A randomized clinical trial of ascorbic acid in open abdominal aortic aneurysm repair

BACKGROUND: Open AAA repair is associated with ischaemia-reperfusion injury where systemic inflammation and endothelial dysfunction can lead to multiple organ injury including acute lung injury. Oxidative stress plays a role that may be inhibited by ascorbic acid.

METHODS: A double blind, allocation concealed, randomized placebo-controlled trial was performed to test the hypothesis that a single bolus dose (2g) of intra-operative parenteral ascorbic acid would attenuate biomarkers of ischaemia-reperfusion injury in patients undergoing elective open AAA repair.

RESULTS: Thirty one patients completed the study; 18 received placebo and 13 ascorbic acid. Groups were comparable demographically. Open AAA repair caused an increase in urinary Albumin:Creatinine Ratio (ACR) as well as plasma IL-6 and IL-8. There was a decrease in exhaled breath pH and oxygenation. Lipid hydroperoxides were significantly higher in the ascorbic acid group following open AAA repair. There were no other differences between the ascorbic acid or placebo groups up to 4 hours after removal of the aortic clamping.

CONCLUSIONS: Open AAA repair caused an increase in markers of systemic endothelial damage and systemic inflammation. Administration of 2g parenteral ascorbic acid did not attenuate this response and with higher levels of lipid hydroperoxides post-operatively a pro-oxidant effect could not be excluded.

TRIAL REGISTRATION: ISRCTN27369400.

Energy Saving - Another Perspective for Parameter Optimization of P and PI Controllers

Modern control methods like optimal control and model predictive control (MPC) provide a framework for simultaneous regulation of the tracking performance and limiting the control energy, thus have been widely deployed in industrial applications. Yet, due to its simplicity and robustness, the conventional P (Proportional) and PI (Proportional–Integral) control are still the most common methods used in many engineering systems, such as electric power systems, automotive, and Heating, Ventilation and Air Conditioning (HVAC) for buildings, where energy efficiency and energy saving are the critical issues to be addressed. Yet, little has been done so far to explore the effect of its parameter tuning on both the system performance and control energy consumption, and how these two objectives are correlated within the P and PI control framework. In this paper, the P and PI controllers are designed with a simultaneous consideration of these two aspects. Two case studies are investigated in detail, including the control of Voltage Source Converters (VSCs) for transmitting offshore wind power to onshore AC grid through High Voltage DC links, and the control of HVAC systems. Results reveal that there exists a better trade-off between the tracking performance and the control energy through a proper choice of the P and PI controller parameters.

Aspirin as a potential treatment in sepsis or acute respiratory distress syndrome

Sepsis is a common condition that is associated with significant morbidity, mortality and health-care cost. Pulmonary and non-pulmonary sepsis are common causes of the acute respiratory distress syndrome (ARDS). The mortality from ARDS remains high despite protective lung ventilation, and currently there are no specific pharmacotherapies to treat sepsis or ARDS. Sepsis and ARDS are characterised by activation of the inflammatory cascade. Although there is much focus on the study of the dysregulated inflammation and its suppression, the associated activation of the haemostatic system has been largely ignored until recently. There has been extensive interest in the role that platelet activation can have in the inflammatory response through induction, aggregation and activation of leucocytes and other platelets. Aspirin can modulate multiple pathogenic mechanisms implicated in the development of multiple organ dysfunction in sepsis and ARDS. This review will discuss the role of the platelet, the mechanisms of action of aspirin in sepsis and ARDS, and aspirin as a potential therapy in treating sepsis and ARDS.

Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries

Importance Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).

Objectives To evaluate intensive care unit (ICU) incidence and outcome of ARDS and to assess clinician recognition, ventilation management, and use of adjuncts—for example prone positioning—in routine clinical practice for patients fulfilling the ARDS Berlin Definition.

Design, Setting, and Participants The Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) was an international, multicenter, prospective cohort study of patients undergoing invasive or noninvasive ventilation, conducted during 4 consecutive weeks in the winter of 2014 in a convenience sample of 459 ICUs from 50 countries across 5 continents.

Exposures Acute respiratory distress syndrome.

Main Outcomes and Measures The primary outcome was ICU incidence of ARDS. Secondary outcomes included assessment of clinician recognition of ARDS, the application of ventilatory management, the use of adjunctive interventions in routine clinical practice, and clinical outcomes from ARDS.

