The Role of Biomarkers for Starting Antifungals in the Intensive Care Unit

Invasive candidiasis is associated with high mortality rates (35% to 60%), similar to the range reported for septic shock. The most common types include candidemia, frequently observed in immunocompromised patients, and noncandidemic systemic candidiasis, which constitutes the majority of cases in critically ill patients. However, they are difficult to prove and a definite diagnosis usually occurs late in the course of the disease, thus contributing to their bad prognosis. Early empirical treatment improves the prognosis and currently relies on the positive predictive value (PPV) of risk-assessment strategies (colonization index, Candida score, predictive rules) based on combinations of risk factors, but it may have also largely contributed to the overuse of antifungal agents in critically ill patients. In this context, non- culture-based diagnostic methods, including specific and nonspecific biomarkers, may significantly improve the diagnosis of invasive candidiasis. Candida DNA and mannan antigen/antimannan antibodies are of limited interest for the diagnosis of invasive candidiasis as they fail to identify noncandidemic systemic candidiasis, despite early positivity in candidemic patients. The utility of 1,3-beta-D-glucan (b-D-glucan), a panfungal cell wall antigen, has been demonstrated for the diagnosis of fungal infections in immunocompromised patients. Preliminary data suggest that it is also detectable early in critically ill patients developing noncandidemic systemic candidiasis. To take advantage of the high negative predictive value of risk-assessment strategies and the early increase in specific fungal biomarkers in high-risk patients, we propose a practical 2-step approach to improve the selection of patients susceptible to benefit from empirical antifungal treatment.

Aerosol therapy in intensive and intermediate care units: prospective observation of 2808 critically ill patients.

PURPOSE: Unlike in the outpatient setting, delivery of aerosols to critically ill patients may be considered complex, particularly in ventilated patients, and benefits remain to be proven. Many factors influence aerosol delivery and recommendations exist, but little is known about knowledge translation into clinical practice. METHODS: Two-week cross-sectional study to assess the prevalence of aerosol therapy in 81 intensive and intermediate care units in 22 countries. All aerosols delivered to patients breathing spontaneously, ventilated invasively or noninvasively (NIV) were recorded, and drugs, devices, ventilator settings, circuit set-up, humidification and side effects were noted. RESULTS: A total of 9714 aerosols were administered to 678 of the 2808 admitted patients (24 %, CI95 22-26 %), whereas only 271 patients (10 %) were taking inhaled medication before admission. There were large variations among centers, from 0 to 57 %. Among intubated patients 22 % (n = 262) received aerosols, and 50 % (n = 149) of patients undergoing NIV, predominantly (75 %) inbetween NIV sessions. Bronchodilators (n = 7960) and corticosteroids (n = 1233) were the most frequently delivered drugs (88 % overall), predominantly but not exclusively (49 %) administered to patients with chronic airway disease. An anti-infectious drug was aerosolized 509 times (5 % of all aerosols) for nosocomial infections. Jet-nebulizers were the most frequently used device (56 %), followed by metered dose inhalers (23 %). Only 106 (<1 %) mild side effects were observed, despite frequent suboptimal set-ups such as an external gas supply of jet nebulizers for intubated patients. CONCLUSIONS: Aerosol therapy concerns every fourth critically ill patient and one-fifth of ventilated patients.

The impact of FTAs on MENA trade in agricultural and industrial products

This paper analyses the impact of Free Trade Agreements (FTAs) on Middle East and North African Countries (MENA) trade for the period 1994-2010. The analysis distinguishes between industrial and agricultural trade to take into account the different liberalisation schedules. An augmented gravity model is estimated using up-to-date panel data techniques to control for all time-invariant bilateral factors that influence bilateral trade as well as for the so-called multilateral resistance factors. We also control for the endogeneity of the agreements and test for self-selection bias due to the presence of zero trade in our sample. The main findings indicate that North-South-FTAs and South-South- FTAs have a differential impact in terms of increasing trade in MENA countries, with the former being more beneficial in terms of exports for MENA countries, but both showing greater global market integration. We also find that FTAs that include agricultural products, in which MENA countries have a clear comparative advantage, have more favourable effects for these countries than those only including industrial products. JEL code: F10, F15

Estudi tècnic-econòmic per a la instal·lació d'una granja d'ànecs per a producció de foie-gras situada en el terme municipal de Fontanals de Cerdanya

