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Purpose: Selection for root traits has become a target in (pre-)breeding programs aiming at improving crop ability to capture soil resources. However, the benefit of selected traits in heterogeneous target environments will depend on spatial and temporal interactions between root systems, the soil environment (fertility and water supply) and management (fertiliser placement). Methods: We assessed growth and phosphorus acquisition of durum wheat (Triticum durum L.) lines defined by contrasting seminal root angles (41° 'Narrow' vs 82° 'Wide'), in response to different soil phosphorus placements and seasonal water dynamics. Responses were evaluated in clear pots (seedlings), rhizoboxes (late-tillering stage) and a custom lysimeter system (flowering stage). Results: The Narrow genotype increased deep soil exploration (down to 50 cm) during early growth, with a tendency to more rapidly acquire phosphorus placed as a deep fertiliser band (25 cm depth). However, genotypic differences in shoot biomass or phosphorus uptake were not apparent at anthesis, in part due to phosphorus-induced changes in phenological development. Contrastingly, the wide genotype increased root growth in the topsoil (0–10 cm) when phosphorus was stratified in this layer and produced greater biomass at anthesis under these conditions. Shoot and root biomass and phosphorus uptake decreased when the topsoil dried out, with the greatest effect observed for phosphorus stratified in this layer. Conclusion: The benefits of the selected root angle trait strongly depend on nutrient and water distributions and dynamics in the target environment. Ideotype breeding efforts and farmer selection of genotypes should consider the context in which genotypes will be deployed. Highlight: The interaction between root system architecture and heterogeneous distributions of phosphorus and available water determine the relative performance of durum wheat genotypes with contrasting root angles. [ABSTRACT FROM AUTHOR]

This investigation explores memory performance using the California Verbal Learning Test in relation to morphometric and connectivity measures of the memory network in severe traumatic brain injury. Twenty-two adolescents with severe traumatic brain injury were recruited for multimodal MRI scanning 1–2 years post-injury at 13 participating sites. Analyses included hippocampal volume derived from anatomical T1-weighted imaging, fornix white matter microstructure from diffusion tensor imaging, and hippocampal resting-state functional magnetic resonance imaging connectivity as well as diffusion-based structural connectivity. A typically developing control cohort of forty-nine age-matched children also underwent scanning and neurocognitive assessment. Results showed hippocampus volume was decreased in traumatic brain injury with respect to controls. Further, hippocampal volume loss was associated with worse performance on memory and learning in traumatic brain injury subjects. Similarly, hippocampal fornix fractional anisotropy was reduced in traumatic brain injury with respect to controls, while decreased fractional anisotropy in the hippocampal fornix also was associated with worse performance on memory and learning in traumatic brain injury subjects. Additionally, reduced structural connectivity of left hippocampus to thalamus and calcarine sulcus was associated with memory and learning in traumatic brain injury subjects. Functional connectivity in the left hippocampal network was also associated with memory and learning in traumatic brain injury subjects. These regional findings from a multi-modal neuroimaging approach should not only be useful for gaining valuable insight into traumatic brain injury induced memory and learning disfunction, but may also be informative for monitoring injury progression, recovery, and for developing rehabilitation as well as therapy strategies. [ABSTRACT FROM AUTHOR]

Extracorporeal membrane oxygenation is a potentially lifesaving intervention for children with severe cardiac or respiratory failure. It is used with increasing frequency and in increasingly more complex and severe diseases. Neurological injuries are important causes of morbidity and mortality in children treated with extracorporeal membrane oxygenation and include ischemic stroke, intracranial hemorrhage, hypoxic-ischemic injury, and seizures. In this review, we discuss the epidemiology and pathophysiology of neurological injury in patients supported with extracorporeal membrane oxygenation, and we review the current state of knowledge for available modalities of monitoring neurological function in these children. These include structural imaging with computed tomography and ultrasound, cerebral blood flow monitoring with near-infrared spectroscopy and transcranial Doppler ultrasound, and physiological monitoring with electroencephalography and plasma biomarkers. We highlight areas of need and emerging advances that will improve our understanding of neurological injury related to extracorporeal membrane oxygenation and help to reduce the burden of neurological sequelae in these children. [ABSTRACT FROM AUTHOR]

