Here, we present the complete chloroplast genomes of Quercus × morehus, Q. wislizeni, and Q. kelloggii from California. The genomes are 161,119 to 161,130 bp and encode 132 genes. Quercus × morehus and Q. wislizeni are identical in sequence but differ from Q. kelloggii by three indels and eight SNPs.

A retrospective analysis was performed of 1637 questionnaires among students of immediate pediatric life support (IPLS) courses. All theory and practice classes and organization and methods received an average score higher than 8.5 except for the schedule and time devoted to developing contents. All parameters evaluating instructors' skills received a score higher than 9. Participants requested more time to practice and for course adaptation to their specific professionals needs. IPLS courses are highly valued by students. The duration of IPLS practice sessions should be increased and the course should be adapted to the specific professional needs of participants.

Background Nutritional support is essential in the care of critically ill children, since malnutrition in this population is associated to increased morbidity and mortality. Injury in patients admitted to pediatric intensive care units (PICU) results in a catabolic state, with augmented protein breakdown, leading to a negative protein balance. Current recommendations about protein prescription in PICU are fundamentally based on expert opinions, with a minimum threshold of 1.5 g/kg/day of protein, although protein needs could be higher in certain subgroups of patients. The main objective of the present study is to examine if the administration of a protein-enriched infant formula increases the serum levels of total proteins, albumin, prealbumin, transferrin, retinol, and improves nitrogen balance; and to analyze the effect of the high-protein diet on energy expenditure. A secondary objective is to register possible secondary effects of the protein-enriched diet. Methods a multicenter prospective randomized controlled trial (RCT) will be performed in three hospitals. Patients meeting inclusion criteria will be randomly allocated to one of three enteral feeding formula with different protein content. Blood and urine test, nitrogen balance assessment and energy expenditure testing by indirect calorimetry will be performed at the beginning of nutrition regimen and at 24 hours, 72 hours and 5-7 days after initiation. The sample size for this trial is estimated as 90 participants, with approximately 30 participants in each group. The data analysis will be by intention to treat. Discussion this RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, surrogate of protein balance, in critically ill infants receiving enteral nutrition.

We have read with interest the article of Anderson et al about the Train the Trainer (TTT) educational strategies regarding resuscitation in limited resource settings [[1]Anderson C.R. Taira B.R. The train the trainer model fro the propoagation of resuscitation knowledge in limited resource settings: a systematic review.Resuscitation. 2018; 127: 1-7Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar]. We agree with the authors that is very important to aim for the long term sustainability of these educational programs [[2]López-Herce J. Urbano J. Carrillo A. Matamoros M. Red Iberoamericana de Estudio de la Parada Cardiorrespiratoria en la Infancia. Resuscitation training in developing countries: importance of a stable program of formation of instructors.Resuscitation. 2011; 82: 780Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. In order to reach this objective is essential to organize a local structure that permits a progressive scientific and economic autonomy. We recently have published our experience with the RIBEPCI program [[3]Urbano J. Matamoros M.M. López-Herce J. Carrillo A.P. Ordóñez F. Moral R. et al.A paediatric cardiopulmonary resuscitation training project in Honduras.Resuscitation. 2010; 81: 472-476Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar]. This is a multinational multicentre program that developed an educational resuscitation network in several Latin American countries. We began our experience in Honduras with a Spanish Paediatric Resuscitation Group [[4]López-Herce J. Matamoros M.M. Moya L. Almonte E. Coronel D. Urbano J. et al.Paediatric cardiopulmonary resuscitation training program in Latin-America: the RIBEPCI experience.BMC Med Educ. 2017; 17PubMed Google Scholar], and after that we extended the program sequentially with the same educational methodology to Guatemala, Dominican Republic and some rural parts of Mexico. In our experience we tried to integrate local instructors in the task of spreading the program. In this way, we incorporated the recently graduated Honduran instructors in the team of teachers that participated the following year when the program was repeated in Guatemala, and so on. During 5 years, 6 instructors courses (94 students), 64 Paediatric Basic Life Support courses (1409 students), 29 Paediatric Intermediate Life Support courses (626 students) and 89 Paediatric Advanced Life Support courses (1804 students) were launched. At this moment all five groups are autonomous, maintain their own educational programs and organize their own instructor courses. We believe that the participation of groups from different countries in the educational activities is an important method to establish a cooperation network. It might be interesting to develop international recommendations about cooperation in resuscitation education to help new teams to organize and begin new programs. Jesús López-Herce, Javier Urbano, Angel Carrillo and Iberoamerican Pediatric Cardiac Arrest Study Network (RIBEPCI). Authors declare no conflict of interest.

