Ventilation conditions and their influence on thermal comfort in examination classrooms in times of COVID-19. A case study in a Spanish area with Mediterranean climate

Current evidence and recent publications have led to the recognition that aerosol-borne transmission of COVID-19 is possible in indoor areas such as educational centers. A crucial measure to reduce the risk of infection in high occupancy indoors is ventilation. In this global pandemic context of SARS-CoV-2 virus infection, a study has been carried out with the main objective of analyzing the effects of natural ventilation conditions through windows on indoor air quality and thermal comfort during on-site examinations in higher education centers during the winter season, as this implies situations of unusual occupation and the impossibility in many cases of taking breaks or leaving classrooms, as well as the existence of unfavorable outdoor weather conditions in terms of low temperatures. For this purpose, in situ measurements of the environmental variables were taken during different evaluation tests. As the main results of the study, ventilation conditions were generally adequate in all the tests carried out, regardless of the ventilation strategy used, with average CO₂ concentration levels of between 450 and 670 ppm. The maximum CO₂ concentration value recorded in one of the tests was 808 ppm. On this basis, the limit for category IDA 2 buildings, corresponding to educational establishments, was not exceeded in any case. However, these measures affected the thermal comfort of the occupants, especially when the outside temperature was below 6 °C, with a dissatisfaction rate of between 25 and 72%. Examinations carried out with outside temperatures above 12 °C were conducted in acceptable comfort conditions regardless of outside air supply and classroom occupancy. In these cases, the dissatisfaction rate was less than 10%. The results obtained have made it possible to establish strategies for ventilation in the implementation of future exams, depending on the climatic conditions outside.

Analysis of pelletizing from corn cob waste

In recent years, biomass market has constantly increased. Pellet industry has started looking for new products with the potential to be used as biofuels. Among them are agricultural wastes, such as corn cob waste, which presents some characteristics that make its direct use in industrial facilities possible. However, these properties are not enough for its use in domestic stoves and boilers, where higher quality of fuel is needed. For this reason, densification is used. In the present research work a technical and energy analysis of corn cob waste pelletizing was carried out in a semi-industrial pelletizer. Some relationships between variables, such as moisture, bulk density and mechanical durability, were analyzed, as well as their influence on energy use and final productivity. The results were satisfactory, as the pellets manufactured fulfilled with most specifications that were consulted, with higher values than those recorded for similar kinds of pellets. Concerning the energy study, the increase in production justified a higher energy consumption of the process in order to get a higher productivity ratio.

Administration of taurolidine-citrate lock solution for prevention of central venous catheter infection in adult neutropenic haematological patients: a randomised, double-blinded, placebo-controlled trial (TAURCAT)

Background

Catheter-related bloodstream infection (CRBSI) is one of the most frequent complications in patients with cancer who have central venous catheters (CVCs) implanted and is associated with substantial morbidity and mortality. Taurolidine is a non-antibiotic agent with broad-spectrum antimicrobial activity, which has been used as a lock solution to prevent CRBSI in some settings. However, little is known about its usefulness in high-risk adult neutropenic patients with cancer. This prospective randomised clinical trial aims to test the hypothesis that taurolidine-citrate lock solution is more effective than placebo for preventing catheter infection in neutropenic haematological patients.

Methods

This study is a prospective, multicentre, randomised, double-blinded, parallel, superiority, placebo-controlled trial. Patients with haematological cancer who are expected to develop prolonged neutropenia (> 7 days) and who have a non-tunnelled CVC implanted will be randomised to receive prophylactic taurolidine-citrate-heparin solution using a lock technique (study group) or heparin alone (placebo group). The primary endpoint will be bacterial colonisation of the CVC hubs. The secondary endpoints will be the incidence of CRBSI, CVC removal, adverse events, and 30-day case-fatality rate.

Discussion

The lock technique is a preventive strategy that inhibits bacterial colonisation in the catheter hubs, which is the initial step of endoluminal catheter colonisation and the development of infection. Taurolidine is a nontoxic agent that does not develop antibiotic resistance because it acts as an antiseptic rather than an antibiotic. Taurolidine has shown controversial results in the few trials conducted in cancer patients. These studies have important limitations due to the lack of data on adult and/or high-risk neutropenic patients, the type of catheters studied (tunnelled or ports), and the lack of information regarding the intervention (e.g. dwelling of the solution, time, and periodicity of the lock technique). If our hypothesis is proven, the study could provide important solid evidence on the potential usefulness of this preventive procedure in a population at high risk of CRBSI, in whom this complication may significantly impair patient outcome.

