Genotypic study of Chlamydia trachomatis for lymphogranuloma venereum diagnosis in rectal specimens from men who have sex with men: a cost-effectiveness analysis

PURPOSE

The significant proportion of asymptomatic patients and the scarcity of genotypic analysis of lymphogranuloma venereum (LGV), mainly among men who have sex with men (MSM), triggers a high incidence of underdiagnosed patients, highlighting the importance of determining the most appropriate strategy for LGV diagnosis, at both clinical and economical levels.

MATERIALS AND METHODS

We conducted L1-L3 serovar detection by molecular biology in stored Chlamydia trachomatis-positive samples from MSM patients with HIV, another STI or belonging to a Pre-exposure prophylaxis program, to make a cost effectiveness study of four diagnostic strategies with a clinical, molecular, or mixed approach.

RESULTS

A total of 85 exudates were analyzed: 35urethral (31 symptomatic/4 positive) and 50 rectal (22 symptomatic/25 positive), 70/85 belonging to MSM with associated risk factors. The average cost per patient was €77.09 and €159.55 for clinical (Strategy I) and molecular (Strategy IV) strategies respectively. For molecular diagnosis by genotyping of all rectal exudate samples previously positive for CT (Strategy II), the cost was €123.84. For molecular diagnosis by genotyping of rectal and/or urethral exudate samples from all symptomatic patients (proctitis or urethritis) with a previous positive result for CT (Strategy III), the cost was €129.39. The effectiveness ratios were 0.80, 0.95, 0.91, and 1.00 for each strategy respectively. The smallest ICER was €311.67 for Strategy II compared to Strategy I.

CONCLUSIONS

With 30% asymptomatic patients, the most cost-effective strategy was based on genotyping all rectal exudates. With less restrictive selection criteria, thus increasing the number of patients with negative results, the most sensitive strategies tend to be the most cost-effective, but with a high incremental cost-effectiveness ratio.

Internet-based interdisciplinary therapeutic group (Grupo Interdisciplinar Online, GIO) for perinatal anxiety and depression-a randomized pilot study during COVID-19

Early interventions may promote reductions in mothers' anxiety-depression (AD) symptoms and improvements in their offspring. This longitudinal randomized research was conducted to assess the effects of interdisciplinary online therapeutic groups (GIO) in at-risk mothers and babies during the COVID-19 pandemic in a disadvantaged neighborhood in Barcelona (Spain). A total of 135 babies were born from March 2020 to June 2021 in a primary healthcare center of Barcelona (Spain). Pregnant woman and new mothers were screened for AD symptomatology through EPDS and STAI questionnaires. Seventy-two of them met high-risk criteria for AD and were included in the study. They were randomly assigned into the two groups of the study: 40 participants were assigned to GIO, the therapeutic group (TG), while 32 of them were assigned to the control group (CG) and received treatment as usual. The course of the mothers' symptomatology was assessed, as well as the baby's development at 6 months old in a blind pediatric follow-up. No differences were found in AD between both groups before the intervention. However, we obtained a significant decrease in AD symptomatology (EPDS p < .001; STAI state p = .015 and STAI trait p < .001at 6 months of life) after the intervention in the TG compared to the CG. Pediatric follow-up at 6 months demonstrated significant differences between groups in babies' development assessment (manipulation p = .003; language p < .001; sociability p < .001). The GIO helped to ensure healthy development of the baby and reduction of the mothers' depressive-anxiety symptomatology.

Validation of the anxiety subscale of the Spanish version of the Edinburgh Postnatal Depression Scale (EPDS-A)

Introduction

There is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population.

Methods

161 women were evaluated with the EPDS and the State-Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated.

Results

The Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model's invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument's sensitivity, a cut-off point of 4 points was established for the EPDS-A.

Conclusion

Our results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

The Biofire® Filmarray® Pneumonia Plus panel for management of lower respiratory tract infection in mechanically-ventilated patients in the COVID-19 era: a diagnostic and cost-benefit evaluation

We assessed the diagnostic performance of the Biofire® Filmarray® Pneumonia Plus panel (FA-PP) compared to standard culture in Intensive Care Unit patients with suspected ventilator-associated lower respiratory tract infection in the COVID-19 era. We determined whether its implementation in routine diagnostic algorithms would be cost-beneficial from a hospital perspective. Of 163 specimens, 96 (59%) returned negative results with FA-PP and conventional culture, and 29 specimens (17.8%) were positive with both diagnostic methods and yielded concordant qualitative bacterial identification/isolation. Thirty-nine specimens (23.9%) gave discordant results (positive via FA-PP and negative via culture). Real-life adjustments of empirical antimicrobial therapy (EAT) after FA-PP results resulted in additional costs beyond EAT alone of 1868.7 €. Adequate EAT adjustments upon FA-PP results would have resulted in a saving of 6675.8 €. In conclusion, the data presented supports the potential utility of FA-PP for early EAT adjustment in patients with ventilator-associated lower respiratory tract infection.

