The community pharmacy model for colorectal cancer screening: Policy insights from a national programme.

BACKGROUND: In Italy, a recent national project has expanded local collaboration between colorectal (CRC) screening programmes and pharmacies to the national level. OBJECTIVE: The objective of this study is to provide an overview of the existing agreements between regional authorities and pharmacy owners in Italy regarding CRC screening programmes, to make internationally available the most qualifying elements of the collaboration. METHODS: We analyzed the agreements, in force on 01/08/2021, arranged between the Regions and their respective pharmacy owners, describing the process phases addressed such as the faecal occult blood test pathway and supplementary activities provided by the pharmacies together with the CRC screening kit delivery. RESULTS: Agreements were received from 18 Regions (86% of the total). The amount of money paid for each kit varies a lot, with a range from 0 to 18 EUR. The number of process phases covered by the agreements ranged from a maximum of 16 (out of 18) to a minimum of 0. The processes most frequently covered were the supply/delivery of kits and education/awareness of CRC screening (68.8%). Less covered processes were warehouse management and awareness of other healthcare initiatives (12.5%), and delivery of preparation for intestinal cleansing (6.3%). CONCLUSIONS: Arrangements between pharmacies and CRC screening programmes in Italy vary widely and lack a unified model. Collaboration quality standards should be set at the national/international level.

Super-resolution and apodization with discrete adaptive optics.

High-resolution imaging is of great importance in various fields. The use of pupil phase-only filters (PPF) exceeds the diffraction limit of the imaging system in a simple way. When dealing with distorted wavefronts, however, PPF require that aberrations be compensated for. In this paper, we introduce a novel technique consisting of the use of discrete adaptive optics with PPFs so that the compensating device implements the PPF at the same time. Analysis of the theory for point spread function reshaping using PPFs has enabled us to develop a new approach to characterizing apodizing filters. A validation experiment has been carried out, the first of its kind to our knowledge, in which a number of PPFs were combined with two levels of compensation. Our experimental results are discussed.

Application of different alkaline materials as polluted soil amendments: A comparative assessment of their impact on trace element mobility and microbial functions.

Treatment with chemical amendments is among the best techniques to remediate soils highly polluted with trace elements. The use of waste-derived products has several advantages in this regard, mainly in terms of reducing process costs and conserving natural resources. In this study, the performance of the synthetic zeolite NaP1 derived from coal combustion fly ash (SZ) and the by-product generated from the processing of aluminum salt slags (BP) was evaluated with this aim in comparison to calcite (CC). For this purpose, mine soils polluted with Zn, Cd, and Pb were amended under controlled laboratory conditions with different doses (0%, 1%, 2%, 5%, and 10%) of SZ, BP, or CC, and their impact on trace element mobility and microbial functions was evaluated. Specifically, the mobile and mobilizable trace element pools, basal soil respiration, and different enzyme activities were analyzed. Both SZ and BP performed better than CC in the immobilization of trace elements, reaching, respectively, mobility decreases up to 89-94% and 66-87% when applied at a dose of 10%. These amendments reduced the mobile trace element pool by precipitating them as acid-soluble precipitates and/or retaining them in the reducible fraction of soils. The alkaline nature of these materials and the concomitant increase in soil pH caused by their application mainly accounted for this behavior. Additionally, soil microbial functionality improved after amendment, especially in the case of SZ, as shown by dehydrogenase and alkaline phosphatase activities, which significantly increased (p < 0.05) up to 536% and 48%, respectively. Therefore, applying SZ or BP as soil amendments can significantly decrease the mobile trace element contents of heavily polluted soils without negatively affecting soil quality, thus facilitating plant growth to revegetate and reclaim degraded spaces.

Efficacy of an information system addressed to nursing staff for diminishing contaminated blood cultures: a blind clinical trial.

OBJECTIVE: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. METHODS: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. RESULTS: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. CONCLUSIONS: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it.

Beach nourishment using sediments from relict sand deposit: Effects on subtidal macrobenthic communities in the Central Adriatic Sea (Eastern Mediterranean Sea-Italy).

