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Introduction Tracheomalacia (TM) often occurs in children with oesophageal atresia (OA), leading to recurrent respiratory symptoms and in severe cases to blue spells or ultimately respiratory arrest. In some patients, a secondary posterior tracheopexy may then be indicated. This secondary surgery, as well as respiratory morbidity, may be prevented by performing a primary posterior tracheopexy (PPT) concurrent with primary OA correction. The aim of this trial is to determine if a PPT can decrease—or prevent—tracheal collapse in newborns with OA and TM. Additionally, the trial aims to determine whether the potential observed effect of PPT on tracheal stability is sustained over time.Methods and analysis This is an international multicentre double-blind randomised controlled trial. Seventy-eight children with OA type C will be randomised 1:1 into the no-PPT group or PPT group. Randomisation will be stratified by centre. The degree and location of TM are assessed during preoperative, intraoperative and two postoperative tracheobronchoscopies. The occurrence of TM will be evaluated during three routine follow-up consultations until the age of 6 months. The primary outcome is the degree of collapse of the tracheal wall during the intraoperative tracheobronchoscopy (after performing the PPT/no-PPT), measured in percentages. The difference in the mean degree of collapse will be compared between the no-PPT and the PPT groups using linear regression, adjusting for centre and the preoperative degree of tracheal collapse at baseline. The adjusted mean difference will be reported as effect size together with its 95% CI.Ethics and dissemination Patients will be included after written parental informed consent. The risks and burden associated with the trial are minimal. The institutional review board of the University Medical Center Utrecht has approved this protocol (METC-number 23-256/A). Results will be shared in a peer-reviewed scientific journal and presented at international conferences.Trial registration number NCT06335862.

Summary: Background: Mucosal administration of monoclonal antibodies (mAbs) against respiratory pathogens is a promising alternative for systemic administration because lower doses are required for protection. Clinical development of mucosal mAbs is a highly active field yet clinical proof-of-concept is lacking. Methods: In this investigator-initiated, double-blind, randomized placebo-controlled trial, we evaluated intranasal palivizumab for the prevention of RSV infection in preterm infants (Dutch Trial Register NTR7378 and NTR7403). We randomized infants 1:1 to receive intranasal palivizumab (1 mg/mL) or placebo once daily during the RSV season. Any RSV infection was the primary outcome and RSV hospitalization was the key secondary outcome. The primary outcome was analyzed with a mixed effect logistic regression on the modified intention-to-treat population. Findings: We recruited 268 infants between Jan 14, 2019 and Jan 28, 2021, after which the trial was stopped for futility following the planned interim analysis. Adverse events were similar in both groups (22/134 (16.4%) palivizumab arm versus 26/134 (19.4%) placebo arm). There were 6 dropouts and 168 infants were excluded from the efficacy analyses due to absent RSV circulation during the SARS-CoV-2 pandemic. Any RSV infection was similar in infants in both groups (18/47 (38.3%) palivizumab arm versus 11/47 (23.4%) placebo arm; aOR 2.2, 95% CI 0.7–6.5). Interpretation: Daily intranasal palivizumab did not prevent RSV infection in late preterm infants. Our findings have important implications for the clinical development of mucosal mAbs, namely the necessity of timely interim analyses and further research to understand mucosal antibody half-life. Funding: Funded by the Department of Pediatrics, University Medical Centre Utrecht, the Netherlands.