Modelling beef cows' individual response to short nutrient restriction in different lactation stages

Short-term nutrient restrictions can occur naturally in extensive beef cattle production systems due to low feed quality or availability. The aims of the study were to (1) model the curves of milk yield, plasma non-esterified fatty acids (NEFAs) and β-hydroxybutyrate (BHB) contents of beef cows in response to short nutritional challenges throughout lactation; (2) identify clusters of cows with different response profiles; (3) quantify differences in cows' response between the clusters and lactation stages. Data of BW, body condition score (BCS), milk yield, NEFA, and BHB plasma concentration from 31 adult beef cows (626 ± 48 kg at calving) were used to study the effect of 4-day feed restriction repeated over months 2, 3 and 4 of lactation. On each month, all cows received a single diet calculated to meet the requirements of the average cow: 100 % requirements for 4 days (d-4 to d-1, basal period), 55 % requirements on the next 4 days (d0 to d3, restriction period) and 100 % requirements for 4 days (d4 to d7, refeeding period). Natural cubic splines were used to model the response of milk yield, NEFA and BHB to restriction and refeeding in the 3 months. The new response variables [baseline value, peak value, days to peak and to regain baseline, and areas under the curve (AUC) during restriction and refeeding] were used to cluster cows according to their metabolic response (MR) into two groups: Low MR and High MR. The month of lactation affected all the traits, and basal values decreased as lactation advanced. Cows from both clusters had similar BW and BCS values, but those in the High MR cluster had higher basal milk yield, NEFA and BHB contents, and responded more intensely to restriction, with more marked peaks and AUCs. Reaction times were similar, and baseline values recovered during refeeding in both clusters. Our results suggest that the response was driven by cows' milk potential rather than size or body reserves, and despite high-responding cattle's higher milk yield, they were able to activate metabolic pathways to respond to and recover from the challenge.

Suitability of two rapid lateral flow immunochromatographic assays for predicting SARS-CoV-2 neutralizing activity of sera

Assessment of commercial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoassays for their capacity to provide reliable information on sera neutralizing activity is an emerging need. We evaluated the performance of two commercially available lateral flow immunochromatographic assays (LFIC; Wondfo SARS-CoV-2 Antibody test and the INNOVITA 2019-nCoV Ab test) in comparison with a SARS-CoV-2 neutralization pseudotyped assay for coronavirus disease 2019 (COVID-19) diagnosis in hospitalized patients and investigate whether the intensity of the test band in LFIC associates with neutralizing antibody (NtAb) titers. Ninety sera were included from 51 patients with moderate to severe COVID-19. A green fluorescent protein (GFP) reporter-based pseudotyped neutralization assay (vesicular stomatitis virus coated with SARS-CoV-2 spike protein) was used. Test line intensity was scored using a 4-level scale (0 to 3+). The overall sensitivity of LFIC assays was 91.1% for the Wondfo SARS-CoV-2 Antibody test, 72.2% for the INNOVITA 2019-nCoV IgG, 85.6% for the INNOVITA 2019-nCoV IgM, and 92.2% for the NtAb assay. Sensitivity increased for all assays in sera collected beyond day 14 after symptoms onset (93.9%, 79.6%, 93.9%, and 93.9%, respectively). Reactivities equal to or more intense than the positive control line (≥2+) in the Wondfo assay had a negative predictive value of 100% and a positive predictive value of 96.4% for high NtAb₅₀ titers (≥1/160). Our findings support the use of LFIC assays evaluated herein, particularly the Wondfo test, for COVID-19 diagnosis. We also find evidence that these rapid immunoassays can be used to predict high SARS-CoV-2-S NtAb₅₀ titers.

On-line monitoring of photosynthetic activity based on pH data to assess microalgae cultivation

Microalgae performance of outdoor cultivation systems is influenced by environmental and operating dynamics. Monitoring and control systems are needed to maximise biomass productivity and nutrient recovery. The goal of this work was to corroborate that pH data could be used to monitor microalgae performance by means of data from an outdoor membrane photobioreactor (MPBR) plant. In this system, microalgae photosynthetic activity was favoured over other physical and biological processes, so that the pH data dynamics was theoretically related to the microalgae carbon uptake rate (CUR). Short- and long-term continuous operations were tested to corroborate the relationship between the first derivate of pH data dynamics (pH') and microalgae photosynthetic activity. Short-term operations showed a good correlation between gross pH' values and MPBR performance. An indicator of the maximum daily average microalgae activity was assessed by a combination of on-line pH' measurements obtained in the long-term and a microalgae growth kinetic model. Both indicators contributed to the development of advanced real-time monitoring and control systems to optimise microalgae cultivation technology.

Qualitative assessment of SARS-CoV-2-specific antibody avidity by lateral flow immunochromatographic IgG/IgM antibody assay

Knowledge of the precise timing of SARS‐CoV‐2 infection may be of clinical and epidemiological relevance. The presence of low‐avidity IgGs has conventionally been considered an indicator of recent infection. Here, we carried out qualitative assessment of SARS‐CoV‐2‐specific antibody avidity using an urea (6M) dissociation test performed on a lateral flow immunochromatographic IgG/IgM device. We included a total of 76 serum specimens collected from 57 COVID‐19 patients, of which 39 tested positive for both IgG and IgM and 37 only for IgG. Sera losing IgG reactivity after urea treatment (n = 28) were drawn significantly earlier (P = .04) after onset of symptoms than those which preserved it (n = 48). This assay may be helpful to estimate the time of acquisition of infection in patients with mild to severe COVID‐19.

A LFIC test was adapted for assessing SARS‐CoV‐2 antibody avidity.

This urea dissociation LFIC assay may hep to determine the time of SARS‐CoV‐2 infection.

