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Cabrera, F., Torres-Aravena, A., Pinto-Ibieta, F., Campos, J. L., & Jeison, D. (2021). On-Line Control of Feast/Famine Cycles to Improve PHB Accumulation during Cultivation of Mixed Microbial Cultures in Sequential Batch Reactors. Int. J. Environ. Res. Public Health, 18(23), 12611.
Abstract: Production of polyhydroxyalkanoates (PHA) has generated great interest as building blocks for bioplastic production. Their production using mixed microbial cultures represents an interesting alternative, since it enables the use of organic wastes as a carbon source. Feast/famine strategy is a common way to promote selection of microorganisms with PHA accumulation capacity. However, when using waste sources, changes in substrate concentration are expected, that may affect performance and efficiency of the process. This study showed how the dissolved oxygen level can be used for online control of the cycle time, ensuring that the desired feast/famine ratio is effectively applied. An operation strategy is presented and validated, using sequential batch reactors fed with acetate as the carbon source. Production of polyhydroxybutyrate (PHB) was studied, which is the expected type of PHA to be synthetized when using acetate as substrate. Two reactors were operated by applying the proposed control strategy, to provide F/F ratios of 0.2 and 0.6, respectively. A third reactor was operated with a fixed cycle time, for comparison purposes. Results showed that the reactor that operated at an F/F ratio of 0.6 promoted higher biomass productivity and PHB content, as a result of a better use of available time, preventing unnecessary long famine times. The application of the tested strategy is a simple a reliable way to promote a better performance of feast/famine-based bioreactors involving mixed microbial cultures for PHB production.
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Garmendia, M. L., Matus, O., Mondschein, S., & Kusanovic, J. P. (2018). Gestational weight gain recommendations for Chilean women: a mathematical optimization approach. Public Health, 163, 80–86.
Abstract: Objectives: We examined if the guidelines for gestational weight gain (GWG) proposed by the Institute of Medicine (IOM) are the most suitable for Chilean women. Study design: Secondary analysis of records of single full-term births at the Dr. Sotero del Rio Hospital, Santiago, Chile, during 2003-2012 (n = 62,579). Methods: From clinical records, we obtained data regarding maternal age, height, prepregnancy and at delivery weights, pathologies during pregnancy such as gestational diabetes (GDM) and pre-eclampsia, gestational age at delivery, and number of infants born small for gestational age (SGA) and large for gestational age (LGA). We formulated a mathematical model (MM) to determine the GWG range that maximizes the likelihood of a healthy pregnancy (HP) if the recommendation is followed. We defined an HP as one where the mother has no complications such as pre-eclampsia, GDM, SGA, or LGA. Results: Forty-six percent of women had prepregnancy overweight or obesity. The prevalence of GDM, pre-eclampsia, SGA, and LGA were 3%, 1.2%, 9%, and 12%, respectively. An HP was present in 76% of pregnancies, 79% in the underweight group, 79% in normal weight group, 74% in the overweight group, and 67% in obese women. The GWG recommendations given by the MM (14-20 kg for underweight, 6-20 kg for normal weight, 9 -11 kg for overweight, and 6-7 kg for obese) led to higher probabilities of achieving an HP than the ones obtained with the IOM recommendations. Conclusion: The adoption of GWG recommendations based on characteristics of the Chilean population might lead to better short- and long-term health results for pregnant women. (C) 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Garmendia, M. L., Mondschein, S., Montiel, B., & Kusanovic, J. P. (2021). Trends and predictors of birth weight in Chilean children. Public Health, 193, 61–68.
Abstract: Objectives: Birth weight is an important public health indicator that reflects fetal health conditions and predicts future health. Identifying the most important factors related to birth weight would help defining preventive health strategies for both mothers and children. The objectives of this study are i. to describe, using a large birth database from a Chilean hospital, the trend of birth weight during 2002-2015, and ii. to determine factors during prenatal care associated with low and high birth weight.
Study design: This study is a secondary analysis of all single birth records at a Chilean Hospital in the southeast district of Santiago, Chile, during 2002-2015 (N = 78,931).
Methods: Sociodemographic information, clinical and obstetric history, lifestyle, and anthropometric variables were evaluated as potential predictors. Birth weight was categorized into five groups as per percentiles of weight as per gestational age. Data were extracted from clinical records. We used classification and regression tree methodology and logistic regression.