Nowadays nourishment is the most popular shore reconstruction strategy to counteract erosion of coastal areas. Sediments used for nourishment can have terrestrial or marine origin. This study analysed the effects of nourishment with relict sand on the subtidal macrobenthic communities and on the surface sediment at 7 sites of the Marche Region (Central Adriatic Sea, Italy). Samples for biological and physical analyses were collected in each site before and after nourishment. One year after nourishment the presence of the relict sands used for the replenishment is still visible in the sediment of each site. In the same period macrobenthic communities are characterised by the dominance of a few species able to avoid burial and suffocation phenomena, showing a low variability respect to the communities present before.

Acquired haemophilia A as a secondary autoimmune disease after alemtuzumab treatment in multiple sclerosis: A case report.

Alemtuzumab is a highly effective monoclonal antibody for the treatment of multiple sclerosis (MS). During the immune reconstitution following the use of this treatment severe secondary autoimmune diseases (SADs) can develop. We present the case of a patient affected by active MS who failed to achieve disease control with several disease-modifying drugs and was thereafter successfully treated with alemtuzumab, obtaining no evidence of disease activity and a high quality of life. Twenty months after the first infusion of alemtuzumab the patient developed acquired haemophilia A (AHA), a treatable but potentially lifethreatening condition that should be considered a possible SADs associated to this drug. In order to allow an early diagnosis and to prevent possible complications of AHA, routine coagulation tests (prothrombin time and activated partial thromboplastin time) should be included in the laboratory serological monitoring of patients treated with alemtuzumab.

Arsenic distribution in a pasture area impacted by past mining activities.

Former mine exploitations entail a serious threat to surrounding ecosystems as after closure of mining activities their unmanaged wastes can be a continuous source of toxic trace elements. Quite often these mine sites are found within agricultural farming areas, involving serious hazards as regards product (feed/food) quality. In this work a grazing land impacted by the abandoned mine exploitation of an arsenical deposit was studied so as to evaluate the fate of arsenic (As) and other trace elements and the potential risks involved. With this aim, profile soil samples (0-50cm) and pasture plant species (Agrostis truncatula, Holcus annus and Leontodon longirostris) were collected at different distances (0-100m) from the mine waste dump and analyzed for their trace element content and distribution. Likewise, plant trace element accumulation from impacted grazing soils and plant trace element translocation were assessed. The exposure of livestock grazing animals to As was also evaluated, establishing its acceptability regarding food safety and animal health. International soil guideline values for As in grazing land soils (50mgkg-1) resulted greatly exceeded (up to about 20-fold) in the studied mining-affected soils. Moreover, As showed a high mobilization potential under circumstances such as phosphate application or establishment of reducing conditions. Arsenic exhibited relatively high translocation factor (TF) values (up to 0.32-0.89) in pasture plant species, reaching unsafe concentrations in their above-ground tissues (up to 32.9, 16.9 and 9.0mgkg-1 in Agrostis truncatula, Leontodon longirostris and Holcus annus, respectively). Such concentrations represent an elevated risk of As transfer to the high trophic-chain levels as established by international legislation. The limited fraction of arsenite found in plant roots should play an important role in the relatively high As root-to-shoot translocation shown by these plant species. Both soil ingestion and pasture intake resulted important entrance pathways of As into livestock animals, showing quite close contribution levels. The cow acceptable daily intake (ADI) of As regarding food safety was surpassed in some locations of the study area when the species Agrostis truncatula was considered as the only pasture feed. Restrictions in the grazing use of lands with considerable As contents where this plant was the predominant pasture species should be established in order to preserve food quality. Therefore, the exposure of livestock animals to As via both soil ingestion and pasture consumption should be taken into account to establish the suitability of mining-impacted areas for gazing.

Cambios en la función motora en pacientes con distrofia muscular de Duchenne: estudio descriptivo / Progression of motor function disorders in patients with Duchenne muscular dystrophy: a descriptive study

