New methodology for assessing the environmental efficiency of transport: Application to the valorization of biomass from phytoremediation.

It is known that any environmental remediation process must be approached as a system and that the transport of materials is key to determining its sustainability. The aim of this work is to establish how far it was possible to transport plant material from a phytoextraction process in such a way that the environmental gain of the remediation process is not compromised. In the absence of a general methodology to answer our question, a new methodology based on spatial analysis and the life cycle perspective is proposed to calculate, under different hypotheses and depending on the type of remediation, the maximum distance that a lorry can travel, taking as a limit the distance in which the environmental benefit would be equal to 0. The results obtained show that there are significant differences depending on the type of optimisation proposed for the transport route as well as the type of valorization of the plant material to be carried out. Thus, in the case of bioethanol, biomass could be transported up to 25 km. For biodiesel, it can be shipped over distances between 255 and 415 km and finally, if it is valorized by anaerobic co-digestion, biodigesters up to 267 km away could be sought for the most favourable case.

Influence of Foot Type on the Clinical Outcome of Minimally Invasive Surgery for Metatarsalgia. A Prospective Pilot Study.

Background and aims: Surgical procedures for central metatarsalgia seek to harmonise the metatarsal parabola with osteotomies that can be performed by minimally invasive techniques. However, the possible relationship of the foot type and the mid-term postoperative outcome is poorly described. The objective of this prospective pilot study was therefore to determine whether the foot type (pronate, neutral, or supinate) conditions the postoperative mid-term functional outcome. Methods: A series of 28 patients (6 men, 22 women) were treated for primary central metatarsalgia by means of minimally invasive distal metaphyseal osteotomy (DMMO). Results: Their functional outcomes at 6 and 12 months were assessed by the self-reporting AOFAS scale. Pre-surgery, the patients' scores were 42.82 ± 15.60. Scores improved at 6 months to 86.50 ± 8.6 and to 92.93 ± 8.6 at 12 months (p < 0.001 in both cases). There were no differences either by sex or by foot type in these overall values, although there was only a slight limitation of interphalangeal mobility in the supinated feet (p = 0.03) at 6-month follow-up as compared to other foot types. Conclusion: Hence, DMMO provides an optimal clinical and functional outcome for the surgical treatment of metatarsalgia, regardless of the patient's foot posture. The occurrence of adverse events was minimal and clinically irrelevant. Trial registration: The study was authorised by the Research Ethics Committee of the Universidad Católica de Valencia San Vicente Mártir, with the registry UCV/2018-2019/019.

Estudio preliminar del proceso fin de vida mediante triangulación de datos en un hospital comarcal / Preliminary study of the end-of-life process through data triangulation in a regional Hospital

OBJETIVO: Conocer las características del proceso de final de vida en un Hospital Comarcal, según los actores implicados, estableciendo los elementos de convergencia/divergencia en el proceso asistencial, toma de decisiones, información y conocimientos. MÉTODO: Estudio observacional, transversal, descriptivo, convergente y analítico de métodos mixtos y triangulación de datos. Se realizó sobre una muestra de 63 sujetos, de los que 25 fueron profesionales, 19 familiares cuidadores y 19 historias clínicas de pacientes fallecidos a lo largo de un año. RESULTADOS: La triangulación de datos muestra discrepancias entre familiares y profesionales de salud en cuanto a la calidad de la asistencia y la información facilitada. Destaca la falta de registro en las historias clínicas revisadas sobre aspectos del proceso asistencial relacionados con la toma de decisiones o la sedación terminal. CONCLUSIÓN: Este estudio proporciona una visión integrada sobre la atención sanitaria en el proceso de final de vida prestada en un Hospital Comarcal. Muestra áreas prioritarias de intervención, para mejorar la calidad de vida en este proceso, como son la implicación del paciente en la toma de decisiones, la cumplimentación adecuada en las historias clínicas y la formación de los profesionales

OBJECTIVE: To know the characteristics of the end-of-life process in a Regional Hospital, according to the actors involved, establishing convergence/divergence elements in care process, decision-making, information and knowledge. METHOD: Observational, cross-sectional, descriptive, convergent of mixed methods and data triangulation study. Carried out on a sample of 63 subjects, of which 25 were health professionals, 19 family caregivers and 19 medical records of patients who died in the course of a year. RESULTS: Data triangulation shows discrepancies between family members and health professionals regarding care quality and the information provided. The lack of documentation in medical records of care aspects related to decision-making or terminal sedation stands out. CONCLUSION: This study provides an integrated view of end-of-life care provided in a Regional Hospital, identifying priority areas of intervention in order to improve quality of life in this process, such as patient involvement in decision-making, appropriate completion of medical records and health professional training

Social axioms on high school students in the North African context: Validation and fit of the SAS-II.

