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Stratification in both the design and analysis of randomized clinical trials is common. Despite features in automated randomization systems to re-confirm the stratifying variables, incorrect values of these variables may be entered. These errors are often detected during subsequent data collection and verification. Questions remain about whether to use the mis-reported initial stratification or the corrected values in subsequent analyses. It is shown that the likelihood function resulting from the design of randomized clinical trials supports the use of the corrected values. New definitions are proposed that characterize misclassification errors as `ignorable' and `non-ignorable'. Ignorable errors may depend on the correct strata and any other modeled baseline covariates, but they are otherwise unrelated to potential treatment outcomes. Data management review suggests most misclassification errors are arbitrarily produced by distracted investigators, so they are ignorable or at most weakly dependent on measured and unmeasured baseline covariates. Ignorable misclassification errors may produce a small increase in standard errors, but other properties of the planned analyses are unchanged (e.g., unbiasedness, confidence interval coverage). It is shown that unbiased linear estimation in the absence of misclassification errors remains unbiased when there are non-ignorable misclassification errors, and the corresponding confidence intervals based on the corrected strata values are conservative., 23 pages

Additional file 4:Top panel shows the receiver operating characteristic curve for the PERSEVERENCE SA-AKI CART model to estimate risk of Day 3 sepsis-associated acute kidney injury among patients with high- or intermediate-PERSEVERE-II mortality risk strata in training and test sets. It shows relative variable importance of predictor variables included in the model.

Supplemental material, sj-docx-1-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Additional file 6. Online Supplement: R code for PERSEVERENCE CART Tree to predict D3 Sepsis Associated-Acute Kidney Injury among children with septic shock.

Supplemental material, sj-docx-1-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Supplemental material, sj-docx-3-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Supplemental material, sj-docx-2-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Supplemental material, sj-docx-2-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Supplemental material, sj-docx-3-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Additional file 1. Clinical characteristics of patients according to PERSEVERE-II mortality class.

Supplemental material, sj-docx-4-jcn-10.1177_08830738231167534 for Odds of Cardiometabolic Diseases and Medications in Children With Cerebral Palsy by Rachel Dum, BS, Vonn Walter, PhD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Additional file 5. Classification of patients with high- and intermediate- PERSEVERE-II mortality risk in the validation cohort (n=84) according to the PERSEVEREnce SA-AKI Risk model without any modifications.

Additional file 2. Univariate associations between predictor variables and risk of D3 SA-AKI SCr.

Additional file 3: Box and whisker plots of concentrations of endothelial dysfunction markers among patients with and without Day 3 sepsis-associated acute kidney injury, across low-, intermediate-, and high PERSEVERE-II mortality risk strata. The asterisk indicates that the interaction between D3 SA-AKI and PERSEVERE-II mortality risk strata influenced concentrations of Tie-2 and Angpt-2/Tie-2 ratio.

Water policy decision-making is hindered by limited involvement and understanding of the issues by the affected community members. This study demonstrates that implementing a serious game concept to explain Strategic Environmental Assessment (SEA) can improve a community’s knowledge and skill in water policy decision-making. The authors developed a tool called SEA Game and Simulation using the MIT App Inventor and participatory techniques. The developed tool was implemented among 39 community members in the East Coast River Basin of Thailand. Key findings indicated a significant improvement in the participants’ knowledge of SEA and skill in water policy decision-making. Results from implementing the tool were dependent on the background of the participants and the context of the events. Further studies related to developing sustainable measures from SEA in community sectors should be considered.