Results Of 29 144 patients admitted to participating ICUs, 3022 (10.4%) fulfilled ARDS criteria. Of these, 2377 patients developed ARDS in the first 48 hours and whose respiratory failure was managed with invasive mechanical ventilation. The period prevalence of mild ARDS was 30.0% (95% CI, 28.2%-31.9%); of moderate ARDS, 46.6% (95% CI, 44.5%-48.6%); and of severe ARDS, 23.4% (95% CI, 21.7%-25.2%). ARDS represented 0.42 cases per ICU bed over 4 weeks and represented 10.4% (95% CI, 10.0%-10.7%) of ICU admissions and 23.4% of patients requiring mechanical ventilation. Clinical recognition of ARDS ranged from 51.3% (95% CI, 47.5%-55.0%) in mild to 78.5% (95% CI, 74.8%-81.8%) in severe ARDS. Less than two-thirds of patients with ARDS received a tidal volume 8 of mL/kg or less of predicted body weight. Plateau pressure was measured in 40.1% (95% CI, 38.2-42.1), whereas 82.6% (95% CI, 81.0%-84.1%) received a positive end-expository pressure (PEEP) of less than 12 cm H2O. Prone positioning was used in 16.3% (95% CI, 13.7%-19.2%) of patients with severe ARDS. Clinician recognition of ARDS was associated with higher PEEP, greater use of neuromuscular blockade, and prone positioning. Hospital mortality was 34.9% (95% CI, 31.4%-38.5%) for those with mild, 40.3% (95% CI, 37.4%-43.3%) for those with moderate, and 46.1% (95% CI, 41.9%-50.4%) for those with severe ARDS.

Conclusions and Relevance Among ICUs in 50 countries, the period prevalence of ARDS was 10.4% of ICU admissions. This syndrome appeared to be underrecognized and undertreated and associated with a high mortality rate. These findings indicate the potential for improvement in the management of patients with ARDS.

Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review

BACKGROUND: Care of critically ill patients in intensive care units (ICUs) often requires potentially invasive or uncomfortable procedures, such as mechanical ventilation (MV). Sedation can alleviate pain and discomfort, provide protection from stressful or harmful events, prevent anxiety and promote sleep. Various sedative agents are available for use in ICUs. In the UK, the most commonly used sedatives are propofol (Diprivan(®), AstraZeneca), benzodiazepines [e.g. midazolam (Hypnovel(®), Roche) and lorazepam (Ativan(®), Pfizer)] and alpha-2 adrenergic receptor agonists [e.g. dexmedetomidine (Dexdor(®), Orion Corporation) and clonidine (Catapres(®), Boehringer Ingelheim)]. Sedative agents vary in onset/duration of effects and in their side effects. The pattern of sedation of alpha-2 agonists is quite different from that of other sedatives in that patients can be aroused readily and their cognitive performance on psychometric tests is usually preserved. Moreover, respiratory depression is less frequent after alpha-2 agonists than after other sedative agents.

OBJECTIVES: To conduct a systematic review to evaluate the comparative effects of alpha-2 agonists (dexmedetomidine and clonidine) and propofol or benzodiazepines (midazolam and lorazepam) in mechanically ventilated adults admitted to ICUs.

DATA SOURCES: We searched major electronic databases (e.g. MEDLINE without revisions, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE and Cochrane Central Register of Controlled Trials) from 1999 to 2014.

METHODS: Evidence was considered from randomised controlled trials (RCTs) comparing dexmedetomidine with clonidine or dexmedetomidine or clonidine with propofol or benzodiazepines such as midazolam, lorazepam and diazepam (Diazemuls(®), Actavis UK Limited). Primary outcomes included mortality, duration of MV, length of ICU stay and adverse events. One reviewer extracted data and assessed the risk of bias of included trials. A second reviewer cross-checked all the data extracted. Random-effects meta-analyses were used for data synthesis.

