Background Understanding the changes in emergency department (ED) visit patterns during the coronavirus disease 2019 (COVID-19) outbreak is important for effectively operating EDs during the pandemic. We aimed to analyze the changes in pediatric ED visits during the COVID-19 pandemic and examine the relationship between the number of ED visits and the stringency of government social distancing measures. Methods This multicenter retrospective study used data of pediatric (age < 18 years) ED visits in Seoul metropolitan area from June 1, 2018, to May 31, 2020. Patient demographics, ED results, and diagnoses were compared during the COVID-19 period and the previous year. To evaluate the effect of the stringency of social distancing measures on the number of ED visits, a Poisson regression model was developed with month, year, and the average monthly Government Response Stringency Index (GRSI) as fixed effects. Results In total, 190,732 patients were included. The number of pediatric ED visits during the COVID-19 period was 58.1% lower than in the previous year. There were disproportionate decreases in the numbers of ED visits for children in early childhood (66.5%), low-acuity children (55.2-63.8%), those who did not use an ambulance (59.0%), and those visiting the ED for noninjury complaints (64.9%). The proportion of admissions increased from 11.9% to 16.6%. For every 10-point increase in the GRSI, there was a 15.1% decrease in monthly ED visits. Conclusion A striking decrease in pediatric ED visits was observed during the COVID-19 outbreak, the scale which was associated with the stringency of government policies. Changes in the number and characteristics of children visiting the ED should be considered to facilitate the effective operation of EDs during the pandemic.

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Purpose Epinephrine is a key drug for treating anaphylaxis; however, its underuse is still a significant issue worldwide. The objective of this study was to compare epinephrine use between pediatric and adult patients who were treated with anaphylaxis in the emergency department (ED). Methods The data were retrieved from the National Sample Cohort of South Korea, which contains claim data from the National Health Insurance Service. We included patients who visited the ED with a discharge code of anaphylaxis between 2004 and 2013. We assessed prescription information of epinephrine, antihistamine and systemic steroid, previous medical history and discharge disposition from the ED. The study population was categorized based on age at the visit. Results A total of 175 pediatric and 1,605 adult patients with anaphylaxis were identified. Only 42 (24%) of the pediatric patients were treated with epinephrine, while 592 (36.9%) of the adult patients were treated with epinephrine ( P = 0.001). Furthermore, the pediatric patients were less likely to be treated with systemic steroid than the adult patients (6.9% vs. 12.3%, P = 0.047). The odds ratios for the administration of epinephrine relative to the baseline in the 19-65 age group were 0.34 (95% confidence interval [CI], 0.15–0.67), 0.56 (95% CI, 0.28–1.03) and 0.79 (95% CI, 0.45–1.33) in the < 7, 7–12 and 13–18 age groups, respectively. Conclusions The pediatric patients with anaphylaxis experienced a lower rate of epinephrine injection use than the adult patients and the injection use decreased as age decreased.

Recommended by Liang-Gee Chen H.264/AVC adopts aggressive compression algorithms at the cost of increased computational complexity. To speed up the H.264/AVC intraframe coding, this paper proposes two novel techniques: early termination and pipelined execution. In P slices, intra 4 × 4 and 16× 16 predictions are early terminated with the threshold determined by the cost of motion estimation. In I slices, intra 4×4 prediction is early terminated with the threshold derived from intra 16×16 prediction. The threshold function is chosen as a monotonically decreasing linear function with its optimal coefficients determined by experiments. For the pipelined execution of 4×4 intrapredictions, the processing order of 4×4 blocks is changed to reduce the dependencies between consecutively processed blocks. In I slices, computation for 4 × 4 intraprediction is reduced by 19 percent with the proposed early termination. In P slices, computations for 4 × 4 and 16 × 16 intrapredictions are reduced by more than 81 and 91 percents, respectively. The pipelined execution reduces the computation time by 41 percent. In spite of the speed-up by the proposed methods, degradation in ratedistortion performance is negligible. The proposed pipelined execution is integrated with other H.264/AVC hardware accelerators and fabricated as an SoC using Dongbu 0.13 μm technology.