Background: To analyse the effectiveness of Paediatric Basic Life Support (PBLS) and Paediatric Immediate Life Support (PILS) courses to train medical students in paediatric cardiopulmonary resuscitation (CPR). Methods: Eighteen courses (13 in PBLS and 5 in PILS) were delivered to 1214 medical students. Two theory tests and one practical test were performed. Students filled in an anonymous questionnaire after each course. Results: The mean scores (out of 20) in the theory tests of the PBLS course were 11.4 before the course, and 19.2 upon completion (P<0.0001). Infant BLS skills were achieved by 98.4% of students, and children BLS skills by 97% of them. The mean scores (out of 30) in the PILS courses were 17.3 before the course, and 29.1 at the end of the course (P<0.0001). PBLS skills were achieved by 99% of students and PILS skills by 98.3% of them. The scores (out of 5) in the anonymous questionnaire were: theory classes, 4.5; teaching methods, 4.5; practice sessions, 4.7; instructor teaching skills, 4.8; and coordination of theory and practice and between instructors, 4.7. There were no significant differences between basic and intermediate CPR courses. Conclusions: PBLS and PILS courses are useful methods for delivering theory and practice training to medical students, and should be mandatory in the paediatric curriculum of medical studies. Resumen: Objetivos: Analizar la utilidad de cursos de reanimación cardiopulmonar básica (RCPB) e intermedia (RCPI) para la formación de los estudiantes del grado de medicina. Métodos: Se impartieron 18 cursos (13 de RCPB y 5 de RCPI) a 1.214 estudiantes de medicina. Se realizaron 2 exámenes teóricos uno inicial y otro final, y una evaluación práctica. Después del curso los estudiantes realizaron una encuesta anónima. Resultados: En el curso de RCPB la puntuación en el examen inicial fue de 11,4 sobre 20 y 19,2 en el examen final (p<0,0001). Un 98,4% de los estudiantes del curso de RCPB adquirieron suficiente práctica en la RCP del lactante y 97 en la RCP del niño. En el curso de RCPI la puntuación en el examen inicial fue de 17,3 sobre 30 y 29,1 en el examen final (p<0,0001). Un 99% de los estudiantes del curso de RCPB adquirieron suficiente práctica en la RCP básica y un 98,3% en la RCP intermedia. Las valoraciones en la encuesta anónima (sobre 5) fueron: clases teóricas 4,5; métodos de enseñanza 4,5; prácticas 4,7; capacidad docente de los profesores 4,8, y coordinación teórico-práctica y entre instructores 4,7. No existieron diferencias entre los cursos de RCP básica e intermedia. Conclusiones: Los cursos de RCP pediátrica básica e intermedia son métodos útiles para la formación teórica y práctica de los estudiantes de medicina y deberían incluirse como obligatorios en el currículum del grado de medicina. Keywords: Cardiac arrest, Paediatric cardiopulmonary resuscitation, Resuscitation courses, Children, Student training, Clinical education, Palabras clave: Parada cardiaca, Reanimación cardiopulmonar pediátrica, Cursos de reanimación, Niños, Formación de estudiantes, Formación clínica

To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest.A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24-48hours and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death.Of the total of 41 children studied, 70.7% male were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48hours, and 7.6% in the following 3 to 5 days. In the first 48hours, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) P=.125, PIM II (26.8% vs. 9.2%) P=.02, PELOD (21 vs. 12) P=.005, and P-MODS (9 vs. 6) P=.001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p=.002 and P-MODS (6.5 vs. 3) P=.003 reached statistical significance.Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality.