Introduction: duchenne muscular dystrophy (DMD) is a neuromuscular disease inherited in an X-linked recessive pattern, characterized by progressive muscle weakness, affecting axial muscles in the first place, and then the rest of the body’s muscles. In our country there is no record of the progressive behavior of the disease in children with DMD. Objective: to describe the progression of motor function disorders per age group in DMD patients. Method: Descriptive, cross-sectional study with 26 patients diagnosed with DMD, classified in 4 groups according to the evolution of the disease, using Motor Function Measure (MFM), Brooke and Vignos scales in Instituto teletón in Santiago between April and october 2013. Results: Median values and interquartile range (IQR) according to total MFM percentages by group were: Group 1 (3-5 years): 88.3 (5.8); Group 2 (6-9 years): 76.0 (20.8); Group 3 (10-14 years): 36.4 (8.3), and Group 4 (≥ 15 years): 31.2 (15.1). According to Vignos scale, G1 reached level 2; G2 reached level 3 and G3 and G4, level 9. According to Brooke scale, G1 and G2 reached level 1 and G3 and G4, level 5. Conclusion: MFM allowed an objective assessment of motor function progression in DMD per age group; dimension 1 shows the progression of the disease at an early stage and dimension 3 is better preserved in later stages of the disease. these results could facilitate a multi and inter-disciplinary approach.

Introducción: la distrofia muscular de Duchenne (DMD) es una enfermedad neuromuscular de carácter hereditario recesivo ligado al cromosoma X, caracterizada por debilidad muscular progresiva, afectando inicialmente a los músculos de cintura pélvica y escapular para luego abarcar todo el cuerpo. En nuestro país no se cuenta con un registro del comportamiento progresivo de la enfermedad en niños con DMD. Objetivo: Describir los cambios en la función motora según grupo etario en pacientes con DMD. Metodología: Estudio descriptivo, transversal, en 26 pacientes, con diagnóstico confirmado de DMD, clasificados en 4 grupos según fase de evolución de la enfermedad, a quienes se aplicó las escalas Medición Evaluación Motora (MFM), Vignos y Brooke en el Instituto teletón Santiago entre abril y octubre de 2013. Resultados: Las medianas y rangos intercuartílicos, según porcentajes totales de MFM, por cada grupo fueron: Grupo 1 (3-5 años): 88,3 (5,8); Grupo 2 (6-9 años): 76,0 (20,8); Grupo 3 (10-14 años): 36,4 (8,3) y Grupo 4 (15 años y más): 31,2 (15,1). Según Escala de Vignos, G1 se situó en nivel 2; G2 en nivel 3 y G3 y G4 en nivel 9. En escala de Brooke, G1 y G2 se situaron en nivel 1 y G3 y G4 en nivel 5. Conclusión: La MFM permitió una evaluación objetiva de los cambios en la función motora de pacientes con DMD según grupos etarios; la Dimensión 1 informa tempranamente la progresión y la Dimensión 3 se preserva mejor en estadios tardíos de la enfermedad, resultados que direccionan el abordaje multi e interdisciplinario.

Trace element levels in an area impacted by old mining operations and their relationship with beehive products.

The environmental status of an area impacted by Roman mining activities was assessed in order to establish the current risks posed by such old mine emplacements. For this purpose, soil samples were collected throughout the mining area and analysed for their total, mobile and mobilizable trace element (As, Cd, Mo, Sb and Zn) contents. Additionally, beehive products (honey and pollen) were also sampled and evaluated for their use as environmental indicators of the area. The results obtained were compared with those from a control non-polluted area. The mine soils presented slightly increased levels of Cd and Sb (about 2- to -3-fold their normal soil concentrations), whereas the enrichment of As reached considerable levels, with concentrations almost ten-fold of those considered the threshold for causing toxicity. Leachable As contents exhibited very high values (1.2-21.9mgkg-1), indicating the need for risk attenuation measures. All trace elements were mainly partitioned in the soil residual fraction, especially Mo (76-99%) and Sb (61-91%). Significant partitioning levels were also found in the reducible fraction of As (up to 35%) and Cd (up to 38%), and in the oxidizable fraction of Mo (up to 23%). The reducible pool of As was particularly relevant due to the eventual mobilization of this element under reducing conditions. Among the beehive products tested, honey proved not to be useful as an environmental indicator, whereas pollen showed great potential as an indicator when the contamination levels were moderate to high.

A comparative study on the influence of different organic amendments on trace element mobility and microbial functionality of a polluted mine soil.