Social axioms or general social beliefs represent people's cognitive map of their social world acquired through social experiences. Empirical research has related the central constructs in the study of psychology and social axioms, establishing a broad nomological network in various cultural settings. This paper studies the validity of the Social Axioms Survey II (SAS-II) short form, Spanish version, on the individual level in Melilla as North Africa´s borderland. Participants were 410 high school students from 14 to 18 years of age. The reliability analysis, the discriminant validity analysis, and the confirmatory factor analysis through the structural model equation, showed similar results to previous studies in other contexts and allowing the use of the survey in Melilla. In addition it is presented a fitted model that improves the psychometric results showing significant differences with the initial model. The confirmatory multi-group analysis of the fitted model shows measurement invariance across educational centers, allowing new research possibilities in the cultural context of Melilla.

Factors Influencing Dietary Patterns during Pregnancy in a Culturally Diverse Society.

The aim of this study was to identify dietary patterns in pregnant women and to assess the relationships between sociodemographic, lifestyle-related, and pregnancy-related factors. This is a descriptive, correlational study involving 306 pregnant women in Melilla (Spain) in any trimester of pregnancy. A validated food frequency questionnaire was used. Dietary patterns were determined via exploratory factor analysis and ordinal logistic regression using the proportional odds model. Three dietary patterns were identified: Western, mixed, and prudent. Sociodemographic, lifestyle-related, and pregnancy-related factors influencing dietary quality were established. The Western dietary pattern was considered the least recommended despite being the most common among women who live in Melilla (p = 0.03), are Christian (p = 0.01), are primiparous women (p < 0.001), and are in their first or second trimester (p = 0.02). Unemployed pregnant women were also more likely to have a less healthy dietary pattern (ß = -0.716; p = 0.040). The prudent dietary pattern, the healthiest of the three, was most commonly observed among Muslim women (p = 0.01), women with more than two children (p < 0.001), and women in the third trimester of pregnancy (p = 0.02). Pregnant women who engaged in no physical activity or a low level of physical activity displayed a mixed pattern (p < 0.001). This study provides evidence on the factors influencing dietary patterns during pregnancy and suggests that more specific nutrition programmes should be developed to improve the nutritional status of pregnant women.

[Analysis of nursing student prejudices towards the migrant population]. / Análisis de los prejuicios del alumnado de enfermería hacia la población migrante.

OBJECTIVE: To determine whether nursing students have subtle or blatant prejudices towards migrants. METHOD: A descriptive ex post facto study was conducted. The sample consisted of 282 students and the study variables were sex, cultural origin, age, year, and contact with migrants. The Subtle and Blatant Prejudice Scale was used. Descriptive and inferential analyses were performed. RESULTS: There were significant differences in the culture variable, with students of Berber origin and of Muslim faith showing less prejudice than those of European origin and of Christian faith. Fourth-year students had the most blatant prejudices. According to the variable contact with migrants, it is the students who have not had contact with this group who have the greatest blatant prejudices. CONCLUSION: Nursing students have more subtle prejudices rather than blatant prejudices towards the migrant population.

Evaluation of results after distal metatarsal osteotomy by minimal invasive surgery for the treatment of metatarsalgia: patient and anatomical pieces study.

BACKGROUND: Metatarsalgia of the lesser toes is a common cause of consultation in the podiatric clinic. However, there continues to be a controversy with respect to which is the best surgical technique, and there is few information in the literature regarding objectively comparable results in percutaneous surgery. METHODS: The second metatarsal bones of 30 feet belonging to patients who had attended the podiatric clinic were studied before and after distal metatarsal pecutaneous osteotomy. The degree of shortening of the second metatarsal (RX) and the degree of functional recovery and perception of the well-being of the patient (AOFAS) were evaluated retrospectively. The same bones of 10 cadaveric feet were also studied. The surgical procedure was identical to that used on patients, and electronic callipers were employed to take measurements of the second metatarsal. The integrity of the plantar plate was checked visually. RESULTS: The mean shortening of the second metatarsal bone, as determined by the radiological study, was 2.76 mm. After an average follow-up period of 1.5 years, the final mean score on the AOFAS scale was 95.26 points. In none of the cases was the mobility of the metatarsophalangeal (MTP) joint affected. The mean shortening in the cadaveric feet was 2.10 mm, and in all cases, the plantar plate and flexor apparatus were perfectly preserved. CONCLUSIONS: Percutaneous osteotomy achieved, in our study, a lower degree of shortening than Weil's surgery, according to the data published in the literature. However, it shows good clinical results without causing problems of consolidation or rigidity in the MTP joint. Neither, with the caution that should be taken due to the use of experimental cadaver models, damage of the flexor apparatus of the foot is observed. These results suggest that this could be a safe and effective surgical procedure to be considered for metatarsalgias of the lesser rays.

