Opinion, Use and Knowledge About Transcranial Magnetic Stimulation in Spain: A National Survey of Mental Health Professionals.

Transcranial magnetic stimulation (TMS) is a non-invasive method of neuromodulation with heterogeneous usage between countries, which may be potentially influenced by healthcare professionals' opinions. This study aimed to assess the knowledge, acceptability, and attitudes of mental health professionals in Spain towards TMS. A cross-sectional multicentric study was conducted using an online survey, with 219 participants including psychiatrists, psychologists, and residents. Nearly 100% of participants correctly answered theoretical aspects related to the rationale and indications of TMS. Although only 55% considered TMS effective, 80% would refer patients if TMS were available at their workplace, and 74% would undergo TMS if experiencing depression. 85% believed neuromodulation training should be increased in residency, and 73% demanded TMS inclusion in public hospitals. Teaching staff and psychologists defined TMS as a last resort (p = 0.03 and 0.045). Both disagreed on its ease of use (p < 0.001) and patient referral (p = 0.01), considering an impact on the therapeutic bond (p = 0.029). Previous TMS training, clinical experience, or availability of TMS at the workplace, were associated with better knowledge, a higher perception of efficacy and utility in treating resistant patients (all p < 0.05). In conclusion, surveyed mental health professionals in Spain demonstrated good knowledge of the technique and positive opinions regarding its utility. Findings emphasized limited clinical experience of the sample, a call for training programs, and the demand for the inclusion of TMS in the portfolio of Spanish public hospitals.

A semi-industrial scale AnMBR for municipal wastewater treatment at ambient temperature: performance of the biological process.

A semi-industrial scale AnMBR plant was operated for more than 600 days to evaluate the long-term operation of this technology at ambient temperature (ranging from 10 to 27 ○C), variable hydraulic retention times (HRT) (from 25 to 41 h) and influent loads (mostly between 15 and 45 kg COD·d-1). The plant was fed with sulfate-rich high-loaded municipal wastewater from the pre-treatment of a full-scale WWTP. The results showed promising AnMBR performance as the core technology for wastewater treatment, obtaining an average 87.2 ± 6.1 % COD removal during long-term operation, with 40 % of the data over 90%. Five periods were considered to evaluate the effect of HRT, influent characteristics, COD/SO42--S ratio and temperature on the biological process. In the selected periods, methane yields varied from 70.2±36.0 to 169.0±95.1 STP L CH4·kg-1 CODinf, depending on the influent sulfate concentration, and wasting sludge production was reduced by between 8 % and 42 % compared to conventional activated sludge systems. The effluent exhibited a significant nutrient recovery potential. Temperature, HRT, SRT and influent COD/SO42--S ratio were corroborated as crucial parameters to consider in maximizing AnMBR performance.

Modeling the anaerobic treatment of sulfate-rich urban wastewater: Application to AnMBR technology.

Although anaerobic membrane bioreactors (AnMBR) are a core technology in the transition of urban wastewater (UWW) treatment towards a circular economy, the transition is being held back by a number of bottlenecks. The dissolved methane released from the effluent, the need to remove nutrients (ideally by recovery), or the energy lost by the competition between methanogenic and sulfate-reducing bacteria (SRB) for the biodegradable COD have been identified as the main issues to be addressed before AnMBR becomes widespread. Mathematical modeling of this technology can be used to obtain further insights into these bottlenecks plus other valuable information for design, simulation and control purposes. This paper therefore proposes an AnMBR anaerobic digestion model to simulate the crucial SRB-related process since these bacteria degrade more than 40% of the organic matter. The proposed model, which is included in the BNRM2 collection model, has a reduced but all-inclusive structure, including hydrolysis, acidogenesis, acetogenesis, methanogenesis and other SRB-related processes. It was calibrated and validated using data from an AnMBR pilot plant treating sulfate-rich UWW, including parameter values obtained in off-line experiments and optimization methods. Despite the complex operating dynamics and influent composition, it was able to reproduce the process performance. In fact, it was able to simulate the AD of sulfate-rich UWW considering only two groups of SRB: heterotrophic SRB growing on both VFA (propionate) and acetate, and autotrophic SRB growing on hydrogen. Besides the above-mentioned constraints, the model reproduced the dynamics of the mixed liquor solids concentration, which helped to integrate biochemical and filtration models. It also reproduced the alkalinity and pH dynamics in the mixed liquor required for assessing the effect of chemical precipitation on membrane scaling.

