[Evaluation of the diagnostic test for rapid detection of covid-19 antigen (Panbio Covid rapid test) in primary care]. / Evaluación de la prueba diagnóstica de detección rápida de antígeno de covid-19 (Panbio Covid rapid test) en atención primaria.

OBJECTIVE: COVID-19 infection requires early diagnosis, with PCR being the gold standard test. The protocols advocate the use of rapid antigenic tests that require evaluation in actual clinical practice. The objective was to evaluate the diagnostic test for rapid antigen detection, Panbio Covid rapid test, compared with PCR, in patients with symptoms of 5 or less days of evolution and with a high-suspicion of infection by COVID-19 in a health center. MATERIALS AND METHODS: 103 patients over 14 years of age who attended an urban health center located in the Usera District of Madrid, with high-suspicion of COVID-19 infection, in the first 5 days of evolution from the onset of symptoms during the month of November 2020. INTERVENTIONS: diagnostic tests for COVID-19 are performed: antigen and PCR. RESULTS: The prevalence of the disease was 24.3% according to the PCR test and 17.5% according to the rapid antigenic test. The sensitivity was 72% (95% CI: 54.3-89.6%). The specificity was 100%. The positive and negative predictive values were 100% and 91.8% respectively. In the bivariate analysis, there was no relationship between symptoms and the presence of disease, except for myalgias (p=0.030). The multivariate analysis found a relationship between cough, dyspnea, fever, myalgia, anosmia/ageusia, and ocular symptoms and the presence of disease. CONCLUSIONS: The sensitivity and specificity for the Panbio rapid antigen test are similar to other studies performed in primary care. In high-prevalence of disease and with highly suspected symptoms, positive test results can be considered definitive, but negative results will require confirmation. Myalgia, fever, dyspnea, anosmia/ageusia, and ocular symptoms may be more related to the presence of COVID-19.

The effect of hypoxia and flow decrease in macroinvertebrate functional responses: A trait-based approach to multiple-stressors in mesocosms.

River ecosystems are most often subject to multiple co-occurring anthropogenic stressors. Mediterranean streams are particularly affected by water scarcity and organic loads that commonly lead to a simultaneous reduction in flow and increasing depletion of dissolved oxygen. In the present study, the single and combined effects of water scarcity (flow velocity reduction) and dissolved oxygen depletion were used to evaluate alterations of drifting macroinvertebrates on a channel mesocosm system, by employing a multiple trait-based approach. Our main findings confirmed that the impact of the two combined stressors can be implicated in alterations of ecosystem functions as result of the changes in proportions of biological traits. Overall, our results showed that, individually, flow velocity reduction and a severe oxygen depletion promoted a shift in community traits. In more detail, biological traits describing the dispersal of organisms and their respiration showed the strongest responses. The respiration mode responded to low flow with drift increase of gill breathers and decrease of individuals with tegument, whereas dispersal was clearly affected by the combination of stressors. Resistance through eggs was higher with the single effect of flow reduction, while swimmers´ relative abundance increased in individuals that drift after exposure to the combination of stressors. Thus, while flow reduction alone is expected to specifically filter out the gill breathers and the egg producers, the combination of stressors will impact more drastically organism's dispersal and swimmers. Such changes in biological traits can result in variations in ecosystem functioning through, for example, local changes in biomass, secondary production, stream metabolism as well as resulting in biodiversity losses or alterations of its distribution patterns.

Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research.

OBJECTIVES: Palliative care (PC) services and patients differ across countries. Data on PC delivery paired with medical and self-reported data are seldom reported. Aims were to describe (1) PC organisation and services in participating centres and (2) characteristics of patients in PC programmes. METHODS: This was an international prospective multicentre study with a single web-based survey on PC organisation, services and academics and patients' self-reported symptoms collected at baseline and monthly thereafter, with concurrent registrations of medical data by healthcare providers. Participants were patients ≥18 enrolled in a PC programme. RESULTS: 30 centres in 12 countries participated; 24 hospitals, 4 hospices, 1 nursing home, 1 home-care service. 22 centres (73%) had PC in-house teams and inpatient and outpatient services. 20 centres (67%) had integral chemotherapy/radiotherapy services, and most (28/30) had access to general medical or oncology inpatient units. Physicians or nurses were present 24 hours/7 days in 50% and 60% of centres, respectively. 50 centres (50%) had professorships, and 12 centres (40%) had full-time/part-time research staff. Data were available on 1698 patients: 50% females; median age 66 (range 21-97); median Karnofsky score 70 (10-100); 1409 patients (83%) had metastatic/disseminated disease; tiredness and pain in the past 24 hours were most prominent. During follow-up, 1060 patients (62%) died; 450 (44%) <3 months from inclusion and 701 (68%) within 6 months. ANOVA and χ2 tests showed that hospice/nursing home patients were significantly older, had poorer performance status and had shorter survival compared with hospital-patients (p<.0.001). CONCLUSIONS: There is a wide variation in PC services and patients across Europe. Detailed characterisation is the first step in improving PC services and research. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01362816.

