Prospective multicenter study of carbapenemase-producing Enterobacteriaceae from 83 hospitals in Spain reveals high in vitro susceptibility to colistin and meropenem

The aim of this study was to determine the impact of carbapenemase-producing Enterobacteriaceae (CPE) in Spain in 2013 by describing the prevalence, dissemination, and geographic distribution of CPE clones, and their population structure and antibi- otic susceptibility. From February 2013 to May 2013, 83 hospitals (about 40,000 hospital beds) prospectively collected nondupli- cate Enterobacteriaceae using the screening cutoff recommended by EUCAST. Carbapenemase characterization was performed by phenotypic methods and confirmed by PCR and sequencing. Multilocus sequencing types (MLST) were determined for Kleb- siella pneumoniae and Escherichia coli. A total of 702 Enterobacteriaceae isolates met the inclusion criteria; 379 (54%) were CPE. OXA-48 (71.5%) and VIM-1 (25.3%) were the most frequent carbapenemases, and K. pneumoniae (74.4%), Enterobacter cloacae (10.3%), and E. coli (8.4%) were the species most affected. Susceptibility to colistin, amikacin, and meropenem was 95.5%, 81.3%, and 74.7%, respectively. The most prevalent sequence types (STs) were ST11 and ST405 for K. pneumoniae and ST131 for E. coli. Forty-five (54.1%) of the hospitals had at least one CPE case. For K. pneumoniae, ST11/OXA-48, ST15/OXA-48, ST405/ OXA-48, and ST11/VIM-1 were detected in two or more Spanish provinces. ST11 isolates carried four carbapenemases (VIM-1, OXA-48, KPC-2, and OXA-245), but ST405 isolates carried OXA-48 only. A wide interregional spread of CPE in Spain was ob- served, mainly due to a few successful clones of OXA-48-producing K. pneumoniae (e.g., ST11 and ST405). The dissemination of OXA-48-producing E. coli is a new finding of public health concern. According to the susceptibilities determined in vitro, most of the CPE (94.5%) had three or more options for antibiotic treatment

Prospective multicenter study of carbapenemase-producing Enterobacteriaceae from 83 hospitals in Spain reveals high in vitro susceptibility to colistin and meropenem

The aim of this study was to determine the impact of carbapenemase-producing Enterobacteriaceae (CPE) in Spain in 2013 by describing the prevalence, dissemination, and geographic distribution of CPE clones, and their population structure and antibiotic susceptibility. From February 2013 to May 2013, 83 hospitals (about 40,000 hospital beds) prospectively collected nonduplicate Enterobacteriaceae using the screening cutoff recommended by EUCAST. Carbapenemase characterization was performed by phenotypic methods and confirmed by PCR and sequencing. Multilocus sequencing types (MLST) were determined for Klebsiella pneumoniae and Escherichia coli. A total of 702 Enterobacteriaceae isolates met the inclusion criteria; 379 (54%) were CPE. OXA-48 (71.5%) and VIM-1 (25.3%) were the most frequent carbapenemases, and K. pneumoniae (74.4%), Enterobacter cloacae (10.3%), and E. coli (8.4%) were the species most affected. Susceptibility to colistin, amikacin, and meropenem was 95.5%, 81.3%, and 74.7%, respectively. The most prevalent sequence types (STs) were ST11 and ST405 for K. pneumoniae and ST131 for E. coli. Forty-five (54.1%) of the hospitals had at least one CPE case. For K. pneumoniae, ST11/OXA-48, ST15/OXA-48, ST405/OXA-48, and ST11/VIM-1 were detected in two or more Spanish provinces. ST11 isolates carried four carbapenemases (VIM-1, OXA-48, KPC-2, and OXA-245), but ST405 isolates carried OXA-48 only. A wide interregional spread of CPE in Spain was observed, mainly due to a few successful clones of OXA-48-producing K. pneumoniae (e.g., ST11 and ST405). The dissemination of OXA-48-producing E. coli is a new finding of public health concern. According to the susceptibilities determined in vitro, most of the CPE (94.5%) had three or more options for antibiotic treatment.This work was supported by a grant from the Fondo de Investigación Sanitaria (grant PI12/01242); the Antibiotic Resistance Surveillance Programme of the Spanish Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ministerio de Economía y Competitividad; the Plan Nacional de I+D+I 2008–2011; and the Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), cofinanced by the European Development Regional Fund (ERDF) “A way to achieve Europe.”S

Deformation monitoring of dam infrastructures via spaceborne MT-InSAR. The case of La Viñuela (Málaga, southern Spain)