Due to the complexity and characteristics of their patients, neonatal units are risk areas for the development of adverse events (AE). For this reason, there is a need to introduce and implement some tools and strategies that will help to improve the safety of the neonatal patient. Safety check-lists have shown to be a useful tool in other health areas but they are not sufficiently developed in Neonatal Units.A quasi-experimental prospective study was conducted on the design and implementation of the use of a checklist and evaluation of its usefulness for detecting incidents. The satisfaction of the health professionals on using the checklist tool was also assessed.The compliance rate in the neonatal intensive care unit (NICU) was 56.5%, with 4.03 incidents per patient being detected. One incident was detected for every 5.3 checklists used. The most frequent detected incidents were those related to medication, followed by inadequate alarm thresholds, adjustments of the monitors, and medication pumps.The large majority (75%) of the NICU health professionals considered the checklist useful or very useful, and 68.75% considered that its use had managed to avoid an AE. The overall satisfaction was 83.33% for the professionals with less than 5 years working experience, and 44.4% of the professionals with more than 5 years of experience were pleased or very pleased.The checklists have shown to be a useful tool for the detection of incidents, especially in NICU, with a positive assessment from the health professionals of the unit.Las unidades neonatales, por su complejidad y las características de los pacientes, son áreas de riesgo para el desarrollo de eventos adversos (EA); de ahí surge la necesidad de implantar e implementar herramientas y estrategias que permitan mejorar la seguridad del paciente neonatal. Las listas de verificación de seguridad (LVS) han demostrado ser una herramienta útil en otras áreas sanitarias, pero están poco estudiadas en neonatología.Estudio prospectivo cuasiexperimental. Diseño e implantación del uso de LVS y valoración de su utilidad para la detección de incidentes, así como valoración de la satisfacción con el uso de esta herramienta por parte del personal sanitario.En la unidad de cuidados intensivos neonatales (UCIN) el cumplimiento fue del 56,5%. Se detectaron 4,03 incidentes por cada paciente ingresado. Para detectar un incidente fue necesario realizar 5,3 LVS. Los incidentes más frecuentes fueron los relacionados con medicación, seguidos por los ajustes inadecuados de las alarmas de monitores y bombas de infusión.El 75% del personal consideró la LVS útil o muy útil y el 68,75%, que la LVS había conseguido evitar algún EA. En cuanto al grado de satisfacción global, se sentían satisfechos o muy satisfechos con la LVS el 83,33% de las personas con menos de 5 años de experiencia frente al 44,4% del personal con más de 5 años de experiencia.Las LVS han demostrado ser una herramienta útil para la detección de incidentes, especialmente en la UCIN, con una valoración positiva por parte del personal de la unidad.

espanolEste articulo resume las recomendaciones europeas de reanimacion cardiopulmonar (RCP) pediatricas, destacando los principales cambios e intenta animar a los profesionales a actualizar y mantener sus conocimientos y habilidades en RCP pediatrica. Las recomendaciones europeas del ano 2015 mantienen el mismo algoritmo de actuacion en la RCP basica y avanzada pediatrica. Los cambios mas significativos son: en la prevencion de la parada cardiaca (PC), los ninos con enfermedad febril sin signos de shock no deben recibir de forma rutinaria expansiones de fluidos porque un volumen excesivo puede empeorar el pronostico. En la RCP basica se recomienda que la administracion de la respiracion dure alrededor de 1 segundo, para unificar las recomendaciones con las del adulto. En las compresiones toracicas el esternon debe deprimirse por lo menos un tercio del diametro toracico anteroposterior. En el nino, la mayoria de las PC tienen ritmos no desfibrilables y en ellos la secuencia coordinada de ventilacion y compresiones toracicas y administracion de adrenalina es el tratamiento esencial. La via intraosea, sobre todo en los lactantes, puede ser el acceso vascular de primera eleccion. En el tratamiento de la taquicardia supraventricular, cuando se realice cardioversion como tratamiento, se recomienda utilizar una dosis inicial de 1 J/kg (antes se recomendaba 0,5 J/kg). En los cuidados postresucitacion tras la recuperacion de la circulacion espontanea, se deben tomar medidas para evitar la fiebre, teniendo como objetivo conseguir la normotermia ya desde el ambito extrahospitalario. EnglishThis summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.

