Methodology to quantify single-use plastic products in municipal solid waste Part 2: Quantification of tobacco products with filters in Germany.

Discharge from unrestricted tobacco products with filters (TPF) causes environmental damage. To reduce TPF litter quantities, Directive (EU) 2019/904 requires TPF producers to proportionally contribute to the costs of discarding their products in public waste collection systems, including litter waste ones. An appropriate output-based cost model requires assessing TPF quantities in relevant waste streams. Currently, there is no comprehensive data available on TPF quantities in municipal solid waste (MSW). Therefore, a case study was conducted to quantify TPF in MSW. This study aimed to determine TPF quantities (1) in residual waste from four German district types and (2) in waste from public collection systems for three settlement structures within Trier City. Relevant waste streams from public collection systems, namely waste from public waste receptacles, street-cleaning waste and sinkhole residues, were identified. For both sampling campaigns, consideration was given to extrapolating the results to a larger scale. The results showed that the average specific TPF quantities in residual waste were 277.7, 271.8, 193.3 and 204.5 gi- 1a- 1 in the selected city district, urban district, densely populated rural district and sparsely populated rural district, respectively. Extrapolation of these results to Germany yielded a specific TPF quantity in residual waste of 250.3 gi-1a-1. The average specific TPF quantities in waste from public waste receptacles, street-cleaning waste and sinkhole residues were 12.2, 47.4 and 9.9 gi-1a- 1, respectively. The results could contribute to cost model development based on Directive (EU) 2019/904.

Methodology to quantify single-use plastic products in municipal solid waste Part 1: Development of a sampling methodology.

In recent years, the consumption of plastic products intended for single use has increased. Directive (EU) 2019/904 aims to reduce the use and the resulting generated waste quantity of single-use plastic (SUP) products. Therefore, manufacturers of SUP products are required to contribute proportionately to the costs of disposing of their products in public collection systems, including litter waste. One possibility to develop a cost model is to determine SUP-product quantities in relevant municipal solid waste (MSW) streams. The partly low quantities and small size of specific SUP products and the focus on waste from public collection systems, including litter waste, impede special requirements for the sampling and analytical procedures. This article provides an approach for sampling and analysing MSW to determine SUP-product quantities. The developed sampling method examines the selection of a suitable sampling area, considering the possibility of extrapolation to a national scale. The adapted sampling procedure aims to achieve statistically representative results. The presented sample preparation is especially suitable for low quantities and small SUP-product sizes. The developed sampling and analytical method aims to achieve representative and reproducible results regarding SUP-product quantities in MSW. The results can contribute to the development of a cost model based on Directive (EU) 2019/904.

Feasibility and acceptability of a hospital-at-home program for adolescents with eating disorders: Making progress in community/family-based treatments.

OBJECTIVE: To explore the feasibility and acceptability of a novel hospital-at-home (HaH) program for adolescent patients with a severe eating disorder (ED). METHOD: Retrospective description of the program during its first year of activity. The feasibility construct is based on accessibility, recruitment, rate of retention, avoidance of hospital stays, and management of crisis situations. Caregivers completed a satisfaction questionnaire on discharge, including an item on perceived safety. All patients referred to the program were included. RESULTS: Fifty-nine female patients with a mean age of 14.69 years (SD = 1.67) were admitted. The mean stay was 39.14 days (SD = 14.47). On admission, 32.2% of patients presented nonsuicidal self-harm behavior and 47.5% had comorbid mental disorders. All patients were screened in the first 48 h after referral, and the program retention rate was 91.52%. As for use of health services, 2016.03 hospital stays were avoided, and only 16.12% of the 31 calls received for urgent care required emergency department visits. Families gave the program an overall satisfaction score of 4.95/5, and all described it as "very safe." DISCUSSION: The HaH program described is a feasible and acceptable care model in adolescents with severe EDs and comorbidities. Effectiveness studies should be performed. PUBLIC SIGNIFICANCE: Eating disorders are a major concern for public health. The adolescent HaH program presented marks an advance in intensive community treatments for patients with severe EDs and comorbidities.

Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries.

The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.

Psychological Distress, Disorder Severity, and Perception of Positive Contributions in Couples Raising Individuals With Autism.