Purpose: We questioned how root ideotypes selected for deep or shallow root architecture function in complex environments with heterogeneous distributions of phosphorus (P), such as in many cropping systems in north-eastern Australia. Methods: We used the rhizobox method to evaluate how contrasting genotypes of durum wheat and sorghum (wide and narrow root angle) responded to combinations of starter-P and deep P bands. Results: Although we found evidence that root angle may influence spatio-temporal exploration for deep P bands, (early) plant access to P was the critical driver for plant growth. Without P, root system growth was retarded such that genotypic differences were hardly observed. Access to P boosted root exploration at depth by virtue of greater root system size, such that wide-angle genotypes with P outperformed narrow-angle ones without P. Plastic root responses to P benefited the expression of the broader root system architecture. We observed variation between species and individual parameters, but overall Starter-P and deep P bands tended to deliver complementary benefits when considering plant growth, P uptake, and phenological development together. Conclusion: Our study highlights that nutritional constraints may limit the ability of root ideotypes to function in complex target environments. Development and deployment of root ideotypes should consider how local conditions (including soil nutrient distribution, physical and biological properties) influence crop phenotype and their ability to deliver the intended benefits. Within this, soil nutrient management is a critical determinant and an opportunity to influence the target environment. [ABSTRACT FROM AUTHOR]

Background: Brain tissue hypoxia is an independent risk factor for unfavorable outcomes in traumatic brain injury (TBI); however, systemic hyperoxemia encountered in the prevention and/or response to brain tissue hypoxia may also impact risk of mortality. We aimed to identify temporal patterns of partial pressure of oxygen in brain tissue (PbtO2), partial pressure of arterial oxygen (PaO2), and PbtO2/PaO2 ratio associated with mortality in children with severe TBI. Methods: Data were extracted from the electronic medical record of a quaternary care children's hospital with a level I trauma center for patients ≤ 18 years old with severe TBI and the presence of PbtO2 and/or intracranial pressure monitors. Temporal analyses were performed for the first 5 days of hospitalization by using locally estimated scatterplot smoothing for less than 1,000 observations and generalized additive models with integrated smoothness estimation for more than 1,000 observations. Results: A total of 138 intracranial pressure–monitored patients with TBI (median 5.0 [1.9–12.8] years; 65% boys; admission Glasgow Coma Scale score 4 [3–7]; mortality 18%), 71 with PbtO2 monitors and 67 without PbtO2 monitors were included. Distinct patterns in PbtO2, PaO2, and PbtO2/PaO2 were evident between survivors and nonsurvivors over the first 5 days of hospitalization. Time-series analyses showed lower PbtO2 values on day 1 and days 3–5 and lower PbtO2/PaO2 ratios on days 1, 2, and 5 among patients who died. Analysis of receiver operating characteristics curves using Youden's index identified a PbtO2 of 30 mm Hg and a PbtO2/PaO2 ratio of 0.12 as the cut points for discriminating between survivors and nonsurvivors. Univariate logistic regression identified PbtO2 < 30 mm Hg, hyperoxemia (PaO2 ≥ 300 mm Hg), and PbtO2/PaO2 ratio < 0.12 to be independently associated with mortality. Conclusions: Lower PbtO2, higher PaO2, and lower PbtO2/PaO2 ratio, consistent with impaired oxygen diffusion into brain tissue, were associated with mortality in this cohort of children with severe TBI. These results corroborate our prior work that suggests targeting a higher PbtO2 threshold than recommended in current guidelines and highlight the potential use of the PbtO2/PaO2 ratio in the management of severe pediatric TBI. [ABSTRACT FROM AUTHOR]

The 15 N natural abundance (NA) method is increasingly used to quantify fertiliser N recovery by crops, even though this method does not always provide comparable results to those obtained using 15 N-enrichment (EN). This study assessed the ability of both methods to quantify urea-N recovery by maize (Zea mays) in soils with different management histories. A pot experiment was conducted using eight soils that differed in tillage, stubble management, and N fertiliser use history. Urea-N (unlabelled or 15 N-enriched at 10 atom-%) was applied at a rate equivalent to 150 kg N ha−1 prior to sowing maize. Method comparison was based on N recovery efficiency (REN) and N derived from fertiliser (Ndff). Maize grown in soils without fertiliser N history had significantly higher δ15N and Ndff but lower REN, than soils with fertiliser N histories. The NA method also consistently estimated 10% lower REN and Ndff than the EN method regardless of management history, although fertiliser N history affected the relationship between the methods. A highly significant linear relationship was obtained for REN measured using NA and EN methods (R2 = 0.98) in soils without fertiliser N history, but no relationship was apparent for soils with a long fertiliser N history. In conclusion, (1) the significant effect of fertiliser N history on the isotopic signature of soil N will limit the use of the NA method if soils with different N fertiliser histories are studied; and (2) REN and Ndff determined by NA were consistently lower than the EN method. [ABSTRACT FROM AUTHOR]

