Modulating cytokine microenvironment during T cell activation induces protective RSV-specific lung resident memory T cells in early life in mice.

Maternal immunisation against respiratory viruses provides protection in early life, but as antibodies wane, there can be a gap in coverage. This immunity gap might be filled by inducing pathogen-specific lung tissue-resident T cells (TRM). However, the neonatal mouse lung has a different inflammatory environment to the adult lung which affects T cell recruitment.

Extubation Failure in the PICU: A Virtual Pediatric Systems Database Study, 2017-2021.

Objectives: Extubation failure (EF) in PICU patients is reintubation within 48, 72, or 96 hours of planned extubation (EF48, EF72, and EF96, respectively). Standardized sedation protocols, extubation readiness testing, and noninvasive respiratory support are used to improve efficient liberation from mechanical ventilation (MV). We therefore aimed to review EF rates, time to failure, and the use of noninvasive respiratory support after extubation, 2017-2021.

Does the sound environment influence the behaviour of zoo-housed birds? A preliminary investigation of ten species across two zoos.

In the zoo, the sound environment experienced by captive wild animals will contain numerous anthropogenic features that may elicit different responses to those stimulated by naturally created, or more biologically relevant, sounds. Husbandry activities, visitor presence and neighbouring species (free-living and captive) will all influence the sounds around zoo-housed species; an animal's behavioural responses may therefore provide an insight into how its welfare state is influenced by this changing sound environment. This project aimed to investigate how animal behaviour was influenced by the sound environment at two large UK zoos; one situated in a more rural location and the other in an urban location.

The Utilization of Critical Care Resources in Pediatric Neurocritical Care Patients.

Objectives: To define the prevalence of neurologic diagnoses and evaluate the utilization of critical care and neurocritical care (NCC) resources among children admitted to the PICU.

Design: Retrospective cohort analysis.

Setting: Data submitted to the Virtual Pediatric Systems (VPS) database.

Genomic analysis of Leuconostoc citreum TR116 with metabolic reconstruction and the effects of fructose on gene expression for mannitol production.

The species Leuconostoc citreum is often isolated from grain and vegetable fermentations such as sourdough, sauerkraut and kimchi. Lc. citreum has seen an increase in its use as a starter culture for various fermentations and food applications.

Visitor presence and a changing soundscape, alongside environmental parameters, can predict enclosure usage in captive flamingos.

The sound environment of a zoo animal is a complex milieu of animal and human-generated sounds; coming from the species itself, other species, visitors, keepers and other zoo-users. Research determining how different components of the sound environment affect animal behaviour is surprisingly lacking but could have real-world impacts for animal welfare and zoo enclosure design. The current study investigated the effects of the sound environment on two flocks of flamingos housed in open-air enclosures at British zoos.

The Impact of Coronavirus Disease 2019 Pandemic on U.S. and Canadian PICUs.

Objectives: There are limited reports of the impact of the coronavirus disease 2019 pandemic focused on U.S. and Canadian PICUs.

Application of mannitol producing Leuconostoc citreum TR116 to reduce sugar content of barley, oat and wheat malt-based worts.

Achieving a high monosaccharide composition in malt wort is instrumental to achieve successful lactic acid bacteria fermentation of malt based beverages. The conversion of monosaccharides to alternative metabolites such as the sweet polyol, mannitol with heterofermentative strains presents a novel approach for sugar reduction and to compensate for the loss of sweetness. This work outlines the application of an adopted mashing regimen with the addition of exogenous enzymes to produce wort with high fructose content which can be applied to different malted grain types with consistently efficacious monosaccharide production for bacterial fermentation.

Isolation, characterisation and exploitation of lactic acid bacteria capable of efficient conversion of sugars to mannitol.

The demand for sugar reduction in products across the food and beverage industries has evoked the development of novel processes including the application of fermentation with lactic acid bacteria. Heterofermentative lactic acid bacteria (LAB) are diverse in their ability to utilise fermentable sugars and can also convert fructose into the sweet tasting polyol, mannitol. The sourdough microbiota has long been recognised as an ecological niche for a range of homofermentative and heterofermentative lactic acid bacteria.

Executive Summary: Criteria for Critical Care of Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance.

This is an executive summary of the 2019 update of the 2004 guidelines and levels of care for PICU. Since previous guidelines, there has been a tremendous transformation of Pediatric Critical Care Medicine with advancements in pediatric cardiovascular medicine, transplant, neurology, trauma, and oncology as well as improvements of care in general PICUs. This has led to the evolution of resources and training in the provision of care through the PICU.

Criteria for Critical Care Infants and Children: PICU Admission, Discharge, and Triage Practice Statement and Levels of Care Guidance.

Objectives: To update the American Academy of Pediatrics and Society of Critical Care Medicine's 2004 Guidelines and levels of care for PICU.

Design: A task force was appointed by the American College of Critical Care Medicine to follow a standardized and systematic review of the literature using an evidence-based approach. The 2004 Admission, Discharge and Triage Guidelines served as the starting point, and searches in Medline (Ovid), Embase (Ovid), and PubMed resulted in 329 articles published from 2004 to 2016.

Sourdough technology as a novel approach to overcome quality losses in sugar-reduced cakes.

