Bioindicator value of flagellates in urban wastewater treatment using membrane bioreactors.

Two experimental submerged membrane bioreactors (MBR) at the industrial scale with different membranes (microfiltration and ultrafiltration) were used to analyse the influence of the small flagellates on the lack of significance of the sludge biotic index (SBI). Also, with these systems, flagellates were analysed as bioindicators in the activated sludge of MBRs. Both facilities were operated in parallel with a pre-denitrification system for a period of nearly two years and fed with real pretreated urban wastewater. During the experimental period, the sludge-retention time in the facilities was from 16.5 to 36.5 days, the organic loading ranged between 1.8 Kg COD/d m3 and 0.14 Kg COD/d m3, and the temperature of the activated sludge was between 32.8 and 12.8 °C. Under these conditions, the concentrations of total solids in the activated sludge reached 21.6 and 0.3 g/L, and the ratio of food:microrganims (F:M) remained stable at around 0.1 Kg BOD5/Kg VSS day, while the trans-membrane pressure (TMP) followed an increasing trend. Both facilities presented a high capacity for organic matter elimination and complete nitrification. The small flagellates were present throughout the experimental period in the activated sludge and showed no significant bioindicator role in the MBR systems which limited the application of SBI. Of the large flagellates studied, only Peranema sp. could be considered to be a bioindicator of MBR systems, indicating the effectiveness of denitrification for systems with complete nitrification and correlating with the time course of the TMP.

[Opinions of healthcare professionals on the definition of severe mental illness: a qualitative study]. / Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo.

BACKGROUND: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. METHODOLOGY: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. RESULTS: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals' discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. CONCLUSIONS: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate.

Opiniones de los profesionales del ámbito sanitario acerca de la definición de trastorno mental grave. Un estudio cualitativo / Opinions of healthcare professionals on the definition of severe mental illness. A qualitative study

Fundamento: Aunque a lo largo de los años se han propuesto diferentes definiciones de trastorno mental grave (TMG), aún existe una gran controversia a la hora de obtener una definición consensuada. El objetivo de este trabajo fue analizar la opinión de un grupo de profesionales de la red pública de servicios sanitarios sobre cuáles son los criterios que se deben tener en cuenta en la definición de TMG. Método: Estudio cualitativo en el cual se llevaron a cabo 5 grupos focales con profesionales (psiquiatras, psicólogos, enfermeras, médicos de familia, monitores y trabajadores sociales) relacionados con la atención a la salud mental del área de la Unidad de Gestión Clínica Salud Mental del Hospital Regional Universitario Carlos Haya de Málaga (España). Se codificaron las transcripciones mediante un análisis de contenido llevado a cabo por tres investigadoras de forma independiente. Resultados: Los profesionales entrevistados estuvieron de acuerdo en que debe tenerse en cuenta un cierto grado de disfuncionalidad para la definición de un TMG. Sin embargo, existía cierta discrepancia en función de la profesión en la inclusión de dimensiones como el diagnóstico, el soporte familiar y social, el uso de recursos sanitarios y la duración de la enfermedad como criterios necesarios y suficientes para la definición de TMG. En el discurso de los profesionales emergieron variables personales de los pacientes como la edad de comienzo de la enfermedad, la falta de insight y el nivel de formación, como relevantes para la definición del TMG. Conclusión: Además de las dimensiones propuestas por la literatura, los profesionales de salud mental entrevistados consideran otros criterios a tener en cuenta en la definición del TMG. Los discursos difieren en función de la profesión y ámbito laboral al que pertenecen (AU)

Background: Over the years, a number of definitions of severe mental illness (SMI) have been proposed and substantial controversy about the definition still remains. The aim of this study was to evaluate the views of a group of mental health professionals on the appropriate criteria for defining SMI. Methodology: This was a qualitative study, based on five focus groups with mental health professionals (psychiatrists, psychologists, nurses, general practitioners, monitors and social workers) from Carlos Haya Hospital in Malaga, Spain. A content analysis was performed on the transcriptions by three independent researchers. Results: The professionals agreed that a certain degree of dysfunctionality must be present for a definition of SMI. There was some disagreement between the different categories of professionals regarding the inclusion of dimensions such as diagnosis, family and social support, use of healthcare resources and duration of the illness as necessary and sufficient criteria for the definition of SMI. From the professionals’ discourse, some personal patient variables such as age of onset of illness, lack of insight and level of education emerged as relevant for the definition of SMI. Conclusions: Apart from the dimensions considered in the literature, the interviewed mental health professionals discussed other criteria that could be taken into account in the definition of SMI. Perceptions differ between categories of professional and work settings in which they operate (AU)

Evolution of filamentous bacteria during urban wastewater treatment by MBR.