A mine soil heavily polluted with zinc and cadmium was employed to evaluate the capacity of organic amendments of different origin to simultaneously reduce soil trace element mobility and enhance soil microbial functionality. With this aim, four organic products, namely olive processing solid waste (OPSW), municipal solid waste compost (MSWC), leonardite and peat, were applied individually at different doses (0, 1, 2 and 5%) to mine soil under controlled laboratory conditions. Extraction studies and analysis of soil microbiological parameters (basal soil respiration and dehydrogenase, ß-glucosidase, urease, arylsulfatase and acid and alkaline phosphatase activities) were performed to assess the effect of such amendments on soil restoration. Their ability to decrease mine soil mobile trace element contents followed the sequence MSWC > OPSW > peat > leonardite, with the former achieving reduction levels of 78 and 73% for Zn and Cd, respectively, when applied at a dose of 5%. This amendment also showed a good performance to restore soil microbial functionality. Thus, basal soil respiration and dehydrogenase, urease and alkaline phosphatase activities experienced increases of 187, 79, 42 and 26%, respectively, when mine soil was treated with 5% MSWC. Among tested organic products, MSWC proved to be the best amendment to perform both the chemical and the microbial soil remediation.

Neutropenia en la infancia: experiencia de 15 años en un hospital terciario / Neutropenia in childhood: a 15-year experience in a tertiary hospital

Objetivos: Analizar las formas clínicas de presentación, hallazgos al diagnóstico, caracterización etiológica y evolución de los diferentes tipos de neutropenia en la infancia, excluida la asociada a diagnóstico o tratamiento oncológico. Material y métodos: Estudio retrospectivo descriptivo sobre una serie de casos clínicos consecutivos en niños diagnosticados de neutropenia, durante los años 2000-2015. Estudio analítico por grupos etiológicos agrupando formas congénitas y adquiridas y grupos de edad. Resultados: Se incluyeron 43 casos predominando las formas adquiridas (35, 81,4%). Las neutropenias congénitas (8, 18,6%) se asociaron a neutropenia benigna familiar (3), anemia de Fanconi (2) y neutropenia cíclica (3), sin otros casos de neutropenia congénita grave. El diagnóstico de la neutropenia se realizó por hallazgo analítico casual en 20 casos (46,5%) y en 17 (39,5%) por analítica por infección. La mediana de neutrófilos al diagnóstico fue significativamente menor en el grupo de neutropenias autoinmune primaria que en el grupo postinfecciosa. En 23 casos (53,5%) la neutropenia fue persistente. En las formas congénitas se apreció mayor duración de la neutropenia y mayor porcentaje de infecciones de repetición. En las adquiridas el porcentaje de neutropenia moderada y grave o muy grave fue mayor en el grupo de menores de dos años. Las pruebas de mayor rentabilidad diagnóstica fueron los anticuerpos antineutrófilos (63,3%) y el estudio de médula ósea (41,6%). Conclusiones: Debido a la excepcionalidad de las formas congénitas graves, en la infancia predominan las formas adquiridas de neutropenia y en éstas se asocia la mayor severidad al diagnóstico de neutropenia autoinmune primaria

Objectives: To analyze the clinical forms of presentation, findings at diagnosis, etiological characterization and clinical evolution of different types of neutropenia in childhood, excluding those associated with diagnosis or oncological treatment. Material and methods: A retrospective descriptive study of a series of consecutive clinical cases in children diagnosed with neutropenia during the years 2000-2015. Etiological form grouping congenital and acquired types and age groups, were investigated. Results: Forty-five cases were included, predominantly acquired forms (35, 81.4%). Congenital neutropenia (8, 18.6%) were associated with ethnic neutropenia (3), Fanconi anemia (2) and cyclic neutropenia (3), without other cases of severe congenital neutropenia. The diagnosis of neutropenia was made by casual analytical finding in 20 cases (46.5%) and in 17 (39.5%) by analytic coincidence with infection. The median neutrophils at diagnosis were significantly lower in the primary autoimmune neutropenia group than in the postinfectious group. In 23 cases (53.5%), neutropenia was persistent. In the congenital forms, the duration of neutropenia and a higher percentage of recurrent infections were observed. In the acquired cases, the percentage of moderate and severe or very severe neutropenia was higher in the group of children under two years. The most diagnostic tests were neutrophil antibodies assay (63.3%) and the bone marrow study (41.6%). Conclusions: Due of the exceptional nature of severe congenital forms, acquired forms of neutropenia predominate in childhood. In these, the greatest severity is associated with the diagnosis of primary autoimmune neutropenia

Lesiones de mancha blanca en Ortodoncia. Conceptos actuals / White Spot Lesions in Dentistry. Current concepts

