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To evaluate changes in the disconnection of mechanical ventilation in Spain from 1998 to 2016.Post-hoc analysis of four cohort studies.138 Spanish ICUs.2141 patients scheduled extubated.None.Demographics, reason for mechanical ventilation, complications, methods for disconnection, failure on the first attempt at disconnection, duration of weaning, reintubation, post-reintubation tracheotomy, ICU stay and mortality.There was a significant increase (p 0.001) in the use of gradual reduction of support pressure. The adjusted probability of using the gradual reduction in pressure support versus a spontaneous breathing trial has increased over time, both for the first attempt at disconnection (taking the 1998 study as a reference: odds ratio 0.99 in 2004, 0.57 in 2010 and 2.43 in 2016) and for difficult/prolonged disconnection (taking the 1998 study as a reference: odds ratio 2.29 in 2004, 1.23 in 2010 and 2.54 in 2016). The proportion of patients extubated after the first attempt at disconnection has increased over time. There is a decrease in the ventilation time dedicated to weaning (from 45% in 1998 to 36% in 2016). However, the duration in difficult/prolonged weaning has not decreased (median 3 days in all studies, p = 0.435).There have been significant changes in the mode of disconnection of mechanical ventilation, with a progressive increase in the use of gradual reduction of pressure support. No relevant changes in outcomes have been observed.

PURPOSE: To evaluate changes in the epidemiology of mechanical ventilation in Spain from 1998 to 2016. DESIGN: A post hoc analysis of four cohort studies was carried out. SETTING: A total of 138 Spanish ICUs. PATIENTS: A sample of 4293 patients requiring invasive mechanical ventilation for more than 12h or noninvasive ventilation for more than 1h. INTERVENTIONS: None. VARIABLES OF INTEREST: Demographic variables, reason for mechanical ventilation, variables related to ventilatory support (ventilation mode, tidal volume, PEEP, airway pressures), complications during mechanical ventilation, duration of mechanical ventilation, ICU stay and ICU mortality. RESULTS: There was an increase in severity (SAPSII: 43 points in 1998 vs. 47 points in 2016), changes in the reason for mechanical ventilation (decrease in chronic obstructive pulmonary disease and acute respiratory failure secondary to trauma, and increase in neurological disease and post-cardiac arrest). There was an increase in noninvasive mechanical ventilation as the first mode of ventilatory support (p

Objetivo: Evaluar cambios en la epidemiología de la ventilación mecánica en España desde 1998 hasta 2016. Diseño: Análisis post-hoc de 4 estudios de cohortes. Ámbito: Un total de 138 UCI españolas. Pacientes: Un total de 4.293 enfermos con ventilación mecánica invasiva más de 12 h o no invasiva más de 1 h. Intervenciones: Ninguna. Variables de interés principales: Demográficas, motivo de ventilación mecánica, relacionadas con el soporte ventilatorio (modo de ventilación, volumen tidal, PEEP, presiones en vía aérea), complicaciones, duración de la ventilación mecánica, estancia y mortalidad en la UCI. Resultados: Se observa aumento en la gravedad (SAPS II: 43 puntos en 1998 frente a 47 puntos en 2016), cambios en el motivo de la ventilación mecánica (disminución de la enfermedad pulmonar obstructiva crónica e insuficiencia respiratoria secundaria a traumatismo y aumento de la patología neurológica y tras parada cardiaca). Aumento en la ventilación no invasiva como primer modo de soporte ventilatorio (p < 0,001). El modo más utilizado es la ventilación controlada por volumen con un aumento de la presión de soporte y de la ventilación controlada por volumen regulada por presión. Disminuyó el volumen tidal (9 ml/kg de peso estimado en 1998 y 6,6 ml/kg en 2016, p < 0,001) y aumentó la PEEP (3 cmH2O en 1998 y 6 cmH2O en 2016, p < 0,001). La mortalidad disminuye (34% en 1998 y 27% en 2016; p < 0,001) sin variabilidad geográfica (MOR 1,43; p = 0,258). Conclusiones: Se observa una disminución en la mortalidad de los enfermos ventilados en UCI españolas. Esta disminución podría estar relacionada con cambios para minimizar el daño inducido por el ventilador. pre-print 1473 KB

Crítica contundent a la totalitat de l'estudi d'Anne Charlon.

