Background & Aims Invariant natural killer T (iNKT) cells undergo canonical, Vα14–Jα18 rearrangement of the T-cell receptor (TCR) in mice; this form of the TCR recognizes glycolipids presented by CD1d. iNKT cells mediate many different immune reactions. Their constitutive activated and memory phenotype and rapid initiation of effector functions after stimulation indicate previous antigen-specific stimulation. However, little is known about this process. We investigated whether symbiotic microbes can determine the activated phenotype and function of iNKT cells. Methods We analyzed the numbers, phenotypes, and functions of iNKT cells in germ-free mice, germ-free mice reconstituted with specified bacteria, and mice housed in specific pathogen-free (SPF) environments. Results SPF mice, obtained from different vendors, have different intestinal microbiota. iNKT cells isolated from these mice differed in TCR Vβ7 frequency and cytokine response to antigen, which depended on the environment. iNKT cells isolated from germ-free mice had a less mature phenotype and were hypo-responsive to activation with the antigen α-galactosylceramide. Intra-gastric exposure of germ-free mice to Sphingomonas bacteria, which carry iNKT cell antigens, fully established phenotypic maturity of iNKT cells. In contrast, reconstitution with Escherichia coli, which lack specific antigens for iNKT cells, did not affect the phenotype of iNKT cells. The effects of intestinal microbes on iNKT cell responsiveness did not require toll-like receptor signals, which can activate iNKT cells independently of TCR stimulation. Conclusions Intestinal microbes can affect iNKT cell phenotypes and functions in mice.

No widely used pediatric standards for hospital discharge care exist, despite nearly 10,000 pediatric discharges per day in the U.S. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality improvement efforts, and adversely affects the health and wellbeing of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge, a variety of toolkits aimed to improve discharge care, and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to 1) initiate pediatric discharge care, 2) develop discharge care plans, 3) monitor discharge progress, and 4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric healthcare providers move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes.

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Preventable AEs occur frequently among patients admitted for bronchiolitis, especially those who are critically ill. CIPs who suffer AEs during their hospitalization have longer hospital LOSs. Future studies should investigate error-prevention strategies with a focus on those patients with severe disease.