Purpose: To conduct a field-based, integrated assessment of the effect of band-applied, polymer-sulfur coated urea (PSCU), plant oil coated urea (POCU), and polymer coated urea (PCU) on (i) the release dynamics of urea-N and mineral N in the soil profile (Experiment 1); and (ii) the crop N recovery and agronomic response of an irrigated maize crop (Experiment 2) relative to standard urea. Methods: Two experiments were conducted in a Vertosol under subtropical field conditions. In both experiments, six treatments (nil, urea, PSCU, POCU, and two PCU products) were replicated four times. Soil samples were collected at 8, 27, 48, 82 and 173 days after fertiliser application (DAF) to quantify N release dynamics. Maize biomass production, N uptake, grain yield and N content were quantified to assess the agronomic performance of CRFs relative to standard urea. Results: CRFs delayed the release of N relative to standard urea. Soil moisture and mass flow impacted N release dynamics from fertiliser bands, with soil chemical changes largely confined to the band for CRFs. Despite obvious differences in N release dynamics, there were no clear advantages of CRFs relative to standard urea for crop productivity and grain yield. A significant amount of in-season mineralization likely masked any potential benefits arising from the slower release of N from CRF products. Conclusion: This study improves our understanding of how CRFs behave in soil under changing environmental conditions and highlights the complexity of synchronizing N supply and crop N requirements to improve NUE in irrigated maize. [ABSTRACT FROM AUTHOR]

A range of enhanced efficiency fertilizers (EEFs) have been developed in response to widespread recognition of poor nitrogen (N) use efficiency (NUE) in agriculture; however, their effective utilization is not properly understood when applied in sub-surface bands. This study quantified soil chemical changes and the distribution of N species that arose from sub-surface banding of urea, a controlled release polymer-coated urea (PCU) and urea coated with either nitrification inhibitors (NIs) or a urease inhibitor (UI), over 71 days in a field trial. Banding NIs extended the duration of nitrification inhibition for up to 50 days longer than banded urea, although the duration of NI-conferred inhibition was dependant on the rate of NI-urea application. The UI preserved urea-N at a concentration which was 16-fold higher cf. standard urea over 7 days, but no urea-N was detected after 21 days. This suggests that the NUE benefits of UIs are transient when applied in sub-surface bands. Slow release of urea-N from banded PCU resulted in lower concentrations of N in the soil solution. This reduced N dispersal by ca. 50 mm cf. urea, resulting in a N-enriched zone which was considerably smaller. Relatively benign chemical conditions around PCU bands enabled rates of nitrification (NH4–N:NO3–N ratio of 46%) which were similar to urea. Collectively, these results demonstrate the relative efficacy and risks of the different EEF technologies, when applied in fertilizer bands. This knowledge supports the effective utilization of band-applied EEFs for improved NUE in agricultural systems. [ABSTRACT FROM AUTHOR]

Main conclusion: In sweetcorn (Zea mays L.), embryo Zn is accumulated mainly as Zn-phytate, whereas endosperm Zn is complexed with a N- or S-containing ligand. Understanding the speciation of Zn in crop plants helps improve the effectiveness of biofortification efforts. Kernels of four sweetcorn (Zea mays L.) varieties were analysed for Zn concentration and content. We also assessed the speciation of the Zn in the embryo, endosperm, and pericarp in situ using synchrotron-based X-ray absorption spectroscopy. The majority of the Zn was in the endosperm and pericarp (72%), with the embryo contributing 28%. Approximately 79% of the Zn in the embryo accumulated as Zn-phytate, whereas in the endosperm most of the Zn was complexed with a N- or S-containing ligand, possibly as Zn-histidine and Zn-cysteine. This suggests that whilst the Zn in the endosperm and pericarp is likely to be bioavailable for humans, the Zn in the embryo is of low bioavailability. This study highlights the importance of targeting the endosperm of sweetcorn kernels as the tissue for increasing bioavailable Zn concentration. [ABSTRACT FROM AUTHOR]

