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This paper shows the application of autonomous Crater Detection using the U-Net, a Fully-Convolutional Neural Network, on Ceres. The U-Net is trained on optical images of the Moon Global Morphology Mosaic based on data collected by the LRO and manual crater catalogues. The Moon-trained network will be tested on Dawn optical images of Ceres: this task is accomplished by means of a Transfer Learning (TL) approach. The trained model has been fine-tuned using 100, 500 and 1000 additional images of Ceres. The test performance was measured on 350 never before seen images, reaching a testing accuracy of 96.24%, 96.95% and 97.19%, respectively. This means that despite the intrinsic differences between the Moon and Ceres, TL works with encouraging results. The output of the U-Net contains predicted craters: it will be post-processed applying global thresholding for image binarization and a template matching algorithm to extract craters positions and radii in the pixel space. Post-processed craters will be counted and compared to the ground truth data in order to compute image segmentation metrics: precision, recall and F1 score. These indices will be computed, and their effect will be discussed for tasks such as automated crater cataloguing and optical navigation.

We demonstrate two new important properties of the 1-path-norm of shallow neural networks. First, despite its non-smoothness and non-convexity it allows a closed form proximal operator which can be efficiently computed, allowing the use of stochastic proximal-gradient-type methods for regularized empirical risk minimization. Second, when the activation functions is differentiable, it provides an upper bound on the Lipschitz constant of the network. Such bound is tighter than the trivial layer-wise product of Lipschitz constants, motivating its use for training networks robust to adversarial perturbations. In practical experiments we illustrate the advantages of using the proximal mapping and we compare the robustness-accuracy trade-off induced by the 1-path-norm, L1-norm and layer-wise constraints on the Lipschitz constant (Parseval networks)., ICML 2020. Fabian Latorre, Paul Rolland and Nadav Hallak have contributed equally

The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment.

Milk and dairy products could contain a variety of microorganisms, deriving from the environment or from infected udders, becoming an important source of foodborne pathogens. The main microorganisms involved in mastitis are Staphylococcus aureus, Prototheca spp., Mycoplasma spp. and Streptococcus spp., while the principal pathogens responsible for foodborne disease are enterotoxigenic Staphylococcus aureus, Salmonella spp., Listeria monocytogenes, Escherichia coli VTEC, Campylobacter spp. and Bacillus cereus. This chapter presents information on characteristics of these pathogens, and illnesses caused by them. An overview in the field of foodborne pathogen identification and detection by using different molecular techniques (multiplex PCR, quantitative PCR, digital PCR and Whole Genome Sequencing) is also reported.

Silvia Scurati1, Franco Frati1, Gianni Passalacqua2, Paola Puccinelli1, Cecile Hilaire1, Cristoforo Incorvaia3, Italian Study Group on SLIT Compliance 1Scientific and Medical Department, Stallergenes, Milan, Italy; 2Allergy and Respiratory Diseases, Department of Internal Medicine, Genoa; 3Allergy/Pulmonary Rehabilitation, ICP Hospital, Milan, ItalyObjectives: Sublingual immunotherapy (SLIT) is a viable alternative to subcutaneous immunotherapy to treat allergic rhinitis and asthma, and is widely used in clinical practice in many European countries. The clinical efficacy of SLIT has been established in a number of clinical trials and meta-analyses. However, because SLIT is self-administered by patients without medical supervision, the degree of patient adherence with treatment is still a concern. The objective of this study was to evaluate the perception by allergists of issues related to SLIT adherence.Methods: We performed a questionnaire-based survey of 296 Italian allergists, based on the adherence issues known from previous studies. The perception of importance of each item was assessed by a VAS scale ranging from 0 to 10.Results: Patient perception of clinical efficacy was considered the most important factor (ranked 1 by 54% of allergists), followed by the possibility of reimbursement (ranked 1 by 34%), and by the absence of side effects (ranked 1 by 21%). Patient education, regular follow-up, and ease of use of SLIT were ranked first by less than 20% of allergists.Conclusion: These findings indicate that clinical efficacy, cost, and side effects are perceived as the major issues influencing patient adherence to SLIT, and that further improvement of adherence is likely to be achieved by improving the patient information provided by prescribers.Keywords: adherence, sublingual immunotherapy, efficacy, cost, side effects