As an important sustainable development goal, the creation of low-carbon cities (LCCs) has become crucial to creating livable cities and environmental sustainability. Thus, we aimed to understand the factors that support the transition of traditional cities to LCCs, by analyzing and synthesizing how to promote practical LCC across 15 pilot municipalities in four regions of Thailand, covering four strategies: City of Trees, City of Waste Minimization, City of Energy Efficiency, and City of Sustainable Consumption. Literature research, in-depth interviews, and observations were employed for data collection, while the 5 ​W (who, says what, in which channel, to whom, and with what effect) and SMCR (sender, message, channel, and receiver) models were used to create a communication analysis framework. Results revealed that the effective activities of municipalities should increase tree planting and implement more serious regulations for the conservation of existing trees. Making compost and establishing waste recycling banks are recommended for rural municipalities, while optimization of garbage and wastewater management systems and facilities should be highlighted in urban municipalities. Moreover, recycling, low-carbon agriculture, second-hand shops/markets, green markets, and homegrown vegetables should be encouraged for sustainable consumption. Working with local municipalities, credible leaders and representatives were the key senders. Additionally, message design should compare the pros and cons of behaviors, connect with local health and tourism, and promote dialogue in easy-to-understand and thought-provoking language. Receivers that drive LCC should have an excellent understanding of LCC practice and its benefits, be public-minded, and have a desire to live in a good environment.

Supplemental material, sj-docx-1-jcn-10.1177_08830738221086863 for Evaluation of Febrile Seizure Diagnoses Associated With COVID-19 by Katsiah Cadet, BS, Jessica Boegner, DO, MS, Gary D. Ceneviva, MD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Supplemental material, sj-docx-1-jcn-10.1177_08830738221047668 for Impact of the Updated Guideline for Pediatric Brain Death Determination on Current Practice by Conrad Krawiec, Mohan R. Mysore, Mudit Mathur, Xinying Fang, Shouhao Zhou, Neal J. Thomas and Thomas A. Nakagawa in Journal of Child Neurology

Additional file 3. Relative variable importance and one predictor partial dependence plots of 22 predictor variables and risk of death or day 7 MODS among children with septic shock.

Additional file 10. Seven terminal node CART tree model to estimate risk of death or day 7 MODS in children with septic shock.

Additional file 9. Top two-way interactions in the simplified organ-specific PERSEVEREnce risk models.

Additional file 4. Test characteristics of 22-variable organ-specific PERSEVEREnce risk models to estimate risk of death or day 7 MODS.

Additional file 8. Test characteristics of 6-variable organ-specific PERSEVEREnce risk models.

Additional file 7. AUROC (Figure) and test characteristics (Table) for simplified PERSEVEREnce model to estimate risk of death or day 7 MODS.

Supplemental material, sj-docx-1-jcn-10.1177_08830738221047668 for Impact of the Updated Guideline for Pediatric Brain Death Determination on Current Practice by Conrad Krawiec, Mohan R. Mysore, Mudit Mathur, Xinying Fang, Shouhao Zhou, Neal J. Thomas and Thomas A. Nakagawa in Journal of Child Neurology

Additional file 1. Definitions and correlation of organ dysfunctions in the study.

Supplemental material, sj-docx-2-jcn-10.1177_08830738221047668 for Impact of the Updated Guideline for Pediatric Brain Death Determination on Current Practice by Conrad Krawiec, Mohan R. Mysore, Mudit Mathur, Xinying Fang, Shouhao Zhou, Neal J. Thomas and Thomas A. Nakagawa in Journal of Child Neurology

Supplemental Material for Impact of the COVID-19 Pandemic on Diagnostic Frequency of Febrile Seizures: An Electronic Health Record Database Observational Study by Katsiah Cadet, Gary D Ceneviva, Vonn Walter, Neal J Thomas, and Conrad Krawiec in The Neurohospitalist

Supplemental material, sj-docx-1-jcn-10.1177_08830738221086863 for Evaluation of Febrile Seizure Diagnoses Associated With COVID-19 by Katsiah Cadet, BS, Jessica Boegner, DO, MS, Gary D. Ceneviva, MD, Neal J. Thomas, MD, and Conrad Krawiec, MD in Journal of Child Neurology

Additional file 5. Relative variable importance of predictors in the 22-variable organ-specific PERSEVEREnce risk models.

Supplemental material, sj-docx-2-jcn-10.1177_08830738221047668 for Impact of the Updated Guideline for Pediatric Brain Death Determination on Current Practice by Conrad Krawiec, Mohan R. Mysore, Mudit Mathur, Xinying Fang, Shouhao Zhou, Neal J. Thomas and Thomas A. Nakagawa in Journal of Child Neurology

Additional file 2. Univariate and multivariate associations between predictor variables and risk of death or day 7 MODS among children with septic shock.

