BackgroundConflict in paediatric healthcare is becoming increasingly prevalent, in particular relation to paediatric end of life. This is damaging to patients, families, professionals and healthcare resources. Current research has begun to explore perspectives of healthcare professionals (HCPs), but the parental views on conflict are lacking.ObjectivesThis scoping review explores parental views on conflict during a child’s end of life. In addition, parental views are mapped onto HCPs’ views.MethodsA search was completed of the databases CINAHL, PubMed, Web of Science, Embase and Medline between 1997 and 2019, focused on parents of children with involvement with palliative or end-of-life care referring to conflict or disagreements.ResultsThe review found 10 papers that included parental views on conflict. Data on conflict were categorised into the following seven themes: communication breakdown, trust, suffering, different understanding of ‘best interest’, disagreements over treatment, spirituality and types of decision-making. In particular, parental expertise, perspectives on suffering and ways of making decisions were significant themes. A subset of themes mirror those of HCPs. However, parents identified views of conflict unique to their perspective.ConclusionsParents identified important themes, in particular their perspective of what constitutes suffering and ‘best interest’. In addition, parents highlight the importance of being recognised as an expert.

Multisystem inflammatory syndrome in children (MIS-C) is a newly recognized disease process that can complicate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We present what we believe to be the earliest case of MIS-C, occurring in February 2020. Our patient’s SARS-CoV-2 infection was caused by an emerging lineage with the D614G variant in the spike protein. This lineage would subsequently become the predominant cause of SARS-CoV-2 outbreaks in Europe and the United States where MIS-C was first described.

An handsheet study was performed to compare the application of unmodified pearl corn starch and cationic tapioca starch on 100% recycled paperboard. To analyze the benefits tensile index, Canadian Standard Freeness, and starch retention was measured. The results found that cationic tapioca starch had the highest tensile index at 61.36 N*m/g for a dosage rate of 16 lbs./ton at a comparable dosage for unmodified pearl corn starch at 48 lbs./ton the tensile index was 56.11 N*m/g. Tests of the Canadian Standard Freeness showed that the unmodified pearl corn starch had the lowest freeness at 34.3 ml. The cationic tapioca starch had a freeness of 53.5 ml. For starch retention, more starch was retained in the sheet with cationic tapioca starch, with only 0.0065 grams ending up in the filtrate, compared to 0.015 grams of filtrate for the sheet containing unmodified pearl corn starch.

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