Impacts of exhaust gas cleaning systems (EGCS) discharge waters on planktonic biological indicators

Exhaust Gas Cleaning Systems (EGCS), operating in open-loop mode, continuously release acidic effluents (scrubber waters) to marine waters. Furthermore, scrubber waters contain high concentrations of metals, polycyclic aromatic hydrocarbons (PAHs), and alkylated PAHs, potentially affecting the plankton in the receiving waters. Toxicity tests evidenced significant impairments in planktonic indicators after acute, early-life stage, and long-term exposures to scrubber water produced by a vessel operating with high sulphur fuel. Acute effects on bacterial bioluminescence (Aliivibrio fischeri), algal growth (Phaeodactylum tricornutum, Dunaliella tertiolecta), and copepod survival (Acartia tonsa) were evident at 10 % and 20 % scrubber water, while larval development in mussels (Mytilus galloprovincialis) showed a 50 % reduction at ∼5 % scrubber water. Conversely, larval development and reproductive success of A. tonsa were severely affected at scrubber water concentrations ≤1.1 %, indicating the risk of severe impacts on copepod populations which in turn may result in impairment of the whole food web.

The low dopamine hypothesis: A plausible mechanism underpinning residual urine, overactive bladder and nocturia (RON) syndrome in older patients

INTRODUCTION

Aging is associated with a combination of several lower urinary tract (LUT) signs and symptoms, including residual urine, overactive bladder and nocturia. One of the mechanisms of this LUT dysfunction that has not been discussed in dept so far is the role of dopamine (DA).

METHODS

In this narrative review, we explore the dopaminergic hypothesis in the development of this combination of LUT signs and symptoms in older adults.

RESULTS

DA is one of the neurotransmitters whose regulation and production is disrupted in aging. In synucleinopathies, altered DAergic activity is associated with the occurrence of LUTS and sleep disorders. Projections of DAergic neurons are involved in the regulation of sleep, diuresis, and bladder activity. The low dopamine hypothesis could explain the genesis of a set of LUT signs and symptoms commonly seen in this population, including elevated residual urine, Overactive bladder syndrome and Nocturia (discussed as the RON syndrome). This presentation is however also common in older patients without synucleinopathies or neurological disorders and therefore we hypothesise that altered DAergic activity because of pathological aging, and selective destruction of DAergic neurons, could underpin the presentation of this triad of LUT dysfunction in the older population.

CONCLUSION

The concept of RON syndrome helps to better understand this common phenotypic presentation in clinical practice, and therefore serves as a useful platform to diagnose and treat LUTS in older adults. Besides recognizing the synucleinopathy "red flag" symptoms, this set of multi-causal LUT signs and symptoms highlights the inevitable need for combination therapy, a challenge in older people with their comorbidities and concomitant medications.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

European scale assessment of the potential of ozonation and activated carbon treatment to reduce micropollutant emissions with wastewater

Micropollutants (MPs) in wastewater pose a growing concern for their potential adverse effects on the receiving aquatic environment, and some countries have started requiring that wastewater treatment plants remove them to a certain extent. Broad spectrum advanced treatment processes, such as ozonation, activated carbon or their combination, are expected to yield a significant reduction in the toxicity of effluents. Here we quantify the reduction of effluent toxicity potentially achieved by implementing these advanced treatment solutions in a selection of European wastewater treatment plants. To this end, we refer to a list of "total pollution proxy substances" (TPPS) composed of 1337 chemicals commonly found in wastewater effluents according to a compilation of datasets of measured concentrations. We consider these substances as an approximation of the "chemical universe" impinging on the European wastewater system. We evaluate the fate of the TPPS in conventional and advanced treatment plants using a compilation of experimental physicochemical properties that describe their sorption, volatilization and biodegradation during activated sludge treatment, as well as known removal efficiency in ozonation and activated carbon treatment, while filling the gaps through in silico prediction models. We estimate that the discharge of micropollutants with wastewater effluents in the European Union has a cumulative MP toxicity to the environment equal to the discharge of untreated wastewater of ca. 160 million population equivalents (PE), i.e. about 30 % of the generated wastewater in the EU. If all plants above a capacity of 100,000 PE were equipped with advanced treatment, we show that this load would be reduced to about 95 million PE. In addition, implementing advanced treatment in wastewater plants above 10,000 PE discharging to water bodies with an average dilution ratio smaller than 10 would yield a widespread improvement in terms of exposure of freshwater ecosystems to micropollutants, almost halving the part of the stream network exposed to the highest toxic risks. Our analysis provides background for a cost-effectiveness appraisal of advanced treatment "at the end of the pipe", which could lead to optimized interventions. This should not be regarded as a stand-alone solution, but as a complement to policies for the control of emissions at the source for the most problematic MPs.

Applicability of an on-line solid-phase extraction liquid chromatography - tandem mass spectrometry for the wastewater-based assessment of human exposure to chemicals from personal care and household products

Wastewater-based epidemiology (WBE) can be a useful complementary approach to assess human exposure to potentially harmful chemicals, including those from personal care and household products. In this work, a fully automated multiresidue method, based on on-line solid-phase extraction liquid chromatography - tandem mass spectrometry, was developed for the determination of 27 biomarkers of human exposure to selected chemicals from personal care and household products, including parabens, UV filters, phthalates and alternative plasticizers, phosphorous flame retardants/plasticizers (PFRs), and bisphenols. These biomarkers include both the parent compounds and their human metabolites. In addition, two oxidative stress biomarkers, 8-epi-prostaglandin F2α and 4-hydroxy nonenal mercapturic acid, were also considered in the study. The method was carefully optimized to tackle the challenges of analyzing compounds with different physico-chemical properties in a highly complex raw wastewater matrix, while model experiments were performed to investigate filtration losses and analyte stability. The applicability of the developed method was tested by analyzing raw wastewater from four European cities: Antwerp, Brussels (Belgium), Girona (Spain), and Zagreb (Croatia). Twenty-one biomarkers (10 parent compounds and 11 metabolites) were detected in all analyzed wastewater samples. The parent compounds with the highest mass loads were PFRs, parabens, and bisphenol S, while phthalate monoesters were the most prominent metabolites. The mass loads of most compounds were quite similar across cities, but geographic differences were observed for some biomarkers, such as metabolites of phthalates and alternative plasticizers. Exposure was then assessed for seven substances for which quantitative urinary excretion data are known. Our results indicate that safe reference values were exceeded for several contaminants, including butylated phthalates, bisphenol A, and tris(2-butoxyethyl) phosphate, particularly for toddlers. With this relatively simple method, which requires less sample manipulation, it is possible to promptly identify and monitor exposure to harmful chemicals at the population level using the WBE approach.