Inversors però, principalment professionals de l'àmbit agrari, per tal de buscar una diversificació de l'activitat agrícola i ramadera que desenvolupen a les seves finques, sobretot joves emprenedors, poden estar interessats en produccions alternatives com la producció d'ànecs per a foie-gras, per tal de complementar la seva renda agrària. Actualment cal augmentar la competitivitat de les finques agrícoles per tal que aquestes siguin econòmicament viables. L’objectiu de l'estudi és determinar la viabilitat econòmica d’una explotació ramadera d’ànecs per a la producció de foie-gras, en el terme municipal de Fontanals de Cerdanya, analitzant les diverses alternatives en quant a dimensionament i disseny de les instal·lacions, segons el cicle productiu de l’animal. L'alternativa escollida per realitzar l'estudi es la de semi-integració (cria, engreix i embocat), de règim semi-intensiu (durant l'etapa de l'engreix), amb animals mascles de la raça híbrida Mulard. Les instal·lacions tindran una capacitat de 6.500 animals, amb lots de 250 caps. Aquest dimensionament permet, durant la fase d'embocat, en la qual es requereix més dedicació, que la demanda de mà d'obra pugui ser satisfeta per un únic treballador. La principal conclusió que es pot extreure de l'estudi és que la inversió projectada és massa elevada i que aquesta econòmicament no és viable o rendible, ja que la despesa és massa elevada. Es mouen uns fluxos de caixa molt elevats i el marge comercial és molt reduït. Únicament si l'objectiu del promotor és obtenir una remuneració per la seva feina, sempre i quan és produeixi un augment del preu actual de la carn i una disminució del preu del pinso, es podria recomanar que es portés a terme la implantació de l'explotació, intentant, però, reduir la despesa d'execució de construccions i instal·lacions.

Engendering Group Support Based Foresight for Capital Intensive Manufacturing Industries - Case Paper and Steel Industry Scenarios by 2018

In recent times of global turmoil, the need for uncertainty management has become ever momentous. The need for enhanced foresight especially concerns capital-intensive industries, which need to commit their resources and assets with long-term planning horizons. Scenario planning has been acknowledged to have many virtues - and limitations - concerning the mapping of the future and illustrating the alternative development paths. The present study has been initiated to address both the need of improved foresight in two capital-intensive industries, i.e. the paper and steel industries and the imperfections in the current scenario practice. The research problem has been approached by engendering a problem-solving vehicle, which combines, e.g. elements of generic scenario process, face-to-face group support methods, deductive scenario reasoning and causal mapping into a fully integrated scenario process. The process, called the SAGES scenario framework, has been empirically tested by creating alternative futures for two capital-intensive industries, i.e. the paper and steel industries. Three scenarios for each industry have been engendered together with the identification of the key megatrends, the most important foreign investment determinants, key future drivers and leading indicators for the materialisation of the scenarios. The empirical results revealed a two-fold outlook for the paper industry, while the steel industry future was seen as much more positive. The research found support for utilising group support systems in scenario and strategic planning context with some limitations. Key perceived benefits include high time-efficiency, productivity and lower resource-intensiveness. Group support also seems to enhance participant satisfaction, encourage innovative thinking and provide the users with personalised qualitative scenarios.

Effects of landscape evolution on flora and habitats in agricultural mosaics

A landscape mosaic is a landscape that consist of various patches, inhabited by different habitat communities over time. Agricultural mosaics area result of the long history between societies and the environment. The understanding of the driving forces for change in this landscapes, and their effect on biodiversity, allow the development of useful tools to assess and manage natural heritage. Plant diversity, endangered plant species and interesting habitats receive the center of attention, because of their capability to integrate and reflect the main changes of this landscapes after medium and long-term.

Yield in double cropping system as affected by N fertilization rate with pig slurry in a Catalonia dryland region

Intensive swine production is an important agricultural and economical activity in Europe. The high availability of pig slurry (PS) lead to attractive fertilization strategy to reduce costs, therefore is mainly applied as fertilizer in agricultural systems. The optimization N fertilization in these areas should be taken in into to avoid nitrates losses by lixiviation and to achieve maximum efficiency in crop nutrition. Many studies have shown that PS applications can achieve satisfactory yields in different crops by partially or completely replacing synthetic fertilizers. In addition, for the last years, in Northeast Spain (Catalonia) has been widely extended the double-cropping forage system.

Transporte de glifosato pelo escoamento superficial e por lixiviação em um solo agrícola

Glyphosate was determined in runoff and leaching waters in agricultural soil that received an application of active ingredient and was exposed to simulated intensive rain conditions. The concentrations decreased during the simulation period and the concentrations of the runoff were higher than those achieved in the samples of leaching waters. The concentrations were lower than the pattern in the Brazilian Regulation MS N. 518/2004 for drinking water. The transported load of the applied active ingredient by the leaching was of 15.4% (w/w) and for the runoff was of 1.7% (w/w).