Achieving Equity in Childhood Vaccination: A Mixed-Methods Study of Immunization Programs, Policies, and Coverage in 3 US States.

OBJECTIVE: In this study, we sought to understand patterns of childhood vaccinations in the United States across socioeconomic and racial/ethnic groups over a 12-year period to identify interventions that improve immunization equity and inform public health practice. DESIGN: We conducted an explanatory, sequential, mixed-methods study. US state- and county-level immunization data were analyzed to understand trends in immunization coverage among racial/ethnic groups. Qualitative interviews with public health and community leaders were used to explain trends, gain insight into routine childhood immunization interventions, and understand local contexts and data limitations. PARTICIPANTS AND SETTING: Secondary data were used from the National Immunization Survey-Child (NIS) public use data sets (2007 and 2019). Eligible participants for qualitative interviews were routine childhood immunization stakeholders from selected counties in North Carolina, Washington, and Arizona. MAIN OUTCOME MEASURE: Our integrated findings report trends and probability of children aged 19 months to 3 years being fully vaccinated (measles-mumps-rubella [MMR], diphtheria and tetanus toxoids and acellular pertussis [DTaP], hepatitis B [Hep B]), interventions, and recommendations to improve routine childhood immunization coverage and equity. RESULTS: Vaccination coverage remained high and relatively stable between 2007 and 2019; however, there were differences across racial/ethnic groups. Public health leaders identified key interventions that effectively improved vaccine equity and coverage, including data quality improvement, tailored interventions for specific populations, multisector partnerships, addressing common barriers, and data limitations. Participants also identified the critical role of state policies, public health funding, and community vaccine norms. CONCLUSIONS: Variability persists in vaccination coverage and equity across states, race/ethnicity, and socioeconomic status despite decades of interventions. Vaccine stakeholders should use our findings to improve coverage and reduce disparities. Equitable improvements can be realized through policy change, data tracking/infrastructure improvements, and tailored interventions. Furthermore, local partners are critical in improving vaccine coverage and equitable interventions to disrupt disparities that long hold true for vaccine-preventable diseases.

Mach-Zehnder Modulators for Microwave Polarization Measurement in Astronomy Applications.

This paper presents a study of the performances of different Mach-Zehnder modulation technologies with applications in microwave polarimeters based on a near-infrared (NIR) frequency up-conversion stage, allowing for optical correlation and signal detection at a wavelength of 1550 nm. Commercial Mach-Zehnder modulators (MZMs) are traditionally implemented using LiNbO3 technology, which does not enable integration for the fabrication of MZMs. In this work, we propose the use of an alternative technology based on InP, which allows for integration in the fabrication process. In this way, it is possible to obtain advantages in terms of bandwidth, cost, and size reductions, which yield results that are very interesting for wide-band applications such as microwave instrumentation for the study of the cosmic microwave background (CMB). Here, we describe and compare the modulation performances of different MZMs, with one commercial unit presenting a higher bandwidth than those in previous works, and another three InP integrated units provided by the Fraunhofer Institute for Telecommunications, Heinrich-Hertz-Institute (HHI). Then, these modulators were coupled to a microwave polarimeter demonstrator, which has also been presented previously, to compare the polarization measurement performances of each of the MZMs.

Consensus on the management of united airways disease with type 2 inflammation: a multidisciplinary Delphi study.