Background: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study.Methods: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy). Children with suspected abusive head trauma (AHT) were excluded to avoid bias related to the association between AHT and mortality. Demographics, and prehospital and resuscitation events were collected/analyzed, and children were stratified based on age at time of injury (< 5, 5-< 11, 11-18 years) and presented as mean ± standard error of the mean (SEM). Analyses of variance were used to test the equality of the means across the group for continuous variable, and Chi-square tests were used to compare percentages for discrete variables (post hoc comparisons were made using t test and Bonferroni corrections, as needed). Kaplan-Meier curves were generated for each age subgroup describing the time of death, and log-rank was used to compare the curves. Cox proportional hazards regression models were used to assess the effect of age on time to death while controlling for covariates.Results: In the final cohort (n = 155, 45 excluded for AHT), overall age was 9.2 years ± 0.4 and GCS was 5.3 ± 0.1. Mortality was similar between strata (14.0, 20.0, 20.9%, respectively, p = 0.58). Motor vehicle accidents were the most common mechanism across all strata, while falls tended to be more common in the youngest stratum (p = 0.08). The youngest stratum demonstrated increased incidence of spontaneous hypothermia at presentation and decreased hemoglobin concentrations and coagulopathies, while the oldest demonstrated lower platelet counts.Conclusions: In contrast to previous reports, we failed to detect mortality differences across age strata in children with severe TBI. We have discerned novel associations between age and various markers of injury-unrelated to AHT-that may lead to testable hypotheses in the future. [ABSTRACT FROM AUTHOR]

Background: Unexpected neurological morbidity in Pediatric Intensive Care Units (PICUs) remains high and is difficult to detect proactively. Brain-specific biomarkers represent a novel approach for early detection of neurological injury. We sought to determine whether serum concentrations of neuron-specific enolase (NSE), myelin basic protein (MBP), and S100B, specific for neurons, oligodendrocytes, and glia, respectively, were predictive of neurological morbidity in critically ill children.Methods: Serum was prospectively collected on days 1-7 from diagnostically diverse PICU patients (n = 103). Unfavorable neurological outcome at hospital discharge was defined as Pediatric Cerebral Performance Category (PCPC) score of 3-6 with a deterioration from baseline. NSE, MBP, and S100B concentrations were measured by enzyme-linked immunosorbent assay.Results: Peak biomarker levels were greater in patients with unfavorable versus favorable neurological outcome [NSE 39.4 ± 44.1 vs. 12.2 ± 22.9 ng/ml (P = 0.005), MBP 9.1 ± 11.5 vs. 0.6 ± 1.3 ng/ml (P = 0.003), S100B 130 ± 232 vs. 34 ± 70 pg/ml (P = 0.04), respectively; mean ± SD]. Peak levels were each independently associated with unfavorable neurological outcome when controlling for presence of primary neurologic admission diagnosis and poor baseline PCPC using logistic regression analysis (NSE, P = 0.04; MBP, P = 0.004; S100B, P = 0.04), and had the following receiver operating characteristics: NSE 0.75 (0.58, 0.92), MBP 0.81 (0.66, 0.94), and S100B 0.80 (0.67, 0.93) (area under the curve [95% confidence intervals]).Conclusions: Prospectively collected brain-specific serum biomarkers predict unfavorable neurological outcome in critically ill children. Serum biomarkers used in conjunction with clinical data could be used to generate models predicting early detection of neurological injury, allowing for more timely diagnostic and therapeutic interventions, potentially reducing neurological morbidity in the PICU. [ABSTRACT FROM AUTHOR]

The unstable temporal behavior of atrial electrical activity during persistent atrial fibrillation (persAF) might influence ablation target identification, which could explain the conflicting persAF ablation outcomes in previous studies. We sought to investigate the temporal behavior and consistency of atrial electrogram (AEG) fractionation using different segment lengths. Seven hundred ninety-seven bipolar AEGs were collected with three segment lengths (2.5, 5,and 8 s) from 18 patients undergoing persAF ablation. The AEGs with 8-s duration were divided into three 2.5-s consecutive segments. AEG fractionation classification was applied off-line to all cases following the CARTO criteria; 43% of the AEGs remained fractionated for the three consecutive AEG segments, while nearly 30% were temporally unstable. AEG classification within the consecutive segments had moderate correlation (segment 1 vs 2: Spearman's correlation ρ = 0.74, kappa score κ = 0.62; segment 1 vs 3: ρ = 0.726, κ = 0.62; segment 2 vs 3: ρ = 0.75, κ = 0.68). AEG classifications were more similar between AEGs with 5 and 8 s (ρ = 0.96, κ = 0.87) than 2.5 versus 5 s (ρ = 0.93, κ = 0.84) and 2.5 versus 8 s (ρ = 0.90, κ = 0.78). Our results show that the CARTO criteria should be revisited and consider recording duration longer than 2.5 s for consistent ablation target identification in persAF. [ABSTRACT FROM AUTHOR]

