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IntroductionContinuous renal replacement therapy (CRRT) is used for the symptomatic management of acute kidney injury (AKI) and fluid overload (FO). Contemporary reports on pediatric CRRT are small and single center in design. Large international studies evaluating CRRT practice and outcomes are lacking. Herein, we describe the design of a multinational collaborative.MethodsThe Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) is an international collaborative of pediatric specialists whose mission is to improve short- and long-term outcomes of children treated with CRRT. The aims of this multicenter retrospective study are to describe the epidemiology, liberation patterns, association of fluid balance and timing of CRRT initiation, and CRRT prescription with outcomes.ResultsWe included children (n = 996, 0-25 years) admitted to an intensive care unit (ICU) and treated with CRRT for AKI or FO at 32 centers (in 7 countries) from 2018 to 2021. Demographics and clinical characteristics before CRRT initiation, during the first 7 days of both CRRT, and liberation were collected. Outcomes include the following: (i) major adverse kidney events at 90 days (mortality, dialysis dependence, and persistent kidney dysfunction), and (ii) functional outcomes (functional stats scale).ConclusionThe retrospective WE-ROCK study represents the largest international registry of children receiving CRRT for AKI or FO. It will serve as a broad and invaluable resource for the field of pediatric critical care nephrology that will improve our understanding of practice heterogeneity and the association of CRRT with clinical and patient-centered outcomes. This will generate preliminary data for future interventional trials in this area.

Human cytomegalovirus (CMV) remains one of the most common opportunistic infections following solid organ transplantation in children. CMV causes morbidity and mortality through direct tissue-invasive disease and indirect immunomodulatory effects. In recent years, several new agents have emerged for the prevention and treatment of CMV disease in solid organ transplant recipients. However, pediatric data remain scarce, and many of the treatments are extrapolated from the adult literature. Controversies exist about the type and duration of prophylactic therapies and the optimal dosing of antiviral agents. This review provides an up-to-date overview of treatment modalities used to prevent and treat CMV disease in solid organ transplant (SOT) recipients.

Although the laboratory information system has largely solved the problem of storing anatomic pathology reports and disseminating their contents across the healthcare system, the retrospective query of anatomic pathology reports remains an area for improvement across laboratory information system vendors. Our institution desired the ability to query our repository of anatomic pathology reports for clinical, operational, research, and educational purposes. To address this need, we developed a full-text anatomic pathology search tool using the business intelligence software, Tableau. Our search tool allows users to query the 333,685 anatomic pathology reports from our institutional clinical relational database using the business intelligence tool's built-in regular expression functionality. Users securely access the search tool using any web browser, thereby avoiding the cost of installing or maintaining software on users' computers. This tool is laboratory information system vendor agnostic and as many institutions already subscribe to business intelligence software, we believe this solution could be easily reproduced at other institutions and in other clinical departments.

ObjectiveTo compare the performance of 3 contemporary ureteroscopic biopsy devices for the histopathologic diagnosis of upper tract urothelial carcinoma (UTUC).MethodsWe retrospectively reviewed 145 patients who underwent 182 urothelial biopsies using 2.4F backloaded cup biopsy forceps, a nitinol basket, or 3F standard cup biopsy forceps at 3 tertiary academic centers between 2011 and 2016. Experienced genitourinary pathologists provided an assessment of each specimen without knowledge of the device used for biopsy. For patients who underwent nephroureterectomy without neoadjuvant chemotherapy within 3 months of biopsy-proven UTUC diagnosis, the biopsy grade was compared with both the grade and stage of the surgical specimen.ResultsBiopsy utilization varied among the 3 institutions (P .05) and was favored over standard cup forceps specimens. Grade concordance was not affected by specimen size (P >.05), morphology (P >.1), or location (P >.5). No difference existed among the devices in the rate of acquiring a grade concordant biopsy; however, the backloaded cup forceps provided concordant biopsies that could be distinguished as low- and high-grade (P = .02).ConclusionThe backloaded cup forceps and nitinol basket obtained a higher quality urothelial specimen compared with standard cup forceps. Ureteroscopic biopsy device selection did not significantly impact the accuracy of the histologic diagnosis of UTUC.