A negative energy balance during the peri-implantational period reduces dam IGF-1 but does not alter progesterone or pregnancy-specific protein B (PSPB) or fertility in suckled cows

The aim of this study was to evaluate the effect of a negative energy balance during the first third of gestation on metabolic, endocrine, and pregnancy recognition parameters in 2 beef cattle breeds adapted to semiextensive conditions. Seventy-five lactating Parda de Montaña and 40 Pirenaica multiparous cows rearing calves were synchronized and timed artificial inseminated (TAI) on day 76 postpartum. Cows were assigned to one of 2 diets (CONTROL or SUBNUT; 100% or 65% of their requirements supplied) until day 82 of gestation. Pregnancy was diagnosed 37 d post-TAI using ultrasound. Blood samples were obtained to determine metabolic (glucose, NEFA, β-hydroxybutyrate, cholesterol, and urea) and endocrine (IGF-1) status throughout the first third of gestation and to determine the concentrations of progesterone and pregnancy-specific protein B (PSPB) in the peri-implantational period. Undernutrition affected both cow and calf performance. The CONTROL cows maintained BCS and BW, whereas SUBNUT cows had negative daily gains. The CONTROL lactating calves had higher BW gains than SUBNUT. These negative effects were more evident in the Pirenaica breed, which was more sensitive to undernutrition. The negative energy balance was reflected in the cows' metabolic profiles, with higher NEFA values and lower IGF-1 concentrations in SUBNUT cows. However, undernutrition did not affect dam pregnancy/TAI or pregnancy recognition and maintenance, confirming that during periods of undernourishment pregnant dams prioritize the allocation of dietary energy toward reproductive functions. Progesterone concentration on day 21 post-TAI (with a 4.8 ng/mL cut-off value) and PSPB on day 26 post-TAI (with a 0.57 ng/mL cut-off value) were determined as the earliest indicators to accurately establish dam pregnancy status, regardless of breed or nutrition treatment. In summary, early undernutrition affected cow performance and metabolic profiles and impaired lactating calf growth, but did not affect progesterone or PSPB concentrations or the pregnancy/TAI rate in suckled cows.

Plant-wide modelling in wastewater treatment: showcasing experiences using the Biological Nutrient Removal Model

Plant-wide modelling can be considered an appropriate approach to represent the current complexity in water resource recovery facilities, reproducing all known phenomena in the different process units. Nonetheless, novel processes and new treatment schemes are still being developed and need to be fully incorporated in these models. This work presents a short chronological overview of some of the most relevant plant-wide models for wastewater treatment, as well as the authors' experience in plant-wide modelling using the general model BNRM (Biological Nutrient Removal Model), illustrating the key role of general models (also known as supermodels) in the field of wastewater treatment, both for engineering and research.

Standardization of acquisition protocols using PET/CT with 18F-Choline in prostate cancer

AIM

To standardize acquisition protocols for ¹⁸F-Choline PET/CT to prevent from urine interference, to determine the best time point for the whole-body study, and to assess whether "dual point" acquisition allows for differentiating malignant vs. benign lesions.

METHODS

One hundred consecutive patients with prostate cancer were prospectively studied. Immediately after ¹⁸F-Choline injection, a pelvis study was acquired, and a whole-body was subsequently obtained 1 and 2 hours p.i. Mean SUVmax was obtained in regions and for every sequential imaging. Mean analysis (χ²) and SUV percentage change (2/1 hours; 1 hours/0 min) were obtained. Metabolic pattern dynamics were assessed: accumulative vs. clearance. Patient follow-up after therapy and directed classification whenever ethically possible were performed.

RESULTS

Fifty-three prostate foci, without disturbing urinary activity was ever found on early images. Accumulative pattern in 42, with percentage increase was: 0 min/1 hour: +16.7% (χ²0.94); 1/2 hours: +10,0% (χ² 0.83). Clearance pattern in 11, with percentage decrease: 0 min/1 hour: -21.4% (χ²0.91): -7.7% (χ²0.85), corresponding in 7 to initial staging and in 4 post-radiotherapy biochemical recurrence. Every infradiaphragmatic uptake (n: 24) showed accumulative pattern, with percentage increase of +9.1% (χ²0.97), all of them depicted on early imaging. As for 12 supradiaphragmantic uptake, 8 of them showed clearance pattern with percentage decrease: -13.0% (χ²0.95). Accumulative pattern showed in 4 of them with percentage increase +13.0% (χ² 0.96), thus being assessed as invasive/malignant. Every bone uptake (n: 18) showed accumulative pattern, with percentage increase: +17.1% (χ²0.95), all of them depicted on 1 hour imaging.

CONCLUSIONS

As for prostate assessment is concerned, dual point at 0 min/1 hour proved to be the best procedure. As for supradiaphragmatic lymph-nodes detection, dual point with 1/2 hours performed best. As for infradiaphragmatic and bone involvement, as well as for inconclusive findings, the 2 hour imaging increased our diagnostic confidence.

Continuous 3-year outdoor operation of a flat-panel membrane photobioreactor to treat effluent from an anaerobic membrane bioreactor

A membrane photobioreactor (MPBR) plant was operated continuously for 3 years to evaluate the separate effects of different factors, including: biomass and hydraulic retention times (BRT, HRT), light path (Lp), nitrification rate (NOxR), nutrient loading rates (NLR, PLR) and others. The overall effect of all these parameters which influence MPBR performance had not previously been assessed. The multivariate projection approach chosen for this study provided a good description of the collected data and facilitated their visualisation and interpretation. Forty variables used to control and assess MPBR performance were evaluated during three years of continuous outdoor operation by means of principal component analysis (PCA) and partial least squares (PLS) analysis. The PCA identified the photobioreactor (PBR) light path as the factor with the largest influence on data variability. Other important factors were: nitrogen and phosphorus recovery rates (NRR, PRR), biomass productivity (BP), optical density of 680 nm (OD680), ammonium and phosphorus effluent concentration (NH₄, P), HRT, BRT, air flow rate (F_air) and nitrogen and phosphorus loading rates (NLR and PLR). The MPBR performance could be adequately estimated by a PLS model based on all the recorded variables, but this estimation worsened appreciably when only the controlled variables (Lp, F_air, HRT and BRT) were used as predictors, which underlines the importance of the non-controlled variables on MPBR performance. The microalgae cultivation process could thus only be partially controlled by the design and operating variables. A high nitrification rate was found to be inadvisable, since it showed an inverse correlation with NRR. In this respect, temperature and microalgae biomass concentration appeared to be the main factors to mitigate nitrifying bacteria activity.