Background: Inflammasome-mediated neuroinflammation may cause secondary injury following traumatic brain injury (TBI) in children. The pattern recognition receptors NACHT domain-, Leucine-rich repeat-, and PYD-containing Protein 1 (NLRP1) and NLRP3 are essential components of their respective inflammasome complexes. We sought to investigate whether NLRP1 and/or NLRP3 abundance is altered in children with severe TBI.Methods: Cerebrospinal fluid (CSF) from children (n = 34) with severe TBI (Glasgow coma scale score [GCS] ≤8) who had externalized ventricular drains (EVD) placed for routine care was evaluated for NLRP1 and NLRP3 at 0-24, 25-48, 49-72, and >72 h post-TBI and was compared to infection-free controls that underwent lumbar puncture to rule out CNS infection (n = 8). Patient age, sex, initial GCS, mechanism of injury, treatment with therapeutic hypothermia, and 6-month Glasgow outcome score were collected.Results: CSF NLRP1 was undetectable in controls and detected in 2 TBI patients at only <24 h post-TBI. CSF NLRP3 levels were increased in TBI patients compared with controls at all time points, p < 0.001. TBI patients ≤4 years of age had higher peak NLRP3 levels versus patients >4 (15.50 [3.65-25.71] vs. 3.04 [1.52-8.87] ng/mL, respectively; p = 0.048). Controlling for initial GCS in multivariate analysis, peak NLRP3 >6.63 ng/mL was independently associated with poor outcome at 6 months.Conclusions: In the first report of NLRP1 and NLRP3 in childhood neurotrauma, we found that CSF NLRP3 is elevated in children with severe TBI and independently associated with younger age and poor outcome. Future studies correlating NLRP3 with other markers of inflammation and response to therapy are warranted. [ABSTRACT FROM AUTHOR]

Purpose: The primary objective is to provide evidence of convergent and discriminant validity for the pediatric and parent-proxy versions of the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, Anger, Peer Relations, Mobility, Pain Interference, and Fatigue item banks, the Neurology Quality of Life measurement system (Neuro-QOL) Cognition-General Concerns and Stigma item banks, and the Traumatic Brain Injury Quality of Life (TBI-QOL) Executive Function and Headache item banks in a pediatric traumatic brain injury (TBI) sample.Methods: Participants were 134 parent-child (ages 8-18 years) days. Children all sustained TBI and the dyads completed outcome ratings 6 months after injury at one of six medical centers across the United States. Ratings included PROMIS, Neuro-QOL, and TBI-QOL item banks, as well as the Pediatric Quality of Life inventory (PedsQL), the Health Behavior Inventory (HBI), and the Strengths and Difficulties Questionnaire (SDQ) as legacy criterion measures against which these item banks were validated.Results: The PROMIS, Neuro-QOL, and TBI-QOL item banks demonstrated good convergent validity, as evidenced by moderate to strong correlations with comparable scales on the legacy measures. PROMIS, Neuro-QOL, and TBI-QOL item banks showed weaker correlations with ratings of unrelated constructs on legacy measures, providing evidence of discriminant validity.Conclusion: Our results indicate that the constructs measured by the PROMIS, Neuro-QOL, and TBI-QOL item banks are valid in our pediatric TBI sample and that it is appropriate to use these standardized scores for our primary study analyses. [ABSTRACT FROM AUTHOR]