Valoració general del volum.

Centrat en el tipus de lector que projecta la novel·la i en la formulació sectària i marginal d'aquesta.

Obra ressenyada: Maria Mercè MARÇAL, Llengua abolida. Valencia: Editorial Tres i Quatre, 1989.

Dins del camp de la demografia és cabdal conèixer una font estadística de gran interès, el Moviment Natural de la Població. La informació recollida en la seva publicació permet l'estudi demogràfic del comportament de la població com a resultat de la interacció dels naixements, de les defuncions i dels matrimonis que li han sobrevingut en el decurs del temps. Per tal de donar una visió global de la font, s'ha considerat convenient tractar-la en perspectiva històrica. La nostra presentació del Moviment Natural es desdoblarà en dos articles. En el present es recollirà el seu origen, els conceptes emprats i la informació de base d'on s'extreuen les dades que conformen la publicació. Es deixarà per a un proper article tot el que fa referència a la tabulació de les dades en funció dels diferents criteris de classificació, així com els problemes que presenta la utilització de la font, de les quals farem aquí tan sols una breu introducció.

Background Metabolic alkalosis (MA) inhibits respiratory drive and may delay weaning from mechanical ventilation (MV). MA is common in CO2-retainer patients that need MV. Acetazolamide (ACTZ) decreases serum bicarbonate concentration and stimulates respiratory drive. This study evaluated the effects of ACTZ on the duration of MV in patients with MA and COPD or obesity hypoventilation syndrome (OHS) intubated with acute respiratory failure. Methods Multicenter, randomized, controlled, double-blind study, with COPD or OHS patients with MV 28 mmol/L and pH > 7.35. Test-treatment, ACTZ 500 mg or placebo, was daily administered if pH > 7.35 and bicarbonate >26 mmol/L. Clinical, respiratory and laboratory parameters were recorded. Results 47 patients (36 men) were randomized. There were no significant differences between groups in comorbidities, baseline characteristics or arterial blood gases at inclusion. The mean difference in the duration of MV between placebo and ACTZ group was 1.3 days (95%CI, −2.1–4.8; p = 0.44). Kaplan-Meier curves showed no differences in the duration of MV (Log-Rank p = 0.41). Between-group comparison of estimated marginal means (CI 95%) during MV were, respectively: PaCO2 55 (51–59) vs 48 (47–50) mm Hg, p = 0.002; bicarbonate concentration 34 (32–35) vs 29 (28–30) mmol/L, p

Resumen El portafolio es un cuaderno de aprendizaje basado en la reflexion sobre la practica diaria. Consiste en una recopilacion de documentos (historias e informes clinicos), encuestas, fotografias y videograbaciones que permiten certificar la adquisicion de las competencias necesarias para ejercer una profesion determinada. Sirve al mismo tiempo como instrumento de evaluacion, tanto formativa como sumativa, ya que permite aglutinar diversos metodos de evaluacion. Para su introduccion en un Servicio de Dermatologia se requiere el apoyo del tutor y del jefe de servicio. Deberia incluir los objetivos de aprendizaje definidos por la Comision Nacional de Dermatologia Medico-Quirurgica y Venereologia, adecuando las metodologias de evaluacion a cada uno de ellos, lo que facilitaria una formacion mas global y que la evaluacion sumativa anual del residente fuera mas objetiva. La incorporacion de esta metodologia a la formacion medica especializada puede proporcionar una mejora del sistema de evaluacion actual, que consideramos que es poco preciso. Proponemos que el portafolio sustituya progresivamente al libro del residente. Tenemos previsto desarrollar una aplicacion on line que facilite su cumplimiento.

