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Pediatric hospital resources including critical care faculty (intensivists) redeployed to provide care to adults in adult ICUs or repurposed PICUs during wave 1 of the coronavirus disease 2019 (COVID-19) pandemic.To determine the magnitude of pediatric hospital resource redeployment and the experience of pediatric intensivists who redeployed to provide critical care to adults with COVID-19.A mixed methods study was conducted at 9 hospitals in 8 United States cities where pediatric resources were redeployed to provide care to critically ill adults with COVID-19. A survey of redeployed pediatric hospital resources and semistructured interviews of 40 redeployed pediatric intensivists were simultaneously conducted. Quantitative data were summarized as median (interquartile range) values.At study hospitals, there was expansion in adult ICU beds from a baseline median of 100 (86–107) to 205 (108–250). The median proportion (%) of redeployed faculty (88; 66–100), nurses (46; 10–100), respiratory therapists (48; 18–100), invasive ventilators (72; 0–100), and PICU beds (71; 0–100) was substantial. Though driven by a desire to help, faculty were challenged by unfamiliar ICU settings and culture, lack of knowledge of COVID-19 and fear of contracting it, limited supplies, exhaustion, and restricted family visitation. They recommended deliberate preparedness with interprofessional collaboration and cross-training, and establishment of a robust supply chain infrastructure for future public health emergencies and will redeploy again if asked.Pediatric resource redeployment was substantial and pediatric intensivists faced formidable challenges yet would readily redeploy again.

Although most pediatric intensive care units invite parents to participate in daily rounds, many families face barriers preventing them from being physically present on rounds. Telehealth for remote parent participation on daily rounds offers one solution to this problem. However, barriers threaten the implementation and sustainability of such programs. Highly reliable, user-friendly telehealth technologies coupled with adequate human resources to address logistical challenges and clinical champions to affect culture change are key. Further research is needed to better quantify the impact of such programs on patient and parent outcomes and to convince hospital leadership to invest in telehealth solutions.

Routine integration of simulation into healthcare education and practice has gained momentum. Simulation is particularly important to acute and critical care pediatrics, as it offers alternative methods of training for high-risk and/or lower-frequency events in children. This review will discuss the recent advances in simulation education for pediatric critical care and emergency medicine and assess its potential for future growth through these subspecialties.

IMPORTANCE: Multisystem inflammatory syndrome in children (MIS-C) is associated with recent or current SARS-CoV-2 infection. Information on MIS-C incidence is limited. OBJECTIVE: To estimate population-based MIS-C incidence per 1?000?000 person-months and to estimate MIS-C incidence per 1?000?000 SARS-CoV-2 infections in persons younger than 21 years. DESIGN, SETTING, AND PARTICIPANTS: This cohort study used enhanced surveillance data to identify persons with MIS-C during April to June 2020, in 7 jurisdictions reporting to both the Centers for Disease Control and Prevention national surveillance and to Overcoming COVID-19, a multicenter MIS-C study. Denominators for population-based estimates were derived from census estimates; denominators for incidence per 1?000?000 SARS-CoV-2 infections were estimated by applying published age- and month-specific multipliers accounting for underdetection of reported COVID-19 case counts. Jurisdictions included Connecticut, Georgia, Massachusetts, Michigan, New Jersey, New York (excluding New York City), and Pennsylvania. Data analyses were conducted from August to December 2020. EXPOSURES: Race/ethnicity, sex, and age group (ie, =5, 6-10, 11-15, and 16-20 years). MAIN OUTCOMES AND MEASURES: Overall and stratum-specific adjusted estimated MIS-C incidence per 1?000?000 person-months and per 1?000?000 SARS-CoV-2 infections. RESULTS: In the 7 jurisdictions examined, 248 persons with MIS-C were reported (median [interquartile range] age, 8 [4-13] years; 133 [53.6%] male; 96 persons [38.7%] were Hispanic or Latino; 75 persons [30.2%] were Black). The incidence of MIS-C per 1?000?000 person-months was 5.1 (95% CI, 4.5-5.8) persons. Compared with White persons, incidence per 1?000?000 person-months was higher among Black persons (adjusted incidence rate ratio [aIRR], 9.26 [95% CI, 6.15-13.93]), Hispanic or Latino persons (aIRR, 8.92 [95% CI, 6.00-13.26]), and Asian or Pacific Islander (aIRR, 2.94 [95% CI, 1.49-5.82]) persons. MIS-C incidence per 1?000?000 SARS-CoV-2 infections was 316 (95% CI, 278-357) persons and was higher among Black (aIRR, 5.62 [95% CI, 3.68-8.60]), Hispanic or Latino (aIRR, 4.26 [95% CI, 2.85-6.38]), and Asian or Pacific Islander persons (aIRR, 2.88 [95% CI, 1.42-5.83]) compared with White persons. For both analyses, incidence was highest among children aged 5 years or younger (4.9 [95% CI, 3.7-6.6] children per 1?000?000 person-months) and children aged 6 to 10 years (6.3 [95% CI, 4.8-8.3] children per 1?000?000 person-months). CONCLUSIONS AND RELEVANCE: In this cohort study, MIS-C was a rare complication associated with SARS-CoV-2 infection. Estimates for population-based incidence and incidence among persons with infection were higher among Black, Hispanic or Latino, and Asian or Pacific Islander persons. Further study is needed to understand variability by race/ethnicity and age group.

