Factors Affecting Parent Treatment Decisions for Children with Autism Spectrum Disorders: A Brief Review.

Parents and caregivers of individuals with autism spectrum disorders (ASD) are faced with a vast array of treatment options, which vary greatly in evidence-based merits, and it is unclear what factors affect their final selections. Understanding the factors that influence family decisions can shed light on avenues for more effectively communicating the importance of selecting empirically supported treatments. In this article, we conducted a systematic literature review on how parents select evidence-based treatments for their children with ASD. We categorized treatment types using a combination of established resources, such as the National Standards Project (NSP), to determine the validity of research evidence for different ASD treatments. We reported the various treatment types, decision-making factors, and sources of recommendations across the literature, and compared those with earlier systematic literature reviews. The results of the present review indicate that parents' decisions are influenced by the accessibility of treatment, trust of practitioners, and alignment on factors such as parental values and the child's specific needs. We conclude with suggestions for practitioners and researchers on future research and wider adoption of evidence-based treatments (EBTs).

Adapting the low-cost pre-disinfection column PREDICO for simultaneous softening and disinfection of pore water.

In previous works, a low-cost predisinfection column that combined coagulation-flocculation and GAC filtration was proposed for combination with electrodisinfection in the successful treatment of highly faecal polluted surface water. In this work, this column is adapted for the treatment of pore water by transforming the coagulation chamber into a chemical reactor with lime and replacing the GAC of the filter with ion exchange resins. This adapted system can soften water, remove nitrate and condition water for very efficient electrochemical disinfection, where 4 logs and 3 logs in the removal of E. coli and P. aeruginosa, respectively, were reached using commercial electrochemical cells, i.e., CabECO ® or MIKROZON®. The availability and low cost of the technology are strong points for usage in poor areas of developing countries.

Toward real applicability of electro-ozonizers: Paying attention to the gas phase using actual commercial PEM electrolyzers technology.

This work focuses on increasing the TRL of electro-ozonizer technology by evaluating the effect of electrolyte composition and operation conditions on the production of ozone, using an actual commercial cell, CONDIAPURE®, in conditions similar to what could be expected in a real application. Not only is attention paid to the changes in the concentration of ozone in the liquid phase, but also to those observed in the gas phase. The electrolyte and its recirculation flowrate, as well as operation temperatures and pressures are found to have significant influence on production rates. The most efficient way to produce ozone is operating at low temperatures and high pressures. In this work, 0.25 and 0.21 mg O3/min were obtained operating at 10 A in electrolytes consisting of aqueous solutions of perchloric and sulfuric acid, respectively, in tests carried out at 13 °C and 2 bars of gauge pressure. The negative effect of scavengers that appear electrochemically along the production of ozone is very important and seems to be partially compensated when organics are present in the solution due to the competition between the reaction of these scavengers with ozone or organics.

Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control / Periodontal disease and gestational diabetes mellitus: a case-control study

Antecedentes: Los estudios que relacionan la enfermedad periodontal (EP) y la diabetes mellitus gestacional (DMG) no son concordantes. Nuestro objetivo principal es evaluar la posible asociación entre la EP y la DMG. Además, analizamos los factores de riesgo para la DMG en nuestra muestra. Métodos: Participaron 180 gestantes, 90 con DMG y 90 controles, del Hospital La Fe de Valencia. Se pasó un cuestionario y realizo un examen periodontal, valorándose los siguientes parámetros: número de dientes, índices de placa y sangrado al sondaje, profundidad de sondaje (PS) y nivel de inserción de clínica (NIC). La periodontitis se definió según criterios de la CDC-AAP. Resultados: Las DMG tuvieron mayor valor promedio de PS (p = 0,001) y NIC (p = 0,028). Un 74,4% de las pacientes con DMG presentaron inflamación gingival vs. 57,8% de las no diabéticas. La periodontitis fue más prevalente en las pacientes con DMG (p < 0,05). La edad materna, el nivel de estudios y la presencia de periodontitis son factores independientes de riesgo para la DMG (OR = 1,16, IC 95% 1,07 a 1,25, p < 0,001), (OR = 0,37, IC 95% 0,19 a 0,72, p < 0,005) y (OR = 2,79, IC 95% 1,40 a 5,59, p < 0,005), respectivamente. Conclusiones: Los resultados sugieren que las embarazadas con diabetes gestacional asocian más enfermedad periodontal que aquellas sin dicha enfermedad gestacional. En nuestra muestra el riesgo de DMG puede estimarse a partir de la periodontitis, la edad y el nivel de estudios.(AU)

