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Floquet codes are an intriguing generalisation of stabiliser and subsystem codes, which can provide good fault-tolerant characteristics while benefiting from reduced connectivity requirements in hardware. A recent question of interest has been how to run Floquet codes on devices which have defective – and therefore unusable – qubits. This is an under-studied issue of crucial importance for running such codes on realistic hardware. To address this challenge, we introduce a new method of accommodating defective qubits on a wide range of two-dimensional Floquet codes, which requires no additional connectivity in the underlying quantum hardware, no modifications to the original Floquet code's measurement schedule, can accommodate boundaries, and is optimal in terms of the number of qubits and stabilisers removed. We numerically demonstrate that, using this method, the planar honeycomb code is fault tolerant up to a fabrication defect probability of $\approx 12\%$. We find the fault-tolerant performance of this code under defect noise is competitive with that of the surface code, despite its sparser connectivity. We finally propose multiple ways this approach can be adapted to the underlying hardware, through utilising any additional connectivity available, and treating defective auxiliary qubits separately to defective data qubits. Our work therefore serves as a guide for the implementation of Floquet codes in realistic quantum hardware.

We simulate the logical Hadamard gate in the surface code under a circuit-level noise model, compiling it to a physical circuit on square-grid connectivity hardware. Our paper is the first to do this for a logical unitary gate on a quantum error-correction code. We consider two proposals, both via patch-deformation: one that applies a transversal Hadamard gate (i.e. a domain wall through time) to interchange the logical $X$ and $Z$ strings, and another that applies a domain wall through space to achieve this interchange. We explain in detail why they perform the logical Hadamard gate by tracking how the stabilisers and the logical operators are transformed in each quantum error-correction round. We optimise the physical circuits and evaluate their logical failure probabilities, which we find to be comparable to those of a quantum memory experiment for the same number of quantum error-correction rounds. We present syndrome-extraction circuits that maintain the same effective distance under circuit-level noise as under phenomenological noise. We also explain how a $SWAP$-quantum error-correction round (required to return the patch to its initial position) can be compiled to only four two-qubit gate layers. This can be applied to more general scenarios and, as a byproduct, explains from first principles how the "stepping" circuits of the recent Google paper \cite{McEwenBaconGidney} can be constructed.

A number of exciting recent results have been seen in the field of quantum error correction. These include initial demonstrations of error correction on current quantum hardware and resource estimates which improve understanding of the requirements to run large-scale quantum algorithms for real-world applications. In this work, we bridge the gap between these two developments by performing careful estimation of the resources required to fault-tolerantly perform quantum phase estimation (QPE) on a minimal chemical example. Specifically, we describe a detailed compilation of the QPE circuit to lattice surgery operations for the rotated surface code, for a hydrogen molecule in a minimal basis set. We describe a number of optimizations at both the algorithmic and error correction levels. We find that implementing even a simple chemistry circuit requires 1000 qubits and 2300 quantum error correction rounds, emphasising the need for improved error correction techniques specifically targeting the early fault-tolerant regime.

Background: Escherichia coli is the predominant urinary pathogen in children. Irish and international studies have demonstrated increasing antimicrobial resistance (AMR) to antibiotics such as co-amoxiclav., Aims: We aimed to (1) examine the AMR patterns of paediatric urinary E. coli isolates, from both hospital and community sources, over a 10-year period; (2) assess the effectiveness of Children's Health Ireland (CHI) antimicrobial guidance given local susceptibility data; and (3) review the clinical management of an admitted patient sub-set over a 6-year period., Methods: Pure growth of urinary E. coli from patients aged ≤ 14 from 2012 to 2021 were analysed for AMR. Differences in susceptibility rates were assessed. A retrospective chart review conducted on inpatients aged ≥ 2 months to ≤ 14 years, 2016-2021., Results: E. coli accounted for 70.8% of likely significant positive pure growth cultures (9314 isolates). Susceptibility to co-amoxiclav significantly increased over time, from 66.7% to 80.4% (2016-2021, p < 0.001). Nitrofurantoin and cefalexin had significantly higher susceptibility rates than trimethoprim (< 70% annually). 85.1% of isolates were susceptible to the combination of co-amoxiclav and gentamicin, recommended for those > 2months and systemically unwell. The additional gain in empiric susceptibility provided by gentamicin above that provided by co-amoxiclav alone has fallen from 16.4% to 6.7% (2016-2021). The 222 clinical cases reviewed showed improved antimicrobial guideline compliance over time., Conclusions: This study provides important regional AMR data. Co-amoxiclav susceptibility increased significantly over time, contrasting with previous studies. This was temporally associated with stewardship measures reducing co-amoxiclav prescribing. Decreasing utility of gentamicin supports recent CHI guideline updates reducing gentamicin use., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