Although leptospiral meningitis has been recognized for many years,1 it is only recently that the importance of leptospiral infection as an etiological factor in central nervous system disease has received attention in this country.2 Numerous cases of meningitis in both icteric and nonicteric cases of leptospirosis have been reported in the foreign literature, and some workers have described muscular weakness and transient paralysis, usually involving the lower extremities, associated with leptospirosis.3 In the United States, it has been customary to assume that patients who present the clinical picture of aseptic meningitis have virus infections; however, in a serologic survey, Beeson2 was able to show that 11 of 86 undiagnosed cases of aseptic meningitis were caused by leptospiral infection. Schaeffer4 has described a waterborne epidemic of leptospiral meningitis in which none of the patients had icterus. The purpose of this article is to draw attention to

Cross-neutralization studies on leptospiral hemolysins from strains of two antigenically different serotypes, pomonaand canicola, were conducted in sheep. A third strain of serotype hardjothat does not produce hemolysin and is antigenically distinct was included for control purposes. Concentrated hemolysins, prepared from supernatant fluids of canicolaor pomonacultures, produced hemolytic anemia in sheep after intravenous injection. Sheep previously infected with hemolysin-producing strains were refractory to effects of homologous or heterologous hemolysins. On the other hand, infection with hardjodid not confer immunity to the action of hemolysins. Hemolysin-neutralizing antibodies were demonstrable in sheep previously infected with pomonaor canicolaonly after challenge with homologous or heterologous hemolysins. Cross-neutralization between two hemolysins were demonstrable in vitro. Hemolysin-neutralizing antibody titers did not correlate with agglutinin titers. Concentrated supernatant fluid of the hardjoculture provoked toxic reactions predominantly in sheep previously infected with pomonaor canicola. The causes of these untoward reactions were not determined.

1. Results of cross agglutination-lysis and cross agglutinin-absorption studies indicate that the etiologic agent of Fort Bragg Fever is closely related to the other members of the leptospiral serogroup autumnalis. 2. Agglutinin-absorption studies with all members of the serogroup autumnalisreveal that the agglutinins responsible for strain specificity are not completely removed when absorbed with any of the other strains. 3. Classification of these leptospiral strains on the basis of a modified adoption of Wolff's scheme(5) designates autumnalisAkiyami A as the “incomplete” biotype of the Fort Bragg isolate and discloses L. autumnalisA Rach-mat, in addition to L. bangkinang, as a heterologous serotype member of the autumnalis group. 4. The Fort Bragg isolate is therefore designated as L. autumnalis, Fort Bragg.

The results of agglutinationlysis, absorption, and animal protection tests indicate that the strains of bovine leptospira of American origin designated as New Jersey C164 and New York A are indistinguishable from L. pomona.These findings stress the need for reclassification of the American strains. They also indicate that L. pomonaor an antigenically indistinguishable organism is present in North America.

A soluble, specific complement-fixing antigen, or antigen complex, was demonstrated in the organism-free culture liquor of each leptospiral strain studied. The antigenic material is heat stable and nonprotein in nature. The antigens are present in amounts which make feasible their employment in serological investigations of the leptospiroses.

Eight strains of leptospirae were examined by electron microscopy. NO morphological differences were fcound between strains. All strains possessed an axial filament. Diameter of the strains was approximately 0.1 μ, lengths varied from 6 to more than 15 μ.

