Efficient arsenic removal from water using iron-impregnated low-temperature biochar derived from henequen fibers: performance, mechanism, and LCA analysis.

The present study aims to investigate the low-energy consumption and high-efficiency removal of arsenic from aqueous solutions. The designed adsorbent Fe/TBC was synthesized by impregnating iron on torrefaction henequen fibers. Isothermal adsorption experiments indicated maximum adsorption capacities of 7.30 mg/g and 8.98 mg/g for arsenic(V) at 25.0 °C and 40.0 °C, respectively. The interference testing showed that elevated levels of pH, HCO3- concentration, and humic acid content in the solution could inhibit the adsorption of arsenic by Fe/TBC. Characterization of the adsorbent before and after adsorption using FTIR and SEM-EDS techniques confirmed arsenic adsorption mechanisms, including pore filling, electrostatic interaction, surface complexation, and H-bond adhesion. Column experiments were conducted to treat arsenic-spiked water and natural groundwater, with effective treatment volumes of 550 mL and 8792 mL, respectively. Lastly, the life cycle assessment (LCA) using OpenLCA 2.0.3 software was performed to treat 1 m3 of natural groundwater as the functional unit. The results indicated relatively significant environmental impacts during the Fe/TBC synthesis stage. The global warming potential resulting from the entire life cycle process was determined to be 0.8 kg CO2-eq. The results from batch and column experiments, regeneration studies, and LCA analysis indicate that Fe/TBC could be a promising adsorbent for arsenic(V).

Influence of construction materials on the natural mummification process: case study of the municipal pantheon of Santa Paula, Guanajuato, Mexico.

The process of natural or spontaneous mummification has been observed for more than a hundred years in various Mexican pantheons. The construction materials used in the niches of the pantheons generate particular microenvironmental conditions that promote the preservation of organic materials. The construction materials (mining adobe, brick and stone material) that make up the three series of the municipal pantheon of Santa Paula were studied and analyzed using X-ray Diffraction, X-ray Fluorescence and petrographic analysis techniques. At the same time, the mechanical and physical properties of the materials were determined, as well as the relative humidity and temperature within the niches. The results indicate that the geochemistry, distribution and percentage of said materials inside of the niches created exceptional microclimatic conditions that favored the conservation of the bodies. With this contribution we intend to advance the understanding of the influence that construction materials had on the process of natural mummification.

Contamination assessment and potential sources of heavy metals and other elements in sediments of a basin impacted by 500 years of mining in central Mexico.

Since the middle of the 1500 s, mining has been active in central Mexico. Total estimates for low-grade piles and mine tailing materials in the Guanajuato mining district (GMD) are in the range of 150 million tons, covering an area of 15 to 20 km2. GMD is located in the Guanajuato River sub-basin (GRB), which is part of one of the largest basins in Mexico (Lerma-Santiago). Previous studies on the GRB found unusually high concentrations of heavy metals in mining tailings and sediments. Geochemical and statistical methods were used here to determine the sediment's origin, background values, degree of contamination, and toxicity through different contamination indices. This analysis shows that Cu, Co, As, Sb, and Hg are higher than they are in the upper continental crust (UCC) overbank sediments without human and mining influence, because of the ore deposits and rock weathering in GRB. Geochemistry results in stream sediments show anomalies, where Hg, Cu, Zn, As, and Pb are higher than UCC because those heavy metals and trace elements (HMT) have been influenced by human activities and mineral recovery (smelting, amalgamation, cyanidation). The distribution of high concentrations of HMTs and contamination indices occur in the main channel of the Guanajuato River and downstream of the city of Guanajuato. Statistical analyses (cluster and principal component analysis) reveal relationships between Cr, Ni, Cu, and Pb, which are primarily of natural origin, related to rocks of the upper basin. The middle and lower basins are distinctive in their associations between As, Sb, Zn, Pb, and Hg. Additionally, it is recognized that the origins of Pb, Zn, and Hg are geogenic and anthropogenic. This study demonstrates how crucial it is to understand the geochemistry of various HMT sources, with both natural and anthropogenic contributions (stream sediments and rocks), in order to calculate a more realistic background in a basin with both natural anomalies and anthropogenic contamination. The basin is a regional aquifer recharge area, so the new geochemical data are important for improving basin environmental management.

How Aromatic Are Molecular Nanorings? The Case of a Six-Porphyrin Nanoring*.

