Comparison of sedation with dexmedetomidine administered subcutaneously at 2 different locations on the head in dogs.

Objective: This study aimed to compare the sedative effects of dexmedetomidine administered to dogs subcutaneously (SC) at the Governing Vessel 20 (GV20) acupuncture point and at another point on the head. Animals and procedure: Ten client-owned dogs were included. Dogs were sedated 2 times, 14 d apart, with 200 µg/m2 of dexmedetomidine, SC, at GV20 and at a point at the base of the ear (SC-head). The sedation was assessed with a sedation scale and a Dynamic and Interactive Visual Analogue Scale (DIVAS). The ease of performing radiographic studies, physiological parameters, and adverse events were recorded. Statistical linear mixed-effect models (ANOVA) were applied. Statistical significance was set at P < 0.05. Results: The time to sedation and sedation scores were similar for both groups. The level of sedation achieved was adequate to perform orthopedic radiographs for 9/10 (90%) cases in the GV20 group and 8/10 (80%) cases in the SC-head group. Heart and respiratory rates decreased significantly over time in both groups (P < 0.001). Adverse events were infrequent and self-limiting. Conclusion: Our study provides evidence that SC administration of dexmedetomidine on the head, at the GV20 point or at the base of the ear, is easy and provides a sufficient level of sedation to obtain orthopedic radiographs in dogs.

Comparaison de la sédation avec de la dexmédétomidine administrée par voie sous-cutanée à deux sites différents sur la tête de chiens. Objectif: Cette étude a pour but de comparer les effets sédatifs de la dexmédétomidine administrée par voie sous-cutanée (SC) au point d'acupuncture VG20 et à un autre point sur la tête, non lié à la relaxation/sédation, chez le chien. Animaux et procédure: Dix chiens de clients ont été inclus dans cette étude clinique, prospective, croisée, randomisée et à l'aveugle. Les chiens ont été sédatés deux fois, à 14 jours d'intervalle, avec une injection de 200 µg/m2 de dexmédétomidine sous-cutanée au point d'acupuncture VG20 et à un autre point sur la tête, à la base de l'oreille (SC-tête). La durée et la qualité de la sédation ont été évaluées avec une échelle de sédation et une échelle analogue visuelle dynamique et interactive (DIVAS). La facilité de réaliser des études radiographiques, les paramètres physiologiques et les effets secondaires ont été enregistrés. Des modèles statistiques linéaires à effet mixte (ANOVA) ont été réalisés. Les résultats étaient considérés comme significatifs quand P < 0,05. Résultats: Le temps nécessaire pour atteindre un niveau de sédation adéquat et les scores de sédation étaient comparables entre les deux groupes. Le niveau de sédation était adéquat pour réaliser des radiographies orthopédiques chez 9/10 (90 %) des cas dans le groupe VG20 et 8/10 (80 %) des cas dans le groupe SC-tête. Les fréquences cardiaque et respiratoire diminuaient significativement dans le temps pour les 2 groupes (P < 0,001). Les effets indésirables étaient peu fréquents et auto-limitants. Conclusion: Notre étude suggère que l'administration sous-cutanée de dexmédétomidine sur la tête, que ce soit au point VG20 ou à la base de l'oreille, est facile et permet d'obtenir un niveau de sédation suffisant pour réaliser des radiographies orthopédiques chez des chiens sains.(Traduit par les auteurs).

Performance of Febrile Infant Algorithms by Duration of Fever.

