Home Management of Childhood Asthma Exacerbations.

INTRODUCTION: Effective home management of childhood asthma by caregivers requires education along with a written asthma action plan (AAP), which should outline clear instructions for treatment during exacerbations. However, a large number of asthma exacerbations continue to be managed in the emergency department (ED) and in hospitals, particularly in Canada. The objective of this study was to assess caregiver management of acute asthma at home following the 2015 Global Initiative for Asthma (GINA) guidelines and to identify factors that may be associated with deviations from these guidelines. METHODS: 122 caregivers of children, aged 3-17 years, with physician diagnosed asthma, completed a paper-based questionnaire. Correct caregiver management (defined according to the GINA guidelines) of acute asthma as well as their use of an AAP were assessed. RESULTS: Out of all caregivers, 74.6% incorrectly treated their child's asthma exacerbation in a home setting. Among those who used an AAP, we observed significantly more ED visits (0.9 ± 1.2 versus 0.5 ± 0.9, p = 0.04) and hospitalizations (0.2 ± 0.4 versus 0.0 ± 0.0, p = 0.02) when compared to non-AAP users in the past 1 year. CONCLUSIONS: Caregivers of children with asthma in Canada may still lack skills for proper home management of asthma exacerbations. We found a higher number of ED visits and hospitalizations in those using an AAP compared to those who did not use an AAP. These data suggest that current AAPs may not be sufficient for home asthma management.

Accurate amorphous silica surface models from first-principles thermodynamics of surface dehydroxylation.

Accurate atomically detailed models of amorphous materials have been elusive to-date due to limitations in both experimental data and computational methods. We present an approach for constructing atomistic models of amorphous silica surfaces encountered in many industrial applications (such as catalytic support materials). We have used a combination of classical molecular modeling and density functional theory calculations to develop models having predictive capabilities. Our approach provides accurate surface models for a range of temperatures as measured by the thermodynamics of surface dehydroxylation. We find that a surprisingly small model of an amorphous silica surface can accurately represent the physics and chemistry of real surfaces as demonstrated by direct experimental validation using macroscopic measurements of the silanol number and type as a function of temperature. Beyond accurately predicting the experimentally observed trends in silanol numbers and types, the model also allows new insights into the dehydroxylation of amorphous silica surfaces. Our formalism is transferrable and provides an approach to generating accurate models of other amorphous materials.

The knee: internal fixation techniques for osteochondritis dissecans.

For the athlete with a newly diagnosed osteochondritis dissecans of the knee, the first step in formulating a treatment plan is determining the stability of the lesion. When the lesion is found to be unstable but salvageable, several methods for fixation are available. Fixation of osteochondritis dissecans in the athletic population has been described and each has its own advantages and disadvantages. Determining the most appropriate method for fixation depends on several variables and should include the athlete's level of play, sport, and overall goals.

The functional analysis of problematic verbal behavior.

This study describes procedures and outcomes in a functional analysis of problem behavior of 2 public school students. For a 13-year-old honors student, bizarre tacts (labeled as psychotic speech by school staff) were maintained by attention. For a 15-year-old with autism, the functional analysis revealed that perseverative mands for toileting were controlled by attention; mands for edible items were controlled by access to any food item; and mands for nonedible items were maintained by access to the specific item manded. The "problematic" aspects of the verbal behavior differed-the bizarre speech was problematic based on its content, but the perseverative verbalizations resulted in high response cost for classroom staff. Research in the area of problematic verbal behavior is sparse and warrants further attention from behavior analysts who work in public school settings. This research demonstrates the applicability and relevance of functionally analyzing problematic verbal behavior in public school settings.