Parents' perception of the positive contributions associated with raising children with autism is considered to be a protective factor in the process of psychological adaptation. Thus, it is essential to unveil what factors are related to this perception. We explore how parents' psychological distress (parental stress and anxiety) predicts the perception of positive contributions in fathers and mothers who raise individuals with different levels of autism severity. The sample comprises 135 couples (270 fathers and mothers) parenting individuals diagnosed with autism aged 3-38 years. Participants completed different self-report questionnaires, including measures of parental stress, anxiety, and positive contributions. To estimate the actor-partner interdependence model, data were analyzed using structural equation modeling (SEM) to explore transactional effects between fathers' and mothers' psychological distress and their perceptions of positive contributions associated with autism. Two separate multigroup models were tested, respectively, analyzing parental stress and anxiety. Each multigroup model considers two levels of disorder severity. The findings revealed that actor and partner effects of stress and anxiety were important predictors of the perception of positive contributions in both disorder severity groups. We conclude that it is necessary to develop family support programs that focus on controlling fathers' and mothers' stress and anxiety symptoms, as these mental states negatively impact the ability to perceive positive contributions.

Characterization of pyrolysis products of high-ash excavated-waste and its char gasification reactivity and kinetics under a steam atmosphere.

The focus of this study is the pyrolysis and gasification of Refuse Derived Fuel (RDF) and fine fractions recovered from the excavation of landfill waste, with an emphasize on the characterization of the reactivity and kinetics of the char-steam gasification. The results from the pyrolysis tests demonstrated that CO and CO2 are the main produced gases during the pyrolysis of the finer fraction of landfill waste. This might be caused by the accumulation of degraded organic materials. The oil products from the pyrolysis of landfill waste were dominated by the derivative products of plastics such as styrene, toluene, and ethylbenzene. The chars obtained from the pyrolysis process were gasified under steam and steam/air atmospheres at temperatures between 800 and 900 °C by using thermogravimetry. The results from the gasification tests demonstrated that the char reactivity was mainly affected by the amount ratio between catalytic elements (K, Ca, Na, Mg, and Fe) over the inhibitor elements (Si, Al, and Cl), as well as the ash amount in the char. The results showed that char from the fine fraction of landfill waste has a higher reactivity than the RDF fraction, due to the high content of catalytic metal elements. These results suggest the use of a smaller sieve opening size for landfill waste separation processes may produce waste fuels with a high reactivity during gasification. Further, based on the thermogravimetric data, the kinetic parameters of landfill waste char gasification were calculated to have activation energies ranging from 54 to 128 kJ/mol.

Supportive Dyadic Coping and Psychological Adaptation in Couples Parenting Children with Autism Spectrum Disorder: The Role of Relationship Satisfaction.

In couples parenting children with Autism Spectrum Disorder (ASD), the partner becomes a primary source of support for addressing the additional parenting demands. The purpose of this study was to examine the associations between supportive dyadic coping and parental adaptation, and to assess the mediating role of relationship satisfaction between them. Seventy-six couples parenting children with ASD participated. Data were gathered through self-report questionnaires and an Actor-Partner Interdependence Mediation Model was used. Mothers' and fathers' supportive dyadic coping was related to both their own and partner's relationship satisfaction and parental adaptation. Findings also revealed the mediation role of relationship satisfaction, in the association between supportive dyadic coping and parental adaptation. The implications for research and clinical practice are discussed.

Parental Self-Efficacy and Positive Contributions Regarding Autism Spectrum Condition: An Actor-Partner Interdependence Model.

Couples affect each other cognitively, emotionally and behaviorally. The goal of this study is to test the benefits and potential use of the actor-partner interdependence model in examining how parental self-efficacy and positive contributions of fathers and mothers of children with Autism Spectrum Condition influence each other's psychological adaptation. The sample includes 76 Spanish couples who completed validated questionnaires measuring predictors, i.e., self-efficacy and positive contributions, and adaptation outcomes i.e., stress, anxiety, depression and psychological well-being. Multilevel analysis revealed many actor and some partner effects of parental self-efficacy and positive contributions to be important determinants of adaptation above and beyond child and sociodemographic factors, and as such, these effects should be targeted in clinical intervention programs.

AULA virtual reality test as an attention measure: convergent validity with Conners' Continuous Performance Test.