BACKGROUND: Scientific evidence on patients with multimorbid type 2 asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) from a united airways disease (UAD) perspective remains scarce, despite the frequent coexistence of these entities. We aimed to generate expert consensus-based recommendations for the management of UAD patients. METHODS: Using a two-round Delphi method, Spanish expert allergists, pulmonologists and otolaryngologists expressed their agreement on 32 statements (52 items) on a 9-point Likert scale, classified as appropriate (median 7-9), uncertain (4-6) or inappropriate (1-3). Consensus was considered when at least two-thirds of the panel scored within the range containing the median. RESULTS: A panel of 30 experts reached consensus on the appropriateness of 43 out of the 52 (82.7%) items. The usefulness of certain biomarkers (tissue and peripheral blood eosinophil count, serum total IgE, and fraction of exhaled nitric oxide [FeNO]) in the identification and follow-up of type 2 inflammation, and assessment of the response to biologics, were agreed. Some of these biomarkers were also associated with disease severity and/or recurrence after endoscopic sinus surgery (ESS). Consensus was achieved on treatment strategies related to the prescription of anti-IL-4/IL-13 or anti-IgE agents, concomitant treatment with systemic corticosteroids, and combining or switching to biologics with a different mechanism of action, considering a number of UAD clinical scenarios. CONCLUSION: We provide expert-based recommendations to assist in clinical decision-making for the management of patients with multimorbid type 2 asthma and CRSwNP. Specific clinical trials and real-world studies focusing on the single-entity UAD are required to address controversial items.

Optimization of a Microwave Polarimeter for Astronomy with Optical Correlation and Detection.

Cosmic Microwave Background (CMB) B-modes detection is the main focus of future CMB experiments because of the valuable information it contains, particularly to probe the physics of the very early universe. For this reason, we have developed an optimized polarimeter demonstrator sensitive to the 10-20 GHz band in which the signal received by each antenna is modulated into a Near Infrared (NIR) laser by a Mach-Zehnder modulator. Then, these modulated signals are optically correlated and detected using photonic back-end modules consisting of voltage-controlled phase shifters, a 90-degree optical hybrid, a pair of lenses, and an NIR camera. During laboratory tests, a 1/f-like noise signal related to the low phase stability of the demonstrator has been found experimentally. To solve this issue, we have developed a calibration method that allows us to remove this noise in an actual experiment, until obtaining the required accuracy level in the measurement of polarization.

Polarization Calibration of a Microwave Polarimeter with Near-Infrared Up-Conversion for Optical Correlation and Detection.

This paper presents a polarization calibration method applied to a microwave polarimeter demonstrator based on a near-infrared (NIR) frequency up-conversion stage that allows both optical correlation and signal detection at a wavelength of 1550 nm. The instrument was designed to measure the polarization of cosmic microwave background (CMB) radiation from the sky, obtaining the Stokes parameters of the incoming signal simultaneously, in a frequency range from 10 to 20 GHz. A linearly polarized input signal with a variable polarization angle is used as excitation in the polarimeter calibration setup mounted in the laboratory. The polarimeter systematic errors can be corrected with the proposed calibration procedure, achieving high levels of polarization efficiency (low polarization percentage errors) and low polarization angle errors. The calibration method is based on the fitting of polarization errors by means of sinusoidal functions composed of additive or multiplicative terms. The accuracy of the fitting increases with the number of terms in such a way that the typical error levels required in low-frequency CMB experiments can be achieved with only a few terms in the fitting functions. On the other hand, assuming that the calibration signal is known with the required accuracy, additional terms can be calculated to reach the error levels needed in ultrasensitive B-mode polarization CMB experiments.

L2-CalSat: A Calibration Satellite for Ultra-Sensitive CMB Polarization Space Missions.

In this work, the use of a calibration satellite (L2-CalSat) flying in formation with a Cosmic Microwave Background (CMB) polarization mission in an orbit located at the second Lagrange point, is proposed. The new generation of CMB telescopes are expected to reach unprecedented levels of sensitivity to allow a very precise measurement of the B-mode of polarization, the curl-like polarization component expected from gravitational waves coming from Starobinski inflationary models. Due to the CMB polarized signal weakness, the instruments must be subjected to very precise calibration processes before and after launching. Celestial sources are often used as external references for calibration after launch, but these sources are not perfectly characterized. As a baseline option, L2-CalSat is based on the CubeSat standard and serves as a perfectly known source of a reference signal to reduce polarization measurements uncertainty. A preliminary design of L2-CalSat is described and, according to the scanning strategy followed by the telescope, the influence of the relative position between the spacecrafts in the calibration process is studied. This new calibration element will have a huge impact on the performance of CMB space missions, providing a significant improvement in the measurements accuracy without requiring new and costly technological developments.

miR-320c Regulates SERPINA1 Expression and Is Induced in Patients With Pulmonary Disease.