Background: Studies linking periodontal disease (PD) and gestational diabetes mellitus (GDM) are not consistent. Our main objective is to evaluate the possible association between PD and GDM. We also analysed the risk factors for GDM in our sample. Methods: 180 pregnant women participated, 90 with GDM and 90 controls, from Valencia's Hospital La Fe. A questionnaire was completed and a periodontal examination was performed, assessing the following parameters: number of teeth, plaque and bleeding on probing indices, probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined according to the criteria of CDC-AAP. Results: The GDM group had a higher mean value of PD (p = .001) and CAL (p = .028). Of the patients with GDM, 74.4% had gingival inflammation compared to 57.8% of the non-diabetic patients. Periodontitis was more prevalent in patients with GDM (p < .05). Maternal age, educational level and periodontitis are independent risk factors for GDM (OR = 1.16, 95% CI 1.07 to 1.25, p < .001), (OR = .37, 95% CI .19 to .72, p < .005) and (OR = 2.79, 95% CI 1.40 to 5.59, p < .005) respectively. Conclusions: The results suggest that pregnant women with gestational diabetes have more associated periodontal disease than those without gestational diabetes. In our sample, the risk for GDM can be estimated from periodontitis, age, and educational level.(AU)

Scale-up of electrokinetic permeable reactive barriers for the removal of organochlorine herbicide from spiked soils.

This work aims to shed light on the scale-up a combined electrokinetic soil flushing process (EKSF) with permeable reactive barriers (PRB) for the treatment of soil spiked with clopyralid. To do this, remediation tests at lab (3.45 L), bench (175 L) and pilot (1400 L) scales have been carried out. The PRB selected was made of soil merged with particles of zero valent iron (ZVI) and granular activated carbon (GAC). Results show that PRB-EKSF involved electrokinetic transport and dehalogenation as the main mechanisms, while adsorption on GAC was not as relevant as initially expected. Clopyralid was not detected in the electrolyte wells and only in the pilot scale, significant amounts of clopyralid remained in the soil after 600 h of operation. Picolinic acid was the main dehalogenated product detected in the soil after treatment and mobilized by electro-osmosis, mostly to the cathodic well. The transport of volatile compounds into the atmosphere was promoted at pilot scale because of the larger soil surface exposed to the atmosphere and the electrical heating caused by ohmic losses and the larger interelectrode gap.

Cobalt mediated electro-scrubbers for the degradation of gaseous perchloroethylene.

This work focuses on the treatment of gaseous perchloroethylene (PCE) using electro-scrubbing with diamond electrodes and cobalt mediators. PCE was obtained by direct desorption from an aqueous solution containing 150 mg L-1, trying to a real pollution case. The electro-scrubber consisted of a packed absorption column connected with an undivided electrochemical cell. Diamond anodes supported on two different substrates (tantalum and silicon) were used and the results indicated that Ta/BDD was more successful in the production of Co (III) species and in the degradation of PCE. Three experimental systems were studied for comparison purposes: absorbent free of Co (III) precursors, absorbent containing Co (III) precursors, and absorbent containing Co (III) precursors undergoing previous electrolysis to the electro-scrubbing to facilitate the accumulation of oxidants. The most successful option was the last, confirming the important role of mediated electrochemical processes in the degradation of PCE. Trichloroacetic acid (TCA) and carbon tetrachloride (CCl4) were found as the primary reaction products and ethyl chloroacetate esters were also identified. A comprehensive mechanism of the processes happening inside electro-scrubber is proposed.

