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Featured Application: Design of energy-efficient retrofitting projects of buildings at the district scale. Energy-efficient retrofitting of buildings has become essential to achieve the environmental objectives of the European Union's (EU) strategies towards reducing carbon emissions and energy dependency on fossil fuels. When tackling retrofitting projects, the issue of scale becomes essential as sometimes this can determine the sustainability of the project. Therefore, a comprehensive approach is essential to ensure effective decision-making. A platform has been designed within the EU funded OptEEmAL project to support stakeholders in this process, providing functionalities that can automatically model and evaluate candidate retrofitting alternatives considering their priorities, targets and boundary conditions. A core element of this platform is the evaluation framework deployed which implements a multi-criteria decision-making approach to transform the priorities of stakeholders into quantifiable weights used to compare the alternatives. As a result, more informed decisions can be made by the stakeholders through a comprehensive evaluation of the candidate retrofitting scenarios. This paper presents the approach followed to develop and integrate this evaluation framework within the platform as well as its validation in a controlled environment to ensure its effectiveness. [ABSTRACT FROM AUTHOR]

Background: At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study. Methods/design: One-hundred nineteen overweight (46 males) and 120 obese (61 males) subjects aged 18-50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation). All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry). 29-34% of the total energy intake came from fat, 14-20% from protein, and 50-55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3%) subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%), low adherence to exercise 3 (5.1%), low adherence to diet 6 (10.2%), job change 6 (10.2%), and lost interest 27 (45.8%). Discussion: Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order that overweight and obese subjects can benefit from the results. The aim is to transfer it to sports centres. Effectiveness on individual health-related parameter in order to determine the most effective training programme will be analysed in forthcoming publications. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the influence of an obesity treatment program on the gut microbiota and body weight of overweight adolescents. Thirty-six adolescents (13–15 years), classified as overweight according to the International Obesity Task Force BMI criteria, were submitted to a calorie-restricted diet (10–40%) and increased physical activity (15–23 kcal/kg body weight/week) program over 10 weeks. Gut bacterial groups were analyzed by quantitative real-time PCR before and after the intervention. A group of subjects (n = 23) experienced >4.0 kg weight loss and showed significant BMI (P = 0.030) and BMI z-score (P = 0.035) reductions after the intervention, while the other group (n = 13) showed <2.0 kg weight loss. No significant differences in dietary intake were found between both groups. In the whole adolescent population, the intervention led to increased Bacteroides fragilis group (P = 0.001) and Lactobacillus group (P = 0.030) counts, and to decreased Clostridium coccoides group (P = 0.028), Bifidobacterium longum (P = 0.031), and Bifidobacterium adolescentis (P = 0.044) counts. In the high weight–loss group, B. fragilis group and Lactobacillus group counts also increased (P = 0.001 and P = 0.007, respectively), whereas C. coccoides group and B. longum counts decreased (P = 0.001 and P = 0.044, respectively) after the intervention. Total bacteria, B. fragilis group and Clostridium leptum group, and Bifidobacterium catenulatum group counts were significantly higher (P < 0.001–0.036) while levels of C. coccoides group, Lactobacillus group, Bifidobacterium, Bifidobacterium breve, and Bifidobacterium bifidum were significantly lower (P < 0.001–0.008) in the high weight–loss group than in the low weight–loss group before and after the intervention. These findings indicate that calorie restriction and physical activity have an impact on gut microbiota composition related to body weight loss, which also seem to be influenced by the individual's microbiota. [ABSTRACT FROM AUTHOR]

We examined whether abdominal and truncal adiposity, assessed with simple anthropometric indices, determines serum triglycerides and high-density lipoprotein (HDL)–cholesterol levels independently of total adiposity amount in adolescents. A total of 547 Spanish adolescents (284 males and 263 females) aged 13–18.5 years were included in this study. Measures of truncal adiposity included subscapular to triceps ratio, and trunk-to-total skinfolds ratio (TTS%). Waist circumference was used as a surrogate of abdominal adiposity, and BMI was used as a measure of total adiposity. The results of the regression models indicated that levels of triglycerides were positively associated with waist circumference and TTS% after controlling for age and Tanner stage in both sexes. Once BMI was entered in the model, these associations remained significant for waist circumference in females. HDL-cholesterol levels were negatively associated with waist circumference in both sexes, and with subscapular to triceps ratio and TTS% in males, after controlling for age and Tanner stage. Once BMI was entered in the model, these associations remained significant for subscapular to triceps ratio and for TTS% in males. The results of this study suggest that in male adolescents, truncal adiposity is negatively associated with levels of HDL-cholesterol, whereas in females, abdominal adiposity is positively associated with levels of triglycerides independently of total adiposity. These findings highlight the deleterious effect of both truncal and abdominal fat depots on the lipid profile already from the first decades of life.Obesity (2009) 17 5, 1086–1091. doi:10.1038/oby.2008.626 [ABSTRACT FROM AUTHOR]