RESULTS: Eighteen RCTs (2489 adult patients) were included. One trial at unclear risk of bias compared dexmedetomidine with clonidine and found that target sedation was achieved in a higher number of patients treated with dexmedetomidine with lesser need for additional sedation. The remaining 17 trials compared dexmedetomidine with propofol or benzodiazepines (midazolam or lorazepam). Trials varied considerably with regard to clinical population, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded outcome assessors. Compared with propofol or benzodiazepines (midazolam or lorazepam), dexmedetomidine had no significant effects on mortality [risk ratio (RR) 1.03, 95% confidence interval (CI) 0.85 to 1.24, I (2) = 0%; p = 0.78]. Length of ICU stay (mean difference -1.26 days, 95% CI -1.96 to -0.55 days, I (2) = 31%; p = 0.0004) and time to extubation (mean difference -1.85 days, 95% CI -2.61 to -1.09 days, I (2) = 0%; p < 0.00001) were significantly shorter among patients who received dexmedetomidine. No difference in time to target sedation range was observed between sedative interventions (I (2) = 0%; p = 0.14). Dexmedetomidine was associated with a higher risk of bradycardia (RR 1.88, 95% CI 1.28 to 2.77, I (2) = 46%; p = 0.001).

LIMITATIONS: Trials varied considerably with regard to participants, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded assessors.

CONCLUSIONS: Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients treated with dexmedetomidine. Well-designed RCTs are needed to assess the use of clonidine in ICUs and identify subgroups of patients that are more likely to benefit from the use of dexmedetomidine.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42014014101.

FUNDING: The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.

Case study investigation of indoor air quality in mechanically ventilated and naturally ventilated UK social housing

There is a significant lack of indoor air quality research in low energy homes. This study compared the indoor air quality of eight
newly built case study homes constructed to similar levels of air-tightness and insulation; with two different ventilation strategies (four homes with Mechanical Ventilation with Heat Recovery (MVHR) systems/Code level 4 and four homes naturally ventilated/Code level 3). Indoor air quality measurements were conducted over a 24 h period in the living room and main bedroom of each home during the summer and winter seasons. Simultaneous outside measurements and an occupant diary were also employed during the measurement period. Occupant interviews were conducted to gain information on perceived indoor air quality, occupant behaviour and building related illnesses. Knowledge of the MVHR system including ventilation related behaviour was also studied. Results suggest indoor air quality problems in both the mechanically ventilated and naturally ventilated homes, with significant issues identified regarding occupant use in the social homes

An investigation of IAQ, thermal comfort and Sick Building Syndrome symptoms in UK energy efficient homes

Purpose
– Concern of the deterioration of indoor environmental quality as a result of energy efficient building design strategies is growing. Apprehensions of the effect of airtight, super insulated envelopes, the reduction of infiltration, and the reliance on mechanical systems to provide adequate ventilation (air supply) is promoting emerging new research in this field. The purpose of this paper is to present the results of an indoor air quality (IAQ) and thermal comfort investigation in UK energy efficient homes, through a case study investigation.

Design/methodology/approach
– The case study dwellings consisted of a row of six new-build homes which utilize mechanical ventilation with heat recovery (MVHR) systems, are built to an average airtightness of 2m3/m2/hr at 50 Pascal’s, and constructed without a central heating system. Physical IAQ measurements and occupant interviews were conducted during the summer and winter months over a 24-hour period, to gain information on occupant activities, perception of the interior environment, building-related health and building use.

Findings
– The results suggest inadequate IAQ and perceived thermal comfort, insufficient use of purge ventilation, presence of fungal growth, significant variances in heating patterns, occurrence of sick building syndrome symptoms and issues with the MVHR system.

Practical implications
– The findings will provide relevant data on the applicability of airtight, mechanically ventilated homes in a UK climate, with particular reference to IAQ.

Originality/value
– IAQ data of this nature is essentially lacking, particularly in the UK context. The findings will aid the development of effective sustainable design strategies that are appropriate to localized climatic conditions and sensitive to the health of building occupants.

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome presents as hypoxia and bilateral pulmonary infiltrates on chest imaging in the absence of heart failure sufficient to account for this clinical state. Management is largely supportive, and is focused on protective mechanical ventilation and the avoidance of fluid overload. Patients with severe hypoxaemia can be managed with early short-term use of neuromuscular blockade, prone position ventilation, or extracorporeal membrane oxygenation. The use of inhaled nitric oxide is rarely indicated and both β2 agonists and late corticosteroids should be avoided. Mortality remains at approximately 30%.