INTRODUCTION: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition resulting in lung and liver disease with a great clinical variability. MicroRNAs have been identified as disease modifiers; therefore miRNA deregulation could play an important role in disease heterogeneity. Members of miR-320 family are involved in regulating of multiple processes including inflammation, and have potential specific binding sites in the 3'UTR region of SERPINA1 gene. In this study we explore the involvement of miR-320c, a member of this family, in this disease. METHODS: Firstly in vitro studies were carried out to demonstrate regulation of SERPINA1 gene by miR-320. Furthermore, the expression of miR-320c was analyzed in the blood of 98 individuals with different AAT serum levels by using quantitative PCR and expression was correlated to clinical parameters of the patients. Finally, HL60 cells were used to analyze induction of miR-320c in inflammatory conditions. RESULTS: Overexpression of miR-320 members in human HepG2 cells led to inhibition of SERPINA1 expression. Analysis of miR-320c expression in patient's samples revealed significantly increased expression of miR-320c in individuals with pulmonary disease. Additionally, HL60 cells treated with the pro-inflammatory factor lipopolysaccharide (LPS) showed increase in miR-320c expression, suggesting that miR-320c responds to inflammation. CONCLUSION: Our findings demonstrate that miR-320c inhibits SERPINA1 expression in a hepatic cell line and its levels in blood are associated with lung disease in a cohort of patients with different AAT serum levels. These results suggest that miR-320c can play a role in AAT regulation and could be a biomarker of inflammatory processes in pulmonary diseases.

Bringing a health systems modelling approach to complex evaluations: multicountry applications in HIV, TB and malaria.

INTRODUCTION: Understanding how to deliver interventions more effectively is a growing emphasis in Global Health. Simultaneously, health system strengthening is a key component to improving delivery. As a result, it is challenging to evaluate programme implementation while reflecting real-world complexity. We present our experience in using a health systems modelling approach as part of a mixed-methods evaluation and describe applications of these models. METHODS: We developed a framework for how health systems translate financial inputs into health outcomes, with in-country and international experts. We collated available data to measure framework indicators and developed models for malaria in Democratic Republic of the Congo (DRC), and tuberculosis in Guatemala and Senegal using Bayesian structural equation modelling. We conducted several postmodelling analyses: measuring efficiency, assessing bottlenecks, understanding mediation, analysing the cascade of care and measuring subnational effectiveness. RESULTS: The DRC model indicated a strong relationship between shipment of commodities and utilisation thereof. In Guatemala, the strongest model coefficients were more evenly distributed. Results in Senegal varied most, but pathways related to community care had the strongest relationships. In DRC, we used model results to estimate the end-to-end cost of delivering commodities. In Guatemala, we used model results to identify potential bottlenecks and understand mediation. In Senegal, we used model results to identify potential weak links in the cascade of care, and explore subnationally. CONCLUSION: This study demonstrates a complementary modelling approach to traditional evaluation methods. Although these models have limitations, they can be applied in a variety of ways to gain greater insight into implementation and functioning of health service delivery.

Inhaled Dry Powder Antibiotics in Patients with Non-Cystic Fibrosis Bronchiectasis: Efficacy and Safety in a Real-Life Study.