Background: Between-country differences have been described in antibiotic prescribing for respiratory tract infection (RTI) in primary care, but not yet for diagnostic testing procedures and prescribing confidence. Aim: To describe between-country differences in RTI management, particularly diagnostic testing and antibiotic prescribing, and investigate which factors relate to antibiotic prescribing and GPs’ prescribing confidence. Design & setting: Prospective audit in 18 European countries. Method: An audit of GP-registered patient, clinical, and management characteristics for patients presenting with sore throat and/or lower RTI (n = 4982), and GPs' confidence in their antibiotic prescribing decision. Factors related to antibiotic prescribing and confidence were analysed using multi-level logistic regression. Results: Antibiotic prescribing proportions varied considerably: 40% in six countries. There was also considerable variation in point-of-care (POC) testing (0% in Croatia, Moldova, and Romania, and >65% in Denmark and Norway, mainly for C-reactive protein [CRP] and group A streptococcal [strep A] infection), and in laboratory or hospital-based testing (30% in Croatia, Georgia, Greece, and Moldova, mainly chest X-ray and white blood cell counting). Antibiotic prescribing was related to illness severity, comorbidity, age, fever, and country, but not to having performed a POC test. In nearly 90% of consultations, GPs were confident in their antibiotic prescribing decision. Conclusion: Despite high confidence in decisions about antibiotic prescribing, there is considerable variation in the primary care of RTI in European countries, with GPs prescribing antibiotics overall more often than is considered appropriate. POC testing may enhance the quality of antibiotic prescribing decisions if it can safely reverse decisions confidently made on clinical grounds alone to prescribe antibiotics.

Abstract Background Landscape modifications, urbanization or changes of use of rural-agricultural areas can create more favourable conditions for certain mosquito species and therefore indirectly cause nuisance problems for humans. This could potentially result in mosquito-borne disease outbreaks when the nuisance is caused by mosquito species that can transmit pathogens. Anopheles plumbeus is a nuisance mosquito species and a potential malaria vector. It is one of the most frequently observed species in the Netherlands. Information on the distribution of this species is essential for risk assessments. The purpose of the study was to investigate the potential spatial distribution of An. plumbeus in the Netherlands. Methods Random forest models were used to link the occurrence and the abundance of An. plumbeus with environmental features and to produce distribution maps in the Netherlands. Mosquito data were collected using a cross-sectional study design in the Netherlands, from April to October 2010–2013. The environmental data were obtained from satellite imagery and weather stations. Statistical measures (accuracy for the occurrence model and mean squared error for the abundance model) were used to evaluate the models performance. The models were externally validated. Results The maps show that forested areas (centre of the Netherlands) and the east of the country were predicted as suitable for An. plumbeus. In particular high suitability and high abundance was predicted in the south-eastern provinces Limburg and North Brabant. Elevation, precipitation, day and night temperature and vegetation indices were important predictors for calculating the probability of occurrence for An. plumbeus. The probability of occurrence, vegetation indices and precipitation were important for predicting its abundance. The AUC value was 0.73 and the error in the validation was 0.29; the mean squared error value was 0.12. Conclusions The areas identified by the model as suitable and with high abundance of An. plumbeus, are consistent with the areas from which nuisance was reported. Our results can be helpful in the assessment of vector-borne disease risk.

The main constraint to the fight against container-breeding mosquito vectors of human arboviruses is the difficulty in targeting the multiplicity of larval sources, mostly represented by small man-made water containers. The aim of this work is to assess the feasibility of the "auto-dissemination" approach, already tested for Aedes aegypti, as a possible alternative to traditional, inefficient control tools, against Ae. albopictus in urban areas. The approach is based on the possibility that wild adult females, exposed to artificial resting sites contaminated with pyriproxyfen, can disseminate this juvenile hormone analogue to larval habitats, thus interfering with adult emergence.We carried out four field experiments in two areas of Rome that are typically highly infested with Ae. albopictus, i.e. the main cemetery and a small green area within a highly urbanised neighbourhood. In each area we used 10 pyriproxyfen "dissemination" stations, 10 "sentinel" sites and 10 covered, control sites. The sentinel and control sites each contained 25 Ae. albopictus larvae. These were monitored for development and adult emergence.When a 5% pyriproxyfen powder was used to contaminate the dissemination sites, we observed significantly higher mortality at the pupal stage in the sentinel sites (50-70%) than in the controls (