The Importance of Rapid Influenza Testing in Pediatric Primary Care: Experience During Three Consecutive Influenza Seasons (2016-2019) in Barcelona (Catalonia, Spain)

Clinical diagnosis of influenza has low sensitivity in infants and children. Signs and symptoms are non-specific and similar to those of other respiratory viruses. Rapid influenza diagnostic tests (RIDTs) with adequate sensitivity and specificity used at the point of care can be useful for an etiologic diagnosis of influenza in primary care. This should have an impact on better management of these patients. We conducted a study during three consecutive influenza seasons (2016-2017, 2017-2018, and 2018-2019) in pediatric primary care settings collecting data from influenza point-of-care tests (POCTs)-confirmed ≤ 6-year-old patients. During the first two influenza seasons, antibiotic prescriptions and additional visits from influenza POCT-confirmed patients (Group_1) were compared to patients with influenza-like illness (ILI) (Group_2), or fever (2016 ICD-10 code R50) with no other signs of influenza (Group_3). Group_1 had 0.19 (2016-2017) and 0.23 (2017-2018) additional visits compared to 0.48 (2016-2017) and 0.49 (2017-2018) Group_2 p < 0.001 and 1.01 (2016-2017) and 0.80 (2017-2018) Group_3 p < 0.001. Antibiotic prescription was lower in Group_1 (10.2%) vs. Group_3 (17.2%) p < 0.002, difference statistically significant only for the 2017-2018 season. During the third season (2018-2019), RIDTs results were transmitted in real time to the reference laboratory ia the cloud, which strengthens the monitoring of circulating influenza viruses in the community. In our experience, the use of POCTs has a great potential in primary care specially in infants and young children in which the diagnosis maybe missed due to non-specific signs and symptoms.

Preliminary data set to assess the performance of an outdoor membrane photobioreactor

This data in brief (DIB) article is related to a Research article entitled 'Optimising an outdoor membrane photobioreactor for tertiary sewage treatment' [1]. Data related to the effect of substrate turbidity, the ammonium concentration at which the culture reaches nitrogen-deplete conditions and the microalgae growth rate under outdoor conditions is provided. Microalgae growth rates under different substrate turbidity were obtained to assess the reduction of the culture's light availability. Lab-scale experiments showed growth rates reductions of 22-44%. Respirometric tests were carried to know the limiting ammonium concentration in this microalgae-based wastewater treatment system. Growth rates (μ) of green microalgae Scenedesmus and Chlorella obtained under outdoor conditions; i.e. 0.40 d^-1 (R² = 0.993) and 0.43 d^-1 (R² = 0.995), respectively, can be useful to obtain optimum operating conditions of membrane photobioreactor (MPBR).

Effect of ambient temperature variations on an indigenous microalgae-nitrifying bacteria culture dominated by Chlorella

Two outdoor photobioreactors were operated to evaluate the effect of variable ambient temperature on an indigenous microalgae-nitrifying bacteria culture dominated by Chlorella. Four experiments were carried out in different seasons, maintaining the temperature-controlled PBR at around 25 °C (by either heating or cooling), while the temperature in the non-temperature-controlled PBR was allowed to vary with the ambient conditions. Temperatures in the range of 15-30 °C had no significant effect on the microalgae cultivation performance. However, when the temperature rose to 30-35 °C microalgae viability was significantly reduced. Sudden temperature rises triggered AOB growth in the indigenous microalgae culture, which worsened microalgae performance, especially when AOB activity made the system ammonium-limited. Microalgae activity could be recovered after a short temperature peak over 30 °C once the temperature dropped, but stopped when the temperature was maintained around 28-30 °C for several days.

Optimising an outdoor membrane photobioreactor for tertiary sewage treatment

The operation of an outdoor membrane photobioreactor plant which treated the effluent of an anaerobic membrane bioreactor was optimised. Biomass retention times of 4.5, 6, and 9 days were tested. At a biomass retention time of 4.5 days, maximum nitrogen recovery rate:light irradiance ratios, photosynthetic efficiencies and carbon biofixations of 51.7 ± 14.3 mg N·mol^-1, 4.4 ± 1.6% and 0.50 ± 0.05 kg CO₂·m³_influent, respectively, were attained. Minimum membrane fouling rates were achieved when operating at the shortest biomass retention time because of the lower solid concentration and the negligible amount of cyanobacteria and protozoa. Hydraulic retention times of 3.5, 2, and 1.5 days were tested at the optimum biomass retention times of 4.5 days under non-nutrient limited conditions, showing no significant differences in the nutrient recovery rates, photosynthetic efficiencies and membrane fouling rates. However, nitrogen recovery rate:light irradiance ratios and photosynthetic efficiency significantly decreased when hydraulic retention time was further shortened to 1 day, probably due to a rise in the substrate turbidity which reduced the light availability in the culture. Optimal carbon biofixations and theoretical energy recoveries from the biomass were obtained at hydraulic retention time of 3.5 days, which accounted for 0.55 ± 0.05 kg CO₂·m^-3_influent and 0.443 ± 0.103 kWh·m^-3_influent, respectively.

