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Highlights • Rapid detection methods used as first diagnostic test for CARVs may delayed the start of antiviral therapy in a significant number of influenza and RSV cases. • Syndromic multiplex RT-PCR-based prospective clinical CARV survey in allo-HCT recipients translates into a lower mortality rate as compared to standard clinical practice based on RSV and influenza virus rapid detection test. • We found that donor/recipient HLA mismatch, CARV LRTD and high-risk ISI were also associated with higher mortality., Background There is a lack of studies comparing clinical outcomes among retrospective versus prospective cohorts of allogeneic stem cell transplant (allo-HCT) recipients with community acquired respiratory virus (CARV) infections. Methods We compare outcomes in two consecutive cohorts of allo-HCT recipients with CARV infections. The retrospective cohort included 63 allo-HCT recipients with 108 CARV infections from January 2013 to April 2016 who were screened and managed following standard clinical practice based on influenza and respiratory syncytial virus rapid antigen detection methods. The prospective cohort was comprised of 144 consecutive recipients with 297 CARV episodes included in a prospective interventional clinical surveillance program (ProClinCarvSur-P) based on syndromic multiplex PCR as first-line test from May 2016 to December 2018 at a single transplant center. Results CARV infections in the retrospective cohort showed more severe clinical features at the time of diagnosis compared to the prospective cohort (fever 83% vs. 57%, hospital admission 69% vs. 28% and lower respiratory tract 58% vs. 31%, respectively, p ≤ 0.002 for all comparisons). Antiviral therapy was more commonly prescribed in the prospective cohort (69 vs. 43 treated CARV episodes), particularly at the upper respiratory tract disease stage (34 vs. 12 treated CARV episodes). Three-month all-cause mortality was significantly higher in the retrospective cohort (n = 23, 37% vs. n = 10, 7%, p

Resumen Introduccion: A pesar de las evidencias sobre la importancia de la satisfaccion del paciente en la evaluacion de los servicios medicos, no hay disponible un instrumento validado en castellano para valorar la satisfaccion percibida respecto a los ingresos psiquiatricos en unidades de agudos. Objetivo: Disenar y validar un instrumento para valorar la satisfaccion percibida respecto a los ingresos en las unidades de hospitalizacion breve (UHB) psiquiatricas. Metodo: Se realizo un estudio transversal, en 14 UHB de hospitales publicos sobre una muestra de 370 pacientes. Se diseno un cuestionario preliminar que fue sometido a un proceso de validacion de contenido por un grupo de expertos y de pacientes. Se realizo el analisis psicometrico incluyendo la fiabilidad de las puntuaciones utilizando el coeficiente Alpha de Cronbach (α) y el Coeficiente Omega (ω), la validez de constructo mediante tecnicas de analisis factorial exploratorio (AFE) y confirmatorio (AFC) y la validez de criterio mediante la validez predictiva empleando el analisis de regresion. Resultados: El cuestionario PSYQUEST definitivo esta compuesto por 20 items y cuatro dimensiones: Informacion y trato con el/la psiquiatra, Cuidados del personal de la unidad, Servicios de la unidad, Satisfaccion general, que explican el 75,52% de la varianza. Mostro buena fiabilidad α=0,88 / ω=0,89 y validez de criterio predictiva observandose peores puntuaciones en los ingresos involuntarios, menor grado de mejoria y restriccion de permisos. Conclusiones: El cuestionario PSYQUEST muestra una buena calidad psicometrica, pudiendo emplearse como instrumento para valorar la satisfaccion percibida con los ingresos psiquiatricos en las UHB.

Highlights • CMV DNA is frequently detected in BAL fluid specimens from allo-HSCT. • CMV DNA detection in BAL fluids is comparable across pneumonia etiologies. • CMV DNA loads in BAL fluids are comparable across pneumonia etiologies. • CMV DNA load in BAL may predict attributable-pneumonia mortality., Summary Objectives To date no definitive cut-off value for cytomegalovirus (CMV) DNA load in bronchoalveolar lavage (BAL) fluid specimens has been established to discriminate between CMV pneumonia and pulmonary CMV DNA shedding in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. Methods The current retrospective study is aimed at assessing the range of CMV DNA loads quantified in BAL fluid specimens from allo-HSCT patients with pneumonia in which different microorganisms were causally involved. Results A total of 144 BAL specimens from 123 patients were included. CMV DNA was detected in 56 out of 144 BAL fluid specimens and the median CMV DNA load from patients in whom CMV pneumonia was unlikely or could be tentatively ruled out was 1210 (31–68, 920) IU/ml. The frequency of CMV DNA detection and median CMV DNA loads were comparable, irrespective of the attributable cause of pneumonia. Detection of CMV DNA loads in BAL fluid specimens >500 IU/ml was independently associated with pneumonia-attributable mortality. Conclusions The current study highlights the difficulty in establishing universal CMV DNA load thresholds in BAL fluid specimens for distinguishing between CMV pneumonia and pulmonary CMV DNA shedding, and suggests that the presence of CMV DNA in BAL fluid specimens beyond a certain level may have a deleterious impact on patient outcome.