Efecto del catéter de hemodiálisis en la permeabilidad de fístulas arteriovenosas / The impact of hemodialysis catheter on arteriovenous fistula permeability

Resumen Objetivo: Evaluar el impacto que tiene el uso de catéteres de hemodiálisis en la permeabilidad de fístulas arteriovenosas. Materiales y Método: Estudio observacional, analítico, tipo cohorte retrospectiva. Se calculó un tamaño muestral de 195 pacientes, seleccionados aleatoriamente a partir del total de pacientes diagnosticados con enfermedad renal crónica (ERC) terminal, a quienes se les realizó su primera fístula arteriovenosa (FAV) entre enero de 2014 y diciembre de 2018. Como variables resultado se consideraron la trombosis de FAV y el tiempo de permeabilidad. Para el análisis inferencial se utilizaron las pruebas de Chi cuadrado; RR (IC 95%); curvas Kaplan-Meier; regresión de Cox; considerando un valor de p significativo < 0,05. Resultados: El 52,3% utilizó catéter de hemodiálisis, de los cuales el 49,5% presentó trombosis de su FAV versus el 17,7% del grupo sin este antecedente (p < 0,001); estimándose en el análisis univariado un riesgo de trombosis 2,7 veces mayor en pacientes con catéter previo a la confección de su FAV (IC 95% 1,7 a 4,4). En el análisis multivariado, se identificó como único factor significativo el antecedente de catéter de hemodiálisis, estimándose que los pacientes usuarios de catéter previo a la confección de su FAV tienen 2,8 veces más riesgo de trombosis en el tiempo que quienes no utilizaron catéter (IC 95% 1,6 a 4,9), quienes además presentaron un tiempo de permeabilidad significativamente menor (p < 0,001) en comparación con pacientes sin antecedente de catéter (28,1 vs 43,9 meses). Conclusión: Identificamos el uso del catéter de hemodiálisis como un factor de riesgo de trombosis de fístulas arteriovenosas, afectando significativamente su permeabilidad en el tiempo.

Objective: To evaluate the effects of hemodialysis catheter on arteriovenous fistula (AVF) permeability. Materials and Method: We conducted a retrospective cohort study, including 195 patients randomly selected from all patients diagnosed with chronic renal failure, who had their first arteriovenous fistula between January 2014 and December 2018. The outcomes were arteriovenous fistula thrombosis and permeability. For data analysis we used Chi-square test; Relative-Risk (CI 95%); Kaplan-Meier analysis and Cox regression; p value less than 0.05 were considered as significant. Results: The 52.3% of the patients used hemodialysis catheter, from this group, the 49.5% had AVF thrombosis versus the 17.7% of the group without history of hemodialysis catheter (p < 0.001), estimating in the univariate analysis a risk of thrombosis 2.7 times higher in patients with catheter before the creation of their AVF (CI 95% 1.7 a 4.4), as well as, in the multivariate analysis the risk of AVF thrombosis was 2.8 times higher in this group of patients, being identified the history of hemodialysis catheter as the only significative risk factor for thrombosis. Additionally, the AVF permeability time in this group was significantly less (p < 0.001) than patients without history of hemodialysis catheter (28.1 vs 43.9 months). Conclusion: We identified the hemodialysis catheter as a risk factor of arteriovenous fistula thrombosis, decreasing significantly its permeability time.

EDIL3 promotes epithelial-mesenchymal transition and paclitaxel resistance through its interaction with integrin αVß3 in cancer cells.

Epithelial-mesenchymal transition (EMT) has recently been associated with tumor progression, metastasis, and chemotherapy resistance in several tumor types. We performed a differential gene expression analysis comparing paclitaxel-resistant vs. paclitaxel-sensitive breast cancer cells that showed the upregulation of EDIL3 (EGF Like Repeats and Discoidin I Like Domains Protein 3). This gene codifies an extracellular matrix protein that has been identified as a novel regulator of EMT, so we studied its role in tumor progression and paclitaxel response. Our results demonstrated that EDIL3 expression levels were increased in paclitaxel-resistant breast and prostate cancer cells, and in subsets of high-grade breast and prostate tumors. Moreover, we observed that EDIL3 modulated the expression of EMT markers and this was impaired by cilengitide, which blocks the EDIL3-integrin αVß3 interaction. EDIL3 knockdown reverted EMT and sensitized cells to paclitaxel. In contrast, EDIL3 overexpression or the culture of cells in the presence of EDIL3-enriched medium induced EMT and paclitaxel resistance. Adding cilengitide resensitized these cells to paclitaxel treatment. In summary, EDIL3 may contribute to EMT and paclitaxel resistance through autocrine or paracrine signaling in cancer cells. Blockade of EDIL3-integrin αVß3 interaction by cilengitide restores sensitivity to paclitaxel and reverts EMT in paclitaxel-resistant cancer cells. Combinations of cilengitide and taxanes could be beneficial in the treatment of subsets of breast and prostate cancers.