Dams require continuous security and monitoring programs, integrated with visual inspection and testing in dam surveillance programs. New approaches for dam monitoring focus on multi-sensor integration, taking into account emerging technologies such as GNSS, optic fiber, TLS, InSAR techniques, GBInSAR, GPR, that can be used as complementary data in dam monitoring, eliciting causes of dam deformation that cannot be assessed with traditional techniques. This paper presents a Multi-temporal InSAR (MT-InSAR) monitoring of La Viñuela dam (Málaga, Spain), a 96 m height earth-fill dam built from 1982 to 1989. The presented MT-InSAR monitoring system comprises three C-band radar (~5,7 cm wavelength) datasets from the European satellites ERS-1/2 (1992-2000), Envisat (2003-2008), and Sentinel-1A/B (2014-2018). ERS-1/2 and Envisat datasets were processed using StaMPS. In the case of Sentinel-1A/B, two different algorithms were applied, SARPROZ and ISCE-SALSIT, allowing the comparison of the estimated LOS velocity pattern. The obtained results confirm that LaViñuela dam is deforming since its construction, as an earth-fill dam. Maximum deformation rates were measured in the initial period (1992-2000), being around -7 mm/yr (LOS direction) on the coronation of the dam. In the period covered by the Envisat dataset (2003-2008), the average deforming pattern was lower, of the order of -4 mm/yr. Sentinel-1A/B monitoring confirms that the deformation is still active in the period 2014-2018 in the central-upper part of the dam, with maximums of velocity reaching -6 mm/yr. SARPROZ and ISCE-SALSIT algorithms provide similar results. It was concluded that MT-InSAR techniques can support the development of new and more effective means of monitoring and analyzing the health of dams complementing actual dam surveillance systems

MT-InSAR and Dam Modeling for the Comprehensive Monitoring of an Earth-Fill Dam: The Case of the Benínar Dam (Almería, Spain)

The Benínar Dam, located in Southeastern Spain, is an earth-fill dam that has experienced filtration issues since its construction in 1985. Despite the installation of various monitoring systems, the data collected are sparse and inadequate for the dam’s lifetime. The present research integrates Multi-Temporal Interferometric Synthetic Aperture Radar (MT-InSAR) and dam modeling to validate the monitoring of this dam, opening the way to enhanced integrated monitoring systems. MT-InSAR was proved to be a reliable and continuous monitoring system for dam deformation, surpassing previously installed systems in terms of precision. MT-InSAR allowed the almost-continuous monitoring of this dam since 1992, combining ERS, Envisat, and Sentinel-1A/B data. Line-of-sight (LOS) velocities of settlement in the crest of the dam evolved from maximums of −6 mm/year (1992–2000), −4 mm/year (2002–2010), and −2 mm/year (2015–2021) with median values of −2.6 and −3.0 mm/year in the first periods (ERS and Envisat) and −1.3 mm/year in the Sentinel 1-A/B period. These results are consistent with the maximum admissible modeled deformation from construction, confirming that settlement was more intense in the dam’s early stages and decreased over time. MT-InSAR was also used to integrate the monitoring of the dam basin, including critical slopes, quarries, and infrastructures, such as roads, tracks, and spillways. This study allows us to conclude that MT-InSAR and dam modeling are important elements for the integrated monitoring systems of embankment dams. This conclusion supports the complete integration of MT-InSAR and 3D modeling into the monitoring systems of embankment dams, as they are a key complement to traditional geotechnical monitoring and can overcome the main limitations of topographical monitoring

Spain: Underwater Exploration on a Narrow Continental Shelf

In spite of Spain’s long coastline (nearly 8000 km) and its well-established tradition in underwater archaeology, the prehistoric settlement of the continental shelf is practically unknown with very few finds. Underwater research has focused on naval archaeology and, until very recently, no attempt had been made to look for prehistoric underwater sites. In the past decade,new research projects have been launched to explore selected areas on the Cantabrian shelf and offshore of Gibraltar. This chapter summarises the currently available evidence of submerged prehistoric archaeology and the preliminary results of these new project

Statement complementing the EFSA Scientific Opinion on application (EFSA‐GMO‐UK‐2006‐34) for authorisation of food and feed containing, consisting of and produced from genetically modified maize 3272

