Efficient readout of a single spin state in diamond via spin-to-charge conversion.

Efficient readout of individual electronic spins associated with atomlike impurities in the solid state is essential for applications in quantum information processing and quantum metrology. We demonstrate a new method for efficient spin readout of nitrogen-vacancy (NV) centers in diamond. The method is based on conversion of the electronic spin state of the NV to a charge-state distribution, followed by single-shot readout of the charge state. Conversion is achieved through a spin-dependent photoionization process in diamond at room temperature. Using NVs in nanofabricated diamond beams, we demonstrate that the resulting spin readout noise is within a factor of 3 of the spin projection noise level. Applications of this technique for nanoscale magnetic sensing are discussed.

Hhex regulates Kit to promote radioresistance of self-renewing thymocytes in Lmo2-transgenic mice.

Lmo2 is an oncogenic transcription factor that is frequently overexpressed in T-cell acute leukemias, in particular poor prognosis early T-cell precursor-like (ETP-) acute lymphoblastic leukemia (ALL). The primary effect of Lmo2 is to cause self-renewal of developing CD4(-)CD8(-) (double negative, DN) T cells in the thymus, leading to serially transplantable thymocytes that eventually give rise to leukemia. These self-renewing thymocytes are intrinsically radioresistant implying that they may be a source of leukemia relapse after therapy. The homeobox transcription factor, Hhex, is highly upregulated in Lmo2-transgenic thymocytes and can phenocopy Lmo2 in inducing thymocyte self-renewal, implying that Hhex may be a key component of the Lmo2-induced self-renewal program. To test this, we conditionally deleted Hhex in the thymi of Lmo2-transgenic mice. Surprisingly, this did not prevent accumulation of DN thymocytes, nor alter the rate of overt leukemia development. However, deletion of Hhex abolished the transplantation capacity of Lmo2-transgenic thymocytes and overcame their radioresistance. We found that Hhex regulates Kit expression in Lmo2-transgenic thymocytes and that abrogation of Kit signaling phenocopied loss of Hhex in abolishing the transplantation capacity and radioresistance of these cells. Thus, targeting the Kit signaling pathway may facilitate the eradication of leukemia-initiating cells in immature T-cell leukemias in which it is expressed.

Coherent optical transitions in implanted nitrogen vacancy centers.

We report the observation of stable optical transitions in nitrogen-vacancy (NV) centers created by ion implantation. Using a combination of high temperature annealing and subsequent surface treatment, we reproducibly create NV centers with zero-phonon lines (ZPL) exhibiting spectral diffusion that is close to the lifetime-limited optical line width. The residual spectral diffusion is further reduced by using resonant optical pumping to maintain the NV(-) charge state. This approach allows for placement of NV centers with excellent optical coherence in a well-defined device layer, which is a crucial step in the development of diamond-based devices for quantum optics, nanophotonics, and quantum information science.

Coupling of NV centers to photonic crystal nanobeams in diamond.

The realization of efficient optical interfaces for solid-state atom-like systems is an important problem in quantum science with potential applications in quantum communications and quantum information processing. We describe and demonstrate a technique for coupling single nitrogen vacancy (NV) centers to suspended diamond photonic crystal cavities with quality factors up to 6000. Specifically, we present an enhancement of the NV center's zero-phonon line fluorescence by a factor of ~ 7 in low-temperature measurements.

Predictors of a child's ability to use a visual analogue scale.