Potentially inappropriate prescribing and its demographic and clinical correlates in older adults with atrial fibrillation: a population-based study

Introduction

Older adults with atrial fibrillation (AF) have an increased risk of comorbidities and often take a combination of medicines. Moreover, it is known that anticoagulants tend to be underprescribed or underdosed in older patients with AF. Thus, it is important to evaluate the overall quality of prescribing because potentially inappropriate prescribing is associated with serious adverse events.

Purpose

To assess the quality of prescribing and to analyze the association between potentially inappropriate prescribing with demographic and clinical variables in a Swedish urban older population with AF.

Methodology

The Swedish National Study on Aging and Care is an observational longitudinal population-based study (baseline: 2001–2004) of adults aged 60 years or older (n=3363). We used the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) version 2 algorithms (1) to assess the quality of prescribing. STOPP and START criteria identify potentially inappropriately prescribed medications and medications that are omitted but should have been prescribed, respectively. We could apply 72% of the STOPP criteria and 50% of the START criteria to the dataset. A hurdle negative binomial regression model was fitted to investigate the association between STOPP/START and age, sex, polypharmacy, and functional status indicated by activities of daily living.

Results

We analyzed data on 293 participants with AF. STOPP and START criteria occurred in 53.6% and 63.5% of older patients with AF, respectively. The most frequently inappropriately prescribed drugs (STOPP) were anticoagulants (4.8%), hypnotic Z-drugs (19.1%), benzodiazepines (19.1%) and drugs contributing to anticholinergic burden (6.8%). The most frequently omitted drugs (START) were antiplatelets (26%), anticoagulants (26%), statins (14.3%), beta-blockers (17.7%), vitamin D (15.7%), calcium supplements (15.7%) and laxatives (16%).

Polypharmacy (≥5 drugs; OR 3.45; 95% CI 1.85–6.44) was significantly associated with higher odds of having at least one STOPP criterion (Table 1). Disability (OR 2.56; 95% CI 1.26–5.21) was significantly associated with higher odds of having at least one START criterion.

Among persons with at least one STOPP or START criterion, the estimated mean number of STOPP and START criterion were 2.35 (95% CI 1.36–4.09) and 2.49 (95% CI 1.48–4.21) times higher, respectively, in persons with high polypharmacy (>10 drugs) compared to those without polypharmacy.

Conclusion

Potentially inappropriate prescribing and prescribing omissions were prevalent in this population of older adults with AF, beyond the well-known case of anticoagulants. Thorough multi-disciplinary medication reviews might improve quality of prescribing, especially in those with polypharmacy and functional impairment.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This project has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 899871.

The comorbidity network in older adults with atrial fibrillation: a Danish nationwide cohort study

Introduction

Individuals affected by atrial fibrillation (AF) often present with multiple comorbidities that challenge their clinical management and worsen the prognosis. Characterizing the network structure of comorbid chronic conditions in AF patients may provide insights to better tailor medical and care management.

Purpose

To examine and compare the network structure of comorbidities in older people with and without AF.

Methods

Cross-sectional data derived from the Danish National Patient Register (period 2012–2017) were examined. Patients 60+ years old by 1. January 2017 with AF were selected and matched by age and sex to non-AF controls. Chronic conditions coded according to the International Classification of Diseases, 10th revision were retrieved and grouped into 60 clinically relevant disease categories for old age. Network analysis was applied to construct the disease networks and the centrality index of expected influence was measured to estimate the disease interconnectedness in each network. The difference in network structure and disease centrality between AF and non-AF patients was formally assessed through network comparison tests.

Results

A total of 96,117 AF patients (72 years old; 45% women) were identified and matched with 96,117 non-AF controls. The most prevalent chronic conditions in AF were hypertension (55.1%), large bowel diseases (36.4%) and ischemic heart disease (36.0%). A significant difference of global network structure was observed between AF and non-AF patients (p<0.001) (Figure1). Chronic obstructive pulmonary disease, depression, inflammatory arthropathy, chronic kidney disease and peripheral neuropathy had a higher connectivity with other diseases in the AF vs. non-AF patients (p<0.001). By contrast, hypertension, heart failure and stroke were more interconnected in the non-AF patients (p<0.001). Among AF patients, network differences were further observed between age categories (60–79 vs 80+ years) in male and female subgroups.

Conclusions

Older AF patients exhibited a complex network structure of chronic conditions that differed from age- and sex- matched non-AF patients. The network-based identification of highly co-morbid diseases in AF can improve our understanding of AF-related chronic conditions and potentially enhance prioritization and a personalized care for older patients with AF.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

Surface modification of poly(methyl-methacrylate) with farnesol to prevent Candida biofilm formation

Candida albicans promotes biofilm formation on dentures, which compromises the use of poly(methyl-methacrylate) (PMMA) as a dental material. Farnesol (FAR), a natural compound that prevents C. albicans filamentation and biofilm formation, was incorporated into the PMMA matrix, to obtain antifungal PMMA_FAR materials. The tested concentrations (0·0125% and 0·4%) of FAR, 24 h after incubation on YPD agar, inhibited filamentation of C. albicans. PMMA was modified with different FAR concentrations (3-12%), and physicochemical properties, antifungal activity and cytotoxicity of these modified materials (PMMA_FAR) were tested. The presence of FAR in PMMA_FAR composites was verified by Fourier-transform infrared spectroscopy (FT-IR). Incorporation of FAR into the polymeric matrix significantly decreased hydrophilicity at all tested concentrations and significantly reduced biofilm and planktonic cells metabolic activity in the early stage of biofilm formation at ≥6% FAR in PMMA. PMMA_FAR composites with <9% FAR were non-toxic. Modification of PMMA with FAR is a good strategy for reducing C. albicans biofilm formation on dentures.