Background The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). The aim of the present study is to determine the psychometric properties of a computerized version of the PHQ-4 used to detect emotional disorders (anxiety and depression) in the primary care setting. Method A total of 1052 patients with suspected anxiety, depression, or somatic symptoms were recruited from 28 primary care centres participating in the PsicAP trial and completed the full version of the computerized PHQ. In addition, 178 of these patients also underwent in clinical interviews as a gold standard. Results Confirmatory factor analyses showed very good fit indices for a two-factor solution. This model was structurally invariant among the various age and gender groups and internal consistency was acceptable (PHQ-4; α = .83, PHQ-2; α = .86, and GAD-2; α = .76). The best cut-off points to obtain high sensitivity values was 3, on both the PHQ-2 (major depressive disorder) and the GAD-2 (generalized anxiety disorder). The criterion validity (sensitivity and specificity) for the PHQ-2 were .90 and .61 and for the GAD-2, .88 and 0.61. Limitations The study was not designed as a prevalence study. Therefore, does not contain information on patients whose general practitioners do not consider them to suffer emotional disorders. Conclusion This is the first study to provide evidence for the reliability and validity of a computerized version of the PHQ-4. This computerized tool can be used to detect depression and anxiety in a primary care setting.

For phytostabilization to successfully reclaim mine tailings, an adequate soil nutrient level should be provided to promote the growth of healthy plants and plant succession. In this study, six Mediterranean shrub species (Lavandula dentata, Rosmarinus officinalis, Thymus vulgaris, Nerium oleander, Cistus albidus and Pistacia lentiscus) were grown in mine tailings, unamended and amended with calcium carbonate and pig manure, and in a reference unpolluted substrate as positive control. We aimed to assess if amendments enhanced plant growth and nutritional status and to study the relationships between soil properties, soil metal(loid) contents and nutrients and plant growth and nutritional status. These data are necessary to infer how soil characteristics influence plant health in tailings for proper management. The experiment was conducted in pots for 120 d. The results showed that at the end of the experiment the addition of amendments had increased soil pH from ∼4.5 to ∼7.7, exchangeable Ca, K and P and had decreased exchangeable Mn and Fe, with no effect on N and Mg. In general, unamended tailings supported plants with high accumulation of Cd, Zn, Mn and B in their tissues, related to high availability of metals and low pH. Amended tailings supported plants with better root development and higher levels of N, K, Ca, Mg, Fe and Cu in all parts, with regard to unamended tailings. Thus, the reclamation strategy improved the nutritional status of plants and root development, mainly related to increases in soil CaCO3 and pH. However, reclamation led to enhanced accumulation of As and Pb (below toxicity limits), related to increases in pH and soluble organic compounds, respectively. Amendment addition did not favor P accumulation by the plants, despite its increase in the soil. Among species, L. dentata and C. albidus were the species with the highest improvement in nutrient content with the addition of the amendments, while T. vulgaris was the species least affected by soil conditions.

Resumen Los metodos para diagnosticar enfermedades infecciosas han de ser rapidos, precisos, sencillos y asequibles. La rapidez en el diagnostico puede jugar un papel crucial en la curacion del paciente, ya que permite la administracion de un tratamiento adecuado. Un aspecto que condiciona cada vez mas la necesidad de disponer de tecnicas de diagnostico rapido es el aumento de las tasas de infecciones graves causadas por bacterias resistentes a los antibioticos, lo que ocasiona una elevada probabilidad de error en el tratamiento antibiotico empirico. Algunos de los metodos convencionales, como la tincion de Gram o la deteccion de antigenos pueden generar resultados en menos de una hora pero adolecen de sensibilidad. En la actualidad estamos asistiendo a un cambio importante en los laboratorios de microbiologia clinica, en el que se incluyen avances tecnologicos tales como el diagnostico molecular, la microbiologia digital y las tecnicas de espectrometria de masas. Existen diversos estudios que demuestran que dichos cambios en el diagnostico microbiologico reducen el tiempo de generacion de los resultados de las pruebas, lo cual posee un impacto clinico evidente. Sin embargo, si miramos hacia el futuro, otras nuevas tecnologias estan en el horizonte, las cuales permitiran cubrir las necesidades que se requieren en el diagnostico microbiologico rapido. Esta revision proporciona un analisis en profundidad del impacto clinico que la implementacion de tecnicas de diagnostico rapido tendra en las necesidades clinicas no satisfechas.

Background Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections and is associated with high mortality. It is typically resistant to fluconazole and voriconazole and, some cases, also to echinocandins and amphotericin B. This species, phylogenetically related to Candida haemulonii, is frequently misidentified by commercial identification techniques in clinical laboratories; therefore, the real prevalence of C. auris infections may be underestimated. Aims To describe the clinical and microbiological features of the first four cases of C. auris fungemia episodes observed in the European continent. Methods The four patients were hospitalized in the adult surgical intensive care unit. A total of 8 isolates (two per patient) from blood and catheter tip were analyzed. Results All isolates were misidentified as Saccharomyces cerevisiae by AuxaColor 2, and as Candida sake by API ID20C. VITEK MS technology misidentified one isolate as Candida lusitaniae, another as C. haemulonii and could not identify the other six. C. auris identification was confirmed by ITS rDNA sequencing. All isolates were fluconazole (MIC >256 mg/l) and voriconazole (MIC 2 mg/l) resistant and susceptible to posaconazole, itraconazole, echinocandins and amphotericin B. Conclusions C. auris should be regarded as an emerging pathogen, which requires molecular methods for definitive identification. Our isolates were highly resistant to fluconazole and resistant to voriconazole, but susceptible to the other antifungals tested, which emphasizes the importance of accurately identifying this species to avoid therapeutic failures.

The diagnostic methods of infectious diseases should be fast, accurate, simple and affordable. The speed of diagnosis can play a crucial role in healing the patient, allowing the administration of appropriate antibiotic treatment. One aspect that increasingly determines the need for rapid diagnostic techniques is the increased rates of serious infections caused by multidrug resistant bacteria, which cause a high probability of error in the empirical treatment. Some of the conventional methods such as Gram staining or antigen detection can generate results in less than 1 hour but lack sensitivity. Today we are witnessing a major change in clinical microbiology laboratories with the technological advances such as molecular diagnostics, digital microbiology and mass spectrometry. There are several studies showing that these changes in the microbiological diagnosis reduce the generation time of the test results, which has an obvious clinical impact. However, if we look into the future, other new technologies which will cover the needs required for a rapid microbiological diagnosis are on the horizon. This review provides an in depth analysis of the clinical impact that the implementation of rapid diagnostic techniques will have on unmet clinical needs. (C) 2016 Elsevier Espatia, S.L.U. and Sociedad Espafiola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

With this study we aimed to assess the effect of the prior development of Piptatherum miliaceum (Pm) in a Technosol on the establishment of Salvia rosmarinus (Sr) as a cash crop. An experimental pot was performed with two biochar (BCh) doses (BCh1 and BCh2) mixed with marble waste and pyritic tailings, with and without Pm. After 12 months of Pm growth, the pots with this species were divided into two sets: Sr alone and Sr + Pm. An agricultural soil (AGR) was used as an external control. The results showed that the growth of Sr led to similar shoot biomass to AGR. Sr + Pm reduced shoot biomass by 50%. Total soil organic and recalcitrant C, and total and recalcitrant N showed the highest values in vegetated pots, with no effect of the BCh rate. The decrease in the soil metals availability was related with increases in soil pH. BCh1Sr + Pm treatment showed a microbial community structure more similar to AGR, related to higher fungal and bacterial abundance, enzyme activities and soluble carbon. Thus, growing Sr + Pm seems a suitable strategy to improve soil properties, including microbial abundance, with low translocation of metals. Although the BCh rate did not affect plant growth or soil physicochemical properties, the lowest rate contributed to the growth of soil microorganisms better. The simultaneous growth of Sr + Pm reduced biomass production, and a source of available nutrients is also recommended. Further studies are needed to test this strategy in the field, and to ensure its suitability and a constant biomass production.