Enfermería Transcultural. Formación de los futuros profesionales de Enfermería en España / Transcultural Nursing. Training of future Nursing professionals in Spain

Objetivo principal: conocer las Facultades de Enfermería que en España se imparte la asignatura de Enfermería Transcultural o similar, así como saber si son asignaturas obligatorias u optativas. Metodología: Revisión de los planes de estudios de las Universidades españolas donde se imparte la titulación de Enfermería. Resultados principales: De las Universidades examinadas, el 63% de las titulaciones de Enfermería ofrece formación específica en Enfermería Transcultural. Conclusión principal: No existe un compromiso firme desde el ámbito académico en Enfermería en la formación transcultural de los futuros profesionales de enfermería

Objective: Know what Faculties of Nursing in Spain are teaching Transcultural Nursing or similar subjetcs, as well as knowing if they are compulsory or optional subjects. Methods: Review of the curricula of the Spanish Universities where the Nursing degree is taught. Results: Results obtained show that only a 63% of Nursing degrees offers specific training in Transcultural Nursing. Conclusions: There is no firm commitment in Nursing degrees about cross-cultural training of future nursing professionals

The nursing department's view towards moroccan patients.

OBJECTIVE: To determine the Melilla Hospital Nursing Department's attitude towards Moroccan patients. METHOD: Descriptive ex post facto study. A questionnaire has been handed over to staff, on the Immigration Attitude Scale for Nursing. RESULTS: In general, nurses exhibit negative attitudes towards Moroccan patients, such as: the increase in crime is caused by the arrival of immigrants, those who commit offenses must be expelled from Spain, they take advantage of the Spanish health system and too many resources are devoted to immigration. The worst-rated immigrants are the Moroccans, considering that they do not pay much attention to their personal hygiene and do not adapt to their host countries. CONCLUSION: It is necessary to work with the nursing staff to change these attitudes. Future degree students must be trained in cultural skills and the care of immigrants will improve with a greater commitment towards cultural differences. OBJETIVO: Conocer la actitud de enfermería del Hospital de Melilla hacia los pacientes marroquíes. MÉTODO: Estudio ex post facto descriptivo. Se ha pasado un cuestionario de Escala de Actitud ante la Inmigración para Enfermería. RESULTADOS: En general las enfermeras presentan actitudes negativas ante los pacientes marroquíes, como: el aumento de la delincuencia es provocado por la llegada de inmigrantes, los que delinquen deben ser expulsados de España, se aprovechan del sistema sanitario y se dedican demasiados recursos para la inmigración. Los inmigrantes peores valorados son los marroquíes, considerando que son pocos cuidadosos con su higiene personal y no se adaptan a los países de acogida. CONCLUSIÓN: Es necesario trabajar con el personal de enfermería para que cambien estas actitudes. Las futuras promociones de Grado deben estar formadas en competencias culturales y mejorarán los cuidados a los inmigrantes como un mayor compromiso con la diferencia cultural.

The nursing department`s view towards moroccan patients / Visão de enfermagem em relação ao coletivo de pacientes marroquinos / Visión de enfermería hacia el colectivo de pacientes marroquíes

Abstract OBJECTIVE To determine the Melilla Hospital Nursing Department’s attitude towards Moroccan patients. METHOD Descriptive ex post facto study. A questionnaire has been handed over to staff, on the Immigration Attitude Scale for Nursing. RESULTS In general, nurses exhibit negative attitudes towards Moroccan patients, such as: the increase in crime is caused by the arrival of immigrants, those who commit offenses must be expelled from Spain, they take advantage of the Spanish health system and too many resources are devoted to immigration. The worst-rated immigrants are the Moroccans, considering that they do not pay much attention to their personal hygiene and do not adapt to their host countries. CONCLUSION It is necessary to work with the nursing staff to change these attitudes. Future degree students must be trained in cultural skills and the care of immigrants will improve with a greater commitment towards cultural differences.

Resumo OBJETIVO Conhecer a atitude do pessoal de enfermagem do Hospital de Melilla em relação aos pacientes marroquinos. MÉTODO Estudo ex post facto descritivo. Foi aplicado um questionário de Escala de Atitudes perante a Imigração para Enfermagem. RESULTADOS Em geral, as enfermeiras apresentaram atitudes negativas diante dos pacientes marroquinos, como considerar que o aumento da delinquência seja provocado pela chegada de imigrantes e que os transgressores devam ser expulsos da Espanha. Que eles se aproveitam do sistema sanitário e que são destinados recursos demais para a imigração. Os imigrantes mais mal avaliados são os marroquinos, considerando-se que são muito pouco cuidadosos com sua higiene pessoal e os que menos se adaptam aos países anfitriões. CONCLUSÃO É necessário trabalhar com o pessoal de enfermagem com vistas a modificar essas atitudes. As graduações devem estar vinculadas à formação em competências culturais para que se melhore os cuidados aos imigrantes, como um maior compromisso com a diferença cultural.

