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How mine tailings storage facilities (TSF) are managed reflects the history, regulatory framework, and environment of a country and locale of the mine. Despite many attempts to find an environmentally friendly strategy for tailings management and governance that balances the needs of society and the ecosystem, there is no worldwide agreement regarding the best practices for tailings management and governance. This article reviews the evolution of copper tailings management and governance in Chile, current practices, and changes that could be or may need to be made to improve practices in response to local environmental conditions and local tolerance for risk. The progress to date in developing a holistic tailings management strategy is summarized. This article also describes recent proposals for the best available technologies (BATs), case histories of Chilean TSF using conventional technology, thickened tailings, paste tailings, filtered tailings, water use reduction, tailings reprocessing to obtain rare earth elements (REEs), circular economy, submarine deep-sea tailings disposal, and ways to avoid failure in a seismic region. Finally, the Chilean tailings industry's pending issues and future challenges in reducing the socioenvironmental impacts of tailings are presented, including advances made and lessons learned in developing more environmentally friendly solutions.

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Resumen La fisiopatología del tinnitus crónico no pulsátil es poco clara, pero se reconoce un componente psicológico relevante, por tanto, existen distintas aproximaciones psicoterapéuticas que han sido estudiadas. La terapia cognitivo conductual es la que cuenta con mayor evidencia. Ella contempla la reestructuración de las cogniciones disfuncionales que favorecen la presencia del tinnitus. Se ha verificado su eficacia en los niveles de distrés, calidad de vida, severidad, sintomatología depresiva e insomnio asociados. La desensibilización y reprocesamiento por movimientos oculares recoge algunos presupuestos de la terapia cognitivo conductual, pero considera técnicas como la estimulación bilateral. Sus resultados en patologías crónicas somáticas han sugerido la aplicación en tinnitus, corroborando su eficacia en calidad de vida, distrés y sintomatología depresiva. Dos psicoterapias basadas en mindfulness aplicadas en tinnitus son la reducción del estrés basado en el mindfulness y la terapia cognitiva basada en mindfulness. La primera ha demostrado eficacia en la calidad de vida y en la disminución y el refuerzo de cogniciones negativas y positivas, respectivamente. La segunda, es eficaz en la severidad, intensidad, distrés, ansiedad, depresión y discapacidad asociadas a tinnitus. Finalmente, la terapia de aceptación y compromiso promueve la aceptación como componente central del tratamiento de condiciones crónicas, considerando el control que ejerce el contexto sobre la vivencia de estas condiciones y el compromiso terapéutico. Esta terapia es eficaz en calidad de vida. Se promueve la investigación en aproximaciones psicoterapéuticas para el tinnitus, lo que posibilitará la aplicación de terapias más específicas y la clarificación de su fisiopatología.

Abstract The pathophysiology of non-pulsatile chronic tinnitus is unclear, but it is recognized a relevant psychological component. In this sense, different psychotherapeutic approaches have been studied. Cognitive behavioral therapy is the psychotherapy with the most evidence. It considers the restructuring of dysfunctional cognitions that favor the presence of tinnitus. Its efficacy has been verified on distress, quality of life, severity, associated depressive symptoms and insomnia. Eye movement desensitization and reprocessing includes some conceptions of cognitive behavioral therapy and considers techniques such as bilateral stimulation. Its results in chronic somatic pathologies have suggested its application in tinnitus, corroborating its efficacy in quality of life, distress, and depressive symptoms. Two mindfulness-based psychotherapies applied in tinnitus are mindfulness-based stress reduction and mindfulness-based cognitive therapy. The first has shown efficacy on quality of life and reduction and reinforcement of negative and positive cognitions, respectively. The second is effective on severity, loudness, distress, anxiety, depression and disability associated with tinnitus. Finally, acceptance and commitment therapy promote acceptance as a central component of the treatment of chronic conditions, considering the control exerted by the context over the experience of these conditions and the therapeutic commitment. This therapy is effective on quality of life. We foster the research on psychotherapeutic approaches to tinnitus, which will make it possible the application of more specific interventions and, at the same time, elucidate its pathophysiology.