P-recovery in a pilot-scale struvite crystallisation reactor for source separated urine systems using seawater and magnesium chloride as magnesium sources

Practical recovery of a non-renewable nutrient, such as phosphorus (P), is essential to support modern agriculture in the near future. The high P content of urine, makes it an attractive source for practicing the recovery of this crucial nutrient. This paper presents the experimental results at pilot-plant scale of struvite crystallisation from a source-separated urine stream using two different magnesium sources, namely magnesium chloride and seawater. The latter was chosen as sustainable option to perform P-recovery in coastal areas. Real seawater was used to assess in a more realistic way its efficiency to precipitate P as struvite, since its composition (with noticeable concentration of ions such as Ca²⁺, SO₄^2-, Na⁺, …) could lead to the formation of impurities and other precipitates. 0.99 g of struvite was obtained per litre of urine irrespective of the operational conditions tested. In all tested conditions, precipitation efficiencies exceeded 90% and recovery efficiencies were higher than 87%, with an average struvite crystal size higher than 110 μm (and up to 320 μm, depending on the experimental conditions) in the harvested struvite samples. Almost pure struvite was obtained when MgCl₂ was used as precipitant, while amorphous calcium phosphate and other impurities appeared in the precipitates using seawater as magnesium source. However, the lower settling velocity of the amorphous precipitates in comparison with the struvite precipitates suggests that their separation at industrial scale could be relatively straightforward.

Dataset to assess the shadow effect of an outdoor microalgae culture

This data in brief (DIB) article is related to a Research article [1].

Microalgae biomass absorb the light photons that are supplied to the culture, reducing the light availability in the inner parts of the photobioreactors. This is known as self-shading or shadow effect. This effect has been widely studied in lab conditions, but information about self-shading in outdoor photobioreactors is scarce.

How this shadow effect affects the light availability in an outdoor photobioreactor was evaluated. In addition, advantages and disadvantages of different artificial light sources which can overcome light limitation are described.

Occurrence of antibiotics and bacterial resistance in wastewater and sea water from the Antarctic

The potential presence of introduced antibiotics in the aquatic environment is a hot topic of concern, particularly in the Antarctic, a highly vulnerable area protected under the Madrid protocol. The increasing presence of human population, especially during summer, might led to the appearance of pharmaceuticals in wastewater. The previous discovery of Escherichia coli strains resistant to antibiotics in sea water and wastewater collected in King George Island motivated our investigation on antibiotics occurrence in these samples. The application of a multi-residue LCMS/MS method for 20 antibiotics, revealed the presence of 8 compounds in treated wastewater, mainly the quinolones ciprofloxacin and norfloxacin (92% and 54% of the samples analyzed, average concentrations 0.89 μg/L and 0.75 μg/L, respectively) and the macrolides azithromycin and clarithromycin (15% positive samples, and average concentrations near 0.4 μg/L), and erythromycin (38% positive samples, average concentration 0.003 μg/L). Metronidazole and clindamycin were found in one sample, at 0.17 and 0.1 μg/L, respectively; and trimethoprim in two samples, at 0.001 μg/L. Analysis of sea water collected near the outfall of the wastewater discharges also showed the sporadic presence of 3 antibiotics (ciprofloxacin, clindamycin, trimethoprim) at low ng/L level, illustrating the impact of pharmaceuticals consumption and the poor removal of these compounds in conventional WWTPs. The most widespread antibiotic in sea water was ciprofloxacin, which was found in 15 out of 34 sea water samples analyzed, at concentrations ranging from 4 to 218 ng/L. Bacteria resistance was observed for some antibiotics identified in the samples (e.g. trimetropim and nalidixic acid -a first generation quinolone). However, resistance to some groups of antibiotics could not be correlated to their presence in the water samples due to analytical limitations (penicillins, tetraciclines). On the contrary, for some groups of antibiotics detected in samples (macrolides), the antibacterial activity against E. Coli was not investigated because these antibiotics do not include this bacterial species in their spectrum of activity. Our preliminary data demonstrate that antibiotics occurrence in the Antarctic aquatic environment is an issue that needs to be properly addressed. Periodical monitoring of water samples and the implementation of additional treatments in the WWTPs are recommended as a first step to prevent potential problems related to the presence of antibiotics and other emerging contaminants in the near future in Antarctica.

Resource recovery from sulphate-rich sewage through an innovative anaerobic-based water resource recovery facility (WRRF)

This research work proposes an innovative water resource recovery facility (WRRF) for the recovery of energy, nutrients and reclaimed water from sewage, which represents a promising approach towards enhanced circular economy scenarios. To this aim, anaerobic technology, microalgae cultivation, and membrane technology were combined in a dedicated platform. The proposed platform produces a high-quality solid- and coliform-free effluent that can be directly discharged to receiving water bodies identified as sensitive areas. Specifically, the content of organic matter, nitrogen and phosphorus in the effluent was 45 mg COD·L^-1, 14.9 mg N·L^-1 and 0.5 mg P·L^-1, respectively. Harvested solar energy and carbon dioxide biofixation in the form of microalgae biomass allowed remarkable methane yields (399 STP L CH₄·kg^-1 COD_inf) to be achieved, equivalent to theoretical electricity productions of around 0.52 kWh per m³ of wastewater entering the WRRF. Furthermore, 26.6% of total nitrogen influent load was recovered as ammonium sulphate, while nitrogen and phosphorus were recovered in the biosolids produced (650 ± 77 mg N·L^-1 and 121.0 ± 7.2 mg P·L^-1).