OBJECTIVES: To analyze the performance of commonly used blood tests in febrile infants ≤90 days of age to identify patients at low risk for invasive bacterial infection (bacterial pathogen in blood or cerebrospinal fluid) by duration of fever. METHODS: We conducted a secondary analysis of a prospective single-center registry that includes all consecutive infants ≤90 days of age with fever without a source evaluated at 1 pediatric emergency department between 2008 and 2021. We defined 3 groups based on caregiver-reported hours of fever (<2, 2-12, and ≥12) and analyzed the performance of the biomarkers and Pediatric Emergency Care Applied Research Network, American Academy of Pediatrics, and Step-by-Step clinical decision rules. RESULTS: We included 2411 infants; 76 (3.0%) were diagnosed with an invasive bacterial infection. The median duration of fever was 4 (interquartile range, 2-12) hours, with 633 (26.3%) patients with fever of <2 hours. The area under the curve was significantly lower in patients with <2 hours for absolute neutrophil count (0.562 vs 0.609 and 0.728) and C-reactive protein (0.568 vs 0.760 and 0.812), but not for procalcitonin (0.749 vs 0.780 and 0.773). Among well-appearing infants older than 21 days and negative urine dipstick with <2 hours of fever, procalcitonin ≥0.14 ng/mL showed a better sensitivity (100% with specificity 53.8%) than that of the combination of biomarkers of Step-by-Step (50.0% and 82.2%), and of the American Academy of Pediatrics and Pediatric Emergency Care Applied Research Network rules (83.3% and 58.3%), respectively. CONCLUSIONS: The performance of blood biomarkers, except for procalcitonin, in febrile young infants is lower in fever of very short duration, decreasing the accuracy of the clinical decision rules.

Analysis of guideline recommendations for treatment of asthma exacerbations in children: a Pediatric Emergency Research Networks (PERN) study.

RATIONALE: There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical guidelines. OBJECTIVES: To describe and compare the content and quality of clinical guidelines for the management of acute exacerbations of asthma in children between geographic regions. METHODS: Observational study of guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks. MEASUREMENTS AND MAIN RESULTS: 158 guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity.There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness.Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline.Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence. CONCLUSIONS: Current guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations.

"Nano in Nano"-Incorporation of ZnO Nanoparticles into Cellulose Acetate-Poly(Ethylene Oxide) Composite Nanofibers Using Solution Blow Spinning.

In this work, the preparation and characterization of composites from cellulose acetate (CA)-poly(ethylene oxide) (PEO) nanofibers (NFs) with incorporated zinc oxide nanoparticles (ZnO-NPs) using solution blow spinning (SBS) is reported. CA-PEO nanofibers were produced by spinning solution that contained a higher CA-to-PEO ratio and lower (equal) CA-to-PEO ratio. Nanoparticles were added to comprise 2.5% and 5% of the solution, calculated on the weight of the polymers. To have better control of the SBS processing conditions, characterization of the spinning suspensions is carried out, which reveals a decrease in viscosity (two- to eightfold) upon the addition of NPs. It is observed that this variation of viscosity does not significantly affect the mean diameters of nanofibers, but does affect the mode of the nanofibers' size distribution, whereby lower viscosity provides thinner fibers. FESEM-EDS confirms ZnO NP encapsulation into nanofibers, specifically into the CA component based on UV-vis studies, since the release of ZnO is not detected for up to 5 days in deionized water, despite the significant swelling of the material and accompanied dissolution of water-soluble PEO. Upon the dissolution of CA nanofibers into acetone, immediate release of ZnO is detected, both visually and by spectrometer. ATR-FTIR studies reveal interaction of ZnO with the CA component of composite nanofibers. As ZnO nanoparticles are known for their bioactivity, it can be concluded that these CA-PEO-ZnO composites are good candidates to be used in filtration membranes, with no loss of incorporated ZnO NPs or their release into an environment.

Tritordeum, a hybrid cereal with a highly tricin-enriched lignin.