La utilizacion de sistemas para establecer el pronostico de los pacientes es habitual en las unidades de cuidados intensivos. Su capacidad predictiva es variable y depende de la poblacion a la que se aplica. Entre las poblaciones en las que han demostrado una menor exactitud se encuentra la de los enfermos ventilados mecanicamente Estudio de cohortes de 1.103 pacientes ventilados mecanicamente. Con un analisis de particiones recursivas se determinaron las variables asociadas a la mortalidad, y con un analisis de regresion logistica se construyeron dos modelos predictivos: el primero con el SAPS II y las variables previas al inicio de la ventilacion mecanica, y el segundo con el SAPS II y las variables previas y aparecidas durante la ventilacion mecanica. Para evaluar la prediccion de la mortalidad se realizo una medida de calibracion con el metodo de Lemeshow y Hosmer y una medida de discriminacion calculando el area bajo la curva ROC La mortalidad observada fue de un 42% (IC del 95%, 39-45) frente a una predicha por el SAPS II de un 36%. En el analisis de particiones recursivas, las variables asociadas a la mortalidad fueron: fracaso renal agudo, shock, PaO2/FiO2 En una cohorte de enfermos ventilados mecanicamente, el SAPS II fue un mal predictor de la mortalidad hospitalaria. La inclusion de factores previos al inicio y aparecidos durante la ventilacion mecanica mejora discretamente la exactitud predictiva

Resumen Objetivo Determinar la eficacia de la version externa previa tocolisis con terbutalina en disminuir las presentaciones de nalgas en el momento del parto. Material y metodos Estudio prospectivo observacional en gestaciones unicas a termino no complicadas, diagnosticadas de presentacion de nalgas. No se excluyen cesareas previas. Tocolisis con terbutalina. Resultados Realizamos 43 intentos de version externa, con un porcentaje de exito del 55,8% de los casos. Observamos un aumento de la eficacia si se realiza antes de la semana 38 (80%) que a partir de esta (42,9%), con unas diferencias estadisticamente significativas (p Conclusiones La version externa es un metodo valido y con baja incidencia de complicaciones para disminuir las presentaciones de nalgas en el momento del parto.

10.1016/j.jas.2014.06.018 Several studies have attempted to identify diagnostic criteria for distinguishing between evidence of trampling and cut marks, two common modifications at archaeological sites. These studies have brought to light, with relative precision, the features that identify and differentiate the two types of modifications. However, few studies differentiate these modifications after they have been affected by other factors. Chemical alteration, related to lixiviated sediments, is documented in a relatively high number of archaeological sites. Following the criteria established by Domínguez-Rodrigo etal. (2009), the aim of this paper is to know if diagnostic criteria that would allow modifications resulting from trampling to be differentiated from cut mark modifications are preserved, after undergoing chemical alterations. The results have been applied to unidentified marks located on faunal skeletal remains from the La Mina site, at the Barranc de la Boella (Tarragona, Spain), the surfaces of which have been heavily modified by the lixiviation of the sediments. The data suggest that chemically altered marks lose the diagnostic criteria necessary for correct identification. The unidentified marks discovered on remains from la Boella could not be verified as cut or trampling marks and therefore cannot be considered in future zooarchaeological and taphonomical studies.

Ressenya de:Sergio Doria. 2013. Ignacio Agustí, el árbol y la ceniza. Pròleg de Carlos Ruiz Zafón. Barcelona: Destino, 342 p., Reseña de:Sergio Doria. 2013. Ignacio Agustí, el árbol y la ceniza. Pròleg de Carlos Ruiz Zafón. Barcelona: Destino, 342 p.

Background In pressure support ventilation (PSV), a non-variable level of pressure support is delivered by the ventilator when triggered by the patient. In contrast, variable PSV delivers a level of pressure support that varies in a random fashion, introducing more physiological variability to the respiratory pattern. Experimental studies show that variable PSV improves gas exchange, reduces lung inflammation and the mean pressure support, compared to non-variable PSV. Thus, it can theoretically shorten weaning from the mechanical ventilator. Methods/design The ViPS (variable pressure support) trial is an international investigator-initiated multicenter randomized controlled open trial comparing variable vs. non-variable PSV. Adult patients on controlled mechanical ventilation for more than 24 hours who are ready to be weaned are eligible for the study. The randomization sequence is blocked per center and performed using a web-based platform. Patients are randomly assigned to one of the two groups: variable PSV or non-variable PSV. In non-variable PSV, breath-by-breath pressure support is kept constant and targeted to achieve a tidal volume of 6 to 8 ml/kg. In variable PSV, the mean pressure support level over a specific time period is targeted at the same mean tidal volume as non-variable PSV, but individual levels vary randomly breath-by-breath. The primary endpoint of the trial is the time to successful weaning, defined as the time from randomization to successful extubation. Discussion ViPS is the first randomized controlled trial investigating whether variable, compared to non-variable PSV, shortens the duration of weaning from mechanical ventilation in a mixed population of critically ill patients. This trial aims to determine the role of variable PSV in the intensive care unit. Trial registration clinicaltrials.gov NCT01769053

