Determination of the Biomass Content of End-of-Life Tyres

Studies have been conducted in France and Spain for (1) the validation of sampling methods to achieve representative samples of end‐of‐life tyre (ELT) materials and (2) the comparison and validation of test methods to quantify their biomass content. Both studies conclude that the 14C techniques are the most reliable techniques for determining the biomass content of end‐of‐life tyres. Indeed, thermogravimetry and pyrolysis‐GC/MS do not lead to results consistent with the theoretical content of biogenic materials present in tyres, and results in both cases differ considerably from the known natural rubber content of the reference samples studied using thermogravimetric analysis. Furthermore, in the two last techniques, natural isoprene cannot be distinguished from synthetic isoprene. Results obtained with radiocarbon analysis based on 14C contents could be used as reference values of the biomass content of the ELTs: in the ranges of 18–22% for passenger car tyres and 29–34% for truck tyres, in line with actual natural rubber and other components content. Additionally, the presence of textile fibres and stearic acid, which are known sources of biomass in the tyre, cannot be evaluated by thermogravimetry and pyrolysis‐GC/MS techniques

Applications of the Transthoracic Impedance Signal during Resuscitation

Defibrillators acquire both the ECG and the transthoracic impedance (TI) signal through defibrillation pads. TI represents the resistance of the thorax to current flow, and is measured by defibrillators to check that defibrillation pads are correctly attached to the chest of the patient. Additionally, some defibrillators use the TI measurement to adjust the energy of the defibrillation pulse. Changes in tissue composition due to redistribution and movement of fluids induce fluctuations in the TI. Blood flow during the cardiac cycle generates small fluctuations synchronized to each heartbeat. Respiration (or assisted ventilation) also causes changes in the TI. Additionally, during cardiopulmonary resuscitation (CPR), chest compressions cause a disturbance in the electrode-skin interface, inducing artifacts in the TI signal. These fluctuations may provide useful information regarding CPR quality, length of pauses in chest compressions (no flow time), presence of circulation, etc. This chapter explores the new applications of the transthoracic impedance signal acquired through defibrillation pads during resuscitative attempts

Audiovisual Feedback Devices for Chest Compression Quality during CPR

During cardiopulmonary resuscitation (CPR), chest compression quality is the key for patient survival. However, several studies have shown that both professionals and laypeople often apply CPR at improper rates and depths. The use of real-time feedback devices increases adherence to CPR quality guidelines. This chapter explores new alternatives to provide feedback on the quality of chest compressions during CPR. First, we describe and evaluate three methods to compute chest compression depth and rate using exclusively the chest acceleration. To evaluate the accuracy of the methods, we used episodes of simulated cardiac arrest acquired in a manikin model. One of the methods, based on the spectral analysis of the acceleration, was particularly accurate in a wide range of conditions. Then, we assessed the feasibility of using the transthoracic impedance (TI) signal acquired through defibrillation pads to provide feedback on chest compression depth and rate. For that purpose, we retrospectively analyzed three databases of out-of-hospital cardiac arrest episodes. When a wide variety of patients and rescuers were included, TI could not be used to reliably estimate the compression depth. However, compression rate could be accurately estimated. Development of simpler methods to provide feedback on CPR quality could contribute to the widespread of these devices

Aspectos conceptuales sobre el proceso de decisión compartida en salud mental.

Uno de los cambios más importantes en la atención sanitaria de las últimas décadas, en lo que a las decisiones terapéuticas se refiere, ha sido la transición desde un modelo centrado en la enfermedad a uno centrado en el paciente. Esto conlleva la progresiva sustitución de una aproximación paternalista por una más deliberativa y, en relación a los tratamientos farmacológicos, del concepto de cumplimiento o adherencia al de concordancia o acuerdo terapéutico. El concepto de concordancia, por su parte, ha sido contemplado como el objetivo final de un proceso de negociación y corresponsabilidad en la decisión de elegir un tratamiento al que se ha denominado proceso de decisión compartida (PDC) (shared decision making). Hasta el momento, el PDC ha sido escasamente implantado en trastornos mentales graves, cuando no contestado como inadecuado dada la presunta alteración de la capacidad del paciente psiquiátrico gravemente enfermo para tomar decisiones. Sin embargo, esta incapacidad no siempre está presente por lo que la decisión compartida debe contemplarse como premisa y no como excepción. El PDC implica la implantación de un procedimiento en etapas (asociación médicopaciente, información sobre opciones, pros y contras, deliberación sobre las mismas y su relación con valores y preferencias del paciente, decisión consensuada). Una de las barreras más importantes para la aplicación del proceso de decisión compartida en salud mental es la cuestión de la capacidad del enfermo mental. Por ello, la evaluación de la capacidad debe hacerse central en la práctica clínica psiquiátrica