The lignin from tritordeum straw, a hybrid cereal from crossbreeding of durum wheat and wild barley, was isolated and chemically characterized. Its composition and structure were studied by analytical pyrolysis (Py-GC/MS), nuclear magnetic resonance spectroscopy (NMR), Derivatization Followed by Reductive Cleavage (DFRC) method, and gel permeation chromatography (GPC). The data revealed an enrichment of guaiacyl (G) units (H:G:S of 3:61:36), which had a significant impact on the distribution of inter-unit linkages. The predominant linkages were the ß-O-4' alkyl-aryl ethers (78 % of all linkages), with substantial proportions of condensed linkages such as phenylcoumarans (11 %), resinols (4 %), spirodienones (4 %), and dibenzodioxocins (2 %). Moreover, DFRC revealed that tridordeum straw lignin was partly acylated at the γ-OH with both acetates and p-coumarates. Acetates were principally attached to G-units, whereas p-coumarates were predominantly attached to S-units. Furthermore, and more importantly, tritordeum lignin incorporates remarkable amounts of a valuable flavone, tricin, exceeding 30 g per kilogram of straw. Given the diverse industrial applications associated with this high-value molecule, tritordeum straw emerges as a promising and sustainable resource for its extraction.

Non-Woven Fibrous Polylactic Acid/Hydroxyapatite Nanocomposites Obtained via Solution Blow Spinning: Morphology, Thermal and Mechanical Behavior.

Polylactic acid (PLA) is widely used in tissue engineering and other biomedical applications. PLA can be modified with appropriate biocompatible ceramic materials since this would allow tailoring the mechanical properties of the tissues to be engineered. In this study, PLA-based non-woven fibrillar nanocomposites containing nanoparticles of hydroxyapatite (HA), a bioceramic commonly used in bone tissue engineering, were prepared via solution blow spinning (SBS). The compositions of the final materials were selected to study the influence of HA concentration on the structure, morphology, and thermal and mechanical properties. The resulting materials were highly porous and mainly constituted fibers. FTIR analysis did not reveal any specific interactions. The diameters of the fibers varied very little with the composition. For example, slightly thinner fibers were obtained for pure PLA and PLA + 10% HA, with fiber diameters of less than 400 nm, while the thicker fibers were found for PLA + 1% HA, with average diameters of 427 ± 170 nm. The crystallinity and stiffness of the PLA/HA composite increased with the HA content. Further, composites containing PLA fibers with slightly larger diameters were more ductile. Thus, with an appropriate balance between factors, such as the diameter of the solution-blow-spun PLA fibers, HA particle content, and degree of crystallinity, PLA/HA composites may be effectively used in tissue engineering applications.

Effect of Collector Rotational Speed on the Morphology and Structure of Solution Blow Spun Polylactic Acid (PLA).

Apart from structure and composition, morphology plays a significant role in influencing the performance of materials in terms of both bulk and surface behavior. In this work, polylactic acid (PLA) constituted by submicrometric fibers is prepared. Using a modified electrospinning (ES) device to carry out solution blow spinning (SBS), the fibrillar morphology is modified, with the aim to induce variations in the properties of the material. The modification of the ES device consists of the incorporation of a source of pressurized gas (air) and a 3D-printed nozzle of our own design. For this work, the morphology of the PLA submicrometric fibers is modified by varying the rotational speed of the collector in order to understand its influence on different properties and, consequently, on the performance of the material. The rotational speed of a cylindrical collector (250, 500, 1000 and 2000 rpm) is considered as variable for changing the morphology. Morphological study of the materials was performed using scanning electron microscopy and image analysis carried out with ImageJ 1.54f software. Besides a morphology study, structural characterization by Fourier transformed infrared spectroscopy using attenuated total reflectance of prepared materials is carried out. Finally, the morphology and structure of produced PLA fibrous mats were correlated with the analysis of mechanical properties, wettability behavior and adhesion of DH5-α E. coli bacteria. It is of interest to highlight how small morphological and chemical structure variations can lead to important changes in materials' performance. These changes include, for example, those above 30% in some mechanical parameters and clear variations in bacterial adhesion capacity.

An update on the underlying risk factors of eating disorders onset during adolescence: a systematic review.

