The effect on the form and structure of starch granules caused by cationisation using a solvent, by dry cationisation and by cationisation in a water slurry has been studied by means of scanning electron microscopy (SEM). By means of energy‐dispersive X‐ray analysis (EDXA) and electron spectroscopy (ESCA) analyses have been made of the chemical elements in the surface layer and inner part of the cationised granules and in gelatinised products prepared from the cationised granules. Cationisation does not change the form of the granules. In granules cationised in a water slurry a slight swelling can be observed. Cationisation gives the starch granules a thin shell‐like outer surface. In the case of solvent‐cationised and especially of dry‐cationised granules there are abundant quantities of small particles in the surface of the granules. These are the remains of chemicals added during cationisation. The ESCA analyses show that the amount of N in the surface layer of solvent‐cationised, dry cationised and water‐cationised granules studied is 3.1, 0.71 and 0.37% (w/w), respectively. In the gelatinised samples prepared from the cationised granules the amount of N in solvent‐ and water‐cationised granules is the same but in dry‐cationised granules it is only half as much, i.e. 0.35% (w/w). The amount of Cl in the surface layer is for solvent‐, dry‐ and water‐cationised granules 88, 47 and 21% of the N content, respectively. The Cl content in the gelatinised products of solvent‐ and water‐cationised granules is approximately the same as before gelatinisation but in the dry‐cationised product it is 50% less. Judging from the analyses it would seem that the cationic amino groups are evenly distributed throughout the granule in the case of solvent‐ and water‐cationised granules. In dry‐cationised granules, however, these groups are concentrated to starch molecules in the outer part of the granule. The significance from the paper‐manufacturing viewpoint of even distribution of the cationic groups throughout the granule, of a low Cl content and of the existence of remains of chemicals in cationic starch is briefly addressed.

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The distribution of molecular size of the native starch prepared according to a new method and of oxidised products of starch has been investigated with the help of agarose gel filtration. It has been noticed that the curve of the molecular distribution of the native wheat starch (product A) shows a big peak excluded by the gel with M̄W > 2 · 106 comprising about 58% of the sample and a part fractioned by the gel within the area 1 · 104 < M̄W < 2 · 106. Comparative gel filterings of native maize, tapioca and potato starch have shown that the distribution of molecular size of wheat starch (A) most resembles that of maize starch. Tapioca starch and especially potato starch have a somewhat lower percentage of molecules within the part fractioned by the gel than wheat starch (A). Native wheat starch, product B has a somewhat higher percentage of molecules within the area 1 · 105 > M̄W > 2 · 104 than the other native types of starch. Heat‐treatening and oxidation of native starch causes a decrease or a disappearance of the macromolecular excluded part of the sample and instead increases the molecules within the fractioning area of the gel, M̄W < 2 · 106. The used gel chromatographic method is thus very suitable when investigating the distribution of molecules of oxidised starch products and in product control.

ObjectivesTo examine the severity and progression of acute illness or injury in children using vital signs obtained during ambulance transport and categorised according to a paediatric triage model.DesignA population-based historical cohort study using data from prehospital patient medical records linked to a national civil registration database.SettingEmergency medical services providing ground-level transport in a mixed urban–rural region with three hospitals in Denmark.Participants25 039 events with patients aged <18 years attended by emergency medical services dispatched after a 1-1-2 emergency call during the years 2006–2018.Primary and secondary outcome measuresDistribution of the first observed vital signs according to a paediatric triage model: heart rate, Glasgow Coma Score, respiratory rate, oxygen saturation and oxygen treatment, and proportion of patients progressing to a triage score with a lower level of urgency during ambulance transport.ResultsThe proportion of patients with the first observed vital signs outside the normal age-specific range was as follows: 33.6% for heart rate, 15.3% for Glasgow Coma Score, 17.4% for respiratory rate and 37.4% for oxygen saturation regardless of oxygen treatment. The proportion of patients progressing to a triage score with a lower level of urgency during transport varied with age: 146/354 (41.2%) for age 0–2 months, 440/986 (44.6%) for age 3–11 months, 1278/3212 (39.8%) for age 1–2 years, 967/2814 (34.4%) for age 3–7 years and 4029/13 864 (29.1%) for age 8–17 years (p<0.001). One-day mortality was 3.05 deaths per 1000 patient-days (95% CI 2.43 to 3.83).ConclusionsOne third of the patients’ condition progressed to a triage score with a lower level of urgency during ambulance transport. Vital sign documentation in paediatric patients was incomplete, and educational initiatives should be taken to increase documentation of vital signs, especially in patients aged ≤2 years.