Rotavirus and illness severity in children presenting with acute gastroenteritis at the primary care out-of-hours service

BACKGROUND: Rotavirus is a common cause of acute gastroenteritis in young children in the Netherlands, where rotavirus vaccination has not yet been implemented. OBJECTIVES: To evaluate a difference in illness severity course depending on the presence of rotavirus infection and assess the prevalence of viruses and the referral rate in children with acute gastroenteritis. METHODS: A prospective cohort of children aged 6 months to 6 years presenting with acute gastroenteritis to a primary care out-of-hours service from October 2016 to March 2018. Faeces were sampled and sent to a laboratory where viral pathogens were identified and quantified by real-time polymerase chain reaction. Severe course of acute gastroenteritis was defined as a Modified Vesikari Score of ≥11. In addition, we assessed referral rates. Chi-square tests were used to evaluate differences between groups. RESULTS: We included 75 children (34 boys) with a median age of 1.5 years (interquartile range, 0.9–2.0 years). The prevalence of rotavirus was 65.3% (95% confidence interval, 53.5–76.0) with a median cycle threshold of 16.0. Severe course of acute gastroenteritis was present in 31 of 71 children (4 were lost to follow-up). Those with rotavirus (20/47) did not have a severe course more often than those without (11/24): odds ratio, 0.88 (95% confidence interval, 0.33–2.36). Referral rates were comparable for rotavirus (15.2%) and non-rotavirus (14.3%). CONCLUSION: In out-of-hours primary care, rotavirus is common but not associated with increased severity and higher referral rates in children with acute gastroenteritis

Course of uncomplicated acute gastroenteritis in children presenting to out-of-hours primary care

Background The aim of this article is to describe the courses of vomiting, diarrhea, fever, and clinical deterioration, in children with uncomplicated gastroenteritis at presentation. This study was performed as a 7-day prospective follow-up study in an out-of-hours primary care service. The course of vomiting, diarrhea, and fever was analyzed by generalized linear mixed modeling. Because young children ( 90%). Vomiting and fever decreased rapidly, but diarrhea decreased at a somewhat slower pace, especially among children aged 6-12 months. Children who deteriorated during follow-up had a higher frequency of vomiting at presentation and higher frequencies of vomiting and fever during follow-up. Conclusions The frequency of vomiting, not its duration, appears to be the more important predictor of deterioration. When advising parents, it is important to explain the typical symptom duration and to focus on alarm symptoms. Clinicians should be vigilant for children with higher vomiting frequencies at presentation and during follow-up because these children are more likely to deteriorate

Cost-effectiveness of oral ondansetron for children with acute gastroenteritis in primary care:a randomised controlled trial

BackgroundAcute gastroenteritis is a common childhood condition with substantial medical and indirect costs, mostly because of referral, hospitalisation, and parental absence from work.AimTo determine the cost-effectiveness of adding oral ondansetron to care as usual (CAU) for children with acute gastroenteritis presenting to out-of-hours primary care (OOH-PC).Design and settingA pragmatic randomised controlled trial from December 2015 to January 2018, at three OOH-PC centres in the north of the Netherlands (Groningen, Zwolle, and Assen) with a follow-up of 7 days.MethodChildren were recruited at the OOH-PC and parents kept a parental diary. Inclusion criteria were: aged 6 months-6 years; diagnosis of acute gastroenteritis; at least four reported episodes of vomiting 24 hours before presentation, at least one of which was in the 4 hours before presentation; and written informed consent from both parents. Children were randomly allocated at a 1:1 ratio to either CAU (oral rehydration therapy) or CAU plus one dose of 0.1 mg/kg oral ondansetron.ResultsIn total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within the first 4 hours from 42.9% to 19.5%, (a decrease of 54.5%), with an odds ratio of 0.4 (95% confidence interval [CI] = 0.2 to 0.7; number needed to treat: four). Total mean costs in the ondansetron group were 31.2% lower ((sic)488 [420] pound versus (sic)709 [610]) pound, and the total incremental mean costs for an additional child free of vomiting in the first 4 hours was -(sic)9 (8) pound (95% CI = -(sic)41 [35] pound to (sic)3 [3]) pound.ConclusionA single oral dose of ondansetron for children with acute gastroenteritis, given in OOH-PC settings, is both clinically beneficial and cost-effective.</p