Milligan-Morgan hemorrhoidectomy (MM) is still the most common treatment for grades III and IV hemorrhoids despite prolonged post-operative anal pain and wound healing. This multicenter, double blind, randomized, controlled trial was designed to assess the safety and the efficacy of anal wound cleansing with Triclosan (Proctocid®) in the control of symptoms and healing time after MM.A total of 113 patients with grades III and IV hemorrhoids, undergoing open hemorroidectomy by diathermy or Ligasure vessel sealing device, were randomly assigned to Triclosan or sodium hypochlorite solution. All patients received analgesics and a fiber-rich diet after hemorrhoidectomy. Postoperative anal pain, bleeding and/or secretion and itch were assessed 7, 14 and 21 days after hemorrhoidectomy by a Visual Analogue Scale (VAS) and the day of complete re-epithelialization of anal wounds was recorded.Fifty-five patients were randomized for Triclosan treatment and 58 for the control drug. The two groups were comparable for demographics, severity of hemorrhoids and technique used for the hemorrhoidectomy. The comparison of days to get complete anal wound healing shows a trend of significance (P=0.05) for the Triclosan group. Bleeding and/or secretion, anal pain and itch were significantly better (P=0.003; P0.0001 and P=0.01, respectively).Triclosan solution for the treatment of post-hemorrhoidectomy wounds is safe and improves the control of post-operative symptoms and wound healing time compared to sodium hypochlorite.

Objectives To determine the performance in learning clinical research methodology (CRM) by means of the Keller Plan (KP), to assess its impact on attitudes towards research (AR) and to estimate its acceptability. Design An educational intervention trial was employed with control group (CG) and random assignment. Setting The Family and Community Medicine Teaching Unit in Valencia, Spain, 1997. Subjects Third-year family residents. Results In the KP both specific written self-teaching material and interactive computer programme were used, focusing on the tutored resident, with compulsory assessments to continue. In the CG a conventional course was followed. Knowledge of CRM and the AR test (previously validated in another study) were measured at the start. Four tests of successive knowledge, time spent studying, tutorials, final AR test and acceptability were conducted. Non-parametric tests were used. Forty (89%) residents participated, 22 were assigned to KP and 18 to CG. Similar basic characteristics, with exception of AR test (medians 55 Keller, 58 control). KP knowledge tests significantly higher (P =

El abordaje unilateral del hiperparatiroidismo primario constituye una opcion tecnica cada vez mas usada y apropiada debido a las caracteristicas de esta cirugia. Este tipo de abordaje ha sido posible por la aparicion del Tc sestamibi, de la subespecializacion de la cirugia y de la determinacion de la PTH intraoperatoria. A continuacion exponemos un estudio epidemiologico, descriptivo y retrospectivo desde enero de 2004 a diciembre de 2008. Durante este tiempo fueron intervenidos en el hospital Ramon y Cajal de Madrid un total de 195 enfermos por hiperparatiroidismo primario. De ellos, 140 fueron sometidos a exploracion unilateral por sospecha de adenoma unico. La correlacion entre los hallazgos gammagraficos y quirurgicos fue correcta en todos los casos (139) menos uno en cuanto a lo que a lateralidad se refiere. Fallo en 30 casos en los que se detecto mal la localizacion superior e inferior. En cuanto a los resultados, se extirpo el adenoma correctamente en 135 de los 140 pacientes. Asi podemos decir que la combinacion de la gammagrafia, de un cirujano con experiencia y el apoyo de la PTH intraoperatoria proporciona una elevada tasa de curacion en el caso de adenomas paratiroideos en el abordaje unilateral con una tasa de hipercalcemia recurrente o persistente entre el 3%-5%, tasa similar a la obtenida por cirujanos expertos al realizar una cervicotomia exploradora (considerada gold standard) pero con menor morbilidad postoperatoria, menor dolor y menor tiempo quirurgico.

