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Aim: To provide data on the inadequate use of emergency medical transports services (EMTS) in children and underlying contributing factors.Methods: This was a prospective single-center cohort study (01/2017-12/2017) performed at the Saarland University Children's Hospital, Homburg, Germany. Patients ≤20 years of age transported by EMTS for suspected acute illness/trauma were included and proportion of inadequate/adequate EMTS use, underlying contributing factors, and additional costs were analyzed.Results: Three hundred seventy-nine patients (mean age: 9.0 ± 6.3 years; 55.7% male, 44.3% female) were included in this study. The three most common reasons for EMTS use were: central nervous system (30.6%), respiratory system affection (14.0%), and traumas (13.2%). ETMS use was categorized as inadequate depending on physician's experience: senior physician (58.8%), pediatrician (54.9%), resident (52.7%). All three physicians considered 127 (33.5%) cases to be medically indicated for transportation by EMTS, and 177 (46.7%) to be medically not indicated. The following parameters were significantly associated with inadequate EMTS use: non-acute onset of symptoms (OR 2.5), parental perception as non-life-threatening (OR 1.7), and subsequent out-patient treatment (OR 4.0). Conversely, transport by an emergency physician (OR 3.5) and first time parental EMTS call (OR 1.7) were associated with adequate use of EMTS. Moreover, a significant relation existed between maternal, respectively, paternal educational status and inadequate EMTS use (each p = 0.01). Using multiple logistic regression analysis, non-acute onset of symptoms (OR 2.2) was associated with inadequate use of EMTS while first time parental EMTS call (OR 1.8), transport by an emergency physician (OR 3.3), and need for in-patient treatment (OR 4.0) were associated with adequate use of EMTS.Conclusion: A substantial number of pediatric EMTS is medically not indicated. Possibly, specific measures including multifaceted educational efforts may be helpful in reducing unnecessary EMTS use.

Subsurface drip irrigation (SDI), because it can precisely deliver nutrients close to plant roots, could lead to carefully determined applications of fertilizer to meet crop needs and less risk of nitrate (NO3−) leaching to groundwater. Appropriate fertilizer applications, however, depend on an accurate assessment of the spatial distribution of the main plant macronutrients (N, P and K) in the soil profile before planting. To develop nutrient sampling guidelines, we determined the spatial distributions of preplant nitrate (NO3−), bicarbonate extractable phosphorus (Olsen-P) and exchangeable potassium (K) in the top 20 inches (50 centimeters) of subsurface drip irrigated processing tomato fields in three of the main growing regions in the Central Valley of California. Nutrient distribution varied with depth (P and K), distance from the center of the bed (NO3−) and growing region (NO3− and K). No depletion of NO3−, Olsen-P or K in the root feeding areas close to the drip tape was detected. Preplant NO3− ranged considerably, from 45 to 438 pounds N per acre (50 to 491 kilograms/hectare), the higher levels in fields with consecutive crops of tomatoes. A sampling protocol that growers could use, developed from analysis of the distribution results, provided reliable estimates of preplant NO3− as well as P and K in all surveyed fields.

Beamformers are a widely-used tool in brain analysis with magnetoencephalography (MEG) and electroencephalography (EEG). For the construction of the beamformer filters realistic head volume conductor modeling is necessary for accurately computing the EEG and MEG leadfields, i.e., for solving the EEG and MEG forward problem. In this work, we investigate the influence of including realistic head tissue compartments into a finite element method (FEM) model on the beamformer's localization ability. Specifically, we investigate the effect of including cerebrospinal fluid, gray matter, and white matter distinction, as well as segmenting the skull bone into compacta and spongiosa, and modeling white matter anisotropy. We simulate an interictal epileptic measurement with white sensor noise. Beamformer filters are constructed with unit gain, unit array gain, and unit noise gain constraint. Beamformer source positions are determined by evaluating power and excess sample kurtosis (g2) of the source-waveforms at all source space nodes. For both modalities, we see a strong effect of modeling the cerebrospinal fluid and white and gray matter. Depending on the source position, both effects can each be in the magnitude of centimeters, rendering their modeling necessary for successful localization. Precise skull modeling mainly effected the EEG up to a few millimeters, while both modalities could profit from modeling white matter anisotropy to a smaller extent of 5–10 mm. The unit noise gain or neural activity index beamformer behaves similarly to the array gain beamformer when noise strength is sufficiently high. Variance localization seems more robust against modeling errors than kurtosis.