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High amounts of phosphogypsum (PG) are generated in the production of phosphoric acid. Previous literature demonstrates that obtaining rare earth elements (REE) from PG is a promising alternative to managing this waste. However, the reported leaching efficiencies are low in most cases, or drastic leaching conditions are required. Therefore, this work aimed to study the leaching conditions of REE from PG to obtain high leaching efficiency values. Initially, a 24 factorial experimental design investigated the factors that affect the conventional acid leaching of REE from PG (leaching acid (citric and sulfuric acid), solid/liquid ratio, acid concentration, and temperature). Better leaching efficiency values of the sum of all REE (62.0% and 89.7% for citric and sulfuric acid, respectively) were obtained using an acid concentration of 3 mol L-1, solid/liquid ratio of 1/20 g mL-1, and temperature of 80 °C. Subsequently, the experiments optimization, performed through a central composite rotational design, indicated that the maximum leaching efficiency was achieved using a sulfuric acid concentration of 2.9 mol L-1, solid/liquid ratio of 1.7/20 g mL-1, and 55 °C. Under these conditions, the leaching efficiency of the sum of all REE was 90.0%. Leaching kinetics results showed that the equilibrium was reached in about 20 min for most REE. The mechanism investigation suggested that surface chemical reaction and diffusion through the boundary layer controlled the leaching.

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Resumen Introducción: la desensibilización y reprocesamiento por movimientos oculares (EMDR) tiene abundante evidencia de eficacia en desórdenes del espectro traumático. Su eficacia en trastornos ansiosos (TA) y depresivos (TD) en niños, niñas y adolescentes ha sido escasamente estudiada. Método: se realizó una revisión narrativa para describir la evidencia disponible sobre eficacia de EMDR en TA y TD en población infantojuvenil. Se buscaron artículos disponibles en PubMed/Medline, SciELO, PsycINFO y Cochrane Library. Se incluyeron todos los artículos primarios y secundarios que evaluaron el efecto de EMDR en TA y TD en población infantojuvenil. Se revisaron sus referencias como segundo método de inclusión. Resultados: se identificaron nueve estudios (cinco en TA y cuatro en TD); tres fueron observacionales y seis experimentales. Todos tuvieron tamaños muestrales reducidos. En TA, los estudios corroboraron la eficacia de EMDR sobre el temor fóbico en fobia a las arañas, pero no sobre la conducta evitativa, donde sería superior la exposición in vivo. Dos series de casos expusieron la utilidad de EMDR en fagogobia y en TA asociados a epilepsia. En TD, EMDR fue eficaz en la reducción de sintomatología depresiva en el contexto del trastorno depresivo mayor, trastorno de estrés agudo y trastornos conductuales. EMDR fue comparable a terapia cognitivo-conductual. Conclusiones: la evidencia corrobora la eficacia de EMDR en TA y TD en niños, niñas y adolescentes. Sin embargo, es muy escasa y cuenta con limitaciones metodológicas. Es necesario realizar estudios experimentales con protocolos estandarizados y especializados de EMDR para TA y TD en población infantojuvenil.

Introduction: Eye movement desensitization and reprocessing (EMDR) has abundant evidence of efficacy in traumatic spectrum disorders. Its efficacy in anxiety disorders (AD) and depressive disorders (DD) in children and adolescents has been scarcely studied. Methods: We conducted a narrative review to describe the available evidence on the efficacy of EMDR in AD and DD in children and adolescents. We searched for articles available in PubMed/Medline, SciELO, PsycInfo and the Cochrane Library. All primary and secondary studies evaluating the effect of EMDR on AD and DD in children and adolescents were included. Their references were reviewed as a second method of inclusion. Results: nine studies were identified (five in AD and four in DD); three were observational and six experimental. All had small sample sizes. In AD, studies corroborated the efficacy of EMDR on phobic fear in spider phobia, but not on avoidance behavior, where in vivo exposure would be superior. Two case series reported the efficacy of EMDR in choking phobia and AD associated with epilepsy. In DD, EMDR was effective in reducing depressive symptomatology in the context of major depressive disorder, acute stress disorder, and conduct disorders. EMDR was comparable to cognitive behavioral therapy. Conclusions: The evidence corroborates the efficacy of EMDR in AD and DD in children and adolescents. However, it is very scarce and has methodological limitations. It is necessary to carry out experimental studies with standardized and specialized EMDR protocols for AD and DD in the child and adolescent population.