Aportación de la Fisioterapia al tratamiento del dolor pélvico crónico en endometriosis / Contribution of physiotherapy to the treatment of chronic pelvic pain in endometriosis

INTRODUCCIÓN: En 2010, el European Working Group on Sarcopenia in Older People (EWGSOP) publicó una definición de consenso para la sarcopenia. También desarrolló un algoritmo basado en la medición del rendimiento físico para la determinación de casos de sarcopenia. Se han publicado diversos estudios que determinan la prevalencia de sarcopenia con este algoritmo, pero hasta donde sabemos, no hay estudios publicados que comparen la prevalencia utilizando 3 métodos diferentes para la determinación del rendimiento físico. El objetivo de este estudio fue determinar la prevalencia de sarcopenia utilizando el algoritmo propuesto por el EWGSOP en 2010 y comparar los resultados utilizando 3 métodos diferentes para el rendimiento físico. MÉTODOS: Se trata de un estudio transversal de 97 personas de edad avanzada. Se obtuvieron medidas de masa muscular, fuerza muscular y rendimiento físico. Para diagnosticar la sarcopenia se utilizaron los puntos de corte y el algoritmo propuesto por el EWGSOP. El análisis de concordancia entre variables cualitativas utilizó el coeficiente kappa de Cohen. RESULTADOS: El coeficiente kappa encontrado comparando los resultados de los 3 métodos empleados para el rendimiento físico (Velocidad de la marcha; Timed Up & Go, Short Physical Performance Battery) indica que no existe concordancia entre ellos. El coeficiente kappa encontrado al comparar la prevalencia de la sarcopenia utilizando 3 métodos diferentes para el rendimiento físico indica que hay una concordancia casi perfecta (kappa ≥ 0,96). Al comparar los resultados del algoritmo propuesto por el EWGSOP en 2010 con un algoritmo simplificado donde no se tiene en cuenta el rendimiento físico, encontramos una concordancia casi perfecta (kappa ≥ 0,96). CONCLUSIONES: La igualdad obtenida para la prevalencia de la sarcopenia independientemente del rendimiento físico cuestiona la necesidad de tener que medir este parámetro para el diagnóstico de sarcopenia. Sería suficiente utilizar un algoritmo simplificado para obtener los mismos resultados en el diagnóstico de la sarcopenia. Los hallazgos encontrados son coherentes con la propuesta hecha por el EWGSOP2 en 2018

INTRODUCTION: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for sarcopenia. They also developed an algorithm based on the measurement of physical performance to determine cases of sarcopenia. Several studies have already been published that determine the prevalence of sarcopenia with this algorithm, but as far as we know, there are no published studies comparing the prevalence using 3 different methods for determining physical performance. The objective of our study was to determine the prevalence of sarcopenia in a group of elderly people using the algorithm proposed by the EWGSOP in 2010, and to compare the results using 3 different methods for determining physical performance. METHODS: A cross-sectional study was conducted with 97 elderly people. Measurements were obtained of muscle mass, muscle strength, and physical performance. To diagnose sarcopenia, the cut-off points and the diagnostic algorithm proposed by the EWGSOP were used. Cohen's Kappa coefficient was used for the analysis of the agreement between qualitative variables. RESULTS: The kappa coefficient, found by comparing the results for the 3 methods used to determine physical performance (Gait speed; Timed Up & Go test, Short Physical Performance Battery), suggests that there is no concordance between them. When comparing the prevalence of sarcopenia using 3 different methods for the determination of physical performance, the kappa coefficient found suggests that there is an almost perfect agreement (kappa ≥ 0.96). An almost perfect agreement (kappa ≥ 0.96) was found when comparing the results of the algorithm proposed by the EWGSOP in 2010 with a simplified algorithm where physical performance for the diagnosis of sarcopenia is not taken into account. CONCLUSIONS: The equality in the results obtained for prevalence showed that the measurement of physical performance is not a necessary parameter for the diagnosis of sarcopenia. To obtain the same results in the diagnosis of sarcopenia, it is enough to use a simplified algorithm. The findings found are consistent with the proposal made by the EWGSOP in 2018