Large conjugated rings with persistent currents are novel promising structures in molecular-scale electronics. A six-porphyrin nanoring structure that allegedly sustained an aromatic ring current involving 78π electrons was recently synthesized. We provide here compelling evidence that this molecule is not aromatic, contrary to what was inferred from the analysis of 1 H-NMR data and computational calculations that suffer from large delocalization errors. The main reason behind the absence of an aromatic ring current in these nanorings is the low delocalization in the transition from the porphyrins to the bridging butadiyne linkers, which disrupts the overall conjugated circuit. These results highlight the importance of choosing a suitable computational method to study large conjugated molecules and the appropriate aromaticity descriptors to identify the part of the molecule responsible for the loss of aromaticity.

Neurologic Conditions Associated with Cavus Foot Deformity.

The cavus foot deformity is an often less understood deformity within the spectrum of foot and ankle conditions. The hallmark concern is the possibility of an underlying neurologic or neuromuscular disorder. Although a proportion of these deformities are idiopathic, a significant majority do correlate with an underlying disorder. The appropriate evaluation of this deformity, in coordination within the multidisciplinary scope of health care, allows for a timely diagnosis and understanding of the patient's condition. We provide an abbreviated survey of possible underlying etiologies for the patient with the cavus foot deformity as a reference to the foot and ankle surgeon.

Ankle and Pantalar Arthrodesis: End-Stage Salvage in Cavus Foot.

Bony alignment is the primary goal in foot and ankle reconstruction of the cavovarus foot. This condition presents as a malalignment causing a medial overload of the ankle articular surface and lateral overload of the hindfoot, midfoot, and forefoot. A painful gait associated with articular degeneration of the numerous joints can lead to a chronic and rigid arthrosis of joints, warranting arthrodesis of the affected joints accordingly.

Magnetic parameters as proxies for anthropogenic pollution in water reservoir sediments from Mexico: An interdisciplinary approach.

We assess the element pollution level of water reservoir sediments using environmental magnetism techniques as a novel approach. Although "La Purísima" Water Reservoir is an important source for multiple activities (e.g. recreational, fishing and agricultural) in Guanajuato state, it has been receiving for the last centuries a high load of pollutants by mining extraction, urbanization and land-use change from the Guanajuato Hydrological Basin. The analyses of environmental magnetism, geochemistry, X-ray energy dispersive spectroscopy, scanning electron microscopy and multivariate methods were applied to study sediments from the reservoir and basin. Accordingly, they indicate the presence of iron oxides (magnetite and hematite) and iron sulfides (pyrite and greigite), which evidences relevant differences in particle size and concentration within the water reservoir (median mass-specific magnetic susceptibility χ = 23.2 × 10-8 m3/kg), as well as with respect to the river basin sediments (median χ = 88.8 × 10-8 m3/kg). The highest enrichment factor EF values (median values of EF = 2-10 for As, Co, Ba, Cu, Cd, Ni and EF > 20 for S) are mainly associated with historical mining activities that have led to an enrichment of potentially toxic elements on these water reservoir sediments. We propose the use of concentration and grain size dependent magnetic parameters, i.e. χ, remanent magnetizations and anhysteretic ratios ARM/SIRM and χARM/χ, as proxies for Ba, Co, Cr, Ni, P and Pb pollution in these river and water reservoir sediments. Such parameters allow to evaluate this sedimentary environment, and similar ones, through useful and convenient proxies.

Adults discharged after an epileptic seizure: a model of 30-day risk for adverse outcomes. / Modelo de riesgo a 30 días en los pacientes adultos con crisis epiléptica dados de alta de urgencias (RACESUR).