Results: The average birth weight for the period was 3316 g (SD 566), with little variation across time. Preterm births increased from 7% in 2002 to 10% in 2015, and births >40 weeks decreased from 10.7% in 2002 to 4.4% in 2015. The percentages of small and large for gestational age changed from 10.9% and 12.7% in 2002 to 9.9% and 13.9% in 2015, respectively. The predictors included in the optimal tree were body mass index, gestational weight gain, pre-eclampsia, and gestational diabetes. We found that women with a pregestational body mass index <28 kg/m(2), gestational weight gain <17 kg, and pre-eclampsia had a probability of 41% of having a small for gestational age neonate. Conversely, women with a body mass index similar to 28 kg/m(2), gestational weight gain similar to 17 kg, and gestational diabetes had a probability of 44% of having a large for gestational age neonate.
Conclusions: This study showed that the most important variables explaining birth weight are those related to maternal nutritional status. Thus, the strategies to promote a normal birth weight should aim for a normal maternal weight at the beginning of pregnancy, gestational weight gain within the recommendations, and prevention of gestational diabetes and pre-eclampsia. (C) 2021 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Mondschein, S., Yankovic, N., & Matus, O. (2021). The Challenges of Administering a New Treatment: The Case of Direct -Acting Antivirals for Hepatitis C Virus. Public Health, 190, 116–122.
Abstract: Objectives: We develop a patient prioritization scheme for treating patients infected with hepatitis C virus (HCV) and study under which scenarios it outperforms the current practices in Spain and Chile.
Study design: We use simulation to evaluate the performance of prioritization rules under two HCV patient cohorts, constructed using secondary data of public records from Chile and Spain, during 2015-2016.
Methods: We use the results of a mathematical model, which determines individual optimal HCV treatment policies as an input for constructing a patient prioritization rule, when limited resources are present. The prioritization is based on marginal analysis on cost increases and health-outcome gains. We construct the Chilean and Spanish case studies and used Monte Carlo simulation to evaluate the performance of our methodology in these two scenarios.
Results: The resulting prioritizations for the Chilean and Spanish patients are similar, despite the significant differences of both countries, in terms of epidemiological profiles and cost structures. Furthermore, when resources are scarce compared with the number of patients in need of the new drug, our prioritization significantly outperforms current practices of treating sicker patients first, both in terms of cost and healthcare indicators: for the Chilean case, we have an increase in the quality-adjusted life years (QALYs) of 0.83 with a cost reduction of 8176 euros per patient, with a budget covering 2.5% of the patients in the cohort. This difference slowly decreases when increasing the available resources, converging to the performance indicators obtained when all patients are treated immediately: for the Spanish case, we have a decrease in the QALYs of 0.17 with a cost reduction of 1134 euros per patient, with a budget covering 20% of the patients in the cohort.
Conclusion: Decision science can provide useful analytical tools for designing efficient public policies that can excel in terms of quantitative health performance indicators.
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Palmeiro-Sanchez, T., Campos, J. L., & Mosquera-Corral, A. (2021). Bioconversion of Organic Pollutants in Fish-Canning Wastewater into Volatile Fatty Acids and Polyhydroxyalkanoate. Int. J. Environ. Res. Public Health, 18(19), 10176.
Abstract: The wastewater from the cookers of a tuna-canning plant was used as feedstock for the process. It was acidified in a continuous stirred tank reactor (CSTR) of 1.5 L to produce a mixture of volatile fatty acids (VFAs). The effluent contained 28.3 & PLUSMN; 8.7 g CODS/L and 25.0 & PLUSMN; 4.6 g CODVFA/L, 4.4 & PLUSMN; 1.6 g NH4+/L, and 10.9 & PLUSMN; 4.0 g Na+/L, which corresponds to about 28 g NaCl/L approximately. This was used to feed a PHA production system. The enriched MMC presented a capacity to accumulate PHAs from the fermented tuna wastewater. The maximum PHA content of the biomass in the fed-batch (8.35 wt% PHA) seemed very low, possibly due to the variable salinity (from 2.2 up to 12.3 g NaCl/L) and the presence of ammonium (which promoted the biomass growth). The batch assay showed a PHA accumulation of 5.70 wt% PHA, but this is a much better result if the productivity of the reactor is taken into account. The fed-batch reactor had a productivity of 10.3 mg PHA/(L h), while the batch value was about five times higher (55.4 mg PHA/(L h)). At the sight of the results, it can be seen that the acidification of fish-canning wastewater is possible even at high saline concentrations (27.7 g NaCl/L). On the other hand, the enrichment and accumulation results show us promising news and which direction has to be followed: PHAs can be obtained from challenging substrates, and the feeding mode during the accumulation stage has an important role to play when it comes to inhibition.
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