Application of Vibrating Reverse Osmosis Technology for Nutrient Recovery from Pig Slurry in a Circular Economy Model.

The rapid growth of the livestock sector in some areas of Europe has caused an imbalance between the generation of livestock manure and the availability of agricultural soil for its direct application as a fertilizer. Since the transport of pig slurry to other areas with nutrient-deficient soils is costly from an economic point of view due to its high water content, the application of new technologies for the concentration of this waste is considered key for reducing management costs. Consequently, the main objective of this study was to demonstrate the potential of vibratory shear enhanced processing (VSEP) operated with reverse osmosis membranes to recover nutrients from the liquid fractions of pig slurry (LF-pig slurry) and digestate (LF-digestate) and obtain concentrated fertilizing products. Use of the VSEP unit permitted reductions in the water contents of the LF-pig slurry and LF-digestate, around 77% and 67%, respectively. Both VSEP concentrates were characterized by their significant nutrient contents and showed a nitrogen fertilizer replacement value similar to that of mineral fertilizer as demonstrated in a barley crop pot-test, although the salinity of the digestate concentrate was identified as a key limitation, negatively impacting the agronomic yield of the test crop.

Hypersaline mining effluents affect the structure and function of stream biofilm.

The salinisation of freshwater ecosystems is a global environmental problem that threatens biodiversity, ecosystem functioning and human welfare. The aim of this study was to investigate the potential impact of a realistic salinity gradient on the structure and functioning of freshwater biofilms. The salinity gradient was based on the real ion concentration of a mining effluent from an abandoned mine in Germany. We exposed biofilm from a pristine stream to 5 increasing salinities (3 to 100 g L-1) under controlled conditions in artificial streams for 21 days. We evaluated its functional (photosynthetic efficiency, nutrient uptake, and microbial respiration) and structural responses (community composition, algal biomass and diatom, cyanobacteria and green algae metrics) over time. Then we compared their responses with an unexposed biofilm used as control. The functionality and structure of the biofilm exposed to the different salinities significantly decreased after short-term and long-term exposure, respectively. The community composition shifted to a new stable state where the most tolerant species increased their abundances. At the same time, we observed an increase in the community tolerance (measured as Pollution-Induced Community Tolerance) along the salinity gradient. This study provides relevant information on the salt threshold concentrations that can substantially damage algal cells (i.e., between 15 and 30 g L-1). The results provide new insights regarding the response and adaptation of stream biofilm to salinity and its potential implications at the ecosystem level.

Desarrollo de la escala DME-C: una escala para la detección del malestar emocional de los cuidadores principales de personas con enfermedad avanzada o al final de la vida / Development of the DME-C: A scale for detecting emotional distress in primary caregivers of patients living with advanced illness or approaching end of their lives

Se presenta el desarrollo de la Escala de Detección de Malestar Emocional de los Cuidadores principales de pacientes con enfermedad avanzada o terminal que reciben cuidados paliativos (DME-C). Se describe el proceso de elaboración de la escala. Para ello, se ha revisado la bibliografía existente sobre el tema, se ha establecido un marco teórico de referencia y los criterios que debía cumplir el instrumento de cribado que se iba a elaborar. La escala DME-C consta de 2 partes: 1) 3 preguntas dirigidas a los cuidadores, y 2) la observación realizada por el personal sanitario de la presencia de signos externos de malestar emocional del cuidador. La escala final fue revisada tanto por expertos como por cuidadores. La escala DME-C es una herramienta apropiada para la identificación del malestar emocional de los cuidadores. Proponemos el uso sistemático de la DME-C para una detección precoz e intervención específica del sufrimiento emocional

This paper presents the development of the Detection of Emotional Distress Scale in primary Caregivers (DED-C) of patients living with advanced disease or terminal illness who are receiving palliative care. The scale development process is described. For this purpose, literature has been reviewed and a theoretica framework of study as well as the characteristics of the screening tool have been established. The DED-C scale consists of 2 parts: 1) 3 questions addressed to primary caregivers, and 2) the health care professional’s appreciation or observation of any external signs of emotional distress on behalf of the caregivers. The final scale was reviewed by experts and caregivers. The DED-C scale will be an appropriate tool for identifying caregivers’ emotional distress. We propose the systematic use of DED-C for early detection of and specific intervention on emotional distress

Evaluación de las propiedades psicométricas del cuestionario de Detección de Malestar Emocional (DME) en pacientes oncológicos / Assessment of the psychometric properties of the Detection of Emotional Distress Scale in cancer patients