OBJECTIVES: To develop a risk model to predict adverse outcomes within 30 days of discharge in adults attended by hospital emergency departments for an epileptic seizure. METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling. We made follow-up telephone calls to registered patients 30 days after discharge. Clinical variables for the index visit were extracted from the register and variables at 30 days were collected by telephone. The main outcome variable was the occurrence of any adverse outcome (seizure recurrence, emergency department revisit, hospitalization, or death) within 30 days of discharge. RESULTS: Of the patients from the ACESUR registry discharged from 18 hospitals, we included 489 (74%) with complete follow-up information. The median (interquartile range) age was de 48 (34-66) years. One hundred forty-four patients (29.4%) experienced an adverse outcome within 30 days of discharge. Factors included in the ACESUR risk model were generalized nonconvulsive tonic-clonic epileptic seizure as the reason for the index visit (odds ratio [OR], 2.42; 95% CI, 1.49-3.90; P<.001), ongoing use of 3 or more medications (OR, 1.98; 95% CI, 1.28-3.07; P=.002), and an emergency visit for any reason in the 6 months prior to the index event (OR, 2.34; 95% CI, 1.47-3.70; P<.001). Each factor contributed 1 point to the risk score. A score of 3 was associated with a 62.2% risk of an adverse outcome within 30 days, a score of 2 was associated with a 38.5% risk, a score of 1 with a 25.9% risk, and a score of 0 with a 10.9% risk. The area under the curve receiver operating characteristic curve was 0.72 (95% CI, 0.675-0.772; P=.025). CONCLUSION: The ACESUR risk model may provide a useful score for identifying patients at high risk of an adverse outcome within 30 days of emergency department discharge after an epileptic seizure.

OBJETIVO: Diseñar un modelo de riesgo para predecir resultado adverso a los 30 días del alta en pacientes adultos atendidos por crisis epiléptica en servicios de urgencias hospitalarios (SUH). METODO: ACESUR fue un registro observacional de cohortes multipropósito, prospectivo, multicéntrico, con muestreo sistemático y con seguimiento telefónico a 30 días. La variable principal fue la presencia de algún resultado adverso (recurrencia de crisis, revisita al SUH, hospitalización o fallecimiento) a 30 días del alta del SUH. RESULTADOS: Se incluyeron 489 (74%) pacientes de 48 años de mediana (RIC 34-66), dados de alta de 18 SUH con datos de seguimiento. Ciento cuarenta y cuatro (29,4%) presentaron algún resultado adverso a 30 días del alta del SUH. El Modelo RACESUR incluyó la presencia de crisis epiléptica no convulsiva generalizada tónico-clónica como motivo de consulta (OR 2,42; IC 95% 1,49-3,90; p < 0,001), consumo habitual de $ 3 fármacos (OR 1,98; IC 95% 1,28- 3,07; p = 0,002) y visita al SUH en el semestre anterior por cualquier causa (OR 2,34; IC 95% 1,7-3,70; p < 0,001). Cada ítem vale 1 punto. El riesgo de padecer un resultado adverso a 30 días fue de un 62,2% con 3 puntos, 38,5% con 2, 25,9% con 1 y 10,9% con 0 puntos. El área bajo la curva del modelo fue de 0,72 (IC 95% 0,675-0,772; p = 0,025). CONCLUSIONES: El Modelo RACESUR podría ser una herramienta pronóstico de utilidad para identificar al paciente adulto con crisis epiléptica y alto riesgo de presentar resultado adverso a los 30 días del alta de urgencias.

[Care of adult patients with epileptic seizure in emergency departments (ACESUR Registry). Differences according to age ≥75 years]. / Atención de pacientes adultos con crisis epilépticas en servicios de urgencias (Registro ACESUR). Diferencias en función de la edad ≥75 años.

OBJECTIVES: To determine whether there are differences in the profile and in the care of adult patients with epileptic seizures in emergency department according to age ≥75 years, and if this is independently associated with results in the emergency department and 30 days after discharge. MATERIAL AND METHODS: ACESUR is a multicentre, prospective, observational cohort multipurpose register that was carried out in 2017. The distribution of the variables corresponding to the clinical presentation and care according to age ≥75 years were compared. Subsequently, logistic regression models were performed with the objective of evaluating the effect of age ≥75 years on the outcome variables. RESULTS: A total of 541 (81.5%) cases younger than 75 years were analysed compared to 123 adult patients (18.5%) of ≥75 years or more. In the group of long-lived it was observed significantly greater probability of dependence, co-morbidity, polypharmacy, a previous visit to the hospital emergency department, arrived by ambulance, first seizures and a symptomatic aetiopathogenic classification. In the multivariate analysis, after adjusting for the above variables, it is observed that age >75 years is associated independently with a higher incidence of specific supplementary tests (OR: 2.31; 95% CI: 1.21-4.44), but not pharmacological intervention (OR: 1.63; 95% CI: 0.96-2.80), or hospitalisation or extended stay in emergency departments (OR: 1.56; 95% CI: 0.94-2.59). On adjusting for all previous variables, age >75 years is associated with lower incidence of adverse events at 30 days (OR: 0.43; 95% CI: 0.25-0.77). CONCLUSIONS: In the ACESUR Registry, differences in clinical presentation and in the care of patients with seizures in emergency departments were identified when comparing those patients >75 years with those <75 years. Age ≥75 years is not independently associated with a higher incidence of intervention in emergency departments, or with more adverse outcomes at 30 days after discharge.

