Temporal and spatial variations in organic and elemental carbon concentrations in PM10/PM2.5 in the metropolitan area of Costa Rica, Central America

AbstractPM2.5 and PM10 samples were collected at 4 and 14 sampling sites, respectively, located in the Metropolitan area of Costa Rica (MACR), during 2010–2011. These sites were representative of commercial, industrial and residential zones of this region. Concentrations of elemental carbon (EC) and organic carbon (OC) were analyzed using the IMPROVE thermal-optical reflectance (TOR) method. OC and EC concentrations were higher in commercial and industrial sites and showed clear seasonal variations with higher concentrations observed in the rainy season (May–November) than in the dry season (December–April), due to wind patterns in the study area. Total carbonaceous aerosol accounted for 35% of PM10 and 56% of PM2.5 mass. Good correlation between OC and EC in PM10 (R=0.89–0.75) and PM2.5 (R=0.79– 0.64) indicated that they had common dominant sources of combustion such as industrial activities and traffic emissions. The annual average concentrations of estimated SOC (Secondary Organic Carbon) in the MACR PM10 samples showed values between 0.65–8.49 μg/m3, accounting for 48% and 56% of the OC in PM10 and PM2.5 respectively. Positive Matrix Factorization (PMF) identified five principal sources for OC and EC in particles: gasoline vehicles, diesel vehicles, on road traffic, wood smoke and industrial combustion. The contribution of each of the source varied between the PM10 and PM2.5 size fractions

Airborne particulate matter PM2.5 from Mexico City affects the generation of reactive oxygen species by blood neutrophils from asthmatics: an in vitro approach

<p>Abstract</p> <p>Background</p> <p>The Mexico City Metropolitan Area is densely populated, and toxic air pollutants are generated and concentrated at a higher rate because of its geographic characteristics. It is well known that exposure to particulate matter, especially to fine and ultra-fine particles, enhances the risk of cardio-respiratory diseases, especially in populations susceptible to oxidative stress. The aim of this study was to evaluate the effect of fine particles on the respiratory burst of circulating neutrophils from asthmatic patients living in Mexico City.</p> <p>Methods</p> <p>In total, 6 subjects diagnosed with mild asthma and 11 healthy volunteers were asked to participate. Neutrophils were isolated from peripheral venous blood and incubated with fine particles, and the generation of reactive oxygen species was recorded by chemiluminescence. We also measured plasma lipoperoxidation susceptibility and plasma myeloperoxidase and paraoxonase activities by spectrophotometry.</p> <p>Results</p> <p>Asthmatic patients showed significantly lower plasma paraoxonase activity, higher susceptibility to plasma lipoperoxidation and an increase in myeloperoxidase activity that differed significantly from the control group. In the presence of fine particles, neutrophils from asthmatic patients showed an increased tendency to generate reactive oxygen species after stimulation with fine particles (PM_2.5).</p> <p>Conclusion</p> <p>These findings suggest that asthmatic patients have higher oxidation of plasmatic lipids due to reduced antioxidant defense. Furthermore, fine particles tended to increase the respiratory burst of blood human neutrophils from the asthmatic group.</p> <p>On the whole, increased myeloperoxidase activity and susceptibility to lipoperoxidation with a concomitant decrease in paraoxonase activity in asthmatic patients could favor lung infection and hence disrupt the control of asthmatic crises.</p

Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?

Background & aims: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for >= 72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for <= 14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were reported. Results: We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following char-acteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 +/- 3.3 vs 8.4 +/- 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 +/- 2.1 vs 5.2 +/- 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Conclusions: Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism

Mapping disparities in education across low- and middle-income countries

Analyses of the proportions of individuals who have completed key levels of schooling across all low- and middle-income countries from 2000 to 2017 reveal inequalities across countries as well as within populations. Educational attainment is an important social determinant of maternal, newborn, and child health(1-3). As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting(4-6). The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness(7,8); however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health(9-11). Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but-to our knowledge-no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries(12-14). By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations.Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Characterization of compost biofilter media