A transmissible agent (MHG) with biological and physical properties similar to the viruses of the enterovirus group has been isolated from pooled tissues of 3 white rats, Sprague-Dawley strain, obtained from the Walter Reed Army Institute of Research animal colony. The agent produced fatal infections in both suckling rats and suckling mice when inoculated intracranially. A high incidence of complement-fixing antibodies against the new virus was found in adult human sera. The relationship of this virus to disease in man or animal has not been ascertained.

A transmissible agent was recovered from primary DKTC which developed a spontaneous CPE. Characterization and serological studies of the virus indicated that the virus was a new member of the herpes virus group.

A method for the preparation of macroscopic leptospiral agglutinating antigens is described. Antigens of this type have been prepared from 9 leptospiral serotypes. Cross reaction patterns are essentially comparable to those observed in the agglutination-lysis technic. Antigens so prepared are sensitive, specific, and stable under protracted periods of storage, and produce easily discernible reactions in the presence of antibodies.

UVEITIS has been recognized as a sequel of leptospiral infection since the time of Weil.1 In one of the four cases reported in his original publication iridocyclitis was manifested six weeks after clinical onset of the disease. Goebel,2 in 1917, again drew attention to iridocyclitis in Leptospira icterohaemorrhagiae infections.Since recognition of infection in man with other leptospiral strains, ocular manifestations have been observed as sequelae of canicola fever,3 swineherd's disease,4 mud (swamp) fever,5 Japanese seven-day fever (nanukayami),3b leptospirosis australis B,6 and Palestine bovine leptospirosis.7 The incidence of ocular involve- ment in the leptospiroses has been varyingly reported as from 10 to 44%.8 This variation reflects the intensity of the search for ocular manifestations. Although not reported in the literature available to us, uveitis is undoubtedly associated with the other leptospiroses of man.Ocular involvement in the leptospiroses may appear as

The potential leptospiral infection hazard in the use of vaccines prepared from canine kidney monolayer cultures was studied. Cell cultures were prepared from kidneys of dogs experimentally infected with Leptospiraserotype canicola.Viable leptospires were found in kidney cell suspensions at the time of seeding, surviving trypsinization either at room temperature for approximately 2 hr or overnight at 4 C, even in the presence of antibiotics. In tissue cultures maintained without antibiotics, leptospires were cultured up to the time of involution of cells at 25 to 34 days of incubation. Cytopathogenic effects of leptospires on cultured kidney cells were not noted; neither was growth of leptospires remarkable. Generally, the leptospire culture titer decreased to 10-4or 10-5at the 4th hr or 1st day of incubation to 10-1or negative by the 30th or 34th day of incubation. The addition of either a combination of penicillin (100 units per ml) plus streptomycin (100 μg/ml) or polymyxin B (50 units per ml) plus dihydrostreptomycin (100 μg/ml) to seeding cell suspensions resulted in the elimination of viable leptospires by the 4th hr of incubation. From cell cultures treated with neomycin (100 μg/ml) or chloramphenicol (100 μg/ml), leptospires were recovered, respectively, after 24 and 48 hr, but not thereafter. It was apparent that antibiotics, particularly the combination of polymyxin B and dihydrostreptomycin, could be effectively used to eliminate leptospires in tissue culture. Other antibiotics with known antileptospiral activities probably would be effective also. If antibiotics are not used in canine kidney tissue culture employed for viral vaccine preparations, rigid testing for the presence of leptospires in donor dogs and tissue-culture vaccine is indicated.

Disseminated encephalomyelitis was readily induced in mice of the Swiss strain by means of repeated intramuscular and subcutaneous injections of apparently normal mouse brain mixed with an adjuvant. The latter consisted of autoclaved virulent tubercle bacilli and heavy liquid petrolatum, a modification of the Freund adjuvant. The syndrome and the histopathological picture of the induced malady were essentially similar to those in monkeys, rabbits, and guinea pigs, previously reported by others. Certain exceptional characteristics of the affection, as occurring in mice, suggest that they may be the animals of choice for its study as well as for that of other encephalitides. Not only were the signs indicative of marked involvement of the central nervous system but also of the respiratory mechanism, and only a few injections of mouse brain-adjuvant mixture were required to evoke the neurological symptom complex in almost every animal.

