Nationwide survey on the management of pediatric pharyngitis in Italian emergency units

Background: Acute pharyngitis is a frequent reason for primary care or emergency unit visits in children. Most available data on pharyngitis management come from primary care studies that demonstrate an underuse of microbiological tests, a tendency to over-prescribe antibiotics and a risk of antimicrobial resistance increase. However, a comprehensive understanding of acute pharyngitis management in emergency units is lacking. This study aimed to investigate the frequency of rapid antigen test use to diagnose acute pharyngitis, as well as other diagnostic approaches, the therapeutic attitude, and follow-up of children with this condition in the emergency units. Methods: A multicentric national study was conducted in Italian emergency departments between April and June 2022. Results: A total of 107 out of 131 invited units (response rate 82%), participated in the survey. The results showed that half of the units use a scoring system to diagnose pharyngitis, with the McIsaac score being the most commonly used. Most emergency units (56%) were not provided with a rapid antigen diagnostic test by their hospital, but the test was more frequently available in units visiting more than 10,000 children yearly (57% vs 33%, respectively, p = 0.02). Almost half (47%) of the units prescribe antibiotics in children with pharyngitis despite the lack of microbiologically confirmed cases of Group A β-hemolytic streptococcus. Finally, about 25% of units prescribe amoxicillin-clavulanic acid to treat Group A β-hemolytic streptococcus pharyngitis. Conclusions: The study sheds light on the approach to pharyngitis in emergency units, providing valuable information to improve the appropriate management of acute pharyngitis in this setting. The routinary provision of rapid antigen tests in the hospitals could enhance the diagnostic and therapeutic approach to pharyngitis

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

A novel extremely localized molecular orbitals based technique for the one-electron density matrix computation

The 'nearsightedness' of electronic structure is an underlying principle in many of the linear scaling methods recently developed to study large systems. Among them, there are strategies based on the transfer of orbitals strictly localized on molecular fragments, such as the extremely localized molecular orbitals (ELMOs). Unfortunately, due to the non-orthogonal nature of these orbitals, the density matrix calculation is computationally demanding, so preventing a straightforward application to very large molecules. In this Letter, we show how this problem can be overcome by a proper application of the 'Divide and Conquer' strategy to the ELMO approach

Strong planners versus weak planners: An analysis of nonprofit organizations

Previous academic research found that two broad approaches characterize non-profit foundations when setting objectives. In the first approach, the business-like model, nonprofit foundations are inspired by for-profit organizations, and they adopt methodologies, tools, and practices typical of business management to better respond to social issues connected to their local dimensions. The second approach, the charity-like model, conversely argues that hybridization toward the market risks undermining the peculiarities of the nonprofit sector, thereby emphasizing the need of nonprofit foundations to be guided by the solidarity of interests that resides in the natural interdependencies of various members of society. To date, no study has fo-cused on the role of nonprofit foundation employees to understand the impact of a business-like approach on employee professionalism and job performance. Using responses from 277 employees of nonprofit foundations, this study investigates whether increased participation in planning and control tools increases employees’ perceptions of the effectiveness of the grant process. The results show that a busi-ness-like approach to planning, if well-balanced and considered, can contribute to greater employee professionalism and lead to improved information clarity and project innovation

Extremely localized molecular orbitals: Theory and applications

Orbitals that are extremely localized on molecular fragments represent a powerful tool for a number of purposes: to cite a few examples, they allow to reduce strongly the complexity of calculations on large systems and are easily transferable from one molecule to another, providing a suitable and efficient way to build up the electronic structure of large molecules. Recently, we have developed efficient algorithms to determine extremely localized molecular orbitals (ELMOs), which will be reviewed in this paper. As a rigorous localization is strictly connected to a reduction in the number of variational parameters, which reflects into an increased value of the associated energy with respect to the Hartree Fock value, we have developed a number of strategies to relax the wavefunction built up using transferred localized orbitals. The extreme localization has also been exploited in connection with the "Divide and Conquer" technique to determine the electron densities of large polypeptides assembled from orbitals computed on small model molecules. Moreover, we will discuss the recent application of the ELMOs in the framework of the hybrid QM/MM methods to describe the frontier region. We will also show that the ELMOs can be used to extract chemical interpretations from numerical results. A variety of applications will be presented. © Springer-Verlag 2007

A novel extremely localized molecular orbitals based technique for the one-electron density matrix computation

The 'nearsightedness' of electronic structure is an underlying principle in many of the linear scaling methods recently developed to study large systems. Among them, there are strategies based on the transfer of orbitals strictly localized on molecular fragments, such as the extremely localized molecular orbitals (ELMOs). Unfortunately, due to the non-orthogonal nature of these orbitals, the density matrix calculation is computationally demanding, so preventing a straightforward application to very large molecules. In this Letter, we show how this problem can be overcome by a proper application of the 'Divide and Conquer' strategy to the ELMO approach. © 2005 Elsevier B.V. All rights reserved