Introduction: Eating disorders (EDs) are serious psychological problems that affect not only the individual, but also their entire environment. The prevalence rates of EDs are higher among the adolescent population. A better understanding of ED risk factors is essential to design effective prevention and intervention programs that focus beyond the areas of weight and appearance. Methods: The main objective of this systematic review was to identify the risk factors of EDs and provide a comprehensive approach, analyzing the interplay between individuals, their inner circle, and the society characteristics. The Web of Science, Scopus, CENTRAL and PsycInfo databases were searched. Results: The initial search produced 8,178 references. After removing duplicates and performing the selection process by three independent reviewers, 42 articles were included in the systematic review according to the pre-specified inclusion criteria. The results suggest the relevance of society and the inner circle on the development of EDs. Discussion: The internalization of the thin ideal, promoted by the current society, and living in an unsupportive, unaffectionate, non-cohesive environment were associated with the onset of EDs symptomatology. Other associated variables with this ED indicator were poor-quality relationships and feeling judged about appearance. These aspects seem to be essential for the development of individual characteristics like self-esteem or adaptative coping during adolescence. This systematic review has shown the complex etiology of EDs and the relevance of the interplay between the different areas involved. Furthermore, this information could be relevant to improve the design of innovative and more effective prevention and intervention programs. Systematic review registration: PROSPERO, identifier CRD42022320881.

Morphological Evaluation of Transscleral Laser Retinopexy in Rabbits: Comparison of Optical Coherence Tomography and Histologic Examinations.

Transscleral retinopexy is a preventive technique used against retinal detachment. Fundus examination can allow the monitoring of morphological retinal changes in the progression of photocoagulation lesions, without offering details on the morphological changes by the retinal lesion. The aim of the study was to assess the progression of photocoagulation lesions induced by transscleral retinopexy (840 nm diode laser), by comparing the optical coherence tomography (OCT) and histological images over a period of six weeks on eight pigmented New Zealand healthy rabbits (four males and four females; n = 16 eyes). All rabbits underwent transscleral retinopexy on their left eye on day 0 (D0). Measurements of the photocoagulation lesions were obtained in vivo on D0, D7, D15, D21, and D42 by acquiring OCT images of both eyes from all rabbits. On D1, D7, D21, and D42, two rabbits were euthanized, and their eyes were enucleated. A significant effect by time on the decrease in the central retinal thickness of the photocoagulation lesion was observed from D1 to D7 (p = 0.001); however, no such effect was observed on the horizontal length ((HL) p = 0.584) of the lesion surface. The reliability between the OCT and histological measurements, which were evaluated using intraclass correlation coefficients, was excellent for measuring the retinal thickness at the center (ICC = 0.91, p < 0.001), moderate for the right side of the retinal lesions (ICC = 0.72, p = 0.006), and not significant for the left side and HL (p = 0.055 and 0.500, respectively). The morphological changes observed in the OCT and histopathological images of the photocoagulation lesions were qualitatively described over time. OCT is an effective tool for monitoring changes in photocoagulation lesions. Some measurements and qualitative changes showed an adequate correlation between the OCT and histological findings.

Validity and reliability of the transculturally adapted Spanish version of the Implementation Leadership Scale (ILS).