Trial registration

ISRCTN, ISRCTN47102251. Registered on 9 September 2015.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2647-y) contains supplementary material, which is available to authorized users.

Age-related characteristics of cutaneous melanoma in a Spanish Mediterranean population

BACKGROUND

Melanoma is considered a heterogeneous tumor with genetic and environmental factors involved in its pathogenesis. The impact of these factors varies depending on age.

OBJECTIVE

The aim of this study was to characterize the epidemiological, phenotypic, and histological features of patients with melanoma according to three age groups: ≤40, 41-65, and >65 years.

METHODS

A total of 1122 consecutive patients with invasive melanoma definitively treated in our institution since January 2000 were selected from our melanoma database. Epidemiological, phenotypic, and histological data were retrieved and analyzed as a function of age.

RESULTS

Female patients predominated in the younger age group. The location of cutaneous malignant melanoma differed with age. In the younger and middle age groups, tumors presented mainly on the trunk, while in the older group they were mainly found on the head/neck. Signs of actinic damage such as actinic keratoses, solar lentigines, or other skin tumors increased with age, while genetic factors such as family history of melanoma or a high number of common melanocytic nevi were more frequent in the younger group.

CONCLUSION

Our results suggest that melanoma development in younger patients is the result of genetic factors, particularly related to multiple nevi, whereas in older patients environmental factors such as severe chronic sun exposure play a major role.

Improvement over the years of long-term survival in high-risk lymphoma patients treated with hematopoietic stem cell transplantation as consolidation or salvage therapy

The role of hemopoietic stem cell transplantation (HSCT) is not well established in certain types of lymphoma, such as those with a high relapse risk or relapsing after initial therapy. New chemotherapeutic schemes and immunotherapy have improved survival of these patients. Nevertheless, there is not enough evidence regarding whether transplantation is the best therapeutic approach. Moreover, published data on long-term follow-up of high-risk lymphoma patients treated with HSCT are scarce. We analyzed 177 consecutive patients diagnosed with a high risk of relapse or with relapsed lymphoma who underwent HSCT after induction with standard chemotherapy in a tertiary academic center from 1989 to 2013. The median age was 40 years. Diagnoses were Hodgkin disease (n = 56), diffuse large B-cell lymphoma (n = 44), follicular lymphoma (n = 29), mantle cell lymphoma (n = 15), T-cell lymphoma (n = 18), and others (n = 15). Patients received either an autologous graft (n = 154) in first complete remission (1CR; n = 59) or more advanced stages (AS; n = 95), or an allogeneic graft (n = 23) in 1CR (n = 4) or AS (n = 19). In the autologous group, overall survival (OS) at 5 years was 57% and 75% in the periods 1989-2001 and 2002-2013, respectively (P = .05). Patients receiving an allogeneic graft presented an OS of 25% and 43% in the 2 periods. With a mean follow-up of 5 years (95% confidence interval 3.5-6.6), for patients receiving a transplant in 1CR, OS at 5 years was 80%, and for those receiving a transplant in AS it was 59% (P = .003). Nonrelapse mortality (NRM) at 5 years was 3.1% in the autologous group and 27.9% in the allogeneic group (P < .001). The main cause of NRM was infection (44%) in the whole cohort. All this leads to the conclusion that transplantation, as a therapeutic strategy, has shown a high long-term OS in this subgroup of patients with such a poor prognosis. OS improved over the years and reaching 1CR was a good prognostic feature. Infections were the main cause of NRM.

Differential cytogenetic profile in advanced chronic myeloid leukemia with sequential lymphoblastic and myeloblastic blast crisis

Frequency of additional chromosomal abnormalities in chronic myeloid leukemia (CML) is estimated to be 7% in chronic phase and increases to 40–70% in advanced disease. Progression of CML from chronic phase to accelerated phase or blast crisis is often associated with secondary chromosomal aberrations. We report an exceptional case of CML as debut in lymphoblastic blast crisis and a subsequent progression in myeloblastic blast crisis with rare cytogenetic abnormalities.