BACKGROUND: Visual analogue scales (VAS) are used to assess the strength of perceptions of both children and adults in many clinical and research settings. Although the VAS has been shown by some authors to be reliable for use by children aged 5 years and older, others have proposed that young children, generally < or =7 years of age, may not have the conceptual ability to use a VAS. OBJECTIVE: To identify demographic and cognitive variables that would maximize the accuracy of predicting children's abilities to use a VAS. METHODS: Forty kindergarten children performed a seriation task, used a VAS to perform a calibration task and completed the Block Design and Vocabulary subtests of the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R). An estimated IQ was calculated from the WPPSI-R subtest scores. Socioeconomic status was assessed using the Hollingshead Four Factor Index of Social Status. Logistic regression was used to determine the best predictive models. Sensitivity, specificity, negative predictive value, positive predictive value and accuracy were calculated for statistically significant predictive models. MAIN OUTCOME MEASURE: Successful completion of the calibration study by the child. RESULTS: Only 42% of the subjects could use a VAS. The subject's age (> or =5.6 years), combined with estimated IQ (> or =100), was the best predictor of a child's ability to use a VAS (88% accuracy). CONCLUSION: The majority of kindergarten children in our study could not complete a VAS accurately. Cognitive ability, combined with chronological age, was the best predictor of a child's accurate use of a VAS, as determined by logistic regression. Paediatric researchers may need to consider alternative rating scales to measure perceptions in children under 7 years of age.

Diagnostic aids in the differentiation of pyloric stenosis from severe gastroesophageal reflux during early infancy: the utility of serum bicarbonate and serum chloride.

This study evaluated whether serum bicarbonate levels, serum chloride levels, and other diagnostic criteria could be used to differentiate pyloric stenosis (PS) from severe gastroesophageal reflux (GER) during early infancy. The investigation was a retrospective, case-control study conducted in the emergency department of a large, academic children's hospital. Cases were 75 consecutive infants with PS confirmed in the operating room. Controls were 75 consecutive infants 12 weeks of age or younger with the diagnosis of GER whose serum electrolytes had been examined. Projectile vomiting was sensitive (0.93) but not specific (0.39) for PS. The mean serum bicarbonate level was 27.2 mmol/L for PS patients and 22.3 mmol/L for GER patients (P < .00001), and the mean serum chloride level was 95.7 mmol/L and 103.6 mmol/L for PS patients and GER patients, respectively (P < .00001). Serum bicarbonate levels of > or =29 mmol/L and serum chloride levels of < or =98 mmol/L had high positive predictive values (0.96 and 0.97, respectively) and were specific (0.99 for both) but not very sensitive (0.36 and 0.50, respectively) in identifying patients with PS. Only one patient would have been misclassified (false positive) as having PS using either of these cutoff values. These laboratory tests can also help discriminate between PS and GER when the history and physical examination fail to do so. For example, of the 20 patients with PS who did not have a pyloric mass palpated, 3 (15%) had serum bicarbonate levels of > or =29 mmol/L, and 6 (30%) had serum chloride levels of < or =98 mmol/L. In conclusion, the serum bicarbonate or serum chloride level offers a useful additional diagnostic tool in the evaluation of children presenting during early infancy with vomiting of uncertain etiology.

Prilocaine-phenylephrine topical anesthesia for repair of mucous membrane lacerations.

OBJECTIVE: To compare the effectiveness of prilocaine-phenylephrine (Prilophen), a new topical anesthetic that does not contain cocaine, to that of lidocaine infiltration during repair of lacerations on or near mucous membranes in children. DESIGN: A prospective, randomized, blinded trial. SETTING: The emergency department of a large academic children's hospital. PATIENTS: Children one year of age or older with a laceration 5 cm or less in length on or near a mucous membrane. INTERVENTIONS: Forty patients were randomly assigned one of the two local anesthetics, with 20 patients in each treatment group. OUTCOME MEASURES: Pain felt during suturing was scored by suture technicians, research assistants, a videotape reviewer, parents, and patients five years of age and older using a visual analog scale (VAS). RESULTS: There was no statistically significant difference in performance between topical Prilophen and lidocaine infiltration when VAS pain scores of research assistants, parents, and patients were compared. However, lidocaine infiltration performed significantly better than topical Prilophen when comparing VAS scores of suture technicians (P = 0.003) and the videotape reviewer (P = 0.02). When power analyses were performed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 2 units for VAS scores of suture technicians, 2 VAS units for research assistants, 3 VAS units for the videotape reviewer and parents, and 7 VAS units for patients. There were no wound healing or other complications. CONCLUSIONS: Prilophen is a new topical anesthetic alternative to lidocaine infiltration for closure of lacerations on or near mucous membranes, where use of tetracaine-adrenaline-cocaine is contraindicated. The performance of Prilophen was rated by two of the observer groups as statistically inferior to that of lidocaine infiltration; however, the differences in pain scores were small and may not be clinically significant. Further investigation of this new topical anesthetic is warranted.

Trampoline-related injuries to children.

OBJECTIVE: To describe the epidemiological features of trampoline-related injuries among children treated in an urban pediatric emergency department. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The emergency department of a large, urban, academic children's hospital. PARTICIPANTS: Children treated for trampoline-related injuries from May 1, 1995, through April 30, 1997. RESULTS: Two hundred fourteen children were treated for trampoline-related injuries during the study period, representing, on average, 1 child treated approximately every 3 days. Children ranged in age from 1 to 16 years (mean [SD], 9.4 [3.6] years). The area of the body most commonly injured was a lower extremity (36.0%), followed by an upper extremity (31.8%), the head (14.5%), the trunk (9.8%), and the neck (7.9%). The most common type of injury was a soft tissue injury (51.9%), followed by fracture (34.6%) and laceration (11.7%). Several patterns of trampoline-related injury were identified. Extremity fractures were more common in the upper extremities (P=.006; relative risk [RR]=1.64; 95% confidence interval [CI], 1.16-2.31); however, soft tissue injuries were more common in the lower extremities (P=.006; RR=1.66; 95% CI, 1.16-2.38). Lacerations were associated with injury to the head region (P<.001; RR=67.9; 95% CI, 16.8-273.6) and were more common among children younger than 6 years (P=.02; RR=2.58; 95% CI, 1.24-5.34). Soft tissue injuries were more common among children 6 years of age and older (P=.01; RR=1.66; 95% CI, 1.08-2.55). Four patients (1.9%) with fractures were admitted to the hospital. The trampoline was located in the backyard in 96% (119/124) of cases. Adult supervision was present at the time of injury for 55.6% (65/117) of children, including 73.3% (22/30) of children younger than 6 years. Parents reported that they had been aware of the potential dangers of trampolines before the injury event (73% [81/111]), that their child had previously attempted a flip on a trampoline (56.9% [66/116]), that this was not the child's first injury on a trampoline (10% [12/120]), and that their child continued to use a trampoline after the current injury event (54.8% [63/115]). CONCLUSIONS: Trampoline-related injuries to children treated in the emergency department are almost exclusively associated with the use of backyard trampolines. The prevention strategies of warning labels, public education, and adult supervision are inadequate to prevent these injuries. Children should not use backyard trampolines, and the sale of trampolines for private recreational use should be halted.

Tetracaine-lidocaine-phenylephrine topical anesthesia compared with lidocaine infiltration during repair of mucous membrane lacerations in children.

This study compared the effectiveness of a new topical anesthetic, tetracaine-lidocaine-phenylephrine (TetraLidoPhen), with that of lidocaine infiltration during repair of mucous membrane lacerations in children. It was conducted in the emergency department of an urban children's hospital with use of a prospective, randomized, blinded study design. Participants were 90 children 1 year of age or older with a laceration 5 cm or less in length on or near a mucous membrane that required suturing. They were randomly assigned to one of two treatment groups, with 45 patients in each group. Pain felt during suturing was scored by suture technicians, research assistants, a videotape reviewer, parents, and patients 5 years of age and older using a Visual Analogue Scale (VAS). Suture technicians, research assistants, a videotape reviewer, and parents also scored pain using a seven-point Likert scale. In addition, suture technicians completed an Anesthesia Effectiveness scale and a Wound Blanching scale. The laceration was located near the eyes in 71 patients (79%), and on or near the lips in 19 (21%). Lidocaine infiltration performed significantly better than topical TetraLidoPhen in comparisons of Likert scores of suture technicians (P = 0.007), research assistants (P = 0.005), the videotape reviewer (P = 0.003), and parents (P = 0.03); Anesthetic Effectiveness scale scores of suture technicians (P = 0.00002; relative risk (RR) = 1.83, 95% confidence interval 1.36 < RR < 2.46); and VAS scores of suture technicians (P = 0.002), research assistants (P = 0.001), and the videotape reviewer (P = 0.005). No significant difference in performance was detected between lidocaine and TetraLidoPhen in comparing VAS scores of parents and patients. There was a 4.4% wound complication rate, including two (2.2%) wound infections. The authors conclude that TetraLidoPhen is a new topical anesthetic that appears to be safe when applied on or near mucous membranes. Its performance among study participants was statistically inferior to that of lidocaine infiltration; however, the differences in pain scores were small and may not be clinically significant. Also, comparisons of pain scores in this study did not take into account the pain associated with the initial injection of lidocaine. Therefore, study findings may underestimate the comparative performance of TetraLidoPhen. Further investigation of this new topical anesthetic is warranted.

The summer penile syndrome: seasonal acute hypersensitivity reaction caused by chigger bites on the penis.

OBJECTIVE: To describe the seasonal acute hypersensitivity reaction of the penis due to chigger bites, known as the summer penile syndrome. DESIGN: A consecutive series of patients. SETTING: The emergency department of an urban academic children's hospital in the midwestern United States. PARTICIPANTS: Male pediatric patients with an acute hypersensitivity reaction of the penis. RESULTS: Ninety-four patients were treated for summer penile syndrome during the four-month period from June through September. Patients ranged in age from seven months to 11 years (mean = 5.1, SD = 2.5). Twenty-one percent of patients had also experienced a similar prior episode of penile swelling. Symptoms included pruritus in 84% of cases, dysuria in 33%, and decreased strength of urine stream in 8% of patients. Eighty-four percent of patients had recent exposure to the woods, park, lawn, or poison ivy. In addition to edema, findings on physical examination included a papule or bite puncture mark in 50% of patients, erythema in 32%, and excoriation in 6% of patients. Fifty-six percent of patients had bites on other areas of the body. The emergency physician attributed the penile edema to an insect or chigger bite in 98% of cases. Treatment consisted of an oral antihistamine and cold compresses in most cases. The reported duration of penile swelling ranged from one to 18 days with a mean of 4.1 days (SD = 3.5), and the reported duration of pruritus ranged from 0 to 14 days with a mean of 3.0 days (SD = 2.6). CONCLUSION: This study provides an understanding of the summer penile syndrome for pediatric care providers. To our knowledge, this study is the first to describe this seasonal syndrome in the medical literature.

Prilocaine-phenylephrine and bupivacaine-phenylephrine topical anesthetics compared with tetracaine-adrenaline-cocaine during repair of lacerations.

The effectiveness of two new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine and bupivacaine-phenylephrine) was compared with that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. This study was a prospective, randomized, double-blind trial conducted in the emergency department of a large children's hospital. Participants were 180 children 1 year of age or older with a laceration 5 cm or less in length that required suturing. Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients 5 years of age and older using a visual analogue scale (VAS). There was no statistical difference demonstrated between the effectiveness of prilocaine-phenylephrine and that of TAC for any of the observer groups. A statistically significant difference was seen among anesthetics when comparing VAS scores of research assistants (P = .002), suture technicians (P = .006), and parents (P = .03), but not when comparing VAS ratings of patients (P = .07). Based on Tukey's post hoc test, these statistically significant differences were between TAC and bupivacaine-phenylephrine. When power analyses were performed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 1.3 VAS units for each rater group. In conclusion, this study demonstrated the effectiveness and safety of prilocaine-phenylephrine and bupivacaine-phenylephrine. Prilocaine-phenylephrine statistically outperformed bupivacaine-phenylephrine and offers an effective alternative to TAC during laceration repair in children.

