at the end of 2018. The measurement items were satisfaction with healthcare personnel, satisfaction with nonhealthcare personnel, satisfaction with facilities and equipment, perception of efficiency, and trust. The scale was administered to a nonprobability sample of 250 users who attended one of two PPP hospitals-Barton and Kaelin. The application of partial least squares path modeling significantly impacted on the perceived efficiency in the items of healthcare personnel, nonhealthcare personnel, and facilities and equipment. The HEALTQUAL scale demonstrated sufficient validity and thus can be applied for measuring user satisfaction in PPP hospitals.

Prospective longitudinal study: use of faecal gluten immunogenic peptides to monitor children diagnosed with coeliac disease during transition to a gluten-free diet.

BACKGROUND: Treatment for coeliac disease is a lifelong strict gluten-free diet. Although guidelines recommend regular follow-up with dietary interviews and coeliac serology, these methods may be inaccurate. AIM: To evaluate the usefulness of faecal gluten immunogenic peptides to support the diagnosis and to determine the adherence to the gluten-free diet in coeliac children. METHODS: Multicentre prospective observational study including 64 coeliac children. Faecal gluten peptides, and tissue transglutaminase and deamidated gliadin peptide antibodies were analyzed at diagnosis, and 6, 12 and 24 months thereafter. Gluten consumption was estimated from gluten peptide levels. RESULTS: Most children (97%) had detectable gluten peptides at diagnosis. On a gluten-free diet, the rate of gluten peptides increased from 13% at 6 months to 25% at 24 months. Mean estimated gluten exposure dropped from 5543 mg/d at diagnosis to 144 mg/d at 6 months, then increased to 606 mg/d by 24 months. In contrast, deamidated gliadin peptide antibodies normalised and only 20% had elevated tissue transglutaminase antibody by 24 months. The elevation of tissue transglutaminase antibody was more prolonged in patients with detectable gluten peptides (P < 0.05). Nevertheless, absolute levels of tissue transglutaminase antibody had low sensitivity to identify patients with detectable gluten peptides (P > 0.1). Dietitian assessment was only moderately correlated with gluten peptide detection (κ = 0.5). CONCLUSIONS: Faecal gluten peptides testing may guide treatment of coeliac disease prior to diagnosis and during the assessment diet adherence. Further studies could determine if early identification of gluten exposure reduces the need for expensive/invasive investigations for non-responsive coeliac disease. ClinicalTrials.gov Number: NCT02711397.

Enteropathy Associated with Olmesartan.

The recognition of an enteropathy caused by olmesartan is recent. It was first described in 2012 by the Mayo Clinic, which presented 22 clinical cases. Olmesartan is a highly prescribed drug and the differential diagnosis of a sprue-like enteropathy is very wide, so it is important to be aware of this pathology. We report a case of a 67-years-old man, with arterial hypertension under treatment with olmesartan, with a 4-months history of diarrhea and weight lost. He was admitted three times in our Department during this period of time. An initial diagnosis was made of lymphocytic colitis but he did not respond to treatment with corticosteroids. There was a high suspicion of celiac disease, so the patient started a gluten-free diet but still there were no symptomatic changes. The patient underwent several blood and imaging tests which were negative. Due to the suspicion of an enteropathy caused by drugs, olmesartan was stopped and the patient showed a significant improvement of his symptoms. The exact pathophysiology of this entity remains to be elucidated. It may affect all gastrointestinal tract and mimic a refractory celiac disease as well as a lymphocytic colitis due to similar symptoms and histology. It is expected more cases like this in the future due to high use of olmesartan in current clinical practice. So, it is important to all gastroenterologists to be aware of this pathology and take it into consideration when putting together a differential diagnosis.