Anaerobic membrane bioreactors (AnMBR) treating urban wastewater in mild climates.

Feasibility of an AnMBR demonstration plant treating urban wastewater (UWW) at temperatures around 25-30 °C was assessed during a 350-day experimental period. The plant was fed with the effluent from the pre-treatment of a full-scale municipal WWTP, characterized by high COD and sulfate concentrations. Biodegradability of the UWW reached values up to 87%, although a portion of the biodegradable COD was consumed by sulfate reducing organisms. Effluent COD remained below effluent discharge limits, achieving COD removals above 90%. System operation resulted in a reduction of sludge production of 36-58% compared to theoretical aerobic sludge productions. The membranes were operated at gross transmembrane fluxes above 20 LMH maintaining low membrane fouling propensities for more than 250 days without chemical cleaning requirements. Thus, the system resulted in net positive energy productions and GHG emissions around zero. The results obtained confirm the feasibility of UWW treatment in AnMBR under mild and warm climates.

New frontiers from removal to recycling of nitrogen and phosphorus from wastewater in the Circular Economy.

Nutrient recovery technologies are rapidly expanding due to the need for the appropriate recycling of key elements from waste resources in order to move towards a truly sustainable modern society based on the Circular Economy. Nutrient recycling is a promising strategy for reducing the depletion of non-renewable resources and the environmental impact linked to their extraction and manufacture. However, nutrient recovery technologies are not yet fully mature, as further research is needed to optimize process efficiency and enhance their commercial applicability. This paper reviews state-of-the-art of nutrient recovery, focusing on frontier technological advances and economic and environmental innovation perspectives. The potentials and limitations of different technologies are discussed, covering systems based on membranes, photosynthesis, crystallization and other physical and biological nutrient recovery systems (e.g. incineration, composting, stripping and absorption and enhanced biological phosphorus recovery).

Comparative neurocognitive effects of lithium and anticonvulsants in long-term stable bipolar patients.

BACKGROUND: The aim of choosing a mood-stabilizing drug (lithium or anticonvulsants) or a combination of them with minimal neurocognitive effects is to stimulate the development of criteria for a therapeutic adequacy, particularly in Bipolar Disorder (BD) patients who are clinically stabilized. METHOD: Three groups of BD patients were established according to their treatment: (i) lithium monotherapy (n=29); (ii) lithium together with one or more anticonvulsants (n=28); and (iii) one or more anticonvulsants (n=16). A group of healthy controls served as the control (n=25). The following tests were applied: Wechsler Adult Intelligence Scale, Trail Making Test, Wechsler Memory Scale, Rey Complex Figure Test, Stroop color-word test, Wisconsin Card Sorting Test, Tower of Hanoi, Frontal Assessment Battery, and Reading the Mind in the Eyes Test. RESULTS: Relative to healthy controls, BD patients showed the following: (i) those on lithium monotherapy, but not other BD groups, had preserved short-term auditory memory, long-term memory, and attention; (ii) those who took only anticonvulsants showed worse findings in short-term visual memory, working memory, and several executive functions; and (iii) all BD patients showed worse performance in processing speed, resistance to interference, and emotion recognition. LIMITATIONS: Medication alone cannot explain why all BD patients showed common cognitive deficits despite different pharmacological treatment. CONCLUSION: The impairment on some executive functions and emotion recognition is an inherent trait in BD patients, regardless of their pharmacological treatment. However, while memory, attention, and most of the executive functions are preserved in long-term stable BD patients, these cognitive functions are impaired in those who take anticonvulsants.

Instrumentation, control, and automation for submerged anaerobic membrane bioreactors.

A submerged anaerobic membrane bioreactor (AnMBR) demonstration plant with two commercial hollow-fibre ultrafiltration systems (PURON®, Koch Membrane Systems, PUR-PSH31) was designed and operated for urban wastewater treatment. An instrumentation, control, and automation (ICA) system was designed and implemented for proper process performance. Several single-input-single-output (SISO) feedback control loops based on conventional on-off and PID algorithms were implemented to control the following operating variables: flow-rates (influent, permeate, sludge recycling and wasting, and recycled biogas through both reactor and membrane tanks), sludge wasting volume, temperature, transmembrane pressure, and gas sparging. The proposed ICA for AnMBRs for urban wastewater treatment enables the optimization of this new technology to be achieved with a high level of process robustness towards disturbances.