A female infant presented to an Irish hospital with a 4-day history of fever, irritability and reduced oral intake. Initial inflammatory markers were significantly elevated, an erythematous tympanic membrane was noted on examination and an initial diagnosis of acute otitis media was made. By the third hospital day, the infant was noted to be irritable when being lifted up; pseudoparalysis of the right upper limb was observed. A radiograph of the right shoulder was normal; MRI identified acute scapular osteomyelitis with subperiosteal abscess formation. The child underwent 3 washout procedures and received 6 weeks of antibiotic therapy, with full clinical recovery at 3 months. This case highlights the importance of remaining flexible in the context of an evolving presentation and recognising hallmarks of musculoskeletal infection, fever, localised pain and pseudoparalysis. Additionally, we review the literature to highlight clues in diagnosis, treatment and outcome for paediatric acute scapular osteomyelitis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction and Aims: Objective structured clinical examinations (OSCEs) play a pivotal role in medical education assessment. The Advanced Clinical Skills (ACS) OSCE examines clinical skills in psychiatry, general practice, obstetrics and gynaecology and paediatrics. This study examined if the 2020 ACS OSCE for fourth year medical students attending the National University of Ireland, Galway, was associated with any significant result differences compared to the equivalent 2019 OSCE. Additionally, we assessed students' satisfaction and explored any organisational difficulties in conducting a face-to-face OSCE during the COVID-19 pandemic., Materials and Methods: This study compared anonymised data between the 2019 and 2020 ACS OSCEs and analysed anonymised student feedback pertaining to the modified 2020 OSCE., Results: The mean total ACS OSCE result achieved in 2020 was statistically higher compared to the 2019 OSCE [62.95% (SD = 6.21) v. 59.35% (SD = 5.54), t = 6.092, p < 0.01], with higher marks noted in psychiatry ( p = 0.001), paediatrics ( p = 0.001) and general practice ( p < 0.001) with more students attaining honours grades (χ 2 = 27.257, df = 3, p < 0.001). No difference in failure rates were found. Students reported feeling safe performing the 2020 OSCE (89.2%), but some expressed face-mask wearing impeded their communication skills (47.8%)., Conclusion: This study demonstrates that conducting a face-to-face OSCE during the pandemic is feasible and associated with positive student feedback. Exam validity has been demonstrated as there was no difference in the overall pass rate.

Competing Interests: None declared

Direct Provision in Ireland provides basic needs of food and shelter to asylum seekers while their refugee status is processed. There are a number of issues associated with living conditions in these centres including overcrowding, nutrition and play facilities (1,2). This article outlines the protocol of contact tracing and management of latent tuberculosis infection in the paediatric setting after a confirmed adult case of tuberculosis within a Direct Provision centre in Ireland. This is a retrospective case series of 82 children living in the centre. Twenty-two children were deemed at risk of infection, all asymptomatic. Sixteen children (20%) were treated for possible latent tuberculosis infection with isoniazid for 6-9 months; compliance was good with no side effects reported. This article highlights the risk to vulnerable populations, especially children, when residing in Direct Provision facilities. Initial migrant screening on entry is essential, in addition to improving living conditions and time spent by families in this living environment., (© 2021. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

A 7-year-old boy presented with a 24-hour history of severe burning pain affecting both hands that had started within minutes of playing outdoors. His mother reported that he had been running his hands under cold water and shaking his hands and head to try and relieve the pain. On examination, there was swelling of his hands, eyelids and cheeks. His parents mentioned that his hands and face had 'swollen in the sun' every summer from the age of 2 years.A 3-year-old girl presented with a 2-day history of left upper limb swelling following a day of prolonged sun exposure. Examination revealed non-pitting oedema extending from her left shoulder to hand with no associated tenderness, erythema or rash. Her mother reported six previous episodes of irritability following sun exposure during which she would cry and flap her hands 'for hours'.Oral steroids and antihistamines were prescribed in both cases with little effect. Findings of routine baseline investigations were normal in both cases. A radiograph of the upper limb in the second patient disclosed nothing abnormal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Cashew nut (CN) allergy appears to be increasing. Reactions are variable and may include anaphylaxis., Aim: To describe the clinical features of CN allergy in a group of children attending an allergy clinic with suspected peanut allergy and confirmed sensitisation to CN., Methods: Patients were identified retrospectively by reviewing the Immunology Database at University Hospital Galway over a 5-year period, Oct. 2010 to Sept. 2015. Patients confirmed sensitised to CN (specific IgE > 0.35 kUa/L, ImmunoCAP Assay) were selected and contacted., Results: Over the 5-year period, 115 children were identified; 102/115 were individually contacted. Of the 102 children, 55 had a history of prior CN exposure with confirmed clinical reaction, 43 had no prior CN exposure, and 4 were sensitised and tolerating CN. For those with clinical CN allergy (N = 55), 30 (55%) were male and median age of onset was 2 years (lower quartile 1.5, upper quartile 4.8). Severity of reaction was graded as mild for 13 children, moderate in 13 additional children, and severe in 29 children. Median CN serum IgE level was 3.2 kUa/L (range 0.36 to > 100) in the clinical reaction group, 2.91 kUa/L (range 0.36 to > 100) in the sensitised group, and 3.4 kUa/L (range 0.94 to 5.21) in those tolerating CN. IgE values were not significantly different between those with mild, moderate, or severe reaction to CN (p = 0.346)., Conclusion: Children are ingesting CN at a young age with more than half of allergic reactions reportedly severe in nature. The specific CN IgE value was not helpful in predicting severity of reactions.

