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A unified surveillance mechanism for hand hygiene and hospital-acquired infections for pediatric wards is lacking in Europe. We managed to setup such a mechanism in 9 pediatric intensive care units in 7 European countries, using World Health Organization's definitions and common methodology which allows for benchmarking among units and countries. Median hand hygiene compliance was found high 82.3% (interquartile range 71.6-94.5%), but gaps in practices were identified.

We investigated severe acute respiratory syndrome coronavirus 2 infections in primary schools, kindergartens, and nurseries in Germany. Of 3,169 oropharyngeal swab specimens, only 2 were positive by real-time reverse transcription PCR. Asymptomatic children attending these institutions do not appear to be driving the pandemic when appropriate infection control measures are used.

Background Nickel allergy is the most prevalent contact allergy. It belongs to a different hypersensitivity type to asthma and rhinoconjunctivitis. The aim of this analysis was to assess whether self-reported nickel allergy is associated with incident wheezing, asthma and rhinoconjunctivitis in young German adults, taking into account potential effect modification by sex. Methods In total, 2051 (70.6%) participants aged 19–24 years took part in the second phase of SOLAR (Study on Occupational Allergy Risks), a follow-up study of ISAAC II (the second phase of the International Study of Asthma and Allergies in Childhood) in Germany. Self-reported nickel allergy, as well as having pierced ears, and the three outcomes incident wheezing, asthma and rhinoconjunctivitis, were analysed stratified for sex. Logistic regression adjusted for potential confounders was performed. Results An association between self-reported nickel allergy and incident wheezing was observed for men and women, while only in males did pierced ears show a significant association with the outcome (adjusted OR 2.26, 95% CI 1.10–4.62). Also only in males, self-reported nickel allergy was associated with elevated odds for incident asthma (adjusted OR 4.34, 95% CI 1.22–15.41). Neither in men nor in women was a significant association observed for incident rhinoconjunctivitis. Conclusion Our results suggest that self-reported nickel allergy is associated with incident wheezing. Whether this association is due to environmental or genetic predisposition, or due to an overlap of the mechanisms of type I and type IV hypersensitivity, needs to be elucidated., Self-reported nickel allergy is associated with incident wheezing in young German males and females, and with incident asthma in males, whereas no significant association was observed for self-reported nickel allergy and incident rhinoconjunctivitis http://bit.ly/2YHmwBA

Purpose Antibiotic exposure among hospitalized children is very high. With inappropriate antimicrobial use resulting in increased rates of antimicrobial resistance, the implementation of antibiotic stewardship programs is critically needed. This survey study aimed to identify current practice and knowledge about antibiotic stewardship and infection control among paediatricians in tertiary care paediatric hospitals in and around Munich, Germany. Methods A prospective cross-sectional study based on an anonymous questionnaire, structured into different sub-sections regarding antibiotic use, antimicrobial resistance, antibiotic stewardship and infection control, was conducted between 1st of May and 30th of June 2016 in five paediatric hospitals. Results In total, 111 paediatricians across all grades were eligible for participation. The overall proportion of correct answers for all sub-sections of the survey ranged from 54.1% correct answers in the antibiotic handling and bacterial resistance section to 72.9% correct answers in the hospital hygiene/infection control section. In general, knowledge across all categories was similar for junior doctors, middle-grade doctors or consultants. Advocating empiric use of narrow-spectrum instead of broad-spectrum antibiotics was considered to be the most difficult measure to implement in daily practice (36.9%). De-escalation from broad-spectrum empirical therapy to targeted treatment was considered the easiest measure to achieve (43.2%). Conclusion Our results demonstrate that principles of antimicrobial stewardship and aspects of hospital hygiene/infection control are not satisfactorily known among hospital-based paediatricians in and around Munich. We identified four important target areas for future educational interventions that should play a more prominent role in both pre- and postgraduate medical training.