Background: Folate and cobalamin are responsible for healthy growth. However, the B-vitamin and homocysteine status of adolescents is not well known. The aim was to assess the status of folate, cobalamin, and homocysteine in healthy Spanish adolescents. Methods: Serum cobalamin, serum folate, homocysteine, methylenetetrahydrofolate reductase 677C>T variant, BMI, smoking habits, and Tanner stage were determined according to gender in 165 adolescents (84 females, 81 males; 13–18.5 years) using the Student’s t test, Mann-Whitney U test and χ2 test, respectively. Interactions between socioeconomic status, age group, methylenetetrahydrofolate reductase polymorphism, BMI, smoking habits, Tanner stage, and vitamin status, respectively, were examined by ANOVA or Kruskal-Wallis H test (p < 0.05). Results: Boys had markedly higher homocysteine (males 8.92 (5.51–22.94) μmol/l; females 7.91 (5.09–13.86) μmol/l), whereas girls showed higher serum cobalamin concentrations (males 540.00 (268.00–946.47) pmol/l; females 594.82 (280.63–1,559.64) pmol/l). Data are shown as medians and the 2.5th to 97.5th percentiles in parentheses. Adolescents with the homozygous variant of methylenetetrahydrofolate reductase displayed significantly higher homocysteine and lower serum folate: normal 5.73 (3.09–10.73) ng/ml serum folate, 7.57 (4.94–12.94) μmol/l homocysteine; homozygous 4.10 (2.75–7.88) ng/ml serum folate, 10.83 (7.00–22.82) μmol/l homocysteine. Conclusion: The present study provides data on the folate, cobalamin, and homocysteine status of Spanish adolescents. To assure a better assessment, revision of references for adolescents is still needed. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Breast-feeding has shown to give a reduction in the risk of hospitalization due to respiratory tract infections and gastrointestinal conditions during the first two years of life. The association of breast-feeding with all admission causes and with fever of unknown origin (FUO) was analysed. Methods: A case-reference study in Cantabria (northern Spain) was carried out. Cases (n=336) were hospitalized children aged less than 24 months at University of Cantabria Hospital; the reference was a 1:1 matched (by time from delivery to admission) sample of children from mothers delivering at the same hospital. Information on breast-feeding, socio-economic variables and employment were obtained. Odds ratios (ORs), their 95% confidence intervals (CIs), and mean length of breast-feeding were estimated after adjusment for confounding variables. Result: In the reference population, shorter duration of breast-feeding was associated with smoking, lower educational level, and less privileged social strata. The frequency of breast-feeding was higher in the reference than in the cases, 82.3% vs 75.6% (p=0.023). Significant negative trends were noted in univariate analyses between the length of breast-feeding and both all admission causes and FU0, although the statistical significance was lost after adjusting for confounding variables (educational level, social class, smoking, and use of incubator after delivery). The adjusted mean length of breast-feeding was shorter in hospitalized children ≤ 6 months old for both all admission causes (40.6 ± 5.4 vs 99.5 ± 5.4, p<0.001) and FUO (40.8 ± 12.4 vs 91.7 ±12.4, p=0.006). Conclusion: Breast-feeding time is shorter in hospitalized children for both all admission causes and FU0. [ABSTRACT FROM AUTHOR]