Following a request from the European Commission, the GMO Panel assessed additional information related to the application for authorisation of food and feed containing, consisting of and produced from genetically modified (GM) maize 3272 (EFSA‐GMO‐UK‐2006‐34). The applicant conducted new agronomic, phenotypic and compositional analysis studies on maize 3272 and assessed the allergenic potential of AMY797E protein, addressing elements that remained inconclusive from previous EFSA opinion issued in 2013. The GMO Panel is of the opinion that the agronomic and phenotypic characteristics as well as forage and grain composition of maize 3272 do not give rise to food and feed safety, and nutritional concerns when compared to non‐GM maize. Considering the scope of this application and the characteristics of the trait introduced in this GM maize, the effect of processing and potential safety implications of specific food or feed products remain to be further investigated. Regarding the allergenic potential of AMY797E protein and considering all possible food and feed uses of maize 3272, the Panel concludes that the information provided does not fully address the concerns previously raised by the Panel in 2013. Owing to the nature and the knowledge available on this protein family, it is still unclear whether under specific circumstances the alpha‐amylase AMY797E has the capacity to sensitise certain individuals and to cause adverse effects. To further support the safety of specific products of maize 3272, the applicant provided thorough information relevant for the allergenicity assessment of dried distiller grains with solubles (DDGS), which is the main product of interest for importation into the EU. Having considered the information provided on this product, the Panel is of the opinion that under the specific conditions of use described by the applicant, DDGS produced from maize 3272 does not raise concerns when compared to DDGS from non‐GM maize

Integral strategy to supportive care in breast cancer survivors through occupational therapy and a m-health system: design of a randomized clinical trial

Background: Technological support using e-health mobile applications (m-health) is a promising strategy to improve the adherence to healthy lifestyles in breast cancer survivors (excess in energy intake or low physical activity are determinants of the risk of recurrence, second cancers and cancer mortality). Moreover, cancer rehabilitation programs supervised by health professionals are needed due to the inherent characteristics of these breast cancer patients. Our main objective is to compare the clinical efficacy of a m-health lifestyle intervention system alone versus an integral strategy to improve Quality of Life in breast cancer survivors. Methods: This therapeutic superiority study will use a two-arm, assessor blinded parallel RCT design. Women will be eligible if: they are diagnosed of stage I, II or III-A breast cancer; are between 25 and 75 years old; have a Body Mass Index > 25 kg/m2; they have basic ability to use mobile apps; they had completed adjuvant therapy except for hormone therapy; and they have some functional shoulder limitations. Participants will be randomized to one of the following groups: integral group will use a mobile application (BENECA APP) and will receive a face-to-face rehabilitation (8-weeks); m-health group will use the BENECA app for 2-months and will received usual care information. Study endpoints will be assessed after 8 weeks and 6 months. The primary outcome will be Quality of Life measured by The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core and breast module. The secondary outcomes: body composition; upper-body functionality (handgrip, Disability of the Arm, Shoulder and Hand questionnaire, goniometry); cognitive function (Wechsler Adult Intelligence Scale, Trail Making Test); anxiety and depression (Hospital Anxiety and Depression Scale); physical fitness (Short version of the Minnesota Leisure Time Physical Activity Questionnaire, Self-Efficacy Scale for Physical Activity); accelerometry and lymphedema. Discussion: This study has been designed to seek to address the new needs for support and treatment of breast cancer survivors, reflecting the emerging need to merge new low cost treatment options with much-needed involvement of health professionals in this type of patients. Trial registration: ClinicalTrials.gov Identifier: NCT02817724 (date of registration: 22/06/2016).The study was funded by the Spanish Ministry of Economy and Competitiveness (Plan Estatal de I + D + I 2013-2016), Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI14/01627), Fondos Estructurales de la Unión Europea (FEDER) and by the Spanish Ministry of Education (FPU14/01069). This is part of a Ph.D. Thesis conducted in the Clinical Medicine and Public Health Doctoral Studies of the University of Granada, Spain

VISUAL PPINOT: A Graphical Notation for Process Performance Indicators

Process performance indicators (PPIs) allow the quantitative evaluation of business processes, providing essential information for decision making. It is common practice today that business processes and PPIs are usually modelled separately using graphical notations for the former and natural language for the latter. This approach makes PPI definitions simple to read and write, but it hinders maintenance consistency between business processes and PPIs. It also requires their manual translation into lower-level implementation languages for their operationalisation, which is a time-consuming, error-prone task because of the ambiguities inherent to natural language definitions. In this article, Visual ppinot, a graphical notation for defining PPIs together with business process models, is presented. Its underlying formal metamodel allows the automated processing of PPIs. Furthermore, it improves current state-of-the-art proposals in terms of expressiveness and in terms of providing an explicit visualisation of the link between PPIs and business processes, which avoids inconsistencies and promotes their co-evolution. The reference implementation, developed as a complete tool suite, has allowed its validation in a multiple-case study, in which five dimensions of Visual ppinot were studied: expressiveness, precision, automation, understandability, and traceability

Factor structure and measurement invariance across various demographic groups and over time for the phq-9 in primary care patients in spain

The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demo- graphic groups (i.e., gender, age, marital status, level of education, and employment situa- tion) and over time. Both one-factor and two-factor re-specified models met all the pre- established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting