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Pill packs are novel packaging systems designed to contain multiple medications and increase medication access but are not child-resistant and increase the risk of pediatric ingestions. We present two pediatric ingestion cases suspected to involve pill packs. Case 1 describes a 19-month-old male presenting to the Emergency Department with altered mental status and unsteady gait after a suspected clonidine and buspirone ingestion. The patient's father reportedly received his medications in mail delivery “baggies”. Case 2 involves a 21-month-old female presenting to the Emergency Department with unsteady gait. During an extensive workup we eventually found a clonazepam metabolite in her urine. A family friend supervising the patient at the time reportedly received medications through mail delivery in “plastic packs”. Emergency physicians should be alert to this packaging system as these products contain multiple medications, potentially increasing injury risk and obfuscating diagnosis. Manufacturers, regulatory agencies and public health authorities should assess and reduce the dangers these products pose to children.

Children awaiting psychiatric hospitalization in the emergency department (ED) may experience prolonged boarding when no appropriate bed is available. Many recent studies of pediatric mental health boarding have focused on children’s hospitals. Thus, we aimed to determine characteristics associated with boarding among pediatric mental health ED visits in a nationally representative sample. This retrospective cross-sectional study examined mental health ED visits by children 5 to 17 years old using the 2018-2022 National Hospital Ambulatory Medical Care Survey, which uses probability sampling to generate national estimates. Survey-weighted multivariable logistic regression examined the association between visit characteristics and boarding, defined as visit length ≥12 hours. Of 5,900,704 estimated pediatric mental health ED visits nationally (42.9% 15-17 years old, 56.4% female), 25.2% resulted in admission or transfer, and, of those, 32.1% had length ≥12 hours. Adjusted odds radio (aOR) of boarding were lower for visits by 10 to 14-year-olds (aOR, 0.19; 95% CI: 0.05, 0.70) than 15- to 17-year-olds, for visits by patients identifying as non-Hispanic other (aOR, 0.06; 95% CI: 0.01, 0.72) than non-Hispanic White, for visits with private insurance (aOR, 0.31; 95% CI: 0.10, 0.95) relative to public insurance, and for visits on weekends (aOR, 0.27; 95% CI: 0.08, 0.91) compared with weekdays. Approximately 1 in 3 pediatric mental health ED visits resulting in admission or transfer exceeded 12 hours. Differences in boarding by race, ethnicity, and insurance type reflect inequities in access to psychiatric services. To reduce ED boarding, attention is needed to improve children’s access to mental health services across the care continuum.

Sting has successfully established himself as one of the most important singer-songwriters in Western popular music over the past twenty years. His affinity for collaborative work and disparate musical styles has pushed his music into an astonishing array of contexts, but no matter what the style or who the collaborator, Sting's voice always remains distinct, and this fact has earned him success amongst a correspondingly broad audience. The Words and Music of Sting subdivides Sting's life and works into rough periods of creative activity and offers a fantastic opportunity to view Sting's many stylistic changes within a coherent general framework. After analyzing Sting's musical output album by album and song by song, author Christopher Gable sums up Sting's accomplishments and places him on the continuum of influential singer-songwriters, showing how he differs and relates to other artists of the same period. Aside from his commercial success, Sting is also interesting for the use of recurring themes in his lyrics (such as family relationships, love, war, spirituality, and work) and for his use of jazz and world music to illustrate or work against the meaning of a song. Sting's life also sheds light on his music, as his working-class roots in Newcastle, England are never far removed from his international superstardom. Throughout his life, he has been musically open-minded and inquisitive, always seeking out new styles and often incorporating them into his compositions.