Changes in the interpretive-breakpoints for antifungals against various Candida species have raised the need to examine the significance of the phenomenon of the growth of microcolonies in agar diffusion inhibition zones, which has generally been considered negligible. The objective was to determine the incidence of cases in which microcolonies demonstrate fluconazole resistance according to current interpretive-breakpoints and whether their growth is associated with therapeutic failure. The fluconazole minimum inhibitory concentrations (MICs) of 100 blood culture isolates of Candida were performed by E-test on Roswell Park Memorial Institute (RPMI) agar and examined for the appearance of microcolonies. Fluconazole MICs of microcolonies were then determined over three generations. The significance of the phenomenon of microcolonies was determined according to clinical data retrieved from electronic files. Microcolonies were a common phenomenon among Candida isolates following incubation on RPMI agar, with a higher frequency among C. albicans isolates as compared to non-albicans Candida across generations (57–93% vs 31–93%, respectively) and a similar fluconazole susceptibility rate over three generations. The rate of microcolonies was similar in both patients with successful and unsuccessful outcome (41% vs 42%, respectively). Microcolonies are a common phenomenon. No increase in MIC was demonstrated throughout three generations of microcolony inoculation on RPMI, and no difference in clinical outcome was observed.

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Background The global prevalence of childhood obesity has risen dramatically recently. Previous studies found an association between rapid infant weight gain and childhood overweight. Evidence suggests that exposure to high ambient air temperatures during prenatal life and during adulthood is associated with birthweight and obesity respectively. Objective The objective of this study was to examine whether exposure to high ambient temperatures during infancy is associated with rapid infant weight gain in Israel. Methods This is a population‐based historical cohort study using data from the Israeli national public network of maternal and child health clinics between 2008 and 2013. We assessed exposure to ambient temperature in the first year of life using a high‐resolution hybrid spatio‐temporal model and calculated annual mean and minimum temperatures for each infant based on daily mean and minimum temperatures at the community clinic location. We defined rapid infant weight gain as a World Health Organization weight z‐score difference >0.67 between birthweight and weight at age one year. We estimated these associations using log‐linear and general additive models and adjusted for population group, district, maternal age, parental education, parity, sex, gestational age, birthweight, calendar year and calendar month of birth. Results The study population included 217,310 singleton‐term infants. Adjusted models demonstrated a positive association between ambient temperature exposure and rapid infant weight gain. Compared to the third quintile of minimum temperature, infants exposed to the first and second quintile had an adjusted relative risk of 0.98 (95% CI 0.96, 1.00) and 0.97 (95% CI 0.95, 0.98), respectively, while those exposed to the fourth and fifth quintiles had an adjusted relative risk of 1.06 (95% CI 1.04, 1.07) and 1.02 (95% CI 1.00, 1.04) respectively. The associations with mean temperature were similar but slightly weaker. Conclusions Exposure to higher ambient temperatures, of emerging importance in the climate change era, is associated with rapid infant weight gain in Israel. Future studies should use additional exposure, covariate, and outcome data to analyse the nature and the source of this association in more detail.

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Objective: To explore responses from primary care physicians(PCPs) from an integrative physician (IP) consultation and recommended integrative oncology (IO) treatment program. Methods: Chemotherapy-treated patients were referred by their oncology healthcare professional to an IP, a physician dually-trained in complementary medicine and supportive cancer care. The consultation summary and patient-centered IO treatment program was then sent to the patient’s PCP, with PCP-to-IP responses analyzed qualitatively using ATLAS.Ti software for systematic coding and content analysis. Trial Registration Number NCT01860365 published May 22, 2013. Results: Of the 597 IP consultations conducted, 470 (78.7%) summaries were sent to patients’ PCPs, with only 69 (14.7%) PCP-to-IP responses returned. PCPs were more likely to respond if the patient was Hebrew-speaking (78.3% vs. 65.1%, P=0.032). Systematic coding identified four predominant themes among PCP narratives: addressing the patient’s medical condition and leading QoL-related concerns; patient-centered reflections; available resources providing support and promoting resilience; and PCP attitudes to the IO treatment program. Conclusion: PCP-IP communication can provide valuable insight into the patient's bio-psycho-social care, addressing the patient’s health-belief model, emotional concerns, caregiver-related factors, preferences and barriers to adherence to IO care. Practice implications: Healthcare services should consider promoting IP-PCP communication in order to facilitate better patient outcomes from an IO treatment program.

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