Perspectives of parents and health care providers about (non)medical treatment in infants with reflux

Background: Reflux occurs in 50% of healthy infants at some point. This is most often a physiological condition and does not require drug treatment. Various studies have shown that the use of drugs affecting gastric acidity (DAGAs) in infants is increasing. This entails disadvantages such as unnecessary exposure of infants to medication and their side effects and a higher cost to society. Objective: To get an image of the current practice in Flanders regarding diagnosis and treatment of gastro-oesophageal reflux disease (GORD) in infants and the associated use of DAGAs. To this end, we determined both parents' and health care providers' experiences and perceptions about these treatments. Method: An observational cross-sectional study was conducted in April and May 2019. We developed a questionnaire for parents and three different questionnaires for health care providers (HCPs), including midwives, general practitioners, paediatricians and community pharmacists (CPs). The questionnaire for parents was only available through an online platform. HCPs were questioned face-to-face and through an online platform. Results: This study made clear that the counselling of children with GORD is multidisciplinary as the median number of counselling HCPs is 3 (interquartile range (IQR) = 2-4). 63% of the included 251 parents also seek support through online forums and groups. 60% of parents report that no physical tests were performed before DAGAs were prescribed and 39% of parents additionally state they perceived no effect of the prescribed DAGAs. Although parents reported to understand HCPs well (average score 7.4/10), satisfaction with care and information provision was scored lower (between 4.8 and 6.1/10). On the other hand, 234 HCPs answered the questionnaire, of which 89 midwives, 78 community pharmacists and 67 physicians. Only 45 HCPs indicate that guidelines to diagnose or treat GORD are clear. Physicians confirm they perform very little physical testing before starting DAGAs. Provided nonmedical measures to patients are largely in line with the European guidelines, however perceived effectiveness is moderate. Conclusion: Parents are in need for more information about tests, nutrition and (non)medical measures. HCPs on the other hand are in need for clear guidelines on diagnosing and treating GORD

Drug administration via enteral feeding tubes in residential care facilities for individuals with intellectual disability : an observational study

Background: The administration of oral medication to patients with an enteral feeding tube (EFT) is challenging. Compliance to guidelines concerning medication administration via EFT has been investigated extensively in the hospital setting. However, studies in residential care facilities (RCFs) for individuals with intellectual disability (ID) are very limited. Therefore, the present study aimed to collect direct observational data on drug administration practices to residents with EFT in multiple RCFs. Method: This cross-sectional, observational study was conducted in six Belgian RCFs for individuals with ID. Observations of medication preparation and administration through EFT were carried out in two randomly selected units per participating RCF, on 2 days per unit during all daytime drug rounds, using a direct observation method. Afterwards, the recorded observations were compared with international guidelines on drug preparation and administration through EFT. Results: In total, 862 drug preparations and 268 administrations in 48 residents with EFT were witnessed. Mixing together multiple drugs, not diluting liquid formulations with at least an equal amount of water, not shaking suspensions/emulsions before use, and not selecting the most appropriate dosage form were the most common deviations from medication preparation guideline recommendations. For medication administration, not flushing the EFT with at least 15mL water was the most common deviation. We also observed high variability in working methods regarding medication preparation and administration via EFT, even between staff members of the same unit. Conclusion: This study found that current guidelines concerning medication preparation and administration through EFT are often not followed in Belgian RCFs for individuals with ID. Further research aimed at understanding why current guidelines are not followed seems warranted

Chemical composition of A--F type post-AGB candidates

An abundance analysis has been conducted for a sample of nine post-AGB candidate stars; eight of them have not been explored before. We find four very promising objects like HD 105262, HD 53300 and CpD$-62^o5428$ among them. We find strong evidence of dust-gas separation through selective depletion of refractive elements in HD 105262. The same effect is also observed in HD 53300, CpD$-62^o5428$ and HD 114855 although abundance peculiarities are relatively smaller for the last two stars. We find strong enrichment of nitrogen for HD 725, HD 842, HD 1457, HD 9233 and HD 61227 but no further evidence to support their post-AGB nature. We have compared the observed [N/C] ratios of these stars with the predictions of evolutionary models which include the rotation induced mixing.Comment: Accepted in MNRAS, 18 pages, 12 figure

A Radial Velocity Study of Composite-Spectra Hot Subdwarf Stars with the Hobby-Eberly Telescope