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Resumen Objetivo: En este estudio se comparan los desenlaces clínicos de cuatro técnicas de apendicectomía laparoscópica utilizadas en una institución colombiana para el manejo de la apendicitis aguda tras la adopción de políticas de reúso y reprocesamiento de dispositivos médicos para la Región de las Américas (2014). Materiales y Método: Mediante el análisis de varianza de una vía (ANOVA) y la prueba de Kruskal Wallis, se compararon las tasas de infección de sitio operatorio (ISO), reoperación no planeada, readmisión y mortalidad (en los primeros 30 días del postoperatorio) de las siguientes técnicas: Técnica 1: Ligadura del muñón apendicular con endonudo y disección del mesenterio apendicular con electrocoagulación bipolar convencional; Técnica 2: Clipaje del muñón con endoclip de polímero y disección del mesenterio con electrocoagulación bipolar convencional; Técnica 3: Clipaje del muñón con endoclip de polímero y disección del mesenterio con electrocoagulación monopolar; Técnica 4: Clipaje del muñón y disección roma y ligadura del mesenterio con endoclip de polímero. Resultados: Se incluyeron 551 pacientes. No se encontraron diferencias en los ANOVAs en cuanto a las características demográficas de los pacientes por cada técnica. Los desenlaces globales fueron: ISO (5,44%), reoperación no planeada (3,08%), readmisión (15,97%) y mortalidad (0,18%). Se encontraron diferencias significativas (p < 0,05) en estos desenlaces explicados por mayores tasas de ISO y reoperación con la Técnica-1. Conclusiones: Los desenlaces globales de la apendicectomía laparoscópica tras la adopción de políticas de reúso de dispositivos médicos se encuentran dentro de los aceptados globalmente cuando se utilizan las Técnicas 2-3-4 en poblaciones equivalentes de pacientes con apendicitis aguda. En este contexto, nuestros resultados invitan a utilizar con precaución la Técnica-1.

Aim: The present study sought to compare the clinical outcomes between four operative techniques for laparoscopic appendectomy in a Colombian institution, following the adoption of reuse and reprocessing policies for medical devices in the Region of Americas (2014). Materials and Methods: One-way analysis of variance (ANOVA) and Kruskal Wallis tests were used to compare the rates of Surgical Site Infection (SSI), unplanned reoperation, readmission and mortality (confined to 30 days after surgery) of these operative techniques: Technique 1: Ligature of appendiceal stump with endo stitch plus mesenteric dissection with conventional bipolar electrocoagulation; Technique 2: Clipping of stump with polymer endoclip plus mesenteric dissection with conventional bipolar electrocoagulation; Technique 3: Clipping of stump with polymer endoclip plus mesenteric dissection with monopolar electrocoagulation; Technique 4: Clipping of stump plus mesenteric dissection with polymer endoclip. Results: A total of 551 patients were included. No differences were found in the demographic characteristics of the patients between techniques during ANOVAs. The global outcomes were SSI (5.44%), unplanned reoperation (3.08%), readmission (15.97%) and mortality (0.18%). Significant differences were found (p < 0.05) in these outcomes explained by higher rates of SSI and unplanned reoperation with Technique 1. Conclusions: The overall outcomes of laparoscopic appendectomy, after the adoption of policies for the reuse and reprocessing of medical devices, are similar to those accepted globally when using operative techniques 2-3-4 in equivalent populations of patients with acute appendicitis. In this context, our results invite to use with caution technique-1.

