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AIM: Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge. METHODS: This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included. RESULTS: There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use. CONCLUSIONS: Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting. IMPACT: Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.

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Despite decades of research, much uncertainty remains regarding the selection pressures responsible for brain size variation. Whilst the influential social brain hypothesis once garnered extensive support, more recent studies have failed to find support for a link between brain size and sociality. Instead, it appears there is now substantial evidence suggesting ecology better predicts brain size in both primates and carnivores. Here, different models of brain evolution were tested, and the relative importance of social, ecological, and life-history traits were assessed on both overall encephalisation and specific brain regions. In primates, evidence is found for consistent associations between brain size and ecological factors, particularly diet; however, evidence was also found advocating sociality as a selection pressure driving brain size. In carnivores, evidence suggests ecological variables, most notably home range size, are influencing brain size; whereas, no support is found for the social brain hypothesis, perhaps reflecting the fact sociality appears to be limited to a select few taxa. Life-history associations reveal complex selection mechanisms to be counterbalancing the costs associated with expensive brain tissue through extended developmental periods, reduced fertility, and extended maximum lifespan. Future studies should give careful consideration of the methods chosen for measuring brain size, investigate both whole brain and specific brain regions where possible, and look to integrate multiple variables, thus fully capturing all of the potential factors influencing brain size.

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Left ventricular assist devices (LVADs) are implantable mechanical devices that pump blood from the apex of the left ventricle to the aorta in order to assist the forward flow of blood; they are most commonly used as a bridge to transplant for patients with heart failure. As of February 2019, a total of 25,145 patients with ventricular assist devices have been reported in the Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs). As this number continues to grow, more and more of these patients will inevitably be seen in the acute care setting outside of their defined LVAD center. Currently, however, LVAD emergencies represent a high-acuity low-occurrence event with limited opportunities for exposure and mastery for most physicians. Therefore, a growing need exists for emergency care providers to familiarize themselves with these devices and the management of LVAD emergencies. We present a novel model for the simulation of LVAD emergencies created through simple modifications of a Laerdal 3G Manikin.

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INTRODUCTION: The goal of the current study was to characterize the rate and estimate associated mortality and morbidity of exertional heat stroke (EHS) in U.S. military service members. MATERIALS AND METHODS: The current study was a retrospective cohort medical chart review study of all active-duty U.S. military service members, hospitalized with EHS at any MTF in the world between January1, 2007 and July 1, 2014. Enrolled patients were identified by altered mental status and elevated temperatures associated with physical exercise. RESULTS: Out of 607 service members with an International Classification of Disease code indicating any type of heat injury, 48 service members met inclusion criteria for EHS. Core temperature was M = 105.8°F (41°C), standard deviation = 1.43, 90% were diagnosed with EHS prior to hospitalization, and 71% received prehospital cooling. Meantime to normothermia post-hospitalization was 56 minutes (standard deviation = 79.28). Acute kidney injury was diagnosed in 40% of patients although none developed hyperkalemia or required dialysis. Disseminated intravascular coagulation was rare (4%, n = 2) and overall observed mortality was very low (2%, n = 1). CONCLUSION: EHS is aggressively identified and treated in U.S. Military Treatment Facilities. Mortality and morbidity were strikingly low.

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Flu encephalopathy is a rare and poorly understood complication of the influenza virus. In children, it presents most commonly in the 6-18 months age range and most often in the first 26 hours of flu symptoms. Here, we present a case of a 13-year old black female who presented with acute-onset encephalopathy two weeks into flu symptoms. As we begin this flu season, this case serves as a reminder that flu encephalopathy should be on the differential for acute-onset altered mental status.

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BACKGROUND AND AIMS: Studies combining brain activity measures with behavior have the potential to reveal more about animal cognition than either on their own. However, brain measure procedures in animal studies are often practically challenging and cost-prohibitive. Therefore, we test whether a simple measure of ear temperature can be used to index hemispheric brain activation using a handheld thermoscanner. Cortisol levels are correlated with the activation of the right cortical region, implying that, when stressful situations are experienced, increased right hemisphere activation occurs. This leads to corresponding locally detectable increases in ipsilateral ear temperature. METHODS: We compared right-and left-ear temperatures of 32 domestic dogs under non-stressful and partially stressful conditions. RESULTS: We detected significant elevations in right-ear temperature - but not left-ear temperature - relative to baseline readings in the partially stressful condition that were not detected in the non-stressful condition. DISCUSSION: These findings provide encouraging support for the notion that tympanic membrane temperature readings can provide a simple index for canine hemispheric brain activation, which can be combined with data on behavioral decision-making, expectancy violations, or other measures of emotional processing. Devices are cheap, simple to use, portable, and only minimally invasive providing a means for realtime brain and behavior measurements to be conducted in real-world settings.