Differences in emergency department care of adults with a first epileptic seizure versus a recurrent seizure: a study of the ACESUR (Acute Epileptic Seizures in the Emergency Department) registr. / Registro ACESUR: atención de pacientes adultos con crisis epilépticas en servicios de urgencias: diferencias entre primer episodio y recurrencia.

OBJECTIVES: To describe the characteristics of care received by patients who come to the emergency department with a first epileptic seizure versus a recurrent seizure in a patient with diagnosed epileps. MATERIAL AND METHODS: ACESUR (Acute Epileptic Seizures in the Emergency Department) is a prospective multicenter, multipurpose registry of cases obtained by systematic sampling on even days in February and July 2017 and on odd days in April and October 2017. Patients were aged 18 years or older and had an emergency department diagnosis of epileptic seizure. We recorded clinical variables and details related to care given during each patient's visit, including whether the event was a first or recurrent seizure. RESULTS: A total of 664 patients attended by 18 Spanish emergency departments were entered into the ACESUR registry. Two hundred twenty-nine (34.5%) were first seizures and 435 (65.5%) were recurrences. Patients who were attended for first seizures were older, consulted for a wider variety of reasons, and were transported in ambulances (P<.001, all comparisons). Care received differed between patients with first seizures versus recurrent seizures. Specific complementary testing was more likely in patients with first seizures (adjusted odds ratio [aOR], 13.94; 95% CI, 29-26.7; P<.001), and they were more often hospitalized or stayed longer in the emergency department, (aOR, 1.69; 95% CI, 1.11-2.58; P=.015). Pharmacologic treatment did not differ between the groups, either in the acute phase or for prevention (aOR, 1.40; 95% CI, 0.94-2.09; P=.096). Antiepileptic drugs were given to 100 patients (43.7%) after a first seizure and were restarted or changed in 142 patients with recurrent seizure (32.6%). CONCLUSION: The clinical characteristics of adults attended for a first epileptic seizure differ from those of patients with diagnosed epilepsy who were attended for recurrent seizures in Spain. The care received also differs.

OBJETIVO: Describir las características y la atención recibida de pacientes adultos que consultan por crisis epiléptica (CE) en los servicios de urgencias hospitalarios (SUH), diferenciando entre primera crisis y recurrencia en epiléptico conocido. METODO: ACESUR es un registro observacional de cohortes multipropósito, prospectivo y multicéntrico con un muestreo sistemático, los días pares de febrero y julio alternando con los impares de abril y octubre de 2017. Se incluyeron pacientes 18 años con diagnóstico de CE en los SUH. Se recogieron variables clínico-asistenciales de la visita índice de pacientes, distinguiendo entre primera CE y recurrencia en epiléptico. RESULTADOS: El registro ACESUR recogió a 664 pacientes procedentes de 18 SUH españoles, 229 (34,5%) con primera CE y 435 (65,5%) con CE recurrentes. Los pacientes con primera CE fueron de mayor edad (p < 0,001), presentaron motivos de consulta distintos (p < 0,001) y requirieron más traslados en ambulancia (p < 0,001). La atención recibida en el SUH fue diferente, en pacientes con primera CE se solicitó con mayor probabilidad una prueba complementaria específica (OR ajustada = 13,94; IC95%:7,29-26,7; p < 0,001) y se necesitó mayor hospitalización o estancia prolongada en el SUH (OR ajustada = 1,69; IC95%:1,11-2,58; p = 0,015). No hubo diferencias en cuanto al tratamiento farmacológico en fase aguda ni preventivo (OR ajustada = 1,40; IC95%:0,94-2,09; p = 0,096). Se inició tratamiento con fármacos antiepiépticos (FAE) en 100 pacientes (43,7%) tras primera CE y se reinició o modificó añadiendo nuevo FAE en 142 pacientes (32,6%) con CE recurrentes. CONCLUSIONES: Las características clínicas y la atención recibida de pacientes adultos con primera CE en SUH en España difieren de las recurrencias en epiléptico conocido.

Energetics and diffusion of liquid water and hydrated ions through nanopores in graphene: ab initio molecular dynamics simulation.