The majority of neuropsychological tests used to evaluate attention processes in children lack ecological validity. The AULA Nesplora (AULA) is a continuous performance test, developed in a virtual setting, very similar to a school classroom. The aim of the present study is to analyze the convergent validity between the AULA and the Continuous Performance Test (CPT) of Conners. The AULA and CPT were administered correlatively to 57 children, aged 6-16 years (26.3% female) with average cognitive ability (IQ mean = 100.56, SD = 10.38) who had a diagnosis of attention deficit/hyperactivity disorder (ADHD) according to DSM-IV-TR criteria. Spearman correlations analyses were conducted among the different variables. Significant correlations were observed between both tests in all the analyzed variables (omissions, commissions, reaction time, and variability of reaction time), including for those measures of the AULA based on different sensorial modalities, presentation of distractors, and task paradigms. Hence, convergent validity between both tests was confirmed. Moreover, the AULA showed differences by gender and correlation to Perceptual Reasoning and Working Memory indexes of the WISC-IV, supporting the relevance of IQ measures in the understanding of cognitive performance in ADHD. In addition, the AULA (but not Conners' CPT) was able to differentiate between ADHD children with and without pharmacological treatment for a wide range of measures related to inattention, impulsivity, processing speed, motor activity, and quality of attention focus. Additional measures and advantages of the AULA versus Conners' CPT are discussed.

Test de escucha dicótica para niños hispanohablantes: validación de unas nuevas series de pares de palabras y de sílabas en castellano / Dichotic listening in Spanish-speaking children: validation of a set of dichotic lists of Spanish words and syllables

Introducción. El test de escucha dicótica verbal (TED) estima la dominancia hemisférica cerebral para el lenguaje. Objetivo. Validar ocho nuevas series dicóticas para niños castellanohablantes. Sujetos y métodos. Hay un grupo de referencia estratificado, con 40 niños diestros de 3,5 a 7,5 años, de ambos sexos, normohablantes del castellano, y un grupo clínico de 12 niños con parálisis cerebral hemiparética derecha, inteligenciamedia e índice superior a -2z en una prueba de repetición de frases. Cada serie dicótica opone 20 pares de palabras, números o sílabas, o trenes de dos o tres números o sílabas, con proporción equilibrada de consonantes sonoras y sordas,duración y acento. Con el número de respuestas, bajo atención libre, desde los oídos derecho e izquierdo, se calcula elíndice de lateralización (IL) hemisférica. Se contrastan las series más adecuadas con arreglo a la edad. Resultados. Con un rango de 0 a 200, los IL ≥ 112 indican dominancia hemisférica izquierda, mientras que los IL ≤ 88 señalan dominancia del hemisferio derecho. En cada niño del grupo de referencia, se constata dominancia hemisférica izquierda para el lenguaje, sin influencia de la edad ni del sexo. En cambio, 10 de 12 (83%) sujetos del grupo clínicopresentan dominancia hemisférica derecha. Esta doble disociación muestra la validez de nuestras series en una primeraestimación de la dominancia cerebral para el lenguaje.Conclusiones. Las series de pares dicóticos en castellano aquí presentadas son válidas para estimar la dominancia hemisféricapara el lenguaje en niños, utilizando el TED bajo atención libre (AU)

Introduction. Dichotic listening test can estimate hemispheric dominance for language. Aim. To study the usefulness of a new set of dichotic pairs of Spanish stimuli in middle childhood. Subjects and methods. The stratified control group comprised 40 healthy, right-handed children, aged 3.5- 7.5 years, of both sexes, with average ability at speaking Spanish. The clinical sample comprised 12 children with right spastic hemiparetic cerebral palsy, average general intelligence and sentence repetition index over -2z. Each listening series is composedof 20 age-appropriate dichotic pairs: one syllable, word, or number; or trains of two or three syllables or numbers. Voiceonset time, duration and stress of stimuli were balanced. Hemispheric dominance index (HDI) for language was calculated using a formula with the scores of stimuli from right or left ears. Statistical analysis evaluated the age-related accuracyand discriminant power of each HDI.Results. In the non-forced attention paradigm, the range of HDI is 0-200. Values of HDI ≥ 112 indicate left hemisphere dominance for language, whereas values of HDI ≤ 88 indicate right hemisphere dominance. All 40 typical subjects showed left HDI for language, without influence of age and sex. In contrast, ten out of twelve (83%) right hemiparetic childrenhad right HDI. Conclusions. The results show that this new set of dichotic pairs is useful in the initial assessment of cerebral dominancefor language and valid for use in Spanish speaking children aged 3.5 years or more (AU)

[Dichotic listening in Spanish-speaking children: validation of a set of dichotic lists of Spanish words and syllables]. / Test de escucha dicótica para niños hispanohablantes: validación de unas nuevas series de pares de palabras y de sílabas en castellano.