Occurrence of veterinary drugs and resistance genes during anaerobic digestion of poultry and cattle manures

In the present paper, the mesophilic (35 °C) and thermophilic (55 °C) biomethanization of poultry and cattle manures were investigated using biochemical methane potential (BMP) tests. Specific methane production (SMP), 24 pharmaceutical compounds (PhACs), and five antibiotic resistance genes (ARGs) (bla_KPC, ermB, qnrS, sul1 and tetW) together with the microbial community were analyzed. Mesophilic BMP tests resulted in the highest SMP when poultry manure was used (285.5 mL CH₄/g VSS with poultry vs 239.6 mL CH₄/g VSS with cattle manure) while thermophilic temperatures led to the highest SMP with cattle manure (231.2 mL CH₄/g VSS with poultry vs 238.0 mL CH₄/g VSS with cattle manure). Higher removals of veterinary pharmaceuticals were detected at 55 °C with both manures indicating that thermophilic digestion is better suited for the removal of these compounds. Tylosin, tilmicosin, chlortetracycline, and sulfamethoxazole presented removals higher than 50%, being the first two completely removed under mesophilic and thermophilic conditions. When comparing the relative abundance of ARGs at the end of each treatment, the most significant removal was found for qnrS which was not detected after the anaerobic treatment. The remaining ARGs did not suffer significant changes. Finally, microbial composition analysis showed that temperature affected the final microbial population more than the microorganisms present in the substrate or inoculum.

Pathways of organic micropollutants degradation in atmospheric pressure plasma processing - A review

Concern of toxic compounds and their, potentially more harmful degradation products, present in aquatic environment alarmed scientific community and research on the development of novel technologies for wastewater treatment had become of great interest. Up to this date, many papers pointed out the challenges and limitations of conventional wastewater treatment and of some advanced oxidation processes. Advanced technologies based on the use of non-equilibrium or non-thermal plasma had been recognized as a possible solution for, not only degradation, but for complete removal of recalcitrant organic micropollutants. While previous review papers have been focused on plasma physics and chemistry of different types of discharges for few organic micropollutants, this paper brings comprehensive review of current knowledge on the chemistry and degradation pathways by using different non-thermal plasma types for several micropollutants' classes, such as pharmaceuticals, perfluorinated compounds, pesticides, phenols and dyes and points out some major research gaps.

Obesity and decreased vibration perception associated with premature cardiovascular mortality in a single center prospective study of people with diabetes

Background and aims

The aim of this prospective, single center study was to define factors associated with early cardiovascular mortality in diabetes.

Materials and methods

1345 patients under age 75 were included who were undergoing assessment of their diabetes between January 2008 and May 2010 as part of standard practice in a specialist clinic at a regional teaching hospital in Serbia. Peripheral artery disease (PAD) was assessed by audible Doppler waveform and ABPI with cut-offs &gt;1.4 and &lt;0.9. Peripheral neuropathy was assessed by vibration perception threshold (VPT, using a semi-quantitative tuning fork: abnormal if ≤5), ankle reflexes (AR) and sudomotor function of the foot. Diabetic retinopathy (DR) was assessed by fundoscopy. Evidence of vascular disease: thromboendarterectomy and/or cerebrovascular insult (TEA/CVI), myocardial infarction (MI), heart failure (HF), diabetic foot ulcer (DFU), minor amputations (sAMP) and major amputations (mAMP) was also collected. Outcome was determined in 2021 and baseline characteristics were compared between those who had and had not suffered cardiovascular death under age 75 years within 10 years of review in two casually selected cohorts.

Results

Those who died (n2=70) were more frequently male (60 vs. 45.3%, p=0.08), younger (66.4±7.4 vs. 79.9±3.4, p&lt;0.000), had a shorter period of follow-up (3.6±2.3 vs. 11.2±1.7 years, p&lt;0.000) when compared to those still alive (n1=75). Those who died were also significantly (p&lt;0.01) more likely to have had TEA/CVI (34.3 vs. 10.7%), HF (21.4 vs. 1.3%), MI (44.3 vs. 20%), PAD (48.6 vs. 9.3%), DFU (25.7 vs. 9.3%), mAMP (17.1 vs. 1.3%) at baseline. There were no differences in proliferative DR (17.1 vs. 8%, p=0.10) and laser photocoagulation (25.7 vs. 13.3%, p=0.06) Following multivariable logistic regression analysis significant differences between groups remained for only creatinine (123±45 vs. 88.9±16.9 mmol/L, p&lt;0.003) and VPT &lt;5 (7.8 [95% CI: 3.7–16.4)], p=0.008), estimated maximum lifetime BMI (3.4 [95% CI: 1.7–6.8)], p&lt;0.000), alcohol usage (4.7 [95% CI: 1.5–14.7)], p=0.005), smoking habit (2.2 [95% CI: 1.1–4.3)], p&lt;0.03) and earlier age of diabetes onset (43.4±12.5 vs. 49.2±9.9, p=0.0029). When the 72 patients with impaired vibration sense were compared with 73 with VPT&gt;6, there were significant differences in TEA/CVI (4.2 [95% CI: 1.6–10.9)], p=0.003), PAD (3.9 [95% CI: 1.8–8.8)], p&lt;0.001) and estimated maximum lifetime BMI (9.4 [95% CI: 3.4–25.7), p&lt;0.000). Finally, when those who had had a previous MI at baseline (n=46) were compared with those who hadn't (n=99), MI was associated with increased death rate (3.2 [95% CI: 1.5–6.6)], p=0.002), as was PAD (2.9 [(1.3–6.1)], p=0.007).

Conclusion

Decreased VPT, the presence of PAD on clinical testing and higher maximum estimated lifetime BMI are strongly associated with premature cardiovascular death. These measures may be independent markers of greater risk of reduced life expectancy.

Funding Acknowledgement

Type of funding sources: None.

Assessing the occurrence of pharmaceuticals and antibiotic resistance genes during the anaerobic treatment of slaughterhouse wastewater at different temperatures

This study investigates the effect of psychrophilic, mesophilic and thermophilic temperatures on the anaerobic treatment of slaughterhouse wastewater, in terms of biogas production, occurrence of 30 pharmaceutical compounds of veterinary use, 4 antibiotic resistance genes (ARGs) which provide resistance to tetracyclines (tetW), fluoroquinolones (qnrS), macrolide-lincosamide-streptogramin (ermB) and sulfonamides (sul1) antibiotics, as well as class I integron-integrase gene (intI1), related to horizontal gene transfer. The highest methane yield was obtained at a mesophilic temperature (35 °C) (323 mL CH₄/g TCOD) followed by the yield obtained at thermophilic temperature (53 °C) (242 mL CH₄/g TCOD). Regarding pharmaceuticals, chlortetracycline, oxytetracycline, tilmicosin, and lincomycin were the most abundant in the slaughterhouse wastewater, being detected predominantly in the solid phase (with median concentrations >200 μg/kg dry weight). On the other hand, ciprofloxacin, ofloxacin, norfloxacin, lincomycin and ibuprofen were the most predominant in the anaerobic digestate regardless of the treatment temperature. Psychrophilic temperatures (21 °C) exhibited moderate to low pharmaceuticals removal, while a large fraction of them were removed at a thermophilic temperature reaching 70-90% removals for tetracycline, macrolides and one sulfonamide (sulfapyridine). The highest relative abundance of the quantified ARGs was found at 53 °C, suggesting that thermophilic temperatures normally associated with better removals of pathogens do not necessarily show better removals of antibiotic resistance genes.