Este artículo analiza los censos de población realizados en España desde 1857 hasta 1970 con el objetivo de examinar los cambios, pero también las continuidades, que éstos han presentado a lo largo del tiempo en lo referido a los conceptos, las variables y las clasificaciones presentes en los mismos. En concreto, se analiza la evolución experimentada por los censos respecto a la población de referencia; el domicilio, la naturaleza y la nacionalidad; el estado civil; el nivel de instrucción; la clasificación de profesiones o actividad económica; el número de hijos nacidos vivos de las mujeres casadas y viudas, y, finalmente, las desagregaciones territoriales y de edad utilizadas. Ello ha implicado sistematizar y analizar la información que se proporciona en las tablas numéricas de cada volumen de las estadísticas censales, información que se ha resumido en forma de cuadros resumen. This paper analyses Spanish population censuses between 1857 and 1970. Concepts, variables and classifications used in each of them are examined to find both differences and similarities through time. More specifically the paper studies changes in the definition of: reference population, legal address, place of birth, nationality, marriage status, education level, profession / econòmic activity, and children ever born to married women or widows. Changes in age categories and spatial units are also analysed. To this aim, the information contained on the tables published in each of the census volumes has been systematised, analysed and summarised in synoptic charts. Este artigo analisa os censos de população realizados na Espanha desde 1857 até 1970 com o objetivo de examinar mudanças e continuidades que estes têm apresentado ao longo do tempo quanto aos conceitos, variáveis e classificações. Mais especificamente, é analisada a evolução do censo quanto à população de referência, domicílio, naturalidade e nacionalidade, estado civil, nível de instrução, classificação das profissões ou atividade econômica, número de filhos nascidos vivos das mulheres casadas e viúvas; e, finalmente, desagregações territoriais e de idade utilizadas. Para isso, a informação contida nas tabelas numéricas de cada volume do censo foi sistematizada, analisada e sintetitzada em quadros resumo.

[ES] La campaña para el estudio del arte rupestre en el Macizo del Erongo (Africa del Sudoeste, Namibia), se desarrolló en 1976 en las zonas de las granjas de Etemba, Anibib y Omandumba West y en el sistema montañoso del Khomas Hochland: Otjompaue Sud, Onduno y Hochfelds. En esta ultima region, objeto de este trabajo, se catalogaron 14 abrigos con pinturas, la mayoría de los cuales situados en la granja de Otjompaue Sud. El arte rupestre de esta zona está en vías de desaparición a causa de la alteración de las losas que forman los abrigos, a pesar de ello se han podido verificar escenas de caza, lucha enfermedad o vejez, pastoreo y danza, junto a grupos de animales salvajes y domésticos, realizados en un estilo naturalista y combinando a menudo dos colores, blanco y rojo, en una misma figura. La falta de trabajos arqueológicos hace prácticamente imposible datar las pinturas aunque parece intuirse una cronología del período Wilton con cerámica, es decir, dentro del primer milenio a. C., [FR] La campagne pour l'étude de l'art rupestre aux montagnes de l'Erongo (Afrique du Sudouest, Namibia), fut réalisée en 1976 dans les terrains des fermes d'Etemba, Anibib et Omandumba West et dans le système montagneux du Khomas Hochland: des fermes d'Otjompaue Sud, Onduno et Hochfelds. Dans cette dernière région du Khomas Hochland on a catalogué 14 abris contenant des peintures rupestres, dont la plupart ont été localisées dans la ferme d'Otjompaue Sud. L'art rupestre de cette zone est en train de disparaître à cause de la grave altération des dalles qui forment les abris. Malgré tout, on a vérifié l'existence de scènes de chasse, lutte, pasteurs, danse, maladie ou vieillesse, auprès d'ensembles d'animaux sauvages et domestiques, réalisés dans un style naturaliste et combinant souvent dans une même figure la couleur blanche et rouge. La datation de ces peintures est presque impossible pour le manque d'études archéologiques, mais on peut penser à une chronologie du période Wilton avec céramique, c'est à dire dans le premier millénaire av. J. C.