Augmented reality meeting table: a novel multi-user interface for architectural design

Immersive virtual environments have received widespread attention as providing possible replacements for the media and systems that designers traditionally use, as well as, more generally, in providing support for collaborative work. Relatively little attention has been given to date however to the problem of how to merge immersive virtual environments into real world work settings, and so to add to the media at the disposal of the designer and the design team, rather than to replace it. In this paper we report on a research project in which optical see-through augmented reality displays have been developed together with prototype decision support software for architectural and urban design. We suggest that a critical characteristic of multi user augmented reality is its ability to generate visualisations from a first person perspective in which the scale of rendition of the design model follows many of the conventions that designers are used to. Different scales of model appear to allow designers to focus on different aspects of the design under consideration. Augmenting the scene with simulations of pedestrian movement appears to assist both in scale recognition, and in moving from a first person to a third person understanding of the design. This research project is funded by the European Commission IST program (IST-2000-28559)

Oral ondansetron for paediatric gastroenteritis in primary care:a randomised controlled trial

BACKGROUND: Acute gastroenteritis (AGE) affects almost all children aged ≤5 years. In secondary care, ondansetron was found to be effective at reducing vomiting. AIM: To determine the effectiveness of adding oral ondansetron to care as usual (CAU) to treat vomiting in children with AGE attending out-ofhours primary care (OOH-PC). DESIGN AND SETTING: A pragmatic randomised controlled trial at three OOH-PC centres in the north of the Netherlands (Groningen, Zwolle, and Assen), with a follow-up of 7 days. METHOD: Children were included if they were: aged 6 months–6 years; AGE diagnosed by a GP; ≥4 reported episodes of vomiting in the 24 hours before presentation; ≥1 reported episode of vomiting in the 4 hours before presentation; and written informed consent from both parents. Children were randomly allocated to either the control group or the intervention group. The control group received CAU, namely oral rehydration therapy. The intervention group received CAU plus one dose of oral ondansetron (0.1 mg/kg). RESULTS: In total, 194 children were included for randomisation. One dose of oral ondansetron decreased the proportion of children who continued vomiting within 4 hours from 42.9% to 19.5%, with an odds ratio of 0.37 (95% confidence interval [CI] = 0.20 to 0.72, number needed to treat: four). Ondansetron also decreased the number of vomiting episodes within 4 hours (incidence rate ratio 0.51 [95% CI = 0.29 to 0.88]) and improved overall parental satisfaction with treatment (P = 0.027). CONCLUSION: Children with AGE and increased risk of dehydration due to vomiting could be treated with ondansetron in primary care to stop vomiting more quickly and increase parental satisfaction with treatment. These results could be used to improve the quality and efficacy of general practice medicine

A Survey of Methods for Volumetric Scene Reconstruction from Photographs

Scene reconstruction, the task of generating a 3D model of a scene given multiple 2D photographs taken of the scene, is an old and difficult problem in computer vision. Since its introduction, scene reconstruction has found application in many fields, including robotics, virtual reality, and entertainment. Volumetric models are a natural choice for scene reconstruction. Three broad classes of volumetric reconstruction techniques have been developed based on geometric intersections, color consistency, and pair-wise matching. Some of these techniques have spawned a number of variations and undergone considerable refinement. This paper is a survey of techniques for volumetric scene reconstruction

Residual Effects of Carbon Dioxide Gas Additions to Soil on Roots of Lactuca sativa

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Improved Computational Methods for Ray Tracing

This paper describes algorithmic procedures that have been implemented to reduce the computational expense of producing ray-traced images. The selection of bounding volumes is examined to reduce the computational cost of the ray-intersection test. The use of object coherence, which relies on a hierarchical description of the environment, is then presented. Finally, since the building of the ray-intersection trees is such a large portion of the computation, a method using image coherence is described. This visible-surface preprocessing method, which is dependent upon the creation of an “item buffer,” takes advantage of a priori image information. Examples that indicate the efficiency of these techniques for a variety of representative environments are presented