BACKGROUND: Nebulised antibiotics are habitually used in patients with bronchiectasis, but the use of dry powder inhaled antibiotics (DPIA) in these patients is extremely limited. This study seeks to analyse the efficacy and safety of DPIA in bronchiectasis patients. MATERIAL AND METHODS: Multi-centre study of historic cohorts. All the hospital centres in Spain were contacted in order to collect data on patients with a diagnosis of bronchiectasis who had taken at least one dose of DPIA. Its efficacy was analysed in clinical, functional and microbiological terms by comparing the year before and the year after the prescription of DPIA. Adverse effects and variables associated with these effects, or any need to withdraw the drug, were also analysed. RESULTS: 164 patients from 33 Spanish centres were included; 86% and 14% of these were treated with dry powder colistin and tobramycin, respectively. Chronic bronchial infection by Pseudomonas aeruginosa was present in 86% of these patients, and DPIA significantly reduced the number of exacerbations, the quantity and purulence of sputum and the isolation of pathogenic microorganisms. The most common adverse effect was cough (40%), particularly in cases of Chronic Obstructive Pulmonary Disease (COPD) and a previous cough and in those patients who had difficulties in handling the device. These factors were associated with a higher level of withdrawal of the treatment. There were no serious adverse effects. CONCLUSIONS: Our study suggests that DPIA are clinically efficacious and safe for treating bronchiectasis patients. Cough was shown to be the most common side-effect and reason for withdrawal of the treatment.

miR-320c Regulates SERPINA1 Expression and Is Induced in Patients With Pulmonary Disease.

INTRODUCTION: Alpha-1 antitrypsin deficiency (AATD) is a genetic condition resulting in lung and liver disease with a great clinical variability. MicroRNAs have been identified as disease modifiers; therefore miRNA deregulation could play an important role in disease heterogeneity. Members of miR-320 family are involved in regulating of multiple processes including inflammation, and have potential specific binding sites in the 3'UTR region of SERPINA1 gene. In this study we explore the involvement of miR-320c, a member of this family, in this disease. METHODS: Firstly in vitro studies were carried out to demonstrate regulation of SERPINA1 gene by miR-320. Furthermore, the expression of miR-320c was analyzed in the blood of 98 individuals with different AAT serum levels by using quantitative PCR and expression was correlated to clinical parameters of the patients. Finally, HL60 cells were used to analyze induction of miR-320c in inflammatory conditions. RESULTS: Overexpression of miR-320 members in human HepG2 cells led to inhibition of SERPINA1 expression. Analysis of miR-320c expression in patient's samples revealed significantly increased expression of miR-320c in individuals with pulmonary disease. Additionally, HL60 cells treated with the pro-inflammatory factor lipopolysaccharide (LPS) showed increase in miR-320c expression, suggesting that miR-320c responds to inflammation. CONCLUSION: Our findings demonstrate that miR-320c inhibits SERPINA1 expression in a hepatic cell line and its levels in blood are associated with lung disease in a cohort of patients with different AAT serum levels. These results suggest that miR-320c can play a role in AAT regulation and could be a biomarker of inflammatory processes in pulmonary diseases.

"Se vale llorar y se vale reír": Latina Immigrants' Coping Strategies for Maintaining Mental Health in the Face of Immigration-Related Stressors.

Latina immigrant women in the U.S. are at increased risk for poor mental health status, due to socioeconomic- and immigration-related stressors. We sought to describe the mechanisms linking immigration-related stressors and mental health, including how the current social and political climate affects women's mental health status, and which coping strategies are used to maintain well-being. We conducted four focus groups with Latina immigrants (N = 58) recruited through local community-based organizations. We drew on the stages of migration framework to guide our study design and analysis. Focus group transcripts were analyzed to identify emergent themes across groups. On average, focus group participants were 35.5 years old and had lived in the U.S. for 12.5 years. Most were from Mexico. Participants reported immigration-related stressors including unsafe migration, worry about immigration enforcement, broken social ties, and limited access to health and social services. In the face of these stressors, they relied on transnational social networks and connections with other Latina immigrant women. Social ties with family in the U.S. also helped them alleviate social isolation and overcome barriers to social services. Those who were mothers expressed that their children were a source of encouragement and comfort with feelings of stress. Immigration policies that contribute to unsafe migration, worry about immigration enforcement, limited social ties, and limited access to social services were associated with increased stress among Latina immigrants who participated in the focus groups. These participants could benefit from increased access to mental health care and community-based programs that connect them to resources.