INTRODUCTION: Dichotic listening test can estimate hemispheric dominance for language. AIM: To study the usefulness of a new set of dichotic pairs of Spanish stimuli in middle childhood. SUBJECTS AND METHODS: The stratified control group comprised 40 healthy, right-handed children, aged 3.5- 7.5 years, of both sexes, with average ability at speaking Spanish. The clinical sample comprised 12 children with right spastic hemi-paretic cerebral palsy, average general intelligence and sentence repetition index over -2z. Each listening series is composed of 20 age-appropriate dichotic pairs: one syllable, word, or number; or trains of two or three syllables or numbers. Voice onset time, duration and stress of stimuli were balanced. Hemispheric dominance index (HDI) for language was calculated using a formula with the scores of stimuli from right or left ears. Statistical analysis evaluated the age-related accuracy and discriminant power of each HDI. RESULTS: In the non-forced attention paradigm, the range of HDI is 0-200. Values of HDI ≥ 112 indicate left hemisphere dominance for language, whereas values of HDI ≤ 88 indicate right hemisphere dominance. All 40 typical subjects showed left HDI for language, without influence of age and sex. In contrast, ten out of twelve (83%) right hemiparetic children had right HDI. CONCLUSIONS: The results show that this new set of dichotic pairs is useful in the initial assessment of cerebral dominance for language and valid for use in Spanish speaking children aged 3.5 years or more.

[Personal health folder]. / Carpeta Personal de Salud.

Personal Health Records shared between patients and their health team can improve the capacity of the patients to become active partners in the care of their own health. PHR can offer the patients access to their medical information, services, such as resources programming, or communication between the members of the health team and the patient. They could also allow patients themselves to directly register certain data, be picked up from home monitoring devices, thus becoming a very useful tool in the management of chronic disease and for the prevention and promotion of health. The Government of Catalonia is developing the Personal Health Folder, a space where the Health Department will give the people of Catalonia secure and confidential access to their health information. The Personal Health Folder is within the framework of the Catalonian Shared Clinical History project, which is based on a index system of medical records shared between different personnel, using interoperability tools and is in accordance with the legislation applicable in Catalonia and within its healthcare system. Within the framework of this project and these principles, the Personal Health Folder has the aim to give people responsibility for their own health, allowing them to take part in the management of the preventive actions and care, and to improve the quality of care, and coordination between the different health areas and professionals.

Carpeta Personal de Salud / Personal Health Folder

La creación de Registros Personales de Salud compartida entre pacientes y su equipo de atención de salud puede mejorar la capacidad de los pacientes a convertirse en socios activos en el cuidado de su propia salud. Pueden ofrecer a los pacientes acceso a su información médica, servicios como la programación de citas, o comunicación entre los miembros del equipo de atención de salud y el paciente/ciudadano. También podrían permitir al propio paciente registrar determinados datos escribiéndolos directamente o recogidos desde aparatos de vigilancia y monitorización domésticos, constituyendo por tanto un instrumento de gran utilidad para la gestión de la enfermedad crónica y para la prevención y promoción de la salud. El Gobierno de Catalunya está desarrollando la Carpeta Personal de Salud, un espacio donde el Departament de Salut pondrá a disposición de cada uno de los ciudadanos de Catalunya datos referentes a su salud de forma segura y garantizando su confidencialidad. La Carpeta Personal de Salud se sitúa en el marco del proyecto de Historia Clínica Compartida de Cataluña, proyecto basado en un sistema índice de historia clínica compartida entre diversidad de agentes de salud, obtenido mediante instrumentos de interoperabilidad y conforme a la legislación aplicable en Catalunya y a su sistema sanitario. Bajo el marco de este proyecto y de estos principios, la Carpeta Personal de Salud tiene el objetivo de favorecer la responsabilización del ciudadano de su propia salud, facilitando su participación en la gestión de las actuaciones preventivas y de su cuidado, para mejorar la calidad de la asistencia, la coordinación entre las diferentes líneas asistenciales y entre los profesionales (AU)

Personal Health Records shared between patients and their health team can improve the capacity of the patients to become active partners in the care of their own health. PHR can offer the patients access to their medical information, services, such as resources programming, or communication between the members of the health team and the patient. They could also allow patients themselves to directly register certain data, be picked up from home monitoring devices, thus becoming a very useful tool in the management of chronic disease and for the prevention and promotion of health. The Government of Catalonia is developing the Personal Health Folder, a space where the Health Department will give the people of Catalonia secure and confidential access to their health information. The Personal Health Folder is within the framework of the Catalonian Shared Clinical History project, which is based on a index system of medical records shared between different personnel, using interoperability tools and is in accordance with the legislation applicable in Catalonia and within its healthcare system. Within the framework of this project and these principles, the Personal Health Folder has the aim to give people responsibility for their own health, allowing them to take part in the management of the preventive actions and care, and to improve the quality of care, and coordination between the different health areas and professionals (AU)