The eastern sarus crane (Antigone antigone sharpii; ESC) is a species related to wetland ecosystems in Southeast Asia. The habitat suitability of the eastern sarus crane in Ayeyarwady Delta was surveyed between March 2018 and February 2019. Eastern sarus cranes were found at 73 locations and Maximum Entropy (MaxEnt) was used to classify the habitat suitability among different seasons. MaxEnt showed the largest total area of highly suitable habitat was in the winter season (2450 km2, AUC = 0.968), while the least amount of available suitable habitat was evident during the rainy season (1028.7 km2, AUC = 0.979). A difference in the assessment of home range areas using the Minimum Convex Polygon (95% MPC) and the Kernel Density Estimate (95% KDE) was found. The total area in the winter season was highest at 95% KDE (13,839.5 km2) and lowest in the rainy season (1238.1 km2), while 95% MCP was highest in the rainy season (7892.9 km2) and lowest in the summer season (7014.6 km2). Analysis of the environmental parameters indicated that low temperature in the summer season and high precipitation in the rainy season and winter season are important for ESC habitat suitability. These climatic parameters were important for ESC in all seasons (AUC > 0.9). Important parameters influencing ESC habitat suitability were elevation, slope, distance to road in the summer season, elevation, distance to road and village and slope in the rainy season, and elevation and slope in the winter season. Annual precipitation was the main parameter influencing ESC habitat suitability in both summer and winter, while in the rainy season it was mean diurnal range (>90%).

Integrated Pest Management is an effective method in agriculture, which can reduce chemical usage, lessen environmental impacts and protect human health. However, the perception and opinions of farmers on the practice of IPM methods are limited. Therefore, this study aims to evaluate the farmers' practices of IPM methods in Kalaw Township, Myanmar. A survey of 150 vegetable farmers who mainly grow Cabbage, Cauliflower and Chinese cabbage was conducted. Binary logistic regression was used to identify factors influencing decisions on practicing IPM methods. The results showed male farmers were more invested in IPM methods than female. Farmers who had high greater experience in farming would be more open to IPM methods. Small households were more likely than large households to adopt IPM methods. Farmers who had encountered high crop loss because of pest outbreaks in the past were more likely to adopt IPM methods. Most farmers are familiar with cultural, physical and mechanical control in IPM methods, whereas practicing pheromone traps, natural pesticide, and traditional usages are relatively rare.

Additional file 1. Data Supplement.

This paper provides a comprehensive review of theories and frameworks for understanding and managing human dimensions of tidal energy. The methods for this review were: 1) the construction of an annotated bibliography of the human dimensions of marine renewable energy literature, 2) an analytical review of the core theories and frameworks found in the literature as applied to tidal energy development in the United States, and 3) an iterative process of conceptual refinement through peer review. Only 48.9% of the articles in the literature review included a theoretical underpinning, or discussed an existing framework. Of these, 42.2% were theories or frameworks that were only featured in a single paper, highlighting the need for theoretical focus within this field of study. For those theories and frameworks that had been explored in multiple articles, these theories and frameworks were grouped into nine overarching concepts: acceptance, place attachment, justice, economics, technology innovation systems, environmental assessment, strategic environmental assessment, adaptive management, and marine spatial planning (MSP). Each of these concepts were expounded on to discuss the limitations of the current research on the concept and identify promising avenues for future research. In comparing the functionality of these concepts, most have a realized capacity for understanding costs and benefits, risk and uncertainty. However less than half have a realized capacity for managing costs and benefits and risk, while less than a third have a realized capacity for managing uncertainty. This paper offers a summary table of existing theories and frameworks that could be used as a launching point for detailing a research agenda for more systematically exploring theories and frameworks for human dimensions of tidal energy.