Background Vancomycin-resistant Enterococcus faecium (VREfm) strains are one of the most important pathogens causing nosocomial infections in Germany. Due to limited treatment options and an increased risk for acquisition in immunocompromised children, surveillance to monitor occurrence of VREfm in paediatric clinical facilities is of critical importance. Following an unusual accumulation of VREfm positive patients between April 2019 and August 2020 at Dr. von Hauner Children’s Hospital in Munich, Germany, our study aimed to identify dynamics and routes of transmission, and analyse the affected population in view of previously described host risk factors for VREfm colonisation or infection. Methods The hospital database was used to collect epidemiological and clinical data of VREfm cases. Descriptive statistical analyses were conducted to outline patient characteristics and depict possible differences between VREfm-colonised and -infected children. An outbreak investigation determining genetic relatedness among VREfm isolates was performed by core genome multilocus sequence typing (cgMLST). To examine potential transmission pathways, results of genome analysis were compared with epidemiological and clinical data of VREfm positive patients. Results VREfm acquisition was documented in a total of 33 children (p = 0.011), showed signs of clinical infection. cgMLST analysis revealed seven distinct clusters, demonstrating a possible connection within each clonal lineage. Additional eight singletons were identified. Comparison with epidemiological and clinical data provided strong evidence for a link between several VREfm positive patients within the hospital. Conclusions A nosocomial spread—at least in part—was the most likely reason for the unusual accumulation of VREfm cases. The study highlights that there is a constant need to increase efforts in hygiene measures, infection control and antibiotic stewardship to combat VREfm transmission events within German paediatric hospitals. Continuous monitoring of adherence to respective policies might reduce the occurrence of clustered cases and prevent future outbreaks.

Feline infectious peritonitis (FIP) caused by feline coronavirus (FCoV) is a common dis-ease in cats, fatal if untreated, and no effective treatment is currently legally available. The aim of this study was to evaluate efficacy and toxicity of the multi-component drug Xraphconn® in vitro and as oral treatment in cats with spontaneous FIP by examining survival rate, development of clinical and laboratory parameters, viral loads, anti-FCoV antibodies, and adverse effects. Mass spectrometry and nuclear magnetic resonance identified GS-441524 as an active component of Xraphconn®. Eighteen cats with FIP were prospectively followed up while being treated orally for 84 days. Values of key parameters on each examination day were compared to values before treatment initiation using linear mixed-effect models. Xraphconn® displayed high virucidal activity in cell culture. All cats recovered with dramatic improvement of clinical and laboratory parameters and massive reduction in viral loads within the first few days of treatment without serious adverse effects. Oral treatment with Xraphconn® containing GS-441524 was highly effective for FIP without causing serious adverse effects. This drug is an excellent option for the oral treatment of FIP and should be trialed as potential effective treatment option for other severe coronavirus-associated diseases across species. ispartof: VIRUSES-BASEL vol:13 issue:11 ispartof: location:Switzerland status: published

Children have been disproportionately affected during the COVID-19 pandemic. We aimed to assess a saliva-based algorithm for SARS-CoV-2 testing to be used in schools and childcare institutions under pandemic conditions. A weekly SARS-CoV-2 sentinel study in primary schools, kindergartens, and childcare facilities was conducted over a 12-week-period. In a sub-study covering 7 weeks, 1895 paired oropharyngeal and saliva samples were processed for SARS-CoV-2 rRT-PCR testing in both asymptomatic children (n = 1243) and staff (n = 652). Forty-nine additional concurrent swab and saliva samples were collected from SARS-CoV-2 infected patients (patient cohort). The Salivette® system was used for saliva collection and assessed for feasibility and diagnostic performance. For children, a mean of 1.18 mL saliva could be obtained. Based on results from both cohorts, the Salivette® testing algorithm demonstrated the specificity of 100% (95% CI 99.7–100) and sensitivity of 94.9% (95% CI 81.4–99.1) with oropharyngeal swabs as reference. Agreement between sampling systems was 100% for moderate to high viral load situations (defined as Ct-values ® system proved to be an easy-to-use, safe and feasible saliva collection method and a more pleasant alternative to oropharyngeal swabs for SARS-CoV-2 testing in children aged 3 years and above.