A enteropatia por Olmesartan não estava reconhecida até ao ano de 2012 quando a "Mayo Clinic" apresentou 22 casos. Apesar de existirem poucos casos publicados, é importante familiarizar os clínicos com aspectos referentes a esta patologia, visto tratar-se de um fármaco muito prescrito e o diagnóstico diferencial da enteropatia "sprue-like" ser muito amplo.Apresentamos o caso de um paciente em tratamento com Olmesartan por hipertensão arterial. É internado 3 vezes num prazo de 4 meses por quadro de diarreia e perda importante de peso. Inicialmente, é diagnosticado de colite linfocítica que não responde ao tratamento com corticóides e, posteriormente, de provável doença celíaca que não responde a dieta sem glúten. Realizam-se inúmeros exames complementários, analíticos e de imagem, sem concluir-se nenhum diagnóstico. Perante a suspeita de uma enteropatia por Olmesartan, retira-se o fármaco definitivamente e reinicia-se o glúten na dieta, confirmando-se uma melhoria espectacular do quadro clínico. Durante os internamentos não tomava Olmesartan, sendo o motivo da melhoria clínica durante os mesmos.Os mecanismos associados a esta patologia são desconhecidos. Pode afectar todo o aparelho digestivo e mimetizar uma doença celíaca refractária e/ou colite linfocítica devido a semelhança dos sintomas e da anatomia patológica. Devido à elevada prescrição deste medicamento, é esperável que no futuro se diagnostiquem mais casos, motivo pelo qual, os clínicos, principalmente os gastroenterologistas, devem de considera-la no diagnóstico diferencial.

Workplace Bullying Among Teachers: An Analysis From the Job Demands-Resources (JD-R) Model Perspective.

This paper adopts the Job Demands-Resources (JD-R) model to analyze workplace bullying among teachers. The data used for this research are obtained from the 5th European Working Conditions Survey. Given the objective of this work, a subsample of 261 education employees is collected: 48.7% of these teachers report having experienced workplace bullying (N = 127), while 51.3% indicate not considering themselves as bullied at work (N = 134). In order to test the research model and hypotheses, this study relies on the use of partial least squares (PLS-SEM), a variance-based structural equation modeling method. The study describes a workplace bullying prevalence rate of 4.4% among education employees. This work summarizes an array of outcomes with the aim of proposing, in general, that workplace bullying may be reduced by limiting job demands and increasing job resources.

A Comparative Study of Workplace Bullying Among Public and Private Employees in Europe.

OBJECTIVES: Workplace bullying emerges from a set of individual, organizational, and contextual factors. The purpose of this article is hence to identify the influence of these factors among public and private employees. METHODS: The study is carried out as a statistical-empirical cross-sectional study. The database used was obtained from the 5th European Working Conditions Survey 2010. RESULTS: The results reveal a common core with respect to the factors that determine workplace bullying. Despite this common base that integrates both models, the distinctive features of the harassed employee within the public sector deal with age, full-time work, the greater nighttime associated with certain public service professions, and a lower level of motivation. CONCLUSIONS: The present work summarizes a set of implications and proposes that, under normal conditions, workplace bullying could be reduced if job demands are limited and job resources are increased.

Adsorción de Cd(II) y Pb(II) presentes en solución acuosa con hueso de nanche (Byrsonima crassifolia) / Adsorption of Cd(ll) and Pb(ll) present in aqueous solution with nanche stone (Byrsonima crassifolia) / Adsorção de Cd(ll) e Pb(ll) presente em solução aquosa com osso nanche (Byrsonima crassifolia)