Ventilation in the prone position for about 7 h/d in patients with acute respiratory distress syndrome (ARDS), acute lung injury, or acute respiratory failure does not decrease mortality. Whether it is beneficial to administer prone ventilation early, and for longer periods of time, is unknown.We enrolled 136 patients within 48 h of tracheal intubation for severe ARDS, 60 randomized to supine and 76 to prone ventilation. Guidelines were established for ventilator settings and weaning. The prone group was targeted to receive continuous prone ventilation treatment for 20 h/d.The intensive care unit mortality was 58% (35/60) in the patients ventilated supine and 43% (33/76) in the patients ventilated prone (p = 0.12). The latter had a higher simplified acute physiology score II at inclusion. Multivariate analysis showed that simplified acute physiology score II at inclusion (odds ratio [OR], 1.07; p0.001), number of days elapsed between ARDS diagnosis and inclusion (OR, 2.83; p0.001), and randomization to supine position (OR, 2.53; p = 0.03) were independent risk factors for mortality. A total of 718 turning procedures were done, and prone position was applied for a mean of 17 h/d for a mean of 10 d. A total of 28 complications were reported, and most were rapidly reversible.Prone ventilation is feasible and safe, and may reduce mortality in patients with severe ARDS when it is initiated early and applied for most of the day.

Josep Maria Folch i Torres (1880-1950) està considerat com un dels principals escriptors de literatura catalana i el creador del teatre català per a infants. L'autora d'aquesta tesi estudia l'aportació fonamental de l'escriptor a la literatura i la cultura de Catalunya del primer terç del segle XX i realitza una aproximació científica i equànime a la seva figura. Josep Maria Folch i Torres (1880-1950) está considerado como uno delos principales escritores de literatura catalana y el creador del teatrocatalán infantil. La autora de esta tesis estudia la aportación fundamentaldel escritor en la literatura y la cultura de Cataluña durante el primertercio del siglo XX y realiza una aproximación científica y ecuánime a sufigura.

Intubation and mechanical ventilation are commonly employed to save the lives of critically ill patients with respiratory failure. However, selection of the most appropriate time for liberation (from the machine) and endotracheal extubation are among the most difficult decisions critical care physicians make. Roughly two thirds of patients can be successfully extubated after a brief period of breathing through a T-tube, once the problems which precipitated respiratory failure have been treated. However, about 30% of patients who require intubation and mechanical ventilation for longer than 24 h cannot tolerate initial attempts to breathe without the mechanical ventilator [1, 2].

Various studies have proven the existence of psychological factors which play an important role in many cases of women that suffer hyperprolactinemia, galactorrhea or even prolactinoma (phenomenon known as the Nunes syndrome). Childhood experiences have been described that generate somatic disorders: divorce or absence of the father, or an alcoholic or/and violent father inducing to infantile regression where the mother and daughter get back to a symbiotic hateful relation symbolized in the lactance period. We present the case of a patient who manifests an euprolactinemia galactorrhea that coincides with the birth and lactance activities of a girlfriend of her.

Diversos estudios han evidenciado la existencia de factores psicológicos que juegan un papel clave en muchos casos de mujeres que padecen hiperprolactinemia, galactorrea o incluso prolactinoma (fenómeno conocido como síndrome de Nunes). Se han descrito vivencias infantiles que generan tales desórdenes somáticos: separación o ausencia del padre, o padre alcohólico y/o violento que favorecen una regresión infantil donde madre e hija recuperan una relación simbiótica maligna, simbolizada en la lactancia. La paciente aquí descrita presenta una galactorrea euprolactinémica, coincidente con el parto y lactancia de una amiga. Various studies have proven the existence of psychological factors which play an important role in many cases of women that suffer hyperprolactinemia, galactorrhea or even prolactinoma (phenomenon known as the Nunes syndrome). Childhood experiences have been described that generate somatic disorders: divorce or absence of the father, or an alcoholic or/and violent father inducing to infantile regression where the mother and daughter get back to a symbiotic hateful relation symbolized in the lactance period. We present the case of a patient who manifests an euprolactinemia galactorrhea that coincides with the birth and lactance activities of a girlfriend of her.

El punto de mira, del presente ensayo, se centra en una de las especies faunísticas más significativas de las etapas postpaleolitícas los cérvidos; animales que fueron reiteradamente expresados, a través de pinturas, en abrigos y covachas de la vertiente mediterránea hispana. Nuestro principal interés es indagar en la analogía etnográfica para reflexionar sobre su papel en la cosmovisión de los pueblos cazadores y primeras comunidades agrícolas.