Many hot subdwarf stars show composite spectral energy distributions indicative of cool main sequence companions. Binary population synthesis (BPS) models demonstrate such systems can be formed via Roche lobe overflow or common envelope evolution but disagree on whether the resulting orbital periods will be long (years) or short (days). Few studies have been carried out to assess the orbital parameters of these spectroscopic composite binaries; current observations suggest the periods are long. To help address this problem, we selected fifteen moderately-bright (V~13) hot subdwarfs with F-K dwarf companions and monitored their radial velocities (RVs) from January 2005 to July 2008 using the bench-mounted Medium Resolution Spectrograph on the Hobby-Eberly Telescope (HET). Here we describe the details of our observing, reduction, and analysis techniques and present preliminary results for all targets. By combining the HET data with recent observations from the Mercator telescope, we are able to calculate precise orbital solutions for three systems using more than 6 years of observations. We also present an up-to-date period histogram for all known hot subdwarf binaries, which suggests those with F-K main sequence companions tend to have orbital periods on the order of several years. Such long periods challenge the predictions of conventional BPS models, although a larger sample is needed for a thorough assessment of the models' predictive success. Lastly, one of our targets has an eccentric orbit, implying some composite-spectrum systems might have formerly been hierarchical triple systems, in which the inner binary merged to create the hot subdwarf.Comment: Published in The Astrophysical Journal, Volume 758, Issue 1, article id. 58 (2012). References updated and Equation (5) corrected. 12 pages, 5 figures, 5 table

Discovery of a peculiar Cepheid-like star towards the northern edge of the Small Magellanic Cloud

For seven years, the EROS-2 project obtained a mass of photometric data on variable stars. We present a peculiar Cepheid-like star, in the direction of the Small Magellanic Cloud, which demonstrates unusual photometric behaviour over a short time interval. We report on data of the photometry acquired by the MARLY telescope and spectroscopy from the EFOSC instrument for this star, called EROS2 J005135-714459(sm0060n13842), which resembles the unusual Cepheid HR 7308. The light curve of our target is analysed using the Analysis of Variance method to determine a pulsational period of 5.5675 days. A fit of time-dependent Fourier coefficients is performed and a search for proper motion is conducted. The light curve exhibits a previously unobserved and spectacular change in both mean magnitude and amplitude, which has no clear theoretical explanation. Our analysis of the spectrum implies a radial velocity of 104 km s$^{-1}$ and a metallicity of -0.4$\pm$0.2 dex. In the direction of right ascension, we measure a proper motion of 17.4$\pm$6.0 mas yr$^{-1}$ using EROS astrometry, which is compatible with data from the NOMAD catalogue. The nature of EROS2 J005135-714459(sm0060n13842) remains unclear. For this star, we may have detected a non-zero proper motion for this star, which would imply that it is a foreground object. Its radial velocity, pulsational characteristics, and photometric data, however, suggest that it is instead a Cepheid-like object located in the SMC. In such a case, it would present a challenge to conventional Cepheid models.Comment: Correction of typos in the abstrac

An incisive look at the symbiotic star SS Leporis -- Milli-arcsecond imaging with PIONIER/VLTI

Context. Determining the mass transfer in a close binary system is of prime importance for understanding its evolution. SS Leporis, a symbiotic star showing the Algol paradox and presenting clear evidence of ongoing mass transfer, in which the donor has been thought to fill its Roche lobe, is a target particularly suited to this kind of study. Aims. Since previous spectroscopic and interferometric observations have not been able to fully constrain the system morphology and characteristics, we go one step further to determine its orbital parameters, for which we need new interferometric observations directly probing the inner parts of the system with a much higher number of spatial frequencies. Methods. We use data obtained at eight different epochs with the VLTI instruments AMBER and PIONIER in the H- and K-bands. We performed aperture synthesis imaging to obtain the first model-independent view of this system. We then modelled it as a binary (whose giant is spatially resolved) that is surrounded by a circumbinary disc. Results. Combining these interferometric measurements with previous radial velocities, we fully constrain the orbit of the system. We then determine the mass of each star and significantly revise the mass ratio. The M giant also appears to be almost twice smaller than previously thought. Additionally, the low spectral resolution of the data allows the flux of both stars and of the dusty disc to be determined along the H and K bands, and thereby extracting their temperatures. Conclusions. We find that the M giant actually does not stricto sensus fill its Roche lobe. The mass transfer is more likely to occur through the accretion of an important part of the giant wind. We finally rise the possibility for an enhanced mass loss from the giant, and we show that an accretion disc should have formed around the A star.Comment: 11 pages, 5 figures, published in A&A Appendix presenting reduced data and extracted parameters Reduced data can be found on the CD

Long-term photometric monitoring with the Mercator telescope. Frequencies and multicolour amplitudes of γ\gamma Doradus stars

Gamma Doradus stars are excellent targets for asteroseismology since the gravity modes present in these stars probe the deep stellar interiors. Mode identification will improve the knowledge of these stars considerably. A selected group of Gamma Doradus stars and some candidates were observed with the Mercator telescope to find and/or confirm the periodicities in the light variations and to derive reliable amplitude ratios in different pass bands. A frequency analysis was performed on all new data obtained in the Geneva photometric system. In order to have more reliable and accurate frequencies, the new data were combined with similar data from the literature and with Hipparcos observations. A set of frequencies that minimized the the residuals in a harmonic fit was searched for while allowing means and amplitudes to vary from one observation set to another. Frequencies and amplitudes in the photometric passbands of the Geneva system are given for 21 Gamma Doradus stars. We report the discovery of HD 74504 as a newly found Gamma Doradus star. Our study provides the first extensive multicolour database for the understanding of gravity modes in F-type stars.Comment: Electronic tables (5 to 25) not included in this versio