Fate of N-nitrosodimethylamine and its precursors during a wastewater reuse trial in the Llobregat River (Spain)

In summer 2019, a full-scale trial was carried out to investigate the effects in drinking water quality when tertiary treated wastewater was discharged into the Llobregat River upstream of the intake of one of the major drinking water treatment plants of Barcelona and its metropolitan area. Two scenarios were investigated, i.e. discharging the reclaimed water with and without chemical disinfection with chlorine. This study investigates the concentration of N-nitrosodimethylamine (NDMA) as the specific disinfection conditions employed in this trial may favor its formation. To this aim, both NDMA and NDMA formation potential, were measured. The river contained NDMA at very low concentrations, but the concentration of NDMA precursors was already high. The NDMA concentration was reduced from discharge to the river to drinking water intake probably due to a combined effect of dilution and photolysis. The formation potential was also reduced probably due to dilution and biodegradation. The concentration of NDMA in the drinking water was always low (<7.3 ng/L), although the formation potential was above 10 ng/L in one sample. Dissolved organic matter characterization by high resolution mass spectrometry revealed differences between the nature of the organic matter in the river before and after reclaimed water discharge.

Priority and emerging organic microcontaminants in three Mediterranean river basins: Occurrence, spatial distribution, and identification of river basin specific pollutants

There is a worldwide growing use of chemicals by our developed, industrialized, and technological society. More than 100,000 chemical substances are thus commonly used both by industry and households. Depending on the amount produced, physical-chemical properties, and mode of use, many of them may reach the environment and, notably, the aquatic receiving systems. This may result in undesirable and harmful side-effects on both the human and the ecosystem's health. Mediterranean rivers are largely different from Northern and Central European rivers in terms of hydrological regime, climate conditions (e.g. air temperature, solar irradiation, precipitation), and socio-economics (e.g. land use, tourism, crop types, etc.), with all these factors leading to differences in the relative importance of the environmental stressors, in the classes and levels of the pollutants found and their environmental fate. Furthermore, water scarcity might be critical in affecting water pollution because of the lowered dilution capacity of chemicals. This work provides raw chemical data from different families of microcontaminants identified in three selected Mediterranean rivers (the Sava, Evrotas, and Adige) collected during two sampling campaigns conducted in 2014 and 2015 in three different matrices, namely, water, sediments, and biota (fish). More than 200 organic micropollutants were analyzed, including relevant groups like pharmaceuticals, personal care products, perfluorinated compounds, pesticides, pyrethroid insecticides, flame retardants, and persistent organic pollutants. Data obtained were summarized with some basic statistics for all compound families and matrices analyzed. Observed occurrence and spatial patterns were interpreted both in terms of compound physical-chemical properties and local environmental pressures. Finally, their spatial distribution was examined and their ecotoxicological risk in the water phase was assessed. This allowed locating, at each basin, the most polluted sites ("hot spots") and identifying the respective river basin specific pollutants (RBSPs), prioritizing them in terms of the potential ecotoxicological risk posed to the aquatic ecosystems.

Pressurized Liquid Extraction (PLE) and QuEChERS evaluation for the analysis of antibiotics in agricultural soils

Vinasse, a liquid waste which originates from the production of ethanol fuel from sugarcane, has been widely used as soil amendment in Brazil. An important concern that arises from vinasse reuse is the dissemination of antibiotics to the environment through crop soils. This work evaluated the performance of Pressurized Liquid Extraction (PLE) and QuEChERS (quick, easy, cheap, effective, rugged and safe) to extract several multiple-class antibiotics, such as cephalosporins, fluoroquinolones, ionophores, lincosamides, macrolides, quinolones, streptogramin, sulfonamides, tetracyclines and others, from agricultural soils. The performance of several parameters was evaluated for both PLE and QuEChERS, such as the extraction temperature (for PLE), solvents composition, pH and the addition of EDTA. Both methods were able to extract most target antibiotics. However, QuEChERS showed higher recoveries for macrolides and nitroimidazoles, while PLE was more suitable for fluoroquinolones and ionophores (i.e. monensin). The use of citrate-phosphate buffer at pH 7.0, in combination with methanol for PLE and with acetonitrile for QuEChERS, provided the highest antibiotic recoveries for both methods. The use of EDTA did not increase antibiotic recovery rates for QuEChERS, while the temperature had almost no influence on the extraction efficiency in PLE.•Citrate-phosphate buffer at pH 7.0 provided higher antibiotic recoveries for QuEChERS and PLE.•The combination buffer-methanol provided higher recoveries for PLE.•QuEChERS and PLE methods were able to extract most of the target antibiotics.

Wastewater-based epidemiology to assess human exposure to personal care and household products - A review of biomarkers, analytical methods, and applications

Humans are nowadays exposed to numerous chemicals in our day-to-day life, including parabens, UV filters, phosphorous flame retardants/plasticizers, bisphenols, phthalates and alternative plasticizers, which can have different adverse effects to human health. Estimating human's exposure to these potentially harmful substances is, therefore, of paramount importance. Human biomonitoring (HBM) is the existing approach to assess exposure to environmental contaminants, which relies on the analysis of specific human biomarkers (parent compounds and/or their metabolic products) in biological matrices from individuals. The main drawback is its implementation, which involves complex cohort studies. A novel approach, wastewater-based epidemiology (WBE), involves estimating exposure from the analysis of biomarkers in sewage (a pooled urine and feces sample of an entire population). One of the key challenges of WBE is the selection of biomarkers which are specific to human metabolism, excreted in sufficient amounts, and stable in sewage. So far, literature data on potential biomarkers for estimating exposure to these chemicals are scattered over numerous pharmacokinetic and HBM studies. Hence, this review provides a list of potential biomarkers of exposure to more than 30 widely used chemicals and report on their urinary excretion rates. Furthermore, the potential and challenges of WBE in this particular field is discussed through the review of pioneer WBE studies, which for the first time explored applicability of this novel approach to assess human exposure to environmental contaminants. In the future, WBE could be potentially applied as an "early warning system", which could promptly identify communities with the highest exposure to environmental contaminants.

