Time-integrated GHG emissions in advanced waste-to-energy plants producing fuels, chemicals and electricity from MSW refuse

The evaluation of the climate benefit in the production of fuels from conventional biomass has recently evolved by incorporating a dynamic approach, a comparison with the reference system and other recommendations from the IPCC. Important drawbacks have been identified in the comparison of conventional (static) and dynamic (time-integrated) assessments for the production of biofuels. This thesis contributes to a better understanding of the real climate benefit in the production of products and services using a specific and plentiful waste in Europe, i.e., MSW refuse (the unsorted stream of MSW usually disposed of). Lately, some dynamic assessments have been made for the production of fuels and electricity using forest and agricultural residues. In this thesis, their work is expanded by the selection of a residue (MSW refuse) which is already in-use within the different regional waste management schemes in Europe (incineration and landfilling) and the production of a material that stores biogenic carbon, i.e., renewable-derived plastic materials. The climate benefit of the proposed advanced waste-to-energy (WtE) plant is evaluated by defining two systems (the one proposed in the thesis and the reference system) using system expansion and substitution. The dynamic modeling of the waste management scheme in Europe (current and future) as well as the temporary storage of the biogenic carbon fraction in the renewable-derived plastics (intimately related to the management scheme) are main contributions to the field. The proposed methodology is based on two climate benefit indicators: the climate mitigation index (CMI) and the differential climate impact (DCI). The indicators analyze the impact of the replacement of the current waste management system for one which is based on advanced WtE plants. In Paper I, a preliminary work applying the static methodology (GHG balance) is carried out for the analysis of the results in advanced WtE plants producing biofuels, drop-in chemicals and electricity and with the possibility of carbon capture and storage in bioenergy (Bio-CCS). In Paper II, the dynamic GHG emission assessment is applied to the advanced WtE plant analyzed in Paper I. In Paper III and IV, two countries are selected for the comparison of the systems: Spain, where landfilling is dominant; and Sweden, where incineration is dominant. Moreover, two different scenarios are taken into account: Scenario 1, in which the reference system remains unaltered, and Scenario 2, in which there is an evolution towards landfill banning and decarbonization of the energy mix. The results reveal that the landfilling replacement in dominant-landfill European countries has a positive climate impact in the short term, although the long-term impact depends on the evolution of the reference system (waste management and electric mix). Renewable-derived plastics are proposed (Paper IV) as an alternative greenhouse gas removal (GGR) technology and compared with Bio-CCS as the common GGR technology in most Integrated Assessment Models (IAMs). The production of plastics compares favorably in terms of climate benefit in the short and medium term and would even provide a larger climate benefit in incineration-dominant regions in the long term. In Paper V and VI, the static and dynamic assessment for the production of electricity is analyzed.Esta tesis está enfocada en el análisis dinámico (integrado en el tiempo) de las emisiones de gases de efecto invernadero (GEI) asociadas a la producción de productos y servicios en un planta de gasificación avanzada alimentada por la fracción rechazo de los residuos sólidos urbanos (RSU) (fracción no reciclable ni compostable que va a depósito en vertedero o incineración). Tradicionalmente, el cálculo de la huella de carbono de un proceso alimentado por fuentes renovables se lleva a cabo desde un punto de vista estático, mediante herramientas exhaustivas que permiten calcular las emisiones asociadas al ciclo de vida completo de un proceso o producto y cuyo objetivo es la comparación de alternativas para producir una misma unidad funcional (por ejemplo, una misma planta de producción que puede ser alimentada por diferentes tipos de biomasa) incluyendo la alternativa de origen fósil. Sin embargo, el resultado final de estos estudios estáticos es un valor promedio de las emisiones anuales, un resultado que puede ser insuficiente cuando la fuente renovable que se analiza es un residuo que forma parte de un ciclo biológico de degradación que se usa como sistema de referencia para valorar si ese residuo debe ser utilizado como fuente energética o no. Por otro lado, recientemente, se están llevando a cabo estudios dinámicos de emisiones centrados en residuos agrícolas y forestales; sin embargo, la fracción rechazo de los RSU tiene un potencial energético similar a los