Development of the small parts cylinder: lessons learned.

OBJECTIVES/HYPOTHESIS: The Consumer Product Safety Commission mandates federal child choking prevention standards in the United States. Consumer Product Safety Commission utilizes the small parts cylinder (SPC), a 31.75-mm inside-diameter cylinder with a slanted bottom and depth ranging from 25.4 to 57.1 mm. The SPC was developed with very limited clinical data, and the effectiveness of the SPC remains controversial. Small parts ingestions remain among the most common causes of injury and fatality to preschool children. This study reviews the history, medical basis, and effectiveness of the SPC and provides recommendations for prevention of choking and airway fatalities. STUDY DESIGN: Retrospective case series, 48 tertiary care pediatric hospitals (1989-2004) and historical review (1972-2007). METHODS: American Academy of Pediatrics and Consumer Product Safety Commission documents and published reports. Forty-eight children's hospital medical records were reviewed by ICD-9 and current procedural terminology codes for injury or fatality data from foreign bodies (FBs) involved in airway obstruction or esophageal injury. All FBs dimensions were measured and statistically analyzed. RESULTS: Twenty-three percent of fatalities resulting from small parts over the study period involve objects that pass SPC evaluation and over 90% of FBs between 27.9 and 30.5 mm involved in nonfatal incidents pass SPC evaluation. Many objects involved in fatal and nonfatal injury pass because of the slanted bottom. CONCLUSIONS: Over one-fifth of injuries and fatalities to children could be prevented if a standard more stringent than the SPC were in use. Alternative gauges and broader age guidelines are recommended. We propose a 38.1-mm diameter open-bottom gauge for nonspherical FBs and a similar 44.5 mm gauge for spherical FBs. We suggest that this new standard would have prevented all small-parts fatalities to children (including children 3 years of age and older) and the overwhelming majority of nonfatal injuries.

Fatal and non-fatal food injuries among children (aged 0-14 years).

OBJECTIVE: To identify and characterize food items with high risk of airway obstruction in children younger than 15 years. METHODS: This retrospective study collected injury data from 1989 to 1998 for 26 pediatric hospitals in the United States and Canada. Aspiration, choking, ingestion, and insertion injuries due to food items were analyzed. The data included 1429 infants and children. Results were compared with fatality data published by the American Association of Pediatrics in 1984. RESULTS: The 10 food objects with the highest frequency for both injuries and fatalities were identified. Peanuts caused the highest frequency of injury, and hot dogs were most often associated with fatal outcomes. The severity of respiratory distress prior to hospital evaluation varied for different foods. Age younger than 3 years was the highest-risk factor. Key characteristics such as bite size, shape, and texture were analyzed and found to demonstrate relationships with severity of clinical outcomes. CONCLUSIONS: Children younger than 3 years remain at greatest risk of food injury and death. We found that hard, round foods with high elasticity or lubricity properties, or both, pose a significant level of risk. Consideration of the key characteristics of the most hazardous foods may greatly decrease airway obstruction injuries. Food safety education can help pediatricians and parents select, process, and supervise appropriate foods for children younger than 3 years to make them safer for this highest-risk population.

Production and performance of multilayer-coated conical x-ray mirrors.

A method of fabricating replica figured x-ray optics with integral multilayer coatings is presented. With the intact electroforming multilayer process (IEMP) technique, we sputter multilayers onto a reusable superpolished mandrel, electroform nickel over the multilayers, and remove the multilayer-coated nickel shell intact from the mandrel. This approach offers advantages over more traditional, original, and segmented-replica fabrication techniques, including low cost; compatibility with a wide range of mirror designs, diameters, and focal lengths; simple integration with multilayer sputtering processes; and the ability to produce complete shells of revolution. The fabrication of W/Si multilayer-coated 10-cm-diameter conical x-ray mirrors is described, as are reflectivity measurements at 10 and 30 keV. The measured reflectivity of the IEMP multilayers at the 10-keV primary Bragg peak was 17%. Measurements of multiple points on the cone showed multilayer uniformity to within a few percent around the mirror.