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Free, open-source participatory platforms like Decidim or Consul were designed by the 15M' citizen activists in Spain. Initially implemented in Barcelona and Madrid, these platforms are spread in many countries. Castells has not examined the institutionalization of the 15M's offspring, and thus we aim to contribute by studying the rollout of the Decidim platform in Catalan municipalities. We examine its disruptive potential along three democratic dimensions: transparency, participation and deliberation. Our study combines in-depth interviews and an online questionnaire administered to public officials in charge of the platform and analyses the levels of participation on the platform. The research shows elements of managerial continuity: the most valued goals are transparency, organisation of information and the collection of citizen proposals, rather than deliberation and transfer of sovereignty towards citizens. However, the platform forces administrations to consider individual citizens' inputs, increases citizens' proposals and initiatives, and brings in new participant publics. Furthermore, democratic innovation is being pushed ahead by a networkof activists and technological experts that continuously improve the platform and function as a counter-power (Castells, 2015, 2016). [ABSTRACT FROM AUTHOR]

The effect of social media as a potential sphere for public deliberation still remains unclear. For some analysts, social media can create a vibrant space for political discussion, whereas others believe they do not provide the right conditions for meaningful interaction and could even have negative effects on public opinion by, for instance, fostering communication within isolated enclaves. Focusing on the debate surrounding Catalonia's secession, this article analyses the interaction on Twitter between the opposite sides of this divisive political issue. Carefully based on a nonbiased random sampling procedure, we describe Twitter conversations through network and content analyses, using both indicators of the structure of conversations and opinion diversity. Remarkably, we find that Twitter users cross lines of difference and interact with people holding opposing views. Through a regression analysis, we show that the level of reciprocity, understood as repeated interaction and measured by the depth of the conversation, is explained by heterogeneity and associated with a higher involvement of the pro-independence side. However, if heterogeneity is combined with extremism, the development of longer conversations is severely cut. Overall, this article points toward the actual use of social media as a space for cross-cutting communication and debate despite strong disagreement. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES To describe the use of ventricular assist devices (VAD) in children in Spain and to identify variables related to survival. METHODS This is an observational cohort study of all children younger than 18 years of age who underwent an initial implantation of a VAD at any of the 6 paediatric heart transplant centres from May 2006 to December 2020. Subjects were identified retrospectively from each hospital's database. RESULTS Paracorporeal VADs were implanted in 118 children [pulsatile (63%), continuous (30.5%) or both types (5.9%)]. Small children (<0.7 m2 of body surface area) comprised the majority of this cohort (63.3%). Overall, 67% survived to VAD explantation, and 64.9% survived to hospital discharge. Non-central nervous system haemorrhage (39%) and stroke (38.1%) were the most common complications. Body weight <5 kg, congenital heart disease, pre-implantation bilirubin >34 μmol/l and bridge to decision strategy were associated with a higher mortality at hospital discharge and in the long-term. Interagency registry for mechanically assisted circulatory support (INTERMACS) status 1 and cardiac arrest prior to VAD implantation were related to long-term mortality, whereas pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not related to mortality. CONCLUSIONS In Spain, 67% of the VAD-supported children have been bridged to heart transplantation or to recovery. Body weight lower than 5 kg, congenital heart disease diagnosis, cholestatic liver dysfunction, bridge to decision as VAD strategy, INTERMACS-1 status and cardiac arrest were pre-implantation variables related to mortality, whereas pre-implantation renal replacement therapy and extracorporeal membrane oxygenation were not. [ABSTRACT FROM AUTHOR]

This paper tests the equalization hypothesis at the vote level. A good number of studies have examined whether the Internet is levelling the playing field in electoral competition by offering fringe parties opportunities to increase their visibility. To test the influence of use of the Internet in vote choice, we analyze the behaviour of ERC voters. Using survey data, we test whether online exposure to political information affects vote choice among these voters. We find that online exposure to political information increases the probability of voting for Solidaritat Catalana relatively to voting again for ERC. The analysis provides empirical evidence to support the idea that the Internet works as a differentiated media environment in which political messages compete in more equal terms. [ABSTRACT FROM AUTHOR]

This paper tests the equalization hypothesis at the vote level. A good number of studies have examined whether the Internet is levelling the playing field in electoral competition by offering fringe parties opportunities to increase their visibility. To test the influence of use of the Internet in vote choice, we analyze the behaviour of ERC voters. Using survey data, we test whether online exposure to political information affects vote choice among these voters. We find that online exposure to political information increases the probability of voting for Solidaritat Catalana relatively to voting again for ERC. The analysis provides empirical evidence to support the idea that the Internet works as a differentiated media environment in which political messages compete in more equal terms. [ABSTRACT FROM AUTHOR]

The author reflects on first description of acute respiratory distress syndrome (ARDS) in 1967, where hypoxemia has been recognized as a distinctive hallmark of the disease. It notes the definition of ARDS by the American-European Consensus Conference to the extent of mechanical ventilatory support or the application of positive end-expiratory pressure. The author also cites a study demonstrating the ratio and oxygenation index in pediatric ARDS patients for risk stratification.