Background To describe the design and to present the results of a paediatric and neonatal cardiopulmonary resuscitation (CPR) training program adapted to Latin-America. Methods A paediatric CPR coordinated training project was set up in several Latin-American countries with the instructional and scientific support of the Spanish Group for Paediatric and Neonatal CPR. The program was divided into four phases: CPR training and preparation of instructors; training for instructors; supervised teaching; and independent teaching. Instructors from each country participated in the development of the next group in the following country. Paediatric Basic Life Support (BLS), Paediatric Intermediate (ILS) and Paediatric Advanced (ALS) courses were organized in each country adapted to local characteristics. Results Five Paediatric Resuscitation groups were created sequentially in Honduras (2), Guatemala, Dominican Republican and Mexico. During 5 years, 6 instructors courses (94 students), 64 Paediatric BLS Courses (1409 students), 29 Paediatrics ILS courses (626 students) and 89 Paediatric ALS courses (1804 students) were given. At the end of the program all five groups are autonomous and organize their own instructor courses. Conclusions Training of autonomous Paediatric CPR groups with the collaboration and scientific assessment of an expert group is a good model program to develop Paediatric CPR training in low- and middle income countries. Participation of groups of different countries in the educational activities is an important method to establish a cooperation network.

We have read with interest the article by Ralston and de Caen about teaching pediatric life support in limited-resource settings.[1] This remarkable publication shows that it is possible to provide suitable educational training programs regarding pediatric life support in developing countries.

OBJECTIVE:to analyze the incidence of infection in children who have suffered an in-hospital cardiac arrest (CA) and the association with mortality.METHODS:A retrospective unicenter observational study on a prospective database with children between one month and 16 years old, who have suffered an in-hospital CA was performed. Clinical, analytical and monitorization data, treatment, mortality and cause of death were recorded.RESULTS:57 children were studied (57.6% males). Recovery of spontaneous circulation (ROSC) was achieved in 50 children (87.7%) and 32 (59.3%) survived. After ROSC, 28 patients (56% of those who achieved ROSC) were diagnosed of infection. There were not significant differences in mortality between patients infected (42.9%) and uninfected (27.3%) p=0.374. Only one died in consequence of a sepsis with multiorganic failure.CONCLUSIONS:The frequency of infection in children after recovering of a cardiac arrest is high. There were no statistically significant differences in mortality between patients with and without infection after ROSC.

Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support.

OBJECTIVESThis summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.

Objective: To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest.Patients and methods: A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24-48 hours and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death.Results: Of the total of 41 children studied, 70.7% male were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48 hours, and 7.6% in the following 3 to 5 days. In the first 48 hours, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) P=.125, PIM II (26.8% vs. 9.2%) P=.02, PELOD (21 vs. 12) P=.005, and P-MODS (9 vs. 6) P=.001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p=.002 and P-MODS (6.5 vs. 3) P=.003 reached statistical significance.Conclusions: Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality. (C) 2016 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U. All rights reserved.

Pediatric Intensive Care Department Gregorio Marañón General University Hospital Instituto de Investigación Sanitaria Gregorio Marañón Hospital General Universitario Gregorio Marañón; and School of Medicine Mother-Child Health and Development Network (Red SAMID) of Carlos III Health Institute Complutense University of Madrid Madrid, Spain *See also p. 1675. RETICS funded by the PN I+D+I 2008–2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF) ref RD12/0026. The authors have disclosed that they do not have any potential conflicts of interest.