Resumen OBJETIVO Conocer la actitud de enfermería del Hospital de Melilla hacia los pacientes marroquíes. MÉTODO Estudio ex post facto descriptivo. Se ha pasado un cuestionario de Escala de Actitud ante la Inmigración para Enfermería. RESULTADOS En general las enfermeras presentan actitudes negativas ante los pacientes marroquíes, como: el aumento de la delincuencia es provocado por la llegada de inmigrantes, los que delinquen deben ser expulsados de España, se aprovechan del sistema sanitario y se dedican demasiados recursos para la inmigración. Los inmigrantes peores valorados son los marroquíes, considerando que son pocos cuidadosos con su higiene personal y no se adaptan a los países de acogida. CONCLUSIÓN Es necesario trabajar con el personal de enfermería para que cambien estas actitudes. Las futuras promociones de Grado deben estar formadas en competencias culturales y mejorarán los cuidados a los inmigrantes como un mayor compromiso con la diferencia cultural.

Is phytoremediation without biomass valorization sustainable? - comparative LCA of landfilling vs. anaerobic co-digestion.

This study examines the sustainability of phytoremediation for soils contaminated with heavy metals, especially the influence of management of the produced metal-enriched biomass on the environmental performance of the complete system. We examine a case study in Asturias (north of Spain), where the land was polluted with Pb by diffuse emissions from an adjacent steelmaking factory. A Phytoremediation scenario based on this case was assessed by performing a comparative life cycle assessment and by applying the multi-impact assessment method ReCiPe. Our Baseline scenario used the produced biomass as feedstock for an anaerobic digester that produces biogas, which is later upgraded cryogenically. The Baseline scenario was compared with two alternative scenarios: one considers depositing the produced biomass into landfill, and the other considers excavating the contaminated soil, disposing it in a landfill, and refilling the site with pristine soil. A sensitivity analysis was performed using different yields of biomass and biogas, and using different distances between site and biomass valorization/disposal center. Our results show that the impacts caused during agricultural activities and biomass valorization were compensated by the production of synthetic natural gas and the avoided impact of natural gas production. In addition, it was found that if the produced biomass was not valorized, the sustainability of phytoremediation is questionable. The distance between the site and the biomass processing center is not a major factor for determining the technology's sustainability, providing distances are less than 200-300 km. However, distance to landfill or to the source of pristine soil is a key factor when deciding to use phytoremediation or other ex-situ conventional remediation techniques.

Obstrucción ventilatoria aguda: herniación del manguito del tubo endotraqueal / Acute ventilatory obstruction: endotracheal tube cuff herniation

Se describen dos casos de obstrucción ventilatoria aguda durante intervenciones quirúrgicas con una inmediata caída del ETCO2' seguida del descenso del porcentaje de SaO2 con aumento concomitante de la presión en la vía aérea, falla en el ciclado del ventilador, silencio auscultatorio en ambos campos pulmonares y aumento de la resistencia a la ventilación manual. Examinado el circuito y descartadas otras causas concomitantes (acodamiento del tubo, comprensión por dentadura, obstrucción por cuerpos extraños), se desfluó el manguito del tubo endotraqueal restaurándose en forma inmediata una ventilación adecuada. Una vez extubado el paciente se constata deformación al inflado del manguito (Hernia del Manguito).

Obstrucción ventilatoria aguda: herniación del manguito del tubo endotraqueal / Acute ventilatory obstruction: endotracheal tube cuff herniation

Se describen dos casos de obstrucción ventilatoria aguda durante intervenciones quirúrgicas con una inmediata caída del ETCO2 seguida del descenso del porcentaje de SaO2 con aumento concomitante de la presión en la vía aérea, falla en el ciclado del ventilador, silencio auscultatorio en ambos campos pulmonares y aumento de la resistencia a la ventilación manual. Examinado el circuito y descartadas otras causas concomitantes (acodamiento del tubo, comprensión por dentadura, obstrucción por cuerpos extraños), se desfluó el manguito del tubo endotraqueal restaurándose en forma inmediata una ventilación adecuada. Una vez extubado el paciente se constata deformación al inflado del manguito (Hernia del Manguito).(AU)