Background: Neonatal sepsis is a leading cause of morbidity and mortality in neonatal units worldwide. Meticillin-resistant Staphylococcus aureus (MRSA) has become a leading causative pathogen. Many neonatal units experience endemic colonization and infection of their infants, which is often very challenging to successfully eradicate., Aim: To assess the impact of neonatal unit refurbishment and redesign on endemic MRSA colonization and infection., Methods: A retrospective review was carried out over an eight-year period in a 14-cot, level 2-3 neonatal unit in University Hospital Galway, a large university teaching hospital in the West of Ireland. Surveillance, colonization, and infection data for a four-year period pre and four-year period post neonatal unit refurbishment are described. Clinical and microbiological data were collected on all MRSA-colonized and -infected infants between 2008 and 2015. Molecular typing data are available for MRSA isolates. An interrupted time-series design was used, with unit refurbishment as the intervention., Findings: Our neonatal unit had a pattern of sustained transmission of endemic resident MRSA strains which we could not eradicate despite repeated standard infection control interventions. Complete unit refurbishment led to successful termination of sustained transmission of these strains. Colonization decreased and no infants were actively infected post refurbishment of the unit., Conclusion: We report successful termination of sustained transmission of endemic strains of MRSA from our neonatal unit following complete unit redesign and refurbishment., (Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Oral rehydration therapy (ORT) remains the ideal first line therapy for acute gastroenteritis (AGE). Our aim was to assess the impact of introducing an Oral Fluid Challenge (OFC) protocol on outcomes such as intravenous fluid use and documentation in our institution. A single centre study with data collected retrospectively pre-implementation (April 2015) of the OFC protocol and post implementation (April 2016). Consecutive sampling of the first 55 patients presenting with GE like symptoms and underwent OFC were recruited. One hundred and ten patients were included in this study with 55 patients per cycle. The rates of IVF use decreased from 22% (12) in cycle one to 18% (10) in cycle two. There was an improvement in documentation by 26% (14) for level of dehydration and 52% (31) for OFC volume from cycle one to two. Overall, the addition of the OFC protocol to the management of patients with uncomplicated AGE would help streamline and improve care., Competing Interests: The authors declare no conflict of interest.

Kawasaki disease (KD) is the most common systemic vasculitis of childhood. The following presentation of a 4-year-old Irish boy referred to a secondary care paediatric service from the community with prolonged fever, oral mucous membrane changes and painless blistering lesions of the hands and feet in the presence of elevated inflammatory markers serves as an opportunity to discuss the diagnostic criteria and treatment for KD and incomplete KD, an often missed diagnosis with significant paediatric morbidity outside an academic paediatric centre., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

The case commences with an innocuous right ankle injury (lateral malleolus), for which the patient, a 9-year-old boy, was placed in a temporary cast at his local hospital. Three days following this incident, the patient was diagnosed with new-onset type 1 diabetes mellitus. He was admitted to his local hospital with severe diabetic ketoacidosis appropriately treated and subsequently discharged c.1 week later clinically well. Approximately 1 week later, again he presented for a third time with a significant serosanguinous discharge from the site of the initial injury permeating through the temporary cast in place for c.2 weeks by that time. On removal of the cast, a severely invasive infection of bone and soft tissue was noted, and the patient was urgently transferred to our unit at the tertiary general hospital for further management. He underwent a series of orthopaedic and plastic surgery procedures with an eventual satisfactory outcome., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Codeine is widely prescribed in clinical practice with over the counter (OTC) preparations of codeine freely available for consumption typically as a component of remedies for the common cold/cough. We describe the first reported case of acute confusional state in a previously healthy 14-year-old girl ultimately attributed to inappropriate codeine use. The usage of codeine in the paediatric setting has been highlighted in recent years with many reported deaths--mostly due to respiratory depression. The risks associated with codeine usage may be particularly unnecessary with OTC cough suppressants as evidence of efficacy is absent. Finally, codeine dependence is a common problem among adults and has been reported locally and internationally among adolescents. The combination of lack of efficacy, risk of acute intoxication and dependence, suggests that the use of OTC codeine preparations may be unwarranted., (2015 BMJ Publishing Group Ltd.)