El desarrollo de lesiones de mancha blanca (WSLs) es un riesgo significativo asociado con el tratamiento de ortodoncia cuando la higiene oral es deficiente. Aparatos de ortodoncia fijos transforman los procedimientos de higiene oral convencionales más difíciles y aumentan el número de sitios de retención de placa. Si bien los valores de prevalencia son variados, los datos son suficientes para considerar la desmineralización como un problema importante, haciendo de la prevención durante el tratamiento uno de los mayores desafíos clínicos. El propósito de este trabajo es realizar una revisión actualizada de la literatura disponible respecto a la etiología, prevención y tratamiento de manchas blancas asociadas al tratamiento de ortodoncia con aparatología fija (AU)

The development of white spot lesions (WSLS) is a significant risk associated with orthodontic treatment when oral hygiene is poor. Fixed orthodontic appliances transform procedures of conventional oral hygiene more difficult and increase the number of sites plaque retention. While prevalence values vary, the data are sufficient to consider the demineralization as an important problem, making prevention during treatment one of the major clinical challenges. The purpose of this paper is review to date the available literature regarding the etiology, prevention and treatment of white spots associated with orthodontic treatment with dental braces (AU)

Supervivencia y estado neurológico de la parada cardiaca extrahospitalaria en edad pediátrica en Andalucía / Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia

OBJETIVO: No existe demasiada información sobre la evolución y estado neurológico a largo plazo de los pacientes en edad pediátrica que sobreviven a una parada cardiaca extrahospitalaria. Nuestro objetivo es describir la supervivencia y estado neurológico de estos pacientes a largo plazo. DISEÑO: Estudio observacional retrospectivo. Basado en el Registro Andaluz de Parada Cardiaca Extrahospitalaria. ÁMBITO: Atención Prehospitalaria. PACIENTES: Entre 0 y 15 años atendidos entre enero de 2008 y diciembre de 2012 por Parada Cardiaca Extrahospitalaria. Intervenciones: Seguimiento de pacientes. Variables: Se incluyen variables de la atención prehospitalaria, hospitalaria y del seguimiento al año y un seguimiento específico de los supervivientes en junio de 2014. RESULTADOS: Se incluyeron en el registro un total de 5069 pacientes de los que 125(2.5%) tenían 15 o menos años. La parada fue presenciada en el 52.8% de los casos y hubo reanimación previa en 65.6%. El ritmo inicial fue desfibrilable en 7 (5.2%) casos. Un 48.8% de los pacientes llegó al hospital aunque un 20% lo hizo en situación de reanimación en curso. De los 9 (7.2%) pacientes que sobrevivieron al alta hospitalaria, 5 de ellos lo hicieron con recuperación ad integrum y 4 con grave deterioro neurológico. Los 5 pacientes con recuperación completa mantuvieron su situación a largo plazo. Los 4 pacientes restantes, aunque con discreta mejoría, se mantuvieron en situación de discapacidad neurológica. CONCLUSIONES: La supervivencia de la parada cardiaca extrahospitalaria en edad pediátrica es baja. El pronóstico a largo plazo de los pacientes con buena recuperación neurológica desde el inicio se mantiene, aunque la mejoría en el resto es mínima

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. Interventions: Patients follow up. Variables: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged less or equal15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal

Welfare effects of a disease eradication programme for dairy goats.

The Norwegian dairy goat industry has largely succeeded in controlling caprine arthritis encephalitis (CAE), caseous lymphadenitis (CLA) and paratuberculosis through a voluntary disease eradication programme called Healthier Goats (HG). The aim of this study was to apply an on-farm welfare assessment protocol to assess the effects of HG on goat welfare. A total of 30 dairy goat farms were visited, of which 15 had completed disease eradication and 15 had not yet started. Three trained observers assessed the welfare on 10 farms each. The welfare assessment protocol comprised both resource-based and animal-based welfare measures, including a preliminary version of qualitative behavioural assessments with five prefixed terms. A total of 20 goats in each herd were randomly selected for observations of human-animal interactions and physical health. The latter included registering abnormalities of eyes, nostrils, ears, skin, lymph nodes, joints, udder, claws and body condition score. For individual-level data, robust clustered logistic regression analyses with farm as cluster variable were conducted to assess the association with disease eradication. Wilcoxon rank-sum tests were used for comparisons of herd-level data between the two groups. Goats with swollen joints (indicative of CAE) and enlarged lymph nodes (indicative of CLA) were registered on 53% and 93% of the non-HG farms, respectively, but on none of the HG farms. The only other health variables with significantly lower levels in HG herds were skin lesions (P=0.008) and damaged ears due to torn out ear tags (P<0.001). Goats on HG farms showed less fear of unknown humans (P=0.013), and the qualitative behavioural assessments indicated that the animals in these herds were calmer than in non-HG herds. Significantly more space and lower gas concentrations reflected the upgrading of buildings usually done on HG farms. In conclusion, HG has resulted in some welfare improvements beyond the elimination of infectious diseases. The protocol was considered a useful tool to evaluate the welfare consequences of a disease eradication programme. However, larger sample sizes would increase the reliability of prevalence estimates for less common conditions and increase the power to detect differences between the groups. Despite the obvious link between disease and suffering, this aspect is rarely taken into account in the evaluation of disease control programmes. We therefore propose that welfare assessment protocols should be applied to evaluate the merits of disease control or eradication programmes in terms of animal welfare.