Comparative structural and electronic studies of hydrogen interaction with isolated versus ordered silicon nanoribbons grown on Ag(110)

We have investigated the geometry and electronic structure of two different types of self-aligned silicon nanoribbons (SiNRs), forming either isolated SiNRs or a self-assembled 5 × 2/5 × 4 grating on an Ag(110) substrate, by scanning tunnelling microscopy and high resolution x-ray photoelectron spectroscopy. At room temperature we further adsorb on these SiNRs either atomic or molecular hydrogen. The hydrogen absorption process and hydrogenation mechanism are similar for isolated or 5 × 2/5 × 4 ordered SiNRs and are not site selective; the main difference arises from the fact that the isolated SiNRs are more easily attacked and destroyed faster. In fact, atomic hydrogen strongly interacts with any Si atoms, modifying their structural and electronic properties, while molecular hydrogen has first to dissociate. Hydrogen finally etches the Si nanoribbons and their complete removal from the Ag(110) surface could eventually be expected.

Independent association of matrix metalloproteinase-10, cardiovascular risk factors and subclinical atherosclerosis

OBJECTIVES

Circulating levels of matrix metalloproteinase (MMP)-10 are related to inflammation in asymptomatic subjects with cardiovascular risk factors. Whether MMP-10 is associated with the severity of atherosclerosis remains to be determined. This study examines the relationship of systemic MMP-10 levels with atherosclerotic risk factors and subclinical atherosclerosis.

METHODS AND RESULTS

Circulating levels of MMP-1, -9 and -10, and markers of inflammation [fibrinogen, interleukin-6, von Willebrand factor, and high-sensitivity C-reactive protein (hs-CRP)] were measured in 400 subjects (mean age 54.3 years, 77.7% men) with cardiovascular risk factors but free from clinical cardiovascular disease. Subclinical atherosclerosis was evaluated by both the mean carotid intima-media thickness (IMT) and the presence of atherosclerotic plaques with the use of B-mode ultrasound in all subjects. MMP-10 levels were positively correlated with fibrinogen (r = 0.24, P < 0.001), hs-CRP (r = 0.14, P < 0.01) and carotid IMT (r = 0.17, P < 0.01). The association between MMP-10 and IMT remained significant in multiple regression analysis (P < 0.02) when controlling for traditional atherosclerotic risk factors and inflammatory markers. Such an association was not observed for MMP-1 and -9. Subjects in the highest MMP-10 tertile had significantly higher carotid IMT (adjusted odds ratio 6.3, 95% confidence interval 1.3-31.4, P = 0.024). In addition, MMP-10 levels were significantly higher in patients with carotid plaques (n = 78) than in those with no plaques after adjusting for age and sex (P < 0.01).

CONCLUSION

Higher serum MMP-10 levels were associated with inflammatory markers, increased carotid IMT and atherosclerotic plaques in asymptomatic subjects. Circulating MMP-10 may be useful to identify subclinical atherosclerosis in subjects free from cardiovascular disease.

[Family intervention in schizophrenia: long-term effect on main caregivers]

INTRODUCTION

The bulk of research on Family Interventions concentrates on assessing its efficacy in reducing psychotic relapses, there being very little research into its ability to reduce the morbidity of the main caregiver over the course of time.

METHOD

Follow-up study at five years of a cohort of informal caregivers of persons with schizophrenia who had taken part in an empirical trial with two therapeutic approaches assigned at random.

RESULTS

87.7 % of main caregivers are women and they tend to care for more chronic and inactive patients than men (p < 0.041). More than 55% of main caregivers had high General Health Questionnaire (GHQ) scores, with women suffering more emotional repercussions than men. Morbidity gradually declines over time (GHQ scores: 8.1 before intervention; 6.9 at the end of intervention and 4.6 five years later) although statistical significance was only achieved when taking the entire period into account, i.e., from beginning to the end of follow-up.

CONCLUSIONS

Family intervention over a limited period followed by a support group gradually reduces morbidity of the caregiver to a significant level at five years, although this reduction is not associated with the type of setting or the absence or presence of the patient. Clinical implications are discussed and likewise the need for a more equitable distribution of responsibilities and risk.

[Modification of family expressed emotion after a psychosocial intervention: stability in time]

INTRODUCTION

There is some controversy about whether expressed emotion (EE) tends to remain stable or fluctuates in time and there are very few studies on EE evolution and its subscales once a family intervention has been performed. Better knowledge about its behavior in time would have important theoretical and clinical implications.

METHODS

We have studied changes in EE and its subscales that are produced in a cohort of 37 relatives of schizophrenic patients to whom a familiar intervention orientated to reducing environmental stress was performed. Changes were analyzed according to three cross-sectional moments of evaluation: one moment previous to intervention, another one when it was finished and finally, one at five years of finishing it.