El abordaje unilateral del hiperparatiroidismo primario constituye una opción técnica cada vez más usada y apropiada debido a las características de esta cirugía. Este tipo de abordaje ha sido posible por la aparición del Tc sestamibi, de la subespecialización de la cirugía y de la determinación de la PTH intraoperatoria. A continuación exponemos un estudio epidemiológico, descriptivo y retrospectivo desde enero de 2004 a diciembre de 2008. Durante este tiempo fueron intervenidos en el hospital Ramón y Cajal de Madrid un total de 195 enfermos por hiperparatiroidismo primario. De ellos, 140 fueron sometidos a exploración unilateral por sospecha de adenoma único. La correlación entre los hallazgos gammagráficos y quirúrgicos fue correcta en todos los casos (139) menos uno en cuanto a lo que a lateralidad se refiere. Falló en 30 casos en los que se detectó mal la localización superior e inferior. En cuanto a los resultados, se extirpó el adenoma correctamente en 135 de los 140 pacientes. Así podemos decir que la combinación de la gammagrafía, de un cirujano con experiencia y el apoyo de la PTH intraoperatoria proporciona una elevada tasa de curación en el caso de adenomas paratiroideos en el abordaje unilateral con una tasa de hipercalcemia recurrente o persistente entre el 3%-5%, tasa similar a la obtenida por cirujanos expertos al realizar una cervicotomía exploradora (considerada gold standard) pero con menor morbilidad postoperatoria, menor dolor y menor tiempo quirúrgico. The unilateral boarding of the primary hiperparatiroidism constitutes a technical option increasingly secondhand and adapted for the characteristics of this surgery. This type of boarding has been possible for the appearance of the Tc sestamibi, of the subspecialization of the surgery and of the determination of the PTH intraoperatory. Later we expose an epidemiological, descriptive and retrospective study from january 2004 to december 2008. During this time there were controlled in the hospital Ramon and Cajal of Madrid a total of 195 patients for primary hiperparatiroidism. Of them, 140 were submitted to unilateral exploration by suspicion of the solitary adenoma. The correlation between the findings of Tc sestamibi and surgical was correct in all the cases (139) except one concerns to right or left side. It failed in 30 cases in which there was detected badly the top and low location. As for the results the adenoma was extirpated correctly in 135 of 140 patients. This way we can say that the combination of the gammagraphy, a surgeon with experience and the support of the PTH intraoperatory they meet a high rate of treatment in case of adenomas in the unilateral boarding on a rate of hipercalcemia appellant or persistently between 3%-5%, rate similar to the obtained one for expert surgeons on having fulfilled an exploratory cervicotomy (considered "gold standard") but with minor postoperatory morbidity, minor pain and minor surgical time.

Objetivo: valorar el entorno familiar y los hábitos de la población adolescente de nuestra área para detectar posibles factores asociados con alteraciones de la autoimagen o un mayor riesgo de presentar un trastorno de la alimentación. Material y métodos: 158 entrevistas a adolescentes que cursaban 1.º y 2.º de Enseñanza Secundaria Obligatoria, recogiendo sexo, edad, entorno familiar y social, horas de pantallas y contenidos, horas de deporte, horas de lectura y contenidos, autoimagen, test de actitud ante la alimentación (EAT-26) y somatometría. Resultados: el análisis de regresión logística mostró una asociación estadísticamente significativa entre la autoimagen correcta y las horas de deporte practicado (B = 0,11; p = 0,047), el hecho de tener hermanos (B = -1,4; p = 0,019), la puntuación total en el EAT-26 (B = -0,06; p = 0,005) y el índice de masa corporal (B = -0,1; p = 0,031). Conclusiones: el fomento del ejercicio físico y la difusión de ideas correctas sobre la imagen corporal pueden influir positivamente en una mejor autoimagen de la población adolescente y, del mismo modo, ayudar a prevenir posibles trastornos de la alimentación. Objetive: To evaluate familiar environment and habits of teenager population from our area to detect factors associated with alterations of self-image or an increased risk of presenting an eating disorder. Methods: One hundred and fifty-eight teenagers from first to second course of ESO (Obligatory Secondary Education) were interviewed collecting information about gender, age, family and social environment, time of screens viewing and contents, time of sport practicing, time of reading and contents, self-image, Eating Attitudes Test (EAT-26) and anthropometry. Results: The logistic regression showed a statistically significant association between self-image and time of sport practicing (B = 0.11; p = 0.047), having brothers (B =-1.4; p = 0.019), total punctuation on EAT-26 (B =-0.06; p = 0.005) and Body Mass Index (B =-0.1; p = 0.031). Conclusions: Promotion of sport practicing and healthy ideas about body image could improve teenager self-image and help to prevent the development of eating disorders.

