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Background: Delay of emergency surgery contributes to morbidity and mortality, and physiologic status affects outcomes of patients requiring emergent surgery. Our purpose was to determine whether delays to emergent surgery in children were associated with increased major morbidity or mortality in a risk-adjusted population. Methods: We performed a retrospective review of class 1 ([less than or equal to] 60 min to operating room) surgical procedures from July 11, 2011, to July 30, 2016, at BC Children's Hospital, Vancouver. Data sources included the operating room database, patient charts, American Society of Anesthesiologists classification, Neonatal Acute Physiology (SNAP II) and Pediatric Risk of Mortality (PRISM III) scores, time from booking to operating room and outcome. Patients were classified as being at low or high risk for death. We defined major morbidity as unintended loss of an organ, limb or function related to surgery, and delay to surgery as more than 60 minutes from booking to in room. We used the [chi square] test for univariate analysis and logistic regression for multivariate analysis. Results: There were 384 cases (367 patients), 223 high-risk and 161 low-risk. The median age was 4 years (range 0 d-18 yr). Overall, 184 cases (47.9%) were delayed. Major morbidity occurred in 94 cases (24.5%), and 28 patients (7.6%) (all in the highrisk group) died. The mean time to the operating room was 1.46 hours for patients with major morbidity/mortality and 1.17 hours for those without. After adjustment for risk level, multivariate analysis showed delay to surgery to be associated with 85% increased odds of morbidity and/or mortality (adjusted odds ratio 1.85, 95% confdence interval 1.20-2.94) compared to no delay. Conclusion: Delay to emergent surgery was associated with a significant increase in major morbidity and/or mortality. Children who require emergency surgery need their care prioritized by not only operating room teams but also hospitals and government; otherwise, they will continue to experience unintended consequences. Contexte : Le retard des chirurgies d'urgence contribue a la morbidite et a la mortalite, et l'etat physiologique influence les resultats des patients en ayant besoin. Notre objectif etait de determiner si le retard des chirurgies d'urgence chez les enfants etait associe a une hausse de la morbidite majeure ou de la mortalite dans une population ajustee en fonction du risque. Methodes : Nous avons mene une etude retrospective sur les interventions chirurgicales de classe 1 (entree au bloc operatoire en 60 min ou moins) realisees entre le 11 juillet 2011 et le 30 juillet 2016 a l'Hopital pour enfants de la Colombie-Britannique de Vancouver. Les sources de donnees comprenaient la base de donnees du bloc operatoire, les dossiers des patients, les scores de la classification de l'American Society of Anesthesiologists, du SNAP II (Neonatal Acute Physiology ou gravite des maladies neonatales) et du PRISM III (Pediatric Risk of Mortality ou risque pediatrique de mortalite), le temps entre l'inscription et l'entree au bloc operatoire et les resultats. Les patients ont ete classes selon leur risque de deces, faible ou eleve. Nous avons defini la morbidite majeure comme la perte imprevue d'un organe, d'un membre ou d'une fonction liee a l'intervention chirurgicale et le retard de la chirurgie comme un temps entre l'inscription et l'entree au bloc operatoire superieur a 60 minutes. Nous avons realise l'analyse unidimensionnelle avec le test [chi square] et l'analyse multivariee avec la regression logistique. Resultats : Nous avons releve 384 cas (367 patients); 223 presentaient un risque eleve et 161, un risque faible. L'age median etait de 4 ans (plage 0 jour a 19 ans). Un retard est survenu dans 184 cas (47,9 %). Pour 94 cas (24,5 %), une morbidite majeure est apparue et 28 patients (7,6 %; appartenant tous au groupe a risque eleve) sont decedes. Pour ces cas de morbidite majeure ou de deces, le temps moyen d'entree au bloc operatoire etait de 1,46 heure, contre 1,17 heure pour les autres. Apres une correction en fonction du risque, l'analyse multivariee a revele que les chirurgies realisees en retard sont associees a une hausse de 85 % (rapport de cotes corrige 1,85, intervalle de confance a 95 % 1,20-2,94) des risques de morbidite et de mortalite comparativement a celles realisees dans les temps. Conclusion : Le retard des chirurgies d'urgence est associe a une hausse significative de la morbidite majeure et de la mortalite. Les chirurgies pediatriques d'urgence doivent etre traitees en priorite par les equipes du bloc operatoire, mais aussi par les hopitaux et les gouvernements, car les enfants continueront sinon de subir des consequences imprevues., The primary objective of the Canada Health Act is 'to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health [...]

Purpose: Standard head coils used at 7T MRI suffer from high signal loss at lower brain regions and neck. This study aimed to increase the field of view (FOV) of a birdcage coil to image the lower brain regions and neck with a straightforward approach of using add‐on transmit shielded coaxial cable coil (SCC) elements. Methods: A new head‐neck coil was modeled as a combination of the 2Tx/32Rx Nova head coil and 6Tx SCC elements. The add‐on transmit SCC elements have been produced. The full wave electromagnetic simulations were performed to analyze the coil geometry and estimate the local specific absorption ratio (SAR). The B1+$$ {\mathrm{B}}_1^{+} $$ field maps and structural images were acquired in a phantom and in vivo on a 7T scanner. Results: The computed SAR histogram revealed a peak SAR10g$$ {\mathrm{SAR}}_{10g} $$ of 4.08 W/kg. The simulated and measured B1+$$ {\mathrm{B}}_1^{+} $$ maps are in good agreement. The manufactured coil's S‐parameters are below −$$ - $$10 dB. The B1+$$ {\mathrm{B}}_1^{+} $$ field measurements on a subject presented the increase in the FOV. The T1‐weighted structural images of three subjects acquired with the head‐neck coil showed increased coverage compared to the head coil only. Conclusion: Combining the 2Tx/32Rx Nova head coil and 6Tx SCC elements allowed imaging of the whole brain with an increased FOV down to the C4 spine. The coil stayed fully functional when different subjects were scanned. We conclude that the SCC transmit‐only coils are a robust adjunct to conventional coil designs and can meaningfully enhance and expand their field of view. [ABSTRACT FROM AUTHOR]

Purpose: The coax monopole antenna is presented for body imaging at 7 T. The antenna is fed at one end, eliminating the possibility of cable‐coil coupling and simplifying cable routing. Additionally, its flexibility improves loading to the subject. Methods: Like the coax dipole antenna, an interruption in the shield of the coaxial cable allows the current to extend to the outside of the shield, generating a B1+ field. Matching is achieved using a single inductor at the distal side, and a cable trap enforces the desired antenna length. Finite difference time domain simulations are employed to optimize the design parameters. Phantom measurements are conducted to determine the antenna's B1+ efficiency and to find the S‐parameters in straight and bent positions. Eight‐channel simulations and measurements are performed for prostate imaging. Results: The optimal configuration is a length of 360 mm with a gap position of 40 mm. Simulation data show higher B1+ levels for the coax monopole (20% in the prostate), albeit with a 5% lower specific absorbance rate efficiency, compared to the fractionated dipole antenna. The S11 of the coax monopole exhibits remarkable robustness to loading changes. In vivo prostate imaging demonstrates B1+ levels of 10–14 μT with an input power of 8 × 800 W, which is comparable to the fractionated dipole antenna. High‐quality images and acceptable coupling levels were achieved. Conclusion: The coax monopole is a novel, flexible antenna for body imaging at 7 T. Its simple design incorporates a single inductor at the distal side to achieve matching, and one‐sided feeding greatly simplifies cable routing. [ABSTRACT FROM AUTHOR]