Evaluation of baseline pediatric readiness of emergency departments in Manitoba, Canada.

BACKGROUND: Data on the readiness of the general emergency departments (EDs) in Canada to care for children requiring emergency care are limited. Recent evidence suggests an inverse association between pediatric readiness of the general ED and mortality. OBJECTIVES: To assess the baseline pediatric readiness of the general EDs in the province of Manitoba, Canada, to care for acutely ill and injured children. METHODS: This was a cross-sectional survey study conducted between 2019 and 2020. We used a validated pediatric readiness research checklist to obtain information on the six domains of the general EDs in Manitoba in the fiscal year 2019. A general ED that managed acutely ill patients (0-17th birthday), except for psychiatric cases (up to the 18th birthday), was defined as eligible. We performed a descriptive analysis using the weighted pediatric readiness score (WPRS) based on a 100-point scale. The factors associated with the total WPRS were examined in linear regression models. RESULTS: Of the 42 eligible general EDs, 34 centers participated with a participation rate of 81%. However, only 27 general EDs plus one specialized children ED (28, 67%) completed the survey. The overall median WPRS (/100) attained by the general EDs was 52.34 (interquartile range [IQR] = 10.44). The only specialized children ED in Manitoba achieved a score of 89.75. Over half (15, 55.6%) of the general EDs scored 50 or more. The mean volume of the general ED that participated was 4010.9 (± SD 2137.2) pediatric general ED visits/year. The average scores attained in the domains such as coordination of patient care, general ED staffing and training, and quality improvement were low across the five Regional Health Authorities. The general ED volume was directly associated with the total WPRS, regression coefficient, ß = 0.24 (95% CI 0.04-0.44). Neither the capacity of the general ED to receive pediatric patients from a nursing station, ß = - 0.07 (95% CI - 0.28-0.14), nor the capacity to admit pediatric patients that visited the general ED, ß = - 0.03 (- 0.23-0.17) was associated with the total WPRS. CONCLUSIONS: The pediatric readiness of the general EDs across Manitoba is comparable to other Canadian region, yet some domains need to be improved.

OCT: A Modality for Identifying Stent Failure in Pediatric Patients With Angiographically Silent Coronary Arteries.

We present the case of a 16-year-old patient with anomalous left coronary artery from the left pulmonary artery requiring percutaneous coronary intervention in infancy who presented with ventricular fibrillation arrest. A coronary angiogram revealed 40% narrowing of the stent relative to the remainder of the left main coronary artery. Optical coherence tomography was performed and revealed an area stenosis of 70% relative to the native left main coronary artery. The patient had outgrown the stent. (Level of Difficulty: Advanced.).

The Comparative Study of the State of Conservation of Two Medieval Documents on Parchment from Different Historical Periods.

The paper explores the potentiality of an experimental multianalytic protocol with appropriate methodology for determining the chemical and morphostructural characteristics of two old documents on parchment support. Such a protocol can authenticate and assess the state of conservation under the influence of environmental factors during storage and archival documentation, thus advancing preventive and prophylactic measures in "treasure" deposits such as the National Archives of Romania, where these documents are kept. The work methodology consisted of three stages. The first stage consists of visual observation for identifying deteriorations and degradations, alongside the selection of representatives' areas from where micro-samples were collected. The second stage involves Scanning Electron Microscopy coupled by Energy Dispersive X-ray Spectrometry (SEM-EDX) analysis, for highlighting the morphology and determining the elemental composition; lastly, the Fourier-transform infrared (FTIR) analysis and correlation of results establish the chemical and morphostructural changes. The use of this gradual system of analyses allowed determining the differences between these two documents in terms of the materials used for producing them, their manufacturing technologies, the writing and ornamentation, and the overall state of conservation. The results provided the first accurate picture of the chemical nature and manufacturing of the two parchment documents by determining the main characteristics of the collagen and of the finishing, writing, and decoration materials, in view of the natural aging through the oxidative and gelatinization processes of the collagen. The SEM-EDX results revealed the morphological changes of the parchment that occurred at various levels in the collagen fibrous mesh and established the state of conservation of the support, writing, and decorations.

[Optic nerve melanocytoma--associated with age related macular degeneration]. / Melanocitom de nerv optic asociat cu DMLV.

We report the case of a 73 year old patient who presented for decreased vision in his right eye, ocular examination revealed a pigmented tumour in the left optic disc (optic nerve melanocytoma). We briefly mention another case of optic nerve melanocytoma in a 6 year old, Caucasian patient.