Sugar reduction in sweet baked goods is one of the most popular trends on the food market. However, reducing sugar without lowering the product quality with respect to sweetness, texture and microbial shelf life is challenging. Sugar alcohols are one group of sugar replacers which maintain the bulk and contribute to sweetness.

A review of polyols - biotechnological production, food applications, regulation, labeling and health effects.

Food research is constantly searching for new ways to replace sugar. This is due to the negative connotations of sugar consumption on health which has driven consumer demand for healthier products and is reflected on a national level by the taxation of sugary beverages. Sugar alcohols, a class of polyols, are present in varying levels in many fruits and vegetables and are also added to foods as low calorific sweeteners.

Leuconostoc citreum TR116: In-situ production of mannitol in sourdough and its application to reduce sugar in burger buns.

A marketing study revealed that commercially available burger buns can contain up to 10% (w/w) of added sugar. In order to reduce sugar and maintaining the product quality at the same time, functional ingredients and alternative sweetening agents have to be incorporated. In this study, the sourdough lactic acid bacteria Leuconostoc citreum TR116, selected for its ability to produce high amounts of mannitol, was used to produce wheat sourdough and its biochemical characteristics (cell count, pH, TTA, sugar- and acid profile, as well as mannitol production) were monitored over 48 h.

Development and Validation of an Empiric Tool to Predict Favorable Neurologic Outcomes Among PICU Patients.

Objectives: To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness.

Design: Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regression model was used to create the final prediction model including all predictors selected from the lasso model.

Pediatric Trauma Assessment and Management Database: Leveraging Existing Data Systems to Predict Mortality and Functional Status after Pediatric Injury.

Background: Efforts to improve pediatric trauma outcomes need detailed data, optimally collected at lowest cost, to assess processes of care. We developed a novel database by merging 2 national data systems for 5 pediatric trauma centers to provide benchmarking metrics for mortality and non-mortality outcomes and to assess care provided throughout the care continuum.

Study Design: Trauma registry and Virtual Pediatric Systems, LLC (VPS) from 5 pediatric trauma centers were merged for children younger than 18 years discharged in 2013 from a pediatric ICU after traumatic injury.

Association of Freestanding Children's Hospitals With Outcomes in Children With Critical Illness.

Objectives: Little is known about the relationship between freestanding children's hospitals and outcomes in children with critical illness. The purpose of this study was to evaluate the association of freestanding children's hospitals with outcomes in children with critical illness.

Design: Propensity score matching was performed to adjust for potential confounding variables between patients cared for in freestanding or nonfreestanding children's hospitals.

Impact of 24/7 In-Hospital Intensivist Coverage on Outcomes in Pediatric Intensive Care. A Multicenter Study.

Rationale: The around-the-clock presence of an in-house attending critical care physician (24/7 coverage) is purported to be associated with improved outcomes among high-risk children with critical illness.

Objectives: To evaluate the association of 24/7 in-house coverage with outcomes in children with critical illness.

Methods: Patients younger than 18 years of age in the Virtual Pediatric Systems Database (2009-2014) were included.

Risk factors and outcomes of in-hospital cardiac arrest following pediatric heart operations of varying complexity.

Background: Multi center data regarding cardiac arrest in children undergoing heart operations of varying complexity are limited.

Methods: Children <18 years undergoing heart surgery (with or without cardiopulmonary bypass) in the Virtual Pediatric Systems (VPS, LLC) Database (2009-2014) were included. Multivariable mixed logistic regression models were adjusted for patient's characteristics, surgical risk category (STS-EACTS Categories 1, 2, and 3 classified as "low" complexity and Categories 4 and 5 classified as "high" complexity), and hospital characteristics.

Risk factors for mechanical ventilation and reintubation after pediatric heart surgery.

Objective: To determine the prevalence of and risk factors associated with the need for mechanical ventilation in children following cardiac surgery and the need for subsequent reintubation after the initial extubation attempt.

Methods: Patients younger than 18 years who underwent cardiac operations for congenital heart disease at one of the participating pediatric intensive care units (ICUs) in the Virtual PICU Systems (VPS), LLC, database were included (2009-2014). Multivariable logistic regression models were fitted to identify factors likely associated with mechanical ventilation and reintubation.

Variability in the structure and care processes for critically injured children: A multicenter survey of trauma bay and intensive care units.

Purpose: Evaluate national variation in structure and care processes for critically injured children.

Methods: Institutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n=72). Prospective survey data were obtained from PICU and Trauma Directors (n=69, 96% response).

Association of house staff training with mortality in children with critical illness.

Aim: To evaluate the association of house staff training with mortality in children with critical illness.

Methods: Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. The study population was divided in two study groups: hospitals with residency programme only and hospitals with both residency and fellowship programme.

Pediatric Index of Cardiac Surgical Intensive Care Mortality Risk Score for Pediatric Cardiac Critical Care.

Objective: Comparison of clinical outcomes is imperative in the evaluation of healthcare quality. Risk adjustment for children undergoing cardiac surgery poses unique challenges, due to its distinct nature. We developed a risk-adjustment tool specifically focused on critical care mortality for the pediatric cardiac surgical population: the Pediatric Index of Cardiac Surgical Intensive care Mortality score.