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BACKGROUND: Coronary angiography and percutaneous coronary intervention are frequently and increasingly performed worldwide. Although catheters for coronary angiography are considered as single-use devices, some people still question this decision. This study evaluated the structural characteristics and thermal stability of new and reprocessed catheters. METHODS: Five catheters (Judkins left) of the same brand and manufacturer were selected for each analysis. We evaluated: new catheters, catheters reprocessed once (first), twice (second), thrice (third), and seven times (seventh). The optical analyses of the proximal, middle and distal parts of the catheters were performed by magnifying glass. Besides, thermogravimetric analyses were done. RESULTS: After reprocessing, the crushing, color changes, folds, dents, deformations, and lumen narrowing were observed; the stainless-steel framework, the external tortuosity, the interlaced mesh of stainless-steel wires and loss of polymeric material were visualized. Thermogravimetric analysis showed lost of mass of the catheters. CONCLUSIONS: This study demonstrated that the structural integrity and mass of catheters are lost with reprocessing. These findings may be caused by several steps of reprocessing; however, regardless of which step or steps were responsible, the presence of structural integrity loss leads to the recommendation of not reusing this type of device.

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PURPOSE: Since the Brazilian current legislation permits the reuse of single-use devices under a validated processing protocol, the main purpose of our study was to develop and validate a method for reusing non-irrigated electrophysiology catheter (EC). METHODS: Manual and mechanical processing by ultrasonic washer was associated with the use of enzymatic solution and hydrogen peroxide with a final rinse with filtered water. Validation of the cleaning process, as well as catheter integrity, was done by observing the ECs in stereoscopic microscope at ×60 magnification, followed by HemoCheck-S® (HCS) test to monitor the presence of residual blood on their surfaces. Ethylene oxide (EO) was used for sterilization, and the final validations of the processing were performed by assays of sterility, pyrogenicity, and EO residuals. Lastly, a cost-minimization study was performed. RESULTS: Cleaning process demonstrated absence of organic material detectable by HCS at the surfaces of the ECs. Assays for sterility were negative, and assays of EO residuals and endotoxins showed levels under established standards. The number of reuses was settled to a maximum of seven uses for the ECs with handle and ten uses for ECS without handle. The cost-minimization study showed an 84% savings, when considering seven reuses. CONCLUSIONS: Processing of ECs was validated at all stages. Therefore, reuse of ECs under the conditions that we designed was considered safe for patients and cost-effective for our institution.

