Diffusion of Shape Stabilized PEG-SiO2 as a Driver for Producing Thermoregulating Facing Bricks.

A novel form-stable phase-change material (PCM) based on facing bricks was developed by incorporating thermoregulating PEG-SiO2, synthetized by sol-gel method and based on polyethylene glycol as phase-change material and silica as stabilizer compound. The PEG-SiO2 in its liquid form (sol) is firstly adsorbed inside the porous brick and lastly stabilized (gel) by controlling its gelation time, obtaining form-stable PCMs with PEG-SiO2 contents within 15-110 wt.%. Kinetic adsorption curves of the sol into bricks having different porosities as well as maximum adsorption capacities were obtained. The effective diffusion coefficients (Deff) were estimated by means of Fick's second law, it being possible to predict the adsorption of sol PEG-SiO2 by the brick as function of its porosity and the free diffusion coefficient. Finally, form-stable PCMs demonstrated an improvement in their thermal energy storage capacity (up to 338%), these materials being capable of buffering the indoor temperature during an entire operational day.

Kinetic Analysis of the Thermal Decomposition of Iron(III) Phosphates: Fe(NH3)2PO4 and Fe(ND3)2PO4.

The hydrothermal synthesis and both the chemical and structural characterization of a diamin iron phosphate are reported. A new synthetic route, by using n-butylammonium dihydrogen phosphate as a precursor, leads to the largest crystals described thus far for this compound. Its crystal structure is determined from single-crystal X-ray diffraction data. It crystallizes in the orthorhombic system (Pnma space group, a = 10.1116(2) Å, b = 6.3652(1) Å, c = 7.5691(1) Å, Z = 4) at room temperature and, below 220 K, changes towards the monoclinic system P21/n, space group. The in situ powder X-ray thermo-diffraction monitoring for the compound, between room temperature and 1100 K, is also included. Thermal analysis shows that the solid is stable up to ca. 440 K. The kinetic analysis of thermal decomposition (hydrogenated and deuterated forms) is performed by using the isoconversional methods of Vyazovkin and a modified version of Friedman. Similar values for the kinetic parameters are achieved by both methods and they are checked by comparing experimental and calculated conversion curves.

Development of physical modelling tools in support of risk scenarios: A new framework focused on deep-sea mining.

Deep-sea mining has gained international interest to provide materials for the worldwide industry. European oceans and, particularly, the Portuguese Exclusive Economic Zone present a recognized number of areas with polymetallic sulphides rich in metals used in high technology developments. A large part of these resources are in the vicinity of sensitive ecosystems, where the mineral extraction can potentially damage deep-ocean life services. In this context, technological research must be intensified, towards the implementation of environmental friendly solutions that mitigate the associated impacts. To reproduce deep-sea dynamics and evaluate the effects of the mining activities, reliable numerical modelling tools should be developed. The present work highlights the usefulness of a new framework for risk and impact assessment based on oceanographic numerical models to support the adoption of good management practices for deep-sea sustainable exploitation. This tool integrates the oceanic circulation model ROMS-Agrif with the semi-Lagrangian model ICHTHYOP, allowing the representation of deep-sea dynamics and particles trajectories considering the sediments physical properties. Numerical simulations for the North Mid-Atlantic Ridge region, revealed the ability of ROMS-Agrif to simulate real deep-sea dynamics through validation with in situ data. Results showed a strong diversity in the particle residence time, with a dependency on their density and size but also on local ocean conditions and bottom topography. The highest distances are obtained for the smaller and less dense particles, although they tend to be confined by bathymetric constrains and deposited in deepest regions. This work highlights the potential of this modelling tool to forecast laden plume trajectories, allowing the definition of risk assessment scenarios for deep-sea mining activities and the implementation of sustainable exploitation plans. Furthermore, the coupling of this numerical solution with models of biota inhabiting deep-sea vent fields into ecosystem models is discussed and outlined as cost-effective tools for the management of these remote ecosystems.