RESULTS

In this work, the EE levels tend to vary in time. These changes are mainly produced in the period when the family intervention is carried out, at the expense of decreasing the levels of emotional overinvolvement. Between the end of therapy and the analysis carried out five years later, levels remain stable. The few changes that take place in this period, if any, are associated to variables of clinical severity and social adjustment.

CONCLUSIONS

Family intervention appears as the determining factor for reducing EE levels, whereas productive clinical severity and the patient's social adjustment condition increases in their levels.

Two strategies for family intervention in schizophrenia: a randomized trial in a Mediterranean environment

Controlled intervention studies carried out in families of schizophrenia patients have been shown to have a positive impact in relapse prevention, but it remains to be seen whether different forms of family intervention affect outcomes other than relapse and hospital readmission in different ways. This study compared the outcome profile of relevant clinical variables after two different family intervention strategies for schizophrenia patients in public health care in a Spanish sample. We conducted a randomized controlled study comparing (1) a relatives group (RG) and (2) a single-family behavioral family therapy (BFT), both offered as standard treatment in one catchment area in Valencia. All randomized patients were included in the main analysis, and all cases remained in the therapy group to which they were originally assigned regardless of whether they suffered a relapse. The relapse rate at 12 months for the 87 cases studied was not significantly different in the two groups, but the two approaches did affect outcomes other than relapse and rehospitalization (such as social functioning, dose of antipsychotic medication, "delusions" and "thought disorder") in different ways. The BFT approach offered more advantages than the RG approach. The results suggest that these approaches should always be implemented in a clinical environment in a Mediterranean setting.

Chemical shift resolved photoionization cross sections of amorphous carbon nitride

The various components in the N 1s photoemission spectra of amorphous carbon nitride are identified by measuring their photon energy dependence and comparing the experimental results with ab initio multiple scattering calculations. The intensity modulations with photon energy are due to the extended x-ray absorption fine structure effects.

Family interventions in schizophrenia: an analysis of non-adherence

OBJECTIVE

The aim of this study was to identify baseline factors which may make it possible to predict non-adherence to prescribed treatment.

METHOD

A total of 87 schizophrenic patients in a catchment area of Valencia (Spain) were randomly assigned to two family strategies. The characteristics associated with lack of adherence to the programmes were analysed in both the patients and their families.

RESULTS

Older patients, those with a higher number of previous hospital admissions, those living in small households and those having relatives with little knowledge of schizophrenia at the time of the initial assessment were the main factors associated with a higher risk of dropping out of the interventions.

CONCLUSIONS

The findings of this study offer some guidance on suggesting intervention strategies that might reduce drop-out rates in these types of programmes.

Social adjustment in schizophrenia: factors predictive of short-term social adjustment in a sample of schizophrenic patients

A sample of 60 Spanish schizophrenic patients was studied in order to ascertain the relationship between their relatives' expressed emotion (EE) and social adjustment after 2 years of follow-up. The average extent of the disability did not increase over time, and differences in dysfunction rates between the various specific social roles were identified. No differences in social outcome were detected between patients with high EE and low EE families. Three factors which predict social adjustment outcome were obtained using logistic regression analysis, namely clinical conditions, baseline social adjustment and the occurrence of a psychotic relapse during the follow-up period.

[Emotional family environment and clinical profile in schizophrenia]

Despite the strong evidence in the literature for considering Expressed Emotion (EE) as a relapse predicting factor in schizophrenia, there are still several aspects open to discussion. One of the controversial issues is whether EE is only an intrinsic characteristic of the family or, at least partially, a response to schizophrenic symptoms. The aim of this study is to analyse the relationship between EE, and each one of its single components, and the patients clinical characteristics. It is an observational study including a sample of 120 schizophrenic patients and their families. Patients have been evaluated for their clinical status as well as their social adjustment, and the key relatives have been assessed with the Camberwell Family Interview. We have found a statistically significant association between the severity of psycotic symptoms and critical comments, as well as with hostility. However, no association was found between clinical severity and the global status of EE. Results are compared with other studies and possible explanations for those discussed.

[Factors associated with the use of gynecology services by climacteric women: a case-control study]

BACKGROUND

The data and concepts described in the literature on menopausic women are based on observations and studies carried out in menopausic women attending medical or gynecological consultations and contrast greatly with the results obtained in women from a general population.