The duration of spontaneous breathing trials before extubation has been set at 2 h in research studies, but the optimal duration is not known. We conducted a prospective, multicenter study involving 526 ventilator-supported patients considered ready for weaning, to compare clinical outcomes for trials of spontaneous breathing with target durations of 30 and 120 min. Of the 270 and 256 patients in the 30- and 120-min trial groups, respectively, 237 (87.8%) and 216 (84.8%), respectively, completed the trial without distress and were extubated (p = 0.32); 32 (13.5%) and 29 (13.4%), respectively, of these patients required reintubation within 48 h. The percentage of patients who remained extubated for 48 h after a spontaneous breathing trial did not differ in the 30- and 120-min trial groups (75.9% versus 73.0%, respectively, p = 0.43). The 30- and 120-min trial groups had similar within-unit mortality rates (13 and 9%, respectively) and in-hospital mortality rates (19 and 18%, respectively). Reintubation was required in 61 (13.5%) patients, and these patients had a higher mortality (20 of 61, 32.8%) than did patients who tolerated extubation (18 of 392, 4.6%) (p0.001). Neither measurements of respiratory frequency, heart rate, systolic blood pressure, and oxygen saturation during the trial, nor other functional measurements before the trial discriminated between patients who required reintubation from those who tolerated extubation. In conclusion, after a first trial of spontaneous breathing, successful extubation was achieved equally effectively with trials targeted to last 30 and 120 min.

A 2-h T-tube trial of spontaneous breathing was used in selecting patients ready for extubation and discontinuation of mechanical ventilation. However, some doubt remains as to whether it is the most appropriate method of performing a spontaneous breathing trial. We carried out a prospective, randomized, multicenter study involving patients who had received mechanical ventilation for more than 48 h and who were considered by their physicians to be ready for weaning according to clinical criteria and standard weaning parameters. Patients were randomly assigned to undergo a 2-h trial of spontaneous breathing in one of two ways: with a T-tube system or with pressure support ventilation of 7 cm H2O. If a patient had signs of poor tolerance at any time during the trial, mechanical ventilation was reinstituted. Patients without these features at the end of the trial were extubated. Of the 246 patients assigned to the T-tube group, 192 successfully completed the trial and were extubated; 36 of them required reintubation. Of the 238 patients in the group receiving pressure support ventilation, 205 were extubated and 38 of them required reintubation. The percentage of patients who remained extubated after 48 h was not different between the two groups (63% T-tube, 70% pressure support ventilation, p = 0.14). The percentage of patients falling the trial was significantly higher when the T-tube was used (22 versus 14%, p = 0.03). Clinical evolution during the trial was not different in patients reintubated and successfully extubated. ICU mortality among reintubated patients was significantly higher than in successfully extubated patients (27 versus 2.6%, p0.001). Spontaneous breathing trials with pressure support or T-tube are suitable methods for successful discontinuation of ventilator support in patients without problems to resume spontaneous breathing.

To study the effect of relaxation therapy on the symptomology of patients with anxiety and somatoform disorders.An experimental prospective study, controlled through random assignation, using evaluation scales.Mn. Jaume Soler Health Centre, Cornellà (Barcelona).31 patients (8 men and 23 women), diagnosed with anxiety or previously untreated somatoform disorders, for whom combined anti-depressive and relaxation therapy over a 5-month period was established. The results were compared with those of a control group (n = 17) with identical diagnoses, which only received antidepressive medication.The STAI tests and two pain scales were administered at 0, 15, 30, 45, 60 and 150 days and the HRS and SCL-90-R at 0 and 150 days. The possible impact of the psychiatric diagnosis, age, gender, married status, existence of concomitant physical illness, SRE, present employment status and the presence of children or not were all considered. The results pointed to a significant improvement over the period in the analogue-visual scale of pain (p = .009) and in the HRS (p = .046) for the group comprised of those complying with the relaxation therapy independently of the psychiatric diagnosis.The benefit of relaxation in anxious and somatoform patients, when pain--and not anxiety--is the principal symptom, was confirmed. Depression improved when antidepressants were administered simultaneously, whereas anxiety varied little, at least during the time the trial lasted.