Pancreatic pseudocyst extended to the mediastinum. Case report We report a 53 years old male consulting for chest pain and dyspnea. On physical examination, an epigastric mass was detected. A TC scan showed a collection located in the omental bursa, which protruded over the posterior gastric wall and ascended to the mediastinum. Due to the presence of pancreatic calcifi ca- tions, a pancreatic pseudocyst was suspected. The mediastinal cyst was drained percutaneously, leaving pig tail drainage in the cavity. Afterwards a cyst excision and Roux en Y gastrostomy was performed. After the surgical procedure the cyst became infected, requiring antimicrobials. After two weeks he was discharged in good conditions.

Los pseudoquistes de páncreas representan el 75% de las lesiones quísticas del páncreas y generalmente se circunscriben en el abdomen. Se presenta el caso de un paciente con un pseudoquiste de páncreas con extensión transhiatal a mediastino. Estos casos deben sospecharse mediante una historia clínica detallada y preguntando por antecedentes de dolor abdominal previo porque la clínica con la que se suelen manifestar es muy poco específica. El tratamiento de los pseudoquistes con extensión a mediastino debería ser el drenaje definitivo, bien de forma quirúrgica o endoscópica. We report a 53 years old male consulting for chest pain and dyspnea. On physical examination, an epigastric mass was detected. A TC scan showed a collection located in the omental bursa, which protruded over the posterior gastric wall and ascended to the mediastinum. Due to the presence of pancreatic calcifications, a pancreatic pseudocyst was suspected. The mediastinal cyst was drained percutaneously, leaving pig tail drainage in the cavity. Afterwards a cyst excision and Roux en Y gastrostomy was performed. After the surgical procedure the cyst became infected, requiring antimicrobials. After two weeks he was discharged in good conditions.

Introducción: el presente estudio valora la antropometría, el desarrollo intelectual y las habilidades sociales de los niños según su exposición al abuso de pantallas (televisión, video-juegos, ordenador). Material y métodos: 130 entrevistas a niños entre 5 y 10 años recogiendo: sexo, edad, entorno familiar, horas de pantallas, horas de deporte, somatometría, puntuación del grado de responsabilidad y sociabilidad y test de Goodenough (como estimación del cociente intelectual). Resultados: los modelos de regresión lineal múltiple mostraron una asociación estadísticamente significativa entre el índice de masa corporal (IMC) y las horas de televisión y vídeos (B = 0,06; p = 0,05) y entre el IMC y las horas de ordenador y videojuegos (B = 0,34; p < 0,01), así como entre la estimación del cociente intelectual y las horas de ordenador y video-juegos (B = -1,67; p = 0,02). Conclusiones: deben desarrollarse estrategias para concienciar a las familias sobre los efectos perjudiciales del abuso de pantallas, tanto de los asociados al sedentarismo y a los contenidos negativos, como del daño sobre el desarrollo intelectual que produce el abuso de los juegos electrónicos. Objective: the present study examines anthropometric measurements, mental development and social skills in children exposed to screen-viewing (television, video games, computer). Methods: one hundred and thirty interviews were addressed to children aged 5 to 10 years. Information about gender, age, family, screen-viewing time, sport-practicing time, anthropometric measurements, responsibility punctuation, sociability punctuation and Goodenough's test (as estimation of intelligence quotient) was collected. Results: multiple regression models showed a statistically significant association between body mass index (BMI) and television and video viewing time (B = 0.06; p = 0.05) and between BMI and computer and videogame use time (B = 0.34; p < 0.01), as well as between estimated intelligence quotient and computer and video game use time (B = -1.67; p = 0.02). Conclusions: screen-viewing abuse is associated with a higher risk of overweight. Electronic games abuse is associated with a lower intelligence quotient. Wide strategies to warn families about these risks are needed.