Predictive and Comparative Study Between Clinic Consensus Document for Pancreas Acceptance and Predictive Value of Preprocurement Pancreas Allocation Suitability Score (P-PASS)

The strict selection of pancreas for transplant has forced the development of different documents to select the suitable organ in order to minimize the risks and complications of the transplant. In 2008, Eurotransplant published the Preprocurement Pancreas Allocation Suitability Score (P-PASS) for pretransplant selection. In 2001 the Hospital Clinic of Barcelona developed a Clinical Consensus Document (CCD).

OBJECTIVES

We aimed to analyze the predictive decision of the pancreas acceptance to offers received in the hospital, according to the CCD criteria and compare it with the recommended value of suitability for accepting the pancreas according to the P-PASS value.

MATERIAL AND METHODS

We performed a retrospective comparative study between the criteria of selection of the CCD for pancreas from 2016-2017 in comparison with the values obtained if the P-PASS had been used: ≤ 17, acceptance criteria and P-PASS; > 17, risk criteria. We defined the organ reported as rejected or accepted. The accepted organ could be procured and transplanted or discarded.

RESULTS

With the CCD criteria, 7 more organs were transplanted than if we only applied the potential P-PASS criteria. In contrast, P-PASS would have ruled out an additional 9% of pancreases in relation to CCD criteria.

CONCLUSIONS

According our experience, it is difficult to find an adequate prediction model to select pancreas for transplantation. The application of the DCC criteria increases the number of organs valid for transplantation. At present, new criteria should be re-evaluated within multicenter studies.

Real-time optimization of the key filtration parameters in an AnMBR: Urban wastewater mono-digestion vs. co-digestion with domestic food waste

This study describes a model-based method for real-time optimization of the key filtration parameters in a submerged anaerobic membrane bioreactor (AnMBR) treating urban wastewater (UWW) and UWW mixed with domestic food waste (FW). The method consists of an initial screening to find out adequate filtration conditions and a real-time optimizer applied to a periodically calibrated filtration model for minimizing the operating costs. The initial screening consists of two statistical analyses: (1) Morris screening method to identify the key filtration parameters; (2) Monte Carlo method to establish suitable initial control inputs values. The operating filtration cost after implementing the control methodology was €0.047 per m³ (59.6% corresponding to energy costs) when treating UWW and €0.067 per m³ when adding FW due to higher fouling rates. However, FW increased the biogas productivities, reducing the total costs to €0.035 per m³. Average downtimes for reversible fouling removal of 0.4% and 1.6% were obtained, respectively. The results confirm the capability of the proposed control system for optimizing the AnMBR performance when treating both substrates.

Influence of postweaning feeding management of beef heifers on performance and physiological profiles through rearing and first lactation

The aim of this study was to examine the effects of 2 postweaning feeding management approaches (FEED: 0.8 [HIGH] vs 0.6 [MOD] kg/d target ADG) on the performance of heifers of 2 beef breeds (BREED: Parda de Montaña [PA] vs Pirenaica) calving at 2 yr. Twenty-five heifers previously creep fed before weaning (6 mo) were assigned to 2 planes of nutrition from 6 to 15 mo of age. At 15 mo, they were inseminated, and then received similar diets until weaning of their first calf (4 mo postcalving). Several parameters were measured to analyze growth and development (BW; ADG; size measures at 6 mo, 15 mo, calving, and weaning), performance at puberty and first breeding, and dam and calf performance in the first lactation (calving traits, ADG, milk yield). Metabolic (glucose, cholesterol, NEFA, β-hydroxybutyrate, and urea) and endocrine status (IGF-I and leptin) were assessed in plasma samples collected every 3 mo from 6 mo to calving and monthly during lactation. No interaction between BREED and FEED was observed. Heifers from the HIGH feeding treatment had higher postweaning ADG than those on the LOW diet. At 15 mo, they had greater BW, heart girth, and external pelvic area, but they did not differ thereafter. All heifers reached puberty at similar BW (55% mature BW) but different ages. Heifers from the HIGH treatment tended (P < 0.09) to be pubertal earlier, and PA heifers were 1.6 mo younger than Pirenaica heifers (P < 0.05) at puberty. At the time of conception (452 ± 59 kg) and calving (471 ± 51 kg), BW was above common recommendations in all groups. Calving traits and performance in lactation did not differ between feeding treatments. BREED only influenced birth weight; PA calves being heavier (P < 0.05), which resulted in a larger calf/cow BW ratio, but no effect on calving difficulty or subsequent performance. Metabolic substrates and hormones depended mostly on sampling date, which was related to current energy and protein intake. Glucose (P < 0.001), cholesterol (P < 0.001), and IGF-I (P < 0.05) were greater during the postweaning phase in heifers on the HIGH diet, and persistent physiological effects were observed during lactation. Age at puberty was negatively related with IGF-I (r = -0.43, P < 0.001), but not with leptin concentrations. In conclusion, regardless of breed, a moderate growth rate ensured adequate heifer development and performance until the first lactation, whereas no advantage was gained from enhanced postweaning gains.