BACKGROUND: There is a need for pragmatic and reliable measures of sound factors that affect evidence-based practice (EBP) adoption and implementation in different languages and cultural environments. The Implementation Leadership Scale (ILS) is a brief and efficient measurement tool of strategic leadership for EBP implementation. The objective of this study was to assess the psychometric properties of the Spanish version of the ILS. METHODS: The process of translation of the original ILS into Spanish consisted of forward translation, panel meeting, and back-translation. Scale face and content validity compared to that of the original version were assessed and ensured before agreement on the final version. Psychometric properties were examined in 144 healthcare professionals (family physicians, pediatricians, practice and pediatric nurses) involved in implementation or improvement research projects. ILS factor structure was tested by confirmatory factor analysis (CFA). Reliability was assessed by internal consistency analysis. The Pearson correlation between the ILS and the Organizational Support dimension of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire in the subsample of pediatricians and pediatric nurses (n = 52) was estimated for convergent validity analysis. RESULTS: The CFA results indicated that the original four theorized first-order factors with a second-order Implementation Leadership factor fit the data well (χ2 = 107.70; df = 45; p < 0.001). All standardized first- and second-order factor loadings were statistically significant. Fit indexes showed acceptable figures (GFI = 0.90; CFI = 0.97; RMSEA = 0.10; SRMR = 0.053). Cronbach's alpha coefficient for the four dimensions of ILS ranged from 0.90 to 0.97, while the reliability estimated for the total scale was 0.95. Results of convergent validity revealed high correlation (r = 0.56) between the ILS and the OR4KT's Organizational Support dimension. CONCLUSION: The CFA results demonstrated that the tested first- and second-order factor structure of the 12-item Spanish version of the ILS is consistent with the factor structure of the original tool. The availability of the ILS will allow Spanish-speaking researchers to assess and advance understanding of the implementation leadership construct as a predictor of organizational implementation context.

Solution blow co-spinning of cellulose acetate with poly(ethylene oxide). Structure, morphology, and properties of nanofibers.

Cellulose acetate (CA) nanofibers are prepared using solution blow co-spinning (SBS) with poly(ethylene oxide) (PEO). The pure CA membranes are obtained by washing water-soluble PEO from the fibrous CA-PEO blend. Nanofibrous membranes are characterized using optical and scanning electron microscopy (SEM), differential scanning calorimetry (DSC), infrared spectroscopy (ATR-FTIR), and surface zeta potential measurements. Thermal transitions from DSC and ATR-FTIR spectra analysis were used to confirm the removal of the PEO. Although the characteristic signals of PEO are not observed by FTIR, an additional thermal step transition in CA nanofibers indicates the embedding of a small amount of PEO (up to 6 wt%). SEM analysis shows that CA-PEO blends are constituted by fibers with mean diameters from 671 to 857 nm (depending on the SBS parameters), while after PEO removal, diameters range from 567 to 605 nm. We propose a new method for staining CA-PEO membranes with iodine solution in absolute ethanol that allows the differentiation of CA and PEO components with an optical microscope. The microscopy results suggest that PEO assists in the spinning by enveloping CA nanofibers, allowing uninterrupted processing. The successful deacetylation to cellulose using an aqueous KOH solution is confirmed with zeta potential measurements and ATR-FTIR.

Characteristics of Pediatric Emergency Department Presentations of Anaphylaxis in Spain.

OBJECTIVE: This study aimed to identify the triggers of pediatric anaphylaxis in Spain and to analyze the circumstances of the episode. METHODS: Planned secondary analysis of a prospective observational multicenter study endorsed by the Spanish Society of Pediatric Emergencies including children aged younger than 18 years diagnosed with anaphylaxis in 7 Spanish pediatric emergency departments (EDs) between 2016 and 2018. We analyzed factors related to the anaphylaxis episode and its management. RESULTS: Four hundred fifty-three cases were registered, happening mainly at home (295 [65.1%]), school (65 [14.3%]), and street (61 [13.5%]). The median age was 5 years, 143 (31.6%) had previous episodes, and 165 (36.4%) had previously been prescribed an epinephrine autoinjector, used in 40 (24.2% of those prescribed). Two thirds were well-appearing when arriving to the pediatric ED. Food was the trigger in 396 (87.4%). In 349 with a single food involved, the most frequent were milk (108 [30.4%]), nuts (103 [29.0%]), hen's egg (40 [11.3%]), and fish (31 [8.7%]), with variations related to the age of the child. CONCLUSIONS: Food, especially milk and nuts, are responsible for most anaphylaxis diagnosed in Spanish pediatric EDs. Consideration should be given to improving health education due to the low use of epinephrine autoinjectors.