El presente escrito conlleva parte de las conclusiones pertenecientes al proyecto interdisciplinar 29A340 “Formas De Comprensión de la Identidad. Paisaje, Arte y Patrimonio Cultural en Patagonia”. Se expondrán características del arte paisajista en hitos sobresalientes. Posteriormente se mencionaran las características del arte contemporáneo en artistas de la Patagonia que tienen en cuenta la presencia del viento como espiritualidad. Se desarrolla para eso el concepto de “espiritualidad sublime”. El mismo está basado en la articulación de los conceptos estéticos de “sublimidad” y “espiritualidad” de impurezas. Los exponentes seleccionados para este caso son teóricos de lo sublime: Longino, Kant, Burke y del principal expositor de la interioridad intelectual del artista: Vasili Kandinski. El desarrollo de los significados de paisaje en el mundo occidental es un proceso de cambio en las tecnologías de percepción y modos de representación. A esto se añaden las relaciones sensitivas con mediación entre el espectador y el espacio cultural y material. La cambiante historicidad del paisaje como de la identidad de la comunidad patagónica son características definitorias de la corriente que sostenemos. Específicamente nos referiremos a obras de dos artistas patagónicos: Mario Baigorria en fotografía y Dolores Morón en Muralismo.

El presente ICT tiene como objetivo básico comunicar a los lectores parte de los resultados del Proyecto de Investigación 29/C043 “La concepción de infancia en la Formación Inicial del Profesorado” (UART-UNPA), comenzando por presentar diversos escenarios formativos relevantes en cuanto a la construcción de significados por parte de los estudiantes de los profesorados, principalmente el de las prácticas profesionalizantes, para luego explicar la metodología utilizada en el proceso de investigación, que consistió fundamentalmente en la construcción y aplicación de dispositivos a fin de indagar en las representaciones sociales acerca de la infancia. A cChildhoodontinuación, se exponen los resultados obtenidos a partir de dichos dispositivos constituidos por la carta personal, la metáfora, la reflexión compartida y la fotografía, hasta arribar a las conclusiones a modo de palabras finales.

Esta es un exposición que en el marco del ciclo “Derecho y Actualidad” organizado por nuestra Facultad de Derecho, se presenta para todos sus egresados, tanto abogados como escribanos.Puede llamar la atención la inclusión de éstos últimos, en virtud de que la ley concursal regula preferentemente una materia contenciosa.Sin embargo, las razones son importantes y hacen legítima su inclusión en estas actividades de actualización.En primer lugar, todos los operadores de Derecho debemos conocer la Ley y el Escribano es un Operador de Derecho.En segundo lugal, la Función notarial no es solamente formativa y autenticante. El Uruguay tiene función notarial completa, la cual comprende también el área de asesoramiento.Esta área de la función notarial suele ser relegada por la mayoría de los Escribanos, dejándola circunscripta a aquellos involucrados en la actividad académica. Creemos que esa actitud es equivocada.Parte 1: Principios de la Ley ConcursalExpositora: María del Carmen AcuñaParte 2: La actuación notarial en el Proceso ConcursalExpositora: Daniela CianciaruloParte 3: La venta en bloque de la empresa en funcionamientoExpositora: Adriana AmadoParte 4: Legitimación del deudor para disponer y obligara la masa del Concurso en la Ley 18.374Expositora: María Wonsiak

The effect of restricted suckling on productive performance and carcass traits of growing lambs was determined. Twenty-one naturally sucked male Comisana lambs were divided into three equal weight groups with differing suckling management systems: 1) only maternal milk (C); 2) only maternal milk until 15 d of age and, from 16 d of age to slaughter, maternal milk, concentrate and hay ad libitum (T1); 3) only maternal milk until 15 d of age and, from 16 d to 30 d of age, maternal milk, concentrate and hay ad libitum, and, from 31 d of age to slaughter, only concentrate and hay ad libitum (T2). Average daily weight gain (ADG) and milk and feed intake were calculated. Ewe milk was collected from each group. At slaughter (63 d) live weight and carcass measurements were recorded. The overall mean of total milk collected was 22.7 and 41.6 kg ewe-1 for T1 and T2, respectively. Suckling management system significantly affected ADG, milk intake, dressing percentage, and percentages of intestines, stomachs, offals, and kidney fat. Suckling management appears to be an important factor affecting lamb growth and carcass quality.