A 73%-88% reduction in paediatric emergency department (PED) presentations has been reported during the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) pandemic. 1 The magnitude of this decrease suggests that a combination of biological, psychological and social factors influence the decisions of families to attend PED.Our hospital is the busiest PED in Ireland, with ~55 000 emergency department (ED) attendances/year. Ireland's first SAR-2-CoV-2 case was reported on 29 February; schools/childcare facilities were closed on 12 March; and a stay-at-home order was issued on 27 March. As of 18 May, only 402 of the 24 036 total cases of SARS-CoV-2 in Ireland were children aged <14 years (1.6%), with 36 hospitalised, 2 requiring intensive care unit care and no reported deaths in children.A single-centre retrospective review of presentations for March and April 2018, 2019 and 2020, covering the three phases of the national response, was undertaken (figure 1). Information was extracted from the PED system, Symphony.Attendances reduced dramatically compared with the same 2-month period in 2018-2019. General practice and urgent care presentations also declined during this period. In 2018, there were 8199 ED presentations (681 admissions); in 2019, there were 9133 presentations (630 admissions); and in 2020, there were 4434 presentations (374 admissions), representing an almost 50% reduction on the preceding 2 years (table 1). Based on the Irish Children's Triage System, the acuity of presentations has remained similar in proportion to the attendances. 2 Category 1 presentations remained stable at 0.7%-0.8%, and a slight increase in category 2 presentations was seen in 2020 (20.3%) compared with 18. 4% and 17.9% in 2018 and 2019. Children frequently present to PEDs with illnesses that do not require emergency care. This may be due to parental anxiety or difficulty accessing community medical services. Our data show a significant decrease in presentations to PED across nearly all categories. This is likely related to a combination of factors, such as a reduction in presentations widely accepted as mediated by viral exposure (wheeze, bronchiolitis and febrile convulsions); reduction in school-related stress (headaches and abdominal pain); and parents deciding to stay at home due to fear of attending during the pandemic, with non-emergent conditions (neonatal feeding issues, vasovagal episodes and non-anaphylactic allergic reactions). Injuries, scalds, ingestions and foreign bodies became less common, possibly due to fewer outdoor activities and more supervision by parents. Significant mental health issues, such as depression, reduced slightly despite concerns regarding increased stresses on this on May 10, 2021 by guest.

Although transcatheter aortic valve replacement thrombosis is a multifactorial process involving foreign materials, patient-specific blood chemistry, and complex flow patterns, our study indicates that deployed THV geometry may have implications on the occurrence of thrombosis. In addition, a supraannular neosinus may reduce thrombosis risk because of reduced flow stasis. Although additional prospective studies are needed to further develop strategies for minimizing thrombus burden, these results may help identify patients at higher thrombosis risk and aid in the development of next-generation devices with reduced thrombosis risk.

The optimal deployment location for VIV in a 23 PERIMOUNT surgical bioprosthesis was at a +6 mm supra-annular position for a 23-mm SAPIEN valve and at the normal position for both the 23-mm and 26-mm CoreValves. The 26-mm CoreValve had lower gradients, but higher RF and PI than the 23-mm CoreValve and the 23-mm SAPIEN. In their optimal positions, all valves resulted in hemodynamics consistent with the definitions of Valve Academic Research Consortium-2 procedural success. Long-term studies are needed to understand the clinical impact of these hemodynamic performance differences in patients who undergo VIV transcatheter aortic valve replacement.