Steps toward determination of the size and structure of the broad-line region in active galactic nuclei. VI. Variability of NGC 3783 from ground-based data

The Seyfert 1 galaxy NGC 3783 was intensely monitored between 1991 December and 1992 August. We present the results from the ground-based observations in the optical and near-IR, which complement the data-set from the IUE, discussed elsewhere. Spectroscopic and photometric data from many observatories were combined in order to obtain well sampled light curves of the continuum and of H-Beta. During the campaign the source varied significantly. The light curves of the optical continuum and of H-Beta are similar to those obtained with the IUE. The near-IR flux did not vary significantly except for an increase at the end of the campaign. The optical continuum and the flux of H-Beta lag the UV continuum by 1 day or less and by 8 days respectively. These results confirm that the continuum variations are simultaneous or have a very small lag across the entire UV-optical range, and that the lines of NGC 3783 respond to ionizing continuum variations with less delay than those of NGC 5548. As in NGC 5548, the lag of H-Beta is greater than those of the high ionization lines.Comment: 34 pages in LaTeX, 7 postscript figures available on request from [email protected] or 37907::stirpe, BAP#10-1993-035-OA

Long term photometric monitoring with the Mercator telescope. Frequencies and mode identification of variable O-B stars

Aims. We selected a large sample of O-B stars that were considered as (candidate) slowly pulsating B, beta Cep, and Maia stars after the analysis of their hipparcos data. We analysed our new seven passband geneva data collected for these stars during the first three years of scientific operations of the mercator telescope. We performed a frequency analysis for 28 targets with more than 50 high-quality measurements to improve their variability classification. For the pulsating stars, we tried both to identify the modes and to search for rotationally split modes. Methods: We searched for frequencies in all the geneva passbands and colours by using two independent frequency analysis methods and we applied a 3.6 S/N-level criterion to locate the significant peaks in the periodograms. The modes were identified by applying the method of photometric amplitudes for which we calculated a large, homogeneous grid of equilibrium models to perform a pulsational stability analysis. When both the radius and the projected rotational velocity of an object are known, we determined a lower limit for the rotation frequency to estimate the expected frequency spacings in rotationally split pulsation modes. Results: We detected 61 frequencies, among which 33 are new. We classified 21 objects as pulsating variables (7 new confirmed pulsating stars, including 2 hybrid beta Cep/SPB stars), 6 as non-pulsating variables (binaries or spotted stars), and 1 as photometrically constant. All the Maia candidates were reclassified into other variability classes. We performed mode identification for the pulsating variables for the first time. The most probable l value is 0, 1, 2, and 4 for 1, 31, 9, and 5 modes, respectively, including only 4 unambiguous identifications. For 7 stars we cannot rule out that some of the observed frequencies belong to the same rotationally split mode. For 4 targets we may begin to resolve close frequency multiplets. Based on observations collected with the p7 photometer attached to the Flemish 1.2-m mercator telescope situated at the Roque de los Muchachos observatory on La Palma (Spain). Section [see full textsee full text], including Figs. is only available in electronic form at http://www.aanda.org, and Tables 2 and 3 are only available in electronic form at the CDS via anonymous ftp to cdsarc.u-strasbg.fr (130.79.128.5) or via http://cdsweb.u-strasbg.fr/cgi-bin/qcat?J/A+A/463/243Peer reviewe

Medication administration via enteral feeding tube: a survey of pharmacists' knowledge

Background: Medication administration to patients with an enteral feeding tube (EFT) is complex and prone to errors. Community pharmacists may be ideally placed to provide training and advice on this topic in individual patients as well as in institutions supplied by the pharmacy. Objective: To assess community pharmacists' knowledge on guideline recommendations regarding medication preparation and administration through EFT. Method: Knowledge of guideline recommendations was assessed using a 15-item self-administered online questionnaire (April-June 2014). Questions reflected key aspects of guideline recommendations on medication administration via EFT. All graduated community pharmacists from the Dutch-speaking part of Belgium were eligible for participation. Results: A total of 105 community pharmacists completed the questionnaire. Median self-perceived knowledge of medication administration via EFT was 2 (on a 0-10 scale). On average 5.2 (SD 2.6) out of the 15 questions were answered correctly. Strikingly, the ability to select suspensions in a list of liquid medications and knowledge on crushability of solid dosage forms were low. Conclusion: Our findings demonstrate that pharmacists' knowledge on correct medication administration via EFT is too limited to be able to provide good advice to EFT patients or their caregivers. Tailored training on this topic is needed