A previously healthy 9-year-old girl developed fulminant myocarditis due to severe influenza A infection complicated with methicillin-resistant Staphylococcus aureus pneumonia, requiring extracorporeal membrane oxygenation (ECMO) support. Twelve days after admission, Aspergillus fumigatus was isolated in tracheal aspirate, and 12 h later she suddenly developed anisocoria. Computed tomography (CT) of the head showed fungal brain lesions. Urgent decompressive craniectomy with lesion drainage was performed; histopathology found hyphae in surgical samples, culturepositive for Aspergillus fumigatus (susceptible to azoles, echinocandins, and amphotericin B). Extension workup showed disseminated aspergillosis. After multiple surgeries and combined antifungal therapy (isavuconazole plus liposomal amphotericin B), her clinical course was favorable. Isavuconazole therapeutic drug monitoring was performed weekly. Extensive immunological study ruled out primary immunodeficiencies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) follow-up showed a gradual decrease in fungal lesions. Influenza-associated pulmonary aspergillosis is well-recognized in critically ill adult patients, but pediatric data are scant. Clinical features described in adults concur with those of our case. Isavuconazole, an off-label drug in children, was chosen because our patient had severe renal failure. To conclude, influenza-associated pulmonary aspergillosis is uncommon in children admitted to intensive care for severe influenza, but pediatricians should be highly aware of this condition to enable prompt diagnosis and treatment [ABSTRACT FROM AUTHOR]

Introduction: Hospital Plató (HP) is a health center in the city of Barcelona, founded in 1925, it's an innovative hospital that from the beginning values the people. Since 2002, HP's strategy has been to view people as the backbone of the hospital's policies. To achieve this, in addition to an organizational and cultural change was necessary to implant as a model of quality management the European Foundation Quality Management (EFQM) and as a model of ethical behavior the Social Responsibility, both of them aimed to aligning the professionals actively with the values of the organization and with the own way of work of HP (differentiating factor), with the aim of improving the involvement, motivation and participation of the people. The "Days of Health on the Street" is a clear example of HP's commitment to their community to promote healthy lifestyles and non-discrimination of fundamental rights based on race, sex, religion, age and economic status. This initiative, born in 2012 and aligned with the mission and values of the organization, emerged from the will of HP of bring health to the citizens. Short description: Hospital Plató drives performing actions to provide knowledge that allow the adoption of a healthy lifestyle in order to highlight the prevention of disease and promotion of healthy habits. In the street, the professionals of the Hospital promote health education of citizens in order to develop their capacity for self-healing. The idea of leaving the physical barriers of the hospital and taking health care teams out into the street to approach citizens is a new idea in the context of our health sector and in our zone of influence. Throughout the duration of the sessions there were challenges in all aspects, at all levels: infrastructure (comfort and privacy), organization and dynamics of the day (attracting citizens) and evaluation of outcomes (satisfaction questionnaire). The "Days of Health on the Street" is an example of the commitment of Hospital Plató to their community. This initiative, aligned with the mission and values of the organization, emerged from the will of the Hospital to bring health to citizens. These days consists to move voluntarily and for a day, a multidisciplinary team of professionals, installed in a tent in different public of Barcelona, addresses issues of health interest in order to promote health, prevent disease and to get to the people the importance of health education. The Days are based on: engage the citizen, interview, describe and identify risk factors, inform about the disease, visit and diagnostic tests by the specialist medical for free. Key findings: The main results and benefits obtained to date are: - More than 600 people attended - Degree of satisfaction over 95% - More than 25 professionals each day have been involved - Interviews and mentions in local TV - Leadership of HP of the collaborative network Barcelona Living Health. Highlights: The key objective is the development and implementation of actions aimed at providing the tools and knowledge to adopt a healthy lifestyle by the population, with the ultimate aim of influencing disease prevention. The key to the implementation of the good practice "Health Street: our commitment to the community" and its achievement is in the people of the organization, that voluntarily perform these actions. Through the good practice "Health Street: our commitment to the community" has enhanced the reputation, image and positioning of HP in the district (area of influence). The Hospital has become known among citizens conducting a health education activity has opened the doors of HP and bring the health and the healthcare professionals to the people at the street. Since 2012, we have done twelve days on the street, the first five are about Neurovascular disease and early detection of STROKE, and the last seven are about Prevention of consumption of drug, tobacco and alcohol. Conclusión: The main lessons learned from the conclusion of these Days of Health are: - To achieve the sustainability, alliances are key - The actions to ensure the right to health of people, generates a strong emotional bond between citizens and increases the involvement of professionals who receive directly on the street, samples of appreciation of the citizens that they attended - If the diagnostic tests are positive, it is necessary to monitor these patients - It is necessary to conduct surveys to professionals involved as volunteers, to know their perception and value their involvement - The volunteer recognition materializes in 2014 with a detail, in addition to public recognition through the Intranet - The professionals participating in these Days of Health as volunteers may be health and nonhealth professionals. [ABSTRACT FROM AUTHOR]

