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Pulmonary infections caused by dimorphic fungi are also seen in this age group. Histoplasma capsulatum , which is found in nitrate-rich soil, is usually acquired as a result of inhalation of spores. Chicken coops and other bird roosts and decaying wood are often-cited sources. Cryptococcus neoformans is a common infection among pigeon breeders, but it is unusual in other immunocompetent individuals.

Blastomyces dermatitides , another dimorphic fungus, is found in certain geographic locations, most notably the Ohio and Mississippi River valleys. As with histoplasmosis, blastomycosis is acquired by inhalation of spores. Although 3 distinct forms of infection exist, the most common is acute pneumonia, which, in previously healthy individuals, most often resolves without treatment.

Viral pneumonias are common in this age group are usually mild and self-limited, but influenza pneumonia can be severe or protracted, particularly when a bacterial infection follows.

TB pneumonia in children warrants special mention. It can occur in any age group, and it is important to remember that children with TB usually do not present with symptoms until 1-6 months after primary infection. Any child with pneumonia who has a history of TB exposure, or who has traveled to a TB-endemic area of the world needs to be fully evaluated for the possibility of tuberculosis.

Legionella pneumophila , the agent of Legionnaires disease, can also cause pneumonia, although it is uncommon in the pediatric age group.

Not all pneumonia is caused by infectious agents. Children who have severe gastroesophageal reflux (GERD) may develop chemical pneumonitis secondary to recurrent aspiration. Inhalation of certain chemicals or smoke may cause pulmonary inflammation. Additionally, aspiration pneumonia is more common in children with neurologic impairment, swallowing abnormalities, gastrointestinal motility, or a gastrostomy tube. Oral anaerobic flora, with or without aerobes, is the most common etiologic agent.

A study by Thomson et al compared hospital management and outcomes of children with neurologic impairment diagnosed with aspiration versus nonaspiration pneumonia. The study found that hospitalized children with neurologic impairment diagnosed with aspiration pneumonia had significantly longer length of stay; more ICU transfers; greater hospitalization costs; and more 30-day readmissions than children with neurologic impairment diagnosed with nonaspiration pneumonia. []

Some children who are immunocompromised, whether secondary to HIV infection/AIDS, an immune disorder, or chemotherapy for a malignancy, are at risk for pneumonias with opportunistic agents. Virtually any bacteria, virus, fungus, or even parasite can invade and infect the lungs if the immune system is sufficiently impaired. Carefully obtained samples for appropriate microbiologic testing are paramount in such patients so that therapy can be optimized.

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By Ollie Williams On cascade

The cascade is such an intrinsic part of CSS that they put it right there in the name. If you’ve ever needed to use !important to affect specificity in the cascade, you’ll know that it can be a tricky thing to deal with. In the early days of CSS, it was common to see highly specific selectors like this:

We’re all much better at managing specificity nowadays. It’s a widely accepted best practice to keep specificity low and flat—to shun ID selectors, to make liberal use of classes, and to avoid unnecessary nesting. But there are still plenty of situations where a more specific selector will be useful. With the introduction of a newly proposed pseudo-class, more support of the shadow DOM, and the use of the all property, we will soon be able to handle inheritance and specificity in new and exciting ways.

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The :is Pseudo-Class

Lea Verou recently proposed this new pseudo-class specifically designed to control specificity. It’s already made its way to the CSS Level 4 Selectors spec . Lea has a write up of why it’s useful and there’s some coverage of it in the CSS-Tricks almanac.

Let’s take :not as an example. The specificity of :not is equal to the specificity of its argument. This makes using :not rather painful. Take the following as an example:

We might expect that the .red class would have higher specificity because it is lower in the cascade. However, for any styles to override div:not(.foobar) they would need to at least match the specificity of a combined element selector ( div ) and class selector ( .foobar ). Another approach would be div.red , but there is a better way. This is where :is can help.

The :not selector no longer adds any specificity, so the total specificity of the above selector is simply that of one element selector ( div ). The .red class would now be able to override it in the cascade. Once implemented, Mens Regular Suede Moccasin Slippers 10 BROWN Lands End cRUMMV
will be a thing of the past.

Today, many people are using classes in HTML like this:

When using Mens 3434 Oxfords Georges 2EOqW6IyO
, rather than following a verbose naming convention, we’ll be able to omit classes altogether. Styles defined within the shadow DOM are scoped to apply only within the component. Styling can be achieved with simple element selectors without worrying about whether the selectors will interfere with elements elsewhere on the page.

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