residuos agrícolas en Europa. Los estudios dinámicos analizan la evolución de las emisiones de GEI producidas en un proceso de degradación de la materia (normalmente residuos) e incorporan la comparación con un sistema de referencia y otras recomendaciones desde el Panel Intergubernamental por el Cambio Climático (IPCC por sus siglas en inglés). La fracción rechazo puede proceder de plantas de tratamiento mecánico y biológico (TMB) o de la separación en origen y la práctica más común en Europa es su depósito en vertedero (principalmente en el sur de Europa). El depósito en vertedero produce emisiones de GEI que empiezan pocos meses u años después del depósito y continúan hasta 40 años después con diferente intensidad a lo largo del tiempo. De ahí la necesidad de aplicar un enfoque dinámico a un estudio donde el sistema de referencia es el vertedero. Esta tesis estudia, en clave de beneficio climático, la sustitución del sistema actual de gestión de la fracción rechazo (vertedero e incineración) por un sistema basado en plantas de gasificación avanzadas. Estas plantas producen un mix de productos (biocombustibles y/o químicos de origen renovable) y/o servicios (electricidad y/o calor) a partir de la fracción rechazo. Dos grandes tipos de plantas de gasificación avanzada son analizados: por un lado, grandes plantas de gasificación llamadas biorefinerías termoquímicas que producen biocombustibles (y químicos de origen renovable) así como electricidad (y calor) con una alta eficiencia. Por otro lado, plantas de gasificación de pequeña y mediana escala produciendo electricidad. Las plantas de producción de electricidad son analizadas también desde el punto de vista económico ya que pueden ser implantadas a corto plazo porque existen tecnologías comerciales maduras que lo permitirían. Los plásticos de origen renovable (fabricados a partir de los químicos) son propuestos como una tecnología alternativa de retirada de carbono de la atmósfera ya que el carbono queda retenido en el plástico de origen renovable durante un periodo de tiempo que dependerá del tipo de plástico, su tiempo de vida y el sistema convencional de gestión de los residuos plásticos. La posibilidad de incorporar captura y almacenamiento de carbono en bioenergía (Bio-CAC) (tecnología comúnmente analizada en los Modelos de Evaluación Integrados (IAMs, en inglés)) y su comparación con el potencial de captura de los plásticos de origen renovable también es analizada. Los resultados revelan que la producción de plásticos de origen renovable compara favorablemente en términos de beneficio climático a corto y medio plazo e incluso podrían proveer un beneficio climático a largo plazo en países donde la incineración es una práctica predominante (norte de Europa). Desde el punto de vista metodológico, dos países europeos son elegidos para el análisis, España, que representa a los países del sur de Europa donde el depósito en vertedero es predominante y Suecia, representando a los países del norte de Europa donde la incineración es predominante. Para el análisis, dos posibles escenarios son considerados, un escenario 1 donde el sistema de gestión de residuos y el mix energético no varían a lo largo del tiempo (este escenario permite la comparación con una evaluación de emisiones estática desarrollada también en esta tesis) y un escenario 2 que evoluciona hacia un sistema sin depósito en vertedero y un mix energético bajo en carbono. En ambos escenarios se estudia un horizonte de tiempo de 100 años según el IPCC. De la colaboración con el Joint Research Centre (JRC, Comisión Europea) surgió una propuesta metodológica basada en dos nuevos indicadores de beneficio climático: el índice de mitigación climática (CMI, en inglés) y el diferencial de impacto climático (DCI, en inglés). Del mismo modo, el JRC colaboró en el modelado del carbono biogénico almacenado en los plásticos de origen renovable que dio lugar a un parámetro para ser incorporado en un análisis estático de emisiones (promedio de carbono biogénico almacenado en plásticos de origen renovable) y en uno dinámico (epool, sumatorio de las corrientes de reciclaje, vertedero e incineración a los largo del tiempo). Por tanto, el modelado dinámico del sistema de gestión de residuos (actual y futura) así como el modelado del almacenamiento de carbono biogénico en los plásticos de origen renovable son las principales contribuciones de esta tesis. Los resultados revelan que un análisis estático de las emisiones temporales resultaría insuficiente para la toma de decisiones sobre la sustitución del vertedero por plantas de gasificación avanzadas. El impacto de esta sustitución tiene un efecto positivo a corto plazo para ambos tipos de plantas aunque el concepto de biorefinería termoquímica produciendo plásticos de origen renovable cursa con el mayor beneficio climático. El beneficio a largo plazo no estaría garantizado a no ser que se tomen medidas para la restricción del depósito en vertedero

