Reliability and Accuracy of the Pediatric Swiss Emergency Triage Scale-the SETSped Study.

BACKGROUND AND IMPORTANCE: The Swiss Emergency Triage Scale (SETS) is an adult triage tool used in several emergency departments. It has been recently adapted to the pediatric population but, before advocating for its use, performance assessment of this tool is needed. OBJECTIVES: The purpose of this study was to assess the reliability and the accuracy of the pediatric version of the SETS for the triage of pediatric patients. DESIGN, SETTING, AND PARTICIPANTS: This study was a cross-sectional study among a sample of emergency triage nurses (ETNs) exposed to 17 clinical scenarios using a computerized simulator. OUTCOME MEASURES AND ANALYSIS: The primary outcome was the reliability of the triage level performed by the ETNs. It was assessed using an intraclass correlation coefficient.Secondary outcomes included accuracy of triage compared with expert-based triage levels and factors associated with accurate triage. MAIN RESULTS: Eighteen ETNs participated in the study and completed the evaluation of all scenarios, for a total of 306 triage decisions. The intraclass correlation coefficient was 0.80 (95% confidence interval, 0.69-0.91), with an agreement by scenario ranging from 61.1% to 100%. The overall accuracy was 85.8%, and nurses were more likely to undertriage (16.0%) than to overtriage (4.3%). No factor for accurate triage was identified. CONCLUSIONS: This simulator-based study showed that the SETS is reliable and accurate among a pediatric population. Future research is needed to confirm these results, compare this triage scale head-to-head with other recognized international tools, and study the SETSped in real-life setting.

First report of Kocuria marina spontaneous peritonitis in a child.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a rare affection in the pediatric population. It usually occurs when concurrent conditions are present, such as nephrotic syndrome, peritoneal dialysis or liver disease. We report a case of spontaneous bacterial peritonitis due to Kocuria marina in a 2-year-old child with no underlying risk factor. This is both the first description of an infection caused by this rare pathogen in a child and the first reported case of primary peritonitis caused by K. marina in a patient with no predisposing condition. CASE PRESENTATION: A 2 year-old boy presented to the Pediatric Emergency Department with clinical signs of peritonitis. Laparoscopic surgical exploration confirmed purulent, generalized peritonitis without perforation. Culture of the peritoneal fluid revealed the presence of Kocuria marina, a Gram-positive coccoid environmental bacteria. After peritoneal lavage and appropriate antibiotic treatment, the patient improved and was discharged without sequel. CONCLUSION: The present report illustrates the first clinical presentation of Kocuria marina SBP in a child with no underlying risk factor. Although never previously described in healthy patients, this pathogen may therefore be considered as a possible cause of SBP in a child. This unusual finding extends the spectrum of infectious diseases caused by Kocuria marina beyond the scope of the previously described susceptible population.

Simulation and validation of residual deformations in additive manufacturing of metal parts.

Selective laser melting (SLM) is gaining increasing relevance in industry. Residual deformations and internal stresses caused by the repeated layerwise melting of the metal powder and transient cooling of the solidified layers still presents a significant challenge to the profitability and quality of the process. Excessive distortions or cracking may lead to expensive rejects. In practice, critical additively manufactured parts are either iteratively pre-compensated or redesigned based on production experience. To satisfy the need for improved understanding of this complex manufacturing process, CAE software providers have recently developed solutions to simulate the SLM process. This study focuses on the evaluation of two solutions by ANSYS, i.e. ANSYS Additive Print and ANSYS Additive Suite. ANSYS Additive Print (AAP), a user-oriented software, and ANSYS Additive Suite (AAS), a software requiring advanced experience with Finite Element Methods (FEM), are investigated and validated with regard to residual deformations. For the evaluation of the two programs, calibration and validation geometries were printed by SLM in Ti-6Al-4V and residual deformations have been measured by 3D scanning. The results have been used for the calibration of isotropic and anisotropic strain scaling factors in AAP, and for sensitivity analyses on the effect of basic model parameters in AAS. The actual validation of the programs is performed on the basis of different sample geometries with varying wall thickness and deformation characteristic. While both simulation approaches, AAP and AAS, are capable of predicting the qualitative characteristics of the residual deformations sufficiently well, accurate quantitative results are difficult to obtain. AAP is more accessible and yields accurate results within the calibrated regime. Extrapolation to other geometries introduces uncertainties, however. AAS, on the other hand, features a sounder physical basis and therefore allows for a more robust extrapolation. Numerical efforts and modelling uncertainties as well as requirements for an extensive set of material parameters reduce its practicality, however. More appropriate calibration geometries, continuing extension of a more reliable material database, improved user guidelines and increased numerical efficiency are key in the future establishment of the process simulation approaches in the industrial practice.

A transversal pilot study of oropharyngeal carriage of Kingella kingae in healthy children younger than 6 months.

BACKGROUND: The aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life. METHODS: We conducted a monocentric transversal pilot study on healthy children younger than 6 months in order to define the oropharyngeal carriage rate. Participants were recruited between December 2013 and September 2015 among children without symptoms or signs of invasive infections. RESULTS: We demonstrated an oropharyngeal carriage rate of 0.67% in children younger than 6 months. Due to the really low carriage rate, it was not possible to draw statistically significant conclusion about any other characteristic of our population. CONCLUSIONS: The present study suggests that the oropharyngeal carriage of Kingella kingae among a Swiss population of healthy infants younger than 6 months is exceptional. The scarcity of colonization and disease in the early months of life suggests thus that defense against mucosal carriage and invasive infection is above all provided by vertically acquired immunity. Limited exposure of the neonates due to limited social contacts may also represent another factor avoiding neonates' mucosal Kingella kingae carriage.

Identifying Reservoirs of Infections Caused by Kingella kingae: A Case-Control Study of Oropharyngeal Carriage of K. kingae Among Healthy Adults.

BACKGROUND: Kingella kingae is currently recognized as a significant pathogen of the pediatric population. Nevertheless, the possibility for adults to serve as a reservoir of healthy carriers has not been studied. METHOD: We conducted a monocentric transversal study on 228 healthy adults to define the carriage rate. Participants were recruited among the staff of a children's hospital, a population exposed to aerosolized droplets from children. A secondary analysis using a case-control method was conducted to assess risk factors for carriage. RESULTS: We demonstrated an oropharyngeal carriage rate of 2.2% in this population. However, there was a striking similarity in the carriage rate among children younger than 4 years of age and adults living with children of that age group (8.8%). Use of day-care facilities for their own children was also demonstrated as a risk factor for adult carriage. CONCLUSIONS: We were able to demonstrate the existence of adult carriage of K. kingae but our results point to transmission from children to adults. Our results do not allow us to conclude that professional exposure in a hospital setting is a risk factor for oropharyngeal carriage.