Protocol of a randomised controlled trial of real-time continuous glucose monitoring in neonatal intensive care 'REACT'.

INTRODUCTION: Hyperglycaemia is common in the very preterm infant and has been associated with adverse outcomes. Preventing hyperglycaemia without increasing the risk of hypoglycaemia has proved challenging. The development of real-time continuous glucose monitors (CGM) to inform treatment decisions provides an opportunity to reduce this risk. This study aims to assess the feasibility of CGM combined with a specifically designed paper guideline to target glucose control in the preterm infant. METHODS AND ANALYSES: The Real Time Continuous Glucose Monitoring in Neonatal Intensive Care (REACT) trial is an international multicentre randomised controlled trial. 200 preterm infants ≤1200 g and ≤24 hours of age will be randomly allocated to either real-time CGM or standard care (with blinded CGM data collection). The primary outcome is time in target 2.6-10 mmol/L during the study intervention assessed using CGM. Secondary outcomes include efficacy relating to glucose control, utility including staff acceptability, safety outcomes relating to incidence and prevalence of hypoglycaemia and health economic analyses. ETHICS AND DISSEMINATION: The REACT trial has been approved by the National Health Service Health Research Authority National Research Ethics Service Committee East of England (Cambridge Central); Medical Ethics Review Committee, VU University Medical Centre, Amsterdam, The Netherlands and the Research Ethics Committee, Sant Joan de Déu Research Foundation, Barcelona, Spain. Recruitment began in July 2016 and will continue until mid-2018. The trial has been adopted by the National Institute of Health Research Clinical Research Network portfolio (ID: 18826) and is registered with anInternational Standard Randomised Control Number (ISRCTN registry ID: 12793535). Dissemination plans include presentations at scientific conferences, scientific publications and efforts at stakeholder engagement. TRIAL REGISTRATION NUMBER: ISRCTN12793535; Pre-results.

Sea level anomaly in the North Atlantic and seas around Europe: Long-term variability and response to North Atlantic teleconnection patterns.

Sea level anomaly (SLA), provided globally by satellite altimetry, is considered a valuable proxy for detecting long-term changes of the global ocean, as well as short-term and annual variations. In this manuscript, monthly sea level anomaly grids for the period 1993-2013 are used to characterise the North Atlantic Ocean variability at inter-annual timescales and its response to the North Atlantic main patterns of atmospheric circulation variability (North Atlantic Oscillation, Eastern Atlantic, Eastern Atlantic/Western Russia, Scandinavian and Polar/Eurasia) and main driven factors as sea level pressure, sea surface temperature and wind fields. SLA variability and long-term trends are analysed for the North Atlantic Ocean and several sub-regions (North, Baltic and Mediterranean and Black seas, Bay of Biscay extended to the west coast of the Iberian Peninsula, and the northern North Atlantic Ocean), depicting the SLA fluctuations at basin and sub-basin scales, aiming at representing the regions of maximum sea level variability. A significant correlation between SLA and the different phases of the teleconnection patterns due to the generated winds, sea level pressure and sea surface temperature anomalies, with a strong variability on temporal and spatial scales, has been identified. Long-term analysis reveals the existence of non-stationary inter-annual SLA fluctuations in terms of the temporal scale. Spectral density analysis has shown the existence of long-period signals in the SLA inter-annual component, with periods of ~10, 5, 4 and 2years, depending on the analysed sub-region. Also, a non-uniform increase in sea level since 1993 is identified for all sub-regions, with trend values between 2.05mm/year, for the Bay of Biscay region, and 3.98mm/year for the Baltic Sea (no GIA correction considered). The obtained results demonstrated a strong link between the atmospheric patterns and SLA, as well as strong long-period fluctuations of this variable in spatial and temporal scales.

Relationship between insulin-like growth factor I levels, early insulin treatment, and clinical outcomes of very low birth weight infants.