The paradox of expert judgment in rivers ecological monitoring.

A great investment has been done in the last decades in the development of numerical and qualitative assessment methods to classify the ecological quality of water bodies. Yet, in spite of all attempts to avoid subjectivity, expert judgment is still used at numerous steps of the ecological classification and is considered by some authors as indispensible for management purposes. Thus, the aim of this study is to test the hypothesis that expert judgment, when done by the adequate experts (limnologists/river ecologist) with experience in the study area (i.e., natural conditions and expected communities), could be as good as quantitative indices and measures (i.e., result in the same classification), but quicker and with lower cost. For that we compared the classifications (on 13 aspects of rivers ecosystems) attributed by two experts to 20 sites (10 each) located in their study areas, with the classifications of ecological quality based on biological indices (for invertebrates and diatoms), hydromorphology and water chemistry, calculated by an independent team. Our results show that assessments made by experts and those calculated through indices (biological quality and hydromorphology) are globally very similar (RELATE test; Rho = 0.442; p < 0.001, 999 permutations). Most differences were of one class and experts tended to attribute a better condition than indices to the best quality sites but a worse condition to the worse quality sites. A Principal Components Analysis revealed that sites to which experts attributed a moderate quality had higher nitrate concentration and pH but were well oxygenated. The sites classified as poor and bad where those with stronger modifications in their habitats (given by the higher values of HMS). The difference between experts and indices is small but still represents 15% of sites, and includes both situations: the experts or the indices lead to the need of measures (i.e., classifications below class Good). Experts' evaluations on hydromorphological conditions of the channel and margins are also significantly correlated with the quality assessments made by the field team that has no experience in the study area (Rh0 = 0.518; p = 0.001; 999 permutation), indicating geographic independence in the expert judgment. We concluded that expert judgment could be used in the determination of streams and rivers ecological quality, saving money and time and helping to redirect monitoring funds to actual implementation of restoration measures. Yet, classification' scoring methods may still be useful for a better targeting of restoration measures.

Human disturbance affects the long-term spatial synchrony of freshwater invertebrate communities.

Taxonomic and trait composition of invertebrate communities were investigated for 4 reference and 5 disturbed Mediterranean stream sites over a 18 y period, to test the hypotheses that: 1) human disturbance reduces the resilience of communities to extreme climatic events by affecting their functional structure; 2) and as a result, extreme climatic events could lead to asynchronous responses of communities from streams with similar environmental characteristics but differently affected by human disturbance. In reference sites, trait compositions changed differently (were less similar over time) in response to extreme events and variation was less synchronic than taxonomic compositions in the same sites. Oppositely, in disturbed sites there was a marked synchrony in trait composition indicating a functional homogenization in response to human pressures. This limitation in "functional diversity" may involve a lower ability to respond to climatic extreme events and also a reduced potential in ecosystem services.

Comparability of ecological quality boundaries in the Mediterranean basin using freshwater benthic invertebrates. Statistical options and implications.

Within the Mediterranean region each country has its own assessment method based on aquatic macroinvertebrates. However, independently of the classification system, quality assessments should be comparable across members of the European Commission, which means, among others, that the boundaries between classes should not deviate significantly. Here we check for comparability between High-Good and Good-Moderate classifications, through the use of a common metric. Additionally, we discuss the influence of the conceptual and statistical approaches used to calculate a common boundary within the Mediterranean countries participating in the Intercalibration Exercise (e.g., using individual national type-boundaries, one value for each common type or an average boundary by country; weighted average, median) in the overall outcome. All methods, except for the IBMWP (the Iberian BMWP) when applied to temporary rivers, were highly correlated (0.82

Least Disturbed Condition for European Mediterranean rivers.

The present report describes a three-step approach that was used to characterize and define thresholds for the Least Disturbed Condition in Mediterranean streams of four different types, regarding organic pollution and nutrients, hydrological and morphological alterations, and land use. For this purpose, a common database composed of national reference sites (929 records) from seven countries, sampled for invertebrates, diatoms and macrophytes was used. The analyses of reference sites showed that small (catchment <100 km(2)) siliceous and non-siliceous streams were mainly affected by channelization, bank alteration and hydropeaking. Medium-sized siliceous rivers were the most affected by stressors: 25-43% of the samples showed at least slight alterations regarding channelization, connectivity, upstream dam influence, hydropeaking and degradation of riparian vegetation. Temporary streams were the least affected by hydromorphological changes, but they were nevertheless affected by alterations in riparian vegetation. There were no major differences between all permanent stream types regarding water quality, but temporary streams showed lower values for oxygenation (DO) and wider ranges for other variables, such as nitrates. A lower threshold value for DO (60%) was determined for this stream type and can be attributed to the streams' natural characteristics. For all other river types, common limits were found for the remaining variables (ammonium, nitrate, phosphate, total P, % of artificial areas, % of intensive and extensive agriculture, % of semi-natural areas in the catchment). These values were then used to select the list of reference sites. The biological communities were characterized, revealing the existence of nine groups of Mediterranean invertebrate communities, six for diatoms and five for macrophytes: each group was characterized by specific indicator taxa that highlighted the differences between groups.