Ecotoxicological tests using Chironomus riparius

Os sistemas aquáticos naturais podem estar sujeitos frequentemente a entrada de tóxicos, quer seja através da lixiviação dos campos agrícolas ou da descarga por parte de unidades industriais. Avaliar o impacto potencial destes contaminantes nos sistemas aquáticos é muito importante, porque pode promover consequências sérias no balanço ecológico dos ecossistemas. Os efeitos de níveis sub-letais destes tóxicos nas populações aquáticas são detectados, em muitos casos, somente após diversas gerações, dependendo da espécie e do contaminante. O comportamento animal é considerado como sendo a primeira linha de defesa perante estímulos ambientais, e pode ser uma representação de alterações fisiológicas no organismo, sendo portanto um indicador excelente de alterações ambientais. O desenvolvimento dos sistemas de aviso prévio que integram parâmetros comportamentais pode ajudar a prever mais rapidamente possíveis alterações ao nível das populações naturais, do que a utilização de testes ecotoxicológicos padrão com a mesma finalidade. O conhecimento acerca de possíveis implicações devido a alterações comportamentais, em organismos bentónicos e em populações do campo sujeitas a tóxicos, é ainda escasso. Sabendo isto, neste estudo pretendeu-se investigar como o comportamento de Chironomus riparius – usando um biomonitor em tempo real – e outros parâmetros tais como crescimento, emergência de adultos, bioacumulação e biomarcadores, são afectados pela exposição a imidacloprid e ao mercúrio, que foram seleccionados como contaminantes. Os resultados demonstraram que a exposição às concentrações sub-letais de imidacloprid afecta o crescimento e o comportamento dos quironomídeos e que estes organismos podem recuperar de uma exposição curta ao insecticida. O comportamento que corresponde à ventilação de C. riparius revelou-se como um parâmetro mais sensível do que a locomoção e do que as respostas bioquímicas, quando as larvas foram sujeitas ao imidacloprid. Larvas de C. riparius expostas a concentrações sub-letais de mercúrio apresentaram uma tendência de diminuição de actividade comportamental, em testes com concentrações crescentes do tóxico; o crescimento das larvas foi também prejudicado, e as taxas de emergência de adultos e o tempo de desenvolvimento apresentaram retardamento. Estes organismos podem bioacumular rapidamente o mercúrio em condições de não alimentação e apresentam uma lenta depuração deste metal. Estes efeitos podem, em último caso, conduzir a prováveis repercussões ao nível da população e das comunidades. As reduções em actividades comportamentais, mesmo em concentrações baixas, podem diminuir a quantidade de tempo gasta na procura de alimento, produzindo efeitos aos níveis morfo-fisiológicos, e assim afectar severamente o desempenho dos quironomídeos no ambiente. O uso destes factores comportamentais como um parâmetro ecotoxicológico sub-letal relevante ao nível da toxicologia aumentará a versatilidade dos testes, permitindo uma resposta comportamental mensurável e quantitativa ao nível do organismo, utilizando uma avaliação não destrutiva, e assim certificando que esta aproximação pode ser usada em testes ecotoxicológicos futuros.

Argamassas funcionais para uma construção sustentável

A aposta na sustentabilidade tem conduzido o mercado da construção a procurar novas soluções técnicas e novos materiais, que por serem mais eficientes, conseguem dar resposta aos requisitos cada vez mais exigentes deste sector. A aplicação dos conceitos de sustentabilidade não se pode restringir a novas construções, tendo que prever também as renovações e a reabilitação de edifícios antigos. Assim, novos materiais que sejam desenvolvidos, devem contemplar todas estas vertentes de utilização. Neste trabalho desenvolveram-se argamassas com novas funcionalidades, que contribuem para melhorar os níveis de sustentabilidade dos edifícios, através da incorporação de nanomateriais para armazenamento de calor latente e degradação de poluentes do ar interior. Estudou-se não só o impacto da incorporação destas nanopartículas no estado fresco e endurecido, mas também o seu desempenho do ponto de vista funcional quando integrados na estrutura da argamassa. É possível obter argamassas com capacidade para armazenar calor latente através da incorporação de um material de mudança de fase. Este material constituído por uma mistura de parafinas, consegue armazenar calor e libertálo posteriormente. As composições desenvolvidas podem ser aplicadas em novos projectos ou na reabilitação de edifícios contribuindo para reduzir o consumo energético, melhorando o conforto térmico no interior. Com a redução da factura energética obtém-se uma efectiva diminuição do impacto ambiental, energético e económico do edifício. Para além do armazenamento de calor latente, também se desenvolveram argamassas capazes de eliminar poluentes do ar interior e, simultaneamente, com capacidade de auto-limpeza. Utilizaram-se nanopartículas de dióxido de titânio como aditivo fotocatalítico, tendo-se analisado o efeito da introdução deste aditivo nas argamassas. As composições testadas demonstraram elevada capacidade fotocatalítica e de auto-limpeza, sem comprometer as suas propriedades no estado endurecido. Ao aplicar estas composições na camada de acabamento interior melhora-se a qualidade do ar no interior das habitações e reduz-se a necessidade de utilização de sistemas de ventilação. As argamassas funcionais contribuem para melhorar os níveis de sustentabilidade da construção, tendo impacto económico e ambiental em todo o ciclo de vida do edifício.