OBJECTIVES: Insulin regulates the secretion of insulin-like growth factor I (IGF-I) in the newborn, and low levels of IGF-I have been linked to neonatal morbidity. As part of the Neonatal Insulin Replacement Therapy in Europe Trial, we investigated the impact of early insulin treatment on IGF-I levels and their relationship with morbidity and growth. STUDY DESIGN: Prospective cohort analyses of data collected as part of an international randomized controlled trial. Blood samples (days 1, 3, 7, and 28), were taken for IGF-I bioassay from 283 very low birth weight infants (<1500 g). RESULTS: Early insulin treatment led to a late increase in IGF-I levels between day 7 and 28 (P = .028). In the first week of life IGF-I levels were lower in infants with early hyperglycemia; mean difference -0.10 µg/L (95% CI -0.19, -0.02, P = .02). Lower levels of IGF-I at day 28 were independently associated with an increased risk of chronic lung disease, OR 3.23 (95% CI, 1.09-9.10), and greater IGF-I levels were independently associated with better weight gain, 0.10 kg (95% CI, 0.03-0.33, P = .02). CONCLUSIONS: Early intervention with insulin is related to increased IGF-I levels at 28 days. Low IGF-I levels are associated with hyperglycemia, increased morbidity, and reduced growth. Increasing IGF-I levels may improve outcomes of very low birth weight infants.

Seasonal predictability of the East Atlantic pattern from sea surface temperatures.

This study analyzes the influence of sea surface temperatures (SSTs) on the second mode of atmospheric variability in the north Atlantic/European sector, namely the East-Atlantic (EA) pattern, for the period 1950-2012. For this purpose, lead-lag relationships between SSTs and the EA pattern, ranging from 0 to 3 seasons, were assessed. As a main result, anomalies of the EA pattern in boreal summer and autumn are significantly related to SST anomalies in the Indo-Pacific Ocean during the preceding seasons. A statistical forecasting scheme based on multiple linear regression was used to hindcast the EA-anomalies with a lead-time of 1 to 2 months. The results of a one-year-out cross-validation approach indicate that the phases of the EA in summer and autumn can be properly hindcast.

Nuevos modelos de gestión de recursos diagnósticos y terapéuticos para una rápida valoración diagnóstica y un tratamiento en tiempo y forma en pacientes en Incapacidad Temporal (IT): el acceso a la historia clínica para control clínico de calidad de la IT / No disponible

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Incidencia etaria y geográfica y patrón de sensibilidad a los antifúngicos de las especies de Candida causantes de candidemia en la población pediátrica española / Age group, geographical incidence and patterns of antifungal susceptibility of Candida species causing candidemia in the Spanish paediatric population

Introducción Existen pocos estudios epidemiológicos sobre candidemia en población pediátrica en España. Nuestro objetivo es conocer la epidemiología de candidemia en estos pacientes. Métodos Estudio prospectivo, observacional, multicéntrico en 44 hospitales españoles sobre episodios de candidemia en población pediátrica desde 0 a 15 años de edad ocurridos entre enero de 2009 y febrero de 2010. Resultados Se estudiaron 197 episodios con 200 aislamientos de levaduras. La especie más frecuentemente aislada fue Candida parapsilosis sensu stricto (43%) seguida de C. albicans (36%), C. tropicalis (6%), C. orthopsilosis y C. glabrata (4% cada una). C. albicans predominó en neonatos, mientras que C. parapsilosis predominó en el resto de las edades. Por comunidades autónomas, en Baleares, Cataluña y Canarias se aisló más frecuentemente C. albicans, y en Andalucía, Castilla y León, Galicia, Madrid y Valencia fue más prevalente C. parapsilosis. El porcentaje de cepas resistentes al fluconazol fue del 1,5% (4,1% con los nuevos criterios especie específicos del CLSI). La resistencia al fluconazol fue menor en neonatos que en el resto de los grupos. Neonatología fue el área donde más frecuentemente se detectaron estos episodios (31,5%). La presencia de catéter y la prematuridad se asociaron, de manera independiente, con candidemia por C. albicans con un riesgo casi 6 y 2 veces mayor, respectivamente, en el análisis multivariante. Conclusiones La epidemiología de candidemia pediátrica varía entre las comunidades autónomas, pero globalmente C. parapsilosis y C. albicans son por este orden las especies más frecuentes y muestran unas tasas de resistencia al fluconazol inferiores al 5% (AU)