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No Brasil, é recomendado que durante a limpeza dos Produtos para Saúde (PPS) o detergente utilizado possua ação enzimática. Embora a Resolução da Diretoria Colegiada nº 55 de 14 de novembro de 2012 da Agência Nacional de Vigilância Sanitária desaconselhe a reutilização desta solução de limpeza, sabe-se que na prática clínica elas são reaproveitadas por diversas vezes para imersão de PPS, como os aparelhos endoscópicos, o que pode comprometer a efetividade da ação do detergente enzimático e com isso a segurança no processamento do PPS. Esta pesquisa objetivou avaliar a carga microbiana presente na solução de detergente enzimático durante sua reutilização na limpeza manual de aparelhos endoscópicos gastrointestinais. Tratou-se de um estudo transversal realizado em um serviço de endoscopia digestiva de um hospital universitário de Belo Horizonte e no Laboratório de Microbiologia Oral e Anaeróbios do ICB/UFMG. A amostra foi composta por 57 aparelhos endoscópicos e 76 alíquotas de solução de detergente enzimáticos coletadas de diversos reusos de 19 diferentes soluções. O material coletado foi agitado em vórtex, acrescido a Caldo Letheem Modificado e submetido a filtração em membrana Millipore® 0,45µm. A membrana foi depositada em Tryptic Soy Ágar para crescimento microbiano. A identificação presuntiva dos micro-organismos foi realizada manualmente considerando-se aspectos morfotintoriais e reações bioquímico/fisiológicas. As variáveis foram descritas utilizando frequências, porcentagens e medidas de tendência central. O projeto foi aprovado pelo Comitê de Ética e Pesquisa da Universidade Federal de Minas Gerais (CAAE ­ 67493417.1.0000.5149). As médias das cargas microbianas na solução de detergente enzimático variaram de 19,9 UFC/mL após primeiro uso, 51,1 UFC/mL após terceiro uso e 67,1UFC/mL após o quinto reuso. Nos canais de ar/água e biópsia houve aumento de micro-organismos Gram negativos ao longo das reutilizações do detergente. Foram recuperados, Enterobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphyloccocus aureus, Staphyloccocus coagulase negativa. Pseudomonas spp. foi o micro-organismo mais identificado em todas as alíquotas coletadas. Verificou-se a importância da escovação do canal de biópsia para correta remoção de micro-organismos. Conclui-se que a reutilização das soluções de detergente enzimático contribuiu para contaminação dos aparelhos endoscópicos com micro-organismos potencialmente patogênicos. Faz-se necessário a reavaliação de protocolos institucionais, no sentido de que seja cumprida a orientação da Anvisa por meio da RDC nº 55 de 14 de novembro de 2012 de que os detergentes enzimáticos não devem ser reutilizados sob perda da eficiência do produto. As características físico químicas dos detergentes enzimáticos devem ser respeitadas pelos serviços de saúde conforme parâmetros estabelecidos pelos fabricantes.(AU)

In Brazil, it is recommended that during the cleaning of Health Products the detergent used has enzymatic action. Although Collegiate Board Resolution No. 55 of November 14, 2012 of the National Agency of Sanitary Surveillance advises against the reuse of this cleaning solution, it is known that in clinical practice they are reused several times for immersion of health products, such a gastrointestinal endoscope, which may compromise the effectiveness of the enzymatic detergent action and thus the safety in the processing. This research aimed to evaluate the microbial load present in the enzymatic detergent solution during its reuse in the manual cleaning of endoscopic gastrointestinal devices. This was a cross-sectional study performed at a gastrointestinal endoscopy service at a university hospital in Belo Horizonte and at the Oral Microbiology and Anaerobic Laboratory of ICB/UFMG. The sample consisted of 57 endoscopes and 76 aliquots of enzymatic detergent solution collected from several replicates of 19 different solutions. The collected material was vortexed, added to Modified Letheem Broth and subjected to Millipore® 0.45 µm membrane filtration. The membrane was deposited in Tryptic Soy Ágar for microbial growth. The identification of the microorganisms was performed manually considering morphotintorial aspects and biochemical/physiological reactions. The variables were described using frequencies, percentages and measures of central tendency. The project was approved by the Ethics and Research Committee of the Federal University of Minas Gerais (CAAE - 67493417.1.0000.5149). The mean values of the microbial loads in the enzymatic detergent solution varied from 19.9 UFC/mL after first use, 51.1 UFC/mL after third use and 67.1 UFC/mL after the fifth reuse. In the air/water and biopsy channels there was an increase of Gram negative microorganisms along the reuse of the detergent. Enterobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas spp., Staphylococcus aureus, Coagulase-negative Staphyloccocus were recovered. Pseudomonas spp. was the most identified microorganism in all aliquots collected. It was verified the importance of brushing the biopsy channel for correct removal of microorganisms. It was concluded that the reuse of enzyme detergent solutions contributed to the contamination of the endoscopes with potentially pathogenic microorganisms. It is necessary to re-evaluate institutional protocols, in order to comply with Anvisa's guidance through RDC nº. 55 of November 14, 2012 that enzymatic detergents should not be reused under loss of product efficiency. The physical characteristics of the enzymatic detergents must be observed by the health services according to the parameters established by the manufacturers.(AU)