Survival and neurological status after out-of-hospital cardiac arrest in the pediatric population in Andalusia.

OBJECTIVE: Little is known about the evolution and long-term neurological status of pediatric patients who survive out-of-hospital cardiac arrest. Our aim is to describe long-term survival and neurological status. DESIGN: Retrospective observational study, based on the Andalusian Register of out-of-hospital Cardiac Arrest. SETTING: Pre-hospital Care. PATIENTS: The study included patients aged 0-15 years between January 2008 and December 2012. INTERVENTIONS: Patients follow up. VARIABLES: Prehospital and hospital care variables were analyzed and one-year follow-up was performed, along with a specific follow-up of survivors in June 2014. RESULTS: Of 5069 patients included in the register, 125 (2.5%) were aged ≤15 years. Cardiac arrest was witnessed in 52.8% of cases and resuscitation was performed in 65.6%. The initial rhythm was shockable in 7 (5.2%) cases. Nearly half (48.8%) the patients reached the hospital alive, of whom 20% did so while receiving resuscitation maneuvers. Only 9 (7.2%) patients survived to hospital discharge; 5 showed ad integrum recovery and 4 showed significant neurological impairment. The 5 patients with complete recovery continued their long-term situation. The remaining 4 patients, although slight improvement, were maintained in situation of neurological disability. CONCLUSIONS: Survival after out-of-hospital cardiac arrest in pediatric patients was low. The long-term prognosis of survivors with good neurological recovery remains, although improvement in the rest was minimal.

Evaluation of ferrihydrite as amendment to restore an arsenic-polluted mine soil.

The effectiveness of ferrihydrite as amendment to restore the soil habitat functioning of a soil polluted with As by mining activities was evaluated. Its influence on As mobility and phytoavailability was also assessed. Soil treated with increasing amendment doses (0, 1, 2, and 5 %) were analyzed for soil microbiological parameters such as basal soil respiration and dehydrogenase, ß-glucosidase, urease, acid and alkaline phosphatase, and arylsulfatase activities. Batch leaching tests and plant growth experiments using ryegrass and alfalfa plants were performed. The treatment with ferrihydrite was effective to reduce As mobility and plant As uptake, translocation, and accumulation. Likewise, the soil microbiological status was generally improved as derived from basal soil respiration and dehydrogenase and acid and alkaline phosphatase activities, which showed increases up to 85, 45, 11, and 47 %, respectively, at a ferrihydrite addition rate of 5 %.

Caprine arthritis encephalitis and caseous lymphadenitis in goats: use of bulk tank milk ELISAs for herd-level surveillance.

The objective of this study was to evaluate the diagnostic performance of two ELISA tests applied to bulk tank milk (BTM) as the first part of a two-step test scheme for the surveillance of caprine arthritis encephalitis (CAE) and caseous lymphadenitis (CLA) infections in goats. The herd-level BTM tests were assessed by comparing them to the test results of individual serological samples. The potential for refining the cut-off levels for BTM tests used as surveillance tools in a population recently cleared of infection was also investigated. Data was gathered on serum (nCAE =9702 and nCLA=13426) and corresponding BTM (nCAE=78 and nCLA=123) samples from dairy goat herds enrolled in the Norwegian disease control and eradication programme 'Healthier Goats'. The results showed that the sensitivity and specificity of the CAE ELISA BTM test with respect to detecting ≥2 per cent within-herd prevalence were 72.7 per cent and 86.6 per cent, respectively. For the CLA ELISA BTM the sensitivity and specificity were 41.4 per cent and 81.7 per cent, respectively, for the same goal of detection. The results suggest that BTM testing can be applied as a cost-effective first step for early detection of CAE and CLA infection.