Waveform Capnography for Monitoring Ventilation during Cardiopulmonary Resuscitation: The Problem of Chest Compression Artifact

Sudden cardiac arrest (SCA) is the sudden cessation of the heart’s effective pumping function, confirmed by the absence of pulse and breathing. Without appropriate treatment, it leads to sudden cardiac death, considered responsible for half of the global cardiac disease deaths. Cardiopulmonary resuscitation (CPR) is a key intervention during SCA. Current resuscitation guidelines emphasize the use of waveform capnography during CPR in order to enhance CPR quality and improve patient outcomes. Capnography represents the concentration of the partial pressure of carbon dioxide (CO2) in respiratory gases and reflects ventilation and perfusion of the patient. Waveform capnography should be used for confirming the correct placement of the tracheal tube and monitoring ventilation. Other potential uses of capnography in resuscitation involve monitoring CPR quality, early identification of restoration of spontaneous circulation (ROSC), and determination of patient prognosis. An important role of waveform capnography is ventilation rate monitoring to prevent overventilation. However, some studies have reported the appearance of high-frequency oscillations synchronized with chest compressions superimposed on the capnogram. This chapter explores the incidence of chest compression artifact in out-of-hospital capnograms, assesses its negative influence in the automated detection of ventilations, and proposes several methods to enhance ventilation detection and capnography waveform

El proceso de decisión compartida en el tratamiento del paciente psiquiátrico: estudios empíricos y evaluación de la capacidad

Existe investigación empírica sobre experiencias de decisión compartida en salud mental, preferentemente en depresión y esquizofrenia, y algo menos en adicciones. La evidencia disponible a partir de los estudios llevados a cabo en los últimos años muestra que esta práctica mejora la calidad de las decisiones y parece efectiva en el proceso decisorio (aumenta el conocimiento y la participación, favorece una mayor congruencia con los valores y preferencias del paciente), aumentando, generalmente, la satisfacción del usuario. Sin embargo, existe escasa o mínima evidencia acerca de su eficacia sobre indicadores de resultados de salud. Uno de los elementos claves de los procesos de decisión compartida es la determinación de la capacidad del paciente para tomar la decisión clínica en cuestión. Se trata de un juicio clínico que posee un papel relevante en el difícil equilibrio entre autonomía y beneficencia/no maleficencia en la atención sanitaria. Así, una adecuada evaluación de la capacidad de tomar decisiones del paciente debe servir para proteger ambos principios y evitar dos tipos de errores: por un lado, el soslayar injustificadamente  la  autonomía  del  paciente  para salvaguardar su bienestar; por otro, el injustificable respeto a su autonomía al precio de su bienestar

Structure of the receptor-binding carboxy-terminal domain of the bacteriophage T5 L-shaped tail fibre with and without its intra-molecular chaperone

Bacteriophage T5, a Siphovirus belonging to the order Caudovirales, has a flexible, three-fold symmetric tail, to which three L-shaped fibres are attached. These fibres recognize oligo-mannose units on the bacterial cell surface prior to infection and are composed of homotrimers of the pb1 protein. Pb1 has 1396 amino acids, of which the carboxy-terminal 133 residues form a trimeric intra-molecular chaperone that is auto-proteolyzed after correct folding. The structure of a trimer of residues 970–1263 was determined by single anomalous dispersion phasing using incorporated selenomethionine residues and refined at 2.3 Å resolution using crystals grown from native, methionine-containing, protein. The protein inhibits phage infection by competition. The phage-distal receptor-binding domain resembles a bullet, with the walls formed by partially intertwined beta-sheets, conferring stability to the structure. The fold of the domain is novel and the topology unique to the pb1 structure. A site-directed mutant (Ser1264 to Ala), in which auto-proteolysis is impeded, was also produced, crystallized and its 2.5 Å structure solved by molecular replacement. The additional chaperone domain (residues 1263–1396) consists of a central trimeric alpha-helical coiled-coil flanked by a mixed alpha-beta domain. Three long beta-hairpin tentacles, one from each chaperone monomer, extend into long curved grooves of the bullet-shaped domain. The chaperone-containing mutant did not inhibit infection by competition.This research was sponsored by grants BFU2011-24843, BIO2011-14756-E, BFU2014-53425P (Mark J. van Raaij), and BFU2014-55475R (José R. Castón) and the BioFiViNet network (FIS2011-16090-E) from the Spanish Ministry of Economy and Competitiveness, grant S2013/MIT-2807 (José R. Castón) from the Comunidad Autónoma de Madrid and a joint networking grant from CSIC (2011FR0016; Mark J. van Raaij) and CNRS (2011EDC25326; Pascale Boulanger). Carmela Garcia-Doval was the recipient of a pre-doctoral FPU fellowship from the Spanish Ministry of Education, Culture and Sports and José M. Otero of a post-doctoral Plan I2C fellowship from the Xunta de Galicia. The research leading to these results has also received funding from the European Community’s Seventh Framework Programme (FP7/2007–2013) under BioStruct-X (grant agreement number 283570). We acknowledge support by the CSIC Open Access Publication Initiative through its Unit of Information Resources for Research (URICI).Peer Reviewe