Solution Blow-Spun Poly (Ethylene Oxide)-Polysulfone Bicomponent Fibers-Characterization of Morphology, Structure, and Properties.

Solution blow spinning was used to prepare nonwoven bicomponent fibers constituted by poly (ethylene oxide)-Polysulfone (PEO-PSF). As a new material, deep characterization was carried out to have a database to understand final performance regarding its multiple functions as a potential material for biomedical applications. The morphology was studied by field emission scanning electron and transmission electron microscopy and optical profilometry. Structural characterization was carried out by Fourier transform infrared spectroscopy and thermal degradation by thermogravimetric analysis. Additionally, wettability and mechanical behavior were studied by contact angle measurements and tensile tests, respectively. The bicomponent material was constituted of fibers with a structure mainly described by a core-shell structure, where the PSF phase is located at the center of the fibers, and the PEO phase is mainly located at the outer parts of the fibers, leading to a kind of shell wall. The study of possible interactions between different phases revealed them to be lacking, pointing to the presence of an interface core/shell more than an interphase. The morphology and roughness of the bicomponent material improved its wettability when glycerol was tested. Indeed, its mechanical properties were enhanced due to the PSF core provided as reinforcement material.

Active Cellulose Acetate/Chitosan Composite Films Prepared Using Solution Blow Spinning: Structure and Electrokinetic Properties.

Cellulose acetate (CA), a very promising derivative of cellulose, has come into the focus of research due to its highly desired good film-forming ability for food packaging applications. Frequently, this derivative is used in combination with other compounds (polymers, nanoparticles) in order to obtain active materials. Here, we report the preparation of thin films made of cellulose acetate loaded with chitosan (CS) using the solution blow spinning (SBS) method. Films are prepared by SBS processing of the polymers mixture solution, considering the following variables: (i) the concentration of cellulose acetate and chitosan in the solution and (ii) the solvent system consisting of acetic or formic acid. The prepared materials are characterized in terms of physical properties, roughness (optical profilometer), porosity, wettability (contact angle measurements), chemical structure (Fourier transform infrared spectrometry), and electrokinetic properties (zeta potential). SBS enables the preparation of CA/CS films with high water vapor permeability, high porosity, and also higher water contact angle compared with pure CA films. The electrokinetic properties of composites are influenced by the inclusion of chitosan, which causes a shift of the isoelectric point (IEP) towards higher pH values, but the magnitude of the shift is not in correlation with chitosan concentration. Adsorption kinetic studies using bovine serum albumin (BSA) as a model protein reveal that chitosan modified cellulose acetate films manifest low affinity towards proteins that suggests prevention of biofilm formation on its surface.

Semantic Priming and Its Link to Verbal Comprehension and Working Memory in Children with Learning Disorders.

Children with learning disorders (LD children) often have heterogeneous cognitive impairments that affect their ability to learn and use basic academic skills. A proposed cause for this variability has been working memory (WM) capacity. Altered patterns of event-related potentials (ERPs) in these children have also been found in the N400 component associated with semantic priming. However, regarding the semantic priming effect in LD children, no distinction has been made for children with varying WM abilities. This study aims to explore the relationship of WM with the brain's electrophysiological response that underlies semantic priming in LD children that performed a lexical decision task. A total of 40 children (8-10 years old) participated: 28 children with LD and 12 age-matched controls. The ERPs were recorded for each group and analyzed with permutation-based t-tests. The N400 effect was observed only in the control group, and both groups showed a late positive complex (LPC). Permutation-based regression analyses were performed for the results from the LD group using the WISC-IV indices (e.g., Verbal Comprehension and WM) as independent predictors of the ERPs. The Verbal Comprehension Index, but not the WM index, was a significant predictor of the N400 and LPC effects in LD children.

Factors associated with salbutamol overuse in bronchiolitis.

Numerous studies have shown that quality improvement methods can reduce the use of medications in the management of bronchiolitis. Our objective is to identify factors related to the overuse of salbutamol in the treatment of bronchiolitis before and after an improvement initiative. Observational study of sociodemographic and clinical factors associated with the use of salbutamol in children diagnosed with bronchiolitis. This was a secondary analysis of a prospective cohort study conducted at 135 primary care (PC) centers and eight pediatric emergency departments (ED) in the Osakidetza/Basque Health Service (Spain) in two epidemic seasons between which a bronchiolitis integrated care pathway (BICP) had been implemented: pre-intervention season from October 2018 to March 2019 and post-intervention season from October 2019 to March 2020. Generalized linear mixed models were used to estimate association of studied variables on use of salbutamol over the two seasons. Four thousand one hundred thirty-four ED attendances and 8573 PC visits were included, of which 1936 (46.8%). And 4067 (47.4%) occurred in the post-intervention period respectively. Six independent risk factors were associated with overuse of salbutamol in both seasons: age ≥ 1 year, aOR 2.32 (2.01 to 2.68) in PC centers, and aOR 6.84 (4.98 to 9.39) in EDs; being seen in the last third of the bronchiolitis season, aOR 1.82 (1.51 to 2.18) in PC centers and aOR 1.78 (1.19 to 2.64) in EDs; making more than one visit to the PC center, aOR 4.18 (3.32 to 5.27) or the ED, aOR 2.06 (1.59 to 2.66); being seen by a general practitioner, aOR 1.97 (1.58 to 2.46) in PC centers; and having a more severe episode, aOR 3.01 (1.89 to 4.79) in EDs.     Conclusion:There are factors associated with salbutamol overuse in children diagnosed with bronchiolitis in PC and emergency settings that persist after the deployment of quality improvement initiatives. What is Known: • Quality improvement initiatives have been shown to decrease the use of non-evidence-based treatments and testing in bronchiolitis. • The magnitude and pattern of change in the use of medications linked to the quality improvement initiatives are not uniform across the same health service. What is New: • Children diagnosed with bronchiolitis ≥ 1 year of age, seen in the last third of the bronchiolitis season, attending more than once, treated by a general practitioner, and/or with more severe episodes are more likely to be treated with salbutamol. • These factors may remain present despite the implementation of improvement initiatives focused on reducing the use of medications in the management of bronchiolitis.

Febrile Urinary Tract Infection in Infants Less Than 3 Months of Age.

INTRODUCTION: Urinary tract infection (UTI) is the leading cause of bacterial infection in infants younger than 3 months of age with fever without a source. OBJECTIVE: The objective of the study was to analyze the characteristics of emergency department presentations of febrile infants younger than 3 months of age with a UTI and identify risk factors for invasive bacterial infection (IBI) secondary to UTI. METHODS: This was a secondary analysis of a prospective observational registry that includes infants younger than 3 months with fever without a source managed at a pediatric emergency department between 2003 and 2019. RESULTS: Of the 2850 patients included, 592 (20.8%) were diagnosed with a UTI (524, 88.5%, for Escherichia coli ). Infants with UTIs showed significant clinical differences when compared with those not diagnosed with a bacterial infection: patients with a UTI were more likely to have a history of renal/urological problems (8.3% vs. 3.5%), temperature ≥39ºC (38.3% vs. 29%) and poor feeding (13% vs. 8.7%). Yet, nearly half (285 of the 592, 48.1%) of the infants with febrile UTIs had none of these 3 risk factors. Thirty-six infants (6.1%) had a secondary IBI. We identified the following independent risk factors for secondary IBI: infants younger than 1 month of age, parent-reported irritability, procalcitonin >0.5 ng/mL, and C-reactive protein >60 mg/L. CONCLUSIONS: History and physical examination do not allow us to safely rule out a UTI among young febrile infants. Age, parent-reported irritability, and biomarkers are useful in identifying patients at increased risk of secondary IBI.

