Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce

Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a "Think globally, act locally" approach is required

Size-dependent response of tropical wetland fish communities to changes in vegetation cover and habitat connectivity

Context: The replacement of native vegetation by exotic grasses for livestock production is driving landscape homogenization, habitat fragmentation and reducing connectivity between habitat patches in floodplains ecosystems. Objective: In this context we examined how changes in native and exotic vegetation cover, connectivity and water depth affect the attributes of the small [standard length (SL) < 80 mm as adults] and large-sized fish assemblages (SL ≥ 80 mm as adults). Method: We assessed the effects of water depth, exotic and native vegetation cover and habitat connectivity on the abundance, species richness, body size and biomass of fish assemblages in a 25 km2 area of the seasonal habitats of the Pantanal wetland over 5 years. Results: We showed that fish assemblage response to meso-scale variation in water depth, vegetation cover and habitat connectivity in seasonal habitats is size-dependent. The gradient from exotic to natural vegetation cover did not affect the assemblages of small-sized fish, which were mostly regulated by water depth, habitat connectivity and the gradient from grassland to forest. However, besides being affected by water depth and habitat connectivity, large-sized fish were also affected by the gradient from exotic to natural vegetation cover. Conclusion: Our results indicate that transformations in the landscape and changes in the dynamics of inundation may have negative consequences for the long-term persistence of fish assemblages in the Pantanal wetlands. © 2015, Springer Science+Business Media Dordrecht