The goal of this study was to determine the physical, chemical and biological properties that can be used to determine the performance of compost as biofilter media. Four types of compost were characterized with regard to pH, total organic carbon and nitrogen content in solid matrix and water extracts, moisture content, oxygen uptake rates, and microbial population densities. Compost were blended with ceramic pellets and oyster shell into three media mixtures: biosolids (BS), yard waste (YW) and a biosolids/horse manure mixture (BSHM). Performance was determined in laboratory scale systems treating a mixture of VOCs under different operational conditions. Media from a full-scale biofilter was also characterized and its properties related to system performance. Performance was closely related to compost quality characteristics. Initial high oxygen uptake rate and soluble total carbon of BSHM shortened the acclimation period. After severe drying, however, rewetting of BSHM could not be achieved. High water holding capacity, good rewettability and low compaction of YW resulted in sustained high removal efficiencies over the operation period. Rewetting after drying was achieved for BS and YW media. Among the four compounds present in the VOC mixture, ethanol was degraded sooner followed by butyraldehyde, ethyl acetate and 1,1-diethoxy butane(DEB). Media drying resulted in ethyl acetate and DEB removal efficiencies decreases due to reduction of active biofilter. The highest total VOC elimination capacities reached by the media were 197, 210 and 241 g/\rm m\sp3-hr on a total VOC basis for BSHM, YW and BS respectively. After 300 days of operation, biofilter media was re-characterized. Profiles with depth were observed for moisture content, volatile solids, water extracted total organic carbon, solid matrix total nitrogen, pH and oxygen uptake rate. Oxygen uptake rates increased in BS and YW, indicating higher microbial activity of VOC degrading organisms. Insignificant changes in total nitrogen, volatile solids, and pH were observed. Water extract total organic carbon and fungi density increased in all media. In the full-scale system, low oxygen uptake rates were related to dry areas. High compaction, hydrophobicity and fine particle sizes indicated media deterioration. Moisture content heterogeneity indicated a need for moisture addition system improvements

Prison crisis and judicial congestion consequences of punitive populism and expansive interpretation of the standard

Se plantea la crisis carcelaria y judicial como consecuencia, entre otras causas, de la interpretación expansiva de la norma por parte de los funcionarios judiciales, ello aunado a la tendencia del legislador a aumentar los delitos y las penas como reacción a la coyuntura política y social. Se presenta, como un elemento de la posible solución, que la medida de aseguramiento intramural por la causal de no comparecencia al proceso, se interprete restrictivamente, en consecuencia los requisitos exigidos por la ley procesal penal, no son optativos, sino que según su redacción taxativa requiere el cumplimiento de lo contenido en los tres numerales del artículo 312 de la ley 906 de 2000, lo anterior aunado a un estricto ejercicio de ponderación cuya responsabilidad reside finalmente en el Juez de Control de Garantías.There stands firm the prison and judicial crisis as consequence of the expansive interpretation of the norm on the part of the judicial civil servants, it united to the trend of the legislator to increasing the crimes and sentences as reaction to the political and social conjuncture. Appears as solution, which the measure of insurance intramural for the grounds of not appearance to the process, interprets restrictively, in consequence the requirements demanded by the procedural Law, they are not optional, but according to his restricted draft there needs the fulfillment of three numerals of the article 312 of the law 906 of 2004 the previous thing united to a strict test of deliberation

Epidemiological factors associated with the evolution of the diabetic foot

Diabetic foot ulcers are advanced chronic vascular lesions with tissue deterioration and with unfavorable prognosis; these ulcers predict the risk of amputation in 90% of cases. This research aims to establish an association between the epidemiological factors and the evolution of the diabetic foot. For this, in this paper, we present an analytical, transversal, prospective study. Our sample consisted of 95 outpatients and hospitalized men and women diabetic patients, who attended Hospital Jos&eacute; Carrasco Arteaga in Cuenca, Ecuador, over the time frame encompassing December 2017 to September 2018. For each patient, we interviewed them with epidemiological data, and a physical examination of the feet was done to assess the Wagner scale degrees. Results revealed that 93% of individuals had some degree of injury to their feet. Out of the examined individuals, 61% were males, 41% have completed elementary school, and 63% lived in urban areas. The average age was of 69 years, the average diagnostic time of the disease was 14 years, and the patients had a BMI (Body Mass Index) average of 26. A significant correlation was observed between the Wagner&acute;s scale classification and the diagnosed time of the disease with a Chi-square of 47.02 and a p-value of 0.025 in the analysis of variance (ANOVA). It is concluded that the diabetic foot can appear at any age and in patients of both sexes. It is conditioned by factors such as physical inactivity, smoking, poor eating habits and lack of sanitary hygiene

Antimicrobial Lessons From a Large Observational Cohort on Intra-abdominal Infections in Intensive Care Units

evere intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by diseasespecific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed