Objectives: To describe the pharmaceutical management of sedation, analgesia, and neuromuscular blockade medications administered to children in ICUs. Design: A retrospective analysis using data extracted from the national database Health Facts. Setting: One hundred sixty-one ICUs in the United States with pediatric admissions. Patients: Children in ICUs receiving medications from 2009 to 2016. Exposure/Intervention: Frequency and duration of administration of sedation, analgesia, and neuromuscular blockade medications. Measurements and Main Results: Of 66,443 patients with a median age of 1.3 years (interquartile range, 0–14.5), 63.3% (n = 42,070) received nonopioid analgesic, opioid analgesic, sedative, and/or neuromuscular blockade medications consisting of 83 different agents. Opioid and nonopioid analgesics were dispensed to 58.4% (n = 38,776), of which nonopioid analgesics were prescribed to 67.4% (n = 26,149). Median duration of opioid analgesic administration was 32 hours (interquartile range, 7–92). Sedatives were dispensed to 39.8% (n = 26,441) for a median duration of 23 hours (interquartile range, 3–84), of which benzodiazepines were most common (73.4%; n = 19,426). Neuromuscular-blocking agents were dispensed to 17.3% (n = 11,517) for a median duration of 2 hours (interquartile range, 1–15). Younger age was associated with longer durations in all medication classes. A greater proportion of operative patients received these medication classes for a longer duration than nonoperative patients. A greater proportion of patients with musculoskeletal and hematologic/oncologic diseases received these medication classes. Conclusions: Analgesic, sedative, and neuromuscular-blocking medications were prescribed to 63.3% of children in ICUs. The durations of opioid analgesic and sedative medication administration found in this study can be associated with known complications, including tolerance and withdrawal. Several medications dispensed to pediatric patients in this analysis are in conflict with Food and Drug Administration warnings, suggesting that there is potential risk in current sedation and analgesia practice that could be reduced with practice changes to improve efficacy and minimize risks.

An experiment was conducted in field for three years to assess the sustainability of aquatic plants Leersia hexandra, Cyperus articulatus, and Eleocharis palustris for use in the removal of total hydrocarbons of weathered oil in four areas contaminated with 60916-119373 mg/kg of hydrocarbons. The variables evaluated were coverage of plant, dry matter, density of plant growth-promoting rhizobacteria, and the removal of total weathered oil. The variables showed statistical differences (p = 0.05) due to the effects of time and the amount of oil in the soil. The three aquatic plants survived on the farm during the 36-month evaluation. The grass L. hexandra yielded the greatest coverage of plant but was inhibited by the toxicity of the oil, which, in contrast, stimulated the coverage of C. articulatus. The rhizosphere of L. hexandra in control soil was more densely colonized by N-fixing bacteria, while the density of phosphate and potassium solubilizing rhizobacteria was stimulated by exposure to oil. C. articulatus coverage showed positive relationship with the removal of weathered oil; positive effect between rhizosphere and L. hexandra grass coverage was also identified. These results contributed to the removal of weathered oil in Gleysols flooded and affected by chronic discharges of crude oil.

In this study were examined chemical, microbiological, and enzymatic changes at different depths of the soil and rhizosphere, produced by the burning of a commercial sugarcane crop in tropical areas of México. Samples of silty loamy soil and rhizosphere were collected at three times in the sugarcane production cycle: before burning (BB), after first burning (AFB), and after second burnings (ASB), with a general interval of 15 days between the first and the third collection date. Soil organic matter (SOM), soil organic carbon (SOC), total nitrogen (Nt), phosphorus available (Pav), pH, and the C/N ratio were determined in soil and rhizosphere, as well as the enzymatic activities of phosphatase and urease. Furthermore, microbial respiration, microbial biomass, and nitrogen-fixing bacteria (NFB) and phosphate solubilizing bacteria (PSB) densities were monitored during 84 days. The Pav and the pH increased significantly in soil samples affected by the second burning of the stubbles, but SOM, SOC, Nt, the C/N ratio, phosphatase, and urease activities decreased as a result of the first and second burnings. This decrease was more pronounced in non-rhizospheric soil. The densities of NFB and PSB increased with the burning, as well as microbial respiration. All the variables evaluated recorded higher values in the soil surface layer.

BackgroundThe Criticality Index-Mortality uses physiology, therapy, and intensity of care to compute mortality risk for pediatric ICU patients. If the frequency of mortality risk computations were increased to every 3 h with model performance that could improve the assessment of severity of illness, it could be utilized to monitor patients for significant mortality risk change.ObjectivesTo assess the performance of a dynamic method of updating mortality risk every 3 h using the Criticality Index-Mortality methodology and identify variables that are significant contributors to mortality risk predictions.PopulationThere were 8,399 pediatric ICU admissions with 312 (3.7%) deaths from January 1, 2018 to February 29, 2020. We randomly selected 75% of patients for training, 13% for validation, and 12% for testing.ModelA neural network was trained to predict hospital survival or death during or following an ICU admission. Variables included age, gender, laboratory tests, vital signs, medications categories, and mechanical ventilation variables. The neural network was calibrated to mortality risk using nonparametric logistic regression.ResultsDiscrimination assessed across all time periods found an AUROC of 0.851 (0.841–0.862) and an AUPRC was 0.443 (0.417–0.467). When assessed for performance every 3 h, the AUROCs had a minimum value of 0.778 (0.689–0.867) and a maximum value of 0.885 (0.841,0.862); the AUPRCs had a minimum value 0.148 (0.058–0.328) and a maximum value of 0.499 (0.229–0.769). The calibration plot had an intercept of 0.011, a slope of 0.956, and the R2 was 0.814. Comparison of observed vs. expected proportion of deaths revealed that 95.8% of the 543 risk intervals were not statistically significantly different. Construct validity assessed by death and survivor risk trajectories analyzed by mortality risk quartiles and 7 high and low risk diseases confirmed a priori clinical expectations about the trajectories of death and survivors.ConclusionsThe Criticality Index-Mortality computing mortality risk every 3 h for pediatric ICU patients has model performance that could enhance the clinical assessment of severity of illness. The overall Criticality Index-Mortality framework was effectively applied to develop an institutionally specific, and clinically relevant model for dynamic risk assessment of pediatric ICU patients.