METHODS

In a case-control study 505 women between 45-55 years of age, 142 having attended a gynecological consultation (cases) and 363 taken from a randomized sample of the general population (controls) were evaluated. Information concerning sociodemography, climacteric phase, psychic morbidity and psychosocial factors as stressing events, social support and adjustment and satisfaction with roles was collected in a personal interview. The odds ratio (OR) was used as the means of association and multiple regression analysis was performed to control possible confusing factors.

RESULTS

The cases were fundamentally young women in a premenopausic phase of a high social class belonging principally to a group of widows, separated or divorcees and a group of married women with high levels of association (OR = 14.7; OR 12.14). The women attending a gynecological consultation were characterized by having greater risk of lacking social support (OR = 8.94), presenting a greater frequency of vital severely stressing events over the previous year (OR = 2.55), and demonstrating greater insatisfaction in social adjustment (OR = 2.42) particularly in their sexual and matrimonial relations.

CONCLUSIONS

Women attending medical, specially gynecological, consultations during climacteric years are not representative of the population of women in these years as a whole. Purely pharmacologic management, principally substitutive hormonal therapy, was the most wide-spread treatment of preventive character should be reestablished in accordance with the results with the most manifold and multifactorial orientations and foci.

Social functioning as a significant factor in women's help-seeking behaviour during the climacteric period

In order to identify the psychosocial factors that lead to the demand for medical care related to the menopause, we carried out a case/control study. A case was defined as a woman who sought gynaecological care due to "menopausal complaints" (n = 85) and a control referred to a woman drawn at random from the general population. The cases showed greater psychiatric morbidity and social dissatisfaction, a lower level of diffused social support and a higher frequency of severe life events and the controls showed greater social maladjustment in objective conditions. The multivariate analysis (logistic regression) carried out after adjusting all the relevant variables, indicated that the demand for medical care due to menopausal complaints was not only determined by the menopausal status itself but also by a set of social and demographic variables, especially dissatisfaction and a lack of social support.

The influence of family expressed emotion on the course of schizophrenia in a sample of Spanish patients. A two-year follow-up study

A sample of 60 Spanish schizophrenic patients was studied to ascertain the relationship between their relatives' expressed emotion (EE) and relapse at follow-up. The relatives' EE and patients' relapse were operationalised following Leff & Vaughn's criteria. At nine months a significant association was not found between the relatives' EE and relapse, but this association became significant on reclassifying the relatives' EE scores after decreasing to four points the cut-off point for critical comments. At 24 months no association was found between EE and relapse. There was a tendency for patients who interrupted their medication or who did not work to relapse more frequently, particularly among the high-EE group.

The irritable bowel syndrome: diagnostic strategies

The irritable bowel syndrome (IBS) is characterized by abdominal pain, abdominal distension and altered bowel habits. The diagnosis is usually made by excluding other diseases. The diagnosis of IBS must be based on a) medical history (i.e. symptoms, bowel habits, normal physical examination, absence of intestinal infections or parasites) b) physiopathological evaluation (hyperactivity of the distal colon, hypersensitivity to stimuli, stress), and c) physiological evaluation of the patient. The diagnosis of IBS can be supposed in patients with typical symptoms in the absence of other diseases that were excluded by complementary examinations.

[Emotional expressiveness and development of schizophrenia: a reply to the work of Vaughn]

The influence of family climate in the course of schizophrenia has been empirically established. However research has been so far limited to the Anglo-American culture and there are reasons to think that straight forward extrapolation to own our culture may not be totally justified. Consecqently a replication of Vaughn's (Vaughn et al, 1984) has been carried out with a sample of 60 schizophrenic patients in Valencia. Relapse rate was not predicted by EE status or by any EE scale-score according to British original criteria. As the cut-off point was changed from six or more critical remarks to four or more, then the relapse rate was significantly different between high and low EE groups. The study confirms the link between EE-status and relapse rates over nine months but is also underlines the need to take into account cultural differences when it comes to establish cut-off scores.

A Spanish experience of DSM III in a Consultation-Liaison psychiatric service

The authors applied the DSM III diagnosis to 500 patients seen at a Consultation-Liaison psychiatric service. Compared with similar American studies there was a lower frequency of adjustment and somatoform disorders and a higher proportion of drug abuse cases. Several possible reasons for these differences are mentioned. Although the use of DSM III has clear advantages in a General Hospital context, important difficulties were found: the use of some diagnostic criteria, the absence of a code to relate Axes I and III, the poor systemization of scores in social Axes IV and V and the lack of a specific category for attempted suicide are but a few of the difficulties encountered. Finally, some modifications of DSM III are suggested in order to improve its clinical usefulness.