Effects of soiling on photovoltaic (PV) modules in the Atacama Desert

Soiling by dry deposition affects the power output of photovoltaic (PV) modules, especially under dry and arid conditions that favor natural atmospheric aerosols (wind-blown dust). In this paper, we report on measurements of the soiling effect on the energy yield of grid-connected crystalline silicon PV modules deployed in five cities across a north-south transect of approximately 1300 km in the Atacama Desert ranging from latitude 18°S to latitude 30°S. Energy losses were assessed by comparing side-by-side outputs of four co-planar PV modules. Two of the PV modules of the array were kept clean as a control, while we allowed the other two to naturally accumulate soiling for 12 months (from January 2017 to January 2018). We found that the combination of high deposition rates and infrequent rainfalls led to annual energy losses that peaked at 39% in the northern coastal part of the desert. In contrast, annual energy losses of 3% or less were measured at relatively high-altitude sites and also at locations in the southern part of the desert. For comparison, soiling-induced annual energy losses of about 7% were measured in Santiago, Chile (33°S), a major city with higher rainfall frequency but where urban pollution plays a significant role.

Outdoor flat-panel membrane photobioreactor to treat the effluent of an anaerobic membrane bioreactor. Influence of operating, design, and environmental conditions

As microalgae have the ability to simultaneously remove nutrients from wastewater streams while producing valuable biomass, microalgae-based wastewater treatment is a win-win strategy. Although recent advances have been made in this field in lab conditions, the transition to outdoor conditions on an industrial scale must be further investigated. In this work an outdoor pilot-scale membrane photobioreactor plant was operated for tertiary sewage treatment. The effects of different parameters on microalgae performance were studied including: temperature, light irradiance (solar and artificial irradiance), hydraulic retention time (HRT), biomass retention time (BRT), air sparging system and influent nutrient concentration. In addition the competition between microalgae and ammonium oxidising bacteria for ammonium was also evaluated. Maximum nitrogen and phosphorus removal rates of 12.5 ± 4.2 mgN·L^-1·d^-1 and 1.5 ± 0.4 mgP·L^-1·d^-1, respectively, were achieved at a BRT of 4.5 days and HRT of 2.5 days, while a maximum biomass productivity of 78 ± 13 mgVSS·L^-1·d^-1 (VSS: volatile suspended solids) was reached. While the results obtained so far are promising, they need to be improved to make the transition to industrial scale operations feasible.

Effect of long residence time and high temperature over anaerobic biodegradation of Scenedesmus microalgae grown in wastewater

Anaerobic digestion of indigenous Scenedesmus spp. microalgae was studied in continuous lab-scale anaerobic reactors at different temperatures (35 °C and 55 °C), and sludge retention time - SRT (50 and 70 days). Mesophilic digestion was performed in a continuous stirred-tank reactor (CSTR) and in an anaerobic membrane bioreactor (AnMBR). Mesophilic CSTR operated at 50 days SRT only achieved 11.9% of anaerobic biodegradability whereas in the AnMBR at 70 days SRT and 50 days HRT reached 39.5%, which is even higher than the biodegradability achieved in the thermophilic CSTR at 50 days SRT (30.4%). Microbial analysis revealed a high abundance of cellulose-degraders in both reactors, AnMBR (mainly composed of 9.4% Bacteroidetes, 10.1% Chloroflexi, 8.0% Firmicutes and 13.2% Thermotogae) and thermophilic CSTR (dominated by 23.8% Chloroflexi and 12.9% Firmicutes). However, higher microbial diversity was found in the AnMBR compared to the thermophilic CSTR which is related to the SRT. since high SRT promoted low growth-rate microorganisms, increasing the hydrolytic potential of the system. These results present the membrane technology as a promising approach to revalue microalgal biomass, suggesting that microalgae biodegradability and consequently the methane production could be improved operating at higher SRT.

Influence of food waste addition over microbial communities in an Anaerobic Membrane Bioreactor plant treating urban wastewater

Notorious changes in microbial communities were observed during and after the joint treatment of wastewater with Food Waste (FW) in an Anaerobic Membrane Bioreactor (AnMBR) plant. The microbial population was analysed by high-throughput sequencing of the 16S rRNA gene and dominance of Chloroflexi, Firmicutes, Synergistetes and Proteobacteria phyla was found. The relative abundance of these potential hydrolytic phyla increased as a higher fraction of FW was jointly treated. Moreover, whereas Specific Methanogenic Activity (SMA) rose from 10 to 51 mL CH₄ g^-1 VS, Methanosarcinales order increased from 34.0% over 80.0% of total Archaea, being Methanosaeta the dominant genus. The effect of FW over AnMBR biomass was observed during the whole experience, as methane production rose from 49.2 to 144.5 L CH₄ · kg^-1 influent COD. Furthermore, biomethanization potential was increased over 82% after the experience. AnMBR technology allows the established microbial community to remain in the bioreactor even after the addition of FW, improving the anaerobic digestion of urban wastewater.

Asbestos-related disease in upholsterers

Before its use was banned in developed countries, asbestos was widely applied in upholstery. However, the risk of asbestos diseases among upholsterers has only rarely been reported. In this case series, we present a first series of 6 workers employed in small workshops who developed several asbestos-related diseases, including pleural plaques, pleural fibrosis, and asbestosis. Exposures were intermittent and difficult to quantify, but lung asbestos content assessed by bronchoalveolar lavage was high in the 3 patients evaluated. In conclusion, upholstery work should be considered an at-risk occupation for developing asbestos-related diseases during the 20th century.