Between 2014 and 2018, we evaluated the severity of 687 cases of bronchiolitis caused by respiratory syncytial virus (RSV) in Catalonia, Spain. Compared to RSV-B, RSV-A cases required intensive care (adjusted relative risk (aRR) = 1.44, p < 0.01) and respiratory support (aRR = 1.07, p < 0.01) more often; hospital stay was one day longer (p < 0.01). Subgroup identification may aid clinical evaluation and seasonal healthcare planning. [ABSTRACT FROM AUTHOR]

Background: Viral lower respiratory tract infections (LRTI) are the leading cause of hospitalization in children. In Catalonia (Spain), information is scarce about the burden of viral LRTIs in paediatric hospitalizations. The aim of this study is to describe epidemiological, clinical, virological and economic features of paediatric hospitalizations due to viral LRTI. Methods: From October 2012 to December 2020, children aged <16 years admitted to a tertiary paediatric hospital in Catalonia (Spain) with confirmed viral LRTI were included in the study. Virus seasonality, prevalence, age and sex distribution, clinical characteristics, hospital costs and bed occupancy rates were determined. Results: A total of 3,325 children were included (57.17% male, 9.44% with comorbidities) accounting for 4056 hospitalizations (32.47% ≤ 12 months): 53.87% with wheezing/asthma, 37.85% with bronchiolitis and 8.28% with pneumonia. The most common virus was respiratory syncytial virus (RSV) (52.59%). Influenza A was associated with pneumonia (odds ratio [OR] 7.75) and caused longer hospitalizations (7 ± 31.58 days), while RSV was associated with bronchiolitis (OR 6.62) and was the most frequent reason for admission to the paediatric intensive care unit (PICU) (11.23%) and for respiratory support (78.76%). Male sex, age ≤12 months, chronic conditions and bronchiolitis significantly increased the odds of PICU admission. From October to May, viral LRTIs accounted for 12.36% of overall hospital bed days. The total hospitalization cost during the study period was €16,603,415. Conclusions: Viral LRTIs are an important cause of morbidity, hospitalization and PICU admission in children. The clinical burden is associated with significant bed occupancy and health‐care costs, especially during seasonal periods. [ABSTRACT FROM AUTHOR]

Parvovirus B19 is one of the most frequent causes of pediatric myocarditis, associating high mortality rates or need for cardiac transplantation. The aim of this study is to describe the clinical course of Parvovirus B19 myocarditis in children with emphasis on the role of endomyocardial biopsy and cardiac magnetic resonance, and the use of an innovative therapeutic strategy. Eleven patients and 12 episodes of polymerase chain reaction (PCR)-confirmed Parvovirus B19 myocarditis were prospectively collected for 14 years. Diagnosis was confirmed either histopathologically or by magnetic resonance. A life-threatening clinical presentation is described, similar to previous series, but with 83.3% overall survival without transplantation. We also present a case of recurrent myocarditis, which is extraordinarily rare. Electrocardiographic patterns presented chiefly peaked p waves, low QRS voltages, and negative T waves on inferior or lateral leads. Endomyocardial biopsy is the gold standard diagnostic test; alternatively magnetic resonance could be a useful diagnostic tool. A good concordance between myocardial and blood PCRs was observed. Seven patients received treatment with corticosteroids and beta interferon and all underwent a significant cardiac function improvement. Conclusion: A severe clinical presentation is reported, similar to previous reports but with better outcomes. Endomyocardial biopsy is the gold standard diagnostic test; alternatively magnetic resonance may be used. Both blood and myocardium PCR can be used in children to establish the microbiological etiology. Steroids with IFNß could be a useful therapeutic option, although further multicenter studies are needed to confirm these results. What is Known: • Parvovirus B19 is one of the most frequent causes of myocarditis in children. It is associated with a fulminant clinical presentation. • Endomyocardial biopsy is the gold standard diagnostic test but it is an invasive procedure. What is New: • Myocarditis may recur in pediatrics, even it is extraordinarily rare. • IFNβ with steroids may be a useful therapeutic option to improve the outcomes. [ABSTRACT FROM AUTHOR]