ObjectivesChildren have been disproportionately affected during the COVID-19 pandemic. Novel test strategies are urgently needed to ensure safe operation of schools and childcare institutions and to avoid prolonged closures. MethodsA weekly SARS-CoV-2 sentinel study in primary schools, kindergartens and childcare facilities over a 12-week-period was conducted. In total, 3123 concurrent oropharyngeal and saliva samples were processed for SARS-CoV-2 rRT-PCR testing in both children (n=2104) and staff (n=1019). Saliva sampling was optimised, and a novel sampling system was introduced and assessed for feasibility, the Salivette(R) system. ResultsFor children across all age groups a mean of 1,18 ml saliva could be obtained with this easy-to-handle system. Using 1293 concurrent oropharyngeal swabs from children, staff and participants of a positive control cohort as reference, the Salivette testing method could be assigned an overall specificity of 99.8% and sensititity of 95.1%. Of note, clinical sensitivity, defined as detection of positive cases with an oropharyngeal-swab derived Ct-value < 33, was 100%. Comparative analysis of Ct-values derived from saliva vs. oropharyngeal swabs demonstrated a significant difference (mean difference 4.23 (95% CI 2.48-6.00). ConclusionsThe Salivette system is an easy-to-use, safe and feasible collection method for saliva sampling and subsequent SARS-CoV-2 testing in children aged 3 years and above. In view of the excellent sensitivity and specificity documented in our study, this novel testing approach is a very reliable and much more pleasant alternative to oropharyngeal swab based testing, particularly in children and for self-testing in the home setting.

A 12-week sentinel programme monitored SARS-CoV-2 in primary schools, kindergartens and nurseries. Out of 3169 oropharyngeal swabs, only two tested positive on rRT-PCR while general incidence rates were surging. Thus, children attending respective institutions are not significantly contributing to the pandemic spread when appropriate infection control measures are in place.

Lejeunea is a morphologically diverse subcosmopolitan genus of predominantly epiphytic leafy liverworts. We describe three Lejeunea fossils preserved in Miocene Dominican amber, Lejeunea hamatiloba sp. nov., L. resinata sp. nov. and L. urbanioides sp. nov., thereby increasing the Lejeunea fossil record to four species. The overall similarity of the fossils and extant species suggests the conservation of the generic composition of Caribbean epiphyte communities since the early Miocene, a pattern that was also confirmed for mosses and ferns.

O presente estudo teve por objetivo investigar as expectativas maternas em relação ao desenvolvimento e escolarização do filho com síndrome de Down, a partir de uma perspectiva psicanalítica. Foi realizado um estudo qualitativo, por meio de entrevistas, que foram gravadas, transcritas e posteriormente analisadas, a partir de análise qualitativa de conteúdo. Participaram do estudo 12 mães de pessoas com síndrome de Down, com idades entre dois meses e 23 anos. Os resultados revelaram que o diagnóstico de síndrome de Down gera impacto nas mães. Em decorrência disso, as mães apresentaram dificuldade de construir expectativas em relação ao desenvolvimento e escolarização. Ressalta-se a importância do apoio e acompanhamento da mãe, no que se refere ao exercício da maternidade, bem como de professores que acompanharão o aluno com síndrome de Down a partir da idade escolar. The present study aimed to investigate the mother's expectations in relation to the development and schooling of the child with Down's syndrome, based on a psychoanalytic approach. A qualitative study was carried through, by means of interviews, which have been recorded, transcribed and later analyzed, from qualitative content analysis. Twelve mothers of individuals with Down's syndrome, ages between two months and 23 years, have participated of the study. The results have disclosed that the diagnosis of syndrome of Down generates impact in the mothers. In this result, the mothers have presented difficulty to construct positive expectations in relation to the development and schooling of their children. The importance of a support and following closer of the mother is standing out, as for the exercise of the motherhood, as well as of teachers who will follow up the pupil with Down's syndrome in the school age. El presente estudio tuvo por objetivo investigar las expectativas maternas con relación al desarrollo y la escolarización de hijos con síndrome de Down, basado en una discusión psicoanalítica. Fue realizado un estudio cualitativo, a través de entrevistas, que fueron grabadas, transcritas y posteriormente analizadas, a partir del análisis cualitativo de contenido. Participaron del estudio 12 madres de personas con síndromes de Down, entre 2 meses y 23 años de edad. Los resultados revelan que el diagnóstico del síndrome de Down genera un impacto importante en las madres. Como consecuencia de ello, las madres presentan dificultades en construir expectativas respecto al desarrollo y escolarización de los hijos. El artículo destaca la importancia del apoyo y de la atención psicológica a la madre, relacionada al ejercicio de la maternidad, bien como a los maestros que acompañarán el alumno con síndrome de Down a partir de la edad escolar.