In vitro, cells derived from Ewing sarcoma (ES) with the characteristic somatic rearrangement between the genes EWS and FLI1 can be induced to differentiate toward a neuronal phenotype by exposure to agents such as dibutyryl cyclic AMP (db cAMP) or retinoic acid. Therefore, expression of the chimeric Ews-Fli1 protein does not irreversibly block the capacity of Ewing cells to engage in the neuronal differentiation program initiated by these agents. To identify genes that might be involved in the maintenance of Ewing cells in their undifferentiated state, a PCR-based differential display method was used to compare gene expression patterns in Ewing cell lines with those induced to differentiate toward a neuronal phenotype. A cDNA was expressed at high levels in proliferating Ewing-derived EW-1 cells and downregulated in EW-1 cells induced to differentiate, which corresponds to ZNF43, a multi-zinc finger protein containing the Krüppel-associated box (KRAB) transcriptional repression domain. Treatment of EW-1 cells with antisense oligonucleotides complementary to ZNF43 mRNA induces morphological differentiation and growth arrest. These findings suggest a role for ZNF43 in the maintenance of ES cells in an undifferentiated state, and that ZNF43 could be a primary target for differentiation stimuli in Ewing cells. [ABSTRACT FROM AUTHOR]

This paper presents a novel evaluation framework to assess the effectiveness of city transformation projects related to energy efficiency and sustainable mobility actions. The evaluation framework is part of an Urban Regeneration Model designed to accelerate the urban transformation toward the smart city concept, taking into account all aspects of sustainability. This model has been developed and validated in the three EU cities (Valladolid, Spain; Nottingham, United Kingdom; and Tepebaşı, Turkey) where interventions in the energy, mobility, and ICT fields have been deployed. This model relies on an Evaluation Framework to support its main phases considering two levels of evaluation: city level, to assess globally the smartness and sustainability of the city, and project level, to support the decision-making and assess the impacts of specific implementations. This paper is focused on the second level and its application through the evaluation-supporting tool STILE in the assessment of the energy efficiency and sustainable urban mobility actions implemented in the city of Valladolid. The assessment analysis has allowed assessing how the energy efficiency interventions carried out in the Valladolid district have reduced the energy consumption, increased the use of renewable energies, and reduced the CO2 emissions. In addition, it has allowed evaluating other aspects such as the air quality, thermal comfort, and energy bill, which have been also improved for the residents. Considering the analysis of the sustainable mobility interventions, the evaluation framework supports the assessment of the reduction of emissions and air pollutants and how the actions have converted electro-mobility into a real option for citizens. The evaluation of results after the implementation of this kind of actions is key to ensuring that successful actions can be replicated in other places achieving smarter and more sustainable cities. [ABSTRACT FROM AUTHOR]

Cases of hypomagnesaemia of hereditary renal origin represent at least three different congenital disorders of tubular reabsorption of magnesium (Mg). Isolated familial hypomagnesaemia has been reported in a heterogeneous group of patients and an autosomal dominant pattern of inheritance has often been found to be present. Familial hypokalaemia-hypomagnesaemia, inherited as an autosomal recessive trait, has been reported in 17 patients and we now describe 3 additional cases. Hypomagnesaemia is accompanied by hypokalaemia, metabolic alkalosis, hypocalciuria and moderate sodium chloride wasting. Titration of renal Mg reabsorption indicates the presence of a low threshold but a normal Tm. The inherited defect is probably situated at the level of the distal convoluted tubule and mimics the therapeutic effect of thiazides. This condition is frequently confused with Bartter's syndrome. Familial hypomagnesaemia-hypercalciuria, also inherited as an autosomal resessive trait, has been reported in at least 15 patients and we now add 3 new cases. Hypomagnesaemia is always accompanied by hypercalciuria and nephrocalcinosis. Ocular abnormalities such as myopia and horizontal nystagmus are often present. Hypermagnesiuria is of a greater degree than that observed in the previous entity and reflects a low Tm of Mg reabsorption. The defect must be situated at the level of the ascending limb of the loop of Henle and affects the transport of both calcium and Mg but not of sodium and chloride. This condition has not been clearly separated from hereditary distal renal tubular acidosis in the literature. [ABSTRACT FROM AUTHOR]

The transformation of cities into smarter and more sustainable environments is essential towards achieving the objectives of the decarbonization of the economy. In this sense, holistic strategies are required to design and implement urban regeneration strategies. The EU-funded REMOURBAN project has developed an Urban Regeneration Model which provides the mechanisms to implement more efficiently these processes, integrating technologies, business models, management procedures and evaluation mechanisms, where the evaluation is sought as the main supporting mechanism throughout the various phases of the city transformation process. The framework developed considers two levels of evaluation: city level, to assess both sustainability and smartness of the city as a whole from a comprehensive and integrated perspective, and project level, to provide a clear identification of the impact of implementation of technologies and solutions on three key priority areas (sustainable districts and built environment, sustainable urban mobility and integrated infrastructures and processes) aimed at achieving the city high-level goals. This paper introduces the Urban Regeneration Model and describes the evaluation framework and its implementation in the city of Valladolid (Spain). [ABSTRACT FROM AUTHOR]