New non-cocaine-containing topical anesthetics compared with tetracaine-adrenaline-cocaine during repair of lacerations.

OBJECTIVE: To compare the effectiveness of three new topical anesthetics that do not contain cocaine (prilocaine-phenylephrine, tetracaine-phenylephrine [tetraphen], and tetracaine-lidocaine-phenylephrine) to that of tetracaine-adrenaline-cocaine (TAC) during laceration repair in children. DESIGN: Prospective, randomized, double-blind clinical trial. SETTING: The emergency department of an urban children's hospital. PARTICIPANTS: Children 1 year of age or older with a laceration /= 5 years of age using a visual analogue scale (VAS). Suture technicians, research assistants, and parents also scored pain using a seven-point Likert scale. In addition, suture technicians completed an anesthetic effectiveness scale. RESULTS: There was consistently no difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. A statistically significant difference was seen among anesthetics when comparing VAS and Likert scale scores of suture technicians and Likert scale scores of research assistants. Based on post hoc analyses, these statistically significant differences were between TAC and prilocaine-phenylephrine (suture technician VAS and Likert scale) and between TAC and tetracaine-lidocaine-phenyl-ephrine (suture technician Likert scale), but not between TAC and tetraphen. When power analyses were performed using alpha = 0.05 and beta = 0.20, it was possible to detect a difference of 1.2 VAS units for each of the observer groups. Based on anesthetic effectiveness scale scores, the three new topical preparations collectively performed significantly better on the face and scalp than on the extremities (relative risk = 1.83; 95% confidence interval 1.20 < relative risk < 2.79). CONCLUSION: This study demonstrated the effectiveness and safety of three new non-cocaine-containing topical anesthetics. Consistently, there was no statistical difference demonstrated between the effectiveness of tetraphen and that of TAC for each outcome measure of each observer group. Tetraphen offers an effective alternative to TAC during laceration repair in children.

Babywalker-related injuries continue despite warning labels and public education.

OBJECTIVE: To describe the epidemiology of babywalker-related injuries to children treated in a pediatric emergency department despite current prevention efforts, and to investigate the beliefs of parents regarding babywalker use. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The emergency department of a large, academic children's hospital. PARTICIPANTS: Children treated for babywalker-related injuries during the 3-year period of March 1993 through February 1996. RESULTS: There were 271 children treated for babywalker-related injuries. The mean age was 9.2 months, and 62% of patients were boys. Ninety-six percent of children were injured when they fell down stairs in their babywalker. The number of stairs that a child fell down was significantly associated with skull fracture and admission to the hospital, and a fall down more than 10 stairs had a relative risk (RR) of skull fracture = 3.28 (95% confidence interval, 1.35 < RR < 7.98). There were 159 children with contusions/abrasions (58.6%), 35 concussions/head injuries (12. 9%), 33 lacerations (12.2%), 26 skull fractures (9.6%), 9 epistaxis (3.3%), 4 nonskull fractures (1.5%), 4 avulsed teeth (1.5%), and 1 burn (0.4%). Three of the skull fractures were depressed, and three also had accompanying intracranial hemorrhage. Ten patients (3.7%) were admitted to the hospital, and all had skull fractures resulting from falls down stairs. Supervision was present in 78% of cases, including supervision by an adult in 69% of cases. Forty-five percent of families kept the walker, and 32% used the walker again for the study patient or another child after the injury episode. Fifty-nine percent of parents acknowledged that they were aware of the potential dangers of babywalkers before the injury event. Fifty-six percent of parents favored a national ban on the sale of walkers, and 20% were opposed. CONCLUSION: Despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children. The US Consumer Product Safety Commission should promulgate a rule, similar to the voluntary standard adopted in Canada, regarding design requirements for babywalkers that will prevent their passage through household doorways at the head of stairs. The manufacture and sale of mobile babywalkers that do not meet this new standard should be banned in the US. A recall or trade-in campaign should be conducted nationally to decrease the number of existing babywalkers.