A Microwave Polarimeter Demonstrator for Astronomy with Near-Infra-Red Up-Conversion for Optical Correlation and Detection.

This paper presents a 10 to 20 GHz bandwidth microwave polarimeter demonstrator, based on the implementation of a near-infra-red frequency up-conversion stage that allows both the optical correlation, when operating as a synthesized-image interferometer, and signal detection, when operating as a direct-image instrument. The proposed idea is oriented towards the implementation of ultra-sensitive instruments presenting several dozens or even thousands of microwave receivers operating in the lowest bands of the cosmic microwave background. In this work, an electro-optical back-end module replaces the usual microwave detection stage with Mach-Zehnder modulators for the frequency up-conversion, and an optical stage for the signals correlation and detection at near-infra-red wavelengths (1550 nm). As interferometer, the instrument is able to correlate the signals of large-format instruments, while operating as a direct imaging instrument also presents advantages in terms of the possibility of implementing the optical back end by means of photonic integrated circuits to achieve reductions in cost, weight, size, and power consumption. A linearly polarized input wave, with a variable polar angle, is used as a signal source for laboratory tests. The receiver demonstrator has proved its capabilities of being used as a new microwave-photonic polarimeter for the study of the lowest bands of cosmic microwave background.

Alpha-1 antitrypsin deficiency: outstanding questions and future directions.

BACKGROUND: Alpha-1 antitrypsin deficiency (AATD) is a rare hereditary condition that leads to decreased circulating alpha-1 antitrypsin (AAT) levels, significantly increasing the risk of serious lung and/or liver disease in children and adults, in which some aspects remain unresolved. METHODS: In this review, we summarise and update current knowledge on alpha-1 antitrypsin deficiency in order to identify and discuss areas of controversy and formulate questions that need further research. RESULTS: 1) AATD is a highly underdiagnosed condition. Over 120,000 European individuals are estimated to have severe AATD and more than 90% of them are underdiagnosed. CONCLUSIONS: 2) Several clinical and etiological aspects of the disease are yet to be resolved. New strategies for early detection and biomarkers for patient outcome prediction are needed to reduce morbidity and mortality in these patients; 3) Augmentation therapy is the only specific approved therapy that has shown clinical efficacy in delaying the progression of emphysema. Regrettably, some countries reject registration and reimbursement for this treatment because of the lack of larger randomised, placebo-controlled trials. 4) Alternative strategies are currently being investigated, including the use of gene therapy or induced pluripotent stem cells, and non-augmentation strategies to prevent AAT polymerisation inside hepatocytes.

Etiología de las bronquiectasias en una cohorte de 2.047 pacientes. Análisis del registro histórico español / Etiology of Bronchiectasis in a Cohort of 2047 Patients. An Analysis of the Spanish Historical Bronchiectasis Registry