La colaboración interdisciplinar en las Unidades de Cuidados Intensivos desde la vivencia de las enfermeras

Objetivo. Comprender la experiencia vivida por las enfermeras que trabajan en las UCI polivalentes de un hospital de tercer nivel de la ciudad de Barcelona en relación con la colaboración interprofesional. Metodología. Diseño cualitativo exploratorio, multicéntrico de tipo descripción interpretativa. El ámbito de estudio fue cuatro UCI polivalentes de cuatro hospitales públicos y universitarios de tercer nivel. La muestra estuvo formada por 8 enfermeras. El muestreo teórico de variación máxima. La técnica de obtención de información fue el grupo de discusión con grabación de audio. Se realizó un análisis temático de contenido. Se siguieron los criterios de confiabilidad y autenticidad, así como el proceso de reflexividad durante todo el estudio. El estudio fue aprobado por el Comité de Ética de Investigación Clínica (CEIC). Resultados. Emergieron 2 grandes temas: la definición de colaboración interprofesional y propuestas de futuro. Las enfermeras consideran que la confianza y el respeto son la base de la colaboración interprofesional y aseguran la continuidad de los objetivos planificados. La comunicación y la relación entre iguales son dos de los factores que intervienen en la colaboración interprofesional. Es necesario cambiar de una jerarquía convencional a una visión compartida que mejoraría la participación de las enfermeras. Conclusiones. Los grandes pilares de la colaboración interdisciplinar son la comunicación efectiva y el trabajo en equipo, basado en la confianza y el respeto. Las líneas futuras de trabajo van enfocadas a la formación interdisciplinar de los futuros profesionales, la implantación real del pase conjunto y la mejora del clima laboral

Epidemiological and clinical features of Kawasaki disease in Spain over 5 years and risk factors for aneurysm development. (2011-2016): KAWA-RACE study group

Background: Kawasaki disease (KD) is an acute self-limited systemic vasculitis of unknown etiology affecting mainly children less than 5 years of age. Risk factors for cardiac involvement and resistance to treatment are insufficiently studied in non-Japanese children. Objective: This study aimed to investigate the epidemiology, clinical features and risk factors for resistance to treatment and coronary artery lesions (CAL) in KD in Spain. Methods: Retrospective study (May 2011-June 2016) of all patients less than 16 years of age diagnosed with KD included in KAWA-RACE network (84 Spanish hospitals). Results: A total of 625 cases were analyzed, 63% were males, 79% under 5 year-olds and 16.8% younger than 12 months. On echocardiographic examination CAL were the most frequent findings (23%) being ectasia the most common (12%). Coronary aneurysms were diagnosed in 9.6%, reaching 20% in infants under 12 months (p 900,000 cells/mm3, maximum temperature 10 days and fever before treatment ≥ 8 days as independent risk factors for developing coronary aneurysms. Conclusions: In our population, children under 12 months develop coronary aneurysms more frequently and children with KD with anemia and leukocytosis have high risk of cardiac involvement. Adding steroids early should be considered in those patients, especially if the treatment is not started before 8 days of fever. A score applicable to non-Japanese children able to predict the risk of aneurysm development and IVIG resistance is necessary