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: To describe the epidemiology, morbidity, and mortality of new or progressive multiple organ dysfunction syndrome in children with severe sepsis. Design: Secondary analysis of a prospective, cross-sectional, point prevalence study. Setting: International, multicenter PICUs. Patients: Pediatric patients with severe sepsis identified on five separate days over a 1-year period. Interventions: None. Measurements and Main Results: Of 567 patients from 128 PICUs in 26 countries enrolled, 384 (68%) developed multiple organ dysfunction syndrome within 7 days of severe sepsis recognition. Three hundred twenty-seven had multiple organ dysfunction syndrome on the day of sepsis recognition. Ninety-one of these patients developed progressive multiple organ dysfunction syndrome, whereas an additional 57 patients subsequently developed new multiple organ dysfunction syndrome, yielding a total proportion with severe sepsis-associated new or progressive multiple organ dysfunction syndrome of 26%. Hospital mortality in patients with progressive multiple organ dysfunction syndrome was 51% compared with patients with new multiple organ dysfunction syndrome (28%) and those with single-organ dysfunction without multiple organ dysfunction syndrome (10%) (p < 0.001). Survivors of new or progressive multiple organ dysfunction syndrome also had a higher frequency of moderate to severe disability defined as a Pediatric Overall Performance Category score of greater than or equal to 3 and an increase of greater than or equal to 1 from baseline: 22% versus 29% versus 11% for progressive, new, and no multiple organ dysfunction syndrome, respectively (p < 0.001). Conclusions: Development of new or progressive multiple organ dysfunction syndrome is common (26%) in severe sepsis and is associated with a higher risk of morbidity and mortality than severe sepsis without new or progressive multiple organ dysfunction syndrome. Our data support the use of new or progressive multiple organ dysfunction syndrome as an important outcome in trials of pediatric severe sepsis although efforts are needed to validate whether reducing new or progressive multiple organ dysfunction syndrome leads to improvements in more definitive morbidity and mortality endpoints.

Through primary source fieldwork with public sector advisors and policy makers, we examine the role of entrepreneurship within charities, not-for-profits and nongovernmental organisations. We consider the literature on the development of social enterprises and explore whether entrepreneurial characteristics are necessarily a feature of such enterprises. These include risk-taking, the ability to identify a market gap, and innovative behaviour. Through primary-source evidence, gathered by face-to-face interviews with key policy makers and support workers in the charitable field, we debate whether the characteristics of an entrepreneur can and should be applied within social enterprises. Our findings are equivocal, in that some can see the benefit, whilst others worry about the commercialisation of public sector ventures and a lack of trust in the motivations of an entrepreneur. Overall, we recommend that further empirical evidence be examined, in order to identify whether and how having an entrepreneurial orientation might legitimise the behaviour of social enterprises.

BackgroundPaediatric acute respiratory distress syndrome (PARDS) is associated with high mortality in children, but until recently no paediatric-specific diagnostic criteria existed. The Pediatric Acute Lung Injury Consensus Conference (PALICC) definition was developed to overcome limitations of the Berlin definition, which was designed and validated for adults. We aimed to determine the incidence and outcomes of children who meet the PALICC definition of PARDS.MethodsIn this international, prospective, cross-sectional, observational study, 145 paediatric intensive care units (PICUs) from 27 countries were recruited, and over a continuous 5 day period across 10 weeks all patients were screened for enrolment. Patients were included if they had a new diagnosis of PARDS that met PALICC criteria during the study week. Exclusion criteria included meeting PARDS criteria more than 24 h before screening, cyanotic heart disease, active perinatal lung disease, and preparation or recovery from a cardiac intervention. Data were collected on the PICU characteristics, patient demographics, and elements of PARDS (ie, PARDS risk factors, hypoxaemia severity metrics, type of ventilation), comorbidities, chest imaging, arterial blood gas measurements, and pulse oximetry. The primary outcome was PICU mortality. Secondary outcomes included 90 day mortality, duration of invasive mechanical and non-invasive ventilation, and cause of death.FindingsBetween May 9, 2016, and June 16, 2017, during the 10 study weeks, 23 280 patients were admitted to participating PICUs, of whom 744 (3·2%) were identified as having PARDS. 95% (708 of 744) of patients had complete data for analysis, with 17% (121 of 708; 95% CI 14-20) mortality, whereas only 32% (230 of 708) of patients met Berlin criteria with 27% (61 of 230) mortality. Based on hypoxaemia severity at PARDS diagnosis, mortality was similar among those who were non-invasively ventilated and with mild or moderate PARDS (10-15%), but higher for those with severe PARDS (33% [54 of 165; 95% CI 26-41]). 50% (80 of 160) of non-invasively ventilated patients with PARDS were subsequently intubated, with 25% (20 of 80; 95% CI 16-36) mortality. By use of PALICC PARDS definition, severity of PARDS at 6 h after initial diagnosis (area under the curve [AUC] 0·69, 95% CI 0·62-0·76) discriminates PICU mortality better than severity at PARDS diagnosis (AUC 0·64, 0·58-0·71), and outperforms Berlin severity groups at 6 h (0·64, 0·58-0·70; p=0·01).InterpretationThe PALICC definition identified more children as having PARDS than the Berlin definition, and PALICC PARDS severity groupings improved the stratification of mortality risk, particularly when applied 6 h after PARDS diagnosis. The PALICC PARDS framework should be considered for use in future epidemiological and therapeutic research among children with PARDS.FundingUniversity of Southern California Clinical Translational Science Institute, Sainte Justine Children's Hospital, University of Montreal, Canada, Réseau en Santé Respiratoire du Fonds de Recherche Quebec-Santé, and Children's Hospital Los Angeles, Department of Anesthesiology and Critical Care Medicine.