The energetics and diffusion of water molecules and hydrated ions (Na+, Cl-) passing through nanopores in graphene are addressed by dispersion-corrected density functional theory calculations and ab initio molecular dynamics (MD) simulations. Pores of about 0.8 nm in diameter with different pore-edge passivations, with (H) and (O, H) atoms, were considered. Our MD simulations show a water flux through the hydroxylated pores of about one H2O molecule every three picoseconds, in close agreement with recent experiments that estimated a water flux of three molecules per picosecond through pores of ∼1 nm. We also find that both pores are effective in blocking hydrated Na+ and Cl- ions with large energy barriers, ranging from 12 to 15 eV. In addition, pore passivation with O atoms would increase the water transport through hydroxylated pores, due to the formation of hydrogen bonds with nearby water molecules, which is not observed in the hydrogenated pores.

Evidence on equity, governance and financing after health care reform in Mexico: lessons for latin american countries / Evidencias sobre gobernanza, equidad y financiamiento en salud en méxico: lecciones para paises latinoamericanos

This article includes evidence on equity, governance and health financing outcomes of the Mexican health system. An evaluative research with a cross-sectional design was oriented towards the qualitative and quantitative analysis of financing, governance and equity indicators. Taking into account feasibility, as well as political and technical criteria, seven Mexican states were selected as study populations and an evaluative research was conducted during 2002-2010. The data collection techniques were based on in-depth interviews with key personnel (providers, users and community leaders), consensus technique and document analysis. The qualitative analysis was done with ATLAS TI and POLICY MAKER softwares. The Mexican health system reform has modified dependence at the central level; there is a new equity equation for resources allocation, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. Inequality on resources allocation in some regions and catastrophic expenditure for users is unequal in all states, producing more negative effects on states with high social marginalization. Special emphasis is placed on the analysis of the main strengths and weaknesses, as relevant evidences for other Latin American countries which are designing, implementing and evaluating reform strategies in order to achieve equity, good governance and a greater financial protection in health.

Este articulo incluye evidencias sobre equidad, gobernanza y financiamiento como resultado de la reforma de la salud en México. Partió de una investigación evaluativa de diseño transversal con análisis cualitativo y cuantitativo en servicios de salud para población no asegurada desarrollada durante 2002-20010 Bajo criterios de factibilidad técnica, política y financiera, siete estados mexicanos fueron seleccionados. Los datos se recopilaron a través entrevistas a profundidad con actores clave (proveedores, usuarios, líderes comunitarios, legisladores y directivos), técnica de consenso y revisión documental y estadísticas oficiales. El procesamiento y análisis de la información se realizó con los paquetes ATLAS-TI Y POLICY MAKER. La reforma en salud ha podido modificar la dependencia del nivel central; existe nueva formula de equidad; los lideres comunitarios y usuarios plantean la necesidad de implementar sistemas de rendición de cuentas en salud a nivel municipal y estatal; las estrategias de reforma no cuentan con mecanismos adecuados para una participación de todos los actores del sistema de salud, aún cuando la democratización en salud se constituyó como eje conductor de la reforma; los niveles de inequidad en la asignación de recursos y los gastos catastróficos en salud afectan de manera desigual, teniendo impacto negativo en los estados con marginación social. Enfasis especial se hace en una lista de fortalezas y debilidades que a manera de lecciones aprendidas se sugieren para lograr una mayor equidad, mejores niveles de gobernanza y mayor protección financiera en los proyectos de reforma en salud a nivel mundial y particularmente en América Latina.

Costs and epidemiological changes of chronic diseases: implications and challenges for health systems.

BACKGROUND: The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries. OBJECTIVE: To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension) in a middle income county. METHODS: We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014-2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test. RESULTS: Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8-12% in all three studied institutions, (p < .05). Indeed, in the case of diabetes, the increase was 41469 cases for uninsured population (SSA) and 65737 for the insured population (IMSS and ISSSTE). On hypertension cases the increase was 38109 for uninsured vs 62895 for insured. Costs in US$ ranged from $699 to $748 for annual case management per patient in the case of diabetes, and from $485 to $622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23%) will be for the insured population (p < .05). The financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population. CONCLUSIONS: If the risk factors and the different health care models remain as they currently are, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant challenge is the appearance of internal competition in the use and allocation of financial resources with programs for other chronic and infectious diseases.