INTRODUÇÃO: A extubação precoce está relacionada à diminuição do tempo de internação e de complicações. OBJETIVO: Análise das características clínicas e evolução imediata dos pacientes extubados em sala após cirurgia cardíaca infantil com CEC. MÉTODOS: Análise retrospectiva dos dados. RESULTADOS: Entre março de 2006 e janeiro de 2008, 15 pacientes, com idade de 4 a 216 meses (média 76,1 meses) foram extubados em sala. A duração da CEC variou de 30 a 95 minutos (média 51,4 min) e anóxia de 14 a 67 minutos (média 35,2 min). Um paciente apresentou acidose respiratória. CONCLUSÃO: Extubação precoce é factível em casos selecionados.INTRODUCTION: Early extubation is related to short lenth of hospitalization and less complications. OBJECTIVE: Data analisys from children extubated atsurgical room after cardiac surgery with ECC. METHODS: Retrospective data analisys. Results: From March 2006 to January 2008, 15 children submitted to heart surgery were extubated at surgery room. Age in months was 4 to 216 (76.1 months). ECC time: 30 to 95 min (51.4 min), anoxia: 14 to 67 min (35.2 min). One patient had respiratory acidosis. CONCLUSION: Early extubation in seleted patients is possible.

In order to discover the advantages and disadvantages of different fertilization regimes and identify the best management practice of fertilization in greenhouse fields, soil enzyme activities involved in carbon (C) transformations, soil chemical characteristics, and crop yields were monitored after long-term (20-year) fertilization regimes, including no fertilizer (CK), 300 kg N ha-1 and 600 kg N ha-1 as urea (N1 and N2), 75 Mg ha-1 horse manure compost (M), and M with either 300 or 600 kg N ha-1 urea (MN1 and MN2). Compared with CK, fertilization increased crop yields by 31% (N2) to 69% (MN1). However, compared with CK, inorganic fertilization (especially N2) also caused soil acidification and salinization. In the N2 treatment, soil total organic carbon (TOC) decreased from 14.1±0.27 g kg-1 at the beginning of the long-term experiment in 1988 to 12.6±0.11 g kg-1 (P

Agricultural soils are important sources of atmospheric N2O and CO2. However, in boreal agro-ecosystems the contribution of the winter season to annual emissions of these gases has rarely been determined. In this study, soil N2O and CO2 fluxes were measured for 6 years in a corn-soybean-wheat rotation in northeast China to quantify the contribution of wintertime N2O and CO2 fluxes to annual emissions. The treatments were chemical fertilizer (NPK), chemical fertilizer plus composted pig manure (NPKOM), and control (Cont.). Mean soil N2O fluxes among all three treatments in the winter (November-March), when soil temperatures are below -7°C for extended periods, were 0.89-3.01 µg N m(-2) h(-1), and in between the growing season and winter (October and April), when freeze-thaw events occur, 1.73-5.48 µg N m(-2) h(-1). The cumulative N2O emissions were on average 0.27-1.39, 0.03-0.08 and 0.03-0.11 kg N2O_N ha(-1) during the growing season, October and April, and winter, respectively. The average contributions of winter N2O efflux to annual emissions were 6.3-12.1%. In all three seasons, the highest N2O emissions occurred in NPKOM, while NPK and Cont. emissions were similar. Cumulative CO2 emissions were 2.73-4.94, 0.13-0.20 and 0.07-0.11 Mg CO2-C ha(-1) during growing season, October and April, and winter, respectively. The contribution of winter CO2 to total annual emissions was 2.0-2.4%. Our results indicate that in boreal agricultural systems in northeast China, CO2 and N2O emissions continue throughout the winter.

Relato do tratamento cirúrgico de anel vascular (arco aórtico à direita e origem anômala de artéria subclávia esquerda) relacionado a divertículo de Kommerel, com realização de secção de ligamento arterial, rafia de divertículo e reimplante de artéria subclávia esquerda em carótida ipsilateral, por toracotomia esquerda, em uma paciente de 13 anos.Report of a surgical treatment of the vascular ring (right aortic arch and the anomalous origin of the left subclavian artery) related with Kommerel diverticula with the section of the ligamentum arteriosum (ductus arteriosus), suture of the Kommerell diverticula, and reimplantation of left subclavian artery in the ipsilateral carotid artery through left thoracotomy in a 13-year-old female.