Objetivo Con el fin de valorar y aliviar el malestar emocional al final de la vida, se necesitan instrumentos de cribado sencillos, de fácil uso por los sanitarios y comprensibles por los enfermos. En el presente estudio multicéntrico se analiza la utilidad clínica del cuestionario de Detección del Malestar Emocional (DME) en enfermos hospitalizados con cáncer avanzado. Métodos Para determinar las propiedades psicométricas de la escala se administró, a la vez que otros instrumentos y procedimientos, a 105 pacientes con enfermedad oncológica avanzada ingresados en unidades de cuidados paliativos de cinco hospitales de Cataluña. Resultados Se observó que el 58,3% presentaba malestar emocional moderado o muy intenso, similar al objetivado con otras escalas, como el termómetro emocional. El análisis estadístico de las curvas ROC sugiere que el punto de corte para la detección de malestar emocional que muestra el DME equivale a una puntuación ≥ 9 puntos, con una sensibilidad y una especificidad superiores al 75%.ConclusionesEl DME es útil y de fácil manejo para la identificación del malestar emocional en los enfermos oncológicos avanzados ingresados en unidades de cuidados paliativos. Se sugiere que esta escala también se podría aplicar a otros enfermos y ámbitos de la atención sanitaria, por ejemplo la atención domiciliaria o la atención primaria en enfermos crónicos (AU)

Objective To evaluate and alleviate the emotional distress suffered by advanced cancer patients, simple screening methods that can be easily used by health staff and easily understood by patients are required. The objective of this multicenter study was to analyze the psychometric properties and clinical utility of the Detection of Emotional Distress (DED) scale in advanced cancer patients attending a palliative care unit. Methods The DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain).Results A total of 58.3% of the patients had moderate to severe emotional distress, a result similar to those of other scales such as the emotional thermometer. Statistical analysis of ROC curves suggested that the cutoff for the detection of emotional distress by the DED scale was equivalent to a score of ≥ 9 points, with a sensitivity and specificity above 75%.ConclusionsThe DED scale is useful and easy to use in the identification of emotional distress in advanced cancer patients attended in palliative care units. This scale could also be applied in other patients and health care fields, such as patients with chronic diseases, home care, and primary care (AU)

[Assessment of the psychometric properties of the Detection of Emotional Distress Scale in cancer patients]. / Evaluación de las propiedades psicométricas del cuestionario de Detección de Malestar Emocional (DME) en pacientes oncológicos.

OBJECTIVE: To evaluate and alleviate the emotional distress suffered by advanced cancer patients, simple screening methods that can be easily used by health staff and easily understood by patients are required. The objective of this multicenter study was to analyze the psychometric properties and clinical utility of the Detection of Emotional Distress (DED) scale in advanced cancer patients attending a palliative care unit. METHODS: The DED scale was administered to 105 advanced cancer patients attended in five palliative care units in Catalonia (Spain). RESULTS: A total of 58.3% of the patients had moderate to severe emotional distress, a result similar to those of other scales such as the emotional thermometer. Statistical analysis of ROC curves suggested that the cutoff for the detection of emotional distress by the DED scale was equivalent to a score of ≥ 9 points, with a sensitivity and specificity above 75%. CONCLUSIONS: The DED scale is useful and easy to use in the identification of emotional distress in advanced cancer patients attended in palliative care units. This scale could also be applied in other patients and health care fields, such as patients with chronic diseases, home care, and primary care.

Elaboración y propuesta de un instrumento para la detección de malestar emocional en enfermos al final de la vida / Purpouse of an instrument for the detection of emotional distress in patients at the end of life

Objetivo: Establecer la sistemática de trabajo de un grupo multidisciplinar cuyo objetivo es elaborar un instrumento para detectar el malestar emocional en enfermos al final de la vida. Material y métodos: Se describe la formación y composición del equipo investigador así como su dinámica de trabajo a lo largo de 2007 y 2008 en múltiples reuniones presenciales y on-line así como la bibliografía, el modelo y criterios que sirvieron de base para el debate que condujo a la elaboración del instrumento. Resultados: Se presenta el cuestionario DME, que consta de dos partes: 1) cuatro preguntas dirigidas al enfermo, y 2) observación, por parte del sanitario, de signos que muestren la presencia de malestar emocional. Actualmente se encuentra en proceso de validación (AU)

Objective: To establish the methodology of work for a multidisciplinary group whose objective is to generate a tool to detect the emotional distress in patients at the end of their lives. Material and method: It describes the configuration and composition of the researching team as well as its method of work throughout 2007 and 2008. The combination of multiple face to face meetings, online conferences and the review of related bibliography formed the model and the criteria used as the basis for the debate that lead to the elaboration of the instrument. Results: The questionnaire DME is presented, and consists of two parts: 1) four questions addressed to the patient, and 2) observation by the health staff of signs that show the presence of emotional distress. At the moment, the instrument is under validation (AU)