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Gaze following is the ability to utilise information from another's gaze. It is most often seen in a social context or as a reflexive response to interesting external stimuli. Social species can potentially reveal utilisable knowledge about another's future intentions by attending to the target of their gaze. However, in even more fundamental situations, being sensitive to another's gaze can also be useful such as when it can facilitate greater foraging efficiency or lead to earlier predator detection. While gaze sensitivity has been shown to be prevalent in a number of social species, little is currently known about the potential for gaze following in asocial species. The current study investigated whether an asocial reptile, the leopard gecko (Eublepharis macularius), could reliably use the visual indicators of attention to follow the gaze of a conspecific around a barrier. We operated three trial conditions and found subjects (N = 6) responded significantly more to the conspecific demonstrator looking up at a laser stimulus projected onto an occluder during the experimental condition compared to either of two control conditions. The study's findings point toward growing evidence for gaze-following ability in reptiles, who are typically categorised as asocial. Furthermore, our findings support developing comparative social cognition research showing the origins of gaze following and other cognitive behaviours that may be more widely distributed across taxonomic groups than hitherto thought.

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Referential gestures are used by a signaller to draw a recipient's attention to a specific object, individual or event in the environment. These gestures have received much research attention in relation to human and non-human primates with great apes being shown to possess impressive gestural repertoires. Domestic dogs (Canis familiaris) meanwhile provide an ideal non-primate candidate for investigating referential signalling due to their unique relationship with humans that centres on non-verbal communication with frequent interaction. Here we observed 37 pet dogs in their own homes. Owners recorded 242 videos containing 47 potential referential gesture events. We analysed those recordings to reveal evidence of 19 referential gestures performed by domestic dogs during everyday communicative bouts with humans, showing that the gestures conform to the five features of referential signalling. Our study exposes impressive gesturing abilities in a non-primate mammal; especially when viewed in the context of the cross-species rather than intraspecific communication.

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Cultural or tool use behaviours are typically conducted in social or food procurement contexts where the individual interacts with conspecifics, heterospecifics or environmental features. We report on postcoital penis cleaning in chimpanzees, an activity that does not fit this pattern. In penis cleaning, leaves are employed as 'napkins' to wipe clean the penis after sex. Alternatively, the same cleaning motion can be done without leaves, simply using the fingers. Not all chimpanzee communities studied across Africa clean their penes and, where documented, the behaviour is rare. By contrast, we identify postcoital penis cleaning in Budongo Forest, Uganda, as customary and corroborate penis cleaning as another cultural trait in chimpanzees, one that is specific to only a subset of the eastern subspecies of chimpanzee (Pan troglodytes schweinfurthii).

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Hepatic microsomes of red mullet (Mullus barbatus) and flounder (Platichthys flesus) were preincubated in the presence of a concentration range of the antifouling agent tributyltin (TBT) chloride, and the interactions of TBT with cytochrome P450 and uridine diphosphate-glucuronyl transferase systems were investigated. The enzyme systems were examined in terms of cytochrome P4501A (CYP1A)-catalyzed 7-ethoxyresorufin O-deethylase (EROD) activity and benzo[a]pyrene (BaP) metabolism and in terms of glucuronidation of testosterone and 17beta-estradiol, respectively. Ethoxyresorufin O-deethylase and BaP hydroxylase (BPH) activities of both fish species were progressively inhibited by increasing concentrations of TBT, and the effects were more pronounced for EROD than for BPH (maximal inhibition at 100 microM TBT for EROD and 250-500 microM TBT for BPH). Hydroxylated metabolites of BaP (3-hydroxy-, 7,8-dihydrodiol, and 9,10-dihydrodiol), representing 95% of the total metabolites formed, were reduced up to 75% in the presence of 100 to 500 microM TBT, whereas the formation of other metabolites was less affected. This may alter BaP toxicity and carcinogenicity. Overall, the results were consistent with a specific inhibitory effect of TBT on CYP1A in the two fish species. Additionally, the conjugation of testosterone was significantly inhibited (20%) at low TBT doses (5 microM), with no effect on the glucuronidation of estradiol.

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