Comparación de la prevalencia de sarcopenia en personas de edad avanzada según el algoritmo propuesto por el EWGSOP en 2010 para la identificación de casos de sarcopenia utilizando tres métodos diferentes para la determinación del rendimiento físico / Comparison of the prevalence of sarcopenia in elderly people according to the algorithm proposed by the EWGSOP in 2010 for sarcopenia case-finding using three different methods for determining physical performance

INTRODUCCIÓN: En 2010, el European Working Group on Sarcopenia in Older People (EWGSOP) publicó una definición de consenso para la sarcopenia. También desarrolló un algoritmo basado en la medición del rendimiento físico para la determinación de casos de sarcopenia. Se han publicado diversos estudios que determinan la prevalencia de sarcopenia con este algoritmo, pero hasta donde sabemos, no hay estudios publicados que comparen la prevalencia utilizando 3 métodos diferentes para la determinación del rendimiento físico. El objetivo de este estudio fue determinar la prevalencia de sarcopenia utilizando el algoritmo propuesto por el EWGSOP en 2010 y comparar los resultados utilizando 3 métodos diferentes para el rendimiento físico. MÉTODOS: Se trata de un estudio transversal de 97 personas de edad avanzada. Se obtuvieron medidas de masa muscular, fuerza muscular y rendimiento físico. Para diagnosticar la sarcopenia se utilizaron los puntos de corte y el algoritmo propuesto por el EWGSOP. El análisis de concordancia entre variables cualitativas utilizó el coeficiente kappa de Cohen. RESULTADOS: El coeficiente kappa encontrado comparando los resultados de los 3 métodos empleados para el rendimiento físico (Velocidad de la marcha; Timed Up & Go, Short Physical Performance Battery) indica que no existe concordancia entre ellos. El coeficiente kappa encontrado al comparar la prevalencia de la sarcopenia utilizando 3 métodos diferentes para el rendimiento físico indica que hay una concordancia casi perfecta (kappa ≥ 0,96). Al comparar los resultados del algoritmo propuesto por el EWGSOP en 2010 con un algoritmo simplificado donde no se tiene en cuenta el rendimiento físico, encontramos una concordancia casi perfecta (kappa ≥ 0,96). CONCLUSIONES: La igualdad obtenida para la prevalencia de la sarcopenia independientemente del rendimiento físico cuestiona la necesidad de tener que medir este parámetro para el diagnóstico de sarcopenia. Sería suficiente utilizar un algoritmo simplificado para obtener los mismos resultados en el diagnóstico de la sarcopenia. Los hallazgos encontrados son coherentes con la propuesta hecha por el EWGSOP2 en 2018

INTRODUCTION: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a definition for sarcopenia. They also developed an algorithm based on the measurement of physical performance to determine cases of sarcopenia. Several studies have already been published that determine the prevalence of sarcopenia with this algorithm, but as far as we know, there are no published studies comparing the prevalence using 3 different methods for determining physical performance. The objective of our study was to determine the prevalence of sarcopenia in a group of elderly people using the algorithm proposed by the EWGSOP in 2010, and to compare the results using 3 different methods for determining physical performance. METHODS: A cross-sectional study was conducted with 97 elderly people. Measurements were obtained of muscle mass, muscle strength, and physical performance. To diagnose sarcopenia, the cut-off points and the diagnostic algorithm proposed by the EWGSOP were used. Cohen's Kappa coefficient was used for the analysis of the agreement between qualitative variables. RESULTS: The kappa coefficient, found by comparing the results for the 3 methods used to determine physical performance (Gait speed; Timed Up & Go test, Short Physical Performance Battery), suggests that there is no concordance between them. When comparing the prevalence of sarcopenia using 3 different methods for the determination of physical performance, the kappa coefficient found suggests that there is an almost perfect agreement (kappa ≥ 0.96). An almost perfect agreement (kappa ≥ 0.96) was found when comparing the results of the algorithm proposed by the EWGSOP in 2010 with a simplified algorithm where physical performance for the diagnosis of sarcopenia is not taken into account. CONCLUSIONS: The equality in the results obtained for prevalence showed that the measurement of physical performance is not a necessary parameter for the diagnosis of sarcopenia. To obtain the same results in the diagnosis of sarcopenia, it is enough to use a simplified algorithm. The findings found are consistent with the proposal made by the EWGSOP in 2018

Perfil biopsicosocial del paciente con tuberculosis y factores asociados a la adherencia terapéutica+ / Biopsychosocial profile of the patient with tuberculosis and factors associated with therapeutic adherence

