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Biomedical subjects

G A Smith

Publications and source records attributed to G A Smith.

At least 91 records · Page 5Linked to original sources
PubMed1997

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 cm in length that required suturing. Intervention. A total of 240 children were randomly assigned to one of four treatment groups. OUTCOME MEASURES: Pain felt during suturing was scored by suture technicians, research assistants, parents, and patients >/= 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.

Adolescent↗
PubMed1997

Test-retest reliability of a battery of sensory motor and physiological measures of aging.

We report test-retest reliabilities for a battery of tests (vision, hearing, vibration sense, proprioception, forced expiratory volume, blood pressure, grip strength, and sway) shown previously to predict functional age. Fifty women aged 60 to 86 were retested on the battery after 3 months. All tests except proprioception and blood pressure had reliabilities between .70 and .94. We conclude that the battery provides reliable measures of sensory, motor, and physiological variables which may be used as markers of biological aging in psychological research.

Aged↗
PubMed1996

Utility of blood cultures in pediatric patients found to have pneumonia in the emergency department.

STUDY OBJECTIVE: To determine the prevalence of bacteremia in pediatric patients with radiographic evidence of pneumonia in whom blood cultures were obtained. METHODS: We carried out a retrospective review of the radiology log of a tertiary care children's hospital to identify patients with radiographic evidence of pneumonia seen between August 1991 and July 1992. These patients were cross-referenced with the hospital laboratory information system, yielding results of any CBC or blood cultures. RESULTS: We found 939 patients with chest radiography findings consistent with pneumonia. Blood culturing was performed in 409 (44%). Eleven of these cultures (2.7%) grew pathogenic bacteria. Review of the medical records revealed no changes in clinical management made on the basis of the results of the blood cultures. CONCLUSION: Blood cultures are uncommonly positive in outpatients diagnosed with pneumonia.

Adolescent↗
PubMed1996

Treatment of an adult with a severe anterior open bite and mutilated malocclusion without orthognathic surgery.

A case report of a 19-year, 7-month-old young woman who had an Angle Class I mutilated malocclusion, characterized by a skeletal/dental anterior open bite, crowding, thumb-sucking habit, and bimaxillary dental protrusion is presented. A nonsurgical approach was used to obtain significant improvement in occlusion and in facial esthetics. [This case report was presented to the American Board of Orthodontics in partial fulfillment of the requirements for the certification process conducted by the Board.]

Adult↗
PubMed1996

The tandem repeat domain in the Listeria monocytogenes ActA protein controls the rate of actin-based motility, the percentage of moving bacteria, and the localization of vasodilator-stimulated phosphoprotein and profilin.

The ActA protein is responsible for the actin-based movement of Listeria monocytogenes in the cytosol of eukaryotic cells. Analysis of mutants in which we varied the number of proline-rich repeats (PRR; consensus sequence DFPPPPTDEEL) revealed a linear relationship between the number of PRRs and the rate of movement, with each repeat contributing approximately 2-3 microns/min. Mutants lacking all functional PRRs (generated by deletion or point mutation) moved at rates 30% of wild-type. Indirect immunofluorescence indicated that the PRRs were directly responsible for binding of vasodilator-stimulated phosphoprotein (VASP) and for the localization of profilin at the bacterial surface. The long repeats, which are interdigitated between the PRRs, increased the frequency with which actin-based motility occurred by a mechanism independent of the PRRs, VASP, and profilin. Lastly, a mutant which expressed low levels of ActA exhibited a phenotype indicative of a threshold; there was a very low percentage of moving bacteria, but when movement did occur, it was at wild-type rates. These results indicate that the ActA protein directs at least three separable events: (1) initiation of actin polymerization that is independent of the repeat region; (2) initiation of movement dependent on the long repeats and the amount of ActA; and (3) movement rate dependent on the PRRs.

Actins↗
PubMed1996

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.

Accident Prevention↗
PubMed1996

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.

Administration, Cutaneous↗
PubMed1996

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.

Adolescent↗
PubMed1995

Determination of ceftiofur and its desfuroylceftiofur-related metabolites in swine tissues by high-performance liquid chromatography.

An HPLC method was developed and validated for the determination of ceftiofur-related metabolites that have the potential to be microbiologically active in swine muscle, kidney, liver and fat. Its performance was evaluated against incurred-residue swine tissues. This method is based on the cleavage of the disulfide and/or thioester bonds between the metabolites and their conjugate sulfur containing moiety using dithioerythritol to yield desfuroylceftiofur, and further stabilization to desfuroylceftiofur acetamide. The limit of quantitation was 0.1 micrograms ceftiofur equivalents/g tissue. The assay is specific for ceftiofur-related metabolites when evaluated against commercially available antibiotics for swine.

Adipose Tissue↗
PubMed1995

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.

Accidental Falls↗
PubMed1995

Iontophoretic delivery of oligonucleotides across full thickness hairless mouse skin.