The principle of motivation has resurfaced as an independent variable in the field of behavior analysis over the past 20 years.The increased interest is the result of refinements of the concept of the motivating operation and its application to the learning needs of persons with developmental disabilities. Notwithstanding the increased emphasis upon modification of motivating operations to reduce problem behavior, there is limited recognition of this important behavioral variable in autism treatment literature. An overview of antecedent-based instructional modifications that lead to a reduction of escape and avoidance behavior of children with autism during instruction is provided. An analysis of these instructional methods as motivating operations is proposed. A conceptually systematic analysis of the influence of instructional methods is offered as a tool for improving the selection and implementation of effective teaching procedures.

Comprehensive intensive treatment based upon the application of behavior analytic principles has proven to be an effective form of intervention for children with autism (Green, 1996). Several comparative studies have demonstrated the superiority of behavior analytic programs over other approaches to autism treatment or differing levels of intensities of services (Birnbrauer & Leach, 1993; Cohen, Amerine-Dickens, & Smith, 2006; Eikseth, Smith, Jahr, & Eldevik, 2002, 2007; Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Lovaas, 1987; Sallows & Graupner, 2005; Remington et al. , in press; Smith, Groen, & Wynne, 2000). This research has provided clear evidence that intensive intervention guided by behavior analytic principles can produce substantial benefits for children with a disorder that was once thought to be resistant to all forms of treatment. There are reports of children with autism entering regular education classrooms, achieving substantial cognitive gains and developing age appropriate social skills after many years of intensive behavioral intervention (Lovaas, 1987). Recently, evidence has been gathered that suggests that school, community, and home applications of intensive behavioral intervention can be equally successful (Eikseth et al. , 2002; Howard et al. , 2005). At least five published manuals (Leaf & McEachin, 1999; Lovaas, 1981, 2003; Maurice, Green, & Foxx, 2001; Maurice, Green, & Luce, 1996) for parents and practitioners are available to provide a summary of the effective teaching methods discovered through controlled studies. These manuals have provided a user-friendly method of disseminating effective behavior analytic methods for teaching children with autism. The result may be greater acceptance and widespread application of behavior analytic methods with children with autism. Much of the research and all of the manualized treatment packages have emphasized the importance of motivating children to respond to teacher directed instructional tasks. Koegel, Carter, and Koegel (1998) and Koegel, Koegel, Shoshan & McNerney (1999) suggested that motivation is pivotal to the teaching of children with autism because its creation is critical to the development of a wide range of skills. Moreover, given the tendency of these children to engage in high rates of escape and avoidance behaviors (Koegel, Koegel, Frea, & Smith, 1995) within instructional demand settings, methods that increase the motivation to respond may be essential to positive long-term outcomes. The ultimate outcome for many children with autism may depend at least partially upon their learning to attend to teacher-directed activities and respond correctly and quickly for reasonable periods of time each day (Drash & Tudor, 1993). This is especially important for children with autism because they frequently fail to learn through exposure to typical social environments (Smith, 2001). As an alternative to mere exposure to everyday experiences, the method of discrete trial instruction (Lovaas, 1981, 1987; Smith, 2001) has been demonstrated to be one of the most effective instructional tools for teaching important language, social, and cognitive skills to children with autism as a component of a comprehensive program of intervention. The method is modeled after Skinner's (1968) three-term contingency arrangement whereby a stimulus is presented by a teacher, a response occurs, and a consequence follows the response in order to strengthen or weaken the likelihood that it will occur again under similar conditions. When discrete trial instruction has been used as a component of a comprehensive program of intensive intervention for children with autism, long-term benefits have been achieved with many children (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993; Smith, 1999). Notwithstanding the benefits of this method, its proper implementation presents substantial challenges to practitioners. …