The evident need for improving the existing building stock still suffers from important barriers, such as the fragmentation of the value chain, the lack of information regarding some solutions, and the lack of confidence with respect to energy savings, which prevent unlocking investments, and the difficult communication among stakeholders. Therefore, new processes based on exploiting the potential of existing and new tools are required. In this framework, the OptEEmAL project has developed a tool that integrates stakeholders, data and tools in order to ease the process of designing energy efficient retrofitting projects at building and district scale. This tool works around an optimisation framework in order to evaluate, compare and optimise candidate retrofitting scenarios against a set of indicators showing the performance of the district. This evaluation and optimisation method is based on aggregating indicators through transforming the priorities of stakeholders into a mathematical weighting scheme, which makes it possible to provide scenarios within their expectations. Therefore, the generation of these scenarios is driven by their design parameters, being thus flexible and adapted to their needs. This paper shows the implementation of this tool and specifically 3 different prioritisation schemes, analysing how they impact into the decision making process and selection of the retrofitting strategy. [ABSTRACT FROM AUTHOR]

Districts can be considered as a system of complex interconnections, interactions, relationships and flows. Therefore, a comprehensive approach is essential for effective decision-making with regards to energy efficiency improvement. When addressing interventions with a wider scale, the range of possible interventions is greater, as well as the possibilities of new business models to make bankable the interventions. However certain barriers can appear linked to the interactions among stakeholders, which are usually more complex than when tackling individual actuations. To overcome these barriers it is necessary to establish integrated and systemic methodologies able to support stakeholders to implement better collaboration approaches and carry out more informed decisions. These decisions should be based on a set of relevant indicators, calculated at district level, capturing the different stages that form the retrofitting process (from the diagnosis to the final assessment). This paper presents a holistic design methodology based on the application of a Multi-Criteria Decision Making approach that allows designing optimised solutions. This methodology is based on the evaluation of a set of District Sustainability Indicators while proposing an Integrated Project Delivery method improving the communications among stakeholders and, therefore, the decision-making process. [ABSTRACT FROM AUTHOR]

Background: At present, scientific consensus exists on the multifactorial etiopatogenia of obesity. Both professionals and researchers agree that treatment must also have a multifactorial approach, including diet, physical activity, pharmacology and/or surgical treatment. These two last ones should be reserved for those cases of morbid obesities or in case of failure of the previous ones. The aim of the PRONAF study is to determine what type of exercise combined with caloric restriction is the most appropriate to be included in overweigth and obesity intervention programs, and the aim of this paper is to describe the design and the evaluation methods used to carry out the PRONAF study.Methods/design: One-hundred nineteen overweight (46 males) and 120 obese (61 males) subjects aged 18-50 years were randomly assigned to a strength training group, an endurance training group, a combined strength + endurance training group or a diet and physical activity recommendations group. The intervention period was 22 weeks (in all cases 3 times/wk of training for 22 weeks and 2 weeks for pre and post evaluation). All subjects followed a hypocaloric diet (25-30% less energy intake than the daily energy expenditure estimated by accelerometry). 29-34% of the total energy intake came from fat, 14-20% from protein, and 50-55% from carbohydrates. The mayor outcome variables assesed were, biochemical and inflamatory markers, body composition, energy balance, physical fitness, nutritional habits, genetic profile and quality of life. 180 (75.3%) subjects finished the study, with a dropout rate of 24.7%. Dropout reasons included: personal reasons 17 (28.8%), low adherence to exercise 3 (5.1%), low adherence to diet 6 (10.2%), job change 6 (10.2%), and lost interest 27 (45.8%).Discussion: Feasibility of the study has been proven, with a low dropout rate which corresponds to the estimated sample size. Transfer of knowledge is foreseen as a spin-off, in order that overweight and obese subjects can benefit from the results. The aim is to transfer it to sports centres. Effectiveness on individual health-related parameter in order to determine the most effective training programme will be analysed in forthcoming publications.Trial Registration: ClinicalTrials.gov NCT01116856. [ABSTRACT FROM AUTHOR]