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El presente artículo, analiza los diferentes aspectos relacionadoscon las medidas de prevención, aplicables a la preparación delpaciente y al ambiente quirúrgico, con la finalidad de disminuir laincidencia de infecciones operatorias. Se describen todos los facto-res ambientales y funcionales, que nos ayudarán a blindar las áreasquirúrgicas y las centrales de esterilización, para ofrecer una atención quirúrgica de calidad, siguiendo las normas y procedimientosrecomendados por organismos internacionales como la OMS(AU)

This article analyses the different aspects related to preventionmeasures, applicable to patient preparedness and surgical environ-ment, in order to reduce the incidence of operating infections. Allenvironmental and functional factors are described, which will helpus to shield surgical areas and sterilization plants, to offer qualitysurgical care, following standards and procedures recommendedby international organizations such as WHO(AU)

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Introducción y objetivo: Encuestas nacionales sobre la práctica broncoscópica se han repetido desde hace tres décadas en el mundo. En Argentina la broncoscopía tiene una larga historia, sin embargo, hay poca información disponible sobre esta práctica. El objetivo del estudio es obtener información sobre las características específicas de las prácticas de prevención de infecciones en los procedimientos broncoscópicos. Métodos: En 2014, distribuimos una encuesta para broncoscopistas y asistentes en la reunión anual de neumólogos. Resultados: Se completaron un total de 41 cuestionarios. No recibió capacitación específica en prevención de infecciones el 68%. Es neumonólogo el 85%. Infecciones, pseudoinfeciones o pseudoepidemias asociadas a broncoscopía fueron registradas por el 7%. No refiere haber sufrido un accidente laboral relacionado con la broncoscopía el 87%. Conoce la conducta a adoptar ante un accidente el 80%. Utiliza detergente enzimático para el proceso de limpieza 97%. Reutiliza este detergente 40%. Ortofitalaldehído, glutaraldehído o ambos es empleado como agente de desinfección de alto nivel (DAN) por el 95%. Realiza DAN sobre el broncoscopio siempre el 75%, lo hace a veces 9% y no lo hace el 14%. Realiza DAN o esterilización sobre material reutilizable el 87%. Los accesorios reutilizables (pinzas o cepillos) son esterilizados, reprocesados con DAN o ambas cosas por el 77%; y sometidos sólo a limpieza de nivel medio por el 12%. Emplea “Single Use Device” 78%, de ellos reprocesa este material 84%. Posee procesador automático el 5%. Conclusiones: Se identificaron características específicas locales de prácticas de prevención de infecciones en los procedimientos broncoscópicos.

Background and objective: Nationwide surveys about bronchoscopic practice have been carried out for three decades over the world. In Argentina, bronchoscopy has a long history; however, little information is available about this practice. The aim of this study is to obtain information regarding specific characteristics of practices to prevent in the bronchoscopy-associated infections. Methods: In 2014, we carried out a survey addressed to bronchoscopists and bronchoscopy assistants at the annual meeting of lung specialists. Results: 41 persons were surveyed. 68% did not receive any specific training in infection prevention practices. 85% were pulmonologists. 7% recorded infections, pseudoepidemics or pseudoinfections. 80% knew how to manage bronchoscopy-related accidents. 97% used enzymatic detergents in the cleaning process. 40% knew when to reuse the detergent. 95% used orthophthaldehyde, glutaraldehyde, or both of them as a high level disinfection agent (HLD). 75% used always HLD to clean the bronchoscope while 9% did it sometimes, and 14% never did it. 87% used HLD or sterilization for reusable materials. 77% sterilized reusable accessories (biopsy forceps or brushes), 77% reprocessed them with HLD, and 12% exposed them to mid level cleaning. 78% used a single device. 84% reprocessed the materials. 5% had an automatic processor. Conclusions: Local specific characteristics on the practice to prevent infections in the bronchoscopic procedures were identified.

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