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases

Prevalence and Clinical Characteristics of SARS-CoV-2 Confirmed and Negative Kawasaki Disease Patients During the Pandemic in Spain

Introduction: COVID-19 has a less severe course in children. In April 2020, some children presented with signs of multisystem inflammation with clinical signs overlapping with Kawasaki disease (KD), most of them requiring admission to the pediatric intensive care unit (PICU). This study aimed to describe the prevalence and clinical characteristics of KD SARS-CoV-2 confirmed and negative patients during the pandemic in Spain. Material and Methods: Medical data of KD patients from January 1, 2018 until May 30, 2020 was collected from the KAWA-RACE study group. We compared the KD cases diagnosed during the COVID-19 period (March 1-May 30, 2020) that were either SARS-CoV-2 confirmed (CoV+) or negative (CoV-) to those from the same period during 2018 and 2019 (PreCoV). Results: One hundred and twenty-four cases were collected. There was a significant increase in cases and PICU admissions in 2020 (P-trend = 0.001 and 0.0004, respectively). CoV+ patients were significantly older (7.5 vs. 2.5 yr) and mainly non-Caucasian (64 vs. 29%), had incomplete KD presentation (73 vs. 32%), lower leucocyte (9.5 vs. 15.5 × 109) and platelet count (174 vs. 423 × 109/L), higher inflammatory markers (C-Reactive Protein 18.5vs. 10.9 mg/dl) and terminal segment of the natriuretic atrial peptide (4,766 vs. 505 pg/ml), less aneurysm development (3.8 vs. 11.1%), and more myocardial dysfunction (30.8 vs. 1.6%) than PreCoV patients. Respiratory symptoms were not increased during the COVID-19 period. Conclusion: The KD CoV+ patients mostly meet pediatric inflammatory multisystem syndrome temporally associated with COVID-19/multisystem inflammatory syndrome in children criteria. Whether this is a novel entity or the same disease on different ends of the spectrum is yet to be clarified

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3.

CARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain. Methods: In total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis. Results: In total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were bla OXA-48 (263/377), bla KPC-3 (62/377), bla VIM-1 (28/377), and bla NDM-1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5). Conclusion: This study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Effects of Enriched Physical and Social Environments on Motor Performance, Associative Learning, and Hippocampal Neurogenesis in Mice

We have studied the motor abilities and associative learning capabilities of adult mice placed in different enriched environments. Three-month-old animals were maintained for a month alone (AL), alone in a physically enriched environment (PHY), and, finally, in groups in the absence (SO) or presence (SOPHY) of an enriched environment. The animals' capabilities were subsequently checked in the rotarod test, and for classical and instrumental learning. The PHY and SOPHY groups presented better performances in the rotarod test and in the acquisition of the instrumental learning task. In contrast, no significant differences between groups were observed for classical eyeblink conditioning. The four groups presented similar increases in the strength of field EPSPs (fEPSPs) evoked at the hippocampal CA3-CA1 synapse across classical conditioning sessions, with no significant differences between groups. These trained animals were pulse-injected with bromodeoxyuridine (BrdU) to determine hippocampal neurogenesis. No significant differences were found in the number of NeuN/BrdU double-labeled neurons. We repeated the same BrdU study in one-month-old mice raised for an additional month in the above-mentioned four different environments. These animals were not submitted to rotarod or conditioned tests. Non-trained PHY and SOPHY groups presented more neurogenesis than the other two groups. Thus, neurogenesis seems to be related to physical enrichment at early ages, but not to learning acquisition in adult mice

Table_4_CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3.pdf

[Objectives] CARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.[Methods] In total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.[Results] In total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).[Conclusion] This study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3.Peer reviewe

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3