A greenhouse pot experiment was conducted to evaluate the potential use of Nerium oleander, Cistus albidus and Pistacia lentiscus for phytostabilization of acidic mine soils. The selected species were grown in mine tailing soil, unamended (TS) and amended with calcium carbonate and pig manure (ATS), and in a reference unpolluted substrate for control (CT); plant growth, root characterization, soil trace element contents, and their accumulation in plants were measured. Results indicated that seed emergence was independent of the substrate characteristics, but seedlings were seriously affected and died in TS, with survival of 5–40% in ATS. Only stem biomass of P. lentiscus and root volume of N. oleander were negatively affected when grown in TS, but without differences between ATS and CT. There were significant negative correlations between soil and plant trace element concentrations and plant biomass and root development, indicating the effect of trace elements on plant growth. The application of amendments reduced the soil exchangeable and extractable fraction concentrations of trace elements in ATS compared with TS, mainly for As, Cd and Pb. The tested species directly contributed to the immobilization of trace elements in the soil. As a general pattern, trace element concentrations in plants grown in the unamended tailing soil were similar to those reported for the amended soil, with levels below toxicity thresholds. Thus, these species fulfill the criteria to be used for phytostabilization purposes, aided by application of amendments to increase plant growth.

An emerging body of evidence has associated exposure to greenspace during pregnancy with improved fetal growth; however, all available studies have been conducted in high-income countries and the available evidence evaluating such an association for visual access to greenspace, use of green spaces and indoor plants is non-existent. We aimed to evaluate the association between a comprehensive array of indicators of exposure to greenspace during pregnancy, including the aforementioned indicators, and birth weight, in a middle-income country and evaluating air pollution and visual access as possible mechanisms underlying the association. This study was based on 301 pregnant women residing in Su et al. (2019). For each pregnant woman, we characterized exposure to residential surrounding greenspace, visual access to greenspace, residential proximity to green space, use of green spaces, and the number of plant pots at home. We used linear regression models adjusted for relevant covariates including measures of socioeconomic status. We found positive associations of maternal exposure to residential surrounding greenspace across a 100 m buffer, frequent viewing of greenspace through the window, percentage of window area covered by greenspace, residential proximity to any green space regardless of its area, time spent in public green spaces and total time spent in public and private green spaces with birth weight. We also observed positive associations of maternal exposure to residential surrounding greenspace across 300 m and 500 m buffers, residential proximity to a green space with an area ≥5000 m2, and indoor plant pots with birth weight, but none of these associations were statistically significant. The magnitude of the associations tended to be higher among parents with lower socioeconomic status. Mediation through air pollution or visual access was not established. Findings from this study suggested a positive role of different aspects of exposure to greenspace during pregnancy on birth weight in a middle-income country.

The potential use of three Laminaceae species (Lavandula dentata, Rosmarinus officinalis and Thymus vulgaris) for the phytostabilisation of a trace elements contaminated (acid) soil has been evaluated. These species were grown in mine tailing soil unamended (TS) and amended with calcium carbonate and pig manure (ATS), and unpolluted substrate for control (CT); plant growth, root characterisation, soil trace elements contents and their accumulation in plants were measured. Results indicated that seed emergence was independent from substrate characteristics, but seedlings died in TS with 40% survival in ATS. The biomass of L. dentata and T. vulgaris and root development in R. officinalis were negatively affected when grown in TS but without differences between ATS and CT. Applicating amendments reduced soil exchangeable and extractable fractions concentrations of trace elements in ATS compared with TS. The establishment of L. dentata and R. officinalis were related to trace elements immobilisation. Trace element concentrations in plants grown in tailing soils were similar to those reported for control, although applicating amendments reduced Zn accumulation in all species, and favoured increased absorption and aerial translocation of As and Pb by L. dentata and T. vulgaris; nonetheless, levels were below toxicity thresholds. Thus, these species fulfill the criteria for phytostabilisation purposes, aided by employing amendments.

