QI methodology improved septic shock program goal adherence and decreased mortality without increasing PICU admissions or PED length of stay over the 8-year period, supporting continued emphasis on early recognition, timely IVF resuscitation, and antibiotic administration.

The ovaries of endoparasitic species of braconid and ichneumonid wasps contain large numbers of polydnavirus (PDV) virions that replicate in specialized calyx cells of the ovaries and are injected into the host larva during parasitization. In the braconid wasp Cotesia congregata that parasitizes the tobacco hornworm, Manduca sexta, the total amount of viral DNA present in the ovaries was determined to be 25-75 ng. Analysis of viral DNA on 0.4% agarose gels showed that the genome was comprised of 15-20 circles of double-stranded DNA. SDS-PAGE analyses showed that a large number (>30) of structural polypeptides were present in the virions, and analysis of the venom likewise showed that multiple components were present. The major size classes of venom proteins differed from those present in the PDV. However, Western blots using polyclonal PDV antibodies showed that some cross-reacting PDV-like proteins were present in the venom, perhaps explaining the mild PDV-enhancing effect of the venom. Injection of PDV into unparasitized larvae provoked pronounced alterations in their growth, development, pigmentation, and hemolymph proteins. A densely staining band of hemolymph proteins of approximately 18-20 kD appeared in large amounts relative to other hemolymph proteins several days following injection of PDV; this band was undetectable in naturally parasitized larvae. Eggs which had been washed extensively to remove PDVs were encapsulated following injection, but development of the host still was disrupted, usually in the post-wandering prepupal stage. Thus,

We conclude that atomized INM is effective in providing anxiolysis to children undergoing minor procedures in the pediatric emergency department. We are encouraged that no adverse events occurred with the use of INM alone despite relatively short fasting times.

Sepsis, defined as an infection with dysregulated host response leading to life‐threatening organ dysfunction, continues to carry a high potential for morbidity and mortality in children. The recognition of sepsis in children in the emergency department (ED) can be challenging, related to the high prevalence of common febrile infections, poor specificity of discriminating features, and the capacity of children to compensate until advanced stages of shock. Sepsis outcomes are strongly dependent on the timeliness of recognition and treatment, which has led to the successful implementation of quality improvement programs, increasing the reliability of sepsis treatment in many US institutions. We review clinical, laboratory, and technical modalities that can be incorporated into ED practice to facilitate the recognition, treatment, and reassessment of children with suspected sepsis. The 2020 updated pediatric sepsis guidelines are reviewed and framed in the context of ED interventions, including guidelines for antibiotic administration, fluid resuscitation, and the use of vasoactive agents. Despite a large body of literature on pediatric sepsis epidemiology in recent years, the evidence base for treatment and management components remains limited, implying an urgent need for large trials in this field. In conclusion, although the burden and impact of pediatric sepsis remains substantial, progress in our understanding of the disease and its management have led to revised guidelines and the available data emphasizes the importance of local quality improvement programs.