Introducción: Las bronquiectasias son la consecuencia final de múltiples patologías. Establecer la etiología tiene implicaciones clínicas y pronósticas. El objetivo fue evaluar la etiología de las bronquiectasias en una amplia muestra de pacientes, su posible relación con factores demográficos, clínicos o de gravedad, así como analizar las diferencias entre las idiopáticas, las postinfecciosas y las debidas a otras causas. Métodos: Estudio multicéntrico, transversal, del Registro Histórico Español de la SEPAR (RHEBQ-SEPAR). Se incluyeron prospectivamente pacientes adultos con bronquiectasias seguidos por neumólogos. Para el estudio etiológico se siguieron las recomendaciones y pruebas diagnósticas protocolizadas en el registro que posteriormente fueron recogidas en la normativa SEPAR de bronquiectasias. Resultados: Se analizaron 2.047 pacientes de 36 centros españoles. La edad media fue de 64,9 años y el 54,9% fueron mujeres. La etiología se identificó en el 75,8% de los casos (postinfecciosa: 30%; fibrosis quística: 12,5%; inmunodeficiencias: 9,4%; EPOC: 7,8%; asma: 5,4%; discinesia ciliar: 2,9%, y enfermedades sistémicas: 1,4%). Las distintas etiologías presentaban diferencias demográficas, clínicas y microbiológicas. Las bronquiectasias postinfecciosas y las secundarias a EPOC y asma presentaban más riesgo de tener peor función pulmonar. Los pacientes con bronquiectasias postinfecciosas eran mayores y se diagnosticaban más tarde. Las bronquiectasias idiopáticas predominaban en mujeres no fumadoras y se asociaban a mejor función pulmonar, mayor índice de masa corporal y menor frecuencia de infección por Pseudomonas aeruginosa que las de causa conocida. Conclusiones: La etiología de las bronquiectasias se ha identificado en una gran proporción de los pacientes incluidos en el RHEBQ-SEPAR. Se pueden reconocer diferentes fenotipos relacionados con las distintas causas (AU)

Introduction: Bronchiectasis is caused by many diseases. Establishing its etiology is important for clinical and prognostic reasons. The aim of this study was to evaluate the etiology of bronchiectasis in a large patient sample and its possible relationship with demographic, clinical or severity factors, and to analyze differences between idiopathic disease, post-infectious disease, and disease caused by other factors. Methods: Multicenter, cross-sectional study of the SEPAR Spanish Historical Registry (RHEBQ-SEPAR). Adult patients with bronchiectasis followed by pulmonologists were included prospectively. Etiological studies were based on guidelines and standardized diagnostic tests included in the register, which were later included in the SEPAR guidelines on bronchiectasis. Results: A total of 2,047 patients from 36 Spanish hospitals were analyzed. Mean age was 64.9 years and 54.9% were women. Etiology was identified in 75.8% of cases (post-Infection: 30%; cystic fibrosis: 12.5%; immunodeficiencies: 9.4%; COPD: 7.8%; asthma: 5.4%; ciliary dyskinesia: 2.9%, and systemic diseases: 1.4%). The different etiologies presented different demographic, clinical, and microbiological factors. Post-infectious bronchiectasis and bronchiectasis caused by COPD and asthma were associated with an increased risk of poorer lung function. Patients with post-infectious bronchiectasis were older and were diagnosed later. Idiopathic bronchiectasis was more common in female non-smokers and was associated with better lung function, a higher body mass index, and a lower rate of Pseudomonas aeruginosa than bronchiectasis of known etiology. Conclusions: The etiology of bronchiectasis was identified in a large proportion of patients included in the RHEBQ-SEPAR registry. Different phenotypes associated with different causes could be identified (AU)

Electro-optic correlator for large-format microwave interferometry: Up-conversion and correlation stages performance analysis.

In this paper, a microwave interferometer prototype with a near-infra-red optical correlator is proposed as a solution to get a large-format interferometer with hundreds of receivers for radio astronomy applications. A 10 Gbits/s Lithium Niobate modulator has been tested as part of an electro-optic correlator up-conversion stage that will be integrated in the interferometer prototype. Its internal circuitry consists of a single-drive modulator biased by a SubMiniature version A (SMA) connector allowing to up-convert microwave signals with bandwidths up to 12.5 GHz to the near infrared band. In order to characterize it, a 12 GHz tone and a bias voltage were applied to the SMA input using a polarization tee. Two different experimental techniques to stabilize the modulator operation point in its minimum optical carrier output power are described. The best achieved results showed a rather stable spectrum in amplitude and wavelength at the output of the modulator with an optical carrier level 23 dB lower than the signal of interest. On the other hand, preliminary measurements were made to analyze the correlation stage, using 4f and 6f optical configurations to characterize both the antenna/fiber array configuration and the corresponding point spread function.