Background: Autophagy is a process that recycles damaged proteins and organelles. Beclin 1 is involved in the nucleation phase, while p62 is consumed during the elongation phase. We hypothesized that these autophagy biomarkers are increased in cerebrospinal fluid (CSF) after traumatic brain injury (TBI) in children and associated with unfavorable outcome.Methods: Thirty children with severe TBI had CSF collected on days 1, 3, and 7. Patients without TBI or meningoencephalitis served as controls. Beclin 1 and p62 were measured by ELISA. Outcome was assigned 6 months after injury (Glasgow Outcome Scale score; GOS).Results: Mean and peak CSF beclin 1 and p62 levels were increased compared to controls (P < 0.05). Peak p62 levels were higher in patients with unfavorable versus favorable outcome (0.79 ± 1.03 vs. 0.17 ± 0.54 ng/ml, respectively; mean ± SD, P = 0.002) and were independently associated with outcome when controlling for age and initial Glasgow Coma Scale score (P = 0.019; AUC 0.88, 95% CI 0.76, 1.00).Conclusions: Beclin 1 and p62 are increased in CSF after TBI, suggesting increased autophagy with impairment of, and/or exceeding the capacity for, autophagic flux. The association of increased p62 with unfavorable outcome suggests that autophagy in excess of the capacity to clear degradation products may be deleterious after TBI. [ABSTRACT FROM AUTHOR]

Background: Traumatic brain injury (TBI) is an important worldwide cause of death and disability for children. The Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial is an observational, cohort study to compare the effectiveness of six aspects of TBI care. Understanding the differences between clinical sites-including their structure, clinical processes, and culture differences-will be necessary to assess differences in outcome from the study and can inform the overall community regarding differences across academic centers.Methods: We developed a survey and queried ADAPT site principal investigators with a focus on six domains: (i) hospital, (ii) pediatric intensive care unit (PICU), (iii) medical staff characteristics, (iv) quality of care, (v) medication safety, and (vi) safety culture. Summary statistics were used to describe differences between centers.Results: ADAPT clinical sites that enrolled a subject within the first year (32 US-based, 11 international) were studied. A wide variation in site characteristics was observed in hospital and ICU characteristics, including an almost sevenfold range in ICU size (8-55 beds) and more than fivefold range of overall ICU admissions (537-2623). Nursing staffing (predominantly 1:1 or 1:2) and the presence of pharmacists within the ICU (79 %) were less variable, and most sites "strongly agreed" or "agreed" that Neurosurgery and Critical Care teams worked well together (81.4 %). However, a minority of sites (46 %) used an explicit protocol for treatment of children with severe TBI care.Conclusions: We found a variety of inter-center structure, process, and culture differences. These intrinsic differences between sites may begin to explain why interventional studies have failed to prove efficacy of experimental therapies. Understanding these differences may be an important factor in analyzing future ADAPT trial results and in determining best practices for pediatric severe TBI. [ABSTRACT FROM AUTHOR]

The article discusses traumatic brain injury (TBI) which, as per the article, is the most common cause of death and disability in children from the developed world. Also discussed in the article is the study called ADAPT (Approaches and Decisions for Acute Pediatric TBI) in which three TBI topics were chosen, which are intracranial hypertension therapies, secondary insult detection/treatment and metabolic support.

Brain injury is the leading cause of death in our pediatric ICU [Au et al. Crit Care Med 36:A128, 2008]. Clinical care for brain injury remains largely supportive. Therapeutic hypothermia has been shown to be effective in improving neurological outcome after adult ventricular-arrhythmia-induced cardiac arrest and neonatal asphyxia, and is under investigation as a neuroprotectant after cardiac arrest and traumatic brain injury in children in our ICU and other centers. To induce hypothermia in children comatose after cardiac arrest we target 32–34°C using cooling blankets and intravenous iced saline as primary methods for induction, for 24–72 h duration with vigilant re-warming. The objective of this article is to share our hypothermia protocol for cooling children with acute brain injury. [ABSTRACT FROM AUTHOR]