Management actions to mitigate the occurrence of pharmaceuticals in river networks in a global change context

Human consumption of pharmaceuticals leads to high concentrations of pharmaceuticals in wastewater, which is usually not or insufficiently collected and treated before release into freshwater ecosystems. There, pharmaceuticals may pose a threat to aquatic biota. Unfortunately, occurrence data of pharmaceuticals in freshwaters at the global scale is scarce and unevenly distributed, thus preventing the identification of hotspots, the prediction of the impact of Global Change (particularly streamflow and population changes) on their occurrence, and the design of appropriate mitigation actions. Here, we use diclofenac (DCL) as a typical pharmaceutical contaminant, and a global model of DCL chemical fate based on wastewater sanitation, population density and hydrology to estimate current concentrations in the river network, the impact of future changes in runoff and population, and potential mitigation actions in line with the Sustainable Development Goals. Our model is calibrated against measurements available in the literature. We estimate that 2.74 ± 0.63% of global river network length has DCL concentrations exceeding the proposed EU Watch list limit (100 ng L^-1). Furthermore, many rivers downstream from highly populated areas show values beyond 1000 ng L^-1, particularly those associated to megacities in Asia lacking sufficient wastewater treatment. This situation will worsen with Global Change, as streamflow changes and human population growth will increase the proportion of the river network above 100 ng L^-1 up to 3.10 ± 0.72%. Given this background, we assessed feasible source and end-of-pipe mitigation actions, including per capita consumption reduction through eco-directed sustainable prescribing (EDSP), the implementation of the United Nations Sustainable Development Goal (SDG) 6 of halving the proportion of population without access to safely managed sanitation services, and improvement of wastewater treatment plants up to the Swiss standards. Among the considered end-of-pipe mitigation actions, implementation of SDG 6 was the most effective, reducing the proportion of the river network above 100 ng L^-1 down to 2.95 ± 0.68%. However, EDSP brought this proportion down to 2.80 ± 0.64%. Overall, our findings indicate that the sole implementation of technological improvements will be insufficient to prevent the expected increase in pharmaceuticals concentration, and that technological solution need to be combined with source mitigation actions.

How do WWTPs operational parameters affect the removal rates of EU Watch list compounds?

This work aims at achieving a better understanding of the mechanisms and the operative conditions regulating the removal of a set of relevant micropollutants in conventional activated sludge (CAS) systems to maximize their removal and, if possible, biodegradation. Eight compounds from the EU Watch list (clothianidin, thiacloprid, methiocarb, E1, E2, EE2, diclofenac and erythromycin) were spiked at 2 μg/L in CAS systems and their behaviour was studied in 6-h batch tests. The role of sorption was also investigated. Information on the removal of the pesticides clothianidin, thiacloprid and methiocarb is here presented for the first time to the best of the authors' knowledge. With the aim of enhancing the removal of the selected compounds in wastewater treatment, four parameters were explored: biomass concentration, temperature, pH and redox conditions. For each parameter, a low and a high value were chosen, based on the ranges usually applied in wastewater treatment plants (WWTPs). Results show that biomass concentration is the most relevant parameter among the ones investigated, followed by the redox conditions. The operational conditions that maximized removal rates were: 5 g/L of biomass, aerobic conditions, 25 °C and pH 7.5. High variability in removal rates was observed for compounds such as E1, erythromycin and methiocarb. The pesticides clothianidin and thiacloprid did not prove to be easily degradable. The highest removal rates were recorded for the hormones, particularly E2, with a transformation rate of at least 96% under all conditions. Sorption proved to be a relevant removal route for EE2, for which the highest sorption rates were recorded, and diclofenac, where the adsorption mechanisms was hypothesised for its prevalence at lower pH values.

Pharmaceuticals removal in an on-farm pig slurry treatment plant based on solid-liquid separation and nitrification-denitrification systems

The fate and degradation of 28 multiple-class veterinary pharmaceuticals in an on-farm pig slurry treatment plant based on solid-liquid separation and a nitrification-denitrification (NDN) sequence batch reactor (SBR) were evaluated for the first time. The pharmaceuticals detected at the highest concentrations in raw pig slurries belonged to the group of tetracycline antibiotics. Fluoroquinolone, lincosamide and pleuromutilin antibiotics and other drugs such as flubendazole and flunixin were also frequently detected. After solid-liquid separation, target compounds were distributed in an average of 64% onto the liquid fraction. Pharmaceuticals distributed in this fraction were removed in an average of almost 50% after being treated in NDN-SBR. Lincomycin was the compound with the highest removal percentage, reaching 100% reduction, while tetracyclines and fluoroquinolones showed moderate removal percentages (50 and 40%, respectively). Regarding nitrogen removal, NDN-SBR reduced a 77% of the content of this nutrient in the liquid slurry fraction.

Validation of Thin-Layer Chromatography Quantitation Determination with CCD Camera and Slit-Scanning Densitometer

Video densitometric and classical slit-scanning determinations of pesticides on thin-layer chromatographic plates were validated for linearity, precision, and detection limit. A comparison of results showed that slit-scanning densitometry is more sensitive and more precise than video densitometry. However, according to validation requirements, relative standard deviation for video densitometry is acceptable (3.5–5.3%). Linearities are very good and almost identical for both techniques. The main advantage of video technology is speed (a few seconds, compared with 20 min with scanning densitometry). Video technology also provides excellent archiving facility. Image and chromatographic data can be stored together, edited, and used for many tasks.

[Towards proactive and personalised care for the elderly]

The Netherlands, like other Western countries, shows an obvious demography of aging, which is associated with many challenges. People age differently, after all. Some remain vital until very old age, while others become frail and disabled much earlier in life. Because of the indicated demographic trend, morbidity is expected to increase and with it, the number of older people needing care. 'Aging in place' has become a central phenomenon in healthcare policies. This means that older people should be empowered to lead a meaningful life in their own living environment as long as possible, even when they are frail and care dependent. Therefore, in the future, most care for older people will actually occur at home. This article aims to present a meaningful care model for the older people. Starting from the 'definition discussion' about frailty and a revaluation of the concept of' resilience, a basis will be provided for a sustainable, proactive and personalised elderly care, close to the living environment of older people, in which dentists and other oral health professionals play an important role as well.