De la planificación a la acción: principales ámbitos de actuación e instrumentos para la operativización / Planning the action: principal fields of action and operational tools

El Mapa Sanitario, Sociosanitario y de Salud Pública de Cataluña es un instrumento que da criterios para la operativización de las políticas y estrategias que vienen definidas por el Plà de Salut y los Plans Directors y Plans Estratègics del Departament de Salut. La efectividad del Mapa viene determinada por la capacidad de servir a la toma de decisiones en los distintos niveles organizativos y de gestión. Los principales ámbitos de operativización son la planificación operativa, los gobiernos territoriales de salud y las relaciones intersectoriales. Los instrumentos de que nos valemos en el momento de la concreción de las ideas y propuestas estratégicas son: el plan de inversiones en infraestructuras sanitarias, la asignación de recursos y la compra de servicios sanitarios y sociosanitarios orientado fundamentalmente a la compra integrada, así como un enfoque de la evaluación orientado a este objetivo, el sistema de información y la investigación aplicada

The Health, Social Health and Public Healthcare Map of Catalonia is an instrument that provides criteria for putting into operation the policies and strategies defined by the Health Plan and the Master Plansand Strategic Plans of the Department of Health. The effectiveness of the Map is determined by its capacity to help in decision making at the different organisational and management levels. The principaloperational fields are, operations planning, territorial healthcare governments and cross-sector relationships. The tools used when setting ideas and strategic proposals included the healthcare infrastructureinvestment plan, the assignation of resources and the purchasing of health and social-health services aimed fundamentally at integrated purchasing, as well as an evaluation approach geared towards this objective,the information system and the applied research

[Impact of a capitation payment system on healthcare coordination]. / Impacto de un sistema de compra capitativo en la coordinación asistencial.

OBJECTIVE: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective. METHODS: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants' groups, themes, and areas. The study area consisted of the 5 pilot zones. RESULTS: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty, providers' fears of losing their identity, lack of interest, and the management limits of some providers. CONCLUSIONS: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia.

Impacto de un sistema de compra capitativo en la coordinación asistencial / Impact of a capitation payment system on healthcare coordination

Objetivo: Evaluar desde una perspectiva cualitativa el impacto sobre la coordinación asistencial de la prueba piloto del sistema de compra capitativo en Cataluña.Métodos: Estudio cualitativo, exploratorio y descriptivo, mediante análisis de documentos y entrevista individual, con muestreo teórico de documentos e informantes: directivos del comprador(9), directivos de los proveedores (26), profesionales(16). Análisis de contenido, con generación mixta de categorías y segmentación por grupos de informantes, temas y áreas. El área de estudio la constituyeron las 5 zonas piloto.Resultados: La prueba facilitó, según los informantes, una visión conjunta del territorio y mejoró la comunicación. No obstante, los cambios introducidos a partir de la prueba para mejorar la coordinación asistencial fueron escasos. Se estableció una única alianza virtual entre proveedores de un territorio,con objetivos compartidos y cambios estructurales. En general, se intercambiaron los mecanismos de coordinación asistencial existentes, con un uso variable. La incertidumbre de la prueba, el temor a perder la identidad, el limitado interés ylos límites de gestión de algunos proveedores se percibían como barreras al cambio.Conclusiones: El sistema de compra capitativo, diseñado yejecutado, no generó incentivos suficientes para desencadenar cambios en la coordinación asistencial. Sería necesario corregir las debilidades identificadas en la evaluación antes de extender la prueba al resto de Cataluña

Objective: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective.Methods: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants’ groups, themes, and areas. The study area consisted of the 5 pilot zones.Results: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty,providers’ fears of losing their identity, lack of interest, and the management limits of some providers.Conclusions: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia

[Planning the action: principal fields of action and operational tools]. / De la planificación a la acción: principales ámbitos de actuación e instrumentos para la operativización.

The Health, Social Health and Public Healthcare Map of Catalonia is an instrument that provides criteria for putting into operation the policies and strategies defined by the Health Plan and the Master Plans and Strategic Plans of the Department of Health. The effectiveness of the Map is determined by its capacity to help in decision making at the different organisational and management levels. The principal operational fields are, operations planning, territorial healthcare governments and cross-sector relationships. The tools used when setting ideas and strategic proposals included the healthcare infrastructure investment plan, the assignation of resources and the purchasing of health and social-health services aimed fundamentally at integrated purchasing, as well as an evaluation approach geared towards this objective, the information system and the applied research.