Evaluation of a model for improving emergency medical and trauma services for children in rural areas.

STUDY OBJECTIVE: To evaluate the effectiveness of a rural emergency medical and trauma services project in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. METHODS: This prospective, quasi-experimental study used an untreated control group design with pretest and posttest of pre-hospital and hospital-based emergency care personnel in two rural counties in central Ohio. Project evaluation compared 50 emergency care providers from the intervention county with 43 emergency care providers from the control county. Changes in knowledge and confidence of these personnel in the assessment and management of pediatric emergencies were compared. RESULTS: Providers in the intervention county demonstrated a significantly greater increase in test scores regarding knowledge of pediatric emergencies than did providers in the control county (P = .001). Significantly greater improvement was also seen when comparisons of test scores were made for field (P = .02) and hospital (P = .03) emergency care personnel separately. Self-reports on a visual analog scale indicated that providers in the project intervention county had a significantly greater decrease in anxiety than did control subjects when presented a scenario of a child experiencing a respiratory arrest (P = .01). On the basis of scores from a five-point Likert scale, emergency personnel in the intervention county had a greater increase in confidence regarding management of the pediatric airway (P = .0003) and a greater increase in the belief that they had adequate pediatric training (P = .000001) after participating in the project than emergency personnel in the control county. CONCLUSION: The rural pediatric emergency medical and trauma services project was effective in increasing the knowledge and confidence of emergency care personnel in the management of acutely ill and injured children. This project offers a model that can be replicated in other rural areas nationally.

Comparison of topical anesthetics with lidocaine infiltration during laceration repair in children.

This study is a randomized, blinded trial that compares the effectiveness of a new topical anesthetic preparation of 2% mepivacaine and 1:100,000 norepinephrine (Mepivanor); a topical solution of 1% tetracaine, 1:4,000 adrenaline, and 4% cocaine (TAC); and 1% lidocaine infiltration during laceration repair in children. The study was conducted in the emergency department of a large academic children's hospital. Study participants were children 2 years of age or older with a laceration on the face or scalp, 5 cm or less in length, that required suturing. Patients were randomly assigned to receive Mepivanor topical solution, TAC topical solution, or lidocaine infiltration anesthesia prior to laceration repair. Seventy-one patients were enrolled in the study during a 2-month period. Outcome measures assessed pain perceptions using a Visual Analogue Scale (VAS) and a seven-point Likert scale. There was statistical power to detect differences of 1.2 to 1.7 units for the VAS outcome measures using alpha = 0.05 and beta = 0.20. There were no statistically significant (P > 0.05) differences between TAC and 1% lidocaine infiltration in providing effective anesthesia. Mepivanor was generally less effective in providing adequate anesthesia during laceration repair than TAC and lidocaine infiltration, with Tukey's post hoc test for ANOVA demonstrating statistically significant (P < 0.05) differences between Mepivanor and these agents for research assistant and suture technician VAS scores. Wound blanching was judged to be less with Mepivanor than with TAC, although this difference was not statistically significant. There were no adverse reactions, wound infections, or healing difficulties for any of the patients who received TAC or Mepivanor. It was concluded that non-cocaine-containing Mepivanor was generally less effective than TAC and lidocaine infiltration in providing adequate local anesthesia during laceration repair. TAC containing only 120 mg of cocaine (3 mL of 4% cocaine) was as effective as 1% lidocaine infiltration in providing local anesthesia during laceration repair. This will allow the amount of cocaine in TAC to be reduced, thereby decreasing costs and the likelihood of adverse reactions.