Indoor air quality in elementary schools of Lisbon and Aveiro

Tem havido uma preocupação crescente com a qualidade do ar interior (QAI) nas escolas em muitos países. Muitos estudos epidemiológicos têm encontrado diferenças regionais entre ambientes interiores. Apesar da elevada incidência de asma e rinite na população infantil, praticamente nada se sabia sobre a QAI em escolas portuguesas. A percepção dos problemas de QAI é crucial para avaliar os riscos para a saúde e rendimento dos estudantes, e para sugerir meios de reduzir a exposição a poluentes indesejáveis. Neste estudo procurou-se obter as concentrações de poluentes de interesse em estabelecimentos de ensino do 1º ciclo de Lisboa e Aveiro, estimar o estado atual de casos de asma e rinite em escolas primárias da capital, avaliar a influência de diferentes materiais das salas de aula/construção e hábitos escolares na QAI, identificar potenciais fontes de poluentes nos interiores e exteriores das salas de aula e propor medidas mitigadoras. Catorze escolas de Lisboa foram visitadas para obter a caracterização física das construções em termos de estrutura, ventilação, materiais de acabamento, produtos de limpeza, densidade de ocupação e potenciais fontes interiores de poluição. Os estudantes foram questionados sobre os seus hábitos e sintomas respiratórios através de inquéritos do modelo ISAAC (International Study of Asthma and Allergies in Childhood). Durante a primavera, outono e inverno (2008-2010), nas salas de aula e pátios, foram monitorizados, por amostragem passiva, compostos orgânicos voláteis (COVs), carbonilos e dióxido de azoto (NO2). Foram também medidos parâmetros de conforto e níveis de microrganismos. Duas escolas localizadas, uma no centro da cidade e outra na região suburbana, em Aveiro foram estudadas em 2010. Parâmetros de conforto, microrganismos, COVs, NO2, material particulado (PM10) foram medidos no interior e no exterior de ambas escolas. Os iões solúveis, carbono orgânico e elementar (OC e EC), e compostos orgânicos presentes no material particulado foram subsequentemente analisados em laboratório. Uma medida mitigadora - fitoremediação - foi avaliada na escola do centro da cidade de Aveiro em 2011. Os resultados do estudo mostraram que a QAI é pior do que a do ar exterior. Em geral, os níveis de CO2 e dos bioaerosóis excederam os níveis máximos aceitáveis para o conforto dos ocupantes estipulado pelas regulamentações portuguesas. Quase todos os COVs e carbonilos identificados mostraram razões interior/exterior (I/E) maiores que uma unidade, o que demonstra a importante contribuição de fontes interiores em todas as escolas. As razões I/E das concentrações de NO2 nunca excederam a unidade. Os níveis interiores diários de PM10 foram sempre maiores que os exteriores, exceto nos fins de semana. Após a colocação de plantas numa das salas de aula, observou-se uma redução estatisticamente significativa nos níveis de CO2, COVs, carbonilos, PM10, OC, e dos iões nitrato, sulfato, amónia, cálcio e carbonato. A possível redução dos níveis de poluentes no interior após a colocação de plantas pode representar uma solução de baixo custo para reduzir a exposição a muitos compostos, melhorar o rendimento e aumentar o bem estar dos alunos e professores em sala de aula.