Transitional and freshwater bioassessments: one site, two perspectives?

The freshwater-saltwater-transition-zone was analysed using two different sampling protocols and assessment methodologies, developed for freshwater and estuaries, to compare their agreement level in terms of community composition and quality assessments. The use of different protocols resulted in significant differences in macroinvertebrate communities, in index scores and initially in quality classes. After modifications in the sensitivity scores of the IBMWP and AMBI indices (average scores or the use of a score of the other index when both were present), the differences were largely reduced and quality classes became coincident for the assessments provided by IPtIs and BAT tools. Such harmonisation of quality assessments for adjacent water categories (e.g., large rivers vs. transitional waters), exemplified here as an harmonisation in one of the metrics comprised in the assessment tools, is essential as it has direct implications on the expansion and accomplishment of River Basin Management Plans committed by the Water Framework Directive.

Morir por cáncer en Évora: utilización y costes hospitalarios durante el último mes de vida / No disponible

Objetivo: evaluar la utilización y costes generados en el periodo de un año por pacientes fallecidos a causa de cáncer avanzado y progresivo en elHospital do Espírito Santo -Évora (HES-Évora)- durante su último mes de vida. Métodos: estudio retrospectivo, identificación por los certificados dede función, seguido de revisión de procesos clínicos y registros informáticos hospitalarios. Costes calculados en base a la contabilidad analítica del HES-Évora. Criterios de inclusión: cáncer avanzado, progresivo, diagnosticado con más de un mes de antelación, muerte causada por progresión de la enfermedad neoplásica. Resultados: identificados 235 pacientes fallecidos con cáncer, 118 cumplían los criterios definidos. Edad media 69,1 ± 10,7 años, 69,5% del sexo masculino, 55% residentes en Évora. Localizaciones más comunes: aparato digestivo 31%, pulmón 20,3%. La sintomatología más frecuente fue: somnolencia, dolor, disnea, astenia. Opiáceos estaban prescritos en 48,3% de estos pacientes. Muertes durante internamiento 82,2%, en elServicio de Urgencia (SU) 11%, domicilio 4%. Ingresados 84,7%, examinados en Consultas Externas 40,6%, SU 62,7%. En todos los pacientes fue realizado al menos un examen complementario. El total de costes calculado fue de 379.761,35 €. Los costes durante ingreso y asistencia en SU fueron los más elevados. El coste medio por paciente, en este último mes de vida, fue de 3218,32 €.Conclusiones: las principales respuestas ofrecidas a estos enfermos fueron el ingreso y la urgencia. Se constató un coste elevado referente al uso hospitalario durante el último mes de vida, asociado a indicadores de menor calidad de cuidados (AU)

Objective: to evaluate hospital usage and costs at Hospital do Espírito Santo - Évora (HES-Évora), within the period of a year, regarding the last month of life of patients who died in Évora from progressive and advanced cancer. Methods: a retrospective study, patient identification through death certificates, followed by research in the hospital clinical data and informatics registrations. Calculation of costs made with the analytical accountability data of HES-Évora. Inclusion criteria: advanced and progressive cancer diagnosed for more than a month, death due to cancer progression. Results: 235 people who died from cancer were identified; 118 obeyed inclusion criteria. Age 69.1±10.7 years, 69.5% were male, 55% lived in the county of Évora. Most common primary topographies were digestive system, 31% and lung, 20.3%. Most common identified symptoms: drowsiness, pain, dyspnea, asthenia. Opioids have been prescribed in 48.3% of these patients. Died in a hospital ward, 82.2%; in the Emergency Room(ER), 11%, and at home, 4%. Of these patients 84.7% were in a hospital ward, 40.6% were seen at an External Consultation, and at the ER 62.7%. All were submitted at least to one complementary exam. The calculated total cost was 379,761.35 €. The biggest fractions were due to in-hospital stays and visits to the ER. The medium cost per patient in the last month of life was 3218.32 €. Conclusions: main care offered to these patients in their last month of life was provided by in-hospital wards and the ER, though associated with great costs and indicators of inferior quality care (AU)

Aldehyde oxidoreductase activity in Desulfovibrio alaskensis NCIMB 13491 EPR assignment of the proximal [2Fe-2S] cluster to the Mo site.