The rockets' red glare, the bombs bursting in air: fireworks-related injuries to children.

OBJECTIVE: To describe the epidemiology of fireworks-related injuries to children treated in a pediatric emergency department. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The emergency department of a large urban children's hospital. PARTICIPANTS: Children treated for injuries associated with fireworks during the 22-year period from 1972 through 1993. RESULTS: Three hundred sixteen children were treated for fireworks-related injuries. Ninety-five percent of patients were injured during the 3-week period of June 22 to July 14 during the study years. Seventy-one percent of patients were male, and the average age was 8.5 years, with a range of 1 month to 17 years. The child was a bystander in 26% of cases, and adult supervision was present in 54% of cases. One patient died, and 11% of children required admission to the hospital, with an average length of stay of 7.8 days (range, 1 to 37 days). Fifteen children (5%) went to the operating room for treatment of injuries. Thirty-three patients (10%) had permanent sequelae from their injuries, including 7 children (2%) with complete or partial loss of vision in one eye. The eyes were injured in 29% of cases, followed by hands and fingers (22%), other head and face sites (18%), and lower extremities (16%). The primary injury was a burn in 72% of cases. Firecrackers were associated with 42% of injuries, followed by bottle rockets (12%), other types of rockets (7%), Roman candles (11%), sparklers (7%), fountains (5%), jumping jacks (4%), and class B (illegal) fireworks (4%). Sixty-seven percent of sparkler-related injuries occurred among children 5 years and younger (Fisher's exact test, P = .000002; odds ratio [OR] = 10.00, 95% confidence interval 3.52 < OR < 29.24). Permanent sequelae were more common for eye injuries caused by rockets than eye injuries caused by other types of fireworks (Fisher's exact test, P = .03; OR = 6.72, 95% confidence interval 1.18 < OR < 38.18). Charges for medical care of a fireworks-related injury averaged $1385 per patient (range, $44 to $15 071). CONCLUSIONS: Fireworks are associated with serious injuries. Findings of this large consecutive series describe the epidemiology of these injuries. Children and their families should be encouraged to enjoy fireworks at public fireworks displays conducted by professionals. Fireworks for individual private use should be banned.

Comparison of topical anesthetics without cocaine to tetracaine-adrenaline-cocaine and lidocaine infiltration during repair of lacerations: bupivacaine-norepinephrine is an effective new topical anesthetic agent.

OBJECTIVE: To compare the effectiveness of four topical anesthetics that do not contain cocaine with that of topical tetracaine-addrenaline-cocaine (TAC) and lidocaine infiltration during laceration repair in children. DESIGN: This was a randomized, blinded trial. SETTING: The study was conducted in the emergency department of a large children's hospital. PARTICIPANTS: Subjects were children 2 years of age or older with a laceration 5 cm or less in length that required sururing. INTERVENTIONS: Patients were randomly assigned to receive one of four noncocaine-containing topical anesthetics, topical TAC, or lidocaine infiltration anesthesia before laceration repair. OUTCOME MEASURES: Outcome measures assessed pain perceptions using a Visual Analogue Scale, Likert scale, and Anethetic Effectiveness scale. Distress behaviors of patients were measured with the Restrained Infants and Children Distress Rating Scale. RESULTS: Two hundred forty patients were enrolled in the study. Using alpha = 0.05 and beta = 0.2, there was statistical power to detect differences of 0.3 to 1.3 U for the outcome measures used. The bupivacaine-norepinephrine topical solution (Bupivanor) performed better than the other three new topical preparations. It provided effective wound anesthesia during lacertion repair, especially for lacerations of the face and scalp, where it was consistently rated as effective as TAC and 1% lidocaine infiltration by all observer groups for all outcome measures. There was a 4% overall wound complication, including one wound infection. CONCLUSION: Bupivanor is an effective alternative to TAC and lidocaine infiltration for local anesthesia during laceration repair, expecially on the face and scalp. The effectiveness of Bupivanor on the face is important, because it is here where TAC is most likely inadvertently to come into contact with mucous membranes and result in systemic toxicity. Because pain and distress scores did not take into consideration the pain associated with the initial injection of lidocaine, the findings of this study conservatively estimate Bupivanor's effectiveness, compared with lidocaine infiltration.

