A regional evaluation of the health care utilization and outcomes of children and young people with long-term ventilation needs.

BACKGROUND: Globally, the number of children and young people (CYP) with long-term ventilation (LTV) needs is increasing, with high associated health care costs, due to frequent hospital admissions and contact with community health care services. However, demographic, health care utilization and outcome details of the CYP cared for locally is unknown. This study aimed to examine health care utilization and outcomes for this patient population. METHODS: Routinely collected data from 2014 to 2018 were extracted from local LTV team records and from hospital electronic patient records. Descriptive and inferential statistical analysis was performed using SPSS 17. RESULTS: A total of 112 CYP aged 0-17 years old were included in the evaluation. Sixty per cent (n = 67) commenced ventilation in hospital, and 62% (n = 69) had at-least one hospitalization event whilst they were on LTV, with a median length of stay of 3 days. Most hospitalizations were unplanned and respiratory in nature. Ninety-five per cent (n = 106) of CYP accessed at least one clinic appointment whilst on LTV, with a median of 20 outpatient clinic appointments during the study period. The majority of CYP received time-intensive support from LTV nurses and physiotherapists during the period that they received LTV. Minimal seasonal variation existed in relation to hospital admissions. Year on year increasing trend of hospital admissions was noted. The observed mortality rate was 3.6% (n = 4), 72.3% (n = 81) remained active on LTV, 14% (n = 16) were liberated from their ventilation and 9% (n = 10) transitioned to adult care by the end of the study. CONCLUSION: The study highlights the most common modes of health care utilization for CYP with LTV needs. To enable formalization of future resource planning and accurate assessment of health care utilization in evaluations, there is an urgent need to create a systematic approach for relevant LTV data collection.

North American temperate conifer (Tsuga canadensis) reveals a complex physiological response to climatic and anthropogenic stressors.

Rising atmospheric CO2 (ca) is expected to promote tree growth and lower water loss via changes in leaf gas exchange. However, uncertainties remain if gas-exchange regulation strategies are homeostatic or dynamical in response to increasing ca, as well as evolving climate and pollution inputs. Using a suite of tree ring-based δ13C-derived physiological parameters (Δ13C, ci, iWUE) and tree growth from a mesic, low elevation stand of canopy-dominant Tsuga canadensis in north-eastern USA, we investigated the influence of rising ca, climate and pollution on, and characterised the dynamical regulation strategy of, leaf gas exchange at multidecadal scales. Isotopic and growth time series revealed an evolving physiological response in which the species shifted its leaf gas-exchange strategy dynamically (constant ci; constant ci/ca; constant ca - ci) in response to rising ca, moisture availability and site conditions over 111 yr. Tree iWUE plateaued after 1975, driven by greater moisture availability and a changing soil biogeochemistry that may have impaired a stomatal response. Results suggested that trees may exhibit more complex physiological responses to the changing environmental conditions over multidecadal periods, and complicating the parameterisation of Earth system models and the estimation of future carbon sink capacity and water balance in midlatitude forests and elsewhere.

Interferometric Laser Cooling of Atomic Rubidium.

We report the 1D cooling of ^{85}Rb atoms using a velocity-dependent optical force based upon Ramsey matter-wave interferometry. Using stimulated Raman transitions between ground hyperfine states, 12 cycles of the interferometer sequence cool a freely moving atom cloud from 21 to 3 µK. This pulsed analog of continuous-wave Doppler cooling is effective at temperatures down to the recoil limit; with augmentation pulses to increase the interferometer area, it should cool more quickly than conventional methods and be more suitable for species that lack a closed radiative transition.

Acute respiratory distress syndrome driven by severe hypercalcemia and acute kidney injury: A case report and literature review of a rare, life-threatening complication.

Acute respiratory distress syndrome (ARDS) is a rare and under-reported complication of hypercalcemia, which often presents in conjunction with acute kidney injury (AKI). Unfamiliarity with the condition inevitably leads to management uncertainty, resulting in fatal outcomes. Early identification, however, confers a good prognosis. We report a case of a 40-year-old male who presented with severe hypercalcemia and AKI and rapidly deteriorated due to ARDS, with no evidence of cardiogenic pulmonary edema or fluid overload. Infection screens were negative. He died despite invasive ventilation and continuous venous-venous hemofiltration. His autopsy revealed extensive metastatic pulmonary calcifications and alveolar edema. We found only 10 other cases of hypercalcemia-induced ARDS in the literature, with only 2 patients surviving. We provide the first literature review on the subject to guide the management of this rare but fatal complication, which can be managed with good outcomes if considered early.

FcgammaRIIa expression with FcgammaRI results in C-reactive protein- and IgG-mediated phagocytosis.

C-reactive protein (CRP) is a pattern-recognition molecule, which can bind to phosphorylcholine and certain phosphorylated carbohydrates found on the surface of a number of microorganisms. CRP has been shown recently to bind human Fc receptor for immunoglobulin G (IgG; FcgammaR)I and mediate phagocytosis and signaling through the gamma-chain. To date, binding of monomeric CRP to FcgammaRII has been contentious. We demonstrate that erythrocytes opsonized with CRP bind FcgammaRIIa-transfected COS-7 cells. In addition, we demonstrate that FcgammaRI can use FcgammaRIIa R131 and H131 to phagocytose erythrocytes coated with IgG or purified or recombinant CRP in the absence of the gamma-chain. COS-7 cells expressing FcgammaRIIa or FcgammaRI alone did not phagocytose opsonized erythrocytes. Such phagocytosis required the cytoplasmic domain of FcgammaRIIa, as mutation of tyrosine at position 205 and truncation of the cytoplasmic domain from the end of the transmembrane region (position 206), resulting in the loss of the immunoreceptor tyrosine activatory motif, abrogated phagocytosis. FcgammaRIIa R131 was more efficient than FcgammaRIIa H131 at mediating CRP-dependent phagocytosis.