Fate of pharmaceuticals and antibiotic resistance genes in a full-scale on-farm livestock waste treatment plant

This study investigated, for the first time, the distribution and fate of 28 multiple-class veterinary pharmaceuticals and antibiotics (PhACs), and their corresponding antibiotic resistance genes (ARGs), in a full-scale on-farm livestock waste treatment plant. The plant relies on several technologies, including: anaerobic digestion (AD), solid-liquid separation, and two stages reverse osmosis (RO) of the liquid digestate. Tetracycline, fluoroquinolone, lincosamide and pleuromutilin antibiotics, together with anti-helmintic (flubendazole) and anti-inflammatory (flunixin) drugs were the most frequently detected compounds in livestock waste and in slaughterhouse sludge. This last fraction is used as co-substrate in the AD process and showed to be an important input source of PhACs and ARGs. In terms of treatment performance, AD exhibited moderate to low PhACs and ARGs reduction, while a large fraction (<50%) of the PhACs present in the digestate were distributed onto the solid fraction, after solid-liquid separation. Both solid and liquid digestates had relatively high copy numbers of ARGs. Finally, RO showed high rejection percentages for all PhACs (<90%), with concentrations in the low ng L^-1 range in permeates, for most target PhACs. Nevertheless, moderate copy numbers of ARGs were detected in permeates.

P5545Predictors of 10-year mortality and re-intervention in patients with multivessel coronary disease, reduced systolic left ventricular function, after complete revascularization by PCI or CABG

Introduction

In patients with multivessel coronary disease, the decision on revascularization should be made through a heart team. Whether there is an optimal method and what are the predictors of mortality and repeated interventions is the subject of numerous studies.

Purpose

To determine what are the predictors of 10-year mortality and repeated interventions in patients with multivessel coronary disease and reduced systolic left ventricular function in which complete revascularization is done through percutaneous coronary intervention (PCI) and surgical aortocoronary bypass (CABG).

Methods

The survey included 178 patients who underwent elective revascularization of multivessel coronary disease in one center during 2008 through PCI or bypass, according to the heart team's decision. All subjects had a reduced left ventricular systolic function, ejection fraction less than 50%. The study excluded patients with acute coronary syndrome. The basic demographic and clinical characteristics of the subjects and risk factors were analyzed.

Results

Ten-year mortality was 31.4%, without a significant difference between the examined groups (in the PCI group 25 patients (30.5%) in the bypass group 30 (32.3%), p>0.05). In subjects with letal outcome during 10-year follow-up, lower hemoglobin levels in discharge, enlarged cardiac cavities, increased internal diameter of left ventricle in systole (LVIDs) and enlarged left atrium, lower systolic left ventricular function, higher EUROscore and higher NYHA class in discharge. The enlarged left ventricular diameter in systole (OR 2.28 (1.27–4.11), p=0.006) and the NYHA class (OR 2.49 (1.22–5.08), p=0.012) are independent predictors ten-year mortality. In the group of patients undergoing surgical revascularization, independent predictors of 10-year mortality are higher levels of uric acid (OR 1,006 (1,000–1,011), P=0,047) and lower serum hemoglobin at discharge (OR 0,959 (0,919–0,999), P=0.046), while in PCI group LVIDs (OR 2.89 (1.351–6.196), p=0.006). During the 10-year follow-up, repeated PCI was performed in 12 (14.5%) patients in the PCI group and in 3 (3.2%) patients in the CABG group, p=0.012. No surgical revascularization was performed during follow up. Diabetes mellitus is an independent predictor of reintervention in the PCI group (OR 4.12 (1.153–14.703), p=0.029).

Conclusion

Mortality predictors during ten years of follow-up in subjects following a revascularization of multivessel coronary disease, and with reduced left ventricular systolic function, are increased systolic left ventricular diameter and higher NYHA class in discharge. Reintervention is more commonly performed after PCI and the presence of diabetes mellitus is an independent predictor.

P2662Factors associated with in-hospital and long-term mortality in STEMI patients: does primary ventricular fibrillation matter?

Introduction

There are still contrary data about causes and long-term prognosis in patients (pts) with primary ventricular fibrillation (PVF) as a complication of ST-elevation myocardial infarction (STEMI).

Purpose

The aim was to analyze characteristics of STEMI patients associated with PVF occurrence and mortality.

Methods

Our study included 755 pts hospitalised due to STEMI between January 2016 and December 2016. One year follow up was done. Study compared pts with cardiac arrest due to PVF and those without PVF. Only pts treated with urgent coronarography and primary percutaneous coronary intervention (PPCI) in whom TIMI 3 in infarct-related artery was acheved were included. Pts with Killip class 4 as well as pts with mechanical complications or complications due to procedure were excluded.

Results

We found 56/755 (7.42%) STEMI pts had PVF. Compared to pts without PVF (n=699), those with PVF (n=56) were younger (57.8±12.9 vs. 61.8±11.9 years, p 0.02) and more frequently had diabetes mellitus (DM) (52.3% vs. 33.4%, p 0.01) alone or DM with abnormal glucoregulation (AGR) (77.3% vs. 58.4%, p 0.01). Pts with STEMI and PVF had more frequently Killip class 2 (32.7% vs. 21.2%, p 0.02) and class 3 (7.3% vs. 3%, p 0.08), most frequently left anterior descending coronary artery affected (51.8% vs. 36.9%, p 0.03) and proximal occlusion of coronary arteries (44.6% vs. 23%, p 0.000), lower left ventricle ejection fraction (LVEF) (45.4±9.8% vs. 48.7±7.5%, p 0.02), longer duration of hospitalisation (7.3±5.7 vs. 5.7±3.2 days, p 0.001) and higher in-hospital mortality (12.5% vs. 4.9%, p 0.02), but with no difference in long-term mortality (14.3% vs. 11.6%, p 0.40). After multivariable logistic regression analysis (MVLR), model with the differences in proximal coronary artery occlusions (OR 2.4 [95% CI: 1.3–4.7], p 0.008) and DM presence (OR 1.9 [95% CI: 1–3.6], p 0.05) persisted. After one year patients who died compared to those still alive were older (70.8±12.8 vs. 61±11.8 years, p 0.000), more frequently male (52% vs. 32.2%, p 0.01), had higher appearance of anterior wall STEMI (46.7% vs. 24.5%, p 0.001), more frequently Killip class 2 and class 3 (50% vs. 20.9% and 23.5 vs. 2.4% respectively, both p 0.000), lower EF (38.6±10.5 vs. 48.8±7.3%) and higher prevalence of DM (75.8% vs. 32.4%) or DM with AGR (87.9% vs. 57.9%) (both p 0.000). After MVLR model with differences in Killip class 3 (OR 4.2 [95% CI: 1.1–84.6], p 0.000), EF (OR 0.93 [95% CI: 0.87–0.99], p 0.04) and DM presence (OR 3.3 [95% CI: 1.1–10.2], p 0.04), all persisted.