Injuries to children related to shopping carts.

STUDY OBJECTIVE: To describe the epidemiology of shopping cart-related injuries among children and to consider targeted prevention strategies based on these epidemiologic findings. DESIGN: A consecutive series of patients. SETTING: The emergency department of a large, academic children's hospital. PARTICIPANTS: Sixty-two children treated for shopping cart-related injuries during a 15-month period. RESULTS: Children ranged in age from 4 months to 10 years (mean, 2.8 years). Thirty-three children (53%) were boys. Twelve patients (19%) arrived via ambulance. Forty-nine children (79%) had injuries to the head, including one child admitted to the hospital. Eleven children (18%) had fractures, including 5 (8%) with skull fractures. Nine patients (14%) had lacerations, and 30 patients (48%) had superficial injuries (ecchymoses or abrasions). The most common mechanism of injury was falling out of the carts (58% of children), followed by cart tip-overs (26% of children). Injuries caused by falls from the carts occurred across the entire age range, whereas injuries caused by cart tip-overs were most frequent among children 1 year of age or younger. The sitting position was associated with tip-over injuries, and standing in the cart basket was associated with falling from the cart. CONCLUSIONS: Shopping cart-related injuries cause serious pediatric morbidity, especially among children younger than 5 years of age, and are potentially fatal. Based on identified age-specific mechanisms of injury, currently used prevention strategies are not sufficient. The use of infant seats and restraining belts is an inadequate strategy for prevention of shopping cart-related injuries among children 1 year of age or younger, because cart tip-over is an important mechanism of injury in this age group. Shopping carts should be redesigned to decrease the tip-over hazard. Transportation of children in shopping carts of current design should be prohibited.

Epidemiology of shopping cart-related injuries to children. An analysis of national data for 1990 to 1992.

OBJECTIVE: To describe the epidemiologic characteristics of shopping cart-related injuries among children in the United States. DESIGN: A retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1990 to 1992. RESULTS: An estimated 75,200 shopping cart-related injuries occurred in children younger than 15 years treated in US emergency departments during 1990 to 1992 (95% confidence interval, 57,500 to 92,900). Children younger than 5 years were at highest risk, accounting for 63,200 (84%) of the injuries. A 20% increase was observed in the number of injuries among 0- to 4-year-old children from 1990 to 1992. Fifty-three percent of injured children were male. The head and neck region was the most common anatomic site of injury, accounting for 74% of injuries among children younger than 15 years. An estimated 2000 children (2.7%) younger than 15 years required hospital admission (1.2% in 1990 compared with 3.5% in 1992). Children aged 0 to 4 years accounted for 93% of these hospital admissions. Among 0- to 14-year-old children, fractures accounted for 45% of hospital admissions, followed by internal injury (22%) and concussion (17%). CONCLUSIONS: Injuries related to shopping carts are an important cause of pediatric morbidity, especially among children younger than 5 years. These injuries can also result in death. Shopping carts should be redesigned to decrease the risk of injury to children, and transportation of children in shopping carts of current design should be prohibited.

A one-month drug analysis laboratory rotation for doctor of pharmacy students.

A one-month drug analysis laboratory rotation for PharmD students is described. The students gain hands-on experience through the performance of a structured sequence of laboratory experiments covering topics such as calibration standards, the calibration curve, extraction recovery, chromatographic resolution, HPLC detectors, and plasma protein binding. The self-paced, independent study approach to the rotation was cited by students to be an effective method for teaching a large number of new concepts in a short time. The course was a good aid in helping students to decide if they wanted to pursue postdoctoral research training.