In recent years there has been an increased interest in the use of oligonucleotides as therapeutic agents. Oligonucleotide therapeutics may have significant potential over traditional drugs due to their high degree of specificity and increased affinity. The major drawbacks to the use of oligonucleotide therapeutics are the problems associated with their delivery and their relative instability in serum. The serum instability problem has been partially overcome through the use of oligonucleotides with modified backbones. Transdermal electrotransport may be used to overcome the problems associated with delivery. Here we report the use of transdermal electrotransport in the delivery of oligonucleotides across hairless mouse skin. The effects of pH, salt concentration, current density, and oligonucleotide concentration, structure, and length have been investigated.

Administration, Cutaneous↗
PubMed1995

Transdermal iontophoresis and solute penetration across excised human skin.

The potential of transdermal iontophoresis to facilitate drug delivery was evaluated by studying the transport kinetics of model compounds salicylate (anion), phenylethylamine (cation), mannitol (polar neutral compound of low molecular weight), and inulin (polar neutral compound of high molecular weight) using an excised human skin model. The transport kinetics of solutes were determined across both intact and cellophane-tape-stripped dermatomed skin both in the presence and absence of applied current to probe the mechanisms of iontophoretic delivery. Iontophoresis effectively enhanced delivery of all compounds relative to passive transport. The skin is shown to be both ion selective and size selective. On the basis of results from present work and other studies, the "aqueous pathway" of iontophoretic transport is further reinforced.

Administration, Cutaneous↗
PubMed1995

Genetically altered herpesviruses as vaccines.

Herpesviruses are a common and important cause of disease in most domestic animals. While many virus diseases have been successfully controlled by conventional vaccines, genetically modified vaccines offer distinct advantages. They are less virulent, less likely to result in latency and they include genotypic and phenotypic markers which allow differentiation of vaccine virus from wild-type virus and serological differentiation of vaccinated animals from infected animals. These benefits are particularly useful in eradication campaigns for herpesvirus diseases such as Aujeszky's disease and infectious bovine rhinotracheitis. Neither conventional nor genetically modified vaccines prevent super-infection. This is a major problem for diseases such as Marek's disease where virulent virus continues to be excreted from vaccinated animals, thus contaminating the environment and making control more difficult. To prevent infection, new strategies will need to be developed such as transgenic animals which are innately resistant.

Animals↗
PubMed1995

Electrical injuries in a pediatric emergency department.

STUDY OBJECTIVE: To examine the spectrum of electrical injuries and develop guidelines for management. DESIGN: Retrospective review of charts compiled during a 6-year period (1988 through 1993). SETTING: Pediatric emergency department. PARTICIPANTS: Seventy-eight patients seen for electrical injuries. RESULTS: Fifty-four percent of patients were boys, and the mean age of the patients was 5.3 years. Eighty-two percent sustained burns. We divided patients into those who were involved in major electrical current events (n = 8) (water contact and high voltage) and minor electrical current events (n = 70) (injury sustained while placing an object in an outlet or touching/plugging in a cord or during oral contact with a cord). Of the minor events, all burns (n = 61) involved less than 1% of body surface area. Eighteen patients sustained second-degree burns, and 19 sustained third-degree burns. Of the eight major-event patients, one had abnormal ECG/rhythm strip findings, two had abnormal urinalysis results, and six had abnormal levels of creatine phosphokinase. All eight were admitted. Of the 70 minor-event patients, 2 of 53 had abnormal ECG/rhythm strip findings, 1 of 48 had abnormal urinalysis results, and 2 of 40 had abnormal creatine phosphokinase levels. Thirty-six of the 70 minor-event patients were admitted. Patients involved in major events were more likely to undergo studies (P = .002), to have an abnormal result (P = .000008), and to be hospitalized (P = .008). In minor-event patients, hospitalization was limited to observation and the fitting of oral appliances. CONCLUSION: Children involved in electrical events are usually exposed to low-voltage household current resulting in minor injury. Asymptomatic children with minor electrical injuries do not require laboratory evaluation or hospitalization.

Accidents, Home↗
PubMed1995

Slowness and age: speed-accuracy mechanisms.

Young and older adults' mechanisms of trial-by-trial control of accuracy and choice reaction times (RTs) were compared in 2,000 trials. With equal mean error rates, the older group's correct and error RT were longer, and their within-subject distribution was a linear function of the younger group's. Conditional accuracy functions (CAFs) were very similar in location and shape, with both groups achieving 95% accuracy at the same RT. Combining RT distributions with CAFs showed that the older group did not track their limits as often as the younger group, and they were more careful, having fewer very fast (near random) responses, more average speed responses in long error-free runs, and more slowing following an error. All participants were faster before an error and slower immediately after, but the older participants had coarser RT control. To compensate for this, the older participants produced slower responding to avoid the very fast, high-error part of the CAF.

Adolescent↗