Conclusions

Proximal coronary occlusions and DM presence as indicators of coronary artery disease severity and ischaemic area size are strongly associated with PVF in STEMI patients. Only in-hospital mortality is higher in patients with STEMI and PVF. Long-term mortality in STEMI patients is strongly associated with heart failure (lower EF and higher Killip class) and again DM presence.

The EU watch list compounds in the Ebro delta region: Assessment of sources, river transport, and seasonal variations

The presence of xenobiotics in the aquatic environment has drawn scientific concern due to possible detrimental effects on the ecosystems. With EU Decision 2015/495, a first Watch list of compounds that could potentially represent a threat for the environment was created, with the objective of gathering high quality monitoring data and support their prioritization. Literature data are still very scarce and the presence of many of the compounds has not been investigated thoroughly. In this study, all the 17 compounds of the EU Watch list 2015/495 were monitored in 14 sampling locations, comprised of freshwater and, for the first time, wastewater. The study was carried out in the Ebro delta, in the north east of Spain, a representative and crucial area not only for its environmental and naturalistic significance, but also for Spain's productivity, especially as regards rice agriculture. Results show that contamination originates both from wastewater treatment plants (WWTPs) and agricultural activities. High levels of pharmaceuticals were detected in wastewater, with azithromycin and diclofenac present at mean concentrations of 1.65 μg/L and 636  ng/L respectively. In freshwater samples, besides antibiotics and diclofenac, substantial contamination by pesticides was reported, with oxadiazon reaching up to 591 ng/L and imidacloprid being present in 93% of samples. Moreover, the study provided insight into the origin of the selected contaminants. The removal of the studied micropollutants in WWTPs was low to moderate. The assessment of risk quotients, calculated based on the available PNECs, demonstrated that the concentrations recorded for these compounds may pose a significant risk in most sampling sites.

Orbitrap molecular fingerprint of dissolved organic matter in natural waters and its relationship with NDMA formation potential

N-nitrosodimethylamine (NDMA) is a disinfection byproduct that has been classified as probable human carcinogen by the US Environmental Protection Agency. According to the published literature, natural dissolved organic matter (DOM) can be a source of NDMA precursors in drinking water. New advances in chemical characterization of DOM with high resolution mass spectrometry (HRMS) are allowing researchers to understand these ultra-complex mixtures. The objective of this study is to investigate analytical methodologies based on HRMS to explore NDMA formation from natural waters. To this aim, different waters from drinking water reservoirs in Spain containing NDMA precursors (quantified by means of NDMA formation potential) in concentrations between 17 and 60 ng/L have been studied. The workflow includes DOM solid-phase extraction and Orbitrap analysis with and without chromatographic separation. Here, we show that the molecular composition of DOM across the studied drinking water reservoirs is correlated with the NDMA formation potential. In particular, we found that NDMA formation potential is associated with compounds with high hydrogen saturation (H/C ≥ 1.5), corresponding also to reservoirs with higher background nutrient concentrations and wastewater indicators. Further chromatographic fractionation did not allow better definition of these possible precursors as they were present in different fractions of the chromatogram, suggesting that they were isomerically complex.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Contaminants of emerging concern in freshwater fish from four Spanish Rivers

This study investigated the occurrence of 135 contaminants of emerging concern (CECs) - pharmaceuticals, pesticides, a set of endocrine disrupting compounds (EDCs) (parabens, bisphenols, hormones, triazoles, organophosphorus flame retardants and triclosan), UV-filters, perfluoroalkyl substances (PFASs) and halogenated flame retardants (HFRs) - in 59 fish samples, collected in 2010 in 4 Spanish Rivers (Guadalquivir, Júcar, Ebro and Llobregat). Of the 135 CECs, 76 including 8 pharmaceuticals, 25 pesticides, 10 EDCs, 5 UV-filters, 15 PFASs and 13 HFRs were detected. Pharmaceuticals were the less frequently found and at lower concentrations. Pesticides, EDCs, UV-filters, PFASs and HFRs were detected more frequently (>50% of the samples). The maximum concentrations were 15 ng/g dry weight (dw) for pharmaceuticals (diclofenac), 840 ng/g dw for pesticides (chlorpyrifos), 224 ng/g dw for EDCs (bisphenol A), 242 ng/g dw for UV-filters (EHMC), 1738 ng/g dw for PFASs (PFHxA) and 64 ng/g dw for HFRs (Dec 602). The contaminants detected in fish are commonly detected also in sediments. In light of current knowledge, the risk assessment revealed that there was no risk for humans related to the exposure to CECs via freshwater fish consumption. However, results provide detailed information on the mixtures of CECs accumulated that would be very useful to identify their effects on aquatic biota.

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research

Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary prevention through judicious prescribing, deprescribing of FRIDs (withdrawal and dose reduction), and gaps in current research are outlined in this position paper.

Detection of potentially inappropriate prescribing in older patients with the GheOP³S-tool: completeness and clinical relevance

OBJECTIVES

The Ghent Older People's Prescriptions community Pharmacy Screening (GheOP³S-) tool was recently developed as an explicit screening method to detect Potentially Inappropriate Prescribing (PIP) in the community pharmacy. We aimed to validate the GheOP³S-tool as an effective screening method for PIP.

METHODS

All patients admitted to the acute geriatric ward of the Sint-Vincentius hospital (Belgium) were consecutively screened for inclusion (≥70 years,≥5 drugs chronically). PIP prevalence was evaluated by applying the GheOP³S-tool on the complete medication history. For each PIP-item, clinical relevance of the detected item, relevance of proposed alternative and subsequent acceptance by the treating geriatrician and a general practitioner were evaluated. Additionally, contribution to the current admission and preventability was assessed by the geriatrician. The completeness of a PIP-screening with the GheOP³S-tool was evaluated through comparison with the adapted Medication Appropriateness Index (aMAI).