Introduction There are few epidemiological studies on candidaemia in the paediatric population in Spain. We sought to determine the epidemiology of candidaemia in these patients. Methods Prospective, observational and multicentre study in 44 Spanish hospitals. All candidaemia episodes in paediatric patients from 0 to 15 years old between January 2009 and February 2010 were studied. Results There were 197 episodes and 200 species were isolated. The most frequent species was Candida parapsilosis sensu stricto (43%), followed by C. albicans (36%), C. tropicalis (6%), C. orthopsilosis, and C. glabrata (4%) respectively. C. albicans was the most prevalent in newborns, and C. parapsilosis was most frequent in the other age groups. As regards the regions of Spain, C. albicans was most prevalent in patients from Catalonia, the Balearic Islands and Canary Islands, and C. parapsilosis in patients from Andalusia, Castilla-León, Galicia, Valencia, and Madrid. The rate of resistance to fluconazole was 1.5% (4.1% with the new species-specific Clinical and Laboratory Standards Institute [CLSI] criteria). Fluconazole resistance was lower in neonates than the other age groups. The Neonatal Wards were the areas with most episodes (31.5%). In the multivariate analysis, the variables associated independently with candidaemia due to C. albicans were: catheter (OR: 5.967; 95% CI: 1.614-22.057; P = .007) and prematurity (OR: 2.229; 95% CI: 1.141- 4.631; P = .020). Conclusions The epidemiology of paediatric candidaemia varies between Spanish regions, but, globally, C. parapsilosis and C. albicans, are respectively, the first and second most frequently isolated species, and they show resistance rates to fluconazole of less than 5% (AU)

[Age group, geographical incidence and patterns of antifungal susceptibility of Candida species causing candidemia in the Spanish paediatric population]. / Incidencia etaria y geográfica y patrón de sensibilidad a los antifúngicos de las especies de Candida causantes de candidemia en la población pediátrica española.

INTRODUCTION: There are few epidemiological studies on candidaemia in the paediatric population in Spain. We sought to determine the epidemiology of candidaemia in these patients. METHODS: Prospective, observational and multicentre study in 44 Spanish hospitals. All candidaemia episodes in paediatric patients from 0 to 15 years old between January 2009 and February 2010 were studied. RESULTS: There were 197 episodes and 200 species were isolated. The most frequent species was Candida parapsilosis sensu stricto (43%), followed by C. albicans (36%), C. tropicalis (6%), C. orthopsilosis, and C. glabrata (4%) respectively. C. albicans was the most prevalent in newborns, and C. parapsilosis was most frequent in the other age groups. As regards the regions of Spain, C. albicans was most prevalent in patients from Catalonia, the Balearic Islands and Canary Islands, and C. parapsilosis in patients from Andalusia, Castilla-León, Galicia, Valencia, and Madrid. The rate of resistance to fluconazole was 1.5% (4.1% with the new species-specific Clinical and Laboratory Standards Institute [CLSI] criteria). Fluconazole resistance was lower in neonates than the other age groups. The Neonatal Wards were the areas with most episodes (31.5%). In the multivariate analysis, the variables associated independently with candidaemia due to C. albicans were: catheter (OR: 5.967; 95% CI: 1.614-22.057; P=.007) and prematurity (OR: 2.229; 95% CI: 1.141- 4.631; P=.020). CONCLUSIONS: The epidemiology of paediatric candidaemia varies between Spanish regions, but, globally, C. parapsilosis and C. albicans, are respectively, the first and second most frequently isolated species, and they show resistance rates to fluconazole of less than 5%.