INTRODUCCIÓN: La resistencia antibiótica y una inadecuada adherencia terapéutica son fenómenos que favorecen la proliferación de la tuberculosis. Los cambios sociodemográficos nos desafían a conocer la realidad actual de la enfermedad a través de antecedentes que nos permitan contextualizar un nuevo escenario. OBJETIVO: Caracterizar el perfil biopsicosocial del paciente con tuberculosis y su relación con la adherencia terapéutica. MATERIAL Y MÉTODO: Estudio descriptivo, transversal, correlacional. Muestra de 90 pacientes tratados en 35 Centros de Salud Familiar de los Servicios de Salud de Iquique, Metropolitano Norte, Concepción y Reloncaví. RESULTADOS: los componentes biopsicosociales como edad, antecedentes de enfermedad mental, autoestima, situación sentimental, pertenencia a grupos de riesgo, alcoholismo, drogadicción y situación de calle presentaron una relación estadísticamente significación con la adherencia terapéutica. CONCLUSIONES: La caracterización biopsicosocial del paciente con tuberculosis visibiliza nuevos factores relacionados con la adherencia que deben ser considerados para una atención interdisciplinaria.

BACKGROUND: Antibiotic resistance and inadequate therapeutic adherence are phenomena that promote the proliferation of tuberculosis. Sociodemographic changes challenge us to know the real situation of the disease and allows us to contextualize a new scenario. OBJECTIVE: To characterize the biopsychosocial profile of the patient with tuberculosis and its relationship to therapeutic adherence. MATERIAL AND METHOD: Descriptive, cross-sectional, correlational study. Sample of 90 patients treated at 35 Family Health Centers from the following Chilean Public Health Services: Iquique, Metropolitan northern (Santiago), Concepción and Reloncaví. RESULTS: Biopsychosocial components such as age, history of mental illness, self-esteem, sentimental status, belonging to risk groups, alcoholism, drug addiction and homeless situation presented a statistically significant relationship with therapeutic adherence. CONCLUSIONS: The biopsychosocial characterization of the TB patient evidence a new adherence-related factors that should be considered for interdisciplinary care.

Electrohysterogram for ANN-Based Prediction of Imminent Labor in Women with Threatened Preterm Labor Undergoing Tocolytic Therapy.

Threatened preterm labor (TPL) is the most common cause of hospitalization in the second half of pregnancy and entails high costs for health systems. Currently, no reliable labor proximity prediction techniques are available for clinical use. Regular checks by uterine electrohysterogram (EHG) for predicting preterm labor have been widely studied. The aim of the present study was to assess the feasibility of predicting labor with a 7- and 14-day time horizon in TPL women, who may be under tocolytic treatment, using EHG and/or obstetric data. Based on 140 EHG recordings, artificial neural networks were used to develop prediction models. Non-linear EHG parameters were found to be more reliable than linear for differentiating labor in under and over 7/14 days. Using EHG and obstetric data, the <7- and <14-day labor prediction models achieved an AUC in the test group of 87.1 ± 4.3% and 76.2 ± 5.8%, respectively. These results suggest that EHG can be reliable for predicting imminent labor in TPL women, regardless of the tocolytic therapy stage. This paves the way for the development of diagnostic tools to help obstetricians make better decisions on treatments, hospital stays and admitting TPL women, and can therefore reduce costs and improve maternal and fetal wellbeing.

How to avoid the formation of hazardous chlorates and perchlorates during electro-disinfection with diamond anodes?

This work focuses on disinfection of water using electrolysis with diamond coatings avoiding or minimizing the formation of hazardous chlorates and perchlorates using a special type of commercial cells designed by CONDIAS (Itzehoe, Germany) in two different sizes: the CabECO and the MIKROZON cells. In these cells, the electrolyte that separates the anode and cathode is a proton exchange membrane. This helps to minimize the production of perchlorate and this behavior is enhanced in the smallest cell for which the very low contact times between the electrodes and the water allows to avoid the production of perchlorates when operating in a single-pass mode, which becomes a really remarkable point. In this paper, we report tests in which we demonstrate this outstanding performance and we also explain the differences observed in the two cells operating with the same water.

Testing the use of cells equipped with solid polymer electrolytes for electro-disinfection.