Clinical impact of chronic obstructive pulmonary disease on non-cystic fibrosis bronchiectasis. A study on 1,790 patients from the Spanish Bronchiectasis Historical Registry.

BACKGROUND: Few studies have evaluated the coexistence of bronchiectasis (BE) and chronic obstructive pulmonary disease (COPD) in series of patients diagnosed primarily with BE. The aim of this study was to analyse the characteristics of patients with BE associated with COPD included in the Spanish Bronchiectasis Historical Registry and compare them to the remaining patients with non-cystic fibrosis BE. METHODS: We conducted a multicentre observational study of historical cohorts, analysing the characteristics of 1,790 patients who had been included in the registry between 2002 and 2011. Of these, 158 (8.8%) were registered as BE related to COPD and were compared to the remaining patients with BE of other aetiologies. RESULTS: Patients with COPD were mostly male, older, had a poorer respiratory function and more frequent exacerbations. There were no differences in the proportion of patients with chronic bronchial colonisation or in the isolated microorganisms. A significantly larger proportion of patients with COPD received treatment with bronchodilators, inhaled steroids and intravenous antibiotics, but there was no difference in the use of long term oral or inhaled antibiotherapy. During a follow-up period of 3.36 years, the overall proportion of deaths was 13.8%. When compared to the remaining aetiologies, patients with BE associated with COPD presented the highest mortality rate. The multivariate analysis showed that the diagnosis of COPD in a patient with BE as a primary diagnosis increased the risk of death by 1.77. CONCLUSION: Patients with BE related to COPD have the same microbiological characteristics as patients with BE due to other aetiologies. They receive treatment with long term oral and inhaled antibiotics aimed at controlling chronic bronchial colonisation, even though the current COPD treatment guidelines do not envisage this type of therapy. These patients' mortality is notably higher than that of remaining patients with non-cystic fibrosis BE.

Adsorption of selected emerging contaminants onto PAC and GAC: Equilibrium isotherms, kinetics, and effect of the water matrix.

The removal of three emerging contaminants (ECs) (amitriptyline hydrochloride (AH), methyl salicylate (MS) and 2-phenoxyethanol (PE)) dissolved in several water matrices by means of their adsorption onto powdered activated carbon (PAC) and granular activated carbon (GAC) has been investigated. When dissolved in ultrapure water, adsorption of the ECs followed the trend of AH > MS > PE, with a positive effect of the adsorbent dose. According to the analysis of the adsorption isotherms and adsorption kinetics, PAC showed strongly higher adsorption efficiency in both capacity and velocity of the adsorption, in agreement with its higher mesoporosity. Equilibrium isotherm data were fitted by Langmuir and Freundlich models. Pseudo-second order kinetics modeled very successfully the adsorption process. Finally, the effect of the presence of dissolved organic matter (DOM) in the water matrices (ultrapure water, surface water and two effluents from wastewater treatment plants) on the adsorption of the selected ECs onto PAC was established, as well as its performance on the removal of water quality parameters. Results show a negative effect of the DOM content on the adsorption efficiency. Over 50% of organic matter was removed with high PAC doses, revealing that adsorption onto PAC is an effective technology to remove both micro-pollutants and DOM from water matrices.

Etiology of Bronchiectasis in a Cohort of 2047 Patients. An Analysis of the Spanish Historical Bronchiectasis Registry. / Etiología de las bronquiectasias en una cohorte de 2.047 pacientes. Análisis del registro histórico español.