Variación de la epidemiología de las fungemias y de la sensibilidad al fluconazol de los aislamientos de hemocultivos en los últimos 10 años en España: resultados del estudio FUNGEMYCA / Changes in the epidemiology of fungaemia and fluconazole susceptibility of blood isolates during the last 10 years in Spain: results from the FUNGEMYCA study

Antecedentes. Recientemente se ha observado un incremento de las fungemias causadas por especies diferentes de Candida albicans y una disminución de la sensibilidad de los microorganismos responsables al fluconazol. Objetivos. Evaluar la epidemiología y la sensibilidad al fluconazol de los casos de fungemia en España en 2009, comparando los resultados con los obtenidos entre los años 1997-1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). Métodos. Estudio prospectivo multicéntrico con 44 centros participantes realizado desde enero de 2009 a febrero de 2010. Los aislamientos fúngicos procedentes de hemocultivo fueron recogidos en cada centro, donde se realizó el estudio de sensibilidad antifúngica mediante microdilución colorimétrica (Sensititre Yeast One). Resultados. Desde enero de 2009 a febrero de 2010 se recogieron 1.377 aislamientos en hemocultivos, correspondientes a 1.357 episodios de fungemia. Las fungemias se observaron principalmente en mayores de 64 años (46,7%) y el 8,6% en menores de 1 año. C. albicans (44,7%), Candida parapsilosis (29,1%), Candida glabrata (11,5%), Candida tropicalis (8,2%) y Candida krusei (1,9%) fueron las especies más frecuentes, pero su distribución no fue geográficamente homogénea. En los últimos 10 años la incidencia de C. albicans ha aumentado significativamente en Cataluña (39,1 vs. 54,7%, P=0,03) y reducido en la Comunidad Valenciana (49,1 vs. 34,6%, P=0,01). C. parapsilosis ha disminuido en Cataluña (29 vs. 12,4%, P=0,002) y Extremadura (58,3 vs. 20%, P=0,01). La sensibilidad a fluconazol fue similar en toda España pero en los aislamientos de C. albicans la resistencia fue diez veces superior en mayores de 64 años. Sin embargo, la tasa de resistencia (CMI > 32 mg/L) global ha disminuido con respecto a la obtenida hace 10 años (3,7 vs. 2,5% actual), sobre todo en C. albicans (3 vs. 1,6%). Conclusiones. En los últimos 10 años la distribución de las especies causantes de fungemia en España y la sensibilidad al fluconazol no han variado significativamente, aunque se observa una menor tasa de resistencia. La distribución de las especies varía según la unidad de hospitalización, hospital y Comunidad Autónoma(AU)

Background. Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility. Objectives. To evaluate changes in the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). Methods. From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered. Results. A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P =0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P =0.002) and Extremadura (58.3 vs. 20%, P =0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%). Conclusions. In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area(AU)

[Changes in the epidemiology of fungaemia and fluconazole susceptibility of blood isolates during the last 10 years in Spain: results from the FUNGEMYCA study]. / Variación de la epidemiología de las fungemias y de la sensibilidad al fluconazol de los aislamientos de hemocultivos en los últimos 10 años en España: resultados del estudio FUNGEMYCA.