Evolution of filamentous bacteria in two full-scale experimental MBR systems (microfiltration and ultrafiltration) was studied during two years. Sludge Retention Time (SRT) and Hydraulic Retention Time (HRT) were modified and acted as variables, together with temperature and variation in loading. With SRT values between 20 and 35 d and HRT between 31 and 40 h, both MBR systems presented a high density of filamentous bacteria, according to the Filamentous Index (FI) and Simplified Technique of Filamentous Count (STFC). Highest density was achieved when contaminant loads were high and temperature was low. However, the elevated presence of filamentous bacteria did not affect the quality of effluent or the permeability of the membranes. Nocardioform bacteria showed a high degree of adaptation to the characteristics of the system. Predominance of Nocardioforms gave rise to isolated episodes of massive growth at temperatures between 15 and 20°C, which in turn caused episodes of intense foaming whose most significant consequence was a loss in biomass, leading to a slight increase in transmembrane pressure. In the light of these results, FI and STFC should not be considered as suitable tools for predicting operational problems deriving from filamentous bacteria in MBR systems, which could be prevented through identification.

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR).

BACKGROUND: The electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice. METHODS: Parameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n=1345) or a new oral antipsychotic (AP) (n=277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review. RESULTS: At 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p<0.0001) and reduction in Clinical Global Impression Severity scores (-1.14 for RLAI versus -0.94 for APs, p=0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p<0.05) and days (18.74 versus 13.02, p<0.01) of hospitalizations at 24 months than oral AP patients. CONCLUSIONS: This 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.

Gluconeogenesis-linked glycogen metabolism is important in the achievement of in vitro capacitation of dog spermatozoa in a medium without glucose.

In vitro capacitation of dog spermatozoa in a medium without sugars and with lactate as the metabolic substrate (l-CCM) was accompanied by a progressive increase of intracellular glycogen during the first 2 h of incubation, which was followed by a subsequent decrease of glycogen levels after up to 4 h of incubation. Lactate from the medium is the source for the observed glycogen synthesis, as the presence of [(14)C]glycogen after the addition to l-CCM with [(14)C]lactate was demonstrated. The existence of functional gluconeogenesis in dog sperm was also sustained by the presence of key enzymes of this metabolic pathway, such as fructose 1,6-bisphophatase and aldolase B. On the other hand, glycogen metabolism from gluconeogenic sources was important in the maintenance of a correct in vitro fertilization after incubation in the l-CCM. This was demonstrated after the addition of phenylacetic acid (PAA) to l-CCM. In the presence of PAA, in vitro capacitation of dog spermatozoa suffered alterations, which translated into changes in capacitation functional markers, like the increase in the percentage of altered acrosomes, a distinct motion pattern, decrease or even disappearance of capacitation-induced tyrosine phosphorylation, and increased heterogeneity of the chlorotetracycline pattern in capacitated cells. Thus, this is the first report indicating the existence of a functional glyconeogenesis in mammalian spermatozoa. Moreover, gluconeogenesis-linked glycogen metabolism seems to be of importance in the maintenance of a correct in vitro capacitation in dog sperm in the absence of hexoses in the medium.

In vitro capacitation and acrosome reaction of dog spermatozoa can be feasibly attained in a defined medium without glucose.

Incubation of dog spermatozoa in a medium without glucose and in the presence of lactate and pyruvate (l-CCM) for 4 h at 38.5 degrees C in a 5% CO(2) atmosphere induced in vitro capacitation of these cells. This was verified after the combined specific capacitation-like changes in percentages of viability and altered acrosomes, motility characteristics, sperm location of reactivity against Pisum sativum, Arachis hypogaea and Helix pomatia lectins and the tyrosine phosphorylation pattern. Furthermore, a feasible acrosome reaction (AR) was induced when spermatozoa incubated in l-CCM for 4 h were further co-incubated for 1 h with canine oocytes. This was demonstrated by AR-like changes in percentages of viability, altered acrosomes, motility characteristics and sperm location of reactivity against P. sativum, A. hypogaea and H. pomatia lectins. All these results clearly indicate that in vitro capacitation, and subsequent AR, can be feasibly achieved without the presence of sugars. This ability can be related to the specific characteristics of energy-metabolism regulation reported in dog spermatozoa.

The effect of rectus EMG patterns on the outcome of rectus femoris transfers.

Rectus femoris transfer to the sartorius is performed in children with cerebral palsy to treat stiff-knee gait. To determine whether preoperative electromyographic (EMG) activity of the rectus femoris is predictive of outcome, we studied 25 children with stiff-knee gait who had preoperative EMG gait analysis before rectus femoris transfer. Fifteen patients had bilateral surgery, and 10 patients had unilateral surgery. The mean age at surgery was 9.6 years for the retrospective review. Patients were divided into three groups based on the recorded EMG patterns of the rectus femoris during the gait cycle. Group I patients had predominant swing-phase activity only. Group II patients had constant rectus activity through the entire gait cycle. Group III patients had normal rectus, defined as minimal EMG activity in the last 75% of swing phase. A repeated gait analysis at a mean of 1.5 years after surgery was available for comparison. In group I, mean peak knee flexion increased 26 degrees after surgery from 44 to 70 degrees. In group II, mean peak knee flexion increased 18 degrees after surgery from 51 to 69 degrees. In group III, mean peak knee flexion increased 12 degrees from 54 to 66 degrees. Results of this study show the greatest improvement in outcome, as measured by knee flexion, occurred in group I in which the rectus fired predominantly in swing phase. Preoperative EMG patterns are therefore useful in determining the outcome after rectus femoris transfer to the sartorius.