INTRODUCTION: Bronchiectasis is caused by many diseases. Establishing its etiology is important for clinical and prognostic reasons. The aim of this study was to evaluate the etiology of bronchiectasis in a large patient sample and its possible relationship with demographic, clinical or severity factors, and to analyze differences between idiopathic disease, post-infectious disease, and disease caused by other factors. METHODS: Multicenter, cross-sectional study of the SEPAR Spanish Historical Registry (RHEBQ-SEPAR). Adult patients with bronchiectasis followed by pulmonologists were included prospectively. Etiological studies were based on guidelines and standardized diagnostic tests included in the register, which were later included in the SEPAR guidelines on bronchiectasis. RESULTS: A total of 2,047 patients from 36 Spanish hospitals were analyzed. Mean age was 64.9years and 54.9% were women. Etiology was identified in 75.8% of cases (post-Infection: 30%; cystic fibrosis: 12.5%; immunodeficiencies: 9.4%; COPD: 7.8%; asthma: 5.4%; ciliary dyskinesia: 2.9%, and systemic diseases: 1.4%). The different etiologies presented different demographic, clinical, and microbiological factors. Post-infectious bronchiectasis and bronchiectasis caused by COPD and asthma were associated with an increased risk of poorer lung function. Patients with post-infectious bronchiectasis were older and were diagnosed later. Idiopathic bronchiectasis was more common in female non-smokers and was associated with better lung function, a higher body mass index, and a lower rate of Pseudomonas aeruginosa than bronchiectasis of known etiology. CONCLUSIONS: The etiology of bronchiectasis was identified in a large proportion of patients included in the RHEBQ-SEPAR registry. Different phenotypes associated with different causes could be identified.

Registro español de pacientes con déficit de alfa-1 antitripsina: evaluación de la base de datos y análisis de la población incluida / Spanish registry of patients with alpha-1 antitrypsin deficiency: database evaluation and population analysis

Introducción y objetivo: El Registro español de pacientes con déficit de alfa-1 antitripsina (REDAAT) se formó con el objetivo de mejorar el conocimiento sobre del DAAT. En este trabajo se evalúa el registro y se analiza la población de pacientes incluida en él. Métodos: Dispone de una base de datos alojada en la Web: www.redaat.es. Su base de datos recoge información clínica y funcional de individuos portadores de los fenotipos PiSZ, ZZ y variantes raras. Resultados: En la actualidad reúne información sobre 511 individuos procedentes de 103 centros sanitarios, gracias a la colaboración de 124 médicos. De ellos, 348 (74,2%) son homocigotos Pi*ZZ y 100 (19,5%) heterocigotos Pi*SZ. Existe una mayor concentración de casos en hospitales universitarios de tercer nivel. El 81% de los casos tiene enfermedad pulmonar y en menor proporción el DAAT se detectó por cribado familiar o enfermedad hepática. Se dispone de datos de seguimiento en el 45% de los casos, y un 35% recibieron tratamiento sustitutivo con alfa-1 antitripsina. Conclusiones: El REDAAT es una herramienta útil para obtener información de calidad sobre esta enfermedad minoritaria en condiciones de práctica clínica habitual, aunque obtener datos de seguimiento es difícil y no es posible conocer la representatividad de la muestra incluida

Introduction and objective: REDAAT, the Spanish Registry of Patients with Alpha-1 Antitrypsin Deficiency, was set up in order to improve knowledge of this disease. This study is an evaluation of the registry and an analysis of its patient population. Methods: The registry has a database hosted on the website www.redaat.es. It collects clinical and functional data on patients with PiSZ, ZZ phenotypes and other rare variants. Results: Thanks to the collaboration of 124 physicians, the registry currently contains information on 511 individuals from 103 healthcare centers. Of these 511, 348 (74.2%) are Pi*ZZ homozygotes, and 100 (19.5%) are Pi*SZ heterozygotes. More cases are seen in tertiary level hospitals. A total of 81% of the cases have respiratory disease, and a lower proportion of AATD cases were detected by family screening or liver disease. Follow-up data are available for 45% of the cases, and 35% received alpha-1 antitripsin replacement therapy. Conclusions: The REDAAT registry is a useful tool for obtaining quality information about this minority disease in routine clinical practice conditions, although it is difficult to obtain follow-up data, and the representativeness of the sample included cannot be determined