Due to its environmental impact, pig slurry management is of great importance in the Region of Murcia, Spain, where pig production is considerable. The current slurry management system consists in its direct use in agricultural land, yet this entails an important associated problem, i.e., the limits of nitrogen imposed by legislation ( −1 yr −1 ). The use of constructed wetlands affords another possibility, achieving a reduction of physicochemical parameters of up to 80%. This paper presents the comparison of both the alternatives by means of life cycle assessment, and reports a major impact in the categories of acidification and eutrophication potential. However, the abiotic depletion potential could be minimized by avoiding the application of fertilizers and irrigation water. For the category of global warming potential, the wetland building displayed a negative role as compared to direct use. After normalization of the data, the main environmental problem for both management alternatives proved to be eutrophication, followed by acidification and global warming potential. The use of the great amounts of pig slurry produced in the Region of Murcia generates a problem of eutrophication in the Valle del Guadalentin, the Campo de Cartagena and the Mar Menor lagoon. For the purposes of normalizing, a database is needed to take all the inputs and outputs into account, in order to establish more realistic scenarios for the use and management of pig slurries in different geographical areas.

The environmental and social impact derived from treated wastewater reuse is an intrinsically complex multidimensional process, which involves multiple criteria and multiple stakeholders. This paper presents the use of multicriteria decision through the TOPSIS method, applied to six different methodologies concerning the disinfection of treated wastewater before reusing. Results have shown that the best disinfection technique for treated wastewater has been chlorination with 4 ppm, if this water is to be destined to an urban, agricultural or industrial use, due to a large weight given to cost and environmental criteria. Conversely, in recreational and environmental uses, the alternative of ultraviolet light disinfection was the chosen alternative. Economic criteria showed priority in the most entrepreneurial uses of the water, although social and political cost had a greater weight in the case of environmental or recreational uses. The inclusion of environmental and social assessment in the disinfection technique decision support clearly provides a cleaner and more sustainable production.

Cucumber fruits (Cucumis sativus L., cv. Tropico F1) grown on perlite substrate and NFT (Nutrient Film Technique) were harvested during two seasons (winter and spring) to monitor the effects of climatic conditions and hydroponic growth systems on fruit quality at harvest. The best fruit quality at harvest, as measured by lightness and hue angle parameters, was obtained during the 3 weeks following the first winter picking. When values of a parameter of preharvest climate value called G * were lower than 0.4 MJ m � 2 8C day � 1 interval � 1 , the cucumber achieved its optimum quality at harvest, as measured by the dark green color of the skin. NFT-grown fruits showed darker and greener skin color (higher hue angle and lower lightness) compared with perlite-grown fruit, irrespective of the season considered. During the winter season, the plant transpiration rate was 30% higher in perlite than in NFT culture, which correlates with higher differences inG * and 40% additional yield in perlite. However, in spring G * was not sensitive enough to discriminate between the two hydroponic systems. In general, fruit quality at harvest in spring was lower than during the winter, due to flesh whitening, higher longitudinal and equatorial calibers, and slightly higher pH, as well as worse epidermal color coordinates (ranging from the dark and dull green color typical of winter fruit to light and a vivid green-yellow color). During the spring season, NFT-grown fruit were less acid than perlite-grown fruit with no apparent correlation with the climatic conditions or fruit nutrition. # 2006 Elsevier B.V. All rights reserved.

Summary Introduction: Clinical pathways are plans of care applied to com- mon processes, with a predictable course and great clinical variabi- lity in their management, which constitute an opportunity for im- provement. In our hospital, thyroidectomy meets the basic require- ments for the design of a plan of care. This article aims to present the development of the clinical pathway. Methodology: A clinical pathway for thyroidectomy was designed jointly by the Departments of Surgery, Anesthesia and Endocrino- logy, as well as the Quality Unit of the JM Morales Meseguer Hospi- tal. The best possible scientific evidence was adapted to the hos- pital's characteristics and to the preferences of the health profes- sionals. Results: The pathway for thyroidectomy was designed to include all patients undergoing this procedure, with the sole exception of those who simultaneously undergo another procedure. We designed a pro- tocol for the treatment of postoperative hypocalcemia and establis- hed a total length of hospital stay of 3 days for hemithyroidectomy and one of 4 days for total thyroidectomy. The clinical pathway do- cuments comprise the clinical pathway cards, indicators of outco- me, and the satisfaction survey. Conclusions: The intra- and interdepartmental consensus as well as review of the best scientific instrument involved in the development of the clinical pathway make this plan of care an instrument to im- prove the postoperative care of patients submitted to this surgical process. Using this instrument, we aim to reduce unjustified variabi- lity and length of hospital stay and to improve patient satisfaction.