A novel molybdenum iron-sulfur-containing aldehyde oxidoreductase (AOR) belonging to the xanthine oxidase family was isolated and characterized from the sulfate-reducing bacterium Desulfovibrio alaskensis NCIMB 13491, a strain isolated from a soured oil reservoir in Purdu Bay, Alaska. D. alaskensis AOR is closely related to other AORs isolated from the Desulfovibrio genus. The protein is a 97-kDa homodimer, with 0.6 +/- 0.1 Mo, 3.6 +/- 0.1 Fe and 0.9 +/- 0.1 pterin cytosine dinucleotides per monomer. The enzyme catalyses the oxidation of aldehydes to their carboxylic acid form, following simple Michaelis-Menten kinetics, with the following parameters (for benzaldehyde): K(app/m)= 6.65 microM; V app = 13.12 microM.min(-1); k(app/cat) = 0.96 s(-1). Three different EPR signals were recorded upon long reduction of the protein with excess dithionite: an almost axial signal split by hyperfine interaction with one proton associated with Mo(V) species and two rhombic signals with EPR parameters and relaxation behavior typical of [2Fe-2S] clusters termed Fe/S I and Fe/S II, respectively. EPR results reveal the existence of magnetic interactions between Mo(V) and one of the Fe/S clusters, as well as between the two Fe/S clusters. Redox titration monitored by EPR yielded midpoint redox potentials of -275 and -325 mV for the Fe/S I and Fe/S II, respectively. The redox potential gap between the two clusters is large enough to obtain differentiated populations of these paramagnetic centers. This fact, together with the observed interactions among paramagnetic centers, was used to assign the EPR-distinguishable Fe/S I and Fe/S II to those seen in the reported crystal structures of homologous enzymes.

In situ corrosion control in industrial water systems.

The main objective of this study was to evaluate the efficacy of a biocide and a corrosion inhibitor against the corrosion of a circulating pipe in a cooling tower. Isothiazolone was tested as the industrial biocide. The results showed that the biocide by itself or combined with a dispersant was not efficient to control corrosion in the industrial system. Corrosion rates of 0.324 mm/year were recorded in both the presence and absence of the biocide. Corrosion control was successfully accomplished by using a corrosion inhibitor. In the latter case the maximum corrosion rate of 0.024 mm/year were obtained.

Isolation and characterisation of a novel sulphate-reducing bacterium of the Desulfovibrio genus.

A novel sulphate-reducing bacterium (Ind 1) was isolated from a biofilm removed from a severely corroded carbon steel structure in a marine environment. Light microscopy observations revealed that cells were Gram-negative, rod shaped and very motile. Partial 16S rRNA gene sequencing and analysis of the fatty acid profile demonstrated a strong similarity between the new species and members from the Desulfovibrio genus. This was confirmed by the results obtained following purification and characterisation of the key proteins involved in the sulphate-reduction pathway. Several metal-containing proteins, such as two periplasmic proteins: hydrogenase and cytochrome c3, and two cytoplasmic proteins: ferredoxin and sulphite reductase, were isolated and purified. The latter proved to be of the desulfoviridin type which is typical of the Desulfovibrio genus. The study of the remaining proteins revealed a high degree of similarity with the homologous proteins isolated from Desulfovibrio gigas. However, the position of the strain within the phylogenetic tree clearly indicates that the bacterium is closely related to Desulfovibrio gabonensis, and these three strains form a separate cluster in the delta subdivision of the Proteobacteria. On the basis of the results obtained, it is suggested that Ind 1 belongs to a new species of the genus Desulfovibrio, and the name Desulfovibrio indonensis is proposed.

Characterization of representative enzymes from a sulfate reducing bacterium implicated in the corrosion of steel.

This communication reports the isolation, purification and characterization of key enzymes involved in dissimilatory sulfate reduction of a sulfate reducing bacterium classified as Desulfovibrio desulfuricans subspecies desulfuricans New Jersey (NCIMB 8313) (Ddd NJ). The chosen strain, originally recovered from a corroding cast iron heat exchanger, was grown in large scale batch cultures. Physico-chemical and spectroscopic studies of the purified enzymes were carried out. These analyses revealed a high degree of similarity between proteins isolated from the DddNJ strain and the homologous proteins obtained from Desulfomicrobium baculatus Norway 4. In view of the results obtained, taxonomic reclassification of Desulfovibrio desulfuricans subspecies desulfuricans New Jersey (NCIMB 8313) into Desulfomicrobium baculatus (New Jersey) is proposed.