Our study isolated and screened rhizobacteria for the ability to produce indole-3-acetic acid (IAA) and grow in the presence of cadmium (Cd), copper (Cu), and lead (Pb). Fifteen isolates resistant to Cd, Cu and Pb, called multi-resistant-heavy metals rhizobacteria, were found. The isolate producing the highest level of IAA was an Enterobacter cloaca, designated as CdRR1, capable of removing Cd, Cu and Pb from aqueous solutions, with the best removal efficiency found for Pb. The effects of E. cloacae CdRR1 on root elongation and translocation of Cd, Cu and Pb in Helianthus annuus L. and Sorghum bicolor L. were investigated. Under toxic conditions of Cd, Cu and Pb, E. cloacae stimulated the shoot and root elongation of H. annuus and S. bicolor, except for the shoots of S. bicolor in the presence of Pb. Interestingly, E. cloacae enhanced the growth and heavy metal accumulation in the lateral roots of H. annuus under Cd and Pb toxic conditions. In addition, increased Pb translocation from the roots to the shoots in H. annuus was found in seedlings with E. cloacae inoculation. Similar findings of increased Cu and Pb translocations in S. bicolor were seen in seedlings with E. cloacae inoculation. These results demonstrate that E. cloacae CdRR1, a potent multi-heavy metal-resistant rhizobacterium, can remove heavy metals from solution, and also promote shoot and root elongation and heavy metal translocation in both H. annuus and S. bicolor.

BackgroundTargeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited.MethodsIn a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest.ResultsThe trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups.ConclusionsAmong comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).

Background Single-incision surgery has gained in popularity, and the recent development of specialized robotic and laparoscopic instruments may remove some of the ergonomic and technical difficulties associated with this approach. However, questions of cost and efficiency remain. Methods We prospectively collected perioperative outcome and efficiency (operative time, case volume) data for our single-site robotic cholecystectomy cases and retrospectively reviewed data for our single-incision laparoscopic cholecystectomy cases. Results There were no differences in patient characteristics or perioperative outcomes between the robotic (n = 20) and laparoscopic (n = 10) groups; operative times were equivalent (84.6 vs 85.5 min; p = 0.8737) and blood loss and complications were minimal. There was a higher robotic case volume, with an average of two robotic cases (range 1–4)/day vs one/day for laparoscopic cases (range 1–1; p = 0.0306). Streamlined instrument costs were essentially equivalent. Conclusions Robotic single-site cholecystectomy is a safe, cost-effective alternative to single-incision laparoscopic cholecystectomy in a robot-existing model. Copyright © 2013 John Wiley & Sons, Ltd.