The placebo and nocebo effects on peak minute power during incremental arm crank ergometry

This investigation aimed to explore the effects of inert sugar-free drinks described as either ‘performance enhancing’ (placebo) or ‘fatigue inducing’ (nocebo) on peak minute power (PMP;W) during incremental arm crank ergometry (ACE). Twelve healthy, non-specifically trained individuals volunteered to take part. A single-blind randomised controlled trial with repeated measures was used to assess for differences in PMP;W, oxygen uptake, heart rate (HR), minute ventilation, respiratory exchange ratio (RER) and subjective reports of local ratings of perceived exertion (LRPE) and central ratings of perceived exertion (CRPE), between three separate, but identical ACE tests. Participants were required to drink either 500 ml of a ‘sports performance’ drink (placebo), a ‘fatigue-inducing’ drink (nocebo) or water prior to exercise. The placebo caused a significant increase in PMP;W, and a significant decrease in LRPE compared to the nocebo (p=0.01; p=0.001) and water trials (p=0.01). No significant differences in PMP;W between the nocebo and water were found. However, the nocebo drink did cause a significant increase in LRPE (p=0.01). These results suggest that the time has come to broaden our understanding of the placebo and nocebo effects and their potential to impact sports performance.

The placebo and nocebo effects on peak minute power during incremental arm crank ergometry

This investigation aimed to explore the effects of inert sugar-free drinks described as either ‘performance enhancing’ (placebo) or ‘fatigue inducing’ (nocebo) on peak minute power (PMP;W) during incremental arm crank ergometry (ACE). Twelve healthy, non-specifically trained individuals volunteered to take part. A single-blind randomised controlled trial with repeated measures was used to assess for differences in PMP;W, oxygen uptake, heart rate (HR), minute ventilation, respiratory exchange ratio (RER) and subjective reports of local ratings of perceived exertion (LRPE) and central ratings of perceived exertion (CRPE), between three separate, but identical ACE tests. Participants were required to drink either 500 ml of a ‘sports performance’ drink (placebo), a ‘fatigue-inducing’ drink (nocebo) or water prior to exercise. The placebo caused a significant increase in PMP;W, and a significant decrease in LRPE compared to the nocebo (p=0.01; p=0.001) and water trials (p=0.01). No significant differences in PMP;W between the nocebo and water were found. However, the nocebo drink did cause a significant increase in LRPE (p=0.01). These results suggest that the time has come to broaden our understanding of the placebo and nocebo effects and their potential to impact sports performance.

Évaluation du potentiel de croissance et de rendement d’une culture de tomates biologiques cultivées dans une serre climatisée à l’aide d’un système géothermique

Ce projet visait à comparer les effets agronomiques d’une serre de tomates biologiques semi-fermée utilisant un système de climatisation par géothermie comparativement à une serre ouverte. Deux serres de 228 et 230 m2 ont été équipées d’un système d’échangeur d’air avec géothermie qui refroidissait et déshumidifiait l’air (serre semi-fermée) et d’un système de ventilation naturelle (serre témoin). Ces dernières ont été comparées au cours des années 2012 et 2013 entre lesquels les traitements ont été permutés. Les variables mesurées étaient les paramètres de croissance des plants ainsi que le rendement, le calibre des fruits et les propriétés physico-chimiques des tomates. Les résultats ont démontré que le système de climatisation n’a pas eu d’effets significatifs sur la croissance des plants, la qualité des fruits ainsi que le rendement. Les deux serres avaient des cibles de concentration en CO2 comprises entre 450 µL L-1 et 1000 µL L-1 selon l’ensoleillement. Les quantités de CO2 injectées ont été de 11 kg/m2 et 15 kg/m2 respectivement en 2012 et 2013 dans la serre semi-fermée alors qu’elles ont été de 24 kg/m2 et 25 kg/m2 dans la serre témoin. Bien qu’ayant nécessité moins d’injection, la serre semi-fermée a permis de conserver des concentrations en CO2 de 638 µL L-1 en 2012 et de 593 µL L-1 en 2013. Ces concentrations sont plus élevées que celles obtenues dans la serre témoin qui étaient respectivement de 385 µL L-1 et 486 µL L-1 en 2012 et 2013. De ce fait, le coût monétaire associé à l’enrichissement carboné a été de 1,6 à 2,0 fois plus élevé dans la serre témoin que dans la serre semi-fermée.

Contribuição da ecografia cerebral transfontanelar para a avaliação do crescimento cerebral do recém-nascido pré-termo

Tese de doutoramento, Medicina (Pediatria), Universidade de Lisboa, Faculdade de Medicina, 2013