The Norwegian Healthier Goats program--modeling lactation curves using a multilevel cubic spline regression model.

In 2001, the Norwegian Goat Health Service initiated the Healthier Goats program (HG), with the aim of eradicating caprine arthritis encephalitis, caseous lymphadenitis, and Johne's disease (caprine paratuberculosis) in Norwegian goat herds. The aim of the present study was to explore how control and eradication of the above-mentioned diseases by enrolling in HG affected milk yield by comparison with herds not enrolled in HG. Lactation curves were modeled using a multilevel cubic spline regression model where farm, goat, and lactation were included as random effect parameters. The data material contained 135,446 registrations of daily milk yield from 28,829 lactations in 43 herds. The multilevel cubic spline regression model was applied to 4 categories of data: enrolled early, control early, enrolled late, and control late. For enrolled herds, the early and late notations refer to the situation before and after enrolling in HG; for nonenrolled herds (controls), they refer to development over time, independent of HG. Total milk yield increased in the enrolled herds after eradication: the total milk yields in the fourth lactation were 634.2 and 873.3 kg in enrolled early and enrolled late herds, respectively, and 613.2 and 701.4 kg in the control early and control late herds, respectively. Day of peak yield differed between enrolled and control herds. The day of peak yield came on d 6 of lactation for the control early category for parities 2, 3, and 4, indicating an inability of the goats to further increase their milk yield from the initial level. For enrolled herds, on the other hand, peak yield came between d 49 and 56, indicating a gradual increase in milk yield after kidding. Our results indicate that enrollment in the HG disease eradication program improved the milk yield of dairy goats considerably, and that the multilevel cubic spline regression was a suitable model for exploring effects of disease control and eradication on milk yield.

The "one-out, all-out" principle entails the risk of imposing unnecessary restoration costs: a study case in two Mediterranean coastal lakes.

The Water Framework Directive uses the "one-out, all-out" principle in assessing water bodies (i.e., the worst status of the elements used in the assessment determines the final status of the water body). In this study, we assessed the ecological status of two coastal lakes in Italy. Indices for all biological quality elements used in transitional waters from the Italian legislation and other European countries were employed and compared. Based on our analyses, the two lakes require restoration, despite the lush harbor seagrass beds, articulated macrobenthic communities and rich fish fauna. The "one-out, all-out" principle tends to inflate Type I errors, i.e., concludes that a water body is below the "good" status even if the water body actually has a "good" status. This may cause additional restoration costs where they are not necessarily needed. The results from this study strongly support the need for alternative approaches to the "one-out, all-out" principle.

Culturable heterotrophic bacteria associated with healthy and bleached scleractinian Madracis decactis and the fireworm Hermodice carunculata from the remote St. Peter and St. Paul Archipelago, Brazil.

We report on the first characterization of the culturable heterotrophic bacteria of the scleractinian Madracis decactis. In addition, we characterized the culturable bacteria associated with the fireworm Hermodice carunculata, observed predating partially bleached coral colonies. Our study was carried out in the remote St. Peter and St. Paul Archipelago (SPSPA), Mid-Atlantic Ridge, Brazil. We constituted a 403 isolates collection and subsequently characterized it by means of pyrH and 16S rRNA partial sequences. We identified Photobacterium, Bacillus, and Vibrio species as members of the culturable microbiota of healthy M. decactis. V. campbellii, V. harveyi, V. communis, and V. maritimus were the most commonly found Vibrio species in healthy corals, representing more than 60 % of all vibrio isolates. Most of the vibrios isolated from the fireworm's tissues (n = 143; >90 %) were identified as V. shiloi. However, we did not recover V. shiloi from bleached M. decactis. Instead, we isolated V. communis, a novel Photobacterium species, Bacillus, Kocuria, and Pseudovibrio, suggesting a possible role of other facultative anaerobic bacteria and/or environmental features (such as water quality) in the onset of bleaching in SPSPA's M. decactis.