Copyright © 2016 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.Objectives: Pediatric severe sepsis remains a significant global health problem without new therapies despite many multicenter clinical trials. We compared children managed with severe sepsis in European and U.S. PICUs to identify geographic variation, which may improve the design of future international studies. Design: We conducted a secondary analysis of the Sepsis PRevalence, OUtcomes, and Therapies study. Data about PICU characteristics, patient demographics, therapies, and outcomes were compared. Multivariable regression models were used to determine adjusted differences in morbidity and mortality. Setting: European and U.S. PICUs. Patients: Children with severe sepsis managed in European and U.S. PICUs enrolled in the Sepsis PRevalence, OUtcomes, and Therapies study. Interventions: None. Measurements and Main Results: European PICUs had fewer beds (median, 11 vs 24; p < 0.001). European patients were younger (median, 1 vs 6 yr; p < 0.001), had higher severity of illness (median Pediatric Index of Mortality-3, 5.0 vs 3.8; p = 0.02), and were more often admitted from the ward (37% vs 24%). Invasive mechanical ventilation, central venous access, and vasoactive infusions were used more frequently in European patients (85% vs 68%, p = 0.002; 91% vs 82%, p = 0.05; and 71% vs 50%; p < 0.001, respectively). Raw morbidity and mortality outcomes were worse for European compared with U.S. patients, but after adjusting for patient characteristics, there were no significant differences in mortality, multiple organ dysfunction, disability at discharge, length of stay, or ventilator/vasoactive-free days. Conclusions: Children with severe sepsis admitted to European PICUs have higher severity of illness, are more likely to be admitted from hospital wards, and receive more intensive care therapies than in the United States. The lack of significant differences in morbidity and mortality after adjusting for patient characteristics suggests that the approach to care between regions, perhaps related to PICU bed availability, needs to be considered in the design of future international clinical trials in pediatric severe sepsis.

Much progress has been made in the past decade in the understanding of the genetic contribution to the development of human disease in general, and critical care illness specifically. With the mapping of the human genome and on-going mapping of genetic polymorphisms and haplotypes in humans, the field of critical care is now in prime position to study the impact of genetics on common illnesses that affect children who require critical care, to examine how differences of the host defense response lead to variable outcomes in outwardly appearing similar disease states, and to study how genetic differences in response to therapy will help practitioners tailor therapeutic interventions to an individual child’s genetic composition. While we are still years away from true individualized medicine, we are now closer than ever to understanding why two might children respond to the same environmental insult in vastly different ways.

Despite vast improvements in the care of children with asthma over the past decades, asthma remains a common cause of admission to pediatric intensive care units. During the 1990s asthma prevalence and hospital admissions increased in the United States and worldwide. The increase occurred in both males and females and across all ethnic groups. However, the largest increases occurred in children of low socioeconomic status living in urban settings. Recent asthma statistics should be interpreted with consideration of changes made in the method for reporting asthma prevalence (Fig. 23-1). From 1980 to 1996, the National Health Interview Survey (NHIS) conducted by the CDC measured pediatric asthma prevalence as the percentage of children with asthma in the past 12 months. Since 1997, asthma prevalence estimates have been defined as: having received an asthma diagnosis, currently having the disease at the time of the interview, and experiencing an attack in the past year. The more specific definition may have led to a reduction in the number of children reported to have asthma.

Respiratory syncytial virus (RSV) is a leading cause of hospitalization in children less than 1 year of age and causes substantial morbidity. Although there is not currently a vaccine available to prevent RSV infection, prophylaxis with the humanized monoclonal antibody palivizumab has been shown to reduce the rate of RSV hospitalization in premature infants and those infants with chronic lung disease or congenital heart disease. Because palivizumab has not been shown to have a beneficial clinical effect on established RSV disease such as reducing the rate of mechanical ventilation and mortality in children afflicted with RSV, there has been considerable debate as to the cost-benefit ratio of administering palivizumab according to international guidelines. Palivizumab has demonstrated a favorable side-effect profile in clinical trials without the development of anti-palivizumab antibodies. Future studies are needed to determine whether palivizumab, or other more potent monoclonal antibodies which are currently undergoing clinical trials, will reduce the long-term sequelae of RSV infection such as the development of wheezing and asthma.

This article will outline the survivorship bias inherent in conducting trading system research on a universe of securities comprised of members of an index, or ranking system, where membership is based on capitalization of other proxy measures of liquidity. We will define a sample research universe and attempt to measure a portion of the survivor bias inherent in that universe. We believe five years is a representative time window across which traders are testing their strategies. As such, we will attempt to measure the bias across the five year period 12/31/98 – 12/31/03.