Acute myocarditis is an inflammatory disease of the myocardium, and it can present as severe heart failure in children. Differential diagnosis with genetic cardiomyopathy can be difficult. The objective of this study is to identify patterns of clinical presentation and to assess invasive and non-invasive measures to differentiate patients with acute myocarditis from patients with dilated genetic cardiomyopathy. We performed a retrospective descriptive study of all paediatric patients (0–16 years old) that presented with new-onset heart failure with left ventricle ejection fraction < 35% in whom we performed an endomyocardial biopsy (EMB) during the period from April 2007 to December 2020. The patients were classified into two groups: Group 1 included 18 patients with myocarditis. Group 2 included 9 patients with genetic cardiomyopathy. Findings favouring a diagnosis of myocarditis included a fulminant or acute presentation (77.8% vs 33.3%, p = 0.01), higher degree of cardiac enzyme elevation (p = 0.011), lower left ventricular dimension z-score (2.2 vs 5.4, p = 0.03) increase of ventricular wall thickness (88.8% vs 33.3%, p = 0.03) and oedema in the EMB. Seven (77.8%) patients with genetic cardiomyopathy had inflammation in the endomyocardial biopsy fulfilling the diagnostic criteria of inflammatory cardiomyopathy. Conclusion: Differentiating patients with a myocarditis from those with genetic cardiomyopathy can be challenging, even performing an EMB. Some patients with genetic cardiomyopathy fulfil the diagnostic criteria of inflammatory cardiomyopathy. Using invasive and non-invasive measures may be useful to develop a predictive model to differentiate myocarditis from genetic cardiomyopathy. What is Known: • Acute myocarditis could present with cardiogenic shock in paediatric patients. • Parvovirus B19 is the main cause of myocarditis in this population. What is New: • Current diagnostic criteria for myocarditis have limited use in paediatric patients presenting with new-onset heart failure. • Some patients with a genetic cardiomyopathy and a new-onset heart failure fulfill the diagnostic criteria of inflammatory cardiomyopathy. [ABSTRACT FROM AUTHOR]

Background: The risk of vertical transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains unknown. Positive reverse-transcription polymerase chain reaction (RT-PCR) test results for SARS-CoV-2 infection in neonates and placental tissue have been reported, and immunoglobulin M antibodies have been detected in neonates born to mothers with infection.Cases: The first case is a woman at 22 3/7 weeks of gestation with coronavirus disease 2019 (COVID-19) who was admitted to the intensive care unit. In the second case, the patient remained at home with mild symptoms, starting at 20 weeks of gestation. In both cases, fetal skin edema was observed on ultrasound examination while maternal SARS-COV-2 RT-PCR test results were positive and resolved when maternal SARS-COV-2 RT-PCR test results became negative. The RT-PCR test result for SARS-CoV-2 in amniotic fluid was negative in both cases. The two pregnancies are ongoing and uneventful.Conclusion: Transient fetal skin edema noted in these two patients with COVID-19 in the second trimester may represent results of fetal infection or altered fetal physiology due to maternal disease or may be unrelated to the maternal illness. [ABSTRACT FROM AUTHOR]

Summary Objective To reduce ventilator-associated infections (VARI) and improve outcomes for children. Methods This prospective interventional cohort study was conducted in a paediatric intensive care unit (PICU) over three periods: pre-intervention, early post-intervention, and late post-intervention. These children were on mechanical ventilation (MV) for ≥48 h. Results Overall, 312 children (11.9% of whom underwent tracheostomy) and 6187 ventilator-days were assessed. There was a significant reduction in ventilator-associated pneumonia (VAP) among tracheostomized patients (8.16, 3.27, and 0.65 per 1000 tracheostomy ventilation-days before the intervention, after the general bundle implementation, and after the tracheostomy intervention, respectively). The median time from onset of MV to diagnosis of ventilator-associated tracheobronchitis (VAT) increased from 5.5 to 48 days in the late post-intervention period ( p = 0.004), and was associated with a significant increase in median 28-day ventilator-free days and PICU-free days. Tracheostomy (odds ratio 7.44) and prolonged MV (odds ratio 2.75) were independent variables significantly associated with VARI. A trend towards a reduction in PICU mortality was observed, from 28.4% to 16.6% (relative risk 0.58). Conclusions The implementation of a care bundle to prevent VARI in children had a different impact on VAP and VAT, diminishing VAP rates and delaying VAT onset, resulting in reduced healthcare resource use. Tracheostomized children were at increased risk of VARI, but preventive measures had a greater impact on them. [ABSTRACT FROM AUTHOR]

Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7-18.8) to 1.92 % (95 % CI 0.4-5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p < 0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p < 0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p = 0.03). Conclusions: The implementation of a new intervention program was associated with an 82 % (95 % CI 34-94) reduction in SSI incidence in children undergoing heart surgery at our center. [ABSTRACT FROM AUTHOR]