People's everyday lives offer plenty of situations where complex processing of information takes place, in which information needs to transfer across modalities to achieve a behavioral goal. The study examined the differential effects on object detection by a visual, verbal, or auditory cue held in working memory (WM), and the role of concurrent cognitive task-load on the final detection of that cue. Three experiments, all using same stimuli set but in different modalities, subjects held in memory a representation of a novel cue for a speeded detection in a search display at the end of each trial. The cue stimulus could be an image (visual), the name (verbal) or the sound (auditory) of a common animal or object. A mental arithmetic task was interleaved between the cue presentation and the cue detection. The results showed that information held in WM, either in verbal or auditory form, can efficiently transfer across modalities to complete a visual detection task for a representation of the initial WM-cue. The speed of detection was not affected by the cross-modal transfer of cue information but there was some detrimental effect on detection that could distinctively be attributed to the cognitive task-load. Together, these findings may provide some evidence for the role of the episodic buffer component of WM in integrating multimodal information originated from different sources, hence supporting the notion of the supramodal nature of WM. The results have been discussed in light of Baddeley's and Cowan's theoretical WM frameworks.

In-situ reconfiguration of software is indispensable in embedded networked sensing systems. The application includes re-tasking a deployed network, fixing bugs, introducing new features and tuning the system parameters to the operating environment. In this poster, we present a system that supports software reconfiguration in embedded sensor networks at multiple levels. The system architecture is based on an operating system consisting of a fixed tiny static kernel and binary modules that can be dynamically inserted, updated or removed unobtrusively. On top of the operating system is a command interpreter, implemented as a dynamically extensible virtual machine, that can execute high-level scripts written in portable byte code. Any binary module dynamically inserted into the operating systems can register custom extensions in the virtual machine interpreter, thus allowing the high-level scripts executed by the virtual machine to efficiently access services exported by a module, such as tuning module parameters. Together these system mechanisms permit the flexibility of selecting the most appropriate level of reconfiguration. In addition to showing the system architecture, we present a systematic analysis of flexibility versus cost tradeoffs provided by these mechanisms.

In-situ reconfiguration is indispensable in sensor network deployments. It is required for efficient management and upgrade of software in large scale sensor networks, re-tasking a deployed network or for recovering a deployed system from crippling bugs or malicious intent. A spectrum of techniques for re-programming have been proposed. The major approaches are: 1. Full binary upgrade supported by TinyOS/Deluge mechansim that allows arbitrary changes to the functionality but incurs a high transmission and storage cost. 2. SOS operating system for sensor nodes consists of a static kernel that is extensible through modular extensions that can be installed and updated over the air. 3. Application specific virtual machines (ASVMs) are domain specific interpreters built on top of TinyOS to enable limited high-level changes to the functionality by injecting concise application level scripts. The three approaches vary in the cost and the flexibility of the updates that they can support. The nature of the update determines the most suitable technique. We have built a system that supports this complete hierarchy of reconfiguration.

We show that perceptual sensitivity to visual stimuli can be modulated by matches between the contents of working memory (WM) and stimuli in the visual field. Observers were presented with an object cue (to hold in WM or to merely attend) and subsequently had to identify a brief target presented within a colored shape. The cue could be re-presented in the display, where it surrounded either the target (on valid trials) or a distractor (on invalid trials). Perceptual identification of the target, as indexed by A[prime], was enhanced on valid relative to invalid trials but only when the cue was kept in WM. There was minimal effect of the cue when it was merely attended and not kept in WM. Verbal cues were as effective as visual cues at modulating perceptual identification, and the effects were independent of the effects of target saliency. Matches to the contents of WM influenced perceptual sensitivity even under conditions that minimized competition for selecting the target. WM cues were also effective when targets were less likely to fall in a repeated WM stimulus than in other stimuli in the search display. There were no effects of WM on decisional criteria, in contrast to sensitivity. The findings suggest that reentrant feedback from WM can affect early stages of perceptual processing. (Contains 1 table, 9 figures and 1 footnote.)