This work focuses on disinfection of water using electrolysis with boron doped diamond (BDD) coatings and faces this challenge by comparing the performance of two different cells manufactured by CONDIAS GmbH (Izehoe, Germany): CONDIACELL® ECWP and CabECO cells. They are both equipped with diamond electrodes, but the mechanical design is completely different, varying not only by geometry but also by the flow conditions. ECWP is a flow-through cell with perforated electrodes while the CabECO cell is a zero-gap cell with a proton exchange membrane as a solid polymer electrolyte (SPE) separating the anode and cathode. At 0.02 Ah dm-3 both cells attain around 3-5 logs pathogen removal, but design and sizing parameters give an advantage to the CabECO: it can minimize the production of chlorates and perchlorates when operating in a single-pass mode, which becomes a really remarkable point. In this paper, we report tests in which we demonstrate this outstanding performance and we also explain the differences observed in the two cells operating with the same water.

Improvement of electrochemical oxidation efficiency through combination with adsorption processes.

In this work, a three-step process (adsorption-desorption-electrolysis) is evaluated as an interesting approach for the removal of organochlorinated compounds (clopyralid, lindane and perchloroethylene) with different physical properties (solubility and vapor pressure) from low concentrated wastewater. First steps are based on the adsorptive capacity of granular active carbon (GAC) particles to retain organics and on the solvent capacity of methanol to extract them to concentrated solution and regenerate GAC. In the last step of electrolysis with conductive diamond electrodes, the degradation of pesticide is projected, as well as the recovery of methanol. Results show that clopyralid, lindane and PCE are efficiently retained in GAC, although adsorption efficiency depend on pollutant/GAC ratio and physicochemical properties of pollutant. Pretreatment allows the concentration of clopyralid and PCE solutions up to 8 times, but worse results are obtained in case of lindane solutions. Electrolysis of concentrated methanol solution seems to be more efficient than electrolysis of diluted aqueous wastes, mainly in the case of clopyralid. In all cases, electrochemical degradation fits a first order kinetics confirming mixed oxidation mechanisms with diffusion control of the direct processes and mediated oxidation. Results obtained in terms of current efficiency and energy consumption of electrolysis step point out the lower operation cost of concentrated liquid wastes and encourage further works on the development of cost-effective combined processes for the treatment of diluted solutions polluted with polar compounds (such as clopyralid).

Clopyralid degradation by AOPs enhanced with zero valent iron.

Four different technologies have been compared (photolysis, ZVI + photolysis, electrolysis and ZVI + electrolysis) regarding the: (1) degradation of clopyralid, (2) extent of its mineralization, (3) formation of by-products and main reaction pathways. Results show that photolysis is the less efficient treatment and it only attains 5 % removal of the pollutant, much less than ZVI, which reaches 45 % removal and that electrolysis, which attains complete removal and 78 % mineralization within 4 h. When ZVI is used as pre-treatment of electrolysis, it was obtained the most efficient technology. The identification of transformation products was carried out for each treatment by LCMS. In total, ten products were identified. Tentative pathways for preferential clopyralid degradation for all processes were proposed. This work draws attention of the synergisms caused by the coupling of techniques involving the treatment of chlorinated compound and sheds light on how the preferential mechanisms of each treatment evaluated occurred.

Improving biotreatability of hazardous effluents combining ZVI, electrolysis and photolysis.

In this work, nine types of combination advanced oxidation processes/zero-valent iron (AOP-ZVI) were tested, in order to determine if any of these combinations demonstrate good chances as pretreatment for the biological degradation processes of organochlorinated pollutants. To do this, the changes undergone in the respirometric behavior, toxicity and short-term biodegradability were compared. The three AOPs studied were anodic oxidation with mixed metal oxides anodes (AO-MMO), with boron doped diamond anodes (AO-BDD) and photolysis and they were evaluated in three different modes: without any addition of ZVI, with ZVI-dehalogenation as pre-treatment and with ZVI-dehalogenation simultaneous to the AOP treatment. Clopyralid has been used as a model of chlorinated hydrocarbon pollutant. Results show that technologies proposed can successfully treat wastes polluted with clopyralid and the biological characteristics of the waste are significantly modified by dehalogenating the waste with ZVI, either previously to the treatment or simultaneously to the treatment, being the information provided by the three techniques very important in order to evaluate later combinations of the advanced oxidation technologies with biological treatments.