Variations in the composition and structure of the lignins of oat (Avena sativa L.) straws according to variety and planting season.

The differences in the composition and structure of the lignins from straws of different oat (Avena sativa L.) varieties, planted in two seasons (winter and spring), were studied in detail by different analytical techniques such as pyrolysis coupled to gas chromatography-mass spectrometry (Py-GC/MS), two-dimensional nuclear magnetic resonance (2D-NMR), derivatization followed by reductive cleavage (DFRC), and gel permeation chromatography (GPC). Overall, the analyses revealed that oat straw lignins were enriched in guaiacyl (G; 50-56 %) and syringyl (S; 39-44 %) units, with relatively lower amounts of p-hydroxyphenyl (H; 4-6 %) units. The lignins also incorporated significant quantities of p-coumarates (8-14 % of total lignin units), which are acylating the γ-OH of the lignin side chains, and predominantly over the S units. Furthermore, oat straw lignins also incorporated considerable amounts of the flavone tricin (5-12 % of total lignin units). Interestingly, this study revealed that the lignin content and composition of the oat straws vary with genotype and planting season. Since p-coumarates and tricin are high-value aromatic compounds especially attractive from a biorefinery point of view, the information disclosed here is highly relevant to plant breeding programs aimed at developing functional foods and lignin modifications for improved biorefinery applications.

Effects of neurofeedback on the self-concept of children with learning disorders.

Children with learning disorders (LDs) often have a lower self-concept than their typically developing peers. Neurofeedback (NFB) treatments seem to improve the cognitive and academic performance of these children, but the effects on self-concept have not been studied. In this exploratory study, 34 right-handed children (8-11 y.o.) with LD and delayed electroencephalographic maturation responded to the Piers-Harris Children's Self-Concept Scale. One group received NFB (n = 20), and another group (n = 14) served as control, which included 9 children treated with sham-NFB and 5 on a waiting-list. A nonparametric permutation approach was used to compare the academic performance and self-concept difference (postscores - prescores) between the NFB and control groups. Given the smaller size of the control subgroups, a comparison of the percent changes between sham-NFB and the waiting-list was performed with the non-overlap of all pairs (NAP) technique. In the NFB group, the scores of reading, math, and global self-concept increased significantly, highlighting the self-concept subdomains of physical appearance, nonanxiety, popularity, and happiness. Additionally, the sham-NFB subgroup showed better outcomes than the waiting-list subgroup, perhaps due to noncontrolled factors. We found improved academic performance and self-concept in children with LDs who received NFB treatment. This study is an important exploratory step in studying a relevant treatment that seems to ameliorate symptoms of LDs such as anxiety and low self-concept.

Polymorph Stability and Free Energy of Crystallization of Freely-Jointed Polymers of Hard Spheres.

The free energy of crystallization of monomeric hard spheres as well as their thermodynamically stable polymorph have been known for several decades. In this work, we present semianalytical calculations of the free energy of crystallization of freely-jointed polymers of hard spheres as well as of the free energy difference between the hexagonal closed packed (HCP) and face-centered cubic (FCC) polymorphs. The phase transition (crystallization) is driven by an increase in translational entropy that is larger than the loss of conformational entropy of chains in the crystal with respect to chains in the initial amorphous phase. The conformational entropic advantage of the HCP polymer crystal over the FCC one is found to be ΔschHCP-FCC≈0.331×10-5k per monomer (expressed in terms of Boltzmann's constant k). This slight conformational entropic advantage of the HCP crystal of chains is by far insufficient to compensate for the larger translational entropic advantage of the FCC crystal, which is predicted to be the stable one. The calculated overall thermodynamic advantage of the FCC over the HCP polymorph is supported by a recent Monte Carlo (MC) simulation on a very large system of 54 chains of 1000 hard sphere monomers. Semianalytical calculations using results from this MC simulation yield in addition a value of the total crystallization entropy for linear, fully flexible, athermal polymers of Δs≈0.93k per monomer.