Food samples were examined for radio-induced phosphorus-32 after exposure in a nuclear reactor to a thermal neutron flux range of 109to 1014n cm−2sec−1. The activities induced closely approximated the activities expected from calculations using a standard activation equation. The use of a nuclear reactor to simulate thermal neutron flux of weapons proved feasible.

Evidence has been brought forward to indicate that Columbia SK, Columbia MM, Mengo encephalomyelitis and encephalomyocarditis viruses agglutinate sheep red cells. It is therefore possible to identify these viruses by means of hemagglutination and to measure the antibody content of antisera. Since the viruses show characteristic spontaneous elution or dispersion from the erythrocytes, the method can be used for purposes of selective adsorption of the viruses without loss of their hemagglutinative activity. Moreover, the uniformity of the hemagglutination reaction shown by the 4 viruses and the cross-inhibition that exists among them supports the findings of Warren and Smadel6and of Dick7that these viruses are similar in many repects and are of the same group.Seventeen other neurotropic viruses were tested for their capacity to agglutinate characteristically erythrvcytes deriving from sheep, man (group O), chicken, horse, hamster, dog, cat and guinea pig; these tests failed.Another phenomenon that was observed is the nonspecific agglutination of dog, cat and guinea pig erythrocytes by normal or virusinfected mouse brains. With respect to agglutination of hamster cells, an inhibitor of agglutination is present not only in suspensions of normal mouse brain but also in normal serum and antiserum against the neurotropic viruses.The fact that neurotropic viruses are often used in the form of mouse brain suspensions renders it important therefore for investigators to use proper controls for the variable of the test and, in addition, to identify positive reactions by specific means.

Japanese encephalitis virus in 20% suspensions of infected chick-embryo tissues may be partially purified by adsorption of inert material on particles of Attaclay SF, a naturally-occurring sorptive clay of exceedingly small pore diameter. Removal of about 75% of the nitrogen content of a crude virus suspension may be accomplished without a prohibitive loss of infectivity.

Serological and cultural studies for leptospirosis were conducted on 37 opossums trapped at a military reservation at Aberdeen, Md. Five of the 37 animals were serologically positive. Questionable reactions were seen in serums from 9 other animals. Two isolates were obtained and identified as Leptospira ballumand L. icterohaemorrhagiae, respectively. L. icterohaemorrhagiaein an opossum had not heretofore been reported. The antigenic interrelationships among the “complete” and “incomplete” bio-types of L. icterohaemorrhagiaeand L. mankarso, disclosed in the serologic studies, differed from previously reported findings.

The tissues of chick embryos dead or dying following infection with the virus of Japanese encephalitis are significantly lower than normal in pentose concentration but no significant differences in desoxyribonucleic acid concentration were demonstrated. The factors responsible for the decrease in pentose have not been elucidated.

Two-day-old chicks uniformly developed leptospiremia persisting for at least 5 days following intraperitoneal inoculation of leptospires. No clinically detected illness resulted from this infection nor was there constant significant serologically demonstrable antibody response. Employment of chicks for recovery of leptospires form materials contaminated with other microorganisms and hence unsuitable for direct culture is suggested.

The production in monkeys of acute disseminated encephalomyelitis accompanied by demyelination following injection of brain tissue, first achieved by Rivers. Sprunt and Berry.1was not only confirmed by others, but similar lesions were later obtained with various preparations in rabbits and guinea pigs. The experimental disease has not hitherto been induced in mice. It would appear that if mice so convenient for experimental work could be shown to be susceptible, a step forward might be made. As the following results will show, it is believed that this has been accomplished.

In a search for wildlife carriers of L. pomona, various species of mammals were trapped in an endemic area of bovine leptospirosis. Direct dark-ground microscopic examinations of urine or bladder saline washings disclosed the presence of leptospires in 10 of the 37 house mice examined. Leptospiral cultural isolates were obtained from 9 of these 10 house mice. The recovery of leptospires from 6 additional house mice and from 1 of 2 opossums emphasizes the importance of cultural methods in any survey for leptospirosis. All isolates, serologically typed on the basis of a cross agglutinationlysis pattern, employing 18 type leptospiral immune rabbit serums, belonged to the serotype L. ballum. The failure to detect L. pomona in the rodent and other wild life population in an endemic area of bovine leptospirosis affords ancillary evidence that the natural hosts of L. pomonaleptospirosis are to be found primarily in the livestock population. To the authors' knowledge, this is the first report of leptospirosis in the opossum.