Determining Position Inside Non-industrial Buildings Using Ultrasound Transducers.

The position determination inside a building where no GPS signal is beingreceived can be ascertained using laser transmitters in industrial situations where there areno people or using triangulation of the signal strength, normally electro-magnetic signals,if the required accuracy is more than a metre. Our solution is aimed at situations wherepeople are present and where the required accuracy is less than 30 cm, such as in shoppingprecincts or supermarkets. To achieve this, a network of ultrasonic transmitters is fittedinto the ceiling which receives a synchronised time signal. Each transmitter has a uniqueidentifier code and emits its code with a delay with respect to the common time signalwhich is proportional to its code number with an ASK modulation over the ultrasonic bandcentred on 40 KHz. The receivers circulating beneath the transmitters receive the codes ofthose within their detection range, translate the time delays into distances and then obtaintheir position by triangulation since the receivers know the position of every transmitter.Since the receivers are not synchronised with the common time signal or the actual speedof the sound, whose value varies appreciably with temperature, relative humidity andatmospheric pressure, a consecutive approximation algorithm has been introduced. This isbased on the fact that the Z coordinator of the receiver is known and constant and thus it is possible, with only three different identifiers received, to deduce the phase of the common time signal and estimate the speed of the sound with a fourth identifier.

El punto de vista de los familiares de pacientes con trastorno bipolar / The point of view of relatives of patients with bipolar disorder

Como consecuencia de la desinstitucionalización de los pacientes psiquiátricos, el papel de los cuidadores ha adquirido un interés relevante a lo largo de los últimos años. Con el objetivo de conocer el impacto de la enfermedad en los cuidadores, 88 familiares de pacientes diagnosticados de trastorno bipolar (DSM-IV) completaron un cuestionario autoadministrado que recogía información sobre variados aspectos clínicos, sociodemográficos, carga experimentada, actitudes y conocimientos acerca de la enfermedad, entre otras cuestiones. Encontramos que los familiares necesitaban con frecuencia ayuda psiquiátrica por el estrés generado por la enfermedad, percibían afectación en los planos laboral, lúdico y económico, junto con la estigmatización social. Resultaban de gran ayuda en la cumpliementación terapéutica y la información recibida acerca de la enfermedad y los recursos destinados eran percibidos como insuficientes. También se obtuvo información de las parejas que describían afectación en las relaciones conyugales, sexuales y en la crianza. Es necesario, por tanto, identificar aquellos factores que contribuyen al estrés familiar. Intervenciones como los grupos psicoeducativos pueden mejorar el conocimiento de la enfermedad y mejorar las técnicas de afrontamiento

As a result of the progressive deinstitutionalization of psychiatric patients, there has been a growing interest in the role of carers over the past few years. In order to find out about the impact of the illness on carers, 88 relatives of patients diagnosed with bipolar disorder (DSM-IV) were asked to complete a self-administered questionnaire. This contained 65 ítems, covering, a mong others, various clinical and demographic aspects, the burden felt by relatives, their knowledge of the illness and attitudes towards it. It was found that a high percentage of relatives needed psychiatric help. They experienced disruption to their work, economic and social lives, as well as suffering a social stigma. While making a major contribution to the implementation of treatment, they complained of lack of information about the nature of the disorder and limited resources. Spouses, who were also questioned, described the high impact on their marital and sexual relationships and co-parenting. It is therefore necessary to identify the factors that contribute to stress on the family. Psychoeducational groups for relatives can help to do so, improving their coping skills skills and knowledge of the illness, and reducing their distress and subjective burden

Modelling anaerobic biomass growth kinetics with a substrate threshold concentration.

Many bacteria have been observed to stop growing below a certain substrate threshold concentration. In this study, a modification of the Monod kinetics expression has been proposed to take into account this substrate threshold concentration observed in bacterial growth. Besides the threshold concentration no additional parameters have been added to the kinetic expression and so, only the substrate threshold concentration and the half-saturation constant have to be estimated for model calibration purposes. Furthermore, for parameter estimation purposes, practical identifiability of this new function has been studied and the results have been satisfactory. The new model has been applied, as an example, to a simple anaerobic model to simulate the competition for hydrogen between sulphate reducers and methanogens in a thermophilic methanol-fed bioreactor. Oscillatory behaviour and mathematical instabilities have been avoided by using the proposed model. Parameter sensitivities have also been calculated along the simulation period in order to investigate the importance of hydrogen threshold concentration parameters.