Fundamentos: Próteses valvares aórticas com desempenho hemodinâmico adequado possibilitariam maior regressão da hipertrofia ventricular e normalização da função ventricular. Isto possivelmente tenha implicações importantes no prognóstico tardio após a substituição da valva aórtica. Objetivo: Avaliar o desempenho hemodinâmico do auto-enxerto pulmonar em posição aórtica e a regressão da hipertrofia ventricular esquerda após a operação de Ross. Casuística e Métodos: De maio/95 a março/97, 45 pacientes com média de idades de 27,1 anos foram submetidos à operação de Ross. Todos os pacientes foram submetidos, no pós-operatório imediato, a ecocardiografia com Doppler e cateterismo cardíaco para avaliação do desempenho hemodinâmico dos auto e homoenxertos, assim como da massa e função ventricular esquerda. Catorze pacientes com evolução superior a seis meses submeteram-se a ecocardiografia de stress com dobutamina, para estudar o desempenho hemodinâmico dos auto e homoenxertos em condição de exercício. Resultados: A mortalidade hospitalar foi de 6%. Após tempo médio de seguimento de 12,8 meses (1-23), ocorreu um óbito súbito tardio e nenhuma complicação relacionada à prótese. O desempenho hemodinâmico imediato e tardio dos auto-enxertos foi praticamente normal, com média de gradiente médio de 1,8 ± 0,6 mmHg e média de gradiente instantâneo máximo de 2,9 ± 0,9 mmHg. O grau de insuficiência valvar foi desprezível. Mesmo em condição de exercício, os gradientes não se elevaram de forma significativa, com média de gradiente médio de 4,3 ± 2,5 mmHg e média de gradiente instantâneo máximo de 10,4 ± 6,1 mmHg. Os homoenxertos utilizados para a reconstrução da via de saída do ventrículo direito tiveram excelente desempenho hemodinâmico imediato; entretanto, no seguimento tardio apresentaram discreto aumento das velocidades de fluxo com média de gradiente médio de 10 ± 7,1 mmHg em repouso e 26 ± 13,3 mmHg durante o exercício. O índice de massa ventricular esquerda caiu de 168 ± 46g/m² no pré-operatório para 115 ± 32g/m² no 6º mês de evolução. A função ventricular esquerda apresentou-se normal em repouso e no exercício na maioria dos pacientes. Conclusões: Dado o desempenho hemodinâmico normal dos auto-enxertos pulmonares, a redução da massa ventricular e normalização da função do ventrículo esquerdo, além da ótima evolução tardia dos pacientes, consideramos a operação de Ross como a operação ideal para pacientes aórticos jovens.Background: Aortic valve prosthesis with adequate hemodynamic performance should allow more complete left ventricular mass regression and return left ventricular function back to normal. This possibly affects long term prognosis after aortic valve replacement. Objective: Assessment of hemodynamic performance of the pulmonary autograft in the aortic position and the regression of left ventricular mass after the Ross procedure. Material and Methods: Between May/95 and Mar/96, 45 patients with mean age of 27.1 years were submitted to a Ross procedure. Doppler echocardiography and cardiac catheterization were performed on all patients before hospital discharge to analyze the hemodynamic performance of the auto and homografts employed, as well as to evaluate left ventricular mass and function. Fourteen patients with follow-up longer than six months were sumitted to dobutamine stress echocardiography to study hemodynamic performance of the auto and homografts at during exercise. Results: Hospital mortality was 6%. After a mean follow-up of 12.8 months (1-23), there was one late sudden death. No valve related event was noted during this period. Immediate and late hemodynamic performance of the pulmonary autografts were normal with average mean gradients of 1.8 ± 0.6 mmHg and average maximum instantaneous gradients of 2.9 ± 0.9 mmHg. Valvular insufficiency was almost null. Even during exercise, gradients did not increase significantly with average mean gradients of 4.3 ± 2.5 mmHg and average maximum gradients of 10.4 ± 6.1 mmHg. Homografts used for right ventricular reconstruction exhibited excellent immediate hemodynamic performance. However, at late follow-up an increase in flow velocities was noted with an average of mean gradients of 10 ± 7.1 mmHg at rest and 26 ± 13.3 mmHg at exercise. Left ventricular mass index dropped from 168 ± 46 g/m² preoperatively to 115 ± 32 g/m² six months after the operation. Left ventricular function was normal at rest and during exercise in the marjority of patients. Conclusions: Given the normal hemodynamic performance of the autografts, the important decrease in left ventricular mass and the normal left ventricular function late postoperatively, the Ross procedure is considered the operation of choice for young patients who need aortic valve replacement.

High residue loads associated with conservation tillage and cover cropping may impede water flow in furrow irrigation and thus decrease the efficiency of water delivery and runoff water quality. In this study, the biomass residue effects on infiltration, runoff, and export of total suspended solids (TSS), dissolved organic carbon (DOC), sediment-associated carbon (TSS-C), and other undesirable constituents such as phosphate (soluble P), nitrate (), and ammonium () in runoff water from a furrow-irrigated field were studied. Furrow irrigation experiments were conducted in 91 and 274 m long fields, in which the amount of residue in the furrows varied among four treatments. The biomass residue in the furrows increased infiltration, and this affected total load of DOC, TSS, and TSS-C. Net storage of DOC took place in the long but not in the short field because most of the applied water ran off in the short field. Increasing field length decreased TSS and TSS-C losses. Total load of , , and soluble P decreased with increasing distance from the inflow due to infiltration. The concentration and load of P increased with increasing residue biomass in furrows, but no particular trend was observed for and . Overall, the constituents in the runoff decreased with increasing surface cover and field length.