Resumen El hueso de nanche es un residuo agrícola con gran potencial de uso como adsorbente. Al respecto, se evaluó la capacidad de adsorción de iones Cd(II) y Pb(II), presentes en solución acuosa, utilizando este residuo. Las pruebas realizadas en este estudio fueron: la determinación del punto de carga cero (pHPZC), determinación de sitios activos (método de Boehm y espectroscopía FTIR) y el desarrollo de los modelos matemáticos de Langmuir, Freundlich y Prausnitz-Radke, a través de isotermas de adsorción. Los resultados obtenidos del pHPZC del hueso de nanche estuvieron en un rango ácido (6,0), mientras que la concentración de sitios ácidos y básicos fue de 0,1037 y 0,046 mol/g, respectivamente. Los espectros infrarrojos (FTIR) detectaron sitios funcionales ácidos asociados al grupo fenol, ácidos carboxílicos y lactonas. Finalmente, la capacidad de adsorción del hueso de nanche para Cd(II) y Pb(II) se incrementó con el pH y alcanzó porcentajes de remoción hasta de 84 % para Cd(II) a pH 8, y de 82% para Pb(II) a pH 5. En conclusión, el pH y la presencia de sitios funcionales ácidos fueron determinantes en la eliminación de los iones Pb(II) y Cd(II).

Abstract The nanche stone is an agricultural residue that has great potential as adsorbent. Then, the adsorption capacity of Cd(II) and Pb(II) ions present in aqueous solution was evaluated, using the stone as adsorbent. The tests performed for this purpose were the determination of point of zero charge (pHPZC), determination of active sites (Boehm method and FTIR spectroscopy), and the development of the mathematical models of Langmuir, Freundlich, and Prausnitz-Radke through adsorption isotherms. The results obtained from the pHPZC of the nanche stone were in an acidic range (6,0), while the concentration of acid and basic sites were 0.1037 and 0.046 mol/g respectively. The infrared spectra (FTIR) detected acid functional sites associated with the phenol group, carboxylic acids, and lactones. Finally, the adsorption capacity of nanche stone to Cd(II) and Pb(II), increased with the pH, achieving percentages of removal up to 84% for Cd (II) to pH 8, and of 82% for Pb(II) to pH 5. In conclusion, the pH and the presence of acidic functional sites were decisive in the elimination of the Pb(II) and Cd(II) ions.

Resumo O osso Nanche é um resíduo agrícola que possui grande potencial como adsorvente, neste respeito, a capacidade de adsorção de íons Cd(II) e Pb(II) presentes em solução aquosa foi avaliada, utilizando osso como adsorvente. Os testes realizados para este fim foram a determinação do ponto zero de carga (pHPZC), a determinação de sites ativos (método Boehm e espectroscopia FTIR) e o desenvolvimento dos modelos matemáticos de Langmuir, Freundlich e Prausnitz-Radke através de isotermas de adsorção. Os resultados obtidos do pHPZC do osso nanche foram em uma faixa ácida (6,0), enquanto a concentração de ácidos e sites básicos foram 0,1037 e 0,046 mol / g, respectivamente. Os espectros de infravermelho (FTIR) detectaram sites funcionais ácidos associados ao grupo fenol, ácidos carboxílicos e lactonas. Finalmente, a capacidade de adsorção do osso nanche para Cd(II) e Pb(II), aumentou com o pH, atingindo porcentagens de remoção de até 84% para o Cd(II) em pH 8, e 82% para Pb(II) a pH 5. Em conclusão, o pH e a presença de sites funcionais ácidos foram decisivos na eliminação dos íons Pb (II) e Cd (II).

Workplace bullying among managers: a multifactorial perspective and understanding.

The aim of this paper is to study certain factors that may be determinant in the emergence of workplace bullying among managers-employees with a recognized and privileged position to exercise power-adopting the individual perspective of the subject, the bullied manager. Individual, organizational, and contextual factors integrate the developed global model, and the methodology utilized to accomplish our research objectives is based on the binary logistic regression model. A sample population of 661 managers was obtained from the micro data file of the 5th European Working Conditions Survey-2010 (European Foundation for the Improvement of Living and Working Conditions) and utilized to conduct the present research. The results indicate that the chance for a manager to refer to him/herself as bullied increases among women that hold managerial positions and live with children under 15 at home, and among subjects that work at night, on a shift system, suffering from work stress, enjoying little satisfaction from their working conditions, and not perceiving opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes, within the usual course of events, that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist directors/general directors in facilitating, to some extent, good social relationships among managers.