We report a 23-month old girl who presented with bilateral epiphora who underwent bilateral lacrimal probing and syringing, during which a cocaine adrenaline solution was used. Two hours after the procedure she developed acute pulmonary oedema secondary to myocardial ischaemia. The patient was treated with intravenous glyceryltrinitrate and milrinone infusions; cardiac enzymes and left ventricular function normalised over the subsequent 72 hours. Topical administration of cocaine and adrenaline solution may have dangerous systemic cardiac effects and should always be used judiciously.

We present the interesting case of a 9-year-old boy with type 1 diabetes mellitus. He presented to the emergency department extremely unwell and the diagnosis of diabetic ketoacidosis was promptly performed. He was started on the local diabetic ketoacidosis (DKA) protocol, but his recovery remained slow. The possibility of an underlying pathology was later addressed and led to the diagnosis of primary adrenal insufficiency. This case highlights the difficulty in diagnosis of childhood Addison's disease due to its vague and non-specific symptoms and the importance of a high degree of clinical suspicion. This case also highlights the existence of autoimmune polyendocrine syndromes and the ongoing need to increase awareness and screening of these conditions., (2014 BMJ Publishing Group Ltd.)

We present a previously undescribed skeletal dysplasia with dental anomalies and ectopic neural tissue in the internal auditory meati., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objective: To assess whether there was any relationship between the number of clinical markers for spinal dysraphism and its presence on ultrasound and whether there was any relationship between the presence of an isolated sacral dimple and the presence of spinal dysraphism. Outcomes and further imaging were also examined., Methods: All patients who underwent spinal ultrasound (SUS) in University Hospital Galway (UHG) over a 5-year period (2006-2011) were identified. Patients were excluded based on age (>14 years old excluded) and indication for imaging (only patients being investigated for suspected spinal dysraphism were included). Indications for imaging, ultrasound results and information on further imaging were accessed from the computerised radiology software in UHG. Statistical analysis was performed using SPSS-18., Results: Data were analysed for 216 patients. A single clinical indication was recorded for 174 ultrasound requests, ≥2 indications for 42 requests. Nineteen of 216 (8.8%) ultrasound images were abnormal, 7 having spinal dysraphism. Multiple clinical indications were 6 times more likely to have dysraphism than those imaged on the basis of a single marker (OR 6.0, 95% CI 1.289 to 27.922, p=0.022), and there was no significant correlation between the presence of a sacral dimple and the presence of dysraphism (95% CI 0.71 to 6.622, p=0.722)., Conclusions: SUS performed on the basis of multiple clinical indications is six times more likely to detect spinal dysraphism than imaging performed for isolated abnormalities or risk factors. Sacral dimple is a poor marker for occult spinal pathology.

Among unvaccinated populations, primary varicella zoster virus (VZV) infection results in a minor childhood illness for the majority of individuals. Mortality is rare, and fatalities associated with cardiac complications are exceptional. In a population where routine VZV vaccination is not practised, we report a death in a previously healthy child secondary to VZV myocarditis. A literature review of cardiac-related VZV mortality in childhood is included. This identified a further 13 cases where death was associated with or attributable to, direct involvement of the myocardium or conducting system with what is frequently considered a benign childhood illness.

Early onset group B streptococcal (EOGBS) infection causes significant neonatal morbidity and mortality. We determined the incidence of EOGBS at Galway University Hospital (GUH) and examined any "missed opportunities" for preventing neonatal infection between 2004 and 2009. Our obstetric approach is risk-based. The incidence was 0.45/1,000 live-births; one death and one with neurological sequelae. A single mother received IAP; however we could not determine any potential for reducing cases of EOGBS by improving current IAP usage.

Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is one of a number of well described hereditary periodic febrile syndromes. We report a case in an infant, with a strong family history of this disorder, who presented on day-of-life 4 with high fever, irritability, diarrhea, lethargy, and raised acute phase reactants. An extensive work-up, including a full sepsis evaluation, proved negative. Symptoms resolved spontaneously. Representation with similar symptoms at 7 months of age prompted successful diagnosis after full evaluation. Subsequent genetic mutation analysis has proven positive for the T50M mutation in exon 2 of the TNFRSF1A gene. To our knowledge, this is the youngest reported age of presentation of this rare autoinflammatory disorder which should be considered even at such a young age.

Primary sternal osteomyelitis (PSO) is rare. In a 9-year-old boy with Staphylococcus aureus bacteremia, magnetic resonance imaging helped to promptly establish the diagnosis of PSO. Eleven previously reported cases are reviewed, emphasiz ing surgical drainage and antimicrobial therapy for optimal outcome. Magnetic resonance imaging may be superior to other imaging studies for the diagnosis of PSO.