Abstract P2-12-05: Real-time, intraoperative detection of residual breast cancer in lumpectomy cavity margins using the LUM imaging system: Results of a feasibility study

Background: Obtaining tumor-free margins is critical for local control in breast conserving surgery. Currently, 20-40% of lumpectomy patients have positive margins that require surgical re-excision. We assessed the LUM Imaging System for real-time, intraoperative detection of residual tumor in breast cancer patients. The LUM System has the particular advantage of assessing in vivo lumpectomy cavity walls rather than excised specimens, to enable more accurate excision of residual tumor.

Methods: Lumpectomy cavity walls of patients undergoing lumpectomy for invasive breast cancer or ductal carcinoma in situ (DCIS), were assessed intraoperatively using the LUM Imaging System (Lumicell Inc., Wellesley MA). LUM015, a cathepsin-activatable fluorescent agent, was given IV 4±2 hrs prior to surgery. Areas of fluorescence generated at potential sites of residual tumor in lumpectomy cavities were evaluated with a sterile hand-held device, displayed on a monitor, excised and correlated with histopathology.

Results: In vivo lumpectomy cavities were imaged with the LUM Imaging System in 60 breast cancer patients. 5 were imaged without dye. 55 received LUM015 dye preoperatively and were scanned intraoperatively. Median age was 60 years (range 44-79). Mean tumor size was 1.2cm (0.06-3.5cm) with 71% invasive cancers, 29% DCIS. The test set included 569 cavity margin surfaces assessed intraoperatively and excised. Image acquisition for each margin took approximately 1 second. The LUM Imaging System showed 100% sensitivity and 73% specificity for detection of tumor &lt;2mm from the margin. Invasive ductal cancer (IDC), invasive lobular cancer (ILC) and areas of DCIS 1mm in size could be identified. 8 patients had positive margins on standard histopathology analysis (Table). The LUM System correctly identified all positive margins identified by standard histopathology and correctly predicted negative re-excisions in 2 of 8 patients. There were no serious adverse events. 1 patient had extravasation of LUM015 at her injection site with temporary blue skin staining but no other complication.

Conclusions: The LUM Imaging System allows real-time identification of residual tumor in the lumpectomy cavity of breast cancer patients. No sites of residual tumor were missed. Additional studies are underway to optimize this approach for reducing positive margins and second surgeries in breast cancer patients.

Table: Margin results in 8 patients with positive margins on initial lumpectomy specimenPositive lumpectomy margin histopathologyLUM cavity wall result (+/- for tumor)Tumor found at re-excisionDCIS++DCIS+-DCIS++IDC++ (Mastectomy)ILC++ (Mastectomy)DCIS+-IDC--DCIS--

Citation Format: Lanahan CR, Gadd MA, Specht MC, Ferrer J, Tang R, Rai U, Merrill AL, Biernacka A, Brachtel E, Smith BL. Real-time, intraoperative detection of residual breast cancer in lumpectomy cavity margins using the LUM imaging system: Results of a feasibility study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-12-05.

Wastewater nutrient removal in a mixed microalgae-bacteria culture: effect of light and temperature on the microalgae-bacteria competition

The aim of this study was to evaluate the effect of light intensity and temperature on nutrient removal and biomass productivity in a microalgae-bacteria culture and their effects on the microalgae-bacteria competition. Three experiments were carried out at constant temperature and various light intensities: 40, 85 and 125 µE m^-2 s^-1. Other two experiments were carried out at variable temperatures: 23 ± 2°C and 28 ± 2°C at light intensity of 85 and 125 µE m^-2 s^-1, respectively. The photobioreactor was fed by the effluent from an anaerobic membrane bioreactor. High nitrogen and phosphorus removal efficiencies (about 99%) were achieved under the following operating conditions: 85-125 µE m^-2 s^-1 and 22 ± 1°C. In the microalgae-bacteria culture studied, increasing light intensity favoured microalgae growth and limited the nitrification process. However, a non-graduated temperature increase (up to 32°C) under the light intensities studied caused the proliferation of nitrifying bacteria and the nitrite and nitrate accumulation. Hence, light intensity and temperature are key parameters in the control of the microalgae-bacteria competition. Biomass productivity significantly increased with light intensity, reaching 50.5 ± 9.6, 80.3 ± 6.5 and 94.3 ± 7.9 mgVSS L^-1 d^-1 for a light intensity of 40, 85 and 125 µE m^-2 s^-1, respectively.

Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening

BACKGROUND

Our aim was to assess the cumulative risk of false-positive screening results, screen-detected cancer, and interval breast cancer in mammography screening among women with and without a previous benign breast disease and a family history of breast cancer.

METHODS

The cohort included 42 928 women first screened at the age of 50-51 years at three areas of the Spanish Screening Programme (Girona, and two areas in Barcelona) between 1996 and 2011, and followed up until December 2012. We used discrete-time survival models to estimate the cumulative risk of each screening outcome over 10 biennial screening exams.

RESULTS

The cumulative risk of false-positive results, screen-detected breast cancer, and interval cancer was 36.6, 5.3, and 1.4 for women with a previous benign breast disease, 24.1, 6.8, and 1.6% for women with a family history of breast cancer, 37.9, 9.0, and 3.2%; for women with both a previous benign breast disease and a family history, and 23.1, 3.2, and 0.9% for women without either of these antecedents, respectively.

CONCLUSIONS

Women with a benign breast disease or a family history of breast cancer had an increased cumulative risk of favourable and unfavourable screening outcomes than women without these characteristics. A family history of breast cancer did not increase the cumulative risk of false-positive results. Identifying different risk profiles among screening participants provides useful information to stratify women according to their individualised risk when personalised screening strategies are discussed.