A comparison between flow-through cathode and mixed tank cells for the electro-Fenton process with conductive diamond anode.

This work focusses on the production of hydrogen peroxide and in the removal of bromacil by the electro-Fenton process using two different electrochemical cells: mixed tank cell (MTC) and flow-through cell (FTC). Both cells use boron doped diamond (BDD) as anode and carbon felt as cathode to promote the formation of hydrogen peroxide. In the case of the MTC, two surface area ratios, Acathode/Aanode, have been used. Results show that the H2O2 produced by MTC and FTCPSC increases with the time until a stabilization state. For the FTCPSC, the average hydrogen peroxide concentration produced increases progressively with the current, while for MTC the maximum values are found in applying very low current densities. In addition, the FTCPSC provides higher concentrations of hydrogen peroxide for the same current density applied. Regarding the MTC, it can be stated that the higher the area of the cathode, the higher is the amount of H2O2 produced and the lower is the cell voltage (because of a more efficient current lines distribution). The initial oxidation of bromacil is very efficiently attained being rapidly depleted from wastewater. However, the higher production of hydrogen peroxide obtained by the FTCPSC cell does not reflect on a better performance of the electro-Fenton process. Thus, bromacil is better mineralized using the MTC cell with the lowest cathode area. This observation has been explained because larger concentrations of produced hydrogen peroxide seems to benefit the oxidation of intermediates and not the mineralization.

Enhanced electrolytic treatment for the removal of clopyralid and lindane.

In this work, it is evaluated the more critical point of a new electrochemical technology for the removal of organic pollutants based on the regeneration of granular active carbon (GAC) (that can be used efficiently to concentrate aqueous wastes) with methanol and in the electrochemical treatment of methanol with conductive diamond electrochemical oxidation (CDEO). The system proposed was studied with lindane and clopyralid. Results show that it is possible the complete removal of the raw pesticides and intermediates formed by electrolyzing these species in methanol media and that both sodium chloride and sodium hydroxide can be used as supporting electrolyte to increase the conductivity of methanol. The cell voltages obtained are quite similar to those obtained during the electrolysis of aqueous wastes. The electrolysis of these dilute solutions does not generate significant concentrations of intermediates and the depletion of the raw pollutant fits well to a pseudo-first order kinetic model. Oxidants capable to oxidize iodide to iodine are produced during the electrolysis in methanol media and they have an important influence on the degradation of the pollutants. The new technology, based on the concentration of the pollutant before electrolysis, allows to remove completely pollutants from soil and soil washing fluids in a more efficient way, although the concentration of pollutant attained and, hence, the efficiency of the overall removal process depends on the adsorption equilibria of the pollutant in aqueous and methanol media.

Initial clinical outcomes and prognostic variables in the implementation of a Code Sepsis in a high complexity University Hospital.

OBJECTIVE: To assess the impact of the first months of application of a Code Sepsis in a high complexity hospital, analyzing patient´s epidemiological and clinical characteristics and prognostic factors. METHODS: A long-term observational study was carried out throughout a consecutive period of seven months (February 2015 - September 2015). The relationship with mortality of risk factors, and analytic values was analyzed using uni- and multivariate analyses. RESULTS: A total of 237 patients were included. The in-hospital mortality was 24% at 30 days and 27% at 60 days. The mortality of patients admitted to Critical Care Units was 30%. Significant differences were found between the patients who died and those who survived in mean levels of creatinine (2.30 vs 1.46 mg/dL, p <0.05), lactic acid (6.10 vs 2.62 mmol/L, p <0.05) and procalcitonin (23.27 vs 12.73 mg/dL, p<0.05). A statistically significant linear trend was found between SOFA scale rating and mortality (p<0.05). In the multivariate analysis additional independent risk factors associated with death were identified: age > 65 years (OR 5.33, p <0.05), lactic acid > 3 mmol/L (OR 5,85, p <0,05), creatinine > 1,2 mgr /dL (OR 4,54, p <0,05) and shock (OR 6,57, P <0,05). CONCLUSIONS: The epidemiological, clinical and mortality characteristics of the patients in our series are similar to the best published in the literature. The study has identified several markers that could be useful at a local level to estimate risk of death in septic patients. Studies like this one are necessary to make improvements in the Code Sepsis programs.