BACKGROUND: Recent epidemiological surveillance studies have reported an increase in fungaemia caused by non-Candida albicans species, as well as a decrease in fluconazole susceptibility. OBJECTIVES: To evaluate changes in the epidemiology of fungaemia in Spain comparing data from a new surveillance epidemiological study conducted in 2009 with a previous study carried out from 1997 to 1999 (Pemán J, et al. Eur J Clin Microbiol Infect Dis. 2005). METHODS: From January 2009 to February 2010, 44 Spanish hospitals participated in a prospective multicentre fungaemia surveillance study to ascertain whether there have been changes in the epidemiology and fluconazole susceptibility. Susceptibility was determined by the colorimetric method Sensititre Yeast One. Demographic and clinical data and the first isolate of each episode were gathered. RESULTS: A total of 1,377 isolates from 1,357 fungaemia episodes were collected, 46.7% from patients older than 64years and 8.6% from children less than 1 year old. C. albicans (44.7%), Candida parapsilosis (29.1%), Candida glabrata (11.5%), Candida tropicalis (8.2%), and Candida krusei (1.9%) were the most frequent species isolated. Distribution varied with the geographical area. C. albicans incidence has increased significantly in the last 10years in Cataluña (39.1 vs. 54.7%, P=0.03) and decreased in the Valencian Community (49.1 vs. 34.6%, P=0.002) and Extremadura (58.3 vs. 20%, P=0.01). Susceptibility to fluconazole was similar for all geographical areas, although resistance in C. albicans was ten times greater for patients aged more than 64years. The overall rate of fluconazole resistance (MIC > 32 mg/L) has decreased with respect to that obtained 10years ago (3.7 vs. 2.5%) mainly in C. albicans (3 vs. 1.6%). CONCLUSIONS: In the last ten years, species distribution and fluconazole susceptibility have not significantly changed, although a lower rate of fluconazole resistance has been observed. Species distribution varies with hospital, hospitalization Unit and geographical area.

Effects of meteorological factors on the levels of Alternaria spores on a potato crop.

Alternaria solani Soraeur produces early blight in Solanum tuberosum L., leading to significant agricultural losses. The current study was carried out on the extensive potato crop situated in north-western of Spain during 2007, 2008 and 2009. In this area potato crops are the most important source of income. In this work we used a Hirst-type volumetric spore-trap for the aerobiological monitoring of Alternaria spores. The highest spore concentrations were recorded during the 2009 cycle (10,555 spores), and the lowest concentrations were recorded during the 2008 cycle (5,471 spores). Over the 3 years of study, the highest concentrations were registered during the last stage of the crop. The aim of the study was to observe the influence of meteorological factors on the concentration of Alternaria spores, which can lead to serious infection and early blight. Prediction of the stages during which a crop is particularly vulnerable to infection allows for adjustment of the application of fungicide and is of environmental and agricultural importance. For this reason, we tested three models (P-Days, DD and IWP) to predict the first treatment and decrease the negative effect that these spores have on potato crops. The parameter that showed the most significant correlation with spore concentrations was minimum temperature. We used ARIMA (autoregressive integrated model of running mean) time-series models to determine the forecast. We considered weather data as predictor variables and the concentration of spores on the previous day as the fixed variable.

Prevalence and determinants of hyperglycemia in very low birth weight infants: cohort analyses of the NIRTURE study.

OBJECTIVES: To investigate the prevalence and determinants of hyperglycemia in the preterm population, as part of the Neonatal Insulin Therapy in Europe (NIRTURE) Trial. STUDY DESIGN: We conducted prospective cohort analyses of continuous glucose monitoring data from control infants participating in an international randomized controlled trial. Data were collected from 188 very low birth weight infants (<1500 g). RESULTS: In the first week of life, 80% of infants had evidence of glucose levels >8 mmol/L, and 32% had glucose levels >10 mmol/L >10% of the time. Independent risk factors for hyperglycemia included increasing prematurity, small size at birth, use of inotropes, lipid infusions, and sepsis. There was a lack of association between rate of dextrose infused and risk of hyperglycemia. CONCLUSION: The prevalence of hyperglycemia in the very low birth weight infant is high, with marked variability in prevalence between infants, not simply related to rates of glucose infused, but to other potentially modifiable risk factors.

Early insulin therapy in very-low-birth-weight infants.