RESULTS

We detected 250 GheOP³S-items in 57 of 60 included patients (95%) (median: four PIP-items per patient; IQR: 3-5). Both the geriatrician and the general practitioners scored the clinical relevance of the detected items 'serious' or 'significant' in over 70% of cases. Proposed alternative treatment plans were accepted for 79% of the PIP-items (n = 198). The aMAI detected 536 items, of which 145 were also detected by the GheOP³S-tool. A total of 119 PIP-items were additionally detected by the GheOP³S-tool.

CONCLUSION

The clinical relevance of the PIP-items detected with the GheOP³S-tool is high, likewise the acceptance rate of proposed alternatives.

Vertical displacement of the centre of mass during walking in people with diabetes and diabetic neuropathy does not explain their higher metabolic cost of walking

People with diabetes display biomechanical gait alterations compared to controls and have a higher metabolic cost of walking (CoW), but it remains unknown whether differences in the vertical displacement of the body centre of mass (CoM) may play a role in this higher CoW. The aim of this study was to investigate vertical CoM displacement (and step length as a potential underpinning factor) as an explanatory factor in the previously observed increased CoW with diabetes. Thirty-one non-diabetic controls (Ctrl); 22 diabetic patients without peripheral neuropathy (DM) and 14 patients with moderate/severe Diabetic Peripheral Neuropathy (DPN), underwent gait analysis using a motion analysis system and force plates while walking at a range of matched speeds between 0.6 and 1.6 m/s. Vertical displacement of the CoM was measured over the gait cycle, and was not different in either diabetes patients with or without diabetic peripheral neuropathy compared to controls across the range of matched walking speeds examined (at 1 m/s: Ctrl: 5.59 (SD: 1.6), DM: 5.41 (1.63), DPN: 4.91 (1.66) cm; p > 0.05). The DPN group displayed significantly shorter steps (at 1 m/s: Ctrl: 69, DM: 67, DPN: 64 cm; p > 0.05) and higher cadence (at 1 m/s: Ctrl: 117 (SD1.12), DM: 119 (1.08), DPN: 122 (1.25) steps per minute; p > 0.05) across all walking speeds compared to controls. The vertical CoM displacement is therefore unlikely to be a factor in itself that contributes towards the higher CoW observed recently in people with diabetic neuropathy. The higher CoW in patients with diabetes may not be explained by the CoM displacement, but rather may be more related to shorter step lengths, increased cadence and the associated increased internal work and higher muscle forces developed by walking with more flexed joints.

Contamination patterns and attenuation of pharmaceuticals in a temporary Mediterranean river

The contamination patterns and fate of pharmaceutically active compounds (PhACs) were investigated in the Evrotas River (Southern Greece). This is a temporary river with differing levels of water stress and water quality impairment in a number of its reaches. Three sampling campaigns were conducted in order to capture different levels of water stress and water quality. Four sampling sites located on the main channel of the Evrotas River were sampled in July 2015 (moderate stream flow), and June and September 2016 (low stream flow). Discharge of urban wastewater has been determined as the main source of pollution, with PhACs, nutrients and other physicochemical parameters considerably increasing downstream the wastewater treatment plant (WWTP) of Sparta city. Due to the pronounced hydrological variation of the Evrotas River, generally, the highest concentrations of PhACs have been detected during low flow conditions. Simultaneously, low flow resulted in an increased water travel time and consequently longer residence time that accounted for the higher attenuation of most PhACs. The average decrease in total concentration of PhACs within the studied waterbody segment (downstream of Sparta city) increased from 22% in July 2015 to 25% in June 2016 and 77% in September 2016. The PhACs with the highest average concentration decrease throughout the sampling campaigns were hydrochlorothiazide, followed by sotalol, carbamazepine, valsartan, and naproxen.

Population pharmacokinetic modelling of intravenous paracetamol in fit older people displays extensive unexplained variability

AIMS

Paracetamol is the analgesic most used by older people. The physiological changes occurring with ageing influence the pharmacokinetics (PK) of paracetamol and its variability. We performed a population PK-analysis to describe the PK of intravenous (IV) paracetamol in fit older people. Simulations were performed to illustrate target attainment and variability of paracetamol exposure following current dosing regimens (1000 mg every 6 h, every 8 h) using steady-state concentration (Css-mean ) of 10 mg l-1 as target for effective analgesia.

METHODS

A population PK-analysis, using NONMEM 7.2, was performed based on 601 concentrations of paracetamol from 30 fit older people (median age 77.3 years, range [61.8-88.5], body weight 79 kg [60-107]). All had received an IV paracetamol dose of 1000 mg (over 15 min) after elective knee surgery.

RESULTS

A two-compartment PK-model best described the data. Volume of distribution of paracetamol increased exponentially with body weight. Clearance was not influenced by any covariate. Simulations of the standardized dosing regimens resulted in a Css of 9.2 mg l-1 and 7.2 mg l-1 , for every 6 h and every 8 h respectively. Variability in paracetamol PK resulted in Css above 5.4 and 4.1 mg l-1 , respectively, in 90% of the population and above 15.5 and 11.7, respectively, in 10% at these dosing regimens.

CONCLUSIONS

The target concentration was achieved in the average patient with 1000 mg every 6 h, while every 8 h resulted in underdosing for the majority of the population. Furthermore, due to a large (unexplained) interindividual variability in paracetamol PK a relevant proportion of the fit older people remained either under- or over exposed.

Equilibrium and kinetic studies of the adsorption of antibiotics from aqueous solutions onto powdered zeolites

The performances of two FAU-type zeolites with different SiO₂/Al₂O₃ ratios were evaluated for the removal of antibiotics of three different classes, namely azithromycin, ofloxacin, and sulfamethoxazole, from aqueous solutions. Commercial zeolites were used, without any previous treatment. Use of a small adsorbent dosage resulted in fast antibiotic adsorption that followed pseudo-second order kinetics. The removals of azithromycin and sulfamethoxazole were highly pH-dependent, with low removal percentages observed under acid (pH 2.5-4.5) and basic (pH 8.5-10.5) conditions, respectively. The Freundlich isotherm model provided the best fits to the adsorption data. The adsorption mechanisms appeared to involve both electrostatic and H-bonding interactions. Using an antibiotics mixture, percentage removals of azithromycin and ofloxacin onto the zeolites of up to 79% were obtained. Both materials presented good adsorption (>50%) of azithromycin and ofloxacin from a real sample of effluent wastewater. The results showed that zeolites with FAU structure can be used as effective adsorbents for the removal of antibiotics with different physicochemical properties, including molecules with large volumes, such as azithromycin.