Objective: To describe the risk factors of early and delayed increases in pancreatic enzymes (PE) in children after severe traumatic brain injury (TBI) and to determine if cerebral events (such as intracranial hemorrhage or intracranial hypertension) are associated with increases in PE.Design and Settings: Retrospective analysis of prospectively collected Pediatric Neurotrauma Registry for children with severe TBI (GCS ≤ 8). We assessed the association of clinical characteristics with the development of increases in PE using regression analyses.Patients: Fifty-one children with severe TBI were classified into three groups [normal PE; early PE (PE increases within first 24 h); delayed PE (PE increases after 24 h)].Measurements and Main Results: Increases in PE were observed in 29/51 children [57% total; n = 9 (18%) early; n = 20 (39%) delayed]. Multisystem trauma was more prevalent in patients with early increases in PE compared to those without increases in PE (70 vs. 30%, RR = 2.8, 95% CI 1.1-7) but not different between delayed PE and normal PE groups. In the bivariate analyses, increasing age (odds ratios, [95% CI]; 1.2, [1.05-1.4]), intracranial hypertension (14.6, [2.6-80.5]), intracranial hemorrhage (6.2, [1.15-33.7]), receipt of pentobarbital (9.3, [2.1-39.9]), mannitol (13.2, [2.7-62.2]), and vasoactive medications (6.9, [1.5-31.3]) were associated with the development of delayed increases in PE, whereas sex, initial Glasgow Coma Scale, severity of injury (PRISM, Injury Severity Score), therapeutic hypothermia, morphine and furosemide were not associated. Both intracranial hypertension and intracranial hemorrhage independently predicted the development of increases in PE (14.6, [2.6-80.5], and 9.1, [1.31-63.3], respectively).Conclusions: Increases in PE, often used as the only measures of pancreatitis in children with other severe injuries, are common in children after severe TBI and delayed presentation appears related to intracranial events. This suggests a possible interaction between the brain and the gastrointestinal system, implying that disturbances in cerebral hemodynamics may lead to pancreatic dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of a Pediatric Neurocritical Care (PNCCM) service; define the patient population that requires the service and describe important outcome parameters.Methods: An analysis of prospectively collected data from a database was performed in a tertiary-care, academic children's hospital. Critically ill children who received a PNCCM consult between April, 2006 and May 2007 were included in the analysis. Demographic data (including age, Pediatric Intensive Care Unit (PICU) admission diagnosis, reason for PNCCM consult, timing of consult, and medical/neurological co-morbidities), outcome (PICU mortality and hospital length of stay) and result of consults (resources utilized, new consults or differential diagnoses suggested) were collected.Results: Over a 14-month period, 373 PNCCM consults were obtained (total PICU admissions 1,423) at an average of 3.6 days +/- 0.5 after PICU admission. PNCCM consults had a higher mortality than overall PICU population (11.0% vs. 5.2%; P < 0.001) and longer hospital length of stay (18.5 days +/- 1.4 vs. 6.7 days +/- 1.9). The majority (64.1%) of PNCCM consults were admitted to the PICU with neurological diagnoses (status epilepticus was the most common). A significant percentage (35.9%) had critical medical conditions at presentation and the disorders of our PNCCM consults were very different from those observed in adult NCCM services. PNCCM consults suggested an additional and differential diagnosis in 148 children and an additional 105 consults from other services. More than 787 procedures or diagnostic neurological tests were performed in this cohort of children in the PICU.Conclusion: A PNCCM team was asked to assist in managing almost one-quarter of the total patient census in an urban, tertiary-care, teaching hospital. The number of consults is comparable to those observed in early studies in adult NCCM team development but the admission diagnoses are distinct. The PNCCM consulted on children with high mortality rates. Future studies will be needed to determine if the presence of a PNCCM can result in improved patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Intracerebral hemorrhages are relatively rare events in children and cerebral vasospasm after such hemorrhages is even more unusual. Children with structural congenital heart disease are particularly at risk for both thrombotic and embolic events but not to isolated hemorrhages.Discussion: We report a case of cerebral vasospasm in a child with structural congenital heart disease after a cerebral hemorrhage.Conclusion: This case illustrates that this rare occurrence must be swiftly recognized and treated in order to maximize clinical outcome. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to determine the effectiveness of natural (NatZeo) and acid-treated (AcidZeo) zeolites in increasing the nitrogen (N) recovery of sugarcane grown under conditions highly conducive for N losses.This glasshouse trial replicated the pedoclimatic conditions typical of the Australian sugarcane industry in the Wet Tropics to evaluate the capacity and economic feasibility of using NatZeo and AcidZeo to reduce leaching and increase plant and soil N recovery in a highly permeable sandy-loam soil. Nitrogen fertiliser was applied at two rates (84 and 120 kg N ha−1) as 15N-enriched urea.Compared with the unamended treatments, AcidZeo led to significantly higher average fertiliser N recoveries in both the soil (+24%) and plant (+54%), which resulted in significantly lower overall N losses (−22%). However, the significantly higher capacity of AcidZeo in retaining ions limited the availability of potassium and sulphur to the plants and led to a 4% yield reduction. The use of NatZeo led to lower abatements of N losses (−6%) but increased N recoveries in the plant (+22%). NatZeo did not result in as much cation immobilisation, which, combined with the increased plant/soil N recovery, resulted in the highest yield of the trial (+8% compared with the unamended treatments). The economic analysis indicated that only NatZeo could potentially increase farmer’s income when applied in 20 cm wide strips around the fertiliser band.This study highlights that zeolites have potential to improve the environmental sustainability and profitability of sugarcane cropping systems.Methods: The aim of this study was to determine the effectiveness of natural (NatZeo) and acid-treated (AcidZeo) zeolites in increasing the nitrogen (N) recovery of sugarcane grown under conditions highly conducive for N losses.This glasshouse trial replicated the pedoclimatic conditions typical of the Australian sugarcane industry in the Wet Tropics to evaluate the capacity and economic feasibility of using NatZeo and AcidZeo to reduce leaching and increase plant and soil N recovery in a highly permeable sandy-loam soil. Nitrogen fertiliser was applied at two rates (84 and 120 kg N ha−1) as 15N-enriched urea.Compared with the unamended treatments, AcidZeo led to significantly higher average fertiliser N recoveries in both the soil (+24%) and plant (+54%), which resulted in significantly lower overall N losses (−22%). However, the significantly higher capacity of AcidZeo in retaining ions limited the availability of potassium and sulphur to the plants and led to a 4% yield reduction. The use of NatZeo led to lower abatements of N losses (−6%) but increased N recoveries in the plant (+22%). NatZeo did not result in as much cation immobilisation, which, combined with the increased plant/soil N recovery, resulted in the highest yield of the trial (+8% compared with the unamended treatments). The economic analysis indicated that only NatZeo could potentially increase farmer’s income when applied in 20 cm wide strips around the fertiliser band.This study highlights that zeolites have potential to improve the environmental sustainability and profitability of sugarcane cropping systems.Results: The aim of this study was to determine the effectiveness of natural (NatZeo) and acid-treated (AcidZeo) zeolites in increasing the nitrogen (N) recovery of sugarcane grown under conditions highly conducive for N losses.This glasshouse trial replicated the pedoclimatic conditions typical of the Australian sugarcane industry in the Wet Tropics to evaluate the capacity and economic feasibility of using NatZeo and AcidZeo to reduce leaching and increase plant and soil N recovery in a highly permeable sandy-loam soil. Nitrogen fertiliser was applied at two rates (84 and 120 kg N ha−1) as 15N-enriched urea.Compared with the unamended treatments, AcidZeo led to significantly higher average fertiliser N recoveries in both the soil (+24%) and plant (+54%), which resulted in significantly lower overall N losses (−22%). However, the significantly higher capacity of AcidZeo in retaining ions limited the availability of potassium and sulphur to the plants and led to a 4% yield reduction. The use of NatZeo led to lower abatements of N losses (−6%) but increased N recoveries in the plant (+22%). NatZeo did not result in as much cation immobilisation, which, combined with the increased plant/soil N recovery, resulted in the highest yield of the trial (+8% compared with the unamended treatments). The economic analysis indicated that only NatZeo could potentially increase farmer’s income when applied in 20 cm wide strips around the fertiliser band.This study highlights that zeolites have potential to improve the environmental sustainability and profitability of sugarcane cropping systems.Conclusions: The aim of this study was to determine the effectiveness of natural (NatZeo) and acid-treated (AcidZeo) zeolites in increasing the nitrogen (N) recovery of sugarcane grown under conditions highly conducive for N losses.This glasshouse trial replicated the pedoclimatic conditions typical of the Australian sugarcane industry in the Wet Tropics to evaluate the capacity and economic feasibility of using NatZeo and AcidZeo to reduce leaching and increase plant and soil N recovery in a highly permeable sandy-loam soil. Nitrogen fertiliser was applied at two rates (84 and 120 kg N ha−1) as 15N-enriched urea.Compared with the unamended treatments, AcidZeo led to significantly higher average fertiliser N recoveries in both the soil (+24%) and plant (+54%), which resulted in significantly lower overall N losses (−22%). However, the significantly higher capacity of AcidZeo in retaining ions limited the availability of potassium and sulphur to the plants and led to a 4% yield reduction. The use of NatZeo led to lower abatements of N losses (−6%) but increased N recoveries in the plant (+22%). NatZeo did not result in as much cation immobilisation, which, combined with the increased plant/soil N recovery, resulted in the highest yield of the trial (+8% compared with the unamended treatments). The economic analysis indicated that only NatZeo could potentially increase farmer’s income when applied in 20 cm wide strips around the fertiliser band.This study highlights that zeolites have potential to improve the environmental sustainability and profitability of sugarcane cropping systems. [ABSTRACT FROM AUTHOR]