To assess the impact of pharmaceutical intervention on the use of sequential therapy (ST) with fluoroquinolones.A prospective comparative study of pharmaceutical intervention in two stages: observational stage and intervention stage for ST promotion.In all, 250 patients receiving intravenous therapy with fluoroquinolones (113 with levofloxacin and 137 with ciprofloxacin) were studied, with 76 and 70 patients, respectively, being eligible for a pharmaceutical intervention program to promote ST. Pharmaceutical intervention showed a decreased duration of intravenous therapy and increased duration of oral therapy for both drugs, as well as decreased medication-related costs, all in a statistically significant manner.ST promotion provides an opportunity to expand the role of hospital pharmacists and to optimize fluoroquinolone-based therapy, which results in decreased intravenous treatments and provides a more cost-effective option.

Se presenta el caso de un varón de 45 años que llevaba olvidado durante 2 años un catéter ureteral doble J izquierdo. El catéter presentaba ambos extremos calcificados no pudiéndose extraer mediante cistoscopia y pinzas. Se realizaron sesiones de litotricia extracorpórea en ambos extremos consiguiéndose la fragmentación de la litiasis y posteriormente pudo ser extraído en dos trozos mediante cistoscopia y ureteroscopia. A 45 year old man with a 2 year forgotten left double-pigtail ureteric stent was referred to our hospital. Because of distal calcifications, the stent could not be removed by means of a cystoscopy. So, extracorporeal wave lithotripsies were performed and then the stent were easily removed in two fragments by cystoscopy and ureteroscopy.

En la radiografia de abdomen se evidencia impor-tante neumoperitoneo con desplazamiento caudal del higado, enfi sema subcutaneo y retroneumoperitoneo que dibuja la silueta del musculo Psoas (Figura 1). En la radiografia de torax importante neumoperito-neo y neumomediastino (Figura 2).La paciente es intervenida quirurgicamente de manera urgente mediante laparotomia exploradora donde se evidencia neoplasia de ciego perforada hacia retroperitoneo, importante enfi sema a nivel

BACKGROUND: Pharmaceutical costs are the main cost item in basic health care. The need to contain health care expenditure has led to the search for alternatives in this area, one of which would be to foster a prescription policy which uses the cheapest presentation for each active principle. The aim of this study was to evaluate the amount which would be saved by prescribing the cheapest alternative from a selection of anti-infective drugs. METHODS: Pharmacy prescriptions in two different health areas were analyzed using the database on turnover of pharmaceutical products for 1995. Single principle drugs with anti-infective action were selected, and for each active principle and presentation the most economic alternative was sought using the records provided by the Ministry of Health and a cost minimisation analysis was undertaken. The cost of applying this prescription policy was not considered. RESULTS: Total pharmaceutical expenditure in the areas was pesetas 8.547 bn in 1995. Expenditure on selected anti-infective drugs was pesetas 522 million (6.1% of the total). The overall saving estimated was 7.63% (pesetas 39,901,778). This saving was centred on the following subgroups: penicillins, quinolones, cephalosporins and macrolides. Of potential savings identified, 75% would be achieved by prescribing the cheaper alternative of 2 active principles: amoxacillin and cyprofloxacine. CONCLUSIONS: The study shows the possibility of containing expenditure in our area and offers a basis for action in this direction. It would be advisable to increase information and training for prescribers and dispensers in order to stimulate the use of the most economical alternative of each medicament prescribed, especially in cases in which there are significant margins to be saved.

