OBJECTIVES: Mortality from pneumonia is three times higher in Asia compared with industrialized countries. We aimed to determine the epidemiology, microbiology, and outcome of severe pneumonia in PICUs across the Pediatric Acute and Critical Care Medicine Asian Network (PACCMAN). DESIGN: Prospective multicenter observational study from June 2020 to September 2022. SETTING: Fifteen PICUs in PACCMAN. PATIENTS: All children younger than 18 years old diagnosed with pneumonia and admitted to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical, microbiologic, and outcome data were recorded. The primary outcome was PICU mortality. Univariate and multivariable logistic regression was performed to investigate associations between PICU mortality and explanatory risk factors on presentation to the PICU. Among patients screened, 846 of 11,778 PICU patients (7.2%) with a median age of 1.2 years (interquartile range, 0.4–3.7 yr) had pneumonia. Respiratory syncytial virus was detected in 111 of 846 cases (13.1%). The most common bacteria were Staphylococcus species (71/846 [8.4%]) followed by Pseudomonas species (60/846 [7.1%]). Second-generation cephalosporins (322/846 [38.1%]) were the most common broad-spectrum antibiotics prescribed, followed by carbapenems (174/846 [20.6%]). Invasive mechanical ventilation and noninvasive respiratory support was provided in 438 of 846 (51.8%) and 500 of 846 (59.1%) patients, respectively. PICU mortality was 65 of 846 (7.7%). In the multivariable logistic regression model, age (adjusted odds ratio [aOR], 1.08; 95% CI, 1.00–1.16), Pediatric Index of Mortality 3 score (aOR, 1.03; 95% CI, 1.02–1.05), and drowsiness (aOR, 2.73; 95% CI, 1.24–6.00) were associated with greater odds of mortality. CONCLUSIONS: In the PACCMAN contributing PICUs, pneumonia is a frequent cause for admission (7%) and is associated with a greater odds of mortality.

Calcareous mudstone, a type of red-bed soft rock, is prevalent in the surrounding rock of the Central Yunnan Water Diversion Project (CYWDP) in Yunnan Province, China, significantly impacting both construction and operation. The mechanical properties of calcareous mudstone vary with depth. This study investigates its mechanical properties, permeability characteristics, energy evolution, and macro- and micro-failure characteristics during deformation using triaxial compression tests under different confining pressures. Results reveal distinct stage characteristics in the stress–strain behavior, permeability, and energy evolution of calcareous mudstone. Crack propagation, permeability evolution, and energy dissipation are closely linked, elucidating the deformation and failure process, with fluid pressure playing a crucial role. The confining pressure σ₃ increased from 2 MPa to 4 MPa and 6 MPa, while the peak stress σ_c (P_w = 1 MPa) of the calcareous mudstone increased by 84.49% and 24.89%, respectively. Conversely, the permeability at σ_c decreased from 11.25 × 10⁻¹⁷ m² to 8.99 × 10⁻¹⁷ m² and 5.72 × 10⁻¹⁷ m², while the dissipative energy at σ_c increased from 12.39 kJ/m³ to 21.14 kJ/m³ and 42.51 kJ/m³. In comparison to those without fluid pressure (P_w = 0), the value of σ_c at P_w = 1 MPa was reduced by 36.61%, 23.23%, and 20.67% when σ₃ was 2, 4, and 6 MPa, respectively. Increasing confining pressure augments characteristic stresses, deformation and failure energy, and ductility, while reducing permeability, crack propagation, and width. These findings enhance our understanding of calcareous mudstone properties at varying depths in tunnel construction scenarios.

Water–rock interaction plays a pivotal role in water-related rock engineering applications such as navigation channel excavation, submarine tunnel construction, and harbor development. The mechanical and permeability properties of rocks under cyclic disturbances significantly influence engineering design and construction practices. In this study, hydro-mechanical coupled triaxial monotonic loading and cyclic loading tests were conducted on granite under different confining pressures (σ3). The results reveal that key mechanical parameters—including peak strength, elastic modulus, and crack damage threshold—increase with higher σ3, while these parameters under cyclic loading are consistently lower than those obtained under monotonic loading. The evolution of stress–strain behavior, crack development, and permeability in granite under cyclic loading exhibits distinct stages, with pore pressure significantly influencing crack growth and subsequent permeability changes. Both the number of loading cycles and σ3 markedly affect deformation, damage accumulation, crack propagation, and permeability evolution in granite, ultimately leading to dominant shear failure. Scanning electron microscopy and backscattered electron analyses further reveal that higher σ3 results in smaller fracture angles, narrower crack widths, and denser rock structures. This study elucidates the hydro-mechanical coupling effects under cyclic disturbances, providing valuable insights into the failure mechanisms and permeability evolution of water-saturated granite that are critical for long-term stability assessments in underwater rock engineering.