Estimación de costes ambientales derivados del corredor La Salve-Ibarrekolanda. Bilbao-España

This paper summarizes the Information on two alternative routes for a highway between the ''La Salve'' Bridge and Ibarrekolanda (Bilbao) in order to assess and compare the environmental costs. The first alternative would involve passing a high-speed road through a densely populated area whereas the second would have more characteristics of a ring road. As expected, the second alternative, which bypasses the built-up areas, would have less impact and lower environmental costs for the inhabitants of the area, not only during construction but also when the road is opened to traffic. In this alternative, the road would run along a steep slope which constitutes one side of the valley. Since the slope is already environmentally degraded and has no significant natural, agricultural or cultural value, important environment costs would not be incurred by locating the road there. Furthermore, this alternative would make it much easier to minimize undesirable effects.Se sintetizan los informes realizados con el fin de efectuar una primera comparación entre los costes ambientales que produciría un corredor entre el Puente de La Salve e Ibarrekolanda (Bilbao) según dos trazados netamente diferentes. El primero implicaría introducir unos viales de circulación rápida por una zona densamente habitada, mientras que el segundo tendría más bien carácter de circunvalación. Como cabía esperar, el trazado que evita las partes densamente edificadas repercutiría sobre la población cercana unos costes ambientales más reducidos (tanto durante la fase de construcción como durante su funcionamiento) y al realizarse sobre una ladera ambientalmente degradada, en la que no existen rasgos o elementos naturales, agroganaderos o culturales de importancia, tampoco daría lugar a costes de consideración a través de los mismos. Además, las posibilidades de minimización de efectos indeseables son muy superiores

Candidate Gene and Genome-Wide Association Studies for Circulating Leptin Levels Reveal Population and Sex-Specific Associations in High Cardiovascular Risk Mediterranean Subjects

Leptin is a hormone crucial in the regulation of food intake and body-weight maintenance. However, the genes and gene variants that influence its plasma levels are still not well known. Results of studies investigating polymorphisms in candidate genes have been inconsistent, and, in addition, very few genome-wide association studies (GWAS) have been undertaken. Our aim was to investigate the genes and gene variants most associated with plasma leptin concentrations in a high-cardiovascular-risk Mediterranean population. We measured plasma leptin in 1011 men and women, and analyzed the genetic factors associated using three approaches: (1) Analyzing the single nucleotide polymorphisms (SNPs) reported in a GWAS meta-analysis in other populations (including an SNP in/near each of these LEP, SLC32A1, GCKR, CCNL, COBLL1, and FTO genes); (2) Investigating additional SNPs in/near those genes, also including the RLEP gene; and (3) Undertaking a GWAS to discover new genes. We did not find any statistically significant associations between the previously published SNPs and plasma leptin (Ln) in the whole population adjusting for sex and age. However, on undertaking an extensive screening of other gene variants in those genes to capture a more complete set of SNPs, we found more associations. Outstanding among the findings was the heterogeneity per sex. We detected several statistically significant interaction terms with sex for these SNPs in the candidate genes. The gene most associated with plasma leptin levels was the FTO gene in men (specifically the rs1075440 SNP) and the LEPR in women (specifically the rs12145690 SNP). In the GWAS on the whole population, we found several new associations at the p < 1 × 10-5 level, among them with the rs245908-CHN2 SNP (p = 1.6 × 10-6). We also detected a SNP*sex interaction at the GWAS significance level (p < 5 × 10-8), involving the SLIT3 gene, a gene regulated by estrogens. In conclusion, our study shows that the SNPs selected as relevant for plasma leptin levels in other populations, are not good markers for this Mediterranean population, so supporting those studies claiming a bias when generalizing GWAS results to different populations. These population-specific differences may include not only genetic characteristics, but also age, health status, and the influence of other environmental variables. In addition, we have detected several sex-specific effects. These results suggest that genomic analyses, involving leptin, should be estimated by sex and consider population-specificity for more precise estimations