In order to define the structure of the time series of rainfall and discharge, and also to improve the knowledge of the Barranco Peñalba karstic system, a correlation and spectral analysis has been made of the Iturriotz spring and the Juncal pluviometer data (period: 6th August 1983 to 12th October 1985). Such analysis reveals a relatively important memory effect and a regulation time of 23,5 days. However, it has been made clear a very small modulation effect with a spectral band of 0.30-0.32. The cross correlation reveals a lag very small between the input and output signals, in spite of the existence of a some regulation power at the end of the impulsional answer. These results do not match exactly any of the type-model defined by Mangin (1982), but suggests a system with mixed characteristics. The apparently contradictory features inferred from this analysis can be atributed to the heterogeneity of the aquifer materials and to the complexity of the recharge mecanisms.Con objeto de definir la estructura de las series cronológicas de lluvias y caudales, así como para mejorar el conocimiento del sistema kárstico del barranco de Peñalba, se ha aplicado el análisis de correlación y espectral a los datos del manantial de Iturriotz y del pluviómetro del Juncal, del período 6 de Agosto de 1983 a 12 de Octubre de 1985. Dicho análisis revela un efecto memoria relativamente importante y un tiempo de regulación de 23,5 días; sin embargo, se pone de manifiesto un efecto de filtro muy reducido, con una banda espectral de 0.30-0.32; el correlograma cruzado evidencia un desfase muy corto entre las señales de entrada y salida, a pesar de que existe un cierto poder regulador al final de la respuesta impulsional. Estos resultados no corresponden exactamente a ninguno de los modelos-tipo definidos por Mangin (1982), sino que sugieren un sistema de características mixtas. Los rasgos aparentemente contradictorios que se deducen de este análisis pueden ser atribuidos a la heterogeneidad del material acuífero y a la complejidad de los mecanismos de recarga.

Expéditions Antarctiques Belgo-Neérlandaises EXANTAR 66-67 - Campaña en el buque MAGGA DAN 1966-67 en la Antártida.-- 1 page

Ten years of publications (1984-1993) about drug compliance in spanish hypertensive patients are presented.A bibliography search of Medline (EBSCO CD-ROM ver 104.1, act Jul 1995), Indice Médico Español (CSIC CD-ROM, act Oct 1993) and other sources has been made.39 articles have been located and 23 investigational publications have been analysed. All the publications, but one, have evaluated the compliance by an indirect method, mainly patient selfdeclaration. The degree of patient compliance determined by interviews, questionnaires or inquiries is 55.5% (IC 95%: 52.7-58.3). The patient compliance in the publications that use methods based in pill counts is 46.4% (IC 95%: 41.6-51.2). The treatment dropout is present in the 18.5% of the patients (IC 95%: 20.5-16.5).The drug compliance degree in Spanish patients with hypertension is low.

To clinically assess effectiveness of therapeutic interchange from glibenclamide to gliclazide in the hospital setting.An open-label prospective, randomized study with two groups of patients: a reference group (patients still receiving their previous outpatient regimen of glibenclamide) and an interchange group (patients with gliclazide substituted for glibenclamide according to a hospital-approved interchange protocol). The efficacy endpoint used was blood glucose at 3 and 6 days post-intervention. A patient with blood glucose200 mg/L was considered clinically controlled, and blood glucose changesor30 mg/dL were considered significant.One hundred and sixteen patients were randomized. Blood glucose on the day before the intervention was 177.9 mg/dL +/- 63.4 in the reference group versus 171.3 mg/dL +/- 52.1 in the interchange group (p = 0.92). Mean blood glucose during the first 3 days post-intervention was 156.1 mg/dL +/- 47.5 and 177.7 mg/dL +/- 36.0 (p = 0.14) in the reference and interchange groups, respectively; and mean values for the first 6 days post-intervention were 142.1 mg/dL +/- 36.0 and 172.8 mg/dL +/- 28.2, respectively (p = 0.01). The overall analysis of blood glucose levels showed a better control in the reference group versus baseline values, which was not seen in the interchange group, where blood glucose remained stable and similar to baseline. In no case were 3-day and 6-day blood glucose mean levels above 200 mg/dL, which may be considered acceptable within the hospital setting.Therapeutic interchange may be safely performed with no clinical impairment, but better controls were achieved in the reference group.