O presente artigo propõe-se a discutir o tema da adoção, partindo de um caso clínico atendido através da Psicoterapia Breve Dinâmica no Centro Integrado de Psicologia - Feevale. Frente ao caso trabalhado, objetiva-se compreender o lugar que a criança adotada é convocada a ocupar no contexto familiar. O estudo aponta para diversas respostas à questão, que dizem respeito à adoção enquanto construção de um imaginário parental e as possíveis implicações no sujeito adotado quando a mesma não é revelada.The Ugly Duckling and parental imaginary. This article proposes to discuss the issue of adoption based on a clinical case observed in a Brief Dynamic Psychotherapy at Centro Integrado de Psicologia - Feevale. In this case, the authors aimed to understand the place that the adopted child is requested to occupy in the family. The study highlights several possible answers to the question, concerning adoption as a construction of a parental imaginary and the possible implications for the child when the adoption is not revealed.

The present study aimed to investigate the mother's expectations in relation to the development and schooling of the child with Down's syndrome, based on a psychoanalytic approach. A qualitative study was carried through, by means of interviews, which have been recorded, transcribed and later analyzed, from qualitative content analysis. Twelve mothers of individuals with Down's syndrome, ages between two months and 23 years, have participated of the study. The results have disclosed that the diagnosis of syndrome of Down generates impact in the mothers. In this result, the mothers have presented difficulty to construct positive expectations in relation to the development and schooling of their children. The importance of a support and following closer of the mother is standing out, as for the exercise of the motherhood, as well as of teachers who will follow up the pupil with Down's syndrome in the school age. El presente estudio tuvo por objetivo investigar las expectativas maternas con relación al desarrollo y la escolarización de hijos con síndrome de Down, basado en una discusión psicoanalítica. Fue realizado un estudio cualitativo, a través de entrevistas, que fueron grabadas, transcritas y posteriormente analizadas, a partir del análisis cualitativo de contenido. Participaron del estudio 12 madres de personas con síndromes de Down, entre 2 meses y 23 años de edad. Los resultados revelan que el diagnóstico del síndrome de Down genera un impacto importante en las madres. Como consecuencia de ello, las madres presentan dificultades en construir expectativas respecto al desarrollo y escolarización de los hijos. El artículo destaca la importancia del apoyo y de la atención psicológica a la madre, relacionada al ejercicio de la maternidad, bien como a los maestros que acompañarán el alumno con síndrome de Down a partir de la edad escolar. O presente estudo teve por objetivo investigar as expectativas maternas em relação ao desenvolvimento e escolarização do filho com síndrome de Down, a partir de uma perspectiva psicanalítica. Foi realizado um estudo qualitativo, por meio de entrevistas, que foram gravadas, transcritas e posteriormente analisadas, a partir de análise qualitativa de conteúdo. Participaram do estudo 12 mães de pessoas com síndrome de Down, com idades entre dois meses e 23 anos. Os resultados revelaram que o diagnóstico de síndrome de Down gera impacto nas mães. Em decorrência disso, as mães apresentaram dificuldade de construir expectativas em relação ao desenvolvimento e escolarização. Ressalta-se a importância do apoio e acompanhamento da mãe, no que se refere ao exercício da maternidade, bem como de professores que acompanharão o aluno com síndrome de Down a partir da idade escolar.