BACKGROUND: Studies involving adults and children being treated in intensive care units indicate that insulin therapy and glucose control may influence survival. Hyperglycemia in very-low-birth-weight infants is also associated with morbidity and mortality. This international randomized, controlled trial aimed to determine whether early insulin replacement reduced hyperglycemia and affected outcomes in such neonates. METHODS: In this multicenter trial, we assigned 195 infants to continuous infusion of insulin at a dose of 0.05 U per kilogram of body weight per hour with 20% dextrose support and 194 to standard neonatal care on days 1 to 7. The efficacy of glucose control was assessed by continuous glucose monitoring. The primary outcome was mortality at the expected date of delivery. The study was discontinued early because of concerns about futility with regard to the primary outcome and potential harm. RESULTS: As compared with infants in the control group, infants in the early-insulin group had lower mean (+/-SD) glucose levels (6.2+/-1.4 vs. 6.7+/-2.2 mmol per liter [112+/-25 vs. 121+/-40 mg per deciliter], P=0.007). Fewer infants in the early-insulin group had hyperglycemia for more than 10% of the first week of life (21% vs. 33%, P=0.008). The early-insulin group had significantly more carbohydrate infused (51+/-13 vs. 43+/-10 kcal per kilogram per day, P<0.001) and less weight loss in the first week (standard-deviation score for change in weight, -0.55+/-0.52 vs. -0.70+/-0.47; P=0.006). More infants in the early-insulin group had episodes of hypoglycemia (defined as a blood glucose level of <2.6 mmol per liter [47 mg per deciliter] for >1 hour) (29% in the early-insulin group vs. 17% in the control group, P=0.005), and the increase in hypoglycemia was significant in infants with birth weights of more than 1 kg. There were no differences in the intention-to-treat analyses for the primary outcome (mortality at the expected date of delivery) and the secondary outcome (morbidity). In the intention-to-treat analysis, mortality at 28 days was higher in the early-insulin group than in the control group (P=0.04). CONCLUSIONS: Early insulin therapy offers little clinical benefit in very-low-birth-weight infants. It reduces hyperglycemia but may increase hypoglycemia (Current Controlled Trials number, ISRCTN78428828.)

Variation assessment of airborne Alternaria and Cladosporium spores at different bioclimatical conditions.

The study of mould spores is of major importance as many fungi can cause considerable economic losses worldwide acting as plant pathogens or triggering respiratory diseases and allergenic processes in humans. Knowledge of spore production relationships to different altitudes or weather patterns can be applied in a more efficient and reliable use of pesticides or improving diagnosis and treatment of respiratory allergic diseases. In this way monitoring of Cladosporium cladosporioides, C. herbarum and Alternaria spp. airborne spores during 2002 was carried out by means of three LANZONI VPPS 2000 pollen traps located in areas of north-west Spain at various altitudes and with various weather patterns. High spore counts were recorded in the late summer and early autumn, with a fairly similar hourly spore-count pattern, increasing the concentrations in the late evening (7-10 p.m.). High spore concentrations were detected in inland rural areas in front of coastal ones. As the continentality index increased, C. cladosporioides spore concentrations rose and Alternaria declined. C. herbarum concentrations increased with increasing height above sea level. The weather factor displaying the strongest positive correlation with mean daily spore counts was temperature. The optimal conditions for high airborne spore concentrations were recorded at temperatures ranging from 23-29 degrees C and RH values of around 80%, followed rapidly by rainfall in Vigo and Ourense and preceded by heavy rain two days prior to recording peak values in Trives.

[Genotypes of Candida dubliniensis in clinical isolates]. / Genotipos de Candida dubliniensis en aislamientos clínicos.

Amplification of specific sequences of the ITS1 and ITS2 regions and the intervening 5.8S rRNA gene has lead to the identification of four separate genotypes in Candida dubliniensis. Using primers specific for each genotype, we have studied the prevalence of these genotypes among 68 clinical isolates, mostly from Spanish patients infected by HIV. The majority of the isolates tested belonged to genotype 1 (97%), while only one isolate each from genotypes 2 (1.5%) and 3 (1.5%) were detected in the oral cavity of two patients with HIV infection.